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Portier E, Chevret S, Walter-Petrich A, Ruyssen-Witrand A, Dougados M, Moltó A. Factors Associated With Treatment Pathways in Early Axial Spondyloarthritis: A Multistate Analysis of the 10-Year Follow-Up of the DESIR Cohort. J Rheumatol 2024; 51:368-377. [PMID: 38359943 DOI: 10.3899/jrheum.2023-0933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Current recommendations for the management of patients with axial spondyloarthritis (axSpA) emphasize the need of an individualized strategy in therapeutic decision-making. The study objectives were to describe therapeutic strategies observed in axSpA, and to assess the factors associated with treatment intensification over time. METHODS We included patients with axSpA from the French prospective cohort DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes), with a scheduled 10-year follow-up. A multistate model with 4 ordered treatment states (no treatment, nonsteroidal antiinflammatory drugs [NSAIDs], conventional synthetic disease-modifying antirheumatic drugs [csDMARDs], and tumor necrosis factor inhibitors [TNFi]) was defined, with 6 possible transitions. Restricted mean sojourn times in each state were estimated. Then, predictors of those transitions were assessed by multivariable Cox models. RESULTS A total of 686/708 (96.9%) patients who had > 1 visit were analyzed. At cohort entry, 199 (29%) were untreated, 427 (62.2%) were receiving NSAIDs, 60 (8.7%) csDMARDs, and none were receiving TNFi. Over the follow-up period, patients mostly (46.4% of the time) received NSAIDs, followed by TNFi (24.4% of the time). The presence of sacroiliitis on radiographs, inflammatory bowel disease, and articular index were jointly associated with the transition to NSAIDs. Longer duration in the previous state often decreased the hazard of the transition to csDMARDs or TNFi. Worse disease activity outcomes increased the hazard of most transitions. CONCLUSION To our knowledge, this was the first study using a multistate model to easily represent different treatment states, detailing the transitions across them and their associated factors. Different time profiles for the management of patients with axSpA were identified, including in those abstaining from treatment up to a significant proportion of patients treated with csDMARDs.
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Affiliation(s)
- Elodie Portier
- E. Portier, MD, M. Dougados, MD, A. Moltó, MD, PhD, Rheumatology Department, Cochin Hospital, AP-HP, and ECAMO, INSERM U-1153: Clinical Epidemiology and Biostatistics, University Paris Cité, Paris
| | - Sylvie Chevret
- S. Chevret, MD, PhD, A. Walter-Petrich, PhD, Biostatistic Departement, Saint-Louis Hospital, AP-HP, University Paris Cité, Paris
| | - Anouk Walter-Petrich
- S. Chevret, MD, PhD, A. Walter-Petrich, PhD, Biostatistic Departement, Saint-Louis Hospital, AP-HP, University Paris Cité, Paris
| | - Adeline Ruyssen-Witrand
- A. Ruyssen-Witrand, MD, PhD, Rheumatology Department, CHU Toulouse, and CIC 1436 Inserm, University of Paul Sabatier Toulouse III, Toulouse, France
| | - Maxime Dougados
- E. Portier, MD, M. Dougados, MD, A. Moltó, MD, PhD, Rheumatology Department, Cochin Hospital, AP-HP, and ECAMO, INSERM U-1153: Clinical Epidemiology and Biostatistics, University Paris Cité, Paris
| | - Anna Moltó
- E. Portier, MD, M. Dougados, MD, A. Moltó, MD, PhD, Rheumatology Department, Cochin Hospital, AP-HP, and ECAMO, INSERM U-1153: Clinical Epidemiology and Biostatistics, University Paris Cité, Paris;
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Ben Tekaya A, Ben Said H, Yousfi I, Ben Dhia S, Bouden S, Rouached L, Mahmoud I, Tekaya R, Saidane O, Abdelmoula L. Burden of disease, pain catastrophizing, and central sensitization in relation to work-related issues in young spondyloarthritis patients. Reumatologia 2024; 62:35-42. [PMID: 38558896 PMCID: PMC10979370 DOI: 10.5114/reum/185390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Spondyloarthritis (SpA) is a common rheumatic inflammatory disease and can impact patients' work productivity. We aimed to evaluate the impact of pain catastrophizing and central sensitization on work outcomes in young SpA patients and determine the predictive factors of work productivity loss. Material and methods We performed a cross-sectional study over 6 months. We included patients aged between 18 and 50 years old, diagnosed with axial or peripheral SpA. Pain catastrophizing and central sensitization were assessed using the Pain Catastrophizing Scale (PCS) and Central Sensitization Inventory (CSI) questionnaire, respectively. Impact of SpA on work productivity and activity impairment during and outside of work was measured with the Work Productivity and Activity Impairment Questionnaire (WPAI: Spondyloarthritis). Results A total of 72 patients were enrolled, with a median age of 39 years (28.3-46), 65.3% men, and 54.4% working patients. Median scores of activity impairment outside of work, and work productivity loss were 50% (40-70), and 50% (40-60), respectively. Median absenteeism and presenteeism scores were 0% (IQR 0-7), and 100% (IQR 86.5-100), respectively. Regarding work-related outcomes: activity impairment was positively correlated with CSI and PCS; presenteeism was significantly associated with male sex (p = 0.009); and work productivity loss was positively associated with anxiety, depression, and poor quality of life. Multivariate regression analysis identified predictive factors of work productivity loss: male sex, poor quality of life, and prolonged morning stiffness. Conclusions Assessment of the impact of pain catastrophizing and central sensitization on work-related outcomes in patients with SpA is important to understand the burden of illness and to identify early those in need of interventions in clinical practice.
