Search

Abstract Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population.

Abstract Background Secukinumab has shown high efficacy in randomized controlled trials in both ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Here, we investigated its real-life effectiveness and tolerability in a cohort of AS and PsA patients. Methods We retrospectively analyzed medical records of outpatients with AS or PsA treated with secukinumab between December 2017 and December 2019. ASDAS-CRP and DAS28-CRP scores were used to measure axial and peripheral disease activity in AS and PsA, respectively. Data were collected at baseline and after 8, 24, and 52 weeks of treatment. Results Eighty-five adult patients with active disease (29 with AS and 56 with PsA; 23 males and 62 females) were treated. Overall, mean disease duration was 6.7 years and biologic-naïve patients were 85%. Significant reductions in ASDAS-CRP and DAS28-CRP were observed at all time-points. Body weight (in AS) and disease activity status at baseline (particularly in PsA) significantly affected disease activity changes. ASDAS-defined inactive disease and DAS28-defined remission were achieved in comparable proportions between AS and PsA patients, at both 24 weeks (45% and 46%) and 52 weeks (65.5% and 68%, respectively); male sex was found an independent predictor of positive response (OR 5.16, P = 0.027). After 52 weeks, achievement of at least low disease activity and drug retention were observed in 75% of patients. Secukinumab was well-tolerated and only mild injection-site reactions were recorded in 4 patients. Conclusion In a real-world setting, secukinumab confirmed great effectiveness and safety in both AS and PsA patients. The influence of gender on treatment response deserves further attention.

BackgroundTo evaluate gender differences in disease activity and health status (HS) in patients with radiographic axial spondyloarthritis (r-axSpA)/ankylosing spondylitis (AS).MethodsAncillary analysis of the MIDAS study, an observational, non-interventional, cross-sectional and retrospective multicenter nationwide study to assess disease activity and its relationship with HS in clinical practice. Adult patients with AS diagnosis, fulfilling ASAS and modified New York criteria, treated for ≥3 months upon study inclusion according to clinical practice were included. The primary outcome was “disease control” assessed by the percentage of patients in remission and low disease activity (BASDAI and ASDAS-CRP scores). HS was evaluated using the ASAS health index (ASAS-HI). Patients' responses and characteristics were analyzed by gender.ResultsWe analyzed 313 patients with AS, 237 (75.7%) males and 76 (24.3%) females. A total of 202 (64.5%) patients had adequate disease control (BASDAI < 4); 69.2% of males [mean (SD) BASDAI 2.9 (2.1)] and 50.0% of females [mean (SD) BASDAI 3.8 (2.4); p = 0.01]. According to ASDAS-CRP, 57.5% of patients were adequately controlled (ASDAS-ID +ASDAS-LDA); 138 (58.2%) males and 42 (55.3%) females. The mean (SD) ASDAS-CRP was 1.9 (1.1); being 1.9 (1.0) in males and 2.0 (1.1) in females. Overall, the impact of AS on HS was low to moderate [mean (SD) ASAS-HI 5.8 (4.4)]; being 5.5 (4.4) for males and 6.8 (4.2) for females (p = 0.02).ConclusionThis study showed a higher proportion of females with AS and active disease using the BASDAI definition. When using the ASDAS-CRP definition these differences by gender were less pronounced. The impact of disease activity on HS appears to be higher in females than males.

Objective: Assessment of ankylosing spondylitis activity patterns during pregnancy using BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score — C-Reactive Protein) disease activity indices.Materials and methods. The prospective study included 36 pregnant women with AS (modified New York AS criteria, 1984). Patients’ mean age was 31.6±4.8 years, mean age at AS onset was 21.8±10.9, and disease duration 134.9±89.3 months. The control group included 30 healthy pregnant women with no history of back pain and arthritis, their mean age was 28.2±4.5 years. In the I trimester of pregnancy 10 (33.3%) As patients experienced back pain, while in the III trimester already 15 (50%) had back pain. Throughout pregnancy, the intensity of back pain in the I, II и III trimesters based on numeric scale was on average 1.9±0.9; 2.1±1.1 and 2.1±0.8. BASDAI and ASDAS-CRP were used to measure disease activity on gestational Weeks 10–11, 20–21 and 31–32. The time of conception BASDAI score was assessed retrospectively at the 1st visit.Results and discussion. BASDAI mean values at the time of conception and I, II и III trimesters of pregnancy were: 2.3±1.9; 2.8±1.72 (p0.7) of fatigue severity with the BASDAI index in the I and II trimesters of pregnancy and moderate correlation (rs >0.53) in the III trimester; as wells as moderate (rs >0.5-0.69) correlation between back pain and BASDAIConclusion. A trend towards increasing AS activity based on BASDAI and ASDAS-CRP scores and CRP levels was established for the first half of pregnancy. Later in pregnancy these increased values failed to return to normal until the end of gestation. The percentage of AS patients with highto-moderate disease activity throughout pregnancy was lower based on BASDAI score vs based on ASDAS-CRP. Some BASDAI components (fatigue and back pain) reflect not only the activity of AS, but also changes associated with physiological pregnancy. The BASDAI index requires adaptation for use in pregnancy

