Ulrich Weber

University of Alberta, Edmonton, Alberta, Canada

Are you Ulrich Weber?

Claim your profile

Publications (49)268.63 Total impact

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):510.4-511. DOI:10.1136/annrheumdis-2015-eular.6079 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9-9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Annals of the rheumatic diseases 04/2015; 74(7). DOI:10.1136/annrheumdis-2014-206971 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9-9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners.
    Annals of the Rheumatic Diseases 04/2015; · 10.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort. Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses. A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively). Current smoking is associated with an impaired response to TNFi in axSpA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Annals of the Rheumatic Diseases 02/2015; DOI:10.1136/annrheumdis-2013-205133 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background A recent consensus statement based on a systematic literature review by the Assessment of SpondyloArthritis International Society suggested the presence of ≥3 corner inflammatory lesions (CIL) or of several corner fat lesions (CFL) as candidate definitions for a positive MRI of the spine in axial spondyloarthritis (SpA) [1]. Objectives To determine data-driven cut-off values for spinal CIL and CFL yielding a specificity ≥90% and to evaluate their diagnostic utility in non-radiographic axial SpA (nr-axSpA) and ankylosing spondylitis (AS). Methods The study sample comprised 2 independent cohorts A/B of 130 consecutive patients with back pain ≤50 years newly referred to 2 university clinics, and 20 healthy controls, in whom MRI scans of the entire spine were available. Patients were classified according to clinical examination and pelvic radiography as having nr-axSpA (n=50), AS (n=33), or non-specific back pain (NSBP; n=47). Spinal MRI were assessed by 4 blinded readers according to the standardized CanDen modules. Readers recorded bone marrow edema and fat infiltration in the central and lateral/posterior compartment of all 23 discovertebral units. We calculated cut-off values for CIL and CFL to obtain ≥90% specificity and the corresponding area under the curve (AUC) with confidence interval (CI). Finally, we tested the diagnostic utility (mean sensitivity/specificity of 4 readers) of cut-off values for spinal MRI as proposed in the literature (≥3 CIL [1] and ≥5 CFL [2]) for nr-axSpA and AS patients in both cohorts. Results For cohorts A/B, the rounded lesion cut-offs to obtain ≥90% specificity were 3/2 CIL and 7/10 CFL, respectively. The corresponding AUC for CIL were 0.69 (CI 0.49-0.84) and 0.69 (CI 0.47-0.85) in the 2 cohorts, and for CFL 0.60 (CI 0.43-0.75) and 0.71 (CI 0.56-0.82), respectively. The diagnostic utility of the spinal thresholds of ≥3 CIL and of ≥5 CFL was low in both cohorts when comparing nr-ax SpA versus NSBP. Diagnostic utility of 2 candidate definitions of a positive MRI of the spine in cohorts A/B Conclusions In this controlled study, the definitions of a positive spinal MRI proposed in a recent consensus statement showed low diagnostic utility in nr-axSpA. While a cut-off of ≥2/≥3 CIL for a positive MRI was optimal, the threshold for CFL was as high as 10. References Disclosure of Interest None Declared
    12/2014; 72(Suppl 3). DOI:10.1002/art.39001
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To evaluate the initiation of and response to tumor necrosis factor (TNF) inhibitors for axial spondyloarthritis (axSpA) in private rheumatology practices versus academic centers. Methods. We compared newly initiated TNF inhibition for axSpA in 363 patients enrolled in private practices with 100 patients recruited in 6 university hospitals within the Swiss Clinical Quality Management (SCQM) cohort. Results. All patients had been treated with >= 1 nonsteroidal antiinflammatory drug and > 70% of patients had a baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) >= 4 before anti-TNF agent initiation. The proportion of patients with nonradiographic axSpA (nr-axSpA) treated with TNF inhibitors was higher in hospitals versus private practices (30.4% vs 18.7%, p = 0.02). The burden of disease as assessed by patient-reported outcomes at baseline was slightly higher in the hospital setting. Mean levels (+/- SD) of the Ankylosing Spondylitis Disease Activity Score were, however, virtually identical in private practices and academic centers (3.4 +/- 1.0 vs 3.4 +/- 0.9, p = 0.68). An Assessment of SpondyloArthritis international Society (ASAS40) response at 1 year was reached for ankylosing spondylitis in 51.7% in private practices and 52.9% in university hospitals (p = 1.0) and for nr-axSpA in 27.5% versus 25.0%, respectively (p = 1.0). Conclusion. With the exception of a lower proportion of patients with nr-axSpA newly treated with anti-TNF agents in private practices in comparison to academic centers, adherence to ASAS treatment recommendations for TNF inhibition was equally high, and similar response rates to TNF blockers were achieved in both clinical settings.