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Affiliation(s)
- Aicha Ben Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hanene Ben Said
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
- Occupational Pathology and Fitness for Work Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Imene Yousfi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
- Occupational Pathology and Fitness for Work Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Siwar Ben Dhia
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Selma Bouden
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Leila Rouached
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ines Mahmoud
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Rawdha Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Olfa Saidane
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Fernández-Carballido C, Jovaní V, Catalán EB, Moreno-Ramos MJ, Sanz Sanz J, Gallego A, García Vivar ML, Rodríguez-Heredia JM, Sanabra C, Sastré C. Disease activity indexes might not capture the same disease aspects in males and females with ankylosing spondylitis: A real-world nationwide analysis. Front Med (Lausanne) 2022; 9:1078325. [PMID: 36619648 PMCID: PMC9811117 DOI: 10.3389/fmed.2022.1078325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background To evaluate gender differences in disease activity and health status (HS) in patients with radiographic axial spondyloarthritis (r-axSpA)/ankylosing spondylitis (AS). Methods Ancillary 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. Results We 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). Conclusion This 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.
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Affiliation(s)
| | - Vega Jovaní
- Department of Rheumatology, Hospital General Universitario Dr. Balmis, Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | | | - Jesús Sanz Sanz
- Department of Rheumatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Adela Gallego
- Department of Rheumatology, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
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Sexual dimorphism in the prevalence, manifestation and outcomes of axial spondyloarthritis. Nat Rev Rheumatol 2022; 18:657-669. [DOI: 10.1038/s41584-022-00833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/08/2022]
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Benavent D, Capelusnik D, Ramiro S, Molto A, López-Medina C, Dougados M, Navarro-Compán V. Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study. RMD Open 2022; 8:rmdopen-2022-002514. [PMID: 36096523 PMCID: PMC9472201 DOI: 10.1136/rmdopen-2022-002514] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the influence of gender on disease outcomes in patients with spondyloarthritis (SpA), including across SpA subtypes. METHODS Data from 4185 patients of 23 countries with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or psoriatic arthritis (PsA) from the Assessment of SpondyloArthritis International Society (ASAS)-perSpA study were analysed. Associations between gender and disease activity (Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), C-reactive protein (CRP)), function (Bath Ankylosing Spondylitis Functional Index (BASFI)) and overall health (ASAS Health Index (ASAS HI), European Quality of Life Five Dimension (EQ-5D)) outcomes were investigated. Multilevel multivariable linear mixed models adjusted for relevant confounders (and stratified by disease subtype in case of a relevant interaction) were used. RESULTS In total, 65%, 10% and 25% of patients had axSpA, pSpA and PsA, respectively. axSpA was more frequent in males (68%), whereas pSpA and PsA were more frequent in females (53% and 52%, respectively). A significant interaction between gender and disease subtype was found for ASDAS, BASDAI and BASFI. While being female independently contributed to higher BASDAI across the three disease subtypes (with varying magnitude), female gender was only associated with higher ASDAS in pSpA (β (95% CI): 0.36 (0.15 to 0.58)) and PsA (0.25 (0.12 to 0.38)) but not in axSpA (0.016 (-0.07 to 0.11)). No associations were observed between gender and CRP levels. Female gender was associated with higher ASAS HI and EQ-5D, without differences across disease subtype. CONCLUSION Female gender is associated with less favourable outcome measures across the SpA spectrum. However, while female gender influences BASDAI across the three subtypes, ASDAS is associated with gender only in pSpA and PsA but not in axSpA. Therefore, ASDAS is an appropriate instrument both for females and males with axSpA.
