Ankylosing Spondylitis Quality Of Life Research Articles

Association of fear assessment in inflammatory rheumatic diseases (FAIR) questionnaire with ankylosing spondylitis quality of life and disease activity in patients with ankylosing spondylitis

Background/Aim: Fear against disease course, treatment, and limitations in family, work, and social life are commonly seen but mostly overlooked by physicians of patients with chronic inflammatory rheumatic diseases. Ankylosing spondylitis (AS) is a chronic inflammatory disease in young adults characterized by limitations in spinal mobility. The Fear Assessment (FAIR) Questionnaire was designed especially for patients with rheumatoid arthritis and spondyloarthritis to assess the level of fear from the patient’s perspective. Here we evaluate the FAIR score in AS patients and its association with disease activity, AS quality of life (ASQoL), depression, anxiety, and fatigue levels.
 Methods: This cross-sectional study included 79 patients with AS, and disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), AS-Disease Activity Score-C reactive protein, and functional status was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Patient global assessment of disease and pain were scored on 0–10 cm visual analog scores. All patients completed FAIR and ASQoL questionnaires. The depression and anxiety were evaluated by Hospital Anxiety and Depression Scale (HADS), and fatigue was assessed by Fatigue Severity Scale (FSS).
 Results: The mean age of AS patients (62% male) was 41.7 (11.3) years. Most of the patients were on biological disease-modifying anti-rheumatic drugs (bDMARDs). The patients’ median BASDAI, ASDAS-CRP, and BASFI were 5.4 (range, 3.8–7.4), 3.83 (1.4), and 4.0 (range, 2.3–6.2), respectively. The overall FAIR, ASQoL, FSS, HADS-depression, and HADS-anxiety scores were 75 (range, 52–91), 9.6 (5.2), 5.4 (range, 4.1–7), 7.7 (4.4) and 9.6 (5.2), respectively. There were statistically significant correlations between disease activity indices and FAIR, ASQoL, FSS, and HADS scores. The FAIR scores significantly correlated with ASQoL, FSS, and HADS scores. The patients with active disease (BASDAI ≥ 4) had significantly higher levels of FAIR, ASQoL, FSS, and HADS. The best cut-off value for the FAIR score of AS patients with moderate to severe disease activity was 50 (AUC: 0.734, 95% CI [0.599–0.870], P = 0.002), with a sensitivity of 89.8%, specificity of 55%, positive likelihood ratio of 1.99, and Youden index of 0.45.
 Conclusion: This study shows that AS patients face a high level of fear which is associated with higher disease activity, higher risk of mood disorders, and lower quality of life. Physicians should not only focus on the physical improvement of the patient but also handle the fear of patients against their diseases and their treatment. This holistic approach will improve the dialogue between the physician and the patient, which will result in increased compliance with treatment and will raise the quality of care.

Sonographic Comparison of Neck Extensor Muscle Thickness of Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis Patients with Healthy Volunteers

Abstract Introduction This study examines the neck extensor muscle thickness of patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) by comparing them with healthy volunteers. It also aims to evaluate the relationship between muscle thickness and disease activity, functional parameters, neck disability and quality of life in patients with AxSpA. Method In this cross-sectional study, 30 patients with AS and 30 patients with nr-AxSpA who were admitted to a Physical Medicine and Rehabilitation outpatient clinic were included consecutively. Thirty healthy participants were included as a control group. The thickness of muscles was measured bilaterally by ultrasound and the muscle thickness average was recorded. All patients with axSpA were asked to complete the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Ankylosing spondylitis Quality of Life (AsQoL) scale and the Neck Disability Index (NDI). Results Mean patient age was 42.36±10.0 in the AS group, 38.13±7.94 in the nr-axSpA group and 39.06±8.25 in the healthy group. A statistically significant decrease was found in multifidus, semispinalis capitis, semispinalis cervicis and splenius capitis muscle thickness in AS patients compared with the healthy group, and in semispinalis cervicis muscle thickness in nr-axSpA patients compared with the healthy group. However, when trapezius muscle thickness was compared between the groups, no statistical difference was found. There was a significant negative correlation between neck extensor muscle thickness and age, BASDAI, NDI and AsQoL in patients with axSpA. Conclusion The thickness of the neck extensor muscles is decreased in patients with AxSpA compared with healthy individuals, and this situation can be reliably detected by ultrasound.

