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Wiąk-Walerowicz K, Wielosz E. Comparison of Ankylosing Spondylitis Disease Activity Score and Bath Ankylosing Spondylitis Disease Activity Index tools in assessment of axial spondyloarthritis activity. Reumatologia 2024; 62:64-69. [PMID: 38558891 PMCID: PMC10979369 DOI: 10.5114/reum/185429] [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: 02/08/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Axial spondyloarthritis (axSpA) is an inflammatory joint disease, in which the dominant symptom is inflammatory back pain. It affects approximately 1% of the population, with a higher incidence in males. Spinal pain associated with spondyloarthritis is referred to as inflammatory back pain. In clinical practice, it is extremely important to be able to assess the activity of inflammatory back diseases and to select appropriate treatment and monitor the therapy. Currently, two main tools are used for assessment of the activity of axial spondyloarthritis: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS (Ankylosing Spondylitis Disease Activity Score). The BASDAI is a tool used for years for assessment of disease activity, determining eligibility for treatment, and making decisions about continuation of therapy. Since BASDAI depends entirely on patient self-assessment, it is considered less objective than the ASDAS index. In turn, the latter includes not only answers to questions provided by the patient but also a parameter of inflammation such as erythrocyte sedimentation rate or C-reactive protein (CRP). Additionally, increasing numbers of studies report advantages of the ASDAS index over BASDAI. Moreover, as indicated by ASAS/EULAR (Assessment in Spondyloarthritis International Society/European Alliance of Associations for Rheumatology) 2022, ASDAS, especially ASDAS-CRP is the preferred tool for assessment of the activity of axSpA, whereas BASDAI is used only when the evaluation of the ASDAS is not possible. This paper presents the definition and symptoms of axSpA and reviews the latest research on ASDAS and BASDAI, with emphasis on the objectivity of the ASDAS assessment also presenting the doubts and limitations concerning this tool.
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Affiliation(s)
- Katarzyna Wiąk-Walerowicz
- Department of Rheumatology and Systemic Connective Tissue Diseases, Medical University of Lublin, Poland
| | - Ewa Wielosz
- Department of Rheumatology and Systemic Connective Tissue Diseases, Medical University of Lublin, Poland
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Kim J, Kim MJ, Oh GY, Lee SK, Kim T, Shin K. The predictability of ASDAS on drug survival in patients with ankylosing spondylitis on biologic therapy: data from the KOBIO registry. Ther Adv Musculoskelet Dis 2023; 15:1759720X231201714. [PMID: 37822329 PMCID: PMC10563457 DOI: 10.1177/1759720x231201714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023] Open
Abstract
Background The Ankylosing Spondylitis (AS) Disease Activity Score (ASDAS) is largely used for assessing disease activity in patients with AS. Objectives We aimed to investigate the predictability of ASDAS on drug survival in patients with low Bath AS Disease Activity Index (BASDAI) during biologic therapy. Design Using data from multi-center, prospective, observational prospective cohort, Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry. Methods The study population consisted of patients enrolled in the KOBIO registry from December 2012 to December 2018. The baseline demographic data and variables such as extra-articular manifestations, HLA-B27 positivity, family history of spondyloarthritis, ASDAS C-reactive protein (CRP), BASDAI, and Bath AS Functional Index scores were collected from the database. The disease activity indices were followed yearly after initiating a tumor necrosis factor (TNF) inhibitor (TNFi). Disease activities were defined as high (ASDAS-CRP ⩾ 2.1, BASDAI ⩾ 4) and low (ASDAS-CRP < 2.1, BASDAI < 4). Results Data from 1773 patients were analyzed. Among 269 patients with low BASDAI at baseline, 151 (56.1%) patients had high ASDAS-CRP, yet in 142 patients with low ASDAS-CRP at baseline, only 24 (16.9%) patients had a high BASDAI. High ASDAS-CRP captured more patients who had initiated or switched to a TNFi than those with high BASDAI (92.5% versus 84.8%, respectively, p < 0.001). Moreover, among AS patients with low BASDAI after 1 year of therapy, drug persistence in the following year was significantly lower in patients with high ASDAS than in those with low ASDAS (68.7% versus 82.5%, p < 0.001). Conclusion ASDAS-CRP not only has its advantages over BASDAI in assessing disease activity but also low ASDAS-CRP at 1 year can be a marker of long-term drug survival of TNFi therapy.
