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Medicine May 2021To clarify if musculoskeletal ultrasound (US) would give additional information for the clinical examination to diagnose and evaluate the activity of ankylosing... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To clarify if musculoskeletal ultrasound (US) would give additional information for the clinical examination to diagnose and evaluate the activity of ankylosing spondylitis (AS).
METHODS
A literature search was performed in PubMed, Embase, Web of Science, the Cochrane Library, Sinomed, Chinese National Knowledge Infrastructure (CINK), and Wanfang databases from their inceptions to May 15, 2020. Studies that examined the musculoskeletal US, which detected sacroiliac joints in people with AS were included. The pooled analyses were performed using Meta Disc version 1.4 software.
RESULTS
A total of 9 studies encompassing 984 participants were included. Statistical analysis suggested an area under the curve (AUC) of 0.9259 (sensitivity 0.86, specificity 0.54) indicating that US had excellent diagnostic test accuracy for AS, an AUC of 0.6441 (sensitivity 0.87, specificity 0.51) indicating that the US did not have a good diagnostic test accuracy for AS activity. A subgroup analysis revealed that the AUC of power Doppler US (PDUS) and color Doppler US (CDUS) was 0.5000 and 0.9274, respectively, indicating that CDUS was superior to PDUS.
CONCLUSION
US, especially CDUS, is a valid and reproducible technique for the diagnosis of AS. While the accuracy of AS activity evaluation of the US is not ideal. It may be considered for routine use as part of the standard diagnostic tools in AS.
Topics: Feasibility Studies; Humans; Musculoskeletal System; ROC Curve; Spondylitis, Ankylosing; Ultrasonography, Doppler, Color
PubMed: 33950988
DOI: 10.1097/MD.0000000000025822 -
Frontiers in Pharmacology 2023To evaluate efficacy and safety of iguratimod (IGU) in the treatment of rheumatic and autoimmune diseases. Databases such as Pubmed, Embase, Sinomed were searched (as...
To evaluate efficacy and safety of iguratimod (IGU) in the treatment of rheumatic and autoimmune diseases. Databases such as Pubmed, Embase, Sinomed were searched (as of July 2022) to collect randomized controlled trials (RCTs) of IGU in the treatment of rheumatic and autoimmune diseases. Two researchers independently screened the literature, extracted data, assessed the risk of bias of the included literature, and performed meta-analysis using RevMan 5.4 software. A total of 84 RCTs and 4 types of rheumatic and autoimmune diseases [rheumatoid arthritis (RA), ankylosing spondylitis (AS), primary Sjögren's syndrome (PSS) and Autoimmune disease with interstitial pneumonia]. Forty-three RCTs reported RA and showed that IGU + MTX therapy can improve ACR20 (RR 1.45 [1.14, 1.84], = 0.003), ACR50 (RR 1.80 [1.43, 2.26], < 0.0000), ACR70 (RR 1.84 [1.27, 2.67], = 0.001), DAS28 (WMD -1.11 [-1.69, -0.52], = 0.0002), reduce ESR (WMD -11.05 [-14.58, -7.51], < 0.00001), CRP (SMD -1.52 [-2.02, -1.02], < 0.00001), RF (SMD -1.65 [-2.48, -0.82], < 0.0001), and have a lower incidence of adverse events (RR 0.84 [0.78, 0.91], < 0.00001) than the control group. Nine RCTs reported AS and showed that IGU can decrease the BASDAI score (SMD -1.62 [-2.20, -1.05], < 0.00001), BASFI score (WMD -1.07 [-1.39, -0.75], < 0.00001), VAS (WMD -2.01 [-2.83, -1.19], < 0.00001), inflammation levels (decreasing ESR, CRP and TNF-α). Thirty-two RCTs reported PSS and showed that IGU can reduce the ESSPRI score (IGU + other therapy group: WMD -1.71 [-2.44, -0.98], < 0.00001; IGU only group: WMD -2.10 [-2.40, -1.81], < 0.00001) and ESSDAI score (IGU + other therapy group: WMD -1.62 [-2.30, -0.94], < 0.00001; IGU only group: WMD -1.51 [-1.65, -1.37], < 0.00001), inhibit the inflammation factors (reduce ESR, CRP and RF) and increase Schirmer's test score (IGU + other therapy group: WMD 2.18 [1.76, 2.59], < 0.00001; IGU only group: WMD 1.55 [0.35, 2.75], = 0.01); The incidence of adverse events in IGU group was also lower than that in control group (IGU only group: RR 0.66 [0.48, 0.98], = 0.01). Three RCTs reported Autoimmune disease with interstitial pneumonia and showed that IGU may improve lung function. Based on current evidence, IGU may be a safe and effective therapy for RA, AS, PSS and autoimmune diseases with interstitial pneumonia. : (CRD42021289489).