Minimal Impact of the COVID-19 Pandemic on Disease Activity and Health-Related Quality of Life in Patients With Ankylosing Spondylitis Receiving Bimekizumab: Exploratory Analyses From a Phase 2b Open-Label Extension Study.

ObjectiveThe impact of the COVID‐19 pandemic on patients with inflammatory rheumatic diseases, such as ankylosing spondylitis (AS), has been variable. Here, we assess disease activity and health‐related quality of life (HRQoL) through the pandemic in patients with AS.MethodsIn the open‐label extension (OLE) of the phase 2b BE AGILE study, patients with AS received 160 mg of subcutaneous bimekizumab every 4 weeks. We assessed Ankylosing Spondylitis Disease Activity Score with C‐reactive protein (ASDAS‐CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Quality of Life (ASQoL) scores in the OLE immediately before and during the COVID‐19 pandemic (September 2019 to April 2021).ResultsA total of 232 patients remained in the BE AGILE OLE and were included in this post hoc study at the start of the analysis period (September 1, 2019); 12 patients had a COVID‐19 treatment‐emergent adverse event, and no cases resulted in death. The number of missed bimekizumab doses due to COVID‐19 (11 doses) was minimal, and missed assessments remained low (≤5%) compared with the prepandemic period. Mean ASDAS‐CRP (1.8), BASDAI (2.4), and ASQoL scores (2.8) in the OLE were low at pre‐pandemic baseline and remained stable at 1.7 to 1.8, 2.2 to 2.4, and 2.0 to 2.8, respectively, across successive 3‐month periods immediately before and during the pandemic. ASDAS‐CRP, BASDAI, and ASQoL stability was consistent across major study countries.ConclusionDisease activity and HRQoL remained stable during the COVID‐19 pandemic in patients with AS receiving bimekizumab in the BE AGILE OLE, with no indication of negative effects on these outcomes.

Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study.

In this study, we evaluated the presence of residual disease in patients with axial spondyloarthritis (axSpA) in remission/low disease activity (LDA) status. This cross-sectional post-hoc analysis of the QUASAR study involving 23 rheumatology centres across Italy included adults with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Patients with inactive disease (score < 1.3) or at least LDA status (score < 2.1) at baseline visit according to Ankylosing Spondylitis Disease Activity Score were investigated to evaluate how residual disease activity impacts patients’ quality of life. They were assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaires. This study included 480 patients with axSpA (mean age, 47.5 ± 12.9 years, 64% male). In total, 123 patients (25.6%) had inactive disease and 262 (54.6%) had at least LDA. Using the ASQoL, ranges of 10–25% and 20–40% of patients with inactive disease and with LDA status, respectively, experienced tiredness/fatigue. Despite being classified with inactive disease, 48.8% of patients reported light pain/discomfort according to the EQ-5D-5L, with 4.1% reporting moderate pain/discomfort, whereas 55.7% of patients with LDA reported light pain/discomfort and 13% had moderate pain/discomfort. Using the ASQoL questionnaire, in patients with at least LDA, a higher proportion of women compared with males and a higher proportion of patients > 48 years of age (vs. patients ≤ 48 years) experienced tiredness. In this post-hoc analysis, ≥25% of axSpA patients in remission/LDA status were still burdened by residual disease, mainly characterised by pain and fatigue.

Effect of tofacitinib on pain, fatigue, health-related quality of life and work productivity in patients with active ankylosing spondylitis: results from a phase III, randomised, double-blind, placebo-controlled trial

BackgroundAnkylosing spondylitis (AS) impacts quality of life. We assessed patient-reported outcomes (PROs), pain, fatigue, health-related quality of life (HRQoL) and work productivity in a phase III trial of tofacitinib.MethodsAdults with...

