Bath Ankylosing Spondylitis Functional Index Scores Research Articles

The Effect of Obesity in Individuals with Ankylosing Spondylitis: A Single Center Cohort Study

Aim: The aim of this study was to compare the disease activity and functional status of individuals with Ankylosing Spondylitis (AS) according to body mass index (BMI). Material and Methods: This study, which was planned as a single-center cohort study, included 437 individuals with AS. Disease activities were evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and functional levels with the Bath Ankylosing Spondylitis Functional Index (BASFI). Participants were categorized in 3 groups according to BMI data based on the criteria of the World Health Organization: normal weight:20-24.9; overweight: 25-29.9; obese:≥30. One Way Anova Test, Kruskal Wallis Test, Mann Whitney U test and Chi-Square Test were used to compare independent group differences. Linear regression models were used to describe the relationship between BASDAI, BASFI (dependent variables) and BMI categories (independent variables). Univariate regression analyses were performed (only one independent variable in the model). Results: Among 437 patients with AS, 30.2% are normal weight, 39.5% are overweight and 30.2% are obese. Analysis results of data between BMI groups; significant difference was in BASFI (p=0.001) in favor of the obese group. In binary group comparisons for BASFI; there was a significant difference in favor of the obese group between normal and obese (p=0.002) and between overweight and obese (p=0.001). Obese was significantly associated with higher BASFI score compared to the normal weight group without adjustment for covariates (β:-0.37, 95%CI -0.66/-0.08, p=0.006). On the other hand, there was no association between BASDAI and obesity (β:-0.50, 95%CI -1.11/ 1.22, p:0.130). Conclusion: The BMI of Turkish AS individuals in a single center cohort had no effect on disease activity, but obesity had a worse effect on functional level.

Navigating the Factors Affecting Functional Impairment in Spondyloarthritis.

This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI). This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI. A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI. Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients.

The relationship between clinical parameters and ultrasonographic enthesitis assessment in patients with spondyloarthritis.

The study aimed to evaluate the role of ultrasonographic assessment of enthesitis in patients with spondyloarthritis (SpA) in terms of disease activity, functionality, and quality of life. Ninety SpA patients (57 males, 33 females; mean age: 37.5±9.7 years; range, 18 to 60 years) were included in cross-sectional study between November 2016 and January 2017. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Short Form-12 (SF-12), and Ankylosing Spondylitis Quality of Life (ASQoL) were utilized for clinical evaluation. The clinical evaluation of enthesitis was performed with the Spondyloarthritis Research Consortium of Canada (SPARCC) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) via an algometer calibrated to 4 kg/cm2 of pressure. Ultrasound evaluation was performed according to Madrid Sonographic Enthesitis Index (MASEI). A total of 2,610 entheseal sites were examined clinically, and 1,080 were assessed ultrasonographically. A significant proportion of enthesitis (463/1,080) was detected on ultrasonographic evaluation but not with clinical enthesitis score (MASES and SPARCC). Although ultrasonographic entheseal evaluation detected enthesitis in at least one enthesis of all patients, 35 of the patients had no enthesitis with clinical examination. The sites most frequently involved in the entheses were the proximal patellar tendon and Achilles tendon. The MASEI score did not correlate with the MASES, SPARCC, BASDAI, SF-12, and ASQoL but moderately correlated with the C-reactive protein (CRP) level (r=0.348), ASDAS-CRP (r=0.294), and BASFI score (r=0.244). The association of ultrasonography scores with CRP levels and ASDAS-CRP indicates that ultrasonography is effective in detecting inflammation. The MASEI score weakly correlates with functionality but not with quality of life. Ultrasonographic evaluation is invaluable and merits to be incorporated into SpA disease scoring system.

Fatigue Assessment Using FACIT-F Scale in Spondyloarthropathy Patients and its Correlation with BASDAI and BASFI Scores.

