BASFI Scores Research Articles

Major Determinants of Well‐Being in Patients With Axial Spondyloarthritis: 2 Year Follow‐Up

ABSTRACTObjectivesBath Ankylosing Spondylitis Patient Global Score (BAS‐G) is a uni‐dimensional scale that enables patients to evaluate the effects of their illness on their health. The aim of this study was to determine the impact of disease related outcomes on the BAS‐G scores in patients with axSpA.MethodsA total of 309 patients (56.6% of whom were male, mean age 44 ± 11) were included in the study. Socio‐demographic characteristics (age, sex and education level) and clinical characteristics such as disease activity (BASDAI and CRP), spinal mobility (BASMI), functional status (BASFI), radiographic structural damage (mSASS, mNY, and BASRI‐hip), and health related quality of life (SF‐36 and ASQoL) of the patients were recorded at baseline. In addition, BASDAI total and each item score, BASFI, BAS‐G, and CRP levels were collected at 6, 12, and 24 months.ResultsFemale patients had significantly higher BAS‐G scores (p = 0.037). Baseline BASDAI total score (p < 0.001) and all BASDAI item scores (p < 0.001 for each item), BASFI total score (p < 0.001), ASQoL total score (p < 0.001), and SF‐36 PCS sum‐score (p < 0.001) were moderately/highly correlated with BAS‐G. Multivariate analysis revealed that back pain (BASDAI Q2) (p < 0.001) and the severity of morning stiffness (BASDAI Q5) (p < 0.001) were the main determinants of BAS‐G in patients with axSpA. In 2‐year follow‐up, BASDAI Q1, BASDAI Q5, and BASFI scores were independent determinants of BAS‐G in patients with axSpA.ConclusionAccording to the results of the present study, patients with axSpA mainly rely on morning stiffness and back pain to determine their global health status. Moreover, fatigue, severity of morning stiffness and function are the determinants of BAS‐G during follow‐up.

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.

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.

"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.

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.

Characteristics and burden of disease in patients with radiographic versus non-radiographic axial spondyloarthritis in the ASRI cohort.

Axial spondyloarthritis (axSpA) comprises patients with both radiographic and non-radiographic features. Previous studies have shown similar burden of disease between these two groups. The Ankylosing Spondylitis Registry of Ireland (ASRI) was formed with the objective to measure the burden of axial spondyloarthritis in the population and identify early predictors of a poor outcome. For this analysis, the ASRI database was used to compare the characteristics and burden of disease in patients with radiographic versus non-radiographic axial spondyloarthritis. Patients with radiographic axial spondyloarthritis (r-axSpA) were defined as those with X-ray evidence of sacroiliitis. Patients with non-radiographic axial spondyloarthritis (nr-axSpA) were defined as having MRI evidence of sacroiliitis but no X-ray evidence of sacroiliitis. In total, 764 patients were included. Analysis of radiographic status showed 88.1% (n = 673) of patients with r-axSpA and 11.9% (n = 91) with nr-axSpA (Table 1). Patients with nr-axSpA were younger (41.3 vs. 46.6years, p < 0.01), had shorter disease duration (14.8 vs. 20.2years, p < 0.01) and had lower proportion of males (66.6% vs. 78.4%, p = 0.02) with lower frequency of HLA-B27 positivity (73.6% vs. 90.5%, p < 0.01). The nr-axSpA group had lower BASDAI (3.37 vs. 4.05, p = 0.01), BASFI (2.46 vs. 3.88, p < 0.01), BASMI (2.33 vs. 4.34, p < 0.01), ASQoL (5.2 vs. 6.67, p = 0.02) and HAQ scores (0.38 vs. 0.57, p < 0.01). There were no significant differences in the prevalence of extra-musculoskeletal manifestations or use of medications. This study provides evidence to suggest that the burden of disease is less in patients with non-radiographic axial spondyloarthritis than radiographic axial spondyloarthritis.

The relationship of cervicothoracic mobility restrictions to fall risk and fear of falling in ankylosing spondylitis.

