Axial Spondyloarthritis Criteria Research Articles

Difficult-to-treat axial spondyloarthritis patients.

This study aimed to formulate D2T (difficult to treat) criteria for axial spondyloarthritis (AxSpA) patients and identify the prevalence of D2T patients and their characteristics. The cross-sectional study was conducted with 166 AxSpA patients (93 males, 73 females; mean age: 47.1±12.9 years; range, 19 to 78 years) between February 2023 and March 2023. The criteria were based on patients treated according to the European Alliance of Associations for Rheumatology (EULAR) recommendations for AxSpA. Entry criteria were treatment failure to ≥2 biological/targeted synthetic disease-modifying antirheumatic drugs with two different mechanisms of action or ≥3 biological/targeted synthetic disease-modifying antirheumatic drugs. Potential preliminary factors for D2T criteria were analyzed, and the characteristics of the subjects matching D2T criteria were compared with those of others. One hundred forty-two ankylosing spondylitis patients and 24 nonradiographic AxSpA patients were included in the study. The rate of fulfilling the D2T criteria was 22.9% (n=38) among AxsPA patients treated with biological agents. The potential D2T criteria were met by 23.2% of ankylosing spondylitis and 20.8% of nonradiographic AxSpA patients. Baseline characteristics, such as sex, age, diagnosis age, occupation, and education, of D2T patients were not statistically different from other patients. The prevalence of fibromyalgia was higher in D2T patients (p<0.001). Disease activity indices and acute phase response indicators were higher and quality of life was worse in D2T patients. There was a considerable amount of AxSpA patients fulfilling the D2T criteria despite new and effective treatment agents.

Evaluation of the Possibility of Axial Psoriatic Arthritis Patients Meeting Classification Criteria for Axial Spondyloarthritis and Ankylosing Spondylitis.

The objective of the study was to analyze whether axial psoriatic arthritis (axPsA) patients meet classification criteria for axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS). A total of 104patients (66 men and 38 women) with PsA according to CASPAR criteria were examined, all patients had back pain. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. Back pain not meeting the ASAS criteria was taken to be chronic back pain (chrBP). Patients underwent hands, feet and pelvis, cervical spine and lumbar spine X-rays. Erosions, osteolysis, and juxta-articular new bone formation were evaluated. Definite radiographic sacroiliitis (d-rSI) was defined as bilateral grade ≥ 2 or unilateral grade ≥ 3. Nineteen patients without d-rSI underwent sacroiliac joints MRI. Ninety-three patients underwent HLA B27 examination. The number of patients who met the criteria for axSpA (ASAS) and the modified New York (mNY) criteria for AS was determined. IBP was identified in 67 (64.4%) patients; chrBP, in 37 (35.6%) patients; 31 (29.8%) patient were of older age (over 40) at the onset of IBP/chrBP; 57 (58.8%) patients had d-rSI; 6 (31.6%) patients had MRI-SI; syndesmophytes were detected in 57 (58.8%) cases. Among 40 patients without d-rSI, 19 (47.5%) had syndesmophytes. In 38/97(39.2%) patients d-rSI was detected along with syndesmophytes, while 19/97(19.6%) patients had isolated d-rSI without spondylitis, and 19/97(19.6%) patients had isolated syndesmophytes without d-rSI. HLA B27 was present in 28 (30.1%) cases. 51 (55.4%) patients met criteria for axSpA. Forty-one (44.6%) patients did not meet criteria for axSpA; however, 27 (65.9%) of them had syndesmophytes. Forty-eight (48.5%) PsA patients met mNY criteria for AS. Among these patients, a set of specific features was revealed: 18 (37.5%) had no IBP, 18 (37.5%) were of older age (over 40) at the onset of IBP/chrBP, 34 (70.8%) had dactylitis, 38 (79.2%) had erosive polyarthritis, 23 (48.8%) had juxta-articular new bone formation, 14 (30.2%) had osteolysis, 23 (48.9%) had "chunky" non-marginal syndesmophytes, and 40 (82.6%) had nail psoriasis; 28 (66.6%) patients were HLA-B27 negative. Forty-five percent of axPsA patients do not meet criteria for axSpA. Characteristic features have been identified to differentiate axPsA from AS.

