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Saba R, Bruderer-Hofstetter M, Rausch AK, Niedermann K. Übersetzung, Test-Retest-Reliabilität und Konstruktvalidität der deutschen Version der Exercise Self-Efficacy Scale für körperliche Aktivität bei Personen mit axialer Spondyloarthritis. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1577-2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund Körperliche Aktivität kann die Symptomatik von Personen mit axialer Spondyloarthritis (axSpA) verbessern. Die Selbstwirksamkeit ist dabei ein wichtiger prädiktiver Faktor. Mit dem Fragebogen „Exercise Self-Efficacy Scale“ (ESES) kann die Selbstwirksamkeit für körperliche Aktivität erfasst werden. Bislang gab es noch keine deutsche, validierte Version des Fragebogens.
Ziel Untersuchung der transkulturell adaptierten deutschen Version der ESES (ESES-D) bezüglich Test-Retest-Reliabilität, interner Konsistenz sowie Konstruktvalidität bei Personen mit axSpA.
Methode Die ESES-D wurde anhand des TRAPD-Team-Translation-Models in die deutsche Sprache übersetzt und in einer Beobachtungsstudie evaluiert. Die interne Konsistenz wurde mittels Cronbachs Alpha und die Test-Retest-Reliabilität mittels Intraklassen-Koeffizienten (ICC, Two-way Mixed Effects Model) überprüft. Die Konstruktvalidität wurde aufgrund a priori definierter Hypothesen mittels Korrelationen zwischen der ESES-D, demografischer Merkmale und Messinstrumente zu krankheitsbedingten Symptomen, Funktionseinschränkungen, körperlicher Aktivität sowie Ergebniserwartung für das Training untersucht. Bei Erfüllung von 6 von 8 Hypothesen galt die Konstruktvalidität als bestätigt.
Ergebnisse Die ESES wurde in die deutsche Sprache übersetzt. Es wurden 52 Personen mit axSpA zwischen 31 und 80 Jahren in die Studie eingeschlossen. Die deutsche Version der ESES demonstrierte gute Werte bezüglich der Reliabilität mit einem ICC von 0,78 (95 % CI; 0,63–0,88) und einem Cronbachs Alpha von 0,85. 5 von 8 a priori definierte Hypothesen zur Überprüfung der Konstruktvalidität wurden bestätigt.
Schlussfolgerung Die ESES-D erfasst die Selbstwirksamkeit für körperliche Aktivität mit guter Test-Retest-Reliabilität und interner Konsistenz. Die Konstruktvalidität konnte nicht abschließend bestätigt werden. Weitere Forschung zur Konstruktvalidität und Responsivität wird empfohlen.
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Rausch AK, Baltisberger P, Meichtry A, Topalidis B, Ciurea A, Vliet Vlieland TPM, Niedermann K. Reliability of an adapted core strength endurance test battery in individuals with axial spondylarthritis. Clin Rheumatol 2021; 40:1353-1360. [PMID: 32959189 PMCID: PMC7943491 DOI: 10.1007/s10067-020-05408-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra-tester reliability and its associations with disease-specific factors. METHODS A cross-sectional study was conducted at axSpA exercise therapy groups, including both axSpA patients and the physiotherapist group leaders (PTs). The aCSE was used to measure the isometric strength endurance of the ventral, lateral, and dorsal core muscle chains (measured in seconds), as well as to assess the disease-specific factors of functional status, self-reported pain, and perceived strength performance. The aCSE was repeated after 7-14 days to measure intra-tester reliability for the same rater (PT group leader). Reliability was calculated as an intra-class correlation coefficient (ICC) using a nested design. The associations between ventral, lateral, and dorsal strength endurance and the disease-specific factors were calculated using Pearson correlation coefficients. RESULTS Study participants were 13 PT group leaders and 62 axSpA patients. The latter were all capable of performing the aCSE, with the exception of one individual. A moderate to substantial intra-rater reliability (ICCs (95%CI)) was found for the ventral (0.54 (0.35, 0.74)), lateral (0.52 (0.33, 0.70)), and dorsal (0.71 (0.58, 0.86)) core muscle chains. None of the aCSE measures correlated with the disease-specific factors. CONCLUSION The aCSE was found to be a reliable test battery for assessing core strength endurance in axSpA patients. Interestingly, aCSE performance was not associated with any disease-specific factors. Key Points • The adapted core strength endurance test battery measures the isometric strength of the ventral, lateral and dorsal core muscle chains. • The adapted core strength endurance test battery showed a moderate to substantial intra-rater reliability for all three muscle chains tested in axSpA patients. • No correlations were found between the adapted core strength endurance test battery and the disease-specific factors of self-reported pain, functional status and perceived strength performance.
