BASDAI Score Research Articles

Cardiovascular Risk in Patients with Ankylosing Spondylitis.

Objectives: Ankylosing spondylitis (AS) is an autoinflammatory, chronic disease. Patients with AS are at increased risk of cardiovascular disease (CVD). The link between AS and subclinical atherosclerosis is multifactorial and still not completely understood. The aim of this study was to examine the potential associations between carotid intima-media thickness (cIMT) and different cardiometabolic biomarkers in individuals with AS. Methods: A total of 96 patients with AS were prospectively included. cIMT was measured via ultrasonography. Multiple linear regression analysis was used to find the best predictors of cIMT values. Principal component analysis (PCA) was implemented to extract factors that were further tested via binary logistic regression analysis in relation to cIMT. Results: Waist circumference (WC), low-density lipoprotein cholesterol (LDL-c), and the BASDAI score were independently correlated with cIMT in AS patients (p = 0.037, p = 0.060, and p = 0.048, respectively; adjusted R2 = 0.113). PCA extracted four panels of biomarkers, i.e., "haematology-lipid-related factor" (i.e., ferritin, haemoglobin, HDL-c, and triglycerides), "proinflammatory-prothrombotic-related factor" (i.e., platelets, neutrophils, and C-reactive protein), "LDL-c-vitamin-related factor" (i.e., vitamins D and B12, and LDL-c), and "age-glucometabolic-related factor" (i.e., age and HbA1c), in relation to higher cIMT in patients with AS. Among these four clusters, "age-glucometabolic-related factor" was an independent predictor of increased cIMT (p < 0.001). Conclusions: In addition to traditional cardiometabolic risk factors, WC and LDL-c, the disease activity score (BASDAI) is independently related to subclinical atherosclerosis in AS patients. The joint involvement of heterogeneous cardiometabolic risk factors may reflect different pathophysiological processes of subclinical atherosclerosis in patients with AS.

Targeted therapies and conventional care for the treatment of ankylosing spondylitis in China: a cost-effectiveness analysis based on the network-meta analysis

ObjectiveThis study aimed to evaluate the long-term cost-effectiveness of conventional care (CC) and seven first-line targeted therapies marketed in China for the treatment of patients with ankylosing spondylitis (AS)–namely secukinumab, ixekizumab, infliximab, etanercept, adalimumab and golimumab and tofacitinib–from the perspective of the Chinese health care system.MethodsThe York model was structured as a 12-week decision tree leading into two Markov models. This study set 1 year as a recurring cycle and a lifetime timeframe for the model. Primary model outcomes included the costs in Chinese yuan (CNY), health outcomes in quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of ¥89,358 (equal to the per capita gross domestic product in China in 2023) per QALY. Parameters in the York model were captured from network meta-analyses and literature including treatment response, short-term disease progression, patient functioning and long-term structural disease progression. Utilities are dependent on indicators such as the BASDAI score, the BASFI score, gender and age. Drug prices were analysed using the median price of the Chinese market from YAOZH net in the basic analysis. Costs and outcomes were discounted at 5.0%. We performed deterministic and probabilistic sensitivity analyses to investigate the robustness of the results. The prices of original drugs and generic drugs were used in the scenario analysis.ResultsCompared with CC, the ICER of golimumab was ¥104,217.4/QALY, which is between 1 and 3 times the GDP per capita, while the ICERs of the other six targeted therapies were less than ¥89,358/QALY. The specific economic rank of the targeted therapy was as follows:secukinumab > ixekizumab > tofacitinib > infliximab > etanercept > adalimumab > golimumab. Treatment response rates such as the BASDAI50, changes in the BASDAI/BASFI scores and the discounting rate were key model drivers. According to the scenario analysis, IL-17 inhibitors were still the most economical intervention when original drugs and generic drugs were used.ConclusionTargeted therapies are cost-effective treatments for AS. Overall, IL-17 inhibitors were the dominant treatment. The choice of the brand-new prices or generic drug prices can greatly affect economics.

Effect of Long-Snake Moxibustion on Gut Microbiota of Patients with Ankylosing Spondylitis

Objective: The objectively was to study the effect of long-snake moxibustion intervention on gut microbiota of patients with ankylosing spondylitis (AS) by 16S rDNA sequencing technology. Methods: Thirty AS patients and 30 healthy volunteers were recruited and treated with long-snake moxibustion once a week for 12 weeks. AS patients were divided into pretreatment and posttreatment groups. VAS, BASDAI, and BASFI scores of AS patients before and after treatment were collected. 16S rDNA high-throughput sequencing technology was used to analyze the characteristics and differences of gut microbiota in AS patients before and after treatment and in healthy volunteers. Results: VAS, BASDAI, and BASFI scores of AS patients after long-snake moxibustion treatment were lower than those of pretreatment group (p < 0.05). The results of gut microbiota alpha diversity showed that Ace and Chao1 index of the posttreatment group were higher than those of the health group (p < 0.05), but there was no statistical significance in Ace and Chao1 index between the pretreatment group and the posttreatment group (p > 0.05). Beta diversity analysis showed that mild classification aggregation occurred between the health group and the pretreatment group but did not reach a significant level, and there was no significant difference between the pretreatment group and the posttreatment group. The results of species abundance showed that, at the phylum level, compared with the health group, the relative abundance of Firmicutes and Proteobacteria decreased in the pretreatment group, while the relative abundance of Bacteroidetes and Actinobacteria increased. Compared with the pretreatment group, the relative abundance of Firmicutes increased and the relative abundance of Actinobacteria decreased in the posttreatment group, but there were no statistically significant differences in the above changes (p > 0.05). At the genus level, compared with the health group, the relative abundances of Subdoligranulum in the pretreatment group were increased (p < 0.05), while the relative abundances of Bifidobacterium and Streptococcus were decreased (p < 0.05). Compared with the pretreatment group, the relative abundance of Romboutsia in the posttreatment group was increased (p < 0.05). Conclusion: Long-snake moxibustion can obviously improve the clinical symptoms of AS patients. The possible mechanism of action is related to regulating the abundance of gut microbiota, increasing beneficial bacteria, and restoring the homeostasis of gut microorganisms.