    The Journal of Rheumatology 11/2014; 42(1). DOI:10.3899/jrheum.140229 · 3.17 Impact Factor
  • Annals of the Rheumatic Diseases 08/2014; 73(10). DOI:10.1136/annrheumdis-2014-205613 · 10.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine candidate lesion-based criteria for a positive sacroiliac joint (SIJ) MRI based on bone marrow oedema (BMO) and/or erosion in non-radiographic axial spondyloarthritis (nr-axSpA); to compare the performance of lesion-based criteria with global evaluation by expert readers.
    Annals of the Rheumatic Diseases 06/2014; DOI:10.1136/annrheumdis-2014-205408 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background We have hypothesized that resolution of inflammatory lesions in erosions of sacroiliac joints in patients with SpA is followed by development of a new tissue, which on T1W MRI has high signal intensity resembling the fat metaplasia in bone marrow seen in SpA. We have called this type of fat lesion “Backfill' due to its appearance in the excavated area caused by erosion. Objectives 1. To demonstrate that Backfill can be reliably detected on T1W MRI. 2. To demonstrate that resolution of inflammation and reduction of erosion are both independently associated with development of Backfill using longitudinal data. Methods We adopted standardized definitions for structural lesions: Backfill is defined as complete loss of iliac or sacral cortical bone at its anticipated location and increased signal on T1WSE that is demarcated from adjacent normal marrow by irregular dark signal reflecting sclerosis. Backfill, erosion, and fat metaplasia were scored dichotomously (present/absent) on 5 consecutive coronal slices anteriorly through the cartilaginous portion of the joint. Four readers assessed baseline and 2 year scans from 20 patients (exercise 1) and then 45 patients after calibration (exercise 2). Inter-observer reliability was assessed by intra-class correlation coefficient (ICC3,1). Two readers independently scored 147 pairs of scans (baseline, 2 years) from a prospective cohort of patients with SpA on either NSAID (n=69) or anti-TNF (n=78) therapies. SIJ inflammation was scored using the SPARCC MRI SIJ method. Correlations between MRI features were assessed by Pearson chi-square. Predictors of new Backfill were analyzed by univariate and multivariate regression adjusted for patient demographics, treatment, baseline and 2-year change in inflammation and damage scores. Results ICC for detection of Backfill in exercises 1 and 2 were 0.86/0.66 for status scores and 0.55/0.56 for 2-year change scores. Development of new Backfill correlated significantly with reduction in SPARCC SIJ score for inflammation (r=-0.50, p<0.0001) reduction of SSS erosion score (r=-0.47, p<0.0001), and development of new fat metaplasia (r=0.29, p=0.003), and was observed for both categories of treatment. In univariate analysis the following variables were associated with new Backfill: SPARCC SIJ inflammation baseline (β=0.08, p=0.01) and change (β=-0.15, p=0.0002) scores, erosion score at baseline (β=0.21, p=0.0001) and change in erosion (β=-0.39, p<0.0001), Backfill score at baseline (β-0.24, p<0.0001), change in fat metaplasia (β=0.28, p=0.009). Multivariate regression revealed the following as independent predictors of new Backfill: change in SPARCC SIJ inflammation (β=-0.10, p=0.003), 2-year change in SSS erosion (β=-0.39, p<0.0001), baseline backfill SSS score (β=-0.32, p<0.0001). Conclusions Backfill is an MRI feature of SpA that can be reliably detected and its development is associated with the resolution of inflammation and reduction of erosion. Reparative tissue at the site of erosion has high signal intensity on T1WSE resembling fat metaplasia in the bone marrow. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3828
