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Spinal Diseases: HELP
Articles by Xenofon Baraliakos
Based on 98 articles published since 2010
(Why 98 articles?)

Between 2010 and 2020, Xenofon Baraliakos wrote the following 98 articles about Spinal Diseases.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. 2018

Smolen, Josef S / Schöls, Monika / Braun, Jürgen / Dougados, Maxime / FitzGerald, Oliver / Gladman, Dafna D / Kavanaugh, Arthur / Landewé, Robert / Mease, Philip / Sieper, Joachim / Stamm, Tanja / Wit, Maarten de / Aletaha, Daniel / Baraliakos, Xenofon / Betteridge, Neil / Bosch, Filip van den / Coates, Laura C / Emery, Paul / Gensler, Lianne S / Gossec, Laure / Helliwell, Philip / Jongkees, Merryn / Kvien, Tore K / Inman, Robert D / McInnes, Iain B / Maccarone, Mara / Machado, Pedro M / Molto, Anna / Ogdie, Alexis / Poddubnyy, Denis / Ritchlin, Christopher / Rudwaleit, Martin / Tanew, Adrian / Thio, Bing / Veale, Douglas / Vlam, Kurt de / van der Heijde, Désirée. ·Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. · 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria. · Health Consult, Vienna, Austria. · Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Paris Descartes University, Paris, France. · Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland. · Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada. · Division of Rheumatology, University of California, San Diego, CA, USA. · Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands. · Division of Rheumatology Research, Swedish-Providence St. Joseph Health System, University of Washington, Seattle, WA, USA. · Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany. · Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands. · Neil Betteridge Associates, UK. · Ghent University Hospital, Ghent, Belgium. · Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK. · Department of Medicine, University of California, San Francisco, CA, USA. · Department of Rheumatology, UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France. · Institute of Molecular Medicine, University of Leeds, Leeds, UK. · Seayn Medical, Voorschoten, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · University Health Network and University of Toronto, Toronto, Ontario, Canada. · University of Glasgow, College of Medical Veterinary and Life Sciences, Glasgow, UK. · A.DI.PSO. (Associazione per la Difesa degli Psoriasici)-PE.Pso.POF (Pan European Psoriasis Patients' Organization Forum), Rome, Italy. · Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK. · Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA. · German Rheumatism Research Centrer, Berlin, Germany. · Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center Rochester, New York, NY, USA. · Division of Internal Medicine and Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. · Department of Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. ·Ann Rheum Dis · Pubmed #28684559.

ABSTRACT: Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field.

2 Guideline 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. 2017

van der Heijde, Désirée / Ramiro, Sofia / Landewé, Robert / Baraliakos, Xenofon / Van den Bosch, Filip / Sepriano, Alexandre / Regel, Andrea / Ciurea, Adrian / Dagfinrud, Hanne / Dougados, Maxime / van Gaalen, Floris / Géher, Pál / van der Horst-Bruinsma, Irene / Inman, Robert D / Jongkees, Merryn / Kiltz, Uta / Kvien, Tore K / Machado, Pedro M / Marzo-Ortega, Helena / Molto, Anna / Navarro-Compàn, Victoria / Ozgocmen, Salih / Pimentel-Santos, Fernando M / Reveille, John / Rudwaleit, Martin / Sieper, Jochen / Sampaio-Barros, Percival / Wiek, Dieter / Braun, Jürgen. ·Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands. · Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands. · Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Ghent University and Ghent University Hospital, Ghent, Belgium. · NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal. · Department of Rheumatology, University Hospital Zurich, Zurich Switzerland. · Diakonhjemmet Hospital, Oslo, Norway. · Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France. · INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France. · Semmelweis University, Budapest, Hungary. · Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. · University of Toronto, Toronto, Ontario, Canada. · Patient Research Partner, Amsterdam, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK. · NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK. · Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK. · Department of Rheumatology, University Hospital La Paz, IdiPaz, Madrid, Spain. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey. · NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal. · The University of Texas-Health McGovern Medical School, Dallas, USA. · Klinikum Bielefeld, Bielefeld, Germany. · Gent University, Gent, Belgium. · Charité University Medicine, Berlin, Germany. · Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany. · Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. · EULAR PARE Patient Research Partner and Chair of EULAR PARE, Berlin, Germany. ·Ann Rheum Dis · Pubmed #28087505.