EFFECTS OF SMOKING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS RECEIVING TUMOR NECROSIS FACTOR INHIBITORS THERAPY

Objective: The aim of this study was to examine the impact of smoking on axial spondyloarthritis (axSpA) patients taking tumor necrosis factor inhibitors (TNFi). Material and Method: Our study consisted of 211 patients who were diagnosed with axSpA and received TNFi treatment in the rheumatology outpatient clinic. The patients were evaluated retrospectively, cross-sectionally and grouped by intensity of smoking (pack-years). Those who smoked&gt;20 pack-years were defined as heavy smokers. Groups were compared in terms of physical examination, laboratory values and disease evaluation indexes (Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL) and Beck Depression Inventory (BDI) scores. Mann-Whitney U and Spearman correlation analysis tests were used for data analysis Results: Comparison of the smoker (n=121) and non-smoker groups (n=90) revealed BASMI was lower in the non-smoker group (p=0.04). Smoking intensity correlated with BDI (r=0.323, p&lt;0.001), BASDAI (r=0.257, p=0.005), BASMI components (lomber lateral flexion (LLF) (r=-0.303, p=0.001), cervical rotation (CR) (r=-0.232, p=0.012), and tragus wall distance (TWD) (r=0.27, p=0.003)). Multivariate analysis revealed an association between the pack-years of smoking and the BASMI [regression coefficient (B)=0.067, standard error (SE)=0.22, 95%CI=0.02, 0.10; p=0.003],&nbsp;baseline (B=pretreatment)-last value (L.=posttreatment) difference of BASFI [B=-0.063, SE=0.02, 95%CI=-0.10, -0.20; p=0.003], of BASDAI [B=-0.047, SE=0.02, 95%CI=-0.08, -0.007; p=0.026], ASQoL [B=-0.125, SE=0.04, 95%CI=0.04, -0.20; p=0.003]. In heavy smokers, significant worsening was found in LLFL (p=0.01), CRL (p=0.04), TWDL (p=0.001), BASFIL (p=0.035) and BASMIL (p=0.001). Significant differences were found in the baseline (B) and last (L) BASDAI (p=0.042), BASFIL (p=0.002), BASFIB-L (p=0.07) and BASMI (p=0.03) values in the nonradiograpic-axSpA group in heavy smokers, compared to the AS group. Conclusion: Our study showed that smoking, especially heavy smoking, has a negative effect in every phase of axSpA. Smoking intensity may correlate with reduced response to TNFi.

Efficacy and safety of Janus kinase inhibitors in patients with ankylosing spondylitis: A systematic review and meta-analysis

ObjectivesTo assess the efficacy and safety of janus kinase (JAK) inhibitors in the treatment of ankylosing spondylitis (AS). MethodsWe searched the PubMed and Cochrane Central Register of Controlled Trials to Nov 1, 2021. We included all randomized controlled trials (RCTs) evaluating JAK inhibitors in the treatment of AS. Two reviewers independently selected studies, extracted data and assessed the risk of bias. ResultsFour RCT studies with 779 participants were included in the meta-analysis. Compared with placebo group, percentages of participants achieving responses of Assessment of spondyloarthritis international society(ASAS) 20, ASAS 40, ASAS 5/6, Bath AS disease activity index (BASDAI) 50 were significantly higher in JAK inhibitor group respectively; changes from baseline in AS disease activity score using C-reactive protein(ASDAS-CRP), Maastricht AS enthesitis score (MASES), AS Quality of Life (ASQoL) score, short-form-36 health survey physical component summary (SF-36 PCS) score, BASDAI, Bath AS functional index (BASFI), Bath AS metrology index (BASMI), Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-F) score, SPARCC joint score and Work Productivity and Activity Impairment (WPAI) Overall Work Impairment score showed significant improvements in JAK inhibitor group. The incidence of adverse events (AEs) and severe adverse events (SAEs) showed no significant differences between the JAK inhibitor and placebo groups. ConclusionsJAK inhibitors showed a satisfactory and promising efficacy in the treatment of active AS not only in mitigating disease activity, but also substantially improving patient's physical function, emotional well-being and social participation. The results of this meta-analysis provide solid evidence for JAK inhibitor as a novel therapeutic strategy for patients with active AS.

