Non-radiographic axial spondyloarthritis: what is it?

The classification criteria recently developed by the Assessment of Spondyloarthritis International Society (ASAS) highlighted a specific entity: non radiographic axial spondyloarthritis (nr-axSpA). Although more and more widely used in the literature as well as clinical trials, limits and profile of this entity is still under known or debated. Some studies have already compared those forms to classical AS, even in recent forms. They showed that, apart from the difference in the ossification process, and the greater degree and frequency of systemic and MRI inflammation in AS, those 2 forms of SpA share the same genetic background, clinical patterns, and burden of disease. TNF antagonists seemed as effective in controlling symptoms in patients with nr-axSpA. Concerning the long-term outcome of nr-ax-SpA, only long-term ongoing cohorts of patients with recent nr-axSpA will be able to determine what proportion of patients have persistent non-radiographic disease and what proportion do progress to AS.

Prevalence and factors associated with uveitis in spondylarthritis patients in France: results from an observational survey.

OBJECTIVE: To accurately estimate the prevalence of and the factors associated with uveitis in spondylarthritis (SpA) patients in France. METHODS: In an observational survey of SpA patients (diagnosis confirmed by the European Spondylarthropathy Study Group and/or Amor's criteria) consulting their rheumatologist for routine followup, we collected information regarding present/past history of uveitis, as well as detailed characteristics of the disease. Factors independently associated with uveitis were determined. RESULTS: From September 2008 to January 2009, 202 rheumatologists participated in the survey and recruited 902 patients (61% men) with a mean ± SD age of 45.3 ± 13.4 years and a mean ± SD disease duration of 10.4 ± 9.6 years. The SpA diagnoses were ankylosing spondylitis (71%), psoriatic arthritis (18%), or other SpA (11%). The HLA-B27 positivity rate was 76%. Uveitis prevalence was 32.2% (95% confidence interval [95% CI] 29.1-35.3%) since psoriasis and inflammatory bowel disease were 22.3% (95% CI 19.5-25.0%) and 8.6% (95% CI 6.7-10.5%), respectively. Recurrence of uveitis occurred in 52.3% and complications occurred in 11.7% of patients. Factors independently associated with uveitis were HLA-B27 positivity (adjusted odds ratio [OR(adj) ] 2.97 [95% CI 1.83-4.81], P < 0.0001) and disease duration (OR(adj) 1.28 [95% CI 1.16-1.41], P < 0.0001 for ≥10 years). CONCLUSION: Results indicate that uveitis is the most common extraarticular feature of SpA, occurring preferentially in HLA-B27-positive patients over the entire course of the disease.

[Optimized use of cross-sectional imaging for the early diagnosis and management of ankylosing spondyloarthropathy]. / Comment intégrer l'imagerie moderne dans le diagnostic précoce et le suivi de la spondylarthrite ankylosante?

It is becoming increasingly desirable to diagnose ankylosing spondyloarthropathy (AS) at its pre-radiographic stage (prior to the presence of sacro-iliitis on radiographs). MRI plays a key role for early diagnosis of AS, as illustrated by recently proposed international diagnostic criteria (ASAS). MRI of the SI joints is most helpful for early diagnosis; sequences using fat suppression and/or Gadolinium administration are necessary for the detection of inflammatory changes. However, the rate of false positive and false negative results of MR imaging of the SI joints, especially early in the course of the disease, is unknown and requires prudent interpretation of imaging findings. In patients with normal MRI examination of the SI joints and/or if symptoms are limited to the spine, MRI of the lumbar spine with STIR and/or Gadolinium administration may be helpful; again the positive and negative predictive values are unknown, especially early in the course of the disease. The demonstration of inflammatory changes on MRI, at the axial level, could be an indication for anti-TNF treatment, outside of WMA (national and international recommendations). The role of Doppler US, especially for peripheral entheses, remains hypothetical for early diagnosis. The role of MRI for structural evaluation is also being assessed even though radiographs remain the standard of reference. To date, no treatment, conventional or other, has been shown to have a structural effect (aside from limitations related to the methodology of available studies).