ABSTRACT: To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6-8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.

3 Editorial Active and chronic sacroiliitis, spondylitis and enthesitis, How specific are imaging findings for axial spondyloarthritis? 2019

Braun, Juergen / Baraliakos, Xenofon. ·Rheumazentrum Ruhrgebiet, Herne, and Ruhr University Bochum, Herne, Germany. ·Rheumatology (Oxford) · Pubmed #30561682.

ABSTRACT: -- No abstract --

4 Editorial Challenges and Advances in Targeting Remission in Axial Spondyloarthritis. 2018

Baraliakos, Xenofon / Berenbaum, Francis / Favalli, Ennio Giulio / Olivieri, Ignazio / Ostendorf, Benedikt / Poddubnyy, Denis / DE Vlam, Kurt. ·Department of Rheumatology, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany; xenofon.baraliakos@elisabethgruppe.de. · Sorbonne University, INSERM UMR_S938, DHU i2B, AP-HP, Saint-Antoine Hospital, Paris, France. · Department of Rheumatology, Gaetano Pini Institute, Milan, Italy. · Rheumatology Department, Rheumatology Institute of Lucania (IRel), the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, and the Basilicata Ricerca Biomedica Foundation, Potenza, Italy. · Poliklinik und Funktionsbereich für Rheumatologie and Hiller Forschungszentrum Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf. · Charité University Hospital, Berlin, Germany. · Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium. ·J Rheumatol · Pubmed #29419447.

ABSTRACT: -- No abstract --

5 Editorial Unanswered questions in the management of axial spondyloarthritis: an opinion piece. 2014

Baraliakos, Xenofon / Deodhar, Atul. · ·Clin Rheumatol · Pubmed #24941929.

ABSTRACT: -- No abstract --

6 Review Treat to Target in Axial Spondyloarthritis. 2019

Nikiphorou, Elena / Baraliakos, Xenofon. ·Department of Inflammation Biology, King's College London, Weston Education Centre, Cutcombe Road, Room 3.53, 3rd Floor, London SE5 9RJ, UK; Department of Rheumatology, King's College Hospital, London, UK. · Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Claudiusstr. 45, Herne 44649, Germany. Electronic address: xenofon.baraliakos@elisabethgruppe.de. ·Rheum Dis Clin North Am · Pubmed #31564294.

ABSTRACT: This article discusses treat-to-target strategies in axial spondyloarthritis and current status. Treatment ranging from nonsteroidal anti-inflammatory drugs to biologic and other disease-modifying drugs is discussed in the context of treat-to-target. The article explores evidence from landmark randomized, controlled trials and observational studies focusing on both radiographic and nonradiographic axial spondyloarthritis. The feasibility of treat-to-target, as well as predictors of remission are addressed in line with existing evidence. Finally, issues around management principles and challenges, as well as unmet need in the field, are highlighted.

7 Review Modified stoke ankylosing spondylitis spinal score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis. 2019

van der Heijde, Désirée / Braun, Jürgen / Deodhar, Atul / Baraliakos, Xenofon / Landewé, Robert / Richards, Hanno B / Porter, Brian / Readie, Aimee. ·Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands. · Rheumazentrum Ruhrgebiet, Herne, and Ruhr University Bochum, Germany. · Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA. · Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands. · Novartis Pharma AG, Basel, Switzerland. · Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. ·Rheumatology (Oxford) · Pubmed #29860356.

ABSTRACT: In ankylosing spondylitis (AS), structural damage that occurs as a result of syndesmophyte formation and ankylosis of the vertebral column is irreversible. Structural damage is currently assessed by conventional radiography and scoring systems that reliably assess radiographic structural damage are needed to capture the differential effects of drugs on structural damage progression. The validity of the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) as a primary outcome measure in evaluating the effect of AS treatments on radiographic progression rates was assessed in this review. The mSASSS has not been used, to date, as a primary outcome measure in a prospective randomized controlled clinical trial of biologic therapy in AS. This review of the medical literature confirmed that the mSASSS is the most validated and widely used method for assessing radiographic progression in AS, correlating with worsening measures of disease signs and symptoms, spinal mobility and physical function, with a 2-year interval being required to ensure sufficient sensitivity to change.

