BASMI Scores Research Articles

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 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.

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.

Serum fibrinogen to albumin ratio in patients with ankylosing spondylitis: correlation with disease activity and severity

BackgroundThe fibrinogen to albumin ratio (FAR) has risen to prominence as a novel biomarker for various conditions, including systemic inflammation. Therefore, this study aims to assess the role of FAR in ankylosing spondylitis (AS) and its correlation with disease activity, severity, and functional status of AS patients. Thirty adult patients with AS were enrolled, along with 20 healthy age- and sex-matched subjects as controls. Bath Indices were used to determine the disease activity, severity, and functional status.ResultsThe patients’ mean age was 35.3 years, including 22 males (73.3%) and eight females (26.7%). The median disease duration was 10 years, ranging from 1 to 28 years. AS cases showed higher FAR than the control group (P < 0.001). Active cases were associated with significantly higher FAR when compared to cases in remission (P < 0.001). FAR showed significant positive correlations with Bath Indices including BASDAI, BASFI, and BASMI scores (P = 0.002, 0.002, < 0.001, 0.019, 0.022).ConclusionFAR has been increased in AS, particularly in active cases. FAR has also been associated with the impaired functional status of AS patients. FAR can represent a novel inflammatory parameter for monitoring disease activity and severity in AS.

Effects of patient and disease characteristics on global functioning in patients with axial spondyloarthritis in routine care

BackgroundThe ASAS Health Index (ASAS HI) was developed to assess global functioning in patients with axial spondyloarthritis (axSpA). Influencing factors have not been studied to date, especially the influence of inflammation and structural changes in the spine has remained unclear to date. ObjectiveTo find out whether and to what degree do axial inflammation, radiographic damage and other clinical features influence global functioning of patients with axSpA. MethodsPatient reported outcomes (ASAS HI, pain, BASDAI, BASFI, EQ-5D and SF-36) were assessed, spinal mobility by BASMI and depression by SF-36 scores. Axial inflammation was quantified using the MRI Berlin score and structural damage as detected by conventional radiographs by the modified Stokes AS Spinal Score (mSASSS). Correlation and regression analyses were performed to analyze the association between global functioning and other variables. ResultsA total of 191 axSpA patients with different degrees of global functioning and disease activity was included, 60.2% had r-axSpA. Syndesmophytes were found in 38.5% of patients - with a median mSASSS score of 3.8 (IQR 1.0-18.7) in r-axSpA and 0.0 (IQR 0.0-1.2) in nr-axSpA patients. The mean MRI score was 2.3 (IQR 0.5-7.6). ASAS HI values correlated significantly with BASMI, BASDAI, BASFI, BMI and MRI scores. However, no significant correlation was found for mSASSS and CRP. Regression analyses revealed that global functioning was significantly influenced by disease activity, physical function, obesity and depression but not by structural damage or spinal inflammation as detected MRI. ConclusionsOur study shows that global functioning is strongly associated with physical function, body weight and depression in patients with axSpA but not with spinal inflammation and structural damage. This may be explained by the relatively low mSASSS of these well treated patients.

Role of Metrology in Axial Spondyloarthritis: Does It Provide Unique Information in Assessing Patients and Predicting Outcome? Results From the British Society for Rheumatology Biologic Register for Ankylosing Spondylitis.

To determine among patients with axial spondyloarthritis (SpA) the factors associated with decreased spinal mobility and to determine whether poor mobility is a predictor of response to anti-tumor necrosis factor (anti-TNF) therapy. This was a prospective UK cohort study of persons meeting Assessment of Spondylarthritis international Society (ASAS) criteria for axial SpA. At recruitment, clinical and patient-reported factors independently associated with spinal mobility (measured by the Bath Ankylosing Spondylitis Metrology Index [BASMI]) were determined. Among those commencing anti-TNF therapy, factors that were independent predictors of response were determined using ASAS criteria, quality of life, and Ankylosing Spondylitis Disease Activity Score (ASDAS) response criteria. A total of 1,960 participants were eligible; 70% were male, the median age was 48 years (interquartile range [IQR] 37, 59), and the median BASMI score 3.6 (IQR 2.2, 5.3). Factors independently associated with poor spinal mobility were poorer function, meeting radiographic criteria for AS, longer symptom duration, higher levels of inflammation (measured by C-reactive protein level), older age, male sex, not being currently employed, and lower levels of education. For 51% of participants, the measured BASMI score was within 1 of that estimated. Poorer mobility (higher BASMI score) was an independent predictor of not meeting response criteria for ASAS 20% improvement (odds ratio [OR] per increasing score 0.80 [IQR 0.66, 0.98]), ASAS 40% improvement (OR 0.69 [IQR 0.50, 0.95]), and quality of life (measured by the Ankylosing Spondylitis Quality of Life Questionnaire) (β = 0.64 [IQR 0.26, 1.02]), but was not related to meeting ASDAS response criteria. The BASMI score was estimated moderately well by other routinely measured factors in patients with axial SpA and was an independent predictor of response to biologic therapy for some, but not all, commonly used measures. Consensus around its role in disease monitoring and clinical decisions, particularly in the likely context of face-to-face consultations becoming less frequent, remains to be established.