To measure fatigue in axial spondyloarthropathy patients and find its correlation with the disease activity measures. Cross-sectional, descriptive study. Place and Duration of the Study: Rheumatology Unit, Federal Government Polyclinic Hospital, from November 2021 to May 2022. This study included 45 patients fulfilling the ASAS criteria for spondyloarthropathy. Bathankylosing spondylitis disease activity (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and functional assessment of chronic illness therapy- fatigue (FACIT-F) scores were measured for each patient. In this study, there were 9 (20%) female patients and 36 (80%) male patients. There were 39 (86.7%) patients who had ankylosing spondylitis, 4 (8.9%) had axial spondyloarthropathy with peripheral arthritis and 2 (4.4%) had enthesitis-related juvenile idiopathic arthritis. The mean duration of the disease was 5.45 ± 4.19 years. Active disease with a BASDAI score of ≥4 was found in 16 (35.6%) patients while 29 (64.4%) had a BASDAI score <4. Severe fatigue with a FACIT-F score of <30 was found in 31 (68.9%) of the patients while less fatigue with FACIT-F score >30 was found in 14 (31.1%). The mean BASFI score of the cohort was 3.23 ± 2.01. Spearman's rho correlation analysis showed a significant strong correlation between the FACIT-F score, BASDAI and BASFI scores (p<0.001). Patients with active disease and higher BASFI scores had a lower FACIT-F score suggesting more fatigue, thus correlating with the disease activity. Bath ankylosing spondylitis disease activity (BASDAI), Functional assessment of chronic illness therapy-fatigue (FACIT-F), Ankylosing spondylitis (AS), Bath ankylosing spondylitis functional index (BASFI), Assessment in ankylosing spondylitis (ASAS).

Short-Term Efficacy and Adverse Effects of Sulfasalazine in the Management of Axial Spondyloarthropathy.

Ankylosing spondylitis (AS) is an inflammatory spondyloarthropathy that involves the sacroiliac joints and the axial skeleton. Sulfasalazine's efficacy in treating the axial symptoms of AS has been a subject of controversy. This prospective observational study recruited AS patients and categorized them into two groups: the first group had AS for less than or equal to four years and the second group had AS for more than four years. Erythrocytic sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded at baseline and at six-month follow-up. Disease severity was assessed using the ankylosing spondylitis disease activity score (ASDAS), Bath ankylosing spondylitis disease activity index (BASDAI) score, and Bath ankylosing spondylitis functional index (BASFI) score. A total of 33 patients diagnosed with AS were recruited in this study, mostly males (88%) and within 21-30 years of age. ESR and CRP values were measured at baseline and at six months post-treatment with sulfasalazine. Mean ESR and mean CRP values showed a statistically significant reduction of 43.5% (p=0.001) and 58.45% (p=0.0012) respectively, at the 6-month follow-up. Four patients (12.12%) reported gastrointestinal intolerance. The mean reduction in the ASDAS score was 24% (p=0.002), the BASDAI score was 40.08% (p=0.001), and the BASFI score was 39.54% (p=0.01). Additionally, the duration of symptoms did not appear to influence with efficacy of sulfasalazine. Sulfasalazine is a safe alternative therapy for patients with AS who cannot afford biologics, due to its reasonable short-term efficacy, good tolerability, cost-effective nature, and low incidence of adverse effects.

Physical function and sex differences in radiographic axial spondyloarthritis: a cross-sectional analysis on Bath Ankylosing Spondylitis Functional Index

BackgroundPhysical function is an important determinant of health-related quality of life in radiographic axial spondyloarthritis patients (r-axSpA). To improve the basis of effective healthcare efforts, we aimed to investigate which demographic and disease-related factors that influence Bath Ankylosing Spondylitis Functional Index (BASFI) in r-axSpA patients overall and stratified by sex. Furthermore, we sought to explore differences between sexes regarding separate BASFI questions and also to explore which factors that may contribute to these differences.MethodsThis observational cross-sectional study included patients fulfilling the modified New York criteria for Ankylosing Spondylitis. Patients were assessed with 66/68 joint count and Bath Ankylosing Spondylitis Metrology Index (BASMI) measurements. Lateral X-rays were performed for Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-Reactive Protein (CRP), and BASFI were registered. Multivariable linear regression analyses were used to investigate which factors that associate with BASFI.ResultsA total of 353 r-axSpA patients were included, mean age 52.2 ± 12.7 years, 62.3% males. No significant sex difference was seen in BASFI scores (2.7 ± 2.0 in males vs 2.9 ± 2.1 in females). Age, body mass index, ASDAS-CRP, BASMI or mSASSS, fatigue, and tenderness were found to associate independently with BASFI in different models (R2 0.53–0.63). Investigation of separate BASFI questions revealed that the ability to look over shoulder was worse in males than females (mean 4.43 ± 3.37 vs 3.74 ± 3.06, p = 0.05) and most strongly correlated with mSASSS and BASMI among separate BASFI questions (r = 0.53, p < 0.001; r = 0.62, p < 0.001). The ability to climb stairs was worse in females than males (mean 2.49 ± 2.77 vs 1.54 ± 2.32, p < 0.001).ConclusionsNo difference between male and female r-axSpA patients was seen in BASFI despite significant sex differences in BASMI, mSASSS, and CRP levels. Our results underline the impact of fatigue and tenderness on BASFI. The ability to climb stairs without a handrail was scored worse among females compared to males. Furthermore, the ability to look over the shoulder was worse in males than females and closely related to spinal mobility and structural spinal changes.

