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Back Pain: HELP
Articles by Joachim Sieper
Based on 21 articles published since 2009
(Why 21 articles?)

Between 2009 and 2019, J. Sieper wrote the following 21 articles about Back Pain.
+ Citations + Abstracts
1 Guideline [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 3 Clinical symptoms]. 2014

Kiltz, U / Rudwaleit, M / Sieper, J / Krause, D / Chenot, J-F / Stallmach, A / Jaresch, S / Oberschelp, U / Schneider, E / Swoboda, B / Böhm, H / Heiligenhaus, A / Pleyer, U / Böhncke, W-H / Stemmer, M / Braun, J / Anonymous1880805. ·Deutsche Gesellschaft für Rheumatologie (DGRh), -, -, Uta.Kiltz@elisabethgruppe.de. ·Z Rheumatol · Pubmed #25181971.

ABSTRACT: -- No abstract --

2 Editorial Editorial: Inflammatory Back Pain and Axial Spondyloarthritis: Lessons for Clinical Practice and Epidemiologic Research. 2018

Dubreuil, Maureen / Sieper, Joachim. ·Boston University School of Medicine and VA Boston Healthcare System, Boston, Massachusetts. · Charity Campus Benjamin Franklin, Berlin, Germany. ·Arthritis Rheumatol · Pubmed #29471586.

ABSTRACT: -- No abstract --

3 Review What low back pain is and why we need to pay attention. 2018

Hartvigsen, Jan / Hancock, Mark J / Kongsted, Alice / Louw, Quinette / Ferreira, Manuela L / Genevay, Stéphane / Hoy, Damian / Karppinen, Jaro / Pransky, Glenn / Sieper, Joachim / Smeets, Rob J / Underwood, Martin / Anonymous501054. ·Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. · Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. · Faculty of Medicine and Health Sciences, Physiotherapy Division and Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa. · Institute of Bone and Joint Research, Sydney Medical School, The University of Sydney, Sydney, Australia. · Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland. · University of Sydney, Sydney, Australia. · Medical Research Centre Oulu, University of Oulu and University Hospital, Oulu, Finland. · Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA USA. · Department of Rheumatology, Charité, Campus Benjamin Franklin, Berlin, Germany. · Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands; Libra Rehabilitation and Audiology, Eindhoven, Netherlands. · Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: m.underwood@warwick.ac.uk. ·Lancet · Pubmed #29573870.

ABSTRACT: Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.

4 Review Axial spondyloarthritis. 2017

Sieper, Joachim / Poddubnyy, Denis. ·Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany. Electronic address: joachim.sieper@charite.de. · Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany. ·Lancet · Pubmed #28110981.

ABSTRACT: The term axial spondyloarthritis covers both patients with non-radiographic and radiographic axial spondyloarthritis, which is also termed ankylosing spondylitis. The disease usually starts in the third decade of life with a male to female ratio of two to one for radiographic axial spondyloarthritis and of one to one for non-radiographic axial spondyloarthritis. More than 90% heritabilty has been estimated, the highest genetic association being with HLA-B27. The pathogenic role of HLA-B27 is still not clear although various hypotheses are available. On the basis of evidence from trials the cytokines tumour necrosis factor (TNF)-α and interleukin-17 appear to have a relevant role in pathogenesis. The mechanisms of interaction between inflammation and new bone formation is still not completely understood but clarification will be important for the prevention of long-term structural damage of the bone. The development of new criteria for classification and for screening of patients with axial spondyloarthritis have been crucial for the early indentification and treatment of such patients, with MRI being the most important existing imaging method. Non-steroidal anti-inflammatory drugs and TNF blockers are effective therapies. Blockade of interleukin-17 is a new and relevant treatment option.

5 Review [Evidence-based recommendations on diagnostics and therapy of axial spondyloarthritis : S3 guidelines of the German Society of Rheumatology (DGRh) in cooperation with the Association of the Scientific Medical Societies in Germany (AWMF)]. 2017

Kiltz, U / Rudwaleit, M / Sieper, J / Braun, J. ·Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland. Uta.kiltz@elisabethgruppe.de. · Klinik Rosenhöhe, Klinikum Bielefeld, Bielefeld, Deutschland. · Campus Benjamin-Franklin, Charité, Berlin, Deutschland. · Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland. ·Z Rheumatol · Pubmed #27882408.

