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Objective: To evaluate the 12-month efficacy and safety profile of adalimumab and etanercept in patients with ankylosing spondylitis (AS) and total spinal ankylosis (TSA)., Type of Study Design: Case-series follow-up study., Design: Twenty-eight patients (26 men and 2 women) with active AS (BASDAI > 4) and TSA were treated as follows: 19 patients receiving adalimumab and 9 patients receiving etanercept. Twelve-month data related to the efficacy and safety of these two TNF-alpha inhibitors were evaluated. The primary endpoint was ASAS 20 (the ASsessment in AS International Working Group criteria for 20% improvement) at weeks 12 and 52. Other measures that were evaluated were function (BASFI), disease activity (BASDAI), patient's and physician's global disease assessment on visual analogue scale (VAS) and C-reactive protein., Results: In both adalimumab and etanercept groups, there was a significant improvement in all observed variables (baseline compared to weeks 12 and 52). This improvement was sustained for the whole follow-up period. In the adalimumab group, at week 12, ASAS 20 was achieved in 18/19 patients and at week 52 in 17/19 patients. In the etanercept group, at week 12 ASAS 20 was achieved in all patients and at week 52 in 6/9 patients., Conclusion: In patients with active AS and TSA, adalimumab and etanercept treatment showed significant improvement in function and disease activity. No serious side effects or adverse effects were observed in our cohort. Key Points • TNF-alpha inhibitors can be effective treatment options for patients with AS and having total spinal ankylosis. • Patients with advanced AS should not be disregarded as good candidates for treatment with biologic disease-modifying antirheumatic drugs., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Objective: To describe the development of an Environmental contextual factors (EF) Item Set (EFIS) accompanying the disease specific Assessment of SpondyloArthritis international Society Health Index (ASAS HI)., Method: First, a candidate item pool was developed by linking items from existing questionnaires to 13 EF previously selected for the International Classification of Functioning, Disability and Health (ICF) /ASAS Core Set. Second, using data from two international surveys, which contained the EF item pool as well as the items from the ASAS HI, the number of EF items was reduced based on the correlation between the item and the ASAS HI sum score combined with expert opinion. Third, the final English EFIS was translated into 15 languages and cross-culturally validated., Results: The initial item pool contained 53 EF addressing four ICF EF chapters: products and technology (e1), support and relationship (e3), attitudes (e4) and health services (e5). Based on 1754 responses of axial spondyloarthritis patients in an international survey, 44 of 53 initial items were removed based on low correlations to the ASAS HI or redundancy combined with expert opinion. Nine items of the initial item pool (range correlation 0.21-0.49) form the final EFIS. The EFIS was translated into 15 languages and field tested in 24 countries., Conclusions: An EFIS is available complementing the ASAS HI and helps to interpret the ASAS HI results by gaining an understanding of the interaction between a health condition and contextual factors. The EFIS emphasizes the importance of support and relationships, as well as attitudes of the patient and health services in relation to self-reported health., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Golimumab is a human monoclonal antibody which inhibits tumor necrosis factor-alpha (TNF-α) and is approved for the treatment of inflammatory arthritides (rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis) when the conventional non-pharmacological and pharmacological therapies fail to cause remission or low disease activity. In this retrospective study there were included patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis who were treated in Croatia with golimumab, from June 2011 to June 2013. included and these retrospective data are compared with similar data from clinical trials and other available databases. Standard variables of disease activity and functional ability were observed. Results demonstrated significant efficacy of golimumab regarding lowring the disease activity and imrpving functional ability in pateints with these inflammatory rherumatic disease. In conclusion, in this retrospective study during two years treatment golimumab showed efficacy in decreasing disease activity and imrpove functional ability in patiemts with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

To determine the correlation between the bone mineral density (BMD) and spinal mobility and chest expansion index in patients with ankylosing spondylitis. Eighty patients with confirmed diagnosis of ankylosing spondylitis were included in this study. In all of them physical examination was performed including assessment of spinal mobility and chest expansion index. Bone mineral density of the lumbar spine (L1-L4, anteroposterior view) and at the left hip was measured by dual X-ray absorptiometry (DXA) in standard manner According to the WHO classification of osteoporosis, patients were classified in three groups (normal, osteopenic or osteoporotic) depending on the osteoporotic status in lumbar spine, hip and femoral neck region. Eighty patients (46 men and 34 women; age 25-73 years) were included. Mean BMD for lumbar spine was 1.104 +/- 1.043 (T score: 0.67 +/- 2.15) and for total hip was 1.057 +/- 0.899 (T score: -0.28 +/- 2.34). Significant difference in the mobility of thoracic spine was observed in patients in regard to the WHO classification of osteoporosis in lumbar and femoral region (p = 0.031, Oneway Anova for osteoporosis of lumbar region; p = 0.022, Oneway Anova for osteoporosis of total hip region). Mean value for the chest expansion index was 3.07 +/- 1.66 cm. Chest expansion index was significantly reduced in patients having osteoporosis in lumbar and total hip region (p = 0.015, Oneway Anova for osteoporosis of lumbar region; p = 0.038, Oneway Anova for osteoporosis of total hip region). The observation that reduced mobility of thoracic and lumbar spine and chest expansion index occured in patients with low BMD in lumbar and total hip region suggest that osteoporosis should be monitored more frequently in patients with AS.

