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Article ; Online: Challenges in the diagnosis of axial spondyloarthritis.

van Gaalen, Floris A / Rudwaleit, Martin

Best practice & research. Clinical rheumatology

2023 Volume 37, Issue 3, Page(s) 101871

Abstract: With back pain as one of the most common complaints in the population and with no single disease feature with sufficient sensitivity and specificity to diagnose axial spondyloarthritis (axSpA) on its own, diagnosing axSpA can be challenging. In this ... ...

Abstract	With back pain as one of the most common complaints in the population and with no single disease feature with sufficient sensitivity and specificity to diagnose axial spondyloarthritis (axSpA) on its own, diagnosing axSpA can be challenging. In this article, we discuss clinical, laboratory, and imaging spondyloarthritis features that can be used in diagnosis and explain the general principles underlying an axSpA diagnosis. Moreover, we discuss three pitfalls to avoid when diagnosing axSpA: i) using classification criteria as diagnostic criteria, ii) making a diagnosis by simple counting of spondyloarthritis features, and iii) over-reliance on imaging findings. Finally, we have some advice on how to build diagnostic skills and discuss new developments that may help facilitate the diagnosis of axSpA in the future.
MeSH term(s)	Humans ; Spondylarthritis/diagnosis ; Spondylarthritis/epidemiology ; Back Pain/diagnosis ; Back Pain/etiology ; Back Pain/epidemiology ; Axial Spondyloarthritis ; Spondylitis, Ankylosing ; Magnetic Resonance Imaging
Language	English
Publishing date	2023-09-14
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2052323-3
ISSN	1532-1770 ; 1521-6942
ISSN (online)	1532-1770
ISSN	1521-6942
DOI	10.1016/j.berh.2023.101871
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Article ; Online: Atlas for the CT Syndesmophyte Score (CTSS) in patients with axial spondyloarthritis.

Marques, Mary Lucy / Ramiro, Sofia / van der Heijde, Désirée / Reijnierse, Monique / Diekhoff, Torsten / Hermann, Kay Geert A / van Gaalen, Floris A / de Hooge, Manouk

RMD open

2024 Volume 10, Issue 1

Abstract: Background: The Computed Tomography Syndesmophyte Score (CTSS) was developed as a reliable and sensitive tool to assess syndesmophytes in low-dose CT images of the entire spine in patients with axial spondyloarthritis (axSpA). The original paper ... ...

Abstract	Background: The Computed Tomography Syndesmophyte Score (CTSS) was developed as a reliable and sensitive tool to assess syndesmophytes in low-dose CT images of the entire spine in patients with axial spondyloarthritis (axSpA). The original paper provided sparce examples of the CTSS grades. Objectives: Provide an atlas tailored to assist readers in understanding and employing the CTSS method. Methods: In this paper, illustrations of the different grades and views of the CTSS are presented. CTSS is used to measure bone formation in the spine of patients with axial spondyloarthritis (axSpA), in the form of syndesmophytes. In both the sagittal and coronal planes, syndesmophytes can be graded from 0 to 3 over 23 vertebral units starting at C2 and ending at S1. The CTSS ranges from 0 (absence of axSpA-related syndesmophytes) to 552 (total ankylosis of the spine). Results: The current atlas contains low-dose CT images of the spine without lesions (for reference) and all grades of syndesmophytes in different planes used in the CTSS. Examples are arranged per spinal segment (cervical, thoracic and lumbar). Conclusions: These images can be used to assist any reader in the assessment of syndesmophytes on (low-dose) CT in patients with axSpA.
MeSH term(s)	Humans ; Axial Spondyloarthritis ; Spine ; Osteogenesis ; Tomography, X-Ray Computed
Language	English
Publishing date	2024-01-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2023-003702
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Article ; Online: The value of correctly diagnosing axial spondyloarthritis for patients and society.

Webers, Casper / Grimm, Sabine / van Tubergen, Astrid / van Gaalen, Floris / van der Heijde, Désirée / Joore, Manuela / Boonen, Annelies

Seminars in arthritis and rheumatism

2023 Volume 62, Page(s) 152242

Abstract: Objective: To demonstrate the value of diagnosing axSpA, by comparing health and costs associated with available diagnostic algorithms and perfect diagnosis.: Methods: Using data from SPACE and other cohorts, a model was developed to estimate health ( ...

