SPIB-project - SIGR · consisting in abdominal pain and more than 12 liquid soft stool/day, and...
Transcript of SPIB-project - SIGR · consisting in abdominal pain and more than 12 liquid soft stool/day, and...
SPIB-project SPondyloarthropaties in Inflammatory Bowel diseases
Dott. Michele M. Luchetti
Clinica Medica Dipartimento di Scienze Cliniche e Molecolari
Enteropathic spondyloarthritis: new topic of interest or a forgotten one ?
A relationship between bowel and joints was reported for the first time by Smith in 1922, who described in patients with rheumatoid arthritis (RA) underwent surgery for colectomy an improvement of articular symptoms (R. Smith. Ann
Surg, 76, 515–578, 1922).
Only in 1964, the American Rheumatism Association classified arthritis associated with IBD as independent clinical form (Blumberg B.S. Arthritis Rheum 7, 93–97, 1964).
And, later, in 1976 Wright and Moll included enteroarthritis definitively among SpA group (V. Wright and J. H. M. Moll, Seronegative
Polyarthritis, North Holland Publishing Company, Amsterdam, The Netherlands, 1976). Luchetti MM Clin Medica, UNIVPM, I l
…This apparent lack of interest is reflected also by the fact that guidelines on IBD up to 2005 did not mention IBD-associated arthritis. Only in 2006 with the publication of the European Crohn’s and Colitis Organization (ECCO) evidence-based consensus on “special situations in Crohn’s disease”, articular manifestations are briefly discussed (Caprilli et al., Gut 2006; 55 Suppl 1: i36-i58)”.
Enteropathic spondyloarthritis: new topic of interest or a forgotten one ?
Luchetti MM Clin Medica, UNIVPM,
Possibile interessamento delle articolazioni assiali (sacroiliache e il rachide, condrosternali)…
…e in questo caso la sintomatologia tipica è costituita dall’ Inflammatory Back Pain (IBP)
Possibile interessamento delle articolazioni periferiche, generalmente in modo asimmetrico e con una maggiore prevalenza le grandi articolazioni…
….ed anche le zone iuxta ed extra-articolari, quali le entesi e i tendini (entesiti-dattilite)
presentano aggregazione familiare importante (background genetico comune HLA-B27 per la Spondilite Anchilosante)
Gruppo di affezioni infiammatorie croniche che condividono alcune caratteristiche comuni:
SpAs
Rudwaleit M. Int J Adv Rheumathol 2010
Diagnostic clues for the rheumatologist
Diagnostic clues for the gastroenterologist
• Family history of IBD • Chronic diarrhea • Chronic abdominal pain • Rectal bleeding • Weight loss • Persistent fever • History or evidence of
perianal fistula/abscess • Anemia
• Chronic back pain (>3 months)
• Peripheral joint pain/swelling
• Presence of signs of enthesitis
• History or evidence of dactylitis
Diagnostic clues for the rheumatologist or for the gastroenterologist to be evaluated in each single patient before considering referral to the gastroenterologist or to the rheumatologist. Adapted from Olivieri I. et al., Autoimmunity Reviews, 2014.
Luchetti MM Clin Medica, UNIVPM, I l
SPIB 2015
I should perhaps declare a personal, as well as a professional, interest in the field: I entered medical school 50 years ago, while suffering from AS that had gone undiagnosed for the previous 4 years. It took another 2 years…for the disease to be finally diagnosed. (Khan M.A., Rheumatology 2011).