The effectiveness of hippotherapy simulation exercises for muscle strength, disease activity and quality of life in sedentary adults with ankylosing spondylitis

Introduction/Objective Newly created systems called hippotherapy simulators (HS) mimic the primitive movements of a live horse. As they are new systems, research examining their usefulness has been well received. The aim of this study is to research the effects of HS on disease activity, quality of life and muscle strength in patients with ankylosing spondylitis (AS). Methods In a prospective, assessor-blinded, block-randomized trial, 48 AS patients were randomly assigned in a 1:1 ratio to receive either HS or conventional home (CH) exercise therapy. All Participants received 48 sessions, that is 4 sessions a week for 12 consecutive weeks. The primary outcome measures included the quadriceps muscle strength, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Ankylosing Spondylitis Quality of Life Scale (ASQoL). Results Both groups demonstrated significant improvement in BASDAI, BASFI, BASMI, ASQoL and muscle strength scores compared to the baseline (p < 0.05). BASDAI, BASFI and BASMI scores decreased significantly in the HS group compared to the CH group at week 12 (p=.005, p=.003, p=.045, respectively), but there was no significant difference between the groups in terms of ASQoL and muscle strength scores at week 12 (p=.245, p=.212, respectively). Conclusions The results of this clinical trial of HS exercises for AS patients indicate a positive effect on disease activity, quality of life and muscle strength. Therefore, horse-riding simulator exercises can be used as an alternative method for the management of individuals with AS.

Reprise d’une arthroplastie totale de la hanche chez les patients atteints de spondylarthrite ankylosante : résultats à moyen terme

BackgroundFew studies have reported on the outcome of revision total hip arthroplasty (THA) for ankylosing spondylitis (AS). Therefore, we sought to investigate the clinical and radiographic outcomes of revision THA in patients with AS. HypothesisThe mid-term outcome of revision THA in AS patients was comparable to conventional revision THA. Materials and methodsForty-one patients with AS who underwent revision THA (on a total of 51 hips) between April 2004 and June 2018 were included. The mean follow-up duration was 7.5±3.6 years (3.0–15.8 years). Clinical outcomes were assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), Harris Hip Score (HHS), and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. Complications were assessed at each follow-up. Radiological outcomes were examined by reviewing postoperative plain radiographs. ResultsSignificant improvements were seen in BASFI, HHS, and WOMAC scores (p<0.01). Postoperative combined range of motion (ROM) was 128.9±45.3° (range, 60–300°). Complications included heterotopic ossification, periprosthetic fractures, aseptic loosening, osteolysis, reinfection, residual pain or stiffness, delayed wound healing, numbness, deep vein thrombosis, leg length discrepancy, and posterior dislocation. Five (9.8%) of the 51 hips were treated with re-revision due to aseptic loosening, re-infection, or re-fracture. The incidence of dislocation was 1.9% at 7.5 years. Implant survival for all reasons was estimated to be 96.3% at 5 years, 85.9% at 10 years and 61.0% at 15 years. Forty-two (82.4%) hip revisions were rated “satisfactory” or “very satisfactory” by the patients. ConclusionsThe mid-term result of revision THA for patients with AS is comparable to conventional revisions in terms of implant survival, despite high complication rates. The benefit-risk ratio of these indications is acceptable but deserves specific information for these patients. Level of evidenceIV; case series.