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Affiliation(s)
- Jinhyun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Min Jung Kim
- Division of Rheumatology, Seoul Metropolitan Government – Seoul National University Boramae Hospital, Seoul, Korea
| | - Geun Young Oh
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Kyung Lee
- Division of Rheumatology, Seoul Metropolitan Government – Seoul National University Boramae Hospital, Seoul, Korea
| | - Taeeun Kim
- Patient Access, Novartis Korea Ltd., Seoul, Korea
| | - Kichul Shin
- Department of Internal Medicine, Seoul Metropolitan Government – Seoul National University Boramae Hospital, Seoul, Korea 20 Boramae-ro-5-gil, Dongjak-gu, Seoul 07061, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Disease control in patients with ankylosing spondylitis in real clinical practice in Spain: Results of the MIDAS study. REUMATOLOGIA CLINICA 2023; 19:99-105. [PMID: 36739123 DOI: 10.1016/j.reumae.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES Understanding the disease activity is fundamental to improve patient prognosis and patients' quality of life. MiDAS study described disease activity in ankylosing spondylitis (AS) Spanish patients and the proportion of them with controlled disease. METHODS Observational, cross-sectional, multicenter study carried out under conditions of routine clinical practice. Adult (≥18 years) patients with ≥6 months since AS diagnosis treated ≥3 months prior to inclusion. The primary endpoint was the percentage of patients with low disease activity assessed through BASDAI (primary endpoint) and ASDAS-CRP (secondary endpoint). RESULTS 313 AS patients included: 75.7% male; 78.5% HLA-B*27 positive; mean (SD) baseline age of 50.4 (12.0) years; mean (SD) disease duration of 15.5 (11.6) years; 73.5% were treated with biological disease-modifying antirheumatic drugs (DMARDs), 22.4% with non-biological DMARDs and 53.7% with non-steroidal anti-inflammatory drugs, alone or in combination. Monotherapy with biologics and non-biologics was used by 29.7% and 26.8% of patients, respectively. According to BASDAI, 38.0% were in remission (BASDAI≤2) and 64.5% showed adequate disease control (BASDAI<4). According to ASDAS-CRP, 29.4% achieved remission (ASDAS-CRP<1.3) and 28.1% low disease activity (1.3≤ASDAS-CRP<2.1). CONCLUSIONS Almost two thirds of the AS patients recruited had low disease activity, with about one third of them being in remission (BASDAI≤2, ASDAS-CRP<1.3). These results highlight the existing room for improvement in treating AS patients in clinical practice.
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Sen R, Kim E, Napier RJ, Cheng E, Fernandez A, Manning ES, Anderson ER, Maier KD, Hashim M, Kerr GS, Fang MA, Hou JK, Chang E, Walsh JA, Raychadhuri SP, Reimold A, Caplan L. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Biomarkers in Axial Spondyloarthritis: Observational Studies From the Program to Understand the Longterm Outcomes in Spondyloarthritis Registry. Arthritis Rheumatol 2023; 75:232-241. [PMID: 36053919 PMCID: PMC9892177 DOI: 10.1002/art.42333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/30/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study was conducted to assess the utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting radiographic sacroiliitis and active disease in axial spondyloarthritis (SpA) and to explore the association between use of a tumor necrosis factor inhibitor (TNFi) and these laboratory values compared with traditional inflammatory markers. METHODS Observational data from the Program to Understand the Longterm Outcomes in Spondyloarthritis (PULSAR) registry were analyzed. We generated receiver operating characteristic curves to calculate laboratory cutoff values; we used these values in multivariable logistic regression models to identify associations with radiographically confirmed sacroiliitis and active disease. We also used logistic regression to determine the likelihood of elevated laboratory values after initiation of TNFi. RESULTS Most study participants (n = 354) were White, male, and HLA-B27 positive. NLR (odds ratio [OR] 1.459, P = 0.034), PLR (OR 4.842, P < 0.001), erythrocyte sedimentation rate (OR 4.397, P < 0.001), and C-reactive protein (CRP) level (OR 2.911, P = 0.001) were independent predictors of radiographic sacroiliitis. Models that included PLR with traditional biomarkers performed better than those with traditional biomarkers alone. NLR (OR 6.931, P = 0.002) and CRP (OR 2.678, P = 0.004) were predictors of active disease, but the model that included both NLR and CRP performed better than CRP alone. TNFi use reduced the odds of elevated NLR (OR 0.172, P < 0.001), PLR (OR 0.073, P < 0.001), erythrocyte sedimentation rate (OR 0.319, P < 0.001), and CRP (OR 0.407, P < 0.001), but models that included NLR or PLR and traditional biomarkers performed best. CONCLUSIONS These findings demonstrate an association between NLR and PLR and sacroiliitis and disease activity, with NLR and PLR showing response after TNFi treatment and adding useful clinical information to established biomarkers, thus perhaps assisting in management of axial SpA.