PubMed: 38143490
DOI: 10.3389/fphar.2023.1189142 -
RMD Open Jul 2023The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for spondyloarthritis (SpA) in...
The 2023 pipeline of disease-modifying antirheumatic drugs (DMARDs) in clinical development for spondyloarthritis (including psoriatic arthritis): a systematic review of trials.
OBJECTIVES
The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for spondyloarthritis (SpA) in the coming years.
METHODS
We conducted a systematic review of 17 national and international clinical trial databases for all disease-modifying antirheumatic drugs (DMARDs) for SpA that are already marketed, in clinical development or withdrawn. The search was performed on February 2023 with the keywords "spondyloarthritis", "ankylosing spondylitis" and "psoriatic arthritis". For each molecule, we only considered the study at the most advanced stage of clinical development.
RESULTS
Concerning axial SpA (axSpA), a total of 44 DMARDs were identified: 6 conventional synthetic DMARDs (csDMARDs), 27 biological DMARDs (bDMARDs) and 11 targeted synthetic DMARDs (tsDMARDs). Among the 18 targeted treatments (b+tsDMARDs) in current development, corresponding trials reached phase I (n=1), II (n=10) and III (n=7). Ten molecules are IL-17 inhibitors, two Janus kinase (JAK) inhibitors and two granulocyte-macrophage colony-stimulating factor inhibitors; four have another mode of action. Concerning psoriatic arthritis (PsA), 44 DMARDs were identified: 5 csDMARDs, 27 bDMARDs and 12 tsDMARDs. Among the 15 molecules in current development, corresponding trials reached phase II (n=8) and III (n=7). Six molecules are JAK inhibitors, six IL-17 inhibitors and one an IL-23 inhibitor; two have another mode of action.
CONCLUSION
This systematic review identified 18 and 15 molecules in clinical development for axSpA and PsA, respectively, which suggests a strengthening of the therapeutic arsenal in the coming years. However, with so many DMARDs but low target diversity, we will need to develop strategies or biomarkers to help clinicians make informed treatment decisions.
Topics: Humans; Arthritis, Psoriatic; Antirheumatic Agents; Interleukin-17; Spondylarthritis; Spondylitis, Ankylosing; Janus Kinase Inhibitors
PubMed: 37507210
DOI: 10.1136/rmdopen-2023-003279 -
Medicine Mar 2016To establish the comparative effectiveness of all available biologic therapy regimens for ankylosing spondylitis, we performed a systematic review and a Bayesian network... (Comparative Study)
Comparative Study Meta-Analysis Review
To establish the comparative effectiveness of all available biologic therapy regimens for ankylosing spondylitis, we performed a systematic review and a Bayesian network meta-analysis of randomized controlled trials. PubMed, Medline, Embase, Cochrane library, and ClinicalTrials.gov were searched from the inception of each database to June 2015. Systematic review and network meta-analysis was reported according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses. The primary outcome was 20% improvement of Assessments in SpondyloArthritis International Society Response Criteria (ASAS20) at Week 12 or 14; secondary outcomes were ASAS40, ASAS5/6, ASAS partial remission and 50% improvement in baseline Bath ankylosing spondylitis (AS) disease activity index. We reported relative risks and 95% confidence intervals from direct meta-analysis and 95% credible intervals from Bayesian network meta-analysis, and ranked the treatment for outcomes. We also used Grading of Recommendations Assessment, Development and Evaluation criteria to appraise quality of evidence. Fourteen RCTs comprising 2672 active AS patients were included in the network meta-analysis. Most biologic therapy regimens were more effective than placebo regarding all the outcomes assessed, except for secukinumab and tocilizumab. No differences between biologic therapies in the treatment of AS could be found, except for the finding that infliximab 5 mg was superior to tocilizumab. Infliximab 5 mg/kg had the highest probability of being ranked the best for achieving ASAS20, whereas notably, secukinumab had the highest probability of being ranked the second best. Our study suggests that no differences between biologic therapies in the treatment of AS could be found except that infliximab 5 mg was superior to tocilizumab. Infliximab 5 mg/kg seems to be the better biologic therapy regimen for AS. Secukinumab appears promising, though additional data is warranted. Nevertheless, these interpretations should be accepted very cautiously.
