Malignancies in spondyloarthritis with and without concomitant psoriasis, and the effect of disease modifying anti-rheumatic drugs.

OBJECTIVES: To determine the risk of 6 types of malignancies in spondyloarthritis (SpA) with and without psoriasis (PsO) and on disease-modifying anti-rheumatic drugs (DMARDs), compared to non-specific back pain (NSBP). METHODS: Medical records were retrieved. Patients with SpA with and without PsO were identified and compared to those with NSBP. Clinical data; follow-up duration; comorbidities; dates and types of cancer diagnosed; types and duration of DMARD therapy were collected. Propensity score adjustment was used to compare the risks of malignancies between SpA, SpA with and without PsO, and NSBP. Cox regression analysis was used to determine the risk of malignancy in DMARD therapy. RESULTS: A total of 3020 patients with SpA and 2527 patients with NSBP were studied. The mean follow-up duration in patients with SpA and NSBP was 9.6 years and 13.5 years respectively. Incidence and risk of malignancies were compatible between SpA and NSBP. The incidences of various carcinomas (per 1000 patient-years) in SpA were: 1.37 for colorectal carcinoma; 0.30 for carcinoma of pancreas; 0.30 for carcinoma of stomach; and 0.91 for lymphomas. Risk of colorectal carcinoma (HR 2.46; p=0.03) and lymphomas (HR 2.86; p=0.04) was increased in SpA with concomitant PsO. DMARD therapy was not associated with increased risks of malignancies after adjustment for confounding factors. CONCLUSIONS: Risk of malignancy was increased in SpA with PsO but not in other subtypes of SpA or DMARD therapy.

MRI inflammation of facet and costovertebral joints is associated with restricted spinal mobility and worsened functional status.

OBJECTIVE: To investigate the association of spinal inflammation on MRI in patients with various clinical, functional and radiological outcomes in patients with axial spondyloarthritis (SpA). METHODS: Three hundred and ninety-seven participants with axial SpA and back pain were recruited from 10 rheumatology centres. Clinical, biochemical and radiological parameters were collected and participants underwent MRI of the spine. MRI features including inflammatory lesions of facet joints and costovertebral joints, corner inflammatory lesions, and spondylitis were assessed. BASFI, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Global Index, BASMI and modified Stoke Ankylosing Spondylitis Spinal Score were measured. Multivariate linear regression models were used to determine the associations between MRI parameters and various clinical, functional and radiological outcomes. RESULTS: BASMI and BASFI correlated well with inflammatory features in spinal MRI. Multivariate analysis showed that lumbar facet joint inflammation was independently associated with BASMI (regression coefficient (ß) = 0.12, P < 0.001), lumbar spinal flexion (ß = 0.13, P = 0.00), lateral spinal flexion (ß = 0.09, P = 0.04), tragus-to-wall distance (ß = 0.16, P < 0.001) and BASFI (ß = 0.14, P = 0.01). Costovertebral joint inflammation was also associated with BASMI (ß = 0.08, P = 0.05). CONCLUSION: Inflammatory lesions of facet and costovertebral joints in MRI are associated with restriction in spinal mobility and functional impairment. These important yet commonly overlooked lesions should be reviewed in clinical practice in patients with SpA.

ASDAS is associated with both the extent and intensity of DW-MRI spinal inflammation in active axial spondyloarthritis.

Objective: To investigate the relationship between Ankylosing Spondylitis Disease Activity Score (ASDAS) and intensity of spinal inflammation measured by apparent diffusion coefficient (ADC) in MRI in participants with active axial spondyloarthritis (SpA). Methods: Participants with axial SpA and back pain were recruited. Clinical, demographic, biochemical and imaging data were collected. ASDAS was calculated based on C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Inflammatory lesions were identified in short tau inversion recovery images and the corresponding ADC maps to determine the maximum apparent diffusion coefficient (ADCmax), normalised maximum ADC, mean apparent diffusion coefficient (ADCmean) and normalised mean ADC by two independent readers. Spondyloarthritis Research Consortium of Canada (SPARCC) spine and sacroiliac (SI) joint MRI indexes were determined. Univariate and multivariate linear regression models were used to determine the associations between of ASDAS with ADC values, SPARCC spine and SI MRI scores. Results: Eighty-two participants had identifiable ADC lesions. Multivariate analyses using ADCmax and SPARCC spine MRI as independent variables showed associations with ASDAS-CRP (ADCmax: B=0.27, p=0.02; SPARCC: B=0.32, p=0.01) and ASDAS-ESR (ADCmax: B=0.24, p=0.03; SPARCC: B=0.36, p<0.01); using ADCmean and SPARCC spine MRI as independent variables also showed an association with ASDAS-ESR (ADCmean: B=0.22, p=0.05; SPARCC: B=0.36, p<0.01) and a tendency to associate with ASDAS-CRP (ADCmean: B=0.21, p=0.07; SPARCC: B=0.34, p<0.01). Conclusion: ASDAS is associated with both the extent and the intensity of spinal inflammation in patients with detectable inflammatory lesions. Our results showed that ASDAS is an objective disease assessment tool. Trial registration number: HKUCTR-2087.