ABSTRACT: The clinical course of axial spondyloarthritis (SpA) is variable and characterized by chronic back pain and extraspinal manifestations, such as asymmetrical arthritis, dactylitis and enthesitis. Extra-articular manifestations in the eyes (anterior uveitis), skin (psoriasis) and intestines (chronic inflammatory bowel disease) are also frequent manifestations in patients with SpA. Due to the heterogeneity of disease manifestations and the partial concentration on structural alterations in the sacroiliac joints visible in X‑ray images, the diagnosis is often delayed for many years. An important step in the direction of improved early recognition of axial SpA was establishment of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria published in 2009, which focused on the initally deep-seated back pain and chronicity in relatively young patients as well as the importance of magnetic resonance imaging and HLA B 27 determination in the early stages of the disease. In order to achieve the foundations for an effective and timely therapy of affected patients, in 2014 on the initiative of the German Society of Rheumatology, S3 guidelines on axial SpA including Bechterew's disease and early forms were formulated in cooperation with other specialist societies. This article gives an overview of the contents of the S3 guidelines on axial SpA.

6 Review Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus. 2016

Hammoudeh, Mohammed / Abdulaziz, Sultana / Alosaimi, Hanan / Al-Rayes, Hanan / Aldeen Sarakbi, Hussam / Baamer, Matouqa / Baraliakos, Xenofon / Dahou Makhloufi, Chafia / Janoudi, Nahid / Shirazy, Khalid / Sieper, Joachim / Sukhbir, Uppal. ·Department of Medicine, Weill Cornell Medical College Qatar, Hamad Medical Corporation, Doha, Qatar mhamoudeh@hmc.org.qa. · Department of Medicine, King Fahad Hospital, Jeddah, Saudi Arabia. · Rheumatology Section, Department of Internal Medicine/Rheumatology, Military Hospital, Jeddah, Saudi Arabia. · Department of Medicine, Armed Force Hospital, Riyadh, Saudi Arabia. · Department of Medicine, Hamad Medical Corporation, Doha, Qatar. · Department of Medicine, King Abdulaziz Hospital and Oncology Centre, Jeddah, Saudi Arabia. · Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Bab El Oued Hospital, Algiers, Algeria. · Department of Rheumatology, DSFH Hospital, Jeddah, Saudi Arabia. · Pfizer AfME, Media City, Dubai, United Arab Emirates. · Klinikum Benjamin Franklin, Freien Universität Berlin, Berlin, Germany. · Rheumatology Division, University Hospital, Sharjah, United Arab Emirates. ·J Int Med Res · Pubmed #26811411.

ABSTRACT: Axial spondyloarthritis (SpA) is a spectrum of inflammatory disease with stages characterized by both nonradiographic and radiographic sacroiliitis. Nonradiographic axial SpA is associated with health-related quality-of-life impairment and may progress to ankylosing spondylitis. Axial SpA has a low prevalence in some countries in North Africa and the Middle East, and pooling of data and resources is needed to increase understanding of the regional picture. Early diagnosis and effective treatment are required to reduce disease burden and prevent progression. Anti-TNF therapy is recommended for patients with persistently high disease activity despite conventional treatment, and has been shown to be effective in patients without radiographic damage. Diagnostic delays can be an obstacle to early treatment and appropriate referral strategies are needed. In some countries, restricted access to magnetic resonance imaging and anti-TNF agents presents a challenge. In this article, a group of experts from North Africa and the Middle East evaluated the diagnosis and management of axial SpA with particular reference to this region.

7 Review Development of an ASAS-endorsed recommendation for the early referral of patients with a suspicion of axial spondyloarthritis. 2015

Poddubnyy, Denis / van Tubergen, Astrid / Landewé, Robert / Sieper, Joachim / van der Heijde, Désirée / Anonymous5280830. ·Charité Universitätsmedizin Berlin, Berlin, Germany. · Maastricht University Medical Center, The Netherlands. · University of Amsterdam, Amsterdam, The Netherlands. · Leiden University Medical Center, Leiden, The Netherlands. ·Ann Rheum Dis · Pubmed #25990288.

ABSTRACT: The aim of this work was to develop a consensual recommendation under the auspices of the Assessment of SpondyloArthritis international Society (ASAS) for early referral of patients with a suspicion of axial spondyloarthritis by non-rheumatologists. The development of a referral recommendation consisted of four phases: (1) systematic literature review, (2) the first Delphi round aiming at identification of unmet needs and development of a candidate list of referral parameters, (3) the second Delphi round aiming at identification of the most useful combination of referral parameters and (4) final discussion and formal endorsement by ASAS membership. The following consensus on a referral recommendation was achieved as a result of the Delphi processes and final voting: "Patients with chronic back pain (duration ≥3 months) and back pain onset before 45 years of age should be referred to a rheumatologist if at least one of the following parameters is present: Inflammatory back pain; human leucocyte antigen-B27; Sacroiliitis on imaging if available (X-rays or magnetic resonance imaging); Peripheral manifestations (arthritis, enthesitis, dactylitis); Extra-articular manifestations (psoriasis, inflammatory bowel disease, uveitis); Positive family history for spondyloarthritis; Good response to non-steroidal anti-inflammatory drugs; Elevated acute phase reactant." A consensual ASAS-endorsed referral recommendation for patients suspected of having axial spondyloarthritis was developed as a flexible and universal strategy to be used in clinical practice by primary care physicians or non-rheumatology specialists. The practical value of this strategy applied in different settings should be determined in future studies.

