ASAS Criteria For Axial Spondyloarthritis Research Articles

Assessment of Association between Fatigue and Disease Activity in Axial Spondyloarthritis

Introduction: Spondyloarthritis (SpA) is a common disease characterised by chronic inflammatory pain and debilitating manifesting itself most often in stiffness. Fatigue is widely regarded as a cardinal manifestation of Axial SpA and is one of the three most frequently reported symptoms alongside pain and stiffness. This study sought to assess the association between fatigue and disease activity in axial spondyloarthritis. Aim of the study: The aim of this study is to assess the association between fatigue and disease activity in axial spondyloarthritis. Methods: This cross-sectional study was conducted at the Department of Physical Medicine & Rehabilitation, BSMMU, from October 2021 to September 2022. A total of 48 patients fulfilling the ASAS criteria for Axial SpA were included. Data were collected through structured interviews, assessing socio-demographic parameters and disease history. Fatigue severity was measured using the FSS, and disease activity was evaluated with the ASDAS-CRP. Statistical analysis was performed using SPSS 24. Result: The majority of the studied patients (70.8%) had a normal BMI. The mean FSS score was significantly higher for patients with high and very high disease activity compared to those with inactive and low disease activity (p < 0.05). A significant association was found between disease activity and fatigue severity (p < 0.05). There is a statistically significant positive correlation between disease activity and fatigue severity (p < 0.05). A significant positive correlation was observed between the ASDAS-CRP score and the FSS score (r = +0.479, p = 0.001). Conclusion: Study results found that fatigue severity and disease activity score had significant positive linear association. Hence, it can be concluded that fatigue and disease activity have significant relationship in axial spondyloarthritis. Further large-scale multicenter research is warranted.

Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial.

BackgroundEvaluation of the effectiveness of caudal epidural injection on pain, spine mobility, disease activity, and activity of daily living in axial spondyloarthritis (SpA) patients.MethodsA total sample of 47 patients were registered in this study. They were randomly assigned into 2 groups; Group I received caudal epidural injections, ultrasound-guided, with 1% lidocaine hydrochloride mixed with triamcinolone, whereas Group II did not receive any injections. All participants fulfilled the ASAS criteria for axial SpA. Outcome measures were as follows visual analogue scale, Oswestry disability index (ODI), modified Schober test, lateral lumbar flexion, and Ankylosing Spondylitis Disease Activity Score (ASDAS) with assessment at baseline, 2 weeks, and 8 weeks post-treatment. This clinical trial was registered on clinicaltrials.gov under the number NCT04143165.ResultsThere was a significant difference between both groups regarding pain, ODI, spine mobility and ASDAS scores in favor of group I. This effect was at its maximum after 2 weeks. Despite the decline of this effect after 2 months, the difference between the groups remained significant. Higher disease activity, younger age, and shorter disease duration were associated with better outcomes.ConclusionsEpidural injection of lidocaine and triamcinolone is a cost effective and a practical technique for controlling pain, as well as improving the function of the spine and disease activity scores in axial SpA patients with acceptable complications and relatively sustained effect.

The usefulness of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences visual assessment in the early diagnosis of axial spondyloarthritis

The aim of the study was to compare the diagnostic efficacy of the visual assessment of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences compared to the STIR sequence in the diagnostics of active sacroiliitis in the course of axial spondyloarthritis (axSpA). The study group consisted of 49 patients who had undergone multiparametric magnetic resonance imaging of the sacroiliac joints (SIJs) due to clinical suspicion of axSpA. Two independent observers retrospectively assessed four quadrants of the SIJs for the presence of subchondral bone marrow oedema/osteitis with the use of modified SPARCC score in sequences: STIR, DWI (with ADC map) and DCE. Diagnostic efficiency parameters were calculated for DWI and DCE sequence separately, using STIR sequence as a reference. Inter-observer agreement was evaluated with the use of κ coefficient. Patients’ clinical symptoms were analysed to identify the group fulfilling the imaging arm of the ASAS criteria for axSpA. Overall, 46.9% (n = 23) of patients fulfilled the imaging arm of ASAS criteria for axial spondyloarthritis. DWI with ADC map: accuracy 95.6%, sensitivity 99.4%, specificity 54.0%. DCE sequence: accuracy 96.8%, sensitivity 98.4%, specificity 79.5%. The highest level of inter-observer agreement was achieved for STIR sequence (κ = 0.888), slightly lower for DCE sequence (κ = 0.773) and the lowest for DWI with ADC (κ = 0.674). Visual assessment of the DWI and DCE sequences has high accuracy and sensitivity of bone marrow oedema/osteitis detection, but the specificity and inter-observer agreement are poor, especially for the DWI sequence with ADC maps.

Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a cross-sectional study comparing MASES, SPARCC and LEI

BackgroundThe presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA.MethodsA cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman’s Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease.ResultsTwo hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034).ConclusionIn this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.

Similarities and differences between patients fulfilling axial and peripheral ASAS criteria for spondyloarthritis: Results from the Esperanza Cohort

To describe and compare the characteristics of patients fulfilling the ASAS criteria for axial Spondyloarthritis (SpA) versus peripheral SpA . Baseline dataset from the ESPeranza cohort was used. In this programme, patients were referred to rheumatologist in case of (1) age <45 years, (2) symptoms duration 3-24 months and (3) inflammatory back pain (IBP) or asymmetrical arthritis or spinal/joint pain plus ≥1 SpA features. The programme was developed between April 2008 and June 2011. Data from 377 patients fulfilling the ASAS classification criteria for SpA were used. Descriptive analysis was employed to compare demographic and disease characteristics between patients with axial SpA versus peripheral SpA. Two hundred and ninety (77.2%) patients were classified as axial SpA (109 ankylosing spondylitis and 182 non-radiographic SpA) while 86 (22.8%) patients had peripheral SpA. Age, gender distribution and degree of disease activity were similar in both groups. Patients with axial SpA were referred after having symptoms for a longer period and had more frequently uveitis and positive HLA-B27. Patients with peripheral SpA had in a greater percentage more working disability and had more frequently enthesitis, psoriasis, dactylitis and inflammatory bowel disease (IBD). The ASAS classification criteria for SpA seem to classify patients within the same spectrum of disease beyond the predominant symptoms at onset. However, despite having similar degree of disease activity, time to be referred to rheumatologist is increased in axial SpA patients compared with peripheral SpA patients.

Specific features of axial spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, in persons of different genders

The increasing number of women with ankylosing spondyloarthritis (SpA) makes it relevant to study the specific features of this disease in persons of different genders. Objective : to study the indicators of activity and functional status in male and female patients with axial SpA. Subjects and methods. The study enrolled 91 patients (43 women and 48 men) with axial SpA admitted to the Rheumatology Unit of the Saratov Regional Clinical Hospital in 2013. The age of the women and men was 41.63±12.04 and 41.94±12.76 years, respectively. All the patients fulfilled the ASAS criteria for axial SpA. 60.43% of the patients had ankylosing spondylitis (AS) meeting the modified New York criteria; 26.37% had psoriatic arthritis (PsA) according to the CASPAR criteria (only patients with axial involvement were included in the study and those with peripheral arthritis were excluded); 9.89% had undifferentiated axial SpA. Age at symptom onset, disease duration, and age at diagnosis of axial SpA were taken into account. The activity of axial SpA (ASDAS, BASDAI, highsensitivity C-reactive protein) and the mobility of the axial skeleton (BASMI and its components) were investigated in patients of different genders. Results . The study has established that the women are hospitalized with diagnosed axial SpA as often as the men. The indicators of activity and axial skeleton mobility are similar in the male and female patients with axial SpA as a whole and with a disease history of less than 10 years. Having a disease history of more than 10 years, the women preserve greater mobility of the lumbar and cervical spine than do the men with the similar disease activity.

AB0685 Ankylosing Spondylitis versus Non-Radiographic Axial Spondyloarthritis with Positive Mri, Which Diagnosis is More Reliable?

BackgroundThe development of the ASAS classification criteria has facilitated the diagnosis of Spondyloarthritis (SpA) at early and non-radiological stages. Despite these non-radiological forms are considered as less aggressive by Rheumatologists,...

THU0077 Prevalence of Obesity and the Relation to Disease Activity, Physical Function, and Quality of Life in Patients with Axial Spondyloarthritis

BackgroundObesity is associated with an increased risk for many disorders, impaired functional capacity, and impaired quality of life (QoL).ObjectivesThe aim of the present study was to evaluate the prevalence of...

FRI0129 Similarities and Differences between Axial and Peripheral Predominant Forms in Patients with Early Spondyloathritis: Results from the Esperanza Cohort

BackgroundBased on the predominant manifestation of the disease, the ASAS classification criteria for spondyloarthritis (SpA) distinguish two clinical forms: Axial SpA, including non-radiographic SpA and Ankylosing Spondylitis (AS), and peripheral...

OP0162 Degenerative Changes of the Spine on MRI in Patients with Inflammatory Back Pain from the DESIR Cohort

BackgroundMagnetic Resonance imaging (MRI) is a sensitive method to detect early signs of axial spondyloarthritis (axSpA). A positive MRI of the Sacroiliac joints is part of the imaging arm of...

FRI0142 Patient-Reported Disease Activity and Outcome in Male versus Female Patients of the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) Cohort

BackgroundThere are differences in clinical presentation of ankylosing spondylitis (AS). Women tend to have milder disease and may therefore be underdiagnosed. Male AS patients are more likely to develop spinal...