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):437-438. DOI:10.1136/annrheumdis-2014-eular.3828 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To develop evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis. Methods The task force comprised an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries. Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography (CR), ultrasound (US), magnetic resonance imaging (MRI), computed-, positron emission- and single photon emission computed tomography, dual-emission x-ray absorptiometry (DXA) and scintigraphy. Experts used research evidence obtained from a systematic literature review using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendation (SOR) was assessed by the group members using a visual analogue scale. Quality assessment of the included studies was performed using the QUADAS-2 tool. Results A total of 7550 references were identified in the search process, from which 157 studies were included in the systematic review. Ten recommendations were produced encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis (OP). The SOR for each proposition varied, but was generally very high (mean 8.9-9.5). Selected aspects of the recommendations are given below (NOT all recommendations and NOT the exact wording, due to space constraints): CR of the sacroiliac joint (SIJ) is recommended as the first imaging method to diagnose sacroiliitis as part of axial SpA, while MRI is an alternative first imaging method in certain cases. US or MRI may be used to detect peripheral arthritis, tenosynovitis, bursitis and particularly peripheral enthesitis, which may support the diagnosis of SpA. MRI of the SIJ and/or spine may be used to assess and monitor disease activity, while CR of the SIJ and/or spine may be used for long-term monitoring of structural damage, particularly new bone formation in axial SpA. In patients with AS (not nonradiographic axial SpA), initial CRs of the lumbar and cervical spine are recommended to detect syndesmophytes, which are predictive of development of new syndesmophytes. MRI (vertebral corner inflammatory lesion) may also be used to predict development of new radiographic syndesmophytes. When spinal fracture in axial SpA is suspected, CR is the recommended initial imaging method. In axial SpA without radiographic syndesmophytes in the lumbar spine, OP should be assessed by hip and AP-spine DXA. Conclusions Ten recommendations for the role of imaging in the clinical management of SpA were developed using research-based evidence and expert opinion. Disclosure of Interest P. Mandl: None declared, V. Navarro-Compán: None declared, L. Terslev: None declared, P. Aegerter: None declared, D. van der Heijde: None declared, M.-A. d'Agostino: None declared, X. Baraliakos: None declared, S. Juhl Pedersen: None declared, A. G. Jurik: None declared, E. Naredo Grant/research support: MSD, Spanish Foundation of Rheumatology, Speakers bureau: Abbvie, Roche Pharma, BMS, Pfizer, UCB, GE, ESAOTE, C. Schueller-Weidekamm: None declared, U. Weber Consultant for: AbbVie, M. Wick: None declared, E. Filippucci: None declared, P. Conaghan: None declared, M. Rudwaleit Consultant for: Roche, MSD, Pfizer, Novartis, UCB, Speakers bureau: AbbVIe, BMS, Chugai, G. Schett: None declared, J. Sieper: None declared, S. Tarp: None declared, H. Marzo-Ortega Speakers bureau: AbbVie, MSD, Janssen, Pfizer, UCB, M. Østergaard: None declared DOI 10.1136/annrheumdis-2014-eular.2204
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):427-428. DOI:10.1136/annrheumdis-2014-eular.2204 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Inflammation on magnetic resonance imaging (MRI) of the sacroiliac joints (SIJ) in patients with spondyloarthritis (SpA) is a major criterion in the Assessment of SpondyloArthritis (ASAS) classification criteria for axial SpA, which are based on expert clinical opinion as gold standard. The definition of a positive SIJ MRI in the ASAS criteria was generated by consensus among experts. Studies using a data-driven approach to defining a positive SIJ MRI are scarce. Objectives To generate candidate definitions for a positive MRI based on confidence in the diagnosis of SpA by expert MRI readers. Methods The study population comprised 220 consecutive patients with back pain ≤50 years newly referred to 2 university clinics, and 79 healthy controls. Patients were classified according to clinical examination and pelvic radiography as having non-radiographic axial SpA (nr-axSpA) (n=74), ankylosing spondylitis (n=60), or mechanical back pain (n=86). SIJ MRI were assessed independently in random order by 4 blinded expert readers according to a standardized module that records SpA features (bone marrow edema (BME), erosion (ER), fat infiltration (FI)) on MRI. Readers recorded their level of confidence in the diagnosis of SpA by global evaluation of the MRI scan on a 0-10 scale (0 = definitely not SpA; 10 = definite SpA). Assignment of a definitive diagnosis of SpA was pre-specified as the majority (at least 3 of 4) of readers recording definite SpA with a confidence level of 