The influence of an aquatic exercise program on balance in patients with ankylosing spondylitis

Abstract Background Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that leads to a limitation of mobility, which can cause postural deficits and progressive loss of balance. Aquatic exercise improves this health condition. The objetive is to verify the influence of an aquatic exercise program, on balance and functionality, in individuals with AS. Methods Pre-experimental study carried out on 6 individuals with AS. All individuals were assessed at baseline (M0) and 12 weeks after the intervention (M1) using the Bath indices (BASMI, BASFI and BASDAI) and the balance assessment protocol (‘Body Sway’) by the Physiosensing Platform. Data were analyzed using the Statistical Program Statistical Package for the Social Sciences (SPSS), version 26. Were used descriptive statistics and Wilcoxon test to compare M0 and M1. The significance value was 0.05. Results We verify improvements in BASMI (P = 0.046), BASFI (P = 0.042) and BASDAI (P = 0.027) scores. Through the analysis of the center of pressure variables, there were no statistically significant differences, between moments, in the protocol. However, when assessing balance, in the anteroposterior mean distance in both the protocol (eyes open) and in the protocol (eyes closed), in the root mean square in both protocols and in mediolateral mean velocity, only in the protocol (eyes open), there was a slight decrease in the median value. Conclusions The present study suggests that the specific aquatic exercise program, may influence balance and improve functionality in a population with AS. Therefore, the Bath indices translate improvements in the symptoms and functionalities of these participants.

P181 Long-term improvement in axial spondyloarthritis clinical outcomes following 2-weeks of intensive education and rehabilitation: results from the Bath residential rehabilitation programme

Abstract Background/Aims Axial spondyloarthritis (axSpA) is a chronic rheumatic condition, characterised by inflammatory back pain - often associated with impaired function and mobility, sleep disturbance, fatigue, and reduced quality of life. Despite the vast advances in pharmacological treatments for axSpA over the last few decades, physical activity and rehabilitation remain vital for effective disease management. At the Royal National Hospital for Rheumatic Diseases in Bath (RNHRD), the 2-week inpatient axSpA rehabilitation programme has been integral to axSpA care since the 1970’s. Prior research has demonstrated significant short-term improvements in spinal mobility (BASMI), function (BASFI) and disease activity (BASDAI) following course attendance. However, the long-term outcomes are yet to be evaluated in this unique cohort. Methods Since the early 1990’s, clinical measures of spinal mobility, function and disease activity have been routinely collected at the RNHRD at all clinical appointments through administration of the BASMI, BASFI and BASDAI, respectively. Dates of attending the axSpA course and standard clinical and treatment follow-up data were also collected. Multiple linear regression models were used to investigate the impact of course attendance on final reported BASMI, BASDAI and BASFI scores (final score=most recent). Length of follow-up was defined as time between first and last recorded BASMI. Results Of the 203 patients within the Bath SPARC200 cohort, 77.8% (158/203) had attended at least one rehabilitation course throughout follow-up. 70.0% (140/203) of patients were male. The mean duration of follow-up was 13.5 years (range 0-35 years); 28.1% (57/203) of individuals with 20+ years of follow-up. Course attendance (yes versus no) significantly reduced final BASMI score by 0.84 (p = 0.001, 95%CI -1.31 to -0.37) and final BASDAI score by 0.74 (p = 0.018, 95%CI -1.34 to -0.13). Although course attendance reduced final BASFI by 0.45 (95%CI -1.17 to 0.28), this relationship did not reach significance (p = 0.225). Whilst minimally clinically important difference (MCID) is, to our knowledge, yet to be defined for BASMI, MCIDs were achieved long-term for both BASDAI and BASFI - defined by van der Heijde and colleagues in 2016 as 0.7 and 0.4 for BASDAI and BASFI, respectively. Conclusion These results provide novel evidence to support the integral role of education, physical activity and rehabilitation in the management of axSpA. Future work should investigate additional outcomes of critical importance to patients and clinicians, such as fatigue, quality of life and work productivity. Furthermore, a greater understanding of the factors that confound these outcomes may provide insights into those patients who may most benefit from attending a 2-week rehabilitation course. In addition to facilitating identification of those patients who may require additional clinical support. Disclosure R. Barnett: None. A. McGrogan: None. M. Young: None. C. Cavill: None. M. Freeth: None. R. Sengupta: Honoraria; Biogen, Celgene, AbbVie, Novartis, MSD. Grants/research support; Novartis, UCB.