Assessment of Association between Fatigue and Disease Activity in Axial Spondyloarthritis

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

Twenty Years of SPARTAN: From Inception to Impact (SPARTAN 2023 Annual Meeting Proceedings).

This review takes a look at the past, present, and future of SPARTAN, the Spondyloarthritis Research and Treatment Network, an organization of North American healthcare professionals dedicated to advancing research, education, and patient care in spondyloarthritis. In 2022, SPARTAN completed the Classification of Axial SpondyloarthritiS Inception Cohort (CLASSIC) study, a collaboration with the Assessment in SpondyloArthritis International Society (ASAS). CLASSIC aimed to validate the 2009 ASAS classification criteria for axial spondyloarthritis. Other ongoing SPARTAN endeavors include the development of US referral recommendations for axial spondyloarthritis, an update of the 2019 ACR/SAA/SPARTAN treatment recommendations for axial spondyloarthritis and multiple educational initiatives. Twenty years after its inception, SPARTAN continues to grow and broaden its impact, guided by the SPARTAN vision of "a world free of spondyloarthritis through leadership in research and education."

MRI for axial SpA: Diagnosis, disease activity assessment, and recent advances.

Magnetic resonance imaging (MRI) is a sensitive imaging modality to detect early inflammatory changes in axial spondyloarthritis (SpA). Over a decade has passed since the inclusion of MRI assessment in the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial SpA. Evidence and clinical experience of MRI in axial SpA have accumulated rapidly since. This has led to a better understanding of the clinical utility of MRI in early diagnosis, disease activity assessment, and monitoring of treatment response in axial SpA. Furthermore, technological advancements have paved the way for the development of novel MRI sequences for the quantification of inflammation and image optimization. The field of artificial intelligence has also been explored to aid medical imaging interpretation, including MRI in axial SpA. This review serves to provide an update on the latest understanding of the evolving roles of MRI in axial SpA.

Impact on Work Productivity Among Patients with Axial Spondyloarthritis in a Rheumatology Specialized Care Centre in Sri Lanka

Background: Axial Spondyloarthritis (AxSpA) is a chronic inflammatory condition which impacts various aspects of patients’ lives, including work productivity. This study aims to identify the impact of AxSpA on key work outcomes including sick leave rate, disease related unemployment rate, work productivity loss and its association with disease activity. Methods: 62 Adult patients aged ¿20 years who met the Assessment in Spondyloarthritis International Society (ASAS) 2009 criteria for AxSpA were enrolled. Work productivity was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). The validated Sinhala version of WPAI questionnaire was used to obtain data and calculate absenteeism, presenteeism and work productivity loss (WPL). Higher scores for presenteeism, absenteeism, or WPL indicate greater work impairment due to illness. Disease activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS). Multivariate linear regression was utilized to assess the association between work productivity and disease activity. Results: Among 62 patients who were on paid employment, permanent loss of employment rate due to disease was 20.9% and disease related sick leave rate for [Formula: see text] 2 months was 58.06%. Out of them 48% engaged in heavy labor jobs and 65% had high or very high disease activity. (Figure 1) Among employed patients, mean Absenteeism, Presenteeism and WPL were 22%, 51.04% and 56% respectively. A decrease in work productivity was related to an increase in disease activity. Disease activity was strongly correlated with absenteeism (p [Formula: see text] 0.01), presenteeism (p [Formula: see text] 0.01) and work productivity loss (p [Formula: see text] 0.001). (Figure 2) Conclusion: The impact of AxSpA on work outcomes is substantial and necessitates effective intervention, like controlling disease activity. The significantly elevated levels of presenteeism, absenteeism, and WPL when compared to global data may be linked to suboptimal disease management due to limited availability of biological treatments as well as labor-intensive jobs among the population.