AB1803-HPR EVALUATION OF THE FACTORS ASSOCIATED WITH THE BIOPSYCHOSOCIAL STATUS OF PATIENTS WITH AS WHO WERE DECIDED TO BE TREATED WITH ANTI-TNF THERAPY FOR THE FIRST TIME

BackgroundAnkylosing spondylitis (AS) is a rheumatic disease that affects patients in a biopsychosocial framework due to its chronic inflammatory nature. It is known that anti-TNF therapy is given to patients with persistently high disease activity despite conventional treatments according to the ASAS recommendations [1].ObjectivesThe aim of this study was to examine the factors associated with the biopsychosocial status of patients with AS who were decided to be treated with anti-TNF therapy for the first time.Methods76 AS patients who were decided to treated with anti-TNF therapy included in the study. Socio-demographic informations of patients were collected. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) values were recorded for disease activity levels. Biopsychosocial status of the patients was evaluated by the BETY-Biopsychosocial Questionnaire (BETY-BQ). The Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire (HAQ) were used to assess functional and and daily living activities. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression levels.ResultsThe mean age of the patients was 39.99 ± 10.0 years. The mean BASDAI scores indicated active disease and were 5.98 ± 1.78. There was a statistically significant moderate correlation between the BETY and the anxiety and depression subscales of HADS and BASDAI, in the positive direction (r= 0.692, p &lt;0.001 and r= 0.685, p &lt;0.001 and r= 0.552, p &lt;0.001). A statistically significant, strong correlation was found between the BETY, HAQ and BASFI scores in the positive direction (r= 0.834, p &lt;0.001 and r= 0.747, p &lt;0.001) (Table 1). It was observed that patients showed anxiety and depression characteristics according to HADS cut-off values (&gt;10 and &gt;7).ConclusionIt was concluded that the biopsychosocial status of anti-TNF naive patients with AS was affected by anxiety-depression levels, functionality, and disease activity score. In addition to anti-TNF therapy, it was interpreted that the treatment of biopsychosocial characteristics of patients should also be taken into consideration in disease management.Reference[1] Braun Jv, Van Den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Annals of the rheumatic diseases. 2011;70(6):896-904.Table 1.Patients characteristics and correlation of outcome measuresPatients Characteristics (n=76)Age (year)39.99 ± 10.0BMI (kg/m2)27.81 ± 5.51Duration of disease (year)4.21 ± 5.65BETY-BQ (0-120)60.0 ±23.7BASDAI (0-10)5.98 ± 1.78BASFI (0-10)5.16 ± 2.31HADS anxiety10.43 ± 4.92 depression8.53 ± 4.34HAQ15.70 ± 9.48CorrelationsBASDAIBASFIHAQHADS-aHADS-dBETY-BQr0.552*0.747*0.834*0.692*0.685*p*0.0000.0000.0000.0000.000*Pearson testAcknowledgements:NIL.Disclosure of InterestsNone Declared.

Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this?

ObjectivesTo (i) determine whether sustained disease activity states, as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), impact function, and (ii) evaluate characteristics predicting sustained low functional impairment in a prospective axial spondyloarthritis (axSpA) cohort.MethodsBiologic Treatment Registry Across Canada (BioTRAC) was a multi-center, prospective registry that collected real-world data on axSpA patients receiving infliximab or golimumab between 2006 and 2017. Generalized estimating equations (GEE) were used to test baseline characteristics, treatment, and duration (at 6 and 12 months vs. only at 6 or 12 months vs. neither) of low BASDAI (< 3), ASDAS-inactive disease (ID)(< 1.3), and ASDAS-low disease activity (LDA) in predicting sustained low Bath Ankylosing Spondylitis Functional Index (BASFI)(< 3) between 12 and 18 months. The adjusted impact of achieving low disease state at 6 and/or 12 months on BASFI at 18 months was analyzed by generalized linear models.ResultsEight hundred ten patients were enrolled. 33.7%, 13.4%, and 24.7% achieved sustained low BASDAI, ASDAS-ID, and ASDAS-LDA, respectively. In univariable GEE of baseline variables, age and baseline BASDAI, BASFI, and ASDAS significantly predicted sustained low BASFI. In multivariable GEE, sustained low BASDAI (p < 0.001), low BASDAI only at 6 or 12 months (p = 0.001), and baseline BASFI (p < 0.001) were the only predictors of sustained low BASFI. Sustained ASDAS-ID (p = 0.040) and ASDAS-LDA (p < 0.001) were also predictors when forced into the model. Similar results were obtained when evaluating the BASFI score at 18 months.ConclusionSustained BASDAI < 3 may be a valid and feasible target for a treat-to-target strategy in axSpA having function as treatment goal.

Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis.