8 Review Classification, diagnosis, and referral of patients with axial spondyloarthritis. 2012

Braun, Jürgen / Sieper, Joachim. ·Rheumazentrum Ruhrgebiet, Herne and Ruhr Universität Bochum, Germany. ·Rheum Dis Clin North Am · Pubmed #23083749.

ABSTRACT: The concepts for classification, diagnosis and referral of patients with axial spondyloarthitis differ, although they of course basically relate to the same disease. While classification criteria and referral strategies concentrate largely on patients with chronic back pain with an age at onset before 45 years, the rheumatologist can make a diagnosis of axial SpA in patients with late onset or in patients with back pain for only some weeks if other items are fulfilled. Early recognition of patients with axial SpA is important to establish the diagnosis, potentially start therapeutic interventions and avoid unnecessary health care procedures.

9 Review Referral strategies for early diagnosis of axial spondyloarthritis. 2012

Rudwaleit, Martin / Sieper, Joachim. ·Endokrinologikum Berlin, Jägerstrasse 61, 10117 Berlin, Germany. martin.rudwaleit@endokrinologikum.com ·Nat Rev Rheumatol · Pubmed #22487797.

ABSTRACT: The spectrum of HLA-B27-associated inflammatory spine diseases is referred to as axial spondyloarthritis (axSpA). AxSpA encompasses established ankylosing spondylitis (AS) but also nonradiographic axSpA, and can be classified according to the Assessment of SpondyloArthritis international Society classification criteria for axSpA. Specific and effective therapy for axSpA includes education, physiotherapy, NSAIDs and biologic agents, as appropriate. Patients with axSpA, however, are often diagnosed late in the course of the disease. As specific therapy is available, the effective identification of those individuals who are likely to have axSpA among patients with chronic back pain in primary care and their subsequent referral to a rheumatologist for establishing a correct diagnosis is worth pursuing. Candidate referral parameters that can easily be applied to patients with chronic back pain and age at onset ≤ 45 years (the target population) include inflammatory back pain (IBP) and positivity for HLA-B27. Following diagnostic work-up by a rheumatologist, these referral parameters, either alone or in combination, have led to the diagnosis of as many as 33-45% of patients within this target population with axSpA, 41-62% of whom had undiagnosed AS. Thus, educating primary care physicians on the value of IBP and HLA-B27 testing within this target population, and referral to a rheumatologist if one of these parameters is positive, is a promising approach to reduce the long delay in diagnosing patients with axSpA.

10 Review How to screen for axial spondyloarthritis in primary care? 2012

Sieper, Joachim. ·Rheumatology, Charité, Campus Benjamin Franklin, Berlin Germany. joachim.sieper@charite.de ·Curr Opin Rheumatol · Pubmed #22450394.

ABSTRACT: PURPOSE OF REVIEW: There is a major delay of several years between first symptoms and making a diagnosis in patients with axial spondyloarthritis. A strategy for earlier diagnosis is urgently needed, for which efficient referral parameters applicable in primary care are an important part. Published studies on referral programs are reviewed and their relevance for daily clinical practice is discussed. RESULTS: Several referral investigations have been performed in several countries using the symptom of 'inflammatory back pain' (IBP) alone or in combination with other referral parameters. All studies performed resulted in a good and acceptable percentage of an axial SpA diagnosis in between 29 and 58%. A set of rather simple parameters (IBP and/or HLA-B27 positivity and/or sacroiliitis on imaging) performed better than IBP alone and is easier to use than more complicated referral strategies. SUMMARY: Referral strategies to screen for axial SpA patients in primary care are available, are effective and should be applied more regularly.

11 Clinical Trial Early response to adalimumab predicts long-term remission through 5 years of treatment in patients with ankylosing spondylitis. 2012

Sieper, Joachim / van der Heijde, Désirée / Dougados, Maxime / Brown, L Steve / Lavie, Frederic / Pangan, Aileen L. ·University Clinic Benjamin Franklin, Medical Department I, Rheumatology, PO Box, Berlin 12200, Germany. joachim.sieper@charite.de ·Ann Rheum Dis · Pubmed #22128084.

