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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for all disease-modifying antirheumatic drugs (DMARDs) for SpA that are already marketed, in clinical development or withdrawn.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 -
Archives of Oral Biology Feb 2023This scoping review aimed to identify the signs and symptoms of temporomandibular joint (TMJ) involvement in individuals with ankylosing spondylitis (AS). (Review)
Review
OBJECTIVE
This scoping review aimed to identify the signs and symptoms of temporomandibular joint (TMJ) involvement in individuals with ankylosing spondylitis (AS).
DESIGN
Systematic literature searches were performed on PubMed, Embase, and Web of Science databases (up to April 2022). Studies with signs and symptoms of temporomandibular joint disorder (TMD) in adults with AS were included. TMJ outcomes were extracted and analyzed qualitatively.
RESULTS
From 527 potentially eligible studies, 22 were included. A total of 4309 individuals with AS were evaluated, aged between 18 and 80 years, being males approximately 65% of the sample. Signs and symptoms of pain, tenderness to palpation on TMJ and masticatory muscles, joint noises (i.e., clicking or crepitus), limited mouth opening, disc displacement, and radiographic changes were often observed.
CONCLUSION
The available evidence shows that different signs and symptoms of TMD co-occur with AS disease, with a higher prevalence of TMD observed in individuals with AS than in individuals without AS. Indeed, it seems that individuals suffering from AS disease have an increased risk of developing TMD.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult; Facial Pain; Masticatory Muscles; Spondylitis, Ankylosing; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 36565536
DOI: 10.1016/j.archoralbio.2022.105609 -
Journal of Clinical Medicine May 2021The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and... (Review)
Review
INTRODUCTION
The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery.
AIM
The aim of this study is to systematically review the currently used variants and modifications of RA.
MATERIALS AND METHODS
The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review.
RESULTS
Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis.
DISCUSSION
All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material.
CONCLUSIONS
In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis.
PubMed: 34064639
DOI: 10.3390/jcm10102049 -
Clinical Rheumatology Sep 2023C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA.
MATERIALS AND METHODS
A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models.
RESULTS
Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS.
CONCLUSIONS
In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
Topics: Humans; C-Reactive Protein; Spondylarthritis; Inflammation; Sacroiliac Joint; Magnetic Resonance Imaging; Axial Spondyloarthritis
PubMed: 37336841
DOI: 10.1007/s10067-023-06658-w -
International Immunopharmacology Nov 2022The emergence of biologics has improved the management of patients with rheumatic disease, mainly with spondyloarthritis (SpA). Sustained remission has become a... (Review)
Review
INTRODUCTION
The emergence of biologics has improved the management of patients with rheumatic disease, mainly with spondyloarthritis (SpA). Sustained remission has become a reachable goal thanks to the treat to target strategy. Contrary to rheumatoid arthritis, data on biologic optimization among SpA patients in remission is scarce and still a subject of debate. The main objective of this systematic review was to provide the most up-to-date published literature regarding biologic tapering in axial spondyloarthritis.
METHODS
This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed and Scopus, published until December 20th 2021, and tackling tapering strategies of the biologics in patients with axial SpA were included RESULTS: Fourteen studies met the inclusion criteria. They were published between 2008 and 2020. The most studied molecules were Etanercept (ETN) (n = 13), Infliximab (IFX) (n = 6), Adalimumab (ADA) (n = 5), certolizumab pegol (CZP) (n = 2), Golimumab (n = 1) and ETN biosimilar. There are no studies published regarding anti-IL 17 tapering strategy. Patient-tailored dose reduction of anti TNF-α agents was successful in preserving stable low disease activity in most of the studies with remission rates ranging between 20.2 % and 93.7 %. Complete treatment discontinuation is associated with a high risk of flares.
CONCLUSION
To conclude, published data indicate that a progressive tapering strategy for anti TNF-α therapy is successful among axial SpA in sustained remission. However, further studies with more homogenized tapering strategies are needed in order to ascertain the specific implication of each subset for a better holistic approach.
Topics: Humans; Etanercept; Adalimumab; Antirheumatic Agents; Infliximab; Certolizumab Pegol; Axial Spondyloarthritis; Biosimilar Pharmaceuticals; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha; Spondylarthritis; Biological Products
PubMed: 36150228
DOI: 10.1016/j.intimp.2022.109256 -
Current Rheumatology Reviews 2022Neutrophil to lymphocyte ratio (NLR) is a marker for many inflammatory diseases. Ankylosing spondylitis (AS) is among these inflammatory diseases, and many studies have... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neutrophil to lymphocyte ratio (NLR) is a marker for many inflammatory diseases. Ankylosing spondylitis (AS) is among these inflammatory diseases, and many studies have compared the NLR ratio between patients with AS and healthy controls.