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Affiliation(s)
- Rouhin Sen
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Emmeline Kim
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Ruth J Napier
- Portland VAMC and Oregon Health Sciences University, Portland
| | - Elizabeth Cheng
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Andrea Fernandez
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Evan S Manning
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | | | - Kyle D Maier
- San Antonio Military Medical Center, San Antonio, Texas
| | - Mena Hashim
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Gail S Kerr
- Georgetown University Hospital, Howard University Hospital, and Washington DC VAMC, Washington, DC
| | - Meika A Fang
- West Los Angeles VAMC, and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason K Hou
- Houston VAMC and Baylor College of Medicine, Houston, Texas
| | | | - Jessica A Walsh
- Salt Lake City VAMC and University of Utah Hospital, Salt Lake City
| | | | - Andreas Reimold
- Dallas VAMC and University of Texas Southwestern Medical Center, Dallas
| | - Liron Caplan
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
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Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, Landewé RBM, Van den Bosch FE, Boteva B, Bremander A, Carron P, Ciurea A, van Gaalen FA, Géher P, Gensler L, Hermann J, de Hooge M, Husakova M, Kiltz U, López-Medina C, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compán V, Nissen MJ, Pimentel-Santos FM, Poddubnyy D, Proft F, Rudwaleit M, Telkman M, Zhao SS, Ziade N, van der Heijde D. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023; 82:19-34. [PMID: 36270658 DOI: 10.1136/ard-2022-223296] [Citation(s) in RCA: 219] [Impact Index Per Article: 219.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). METHODS Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. RESULTS Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. CONCLUSIONS The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
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Affiliation(s)
- Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Elena Nikiphorou
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Rheumatic Diseases, King's College London, London, UK
| | - Alexandre Sepriano
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Nova Medical School, CHRC Campus, Lisbon, Portugal
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Robert B M Landewé
- Rheumatology & Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium
- Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Boryana Boteva
- Patient Research Partner, European Alliance of Associations for Rheumatology, Sofia, Bulgaria
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Lund University, Lund, Sweden
| | - Philippe Carron
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium
- Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Adrian Ciurea
- Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Pál Géher
- Semmelweis University, Budapest, Hungary
| | - Lianne Gensler
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Josef Hermann
- Internal Medicine, Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Manouk de Hooge
- Internal Medicine and Pediatrics, Ghent University-VIB Center for Inflammation Research, Ghent, Belgium
| | - Marketa Husakova
- First Faculty of Medicine Charles University and Rheumatology Institute, Prague, Czech Republic
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals (UCLH) NHS Foundation Trust, London, UK
- Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
| | - Anna Molto
- Rheumatology, Paris Descartes University, Cochin Hospital, AP-HP, and INSERM (U1153), PRES Sorbonne Paris-Cité, Université Paris-Cité, Paris, France
| | | | | | | | - Denis Poddubnyy
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Mark Telkman
- Patients with Arthritis and Rheumatism (PARE) working group, European Alliance of Associations for Rheumatology, Patient Research Partner, Oxford, UK
| | - Sizheng Steven Zhao
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Nelly Ziade
- Rheumatology, Hotel-Dieu De France, Achrafieh, Lebanon
- Rheumatology, Saint Joseph University, Beirut, Lebanon
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Chen YH, Huang WN, Chen YM, Lai KL, Hsieh TY, Hung WT, Lin CT, Tseng CW, Tang KT, Chou YY, Wu YD, Huang CY, Hsieh CW, Chen YJ, Liao YW, Chen HH. The BASDAI Cut-Off for Disease Activity Corresponding to the ASDAS Scores in a Taiwanese Cohort of Ankylosing Spondylitis. Front Med (Lausanne) 2022; 9:856654. [PMID: 35652077 PMCID: PMC9149077 DOI: 10.3389/fmed.2022.856654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) has been widely utilized to evaluate disease activity in patients with ankylosing spondylitis (AS) by an arbitrary cut-off of ≥4 to indicate high disease activity and initiate biological therapy. The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a new composite index to assess AS disease activity states that have been defined and validated. ASDAS ≥2.1 was selected as a criterion to start biological therapy. The purpose of this study was to estimate the corresponding BASDAI and ASDAS cut-off in a Taiwanese AS cohort. Methods From November 2016 to October 2018, we assessed the ASDAS and the BASDAI regularly and recorded demographic data for 489 AS patients in Taichung Veterans General hospital (TCVGH) using an electronic patient-reported data system linked to electronic medical records. We used receiver operating characteristic curves with Youden's J statistic to determine the BASDAI values that correspond to ASDAS disease activity cut-offs (i.e., 1.3, 2.1, and 3.5). Results In our population, the best trade-off BASDAI values corresponding to ASDAS -C-reactive protein (CRP) 1.3, 2.1, and 3.5 were 2.1, 3.1, and 3.7, respectively. The optimal BASDAI values corresponding to ASDAS-erythrocyte sedimentation rates 1.3, 2.1, and 3.5 were 2.0, 2.6, and 4.8, respectively. Conclusion We propose a revised BASDAI cut-off based on our data, as BASDAI scores are commonly used globally. A more reasonable, lower BASDAI cut-off to initiate or change biological therapy will bring us closer to better decisions to treat AS patients.