In ankylosing spondylitis, inflammatory activity probably plays a key role in the pathophysiology of bone loss. The aim of the study was to investigate the relationship of bone mineral density (BMD) at the lumbar spine and hip region with some measures of disease activity and functional ability in patients with ankylosing spondylitis. In 80 patients with established ankylosing spondylitis, disease activity and functional ability were determined by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal pain and patient global health were assessed using horizontal visual analog scale. BMD was measured by dual-energy X-ray absorptiometry. There was a significant negative correlation of bone density T scores with acute-phase reactants (i.e., patients with lower T scores had higher level of CRP and ESR). That relationship was reflected more reliably at proximal femur sites than at the lumbar spine. There were also significant differences in ESR, BASDAI, BASFI, spinal pain and global health between three groups of patients according to WHO classification of osteoporosis (normal, osteopenic and osteoporotic). Significantly, more patients with osteopenia at the lumbar spine had lower BASDAI index than those with normal BMD (P = 0.030). Our results indicate an association of low BMD with high disease activity in patients with AS. Femoral BMD seems to be more associated with disease activity and functional ability than lumbar spine BMD.

The aim of the study was to investigate the reliability and the validity of the Croatian version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity index (BASDAI) in patients with ankylosing spondylitis (AS). Patients with established diagnosis of AS participated in the study. Fifty-two and 48 patients were included for the evaluation of BASFI and BASDAI, respectively. For translation international translation steps were followed. For reliability patients recompleted both indices on the following day. To assess validity following parameters were obtained: spinal mobility in sagittal plane, chest expansion index, erythrocyte sedimentation rate, serum C-reactive protein, level of pain and patient's global health. Apart from descriptive statistics Spearman's rho coefficient was used. Correlation between BASFI and BASDAI score was 0.621. The mean BASFI scores on two occasions (within 24 hours) were 4.82 +/- 2.67 versus 4.88 +/- 2.52 (r = 0.961; p < 0.01), and for BASDAI scores were 5.46 +/- 2.30 versus 5.32 +/- 2.19, respectively (r = 0.959; p < 0.01). Stability index for both indices was 0.98. High correlation was found for each repeated question of BASFI and BASDAI. For both indices congruent validity demonstrated the best correlation with cervical and thoracic mobility. Also, the correlation was observed for BASFI with spinal mobility in lumbar region and with chest expansion index, and for BASDAI with the level of pain. Our findings indicate that Croatian version ofBASFI and BASDAI is reliable and valid. Therefore, it can be used in clinical research as well as in clinical practice.

Ankylosing spondylitis is a chronic inflammatory rheumatic disease that primarily affects the sacroiliac joints and spine, although it may involve entheses, peripheral joints and extraarticular organs. Disease treatment is directed toward the suppression of the inflammatory process and the improvement of the musculoskeletal system function. There are several treatment modalities: education of the patient and members of the family, pharmacological treatment, physical therapy and, in some cases, surgical treatment. An important segment of various modalities of physical therapy belongs to kinesitherapy, sports and recreation whose duration and intensity largely depends not only on the actual functional impairments, but also on the presence of some other disease or contraindications. Kinesitherapy is directed toward maintenance and improvement of the function of the spine, thoracic cavity and large synovial joints as well as the prevention of deformities or contractures. Kinesitherapy and sports programmes may involve individual or group approach. Patients are encouraged to participate in sports activities that may imitate or substitute specific forms of exercises.

Purpose: To evaluate the symphyseal changes in patients with ankylosing spondylitis., Material and Methods: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years., Results and Conclusion: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphsis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.

The aim of the study was to establish the employment and working ability for patients with ankylosing spondylitis. The study was performed using a questionnaire mailed to 185 patients with verified diagnosis of ankylosing spondylitis who were treated at the Department of Rheumatology of the University Hospital "Sestre milosrdnice" in Zagreb in the last 5 years. The questionnaire included a few categories of questions and here we analysed those referring the working abilities. The answers were obtained from 92 patients. We took in account the data for 79 patients who fall into the age group of working population (men to 65 yrs, women to 60 yrs.). In that group there were 50 men and 29 women. Twenty-six patients have a full time job, 7 patients have a part-time job, one changed the job and 45 of them are retired. The difference of working abilities was observed regarding to the physical requirement for the job (P < 0.05) and the duration of the disease (P < 0.05). Among the patients who are retired majority stated that ankylosing spondylitis was the cause of their retirement. As for the patients who still work (N = 34), 14 of them were not on sick-leave the last year at all, 2 of them were absent up to one week, 10 patients were absent from 1 to 4 weeks, 3 patients were on sick-leave from 1 to 3 months, and 5 of them more than 3 months. Statistically significant difference was observed in sick-leave rate regarding to the physical requirements for the job (P < 0.01), but not regarding to the duration of the disease (P > 0.05). The results of our study suggest that ankylosing spondylitis reduce the working ability especially for patients who have a hard job. There is an imperative to maintain the working abilities of patients with ankylosing spondylitis as long as possible.

The aim of the study was to establish some clinical features of ankylosing spondylitis in an epidemiological study using a mailed questionnaire. The questionnaire was sent to 185 patients with ankylosing spondylitis who were treated at the Department for Physical Medicine, Rehabilitation and Rheumatology. The answers were obtained from 92 patients (49.7%). In the studied cohort there were 60 men and 32 women. The average age of all patients were 51.6 +/- 11.8 yrs. In most of the patients (69 or 75%) the duration of ankylosing spondylitis is more than 15 years. The diagnosis of ankylosing spondylitis was established on average 6.5 years after the beginning of symptoms. Patients suffering from ankylosing spondylitis more than 15 years reported that the worst period of the disease was the starting 10 years. The main symptoms of the disease are stiffness and pain. The aggravation of pain occurs with enhanced physical activity as well as with prolonged rest--Painful swelling of one or more joints of 3 weeks duration had 63.7%, and more than 3 weeks duration 40.7% patients. There was no difference in occurrence of painful swelling extravertebral joints regarding to duration of the disease (P > 0.05). The most often affected joints were hips and shoulders. Eyes inflammation was reported by 63 patients, and unspecified enterocolitis had 16 patients.