The objective of this study is to determine whether restricted cervical mobility in ankylosing spondylitis (AS) is associated with increased fall frequency or fear of falling. A total of 134 AS patients and 199 age- and gender-matched control subjects (CS) with soft-tissue cervicothoracic pain were prospectively evaluated for fall risk. Subjects were divided into non-fallers, single fallers, and multiple fallers. Dynamic cervical rotations and static cervicothoracic axial measurements were compared between the groups. In total, 88 AS patients were reviewed more than once; Kaplan-Meier plots were constructed for fall risk as a function of cervical rotation amplitudes. Falls Efficacy Scale-International (FES-I) questionnaire measured the fear of falling. In total, 34% of AS patients and 29% of CS fell (p = 0.271) in the year prior to evaluation. In AS, static anatomical measurements were unrelated to fall occurrence. The trends of multiple AS fallers to greater flexed forward postures and reduced dynamic cervical rotations were not statistically significant. Cervicothoracic pain (p = 0.0459), BASDAI (p = 0.002), and BASFI (p = 0.003) scores were greater in multiple fallers. FES-I scores were greater in fallers (p = 0.004). Of the 88 AS patients reviewed (or seen) on more than one occasion, 46.5% fell over the 9-year observation period, including all multiple fallers and 71.4% of single fallers. Survival curves showed increased fall risk as cervical rotational amplitudes decreased. In AS, decreased cervical rotations increase fall risk and fear of falling. In multiple fallers, falls were associated with greater disease activity. Cervical muscle stiffness in AS may cause non-veridical proprioceptive inputs and contribute to increased fall frequency similar to individuals with soft-tissue cervicothoracic pain.

P193 Bimekizumab improves key symptoms, disease activity and function in patients across the full spectrum of axial spondyloarthritis up to week 24: results from two phase 3 studies

Abstract Background/Aims Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. BKZ demonstrated rapid and clinically meaningful improvements in disease activity across the full spectrum of axial spondyloarthritis (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 clinical outcomes from the ongoing phase 3 studies up to week (wk) 24. Methods BE MOBILE 1 and 2 have similar study designs: 16-wk double-blind period followed by a 36-wk maintenance period. Patients were randomised (1:1 in BE MOBILE 1 and 2:1 in BE MOBILE 2) to BKZ 160 mg every 4 wks (Q4W) or placebo (PBO). All patients received BKZ 160 mg Q4W from wk16. ASAS40 and BASDAI50 rates, mean change from baseline (CfB) in BASDAI (total and components) and BASFI scores are reported up to wk24. Missing data is imputed using non-responder or multiple imputation. Results Overall, 240/254 (94.5%; nr-axSpA) and 313/332 (94.3%; r-axSpA) patients completed the studies up to wk24. Both studies met their primary (ASAS40) and ranked secondary endpoints at wk16. Higher BASDAI50 response rates and larger mean reduction in BASDAI and BASFI scores were seen at wk16 for BKZ versus PBO (Table). After switching to BKZ, mean changes in BASDAI and BASFI scores for patients in the PBO group reached levels similar to BKZ-treated patients. 50.8% of nr-axSpA and 55.5% of r-axSpA patients had ≥1 treatment emergent adverse events (TEAE) and incidence of serious TEAEs was low up to wk24 (0.4% and 3.6%). No systemic candidiasis, MACE or deaths were reported with BKZ in either study up to wk24. No IBD was reported in BE MOBILE 1 (nr-axSpA), there was low incidence of adjudicated IBD in BE MOBILE 2 (r-axSpA: 0.3%). Incidence of uveitis was low in both studies (nr-axSpA: 4.8% [PBO], 1.6% [BKZ]; r-axSpA: 4.5% [PBO], 0% [BKZ]) at wk16. Conclusion Dual inhibition of IL-17A and IL-17F with BKZ provided significant improvement in key signs and symptoms, disease activity and physical function across the full spectrum of axSpA. No new safety signals were observed. Disclosure K. Gaffney: Consultancies; KG has received honoraria or consultancy fees from Novartis, AbbVie, UCB Pharma, Eli Lilly and Pfizer. Shareholder/stock ownership; KG is a shareholder of Rheumatology Events. Member of speakers’ bureau; KG has paticipated in speaker's bureau for Novartis, UCB Pharma, AbbVie and Eli Lilly. Grants/research support; KG has received grants/research support from NASS, Versus Arthritis, AbbVie, Pfizer, UCB Pharma, Norvartis, Eli Lilly, Cellgene, Celltrion, Janssen, Gilead and Biogen. Other; KG has received meeting expenses from AbbVie, Eli Lilly, Roche, Novartis, Pfizer and UCB Pharma. N. McKay: Member of speakers’ bureau; NM has received Speaker' bureau from Gilead. Other; NM has received travel fees from UCB Pharma and Gilead. R. Sengupta: Consultancies; RS has honoraria or consultancy fees from Abbvie, Biogen, Novartis, Celgene, Lilly, Chugai, MSD and UCB Pharma. Grants/research support; RS has received grants/ research support from AbbVie, Celgene, Novartis and UCB Pharma. Other; 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 employee of UCB Pharma. S. Zhao: Honoraria; SZ has received honoraria from UCB Pharma. H. Marzo-Ortega: Grants/research support; HMO has received grants/research support from Janssen, Novartis and UCB Pharma. Other; HMO has received honoraria and/or consultancy and/or speaker fees from Abbvie, Biogen, Celgene, Janssen, Eli-Lilly, Moonlake, Novartis, Pfizer and UCB Pharma.