AB0910 Validity and reliability of the IPAQ and squash to assess daily physical activity in patients with ankylosing spondylitis

BackgroundPhysical activity questionnaires are considered to be the most applicable method to assess daily physical activity in population studies because of participant convenience, minimal cost, and scoring flexibility. The International...

THU0265 Early change in bone resorption predicts discontinuation of tumor necrosis factor-alpha blocking therapy in patients with ankylosing spondylitis

BackgroundIn ankylosing spondylitis (AS), objective measurements evaluating the effect of tumor necrosis factor-alpha (TNF-α) blocking therapy are lacking.ObjectivesTo investigate the predictive value of bone turnover markers (BTM) in relation to...

OP0094 DKK1 serum level is increased in recent spondyloarthritis and is associated with higher prevalence of syndesmophytes. Data from the desir cohort

BackgroundDickkopf-1 (DKK-1) is an inhibitory protein of the Wnt signalling pathway that could rationally be involved either in AS osteoporosis or in the osteoblastogenesis associated with syndesmophyte construction.ObjectivesTo investigate DKK-1...

FRI0295 Syndesmophytes are associated with higher bone turnover in ankylosing spondylitis patients with active disease

BackgroundBone formation and bone loss are both present in ankylosing spondylitis (AS). New bone formation can lead to the formation of syndesmophytes, ankylosis of the spine and sacroiliac joints, and...

AB0118 Evaluation of wingless (wnt) pathway inhibitors dickkopf-1 and sclerostin and il-23-th17-il-17 pathway in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis

BackgroundInflammation and new bone formation is characteristic in spondyloarthritis (SpA). Wingless (Wnt) pathway is one of the regulator elements of bone formation and inhibited by Dickkopf-1 (Dkk-1) and sclerostin which...

SAT0275 Almost 40% of patients with chronic back pain starting before the age of 45 fulfill the asas axial spondyloarthritis criteria

BackgroundChronic back pain is a very prevalent complaint in the general population but only a small proportion of these patients suffer from spondyloarthritis (SpA). Unfortunately, it is not clear when...

Early change in bone resorption predicts discontinuation of tumor necrosis factor-alpha blocking therapy in patients with ankylosing spondylitis

Background In ankylosing spondylitis (AS), objective measurements evaluating the effect of tumor necrosis factor-alpha (TNF-α) blocking therapy are lacking. Objectives To investigate the predictive value of bone turnover markers (BTM) in relation to discontinuation of TNF-α blocking therapy in patients with AS. Methods 111 consecutive AS outpatients from the Medical Center Leeuwarden and the University Medical Center Groningen who started TNF-α blocking therapy (infliximab n=22; etanercept n=71; adalimumab n=18) were included between November 2004 and December 2007. All patients fulfilled the modified New York criteria for AS (n=109) or the ASAS criteria for axial spondyloarthritis (n=2). Patients with recent fractures and/or use of bisphosphonates were excluded. Continuation of TNF-α blocking therapy was based on decrease in Bath AS Disease Activity Index (BASDAI) of at least 50% or 2 units compared with baseline, and/or expert opinion in favor of treatment continuation. Clinical assessments, marker of bone formation bone-specific alkaline phosphatase (BALP), and marker of bone resorption serum collagen-telopeptide (sCTX) were assessed at baseline, 3 and 6 months, and 1, 2, and 3 years. Z-scores of BTM were calculated using matched 10-years-cohorts of a Dutch reference group (200 men or 350 women) to correct for the normal influence that age and gender have on bone turnover. Results Mean age of the 111 AS patients was 42.2 years (SD ± 10.3), median disease duration was 16 years (range 1-49), and 70% were male. Mean BASDAI was 6.1 (SD ± 1.7) and mean AS disease activity index (ASDAS) was 3.8 (SD ± 0.8) at baseline. After 3 years, 72 patients (65%) were still using their first TNF-α blocking agent. In these patients, TNF-α blocking therapy resulted in significantly increased BALP Z-score and significantly decreased sCTX Z-score compared to baseline. Baseline to 3 months decrease in sCTX Z-score (HR: 0.513, 95% CI: 0.367-0.717) was inversely associated with time to discontinuation of TNF-α blocking therapy in univariate Cox regression. Multivariate analysis showed that baseline to 3 months decrease in sCTX Z-score (HR: 0.394, 95% CI: 0.263-0.591), ASDAS (HR: 0.488, 95% CI: 0.317-0.752), and physician’s global disease activity (GDA) (HR: 0.739, 95% CI: 0.600-0.909) were independent inversely related predictors of time to treatment discontinuation. Conclusions In addition to the ASDAS and physician’s GDA, early change in bone resorption marker sCTX after starting treatment can serve as an objective measure in the prediction of long-term continuation of TNF-α blocking therapy in AS. Disclosure of Interest None Declared