To identify the determinants of central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Central Sensitization Inventory (CSI) was used to determine CS frequency. Disease-related variables including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP/-ESR), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and Numeric Rating Scale (NRS)GLOBAL were assessed. Biopsychosocial variables were evaluated by the Multidimensional Scale of Perceived Social Support (MSPSS), Brief Illness Perception Questionnaire (B-IPQ), Hospital Anxiety and Depression Scale (HADS) and subscales for Anxiety (HADS-A) and Depression (HADS-D), and Jenkins Sleep Evaluation Scale (JSS). To determine the predictors of the development and severity of CS, multiple linear and logistic regression analyses were performed. The frequency of CS was 57.4% in the study population (n = 108). CSI score was correlated with the duration of morning stiffness, BASDAI, ASDAS-CRP, ASDAS-ESR, NRSGLOBAL, BASFI, MASES, ASOoL, JSS, HADS, and B-IPQ total scores (ρ ranged from 0.510 to 0.853). Multiple regression analysis indicated that BASDAI (OR: 10.44, 95% CI: 2.65-41.09), MASES (OR: 2.47, 95% CI: 1.09-5.56) and HADS-A (OR: 1.62, 95% CI: 1.11-2.37) were independent predictors of the development of CS. Additionally, higher NRSGLOBAL, JSS, HADS-D, and HADS-A scores appeared to determine the severity of CS. This study confirms that worse disease activity, more enthesal involvement, and anxiety independently predict the development of CS. Additionally, higher patient-perceived disease activity, sleep impairment and poor mental health significantly contribute to the severity of CS.

Anxiety and depression among patients with spondyloarthritis

IntroductionAnkylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spinal and/or peripheral involvement, enthesitis, dactylitis, and several extra-articular manifestations. Chronic inflammation often leads to reduced spinal mobility and functional disability. The frequency of psychological problems has increased in AS patients.ObjectivesThe objective of this study was to determine the prevalence of symptoms of anxiety and depression among AS patients and explore the underlying associated factors.MethodsThe Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and other clinical measures were collected during the clinical trial. We evaluated also the hospital anxiety and depression scale (HADs). P values &lt; 0.05 were considered statistically significant.ResultsSixty-two patients with AS were included in the study. The average age was 41 years [18-65]. The diagnostic delay varied from one year to 26 years with an average of 4 years. Twenty-nine years is the average age of onset of symptoms with a standard deviation of 10 years. The mean duration of the disease was 10 ± 8 years. At baseline, the mean BASFI score was 53.9 ± 2 and BASDAI was 4.5± 2.Clinically significant symptoms of anxiety and depression were present in 48.4% and 54.8% of patients, respectively. Depression was noted with a mean HADS depression of 10,5 ± 5,2. Anxiety was noted with a mean HADS anxiety of 11,3 ± 4,6.In univariate analysis, anxiety was associated with the low educational level of patients (p = 0.038) and with CRP level (p= 0.041). There was a significant association between depression and anxiety (p=0.000). There was no relationship between these psychiatric disorders and disease activity, treatment modalities or functional status (p&gt;0.05)ConclusionsIn patients with Ankylosing spondylitis, the prevalence of risk of mental disorders is high.Anxiety and depression are common in AS and even alter the quality of life.Patients should be regularly screened for these disorders.Disclosure of InterestNone Declared

Comparative Efficacy of Biologic Disease-Modifying Anti-Rheumatic Drugs for Non-Radiographic Axial Spondyloarthritis: A Systematic Literature Review and Bucher Indirect Comparisons.

Biologic disease-modifying anti-rheumatic drugs (bDMARDs), including certolizumab pegol (CZP), are effective treatment options for the management of non-radiographic spondyloarthritis (nr-axSpA). In the absence of head-to-head comparisons in nr-axSpA, we conducted a systematic literature review (SLR) and indirect treatment comparison (ITC) to better understand the comparative efficacy of CZP vs. other bDMARDs. Literature searches were conducted in October 2020 in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials in patients with nr-axSpA who had failed at least one non-steroidal anti-inflammatory drug and were treated with bDMARDs. Outcomes of interest included the Assessment of Spondyloarthritis international Society (ASAS), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI) and Disease Activity Index (BASDAI), and spinal pain score. Comparative efficacy was examined using a series of Bucher ITCs in subgroups matched by prior exposure to bDMARDs, disease duration, baseline C-reactive protein (CRP) levels/magnetic resonance imaging (MRI) status, and timepoints, to ensure comparability between studies. At 12-16weeks, treatment with CZP was significantly more likely to achieve ASAS20/40 response and ASDAS-inactive disease status vs. etanercept (ETN), ixekizumab (IXE), and secukinumab (SEC). CZP showed statistically significant improvement in BASDAI, BASFI, and total spine pain score over adalimumab (ADA), ETN, and IXE, and in BASFI over SEC. Among patients with objective signs of inflammation (OSI; elevated CRP levels and/or inflammation on MRI at baseline), CZP had a statistically significant advantage over ETN and SEC (with or without loading dose) in achieving ASAS40, whereas the comparisons with other bDMARDs did not show any statistically significant differences. In the overall matched population, CZP performed significantly better than most comparators in improving the clinical outcomes. Among patients with OSI, CZP was found to be superior to SEC (in the MRI-/CRP + and MRI + /CRP- subgroups) and ETN (in the MRI + /CRP- subgroup) and it was comparable to golimumab and IXE across the different OSI subgroups.