8 Review Imaging in axial spondyloarthritis: Changing concepts and thresholds. 2018

Weber, Ulrich / Baraliakos, Xenofon. ·King Christian 10th Hospital for Rheumatic Diseases, Toldbodgade 3, 6300, Gråsten, Denmark; Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. Electronic address: ulrich.weber02@bluewin.ch. · Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649, Herne, Germany. Electronic address: baraliakos@me.com. ·Best Pract Res Clin Rheumatol · Pubmed #31171307.

ABSTRACT: Imaging is key to recognition of axial spondyloarthritis (SpA) because clinical and laboratory examinations have limited diagnostic utility. Only MRI can capture both inflammation and bone remodeling by simultaneous depiction of active and structural lesions and their anatomic location. Bone marrow edema of limited extent on the sacroiliac joint (SIJ) MRI is often nonspecific and should be interpreted along with the clinical context. Contextual interpretation of the SIJ lesion signature viewed simultaneously on fluid- and fat-sensitive MRI sequences enhances confidence in the recognition of disease. A critical re-appraisal of using pelvic radiographs in clinically suspected early spondyloarthritis is warranted because of substantial limitations. In health care settings with low threshold access to advanced imaging, MRI is the preferred modality in early SpA. CT has recently advanced spinal outcome research, but substantial radiation exposure in young patients with spondyloarthritis and limited evidence on its relevance in practice do not advocate its use in daily routine.

9 Review Imaging of axial spondyloarthritis. New aspects and differential diagnoses. 2018

Braun, Juergen / Baraliakos, Xenofon / Buehring, Bjoern / Kiltz, Uta / Fruth, Martin. ·Rheumazentrum Ruhrgebiet, Herne, Germany. juergen.braun@elisabethgruppe.de. · Rheumazentrum Ruhrgebiet, Herne, Germany. ·Clin Exp Rheumatol · Pubmed #30296971.

ABSTRACT: Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammatory back pain and several other disease manifestations and comorbidities. The 2009 ASAS classification criteria differentiate between the classical ankylosing spondylitis or radiographic axSpA and non-radiographic axSpA based on the presence or absence of definite radiographic changes in the sacroiliac joints. Importantly, back pain in patients with axSpA may well have reasons other than axial inflammation or new bone formation. There are several important differential diagnoses such as diffuse idiopathic skeletal hyperostosis and osteitis condensans. This review summarises recent publications concerning the performance of imaging modalities in the field, such as conventional radiography, magnetic resonance imaging, computed tomography and dual energy x-ray absorptiometry including the trabecular bone score.

10 Review Is undifferentiated spondyloarthritis a discrete entity? A debate. 2018

Deodhar, Atul / Miossec, Pierre / Baraliakos, Xenofon. ·Oregon Health & Science University, Portland, OR, USA. · University of Lyon, Lyon, France. Electronic address: miossec@univ-lyon1.fr. · Rheumazentrum Ruhrgebiet, Herne, Ruhr-University Bochum, Germany. ·Autoimmun Rev · Pubmed #29108820.

ABSTRACT: The concept of undifferentiated spondyloarthritis has been introduced recently to describe a clinical setting where the classical features of spondyloarthritis (SpA) are not fully present. Whether this is a discrete entity was the basis of a debate during the 4th International Congress on Controversies in Rheumatology & Autoimmunity held in Bologna, Italy 9-11 March 2017. The pro and con aspects of the debate are presented. The implications of the debate are important ranging from diagnostic aspects to consequences for the society and the payers.

11 Review Imaging in Axial Spondyloarthritis. 2017

Baraliakos, Xenofon. ·Rheumazentrum Ruhrgebiet, Herne, Ruhr-University Bochum, Germany. ·Isr Med Assoc J · Pubmed #29185288.