Impact of biologics on health-related quality of life in patients with Ankylosing spondylitis: A systematic review and meta-analysis of randomized controlled trials

ObjectiveTo examine the impact of novel biologic disease-modifying antirheumatic drugs (bDMARDs) with tumor necrosis factor (TNF) inhibitors or Interleukin-17A (IL-17A) antibody agents on health-related quality of life (HRQoL) outcomes in patients with radiographic axial spondyloarthritis (r-axSpA). MethodsA literature search on PubMed, Embase, and Clinicaltrials.gov databases was performed through February 2022 to identify randomized controlled trials (RCTs) reporting HRQoL outcomes of bDMARDs for treatment of r-axSpA. Approved bDMARD therapy for r-axSpA included five TNF-inhibitors (infliximab, etanercept, adalimumab, golimumab, and certolizumab pegol) and two IL-17A antibody agents (secukinumab, and ixekizumab). Heterogeneity (I2) was used to determine the variability between studies. ResultsSixteen RCTs, involving 3481 participants, were included. The placebo-controlled and treatment blinded durations ranged from 12 to 24 weeks. Compared with the placebo, bDMARD therapy was associated with significant improvement in HRQoL measures with the 36-item Short Form Survey (SF-36), European Quality of Life–5 Dimensions (EQ-5D), and Ankylosing Spondylitis Quality of Life (ASQoL). The pooled mean differences of changes from baseline for the SF-36 Physical Component Score (PCS), SF-36 Mental Component Score (MCS), EQ-5D, and ASQoL were 4.39 [95% Confidence Interval (CI): 3.24 to 5.54, P < 0.001]; 2.37 (95%-CI: 1.25 to 3.49, P = 0.003); 0.11 (95%-CI: 0.07 to 0.14, P < 0.001); and -2.45 (95%-CI: -3.21 to -1.70, P < 0.001), respectively. Heterogeneity was high (I2 = 79%) among studies reporting SF-36 PCS, and moderate (I2 = 61%, 34%, and 49%) among studies reporting SF-36 MCS, EQ-5D, and ASQoL, respectively. ConclusionsBiologic therapy was associated with a significant improvement in quality of life in patients with r-axSpA. The results were consistent among all three measures of HRQoL outcomes.

Central Obesity in Axial Spondyloarthritis: The Missing Link to Understanding Worse Outcomes in Women?

To determine (1) the prevalence of central obesity in axial spondyloarthritis (axSpA) and its effect on disease-related outcomes and (2) how this differs between sexes. Data were extracted from the Ankylosing Spondylitis Registry of Ireland. Patients with physical measurements for the calculation of anthropometric measures were included. BMI and waist-to-hip ratio (WHR) were used to compare classifications of obesity. Comparison analyses based on sex and central obesity were carried out. Multivariate analysis examined the effects of these factors on the following patient-reported outcomes: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and the Health Assessment Questionnaire (HAQ). In total, 753 patients were included in the analysis. Of these patients, 29.6% (n = 223) were classified as obese based on their BMI, and 41.3% (n = 311) were classified as centrally obese according to the WHR. The prevalence of central obesity was significantly higher among women with axSpA compared to men (71.6% vs 29.9%, P < 0.01). Central obesity had a clear effect on patient outcomes, regardless of sex. Presence of central obesity was associated with significantly worse BASFI scores (P < 0.01), HAQ scores (P < 0.01), and ASQoL questionnaire scores (P = 0.01), with a nonsignificant trend toward worse BASDAI scores (P = 0.07). There was a high prevalence of central obesity as assessed by the WHR in axSpA, most notably among women with axSpA. This modifiable comorbidity was significantly associated with worse quality of life, greater impairment of functional ability, and a trend toward worse disease activity. Regular use of the WHR to screen for central obesity as part of an axSpA assessment would provide an opportunity for prompt identification and intervention for at-risk patients.

Individuals with reactive arthritis suffer from poor health-related quality of life akin to individuals with ankylosing spondylitis: A multigroup study