Sex-specific disparities in disease activity scores among patients with axial spondyloarthritis and their implications for evaluating the response to tumor necrosis factor alpha inhibitor therapy

BackgroundWe aimed to investigate whether there are sex differences in disease activity measures among patients with axial spondyloarthritis (axSpA) and to determine any potential impact on the assessment of treatment responses to tumor necrosis factor alpha inhibitors (TNFi).MethodsUsing the Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry data, we compared sex differences in changes in the Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) levels at baseline and one year after TNFi initiation in patients with axSpA.ResultsThis study included 1,753 patients with axSpA who started or changed TNFi, of whom 1,343 (76.6%) were male. At baseline, the mean BASDAI and ASDAS scores of all patients were 5.98 and 3.6, respectively. The BASDAI changes between baseline and the one-year follow-up were independently associated with sex (\U0001d6fd = 0.343, p = 0.011), whereas ASDAS was not (\U0001d6fd = 0.079, p = 0.235). When judging the effect of TNFi at one-year of treatment, male patients were more likely to be assessed as effective by the BASDAI-based criterion (ΔBASDAI ≥ 50% or ≥ 2; OR 1.700, 95% CI 1.200–2.406), while the ASDAS-based criterion (ΔASDAS ≥ 1.1) showed no significant difference between sexes (OR 0.993, 95% CI 0.678–1.455), after adjusting for other baseline characteristics.ConclusionsThe changes in disease activity before and after TNFi use were significantly different between sexes when measured by BASDAI, but not ASDAS. TNFi treatment effects may be interpreted differently between sexes depending on the disease activity measure used.

P165 Sustained improvement in clinical outcomes and long-term safety of bimekizumab in patients across the spectrum of axial spondyloarthritis up to week 52: results from two phase 3 studies

Abstract Background/Aims Bimekizumab (BKZ), a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A, has shown rapid and clinically meaningful improvements in disease activity across the axial spondyloarthritis spectrum (axSpA; active non-radiographic axSpA [nr-axSpA; BE MOBILE 1, NCT03928704] and ankylosing spondylitis [AS] / radiographic axSpA [r-axSpA; BE MOBILE 2, NCT03928743]). Here we present outcomes from these two phase 3 studies up to Week (Wk)52. Methods BE MOBILE 1 and 2 have similar study designs: 16-Wk double-blind period followed by 36-Wk maintenance period. Patients were randomised (1:1 in BE MOBILE 1; 2:1 in BE MOBILE 2) to BKZ 160 mg every 4Wks (Q4W) or placebo (PBO). All patients received BKZ 160 mg Q4W from Wk16 up to Wk52. Sustained improvements in ASAS40, BASDAI50 responses, BASDAI, BASFI and ASDAS-CRP scores were assessed up to Wk52. Missing data were imputed using non-responder or multiple imputation for binary and quantitative variables, respectively. Results 254 nr-axSpA (BKZ: 128; PBO: 126) and 332 r-axSpA (BKZ: 221; PBO: 111) patients were randomised; 86.6% and 89.8% completed Wk52, respectively. ASAS40 responses increased from Wk16 to Wk52 with similar efficacy across TNF-naïve/IR patients (Table). Approximately 47% of patients on BKZ achieved BASDAI50 at Wk16, increasing to ∼54% at Wk52 (NRI, Table). All improvements at Wk16 in BASDAI, BASFI and ASDAS were sustained up to Wk52 (Table). Efficacy was similar between treatment arms at Wk52. During the overall study period, 75% (183/244, nr-axSpA) and 75.5% (249/330, r-axSpA) patients reported ≥1 treatment-emergent adverse events (TEAEs). Most common TEAEs included nasopharyngitis, upper respiratory tract infection and oral candidiasis. Incidence of serious TEAEs were low (3.7% [nr-axSpA] and 6.1% [r-axSpA]); no incidence of systemic candidiasis, adjudicated MACE or deaths were reported. ‘Any definite or probable adjudicated IBD TEAE’ was reported in 0.8% (2/240, nr-axSpA) and 0.6% (2/326, r-axSpA) patients with no history of IBD and 25% (1/4, r-axSpA) patients with prior history of IBD. Incidence of uveitis (1.2% [3/244, nr-axSpA]; 2.1% [7/330, r-axSpA]) was low. Conclusion Across the axSpA disease spectrum, bimekizumab demonstrated sustained improvements in clinical outcomes up to Wk52 with no new safety signals. Disclosure K. Gaffney: Shareholder/stock ownership; KG is a shareholder of Rheumatology events. Grants/research support; KG received grant/research support from NASS, Versus Arthritis, AbbVie, Pfizer, UCB Pharma, Novartis, Lilly, Cellgene, Celltrion, Janssen, Gilead and Biogen. Other; KG has received honoraria/ consultation fees from Novartis, AbbVie, UCB Pharma, Lilly and Pfizer, KG has received speaker’s bureau from Novartis, UCB Pharma, AbbVie and Lilly; meeting expenses from AbbVie, Lilly, Roche, Novartis, Pfizer and UCB Pharma. N.D. McKay: Other; NDM received travel fees from UCB Pharma and Gilead, and Speaker’s bureau from Gilead. R. Sengupta: Grants/research support; RS received grants/ research support from AbbVie, Celgene, Novartis and UCB Pharma. Other; RS recevied honoraria or consultancy fees from Abbvie, Biogen, Novartis, Celgene, Lilly, Chugai, MSD and UCB Pharma, RS is on the advisory boards for AbbVie, Biogen, Chugai, Lilly, Novartis and UCB Pharma. C. Fleurinck: Other; CF is an employee of UCB Pharma. C. de la Loge: Consultancies; CdlL is a consultant to UCB Pharma, Brussels, Belgium. U. Massow: Other; UM is an employee of UCB Pharma. V. Taieb: Other; VT is an employee of UCB Pharma. S. Zhao: Honoraria; SSZ received honoraria from UCB Pharma. H. Marzo-Ortega: Grants/research support; HMO received grants/research support from Janssen, Novartis and UCB Pharma. Other; HMO received honoraria and/or consultancy and/or speaker fees from Abbvie, Biogen, Celgene, Janssen, Eli-Lilly, Moonlake, Novartis, Pfizer and UCB Pharma.