Concept and understanding of non-radiographic axial spondyloarthritis

Since the publication of the classification criteria for axial spondyloarthritis (axSpA) by Assessment of SpondyloArthritis international Society (ASAS), a new disease concept "non-radiographic axial spondyloarthritis (nr-axSpA)" has emerged. Some domestic experts in China have translated it as "radiologically negative" axSpA, but it can easily lead to misunderstandings literally, as not all patients with nr-axSpA are completely free from radiological abnormalities. This article briefly describes the evolution of the concept of axSpA, proposes to translate the term of nr-axSpA directly rather than "radiologically negative" axSpA, compares the differences and similarities between nr-axSpA and radiologically negative axSpA, delineates the relationship between nr-axSpA and early ankylosing spondylitis, and points out not all the patients who meet the ASAS classification criteria for nr-axSpA are genuine patients with axSpA, because of the relatively low specificity of the ASAS classification criteria. Five common scenarios easily leading to misdiagnosis of nr-axSpA are exampled to remind domestic colleagues.

Evaluation of the possibility of axial psoriatic arthritis patients meet classification criteria for axial spondyloarthritis and ankylosing spondylitis

Objective – to analyze whether axial psoriatic arthritis (axPsA) patients meet classification criteria for axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS).Subjects and methods. 104 patients (66 men and 38 women) with PsA according to CASPAR criteria were examined, all patients had back pain. Patients were evaluated for presence of inflammatory back pain (IBP) by ASAS criteria. Back pain not meeting the ASAS criteria was taken to be chronic back (chrBP). Patients underwent hands, feet and pelvis, cervical spine and lumbar spine X-rays. Erosions, osteolysis, and periarticular osteo-proliferative lesions were evaluated. Radiographically significant sacroiliitis (r-sSI) was defined as bilateral grade ≥2 or unilateral grade ≥3. 19 patients without r-sSI underwent sacroiliac joints MRI. 93 patients underwent HLA B27 examination. The number of patients who met the criteria for axSpA (ASAS) and the modified New York (mNY) criteria for AS was determined.Results. IBP was identified in 67 (64.4%), chrBP in 37 (35.6%) patients; 31 (29.8%) patients were of advanced age (over 40) at the onset of IBP/chrBP; 57 (58.8%) cases had r-sSI; 6 (31.6%) patients had MRI-SI; syndesmophytes were detected in 57 (58.8%) cases. Among 40 patients without r-sSI, 19 (47.5%) had syndesmophytes. In 38 (39.2%) out of 97 patients r-sSI was detected along with syndesmophytes, while 19 (19.6%) out of 97 patients had isolated r-sSI without spondylitis, and 19 (19.6%) out of 97 patients had isolated syndesmophytes without r-sSI. HLA B27 was present in 28 (30.1%) cases. 51 (55.4%) patients met criteria for axSpA. 41 (44.6%) patients didn’t meet criteria for axSpA, however 27 (65.9%) of them had syndesmophytes. 48 (48.5%) PsA patients met mNY criteria for AS.Among these patients a set of specific features was revealed: 18 (37.5%) had no IBP, 18 (37.5%) were of advanced age (over 40) at the onset of IBP/ chrBP, 34 (70.8%) had dactylitis, 38 (79.2%) – erosive polyarthritis, 23 (48.8%) – periarticular osteo-proliferative lesions, 14 (30.2%) – osteolysis, 23 (48,9%) – “chunky” non-marginal syndesmophytes, 40 (82,6%) – nail psoriasis, 28 (66,6%) patients were HLA-B27 negative.Conclusion. 45% of axPsA patients don’t meet criteria for axSpA. Characteristic features have been identified to differentiate axPsA from AS.