Background: Reactive arthritis (ReA) and ankylosing spondylitis (AS), both spondyloarthropathies predominantly affecting young men seriously hamper mobility during the active phases of disease. While AS is thoroughly researched, specific studies on ReA are relatively scarce despite its pervasive nature and ever evolving epidemiology. Thus, it is imperative to understand the quality of life (QoL) of ReA patients in comparison to those with AS and healthy controls (HC) to reduce the disparity in patient care.Methods: An inception cohort of adults with ReA (Braun’s criteria) was surveyed to collect the data on demographics, clinical profile, disease activity (Bath AS Disease Activity Index [BASDAI], pain Visual Analog Scale [VAS]), functional status Bath AS Functional Index (BASFI), and QoL (ASQoL instrument) between November 2019 and January 2020. HC and AS were surveyed for the same parameters using an anonymized e-survey (SurveyMonkey.com). All the data are expressed as medians and interquartile range.Results: A total of 147 participants (62 ReA, 45 AS and 40 HC) were included. Patients with ReA were younger than those with AS and HC - 25, 29, and 28 years, respectively, and had a shorter disease duration (P < 0.0001). Baseline clinical characteristics (peripheral arthritis and enthesitis), pain VAS (body pain and back pain) were comparable in ReA and AS groups. All the clinical characteristics of ReA and AS cohorts were significant in comparison to the HC cohort. Notably, functional and activity scores of AS and ReA patients were similar, whereas all functional scores of patients with either spondyloarthropathy were significantly worse than HC (BASDAI, BASFI, ASQoL, P < 0.0001). ASQoL scores were comparable across all domains of ReA and AS except in upper limb activities where patients with ReA fared better than AS. No difference in QoL was observed between acute or chronic ReA.Conclusion: QoL in ReA and AS is comparable, thus the impact of disease on physical function must be recognized to improve patient care. Patients with ReA exhibit significantly worse QoL than HC using ASQoL instrument.

Central sensitization has major impact on quality of life in patients with axial spondyloarthritis

IntroductionPersistent pain has large potential impact on quality of life (QoL). During the course of the disease, many patients with axial spondyloarthritis (axSpA) report persistent pain. Central sensitization (CS) may explain part of this chronic pain. However, the role of CS in relation to QoL has been sparsely studied in axSpA. Therefore, our aim was to explore the relationship between CS and QoL in patients with axSpA. MethodsConsecutive outpatients from the Groningen Leeuwarden axSpA (GLAS) cohort completed the Central Sensitization Inventory (CSI; range 0–100) and the AS Quality of Life (ASQoL; range 0–18). Multivariable linear regression analysis was used to explore the relationship between CSI and ASQoL scores correcting for potential confounders. ResultsOf the 178 included axSpA patients, mean CSI score was 38.0 ± 14.1 and 45% scored ≥40, which indicates a high probability of CS. Mean ASQoL score was 6.0 ± 5.3 and mean ASDASCRP 2.1 ± 1.0. A CSI score ≥40 was significantly associated with higher ASQoL score (mean 9.7 vs. 3.3), higher ASDASCRP (mean 2.6 vs. 1.7), female gender (60% vs. 29%) and more often entheseal involvement (61% vs. 26%). In univariable analysis, CSI score explained a large proportion of the variation in ASQoL (B = 0.06, 95%CI: 0.05–0.07; R2=0.46). This association remained significant after correction for ASDASCRP, gender, entheseal involvement, comorbidities, symptom duration, smoking status, BMI class and educational level (B = 0.04, 95%CI: 0.03–0.05). ConclusionCS is strongly related to patient-reported QoL in patients with axSpA independently from other patient- and disease-related aspects.

The comparison of effects of balneotherapy, water-based and land-based exercises on disease activity, symptoms, sleep quality, quality of life and serum sclerostin level in patients with ankylosing spondylitis: A prospective, randomized study.

Objectives This study aims to compare the effects of balneotherapy, water-based exercise (WBE), and land-based exercise (LBE) on disease activity, symptoms, sleep quality, quality of life, and serum sclerostin level (SSL) in patients with ankylosing spondylitis (AS).Patients and methods Between January 2019 and January 2020, a total of 60 patients (35 males, 25 females; mean age: 40.9±11.2 years; range, 18 to 55 years) who were diagnosed with AS were randomly divided into the balneotherapy (n=20), WBE (n=20), and LBE (n=20) groups (20 sessions of treatment in groups of five to six patients). The patients were evaluated before treatment and at 4 and 12 weeks using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, Fatigue Severity Scale (FSS), and Pittsburg Sleep Quality Index (PSQI), and SSL were measured.Results Statistically significant improvements in the BASDAI, BASFI, MASES, BASMI, ASQoL, FSS, and ASDAS-CRP scores were observed in all groups at 4 and 12 weeks of follow-up (p<0.05). A significant improvement in sleep latency was seen in the balneotherapy and WBE groups. Changes in SSL were not statistically significant in any group (p>0.05).Conclusion Balneotherapy, WBE, and LBE are effective in the treatment of AS, and the beneficial effects may last for at least 12 weeks.