Luchetti MM, Clin Medica, UNIVPM
Khan M. Arthritis Rheum 2000
Luchetti MM Clin Medica, UNIVPM, I l
The Journal of Rheumatology 2013; 40:10
“There is an UNACCEPTABLE DELAY in the diagnosis of axial spondyloarthritis (axSpA) in its early stages among patients at high risk, in particular those with inflammatory bowel disease (IBD)”
precedes IBD symptoms in 31% to 50% of patients
IBD and axSpA can occur simultaneously in 15% to
40% of patients
SPIB 2015
Ovvero: Pazienti affetti da IBD e LOMBALGIA INFIAMMATORIA: 1- HLA-27+
oppure 2- Sacroileite Rx e/o RMN
Diagnosi: SpA-IBD ASSIALE
Ovvero: Pazienti affetti da IBD e artrite periferica 1- HLA-27+
oppure 2- + entesite o dattilite
oppure 3- LOMBALGIA INFIAMMATORIA
Diagnosi: SpA-IBD PERIFERICA
Sacroileite, Sindesmofiti
< 40 anni
Cronico
Migliora i sintomi
>1 ora al risveglio Sciatica “TRONCA” (ginocchio-pube)
INFIAMMATORIO
Restringimento spazio discale, scoliosi, osteofitosi
RX-RMN
> 40 anni Esordio
Acuto o cronico Durata
Peggiora i sintomi Attività fisica
< 45’ al risveglio Sciatica CLASSICA
(schiena-piede)
Dolore/Rigidità
MECCANICO Caratteri
Inflammatory Back Pain Diagnostic Criteria
Luchetti MM Clin Medica, UNIVPM, I l
First recommendation
IBD patient • Active • Anamnestic
Enthesitis Dactilitis
Back pain Arthralgia-arthritis
Early Referral to the Rheumatologist
SPIB 2015
A.S., age 42, affected by CD and admitted in the hospital for a flare of the disease, consisting in abdominal pain and more than 12 liquid soft stool/day, and subjected to entero-MRI. Rheumatologic consultation requested for “arthralgia”
Entero-MRI
R L
Bone marrow oedema = ACTIVE sacroiiletis
Luchetti MM Clin Medica, UNIVPM, I l
Medical Problem: Arthralgia in patients affected by Inflammatory Bowel Diseases (IBD)
SPIB 2015
Divisione di Gastroenterologia
SPIB START: 2013
Consulenza Clinica Medica
INTRO
Luchetti MM Clin Medica, UNIVPM, I l
General issues and specific problems from the start
Symptoms present for years Underestimated, in particular in young patients
Treated with symptomatic drugs
Often considered consequent to the IBD Often “mitigated” by the treatment for IBD (anti-TNF-alfa!)
Never considered the option of a “specific” treatment for both the articular and the gastrointestinal inflammation
Need for an early diagnosis of Enteropatic Spondiloarthritis
(ES)
SPIB 2015 INTRO
Luchetti MM Clin Medica, UNIVPM, I l
I. (Early) Diagnosis of Enteropatic SpA (ES): not easy
ES: diagnosed by ASAS criteria
① Treatment ? ① Clinical Outcomes ? ① Quality of life of ES
patients ?
? Few lines in the ASAS/EULAR recomendations for
the management of AS (ARD 2014) Indipendent Clinical Outcomes of SpA and of IBD
Significantly worsened by articular symptoms
SPIB 2015
Luchetti MM Clin Medica, UNIVPM, I l
SPIB-project (SPondyloarthropaties in Inflammatory Bowel diseases )
2013-2014
2015 (ENDED follow up at 12 months)
Schematic Overview
A. Integration of the Gastroenterology and Rheumatologic Examination
B. Screening of pts affected by articular symptoms C. Diagnosis of ES D. Integrated Therapy E. Follow up and integrated evaluation of patient-reported
and clinical outcomes
SPIB 2015
Luchetti MM Clin Medica, UNIVPM, I l
Patient Studied:
n. 220 IBD pts In the outpatient clinics and clinical wards
(Gastroenterology and Internal Medicine)
Gastro
INTEGRATED EVALUATION
Rheuma
SPIB 2015
Luchetti MM Clin Medica, UNIVPM, I l
Patient Studied:
n. 220 IBD pts
Cohort of the Study: n. 178 IBD pts
Compliant
SCREENING for articular symptoms
PROs: HAQ VAS SF-36
Project Plan Scheme – T zero
PROs Gastro-Activity: CDAI IBDQ
Reuma-Activity: ASDAS BASDAI BASMI BASFI
II Rheumatologic Examination
No SpA SpA?
