Ankylosing Spondylitis Disease Activity Research Articles

Clinical characteristics and medical management of Iranian patients with ankylosing spondylitis

Objectives. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease with variable clinical expression. Ethnic, racial and geographical factors have been associated with disease occurrence and expression. We intended to describe the clinical characteristics and assess the disease severity and treatment status in Iranian AS patients.Methods. A total of 320 AS patients were assessed for demographic variables, clinical manifestations, human leukocyte antigen (HLA) status, disease severity, functional capacities, quality of life and treatment status.Results. A gender ratio of 3.8:1, an average age onset of 27 ± 7.3 and a mean diagnostic delay of 8 years were observed. Eleven percent had juvenile onset AS. Positive family history was higher than that observed in most other countries. Enthesitis was a very common finding involving more than two-thirds of our patients. Uveitis was the leading extra-articular manifestation. We found an HLA-B27 prevalence of 73% and four HLA-B27 subtypes. Disease activity was high and the functional status was poor as indicated by mean Bath AS Disease Activity, Functional and Metrology indices. Quality of life was considerably impaired in our patients. We found a low percentage of patients on biological medications and a relatively higher percentage on disease modifying anti-rheumatic drugs and corticosteroids.Conclusions. Our results demonstrate a broad characterization of Iranian AS patients providing a better understanding of this disease. A national multicenter registry would enable larger- scale prospective studies to be carried out further evaluating the disease burden on patients and society.

High disease activity is related to low levels of physical activity in patients with ankylosing spondylitis

This study aims to compare physical activity (PA) level and exercise habits in patients with ankylosing spondylitis (AS) who have high disease activity with those who have low disease activity and, further, to compare both groups with population controls. Cross-sectional study design was used. The participants include 149 patients (mean age 49.3 (SD 11.1), 61% men, 54% high disease activity) and 133 controls (mean age 52.7 (SD11.3), 58% men). PA was reported with the International PA Questionnaire-Long and results were presented as weekly energy expenditure (metabolic equivalent, MET) in different intensities, domains, and proportion reaching health enhancing physical activity (HEPA). Types of PA were registered in a structured interview. The AS Disease Activity Score was used to assess patients' disease activity. Patients with high disease activity reported significantly lower total weekly energy expenditure (MET) than patients with low disease activity and controls (p = 0.02, p = 0.01, respectively) and lower amounts of walking (p < 0.01, p = 0.02, respectively) and vigorous activity (p = 0.06, p = 0.06, respectively). Only 41% of the patients with high disease activity reached HEPA compared to 61% of the patients with low disease activity (p = 0.02). Patients in general participated less in leisure PA performed outdoor and with higher intensities (MET ≥ 6) than controls.AS patients with high disease activity had lower weekly energy expenditure in PA than patients with low disease activity and controls, and were less likely to reach HEPA than patients with low disease activity. For optimal management, health professionals should focus on physical activity in their consultations with AS patients, especially those with high disease activity.

Associations between inflammation, nocturnal back pain and fatigue in ankylosing spondylitis and improvements with etanercept therapy

To investigate the relationships between inflammation, nocturnal back pain and fatigue in ankylosing spondylitis (AS) and the impact of 12 weeks' etanercept treatment versus sulfasalazine or placebo. Data were combined from four clinical trials for patients with AS who received at least one dose of etanercept, sulfasalazine or placebo and had at least one postbaseline assessment value. Linear regression was performed (controlling for site, protocol and demographics), to explore the relationship between inflammation (C-reactive protein [CRP]), nocturnal back pain (visual analog scale [VAS] 0-100 mm) and fatigue (VAS 0-100 mm Bath AS Disease Activity Index fatigue item). Out of 1283 patients (etanercept, n = 867; sulfasalazine, n = 187; placebo, n = 229), improvement in nocturnal back pain was a significant predictor of improvement in fatigue. Significant correlations were found between nocturnal back pain and fatigue, but not CRP levels. Etanercept provided significantly greater pain/fatigue improvement than sulfasalazine or placebo. Improvements in nocturnal back pain and fatigue had weak relationships with improvement in inflammation (CRP level). AS patients treated with etanercept demonstrated superior improvement in nocturnal back pain and fatigue versus sulfasalazine or placebo. Decrease in nocturnal back pain can improve fatigue. Assessing treatment response using CRP levels alone may be misleading without also examining patient-reported outcomes such as back pain and fatigue.

Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire

The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a disease-specific measure of needs-based quality of life developed in the UK and the Netherlands. This study describes translation, validation, and reliability of the scale into Turkish population. The ASQoL was translated into Turkish using the dual-panel process. Content validity was assessed via cognitive debriefing interviews with ankylosing spondylitis (AS) patients. Patients with AS according to modified New York criteria were recruited into the study from 12 hospitals of all part of Turkey. Psychometric and scaling properties were assessed via a two administration survey involving the ASQoL, the Nottingham Health Profile (NHP), Bath AS Functional Index (BASFI), and Bath AS Disease Activity Index (BASDAI). Classical psychometrics assessed reliability, convergent validity (correlation of ASQoL with NHP, BASFI, and BASDAI) and discriminative validity (correlation of ASQoL with perceived AS-severity and general health). Cognitive debriefing showed the new Turkish ASQoL to be clear, relevant, and comprehensive. Completed survey questionnaires were received from 277 AS patients (80% Male, mean age 42.2/SD 11.6, mean AS duration 9.4 years/SD 9.4). Test-retest reliability was excellent (0.96), indicating low random measurement error for the scale. Correlations of ASQoL with NHP sections were low to moderate (NHP Sleep 0.34; NHP Emotional Reactions 0.83) suggesting the measures assess related but distinct constructs. The measure was able to discriminate between patients based on their perceived disease severity (p < 0.0001) and self-reported general health (p < 0.0001). The Turkish version of ASQoL has good reliability and validity properties. It is practical and useful scale to assess the quality of life in AS patients in Turkish population.