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Affiliation(s)
- Anne-Kathrin Rausch
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland.
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands.
| | - Philipp Baltisberger
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland
| | - Beatrice Topalidis
- Ankylosing Spondylitis Association of Switzerland, 8050, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, 8091, Zurich, Switzerland
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
| | - Karin Niedermann
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, 8401, Winterthur, Switzerland
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Sundaram TG, Muhammed H, Aggarwal A, Gupta L. A prospective study of novel disease activity indices for ankylosing spondylitis. Rheumatol Int 2020; 40:1843-1849. [PMID: 32757024 DOI: 10.1007/s00296-020-04662-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
There is an ongoing quest for robust disease activity measures in Ankylosing spondylitis (AS). Thus, we prospectively validated two new disease activity indices, Simplified AS Disease Activity Score (SASDAS) and modified Juvenile Spondyloarthritis Disease Activity Score (JSpADA). Patients with AS were assessed for BASDAI, ASDAS and other outcome measures at baseline and 3 months. Comparisons were drawn between those with juvenile onset, early disease and peripheral involvement, with the rest. Fisher's r to Z transformation was used to compare correlations. Receiver-operating characteristic (ROC) curves were used to calculate cutoffs for inactive, low, high and very high disease activity. Of the 107 patients (mean age-29 years) of 6-years long disease, 38.3% had a juvenile onset. SASDAS and modified JSpADA exhibited excellent correlation with BASDAI and ASDAS (all p < 0.001) and were higher in active vs. inactive disease. Treatment responders had a greater fall in SASDAS and modified JSpADA as compared to non-responders. The novel scores were higher in those with peripheral disease. Only SASDAS could discriminate early from late disease. Based on the previously proposed cutoffs, optimal scores for inactive, moderate, high and very high disease activity were deduced. SASDAS-CRP showed better internal consistency than SASDAS-ESR and correlated better with ASDAS-CRP in late disease (Z = 3.04; p = 002) and those with adult onset disease (Z = 2.18; p = 0.03). SASDAS and Modified JSpADA perform as well as standard complex scores and have potential for simpler daily use. From our analyses, SASDAS with CRP performs better than SASDAS-ESR, pending further validation.
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Affiliation(s)
- T G Sundaram
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Hafis Muhammed
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Amita Aggarwal
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Latika Gupta
- Departments of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Braun J, Baraliakos X, Kiltz U, Krüger K, Burmester GR, Wassenberg S, Thomas MH. Disease Activity Cutoff Values in Initiating Tumor Necrosis Factor Inhibitor Therapy in Ankylosing Spondylitis: A German GO-NICE Study Subanalysis. J Rheumatol 2019; 47:35-41. [PMID: 30877206 DOI: 10.3899/jrheum.181040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE International recommendations for the management of axial spondyloarthritis including ankylosing spondylitis (AS) recommend a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) level of disease activity of ≥ 4 to initiate treatment with biologics. We aimed to evaluate the level of disease activity used to initiate tumor necrosis factor inhibitor (TNFi) treatment and the level of responses to treatment based on different BASDAI cutoffs. METHODS This is a posthoc analysis of the noninterventional, prospective, GO-NICE study in the subgroup of biologic-naive AS treated with golimumab (GOL) 50 mg subcutaneously once monthly. RESULTS Of the 244 biologic-naive AS patients at baseline, 70.5% had a BASDAI ≥ 4 (Group 1), 14.3% had 2.8 to < 4 (Group 2), and 15.2% had even < 2.8 (Group 3). A total of 134 patients (54.9%) completed the 24-month observational period. The mean BASDAI in Groups 1, 2, and 3 was initially 5.9 ± 1.3, 3.4 ± 0.4, and 2.0 ± 0.8, decreased to 2.2 ± 2.0, 1.9 ± 1.2, and 1.0 ± 1.2 within 3 months (all p < 0.0001 vs baseline), and decreased significantly to 2.2 ± 1.7, 1.9 ± 1.7, and 1.4 ± 1.0 at Month 24 (all p < 0.005), respectively. BASDAI 50% improvement was noted in 68.8%, 44.8%, and 45.2% of patients at Month 3, and in 84.9%, 61.9%, and 55.0% at Month 24. CONCLUSION TNFi treatment was initiated in almost a third of AS patients with lower disease activity states as assessed by BASDAI cutoff of ≥ 4. Patients with a BASDAI between 2.8 and < 4 appeared to benefit significantly from GOL treatment, while patients with BASDAI < 2.8 did not. This finding should lead to a reevaluation of the established BASDAI cutoff of ≥ 4.