8-10. Absence of SpA required all 4 expert readers to record non-SpA (≤4 on 0-10 scale). We estimated the type and extent of involvement according to number of affected SIJ quadrants attaining specificity of 90% and 95% for SpA and corresponding sensitivity. The corresponding area under the curve (AUC) was computed by receiver operating curves using the number of affected SIJ quadrants. Results 86 subjects met the MRI criterion of definite SpA (≥3 readers scoring ≥8 on 0-10 scale of confidence), and 151 subjects had no SpA (score of ≤4 by all 4 readers). Conclusions ER in 1 SIJ quadrant or BME in 3 SIJ quadrants yielded a specificity of over 90% for a positive SIJ MRI and the combination increased sensitivity, compared to ASAS definition, without reducing specificity. This combination represents the best candidate definition for a positive SIJ MRI in SpA for incorporation into future classification criteria. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):112-113. DOI:10.1136/annrheumdis-2012-eular.1854 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Defining a positive MRI in early axial spondyloarthritis (SpA) requires a gold standard criterion for the diagnosis of SpA and is typically based on clinical findings because structural changes on pelvic radiographs may take more than 10 years to become apparent. However, clinician expert opinion as gold standard has inherent limitations leading to false positive or negative assignments and requires lengthy follow up to ascertain development of radiographic sacroiliitis. Level of confidence in the diagnosis of SpA according to expert global assessment of sacroiliac joint (SIJ) MRI may constitute a candidate gold standard criterion for defining a positive MRI in non-radiographic axial SpA (nr-axSpA). Objectives (1) To assess the inter-reader reliability of the level of confidence in the diagnosis of SpA according to expert global assessment of SIJ MRI; (2) To compare this MRI-based criterion with clinician expert opinion. Methods The study population comprised 220 consecutive patients with back pain ≤50 years old newly referred to 2 university clinics, and 79 healthy controls. Patients were classified by clinical examination and pelvic radiography as having nr-axSpA (n=74), ankylosing spondylitis (n=60), or mechanical back pain (n=86). SIJ MRI were assessed in random order by 4 blinded expert readers according to a standardized module. Readers recorded their level of confidence in the diagnosis of SpA by global evaluation of the MRI scan on a 0-10 scale (0 = definitely not SpA; 10 = definite SpA). Assignment of a definitive diagnosis of SpA was pre-specified as the majority (at least 3 of 4) of readers recording definite SpA with a confidence level of 8-10. Absence of SpA required all 4 expert readers to record non-SpA (≤4 on 0-10 scale). We calculated the inter-reader agreement for a diagnosis of SpA or non-SpA according to these confidence level cut-offs on global SIJ MRI assessments, and we compared this MRI-based criterion with clinician diagnosis, both by percentage agreement and kappa statistics. Results The mean percentage agreement among 6 reader pairs for a diagnosis of SpA/non-SpA according to global SIJ MRI was 92.0% and the mean kappa 0.83. Kappa for agreement regarding level of confidence in the diagnosis of SpA by all 4 readers was excellent (0.83; CI 0.78-0.88). Conclusions Level of confidence in the diagnosis of SpA according to expert global assessment of SIJ MRI by expert readers may constitute a candidate gold standard criterion for defining a positive MRI in nr-axSpA. This alternative to clinician expert classification deserves further validation in other inception cohorts of early SpA patients. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):414-414. DOI:10.1136/annrheumdis-2012-eular.2753 · 10.38 Impact Factor
  • Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A125-A126. DOI:10.1136/annrheumdis-2013-eular.422 · 10.38 Impact Factor
  • W. Maksymowych · U. Weber · M. Pianta · R. Lambert