P181 Assessing and improving mental health in axial spondyloarthritis through digital solutions

Abstract Background/Aims Mental health issues in axial spondyloarthritis (AxSpA) such as anxiety and depression can affect up to two thirds of patients. We aimed to detect the prevalence of anxiety and depression in our AxSpA patients in order to provide interventions to improve the condition. This is part of our work in the National Axial Spondyloarthritis Society’s (NASS) Aspiring to Excellence programme to improve patient outcomes. We have provided an online mental health assessment and self-management video that signpost patients to psychological help and resources. Methods We used the Hospital Anxiety and Depression Score (HADS) for AxSpA patients attending the clinic in January to March 2020. We also collected the BASDAI, Spinal Pain, BASFI and BASG. The HADS scores are divided into three groups, 0-7 (normal), 8-10 (borderline abnormal) and 11-21 (abnormal). Patients were invited to watch a self-help video on managing anxiety and depression, which we produced in house with our clinical psychologist. Patients were directed to online mental health resources and self-management programmes. Follow up HADS were collected post watching the video. Results All patients met the ASAS criteria for AxSpA. 100 patients were assessed and invited to watch the video. 90/100 (90%) of patients completed the baseline and follow up score. The mean (SD) age was 44.7 (13.2) years. The male:female ratio was 3:1. The mean disease duration was 9 years. The number of patients on biologics was 36 (40%). At baseline, the mean (SD) HADS was 10 (6), BASDAI 4.4 (2.3), Spinal pain 4.2 (3), BASFI 3.7 (2.7) and BASG 4.3 (2.7). The number of patients with a HADS score 0-7 was 28 (31%), 8-10 was 18 (20%) and &amp;gt;11 was 44 (49%). All patients participated in the viewing of the video and used the self-management programme. 34 (38%) patients reported engaging with psychological services such as talking therapies. At follow up, the mean (SD) HADS score was 9 (6), BASDAI 3.7 (2.1), Spinal pain 3.8 (2.2), BASFI 3.4 (2) and BASG 3.9 (2.4). The number of patients with a HADS score 0-7 was 38 (42%), 8-10 was 28 (31%) and &amp;gt;11 reduced to 24 (27%). There was a reduction in the number of patients with HADS &amp;gt;11 (from 49% to 31%) and a trend towards lower HADS (HADS 0-7 increased from 31% to 42%) and AxSpA outcome scores (reduction in all four AS scores from baseline). Conclusion Mental health issues in AxSpA can be improved through the use of digital mental health assessment and self-management programmes. This study shows that this is a useful method of delivering care. There was a trend towards the improvement of the mental health and AS disease activity scores using the digital video. Disclosure A. Chan: None. K. Rigler: None. A. McDougall: None.

OA17 Patient values and what matters to patients with axial spondyloarthritis in clinic

Abstract Background/Aims Physician-patient discrepancy in the goals of treatment remains an issue in axial spondyloarthritis (AxSpA). The National Axial Spondyloarthritis Society (NASS) has recently launched a national survey on patient values. Bridging the gap and improving alignment of physician-patient goals may lead to better outcomes. The objectives of this study were to investigate what patients wanted to discuss prior to their clinic attendance and to explore if these topics were discussed by the physician. The discrepancies between patient and physician goals were reviewed and steps put in place to bridge this gap. Methods Patients fulfilled the ASAS criteria for AxSpA. At baseline 130 consecutive patients attending the AxSpA clinic between April to December 2021 were sent a pre-clinic questionnaire. Patients were asked 2 questions and these were: 1) What do you wish to discuss at your appointment? 2) What goals do wish to achieve following treatment? Questionnaires were collected prior to the clinic. The medical notes and clinic letters were then reviewed post-clinic to check if questions 1 and 2 were discussed. The patient demographics and disease activity scores BASMI, BASFI and BASDAI were also collected. Results At baseline, 100/130 (77%) patients returned the questionnaire prior to clinic. The mean age was 41 years (range 23-67). 74 patients (74%) were male and 80 patients (80%) were in work. Patients were seen by a doctor (38%), specialist nurse (32%) and physiotherapist (30%). In terms of treatment, patients were currently on biologics (64%), NSAIDs (46%) and DMARDs (30%). The mean BASMI was 1.6 (range 0.2-5.4), BASFI 2.7 (0-9.2), BASDAI 3.5 (0.2-8.6) and CRP 3 (0-20). For pre-clinic question 1, the top three topics were medication, pain management and progression of disease. For question 2, the top three topics were to be pain-free, maintain flexibility and being mobile and active. There were also other topics that were raised including fatigue, sleep, infections and family planning. Post clinic, the topics in question 1 were discussed directly by the physician in 73% and question 2 in 59% of cases. The topics that were most discussed in clinic were medication, exercise and pain. Pooling the topics, the top five themes were pain, medication, flexibility, exercise and disease progression. A limitation is that the post clinic analysis was based on written clinic notes and letters. Conclusion This study confirms a degree of discordance in patient and physician goals. To bridge this gap, we are now focused on the top topics that patients wish to discuss in clinic and what they hope to achieve from their treatment. We have updated our AxSpA pathway to include these topics. Understanding patient goals will help us develop the content for the interventions and educational programmes to improve alignment and clinical outcomes. Disclosure A. Chan: None. A. Suarez: None. K. Rigler: None. J. Hamilton: None.