Topics: Biological Therapy; Humans; Spondylitis, Ankylosing; Treatment Outcome
PubMed: 26986130
DOI: 10.1097/MD.0000000000003060 -
Clinical Rheumatology Jul 2022Identification of axial spondyloarthritis (axSpA) remains challenging, frequently resulting in a diagnostic delay for patients. Current benchmarks of delay are usually... (Review)
Review
Identification of axial spondyloarthritis (axSpA) remains challenging, frequently resulting in a diagnostic delay for patients. Current benchmarks of delay are usually reported as mean data, which are typically skewed and therefore may be overestimating delay. Our aim was to determine the extent of median delay patients' experience in receiving a diagnosis of axSpA and examine whether specific factors are associated with the presence of such delay. We conducted a systematic review across five literature databases (from inception to November 2021), with studies reporting the average time period of diagnostic delay in patients with axSpA being included. Any additional information examining associations between specific factors and delay were also extracted. A narrative synthesis was used to report the median range of diagnostic delay experienced by patients with axSpA and summarise which factors have a role in the delay. From an initial 11,995 articles, 69 reported an average time period of diagnostic delay, with 25 of these providing a median delay from symptom onset to diagnosis. Across these studies, delay ranged from 0.67 to 8 years, with over three-quarters reporting a median of between 2 years and 6 years. A third of all studies reported median delay data ranging from just 2 to 2.3 years. Of seven variables reported with sufficient frequency to evaluate, only 'gender' and 'family history of axSpA' had sufficient concordant data to draw any conclusion on their role, neither influenced the extent of the delay. Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay and this remains an extensive worldwide problem. This is further compounded by a mixed picture of the disease, patient and healthcare-related factors influencing delay. Key points • Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay. • Median diagnostic delay typically ranges from 2 to 6 years globally. • Neither 'gender' nor 'family history of axSpA' influenced the extent of diagnostic delay experienced. • Diagnostic delay based on mean, rather than median, data influences the interpretation of the delay time period and consistently reports a longer delay period.
Topics: Axial Spondyloarthritis; Databases, Factual; Delayed Diagnosis; Humans; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 35182270
DOI: 10.1007/s10067-022-06100-7 -
Patient Preference and Adherence 2018This review aims to summarize the current literature on patient-reported outcomes (PROs) in spondyloarthritis (SpA). (Review)
Review
OBJECTIVE
This review aims to summarize the current literature on patient-reported outcomes (PROs) in spondyloarthritis (SpA).
PATIENTS AND METHODS
We performed a systematic literature review to identify studies (original articles and narrative and systematic reviews) regarding PROs (health-related quality of life [HRQoL], satisfaction, preferences, adherence/compliance, and persistence) in SpA patients published in the European Union through December 2016. International databases (Medline/PubMed, Cochrane Library, ISI Web of Knowledge, Scopus) were searched using keywords in English. The methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine criteria.
RESULTS
A total of 26 publications met the inclusion criteria. Generally, studies indicated that SpA has a negative impact on patients' HRQoL. In patients with ankylosing spondylitis, physical domains were more affected than emotional ones, whereas for psoriatic arthritis, both physical and psychological factors were strongly affected by the disease. Data indicated that biological agents (BAs) greatly contributed to improvement in HRQoL in both ankylosing spondylitis and psoriatic arthritis patients. Findings on compliance with BAs were heterogeneous. However, persistence rates exceeded 50% irrespective of the BA administered. Results on preferences indicated that most SpA patients prefer being involved in decisions regarding their treatment and that besides efficacy and safety, frequency and route of administration may influence patients' preferences for BAs.
CONCLUSION
Implementing management programs for SpA patients focuses on the physical, emotional, and social consequences of the disease, in addition to assessing and including patient preferences in the treatment decision-making process, could be crucial to improve patients' HRQoL and ensure their satisfaction and compliance with treatment.
PubMed: 29780239
DOI: 10.2147/PPA.S162420 -
European Journal of Rheumatology Jul 2021A close association between periodontal disease (PD) and ankylosing spondylitis (AS) has long been speculated. Both diseases are characterized by dysregulation of the...