ABSTRACT: BACKGROUND: Axial spondyloarthritis (axSpA) covers the stage of non-radiographic axial spondyloarthritis (nr-axSpA) and classic ankylosing spondylitis. The pathognomonic findings of axSpA are mainly inflammatory and osteoproliferative changes in the sacroiliac joints (SIJ) and the spine. Various imaging techniques are being used in daily practice for assessment of disease-specific changes, such as periarticular bone marrow edema, erosions, sclerosis, fat metaplasia and ankylosis in the SIJ or spondylitis, spondylodiscitis, facet joint involvement, or syndesmophytes in the spine of patients with axSpA. Conventional radiographs are still considered the gold standard for assessment of structural changes, while the method of for detection of inflammatory changes is magnetic resonance imaging (MRI). A result for an MRI in the SIJ is considered positive for axSpA when more than one lesion is present on one MRI slice, If there is one lesion only, this should be present on at least two consecutive slices. For the spine, inflammatory lesions should preferably be located in the corner of the vertebral bodies, while occurrence of spondylitis in three or more vertebral corners is considered highly suggestive of axSpA. This review gives a detailed overview about the benefits and limitations of all available imaging techniques in patients with axSpA, explains the usage of imaging techniques in the context of diagnosis and differential diagnosis of the disease, and reports on the potential future trends in the area of imaging of the axial skeleton in patients who are suspicious for this diagnosis.

12 Review Causes of pain in patients with axial spondyloarthritis. 2017

Kiltz, Uta / Baraliakos, Xenofon / Regel, Andrea / Bühring, Bjoern / Braun, Juergen. ·Rheumazentrum Ruhrgebiet, Herne, Germany. uta.kiltz@elisabethgruppe.de. · Rheumazentrum Ruhrgebiet, Herne, Germany. ·Clin Exp Rheumatol · Pubmed #28967358.

ABSTRACT: Back pain, most frequently of the inflammatory type, is the leading symptom in patients with axial spondyloarthritis (axSpA). Back pain in these patients is usually either due to axial inflammation or structural changes based on new bone formation. However, there are other possible causes of pain in these patients. There is, for example, a strongly increased risk of vertebral fractures, and, especially in patients with longstanding disease, degenerative spinal changes may play an additional role as a cause of pain. Rarely, but rather specifically, patients with ankylosing spondylitis may develop subarachnoidal cysts that often cause neurologic symptoms, in extreme cases a cauda equina syndrome. It is therefore mandatory to always carefully evaluate the origin of back pain in these patients and to consider all possible differential diagnoses. The correct diagnosis is of major importance because treatments may differ considerably. In the monitoring of patients with axSpA it is especially important to consider that pain may have a different origin and it is crucial to notice changes in the nature of the reported back pain. Accordingly, the recently updated Assessment of Spondyloarthritis international Society (ASAS)/European League Against Rheumatism (EULAR) and the treat-to-target recommendations both define improvement of symptoms, a reduction of pain and abrogation of inflammation as important targets in axSpA that can be achieved by pharmacological and nonpharmacological treatments, in rare cases including surgical methods.

13 Review Ocular involvement in patients with spondyloarthritis. 2017

Bacchiega, Ana Beatriz Santos / Balbi, Gustavo Guimarães Moreira / Ochtrop, Manuella Lima Gomes / de Andrade, Francisco Assis / Levy, Roger Abramino / Baraliakos, Xenofon. ·Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ. · Commission of vascular disease, Sociedade Brasileira de Reumatologia, São Paulo. · Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. · Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany. ·Rheumatology (Oxford) · Pubmed #28340205.

ABSTRACT: Ocular inflammatory diseases can present as isolated conditions but also as part of systemic inflammatory diseases. Anterior uveitis is closely related to SpA and shares the common genetic background of HLA-B27. Other ocular manifestations, such as episcleritis and scleritis, may also occur, although less frequently. Therefore, ocular involvement has been included as one of the important clinical features of SpA in the recently published classification criteria for axial and peripheral disease. However, there are a wide variety of aetiologies for ocular diseases and this must be considered in assessment of SpA.

14 Review Imaging Scoring Methods in Axial Spondyloarthritis. 2016

Baraliakos, Xenofon / Braun, Juergen. ·Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr 45, Herne 44649, Germany. Electronic address: baraliakos@me.com. · Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr 45, Herne 44649, Germany. ·Rheum Dis Clin North Am · Pubmed #27742020.