Efficacy and Safety of Wenbu Zhibi Granule in Patients with Ankylosing Spondylitis: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial.

Background. Ankylosing spondylitis (AS) is a chronic disease in which the column is the main lesion. It is caused by a combination of genetic and environmental factors, mainly involving the axial skeleton, resulting in column rigidity and difficulty in movement, and there may be different degrees of eye, lung, cardiovascular, kidney, and other organ damage. Long-term treatment lacks in ankylosing spondylitis. Wenbu Zhibi granule (WZG) is a prescription handed down from the history of Chinese medicine for thousands of years, which is used to treat the pain of patients with AS and to prevent the further development of the disease. However, there is no scientific evidence based on clinical trials to evaluate the efficacy and safety of WZG for ankylosing spondylitis. Methods/Design. We will conduct a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of the WZG in the treatment of AS. We will randomly assign 100 patients with active AS to two groups, treated for 16 weeks. The primary efficacy endpoint is the proportion of subjects who reached 40% improvement criteria proposed by Assessment of SpondyloArthritis International Society (ASAS40) at 16 weeks from baseline, the secondary efficacy endpoint includes ASAS20 response rate, ASAS partial remission response rate, 5/6 improvement criteria proposed by ASAS (ASAS5/6) response rate, and change in the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI spine score, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS), linear Bath Ankylosing Spondylitis Metrology Index (BASMI), ankylosing spondylitis quality of life (ASQoL). In addition, the time points will be set as baseline, 2 weeks, 4 weeks, 8 weeks, 12 weeks, 16 weeks, 24 weeks, and 48 weeks. Discussion. The results of this study will elucidate the efficacy and safety of WZG and provide an appropriate treatment option for patients with AS. Trial registration: ClinicalTrials.gov ID: https://clinicaltrials.gov/ct2/show/ChiCTR2000041010. (Chinese Clinical Trail Registry, Registered 16 December 2020, http://www.chictr.org.cn).

Alexithymia in ankylosing spondylitis.

Objectives This study aims to determine the effect of ankylosing spondylitis (AS) on alexithymia. Patients and methods In this study, a total of 55 AS patients (30 males, 25 females; mean age: 40±8 years; range, 21 to 57 years) who were under follow-up and 55 age- and sex-matched healthy volunteers (31 males, 24 females; mean age: 38.9±8.5 years; range, 21 to 53 years) were included between March 2016 and August 2016. Toronto Alexithymia Scale (TAS), and Beck Depression Inventory (BDI) were performed to assess both patient and control groups. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Ankylosing Spondylitis Quality of Life (ASQoL) were performed to assess AS patients. Results The mean diagnosis time in the patient group was 5.18±4.32 (range, 1 to 18) years. Compared to the control group, depression scores were higher in the patient group and the alexithymic characteristics were significantly higher in the patient group (p<0.05). There was a positive correlation between complaint duration and BASMI, BASFI, and ASQoL scores (p<0.01). In our study, alexithymia rate was significantly higher in women (p<0.05). Conclusion As in all inflammatory chronic diseases, depression and anxiety are commonly seen in AS patients. Alexithymia of these patients should be considered carefully.

Cross-walk of the Assessment of Spondyloarthritis International Society Health Index and Ankylosing Spondylitis Quality of Life Scores in Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis Patients.