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Affiliation(s)
- Diego Benavent
- Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Dafne Capelusnik
- Maastricht University Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute CAPHRI, Maastricht, The Netherlands.,Rheumatology, Instituto de rehabilitación psicofísica, Ciudad de Buenos Aires, Argentina
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Anna Molto
- Clinical Epidemiology and Biostatistics, INSERM U1153, Université Paris-Cité, Paris, France.,Rheumatology, Hospital Cochin, Université Paris Descartes Faculté de Médecine, Paris, France
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- Rheumatology, Hospital Cochin, Université Paris Descartes Faculté de Médecine, Paris, France
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Chimenti MS, Perricone C, D'Antonio A, Ferraioli M, Conigliaro P, Triggianese P, Ciccacci C, Borgiani P, Perricone R. Genetics, Epigenetics, and Gender Impact in Axial-Spondyloarthritis Susceptibility: An Update on Genetic Polymorphisms and Their Sex Related Associations. Front Genet 2021; 12:671976. [PMID: 34447407 PMCID: PMC8383732 DOI: 10.3389/fgene.2021.671976] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/10/2021] [Indexed: 12/20/2022] Open
Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic disease that can be divided into predominantly axial or predominantly peripheral involvement, with or without associated psoriasis, inflammatory bowel disease or previous infection. Axial SpA (axSpA) encompasses ankylosing spondylitis (AS) with radiological sacroiliitis, and a type without radiographic sacroiliitis, called “non-radiographic axial SpA” (nr-axSpA). Males and females show large differences in their susceptibility to SpA, such as distinctions in clinical patterns, phenotypes and in therapeutical response, particularly to TNF inhibitors (TNFi). Several studies indicate that AS women have doubled risk to failure TNFi compared with males. This diversity in drugs’ efficacy among women and men may be caused by differences in the balance of sex hormones and in gene-specific expression likely triggered by X-chromosome instability and gene-specific epigenetic modifications. Evidence reported that polymorphisms in microRNAs on X- and other chromosomes, such as miR-146a, miR-155, miR-125a-5p, miR-151a-3p and miR-22-3p, miR-199a-5p could be involved in the different clinical presentation of SpA, as well as disease activity. In addition, association with non−response to TNFi treatment and presence of IRAK3 and CHUCK genes in SpA patients was recently detected. Finally, polymorphisms in genes involved in IL-23/IL-17 pathway, such as in drug pharmacodynamics and pharmacokinetics may have a role in response to TNFi, IL17i, and IL23i. A major understanding of genomic variability could help in the development of new therapeutic targets or in taking advantages of different mechanisms of action of biological drugs. Moving from the multifactorial etiology of disease, the present review aims at evaluating genetic and epigenetic factors and their relationship with sex and bDMARDs response, helping to investigate the different expression among males and females of genes on X- and other chromosomes, as well as mi-RNA, to highlight relationships between sex and occurrence of specific phenotypes and symptoms of the disease. Moreover, the role of the epigenetic modification in relation to immune-regulatory mechanisms will be evaluated.