Determination of IL-23 receptor expression and gene polymorphism (rs1884444) in Iranian patients with ankylosing spondylitis

BackgroundThrough investigating genetic variations, it has been demonstrated that single nucleotide polymorphisms (SNPs) in the IL-23 receptor (IL23R) gene have a critical role in the pathophysiology of ankylosing spondylitis (AS). Here, we investigated whether the IL23R variant (rs1884444) is associated with AS in the Iranian population.Methods and materialIn this research, we analyzed rs1884444 in a group of 425 patients with AS and 400 matched controls. For DNA extraction, the phenol/chloroform technique was utilized. Peripheral blood mononuclear cells (PBMCs) were obtained from the whole blood of 39 patients and 43 healthy controls and total RNA was extracted. Genotyping was performed by amplification-refractory mutation system (ARMS)–PCR method. Afterward, the expression level of IL23R was analyzed by the real-time quantitative (Q)-PCR method.ResultsWe observed no significant association between the distribution of alleles and genotypes of rs1884444 and susceptibility to AS. In addition, the expression level of IL23R did not differ between PBMCs from AS patients compared to the control group (P = 0.167). Furthermore, the relative expression level of IL23R was positively correlated with the BASDAI (P < 0.01) and BASFI (P < 0.05) scores of the patients.ConclusionIt appears that IL23R polymorphism (rs1884444) and the level of gene expression might not contribute to the susceptibility to AS in the Iranian population. The correlation of IL23R expression with the level of BASDAI and BASFI scores in patients may be due to the role of the IL-23/IL-23R signaling cascade in inflammation and exert a critical role in the development of AS.

BASDAI versus ASDAS in evaluating axial involvement in patients with psoriatic arthritis: a pooled analysis of two phase 3 studies.

In the absence of axial psoriatic arthritis (axPsA)-specific tools, the BASDAI and Ankylosing Spondylitis Disease Activity Score (ASDAS) are used to assess axial symptoms in patients with PsA. Here, we assessed the performance of BASDAI and ASDAS in patients with PsA. Patients with active PsA in DISCOVER-1 and DISCOVER-2 (ClinicalTrials.gov: NCT03162796 and NCT03158285, respectively) with or without axPsA but with available baseline BASDAI information were analysed; those with investigator-identified axial symptoms and imaging-confirmed sacroiliitis comprised the axPsA cohort. Correlations between BASDAI/ASDAS and clinical variables were assessed with Pearson's coefficient (r). Longitudinal effects of enthesitis (Leeds Enthesitis Index [LEI]), swollen joint count and presence versus absence of axPsA on BASDAI/ASDAS (normalized 0-10 scale) were analysed with mixed models for repeated measures. At baseline in the axPsA (n = 312) and non-axPsA (n = 124) cohorts, BASDAI scores showed no or weak correlation with swollen joint count (0.18-0.20), tender joint count (0.12-0.29), LEI (-0.04 to 0.24) and physician global assessment (0.35-0.43); moderate correlation with fatigue (both -0.56); and strong correlation with patient global assessment of disease activity (0.62-0.69) and patient-reported pain (0.66-0.70). Similar correlations were observed for ASDAS. Axial involvement versus non-involvement was associated with higher BASDAI scores and ASDAS (all β ≥ 0.5), without differences between instruments; longitudinal associations between swollen joint count (β ≤ 0.06)/LEI (β ≤ 0.19) and BASDAI/ASDAS were clinically unimportant. BASDAI and ASDAS performed similarly in patients with active PsA and axial involvement, independent of peripheral disease involvement, supporting their performance in assessing axial disease activity. ClinicalTrials.gov, http://clinicaltrials.gov, NCT03162796 and NCT03158285.

Progression of subclinical atherosclerosis in ankylosing spondylitis: a 10-year prospective study.

