*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. †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. Parameter Sensitivity (%) Specificity (%) LR+ LR- Inflammatory back pain 75 76 3.1 0.33 Heel pain (enthesitis) 37 89 3.4 (0.71 )† Peripheral arthritis 40 90 4.0 (0.67 )† Dactylitis 18 96 4.5 (0.85 )† Iritis or anterior uveitis 22 97 7.3 (0.80 )† Psoriasis 10 96 2.5 (0.94 )† Inflammatory bowel disease (IBD) 4 99 4.0 (0.97 )† Family history of axial SpA, psoriasis, reactive arthritis, IBD, or anterior uveitis 32 95 6.4 0.72 Good response to NSAIDs 77 85 5.1 0.27 Elevated C-reactive protein or erythrocyte sedimentation rate 50 80 2.5 0.63 HLA-B27‡ 90 90 9.0 0.11 Sacroiliitis on MRI 90 90 9.0 0.11

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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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Page 1: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

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.

Parameter Sensitivity (%) Specificity (%) LR+ LR-

Inflammatory back pain 75 76 3.1 0.33

Heel pain (enthesitis) 37 89 3.4 (0.71)†

Peripheral arthritis 40 90 4.0 (0.67)†

Dactylitis 18 96 4.5 (0.85)†

Iritis or anterior uveitis 22 97 7.3 (0.80)†

Psoriasis 10 96 2.5 (0.94)†

Inflammatory bowel disease (IBD) 4 99 4.0 (0.97)†

Family history of axial SpA, psoriasis, reactive arthritis, IBD, or anterior uveitis

32 95 6.4 0.72

Good response to NSAIDs 77 85 5.1 0.27

Elevated C-reactive protein or erythrocyte sedimentation rate

50 80 2.5 0.63

HLA-B27‡ 90 90 9.0 0.11

Sacroiliitis on MRI 90 90 9.0 0.11

Page 2: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

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.

Page 3: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

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.

Page 4: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

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.

Page 5: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

Assessment of Spinal Lesions at 12 Weeks and at Two Years After Placebo/infliximab or Open-label Infliximab Treatment

Adapted from Sieper et al. Rheumatology 2005;44:1525-30.

Page 6: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

  Placebo (n=78) Infliximab (n=201)

Baseline

  n=77 n=200

Mean (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 24

  n=72 n=195

Mean (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 102

  n=60 n=161

Mean (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)

ASSERT Results: AS MRI Spinal Score for Activity

Adapted from Braun et al. EULAR 2007, abstract OP0044.

Page 7: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

Histological and Immunohistochemical Evaluation in Spondyloarthropathy in Infliximab Treated Patients

Study population I (n=10 infliximab)Baseline Week 12 P value

Lining layerSynovial lining layer thickness 1.5 (1 to 2) 1 (1 to 1.5) 0.015V3 lining 0 (0 to 3) 1 (0 to 2.5) 0.516VCAM-1 lining 3 (1.5 to 3) 1.5 (1 to 3) 0.034ICAM-1 lining 3 (1.5 to 3) 2.5 (1.5 to 3) 0.238E-selectin lining 0 (0 to 1.5) 0 (0 to 0.5) 0.180CD163 lining 2 (0 to 2.5) 1.5 (0 to 3) 0.864Blood vesselsVascularity 1.75 (1 to 3) 1.25 (1 to 2.5) 0.339von Willebrand factor 3 (0 to 3) 1.5 (1 to 3) 0.170CD146 3 (1 to 3) 1.5 (0 to 3) 0.105V3 endothelial 1 (0 to 2.5) 0 (0 to 1.5) 0.058VCAM-1 endothelial 0 (0 to 1.5) 0 (0 to 1.5) 0.180ICAM-1 endothelial 3 (0 to 3) 2.5 (1 to 3) 1.000E-selectin endothelial 1.5 (0 to 3) 1 (0 to 2.5) 0.230Sublining layerVCAM-1 sublining 1 (0 to 3) 0 (0 to 2.5) 0.173ICAM-1 sublining 3 (0 to 3) 1.25 (0.5 to 3) 0.141E-selectin sublining 2 (0.5 to 3) 1 (0 to 2) 0.034Degree of inflammatory cell infiltration 1.75 (0.5 to 2.5) 0.75 (0 to 2) 0.018Number of neutrophils 0.5 (0 to 3) 0 (0 to 0) 0.041Number of lymphoid aggregates 1.75 (0 to 3) 0.5 (0 to 3) 0.073CD3 2 (0 to 3) 0.5 (0 to 2) 0.026CD4 1.5 (0 to 3) 0.5 (0 to 2) 0.076CD8 2 (0 to 2.5) 1 (0 to 1) 0.061CD19 1 (0 to 3) 0 (0 to 1) 0.059CD20 1.5 (0 to 3) 1 (0 to 3) 0.750Number of plasma cells 0.5 (0 to 3) 0 (0 to 3) 0.258CD38 1.5 (0 to 3) 1.5 (0 to 3) 0.516CD138 1 (0 to 3) 1 (0 to 3) 0.680CD68 2 (0 to 3) 1 (0.5 to 2) 0.034CD163 1.25 (0 to 3) 0.5 (0 to 2.5) 0.469CD83 (+/-) 4/9 0/9 NCCD1a (+/-) 6/9 2/9 0.125

Adapted 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)

Page 8: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

Clinical Response of Spondylarthritis Patients Treated for 12 Weeks*

*Values are the median (range). † P<0.05 vs. week 0.

Adapted from Kruitoff et al. Arthritis Rheum 2006;54:1795-804.

Infliximab (n=20) Etanercept (n=20) Control (n=12)

Week 0 Week 12 Week 0 Week 12 Week 0 Week 12

Patient globalassessment, 100-mm VAS 69 (17-100) 15 (0-73)† 73 (18-100) 14 (0-69)† 79 (24-90) 67 (47-98)Physician global assessment, 100-mm VAS 64 (35-89) 15 (8-75)† 54 (36-89) 15 (1-59)† 43 (20-94) 62 (27-89)Patient painassessment, 100-mm VAS 69 (14-100) 16.5 (1-86)† 69 (17-99) 12 (0-80)† 68.5 (9-90) 73 (37-97)†Swollen jointcount 7 (0-24) 1 (0-7)† 3 (1-19) 1 (0-10)† 2 (1-11) 2 (1-24)Tender jointcount 10 (1-20) 0 (0-6) † 5 (0-23) 1 (0-13) † 2 (0-6) 3 (0-20)C-reactive protein, mg/dL 2.3 (1.0-7.4) 0.3 (0-7.9)† 1.0 (0-15.0) 0.3 (0-3.4)† 3.1 (0.2-15.8) 1.8 (0.1-7.4)Erythrocyte sedimentation rate, mm/hour 24 (11-101) 6 (1-34)† 16 (1-86) 8 (1-39)† 21 (5-107) 17 (4-101)

Page 9: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

IMPACT 2: Mean Changes in Modified Sharp/van der Heijde Erosion and Joint Space Narrowing (JSN) Scores to Week 54

Adapted from Van der Heijde et al. Arthritis Rheum 2007;56(8):2698-707.

Page 10: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

Course of Radiographic Deterioration: Infliximab vs. Conventional Treatment in the OASIS Cohort

Adapted from Baraliakos et al. Reumatology 2007;46:1450–3.

Page 11: *LR+ = sensitivity/(1 – specificity); LR- = (1 – sensitivity)/specificity

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