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Affiliation(s)
- Jürgen Braun
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany. .,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer. .,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH.
| | - Xenofon Baraliakos
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Uta Kiltz
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Klaus Krüger
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Gerd R Burmester
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Siegfried Wassenberg
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
| | - Matthias H Thomas
- From the Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum, Herne; Rheumatologisches Praxiszentrum München; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin; Rheumazentrum Ratingen, Ratingen; Medical Affairs, MSD Sharp & Dohme GmbH, Haar, Germany.,M. Thomas is a full-time employee of MSD Sharp & Dohme GmbH, Haar. U. Kiltz received an unrestricted grant from AbbVie. G.R. Burmester received lecture and/or consulting fees from MSD. K. Krüger received speaker fees and research grants from AbbVie, MSD, and Pfizer.,J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne and Ruhr University Bochum; K. Krüger, MD, Rheumatologisches Praxiszentrum München; G.R. Burmester, MD, Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin; S. Wassenberg, MD, Rheumazentrum Ratingen; M.H. Thomas, PhD, Medical Affairs, MSD Sharp & Dohme GmbH
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Zbinden A, van den Brandt S, Østensen M, Villiger PM, Förger F. Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters. Rheumatology (Oxford) 2018; 57:1235-1242. [PMID: 29617883 DOI: 10.1093/rheumatology/key053] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/06/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To analyse pregnancy outcome and delivery mode in patients with RA and axial spondyloarthritis (axSpA) in relation to disease activity and anti-rheumatic drugs. METHODS Patients with RA and axSpA were compared with age-matched healthy controls (HCs) with respect to pregnancy outcome and delivery mode. Disease activity (DAS28, ASDAS, CRP) and medication use of patients was assessed once at each trimester. ORs with 95% CI were calculated with univariate and multivariate regression models. RESULTS We analysed 244 pregnancies, of which 96 occurred in patients with RA, 78 in patients with axSpA and 70 in HCs. The adjusted analysis showed that pregnant women with RA and axSpA had a higher risk of pregnancy complications (gestational diabetes, preeclampsia, infection, preterm premature rupture of membranes), small for gestational age infants and preterm deliveries (all P < 0.05). Active disease was a predictor for preterm delivery in both RA [odds ratio (OR) = 3.9, 95% CI: 1.25, 12.15] and axSpA (OR = 13.8, 95% CI: 1.33, 143.94). Regarding delivery mode, most patients had vaginal deliveries. However, women with RA revealed an increased risk of caesarean section compared with HC (P < 0.05), which was not seen in patients with axSpA. CONCLUSION Our findings show that disease activity of RA and axSpA during pregnancy influences pregnancy outcome. To allow for successful pregnancy a treatment strategy that targets inactive disease beyond conception should be followed.