ABSTRACT: OBJECTIVES: To describe the efficacy and safety through 5 years of adalimumab treatment in patients with ankylosing spondylitis (AS), and to identify predictors of remission. METHODS: Patients with active AS were followed up to 5 years during a 24-week randomised, controlled period, followed by an open-label extension. Disease activity and clinical improvement were evaluated by Assessment in Spondyloarthritis International Society (ASAS) responses, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Kaplan-Meier was used to identify patients with sustained ASAS partial remission (PR) or ASDAS inactive disease (ID) for three or more consecutive visits spanning ≥ 6 months. Logistic regression was used to identify factors associated with remission. Explanatory variables included baseline demographic and disease characteristics and week 12 responses. RESULTS: Of the 311 patients who received at least one dose of adalimumab, 202 (65%) completed the 5-year study. Among 125 patients who received 5 years of adalimumab, 70%, 77%, 51% and 61% achieved ASAS40, BASDAI 50, ASAS PR and ASDAS ID, respectively. Of 311 adalimumab-treated patients, 45% and 55% achieved sustained ASAS PR and ASDAS ID at any time during study participation. The strongest predictor of remission at years 1 and 5 and of sustained remission was achieving remission at 12 weeks of treatment; baseline characteristics showed weaker associations. Adverse events were comparable with previous reports on adalimumab safety. CONCLUSIONS: In patients with active AS, the efficacy and safety of adalimumab were maintained through 5 years with about half of the patients experiencing sustained remission at any time during the study. Early achievement of remission was the best predictor of long-term and sustained remission.

12 Article Genetic diagnostic profiling in axial spondyloarthritis: a real world study. 2017

Thomas, Gothic P / Willner, Dana / Robinson, Philip C / Cortes, Adrian / Duan, Ran / Rudwaleit, Martin / Akkoc, Nurullah / Braun, Jurgen / Chou, Chung-Tei / Maksymowych, Walter P / Ozgocmen, Salih / Roussou, Euthalia / Sieper, Joachim / Valle-Oñate, Rafael / van der Heijde, Desiree / Wei, James / Leo, Paul / Brown, Matthew A / Anonymous19080884. ·University of Queensland Diamantina Institute, Translational Research Institute, Brisbane; and Charles Sturt University, Wagga Wagga, New South Wales, Australia. · University of Queensland Diamantina Institute, Translational Research Institute, Brisbane; and Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia. · University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia. · Klinikum Bielefeld and Charité University Medicine, Berlin, Germany; and Gent University, Gent, Belgium. · Dokuz Eylul University Hospital, Izmir, Turkey. · German Rheumatology Research Centre, Berlin, Germany. · Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei; and School of Medicine, National Yang-Ming University, Taipei, Taiwan. · Department of Medicine, University of Alberta, Canada. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University, Faculty of Medicine, Kayseri, Turkey. · King George Hospital, London, UK. · German Rheumatology Research Centre, Berlin; and Rheumatology, Med Klinik 1, Charite, Campus Benjamin Franklin, Berlin, Germany. · Spondyloarthropathy Group-Division of Rheumatology, Hospital Militar Central/ Universidad de La Sabana, Colombia. · Leiden University Medical Center, Leiden, the Netherlands. · Chung Shan Medical University, Taichung, Taiwan. · University of Queensland Diamantina Institute, Translational Research Institute; and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Australia. ·Clin Exp Rheumatol · Pubmed #27749235.

ABSTRACT: OBJECTIVES: Spondyloarthritis (SpA) is often diagnosed late in the course of the disease and improved methods for early diagnosis are required. We have tested the ability of genetic profiling to diagnose axial SpA (axSpA) as a whole group, or ankylosing spondylitis (AS) alone, in a cohort of chronic back pain patients. METHODS: 282 patients were recruited from centres in the United Kingdom, Germany, Taiwan, Canada, Columbia and Turkey as part of the ASAS classification criteria for axSpA study (ASAS cohort). Subjects were classified according to the ASAS axSpA criteria, and the modified New York Criteria for AS. Patients were genotyped for ~200,000 immune-mediated disease SNPs using the Illumina Immunochip. RESULTS: We first established the predictive accuracy of genetic data comparing 9,638 healthy controls and 4,428 AS cases from the homogenous International Genetics of AS (IGAS) Consortium Immunochip study which showed excellent predictive power (AUC=0.91). Genetic risk scores had lower predictive power (AUC=0.83) comparing ASAS cohort axSpA cases meeting the ASAS imaging criteria with IGAS controls. Comparing genetic risk scores showed moderate discriminatory capacity between IGAS AS and ASAS imaging positive cases (AUC 0.67±0.05), indicating that significant differences in genetic makeup exist between the cohorts. CONCLUSIONS: In a clinical setting of referred back pain patients suspected to have axial SpA we were unable to use genetic data to construct a predictive model better than that based on existing clinical data. Potential confounding factors include significant heterogeneity in the ASAS cohort, possibly reflecting the disease heterogeneity of axSpA, or differences between centres in ascertainment or classification performance.