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Current MRI scoring methods for assessment of acute lesions such as bone marrow edema (BME) in the knee of patients with osteoarthritis rely on a complex subdivision of the knee into 15 subregions and then a further estimation of the proportion of subregion with BME1. This limits feasibility for widespread adoption. Scoring of synovitis-effusion (S-E) is based on a restricted grading scheme assessing the whole joint (0= none, 3 = large) which limits responsiveness, especially for interventions that might target inflammation. Objectives To develop and conduct preliminary validation of an MRI method (KIMRISS) for direct semi-quantitative assessment of acute lesions, BME and S-E, that focuses on detection of change. Methods Assessment of BME is based on assessment of coronal and sagittal images for medial/lateral knee compartments and axial/sagittal images for patella-femoral compartment using a fluid-sensitive MRI sequence (STIR, T2 FatSat). Size of a BME lesion is defined according to the largest continuous increase in signal assessed in all dimensions and number of slices in which the increased signal can be detected (small = <1cm in all dimensions on ≤2 slices; moderate = >1cm but NOT >2 cm in ≥2 dimensions; large = >2cm in ≥2 dimensions). A weighting is applied to change in BME size (1.5x and 2x for moderate and large lesions, respectively). Size of S-E is assessed in each of 4 compartments (medial and lateral patellar recess, suprapatellar, semimembranosus bursa) according to a 0-4 grading scheme and a weighting is applied for change in S-E size (1.5x and 2x for grade 3 and 4 lesions, respectively). MRI scans were performed on the knee joints of 15 patients enrolled into an open label trial of an anti-TNF agent in subjects with persistent pain due to knee osteoarthritis and clinical evidence of effusion who had failed conventional therapy. Scans were performed at baseline and 12 weeks and independently reviewed by 3 readers blinded to timepoint. Reliability of change scores was assessed by intraclass correlation coefficient (ICC) and responsiveness by standardized response mean (SRM). We assessed correlations with WOMAC pain, patient global, and target joint clinical effusion score. Results Reliability of detection of change in KIMRISS BME (ICC for 3 reader pairs =0.71. 0.73. 0.75), KIMRISS S-E (ICC for 3 reader pairs =0.78, 0.82, 0.86), and Total KIMRISS (ICC for 3 reader pairs =0.77, 0.81, 0.89) was very good with substantial responsiveness after 12 weeks of treatment (Table). Improvement in Total KIMRISS score was observed in 12 patients although change in either the Total KIMRISS score or KIMRISS BME did not significantly correlate with change in WOMAC pain or patient global. KIMRISS S-E did not correlate with target joint effusion score. Conclusions The KIMRISS methodology for MRI-based semi-quantitative assessment of acute lesions in knee joints is responsive and is capable of reliably detecting change. It merits further validation in inflammatory knee joint disorders. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):585-585. DOI:10.1136/annrheumdis-2012-eular.3281 · 10.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the incremental diagnostic value of spine MRI evaluated separately from and combined with sacroiliac joint (SIJ) MRI in non-radiographic axial spondyloarthritis (nr-axSpA) compared with SIJ MRI alone. The study sample comprised two independent cohorts A/B of 130 consecutive patients aged ≤50 years with back pain, newly referred to two university clinics, and 20 healthy controls. Patients were classified according to clinical examination and pelvic radiographs as having nr-axSpA (n=50), ankylosing spondylitis (n=33), or non-specific back pain (n=47). Four readers assessed SIJ and spine MRI separately 6 months apart, and 1-12 months later both scans simultaneously using standardised modules. Readers recorded presence/absence of SpA and their level of confidence in this conclusion on a 0-10 scale (0=definitely not; 10=definite). We analysed differences between SIJ MRI versus spine MRI alone, and SIJ MRI alone versus combined MRI, descriptively by the number/percentage of subjects according to the mean of four readers. In cohorts A/B, 15.8%/24.2% of patients with nr-axSpA having a negative SIJ MRI were reclassified as being positive for SpA by global evaluation of combined scans. However, 26.8%/11.4% of non-specific back pain controls and 17.5% of healthy volunteers with a negative SIJ MRI were falsely reclassified as having SpA by combined MRI. Low confidence in a diagnosis of SpA by SIJ MRI increased to high confidence by combined MRI in 6.6%/7.3% of patients with nr-axSpA. Combined spine and SIJ MRI added little incremental value compared with SIJ MRI alone for diagnosing patients with nr-axSpA and enhancing confidence in this diagnosis.