IntroductionAxial spondyloarthritis (axSpA) is a chronic rheumatic disease affecting the spine and sacroiliac joints, encompassing both ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) patients. Patient quality of life (QoL) is assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) (disease-specific measure) and the Assessment of SpondyloArthritis International Society Health Index (ASAS HI) (disease-specific measure). Both ASQoL and ASAS HI have similar parameters and scoring ranges, however, their performance relative to each other is unknown. We conducted a cross-walk analysis of the ASAS HI to the ASQoL in AS and nr-axSpA patients.MethodsA cross-sectional survey using the Adelphi axSpA Disease Specific Programme™, conducted with rheumatologists and their consulting AS and nr-axSpA patients in the United States, was undertaken between Jun and Aug 2018. Rheumatologists provided confirmed diagnoses of AS and nr-axSpA alongside patients’ demographic and clinical characteristics. Patients reported quality-of-life measures using the validated ASAS HI and ASQoL questionnaires. Model performance was assessed by comparing root-mean squared error (RMSE) from tenfold cross-validation to determine the best mapping from ASAS HI to ASQoL, and vice versa. RMSE was calculated overall, and for lower, middle and upper thirds of the predicted scale.ResultsData from 283 AS and 274 nr-axSpA patients were analyzed. Predicting ASAS HI using ASQoL values, the best model was non-parametric local linear regression, with overall RMSE of 1.851. Predicting ASQoL using ASAS HI values, the best model also used non-parametric local-linear regression, with overall RMSE of 2.254. In predicting ASAS HI and ASQoL, models performed better in predicting lower values in the predicted scale (RMSE 1.597, 1.871, 2.871 across thirds for ASAS HI; and 1.719, 2.577, 3.140 for ASQoL).ConclusionsResults present a scoring algorithm for cross-walking the ASAS HI to the ASQoL and vice versa, with the approach enabling comparisons to be made across studies.

Relationship between periodontal status and disease activity in patients with ankylosing spondylitis.

ObjectivesAnkylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the spine and sacroiliac joints, characterized by enthesitis. Recent studies have investigated the relationship between AS and periodontitis. The aim of this study was to evaluate the periodontal status of patients with AS and to determine the factors affecting this.Material and methodsThe study included 200 AS patients, of which 129 were taking anti-tumour necrosis factor (TNF) drugs and 71 were taking non-steroid anti-inflammatory drugs (NSAID). Patients did not change their medication during the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), mobility with the Bath Ankylosing Spondylitis Metrology Index (BASMI), functional status with the Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis with the integrated Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and quality of life with the Ankylosing Spondylitis Quality of Life (ASQoL) scale. Data related to erythrocyte sedimentation rate, and C-reactive protein were recorded from the hospital information system. The plaque index (PI), gingival index (GI), pocket depth (PD), attachment level (CAL) measurements, and bleeding index (BOP) were measured.ResultsThe results showed that 35.5% of the AS patients had periodontitis, at a lower rate in the anti-TNF group than in the NSAID group, but the difference was not statistically significant. Periodontitis-related factors were found to be age, BASFI and BASMI. A significant relationship was found between MASES and BOP and GI.ConclusionsThis suggests that periodontitis may be an enthesis in AS. Nevertheless, further studies are needed to explain the mechanism of periodontitis in AS patients.

Ankilozan Spondilitli Hastalarda Nöropatik Bel Ağrısı ve Hastalık Aktivitesi, Fonksiyonel kapasite ve Yaşam kalitesi ile İlişkisi

Amaç: Bu çalışmada Ankilozan spondilit (AS)’li hastalarda bel ağrısının nöropatik komponentinin değerlendirmesi ve nöropatik ağrının; hastalık aktivitesi, fonksiyonel kapasite ve yaşam kalitesi ile ilişkisini araştırması amaçlandı.&#x0D; Gereç ve yöntemler: Çalışmaya 15 AS tanılı hasta dahil edildi. Hastalık aktivitesini değerlendirmek için Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI), fonksiyonel durumu değerlendirmek için Bath Ankylosing Spondylitis Functional Index (BASFI), ve yaşam kalitesini değerlendirmek için Ankylosing Spondylitis Quality of Life (ASQoL), bel ağrısının şiddetinin değerlendirmek için visual analog scale (VAS), nöropatik ağrıyı değerlendirmek için ise painDETECT anketi kullanıldı. &#x0D; Bulgular: PainDETECT skoru hastaların % 13'ünde kesin nöropatik ağrı, % 33'ünde ise olası nöropatik ağrı saptandı. PainDETECT skorları ile bel ağrısı VAS değerleri, BASFI ve CRP düzeyleri arasında anlamlı düzeyde pozitif korelasyon saptandı (p

The relationship between disease activity, quality of life, functional status, spinal mobility, heel enthesitis, and cartilage thickness in patients with axial spondyloarthritis: A cross-sectional study