13 Article Predictive validity of the ASAS classification criteria for axial and peripheral spondyloarthritis after follow-up in the ASAS cohort: a final analysis. 2016

Sepriano, Alexandre / Landewé, Robert / van der Heijde, Désirée / Sieper, Joachim / Akkoc, Nurullah / Brandt, Jan / Braun, Jürgen / Collantes-Estevez, Eduardo / Dougados, Maxime / Fitzgerald, Oliver / Huang, Feng / Gu, Jieruo / Kirazli, Yesim / Maksymowych, Walter P / Marzo-Ortega, Helena / Olivieri, Ignazio / Ozgocmen, Salih / Roussou, Euthalia / Scarpato, Salvatore / Sørensen, Inge J / Valle-Oñate, Rafael / Van den Bosch, Filip / van der Horst-Bruinsma, Irene / Weber, Ulrich / Wei, James / Rudwaleit, Martin / Anonymous550858. ·Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Department of Rheumatology, Hospital de Egas Moniz-CHLO, Lisbon, Portugal. · Departments of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Rheumatology, Atrium Medical Center, Heerlen, The Netherlands. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Rheumatology, Med Klinik I, Charité Campus Benjamin Franklin, Berlin, Germany German Rheumatism Research Centre, Berlin, Germany. · Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. · Department of Rheumatology, Private Practice, Berlin, Germany. · Rheumazentrum Ruhrgebiet, Herne, Germany. · Rheumatology Department, "Reina Sofia" Hospital/IMIBIC/University of Córdoba, Córdoba, Spain. · Rheumatology Department, Paris Descartes University, Cochin Hospital, Paris, France. · Department of Rheumatology, St Vincent's University Hospital, Dublin, Elm Park, Ireland. · Department of Rheumatology, Chinese PLA General Hospital, Beijing, China. · Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. · Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Izmir, Turkey. · Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK. · Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey. · Department of Rheumatology and Rehabilitation, King George's Hospital, London, UK. · Rheumatology Unit, M. Scarlato Hospital, Scafati, Salerno, Italy. · Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. · Division of Rheumatology, Department of Internal Medicine, Hospital Militar Central, Bogotá, Colombia. · Department of Rheumatology, Ghent University Hospital, Ghent, Belgium. · Department of Rheumatology, VU University Medical Centre, Amsterdam, Netherlands. · King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Denmark Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. · Chung Shan Medical University Hospital, Taichung, Taiwan. · Klinikum Bielefeld, Berlin, Germany Charité University Medicine, Berlin, Germany. ·Ann Rheum Dis · Pubmed #26865599.

ABSTRACT: OBJECTIVE: To establish the predictive validity of the Assessment of SpondyloArthritis international Society (ASAS) spondyloarthritis (SpA) classification criteria. METHODS: 22 centres (N=909 patients) from the initial 29 ASAS centres (N=975) participated in the ASAS-cohort follow-up study. Patients had either chronic (>3 months) back pain of unknown origin and age of onset below 45 years (N=658) or peripheral arthritis and/or enthesitis and/or dactylitis (N=251). At follow-up, information was obtained at a clinic visit or by telephone. The positive predictive value (PPV) of the baseline classification by the ASAS criteria was calculated using rheumatologist's diagnosis at follow-up as external standard. RESULTS: In total, 564 patients were assessed at follow-up (345 visits; 219 telephone) with a mean follow-up of 4.4 years (range: 1.9; 6.8) and 70.2% received a SpA diagnosis by the rheumatologist. 335 patients fulfilled the axial SpA (axSpA) or peripheral SpA (pSpA) criteria at baseline and of these, 309 were diagnosed SpA after follow-up (PPV SpA criteria: 92.2%). The PPV of the axSpA and pSpA criteria was 93.3% and 89.5%, respectively. The PPV for the 'clinical arm only' was 88.0% and for the 'clinical arm'±'imaging arm' 96.0%, for the 'imaging arm only' 86.2% and for the 'imaging arm'+/-'clinical arm' 94.7%. A series of sensitivity analyses yielded similar results (range: 85.1-98.2%). CONCLUSIONS: The PPV of the axSpA and pSpA criteria to forecast an expert's diagnosis of 'SpA' after more than 4 years is excellent. The 'imaging arm' and 'clinical arm' of the axSpA criteria have similar predictive validity and are truly complementary.

14 Article ASAS modification of the Berlin algorithm for diagnosing axial spondyloarthritis: results from the SPondyloArthritis Caught Early (SPACE)-cohort and from the Assessment of SpondyloArthritis international Society (ASAS)-cohort. 2013

van den Berg, Rosaline / de Hooge, Manouk / Rudwaleit, Martin / Sieper, Joachim / van Gaalen, Floris / Reijnierse, Monique / Landewé, Robert / Huizinga, Tom / van der Heijde, Désirée. ·Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. ·Ann Rheum Dis · Pubmed #23139266.