E091 Improving recognition and referrals for axial spondyloarthritis in primary care

Abstract Background/Aims It is estimated there is an 8.5-year delay from onset of symptoms to diagnosis of axial spondyloarthritis. The condition is poorly recognised in the United Kingdom. An audit of a general practice with 7,500 patients revealed only 7 patients living with the diagnosis, of which only 2 were diagnosed before the age of 45. Estimates suggest this figure should be closer to 35 to 40. In the 12 months prior to the audit, only 2 referrals were sent to rheumatology suspecting axial spondyloarthritis. The short-term aim of this study was to improve the recognition and referrals for axial spondyloarthritis in primary care from 2 per year to 15. The long-term goal is to increase the number of patients living with the diagnosis from 7 to 37. Methods EMIS alerts and pop-ups were created for patients, aged 20-45, presenting with “low back pain” or a similar coding to increase clinicians' clinical suspicion index. The alerts and pops included a hyperlink to the SPADE tool to facilitate reasoning. This was consolidated with an education webinar to refresh General Practitioners and Advanced Nurse Practitioners on the diagnostic criteria for axial spondyloarthritis. Results Following implementation of alerts and hyperlinks to the SPADE tool, general practitioners' confidence and knowledge of knowing when to suspect, assess and refer axial spondyloarthritis increased from 1.9, 1.7 and 2 to 4.8, 4.4 and 4.2 on a 5 point self-rated Likert scale. In the 12 months following the intervention, number of referrals had increased from 2 per year to 11. Conclusion This study has highlighted various findings. It has highlighted an insufficient number of referrals to rheumatology suspecting axial spondyloarthritis in order to maintain the suspected population of a general practice. This is likely linked to poor awareness and screening of the condition. It has also highlighted that clinicians in primary care respond positively to training for knowing when to suspect, assess and refer on for axial spondyloarthritis. However, this only measured a short-term change in knowledge and further testing is required to assess long term change. Furthermore, combined with education and the use of pop up and alerts has increased the awareness and referrals for axial spondyloarthritis from primary to secondary care. Future audits are required in the long term to assess for success in the long term goal. Disclosure D. Hamilton: None.

Influence of Sex on Early Axial Spondyloarthritis: A Six-Year Longitudinal Analysis From a Large National Cohort.

The objective was to determine sex differences in disease outcomes in recent axial spondyloarthritis (SpA) over time. We analyzed the first 6 years of follow-up of the prospective French multicenter DESIR cohort. Patients analyzed had <3 years of disease, were naive to disease-modifying antirheumatic drugs, and fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axial SpA. Disease activity (Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C-reactive protein [CRP] level), patient global assessment (PtGA), CRP level, and radiographic sacroiliitis were compared between men and women (self-reported sex) by linear and logistic mixed-effects models.Models were created for trajectories of disease activity over 6 years in men and women, using k-means. Of 494 patients analyzed (mean ± SD age 31.9 ± 7.5 years, symptoms duration 20.7 ± 11.7 months), 50.4% were men. Over 6 years of follow-up, both men and women showed clear improvements in ASDAS-CRP, PtGA, and CRP level. Women had higher ASDAS-CRP and PtGA over time compared to men (both P < 0.0001) with overall similar CRP levels (P=0.089), whereas structural damage increased more in men (P < 0.0001). One-third of both men (33%) and women (34%) belonged to persistent high/very high disease activity trajectories, but ASDAS-CRP was globally higher in women in these trajectories. In early axial SpA, clinical outcomes (disease activity and symptoms) were worse in women than men over 6 years of follow-up, whereas CRP was similar and structural damage was more frequent in men. Although similarly distributed, disease activity scores were higher in women in high/very high disease activity trajectories. Sex appears to be an important contextual factor in axial SpA.