AIM
This study aims to systematically review and analyze the available evidence about the significance of NLR values in AS.
METHOD
Based on Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we searched Embase, Pubmed, ISI Web of Science, and Scopus databases from inception to August 2020 using ("Ankylosing spondyl* " OR "Bechterew Disease" OR "Rheumatoid Spondylitis") AND ((neutrophil* AND lymphocyte*) OR NLR) as key terms of the search strategy. Data selection and extraction were conducted separately by two authors. We appraised the included articles according to the Joanna Briggs checklist. Comprehensive Meta-analysis Version 2 was used for analysis and assessment of publication bias. I2 > 75% and p-value < 0.05 were considered significant.
RESULT
In total, 182 studies resulted from a search in all databases. Duplicate removal, title, abstract, and full-text screening yielded 12 related studies, with 11 included in the meta-analysis. Quality assessment was satisfying in all studies. Pooled difference in NLR means value between patients and controls was 0.38 (95% CI: 0.24-0.52, p-value <0.0001). An I2 of 51% and a Cochran Q test p-value of <0.05 indicated moderate heterogeneity; thus, subgroup analysis had no indication. Publication bias was not significant (Funnel plot with an Egger's intercept of -0.07; p-value=0.95).
CONCLUSION
Significant higher amounts of NLR may be strongly indicative of underlying inflammation in AS.
Topics: Arthritis, Rheumatoid; Biomarkers; Humans; Lymphocytes; Neutrophils; Spondylitis, Ankylosing
PubMed: 34548002
DOI: 10.2174/1573397117666210921114431 -
Health and Quality of Life Outcomes Jul 2022Patients who suffered from ankylosing spondylitis (AS) or non-radiographic axial spondyloarthritis (nr-axSpA) often have poor quality of life (QoL) and there has been a... (Meta-Analysis)
Meta-Analysis Review
The validity and reliability of quality of life questionnaires in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and meta-analysis.
BACKGROUND
Patients who suffered from ankylosing spondylitis (AS) or non-radiographic axial spondyloarthritis (nr-axSpA) often have poor quality of life (QoL) and there has been a substantial increase in research on acceptable questionnaires for assessment of QoL. This systematic review aims at examining the validity and reliability of QoL questionnaires in patients with AS/nr-axSpA.
METHODS
Randomized controlled trials (RCTs), cohort trials, and cross-sectional trails were retrieved by searching seven databases. Primary outcomes included test-retest reliability and construct validity. Secondary outcomes included internal consistency, structural validity, responsiveness and so on. Data extraction and analyses were conducted according to the Cochrane standards. The Agency for Healthcare Research and Quality (AHRQ) checklists was used to assess the risk of bias for each included study. We used the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) to assess the methodological quality and measurement property of included instruments. The quality of evidence on pre-specified outcomes were assessed by the Grades of Recommendations, Development and Evaluation (GRADE) approach.
RESULTS
22 publications containing 10 self-rating instruments were included in this study. Most studies were cross-sectional in design and a total of 3,085 participants were enrolled. 19 studies had moderate to high test-retest reliability. Cronbach's alpha (α) Coefficients were generally high (0.79-0.97) for overall scales. The ankylosing spondylitis quality of life (ASQOL) and evaluation of ankylosing spondylitis quality of life (EASi-QoL) questionnaires showed the strongest measurement properties in high-quality studies. The correlation coefficient for test-retest reliability of the ASQOL questionnaire was 0.85 (95% CI 0.80 to 0.89). The pooled Cronbach's α coefficients of the ASQOL questionnaire and the EASi-QoL questionnaire were high. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were considered as two validity criteria. For the ASQOL and EASi-QoL questionnaire, pooled convergent validity associations with BASDAI and BASFI were low to strong (0.24-0.81).
CONCLUSIONS
This study indicated acceptable reliability and stability of included QoL questionnaires. The ASQOL and the EASi-QoL questionnaires are validated and reliable disease-specific questionnaires for the assessment of QoL in patients with AS/nr-axSpA.
Topics: Axial Spondyloarthritis; Humans; Non-Radiographic Axial Spondyloarthritis; Quality of Life; Reproducibility of Results; Severity of Illness Index; Spondylitis, Ankylosing; Surveys and Questionnaires
PubMed: 35907948
DOI: 10.1186/s12955-022-02026-5 -
Journal of Maxillofacial and Oral... Jun 2023Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various... (Review)
Review
BACKGROUND
Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various interposition materials like meniscus, muscle, fascia, skin, cartilage, fat, dura and alloplastic materials have been used for the treatment of ankylosis and improve joint functions.
