Ankylosing Spondylitis Disease Activity Research Articles

The relationship of serum vitamin D receptor levels with disease activity and clinical parameters in patients with ankylosing spondylitis.

The aim of this study was to investigate the relationship between serum vitamin D receptor (SVDR) levels and disease activity parameters in patients with ankylosing spondylitis (AS). Between July 2016 and January 2017, a total of 62 patients (51 males, 11 females; mean age 36.5±12.8 years; range, 23 to 49 years) with AS and 32 healthy volunteers (25 males, 7 females; mean age 41.57±13.6 years; range, 26 to 48 years) were included in the study. The SVDR levels were measured using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels were recorded. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were used to assess disease activity. Although there was no significant difference between the patient and control groups (p=0.66), SVDR levels were significantly elevated in patients with active AS (BASDAI score ≥4) (p=0.01). The SVDR levels significantly increased in AS patients with peripheral joint involvement and enthesitis (p=0.01, p=0.05, respectively). The SVDR levels significantly elevated in patients treated with non-steroidal anti- inflammatory drugs, compared to those treated with biological agents and control group (p=0.01, p=0.03, respectively). The SVDR levels were positively correlated with the BASDAI, CRP and ESR in the patient group (p=0.01, r=0.751; p=0.01, r=0.75; p=0.01, r=0.81, respectively). Our study results suggest that serum SVDR levels are associated with the disease activity and clinical parameters in patients with AS. Based on these findings, SVDR level may be used as a marker of disease activity in AS.

Cardiac conduction disturbances in patients with ankylosing spondylitis: results from a 5-year follow-up cohort study

ObjectivesTo describe electrocardiographic (ECG) development in patients with ankylosing spondylitis (AS) and identify associations between baseline characteristics and cardiac conduction disturbances (CCD) at 5-year follow-up.MethodsIn a longitudinal cohort study, 172...

The Role of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers of Disease Activity in Ankylosing Spondylitis

BackgroundAnkylosing spondylitis (AS) is a chronic rheumatological condition affecting sacroiliac joint and spine and occurs more often in younger patients than in the elderly population.ObjectiveThe purpose of the study was to determine the association of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with the disease activity of AS.MethodologyThis case-control study was conducted in the rheumatology department at the Pakistan Institute of Medical Sciences (PIMS) hospital in Islamabad from September 2018 to July 2019. The study consisted of two groups of 59 patients per group. We assessed a full blood count with erythrocyte sedimentation rate (ESR) for each participant using the PIMS hospital laboratory. NLR and PLR were calculated.ResultsThe mean age of the participants in the control group and the cases group was the same (32 ± 4 years). The control group NLR was 1.30 ± 0.16, the PLR was 94.98 ± 17.96, and the ESR was 16.88 ± 3.76 mm/hour. For the cases group, the NLR was 3.08 ± 0.91, the PLR was 171.50 ± 38.06, and the ESR was 29.30 ± 9.20 mm/hour. There was a significant increase in cases for NLR, PLR, and ESR as compared to control samples (p<0.05). The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score of participants with active diseases was 5.91±1.28. In the same group, the mean ESR was 27.65 ± 9.07 mm/hour, the NLR was 3.46 ± 0.80, and the PLR was 184.39 ± 36.13. For those in the inactive disease group, the mean BASDAI score was 2.84 ± 0.46, the ESR was 33.42 ± 8.48 mm/hour, the NLR was 2.17 ± 0.37, and the PLR was 139.71 ± 26.05. NLR and PLR were significantly higher in the active disease group (p<0.05).ConclusionNLR and PLR are good markers of inflammation in AS patients, and higher values indicate more active disease activity.