O11 Examining BASDAI by gender: differing scores, but similar patterns of disease

Abstract Background/Aims Research has shown that females with axial spondyloarthritis (axSpA) score worse on patient reported outcomes (PROs) than males. However, this does not always correlate to worse clinical findings. The purpose of this study was to understand why women with axSpA have worse BASDAI scores than men, by examining how both genders score across the components of the BASDAI. The Ankylosing Spondylitis Registry of Ireland (ARSI) is a national registry on patients with axSpA in Ireland and a source of epidemiological data. Methods Analysis of the ASRI was preformed using IBM SPSS version 26. Patients were analysed on the basis of gender. Comparison of baseline characteristics and mean BASMI, BASFI, HAQ and ASQoL were tested for significance using an independent two tailed t-test and a Mann Whitney U test. Mean total BASDAI score and mean score for each component of the BASDAI were compared and tested for significance with the same statistical tests. A chi-squared test for independence was used to determine significance in variation of HLA-B27 status and radiographic findings. Results A total of 857 patients were included in the analysis. Patient population was 24.9% (213) female and 75.1% (644) male with a mean age of 45.9 years and mean disease duration of 19.4 years (means: BASDAI 4.02, BASMI 4, BASFI 3.67, HAQ 0.53, ASQoL 6.48). Females had worse BASDAI(4.6 vs 3.83, p &amp;lt; 0.01), HAQ(0.6 vs 0.51, p = 0.03) and ASQoL scores (7.62 vs 6.12, p &amp;lt; 0.01) than males. BASFI scores were worse in females which did not reach significance (3.89 vs 3.63, p = 0.26). However, females had significantly better BASMI scores than males (3.51 vs 4.16, p &amp;lt; 0.01). Within the BASDAI, females scored significantly worse than males across all components (Fatigue: 5.56 vs 4.51, p &amp;lt; 0.01; Spinal pain: 5.51 vs 4.63, p &amp;lt; 0.01; Other pain: 3.82 vs 3.19, p = 0.01; Discomfort: 4.05 vs 3.29, p &amp;lt; 0.01; EMS: 4.55 vs 3.94, p = 0.01), however duration of EMS did not reach significance (3.54 vs 3.12, p = 0.07)(table 1). Within the BASDAI, females recorded highest mean scores for fatigue (5.56), while males recorded highest mean scores for spinal pain(4.63). Lowest mean scores for both genders was for EMS duration (3.54 vs 3.12). Ranking of the BASDAI components by mean scores show similarity in the ranking of discomfort, EMS, other pain and EMS duration. Conclusion AxSpA females have consistently worse PROs but have better spinal mobility than males. Despite females recording worse BASDAI scores than males, the pattern of disease activity manifestation is similar in 4 of the 6 components of the BASDAI. However, fatigue is the most problematic symptom in females with active axSpA while spinal pain is the most problematic symptom for males. This variation by gender should be kept in consideration when evaluating a patient with suspected active axSpA. Disclosure S. Maguire: None. P. Gallagher: None. F. O'Shea: None.