ES Cohort (n. 52)
IBD-def Cohort (n. 126)
III Evaluation: HLA-B27 Rx RMN
Venous sampling for Biomarkers Evaluation
INTEGRATED EVALUATION OF THE TREATMENT
TEST
SPIB 2015
Luchetti MM Clin Medica, UNIVPM, I l
SCREENING Time = 5-10 min Made by the MD In the
GASTROENTEROLOGY: • outpatient clinic • In DH • in the clinical ward
METHODS- Screening
II phase: Rheumatologic Evaluation Time = 30-45 min Made by the MD In the INTERNAL MEDICINE
outpatient clinic or in the clinical ward
SPIB 2015
Luchetti MM Clin Medica, UNIVPM, I l
SCREENING vs.The Toronto Questionary, Alnaqbi KA, J Rheumatol 2013, 40:10.
SPIB 2015 METHODS- Screening
Luchetti MM Clin Medica, UNIVPM, I l
METHODS - TESTs
Patient Reported Outcomes (PROs) “qualsiasi informazione riferita direttamente dai pazienti (report), senza interpretazione di medici o altri, sul proprio essere, il proprio agire e le proprie sensazioni in relazione alle condizioni di salute e agli interventi che ne sono connessi” Patrick DL, Burke LB, Powers JH, et al. Patient-reported outcomes to support medical product labelling claims: FDA perspective. Value in Health 2007;10(suppl.2):125-37 Dawson J, Doll H, Fitzpatrick R, Jenkinson C, et al. The routine use of patient reported outcome measures in healthcare settings, BMJ 2010; 340:c186
SPIB 2015
QUALITY OF LIFE
SF-36 HealthAssessement Questionary (HAQ)
Patient Global Assessment (PtGA)
Function explored General health status General health status Pain Items 36 22 Visual Analogue
Scale Peculiarity 8-scale profile of functional health and well-being
scores, as well as psychometrically-based physical /mental health summary measures
Assessment of the ability to perform normal daily duties
Normal score >80 (The higher the score the less disability) <20 <10
Gastroenterologic ACTIVITY
Crohn’s Disease Activity Index (CDAI) Inflammatory Bowel Disease Questionary (IBDQ)
Function explored Clinical and laboratory disease activity Social, systemic and emotional symptoms, as well as bowel related symptoms
Items 8 32 Peculiarity Item 4 (score value = 20): arthritis ? Normal score <150 >190 (The higher the score the less disability)
Rheumatologic ACTIVITY
ASDAS-CRP Ankylosing Spondylitis Disease
Activity Score
BASDAI Bath Ankylosing Spondylitis
Disease Activity Index
BASFI Bath Ankylosing Spondylitis
Functional Index
BASM Bath Ankylosing Spondylitis Metrology Index
Function explored Disease activity Disease activity Functional activity Functional activity Items 5 6 10 5 Peculiarity 1 laboratory item: CRP Visual scale Visual scale Measurement of
anatomical parameters
Normal score <1,3 <4 <4 <1
METHODS - TESTs SPIB 2015
Luchetti MM Clin Medica, UNIVPM, I l
SF-36
HAQ
VAS
CDAI
IBDQ
ASDAS BASDAI
BASMI
BASFI
TEST administration time: 30 min/each pt
entered in a specific database based on the Epi-Info platform
METHODS - TESTs SPIB 2015
STATISTICS Softwares: • GraphPad InStat • GraphPad Prism Clinical Data: Wilcoxon and Mann-Whitney non-parametric test Laboratory Data: Wilcoxon non-parametric test; Correlation by Spearman’s test; Deming (method II) linear regression
Luchetti MM Clin Medica, UNIVPM, I l
Project Plan – Follow Up
ES Cohort
IBD-def
Cohort Venous sampling for Biomarkers Evaluation
INTEGRATED EVALUATION OF THE TREATMENT
2014 2015 3
months 6
months 12
Months (JUNE)
SCREENING for articular symptoms
Gastro-Activity Evaluation: CDAI, IBDQ PROs Evaluation: HAQ, VAS, SF-36
Reuma-Activity Evaluation: ASDAS, BASDAI, BASMI, BASFI
In progress
SPIB 2015
Luchetti MM Clin Medica, UNIVPM, I l
Integration of the Gastroenterology and Rheumatologic Examination Screening of pts affected by articular symptoms
END POINTs SPIB Schematic Overview
1. DIAGNOSIS OF ENTEROPATIC SpA (ES)
2. EVALUATION OF THE QUALITY OF LIFE IN THE ES PTS
3. INTEGRATED ACTION (GASTRO-RHEUMA) FOR THE CHOICE
OF THE OPTIMAL TREATMENT-BASED ON ARTICULAR-
INTESTINAL INFLAMMATION
4. INTEGRATED EVALUATION (GASTRO-RHEUMA) OF THE
QUALITY OF LIFE, DISEASE ACTIVITY AND CLINICAL
REMISSION AFTER ACTION 3.