    Annals of the rheumatic diseases 01/2014; 74(6). DOI:10.1136/annrheumdis-2013-203887 · 10.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies have shown that fat lesions follow resolution of inflammation in the spine of patients with axial spondyloarthritis (SpA). Fat lesions at vertebral corners have also been shown to predict development of new syndesmophytes. Therefore, scoring of fat lesions in the spine may constitute both an important measure of treatment efficacy as well as a surrogate marker for new bone formation. The aim of this study was to develop and validate a new scoring method for fat lesions in the spine, the Fat SpA Spine Score (FASSS), which in contrast to the existing scoring method addresses the localization and phenotypic diversity of fat lesions in patients with axial SpA. Fat lesions at pre-specified anatomical locations at each vertebral endplate (C2 lower-S1 upper) were assessed dichotomously (present/absent) on spine MRIs. Two readers independently evaluated MRIs obtained at two time points for 58 patients (Exercise 1), followed by optimization of scoring methodology and reader calibration. Thereafter, the same readers read 135 pairs of MRI scans (Exercise 2; including the 58 pairs from exercise 1 randomly mixed with 77 new pairs). In Exercise 2, the mean (SD) baseline FASSS score for the two readers was 22.5(29.6) and 21.1(28.0), respectively, and the FASSS change score was 4.2(10.6) and 6.0(12.2). Inter-reader reliability assessed as intra-class correlation coefficients (ICCs) for status and change scores were excellent (0.96 (95%CI (0.94 to 0.97)) and very good (0.86 (0.80 to 0.90)), respectively. The smallest detectable change (SDC) was 3.7 for the 135 patients. Good reliability of change scores was also observed for MRI scans conducted one year apart (ICC 0.74 (CI95% 0.44 to 0.89) and SDC 4.5). For the 58 MRI-pairs assessed in both exercises, inter-reader reproducibility for the total FASSS status score improved from very good (ICCs: 0.89 (95%CI: 0.81 to 0.93) in exercise 1 to excellent in exercise 2 (0.96 (0.93 to 0.98)), and improved substantially for the total change score (from 0.67 (0.51 to 0.80) to 0.83 (0.73 to 0.90). FASSS meets essential validation criteria for quantification of a common structural abnormality in clinical trials of axial spondyloarthritis.