Is there a relationship between kinesiophobia, pain, depression, disease activity, functional status and quality of life in patients with ankylosing spondylitis? Running Short Title: Kinesiophobia in patients with ankylosing spondylitis

Aim: To evaluate the presence of kinesiophobia and its potential effects on depression, disease activity and quality of life in patients with ankylosing spondylitis (AS). Materials and methods: The study included 58 AS patients and 55 healthy controls. Tampa Kinesiophobia Scale (TKS) was used to evaluate the presence of kinesiophobia, Visual Analogue Scale (VAS) for pain severity, Beck Depression Index (BDI) for depression level, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity, Bath Ankylosing Spondylitis Functional Index (BAS-FI) for functional status, and Ankylosing Spondylitis Functional Index (ASQoL) for Quality of life. Results: In patient group, kinesiophobia rate was significantly higher (68%) than in healthy controls (27%) (p&lt;0.001). TKS score, VAS pain level, and BDI levels were significantly higher in patients with AS compared to the healthy controls (for all p &lt;0.001). In the AS group, patients with high kinesiophobia score had higher VAS, BDI, BAS-FI, BASDAI, and ASQoL scores compared to the patients with low kinesiophobia score (p&lt;0.001) and the relationships between kinesiophobia and VAS, BDI, BAS-FI, BASDAI, and ASQoL scores (for all p&lt;0.001) were significant. In addition, there was no significant relationship was found between kinesiophobia and age, and disease duration (p&gt;0.05). Conclusions: Kinesiophobia is more common in patients with AS compared to healthy controls, and presence of kinesophobia is associated with increased pain and impaired quality of life. Therefore, we suggest that approaches to increase awareness of fear of movement and physical activity and cognitive behavioral therapy related to fear of movement should be included in the treatment program.

The predictability of ASDAS on drug survival in patients with ankylosing spondylitis on biologic therapy: data from the KOBIO registry.

The Ankylosing Spondylitis (AS) Disease Activity Score (ASDAS) is largely used for assessing disease activity in patients with AS. We aimed to investigate the predictability of ASDAS on drug survival in patients with low Bath AS Disease Activity Index (BASDAI) during biologic therapy. Using data from multi-center, prospective, observational prospective cohort, Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry. The study population consisted of patients enrolled in the KOBIO registry from December 2012 to December 2018. The baseline demographic data and variables such as extra-articular manifestations, HLA-B27 positivity, family history of spondyloarthritis, ASDAS C-reactive protein (CRP), BASDAI, and Bath AS Functional Index scores were collected from the database. The disease activity indices were followed yearly after initiating a tumor necrosis factor (TNF) inhibitor (TNFi). Disease activities were defined as high (ASDAS-CRP ⩾ 2.1, BASDAI ⩾ 4) and low (ASDAS-CRP < 2.1, BASDAI < 4). Data from 1773 patients were analyzed. Among 269 patients with low BASDAI at baseline, 151 (56.1%) patients had high ASDAS-CRP, yet in 142 patients with low ASDAS-CRP at baseline, only 24 (16.9%) patients had a high BASDAI. High ASDAS-CRP captured more patients who had initiated or switched to a TNFi than those with high BASDAI (92.5% versus 84.8%, respectively, p < 0.001). Moreover, among AS patients with low BASDAI after 1 year of therapy, drug persistence in the following year was significantly lower in patients with high ASDAS than in those with low ASDAS (68.7% versus 82.5%, p < 0.001). ASDAS-CRP not only has its advantages over BASDAI in assessing disease activity but also low ASDAS-CRP at 1 year can be a marker of long-term drug survival of TNFi therapy.