OBJECTIVE
The objective of this systematic review is to evaluate the effectiveness of dermis fat graft and temporalis myofascial flap as an interpositional material in treatment of temporomandibular joint ankylosis and to compare the effectiveness of the two materials.
MATERIALS AND METHODS
PubMed, Google scholar, and Cochrane library search in combination with hand search of relevant journals were conducted published in English from January 2000 to August 2021. Randomized controlled trials, prospective and retrospective cohort studies were included. Outcome measure included improvement in mouth opening. Risk of bias assessment was assessed using Cochrane risk of bias tool and Newcastle-Ottawa scale.
RESULTS
A total of 144 articles were found from the primary search which on thorough assessment, duplicate and exclusion removal resulted in 9 cohort studies and 1 randomized controlled trial that fulfilled the inclusion criteria. All the studies included reported significant improvement in mouth opening after interposition of the 2 materials. Four studies compared temporalis myofascial flap with dermis fat graft, 2 studies reported dermis fat graft gives better outcomes, whereas 1 study reported temporalis myofascial flap to be better and 1 study has been inconclusive.
CONCLUSION
Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However a general consensus has been toward dermis fat graft owing to fewer complications.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12663-023-01869-9.
PubMed: 37122786
DOI: 10.1007/s12663-023-01869-9 -
Current Cardiology Reviews 2021The objective of this study isto assess the association between ankylosing spondylitis (AS) and risk of heart conduction disorders and arrhythmia. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this study isto assess the association between ankylosing spondylitis (AS) and risk of heart conduction disorders and arrhythmia.
METHODS
PubMed, Embase, and Web of Science databases were systematically searched for observational studies that investigated the association between AS and risk of heart conduction disorders and arrhythmia with no language or date restrictions until September 16, 2019. We used randomand fixed-effects models to pool the results of the studies. Publication bias was assessed by Egger's test. Subgroup analysis was carried out based on the study design. A p-value less than 0.05 was considered significant. Comprehensive Meta-Analysis (CMA) software was used to perform meta-analysis.
RESULTS
After removing duplicates, we reviewed 135 articles. Finally, we included seven articles in our meta-analysis, of which four studies reported AV block and any conductive abnormality and three focused on atrial fibrillation and any arrhythmia. Based on our meta-analysis, an increased risk of atrial fibrillation (RR: 1.85, 95%CI: 1.15-2.98) and atrioventricular block (OR: 3.46, 95%- CI: 1.09-10.93) was found in AS subjects compared to the general population. In a subgroup analysis based on study design, we found a greater association between AS and atrioventricular block in cohort studies (RR: 5.14, 95%CI: 1.001-26.50) compared to cross-sectional ones. However, we did not find any association between AS and any arrhythmia (OR=3.36, 95% CI: 0.93-12.15), or conduction disorders (OR: 0.64, 95%CI: 0.38-1.06). No publication bias was found.
CONCLUSION
Our results support an association between AS and a higher risk of atrial fibrillation and atrioventricular block.
Topics: Atrial Fibrillation; Cross-Sectional Studies; Humans; Spondylitis, Ankylosing
PubMed: 33992063
DOI: 10.2174/1573403X17666210515164206 -
Oral Surgery, Oral Medicine, Oral... Jan 2023We used consensus-based, systematic protocols to evaluate the reliability and validity of patient-reported outcome measures (PROMs) for use in documenting treatment... (Review)
Review
OBJECTIVE
We used consensus-based, systematic protocols to evaluate the reliability and validity of patient-reported outcome measures (PROMs) for use in documenting treatment outcomes for temporomandibular disorders (TMDs).
STUDY DESIGN
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a focused search of 5 literature databases resulting in a yield of 445 articles that qualified for full-text review. Our review identified 124 PROMs, from which we selected 19 directly related to symptoms of TMD including temporomandibular joint (TMJ) function.
RESULTS
We abstracted data on 9 Consensus-based Standards of the selection of health Measurements INstruments (COSMIN) measurement properties and analyzed these data according to COSMIN criteria. Only 3 PROMs provided evidence for at least half of the COSMIN properties: Eight-item Jaw Function Limitations Scale, Oral Health Impact Profile (OHIP)-TMD (OHIP-TMD), and TMJ Ankylosis Specific Quality of Life Questionnaire. Only the OHIP-TMD provided evidence for properties essential to evaluating change over time: reliability, measurement error, and responsiveness.
CONCLUSION
We believe these results can alert clinical practitioners to gaps in our knowledge about the most widely used PROMs in TMD practice, and identify topics requiring further study for clinical researchers.
Topics: Humans; Patient Reported Outcome Measures; Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Temporomandibular Joint Disorders
PubMed: 36241593
DOI: 10.1016/j.oooo.2022.08.002