Abstract	Objective: To demonstrate the value of diagnosing axSpA, by comparing health and costs associated with available diagnostic algorithms and perfect diagnosis. Methods: Using data from SPACE and other cohorts, a model was developed to estimate health (quality-adjusted life-years, QALYs) and costs (healthcare consumption and work productivity losses) of different diagnostic algorithms for axSpA amongst patients with low back pain referred to a rheumatologist, over a 60-year horizon. The model combined a decision-tree (diagnosis) with a state-transition model (treatment). The three algorithms (Berlin [BER, highest specificity], Modification 1 [M1; less strict inflammatory back pain (IBP) criterion] and Modification 2 [M2; IBP not mandatory as entry criterion, highest sensitivity]) were compared. Changes in sensitivity/specificity were explored and the value of perfect diagnosis was investigated. Results: For each correctly diagnosed axSpA patient, up to 4.7 QALYs and €60,000 could be gained/saved, considering a societal perspective. Algorithm M2 resulted in more health and lower costs per patient (24.23 QALYs; €157,469), compared to BER (23.96 QALYs; €159,423) and M1 (24.15 QALYs; €158,417). Hypothetical improvements in M2 sensitivity resulted in slightly more value compared to improvements in specificity. Perfect diagnosis can cost €7,500 per patient and still provide enough value. Conclusion: Correct diagnosis of axSpA results in substantial health and cost benefits for patients and society. Not requiring IBP as mandatory for diagnosis of axSpA (algorithm M2) provides more value and would be preferable. A considerably more expensive diagnostic algorithm with better accuracy than M2 would still be considered good value for money.
MeSH term(s)	Humans ; Spondylarthritis/diagnosis ; Spondylarthritis/complications ; Low Back Pain/diagnosis ; Axial Spondyloarthritis ; Sensitivity and Specificity ; Algorithms
Language	English
Publishing date	2023-07-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	120247-9
ISSN	1532-866X ; 0049-0172
ISSN (online)	1532-866X
ISSN	0049-0172
DOI	10.1016/j.semarthrit.2023.152242
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Article ; Online: Spondyloarthritis mass cytometry immuno-monitoring: a proof of concept study in the tight-control and treat-to target TiCoSpA trial.

Koppejan, Hester / Beyrend, Guillaume / Hameetman, Marjolijn / Abdelaal, Tamim / Toes, René E M / van Gaalen, Floris A

Clinical rheumatology

2023 Volume 42, Issue 9, Page(s) 2387–2396

Abstract: Objective: Mass cytometry (MC) immunoprofiling allows high-parameter phenotyping of immune cells. We set to investigate the potential of MC immuno-monitoring of axial spondyloarthritis (axSpA) patients enrolled in the Tight Control SpondyloArthritis ( ... ...

Abstract	Objective: Mass cytometry (MC) immunoprofiling allows high-parameter phenotyping of immune cells. We set to investigate the potential of MC immuno-monitoring of axial spondyloarthritis (axSpA) patients enrolled in the Tight Control SpondyloArthritis (TiCoSpA) trial. Methods: Fresh, longitudinal PBMCs samples (baseline, 24, and 48 weeks) from 9 early, untreated axSpA patients and 7 HLA-B27 Results: Unsupervised analysis yielded a clear separation of baseline patients and controls including a significant difference in 9 T cell, B cell, and monocyte clusters (cl), indicating disrupted immune homeostasis. Decrease in disease activity (ASDAS score; median 1.7, range 0.6-3.2) from baseline to week 48 matched significant changes over time in five clusters: cl10 CD4 T Conclusions: Our results showed that a decrease in disease activity in axSpA coincided with normalization of peripheral T- and B-cell frequency abnormalities. This proof of concept study shows the value of MC immuno-monitoring in clinical trials and longitudinal studies in axSpA. MC immunophenotyping on a larger, multi-center scale is likely to provide crucial new insights in the effect of anti-inflammatory treatment and thereby the pathogenesis of inflammatory rheumatic diseases. Key Points • Longitudinal immuno-monitoring of axSpA patients through mass cytometry indicates that normalization of immune cell compartments coincides with decrease in disease activity. • Our proof of concept study confirms the value of immune-monitoring utilizing mass cytometry.
MeSH term(s)	Humans ; Proof of Concept Study ; Spondylarthritis/drug therapy ; Spondylitis, Ankylosing/drug therapy
Language	English
Publishing date	2023-06-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-023-06637-1
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Article ; Online: Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort.

Marques, Mary Lucy / Ramiro, Sofia / van Lunteren, Miranda / Stal, Rosalinde Anne / Landewé, Robert Bm / van de Sande, Marleen / Fagerli, Karen Minde / Berg, Inger Jorid / van Oosterhout, Maikel / Exarchou, Sofia / Ramonda, Roberta / van der Heijde, Désirée / van Gaalen, Floris A

Annals of the rheumatic diseases

2024 Volume 83, Issue 5, Page(s) 589–598

Abstract: Objectives: To investigate the prevalence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP) of less than 2 years (2y) duration referred to the rheumatologist, the development of diagnosis over time, and patient characteristics ... ...