Efficacy and safety of Iguratimod in the treatment of Ankylosing Spondylitis: A systematic review and meta-analysis of randomized controlled trials.

To explore the efficacy and safety of Iguratimod (IGU) intervention in the treatment of Ankylosing Spondylitis (AS). We used computer to search literature databases, collected randomized controlled trials (RCTs) related to IGU treatment of AS, and searched the relevant literature in each database until Sep. 2022. Two researchers independently carried out literature screening, data extraction, and evaluation and analysis of the risk of bias in the included studies, and then used Rev Man5.3 software for meta-analysis. The protocol is CRD42020220798. A total of 10 RCTs involves in 622 patients were collected. The statistical analysis showed that IGU can decrease the BASDAI score (SMD -1.62 [-2.20, -1.05], P<0.00001. Quality of evidence: low), the BASFI score (WMD -1.30 [-1.48, -1.12], P<0.00001. Quality of evidence: low) and the VAS (WMD -2.01 [-2.83, -1.19], P<0.00001. Quality of evidence: very low). Meanwhile, the addition of IGU into the conventional therapy would not increase the adverse events (RR 0.65 [0.43, 0.98], P=0.04. Quality of evidence: moderate). IGU may be an effective and safe intervention for AS. https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42020220798.

The effect of different anti-inflammatory treatment strategies on process of atherosclerosis in ankylosing spondylitis patients

Abstract Objectives Our aim in this study was to examine the effects of different anti-inflammatory treatment strategies on the process of atherosclerosis, which is an important cause of mortality in ankylosing spondylitis (AS) patients, by examining the possible effect of treatments on inflammation, lipid profile and oxidative stress parameters in patients with AS. Methods In this study, 32 healthy volunteers served as the control group in addition to a total of 76 AS patients who were divided into two groups according to whether they were receiving anti-TNF medications or not. We assessed the levels of inflammation, oxidative stress, lipid profile parameters, and oxidized low-density lipoprotein (oxLDL). The atherogenic index of plasma (AIP), non-HDL cholesterol levels, BASDAI, and BASFI scores were also calculated. Results AS patient groups and the control group had similar lipid profile parameters, thiol-disulfide homeostasis metrics, non-HDL cholesterol, oxLDL, and AIP levels (p&gt;0.05). In contrast to AS patients receiving non-anti-TNF treatment, the BASDAI and BASFI scores, ESR, and CRP levels were lower in AS patients receiving anti-TNF treatment (p&lt;0.05). In contrast to the controls, AS patients demonstrated high TOS and OSI values (p&lt;0.05). Conclusions AS patients face increased oxidative stress that does not correlate with inflammatory status and disease activation level. Anti-TNF alpha treatment may reduce some risk factors of atherosclerotic CVD in AS patients.