Depression in ankylosing spondylitis and the role of disease-related and contextual factors: a cross-sectional study

BackgroundPatients with ankylosing spondylitis (AS) have a higher prevalence of depression compared to the general population. Comorbid depression in AS likely has a multifactorial origin. While several disease-related and contextual factors have been associated with depressive symptoms in AS, a comprehensive model of their interrelations is currently lacking. Such a model could help understand the mechanisms leading to, or maintaining, depression in AS. The objectives of the current study were to determine which factors are associated with depressive symptoms in AS and to understand their underlying relationships.MethodsData from a cross-sectional survey-based multicentre study were used. Potential determinants included both contextual and disease-related factors. Depressive symptoms were assessed by the Hospital Anxiety and Depression Subscale (HADS-D). Direct and indirect associations between risk factors and the latent depressive symptom outcome were explored using structural equation modelling. A final model was selected based on model fit criteria and clinical plausibility.ResultsAmong 245 patients, median HADS-D score was 3 (interquartile range 1–6), and 44 patients (18%) had a HADS-D score ≥ 8, indicating possible depression. In the final model, contextual factors significantly associated with depressive symptoms were male gender, being employed, lower income, lower mastery and worse satisfaction with social role participation. Bath AS Disease Activity Index (BASDAI) was the only disease-related factor that was associated with depressive symptoms, acted only indirectly via mastery, and its standardized total effect on depressive symptoms was smaller than that of several contextual factors. Mastery had a central role in the path diagram and mediated the effects of BASDAI, income and satisfaction with social role participation on depressive symptoms. The final model explained 64% of the variance in the depression outcome.ConclusionsBoth contextual and disease-related factors are associated with depressive symptoms in AS. Mastery, the extent to which one feels in control over life and disease, has a key role in this process. Results support a relevance of self-efficacy in disease management and patient education. In order to improve patients’ mental health, research is warranted whether mastery and its relation with depression can be modified.

Health-Related Quality of Life in Patients with Ankylosing Spondylitis: Relationship with Disease-Related Variables.

Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease leading to functional limitations and subsequently impaired quality of life (QoL). Despite the fact that QoL was recognized as a significant perception, it was excluded from the core domains (defined by the Assessment of Spondyloarthritis International Society), because of ambiguity of measurement choice. To assess QoL in patients with AS using a generic; Short Form-36 (SF-36) and a diseasespecific; Ankylosing Spondylitis quality of life (ASQoL) instruments and to explore its relationship to the clinical characteristics, disease activity, functional status, and radiographic severity. A total of 47 AS patients who fulfilled modified New York criteria were included. Disease activity, functional status, spinal mobility, and radiographic severity were assessed by Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI) and Bath AS Radiology Index (BASRI) respectively. SF-36 and ASQoL instruments evaluated Qol. Physical health was more affected especially in patients with peripheral arthritis by SF-36 (p=0.008) and ASQoL (p=0.022) scores. Both SF-36 total and ASQoL scores correlated significantly with BASDAI (r = -0.329, p = 0.024 and r = 0.420, p = 0.003), BASFI (r = -0.399, p = 0.005 and r = 0.513, p=0.001) and BASMI (r = -0.382, p = 0.008 and r = 0.482, p= 0.001) respectively. QoL was impaired in AS patients with highest impact on physical health especially in association with peripheral arthritis. SF-36 and ASQol have a comparable achievement in the evaluation of QoL in AS patients and both physical function and spinal mobility were identified as predictors of poor QoL.

Clinical Findings of Ankylosing Spondylitis With and Without Human Leukocyte Antigen (HLA)-B27 and HLA-B51

Ankylosing spondylitis (AS) and Behçet's disease are known to be associated with the human leukocyte antigen (HLA)-B27 and HLA-B51 genes, respectively. However, many of their clinical findings-including articular and extra-articular symptoms-are similar, making diagnosis a challenge in the early stage of the disease. The aim of this study was to investigate the differences in clinical findings of AS patients with and without the HLA-B27 gene. We performed a retrospective chart review of 151 AS patients. The following clinical findings were evaluated: oral ulcer, genital ulcer, skin manifestation, uveitis, peripheral arthritis; and gastrointestinal, cardiac and pulmonary involvement. Patients were divided into 4 groups based on absence or presence of the HLA-B27 and HLA-B51 genes. The number of patients with each clinical finding was subsequently examined in each group. The incidence of uveitis was significantly higher in the HLA-B27-positive group (P = 0.004); however, other clinical findings did not differ significantly according to the absence or presence of the HLA-B27 gene. There were no significant differences in the clinical findings of patients with positive and negative HLA-B51. HLA-B27 was associated with the development of uveitis but not with other clinical findings or disease activity in AS patients. HLA-B51 was not associated with the clinical findings or disease activity of AS.