P180 Undiagnosed depression in axial spondyloarthropathy negatively affects disease activity and quality of life

Abstract Background/Aims Previous research in axial spondyloarthropathy (axSpA) has shown this population to have a high prevalence of depression. This co-morbidity has been previously shown to impact disease activity in patients with rheumatic disease. The purpose of this study was to screen for signs of depression using two validated tools, the Patient Health Questionaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale for depression (HADs-D) in axSpA patients. Methods AxSpA patients attending the rheumatology department in St James’ Hospital between February and October 2020 were invited to take a self-administered survey which included the PHQ-9 and the HADs-D. Scores from the HADs-D yielded a numerical result which was then categorised as normal, borderline or abnormal. PHQ-9 numerical results were categorised as normal, mild, moderate, moderate/severe or severe. Patients with a known diagnosis of depression were excluded. In addition to baseline demographics, patient reported outcomes were also recorded. Data analysis was performed using IBM SPSS version 26. Continuous variables were recorded as means, categorical variables as frequencies with percentages. A one-way analysis of variance analysis (ANOVA) determined significance of variation in outcomes between patient outcomes as determined by the HADs-D and PHQ-9. A p-value of &amp;lt; 0.05 was deemed significant. Consent was obtained prior to participation. Approval was received from the St James’/Tallaght Hospital Joint Ethics Committee. Results In total 71 axSpA patients took part in the survey. The population was 70.4% (50) males and 29.5% (21) female, with an average age 47.9 years and mean disease duration 19.7 years (mean outcomes: BASDAI 4.08, BASFI 3.62, BASMI 3.54, ASQoL 6.79). Overall, 7 (9.9%) participants recorded abnormal HADs D scores, while 17 (23.9%) recorded moderate to severe PHQ-9 scores indicative of underlying depression. AxSpA females had higher mean HADs-D scores (7.5 vs 4.8, p = 0.01) than males, with abnormal scores in 19% (4) of females and 6% (3) of males. No significant differences were found in PHQ-9 scores between genders. Analysis revealed significantly worse BASDAI (6.27 vs 3.42, p &amp;lt; 0.01) and AQoL scores (12.57 vs 5.26, p &amp;lt; 0.01) in axSpA patients with abnormal compared to normal HADs D scores. No significant differences were noted in BASFI, BASMI or baseline demographics. A similar pattern was noted on analysis of PHQ-9 scores, with significantly worse BASDAI (7.9 vs 2.55, p &amp;lt; 0.01), BASFI (8.05 vs 2.33, p &amp;lt; 0.01) and ASQoL (19.5 vs 2.62, p &amp;lt; 0.01) noted in those scoring as severe compared to normal. No significant differences were detected in BASMI scores or baseline demographics. Conclusion A high percentage of axSpA patients recorded high HADs D and PHQ-9 scores for undiagnosed depression. These patients had significantly worse disease activity and quality of life as compared to patients with normal scores. Clinicians treating axSpA should consider screening for depression in this population. Disclosure S. Maguire: None. F. O'Shea: None.

Correlation between Different Parameters of Disease Status and Quality of Life in Patients with Ankylosing Spondyolitis

Ankylosing spondylitis (as) is a complex, conceivably incapacitating illness that is treacherous in beginning, advancing to radiological sacroiliitis more than quite a while. The point of this examination was to research the connection between sickness status and personal satisfaction (qol) in ankylosing spondylitis patients. A sum of 20 as male patients analyzed by.. Were remembered for this investigation. Patients' illness status was evaluated utilizing; the shower as sickness action list (basdai), the shower as useful record (basfi), the shower as metrology file (basmi), the maastricht as enthesitis score (mases), as personal satisfaction (asqol), multidimensional appraisal of weakness (maf). The mean asqol score in patients was altogether higher (p=0.001) contrasted with the control. Patients with fringe joint pain had higher asqol score than patients without with genuinely huge difference(p=0.002). Statically critical positive relationships between's bas (qol) score and basdai, basfi, maf, mases, basmi scores (p=0.001, 0.003, 0.004, 0.002, 0.000 separately). Similar to a persistent incendiary sickness that influences hrqol particularly with higher infection action, useful handicap, and with more fringe joint association. Accordingly it is essential to improve infection status to accomplish better qol.

Somatosensory dysfunction related neuropathic pain component affects disease activity, functional status and quality of life in ankylosing spondylitis.