Diagnosis of ES Integrated Therapy Follow up and integrated evaluation of
patient-reported and clinical outcomes
SPIB 2015
RESULTS
I.Patients: screening for articular symptoms and constitution of the ES cohort
SPIB 2015
Luchetti MM et al. ARD June 2015
RESULTS - Patients
IBD: n. 220 pts affering into the study
80 pts (36%)
ENTEROPATHIC SpA (ES) n. 52 pts • 24 % of IBD pts • 65 % of the “Articular Symptoms Cohort”
IBD-def
COHORT: n. 126 pts
SCREENING
Articular symptoms
YES
NO
Osteoarthritis and/or other condition: n. 28 pts (16 % of IBD pts)
According to ASAS criteria
SPIB 2015
Luchetti MM et al. ARD June 2015
Articular Symptoms Cohort
Luchetti MM Clin Medica, UNIVPM, I l
IBD-def COHORT n=126 CD (Crohn’s Disease):UC (Ulcerative Colitis) 117 (67,5%) : 61 (32,5%)
M:F 98:80
Age (mean ± SD) 46,6 ± 14,44
Disease duration, in years (mean ± SD) 10,68 ± 9,23
Extra-intestinal symptoms (rheumatologic excluded), pts number 8 (4.5%)
Erythema nodosum, pts number 9 (5%)
Uveitis, pts number 3 (1,7%)
Therapy • Mesalazine • NSAID • DMARD • Corticosteroids • Anti-TNF-alfa drugs (infliximab:adalimumab)
38 (24,7%)
0 22 (14,3%) 28 (18,2%) 33 (28:5)
Oral contraceptives, pts number 8 (5,2%)
Smokers Ex-smokers
45 (29,2%) 35 (22,7%)
CD-Gastrointestinal Activity (assessed by CDAI) 76 REMISSION (65%) 25 MODERATE (21%) 16 MODERATE-TO-SEVERE (14%)
UC-Gastrointestinal Activity (assessed by Truelove and Witt’s)
• 41 MILD (67%) • 14 MODERATE (23%) • 6 SEVERE (10%)
SPIB 2015 RESULTS – Patients at the baseline
ES COHORT N=52 CD (Crohn’s Disease):UC (Ulcerative Colitis) 33(63%) :19 (37%)
M:F 22:29
Age (mean ± SD) 48,4 ± 12,34
Disease duration of IBD, in years (mean ± SD) 12,16 10,66 yrs
Erythema nodosum, pts number 1 (2%)
Uveitis, pts number 2 (3,9%)
Therapy • Mesalazine • NSAID • DMARD • Corticosteroids • Anti-TNF-alfa drugs (infliximab:adalimumab)
20 (39,2%)
1 (2%) 11 (21,6%) 8 (15,7%) 11 (7:7)
Oral contraceptives, pts number 3 (5,2%)
Smokers Ex-smokers
9 (17,6%) 12 (23,5%)
CD- Gastrointestinal Activity 13 inactive (40,6%) 12 mild (37,4) 8 moderate-to-severe (22%)
UC -Gastrointestinal Activity
• 10 mild (52,6%) • 6 moderate (31,5%) • 3 severe (15,9%)
CD - Gastrointestinal Activity
13 inactive (40,6%) 12 mild (37,4) 8 moderate-to-severe(22%)
76 remission (65%) 25 moderate (21%) 16 moderate-to-severe (14%)
UC - Gastrointestinal Activity
• 10 mild (52,6%) • 6 moderate (31,5%) • 3 severe (15,9%)
•41 mild (67%) •14 moderate (23%) •6 severe (10%)
RESULTS – Patients at the baseline SPIB 2015
Luchetti MM et al. ARD June 2015
ES IBD-def