Background: The aim of this study was to evaluate lower extremity cartilage thickness in axial spondyloarthritis (SpA) patients and healthy controls using ultrasound (US) and to determine the relationship between the indices, quality of life, enthesopathy, and cartilage thickness of patients with axial SpA. Materials and Methods: This study included 73 axial SpA patients and 30 healthy controls. The patients with axial SpA were divided into two groups as with and without heel enthesitis. Demographic data, disease duration, and medical treatments of patients were recorded. The cartilage (hip, talar, and knee), plantar fascia, and Achilles tendon thicknesses of both healthy controls and axial SpA patients were measured by US. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), patient global assessment (PGA), and Ankylosing Spondylitis Quality of Life (ASQoL) scores of patients were evaluated. Results: There was no difference between the groups in terms of demographic data and body mass index. The axial SpA groups with and without heel enthesitis were similar in terms of medical treatment and disease duration. The axial SpA patients with heel enthesitis had thinner cartilages than those without heel enthesitis (P Conclusion: Lower extremity cartilage thickness is associated with disease activity, quality of life, and spinal mobility in patients with axial SpA.

Impact of biologics drugs adherence on treatment outcomes and work productivity of Al Sharqia Governorate patients with Ankylosing Spondylitis

Aim & objectives: to improve ankylosing spondylitis (AS) treatment outcomes by clarifying the impact of biological medication adherence on their treatment outcomes, quality of life, and work productivity. Patients and methods: Sixty -six patients with AS were included according to eligibility criteria recruited from the Rheumatology and Rehabilitation Department at Zagazig University Hospitals(ZUH) and insurance hospital. Patients characteristics are collected. Biologics medication adherence was evaluated by the Compliance Questionnaire on Rheumatology (CQR). Disease activity and treatment response outcome measures were recorded at baseline of biologics, after 6 months,s and after one year. Results: Insurance, education, employment, and early diagnosis are the modifiable factors which can increase adherence to biologics drugs in adherent cases ASDAS CRP, ASDAS ESR, and BASADI were significantly decreased after 6 months and highly significantly decreased after 12 months. BASFI & BASMI were significantly decreasing after 12 months, frequency of overall work and activity impairment was decreased after 6 months but after 12 months the decrease became significant with percent of the reduction in both more than 50%. Also AS quality of life (ASQOL), significantly decreased after 6 months and 12 months. In non -adherent there was a significant increase in ASQOL score after 12 months Conclusion: Biological therapy adherence leads to control of disease activity confirmed by the percentage of change in activity parameters after 6 months and highly significant change after 12 months of follow up especially BASMI in addition to improvements of work productivity and activity impairment and overall health-related quality of life.

Validation of the Ankylosing Spondylitis Quality of Life assessment tool in patients with non-radiographic axial spondyloarthritis

PurposeTo evaluate the psychometric performance of the Ankylosing Spondylitis Quality of Life (ASQoL) scale in patients with non-radiographic axial spondyloarthritis (nr-axSpA) to assess its appropriateness as an outcome measure in future clinical studies.MethodsPatients with active axSpA from a Phase III, randomized, double-blind, placebo-controlled trial (RAPID-axSpA, NCT01087762) were included (N = 325). Modified New York (mNY) classification criteria were used to classify patients as having ankylosing spondylitis or nr-axSpA; those with nr-axSpA were further categorized based on objective signs of inflammation. Psychometric properties of the ASQoL were assessed/documented using a mixture of modern psychometric methods and classical test theory methods. These included exploratory factor analysis and item response theory models to assess the domain structure, test the utility of a single domain relative to subdomains, assess bias, and generate statistics to guide an empirical scoring algorithm. The reliability and validity of scores were evaluated via internal consistency, test–retest reliability, concurrent validity, and known-groups validity. Score responsiveness was assessed via anchor-based clinically meaningful change, supplemented with empirical cumulative distribution function visualizations.ResultsThe ASQoL data were defined by four domains. However, a four-domain solution was found to be inferior to a bifactor solution in which the four domains were included within a total domain. Scoring statistics supported a unit-weighted total score. Within the nr-axSpA population with objective signs of inflammation, the ASQoL mean score had adequate reliability, validity, and ability to detect clinically meaningful change.ConclusionsOur findings suggest that the ASQoL is an appropriate outcome measure in interventional clinical trials in patients with nr-axSpA.