Chronic systemic inflammation contributes to increased CVD burden in Ankylosing Spondylitis (AS). Since long-term follow-up data on subclinical atherosclerosis acceleration are lacking, we examined its progression in contemporary AS patients during 10years. Fifty-three (89% male, aged 50.4 (36.3-55.9) years,) non-diabetic, CVD-free AS patients and 53 age-sex-matched non-diabetic, control individuals were re-evaluated after 9.2-10.2years by ultrasonography for carotid/femoral atheromatosis, pulse wave velocity (PWV) and intima-media thickness (IMT), performed by the same operator/protocol. New atheromatic plaque formation, PWV deterioration, and IMT increase were associated only with classical CVD risk factors, as reflected by the heartSCORE (age, gender, smoking status, blood pressure and cholesterol levels) by multivariate analysis, rather than disease presence. However, among AS patients, despite remission/low disease activity at follow-up end in 79%, atheromatosis progression was associated by multivariate analysis with higher BASDAI scores (p = 0.028), independently of biologic therapies administered in 2/3 of them. Moreover, in AS patients, but not in controls, PWV values at baseline were associated with plaque progression during the 10-year follow-up after taking into account baseline heartSCORE and plaque burden status (p = 0.033). Despite comparable prevalence of both hypertension and hypercholesterolemia at baseline between patients and controls, a lower percentage of AS patients had achieved "adequate" CVD risk factor control at follow-up end (11% vs 25% respectively, p = 0.076). Classical CVD risk factors and residual disease activity account for the progression of subclinical atherosclerosis in AS, pointing to the unmet needs in the contemporary management of these patients.

"Long-term MRI findings in Ankylosing spondylitis patients treated with TNF inhibitors for a decade".

This study aims to evaluate the active and chronic lesions in sacroiliac joints and lumbar spine over a decade of TNFi therapy in patients with AS. The study enrolled patients with AS under treatment with a TNFi for over a decade. The patients underwent a new MRI scan of their lumbar spine and sacroiliac joint (SIJ). Two readers evaluated all images. Inflammation of SIJ(SIS), SIJ structural damage (SSS) including Fat Metaplasia, Erosions, Backfill and Ankylosis, and Spondyloarthritis Research Consortium of Canada Bone marrow edema (SPARCC) spine score were recorded. In the study, 15 patients were included, with 80% being male. The mean age during their first MRI was 38.1 (± 11.9) years old, and the majority (86.7%) tested positive for HLA-B27. While TNFi improved both BASDAI and BASFI scores, there was a noticeable increase in MRI acute lesions in the SIJ over time, where the median score increased from 0 (0-4) to 3 (0-10) after ten years (p = 0.028). After a decade of treatment, the median SPARCC spine score also increased from 0 (0-9) to 5 (0-16), p = 0.093. Finally, it was observed that there was a significant positive correlation between ESR and SIS erosions in cases of chronic lesions (r = 0.819, p < 0.001). While TNFi have significantly improved the treatment of AS, this study shows that acute lesions can still develop despite treatment. A personalized approach that adapts MRI assessment to each patient's specific requirements may help detect changes early and enable doctors to intervene promptly to prevent further damage.

AYURVEDIC MANAGEMENT OF JUVENILE ANKYLOSING SPONDYLITIS: A CASE STUDY

A 16year old boy, who wasdiagnosed with Juvenile Ankylosing Spondylitis treated with a combination of Panchakarma procedures and Ayurvedic medicines(Integrative approach). The patient was considered suffering from Aamavata(∼Vata disorder involving bone and joints) and was treated based on fundamentals of treatment as mentioned by ayurvedic texts. Patients condition was assessed every 7 days initially for 1 monthend later monthly.Thescore sets of Assessment of Spondylo Arthritis BASDAI and ASDAS score and symptoms showed substantial improvement after 120 days of treatment.

The efficacy of tofacitinib combined with bDMARDs in the treatment of ankylosing spondylitis patients with inadequate response to bDMARDs: a retrospective study

IntroductionAnkylosing spondylitis(AS) is a chronic inflammatory rheumatic disease primarily affecting the spine and sacroiliac joints. While biologic disease-modifying antirheumatic drugs(bDMARDs) and targeted synthetic DMARDs(tsDMARDs) are popular treatments for AS, there is limited research on their combined use. This study examined a cohort of AS patients who demonstrated inadequate response to bDMARDs and subsequently initiated combination therapy with tofacitinib in conjunction with bDMARDs, assessing both the efficacy and safety profile of this therapeutic approach.MethodsIn this study, we retrospectively collected the electronic medical records (EMR) of 15 adult patients with AS who were admitted to the Fourth Affiliated Hospital Zhejiang University School of Medicine between January 2018 and June 2022. All patients had received at least one bDMARD treatment for more than three months and still exhibited moderate to high disease activity. Tofacitinib 5 mg bid was added to their original biological treatment. Treatment was continued for a minimum of 12 weeks following the initiation of combination therapy. Changes in ASDAS-CRP and BASDAI scores at week 12 were collected and analyzed from baseline, while changes in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at weeks 4, 8, and 12 were also collected and analyzed.ResultsAfter 12 weeks of treatment, the overall ASDAS-CRP score decreased significantly from a baseline of 3.82 ± 1.47 (2.83 ~ 4.99) to 1.47 ± 0.48 (0.75 ~ 2.44), with remission achieved by 7 patients (46.7%) and low disease activity achieved by 5 patients (33.3%). The overall BASDAI score also showed significant improvement, decreasing from a baseline of 5.11 ± 1.42 (3.25 ~ 7 0.75) to 1.28 ± 0.70(0.20 ~ 2.55). Additionally, both ESR and CRP levels decreased significantly during the course of treatment without any reported adverse events leading to discontinuation.ConclusionTo a certain extent, our findings provide some evidence supporting the efficacy and safety of the combination of bDMARD and JAK inhibitor tofacitinib in AS patients with inadequate response to bDMARD monotherapy. It effectively controls disease activity while maintaining a relatively low and manageable incidence of adverse events. Further prospective randomized controlled trials with large sample sizes are anticipated to provide evidence-based medical support.