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Affiliation(s)
- Astrid Zbinden
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
| | - Stephanie van den Brandt
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
| | - Monika Østensen
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
| | - Frauke Förger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
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Rauseo Vera M, Gutiérrez-González LA, Maldonado I, Al Snih S. Validity of a Venezuelan version of the Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Disease Activity Index. ACTA ACUST UNITED AC 2017; 15:223-228. [PMID: 28943073 DOI: 10.1016/j.reuma.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Spondyloarthropathies (SpA) are disabling diseases with a prevalence of 1.9% in the general population. The indices designed for monitoring the disease should be valid, reliable and cross-culturally adapted for decision-making concerning the appropriate treatment. Changing an adjective or pronoun in a self-administered questionnaire could be the big difference in condensing an idea in a few words and transmitting that concept to all those who share the same language. OBJECTIVES To develop a Venezuelan version of the original English version of the BASDAI/BASFI and to evaluate its reliability and validity in Venezuelan patients with SpA. METHODS Certified linguists were needed for the translation of a Venezuelan version of the BASDAI/BASFI. The evaluation of reliability and validity was performed by calculating correlation coefficients in addition to Cronbach's alpha correlation between the BASDAI score and the clinical parameters (for example: erythrocyte sedimentation rate, C-reactive protein, modified Schöber test, occiput-to-wall distance and enthesis count). RESULTS We studied 40 patients including 31 men (77.5%) and 9 women (22.5%). The mean age was 35.9 years ± standard deviation (SD) 12.01 and the disease duration was 11.5 years (± SD 9.5). The most common diagnoses were undifferentiated spondyloarthritis (45%), ankylosing spondylitis (27.5%) and psoriatic arthritis (20%). The incidences of reactive arthritis, ankylosing spondylitis and juvenile Reiter's syndrome were 2.5% each. The test-retest reliability of the BASDAI and BASFI was high (R = 0.99 and 0.99, respectively; P<.0001). The internal consistency for the BASDAI was high (Cronbach's alpha = 0.88; P=.002) and the intraclass correlation coefficient for internal consistency: 0.9867 (P=.001). Internal consistency for the BASFI: Cronbach's alpha = 0.7985 (P=.002), intraclass correlation coefficient for internal consistency: 0.9055 (P=.001). Construct validity of the BASDAI was high for general well-being of the patient (R = 0.84) and for enthesis count (R = 0.84). Low back pain showed moderate correlation with BASDAI (R = 0.69; P<.0001) and the erythrocyte sedimentation rate showed a low correlation (R = 0.39683; P=.0112). CONCLUSION The Venezuelan version of the BASDAI/BASFI could be used in clinical research to assess and evaluate the course of disease activity in Venezuelan SpA patients.
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Affiliation(s)
- Mayra Rauseo Vera
- Hospital Universitario de Caracas, Centro Nacional de Enfermedades. Reumáticas (CNER). HUC-UCV, Caracas, Venezuela
| | | | - Irama Maldonado
- Servicio de Reumatología, Complejo Hospital Universitario, Hospital Ruiz y Páez, Universidad de Oriente (UDO), Ciudad Bolívar, Bolívar, Venezuela
| | - Soham Al Snih
- School of Allied Health Sciences. Searly Center Aging, Galveston, Texas, EE. UU
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Reusch A, Musekamp G, Küffner R, Dorn M, Braun J, Ehlebracht-König I. Wirksamkeitsprüfung rheumatologischer Schulungen. Z Rheumatol 2016; 76:613-621. [DOI: 10.1007/s00393-016-0120-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aeberli D, Kamgang R, Balani D, Hofstetter W, Villiger PM, Seitz M. Regulation of peripheral classical and non-classical monocytes on infliximab treatment in patients with rheumatoid arthritis and ankylosing spondylitis. RMD Open 2016; 2:e000079. [PMID: 26819749 PMCID: PMC4716562 DOI: 10.1136/rmdopen-2015-000079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 10/07/2015] [Accepted: 10/20/2015] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the regulatory effect of tumour necrosis factor (TNF) blockade with infliximab on the distribution of peripheral blood monocyte subpopulations in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods Purified CD11b+CD14+ monocytes from 5 patients with RA and 5 AS were analysed ex vivo before and after infliximab treatment by flow cytometry for CD16, CD163, CD11b, C-C chemokine receptor type 2 (CCR2) and CXC chemokine receptor 4 (CXCR4) at baseline and at days 2, 14, 84 and 168 after the first infliximab administration. Serum levels of the stromal cell-derived factor (SDF)-1 and monocyte chemotactic peptide (MCP)-1 at different time points were measured in either patient group before and on infliximab treatment. Results Anti-TNF treatment with infliximab led to a significant increase of circulating CD11b+ non-classical and a concomitantly decrease of CD11b+ classical monocytes, to a decline in SDF-1 levels and reduced expression of CCR2 and CXCR4 on non-classical monocyte subpopulation. Conclusions Our study shows, that TNFα blockade by infliximab resulted in a dichotomy of the regulation of classical and non-classical monocytes that might have substantial impact on inhibition of osteoclastogenesis and of subsequent juxta-articular bone destruction and systemic bone loss in RA and AS.
