Contextual factors influence work outcomes in employed patients with ankylosing spondylitis starting etanercept: 2-year results from AS@Work.

Objectives: The aim was to determine changes over time in work outcomes and investigate the predictive value of baseline personal and work-related factors on the evolution of work outcomes among employed patients with AS initiating etanercept.

Methods: Employment status, absenteeism and presenteeism were assessed using the Work Productivity and Activity Impairment for AS questionnaire in a 24-month open-label, observational study (NCT01421303). The potential effect of baseline factors on work outcomes was analysed using predictive modelling (Cox regression and linear mixed models).

To be or not to be rheumatologist: survey among Belgian medical students and internal medicine trainees: what do certified rheumatologists think about the current rheumatology training program?

In several countries, there have been increasing concerns over the years that fewer medical students or trainees choose rheumatology as a specialty. The aim of this three-step survey is to study the motivational factors for students and trainees in internal medicine to choose for rheumatology as a future career option and the idea among experienced rheumatologists about the needs for changes in the training program. An online survey was distributed among students in medical training (in the final 3 years) and trainees in internal medicine from the Ghent University and University Hospital.

High Prevalence of Undiagnosed Axial Spondyloarthritis in Patients with Chronic Low Back Pain Consulting Non-Rheumatologist Specialists in Belgium: SUSPECT Study.

Introduction: Diagnosis of axial spondyloarthritis (SpA) can be delayed for several years mainly because of low awareness of axial SpA among non-rheumatologists who are the first interlocutors of potential SpA patients. One strategy to decrease the delay between appearance of first symptoms and diagnosis of axial SpA and to allow early management of the disease is to provide the non-rheumatologists with tools to identify patients requiring prompt referral to rheumatologists. This study was designed to evaluate in a real-world setting whether screening patients with chronic low back pain who consult physical medicine and rehabilitation (PMR) physicians, orthopedists, and ophthalmologists is useful in detecting axial SpA.

A Nationwide Survey on Patient's versus Physician´s Evaluation of Biological Therapy in Rheumatoid Arthritis in Relation to Disease Activity and Route of Administration: The Be-Raise Study.

Objectives: Biological treatment of rheumatoid arthritis (RA) is one of the cornerstones of current treatment strategies for the disease. Surprisingly little information exists on whether the route of administration affects patients' treatment satisfaction. It is equally unclear whether rheumatologists are able to accurately perceive their patients' appreciation.

Rapidly growing gastric metastasis of Merkel cell carcinoma, an unusual cause of melena.

Merkel cell carcinoma (MCC) is an uncommon, highly aggressive neuroendocrine skin carcinoma that has a tendency for local recurrence and metastatic disease. We report a rare case of recurrent melena in a 77-year-old Caucasian male. Three years earlier, the patient had undergone a radical resection of a para-umbilical MCC.

Understanding limitations in at-work productivity in patients with active ankylosing spondylitis: the role of work-related contextual factors.

Objective: To explore the effect of health-related and contextual factors on presenteeism, absenteeism, and overall work productivity loss in patients with active ankylosing spondylitis (AS).

Methods: Consecutive patients with AS starting their first tumor necrosis factor inhibitor and in paid employment were eligible. Patients completed the Work Productivity and Activity Impairment (WPAI) questionnaire for AS to assess presenteeism, absenteeism, and overall work productivity loss in the previous 7 days.

Sustained response to tocilizumab in a patient with relapsing polychondritis with aortic involvement: a case based review.

This paper presents a case with refractory relapsing polychondritis (RPC), complicated with severe aortic involvement, which is successfully treated with tocilizumab. Previous treatments consisted of methotrexate, corticosteroids, cyclosporine, cyclophosphamide, infliximab, and etanercept. With these treatments, the patient had recurrent episodes of fever, polyarthritis, tenosynovitis, subcutaneous nodules, and progressive cardiac disease.

Degree of bone marrow oedema in sacroiliac joints of patients with axial spondyloarthritis is linked to gut inflammation and male sex: results from the GIANT cohort.