Characterisation of gut microbiota composition in patients with axial spondyloarthritis and its modulation by TNF inhibitor treatment

ObjectiveTo assess whether gut microbiota composition is associated with patient characteristics and may have predictive value on the response to TNF inhibitor (TNFi) treatment in axial spondyloarthritis (AxSpA).MethodsThe study involved...

The Level of IgA Antibodies to CD74 in Patients with Spondyloarthritis and Degenerative-Dystrophic Diseases of the Spine

Background. According to the scientific literature, anti-CD74 IgA antibodies (IgA anti-CD74) are considered as a possible marker for the diagnosis of axial spondyloarthritis (SpA). The level of IgA anti-CD74 in patients with back pain due to degenerative spine disease has not been studied. Therefore, it could be interesting to compare the serum levels of IgA anti-CD74 in patients with chronic back pain in various diseases. Aim: to compare the levels of IgA anti-CD74 in patients with SpA and degenerative spine diseases. Material and methods. A total of 87 SpA patients (55 male, mean age 41 [29; 49] years) fulfilling the Assessment of Spondyloarthritis International Society (2009) criteria for Axial SpA, and 39 patients (25 male, mean age 45 [34; 53] years) with neurologist-verified degenerative spine diseases (ICD 10 codes — M 51.1 and M 54.4) were enrolled to the study. The serum levels of IgA anti-CD74 were analyzed by enzyme-linked immunosorbent assay (ELISA) in all patients. Results. The median levels of IgA anti-CD74 in patients with SpA were 11.3 [5.4; 19.4] U/ml, in patients with degenerative spine disease — 6.9 [4.5; 13.7] U/ml (p=0.024). IgA anti-CD74 serum levels were above the cut-off value in 58 (66.7 %) patients with SpA and only in 11 (28.2 %) patients with degenerative spine disease (p&lt;0,001). The elevated serum levels of IgA anti-CD74 were detected in 10 (40 %) of 25 male patients and in 1 (7.1 %) of 14 female patients (p = 0.029, χ2 = 4.785) with degenerative spine disease. Conclusion. Serum levels of I gA anti-CD74 were increased in two-thirds of patients with SpA. IgA anti-CD74 was significantly higher in SpA patients compared to patients with degenerative spine disease. &gt;&lt; 0,001). The elevated serum levels of IgA anti-CD74 were detected in 10 (40 %) of 25 male patients and in 1 (7.1 %) of 14 female patients (p = 0.029, χ2 = 4.785) with degenerative spine disease. Conclusion. Serum levels of I gA anti-CD74 were increased in two-thirds of patients with SpA. IgA anti-CD74 was significantly higher in SpA patients compared to patients with degenerative spine disease.

Predictors of not Achieving Remission or Low Disease Activity in Axial Spondyloarthritis Patients from Middle Eastern Countries: A Prospective, Multicenter, Real-world Study.