FRI0426 Immunogenicity, adalimumab levels and clinical response in ankylosing spondylitis patients during 24 weeks of follow-up.

BackgroundImmunogenicity influences adalimumab levels and therefore clinical response in patients with rheumatic diseases.ObjectivesTo study the relation between clinical response, adalimumab levels and anti-drug antibodies (ADA) in ankylosing spondylitis (AS) patients.MethodsObservational...

THU0364 Lower Etanercept Levels are Associated with High Disease Activity in Ankylosing Spondylitis Patients at 24 Weeks of Follow-Up

BackgroundEtanercept levels are associated with clinical response in rheumatoid arthritis, however, in a small group of 53 patients with ankylosing spondylitis (AS) this association was not found (de Vries MK...

AB0868 The relation between different disease activity parameters and functional status in patients with ankylosing spondylitis

BackgroundTo evaluate disease activity is important for use in clinical practice, observational studies and clinical trials. There are different indexes to evaluate disease activity in patients with ankylosing spondylitis (AS).ObjectivesThe...

OP0215 Baseline ASDAS and CRP Predicts Future Cardiovascular Risk in Ankylosing Spondylitis: Results After 5-Year Follow-Up

BackgroundPatients with ankylosing spondylitis (AS) have increased risk of cardiovascular disease (CVD), and we have previously shown in a cross-sectional study that high ASDAS is associated with atherosclerotic CVD.ObjectivesTo investigate...

THU0265 Early change in bone resorption predicts discontinuation of tumor necrosis factor-alpha blocking therapy in patients with ankylosing spondylitis

BackgroundIn ankylosing spondylitis (AS), objective measurements evaluating the effect of tumor necrosis factor-alpha (TNF-α) blocking therapy are lacking.ObjectivesTo investigate the predictive value of bone turnover markers (BTM) in relation to...

OP0166 Tocilizumab (TCZ) is not effective for the treatment of ankylosing spondylitis (AS): Results of a phase 2, international, multicentre, randomised, double-blind, placebo-controlled trial

BackgroundInterleukin-6 (IL-6) has been shown to be elevated in patients (pts) with AS and correlates with disease activity.1 Case reports concerning the use of TCZ in pts with AS have...

AB0899 Hip involvement and its predicting factors in turkish ankylosing spondylitis: A single center experience

BackgroundHip involvement is present in 25 to 35 percent of patients with ankylosing spondylitis (AS) and is associated with higher degrees of disability and a worse prognosis. Thus, early detection...

SAT0270 Cardiovascular disease is related to disease activity in ankylosing spondylitis

BackgroundStudies have suggested a higher risk of cardiovascular (CVD) in patients with ankylosing spondylitis (AS). The increased risk of CVD cannot be explained by traditional risk factors alone and this...

Elevated Serum Level of IL-33 and sST2 in Patients With Ankylosing Spondylitis

ObjectiveInterleukin (IL)-33 is a cytokine belonging to the IL-1 family and was recently identified as a ligand for ST2, which belongs to the IL-1 receptor (IL-1R) family. In this study,...

FRI0438 Disease management of ankylosing spondylitis and non-radiographic axial spondyloarthritis patients is similar in academic and community practice among 654 surveyed rheumatologists

BackgroundThe Assessment of SpondyloArthritis International Society (ASAS) has recently updated recommendations for the use of anti-TNF in patients (pts) with axial SpondyloArthritis (axSpA), which include ankylosing spondylitis (AS) and non-radiographic...

SAT0262 Quality of life in early spondyloarthritis and associated factors

BackgroundThe aim of the ESPeranza program was to provide an early and effective access to rheumatologic care for patients with spondyloarthritis (SpA). Specific Rheumatologic Units (SRU) for an early evaluation,...

AB0188 The serum levels of adipocytokines (leptin, adiponectin and resistin) in ankylosing spondylitis patients

BackgroundThere is evidence that adipocytokines play an important role in metabolism and in inflammation. Adipocytokines are involved in numerous rheumatic diseases, such as rheumatoid arthritis, osteoarthritis and systemic lupus erythematosus....

FRI0460-HPR High disease activity is related to low levels of physical activity in patients with ankylosing spondylitis

BackgroundRecent studies have revealed that patients with ankylosing spondylitis (AS) also have a higher risk of cardiovascular diseases (CVD) than the general population (Mathieu et al, 2011) and physical activity...

SAT0238 Risk of Falls in Patients with Ankylosing Spondylitis

BackgroundRisk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks.ObjectivesThe aim of...

FRI0295 Syndesmophytes are associated with higher bone turnover in ankylosing spondylitis patients with active disease

BackgroundBone formation and bone loss are both present in ankylosing spondylitis (AS). New bone formation can lead to the formation of syndesmophytes, ankylosis of the spine and sacroiliac joints, and...

FRI0286 Burden of the disease in axial spondyloarthritis

BackgroundAxial spondyloarthritis (axSpA) is a new classification that includes ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA). Little is known about the severity and progressive nature of nr-axSpA relative to AS....