A Novel Treatment Method for Ankylosing Spondylitis Combined With Sacroiliac Joint Bone Marrow Edema

Objective: To investigate whether high-energy extracorporeal shock wave therapy (ESWT) combined with conventional oral medicine as a potential novel therapeutic approach for the treatment of ankylosing spondylitis (AS)combined with sacroiliac joint bone marrow edema. Materials &amp; Methods: 40 patients were divided into two groups and were treated with or without ESWT in combination with conventional oral medicine. A visual analog scale (VAS) score of spinal pain, as well as indicators of spinal mobility, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores, inflammatory index (C-reactive protein, blood cell sedimentation rate), and other indicators were compared between the two groups. The Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system was used to evaluate pain and structural damage in the sacroiliac joint. Results: (1) After one month of treatment (T1), VAS, BASDAI, BASFI, and SPARCC scores were lower in both groups than at the start of treatment (T0) (P &lt; 0.05), with greater decreases observed in the treatment group (P &lt; 0.05). (2) Also, at T1, indicators of spinal mobility for the two groups were improved (P &lt; 0.05). (3) ESR and C-reactive protein levels for the two groups decreased significantly at T1 versus T0 (P &lt; 0.05). Conclusion: ESWT combined with oral medication can significantly relieve pain and improve clinical functional symptoms for patients with AS. It can also reduce sacroiliac joint bone marrow edema and control the inflammatory reaction in the sacroiliac joint, which represents a novel, effective, reliable, and safe clinical treatment therapeutic method. Keywords: Ankylosing spondylitis, Sacroiliac joint, extracorporeal shock wave therapy, oral medicine.

Revision total hip arthroplasty in patients with ankylosing spondylitis: Mid-term results

BackgroundFew studies have reported on the outcome of revision total hip arthroplasty (THA) for ankylosing spondylitis (AS). Therefore, we sought to investigate the clinical and radiographic outcomes of revision THA in patients with AS. HypothesisThe mid-term outcome of revision THA in AS patients was comparable to conventional revision THA. Materials and methodsForty-one patients with AS who underwent revision THA (on a total of 51 hips) between April 2004 and June 2018 were included. The mean follow-up duration was 7.5±3.6 years (3.0–15.8 years). Clinical outcomes were assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), Harris Hip Score (HHS), and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. Complications were assessed at each follow-up. Radiological outcomes were examined by reviewing postoperative plain radiographs. ResultsSignificant improvements were seen in BASFI, HHS, and WOMAC scores (p<0.01). Postoperative combined range of motion (ROM) was 128.9±45.3° (range, 60–300°). Complications included heterotopic ossification, periprosthetic fractures, aseptic loosening, osteolysis, reinfection, residual pain or stiffness, delayed wound healing, numbness, deep vein thrombosis, leg length discrepancy, and posterior dislocation. Five (9.8%) of the 51 hips were treated with re-revision due to aseptic loosening, re-infection, or re-fracture. The incidence of dislocation was 1.9% at 7.5 years. Implant survival for all reasons was estimated to be 96.3% at 5 years, 85.9% at 10 years and 61.0% at 15 years. Forty-two (82.4%) hip revisions were rated “satisfactory” or “very satisfactory” by the patients. ConclusionsThe mid-term result of revision THA for patients with AS is comparable to conventional revisions in terms of implant survival, despite high complication rates. The benefit-risk ratio of these indications is acceptable but deserves specific information for these patients. Level of evidenceIV; case series.

Long-Term Adherence to Etanercept in Treatment Effectiveness of Patients with Spondyloarthritis: 7-Year Data from the Iraq National Registry.