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Affiliation(s)
- Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Arianna D'Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Ciccacci
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy.,Department of Biomedicine and Prevention, Genetics Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Borgiani
- Department of Biomedicine and Prevention, Genetics Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Blasco-Blasco M, Castrejón I, Jovaní V, Pascual E, Ruiz-Cantero MT. Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis. J Rheumatol 2021; 48:1395-1404. [PMID: 33795327 DOI: 10.3899/jrheum.200967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) exhibited differences between women and men. METHODS We systematically searched MEDLINE, Embase, Web of Science, and other sources in English or Spanish from January 1, 1995, to July 31, 2020, to assess the differences according to sex in BASDAI and ASDAS. We performed a comparative analysis by sex using t test and mean difference by sex metaanalyses for BASDAI and ASDAS, as well as a random-effects model using the inverse-variance method. RESULTS Forty-one studies included BASDAI (6785 women, 12,929 men) and 16 of them included ASDAS (2046 women, 4403 men). Disease activity detected using BASDAI was significantly higher in women than in men (mean 4.9 vs 4.2, P = 0.02), whereas ASDAS did not detect differences between sexes (mean 2.8 women vs 2.8 men). In the metaanalyses, BASDAI detected significant differences between women and men (mean difference = 0.55 [95% CI 0.46-0.65], P < 0.00001), but ASDAS did not identify significant mean difference between sexes (0.04, 95% CI -0.05 to 0.12], P = 0.38). CONCLUSION The 2 most widely used indices of disease activity in spondyloarthritis (SpA) discriminate differently according to sex by their different evaluations of peripheral disease. The different components and weights in BASDAI and ASDAS influence their values. BASDAI may be affected by fatigue, and in predominantly peripheral manifestations such as enthesitis, ASDAS may not be sensitive enough to detect activity. This may represent a sex bias unfavorable to women, because peripheral SpA is more common in women than in men.
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Affiliation(s)
- Mar Blasco-Blasco
- M. Blasco-Blasco, PhD, Public Health Research Group, University of Alicante, Alicante, Spain;
| | - Isabel Castrejón
- I. Castrejón, MD, PhD, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Vega Jovaní
- V. Jovaní, MD, PhD, Department of Rheumatology, Alicante University General Hospital, Alicante, Spain
| | - Eliseo Pascual
- E. Pascual, MD, PhD, Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - María Teresa Ruiz-Cantero
- M.T. Ruiz-Cantero, MD, PhD, Public Health Research Group, University of Alicante, and CIBERESP (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública), Alicante, Spain
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8
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Nam B, Koo BS, Lee TH, Shin JH, Kim JJ, Lee S, Joo KB, Kim TH. Low BASDAI score alone is not a good predictor of anti-tumor necrosis factor treatment efficacy in ankylosing spondylitis: a retrospective cohort study. BMC Musculoskelet Disord 2021; 22:140. [PMID: 33541326 PMCID: PMC7860220 DOI: 10.1186/s12891-020-03941-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/21/2020] [Indexed: 01/21/2023] Open
Abstract
Background The purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who nonetheless have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment. Its clinical impact on anti-TNF survival was also investigated. Methods We conducted a single-centre retrospective cohort study of AS patients having low BASDAI scores (< 4) and available ASDAS-C-reactive protein (CRP) data after 3 months of first-line anti-TNF treatment. Patients were grouped into high-ASDAS (≥ 2.1) and low-ASDAS (< 2.1) groups according to the ASDAS-CRP after 3 months of anti-TNF treatment. Their characteristics were compared. And survival analyses were carried out using Kaplan–Meier curves and log-rank test with the event being discontinuation of anti-TNF treatment due to lack/loss of efficacy. Results Among 116 AS patients with low BASDAI scores after 3 months of anti-TNF treatment, 38.8% were grouped into the high-ASDAS group. The high-ASDAS group tended to have greater disease activity after 9 months of treatment (BASDAI 2.9 ± 1.1 vs. 2.3 ± 1.4, p=0.007; ASDAS-CRP 1.8 ± 0.6 vs. 1.5 ± 0.7, p=0.079; proportion of high ASDAS-CRP 27.8% vs. 13.8%, p=0.094) and greater risk of discontinuing anti-TNF treatment due to lack/loss of efficacy than the low-ASDAS group (p=0.011). Conclusions A relatively high proportion of AS patients with low BASDAI scores had high ASDAS-CRP. These low-BASDAI/high-ASDAS-CRP patients also had a greater risk for discontinuation of anti-TNF treatment due to low/lack of efficacy than the low-ASDAS group. The use of the ASDAS-CRP alone or in addition to the BASDAI may improve the assessment of AS patients treated with anti-TNF agents.