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Affiliation(s)
- Yi-Hsing Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wen-Nan Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Business Administration, Ling-Tung University, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- PhD Program of Business, College of Business, Feng Chia University, Taichung, Taiwan
| | - Wei-Ting Hung
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Tsai Lin
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chih-Wei Tseng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yin-Yi Chou
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Yi-Da Wu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chin-Yin Huang
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Chia-Wei Hsieh
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yen-Ju Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Wan Liao
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Hsin-Hua Chen
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Llop M, Moreno M, Navarro-Compán V, Juanola X, de Miguel E, Almodóvar R, Quintana EC, Sanz JS, Beltrán E, Montesinos MDR, Calvet J, Berenguer-Llergo A, Gratacós J, Montejo PZ, Joven B, Almirall M, Espartero MCF, Gualda EB, Campos C, Estevez EC, Font P, Poch TC, Linares Ferrando LF, Lozano CR, Yoldi B. Sustained low disease activity measured by ASDAS slow radiographic spinal progression in axial spondyloarthritis patients treated with TNF-inhibitors: data from REGISPONSERBIO. Arthritis Res Ther 2022; 24:30. [PMID: 35063018 PMCID: PMC8780330 DOI: 10.1186/s13075-021-02695-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
To evaluate the influence of the disease activity on radiographic progression in axial spondyloarthritis (axSpA) patients treated with TNF inhibitors (TNFi).
Methods
The study included 101 axSpA patients from the Spanish Register of Biological Therapy in Spondyloarthritides (REGISPONSERBIO), which had clinical data and radiographic assessment available. Patients were classified into 2 groups based on the duration of TNFi treatment at baseline: (i) long-term treatment (≥4 years) and (ii) no long-term treatment (< 4 years). Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. Disease activity differences between patients’ groups at each time point were assessed using a linear mixed-effect model.
Results
Radiographic progression was defined as an increase in ≥2 mSASSS units. At inclusion, approximately half of the patients (45.5%) were receiving long-term treatment with TNFi (≥4 years). In this group of subjects, a significant difference in averaged Ankylosing Spondylitis disease Activity Score (ASDAS) across follow-up was found between progressors and non-progressors (2.33 vs 1.76, p=0.027, respectively). In patients not under long-term TNFi treatment (54.5%) though, no significant ASDAS differences were observed between progressors and non-progressors until the third year of follow-up. Furthermore, no significant differences were found in progression status, when disease activity was measured by Bath Ankylosing spondylitis Disease Activity Index (BASDAI) and C reactive protein (CRP).
Conclusions
Patients on long-term TNFi treatment with a mean sustained low disease activity measures by ASDAS presented lower radiographic progression than those with active disease.
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Chan Kwon O, Park MC. BASDAI cut-off values corresponding to ASDAS cut-off values. Rheumatology (Oxford) 2021; 61:2369-2374. [PMID: 34558610 DOI: 10.1093/rheumatology/keab494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/07/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To determine cut-off values of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) that can discriminate the four disease activity states (inactive disease, moderate disease activity, high disease activity, and very high disease activity), separated by the validated Ankylosing Spondylitis Disease Activity Score (ASDAS) cut-off values (1.3, 2.1, and 3.5). METHODS We included 333 patients with axial spondyloarthritis whose data on BASDAI and ASDAS-C reactive protein (ASDAS-CRP) were available. Receiver operating characteristic curve (ROC) analysis was performed to determine the BASDAI cut-off values that best corresponded to ASDAS-CRP cut-off values. The degree of agreement between disease activity states based on the BASDAI and ASDAS-CRP cut-off values was assessed using weighted kappa. RESULTS Of the total 333 patients, 52 (15.6%), 190 (57.1%), 76 (22.8%), and 15 (4.5%) patients had inactive disease, moderate disease activity, high disease activity, and very high disease activity, respectively, according to the ASDAS-CRP. ROC analyses revealed that the BASDAI values 1.9 (area under the curve [AUC]: 0.948 [0.922-0.974]), 3.5 (AUC: 0.926 [0.887-0.966]), and 4.9 (AUC: 0.917 [0.837-0.996]) best corresponded to the ASDAS-CRP values 1.3, 2.1, and 3.5, respectively. The degree of agreement between disease activity states based on the BASDAI and ASDAS-CRP cut-off values was good (weighted kappa: 0.724, p< 0.001). CONCLUSION The BASDAI values 1.9, 3.5, and 4.9 corresponded to the ASDAS-CRP values 1.3, 2.1, and 3.5, respectively. These cut-off values could be useful in clinical studies and real-world practice for determining disease activity status when ASDAS-CRP is unavailable.