ES COHORT - Rheumatologic features N=52 HLA-B27 positive, pts number 5 (10 %) Axial SpA: Peripheral SpA 28(54 %) : 24(46 %) Type of Axial Involvement, pts number Syndesmophytosis Bamboo Spine Sacroiliitis (MRI imaging)
2 (3,9%) 1 (1,9%) 25 (49%
of the cohort, 100% of the Axial-ES))
CD Articular Involvement, pts number • Axial • Peripheral • Enthesis
18 (35,3%) 14 (27,5%) 14 (27,5%)
UC Articular Involvement, pts number • Axial • Peripheral • Enthesis
10 (19,6%) 7 (13,7%) 8 (14 %)
Articular Disease Activity (global evaluation, score number) ASDAS-CRP BASDAI BASFI BASMI
3,2 ± 0,72 5,6 ± 1,98 3,1 ± 3,42 1,2 ± 1,35
SPIB 2015
Luchetti MM et al. ARD June 2015
RESULTS – Patients at the baseline
RESULTS
II. Analysis of the Quality of Life: the impact of articular disease on the quality of life of IBD pts
SPIB 2015
Luchetti MM et al. ARD June 2015
SPIB 2015 RESULTS – Quality of life at the baseline
SF-36 The quality of life in ES pts is significantly worsened by articular symptoms...
IBD
ES
PF PF SF SF BP BP RP RP
MH MH VT VT
*** *** *** *** *** *** *** ***
GH GH RE RE Luchetti MM et al. ARD June 2015
well-being
***p<0.001
SPIB 2015 RESULTS – Quality of life at the baseline
well-being
***p<0.001
Luchetti MM et al. ARD June 2015
The quality of life in ES pts is significantly worsened by articular symptoms...
IBD ES
*** HAQ PtGA
IBD ES
SPIB 2015 RESULTS – Quality of life at the baseline
…and it is significantly worsened by the persistence of gastrointestinal symptoms
CDAI
IBD ES
**
IBDQ
IBD ES
***
Active IBD **p<0.01; ***p<0.001 Luchetti MM et al. ARD June 2015
RESULTS
III. Analysis of the Quality of Life: the impact of the optimal therapeutic strategy on the quality of life of IBD pts
SPIB 2015
Luchetti MM et al. ARD June 2015
RESULTS – The integrated options of treatment SPIB 2015
ENTEROPATIC SpA (ES) Naive, n. 39 pts
Active IBD
IBD in remission
Peripheral SpA
Axial SpA
IBD refractory to conventional therapy at least for 3 months
+ Anti-TNF-alfa (used as recommended
for IBD treatment)
Axial SpA
Peripheral SpA
Salazopyrinor
Mtx
Salazopyrinor
Mtx
Dashed line: refractory
• PERIPHERAL-SpA = 14 pts (10 + MTX ; 4 + SZP) • AXIAL-SpA = 22 pts : + ADA; • PERIPHERAL-SpA, active-IBD and refractory to DMARDs = 3 pts : + ADA
Luchetti MM et al. ARD June 2015
RESULTS – The integrated options of treatment SPIB 2015
ENTEROPATIC SpA (ES) in-treatment with anti-TNF-alfa, n. 13 pts
Active IBD
IBD in remission
Peripheral SpA
Axial SpA
IBD refractory to therapy and posology variations at least for 5 months
SWITCH to another anti-TNF-alfa
(used as recommended for IBD treatment)
Axial SpA
Peripheral SpA
Salazopyrinor
Mtx