ABSTRACT: OBJECTIVE: To compare the original Berlin algorithm for diagnosing axial Spondyloarthritis (axSpA) with two modifications in the SPondyloArthritis Caught Early (SPACE)-cohort and the Assessment of SpondyloArthritis international Society (ASAS) axSpA criteria validation (ASAS)-cohort. METHODS: Patients in the SPACE-cohort (back pain ≥3 months, ≤2 years, onset <45 years) and the ASAS-cohort (undiagnosed chronic back pain) were diagnosed according to three algorithms: original (inflammatory back pain (IBP) mandatory), modification 1 (IBP defined by ≥3/5 IBP-features instead of ≥4/5) and modification 2 (IBP deleted as obligatory entry criterion, added as SpA-feature). Diagnosis by rheumatologist, ASAS axSpA criteria and likelihood ratio product were used as external standards to test the performance of the algorithms. RESULTS: SPACE-cohort: Compared to the diagnosis by rheumatologist (either axSpA or no-axSpA), the original algorithm agreed in 120 patients (76.4%). Agreement decreased using modification 1 (119 patients; 75.8%), increased using modification 2 (125 patients; 79.6%). Sensitivity increased from 66.2% (original) to 72.3% (modification 1) and 78.5% (modification 2). Specificity decreased more using modification 1 (83.7% to 78.3%) than when using modification 2 (83.7% to 79.6%). ASAS-cohort: Compared to the diagnosis by rheumatologist (either axSpA or no-axSpA), the original algorithm agreed in 484 patients (70.7%). Agreement increased using modification 1 (520 patients; 75.9%) and modification 2 (548 patients; 80.0%). Sensitivity increased from 65.3% (original) to 77.9% (modification 1) and 79.6% (modification 2). Specificity decreased more using modification 1 (79.2% to 72.2%) than when using modification 2 (79.2% to 75.6%). CONCLUSIONS: ASAS accepted a modified algorithm for diagnosing axSpA in which IBP is excluded as obligatory entry criterion and added as SpA-feature.

15 Article Comparison of two referral strategies for diagnosis of axial spondyloarthritis: the Recognising and Diagnosing Ankylosing Spondylitis Reliably (RADAR) study. 2013

Sieper, Joachim / Srinivasan, Shankar / Zamani, Omid / Mielants, Herman / Choquette, Denis / Pavelka, Karel / Loft, Anne Gitte / Géher, Pál / Danda, Debashish / Reitblat, Tatiana / Cantini, Fabrizio / Ancuta, Codrina / Erdes, Shandor / Raffayová, Helena / Keat, Andrew / Gaston, J S H / Praprotnik, Sonja / Vastesaeger, Nathan. ·Medical Department I, Rheumatology, Charite Campus Benjamin Franklin, Berlin, Germany. joachim.sieper@charite.de ·Ann Rheum Dis · Pubmed #23065731.

ABSTRACT: 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. The primary analysis compared the proportion of patients diagnosed with definite axial SpA by referral strategy. RESULTS: Patients (N=1072) were referred by 278 sites to 64 rheumatologists: 504 patients by strategy 1 and 568 patients by strategy 2. Axial SpA was diagnosed in 35.6% and 39.8% of patients referred by these respective strategies (between-group difference 4.40%; 95% CI -7.09% to 15.89%; p=0.447). IBP was the most frequently used referral criterion (94.7% of cases), showing high concordance (85.4%) with rheumatologists' assessments, and having sensitivity and a negative predictive value of >85% but a positive predictive value and specificity of <50%. Combining IBP with other criteria (eg, sacroiliitis, HLA-B27) increased the likelihood for diagnosing axial SpA. CONCLUSIONS: A referral strategy based on three criteria leads to a diagnosis of axial SpA in approximately 35% of patients with CBP and is applicable across countries and geographical locales with presumably different levels of expertise in axial SpA.

16 Article The frequency of non-radiographic axial spondyloarthritis in relation to symptom duration in patients referred because of chronic back pain: results from the Berlin early spondyloarthritis clinic. 2012

Poddubnyy, Denis / Brandt, Henning / Vahldiek, Janis / Spiller, Inge / Song, In-Ho / Rudwaleit, Martin / Sieper, Joachim. ·Rheumatology, Medical Department I, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin 12203, Germany. denis.poddubnyy@charite.de ·Ann Rheum Dis · Pubmed #22915622.