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Affiliation(s)
- Daniel Aeberli
- Department of Rheumatology, Immunology and Allergology , University Hospital of Bern , Bern , Switzerland
| | - Richard Kamgang
- Department of Rheumatology, Immunology and Allergology , University Hospital of Bern , Bern , Switzerland
| | - Deepak Balani
- Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland; Group for Bone Biology & Orthopaedic Research, Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Willy Hofstetter
- Group for Bone Biology & Orthopaedic Research, Department of Clinical Research , University of Bern , Bern , Switzerland
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology , University Hospital of Bern , Bern , Switzerland
| | - Michael Seitz
- Department of Rheumatology, Immunology and Allergology , University Hospital of Bern , Bern , Switzerland
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Costa IPD, Bortoluzzo AB, Gonçalves CR, Silva JABD, Ximenes AC, Bértolo MB, Ribeiro SL, Keiserman M, Menin R, Skare TL, Carneiro S, Azevedo VF, Vieira WP, Albuquerque EN, Bianchi WA, Bonfiglioli R, Campanholo C, Carvalho HM, Duarte ALP, Kohem CL, Leite NH, Lima SA, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FAC, Santiago MB, Sauma MDFL, Valim V, Sampaio‐Barros PD. Avaliação do desempenho do BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) numa coorte brasileira de 1.492 pacientes com espondiloartrites: dados do Registro Brasileiro de Espondiloartrites (RBE). REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:48-54. [DOI: 10.1016/j.rbr.2014.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/25/2014] [Accepted: 05/19/2014] [Indexed: 11/26/2022] Open
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Kampling C, Chehab G, Schneider M, Richter JG. [Self-monitoring in inflammatory rheumatic diseases]. Z Rheumatol 2014; 73:706-13. [PMID: 25260817 DOI: 10.1007/s00393-014-1413-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Active involvement of patients in their care has led to better treatment and outcomes. Tight control concepts emphasize the need for regular assessments including patients' active involvement by self-monitoring. METHODS The literature was screened with respect to published experiences of self-monitoring of rheumatoid arthritis and spondyloarthritides. The use of "patient-reported outcome" (PRO) instruments can facilitate self-monitoring. Potentially applicable PROs and their correlations to clinical parameters as well as modern data acquisition modes are presented. RESULTS Some experiences for self-monitoring have been reported. Recommendations from national and international professional rheumatology societies do not yet consider self-monitoring; however, PROs might be used for self-monitoring but instructions for patients on "how to deal with self-monitored PRO values" are missing. CONCLUSION Self-monitoring of inflammatory rheumatic diseases seems feasible. Further evaluation studies are warranted to guarantee an optimized direct patient involvement in their management beyond outpatient care in hospitals and private practices so that they can thus contribute to a better outcome.
