Disease control in patients with ankylosing spondylitis in real clinical practice in Spain: Results of the MIDAS study

Introduction and objectivesUnderstanding the disease activity is fundamental to improve patient prognosis and patients’ quality of life. MiDAS study described disease activity in ankylosing spondylitis (AS) Spanish patients and the proportion of them with controlled disease.MethodsObservational, cross-sectional, multicenter study carried out under conditions of routine clinical practice. Adult (≥18 years) patients with ≥6 months since AS diagnosis treated ≥3 months prior to inclusion. The primary endpoint was the percentage of patients with low disease activity assessed through BASDAI (primary endpoint) and ASDAS-CRP (secondary endpoint).Results313 AS patients included: 75.7% male; 78.5% HLA-B*27 positive; mean (SD) baseline age of 50.4 (12.0) years; mean (SD) disease duration of 15.5 (11.6) years; 73.5% were treated with biological disease-modifying antirheumatic drugs (DMARDs), 22.4% with non-biological DMARDs and 53.7% with non-steroidal anti-inflammatory drugs, alone or in combination. Monotherapy with biologics and non-biologics was used by 29.7% and 26.8% of patients, respectively. According to BASDAI, 38.0% were in remission (BASDAI ≤ 2) and 64.5% showed adequate disease control (BASDAI < 4). According to ASDAS-CRP, 29.4% achieved remission (ASDAS-CRP < 1.3) and 28.1% low disease activity (1.3 ≤ ASDAS-CRP < 2.1).ConclusionsAlmost two thirds of the AS patients recruited had low disease activity, with about one third of them being in remission (BASDAI ≤ 2, ASDAS-CRP < 1.3). These results highlight the existing room for improvement in treating AS patients in clinical practice.     

病情活动性指标ASDAS、RAPID3和BASDAI在判断强直性脊柱炎患者疾病活动度中的比较

目的 研究ASDAS和RAPID3对强直性脊柱炎(ankylosing spondylitis,AS)患者疾病活动度的判断价值。 方法 对82例AS患者进行问卷调查,统计其一般情况、病情活动度指标,抽取静脉血测定红细胞沉降率(erythrocyte sedimentation rate,ESR)和C反应蛋白(C-reactive protein,CRP)水平。通过相关性分析、kappa一致性检验比较传统方法Bath强直性脊柱炎病情活动性指数(BASDAI)与新型方法ASDAS、RAPID3对疾病活动度的评估价值。 结果 ASDAS-CRP与RAPID3具有较好的一致性(kappa值: 0.788),而这两者与BASDAI的一致性检验结果不理想(kappa值: 0.342, 0.367)。BASDAI、ASDAS、RAPID3与医生总体评价(DOCGL)、患者自身评价(PATGL)均具有良好的相关性,其中ASDAS、RAPID3与DOCGL、PATGL的相关性明显强于BASDAI与DOCGL、PATGL的相关性(ASDAS-CRP、ASDAS-ESR、RAPID3、BASDAI与DOCGL的相关性分析r值分别为0.684、0.720、0.642及0.576;与PATGL的相关性分析r值分别为0.822、0.816、0.851及0.725)。 结论 ASDAS对AS疾病活动的评估能力优于BASDAI,是理想的评价疾病活动度的新指标,值得推广应用;RAPID3具有方便、简洁、不受实验室检查结果限制的特点,在评价AS活动度时同样具有良好的可靠性及有效性。     

High prevalence of hidradenitis suppurativa symptoms in axial spondyloarthritis patients: A possible new extra-articular manifestation

Background

Spondyloarthritis (SpA), a chronic inflammatory, rheumatic disease, and hidradenitis suppurativa (HS), a chronic, debilitating, inflammatory skin disease, share several clinical and pathophysiological features, such as the association with inflammatory bowel disease and elevated cytokine levels IL-17 and TNF-α. Recently, SpA was reported to be more prevalent (2.3–28.2%) in patients with HS than in the general population. Conversely, the prevalence of HS in SpA is not exactly known.

Prevalence of Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease in a cohort of patients treated with TNF-alpha inhibitors

Background: Treat to target (T2T), aiming at inactive disease (ID), has become the recommended strategy for axial-SpA (ax-SpA). Using the Ankylosing Spondylitis Disease Activity Score (ASDAS), we assessed the prevalence of ID in ax-SpA patients treated with TNFα inhibitors (TNFi).

Methods: A multicentric, cross-sectional study was performed assessing disease activity status (BASDAI and ASDAS) of consecutive patients with ax-SpA on stable treatment with TNFi for at least six months. We analyzed differences with nonradiographic axSpA (nr-ax-SpA) and the influence of population characteristics and comorbidities in reaching ID. ID was defined as ASDAS-CRP <1.3.

Results: A total of 218 patients were enrolled, 165 with AS and 53 with nr-ax-SpA. ASDAS-CRP ID was reached by 89 (40.8%) patients, while 163 (74.8%) of patients achieved good disease control with BASDAI. There were no significant differences between the two diagnostic groups. Multivariate logistic regression demonstrated a negative correlation of concomitant fibromyalgia, higher BASMI and current NSAIDs with the chances of reaching ASDAS-CRP ID or BASDAI <4.

Conclusion: T2T represents a new challenge in the management of ax-SpA, with recently introduced disease activity measures being significantly more stringent. The prevalence of ID was affected by concomitant fibromyalgia, decreased spine mobility and concomitant NSAIDs.     

