The 5-year data of the DESIR cohort

Funding Information: Acknowledgements the dESIr cohort was sponsored by the département de la recherche Clinique et du développement de l’Assistance publique–Hôpitaux de paris. this study is conducted under the umbrella of the French Society of rheumatology and InSErM (Institut national de la Santé et de la recherche Médicale). the database management is performed within the department of epidemiology and biostatistics (professor paul Landais, d.I.M., nîmes, France). An unrestricted grant from pfizer was allocated for the 10 years of the follow-up of the recruited patients. the authors would like to thank the different regional participating centres: pr Maxime dougados (paris – Cochin B), pr André Kahan (paris - Cochin A), pr olivier Meyer (paris - Bichat), pr pierre Bourgeois (paris - La pitié Salpetrière), pr Francis Berenbaum (paris - Saint Antoine), pr pascal Claudepierre (Créteil), pr Maxime Breban (Boulogne Billancourt), dr Bernadette Saint-Marcoux (Aulnay-sous-Bois), pr philippe Goupille (tours), pr Jean-Francis Maillefert (dijon), dr xavier puéchal, dr Emmanuel dernis (Le Mans), pr daniel Wendling (Besançon), pr Bernard Combe (Montpellier), pr Liana Euller-Ziegler (nice), pr philippe orcel, dr pascal richette (paris - Lariboisière), pr pierre Lafforgue (Marseille), dr patrick Boumier (Amiens), pr Jean-Michel ristori, pr Martin Soubrier (Clermont-Ferrand), dr nadia Mehsen (Bordeaux), pr damien Loeuille (nancy), pr rené-Marc Flipo (Lille), pr Alain Saraux (Brest), pr Corinne Miceli (Le Kremlin Bicêtre), pr Alain Cantagrel (toulouse), pr olivier Vittecoq (rouen). the authors would also like to thank UrC-CIC paris Centre for the coordination and monitoring of the study. Contributors All authors contributed and finally approved the current manuscript. Competing interests none declared. Patient consent obtained. ethics approval Comitte de protection des personnes Ile de France III. Provenance and peer review not commissioned; externally peer reviewed. Open Access this is an open Access article distributed in accordance with the Creative Commons Attribution non Commercial (CC BY-nC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. no commercial use is permitted unless otherwise expressly granted. Publisher Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved.Objective To estimate sacroiliac joint radiographic (X-SIJ) progression in patients with axial spondyloarthritis (axSpA) and to evaluate the effects of inflammation on MRI (MRI-SIJ) on X-SIJ progression. Methods X-SIJ and MRI-SIJ at baseline and after 2 and 5 years in patients with recent onset axSpA from the DESIR cohort were scored by three central readers. Progression was defined as (1) the shift from non-radiographic (nr) to radiographic (r) sacroiliitis (by modified New York (mNY) criteria) or alternative criteria, (2) a change of at least one grade or (3) a change of at least one grade but ignoring a change from grade 0 to 1. The effects of baseline inflammation on MRI-SIJ on 5-year X-SIJ damage (mNY) were tested by generalised estimating equations. Results In 416 patients with pairs of baseline and 5-year X-SIJ present, net progression occurred in 5.1% (1), 13.0% (2) and 10.3% (3) respectively, regarding a shift from nr-axSpA to r-axSpA (1), a change of at least one grade (2) or a change of at least one grade but ignoring a change from grade 0 to 1 (3). Baseline MRI-SIJ predicted structural damage after 5 years in human leukocyte antigen-B27 (HLA-B27) positive (OR 5.39 (95% CI 3.25 to 8.94)) and in HLA-B27 negative (OR 2.16 (95% CI 1.04 to 4.51)) patients. Conclusions Five-year progression of X-SIJ damage in patients with recent onset axSpA is limited but present beyond measurement error. Baseline MRI-SIJ inflammation drives 5-year radiographic changes.publishersversionpublishe

Do fatty lesions explain the effect of inflammation on new syndesmophytes in patients with radiographic axial spondyloarthritis? Results from the SIAS cohort and ASSERT trial

OBJECTIVES: To determine how much of the effect of vertebral corner inflammation on development of syndesmophytes is explained by vertebral corner fat deposition. METHODS: Patients with radiographic axial spondyloarthritis (r-axSpA) from the SIAS (Sensitive Imaging in Ankylosing Spondylitis) cohort and ASSERT (Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy) trial were assessed at T0, T1 (SIAS: 1 year; ASSERT: 24 weeks) and T2 (2 years). Syndesmophytes assessed in each vertebral corner by whole spine low-dose CT (SIAS) or spinal radiographs (ASSERT) at T0 and T2 were considered present if seen by two of two readers. Inflammation (T0) and fat deposition (T0 and T1) on MRI were present if seen by ≥2 of 3 readers (SIAS) or 2 of 2 readers (ASSERT). Vertebral corners showing fat deposition or a syndesmophyte at baseline were ignored. Mediation analysis was applied to determine what proportion of the total effect of inflammation on syndesmophyte formation could be explained via the path of intermediate fat deposition. RESULTS: Forty-nine SIAS patients (with 2667 vertebral corners) and 168 ASSERT patients (with 2918 vertebral corners) were analysed. The presence of inflammation at T0 increased the probability of a new syndesmophyte in the same vertebral corner at T2 by 9.3%. Of this total effect, 0.2% (2% (0.2 of 9.3) of the total effect) went via intermediate new fat deposition. In ASSERT, the total effect was 7.3%, of which 0.8% (10% of the total effect) went via new fat deposition. CONCLUSION: In r-axSpA, vertebral corner inflammation may lead to syndesmophyte formation but in a minority of cases via visible fat deposition