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Affiliation(s)
- Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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9
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Marona J, Sepriano A, Rodrigues-Manica S, Pimentel-Santos F, Mourão AF, Gouveia N, Branco JC, Santos H, Vieira-Sousa E, Vinagre F, Tavares-Costa J, Rovisco J, Bernardes M, Madeira N, Cruz-Machado R, Roque R, Silva JL, Marques ML, Ferreira RM, Ramiro S. Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI. RMD Open 2021; 6:rmdopen-2019-001145. [PMID: 32144137 PMCID: PMC7061099 DOI: 10.1136/rmdopen-2019-001145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs). METHODS Patients from Rheumatic Diseases Portuguese Register (Reuma.pt) with a clinical diagnosis of axial spondyloarthritis (axSpA) were included. Four subgroups (cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of high disease activity) were compared regarding baseline characteristics and response to bDMARDs at 3 and 6 months estimated in multivariable regression models. RESULTS Of the 594 patients included, the majority (82%) had both BASDAI≥4 and ASDAS ≥2.1. The frequency of ASDAS ≥2.1, if BASDAI<4 was much larger than the opposite (ie, ASDAS <2.1, if BASDAI≥4): 62% vs 0.8%. Compared to patients fulfilling both definitions, those with ASDAS ≥2.1 only were more likely to be male (77% vs 51%), human leucocyte antigen B27 positive (79% vs 65%) and have a higher C reactive protein (2.9 (SD 3.5) vs 2.1 (2.9)). Among bDMARD-treated patients (n=359), responses across subgroups were globally overlapping, except for the most 'stringent' outcomes. Patients captured only by ASDAS responded better compared to patients fulfilling both definitions (eg, ASDAS inactive disease at 3 months: 61% vs 25% and at 6 months: 42% vs 25%). CONCLUSION The ASDAS definition of high disease activity is more inclusive than the BASDAI definition in selecting patients with axSpA for bDMARD treatment. The additionally 'captured' patients respond better and have higher likelihood of predictors thereof. These results support using ASDAS≥2.1 as a criterion for treatment decisions.
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Affiliation(s)
- Jose Marona
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Alexandre Sepriano
- CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Santiago Rodrigues-Manica
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fernando Pimentel-Santos
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Filipa Mourão
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Nélia Gouveia
- CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jaime Cunha Branco
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Santos
- Rheumatology, Instituto Português de Reumatologia, Lisboa, Portugal
| | - Elsa Vieira-Sousa
- Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Filipe Vinagre
- Rheumatology, Hospital Garcia de Orta EPE, Almada, Portugal
| | - João Tavares-Costa
- Rheumatology, Unidade Local de Saude do Alto Minho EPE, Viana do Castelo, Portugal
| | - João Rovisco
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Clínica Universitária de Reumatologia, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Miguel Bernardes
- Rheumatology, Centro Hospitalar de Sao Joao EPE, Porto, Portugal
| | - Nathalie Madeira
- Rheumatology, Instituto Português de Reumatologia, Lisboa, Portugal
| | - Rita Cruz-Machado
- Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Raquel Roque
- Rheumatology, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Joana Leite Silva
- Rheumatology, Unidade Local de Saude do Alto Minho EPE, Viana do Castelo, Portugal
| | - Mary Lucy Marques
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Sofia Ramiro
- CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal .,Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, Netherlands
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10
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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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11
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Romanowski MW, Straburzyńska-Lupa A. Is the whole-body cryotherapy a beneficial supplement to exercise therapy for patients with ankylosing spondylitis? J Back Musculoskelet Rehabil 2020; 33:185-192. [PMID: 31594196 DOI: 10.3233/bmr-170978] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of ankylosing spondylitis (AS) patients requires a combination of non-pharmacological (education, exercise and physical therapy), as well as pharmacological treatment modalities. The optimal management of AS still remains unresolved. OBJECTIVE The aim was to measure and compare the effects of whole-body cryotherapy (WBC) at -110∘C and at -60∘C and exercise therapy alone on disease activity and the functional parameters of patients with AS. METHODS Ninety-two patients were allocated to three groups: with WBC at -110∘C or at -60∘C (each concurrent with exercise therapy), or exercise therapy alone. Disease activity and the functional parameters of the patients were measured at study entry and at the end of the 8-day treatment. RESULTS Supervised therapy, irrespective of the program, led to a significant reduction in disease activity (Bath Ankylosing Spondylitis Disease Activity Index: BASDAI, Ankylosing Spondylitis Disease Activity Score: ASDAS-CRP), disease-related back pain, fatigue, duration and intensity of morning stiffness and a significant improvement in the patient's functional capacity (Bath Ankylosing Spondylitis Functional Index: BASFI), spine mobility (Bath Ankylosing Spondylitis Metrology Index: BASMI) and chest expandability, with no changes in the levels of CRP. It has been demonstrated that following therapy, the group that underwent cryotherapy at -110∘C manifested significantly reduced disease activity (BASDAI) compared with exercise therapy only (p= 0.024). CONCLUSION Adding cryotherapy at -110∘C to exercise therapy led to significantly reduced disease activity expressed in BASDAI, compared with exercise therapy alone.