ABSTRACT: Inflammatory and chronic structural changes are objective signs of axial spondyloarthritis. In the sacroiliac joints (SIJs), inflammation (sacroiliitis) can be visualized as bone marrow edema, whereas chronic structural changes are visualized as fat metaplasia, erosions, sclerosis, or ankylosis in the area of the SIJ. In the spine, bone marrow edema in the vertebral bodies represents spondylitis but can also affect the facet and the costovertebral and costotransverse joints (arthritis), whereas structural changes are visualized as fat metaplasia, sclerosis or syndesmophytes and ankylosis at the vertebral edges.

15 Review Secukinumab (AIN457) in the treatment of ankylosing spondylitis. 2016

Braun, Jürgen / Baraliakos, Xenofon / Kiltz, Uta. ·a Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität , Bochum , Germany. ·Expert Opin Biol Ther · Pubmed #26982813.

ABSTRACT: INTRODUCTION: Ankylosing spondylitis (AS) is a chronic immune-mediated disease characterised by inflammation and new bone formation in the axial skeleton. Current therapeutic strategies include non-steroidal anti-inflammatory drugs, local glucocorticoids and tumour necrosis factor inhibitors. However, an unmet need exists for more treatment options particularly for patients who become unresponsive to and/or cannot tolerate these medications. Interleukin (IL)-17A, a proinflammatory cytokine that plays a crucial role in the pathogenesis of AS, has emerged as a promising target in the search for new therapies. Recently, the IL-17A inhibitor secukinumab has demonstrated significant efficacy in reducing the signs and symptoms of AS. AREAS COVERED: Inhibition of IL-17A by secukinumab represents a novel therapeutic approach in the management of AS. Secukinumab selectively targets IL-17A and inhibits its interaction with the IL-17 receptor, thus inhibiting the release of proinflammatory cytokines, chemokines and mediators of tissue damage. Here we provide an overview of the pharmacology, clinical efficacy and safety of secukinumab in the treatment of AS. EXPERT OPINION: Secukinumab has shown strong efficacy and a good safety profile in several immune-mediated diseases including psoriasis, psoriatic arthritis and AS. Secukinumab recently received Food and Drug Administration (FDA) and European Union (EU) approval for the treatment of adult patients with active AS and can be expected to become an established therapy for AS over the next 5 years.

16 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.

17 Review Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. 2016

Lambert, Robert G W / Bakker, Pauline A C / van der Heijde, Désirée / Weber, Ulrich / Rudwaleit, Martin / Hermann, K G / Sieper, Joachim / Baraliakos, Xenofon / Bennett, Alex / Braun, Jürgen / Burgos-Vargas, Rubén / Dougados, Maxime / Pedersen, Susanne Juhl / Jurik, Anne Grethe / Maksymowych, Walter P / Marzo-Ortega, Helena / Østergaard, Mikkel / Poddubnyy, Denis / Reijnierse, Monique / van den Bosch, Filip / van der Horst-Bruinsma, Irene / Landewé, Robert. ·Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark South Jutland Hospital and Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark. · Endokrinologikum Berlin and Charité University Medicine, Berlin, Germany. · Department of Radiology, Charité Universitätsmedizin, Berlin, Germany. · Charité Universitätsmedizin, Berlin, Germany. · Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany. · Defence Medical Rehabilitation Centre, Surry, UK. · Department of Rheumatology, Hospital General de México and Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico. · Department of Rheumatology, Hôpital Cochin, Paris Descartes University, Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France. · Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. · Department of Radiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Ghent University Hospital, Ghent, Belgium. · Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands. · Amsterdam Rheumatology & Immunology Center, Academic Medical Center, Amsterdam, The Netherlands. ·Ann Rheum Dis · Pubmed #26768408.

ABSTRACT: OBJECTIVES: To review and update the existing definition of a positive MRI for classification of axial spondyloarthritis (SpA). METHODS: The Assessment in SpondyloArthritis International Society (ASAS) MRI working group conducted a consensus exercise to review the definition of a positive MRI for inclusion in the ASAS classification criteria of axial SpA. Existing definitions and new data relevant to the MRI diagnosis and classification of sacroiliitis and spondylitis in axial SpA, published since the ASAS definition first appeared in print in 2009, were reviewed and discussed. The precise wording of the existing definition was examined in detail and the data and a draft proposal were presented to and voted on by the ASAS membership. RESULTS: The clear presence of bone marrow oedema on MRI in subchondral bone is still considered to be the defining observation that determines the presence of active sacroiliitis. Structural damage lesions seen on MRI may contribute to a decision by the observer that inflammatory lesions are genuinely due to SpA but are not required to meet the definition. The existing definition was clarified adding guidelines and images to assist in the application of the definition. CONCLUSION: The definition of a positive MRI for classification of axial SpA should continue to primarily depend on the imaging features of 'active sacroiliitis' until more data are available regarding MRI features of structural damage in the sacroiliac joint and MRI features in the spine and their utility when used for classification purposes.