Dashed line: refractory
PERIPHERAL-SpA, 10 pts : 8 + MTX ; 2 + SZP AXIAL-SpA, 3 pts switched : + ADA
SpA-Refractory
Luchetti MM et al. ARD June 2015
+
SPIB 2015 RESULTS- PATIENTS AND TREATMENT ENTEROPATIC SpA (ES)
n. 52 pts
PERIPHERAL SpA n. 24 pts: • MTX, n. 18 • SZP, n. 6
AXIAL SpA n. 22 naive pts
AXIAL SpA n. 3 pts switched from IFX for inefficacy
PERIPHERAL SpA, Refractory, n. 3 naive pts
CD 33 (63%), UC 19 (37%) IBD active in 29 (56%) pts
DMARDs ADA, n. 28 pts
• MTX, 15-20 mg/week
• SZP, 1 gr x 2/daily
Dose: 160 mg the Ist week; 80 mg the IInd week; then, 40 mg every other week
Baseline
12 months Luchetti MM et al. ARD June 2015
N.B. THERAPY CHOICE STRICTLY BASED ON: 1. IBD activity + 2. IBD therapy at the baseline + 3. Articular involvement N.B. THERAPY DOSAGE BASED ON: 1. IBD activity
SPIB 2015 RESULTS – Quality of life after 12-months of treatment
IBD
ES
90% of the ES upon the start of the therapy pts reported a significant improvement in some indicators of the quality of life
well-being
Luchetti MM et al. ARD June 2015
SF-36
SPIB 2015 RESULTS – Quality of life after 12-months of treatment
CDAI
IBD ES
IBDQ
IBD ES
Active IBD or SpA *p<0.05; **p<0.01; ***p<0.001
This therapeutic effect has played a crucial role in improving the quality of life of ES pts
88% of ES pts receiving anti-TNF-alfa drugs has achieved a significant improvement of both gastrointestinal
T0= ES pts at baseline evaluation and after 12-months (T12) of treatment with anti-TNF-alfa drugs
Luchetti MM et al. ARD June 2015
*
T0 T12
BASDAI
***
T0 T12
ASDAS-CRP
***
and articular disease
SPIB 2015 RESULTS – COMPLIANCE AND SAFETY AT 12-MONTHS
ADHERENCE TO THERAPY
Luchetti MM et al. ARD June 2015
• 30 pts under BIOLOGIC THERAPY n. 24 ADA (4 switch from IFX) n. 6 IFX (1 switch from ADA)
• 8 pts under DMARDs n. 8 MTX n. 2 SZP
• 14 pts --> NO THERAPY FOR SPA 9 refused (safety concern) 1 stop ADA for surgery 1 stop ADA for pregnancy 1 stop ADA for psoriatic eruption 1 stop IFX for psoriatic eruption 1 stop IFX for infusion reaction
Reaction reported (n. 13, 33 %) IFX Psoriatic Eruption 2
Anaphylaxis 1 Leukopenia 1 Infusion Reactions 2
ADA Hair Loss 1 Serious Infection 3 Psoriatic Eruption 1 Recurrent Upper Respiratory
Tract Infection 2 Fatigue 2 Headache 1 Itching 1
SAFETY
SPIB 2015 CONCLUSIONS - 1
1) The QUALITY OF LIFE in ES pts is dramatically worsened by the occurrence of articular symptoms
2) The early diagnosis of ES and… 3) ….the choice of the optimal therapeutic strategy lead to a
consistent clinical remission of both the gastrointestinal (IBD) and articular disease (SpA).