Clinical and structural damage outcomes in axial spondyloarthritis patients receiving NSAIDs or advanced therapies: a description of a real-life cohort.

This study aims to describe the clinical characteristics, disease activity, and structural damage in patients with axial spondyloarthritis (axSpA) who receive chronic treatment with nonsteroideal anti-inflammatory drugs (NSAIDs) or advanced therapies in a clinical setting. Cross-sectional study on axSpA patients consecutively recruited from the outpatient clinic of a tertiary hospital. We collected data on clinical and demographic characteristics, as well as treatment patterns involving NSAIDs and advanced therapies. Structural damage was assessed using mSASSS. Overall, data from 193 axSpA patients (83% ankylosing spondylitis) were gathered, with a mean disease duration of 21.4 years. Of these, 85 patients (44%) were exclusively taking NSAIDs, while 108 (56%) were receiving advanced therapies, with TNF inhibitors being the predominant choice (93 out of 108, 86.1%). Among patients using NSAIDs, 64.7% followed an on-demand dosing regimen, while only 17.6% used full doses. Disease activity was low, with a mean BASDAI of 3.1 and a mean ASDAS-CRP of 1.8. In comparison to patients under chronic NSAID treatment, those taking advanced therapies were primarily male (69.4% versus 51.8%, p = 0.025) and significantly younger (mean age of 49 versus 53.9 years, p = 0.033). Additionally, patients on advanced therapies exhibited lower ASDAS-CRP (p = 0.046), although CRP serum levels and BASDAI scores did not differ between the two groups. In the multivariable analysis, therapy (NSAID versus biological treatment) was not independently associated with ASDAS-CRP, BASDAI or mSASSS. This cross-sectional analysis of a real-world cohort of axSpA patients shows positive clinical and radiological outcomes for both NSAIDs and advanced therapies.

Real-world experience with netakimab in the treatment of spondyloarthritis

To study the real-world efficacy and safety of netakimab in the treatment of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The retrospective analysis included 23 patients (13 males; 56.5%) aged 23 to 73 years (median 42, interquartile range 28 to 52 years) with AS (n=12) or PsA (n=11) who received netakimab therapy from February 2021 to April 2023. Disease activity was assessed every 3-6 months based on the C-reactive protein (CRP) level for all patients according to the BASDAI and ASDAS-CRP indices for AS, DAPSA and PASI for PsA. These indicators were analyzed before therapy and at the last visit to assess the effectiveness of treatment. The results are presented as median (interquartile range). In all patients treated with netakimab (median duration of treatment 11 months), the CRP level decreased from 10.6 (3.1; 17.3) to 3.1 (1.9; 8.9) mg/L (absolute difference -7.5 mg/L, median relative reduction -60%; p=0.008), and the proportion of patients with elevated CRP decreased from 70 to 41%; p=0.039. In patients with AS (median duration of treatment 9 months), BASDAI score decreased from 5.8 (4.7; 6.5) to 3.0 (1.9; 3.8) points (absolute difference -2.8 points, median relative reduction of -45%; p=0.008) and ASDAS-CRP score decreased from 2.8 (1.9; 3.9) to 1.9 (1.7; 2.6) points (absolute difference -0.9 points, median relative reduction -21%; p=0.007). The proportion of patients with high AS activity (BASDAI≥4) decreased from 90% to 20% (p=0.031); however, there was no significant change in the CRP level (absolute difference -4.9 mg/L, median relative reduction -57%; p=0.110). In patients with PsA (median duration of treatment 18 months), the CRP level decreased from 12.0 (4.5; 17.3) to 3.3 (2.0; 7.8) mg/L (absolute difference -8.7 mg/L, median relative reduction -80%; p=0.041), the DAPSA score decreased from 23.0 (19.0; 30.5) to 6.3 (5.2; 13.5) points (absolute difference -16.7 points, median relative reduction -69%; p=0.018). Three (13%) patients reported mild to moderate adverse events. The obtained data confirm the effectiveness and safety of netakimab in treating AS and PsA in real-world practice.

Association of Interleukin-10 Gene Polymorphism with Susceptibility and Severity of Axial Spondyloarthritis