18 Review The involvement of the spine in psoriatic arthritis. 2015

Baraliakos, Xenofon / Coates, Laura C / Braun, Juergen. ·Rheumazentrum Ruhrgebiet Herne, and Ruhr-University Bochum, Germany. baraliakos@me.com. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Rheumazentrum Ruhrgebiet, Herne, and Ruhr-University Bochum, Germany. ·Clin Exp Rheumatol · Pubmed #26471338.

ABSTRACT: Although different classification criteria have been developed for psoriatic arthritis (PsA) and spondyloarthritis (SpA), a clear distinction is still not always possible in daily practice. In addition, clinical examination of patients initially diagnosed as PsA due to peripheral symptoms and skin lesions may also show inflammation in the axial skeleton causing inflammatory back pain, stiffness and changes on imaging including sacroiliitis, spondylitis and syndesmophyte formation, similar to what is known from ankylosing spondylitis (AS), the prototype of SpA. However, and in contrast to patients with AS, the long-term radiographic progression of patients with axial disease in PsA seems to be rather independent from spinal mobility. If axial symptoms predominate, diagnosis and classification can be made as axSpA - with or without psoriasis. Furthermore, also the role of HLA-B27 appears to be different in patients with PsA. Overall, the most data about axial involvement in SpA come from AS and axSpA studies, while data about the axial involvement in PsA is limited. Finally, there are no approved therapies for treatment of axial PsA at present, despite significant clinical morbidity. In recent years, anti-TNF therapies have revolutionised the management of ax-SpA. The new GRAPPA treatment recommendations have given specific management advice for patients with axial involvement based on literature from AS and axial SpA. This review aims to give an overview of the existing evidence, the clinical and imaging presentation, and therapeutic consequences of axial involvement in patients with PsA.

19 Review Monitoring ankylosing spondylitis: clinically useful markers and prediction of clinical outcomes. 2015

Braun, Juergen / Kiltz, Uta / Sarholz, Michael / Heldmann, Frank / Regel, Andrea / Baraliakos, Xenofon. ·Rheumazentrum Ruhrgebiet, Claudiusstr 45, 44649 Herne Germany. ·Expert Rev Clin Immunol · Pubmed #26048334.

ABSTRACT: Patient assessment in axial spondyloarthritis (axSpA) is multidimensional, and monitoring of disease activity, function and radiographic progression is complex. There is no simple 'gold standard' for measuring disease activity in all individual patients, as disease activity in axSpA is the sum of many different aspects and a complexity that cannot be represented by a single variable. Limited spinal mobility is a cardinal sign of ankylosing spondylitis and loss of spinal mobility has been reported to be a prognostic factor and most often evaluated with the Bath Ankylosing Spondylitis Functional Index. Imaging of the spine and assessment of safety aspects plays an important role in the monitoring of patients with axSpA. The timeframe for collecting information regarding disease activity, function and radiographic progression are recommended on an individual basis.

20 Review Emerging drugs for the treatment of axial and peripheral spondyloarthritis. 2015

Braun, Juergen / Kiltz, Uta / Heldmann, Frank / Baraliakos, Xenofon. ·Rheumazentrum Ruhrgebiet , Claudiusstr. 45, 44649 Herne , Germany +49 2325 592131 ; +49 2325592136 ; j.braun@rheumazentrum-ruhrgebiet.de. ·Expert Opin Emerg Drugs · Pubmed #25575936.