Frequencies of the LILRA3 6.7-kb Deletion Are Highly Differentiated Among Han Chinese Subpopulations and Involved in Ankylosing Spondylitis Predisposition.

Introduction: Leukocyte immunoglobulin-like receptor A3 (LILRA3) belongs to the LILR family with unique feature of a 6.7-kb deletion variation among individuals. Frequencies of the 6.7-kb deletion vary widely across populations, but so far it has not been carefully investigated among Han Chinese subpopulations. Furthermore, we previously identified the non-deleted (functional) LILRA3 as a novel genetic risk for multiple autoimmune diseases. The current study aimed to investigate (i) whether frequencies of the LILRA3 6.7-kb deletion differ within Han Chinese subpopulations and (ii) whether the functional LILRA3 is a novel genetic risk for ankylosing spondylitis (AS).Methods: The LILRA3 6.7-kb deletion was genotyped in two independent cohorts, including 1,567 subjects from Shenzhen Hospital and 2,507 subjects from People’s Hospital of Peking University. Frequencies of the 6.7-kb deletion were first investigated in combined healthy cohort according to the Chinese administrative district divisions. Association analyses were performed on whole dataset and subsets according to the geographic regions. Impact of the functional LILRA3 on AS disease activity was evaluated.Results: Frequencies of LILRA3 6.7-kb deletion were highly differentiated within Han Chinese subpopulations, being gradually decreased from Northeast (80.6%) to South (47.4%). Functional LILRA3 seemed to be a strong genetic risk in susceptibility to AS under almost all the alternative genetic models, if the study subjects were not geographically stratified. However, stratification analysis revealed that the functional LILRA3 was consistently associated with AS susceptibility mainly in Northern Han subgroup under the alternative genetic models, but not in Central and Southern Hans. Functional LILRA3 conferred an increased disease activity in AS patients (P < 0.0001 both for CRP and ESR, and P = 0.003 for BASDAI).Conclusions: The present study is the first to report that the frequencies of LILRA3 6.7-kb deletion vary among Chinese Hans across geographic regions. The functional LILRA3 is associated with AS susceptibility mainly in Northern Han, but not in Central and Southern Han subgroups. Our finding provides new evidence that LILRA3 is a common genetic risk for multiple autoimmune diseases and highlights the genetic differentiation among different ethnicities, even within the subpopulations of an ethnic group.

Left Ventricular Systolic Myocardial Function in Ankylosing Spondylitis.

Subclinical left ventricular (LV) myocardial dysfunction is associated with an increased risk of cardiovascular disease (CVD), but it is not known whether subclinical LV myocardial dysfunction is present in patients with ankylosing spondylitis (AS) independent of CVD risk factors. Conventional and speckle tracking echocardiography were performed in 106 patients with AS (mean ± SD age 48 ± 12 years; 59% men) and 106 matched controls (mean ± SD age 51 ± 12 years; 59% men). LV systolic myocardial function was assessed by peak systolic global longitudinal strain (GLS). CVD risk factors were similarly distributed in patients with AS and controls, but more controls received statin therapy (P = 0.05). GLS was significantly lower in patients with AS compared to controls (mean ± SD -17.7 ± 2.5% versus -18.4 ± 2.3%; P = 0.03). In univariable linear regression analyses in the total study population, lower GLS was associated with having AS, male sex, higher body mass index, higher LV mass index, and lower LV ejection fraction (all P < 0.05). Having AS retained an independent association with lower GLS when adjusted for these factors in multivariable analyses (β = 0.16, P = 0.02). In patients with AS, lower GLS was independently associated with larger aortic root diameter in multivariable analyses (β = 0.24, P = 0.02), while no association with AS disease activity, disease duration, or use of antirheumatic medication was observed. Patients with AS had lower GLS compared with controls, independent of confounders. In AS patients, lower GLS was associated with larger aortic root diameter. Prospective studies should test whether lower GLS contributes to the observed higher CVD risk in patients with AS.