Introduction: Bone marrow oedema (BMO) of the sacroiliac joints (SIJs) is a hallmark of axial spondyloarthritis (SpA). However, the relationship between the extent of BMO and disease phenotype is poorly understood.

Objective: To assess the link between BMO of the SIJs and gut inflammation.

Microscopic gut inflammation in axial spondyloarthritis: a multiparametric predictive model.

Objective: To assess the rates and explore predictors of microscopic gut inflammation in a cohort of patients with axial and peripheral spondyloarthritis (SpA).

Methods: Ileocolonoscopy was performed in 65 patients with axial and peripheral SpA from the Gent Inflammatory Arthritis and spoNdylitis cohorT. Histopathological analysis and scoring were performed by an experienced pathologist.

Comparison of two referral strategies for diagnosis of axial spondyloarthritis: the Recognising and Diagnosing Ankylosing Spondylitis Reliably (RADAR) study.

Objective: To determine which of two referral strategies, when used by referring physicians for patients with chronic back pain (CBP), is superior for diagnosing axial spondyloarthritis (SpA) by rheumatologists across several countries.

Methods: Primary care referral sites in 16 countries were randomised (1 : 1) to refer patients with CBP lasting >3 months and onset before age 45 years to a rheumatologist using either strategy 1 (any of inflammatory back pain (IBP), HLA-B27 or sacroiliitis on imaging) or strategy 2 (two of the following: IBP, HLA-B27, sacroiliitis, family history of axial SpA, good response to non-steroidal anti-inflammatory drugs, extra-articular manifestations). The rheumatologist established the diagnosis.

Quantitative assessment of foot structure in rheumatoid arthritis by a foot digitizer: detection of deformities even in the absence of erosions.

Objective: Foot involvement is a major feature in rheumatoid arthritis (RA), leading to structural deformities. Methods to allow a 3-dimensional (3-D) evaluation of foot structure in RA to be applicable in daily clinical practice have not been evaluated. This study assessed the use of a foot digitizer, a noninvasive 3-D scanner collecting objective quantitative data of the feet, to evaluate the presence of foot structure abnormalities in an RA outpatient cohort.

Are syndesmophytes most prevalent in the lumbar or in the cervical spine in patients with ankylosing spondylitis and do they develop in a specific direction?

Objectives: To describe the distribution of prevalent syndesmophytes and bridges, and the occurrence of new ones in a prevalence cohort of patients with AS.

Methods: Clinical and radiological data from 132 patients from the Outcome in Ankylosing Spondylitis International Study of which complete sets of radiographs were available at baseline and at 2- and 4-year follow-up were used.

Results: At baseline, 81 (61%) patients, of which 17 (45%) were females and 64 (65%) males (P = 0.

Development of new syndesmophytes and bridges in ankylosing spondylitis and their predictors: a longitudinal study.

Background: Structural damage of the spine in ankylosing spondylitis (AS) is associated with worse physical function and impaired spinal mobility. Knowledge about predictors of new syndesmophyte formation is limited.

Objectives: To assess the development of new syndesmophytes at the level of individual vertebral bodies and to assess predictors for this development.

Mucosal inflammation in spondylarthritides: past, present, and future.

Spondylarthritides (SpA) and inflammatory bowel disease (IBD) are idiopathic, chronic inflammatory disorders. Although they are very distinct and well-defined entities, there is clinical and genetic evidence supporting some degree of overlap between the pathogenesis of the two. Subclinical gut inflammation is present in up to two thirds of all SpA patients and can evolve into IBD.

Interactions between gut inflammation and arthritis/spondylitis.

Purpose Of Review: The spectrum of spondyloarthritis is characterized by the intriguing co-occurrence of gut and joint inflammation, although no obvious anatomical link exists.

Recent Findings: Data from animal models identify stromal cells as important players in pathogenesis, although signalling through TNFRI appeared to be sufficient for development of combined gut and joint inflammation. Interleukin-23 receptor was identified as a susceptibility locus for ankylosing spondylitis.

Clinical assessment in the spondyloarthropathies.