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Affiliation(s)
- Mateusz Wojciech Romanowski
- Department of Physiotherapy, Poznan University of Medical Sciences, Poznan, Poland.,Rheumatological Centre, Srem, Poland
| | - Anna Straburzyńska-Lupa
- Department of Physical Therapy and Sports Recovery, Poznan University of Physical Education, Poznan, Poland.,Rheumatological Centre, Srem, Poland
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12
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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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13
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Menegatti S, Bianchi E, Rogge L. Anti-TNF Therapy in Spondyloarthritis and Related Diseases, Impact on the Immune System and Prediction of Treatment Responses. Front Immunol 2019; 10:382. [PMID: 30941119 PMCID: PMC6434926 DOI: 10.3389/fimmu.2019.00382] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs), such as spondyloarthritis (SpA), psoriasis, Crohn's disease (CD), and rheumatoid arthritis (RA) remain challenging illnesses. They often strike at a young age and cause lifelong morbidity, representing a considerable burden for the affected individuals and society. Pioneering studies have revealed the presence of a TNF-dependent proinflammatory cytokine cascade in several IMIDs, and the introduction of anti-TNF therapy 20 years ago has proven effective to reduce inflammation and clinical symptoms in RA, SpA, and other IMID, providing unprecedented clinical benefits and a valid alternative in case of failure or intolerable adverse effects of conventional disease-modifying antirheumatic drugs (DMARDs, for RA) or non-steroidal anti-inflammatory drugs (NSAIDs, for SpA). However, our understanding of how TNF inhibitors (TNFi) affect the immune system in patients is limited. This question is relevant because anti-TNF therapy has been associated with infectious complications. Furthermore, clinical efficacy of TNFi is limited by a high rate of non-responsiveness (30–40%) in RA, SpA, and other IMID, exposing a substantial fraction of patients to side-effects without clinical benefit. Despite the extensive use of TNFi, it is still not possible to determine which patients will respond to TNFi before treatment initiation. The recent introduction of antibodies blocking IL-17 has expanded the therapeutic options for SpA, as well as psoriasis and psoriatic arthritis. It is therefore essential to develop tools to guide treatment decisions for patients affected by SpA and other IMID, both to optimize clinical care and contain health care costs. After a brief overview of the biology of TNF, its receptors and currently used TNFi in the clinics, we summarize the progress that has been made to increase our understanding of the action of TNFi on the immune system in patients. We then summarize efforts dedicated to identify biomarkers that can predict treatment responses to TNFi and we conclude with a section dedicated to the recently introduced inhibitors of IL-17A and IL-23 in SpA and related diseases. The focus of this review is on SpA, however, we also refer to RA on topics for which only limited information is available on SpA in the literature.