ObjectivesWe sought to identify the predictors of not achieving remission or low disease activity (LDA) among axial spondyloarthritis (SpA) patients in four Middle Eastern countries.MethodsIn this multicenter prospective real-world study, adult patients with axial SpA diagnosed clinically during January–June 2019, and who met the Assessment of SpondyloArthritis International Society classification criteria for axial SpA, were enrolled from the participating centers of four countries—Lebanon, Oman, Qatar, and the UAE. Patient demographics, disease history, comorbidities, treatment, and compliance data were obtained at baseline. The primary outcome was to determine the percentage of patients who did not achieve the clinical target of remission or LDA as indicated by Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) < 2.1 after a three-month follow-up period. Secondary outcomes were assessing the demographic and clinical characteristics of ‘achievers’ and ‘non-achievers’ and to study the predictors of ASDAS-CRP ≥ 2.1 in different clinical subsets.ResultsThe participants were 309 patients of both sexes, with a median age of 43 years. Women had a slight majority (53.7%). At the end of the study, 72.2% of patients achieved the clinical target of ASDAS-CRP < 2.1. Non-achievers were significantly more likely to have enthesitis, positive human leukocyte antigen B 27 status, psoriasis, peripheral involvement, fibromyalgia, and a lower score on Compliance Questionnaire for Rheumatology (CQR). Multiple regression analysis showed that low CQR score, enthesitis, psoriasis, and family history of SpA were independent predictors of ASDAS-CRP ≥ 2.1.ConclusionsThis real-world study suggests that low compliance, positive human leukocyte antigen B 27 status, peripheral involvement, and presence of enthesitis, psoriasis, and fibromyalgia are predictors of not achieving remission or LDA in axial SpA patients.

Prevalence and risk factors for uveitis in spondyloarthritis.

To determine the prevalence and risk factors for uveitis in spondyloarthritis (SpA) patients. A total of 225 patients who fulfilled Assessment of Spondyloarthritis International Society classification criteria for axial and peripheral SpA were enrolled. The diagnosis of uveitis was confirmed by an ophthalmologist. From medical records and from clinical evaluation associated information like disease duration, and human leukocyte antigen B27 was collected. Relevant laboratory tests were done and disease severity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score - erythrocyte sedimentation rate and C-reactive protein. Characteristics of uveitis positive and uveitis negative groups were compared. Multivariate logistic regression analysis was done for the risk factors, and P values <.05 were considered significant. Prevalence of uveitis was 18.7%. The disease duration was 9.3±7years and 5.4±4.5years in uveitis and no uveitis groups respectively (P≤.001). Family history of SpA was positive in 45.2% in the uveitis group (P≤.001). The frequency of axial SpA was 92.9% and 73.8% in the uveitis and no uveitis groups respectively (P≤.008). The mean BASDAI was 2.4±1.9 and 3.3±2.8 in uveitis and no uveitis groups respectively (P=.050). In multivariate logistic regression analysis, among the selected variables, family history of SpA (odds ratio [OR] =3.697; 95% CI =1.616-8.457; P=.002) and duration of disease (OR =1.089; 95% CI =1.004-1.181; P=.039) were independently associated with the occurrence of uveitis. The prevalence of uveitis was 18.7%. The family history and the disease duration of SpA were independently associated with uveitis.

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.

Imaging Outcomes for Axial Spondyloarthritis and Sensitivity to Change: A Five-Year Analysis of the DESIR Cohort.

ObjectiveTo compare the sensitivity to change of different imaging scoring methods in patients with early axial spondyloarthritis (SpA).MethodsPatients from the Devenir des Spondylarthropathies Indifferérenciées Récentes (DESIR) cohort fulfilling the Assessment of SpondyloArthritis international Society criteria for axial SpA were included. Radiographs and magnetic resonance imaging (MRI) of the sacroiliac (SI) joints and spine were obtained at baseline, 1, 2, and 5 years. Each image was scored by 2 or 3 readers in 3 separate reading waves. The rate of change of outcomes measuring inflammation of the spine and SI joints (e.g., Spondyloarthritis Research Consortium of Canada [SPARCC] score) and structural damage on MRI (e.g., ≥3 fatty lesions) and radiographs (e.g., modified New York grading) was assessed using multilevel generalized estimating equation models (taking all readers and waves into account). To allow comparisons across outcomes, rates were standardized (difference between the individual's value and the population mean divided by the SD).ResultsIn total, 345 patients were included. Inflammation detected on MRI of the SI joints (MRI‐SI joints) (standardized rate range –0.278, –0.441) was more sensitive to change compared to spinal inflammation (range –0.030, –0.055). Structural damage in the SI joints showed a higher standardized rate of change on MRI‐SI joints (range 0.015, 0.274) compared to radiography of the SI joints (range 0.043, 0.126). MRI‐SI joints damage defined by ≥3 fatty lesions showed the highest sensitivity to change (0.274). Spinal structural damage slowly progressed over time with no meaningful difference between radiographic (range 0.037, 0.043) and MRI structural outcomes (range 0.008, 0.027).ConclusionStructural damage assessed in pelvic radiographs has low sensitivity to change, while fatty lesions detected on MRI‐SI joints are a promising alternative. In contrast, MRI of the spine is not better than radiography of the spine in detecting structural changes in patients with early axial SpA.