To investigate the neuropathic pain (NP) component in ankylosing spondylitis (AS) and to assess the relations between NP and disease characteristics. Eighty participants were included in this study. Demographic properties, duration of disease, laboratory values and clinical assessments (visual analog scale [VAS], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], Bath Ankylosing Spondylitis Metrology Index [BASMI], Short Form [SF]-36 questionnaire, Beck Depression Inventory [BDI]) were recorded. The NP component was assessed by both DN4 and PainDETECT questionnaires (PD-Q) and patients were classified into groups according to questionnaire scores. NP component was detected by the DN4 and PD-Q in 40% and 28.7% of our patients, respectively. Likely-NP group had significantly higher scores in VAS-pain, BASDAI, BASFI, BASMI and BDI compared with both uncertain-NP and unlikely-NP groups. There was no significant difference between the SF-36 scores of the likely-NP and uncertain-NP groups. Moreover, all SF-36 scores were significantly lower in the likely-NP group than in the unlikely-NP group. Based on DN4 scale, patients with NP had significantly higher erythrocyte sedimentation rate (ESR), VAS, BASDAI, BASFI, BASMI scores and significantly lower SF-36 (except social functioning) scores compared to patients without NP. Both painDETECT and DN4 scores of the patients were significantly positively correlated with ESR, VAS, BASDAI, BASFI, BASMI, BDI scores and negatively correlated with all SF-36 scores. Our results revealed that the presence of NP component in patients with AS is associated with various disease-related variables, including pain, high disease activity, reduced mobility of the axial skeleton, depression and poor quality of life.

Presistolik dalga ankilozan spondilitte subklinik sol ventrikül diyastolik disfonksiyonu için bir belirteç olabilir mi?

Purpose: The aim of this study was to evaluate the clinical significance of presystolic wave in the detection of diastolic dysfunction in ankylosing spondylitis patients. Materials and Methods: In this cross-sectional study, 59 patients and 65 healthy controls were included in the study. Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Metrology Index, Maastricht Ankylosing Spondylitis Enthesitis Score and Bath Ankylosing Spondylitis Functional Index was eveluated. The Doppler tissue-imaging and presystolic wave measurements were performed by same cardiologist who was blinded to study details. Results: Presystolic wave was detected in 26.6% of the whole study population; in 37.3% of patients and 16.9% of the control group. When the patient and control groups were divided into two subgroups according to the presence or absence of presystolic wave; myocardial performance index, transmitral E wave velocity, E/A ratio, left ventricular outflow tract velocity and septal e’ wave velocity were statistically significant in subjects with presence presystolic wave in both groups. In the univariate model, high c-reactive protein level, increased BASMI and BASFI scores and elevated myocardial performance index were determined as risk factors for the presence of presystolic wave in ankylosing spondylitis patients. Conclusion: The assessment of presystolic wave on echocardiography examination may provide important information about the left ventricul diastolic function, which has a prognostic impact for ankylosing spondylitis patients.

P285 Using FITBITR for fitness monitoring in patients attending the AS residential course at RNHRD: it does make a difference!

Abstract Background Wearable technology has become a very popular tool in fitness training. It empowers people to be in charge of their own health and encourages them to exercise more. At the Royal National Hospital for Rheumatic Diseases we have been offering dedicated inpatient courses for management of spondyloarthropathy patients. Historically this course has helped patients with chronic arthritis to improve their physical well being while also focusing on different extra articular aspects of their condition like fatigue, sleep and pain issues. As part of this programme, we provided patients with Fitbit devices to evaluate whether regular recording of their activity and sleep tracking had an impact on their overall physical activity. Methods Patients attending the 2 weeks’ residential course from July 2018 to June 2019 were provided with Fitbit devices and were given a paper chart to log their data in. The patients gave verbal permission for their data to be included for audit purposes. The demographic data regarding the patients was collected through electronic patient record system. Bath indices were collected from electronic patient record system and results were compiled through Microsoft Excel. Results Data from 42 patients was collected. Data from 38 patients was analysed. Data for sleep indices was incomplete in 16 patients. 67% participants on the course were male and 33% were female. 90% patients had a diagnosis of ankylosing spondylitis, 5% had nonradiographic SpA and the rest had PsA or undifferentiated SpA. Majority of patients (97%) had improvement in their BASMI scores with a mean improvement of 37%. 51% patients improved their physical activity with an average increase in their step count by 13.3% compared to baseline. The participants on average spent 55.67 minutes being active on the course. While resting, majority of patients spent more time being awake or in light sleep (mean 14.3% and 54% respectively) although it might have been confounded by their stay in hospital. The verbal feedback from patients regarding the use of these devices has been mostly positive and it encouraged them to be more active. Conclusion Majority of patients attending the residential course noticed an improvement in their arthritis. The verbal feedback on using Fitbit devices to track daily activity and sleep was positive as it encouraged patients to increase their activity and improve sleep hygiene in future. Further refinement in data collection process and including other variables like pain, stiffness and fatigue scores can be valuable in a more focused discussion regarding management strategies of spondyloarthritis. Disclosures M. Jamal None. S. Saeed None. E. Clarke None. R. Sengupta None.