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Affiliation(s)
- Silvia Menegatti
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France.,Unité Mixte de Recherche, Institut Pasteur/AP-HP Hôpital Cochin, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Elisabetta Bianchi
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France.,Unité Mixte de Recherche, Institut Pasteur/AP-HP Hôpital Cochin, Paris, France
| | - Lars Rogge
- Immunoregulation Unit, Department of Immunology, Institut Pasteur, Paris, France.,Unité Mixte de Recherche, Institut Pasteur/AP-HP Hôpital Cochin, Paris, France
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14
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Braun J, Deodhar A, Landewé R, Baraliakos X, Miceli-Richard C, Sieper J, Quebe-Fehling E, Martin R, Porter B, Gandhi KK, van der Heijde D. Impact of baseline C-reactive protein levels on the response to secukinumab in ankylosing spondylitis: 3-year pooled data from two phase III studies. RMD Open 2018; 4:e000749. [PMID: 30564451 PMCID: PMC6269637 DOI: 10.1136/rmdopen-2018-000749] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/02/2023] Open
Abstract
Objective To evaluate the magnitude of response to secukinumab treatment over 3 years in patients with ankylosing spondylitis (AS) grouped by baseline C-reactive protein (CRP) levels in a pooled study of two pivotal phase III studies: MEASURE 1 (NCT01358175) and MEASURE 2 (NCT01649375). Methods This post hoc analysis pooled data from all patients with available baseline CRP in the two studies who received subcutaneous secukinumab 150 mg (approved dose; N=197) or placebo (N=195). Assessed efficacy endpoints included Assessments of SpondyloArthritis international Society (ASAS)20/40, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASDAI50, AS Disease Activity Score inactive disease and ASAS partial remission among patients grouped by baseline CRP based on central laboratory cut-off <5 mg/L (normal) or ≥5 mg/L (elevated) and a cut-off <10 mg/L or ≥10 mg/L. Results At baseline, 36.5% (143/392) patients had normal and 63.5% (249/392) had elevated CRP. At week 16, ASAS20/40 response rates were higher for secukinumab versus placebo in normal (56.9%/34.7% vs 28.2%/7.0%; p<0.01/p<0.001) and in elevated (63.2%/42.4% vs 29.0%/15.3%; both p<0.0001) CRP groups. Improvement was reported for all outcomes (p<0.05) in both groups, except for ASAS partial remission in the normal CRP group, where a numerical difference 12.5% vs 2.8%, p=0.07) was observed. Similar trends of improvement were observed in the <10 and ≥10 mg/L groups across all efficacy outcomes at week 16. Treatment responses to secukinumab in all CRP groups further improved over 156 weeks. Conclusion Secukinumab 150 mg demonstrated rapid and sustained efficacy in patients with AS irrespective of baseline CRP, with greater magnitude of response in patients with more elevated CRP.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | - Atul Deodhar
- Oregon Health & Science University, Portland, Oregon, USA
| | - Robert Landewé
- University of Amsterdam and Atrium Medical Centre, Amsterdam, The Netherlands
| | | | - Corinne Miceli-Richard
- Paris Descartes University, Department of Rheumatology -Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | | | - Ruvie Martin
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Brian Porter
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Kunal K Gandhi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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15
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Monti S, Todoerti M, Codullo V, Favalli EG, Biggioggero M, Becciolini A, Montecucco C, Caporali R. Prevalence of Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease in a cohort of patients treated with TNF-alpha inhibitors. Mod Rheumatol 2017; 28:542-549. [PMID: 28880727 DOI: 10.1080/14397595.2017.1367076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treat to target (T2T), aiming at inactive disease (ID), has become the recommended strategy for axial-SpA (ax-SpA). Using the Ankylosing Spondylitis Disease Activity Score (ASDAS), we assessed the prevalence of ID in ax-SpA patients treated with TNFα inhibitors (TNFi). METHODS A multicentric, cross-sectional study was performed assessing disease activity status (BASDAI and ASDAS) of consecutive patients with ax-SpA on stable treatment with TNFi for at least six months. We analyzed differences with nonradiographic axSpA (nr-ax-SpA) and the influence of population characteristics and comorbidities in reaching ID. ID was defined as ASDAS-CRP <1.3. RESULTS A total of 218 patients were enrolled, 165 with AS and 53 with nr-ax-SpA. ASDAS-CRP ID was reached by 89 (40.8%) patients, while 163 (74.8%) of patients achieved good disease control with BASDAI. There were no significant differences between the two diagnostic groups. Multivariate logistic regression demonstrated a negative correlation of concomitant fibromyalgia, higher BASMI and current NSAIDs with the chances of reaching ASDAS-CRP ID or BASDAI <4. CONCLUSION T2T represents a new challenge in the management of ax-SpA, with recently introduced disease activity measures being significantly more stringent. The prevalence of ID was affected by concomitant fibromyalgia, decreased spine mobility and concomitant NSAIDs.