Background: This study aimed to determine the association of Interleukin-10 (IL-10) gene polymorphisms with the susceptibility and severity of axial spondyloarthritis (axSpA) that may guide to have an idea about the genetic basis of the disease and it’s association with severity. Objective: Aim of the study was to demonstrate the IL-10 gene polymorphisms to determine their association with susceptibility and severity of axSpA. Methods: According to Assessment of Spondyloarthritis International Society (ASAS) classification criteria total 38 patients with axSpA (clinically diagnosed by an expert Rheumatologist, attending in outpatient department (OPD) of Rheumatology, Bangabandhu Sheikh Mujib Medical University, BSMMU) and 38 healthy controls (resident doctors, laboratory staffs of BSMMU and general people) after fulfilling the inclusion criteria were enrolled in this study. Blood samples were collected after taking informed written consent and data were collected in a predesigned data collection sheet. The IL-10 gene polymorphisms IL-10 (819T/C), IL-10 (1082A/G) and IL-10 (592C/A) were detected by Polymerase chain reaction- Restriction fragment length polymorphism (PCR- RFLP) method at Department of Microbiology and Immunology, BSMMU, Dhaka. Results: According to BASDAI score, 14 patients were in inactive disease group and 24 patients were in active disease group. The homozygous CC genotype and C allele of IL-10 (-819T/C) were found significantly higher in patients than control group (p=0.022 and p=0.045 respectively). The heterozygous GA genotype of IL-10 (-1082A/G) gene has significant association (p=0.001) with axSpA. It indicates that the homozygous CC genotype and C allele of IL-10 (819T/C) and heterozygous GA genotype of IL-10 (1082A/G) have an association with the susceptibility of axSpA. Conclusion: CC genotype and C allele of IL-10 (-819T/C) and GA genotype of IL-10 (1082A/G) are associated with axSpA susceptibility. But no association of these genotypes were found with disease severity. Bangladesh Med Res Counc Bull 2023; 49: 171-176

Effect of neridronate on axial involvement in patients with spondyloarthritis when biologics are not possible. Results of a monocentric study

IntroductionThis study aims to examine the potential effectiveness of intravenous neridronate (IVNer) on axial involvement in patients with spondyloarthritis (SpA) refractory to non-steroidal anti-inflammatory drugs (NSAIDs) but not eligible for biological disease-modifying antirheumatic drugs (bDMARDs).MethodPatients with active SpA (BASDAI score ≥ 4) and active sacroiliitis (SI) on MRI (according to ASAS MRI definition), who were NSAID-insufficient responder/intolerant but not eligible for bDMARDs, were retrospectively recruited in a tertiary rheumatology centre between September 2015 and December 2021. IVNer (100 mg) was administered to the patients on days 1, 4, 7, and 10. Responses were evaluated 60 days after the last infusion as the median changes from the baseline of BASDAI and Visual Analogue Scale (VAS) pain and there are improvements on MRI signs.ResultsA total of 38 patients (26 axial SpA, 3 enteropathic arthritis, and 9 axial psoriatic arthritis) were included [66% women, mean age ± SD: 38.0 ± 14.1 years, mean disease duration: 30.5 ± 49.5 months (range 1.0–298), 47% HLAB27+]. The reason for bDMARD ineligibility was concurrent solid tumors (n = 6) or hematological (n = 1) malignancy, comorbidities (n = 11), or patient preference (n = 20). Both median BASDAI [5.83 (4.2–8.33) versus 3.66 (1.1–6.85), p &amp;lt; 0.001] and VAS pain [7 (5.75–8.0) versus 3 (1.0–7.0), p &amp;lt; 0.0001] significantly decreased after IVNer. Of 28 available MRI at follow-up, we observed a complete (36%) or partial (39%) resolution of sacroiliitis or a persistent activity (25%).DiscussionIVNer was effective in improving axial involvement in patients with SpA refractory to NSAIDs but not eligible for bDMARDs. IVNer can be considered as a potential alternative therapeutic option in selected settings.

Expression and Clinical Significance of microRNA-138-5p and TGF-β3 in Peripheral Blood of Patients With Ankylosing Spondylitis.

Clinical study. Our work was aimed at exploring the expression and clinical significance of microRNA-138-5p (miR-138-5p) and Transforming Growth Factor-beta 3 (TGF-β3) in peripheral blood of patients with ankylosing spondylitis (AS). Forty-seven patients with AS were selected as the AS group, and the staging of the enrolled AS patients was based on the BASDAI score: <4 points were classified as the stable stage (stable group) and ≥4 points were classified as the active stage (active group). Forty-seven cases were selected from the same period of healthy physical examination in our hospital as the control group. miR-138-5p and TGF-β3 levels and disease activity factors in peripheral blood were measured in all patients. Compared to healthy subjects, reduced miR-138-5p levels and increased TGF-β3 levels were found in AS patient. Even more, level of miR-138-5p was decreased and level of TGF-β3 was found to be increased in active disease stage of AS in comparison to inactive disease. Correlation analysis disclosed that miR-138-5p expression in peripheral blood of AS patients was negatively correlated with TGF-β3, HLA-B27, ESR, CRP, and BASDAI; serum TGF-β3 was positively correlated with HLA-B27, ESR, CRP, and BASDAI. The ROC curve analysis disclosed that miR-138-5p and TGF-β3 had certain diagnostic value for AS, and the combined detection could improve the clinical diagnostic capability of this disease. miR-138-5p and TGF-β3 in peripheral blood of AS patients are potential biological markers for the diagnosis of AS and are expected to be new clinical diagnostic indicators.

The Taiwanese Map of Axial Spondyloarthritis: Living with the Condition.