P263 Should we advocate biologic dose-reduction in patients with AxSpA?

Abstract Background Dose optimisation of biologic drugs is attractive on cost and safety grounds. As in RA, some patients with axSpA who respond well to TNF-inhibitor (TNFi) drugs can reduce the dose and remain symptomatically well. However, there are no clear data to support dose reduction strategies nor to identify those likely, and those unlikely, to respond to lower dose treatment. Methods 71 patients, from 6 UK centres, who fulfilled criteria for AS (modified New York criteria) or AxSpA (ASAS criteria) and who had reduced their dose of TNFi therapy were identified and followed up for 24 months. All were stable responders to TNFi treatment; their responses to treatment fulfilled NICE criteria and were maintained for at least six months by the time of dose reduction. Those who reverted to full-dose treatment and those who did not were identified and data about demographics, disease activity and patients’ approaches to dose reduction were recorded. Results 55 (77.5%) patients remained on lower-dose treatment (REM) and 16 (22.5%) reverted to full-dose (REV). Mean dose reduction for each of the 4 agents was adalimumab 39%, etanercept 39%, golimumab 26%, and infliximab 46%. Overall dose reduction was 39% and 44% for REM and REV patients respectively. Both groups responded equally to treatment by all measures at dose reduction. In this small study, the data suggest that female gender and younger age are associated with reversion and that REV patients scored lower on BASDAI and CRP at the initiation of TNFi treatment. REV patients’ mean BASDAI, BASFI, BASMI scores increased from dose reduction to dose reversion but mean CRP scores decreased from 3.76 to 3.5mg/dl (7.9%). Even at the point of reversion REV patients still met original response criteria. The majority of patients in both groups reached the decision jointly with clinicians. 62 (89.9%) patients were either confident or neither worried nor confident about the decision to reduce the dose. Patients’ approach to dose-reduction was not associated with reversion and neither the duration of disease nor the time to initiation of biologic treatment appeared to associate with the likely success or failure of reduced dose TNFi treatment. Men with high initial CRP levels appear likely to respond well to biologic dose-reduction. The worsening of symptoms but maintenance of low CRP levels raises questions as to the mechanisms underpinning dose-reversion. Conclusion 77.5% patients in this study continued to respond well to a mean 39% reduction in biologic dose for 2 years. In the absence of long-term efficacy data, advocating dose-reduction to stable responders is appropriate. Disclosures L. Van Rossen: Consultancies; Novartis, UCB. Honoraria; Abbvie, Novartis, pfizer, UCB. Grants/research support; EKHUFT, UCB. C. Boyle: Honoraria; Novartis. A. Chan: None. K. Gaffney: Consultancies; Abbvie, UCB, Pfizer, Novartis, Lilly. Honoraria; Abbvie, UCB, Pfizer, Novartis, Lilly. Member of speakers’ bureau; Abbvie, UCB, Pfizer, Novartis, Lilly. Grants/research support; Abbvie, UCB, Pfizer, Novartis, Lilly. A. Gilbert: Other; consultant for Boehringer Ingelheim Germany as a Global Patient Relations manager working in Scleroderma. C. Harris: Honoraria; Novartis, UCB. P. Machado: Consultancies; Abbvie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche and UCB. Honoraria; Abbvie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche and UCB. S. Liliana: None. R. Sengupta: Consultancies; Abbvie, Biogen, Celgene, Novartis, UCB. Honoraria; Abbvie, Biogen, Celgene, Novartis, UCB. A. Keat: None.