The incidence of extra-articular manifestations in southern Chinese patients with inflammatory joint diseases.

Inflammatory joint diseases (IJDs) are chronic arthritis, but frequently present with co-morbidities of other organs and systems, which is known as extra-articular manifestations (EAMs). It is still unclear which clinical characteristics or bio-markers can predict the development of EAMs. The aim of this study was to estimate the proportion of EAMs in southern Chinese patients with IJDs and to explore the risk factors. This was a retrospective cohort study of a total 1135 IJDs patients, including 788 rheumatoid arthritis (RA) patients, 307 ankylosing spondylitis (AS) patients and 40 psoriatic arthritis (PsA) patients. Demographic data, disease characteristics, laboratory blood tests, medical imaging, and the presence of EAMs were recorded. We found 459 (40.44%) patients presented with EAMs: 30.84% had cardiovascular involvement, 7.67% had pulmonary involvement, 5.29% had osteoporosis/low bone mineral density, 2.29% had ocular, 0.79% had gastrointestinal and 0.26% had renal involvements. Multivariate logistic regression showed older age (odds ratio [OR] 1.06, P<.001) and higher anti-cyclic citrullinated peptide antibody (anti-CCP) levels (OR 1.003, P=.019) were independent risks of EAMs in RA patients. In the AS group, older age (OR 1.07, P<.001) and higher disease activity (OR 3.24-7.42, both P<.05), were independent risks of EAMs. In the PsA group, longer disease duration (OR 1.01, P=.036) and higher disease activity (OR 1.15, P=.004) were univariate associated factors. These results suggested the high prevalence of EAMs, and it is important to regularly screen for EAMs, as they influence treatment decisions and impact on patients' quality of life.

Elevated circulating IL-17 level is associated with inflammatory arthritis and disease activity: A meta-analysis

ObjectivesPrevious studies found that the interleukin (IL)-17 level was elevated in inflammatory arthritis, but results were inconsistent. This meta-analysis aimed to investigate the association of IL-17 cytokine with osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). MethodsRelevant studies were searched using databases. Standardized mean difference (SMD) was calculated. Correlation coefficient was utilized to evaluate the relationship between IL-17 and disease activity of AS and RA. Subgroup analysis, sensitivity analysis and meta-regression were applied to explore the sources of heterogeneity. Results83 records were enrolled. The IL-17 level was elevated in AS (SMD = 2.348, P < .001), RA (SMD = 1.502, P < .001), PsA (SMD = 1.710, P < .001) and OA (SMD = 1.192, P = .016), and similar results occurred in subgroup analysis. Furthermore, the IL-17 level was positively associated with disease activity of AS and RA. ConclusionCirculating IL-17 level is significantly elevated in inflammatory arthritis and is related to the disease activity of AS and RA, suggesting that it plays an important role in the pathogenesis and progression of inflammatory arthritis (especially in AS and RA).

Bone mineral density and bone remodelling in Tunisian patients with ankylosing spondylitis: A cross-sectional study