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Affiliation(s)
- C Kampling
- Poliklinik für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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[German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 7 Disease activity and prognosis of spondyloarthritis]. Z Rheumatol 2014; 73 Suppl 2:66-8. [PMID: 25181975 DOI: 10.1007/s00393-014-1432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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High prevalence of psoriatic arthritis in dermatological patients with psoriasis: a cross-sectional study. Rheumatol Int 2013; 34:227-34. [PMID: 24114527 DOI: 10.1007/s00296-013-2876-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/28/2013] [Indexed: 10/26/2022]
Abstract
The exact prevalence of psoriatic arthritis (PsA) among patients with psoriasis is still not conclusive. Data in the literature vary between 5.8 and 30 %. Objective of this study was to gain more information on the prevalence of PsA among patients with psoriasis in Germany. Between 09/2010 and 05/2011, consecutive patients from dermatological private practices and a university hospital with psoriasis were asked to fill out the validated German Psoriatic Arthritis Diagnostic (GEPARD) Questionnaire. Patients who answered ≥4 questions with "yes" were invited to come for a rheumatological check up. Those patients who refused a rheumatological examination were counted as "absence of PsA". Laboratory tests for inflammatory markers as well as the severity of skin manifestations were assessed. The diagnosis of PsA was made according to the CASPAR criteria, and imaging was performed in addition. A total of 404 questionnaires were evaluated; 50.5 % answered ≥4 questions positively; 19.3 % had a history of PsA confirmed by a rheumatologist; and in 10.9 %, PsA or spondyloarthritis was newly diagnosed during the present study. This leads to an overall prevalence of PsA in patients with psoriasis of 30.2 %. The frequency of psoriatic arthritis in the present study is higher than expected from previous studies in Germany. The prevalence is consistent with findings of a large observational survey from Scandinavia. Using the CASPAR criteria and imaging in all patients, certainty of the diagnosis is very high. The GEPARD Questionnaire is a helpful tool to identify people at risk for psoriatic arthritis.
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Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S47-58. [PMID: 22588768 DOI: 10.1002/acr.20575] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bidad K, Fallahi S, Mahmoudi M, Jamshidi A, Farhadi E, Meysamie A, Nicknam MH. Evaluation of the Iranian versions of the bath ankylosing spondylitis disease activity index (BASDAI), the bath ankylosing spondylitis functional index (BASFI) and the patient acceptable symptom state (PASS) in patients with ankylosing spondylitis. Rheumatol Int 2011; 32:3613-8. [DOI: 10.1007/s00296-011-2186-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 10/22/2011] [Indexed: 11/29/2022]
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Rostom S, Benbouaaza K, Amine B, Bahiri R, Ibn Yacoub Y, Ali Ou Alla S, Abouqal R, Hajjaj-Hassouni N. Psychometric evaluation of the Moroccan version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for use in patients with ankylosing spondylitis. Clin Rheumatol 2010; 29:781-8. [DOI: 10.1007/s10067-010-1431-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 12/14/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
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Park HJ, Kim S, Lee JE, Jun JB, Bae SC. The reliability and validity of a Korean translation of the BASDAI in Korean patients with ankylosing spondylitis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11 Suppl 1:S99-S104. [PMID: 18387074 DOI: 10.1111/j.1524-4733.2008.00373.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The objective of this study was to develop a Korean version of the original English version of BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and to evaluate its reliability and validity in Korean patients with Ankylosing Spondylitis (AS). METHODS A total of 50 outpatients diagnosed as AS by the modified New York criteria participated. To develop a Korean version of the BASDAI, we followed rigorous international translation steps and evaluated reliability and validity by calculating Cronbach's alpha and correlation coefficients between BASDAI score and clinical parameters (e.g., ESR, CRP, modified Schober test index, finger-to-ground index, and Bath Ankylosing Spondylitis Radiologic Index Score, and bone mineral density). RESULTS Cronbach's alpha (= 0.75) was acceptable. The distribution of item responses evaluated by the ceiling and floor effects showed appropriate proportions and a good discrimination with the Korean version of the BASDAI. The correlations among the mean BASDAI score and five scales for the convergent validity was significantly correlated with each other (all P-values < 0.01). The correlations between the BASDAI score and both erythrocyte sedimentation rate and C-reactive protein for the criterion validity were positively correlated (all P-values < 0.05). The results of this study showed that the Korean translation of the BASDAI is an efficient tool in terms of its reliability and validity for the measurement of the disease activity in patients with AS. CONCLUSIONS The Korean version of the BASDAI could be used in clinical research to assess and evaluate the course of disease activity in Korean AS patients.