IntroductionThe diagnosis and treatment of spondyloarthritis (SpA) is a global challenge, with no cure available. Adherence to treatment with biologic disease-modifying antirheumatic drugs, such as the tumor necrosis factor-α inhibitor etanercept, varies among patients with SpA. Inadequate or poor adherence to treatment may have a negative effect on clinical outcome and quality of life and may lead to greater health-related expense.MethodsThis observational, retrospective study used real-world patient data from the Iraq National Center of Rheumatology database to retrospectively assess long-term adherence to etanercept, specifically evaluating 1- and 7-year adherence to etanercept among Iraqi patients with SpA.ResultsIn total, data from 763 patients were included in the analysis. The majority of patients were men (82.2%). Mean disease duration at baseline was 5.85 years; 84.0% of patients received concomitant steroids, and 14.2% were treated with concomitant methotrexate. Measures of disease activity and functional status (mean ± SD) at baseline based on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) were 8.06 ± 0.83 (range 6.0–9.5) and 7.75 ± 1.12 (range 4.1–9.7), respectively. Around 30% of patients initiated etanercept treatment within 1 year of diagnosis. After 1 and 7 years, 91.7% (700/763) and 60.6% (80/132) of patients were adherent to etanercept treatment. Mean (± SD) changes from baseline in BASDAI and BASFI scores for adherent versus non-adherent patients at 1 year were 6.73 (± 1.90) versus 4.20 (± 1.85) (p = 0.0001) and 6.43 (± 2.04) versus 4.18 (± 1.88) (p = 0.0001), respectively.ConclusionsThese results suggest that Iraqi patients with SpA benefit from long-term adherence to etanercept treatment; however, additional analyses are needed to further assess the reasons for treatment discontinuation, which may include disease remission.Trial RegistrationClinicalTrials.gov: NCT04507776.

Inflammatory Arthritis Facilitators and Barriers (IFAB) for physical activity questionnaire: cross-cultural adaptation into Turkish and evaluation of its psychometric properties

Purpose We aimed to conduct the translation and cross-cultural adaptation of the Inflammatory arthritis Facilitators and Barriers (IFAB) questionnaire into Turkish language for patients with axial spondyloarthritis (axSpA) and analyze the psychometric properties of the IFAB-Turkish version (IFAB-Tr). Methods Data from ninety-three patients with axSpA were analyzed who completed the IFAB-Tr, Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS) and Bath Ankylosing Spondylitis Functional Index (BASFI). Internal consistency, test-retest reliability, convergent validity, floor and ceiling effect, measurement error were examined. Exploratory factor analysis (EFA) and confirmatory factor analysis were conducted. Results Small modification was needed in the translation and cultural adaptation process. Internal consistency of the IFAB-Tr total score was 0.71 and test-retest reliability was excellent for IFAB-Tr (ICC = 0.90). A moderate negative correlation was found between IFAB-Tr total score and HAQ, HADS, BASFI scores. No floor and ceiling effect was detected. Minimal detectable change was 10.34 points. EFA revealed two factors which accounted for 55% of the variance. Conclusions The IFAB was successfully translated into the Turkish language and seems suitable for evaluating barriers and facilitators for physical activity in rheumatic diseases and could be used in clinical settings before designing a physical activity intervention. IMPLICATIONS FOR REHABILITATION The Turkish version of the Inflammatory arthritis FAcilitators and Barriers (IFAB) is a valid and reliable tool to assess barriers and facilitators to physical activity for patients with axial spondyloarthritis. More work is needed to assess all psychometric properties of the IFAB questionnaire in other inflammatory rheumatic disorders. The Inflammatory arthritis FAcilitators and Barriers questionnaire in Turkish is an easy and quick way to determine potential barriers to physical activity in clinical and research settings.

Combined moxibustion/adalimumabin treatment of ankylosing spondylitis, and its influence on related functional indicators

Purpose: To study the clinical efficacy of the combination of du-moxibustion and adalimumab in the treatment of ankylosing spondylitis, as well as its influence on related functional indicators.Methods: From 2019 to 2020, 90 ankylosing spondylitis patients treated in Shandong Traditional Chinese Medicine University Hospital were assessed for eligibility and recruited. They were assigned, based on the order of admission, to receive either conventional treatment (control group) or dumoxibustion plus adalimumab (study group). Clinical treatment efficacy, levels of inflammatory indices, and spinal mobility in the two groups were determined and compared. Numerical Rating Scale (NRS) was employed for pain assessment, while Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used for disease status evaluation. Bath Ankylosing Spondylitis Functional Index (BASFI) was used for assessing functional limitation.Results: Du-moxibustion plus adalimumab was associated with significantly higher treatment efficacy and lower levels of inflammatory factors when compared to conventional treatment (p &lt; 0.05). Comparable NRS scores before treatment and 2 weeks after treatment were observed in the two groups (p &gt; 0.05). The eligible patients given du-moxibustion plus adalimumab showed lower NRS scores, higher BASDAI scores, and lower BASFI scores versus those receiving conventional treatment (p &lt; 0.001).Conclusion: Treatment of ankylosing spondylitis patients with the combination of du-moxibustion and adalimumab mitigates symptoms and clinical indicators of the disease and relieves pain in the patients. Therefore, the combined treatment should be subjected to further clinical trials prior to its use in clinical practice.