Imaging of ankylosing spondylitis

Conventional radiography can visualize bone erosion, sclerosis, joint space narrowing and new bone formation in sacroiliac joints and the spine, but is unfortunately not very sensitive in early disease. Diagnosis of ankylosing spondylitis (AS) is dependent on presence of bilateral moderate or unilateral severe radiographic sacroiliitis, as part of the modified New York criteria for AS. This has, until recently (see MRI below), delayed the diagnosis by 7-10 years. Furthermore, the modified Stokes ankylosing spondylitis spine score (mSASSS), which is the most sensitive radiographic method for monitoring structural damage in AS, is not very reproducible or sensitive to change, so improved methods for structural damage assessment are highly needed. MRI has resulted in a major improvement in the evaluation and management of patients with SpA. Firstly, it permits earlier diagnosis, as MRI findings of active sacroiliitis form part of the recent ASAS criteria for axial spondyloarthritis. Secondly, MRI can provide objective evidence of currently active inflammation in patients with SpA. MRI is by far the best available method for detecting and monitoring inflammation in the spine and sacroiliac joints, and several validated assessment systems exist. Until the introduction of MRI, disease activity assessment was restricted to patient-reported outcomes, such as the Bath ankylosing spondylitis disease activity index (BASDAI) and functional index (BASFI), because disease activity could not be assessed in a sensitive manner by biochemical (mainly C- reactive protein (CRP)) or physical evaluation. Furthermore, MRI can visualize structural damage (erosion, fat infiltration, syndesmophytes and ankylosis) in the sacroiliac joint and spine, but the clinical role of MRI for monitoring structural damage remains to be established. Finally, certain MRI findings (inflammation at the vertebral corners) have predictive value with respect to subsequent development of radiographic syndesmophytes. However, clarification of the prognostic value of MRI in clinical practice requires further research. Despite contrast-enhanced Doppler US has been reported to have a high negative predictive value for the detection of sacroiliitis, the role of US in assessment of sacroiliac and spine involvement in AS and other types of axial SpA is minimal.

Principal Bid vs. Agency Trading

<h3>Background</h3> Bone formation and bone loss are both present in ankylosing spondylitis (AS). New bone formation can lead to the formation of syndesmophytes, ankylosis of the spine and sacroiliac joints, and bone formations on enthesal sites. <h3>Objectives</h3> To investigate the relation between the presence of syndesmophytes and bone turnover markers (BTM) in AS patients with active disease. <h3>Methods</h3> 55 consecutive outpatients with AS based on the modified New York criteria (n=54) or the ASAS criteria for axial spondyloarthritis (n=1) and active disease defined by Bath AS Disease Activity Index (BASDAI) ≥4 (range 0-10) or based on expert opinion were included. Patients with recent fractures, use of bisphosphonates, and/or inflammatory bowel disease were excluded. The lateral view of radiographs of the cervical and lumbar spine were blinded and scored for the presence of syndesmophytes at the anterior corners of the vertebrae by two independent observers. In case of discrepancy between the two observers, there was a consensus meeting afterwards. Markers of bone formation procollagen type 1 N-terminal peptide (PINP) and bone-specific alkaline phosphatase (BALP), and marker of bone resorption serum collagen-telopeptide (sCTX) were measured. Z-scores of BTM were calculated using matched 10-years-cohorts of a Dutch reference group (200 men or 350 women) to correct for the normal influence that age and gender have on bone turnover. <h3>Results</h3> Mean age of the 55 AS patients was 40.4 years (SD ± 11.2), median duration of symptoms was 15 years (range 3-46), median time since diagnosis was 5 years (range 0-27), mean BASDAI was 6.1 (SD ± 1.8), and 58% were male. Syndesmophytes were present in 33 of the 55 (60%) patients. Patients with syndesmophytes had significantly higher levels of PINP (median Z-score: 0.41 vs. -0.17, p=0.005) and sCTX (median Z-score: -0.02 vs. -0.58, p=0.025) than patients without syndesmophytes. No significant differences were found in BALP (median Z-score: 1.56 vs. 0.67, p=0.213) and BASDAI (mean: 6.2 vs. 5.9, p=0.581) between patients with and without syndesmophytes. <h3>Conclusions</h3> This cross-sectional analysis in AS patients with active disease shows that markers of both bone formation (PINP) and bone resorption (sCTX) are significantly higher in patients with syndesmophytes compared to patients without syndesmophytes. Further longitudinal studies are needed to investigate whether BTM can serve as potential biomarkers for radiographic damage in AS. <h3>Disclosure of Interest</h3> None Declared