*lr+ = sensitivity/(1 – specificity); lr- = (1 – sensitivity)/specificity

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Axial Spondyloarthritis (SpA): Representative Values of Sensitivity and Specificity for Several Tests with the Resulting LRs. *LR+ = sensitivity/(1 specificity); LR- = (1 sensitivity)/specificity. - PowerPoint PPT Presentation

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  • Axial Spondyloarthritis (SpA): Representative Values of Sensitivity and Specificity for Several Tests with the Resulting LRs*LR+ = sensitivity/(1 specificity); LR- = (1 sensitivity)/specificity.As enthesitis, dactylitis, uveitis, peripheral arthritis, psoriasis and IBD may not be present at disease onset but may develop later, it is recommended to ignore a negative test result of these tests in an early state of possible axial SpA. The LR- of parameters, which should be ignored, are shown in brackets.The figures for sensitivity and specificity of HLA-B27 refer to a European Caucasian population. In European Caucasian patients with psoriasis or IBD, a sensitivity of 50%, a specificity of 90%, an LR+ of 5.0 and an LR- of 0.56 for HLA-B27 should be applied. In other ethnic populations, sensitivity and specificity of HLA-B27 may be different, resulting in different LR+ and LR-.Adapted from Rudwaleit M, Feldtkeller E, Sieper J. Ann Rheum Dis 2006;65:1251-2.

    ParameterSensitivity (%)Specificity (%)LR+LR-Inflammatory back pain75763.10.33Heel pain (enthesitis)37893.4(0.71)Peripheral arthritis40904.0(0.67)Dactylitis18964.5(0.85)Iritis or anterior uveitis22977.3(0.80)Psoriasis10962.5(0.94)Inflammatory bowel disease (IBD)4994.0(0.97)Family history of axial SpA, psoriasis, reactive arthritis, IBD, or anterior uveitis32956.40.72Good response to NSAIDs77855.10.27Elevated C-reactive protein or erythrocyte sedimentation rate50802.50.63HLA-B2790909.00.11Sacroiliitis on MRI90909.00.11

  • Post-test Probability of Axial SpA on the Resulting LR Product for a Pretest Probability of 5%Adapted from Rudwaleit M, Feldtkeller E, Sieper J Ann Rheum Dis 2006;65:1251-2.

  • Coronal T1-weighted MR image shows subchondral fatty marrowchanges (arrows). There is irregularity of sacroiliac joint.Coronal fat-saturated contrast-enhanced T1-weighted image shows small foci of enhancement at inferior sacroiliac joint arrows).Adapted from Bredella et al. AJR 2006;187:1420-6.

  • Spondylitis anterior in T6/7 and T7/8 and spondylitis posterior in T8/9 as seen in the STIR MRI sequence. Inflammation is seen as a spot in the vertebra (arrows). Adapted from Baraliakos et al. Ann Rheum Dis 2005;64:730-4.

  • Assessment of Spinal Lesions at 12 Weeks and at Two Years After Placebo/infliximab or Open-label Infliximab TreatmentAdapted from Sieper et al. Rheumatology 2005;44:1525-30.

  • ASSERT Results: AS MRI Spinal Score for Activity Adapted from Braun et al. EULAR 2007, abstract OP0044.

    Placebo (n=78)Infliximab (n=201)Baselinen=77n=200Mean (standard deviation)6.21 (7.95)5.91 (6.58)Median (interquartile range)4.00 (0.00, 9.50)3.57 (0.25, 9.00)Change from baseline to week 24n=72n=195Mean (standard deviation)0.38 (3.97)-4.44 (6.16)Median (interquartile range)0.25 (-2.50, 2.75)-2.00 (-8.00, 0.00)Change from baseline to week 102n=60n=161Mean (standard deviation)-4.89 (6.85)-4.87 (6.42)Median (interquartile range)-1.00 (-8.75, 0.00)-2.00 (-8.50, 0.00)

  • Histological and Immunohistochemical Evaluation in Spondyloarthropathy in Infliximab Treated PatientsAdapted from Kruitoff et al. Ann Rheum Dis 2005;64:529-36.Semiquantitative histological and immunohistochemical scores are given as median (range). The immunohistochemical markers CD83 and CD1a (sublining layer) were scored as present (+) or absent (-). The P value was calculated for study population I using the paired Wilcoxon signed rank test for the semiquantitative scores and the McNemor test for the dichotomous scores. (NC = not calculable)

    Study population I (n=10 infliximab)BaselineWeek 12P valueLining layerSynovial lining layer thickness1.5 (1 to 2)1 (1 to 1.5)0.015V3 lining0 (0 to 3)1 (0 to 2.5)0.516VCAM-1 lining3 (1.5 to 3)1.5 (1 to 3)0.034ICAM-1 lining3 (1.5 to 3)2.5 (1.5 to 3)0.238E-selectin lining0 (0 to 1.5)0 (0 to 0.5)0.180CD163 lining2 (0 to 2.5)1.5 (0 to 3)0.864Blood vesselsVascularity1.75 (1 to 3)1.25 (1 to 2.5)0.339von Willebrand factor3 (0 to 3)1.5 (1 to 3)0.170CD1463 (1 to 3)1.5 (0 to 3)0.105V3 endothelial1 (0 to 2.5)0 (0 to 1.5)0.058VCAM-1 endothelial0 (0 to 1.5)0 (0 to 1.5)0.180ICAM-1 endothelial3 (0 to 3)2.5 (1 to 3)1.000E-selectin endothelial1.5 (0 to 3)1 (0 to 2.5)0.230Sublining layerVCAM-1 sublining1 (0 to 3)0 (0 to 2.5)0.173ICAM-1 sublining3 (0 to 3)1.25 (0.5 to 3)0.141E-selectin sublining2 (0.5 to 3)1 (0 to 2)0.034Degree of inflammatory cell infiltration1.75 (0.5 to 2.5)0.75 (0 to 2)0.018Number of neutrophils0.5 (0 to 3)0 (0 to 0)0.041Number of lymphoid aggregates1.75 (0 to 3)0.5 (0 to 3)0.073CD32 (0 to 3)0.5 (0 to 2)0.026CD41.5 (0 to 3)0.5 (0 to 2)0.076CD82 (0 to 2.5)1 (0 to 1)0.061CD191 (0 to 3)0 (0 to 1)0.059CD201.5 (0 to 3)1 (0 to 3)0.750Number of plasma cells0.5 (0 to 3)0 (0 to 3)0.258CD381.5 (0 to 3)1.5 (0 to 3)0.516CD1381 (0 to 3)1 (0 to 3)0.680CD682 (0 to 3)1 (0.5 to 2)0.034CD1631.25 (0 to 3)0.5 (0 to 2.5)0.469CD83 (+/-)4/90/9NCCD1a (+/-)6/92/90.125

  • Clinical Response of Spondylarthritis Patients Treated for 12 Weeks**Values are the median (range). P
  • IMPACT 2: Mean Changes in Modified Sharp/van der Heijde Erosion and Joint Space Narrowing (JSN) Scores to Week 54Adapted from Van der Heijde et al. Arthritis Rheum 2007;56(8):2698-707.

  • Course of Radiographic Deterioration: Infliximab vs. Conventional Treatment in the OASIS CohortAdapted from Baraliakos et al. Reumatology 2007;46:14503.

  • Adapted from Vastesaeger et al. SpA Congress 2006, Ghent, Belgium. ASPECT trial poster P21.

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