Abstract Introduction Ankylosing spondylitis (AS) is a lifelong condition where spinal inflammation causes chronic back pain and restriction of spinal function. While proinflammatory cytokines participate in the disease process, their relation with disease activity, spinal function, and quality of life is less well understood. Methods Cross-sectional study of serum levels of four inflammatory cytokines (IL-6, TNF, IL-23, and IL-17A) in AS patients not on biologics. Disease characteristics and simultaneous spinal function tests and patient-reported health measures (Bath Functional Index (BASFI), Dougados Functional Index (DFI), Modified Health Assessment Questionnaire (MHAQ), and routine laboratory parameters were recorded. The composite ASDAS-CRP score was used to classify disease activity as absent, low, or high. Results In 164 AS patients (age 46 years, 70.1% males, 90.9% HLAB27 positive, ASDAS-CRP 1.8), disease activity was classified as inactive in 14%, low in 54%, and high in 31%. ASDAS-CRP correlated well with MHAQ, DFI, BASFI, and spinal mobility across patients with low and high disease activity (all p 0.2). Conclusions A large proportion of AS not on biologics have active disease far into the disease course. This impacts negatively on quality of life, work ability, and spinal mobility. Serum cytokine levels are poor markers for these central disease features in AS management. Funding Abbott Norway AS and Arthritis Foundation of Western Australia.

Background: Fecal calprotectin (FC) is one of fecal biomarkers that has validation to distinguish the organic and functional bowel disease but the relationship with disease activity in Spondyloarthritis (SpA) is still questionable. We determined the correlation of FC to the degree of disease activity on SpA. Material and Method: This cross sectional analytic study involved thirty-two subjects diagnosed with SpA. FC levels were analyzed using ELISA method. The Spondylartritis disease activities were assessed by ASDASCRP scores. Results: The median age was 52.5 (23.0-71.0) years with the average ASDAS-CRP score of 2.53 ± 0.61. The median level of FC increased by 58.15 (5.20-269.20) µg/g and was found to be positive (≥50 µg/g) in 56.3% subjects. FC levels was significantly correlated with the degree of SpA activity according to ASDAS-CRP scores (r = 0.563; P = 0.001) Conclusion: Fecal Calprotectin associated with the degree of activity in the SpA measured by ASDAS-CRP scores. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is frequent among axial spondyloarthritis (SpA) patients. However, the association between vitamin D level and axial SpA disease activity is still in debate. This study aimed to determine the correlation between serum calcidiol level and axial SpA disease activity. Methods: A cross-sectional study involving thirty axial SpA patients was conducted. All patients were diagnosed by rheumatologists according to the ASAS 2010 criteria. Axial SpA disease activities were measured using ASDASCRP score, and calcidiol level was examined using the ECLIA method. Results: The calcidiol levels had median value of 16.56 ng/ml (7.68-52 ng/ml). Calcidiol deficiency (<20 ng/ml) was found in 66.7% patients, calcidiol insufficiency (20-29.9 ng/ml) found in 16.7% patients, and normal level (≥30 ng/ml) found in16.7% patients. Mean of ASDAS-CRP score was 3.36±0.96. Low disease activity was in 10% patients, high disease activity in 56.7% patients, and very high disease activity in 33.3% patients. There was significant correlation between calcidiol level and ASDAS-CRP score (r = -0.464, P = 0.01). Conclusion: Serum calcidiol level was significant negative correlated with axial SpA disease activity. [ABSTRACT FROM AUTHOR]