Aim of the workTo assess the bone turnover markers and bone mineral density (BMD) in ankylosing spondylitis (AS) patients and to evaluate their association with clinical variables. Patients and methodsForty-seven AS patients were compared with 47 matched control. Clinical features and inflammatory parameters were assessed. C-terminal telopeptide fragments of type I collagen (CTX), alkaline phosphatases (ALP), N-terminal propeptide of type I procollagen (PINP) serum levels, and BMD of the lumbar spine and femoral neck were evaluated. The Bath AS disease activity and functional indices (BASDAI and BASFI) were assessed. ResultsMean serum levels of C-reactive protein, ALP and CTX were higher in AS patients than control (p = 0.001, p = 0.001 and p = 0.027 respectively). Osteopenia and osteoporosis were significantly more frequent in AS patients (57.4%) than control (21.3%) (p < 0.001). The PINP and ALP significantly correlated with disease duration (r = 0.33, p = 0.02 and r = 0.3, p = 0.04 respectively). BMD of the femoral neck was significantly lower in AS patients with history of coxitis than AS patients without (p = 0.02). Patients on anti-tumour necrosis factor (TNFα) therapy had higher T score (lumbar spine) compared to those not. Multivariate regression showed that CRP levels and disease activity were independently associated with low BMD and T score (lumbar) was significantly associated with anti-TNF use (p = 0.007). ConclusionsAn increase in bone turnover markers and decrease of BMD were observed in AS patients. Inflammatory activity of AS was associated to hyper bone remodelling and decrease of BMD. Anti-TNF use seems to be beneficial on AS inflammation and therefore on the BMD.

Core stability and balance in patients with ankylosing spondylitis.

The main purpose of this study was to compare core stability and balance between ankylosing spondylitis (AS) patients and healthy controls. AS patients diagnosed according to the Modified New York criteria and healthy age- and sex-matched controls were included in the study. Clinical status of AS patients was assessed using Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Spinal Mobility Index (BASMI). For evaluation of core stability, static and dynamic core endurance and hip strength were assessed. Trunk flexor and extensor endurance, lateral side bridge tests for static core endurance; modified sit-up test for dynamic core endurance were used. Hip strength was measured with a hand-held dynamometer. Biodex Balance System was used to assess static and dynamic balance. Bilateral standing static and dynamic postural stability, single leg standing postural stability and limits of stability test results were recorded. 64 AS patients (40 male, 24 female) and 64 healthy controls (39 male, 25 female) were assessed. Static and dynamic core endurance test results, hip abductor strength were significantly higher in control group than AS group (p < 0.05). Static postural stability and left leg postural stability test results were significantly better in control group than AS group (p < 0.05). Overall, forward, backward, and right, limits of stability test results were significantly higher in control group (p < 0.05). The results of our study demonstrate that AS has negative effects on core stability and balance. It would be beneficial to add core stability and balance training to AS patients' rehabilitation program.

Effect of Smoking in Patients with Ankylosing Spondylitis: A Cross-sectional Study in State of Madhya Pradesh, India

Aim: Understanding the impact of smoking on the development and severity of ankylosing spondylitis (AS) is pivotal, as it affects the management of the disease. This study investigated the effect of smoking in patients with AS and its outcome on the disease. Methods: This was a cross-sectional study from September 1, 2018, to November 30, 2018, in a rheumatology outpatient department enrolled patients aged >18 years diagnosed with AS and divided into two groups according to their smoking status. Demographic details and hematological and biochemical parameters were noted. Modified Schober's test, chest expansion, and duration of disease measurements were performed. Disease activity and functional state were evaluated using the Bath AS Disease Activity Index (BASDAI) and Bath AS Functional Index (BASFI). Results: A total of 48 patients were enrolled (smoker, n = 20; nonsmoker, n = 28). The mean age in smoker and nonsmoker groups was 39.40 years and 26.18 years, respectively, and male preponderance was observed; the mean duration of disease was 42.90 months and 43.14 months, respectively. BASDAI and BASFI scores were significantly higher in the smoker group (5.08 and 4.51, respectively) as compared to nonsmoker group (3.40 and 2.34, respectively) (P

Serum galectin-3 concentrations in patients with ankylosing spondylitis.