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Affiliation(s)
- Sara Monti
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | - Monica Todoerti
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | - Veronica Codullo
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | | | | | - Andrea Becciolini
- b Department of Rheumatology , Gaetano Pini Institute , Milan , Italy
| | - Carlomaurizio Montecucco
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
| | - Roberto Caporali
- a Department of Rheumatology , University of Pavia, IRCCS Policlinico S. Matteo Foundation , Pavia , Italy
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van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, Regel A, Ciurea A, Dagfinrud H, Dougados M, van Gaalen F, Géher P, van der Horst-Bruinsma I, Inman RD, Jongkees M, Kiltz U, Kvien TK, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compàn V, Ozgocmen S, Pimentel-Santos FM, Reveille J, Rudwaleit M, Sieper J, Sampaio-Barros P, Wiek D, Braun J. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76:978-991. [PMID: 28087505 DOI: 10.1136/annrheumdis-2016-210770] [Citation(s) in RCA: 979] [Impact Index Per Article: 139.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 12/16/2022]
Abstract
To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6-8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
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Affiliation(s)
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Filip Van den Bosch
- Department of Rheumatology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Andrea Regel
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich Switzerland
| | | | - Maxime Dougados
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Floris van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Géher
- Semmelweis University, Budapest, Hungary
| | | | | | | | - Uta Kiltz
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Pedro M Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
| | - Anna Molto
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | | | - Salih Ozgocmen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | | - John Reveille
- The University of Texas-Health McGovern Medical School, Dallas, USA
| | - Martin Rudwaleit
- Klinikum Bielefeld, Bielefeld, Germany
- Gent University, Gent, Belgium
- Charité University Medicine, Berlin, Germany
| | - Jochen Sieper
- Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | | | - Dieter Wiek
- EULAR PARE Patient Research Partner and Chair of EULAR PARE, Berlin, Germany
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
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Serum HMGB1 Serves as a Novel Laboratory Indicator Reflecting Disease Activity and Treatment Response in Ankylosing Spondylitis Patients. J Immunol Res 2016; 2016:6537248. [PMID: 27800496 PMCID: PMC5069358 DOI: 10.1155/2016/6537248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/10/2016] [Indexed: 01/10/2023] Open
Abstract
Objective. High mobility group box 1 (HMGB1) is a late inflammatory factor participating in the pathogenesis of various autoimmune and inflammatory diseases. In the current study, we analyzed the association between serum levels of HMGB1 and clinical features of AS patients before and during treatment. Methods. Serum HMGB1 was detected in 147 AS patients and 61 healthy controls using ELISA. We evaluated the association between HMGB1 and extra-articular manifestations as well as disease severity indices. Among these AS patients, 41 patients received close follow-up at 1, 3, and 6 months after treatment. This group comprised 25 patients treated with anti-TNF-α biologics and 16 patients receiving oral NSAIDs plus sulfasalazine. Results. The serum HMGB1 of AS patients was significantly higher than in healthy controls and positively correlated with BASDAI, BASFI, ASDAS-ESR, ASDAS-CRP, ESR, and CRP, but not with HLA-B27, anterior uveitis, and recurrent diarrhea. There was no significant difference between patients with radiographic damage of hip joints and those without. We observed that serum HMGB1 paralleled disease activity after treatment. Conclusion. Serum level of HMGB1 is higher in AS patients, and to some extent, HMGB1 can reflect the activity of AS and be used as a laboratory indicator to reflect the therapeutic response.
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Braun J, Kiltz U, Sarholz M, Heldmann F, Regel A, Baraliakos X. Monitoring ankylosing spondylitis: clinically useful markers and prediction of clinical outcomes. Expert Rev Clin Immunol 2015; 11:935-46. [PMID: 26048334 DOI: 10.1586/1744666x.2015.1052795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient assessment in axial spondyloarthritis (axSpA) is multidimensional, and monitoring of disease activity, function and radiographic progression is complex. There is no simple 'gold standard' for measuring disease activity in all individual patients, as disease activity in axSpA is the sum of many different aspects and a complexity that cannot be represented by a single variable. Limited spinal mobility is a cardinal sign of ankylosing spondylitis and loss of spinal mobility has been reported to be a prognostic factor and most often evaluated with the Bath Ankylosing Spondylitis Functional Index. Imaging of the spine and assessment of safety aspects plays an important role in the monitoring of patients with axSpA. The timeframe for collecting information regarding disease activity, function and radiographic progression are recommended on an individual basis.
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Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr 45, 44649 Herne Germany
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Machado P, Navarro‐Compán V, Landewé R, Gaalen FA, Roux C, Heijde D. Brief Report: Calculating the Ankylosing Spondylitis Disease Activity Score If the Conventional C‐Reactive Protein Level Is Below the Limit of Detection or If High‐Sensitivity C‐Reactive Protein Is Used: An Analysis in the DESIR Cohort. Arthritis Rheumatol 2015; 67:408-13. [DOI: 10.1002/art.38921] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/11/2014] [Accepted: 10/14/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Pedro Machado
- Leiden University Medical CenterLeidenThe Netherlands
- University of CoimbraCoimbraPortugal
| | | | - Robert Landewé
- Amsterdam Rheumatology Center, Amsterdam, The Netherlands, and Atrium Medical CenterHeerlenThe Netherlands
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