Introduction: The Ankylosing Spondylitis Disease Activity Score with C‐reactive protein (ASDAS‐CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) are commonly used instruments for measuring disease activity. However, few studies have assessed their psychometric properties in patients with axial spondyloarthritis (axSpA). We aimed to assess the validity and reliability of ASDAS‐CRP and BASDAI in patients with axSpA in Singapore. Methods: Cross‐sectional data from 280 patients with axSpA from a dedicated axSpA clinic in a Singapore tertiary referral hospital from 2011 to 2019 were used. Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed through 12 a priori hypotheses by correlation of overall ASDAS‐CRP and BASDAI score with other patient‐reported outcomes measures (PROMs). Structural validity was evaluated via confirmatory factor analysis using maximum‐likelihood method, where Comparative Fit Index (CFI) >0.95, Tucker‐Lewis Index (TLI) >0.95, Root Mean Square Error of Approximation (RMSEA) <0.06 and Standardized Root Mean Residuals (SRMR) <0.08 were indicative of good fit. Results: Among 280 patients (78.2% Male; 92.5% Chinese), ASDAS‐CRP showed poor internal consistency of 0.33, while BASDAI showed high internal consistency of 0.87. Convergent and divergent construct validity were demonstrated by fulfillment of 11 out of 12 a priori hypotheses when ASDAS‐CRP and BASDAI were compared with other PROMs. Our proposed ASDAS‐CRP and BASDAI model showed good fit for a 1‐factor structure respectively (CFI = 0.993, TLI = 0.984, RMSEA = 0.036, SRMR = 0.026 for ASDAS‐CRP; CFI = 0.993, TLI = 0.985, RMSEA = 0.057, SRMR = 0.022 for BASDAI), demonstrating structural validity. Conclusion: This study supports the use of both ASDAS‐CRP and BASDAI in measuring disease activity in patients with axSpA in Singapore. [ABSTRACT FROM AUTHOR]

Introduction: Ankylosing spondylitis (AS) is a lifelong condition where spinal inflammation causes chronic back pain and restriction of spinal function. While proinflammatory cytokines participate in the disease process, their relation with disease activity, spinal function, and quality of life is less well understood. Methods: Cross-sectional study of serum levels of four inflammatory cytokines (IL-6, TNF, IL-23, and IL-17A) in AS patients not on biologics. Disease characteristics and simultaneous spinal function tests and patient-reported health measures (Bath Functional Index (BASFI), Dougados Functional Index (DFI), Modified Health Assessment Questionnaire (MHAQ), and routine laboratory parameters were recorded. The composite ASDAS-CRP score was used to classify disease activity as absent, low, or high. Results: In 164 AS patients (age 46 years, 70.1% males, 90.9% HLAB27 positive, ASDAS-CRP 1.8), disease activity was classified as inactive in 14%, low in 54%, and high in 31%. ASDAS-CRP correlated well with MHAQ, DFI, BASFI, and spinal mobility across patients with low and high disease activity (all p < 0.05). Cytokine levels did not correlate with ASDAS-CRP, ESR, BASFI, or spinal mobility scores and were comparable between patients with no, low, or high disease activity regardless of gender or disease duration (all p > 0.2). Conclusions: A large proportion of AS not on biologics have active disease far into the disease course. This impacts negatively on quality of life, work ability, and spinal mobility. Serum cytokine levels are poor markers for these central disease features in AS management. Funding: Abbott Norway AS and Arthritis Foundation of Western Australia. [ABSTRACT FROM AUTHOR]

Amaç: Aksiyel spondiloartrit (AksSpA) hastalarında sonlanım ölçütlerinden BASDAI ve ASDAS-CRP arasındaki uyumsuzluk sıklığını ve uyumsuz hastaların özelliklerini belirlemek amaçlanmıştır. Yöntem: Tek merkez AksSpA kohortunda izlenen ve aynı vizitte BASDAI ve ASDAS-CRP değerlerine sahip 575 hasta (ortalama yaş: 40,2±11,5; erkek cinsiyet: 358, %62,3) çalışmaya dahil edildi. Hastaların 369'u (%64,2) radyografik aksSpA (r-aksSpA) olarak sınıflandırıldı. BASDAI inaktif/aktif değerlendirilmesi için 4 kestirim değeri olarak kullanıldı. ASDAS-CRP için ise 2,1 değeri kabul edildi. İki ölçüm metoduna göre değerlendirildiğinde farklılık olan hasta uyumsuz olarak değerlendirildi. Hastaların demografik, klinik, aktivite ve yapısal değerlendirmeleri elde olundu. Bulgular: Yüz kırk altı (%25,4) hastada iki sonlanım ölçeği arasında uyumsuzluk saptandı. İki ölçeğin uyum oranı: %75,4 olarak hesaplandı (Kappa: 0,458). BASDAI'ya göre inaktif olan 274 hastanın %46,4'ü ASDAS-CRP'ye göre aktif olarak değerlendirildi (Şekil). Tüm hasta grubuna bakıldığında uyumsuz hastaların daha yüksek CRP değerlerine sahip oldukları, daha düşük oranda topuk ağrısı tanımladıkları ve daha az oranda biyolojik kullandıkları görüldü. Bu hastalar aynı zamanda daha düşük BASFI, HAQ-S ve BAS genel ağrı değerlerine sahiplerdi (Tablo). BASDAI inaktif hasta grubuna bakıldığında uyumlu ve uyumsuz hastalar arasında uyumsuz hastalar daha ileri yaşta, daha düşük eğitim seviyesine sahip ve daha fazla periferik artrit tutulumuna sahiptiler. Yine grupta uyumsuz hastaların bazal mSSASS değerleri, bazal sindesmofit varlığı, mSSASS progresyon oranları ve BASMI değerleri daha yüksek olarak tespit edildi. Ek olarak genel gruptakilere benzer şekilde daha düşük BASFI, HAQ-S ve BAS genel ağrı skorlarına sahiptiler. Sonuç: Hastalık aktivitesinin belirlenmesinde kullanılan iki ölçek arasında %25 hastada uyumsuzluk olduğu görülmüştür. Özellikle tedavi kararın değişebileceği grup olan BASDAI'ya göre inaktif hastalarda CRP yüksekliği ile birlikte ileri yaş, düşük eğitim düzeyi ve periferik artrit varlığı uyumsuzluk varlığında gözlenmiştir. BASDAI <4 ve uyumsuz olan hastalarda yapısal hasar bazalde ve takipte daha fazla olarak görülmüştür. Lokal önerilere göre tedavisiz kalacak bu grubun progresyon açısından durumu da göz önüne alındığında ASAS'nin ASDAS >2,1 kararını değerlendirmek uygun olacaktır. [ABSTRACT FROM AUTHOR]