ObjectiveThe aim of our study was to assess potential correlations between serum galectin‐3 concentrations and Ankylosing Spondylitis Disease Activity (ASDAS) index in patients with ankylosing spondylitis (AS).MethodsA total of 112 patients with AS were included, and 130 healthy subjects were considered as controls. We collected the detailed medical history, and ASDAS index was used to assess the disease severity in patients with AS.ResultsThe serum galectin concentrations were higher in AS patients compared to the health groups (14.1 ± 9.6 vs 9.2 ± 3.7, P < 0.001). The correlation analysis showed that serum galectin concentrations were significantly positively correlated with C‐reactive protein and erythrocyte sedimentation rate (r = 0.369, P < 0.001; r = 0.240, P = 0.011). In addition, the positively correlation of serum galectin‐3 with global pain index (r = 0.238, P = 0.011) was observed in AS patients. A significant positively correlation between serum galectin and ASDAS index in AS patients was found (r = 0.367; P < 0.001). In multiple linear regression analysis, the results indicated that increased serum galectin still was correlated with ASDAS index (r = 0.322, P < 0.001) in patients with AS.ConclusionsSerum galectin concentrations were found to be correlated with ASDAS index in patients with AS.

Study of quality control results in Atellica CH 930 Clinical Chemistry System comparing with ADVIA Chemistry System XPT

Previous studies found that the interleukin (IL)-17 level was elevated in inflammatory arthritis, but results were inconsistent. This meta-analysis aimed to investigate the association of IL-17 cytokine with osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA).Relevant studies were searched using databases. Standardized mean difference (SMD) was calculated. Correlation coefficient was utilized to evaluate the relationship between IL-17 and disease activity of AS and RA. Subgroup analysis, sensitivity analysis and meta-regression were applied to explore the sources of heterogeneity.83 records were enrolled. The IL-17 level was elevated in AS (SMD = 2.348, P < .001), RA (SMD = 1.502, P < .001), PsA (SMD = 1.710, P < .001) and OA (SMD = 1.192, P = .016), and similar results occurred in subgroup analysis. Furthermore, the IL-17 level was positively associated with disease activity of AS and RA.Circulating IL-17 level is significantly elevated in inflammatory arthritis and is related to the disease activity of AS and RA, suggesting that it plays an important role in the pathogenesis and progression of inflammatory arthritis (especially in AS and RA).

Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment.

Spondyloarthropathies (SpA) include many different forms of inflammatory arthritis and can affect the spine (axial SpA) and/or peripheral joints (peripheral SpA) with Ankylosing spondylitis (AS) being the prototype of the former. Extra-articular manifestations, like uveitis, psoriasis and inflammatory bowel disease (IBD) are frequently observed in the setting of SpA and are, in fact, part of the SpA classification criteria. Bowel involvement seems to be the most common of these manifestations. Clinically evident IBD is observed in 6%-14% of AS patients, which is significantly more frequent compared to the general population. Besides, it seems that silent microscopic gut inflammation, is evident in around 60% in AS patients. Interestingly, occurrence of IBD has been associated with AS disease activity. For peripheral SpA, two different forms have been proposed with diverse characteristics. Of note, SpA (axial or peripheral) is more commonly observed in Crohn’s disease than in ulcerative colitis. The common pathogenetic mechanisms that explain the link between IBD and SpA are still ill-defined. The role of dysregulated microbiome along with migration of T lymphocytes and other cells from gut to the joint (“gut-joint” axis) has been recognized, in the context of a genetic background including associations with alleles inside or outside the human leukocyte antigen system. Various therapeutic modalities are available with monoclonal antibodies against tumour necrosis factor, interleukin-23 and interleukin-17, being the most effective. Both gastroenterologists and rheumatologists should be alert to identify the co-existence of these conditions and ideally follow-up these patients in combined clinics.

Neutrophil lymphocyte ratio in patients with ankylosing spondylitis: A systematic review and meta-analysis

Objective: The aim of this meta-analysis was to investigate the association of neutrophil lymphocyte ratio (NLR) with AS (ankylosing spondylitis) patients.Methods: PubMed, Web of Science, Cochrane Library, Elsevier Science Direct and Google Scholar databases (up to 30 September 2018) were searched to collect all pertinent articles. The pooled standard mean difference (SMD) with 95% confidence interval (CI) was calculated by the random effects model.Results: Totally 10 studies contained 765 AS patients and 701 healthy controls were included in our meta-analysis. The results indicated that there were significant statistical differences between AS patients and healthy controls in NLR (SMD = 0.418, 95%CI = 0.239–0.598, p < .001). Meanwhile, the results of subgroup analysis showed, in the subgroup of C-reactive protein (CRP) ≥10 and the two subgroups of BASDAI (the Bath AS Disease Activity Index), NLR levels in AS were significantly higher than in control (all p < .001). The results of subgroup analysis and meta-regression suggested that BASDAI and CRP were likely associated with NLR in AS patients.Conclusion: The current meta-analysis provides evidence that NLR is a reasonable measure to detect systemic inflammation in AS patients. Besides, NLR may be able to indicate disease activity in patients with AS.