    Arthritis research & therapy 12/2013; 15(6):R216. DOI:10.1186/ar4411 · 3.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE Our aim was to assess the prevalence of axial skeleton changes by whole-body MRI (wbMRI) in skin psoriasis patients without clinical evidence of arthritis and in age- and sex-matched healthy controls. METHOD AND MATERIALS Twenty-five patients (meadian age 52; range 20-69) with plaque psoriasis and no history or clinical evidence of arthritis and twenty-five age- and sex-matched healthy controls with no history of inflammatory back pain or skin psoriasis were recruited by the Nordic questionnaire. All patients and controls were clinically examined by the same dermatologist and rheumatologist according to a standardized protocol. All subjects underwent standardized unenhanced 1.5 T wbMRI (coronal and sagittal T1w and STIR). Image sets including both the sacroiliac joints (SIJ) and the entire spine were read in a random order and independently by a radiologist and a rheumatologist blinded to the clinical and demographic parameters. The readers recorded the presence of spondyloarthritis (SpA) by a global assessment of the SIJ and spine images on a confidence scale of 0-10 (0=definitely no SpA, 10=definite SpA). Bone marrow edema (BME), fatty marrow infiltration (FMI) and erosive changes in each SIJ quadrant were recorded by the Morpho module. Spinal BME and FMI of all discovertebral units from C2/3 to L5/S1 were assessed according to the CanDen module. The lesion prevalence was expressed as mean percentage of subjects with ≥2 affected SIJ-quadrants or ≥2 spinal lesions in each group according to the two readers. Fisher’s exact test was used to test for a significant difference in prevalence between the 2 groups (p≤0.05). RESULTS 24% of healthy controls and 30% of skin psoriasis patients were classified as axial SpA by global wbMRI assessment. A high classification confidence (8-10) was recorded in 12% of controls and 18% of patients. The differences between the 2 groups were not statistically significant, both for the global and the lesion-based assessement in the spine and the SIJ. CONCLUSION On wbMRI every fourth healthy control was falsely classified as axial SpA. Skin psoriasis patients without clinical evidence of axial or peripheral arthritis showed a similar frequency of SIJ and spinal changes as healthy controls. CLINICAL RELEVANCE/APPLICATION Subclinical axial inflammation in skin psoriasis patients might be overestimated on wbMRI since matched healthy subjects showed a similar frequency of MRI-findings.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To evaluate the baseline characteristics of patients with radiographic axial spondyloarthritis (SpA; ankylosing spondylitis [AS]) and patients with nonradiographic axial SpA, to investigate determinants of anti-tumor necrosis factor (anti-TNF) agent prescription on the background of a nonrestrictive reimbursement policy, and to assess the response to TNF inhibition. Methods We compared the characteristics of radiographic axial SpA and nonradiographic axial SpA in 1,070 patients from the Swiss Clinical Quality Management (SCQM) Cohort who fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial SpA. By taking advantage of the situation that patients who are eligible for anti-TNF treatment are preferentially enrolled in the SCQM Cohort for patients with AS/axial SpA, we explored parameters leading to the initiation of anti-TNF treatment in single and multiple regression models and assessed treatment responses. ResultsWe confirmed a similar burden of disease (as determined by self-reported disease activity, impaired function, and quality of life) in patients with nonradiographic axial SpA (n = 232) and those with radiographic axial SpA (n = 838). Patients with radiographic axial SpA had higher median levels of acute-phase reactants and higher median AS Disease Activity Scores (ASDAS; 3.2 versus 3.0). Anti-TNF treatment was initiated in 363 patients with radiographic axial SpA and 102 patients with nonradiographic axial SpA, preferentially in those with sacroiliitis on magnetic resonance imaging, peripheral arthritis, a higher C-reactive protein (CRP) level, a higher ASDAS, and a higher Bath Ankylosing Spondylitis Disease Activity Index level. The ASAS criteria for 40% improvement responses at 1 year were higher in patients with radiographic axial SpA compared with those with nonradiographic axial SpA (48.1% versus 29.6%; odds ratio [OR] 2.2, 95% confidence interval [95% CI] 1.12-4.46, P = 0.02). The difference was smaller in the subgroups of patients with elevated baseline CRP levels (51.6% in patients with radiographic axial SpA versus 38.5% in those with nonradiographic axial SpA; OR 1.7, 95% CI 0.68-4.48, P = 0.29). Conclusion The indications for treatment with anti-TNF agents were comparable for patients with radiographic axial SpA and those with nonradiographic axial SpA. With the exception of patients with elevated CRP levels at baseline, higher rates of response to TNF inhibition were achieved in the group of patients with radiographic axial SpA than in the group with nonradiographic axial SpA.