ABSTRACT: INTRODUCTION: The topic under discussion is of strong relevance to the field of spondyloarthritis (SpA) because, in addition to established biological, there are new promising compounds. The reason for the review is to put all available data together to allow for an overview on recent developments and to especially inform readers about emerging drugs, biologics and small molecules in the field of SpA. AREAS COVERED: This review on new therapies in axial and peripheral SpA comprising psoriatic arthritis (PsA) shows, that, in addition to the established anti-TNF agents infliximab, etanercept, adalimumab, golimumab, certolizumab and the first biosimilar approved in the EU, there are at least two emerging biologics in the field of SpA: ustekinumab, a compound targeting IL12/IL-23 via the p40 subunit of both cytokines works for psoriasis and PsA and probably also for Crohn's disease, and the anti-IL-17 antibody secukinumab which has also been shown to work in psoriasis, both compounds seem to also work in ankylosing spondylitis. In addition, the potential of two small molecules, apremilast a phoshodiesterase4 inhibitor and tofacitinib, a januskinase inhibitor is discussed. EXPERT OPINION: Since, in contrast to rheumatoid arthritis, the therapeutic array in SpA is currently limited to TNF-blockers, and since there is still an unmet need because some patients do not respond to anti-TNF therapy at all or they loose response, new agents with a different mechanism of action are eagerly awaited.

21 Review Classification and diagnosis of axial spondyloarthritis--what is the clinically relevant difference? 2015

Braun, Jurgen / Baraliakos, Xenofon / Kiltz, Uta / Heldmann, Frank / Sieper, Joachim. ·From the Rheumazentrum Ruhrgebiet, Herne; Rheumatologie, Universitätsmedizin Charité, Berlin, Germany.J. Braun, MD, Professor; X. Baraliakos, MD; U. Klitz, MD; F. Heldmann, MD; Rheumazentrum Ruhrgebiet; J. Sieper, MD, Professor, Rheumatologie, Universitätsmedizin Charité. ·J Rheumatol · Pubmed #25399389.

ABSTRACT: OBJECTIVE: The Assessment of Spondyloarthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA) have added nonradiographic axSpA (nr-axSpA) to the classic ankylosing spondylitis (AS) as defined by the modified New York criteria. However, some confusion remains about differences between classification and diagnosis of axSpA. Our objective was to analyze differences between classification and diagnostic criteria by discussing each feature of the classification criteria based on real cases. METHODS: The clinical features of the ASAS classification criteria were evaluated in relation to their significance for an expert diagnosis of axSpA. Twenty cases referred to our tertiary center outpatient clinic were selected because of an incorrect diagnosis of axSpA: 10 cases in which axSpA had been excluded initially because the classification criteria were not fulfilled, and 10 patients who had been previously diagnosed with axSpA because the classification criteria were fulfilled. Upon reevaluation, the former were diagnosed with axSpA while the latter had other diseases. RESULTS: All items that are part of the classification criteria show some variability related to their relevance for a diagnosis of axSpA. There are clinical features suggestive of axSpA that are not part of the classification criteria. Misinterpretation of imaging procedures contributed to false-positive results. Rarely, other diseases may mimic axSpA. CONCLUSION: Because the sensitivity and specificity of the axSpA classification criteria have been around 80% in clinical trials, some false-positive and false-negative cases were expected. It is hoped that their detailed description and discussion will help to increase the understanding of diagnosing axSpA in relation to the ASAS classification criteria.

22 Review The contribution of imaging in the diagnosis and treatment of axial spondyloarthritis. 2015

Baraliakos, Xenofon. ·Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany. ·Eur J Clin Invest · Pubmed #25376099.

ABSTRACT: BACKGROUND: The concept of axial Spondyloarthritis (axSpA) includes patients with non-radiographic axSpA and ankylosing spondylitis (AS). Inflammatory and chronic/structural changes of the sacroiliac joints and the spine are pathognomonic in patients who are diagnosed with axSpA. MATERIALS AND METHODS: In the last years, the evaluation of the natural course of axSpA has been in the focus of research, especially with respect to the relationship between inflammation or postinflammatory changes [detected by magnetic resonance imaging (MRI)] and bone formation (detected by conventional radiographs). RESULTS: Based on the analysis of spinal MRI data, development of new syndesmophytes is directly associated with the parallel occurrence of inflammatory and postinflammatory (fatty) changes in the edges of the vertebral bodies. In contrast, vertebral edges that show only inflammation but no transformation into fatty lesions show a decreased relative risk for development of new bone formation over time. An inhibitory effect on radiographic progression had not been demonstrated during the first 2 years of continuous anti-TNFa treatment, however, very recently first studies reported a decreased rate of radiographic progression when patients were continuously treated with TNFa-blockers for a time period of ≥4 years. CONCLUSIONS: These data are crucial in the understanding of the long-term clinical course of patients with axSpAin daily practice. According to these results, it becomes obvious that anti-inflammatory treatment, especially by using tumor-necrosis-factor alpha (TNFa)-blockers, has the best effect on the radiographic outcomes when it is started in anearly disease stage, where only inflammation is driving the disease activity and where structural, postinflammatory changes have not yet occurred.