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Affiliation(s)
- Bora Nam
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Bon San Koo
- Department of Rheumatology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Tae-Han Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Ji-Hui Shin
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jin-Ju Kim
- Medical Affairs, AbbVie Ltd., Seoul, South Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Kyung Bin Joo
- Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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9
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Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford) 2021; 59:iv38-iv46. [PMID: 33053194 PMCID: PMC7566372 DOI: 10.1093/rheumatology/keaa543] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
Mounting evidence reveals evident sex differences in physiology, disease presentation and response to medication in axial SpA (axSpA). Unfortunately these data are often neglected in clinical practice and research. In this review, myths that still exist on diagnosis, disease manifestation and drug effectiveness were argued against data of the most recent literature. The aim is to increase awareness of sex differences in the clinical aspects of axSpA.
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Affiliation(s)
- Tamara Rusman
- Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Rianne E van Bentum
- Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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Akgul O, Bodur H, Ataman S, Yurdakul FG, Capkin E, Gurer G, Sezer I, Duruoz MT, Melikoglu MA, Cay HF, Rezvani A, Yagci I, Gogus F, Kamanli A, Cevik R. Clinical performance of ASAS Health Index in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: real-world evidence from Multicenter Nationwide Registry. Rheumatol Int 2020; 40:1793-1801. [PMID: 32814986 DOI: 10.1007/s00296-020-04680-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/07/2020] [Indexed: 01/13/2023]
Abstract
The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is used as a new instrument in measuring the function, disability and health of patients with spondyloarthritis (SpA). However, the real-world evidence of ASAS HI is very limited. In the present study, our objective is to evaluate the psychometric properties and performance of ASAS HI in the real-world setting as well as comparing ASAS HI with the current instruments to assess the construct validity and determine the cut-off points in patients with both ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). A total of 991 patients with axSpA who fulfilled either the ASAS classification criteria for axial SpA (axSpA) or the Modified New York Criteria (mNY) for AS were recruited from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStaR) SpA. The construct validity of ASAS HI against the Bath Ankylosing Spondylitis Disease Activities Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) the Bath Ankylosing Spondylitis Functional index (BASFI) was performed. Using the receiver operating characteristic (ROC) curves analysis, the cut-off points were calculated. Of all the recruited patients, 851 (85.9%) were AS and 140 (14.1%) were nr-axSpA. The difference in the mean ASAS HI scores of the patients with AS and the ones with nr-axSpA were not statistically significant (6.12 ± 4.29 and 6.42 ± 4.86, respectively). The mean ASAS HI score was significantly higher in females and small city residents. The ASAS HI had a strong construct validity against ASDAS-CRP, BASDAI and BASFI. A cut-off point of ≤ 4 was determined to discriminate good and moderate, as well as ≥ 12 to discriminate moderate and poor health status. In conclusion, ASAS HI is a reliable instrument to evaluate health and functioning for both patients with AS and nr-axSpA in clinical practice.
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Affiliation(s)
- Ozgur Akgul
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Manisa Celal Bayar University School of Medicine, Manisa, Turkey.
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Universiteler Mah. 1604. Cad. Cankaya, Ankara, Turkey
| | - Sebnem Ataman
- Department of Physical Medicine and Rehabilitaton, Division of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Fatma Gul Yurdakul
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Universiteler Mah. 1604. Cad. Cankaya, Ankara, Turkey
| | - Erhan Capkin
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gulcan Gurer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Ilhan Sezer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mehmet Tuncay Duruoz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Meltem Alkan Melikoglu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Hasan Fatih Cay
- Department of Rheumatology, Saglik Bilimleri University, Antalya Education and Research Hospital, Antalya, Turkey
| | - Aylin Rezvani
- Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, Istanbul, Turkey
| | - Ilker Yagci
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Ayhan Kamanli
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Remzi Cevik
- Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakir, Turkey
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