Abstract	Objectives: To investigate the prevalence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP) of less than 2 years (2y) duration referred to the rheumatologist, the development of diagnosis over time, and patient characteristics of those developing Methods: We analysed the 2y data from SPondyloArthritis Caught Early, a European cohort of patients (<45 years) with CBP (≥3 months, ≤2y) of unknown origin. The diagnostic workup comprised evaluation of clinical SpA features, acute phase reactants, HLA-B27, radiographs and MRI (sacroiliac joints and spine), with repeated assessments. At each visit (baseline, 3 months, 1y and 2y), rheumatologists reported a diagnosis of Main outcome: axSpA diagnosis with LoC≥7 ( Results: In 552 patients with CBP, Conclusion: A diagnosis of
MeSH term(s)	Humans ; Male ; Rheumatologists ; Sacroiliitis/diagnostic imaging ; HLA-B27 Antigen ; Spondylarthritis/diagnosis ; Spondylarthritis/diagnostic imaging ; Back Pain/diagnosis ; Magnetic Resonance Imaging/methods ; Axial Spondyloarthritis ; Spondylitis, Ankylosing/diagnosis
Chemical Substances	HLA-B27 Antigen
Language	English
Publishing date	2024-04-11
Publishing country	England
Document type	Journal Article
ZDB-ID	7090-7
ISSN	1468-2060 ; 0003-4967
ISSN (online)	1468-2060
ISSN	0003-4967
DOI	10.1136/ard-2023-224959
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Article ; Online: Top-Ten Tips for Effective Imaging of Axial Spondyloarthritis.

Reijnierse, Monique / Eshed, Iris / Gaalen, Floris van

Seminars in musculoskeletal radiology

2019 Volume 23, Issue 4, Page(s) 376–391

Abstract: Axial spondyloarthritis (axSpA) is a chronic inflammatory condition that encompasses ankylosing spondylitis as well as nonradiographic axSpA and can lead to chronic pain, structural damage, and disability. The disease is strongly associated with the ... ...

Abstract	Axial spondyloarthritis (axSpA) is a chronic inflammatory condition that encompasses ankylosing spondylitis as well as nonradiographic axSpA and can lead to chronic pain, structural damage, and disability. The disease is strongly associated with the presence of human leukocyte antigen-B27. Early diagnosis of axSpA is significant due to new treatment regimens leading to reduction of inflammation and potentially delaying disease progression. Imaging of the sacroiliac joints and the spine plays an important role in the early diagnosis of spondyloarthritis. In the current review, the top-ten tips for the effective imaging of axSpA are presented to help both radiologists and rheumatologists in using imaging properly and effectively in their clinical practice.
MeSH term(s)	Humans ; Magnetic Resonance Imaging/methods ; Radiography/methods ; Sacroiliac Joint/diagnostic imaging ; Spine/diagnostic imaging ; Spondylarthritis/diagnostic imaging
Language	English
Publishing date	2019-09-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1360919-1
ISSN	1098-898X ; 1089-7860
ISSN (online)	1098-898X
ISSN	1089-7860
DOI	10.1055/s-0039-1693661
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Article ; Online: Geographical prevalence of family history in patients with axial spondyloarthritis and its association with HLA-B27 in the ASAS-PerSpA study

Désirée van der Heijde / Joachim Sieper / Clementina López-Medina / Anne Boel / Floris A van Gaalen / Miranda van Lunteren

RMD Open, Vol 8, Iss

2022 Volume 1

Keywords	Medicine ; R
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Geographical prevalence of family history in patients with axial spondyloarthritis and its association with HLA-B27 in the ASAS-PerSpA study.

Boel, Anne / van Lunteren, Miranda / López-Medina, Clementina / Sieper, Joachim / van der Heijde, Desirée / van Gaalen, Floris A

RMD open

2022 Volume 8, Issue 1

Abstract: Background: A positive family history (PFH) of spondyloarthritis (SpA) consists of five SpA-related entities, of which a PFH of axial spondyloarthritis (axSpA) is most common in European patients with axSpA. Moreover, a PFH of axSpA is associated with ... ...