The &amp;quot;5A&amp;quot; Management Model Was Used to Study Navy Patients with Ankylosing Spondylitis

Objective: To explore the effect of 5A management mode on the disease control of inpatients with naval ankylosing spondylitis (AS) under the background of information technology. Methods: A total of 58 Navy AS patients admitted to the Rheumatology and Immunology Department of Shanghai Changhai Hospital from January 2021 to October 2021 were selected. According to whether they were willing to accept 5A intervention, they were divided into experimental group and control group. The experimental group carried out intervention in accordance with 5A management mode, and the control group carried out routine nursing and treatment. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), morning stiffness time, pain score, spinal motion function and sleep quality were collected in two groups, respectively. All patients were evaluated again in the outpatient department 1 month later. Results: Before 5A management mode intervention, there were no statistical differences in all indexes between the two groups (P≥0.05). After 5A mode intervention, ESR, CRP, morning stiffness time, pain score, BASFI score and PSQI score were significantly lower than before 5A mode intervention, and the differences were statistically significant (P<0.05). After receiving conventional treatment and nursing, ESR, CRP, morning stiffness time, pain score, BASFI score and PSQI score were also significantly lower than before follow-up, with statistical significance (P<0.05). After receiving 5A mode, ESR, CRP, morning stiffness time and BASFI scores of the experimental group were significantly lower than those of the control group after receiving conventional treatment and nursing, the differences were statistically significant (P<0.05), but there was no statistical difference between the pain scores and PSQI scores of the two groups (P≥0.05). Conclusions: The application of 5A management mode under the information background can improve the physical activity and daily training ability of AS officers and soldiers to a certain extent, delay the invasion of diseases on bones and joints, and improve sleep quality. Compared with conventional treatment and nursing interventions, the application of 5A management mode can more effectively inhibit the progression of AS disease and promote the recovery of physical activity function of patients.

Achilles enthesitis on physical examination leads to worse outcomes after 2 years of follow up in patients with ankylosing spondylitis from REGISPONSER-AS registry

BackgroundEnthesitis represents one of the most important peripheral musculoskeletal manifestations in patients with axial spondyloarthritis (axSpA). However, studies specifically evaluating Achilles tendon enthesitis and its impact over time are scarce. The objectives of this study were to evaluate the impact of Achilles’ tendon enthesitis found at baseline during physical examination on the outcome measures after 2 years of follow-up in patients with ankylosing spondylitis (AS).MethodsThis was an observational and prospective study conducted during 2 years of follow-up in the REGISPONSER-AS registry. Linear regression models adjusted for age, body mass index (BMI), and anti-TNF intake were conducted to evaluate the association between the presence of Achilles enthesitis at baseline and the patient-reported outcome (PRO) scores at baseline. The impact of this feature on PROs over 2 years of follow-up was evaluated using mixed models for repeated measures adjusted for age, BMI, and anti-TNF intake.ResultsAmong the 749 patients included, 46 patients (6.1%) showed Achilles’ tendon enthesitis during physical examination at the baseline study visit. Patients with Achilles enthesitis had an increase in the global VAS score, BASDAI, mBASDAI, ASDAS-CRP, and BASFI scores in comparison with patients without this feature. In addition, the mean global VAS, BASDAI, and ASDAS-CRP scores were significantly higher among patients with Achilles enthesitis over the 2 years of follow-up after adjusting for age, BMI, and current anti-TNF intake. The percentage of patients achieving ASDAS low disease activity (ASDAS < 2.1) after 2 years of follow-up was 15.9% and 31.5% for patients with and without Achilles enthesitis, respectively (p = 0.030).ConclusionsIn patients with AS, the presence of Achilles’ tendon enthesitis was associated with worse scores on the outcome measures after 2 years of follow-up, leading to a lower probability of achieving low disease activity.

Does Late Axial Spondyloarthropathy Diagnosis Cause Extra Anti-TNF Therapy?

Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease that mainly characterized by sacroiliac joint and spine involvement. Although there is no clear evidence that any of these agent prevent the radiologic progression, anti-TNF drugs provide significant improvements in the disease activity score, functional index and quality of life. In AS patients, knowledge of the factors that determine the need for anti-TNF treatment will be associated with fewer complication sand better treatment. The purpose of this study is to investigate the possible factors which willmark the transition to the anti-TNF therapy in AS patients. Materials and Methods: This study was conducted in the Rheumatology division of the Internal medicine department of the Ondokuz Mayis University of Medicine hospital between January 2012- June 2015. The study protocol was approved by the Ethics Committee of Ondokuz Mayis University. A total of 165 patients, who were diagnosed as AS according to the ASAS classification criteria, were enrolled in this study. There were 85 women (51.5%) and 80 men (48.5%), aged between 15-69. Patients were divided into two groups according to their use of anti-TNF drug. Results: A total of 165 Ax-SpA patients (85 women and 80 men) were included in the study. The mean age was 37.82±11.24 years. The mean duration of the disease was 4.59±5.35 years. male gender, uveitis, delay in diagnosis, elevations in sedimentation CRP levels, increase in disease activity and functional indexes such as BASDAI and BASFI scores shows the more frequent need for anti-TNF drug use. Conclusion: In our study, patients who needed anti-TNF treatment had a longer time between symptom onset and diagnosis than patients who did not hear. The delay in diagnosing these patients leads to a delay in treatment so that the focus of inflammation increases and these patients need more anti-TNF as this window of opportunity escapes.