A close association between periodontal disease (PD) and ankylosing spondylitis (AS) has long been speculated. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of the soft and hard connective tissue. There is evidence of increased levels of tumor necrosis factor-alpha and various interleukins in both patients of AS and periodontitis. This study aimed to conduct a systematic review exploring the relationship between AS and PD. We searched MEDLINE - Embase databases (from their inception till October 2019) using appropriate combinations of the following search items with limits '(English, Human)': Ankylosing spondylitis, spondyloarthritis, spondyloarthropathies, spondyloarthritides, spinal disease, musculoskeletal disease, rheumatic disease and periodontitis, PD, periodontoses, parodontoses, chronic periodontitis, gum disease, gingivitis, oral health, dental health, plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL). This search was supplemented by the manual search of bibliographies of the selected articles and conference proceedings of the European League against Rheumatism. Only the reviews and observational studies of cross-sectional, cohort, or case-control type on adult patients with AS were selected. Data were extracted from a predesigned PROforma. A total of 984 articles were identified, and 12 were selected for a detailed appraisal. All the identified studies were of the case-control type. The prevalence of periodontitis ranged from 38% to 88% in patients with AS and 26% to 71% in the control group. Of the 12 studies, 2 showed significant changes in PI, 2 showed altered PPD, 3 showed significantly increased CAL, and 2 showed increased BOP. In 7 studies, periodontitis was seen in a significant number of patients with AS (p<0.05). All the studies reported that the prevalence of PD in patients with AS was higher than that in patients without AS. Our systematic review found an association between AS and PD. Patients with AS show a higher prevalence of periodontitis and poor oral hygiene than the healthy controls.
PubMed: 33284102
DOI: 10.5152/eurjrheum.2020.20177 -
Reumatologia Clinica Mar 2023Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke.
METHODS
A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity.
RESULTS
A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33-1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23-1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef=-0.0010, P=0.951).
CONCLUSION
This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis.
Topics: Humans; Spondylitis, Ankylosing; Risk Factors
PubMed: 36906389
DOI: 10.1016/j.reumae.2023.02.002 -
International Braz J Urol : Official... 2016Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer... (Review)
Review
BACKGROUND
Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility.
MATERIALS AND METHODS
A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behçet disease and gout. Two independent researchers carried out the search in online databases.
RESULTS
A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behçet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behçet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies.
CONCLUSIONS
Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.
Topics: Alkylating Agents; Behcet Syndrome; Dermatomyositis; Gout; Humans; Infertility, Male; Lupus Erythematosus, Systemic; Male; Rheumatic Diseases; Spondylitis, Ankylosing
PubMed: 27120778
DOI: 10.1590/S1677-5538.IBJU.2014.0595 -
The South African Journal of... 2024Ankylosing spondylitis (AS) is characterised as a chronic inflammatory disease of the axial skeleton. The force platform is an option for performing the postural... (Review)
Review
BACKGROUND
Ankylosing spondylitis (AS) is characterised as a chronic inflammatory disease of the axial skeleton. The force platform is an option for performing the postural assessment of these individuals.
OBJECTIVES
To review and evaluate the behaviour of the centre of pressure (CoP) variables during the postural control examination in patients with AS compared to a control group.
METHOD
A systematic review, registered in PROSPERO, that followed the PRISMA Statement. A search was carried out in the following databases: Medline, Web of Science, Embase, Scopus, and Scielo, from 1945 to 2023. Studies were selected that aimed to understand the use of the force platform for the assessment of postural control. The risk of bias assessment was performed using the AXIS tool.
RESULTS
Five studies were included, with a total of 247 participants. The assessment of risk of bias presented high scores in the AXIS tool. Patients with a diagnosis of AS presented increased thoracic kyphosis in most of the studies, as well as large displacements in the anteroposterior (AP) and mediolateral (ML) directions, and altered total mean velocity (TMV) and frequency, indicating worse postural stability. Regarding the functional status, the most used questionnaires were the Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Disease Activity Index (BASDAI).
CONCLUSION
Patients with ankylosing spondylitis present postural instability, verified by means of higher values of centre of posture variables.
CLINICAL IMPLICATIONS
Individuals with ankylosing spondylitis presented postural instability and balance deficit. Therefore, exercises for balance training and postural control are essential in the clinical management of these patients.
PubMed: 38841593
DOI: 10.4102/sajp.v80i1.1953