23 Review Tumor necrosis factor alpha antagonists in the treatment of axial spondyloarthritis. 2014

Braun, Juergen / Baraliakos, Xenofon / Heldmann, Frank / Kiltz, Uta. ·Rheumazentrum Ruhrgebiet , Landgrafenstr. 15, 44652 Herne , Germany +49 2325 592 131 ; + 49 2325 592 136 ; braun@elisabethgruppe.de. ·Expert Opin Investig Drugs · Pubmed #24654630.

ABSTRACT: INTRODUCTION: The introduction of therapy with tumor necrosis factor antagonists (aTNF) was a cornerstone of treatment modalities in patients with ankylosing spondylitis (AS). After > 10 years of using aTNF, the introduction of aTNF therapy was a major step forward in the medical management of patients with spondyloarthritis (SpA), but there are still a number of scientific questions that have not been resolved. AREAS COVERED: This review includes both subtypes of axial spondyloarthritis (axSpA), non-radiographic axial SpA (nr-axSpA), and AS. It covers all five aTNF adalimumab, certolizumab, etanercept, golimumab, and infliximab, which are approved for patients with active AS. EXPERT OPINION: aTNF are efficacious and effective in reducing signs and symptoms of patients with axSpA. While aTNF reduce spinal inflammation, the effects on new bone formation are less clear. There may be a deceleration of radiographic progression in 4 years. The development of fatty lesions in vertebral edges seems to be relevant for that - especially when inflammation also persists. Reduction of aTNF doses seems to be possible in selected patients over time. In case of failure, switching to another aTNF works in the majority of cases. Long-term data suggest a favorable safety profile of aTNF.

24 Review Withdrawal of biologic therapy in axial spondyloarthritis: the experience in established disease. 2013

Baraliakos, Xenofon / Kiltz, Uta / Heldmann, Frank / Sieper, Joachim / Braun, Jürgen. ·Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany. ·Clin Exp Rheumatol · Pubmed #24129136.

ABSTRACT: Treatment of patients suffering from active ankylosing spondylitis (AS) with TNFα blockers, has been shown to result in clinically significant improvement of signs and symptoms of the disease. Long-term extension studies with these agents have shown sustained clinical efficacy for up to 10 years in patients who continued treatment. However, only a few studies have examined whether reduction of dosage of discontinuation of anti-TNF therapy is possible. In daily clinical practice, prolongation of treatment intervals is frequently tried in patients who are in clinical remission for longer periods of time, but no data on the success of that are available. Discontinuation of treatment is usually needed in patients who want to become pregnant, and in patients with severe infections. This review summarises what is known on the topic of discontinuation of biologic treatment in patients with AS.

25 Review Opinion: Perspectives on imaging in axial spondyloarthritis. 2013

Baraliakos, Xenofon / Braun, Jürgen. ·Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Landgrafenstrasse 15, 44652 Herne, Germany. baraliakos@me.com ·Nat Rev Rheumatol · Pubmed #23774899.

ABSTRACT: The diagnosis of axial spondyloarthritis (axSpA) is based on detection of characteristic inflammatory or structural changes (or a combination of both) in the spine and sacroiliac joints. Imaging of the axial skeleton is, therefore, useful for the identification of these pathological changes. Both inflammation (best detected by MRI) and bone formation (best visualized by conventional radiography) can predict the development of future structural changes. In addition, a high degree of spinal inflammation on MRI is predictive of a successful response to anti-TNF therapy. Emerging data indicate that the combination of acute and chronic changes on MRI has an important influence on progression of nonradiographic axSpA to ankylosing spondylitis. This Perspectives article provides an overview of the role of imaging in the diagnosis and management of axSpA, and also discusses open questions and future perspectives in this field.