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Affiliation(s)
- Hye-Ja Park
- Nursing, College of Medicine, Pochon CHA University, Pochon, Republic of Korea
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Alberding A, Stierle H, Brandt J, Braun J. [Effectiveness and safety of radium chloride in the treatment of ankylosing spondylitis. Results of an observational study]. Z Rheumatol 2007; 65:245-51. [PMID: 16477453 DOI: 10.1007/s00393-005-0009-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 07/14/2005] [Indexed: 01/06/2023]
Abstract
After radium chloride was approved for the therapy of ankylosing spondylitis (AS) in Germany on October 23, 2000, an open, non-comparative prospective observational study was planed. The assessment involved 308 patients with the diagnosis of AS and radiological evidence of spinal involvement who were treated with at least one injection of radium chloride. 278 of these patients received the full cycle of 10 injections (a total of 10 MBq radium-224) one injection one per week for a period of 10 successive weeks. Validated outcomes were measured before therapy and six months after therapy according to the recommendations of the "assessment in ankylosing spondylitis working group"(ASAS). The primary endpoint was disease activity assessed using the BASDAI ("Bath Ankylosing Spondylitis Disease Activity Index"). Secondary endpoints included the BASFI ("Bath Ankylosing Spondylitis Functional Index"), as well as self-reported pain and global patient ratings. Patients showed significant improvement in all of the parameters assessed (BASDAI, BASFI, pain, global patient rating) at 6-months post-treatment. At this time, the mean BASDAI and BASFI scores improved from 5.5 to 3.5 and from 5.6 to 3.7, respectively. Pain decreased from a mean of 7.3 to 4.1, and disease activity (as rated by patients) also decreased from 7.2 to 4.1 (p < 0.001 for all of them). Drug tolerance was good. Six adverse events were documented, none of which was serious and none led to discontinuation of treatment. According to the data provided here medical treatment with radium chloride seems to be effective and safe during an observation period of 6 months. Nevertheless, a randomized placebo-controlled study should be performed in the near future in order to safeguard the level of evidence.
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Affiliation(s)
- A Alberding
- Krankenhaus St. Josef, Zentrum für Orthopädie und Rheumatologie, Wuppertal.
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Braun J, Zochling J, Baraliakos X, Alten R, Burmester G, Grasedyck K, Brandt J, Haibel H, Hammer M, Krause A, Mielke F, Tony HP, Ebner W, Gömör B, Hermann J, Zeidler H, Beck E, Baumgaertner M, Sieper J. Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomised controlled trial. Ann Rheum Dis 2006; 65:1147-53. [PMID: 16606646 PMCID: PMC1798286 DOI: 10.1136/ard.2006.052878] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2006] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the effect of sulfasalazine (SSZ) on inflammatory back pain (IBP) due to active undifferentiated spondyloarthritis (uSpA) or ankylosing spondylitis in patients with symptom duration <5 years. METHODS Patients with IBP and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) >3 from 12 centres were randomly assigned to 24 weeks' treatment with SSZ 2 g/day or placebo. The primary outcome variable was the change in BASDAI over 6 months. Secondary outcomes included measures of spinal pain, physical function and inflammation. RESULTS 230 patients (50% men, age range 18-64 years, 67% human leucocyte antigen B27 positive) were treated with either SSZ 2x1 g/day or placebo for 6 months. Enthesitis was found in 50%, and peripheral arthritis in 47% of the patients. The mean (SD) BASDAI dropped markedly in both groups: by 3.7 (2.7) and 3.8 (2.4), respectively, as did most secondary outcome measures. No noticeable difference in treatment was observed between groups. Patients with IBP and no peripheral arthritis had significantly (p = 0.03) more benefit with SSZ (BASDAI 5.1 (1.3) to 2.8 (2.3)) than with placebo (5.2 (1.6) to 3.8 (2.4)). Spinal pain (p = 0.03) and morning stiffness (p = 0.05) improved with SSZ in these patients, but other secondary outcomes were not markedly different. CONCLUSION SSZ was no better than placebo for the treatment of the signs and symptoms of uSpA; however, SSZ was more effective than placebo in the subgroup of patients with IBP and no peripheral arthritis.