Amaç: Spondiloartritler (SpA) ve psoriatik artritte (PsA) özellikle son 10 yılda birçok yeni tedavi seçeneği ortaya çıkmasına karşın düşük hastalık aktivitesi/remisyon hedefinden uzak olduğumuz bilinmektedir. Bu çalışmada son 6 ay içerisinde ayaktan başvuru yapan hastaların hastalık aktivitesinin belirlenmesi amaçlanmıştır. Yöntem: Kasım 2021 ile Haziran 2022 tarihleri arasına ayaktan polikliniğimize başvuran 834 hastanın hastalık aktiviteleri kesitsel olarak değerlendirilmiştir. Spondiloartritler şu şekilde gruplanmıştır. Ankilozan spondilit, non-radyografik SpA ve sadece periferik SpA. PsA tanısı klinisyene göre konulmuştur. Hastalık aktivitesi olarak BASDAI, BASFI, ASDAS-CRP ve CRP hesaplanmıştır. ASDAS-CRP skoruna göre <1,3 remisyon, 1,3-<2,1 düşük hastalık aktivitesi, 2,1-3,5 orta hastalık aktivitesi, >3,5 yüksek hastalık aktivitesi olarak değerlendirilmiştir. BASDAI'de sınır değerler ise <1,9 remisyon, 1,9-<3,5 arası düşük hastalık aktivitesi, 3,5-4,9 arası orta hastalık aktivitesi ve >4,9 yüksek hastalık aktivitesi olarak belirlenmiştir. Bulgular: Bu kesitsel çalışmaya 834 hasta dahil edilmiştir; 582 AS, 156 PsA, 72 nr-AxSpA, 26 sadece periferik SpA. Tüm hastaların ortalama yaşı 45,9 (10,4) [AS 45,8 (10,6), nr-AxSpa 43,5 (9,6), periferik SpA 47,3 (8,4), PsA 46,9 (10,7)]. Hastaların %53,6'sı kadındı (AS %52,0, nr-AxSpA %40,2, periferik SpA %46,1, PsA %65,3). Tüm hastaların 468'i (%55,1) değerlendirme sırasında bir bDMARD kullanıyordu. Tüm hastaların ortalama ASDASCRP değerleri 2,37 (1,07), ortalama BASDAI 3,63 (2,44), ortalama BASFI 3,13 (2,57) olarak hesaplandı. ASDAS-CRP değerine göre hastalık aktivitesi grupları Tablo 1'de gösterilmiştir. BASDAI skoruna göre düşük hastalık aktivitesi ve remisyon %48,7 hastada saptanmıştır (AS'de %51,8, nr-AxSpA %50,0, periferik SpA %50,0, PsA %38,6). bDMARD kullanan ve kullanmayan hastalar arasında ASDAS-CRP grupları arasında farklılık yoktur. Sonuç: Kesitsel olarak son 6 ayda ayaktan başvuru yapan SpA/PsA hastalarında düşük hastalık aktivitesi ve remisyon ancak %40 civarında hastada elde edilebilmiştir. SpA alt grupları arasında büyük farklılık görülmemektedir. Poliklinik SpA başvurularının yarısından fazlasını bDMARD kullanan hastalar oluşturmasına karşın hedefe ulaşma açısından farklılık saptanmamıştır. SpA hasta yönetiminde halen alınması gereken yollar vardır. [ABSTRACT FROM AUTHOR]