Abstract	Background: A positive family history (PFH) of spondyloarthritis (SpA) consists of five SpA-related entities, of which a PFH of axial spondyloarthritis (axSpA) is most common in European patients with axSpA. Moreover, a PFH of axSpA is associated with human leucocyte antigen B27 (HLA-B27) positivity in these patients. It is unknown if this holds true in patients with axSpA in other parts of the world. Objective: To investigate the geographical prevalence of a PFH of SpA and its association with HLA-B27 positivity in patients with axSpA worldwide. Methods: Cross-sectional analyses included patients from the ASAS peripheral involvement in Spondyloarthritis (PerSpA) study from 24 countries worldwide with an axSpA diagnosis, known HLA-B27 status and family history. Logistic regression models were built to assess the effect of HLA-B27 status on the occurrence of PFH. This was repeated for each of the five SpA entities in a PFH. Results: Among 2048 patients, axSpA was the most common SpA entity in a PFH in all geographical regions (Asia 28%, Europe and North America 27%, Latin America 20%, Middle East and North Africa 41%). A PFH of axSpA was associated with HLA-B27 positivity in Asia (OR 4.19), Europe and North America (OR 2.09) and Latin America (OR 3.95), but not in the Middle East and North Africa (OR 0.98), which has a lower prevalence of HLA-B27 positivity. A PFH of other SpA entities was less prevalent and not consistently associated with HLA-B27 positivity. Conclusion: In patients with axSpA worldwide, axSpA was consistently the most common SpA entity in a family history and was associated with HLA-B27 positivity in all geographical regions but one.
MeSH term(s)	Axial Spondyloarthritis ; Cross-Sectional Studies ; HLA-B27 Antigen/genetics ; Humans ; Prevalence ; Spondylarthritis/diagnosis ; Spondylarthritis/epidemiology ; Spondylarthritis/genetics
Chemical Substances	HLA-B27 Antigen
Language	English
Publishing date	2022-03-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2021-002174
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Article: Adäquat dosierte körperliche Aktivität bei axialer Spondyloarthritis

Hilberdink, Bas / Vliet Vlieland, Thea / van der Giesen, Florus / van Gaalen, Floris / Goekoop, Robbert

Morbus-Bechterew-Journal

2021 Volume 42, Issue 166, Page(s) 3

Language	German
Document type	Article
ZDB-ID	2119820-2
ISSN	1861-2105
Database	Current Contents Medicine

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Article ; Online: Age at onset in axial spondyloarthritis around the world: data from the Assessment in SpondyloArthritis international Society Peripheral Involvement in Spondyloarthritis study.

Boel, Anne / López-Medina, Clementina / van der Heijde, Désirée M F M / van Gaalen, Floris Alexander

Rheumatology (Oxford, England)

2021 Volume 61, Issue 4, Page(s) 1468–1475

Abstract: Objective: Age at onset is useful in identifying chronic back patients at an increased risk of axial SpA (axSpA). However, the majority of data on which the criterion of age at onset <45 years is based originates from Europe. Therefore it is unknown if ... ...

Abstract	Objective: Age at onset is useful in identifying chronic back patients at an increased risk of axial SpA (axSpA). However, the majority of data on which the criterion of age at onset <45 years is based originates from Europe. Therefore it is unknown if this criterion applies in other parts of the world. We aimed to assess the age at onset of axSpA and its relationship with HLA-B27 and gender across the world. Methods: Analyses were applied to patients from 24 countries across the world with an axSpA diagnosis and known age at onset of axial complaints. Cumulative probability plots were used to display the cumulative distribution of age at onset of axial symptoms. Linear regression models were built to assess the effect of HLA-B27 and gender on age at onset of axial symptoms. Results: Of 2579 axSpA patients, 92% had an age at onset of axial symptoms <45 years, with only small variations across the geographical regions [Asia, n = 574 (94%); Europe and North America, n = 988 (92%); Latin America, n = 246 (89%); Middle East and North Africa, n = 771 (91%)]. Age at onset of axial symptoms was consistently lower in HLA-B27-positive patients {median 25 years [interquartile range (IQR) 19-32] vs 31 [IQR 22-39]} and male patients [median 25 years (IQR 19-33) vs 28 (IQR 21-37)], but in multivariable models an additional statistically significant effect of male gender independent of HLA-B27 was only found in Asia. Conclusion: Around the world, the great majority of axSpA patients had an age at onset of axial disease of <45 years, with HLA-B27 and male gender associated with earlier disease onset.
MeSH term(s)	Adult ; Age of Onset ; Axial Spondyloarthritis ; HLA-B27 Antigen ; Humans ; Male ; Middle East/epidemiology ; Spondylarthritis/diagnosis ; Spondylarthritis/epidemiology ; Young Adult
Chemical Substances	HLA-B27 Antigen
Language	English
Publishing date	2021-07-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/keab544
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