Clinical and laboratory factors associated with bamboo spine in patients with axial spondyloarthritis: are there clues for bamboo spine?

To analyse the clinical and laboratory factors associated with bamboo spine. Data of patients fulfilling the 2009 ASAS classification criteria for axial spondyloarthritis, registered in the national, multicentre, longitudinal, and observational database of TReasure was analysed. Radiographs were assessed using the Bath Ankylosing Spondylitis Radiologic Index (BASRI). Data of patients with a bamboo spine (Group 1) was compared to data derived from patients with a longstanding disease of at least 15 years but no syndesmophytes (Group 2). Out of the 5060 patients, 1246 had eligible radiographs. There were 111 patients (8.9%) with a bamboo spine. Male sex was more common among patients with bamboo spine. The median BMI of 27.7 (25.8-31.1) in Group1 was higher than the BMI of 25.9 (22.9-29.2) in Group 2 (p<0.001). Hip arthritis, present or documented by a physician, was more common in Group 1 [(58/108 (53.7%) vs. 35/103 (34%), p=0.004]. There was a tendency towards a more prevalent enthesitis in these patients [29.1% (25/86) vs. 15.9%(11/69), p=0.054]. HLA-B27 status did not differ between groups. Smoking was more prevalent in Group 1. Multivariate logistic regression analysis revealed that male sex, body mass index, hip arthritis, and enthesitis are associated with bamboo spine in axSpA. Bamboo spine was more common in the male sex and associated with a delay in diagnosis, high BMI, hip involvement, and enthesitis. The constellation of increased body weight, hip arthritis, and enthesitis may imply that mechanical stress contributes to radiographic damage in the presence of chronic inflammation.

Peripheral manifestations are major determinants of disease phenotype and outcome in new onset spondyloarthritis.

To delineate the impact of peripheral musculoskeletal manifestations on stratification of disease phenotype and outcome in new-onset spondyloarthritis (SpA), using a prospective observational nationwide inception cohort, the BelGian Inflammatory Arthritis and spoNdylitis cohorT (Be-Giant). Newly diagnosed adult SpA patients, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial or peripheral SpA, were included in Be-Giant and prospectively followed every six months. Peripheral involvement (defined as arthritis, enthesitis and/or dactylitis) was determined in relation to clinically similar patient subsets at baseline and disease activity patterns during two-year follow-up, identified through K-means cluster analysis and latent class growth analysis. From November 2010 to March 2020, 367 patients were enrolled in Be-Giant, of whom 162 (44%) had peripheral manifestations. Two patient clusters [A, axial predominant (n = 248) and B, peripheral predominant (n = 119)] were identified at diagnosis. Longitudinal analysis (n = 115) revealed two trajectories of disease activity in each cluster: one with persistently high disease activity over time ('High'), the other rapidly evolving to low disease activity ('Low'). In cluster A patients, peripheral manifestations predisposed to the 'High' trajectory [odds ratio (OR) = 2.0, 95% CI: 1.3, 3.1, P= 0.001], despite more rapid initiation of biologics compared with patients without peripheral manifestations (hazard ratio (HR) = 2.1, 95% CI: 1.0, 4.4, P= 0.04 - Cox proportional-hazards model). Peripheral musculoskeletal manifestations are major determinants of phenotypical diversity in new-onset SpA. Intriguingly, stratification of axial SpA according to concomitant peripheral involvement identified an endotype with an unfavorable outcome despite more prompt therapeutic intensification with biologics. These observations justify an endotype-tailored approach beyond current ASAS/EULAR management recommendations.