Increase in Il-31 Serum Levels Is Associated with Reduced Structural Damage in Early Axial Spondyloarthritis

In spondyloarthritis, little is known about the relation between circulating cytokines and patient phenotype. We have quantified serum levels of T helper type 1 cell (Th1), Th2 and Th17 cytokines in patients with recent-onset axial spondyloarthritis (AxSpA) from the DESIR cohort, a prospective, multicenter French cohort consisting of 708 patients with recent-onset inflammatory back pain (duration >3 months but <3 years) suggestive of AxSpA. Serum levels of Th1, Th2, and Th17 cytokines were assessed at baseline in patients from the DESIR cohort fulfilling the ASAS criteria (ASAS+) and were compared with age- and sex-matched healthy controls. At baseline, ASAS+ patients (n = 443) and healthy controls (n = 79) did not differ in levels of most of the Th1, Th2 and Th17 cytokines except for IL-31, and sCD40L, which were significantly higher for ASAS+ patients than controls (p < 0.001 and p = 0.012, respectively). On multivariable analysis of ASAS+ patients, IL-31 level was associated with sCD40L level (p < 0.0001), modified Stoke AS Spine Score (mSASSS) < 1 (p = 0.035). The multivariable analyses showed that IL-31 was an independent factor associated with mSASSS < 1 (p = 0.001) and low bone mineral density (p = 0.01). Increased level of IL-31 might protect against structural damage but is also related to low BMD

Starting Home Telemonitoring and Oxygen Therapy Directly after Emergency Department Assessment Appears to Be Safe in COVID-19 Patients

Background: Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. Methods: All COVID-19 patients ≥18 years eligible for receiving home telemonitoring (November 2020-February 2022, Albert Schweitzer hospital, the Netherlands) were included: patients started directly after ED assessment (ED group) or after hospital admission (admission group). Safety (number of ED reassessments and hospital readmissions) and effectiveness (number of phone calls, duration of oxygen usage and home telemonitoring) were described in both groups. Results: 278 patients were included (n = 65 ED group, n = 213 admission group). ED group: 23.8% (n = 15) was reassessed, 15.9% (n = 10) was admitted and 7.7% (n = 5) ICU admitted. Admission group: 15.8% (n = 37) was reassessed, 6.5% (n = 14) was readmitted and 2.4% (n = 5) ICU (re)admitted. Ten patients died, of whom 7 due to COVID-19 (1 in ED group; 6 in the admission group). ED group: median duration of oxygen therapy was 9 (IQR 7–13) days; the total duration of home telemonitoring was 14 (IQR 9–18) days. Admission group: duration of oxygen therapy was 10 (IQR 6–16) days; total duration of home telemonitoring was 14 (IQR 10–20) days. Conclusion: it appears to be safe to start home telemonitoring and oxygen therapy directly after ED assessment

Agreement Between Clinical Practice and Trained Central Reading in Reading of Sacroiliac Joints on Plain Pelvic Radiographs: Results From the DESIR Cohort

International audienc

Agreement Between Clinical Practice and Trained Central Reading in Reading of Sacroiliac Joints on Plain Pelvic Radiographs: Results From the DESIR Cohort

International audienc

Similar short-term clinical response to high-dose versus low-dose methotrexate in monotherapy and combination therapy in patients with rheumatoid arthritis

Background: Aiming at rapid decrease of disease activity, there has been a trend to start with higher doses of methotrexate (MTX) in patients newly diagnosed with rheumatoid arthritis (RA), both as monotherapy and in combination with other antirheumatic drugs. We aimed to study the relationship between clinical response and MTX dose as monotherapy or combination therapy in patients with early RA. Methods: Disease-modifying anti-rheumatic drug (DMARD)-naive patients with early RA, from a large international observational database, the METEOR database, were selected if MTX was part of their initial treatment. Patients were divided into four groups: MTX monotherapy, MTX + convention synthetic (cs)DMARDs, MTX + glucocorticoids or MT

Agreement Between Clinical Practice and Trained Central Reading in Reading of Sacroiliac Joints on Plain Pelvic Radiographs: Results From the DESIR Cohort

International audienc

Agreement Between Clinical Practice and Trained Central Reading in Reading of Sacroiliac Joints on Plain Pelvic Radiographs: Results From the DESIR Cohort

International audienc