The natural history of chronic widespread pain in patients with axial spondyloarthritis: a cohort study with clinical and self-tracking data.

This study investigates longitudinal patterns, predictors and long-term impact of pain in axial spondyloarthritis (axSpA), using clinical and self-tracking data. The presence of multisite pain (MSP), affecting at least six of nine body regions using a Margolis pain drawing, and subsequent chronic widespread pain (CWP), MSP at more than one timepoint, was assessed in a cohort of axSpA patients. Incident MSP (MSP at two consecutive visits or more), intermittent MSP (MSP at two or more non-consecutive visits) and persistent MSP (MSP at each visit) were described. Demographic, clinical and self-tracking measures were compared for the CWP vs non-CWP groups using Students t test, Wilcoxon-Mann-Whitney and χ2 test for normal, non-normal and categorical data, respectively. Predictors of CWP were evaluated using logistic regression modelling. A total of 136 patients, mean clinical study duration of 120 weeks (range 27-277 weeks) were included, with sufficient self-tracking data in 97 patients. Sixty-eight (50%) patients reported MSP during at least one clinical visit: eight (6%) incident MSP; 16 (12%) persistent MSP; and 44 (32%) intermittent MSP. Forty-six (34%) of the cohort had CWP. All baseline measures of disease activity, function, quality of life, sleep disturbance, fatigue and overall activity impairment were significant predictors of the development of CWP. BASDAI and BASFI scores were significantly higher in those with CWP and self-tracking data revealed significantly worse pain, fatigue, sleep quality and stress. The development of CWP is predicted by higher levels of disease activity and burden at baseline. It also impacts future disease activity and wellbeing.

Depression and anxiety in individuals with axial spondyloarthritis and nonspecific low back pain who are interested in non-pharmacological therapy options: Cross-sectional study.

Psychological burden, such as depression and anxiety, may be associated with axial spondyloarthritis (axSpA) and poor prognosis of nonspecific low back pain (NSLBP). Non-pharmacological therapy is a substantial part of the management of both illnesses. Our study describes the psychological outcomes in patients with axSpA and NSLBP who were actively looking for non-pharmacological therapy. A total of 60 participants (34 with axSpA and 26 with NSLBP) were included in this cross-sectional study. Anxiety and depression were examined using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-II), respectively. The relationships between BAI and BDI-II and quality of life (EQ-5D), pain intensity (NRS pain), disease activity (AS disease activity score, ASDAS-CRP), and function (Bath AS Functional Index, BASFI) were determined. The intensity of anxiety and depression did not differ between patients with and without axSpA. In both, axSpA and NSLBP, BAI, and BDI-II scores were inversely correlated with EQ-5D, R = −0.268 (P ˂ .05) and R = −0.486 (P ˂ .0001), respectively. We found a variation in the relationship between pain intensity and psychological outcomes in NSLBP and axSpA. The pain intensity score was correlated with the BDI-II (R = 0.542, P = .001) and BAI (R = 0.489, P = .003) scores only in patients with axSpA. In patients with axSpA, BAI was inversely correlated with disease duration (R = −0.356, P = .039) and positively correlated with increased disease activity and poor function, ASDAS-CRP (R = 0.431, P = .012) and BASFI (R = 0.621, P ˂ .0001) scores. The ASDAS-CRP score was positively correlated with BDI-II (R = 0.562, P = .001), and both disease activity and female sex were identified as risk factors for poor BDI-II outcomes in axSpA patients according to multiple regression analysis. Experiences of anxiety and depression seem to be similar for patients with axSpA and NSLBP in this selected group of participants. However, pain intensity may influence psychological outcomes, mainly in patients with axSpA. Disease activity, impaired function, and female sex were risk factors for anxiety and depression in patients with axSpA.

