Annual updates: SpA and PsA SPARCC
Vinod Chandran
27 May 2013
Learning Objectives
• To understand the utility of a spondyloarthritis
database
• Review results of studies conducted using the
database
2
Disclosures
• Honoraria:
• Abbott/Abbvie, Amgen, Bristol-Myers Squibb,
Celgene, Janssen, Pfizer
• Advisory Board:
• Abbott/Abbvie, Amgen, Celgene, Janssen, Pfizer
• Research Grants:
• Abbvie
Spondyloarthritis
A group of inflammatory rheumatic diseases with the
following common features:
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peripheral as well as axial arthritis
radiological sacroiliitis
mucosal and skin inflammation
tendency for familial aggregation
absence of rheumatoid factors
absence of subcutaneous nodules
Ann Rheum Dis 2011;70:1-3.
A trans-disciplinary national research program
focusing on Genetic and Pathogenesis Studies
and Outcome Measures for Patients with SpA
Established 2003
Funded by The Arthritis Society National Research
Initiative Grant 2006-2010
The SPARCC Executive Committee
SPARCC Objectives
Overall Objective
• To improve the health of SpA patients in Canada by
better defining, diagnosing, and predicting the
course of AS and PsA
The three objectives and key elements of the
SPARCC research network are
• Improved understanding of the biological basis
of SpA
• Improved clinical outcomes in SpA
• Improved assessment of the impact of SpA in
Canada.
SPARCC Research
Areas of focus
•Cohort expansion and detailed longitudinal
follow up
•Identification and validation of biomarkers
•Development of personalized treatments
•Development of strategies for early detection
•Development of tools and techniques for best
practices for clinicians
SPARCC Achievements
•Advances in
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Genetics and Outcome Measures
Unique Populations
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juvenile SpA
First Nations population
Access to Care
Social Role Participation measuring the impact of SpA
on quality of life
Knowledge Transfer and Exchange
•Establishment of a common clinical database
•Partnership with the Canadian Spondylitis
Association (CSA)
SPARCC Database
Site
AS
PsA
nXR
ReA
USpA
Total
Toronto
657
1257
40
27
128
2109
St. John’s
233
528
0
0
0
761
Edmonton
836
0
0
0
0
836
Montreal
54
76
0
2
11
143
Winnipeg
39
0
0
0
0
39
Saskatoon
14
13
1
4
3
35
London
46
50
0
0
0
96
Newmarket
53
12
11
0
0
76
1932
1936
52
33
142
4095
Total
AS=ankylosing spondylitis; PsA=psoriatic arthritis; nXR=non-radiographic AS;
ReA=reactive arthritis; USpA=undifferentiated Spondyloarthritis.
SPARCC Database
Demographics
Disease
No.
Age Dx
F/M(%)
% Caucasian
% HLA-B27+
AS
1096 31.2 28 / 72
87
80.7
PsA
1933 37.9 46 / 54
89
43.5
nXR
52
33.7 60 / 40
92
56.3
ReA
33
35.8 45 / 55
91
73.5
USpA
142
29.9 38 / 62
85
60.1
SPARCC Database
Extra-articular features at 1st Visit
Disease
% Uveitis
% Ps vulgaris
PASI
% Nail
AS
6.1
5.3
0.9
8.7
PsA
0.4
78.0
5.4
63.5
nXR
0
7.3
4.4
8.6
ReA
3.2
8.7
0.4
5.9
0
2.9
0.2
2.5
USpA
SPARCC Database
Co-morbid conditions
Disease
% Cardiac
% Diabetes
% Cancer
% Trauma
% Infection
AS
19.1
2.9
2.4
13.8
16.0
PsA
36.9
8.2
5.9
15.1
17.2
nXR
17.0
3.8
1.9
12.2
15.7
ReA
15.0
2.5
0
6.3
63.9
USpA
15.4
3.7
2.5
5.6
20.4
SPARCC Database
Medication Use 1st Visit
Disease
% NSAIDs
% DMARDs
% Biologics
AS
71
27
26
PsA
79
55
11
nXR
77
15
13
ReA
51
40
10
USpA
60
30
12
SPARCC Achievements
Advances in Genetics
• AS
• IL-1 gene cluster, IL-23R, and ERAP-1
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Functional implications of ERAP1
• GWAS and meta-analysis underway
• Immunochip analysis with IGAS consortium
• CNV analysis
•
UGT2B17 gene CNV
• Exome sequencing
• PsA
• HLA-Cw6/MICA/TNF-α/KIR alleles,
IL-1 gene cluster, IL-23R
• GWAS and meta-analysis underway
• ReA
• TLR2
Ann Rheum Dis 2008;67:1305-9.
Arthritis Rheum 2008;58:1020-5.
Arthritis Rheum 2009;60:1317-23.
Ann Rheum Dis 2010;69:297-300.
J Rheumatol 2009;36:137-40.
Arthritis Rheum 2008;58:3436-8.
SPARCC Achievements
Advances in Biomarkers
• Multiplex assay of a panel of 58 biomarkers in AS:
• identification of high priority candidates for prediction of
structural damage
• Osteocalcin and RANTES higher in AS
• Progressor subgroup:
• MMP-9, TGFα, TNFα elevated
• Non-progressor subgroup:
• eotaxin, IFNα-2, and MCP-3 elevated
Arthritis Rheum 63(10suppl):S644, 2011.
SPARCC Achievements
Advances in Outcome Measures
• INSPIRE study
• MRI
• SPARCC MRI scoring system
• Impact
• Social Role Participation Questionnaire
• Work Instability
J Rheumatol 2007;34:1740-5.
J Rheumatol 2007;34:1733-9.
Arthritis Rheum2007;57:501-7.
Ann Rheum Dis 2011;70:1765-9.
Arthritis Rheum 2012;64(Suppl 10):S 595-6
SPARCC Achievements
Advances in Unique Populations
• Paediatric Populations
• Validation of outcome measures used in adult SpA
in Juvenile SpA
• Whole-body MRI
• First Nations
• Access to effective therapeutics amongst SpA
patients from the First Nations peoples in British
Columbia
SPARCC Achievements
Advances in Access to Care & Guidelines of SPARCC/CRA
• The CRA/SPARCC Treatment Recommendations
for the Management of Spondyloarthritis: A
National Multidisciplinary Stakeholder Project
J Rheumatol 2007;34:2273-84.
SPARCC Achievements
Advances in Knowledge Transfer and Exchange
• Handbook for physicians entitled
• Ankylosing Spondylitis: Assessment Scores,
Classification and Diagnostic Criteria
• Public Symposia on SpA in collaboration with the
Canadian Spondylitis Association
• Web videos (sparcc.ca )
• Spinal mobility measurements
• Video archive of all the public patient fora
• Annual Fellows training day
Future Direction
• Longitudinal changes in SpA
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predictors for progression of joint damage
Compare differences among SpA over time
Compare quality of life and function among different SpA
Comparison amongst different regions of Canada
Gender effect on disease progression
Drug Response
Economic impact
Co-morbidities
Imaging
Access to Care
Predictive profiles of radiographic progression: Serum biomarker
analysis
• SpA in children (novel markers for prognosis and activity)
• SpA in First Nations (prevalence, genetic susceptibility, care gaps)
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Summary
• Spondyloarthritis not well studied in
North America
• SPARCC developed to address need
• SPARCC has made important new
observations in SpA and has a significant
international profile
• SPARCC will continue to further research,
advocacy and education in SpA