Cross-sectional study of patients with axial spondyloarthritis fulfilling imaging arm of ASAS classification criteria: baseline clinical characteristics and subset differences in a single-centre cohort

ObjectiveThis study compared demographic, clinical and laboratory characteristics between patients with radiographic and non-radiographic axial spondyloarthritis (axSpA).MethodsIn this single-centre cross-sectional study, a total of 246 patients with axSpA fulfilling the...

Plasma let-7i, miR-16, and miR-221 levels as candidate biomarkers for the assessment of ankylosing spondylitis in Mexican patients naïve to anti-TNF therapy.

Novel biomarkers are needed for the diagnosis and clinical assessment of ankylosing spondylitis (AS). Our objective was to investigate plasma microRNAs differentially expressed between AS patients and controls and to evaluate their potential as biomarkers in Mexican subjects. A cross-sectional study including 15 AS patients naïve to anti-TNF therapy and 13 controls was performed. Disease activity, physical function, and global well-being were evaluated by the AS Disease Activity Score (ASDAS-CRP), the Bath AS Disease Activity Index (BASDAI), the Bath AS Functional Index (BASFI), and the AS Quality of Life Questionnaire (ASQoL), respectively. Total RNA was isolated from plasma of participants and relative expression of let-7i, miR-16, and miR-221 was evaluated. Serum levels of C-reactive protein (CRP), matrix metalloproteinase-1 (MMP-1), MMP-9, and intercellular adhesion molecule-1 (ICAM-1) were also measured. Expression of let-7i was higher in patients than in controls (1.8, 0.9 to 3.4 versus 0.6, 0.4 to 1.2; P = 0.033) with an AUC/ROC of 0.74 (0.54 to 0.93; P = 0.032). Levels of miR-16 and miR-221 were unable to discriminate between patients and controls. Notably, plasma miR-16 levels were inversely correlated with the ASDAS-CRP score (rho - 64, - 0.87 to - 0.18; P = 0.011), the BASFI score (rho - 0.78, - 0.93 to - 0.43; P = 0.001), and serum MMP-1 levels (rho - 0.59, - 0.85 to - 0.09; P = 0.022). No other associations were found. Plasma let-7i levels may serve as a biomarker for the diagnosis of AS in Mexican individuals. Additionally, plasma miR-16 levels are associated with disease activity and physical functionality in patients naïve to anti-TNF therapy.

Measuring outcomes in ankylosing spondylitis: pearls and pitfalls.

Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to biologic therapy. Multiple AS-related questionnaires have been developed to assess the disease status accurately, but feasibility remains a problem in clinical practice. The purpose of this review is to assess the pearls and pitfalls of AS-related outcome measures. Single-item questionnaires to measure pain, stiffness and fatigue in patients with AS are easily administrable but may lack a sufficient degree of responsiveness on an individual patient level. The Bath Ankylosing Disease Activity Index remains the gold standard for assessing disease activity in a routine practice, despite poor correlation with C-reactive protein (CRP) levels and MRI inflammation. The Ankylosing Spondylitis Disease Activity Score, a validated and highly discriminatory tool for assessing disease activity in AS, has been developed but lacks feasibility as erythrocytic sedimentation rate and CRP values are often not available during a clinic visit. RAPID-3 appears feasible to assess patients with AS quantitatively over time in busy clinical settings. The assessment of disease status in AS is complex and is impacted by multiple factors. The biggest challenge in AS is to incorporate the disease-specific indices into a routine practice. VIDEO ABSTRACT: http://links.lww.com/COR/A42.