Effect of food intake and ambient air pollution exposure on ankylosing spondylitis disease activity

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial arthritis. The genetic–environmental factors seem to be involved in the pathogenesis of the disease and the disease debilitates patients during the most productive stages of their lives. The aim of this study was to examine the relationships between two environmental factors, diet and air pollution with disease activity and functional impairment in AS.MethodsA case-control study was carried out. Thirty patients with AS and 30 age and sex-matched healthy controls were included. Disease scores including BASMI, BASDAI, BASFI, and BASG were calculated by means of the international Ankylosing Spondylitis Assessment working group consensus recommendations. The food intake was evaluated by semi-quantitative food frequency questionnaire (147 items FFQ). Level of air pollution indices, PM10 and PM2.5 information was obtained from the Tehran air quality control network.ResultsTotal energy and fat intake, some vitamins (A, B1, B2, C) and mineral intake (potassium, calcium, iron, phosphorus, magnesium, zinc, copper and selenium) were significantly higher in patients with AS compared to controls. Fat component consumption especially Saturated Fat of Food was moderately correlated with BASFI score. PM2.5 long term exposure was strongly correlated with BASMI, BASFI and BASDAI scores of patients.ConclusionHigh-fat diet and long term exposure to air pollution are associated with worse disease outcomes reported in patients with AS. This is an interesting area of investigation in AS pathogenesis and management.

COMPARATIVE EVALUATION OF THE LONG-TERM EFFICACY AND SAFETY OF THE INFLIXIMAB BIOSIMILAR BCD-055 AND REFERENCE INFLIXIMAB IN PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS OF THE INTERNATIONAL MULTICENTER RANDOMIZED DOUBLE-BLIND PHASE III CLINICAL STUDY ASART-2

The paper gives data on the clinical efficiency and safety profile of long-term use of the infliximab (INF) biosimilar BCD-055 versus the reference drug Remicade® (REM) in a population of patients with active ankylosing spondylitis (AS).Subjects and methods. An international multicenter randomized double-blind Phase III clinical trial was conducted in 199 patients who were randomized into two groups in a 2:1 ratio and who received BCD-055 or REM at a dose of 5 mg/kg at 0, 2, and 6 weeks, then every 8 weeks. Efficiency assessment was made at 14, 30 and 54 weeks in patients who received at least one dose of INF [intent-to-treat (ITT)], as well as at 54 weeks in those who completed the study according to the Protocol (PP) (per protocol). The efficiency endpoints were the proportion of patients who had achieved ASAS20/ASAS40 responses; changes in BASDAI, BASMI, BASFI, MASES, and SF-36 scores. Immunogenicity was assessed by the proportion of patients in each group with identified binding and neutralizing antibodies (BAbs and NAbs) against INF. The safety analysis included the overall rate of adverse events (AEs), including those that met the respective criteria for serous AEs (SAEs), and grade 3–4 toxicity, as well as the number of cases of early termination of the study because of AEs and SAEs.Results and discussion. The ITT population included 199 patients and the PP one consisted of 161 people. The groups were not statistically different in the rate of and reasons for patient withdrawal from the study. A comparable number of patients achieved ASAS20/ASAS40 responses at 14, 30, 54 weeks (р ≥ 0.05). At 54 week, the proportion of patients who received BCD-055 and REM therapy and achieved an ASAS20 response was 67.42 and 52.24% in the ITT population (p = 0.053) and 80.91 and 68.63% in the PP population (p = 0.128). The BCD-055 and drug comparison groups achieved an ASAS40 response in 53.03 and 38.81% in the ITT population (p = 0.081) and in 63.64 and 50.98% in the PP one (p = 0.177). The proportion of persons with identified BAbs and NAbs was comparable: 21.26 and 3.15% in the BCD-055 group (p = 0.920) and 20.63 and 6.35% in the group REM (p = 0.443), respectively. It was found that the presence of NAbs did not affect the therapeutic response. Both groups did not differ in the detection rate and profile of AEs and SAEs or in the rate of patient withdrawal due to AEs. Most identified AEs were mild to moderate.Conclusion. The efficacy of the INF biosimilar BCD-055 used long in patients with AS did not significantly differ from that of the original drug REM; the safety profile of both drugs was comparable.