ABSTRACT: OBJECTIVE: This study was aimed at investigating the frequencies of non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) diagnoses and their ratios in relation to symptom duration in patients referred because of chronic back pain and suspicion of axial SpA. METHODS: In this monocentre study, orthopaedists and primary care physicians were requested to refer patients with chronic low back pain (duration >3 months) and onset of back pain before 45 years of age to a SpA-specialised rheumatology outpatient clinic for further diagnostic investigation, if proposed screening parameters were present. The ratio of nr-axSpA to AS was analysed in relation to the duration of symptoms. RESULTS: A diagnosis of definite axial SpA was made in 43.7% of the referred patients (n=522). Axial SpA was diagnosed in a similar percentage of about 50% if back pain duration was <9 years but decreased to 36% if symptom duration was >9 years. Nr-axSpA represented the majority of patients (67.3%) only if duration of back pain was 1 year and less at the time of referral. Between 1 and 6 years of back pain duration the probability of nr-axSpA and AS was nearly equal (1-3 years: 52.5% and 47.5%, respectively; 3-6 years: 53.7% and 46.3%, respectively). In patients with back pain duration of 6-9 years, AS was more likely (61.1%) to be diagnosed than nr-axSpA (38.9%), and this increased further over time. CONCLUSIONS: Non-radiographic axial SpA represents an important differential diagnosis of back pain, especially in patients with recent symptom onset.

17 Article Evaluation of the spinal pain score in AS--a psychometric analysis. 2012

Song, In-Ho / Haibel, Hildrun / Stelling, Elke S / Sieper, Joachim / Rudwaleit, Martin. ·Rheumatology Unit, Charité Medical University, Berlin, Germany. ·Rheumatology (Oxford) · Pubmed #22157684.

ABSTRACT: OBJECTIVE: To evaluate the spinal pain score (SpiPS), a semi-objective instrument for measuring disease activity in AS. METHODS: The SpiPS is based on the physical examination of the spine and was evaluated according to the outcome measures in rheumatology filter in 659 AS patients from different cohorts including two interventional trials. Aspects of truth, discrimination and feasibility were assessed. RESULTS: The SpiPS significantly distinguished between patients with high and low disease activity. The correlation of the SpiPS with the disease activity index BASDAI was relatively weak in the entire cohort of AS patients (r = 0.36) but moderate to good in AS patients with short disease duration (r = 0.66). Correlations with the functional index BASFI (r = 0.38), patient global (r = 0.18), physician global (r = 0.51) and BASMI (r = 0.36) were weak to moderate in the entire cohort. Logistic regression revealed SpiPS and patient global to be independently associated with disease activity (BASDAI) after adjustments for age, gender, disease duration, CRP and HLA-B27. Sensitivity to change expressed as effect size (ES) was 0.82 and 1.58, respectively, and highly comparable with that of BASDAI in the two interventional trials. Reproducibility of the SpiPS was good (intra-observer variability r = 0.93, inter-observer variability r = 0.79). CONCLUSION: The SpiPS is a measure of disease activity in AS and is sensitive to change. However, disease domains other than disease activity are also captured by the SpiPS, and our analysis failed to demonstrate any additional value of the SpiPS over existing instruments.

18 Article Evaluation of 2 screening strategies for early identification of patients with axial spondyloarthritis in primary care. 2011

Poddubnyy, Denis / Vahldiek, Janis / Spiller, Inge / Buss, Beate / Listing, Joachim / Rudwaleit, Martin / Sieper, Joachim. ·Department of Rheumatology, Charité – Campus Benjamin Franklin, Berlin, Germany. joachim.sieper@charite.de ·J Rheumatol · Pubmed #21921100.

ABSTRACT: OBJECTIVE: To evaluate 2 referral strategies for axial spondyloarthritis (SpA) in patients with chronic low back pain at the primary care level. METHODS: Referral physicians (n = 259) were randomly assigned to either Strategy 1 or Strategy 2 in order to refer patients with chronic back pain (duration > 3 months), age at onset of back pain < 45 years, and no diagnosis of axial SpA, to a cooperating rheumatologist (n = 43). According to Strategy 1, suitable patients were referred if at least 1 of the following screening criteria was present: inflammatory back pain, HLA-B27, or sacroiliitis detected by imaging. According to Strategy 2, patients were referred if 2 out of 5 criteria were positive: the same 3 criteria from Strategy 1 and additionally a positive family history of ankylosing spondylitis (AS) or a good treatment response to nonsteroidal antiinflammatory drugs. The final diagnosis of the rheumatologist was used as the "gold standard." RESULTS: In total, 560 consecutively referred patients were included in the analysis. Among 318 patients referred by Strategy 1, 41.8% (95% CI 36.5%-47.3%) were diagnosed with definite axial SpA. Among 242 patients referred by the second strategy, definite axial SpA was diagnosed in 36.8% (95% CI 31.0%-43.0%) of the cases. CONCLUSION: Both referral strategies demonstrated comparable performance in identification of patients with axial SpA. Strategy 1 might be preferred as an easy and reliable screening method for axial SpA at the primary care level.