Background and Objective: The International Map of Axial Spondyloarthritis (IMAS) explores the physical, psychological, and social experiences of patients with axial spondyloarthritis (axSpA). This initiative is now being expanded to Taiwan as the Taiwanese Map of Axial Spondyloarthritis (TMAS). We aim to provide rheumatologists with insights into the perspectives of Taiwanese patients, enabling physicians to better understand the unmet needs of these patients and optimize their management. Materials and Methods: The TMAS is a cross-sectional study gathering data through an online survey of axSpA patients, promoted by the Ankylosing Spondylitis Caring Society of R.O.C. (ASCARES), conducted from July 2017 to March 2018 by Ipsos, and analyzed by the Health & Territory Research (HTR) group of the University of Seville. The questionnaire includes 99 questions that cover domains such as patient profile, diagnosis, habits/lifestyle, employment status, physical/psychological health status, social support, use of healthcare services, and treatments. Results: A total of 112 axSpA patients were included in this survey. The mean age was 38.6 years and 75.0% were male. The average diagnostic delay was 3 years, and 19.6% reported extra-articular manifestations. Out of the 49 respondents who reported HLA-B27 information, 35 were HLA-B27-positive. The disease burden was high, with a mean BASDAI score of 4.9 and 75.9% having a mild to moderate degree of spinal stiffness. Furthermore, they were socially and psychologically burdened, with 88.4% experiencing work-related issues and 25.9% suffering from anxiety. Conclusions: The TMAS sheds light on the overall perspective of axSpA patients in Taiwan. The TMAS shows shorter diagnostic delay compared to patients from the EMAS. However, high disease activity and significant psychological distress still trouble the patients, causing functional impairments and even leading to career failures. Understanding the perspective of axSpA patients can help rheumatologists adjust treatment strategies to their unmet needs and improve their disease outcomes.

Abstract 14 — Comparison of the ASAS Health Index Between Radiographic Axial Spondyloarthritis and Non-Radiographic Spondyloarthritis in Singapore

Background Prior studies reported conflicting results regarding differences in Assessment of SpondyloArthritis (ASAS) Health Index (HI) scores between radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA). Country-level variations in disease activity were also observed. Hence, this study aimed to compare the ASAS HI scores between r-axSpA and nr-axSpA in Singapore, and determine factors associated with poorer ASAS HI scores. Methods This was a cross-sectional evaluation of baseline data from a prospective cohort study in Singapore General Hospital, from January 2018 to March 2023. Patients aged 21 years and above who were clinically diagnosed with axial spondyloarthritis (axSpA) based on the 2009 ASAS criteria were included. Sociodemographic variables, clinical variables and patient-reported outcomes were collected. Univariable and multivariable linear regression were performed to identify variables associated with ASAS HI scores. Variables with p-value of &lt;0.10 were included in the multivariable regression. A p-value of &lt;0.05 was considered significant. Results Of the 331 patients, 265 (80.0%) and 66 (20.0%) had r-axSpA and nr-axSpA respectively. The median (IQR) age in r-axSpA was [40.0 (30.0-53.0) years], higher than nr-axSpA [34.0 (25.0-47.0) years], p&lt;0.01. There was a higher proportion of males in r-axSpA (80.4%) than nr-axSpA (65.2%), p=0.01. Patients with r-axSpA had a longer disease duration [6.8 (1.8-14.0) years] than nr-axSpA [1.1 (0.2-5.4) years], p&lt;0.01. More patients with r-axSpA (90.2%) were positive for HLA-B27 than nr-axSpA (69.7%), p&lt;0.01. Differences in ASAS HI scores were not statistically significant between r-axSpA and nr-axSpA [4.0 (2.0-6.8) vs 5.5 (1.1-8.5), p=0.12]. Post multivariable regression, nr-axSpA ([Formula: see text]: 0.70, 95% CI: 0.09, 1.32, p=0.02), BASDAI ([Formula: see text]: 0.18, 95% CI: 0.01, 0.35, p=0.04), BASFI ([Formula: see text]: 0.47, 95% CI: 0.30, 0.65, p&lt;0.01) and HADS-Depression scores ([Formula: see text]: 0.11, 95% CI: 0.01, 0.21, p=0.04) were positively associated with ASAS HI. Higher SF36-PCS ([Formula: see text]: −0.11, 95% CI: −0.14, −0.08, p&lt;0.01) and SF36-MCS ([Formula: see text]: −0.07, 95% CI: −0.10, −0.04, p&lt;0.01) were negatively associated with ASAS HI (Table 1). Conclusion Patients with nr-axSpA were associated with poorer overall health and functioning as compared to r-axSpA. Higher disease activity, poorer physical function, poorer mental health status and more depressive symptoms were associated with worse health and functioning.

Efficacy of Guselkumab on Axial-Related Symptoms Through up to 2 Years in Adults with Active Psoriatic Arthritis in the Phase 3, Randomized, Placebo-Controlled DISCOVER-2 Study.