Surfactant protein-D, a potential mediator of inflammation in axial spondyloarthritis.

Surfactant protein-D (SP-D), an innate immune defence molecule of the collectin family, is expressed in lungs and additional extrapulmonary epithelia. SP-D has immune modulatory and anti-microbial effects depending on its oligomerization. The ratio of high molecular weight (HMW): low molecular weight (LMW) SP-D in serum is mainly determined by the Met11Thr polymorphism (SNP rs721917). We aimed to study the SP-D serum level and the molecular size distribution in patients with untreated axial spondyloarthritis (axSpA) as compared with control subjects. Thirty-four patients with disease modifier untreated axSpA according to the ASAS criteria, age 19-63 years, disease duration 3.9 (2.2-5.6) years were included. Demographics, smoking habits, HLA-B27 status, ASDAS, BASDAI, BASFI, BASMI and visual analogue scale scores were recorded. SP-D in serum was measured by ELISA. DNA was isolated from whole blood and single nucleotide polymorphism rs721917 was genotyped. SP-D molecular size distribution was determined using gel filtration chromatography. SP-D in serum did not differ between patients with axSpA and healthy controls, 1177 (869, 1536) vs 910 (494, 1682) (P = 0.35) and SP-D did not correlate with disease activity. However, the HMW/LMW ratio of SP-D in serum was significantly lower in axSpA, 0.38 (0.18, 0.53) compared with controls 1.49 (0.37, 3.24) when adjusting for the Met11Thr polymorphism, gender, age, BMI and smoking (P = 0.0004). There was no correlation between HMW/LMW ratio and CRP or composite diseases outcome measures. We suggest that predominance of LMW oligomeric variants of SP-D may enhance local or systemic inflammatory responses in axSpA.

The effects of balance and postural stability exercises on spa based rehabilitation programme in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) can cause severe functional disorders that lead to loss of balance. The aim of this study was to investigate the effects of balance and postural stability exercises on spa based rehabilitation programme in AS subjects. Twenty-one participants were randomized to the study (n= 11) and control groups (n= 10). Patients balance and stability were assessed with the Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, Single Leg Stance Test (SLST) and Functional Reach Test (FRT). AS spesicied measures were used for assessing to other parameters. The treatment plan for both groups consisted of conventional transcutaneous electrical nerve stimulation (TENS), spa and land-based exercises 5 days per week for 3 weeks. The study group performed exercises based on postural stability and balance with routine physiotherapy practice in thermal water and in exercise room. The TUG, SLST and FUT scores were significantly increased in the study group. In both groups, the BASMI, BASFI, BASDAI and ASQoL scores decreased significantly by the end of the treatment period (p< 0.05). In AS rehabilitation, performing balance and stability exercises in addition to spa based routine approaches can increase the duration of maintaining balance and can improve the benefits of physiotherapy.

Early-stage hip involvement in patients with ankylosing spondylitis: A Chinese study based on magnetic resonance imaging

Objectives: To evaluate the clinical characteristics and identify potential factors of the early-stage hip involvement in patients with ankylosing spondylitis (AS) based on the magnetic resonance imaging (MRI).Methods: A cross-sectional retrospective study of 655 consecutive patients was performed. Patients with hip pain or limited hip function but lacking definitive evidence of hip involvement on radiography underwent hip MRI. Based on the results of the imaging tests, the patients were classified into three categories: (1) no hip involvement; (2) early-stage hip involvement according to MRI but not radiography; (3) advanced-stage hip involvement according to a Bath Ankylosing Spondylitis Radiology Index-hip score ≥2.Results: One hundred and sixty-eight patients had early-stage hip involvement and 103 patients had advanced-stage hip involvement. Multivariate logistic regression analysis indicated that younger age at onset, worse BASMI score, and more active inflammation in the sacroiliac joints were associated with the occurrence of early-stage hip involvement.Conclusion: Negative plain radiography results cannot be used to rule out hip involvement. MRI was superior to radiography for the detection of early-stage hip involvement. Susceptible AS patients with symptoms or risk factors for hip involvement should undergo hip MRI to test for lesions in the early stage.