    Arthritis & Rheumatology 12/2013; 65(12). DOI:10.1002/art.38140 · 7.87 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To explore whether morphological features of fat infiltration (FI) on sacroiliac joint (SIJ) magnetic resonance imaging (MRI) contribute to diagnostic utility in 2 inception cohorts of patients with nonradiographic axial spondyloarthritis (nr-axSpA). Four blinded readers assessed SIJ MRI in 2 cohorts (A/B) of 157 consecutive patients with back pain who were ≤ 50 years old, and in 20 healthy controls. Patients were classified according to clinical examination and pelvic radiography as having nr-axSpA (n = 51), ankylosing spondylitis (n = 34), or nonspecific back pain (n = 72). Readers recorded FI, bone marrow edema (BME), and erosion, predefined morphological features of FI (distinct border, homogeneity, subchondral location), and anatomical distribution of SIJ FI. The proportion of SIJ quadrants affected by FI and frequencies of various SIJ FI features were analyzed descriptively. We calculated positive/negative likelihood ratios (LR) to estimate the diagnostic utility of various features of FI, with and without associated BME, and erosion. Of the patients with nr-axSpA in cohorts A/B, 45.0%/48.4% had FI in ≥ 2 SIJ quadrants. Of those, 25.0%/22.6% and 20.0%/25.8% showed FI with distinct border or homogeneous pattern, respectively, and 50% to 100% of those patients displayed concomitant BME or erosion. FI per se in ≥ 2 SIJ quadrants had no diagnostic utility (LR+ 1.62/1.91). FI with distinct border (LR+ 8.29/2.13) or homogeneity (LR+ 6.24/3.78) demonstrated small to moderate diagnostic utility. SIJ FI per se was not of clinical utility in recognition of nr-axSpA. Distinct border or homogeneity of FI on SIJ MRI showed small to moderate diagnostic utility in nr-axSpA, but were strongly associated with concomitant BME or erosion, highlighting the contextual interpretation of SIJ MRI.
    The Journal of Rheumatology 12/2013; 41(1). DOI:10.3899/jrheum.130568 · 3.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As a wider variety of therapeutic options for osteoarthritis (OA) becomes available, there is an increasing need to objectively evaluate disease severity on magnetic resonance imaging (MRI). This is more technically challenging at the hip than at the knee, and as a result, few systematic scoring systems exist. The OMERACT (Outcome Measures in Rheumatology) filter of truth, discrimination, and feasibility can be used to validate image-based scoring systems. Our objective was (1) to review the imaging features relevant to the assessment of severity and progression of hip OA; and (2) to review currently used methods to grade these features in existing hip OA scoring systems. A systematic literature review was conducted. MEDLINE keyword search was performed for features of arthropathy (such as hip + bone marrow edema or lesion, synovitis, cyst, effusion, cartilage, etc.) and scoring system (hip + OA + MRI + score or grade), with a secondary manual search for additional references in the retrieved publications. Findings relevant to the severity of hip OA include imaging markers associated with inflammation (bone marrow lesion, synovitis, effusion), structural damage (cartilage loss, osteophytes, subchondral cysts, labral tears), and predisposing geometric factors (hip dysplasia, femoral-acetabular impingement). Two approaches to the semiquantitative assessment of hip OA are represented by Hip OA MRI Scoring System (HOAMS), a comprehensive whole organ assessment of nearly all findings, and the Hip Inflammation MRI Scoring System (HIMRISS), which selectively scores only active lesions (bone marrow lesion, synovitis/effusion). Validation is presently confined to limited assessment of reliability. Two methods for semiquantitative assessment of hip OA on MRI have been described and validation according to the OMERACT Filter is limited to evaluation of reliability.
    The Journal of Rheumatology 11/2013; 41(2). DOI:10.3899/jrheum.131082 · 3.17 Impact Factor

Publication Stats

1k Citations
268.63 Total Impact Points

Institutions

  • 2011–2014
    • University of Alberta
      • • Division of Rheumatology
      • • Department of Medicine
      Edmonton, Alberta, Canada
  • 2009–2014
    • University of Zurich
      • • Department of Biostatistics
      • • Department of Pediatric Orthopaedics
      Zürich, Zurich, Switzerland