Guselkumab previously showed greater improvements versus placebo in axial symptoms in patients with psoriatic arthritis (PsA) (assessed by Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Ankylosing Spondylitis Disease Activity Score [ASDAS]), in post hoc analyses of the phase 3, placebo-controlled, randomized DISCOVER-1 and DISCOVER-2 studies. We now evaluate durability of response in axial-related outcomes through 2 years of DISCOVER-2. DISCOVER-2 biologic-naive adults with active PsA (≥ 5 tender/ ≥ 5 swollen joints, C-reactive protein ≥ 0.6 mg/dl) were randomized to guselkumab 100 mg every 4 weeks (Q4W) or at week0, week4, then Q8W, or placebo → guselkumab Q4W at week 24. Among patients with imaging-confirmed sacroiliitis (investigator-identified), axial symptoms were assessed through 2years utilizing BASDAI, BASDAI Question #2 (spinal pain), modified BASDAI (mBASDAI; excludes Question #3 [peripheral joint pain]), and ASDAS. Mean changes in scores and proportions of patients achieving ≥ 50% improvement in BASDAI (BASDAI 50) and ASDAS responses, including major improvement (decrease ≥ 2.0), were determined through week 100. Treatment failure rules (through week 24) and nonresponder imputation of missing data (post-week 24) were utilized. Mean BASDAI component scores were assessed through week 100 (observed data). Exploratory analyses evaluated efficacy by sex and HLA-B*27 status. Among 246 patients with PsA and imaging-confirmed sacroiliitis, guselkumab-treated patients had greater mean improvements in BASDAI, mBASDAI, spinal pain, and ASDAS scores, lower mean BASDAI component scores, and greater response rates in achieving BASDAI 50 and ASDAS major improvement vs. placebo at week 24. Differences from placebo were observed for guselkumab-treated patients in selected endpoints regardless of sex or HLA-B*27 status. At week 100, mean improvements were ~ 3 points for all BASDAI scores and 1.6-1.7 for ASDAS; 49-54% achieved BASDAI50 and 39% achieved ASDAS major improvement at week 100. Guselkumab treatment provided durable and meaningful improvements in axial symptoms and disease activity in substantial proportions of patients with active PsA and imaging-confirmed sacroiliitis. Clinicaltrials.gov NCT03158285.

OA03 Trauma secondary to a horse riding accident as a potential accelerating factor in inflammatory axial sponyloarthropathy: a case report and literature review

Abstract Introduction Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterised by axial involvement and sacroiliitis. The etiology of AS remains elusive, with genetic and environmental factors implicated in disease development and progression. This case report aims to investigate the potential association between trauma and the acceleration of AS in individuals positive for HLA-B27. Furthermore one purpose of this case-report is to ascertain any link between horse riding accidents in jockeys or professionals undertaking horse riding as a career choice. Is there a correlation between trauma and development of inflammatory axial spondyloarthropathy subsequently or not. Case description A 24-year-old female patient with a medical history of eczema and Graves' disease, currently undergoing propylthiouracil treatment, was referred to the rheumatology clinic due to persistent back pain for the past six to seven years following a horse riding accident. The patient had previously received physiotherapy and found relief with naproxen and co-codamol. The pain primarily affects her lower spine and radiates down her legs. While movement provides some relief, lying down exacerbates the pain. The patient experiences stiffness for approximately 30 minutes in the morning but does not exhibit peripheral joint symptoms. Exercise helps alleviate her symptoms. The patient reported a family history of psoriasis but denied any history of uveitis, inflammatory bowel disease, weight loss, night sweats, heartblock or achilles tendinitis. She also gave a history of joint hyper mobility with reduced flexion at the spine over the years. Blood tests revealed normal levels of ANA, CCP, ESR, rheumatoid factor, B12, HbA1c, and thyroid function. Ferritin levels were 30.2, and HLA B27 was positive. Joint examination did not reveal any signs of synovitis. The patient exhibited good range of motion in the spine. SLR's were positive on both sides and no tenderness over spine or sacroiliac joints. Systemic Examination was normal. BASDAI score was 4. Occiput to wall distance of 0 centimeters. Beighton score 4/9. Subsequently MRI whole spine/SI Joints were organised and results indicated a central disc protrusion at the L4-L5 level leading to critical spinal stenosis and likely impinging on the transitioning L5 and S1 nerve roots. Additionally, a disc protrusion at the L5-S1 which was impinging on the left S1 nerve root. Bilateral sacroiliitis was also observed. Patient was treated with NSAIDs and physiotherapy with good results with a view for a subsequent MRI, and escalation to biologics if symptoms were to worsen. Discussion The presented case raises the question of whether trauma accelerates the progression of ankylosing spondylitis (AS) in individuals who are positive for HLA-B27. Although this specific case involves a 24-year-old female patient with a history of back pain following a horse riding accident, additional research and studies would be required to draw definitive conclusions regarding the relationship between trauma and the development or acceleration of AS in HLA-B27 positive individuals. The question this case report poses and there is little in terms of research and case reports present, whether the involvement of the lady in question in a horse riding accident unmasked her ankylosing spondylitis given her HLA B27 positivity and the presence of sacroilitis on MRI scans. Literature review revealed a potential role of trauma accelerating the progression of ankylosing spondylitis in individuals who are also positive for HLA B-27, in addition in some cases it lead to detection and unmasking of chronic back pain which was inflammatory in nature rather than mechanical or a combination of both. This was revealed by the horse riding accident given the nature of the pain which had been constant and worsening which lead to a suspicion of a possible inflammatory component and hence further investigations were done. In conclusion this case report highlights the importance of a possible correlation between AS in HLA B27 positive individuals and raises the question whether trauma secondary to sports injuries like horseback riding accidents in our patients case, accelerates the progression of AS in individuals who are positive for HLA-B27. Key learning points This case report highlights the potential role of trauma following a sports injury as a contributing factor in the acceleration of AS in individuals positive for HLA-B27. Further investigations, including prospective studies, are warranted to elucidate the complex interplay between trauma, genetic predisposition, and disease progression in AS. The purpose of this case report is to remind sports medicine physicians of the prevalence of rheumatologic diseases in general and ankylosing spondylitis in particular and of the various ways in which spondyloarthropathies may present in athletes/sports personnel. Increased suspicion may lead to earlier diagnosis and treatment, potentially reducing illness severity and duration and improving the performance of athletes with this condition.