4) Thus, the integrated clinical evaluation of these pts, carried out by the gastroenterologist and rheumatologist, should be strongly encouraged and supported in clinical practice
Patient reported outcomes and quality of life in a cohort of patients affected by entheropathic spondyloarthritis (ES): results at one-year of a monocentric prospective observational study
Luchetti MM et al. ARD June 2015
RESULTS
IV. Effect of adalimumab in ES: What’s about the impact of anti-TNF-alfa therapy, compared to DMARDs, on both the articular and the gastrointestinal inflammation?
SPIB 2015
Luchetti MM et al. ARD June 2015
SPIB 2015 RESULTS- ADA vs Sinth-DMARDs IN ES ADA, but not methotrexate or salazopyrine, consistently decreases articular inflammation…
Active SpA T0= ES pts at baseline evaluation and after 12-months (T12) of treatment with anti-TNF-alfa drugs
*
T0 Sinth-DMARDs
T0 ADA
T12 T12 T0 Sinth-DMARDs
T0 ADA
T12 T12
*p<0.05; ***p<0.001.
BASDAI ASDAS-CRP
Luchetti MM et al. ARD June 2015
***
* *
SPIB 2015 RESULTS- ADA vs Sinth-DMARDs IN ES
…and ADA, but not methotrexate or salazopyrine, significantly improves the quality of life globally considered in ES pts
Luchetti MM et al. ARD June 2015
PF PF SF SF BP BP RP RP MH MH VT VT GH GH RE RE
*** *** *** *** *** *** *** ***
SF-36 PtGA
T0 T12+ ADA
***
T0
T12+ADA well-being
***p<0.001
SPIB 2015 RESULTS- ARTICULAR VS. GASTROINTESTINAL ACTIVITY in ES
BASDAI
ASD
AS-
CR
P
ASD
AS-
CR
P
IBDQ
p<0.01* p<0.05*
*Spearman’s Correlation Stat-Test
In Axial-ES, but not in Peripheral-ES, articular inflammation is significantly correlated to gastrointestinal symptoms (and likely inflammation)
Luchetti MM et al. ARD June 2015
SPIB 2015 RESULTS- ADA vs Sinth-DMARDs IN ES
T0 ADA
naive T12
mg/
dl
** CRP
CDAI
T0 T12 + ADA
*
Active IBD *p<0.05; **p<0.01; ***p<0.001.
T0= ES pts at baseline evaluation and after 12-months (T12) of treatment with anti-TNF-alfa drugs
IBDQ
T0 T12+ ADA
***
Only ADA, but not methotrexate or salazopyrine, has been effective in reducing: systemic (CRP) and gastrointestinal inflammation
Luchetti MM et al. ARD June 2015
SPIB 2015 CONCLUSIONS - 2
1)The choice of the optimal therapeutic strategy in ES should consider drugs that are effective in inducing the disease remission of both SpA and IBD…
2)…thus reinforcing the importance of the integrated clinical evaluation of these pts.
3)ADA, but not synthetic DMARDs, is effective in reducing both the articular and the intestinal inflammation (88% of ES pts)…
4)…also in those refractory to DMARDs or IFX (n. 5 pts, 9,8%) 5)In Axial-ES (but not in Peripheral-ES) articular and
gastrointestinal inflammation seem to be correlated (implications in the pathogenesis of ES?)
Effect of adalimumab therapy on both gastrointestinal and articular inflammation at 12 months in patients affected by enteropathic spondyloarthritis: results from a monocentric prospective observational study
Luchetti MM et al. ARD June 2015
SPIB 2015 The SPIB Study Group
Dipartimento di Gastroenterologia Dott. Lorenzini I. Mosca P. Bolognini L. Fava G.
Clinica Medica Prof. Gabrielli A. Luchetti M.M. Balloni A. Benfaremo D. Capeci W. Rossini M.
Cedraro S. Ciferri M. Farinelli A. Gambacorta G.
Manfredi L. Pomponio G. Postacchini L. Tedesco S.
Lab. Med.Mol Avellini C. Spadoni T. Svegliati S.
Biomedico di Medicina Interna e Specialistica Prof. Triolo G. Ciccia F. Guggino G.
Luchetti MM, Clin Medica
email to: [email protected]
How could we increase the adherence to a study ?