19 Article Limited diagnostic value of unilateral sacroiliitis in scintigraphy in assessing axial spondyloarthritis. 2010

Song, In-Ho / Brandt, Henning / Rudwaleit, Martin / Sieper, Joachim. ·Charité Medical University, Campus Benjamin Franklin, Medical Clinic I, Rheumatology, Hindenburgdamm 30, 12200 Berlin, Germany. ·J Rheumatol · Pubmed #20395643.

ABSTRACT: OBJECTIVE: To assess the diagnostic value for axial spondyloarthritis (SpA) of unilateral sacroiliitis in scintigraphy in daily clinical practice. METHODS: In 207 patients with chronic back pain, the diagnostic value of scintigraphy was assessed retrospectively. The diagnosis made by the rheumatologist (axial SpA vs no axial SpA) was the standard. RESULTS: Sensitivities of scintigraphy for any (unilateral or bilateral), bilateral, and isolated unilateral sacroiliitis were 64.9%, 40.2%, and 24.7%, respectively. Respective specificities were 50.5%, 57.7%, and 92.8%, resulting in likelihood ratios of 1.3, 1.0, and 3.4. CONCLUSION: Scintigraphy of the sacroiliac joints is of limited value for the diagnosis of axial SpA. Unilateral compared to bilateral sacroiliitis is slightly superior, but is associated with a low sensitivity.

20 Article Classification criteria for rheumatoid arthritis and ankylosing spondylitis. 2009

Braun, J / Sieper, J. ·Rheumazentrum Ruhrgebiet, Herne, Germany. ·Clin Exp Rheumatol · Pubmed #19822049.

ABSTRACT: The history of classification and diagnostic criteria for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is similar and different. Important criteria sets have been published for both disease in the mid eighties, for AS in 1984 and for RA in 1987. The leading clinical symptoms, inflammatory back pain (IBP) in AS and the predominant polyarticular symmetric involvement of the hands in RA were, of course, central, and so was morning stiffness as a major clinical sign of an inflammatory disease state. In RA, there was more focus on laboratory parameters (rheumatoid factor), while this could have been the case also in AS (HLA B27) but this was not recognized at this point in time. In contrast, imaging has played a more important role in AS - especially because the sacroiliac joints are involved in the vast majority of AS patients, while in RA radiographic changes of the joints of hands and feet may contribute to the diagnosis. However, in both diseases, early structural changes visualized by conventional radiography rather have prognostic impact since these patients are much more likely to progress in comparison to others who do not have cartilage and joint damage early in the course of the disease. Further developments of criteria for AS have broadened the spectrum of AS to spondyloarthritis (SpA) and axial SpA which covers most early forms. The leading clinical symptom is chronic back pain in young adults and IBP. New criteria for RA which include more patients with early disease and anti-CCP antibodies as new markers are being developed. This is important since early treatment strategies are increasingly and successfully used to treat inflammatory diseases more efficiently.

21 Article New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). 2009

Sieper, J / van der Heijde, D / Landewé, R / Brandt, J / Burgos-Vagas, R / Collantes-Estevez, E / Dijkmans, B / Dougados, M / Khan, M A / Leirisalo-Repo, M / van der Linden, S / Maksymowych, W P / Mielants, H / Olivieri, I / Rudwaleit, M. ·Medizinische Klinik I, Charité - Campus Benjamin Franklin, Berlin, Germany. ·Ann Rheum Dis · Pubmed #19147614.

ABSTRACT: OBJECTIVE: Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA), and relevant for classification and diagnosis. In the present report, a new approach for the development of IBP classification criteria is discussed. METHODS: Rheumatologists (n = 13) who are experts in SpA took part in a 2-day international workshop to investigate 20 patients with back pain and possible SpA. Each expert documented the presence/absence of clinical parameters typical for IBP, and judged whether IBP was considered present or absent based on the received information. This expert judgement was used as the dependent variable in a logistic regression analysis in order to identify those individual IBP parameters that contributed best to a diagnosis of IBP. The new set of IBP criteria was validated in a separate cohort of patients (n = 648). RESULTS: Five parameters best explained IBP according to the experts. These were: (1) improvement with exercise (odds ratio (OR) 23.1); (2) pain at night (OR 20.4); (3) insidious onset (OR 12.7); (4) age at onset <40 years (OR 9.9); and (5) no improvement with rest (OR 7.7). If at least four out of these five parameters were fulfilled, the criteria had a sensitivity of 77.0% and specificity of 91.7% in the patients participating in the workshop, and 79.6% and 72.4%, respectively, in the validation cohort. CONCLUSION: This new approach with real patients defines a set of IBP definition criteria using overall expert judgement on IBP as the gold standard. The IBP experts' criteria are robust, easy to apply and have good face validity.