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Affiliation(s)
- J Braun
- Rheumazentrum-Ruhrgebiet, Landgrafenstrasse 15, 44652 Herne, Germany.
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Abstract
Ankylosing spondylitis (AS) is a frequent inflammatory rheumatic disease and prototype of the Spondyloarthitides (SpA). During the last years outcome parameters have been developed to evaluate different aspects of the disease. Among these are the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), numeric rating scales for general pain, night pain, patients and physicians global assessment, as well as questionnaires to evaluate quality of life as the short Form (SF)- 36, Euroquol 5 Dimensions (EQ-5D), or the AS specific the ASQuol. These outcome parameters are the basis to conduct clinical trials. The ASessements in AS (ASAS) improvement criteria were developed to evaluate the short term efficacy of Non-Steroidal Antirheumatic Drugs (NSAIDs) and adjusted for the measurement of the high efficacy of the TNF-alpha blocking agents. To examine the x-rays of sacroiliac joints (SIG), the radiological criteria as part of the modified New York criteria are mostly used. For the x-rays of the spine the Bath AS Radiology Index (BASRI) is valuable in daily practice, but the modified Stokes AS Spine Score (mSASSS) is more sensitive for clinical trials. To examine Magnetic Resonance Images (MRI) of SIG and spine also scores are currently developed. Altogether, using the new outcome parameters it was possible to demonstrate the strikingly high efficacy of theTNF-alpha blocking agents. However, it could also be shown that conventional disease modifying antirheumatic drugs (DMARDs) are not effective in the treatment of the axial forms of SpA.
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van der Heijde D. New directions in classification and outcome assessment in ankylosing spondylitis. Curr Rheumatol Rep 2004; 6:98-101. [PMID: 15016339 DOI: 10.1007/s11926-004-0053-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 2003, several manuscripts on the classification of patients as having ankylosing spondylitis and the further development of outcome assessment tools have been published. It is obvious that the use of radiographic sacroiliitis is a problematic part of the classification criteria because there is major interobserver variation and is one of the causes of a long delay between onset of symptoms and diagnosis. Especially in patients without human leukocyte antigen B27, the diagnostic delay is long. Existing outcome tools, such as the Bath Ankylosing Spondylitis Disease Activity Index, have been adapted and validated for use in other languages. New instruments to assess quality of life (Ankylosing Spondylitis Quality of Life Index; Patient Generated Index) and physical functioning (World Health Organization Disability Assessment Schedule II) have been developed and validated for the use in ankylosing spondylitis. In addition, a new and feasible tool to assess enthesitis has been constructed and validated. Because fatigue is an important symptom for patients with ankylosing spondylitis, a recommendation to use a specific fatigue instrument was created. The statistically derived Assessment in Ankylosing Spondylitis response criteria have been compared with expert opinion and are strict criteria. Responders as defined by the Assessment in Ankylosing Spondylitis response criteria also are considered by the experts as responders.
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Affiliation(s)
- Désirée van der Heijde
- Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, Caphri Research Institute, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 2004; 25:280-4. [PMID: 14730386 DOI: 10.1007/s00296-003-0432-y] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 11/30/2003] [Indexed: 11/25/2022]
Abstract
The aim of this study was to develop a Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and assess its reliability, validity, and sensitivity to change. The Turkish version was obtained after a translation and back-translation process. Seventy-one patients with ankylosing spondylitis were assessed with it. To assess its validity, patients were also evaluated with the Turkish version of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Bath Ankylosing Spondylitis Patient Global Score (BAS-G), and physicians' assessments of disease activity. Over 24 h, the Turkish BASDAI did not show significant differences between the two assessments (P>0.05). Correlations were found between BASDAI and all of the evaluation parameters except BASMI (P<0.01). Both BASDAI and BASMI showed significant improvements after 8-week home exercise programmes. The results of this study show that the Turkish version of the BASDAI is reliable, valid, and sensitive to change.
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Affiliation(s)
- Yesim Akkoc
- Department of Physical Medicine and Rehabilitation, Ege University Medical Faculty, Izmir, Turkey.
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