In order to measure disease activity, progression and response to therapy, it is important to use accurate, reliable and feasible outcome measures that can ideally be used in longitudinal cohorts, clinical trials and clinical practice. With emerging therapies, the focus on the methodology of outcome assessment has increased to ensure that discriminant and responsive instruments are used. This chapter reviews available measures of three major areas of disease impact in the spondyloarthropathies (disease activity, structural damage and functioning) and discusses the relevance for use in clinical practice.

Spinal radiographic changes in ankylosing spondylitis: association with clinical characteristics and functional outcome.

Objective: To determine which patients with ankylosing spondylitis (AS) have radiographic spinal damage and to investigate the relation between radiographic spinal changes and limitations in physical function.

Methods: A cross-sectional nationwide study in Belgium of patients with AS under the care of a rheumatologist. The treating physician completed a questionnaire including clinical disease manifestations and laboratory findings (HLA-B27 and C-reactive protein), and classified spinal radiographs into 3 categories: (1) no AS-related spinal abnormalities; (2) syndesmophytes; and (3) spinal ankylosis.

Systemic levels of IL-23 are strongly associated with disease activity in rheumatoid arthritis but not spondyloarthritis.

Objectives: Th17 cells are an effector T-cell population that plays a role in chronic inflammatory conditions and is dependent on IL-23 for their survival and expansion. More recently, a genetic association was discovered between polymorphisms in the gene coding for the IL-23 receptor and spondyloarthritis. This study aimed to evaluate the role of Th17-associated cytokines in spondyloarthritis pathogenesis by measuring their levels in the joints and circulation as well as correlating them with disease activity parameters.

Clinical observations programme in SpA: disease parameters, treatment options and practical management issues.

Spondyloarthritides (SpAs) are a cluster of chronic inflammatory rheumatic diseases that typically involve inflammation of axial and peripheral joint or tendon and ligament insertions, distinct radiographic changes and diverse extra-articular features. Conventional treatments relieve the signs and symptoms but do not prevent disease progression. TNFalpha inhibitors provide clinicians with the potential to treat the underlying pathology and to alter disease progression.

Spondyloarthropathies: progress and challenges.

The spondyloarthropathies are a group of human rheumatic disorders that are often associated with extra-articular features. Although a substantial number of studies is undertaken each year, many issues concerning the pathogenesis remain unanswered. There are several unresolved questions with regard to pathogenesis and treatment in spondyloarthropathies.

Clinical and genetic factors associated with sacroiliitis in Crohn's disease.

Background And Aim: Radiographic sacroiliitis (SI), often asymptomatic, is considered the most frequent extra-intestinal manifestation (EIM) of Crohn's disease (CD). Data on the association of SI with other clinical features of CD are limited. Association of SI with CARD15 polymorphisms has recently been suggested.

The intimate relationship between gut and joint in spondyloarthropathies.

Purpose Of Review: The aim of this article is to highlight recent progress in the combined joint and gut disease in spondyloarthropathies.

Recent Findings: A set of genes has been identified that are differentially expressed in the colon of spondyloarthropathy and Crohn's disease patients. Reduction of human leukocyte antigen B27 (HLA B27) misfolding by additional beta2-microglobulin in HLA B27 transgenic rats unexpectedly increased disease severity, with more similarities to spondyloarthropathies.

Serum matrix metalloproteinase 3 is an independent predictor of structural damage progression in patients with ankylosing spondylitis.

Objective: In prospective studies, only baseline radiographic damage has been identified as an independent predictor of radiographic progression in ankylosing spondylitis (AS). Several biomarkers have been identified as independent predictors of radiographic progression in rheumatoid arthritis, however, and these may be of use in AS. This study was undertaken to analyze serologic biomarkers as predictors of radiographic progression in AS.

The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice.

Objectives: This study aimed to describe the epidemiology of ankylosing spondylitis (AS) in rheumatology practice at the beginning of the anti-TNF (tumour necrosis factor) era, and to evaluate the initiation of anti-TNF therapy in a clinical setting where prescription is regulated by the authority's imposed reimbursement criteria.

Methods: Between February 2004 and February 2005, all Belgian rheumatologists in academic and non-academic outpatient settings were invited to register all AS patients who visited their practice. A random sample of these patients was further examined by an in-depth clinical profile.