The effects of clinical pilates training on disease-specific indices, core stability, and balance in patients with ankylosing spondylitis

ObjectiveTo assess the effects of clinical Pilates training on disease-specific indices, core stability, and balance in ankylosing spondylitis (AS) patients. MethodsAS patients were randomly assigned to either the Pilates group (PG) or control group (CG). The PG participated in Pilates training 3 times a week for 8 weeks. Patients in the CG were instructed to follow a home exercise program for 8 weeks. Assessments were performed before and after the interventions. BASDAI, BASFI, BASMI, and the AS Quality of Life (ASqOL) questionnaire were used were used to evaluate disease activity, functionality spinal mobility and quality of life respectively. Static core endurance was assessed with trunk flexor, extensor endurance, and lateral bridge tests, while dynamic core endurance was assessed using modified sit-up test. Balance was evaluated with bilateral and unilateral stance static postural stability (PS), bilateral stance dynamic PS and limits of stability (LOS) tests using the Biodex Balance System. ResultsTwenty-one patients in the PG and 21 patients in the CG completed the study. PG showed statistically significant improvements in BASDAI, BASFI, BASMI, and ASQoL scores, all core endurance tests, and dynamic PS and LOS results. The CG demonstrated significant improvement only in flexor endurance and LOS results. Post-intervention BASDAI, BASMI, and all core endurance tests were significantly better in the PG than in the CG (p < 0.05). ConclusionPilates training has positive effects on disease activity and functional capacity, spinal mobility, core endurance, balance, and quality of life in AS patients. Clinicaltrials.gov identifierNCT04292028.

HLA class I and discoveries of the HLA-K (pseudogene) related to disease severity and progression in patients with spondyloarthritis in Dr. Soetomo General Hospital, a tertiary health care center in Surabaya, Indonesia

Background: Spondyloarthritis (SpA) is a chronic inflammatory disease characterized by enthesitis, sacroiliitis, and axial joint involvement. Although the association of HLA with SpA has been widely reported, there have been no studies of HLA type in the Indonesian population within the last 20 years. This study aims to identify the HLA type in SpA patients at Dr. Soetomo General Hospital, Indonesia. Methods: This study used a cross-sectional analytical design with samples that met the criteria for SpA according to the 2009 ASAS. The clinical scores used in this study were mSASSS, BASFI, ASDAS, and Schober. Genetic identification using PCR was performed followed by sanger sequencing to determine the HLA type in the patient. DNA sequences were aligned with BLAST, and a phylogenetic tree was created using MEGA 11. Descriptive and comparative analyzes were performed using GraphPad Prism 9. Results: This study founded four types of HLA in SpA patients at Dr. Soetomo General Hospital, that is HLA-B with six alleles; -B*2704 (12.86%), -B*2705 (1.43%), -B*2706 (1.43%), -B*1802 (4.28%), -B*57v (1.43%), -B*35 (2.86%), HLA - C (21.43%), and HLA - K (52.83%). Clinical scoring of HLA-C and HLA-K indicated severe and progressive disease activity. The HLA-K had the highest mSASSS (26, 95% CI: 22–28), while HLA-C had the highest BASFI score (60, 95% CI: 55–68), the lowest Schober score (12, 95% CI: 10–14), and the shortest duration of illness (22, 95% CI: 12–36). There is no significant difference in the ASDAS score among types. Conclusions: The most common HLA types found in SpA patients at Dr. Soetomo were HLA-C and HLA-K, with the most progressive disease activity indicated by poor mSASSS, BASFI, ASDAS, and Schober scores with a short duration of illness.

Degenerative changes of lumbar spine and their clinical implications in patients with axial spondyloarthritis.

The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specific mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfirrmann classification), endplate changes (Modic, types 1, 2, and 3), annular fissure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI findings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis(AS). Degenerative changes were more prevalent in patients with mLBP (n = 105) than axSpA. Disk degeneration was the most prevalent MRI finding, followed by annular fissure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR = 6.455), lumbar disk herniation (OR = 2.278), annular fissure (OR = 2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR = 2.225), and advanced age (OR = 31.556) were factors associated with an increased risk of DD in axSpA. Coexisting DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaintsand should not been overlooked in patients with axSpA.