Performance of the Ankylosing Spondylitis Disease Activity Score based on a quick quantitative C-reactive protein assay in patients with axial spondyloarthritis

ObjectivesTo evaluate the performance of the Ankylosing Spondylitis Disease Activity Score based on a validated quick quantitative C-reactive protein assay (ASDAS-qCRP) as compared to ASDAS based on a routine lab CRP assay (ASDAS-CRP) and ASDAS based on erythrocyte sedimentation rate (ASDAS-ESR).MethodsDisease activity assessment was performed in 50 patients with axial spondyloarthritis (axSpA). Routine lab CRP was measured in the central lab while the quantitative quick-CRP assay and ESR measurements were performed locally. ASDAS-CRP, ASDAS-qCRP and ASDAS-ESR were subsequently calculated.ResultsThe mean (± SD) serum level of the routine lab CRP (6.2 ± 8.3 mg/l) was lower than of the quick-CRP (7.4 ± 8.4 mg/l) (P < 0.05). Whereat, there was no significant difference in the mean values of ASDAS-CRP and ASDAS-qCRP in axSpA patients (2.70 ± 0.94 and 2.74 ± 0.96, respectively, P = 0.069), while the ASDAS-ESR (2.85 ± 1.0) was significantly higher than ASDAS-CRP (P = 0.036) and numerically higher than ASDAS-qCRP (P = 0.125). In 47 of the 50 cases of axSpA (94%), patients were assigned to the same disease activity category according to ASDAS-CRP and ASDAS-qCRP.ConclusionsASDAS-qCRP performed similarly well compared to ASDAS-CRP with the absolute agreement on the disease activity category according to the ASDAS of 94%. ASDAS-qCRP is, therefore, feasible for an immediate decision-making in clinical practice and trials aimed at treating to target.     

Health related quality of life (HRQoL) in ankylosing spondylitis patients: Relation to clinical features,disease activity and radiographic damage

Aim of the workTo assess health-related quality of life (HRQoL) and associated variables in Egyptian ankylosing spondylitis (AS) patients.Patients and methods50 male patients with AS and 50 age-matched controls were enrolled. Clinical and laboratory data were examined including history for peripheral arthritis. Visual analog scale (VAS), Bath AS disease activity index (BASDAI), AS disease activity score (ASDAS)-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR), Bath AS functional index (BASFI), Bath AS metrology index (BASMI) and AS quality of life (ASQoL). Spinal radiographs were graded by the modified Stoke AS spinal score (mSASSS).ResultsThe mean age of the patients was 33.1 ± 7.4 years and disease duration of 6.8 ± 3.1 years. The mean ASQoL score in patients was significantly higher (9.4 ± 3.8; 3–15) compared to the control. 26 (52%) patients had peripheral arthritis. Of these, 17 (65.4%) had hip involvement, 6 (23.1%) had knee, 5 (19.2%) had shoulder affection and 3 (11.5%) had ankle joint involvement. Patients with peripheral joint involvement had significantly higher ASQoL score than those without (11.4 ± 3.1 and 7.3 ± 3.4 respectively, p < 0.001). ASQoL significantly correlated with BASMI (p = 0.048), BASFI (p = 0.02), BASDAI (p = 0.01), ASDAS.CRP (p = 0.02) and ASDAS.ESR (p = 0.01). The multiple regression analysis to identify the independent variables associated with the ASQoL showed a significant association with peripheral joint involvement, BASDAI, ASDAS.ESR, ASDAS.CRP and BASFI scores.ConclusionAS is a chronic inflammatory disease that affects HRQoL especially with higher disease activity, functional disability, more peripheral joint involvement and lesser spinal mobility in Egyptian patients.     

Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis

Objectives: To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS). Methods: Patients consecutively included into the joint database of five university hospitals were analyzed for low or high disease activity according to different criteria. Standardized mean differences (SMD) for two ASDAS versions were evaluated. Results: The ASDAS versions (back pain, morning stiffness, patient global pain, pain/swelling of peripheral joints, plus either erythrocyte sedimentation rate or C‐reactive protein) discriminated high and low disease activity in subgroups according to Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and ASAS remission/partial remission criteria. ASDAS versions were also not influenced by peripheral arthritis and correlated well with other outcome measurements and acute‐phase reactants. The ASDAS versions performed better than patient‐reported measures or acute‐phase reactants discriminating high and low disease activity status. Conclusion: Both ASDAS versions, consisting of both patient‐reported data and acute‐phase reactants, performed well in discriminating low and high disease activity. Further longitudinal data may better estimate the usefulness of ASDAS to assess disease activity subgroups and treatment response.     

Spondyloarthritis and smoking: towards a new insight into the disease

In spondyloarthritis, smoking was found in several studies from the literature to be associated with earlier onset, more severe disease in activity, function, quality of life and imaging (inflammatory and structural lesions), sometimes in a dose-dependent manner. Smoking is also associated with elevated inflammatory biologic parameters (e.g., C-reactive protein). Periodontitis, associated with smoking, is more frequent in patients with ankylosing spondylitis as compared with controls. This periodontal disease may favor citrullination, as in rheumatoid arthritis. Citrullinated vimentin has been demonstrated to be associated with radiographic damage. In this line, smoking was found to be associated with matrix metalloproteinase levels, which is also a predictive factor for spinal radiographic progression. Finally, smoking has a negative influence on bronchopulmonary and cardiovascular outcomes, already impaired by the disease itself. Smoking represents a target for therapeutic impact and disease modification in spondyloarthritis.