Ankylosing Spondylitis Disease Activity Research Articles

Spinal inflammation by magnetic resonance imaging in patients with ankylosing spondylitis: association with disease activity and outcome parameters

Magnetic resonance imaging (MRI) has major contribution in early diagnosis of ankylosing spondylitis (AS). As it is difficult to determine disease activity owing to the lack of close relation between laboratory tests, clinical findings and imaging, MRI has been used as an objective outcome measure. The aim of this study is to investigate the relation between spinal MRI findings with disease activity and other outcome measures. Fifty patients fulfilling modified New York criteria for AS were enrolled to the study. All the patients were evaluated with Bath AS Disease Activity Index (BASDAI), AS Disease Activity Score (ASDAS), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), Bath AS Radiology Index (BASRI) and As Quality of Life. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured as laboratory parameters, and ASspiMR scores were determined by spinal MRI. The median total ASspiMR-a score was 5.2. Spinal inflammation was evaluated in spinal segments, and thoracic segments had the highest mean ASspiMR-a level (3.1 ± 5.94). Cervical and lumbar ASspiMR were correlated with only BASRI, and total ASspiMR score was correlated with BASRI, BASMI and CRP. Thoracic ASspiMR score was correlated with patient's and doctor's global assessments, BASFI, BASMI, BASRI, ASDAS A, ASDAS B, ASDAS C, ASDAS D, ESR and CRP (P < 0.05). According to our results, the thoracic spine was the most related region with disease activity parameters and clinical outcome measures, so we suggest thoracic spine MRI evaluation in order to determine the disease activity.

P271 Impact of structured referral and follow-up pathways on access to ventilatory support for people with motor neurone disease (MND)

<h3>Objective.</h3> To investigate whether patient disease severity in ankylosing spondylitis (AS) varies among regions or by local area social deprivation. <h3>Methods.</h3> Eight hundred patients with AS from 8 specialist rheumatology centers across England were invited to participate in a cross-sectional survey. Sociodemographic and disease-related variables were collected [pain (numerical rating scale), disease activity (Bath AS Disease Activity Index), and physical function (Bath AS Functional Index)]. Deprivation was measured using the Index of Multiple Deprivation 2004. <h3>Results.</h3> Of the 800 patients invited, 468 responded (adjusted response rate 62.8%). Most were male (72.9%), with a mean age of 50.2 years (SD 12.1), and a mean diagnosed disease duration of 17 years (SD 11.4). Across all centers, those living in more deprived areas demonstrated significantly greater disease severity and poorer psychological health. After controlling for age, gender, disease duration, and region, greater deprivation was significantly associated with greater disease activity (OR 3.39; 95% CI 1.65, 6.98) and poorer function (OR 4.46; 95% CI 2.11, 9.44). There was a nonsignificant trend toward more pain (OR 1.98; 95% CI 0.97, 4.07). There was also a significant independent association between region and disease severity. <h3>Conclusion.</h3> The need for healthcare is greatest for patients with AS who are living in more socially deprived areas. With the growing use of interventional therapies, these findings have important implications if health service resources are to be allocated equitably; particularly as deprived patients are known to access healthcare less frequently.

Golimumab reduces spinal inflammation in ankylosing spondylitis: MRI results of the randomised, placebo- controlled GO-RAISE study

ObjectiveTo evaluate golimumab's effect on MRI-detected spinal inflammation in ankylosing spondylitis (AS).MethodsPatients were randomly assigned to subcutaneous injections of placebo (n=78), golimumab 50 mg (n=138), or golimumab 100 mg (n=140)...

Serum melatonin level in ankylosing spondylitis: is it increased in active disease?

In the recent years, the role of melatonin (MLT) in the pathogenesis of inflammatory arthritis has been investigated, and the serum levels of MLT have been evaluated, but clinical study concerning MLT and ankylosing spondylitis (AS) is little reported in literature. We aimed to investigate the serum levels of MLT and their relation with the disease activity parameters of patients with AS. Forty AS patients and 40 healthy controls (matched for age and sex with the patients) participated in this study. Demographic and clinical data were collected and assessed. Disease activity of AS patients was assessed clinically according to the Bath AS Disease Activity Index (BASDAI), while AS functional impairment was assessed using the Bath AS Functional Index (BASFI). Serum samples were collected from all subjects to evaluate serum MLT, ESR, and CRP. Serum MLT levels were significantly increased in AS patients as compared to healthy controls (95% CI: 4.63, 8.77, P < 0.001). ESR and CRP are significantly higher in the AS patients compared with the controls (P < 0.001). AS patients with active disease had significantly higher ESR (P = 0.0151), CRP (P = 0.0124), and BASFI (P = 0.0016). Also, the MLT serum level in AS patients with BASDAI ≥40 was 39.7 ± 6.2 pg/ml compared with 35.2 ± 3.5 pg/ml in AS patients with BASDAI <40 (95% CI: 1.22, 7.78, P = 0.0106). Also, serum MLT level was significantly higher in the AS patients with enthesopathy than those without enthesopathy. Serum MLT levels were correlated with the duration of morning stiffness, BASDAI, BASFI, and CRP but not with ESR or duration of the disease. Serum levels of MLT were significantly increased in AS patients as compared to healthy controls. MLT levels correlated positively with BASDAI, BASFI, duration of morning stiffness, and CRP levels. Thus, it seems that MLT levels reflect the disease activity in AS patients.

Inverse Correlation between CD4+CD25HighCD127low/− Regulatory T-Cells and Serum Immunoglobulin A in Patients with New-Onset Ankylosing Spondylitis

This study investigated the role of regulatory T (T(reg)) cells in patients with new-onset, treatment-naïve ankylosing spondylitis (AS). Levels of CD4(+)CD25(high)CD127(low/-) T(reg) cells in the peripheral blood of 14 AS patients and 18 age-matched healthy volunteers were investigated by flow cytometry and correlations with serum levels of immunoglobulin A (IgA) and AS activity, as assessed by the Bath AS Disease Activity Index (BASDAI), were analysed. The number of peripheral blood CD4(+)CD25(high)CD127(low/-) T(reg) cells in AS patients was found to be significantly lower than in healthy controls and was inversely correlated with serum IgA levels. There was no significant correlation between CD4(+)CD25(high)CD127(low/-) T(reg) cell numbers and BASDAI scores. It is concluded that CD4(+)CD25(high)CD127(low/-) T(reg) cells may play a role in the pathogenesis and activity of AS.

Relationship Between Smoking and Patient-reported Measures of Disease Outcome in Ankylosing Spondylitis

To investigate the relationship between smoking and disease activity, pain, function, and quality of life in patients with ankylosing spondylitis (AS). Patients with AS (n = 612) from areas across the United Kingdom took part in a cross-sectional postal survey. Patient-reported outcome measures including the Bath AS Disease Activity Index, the Bath AS Functional Index (BASFI), a numerical rating scale (NRS) of pain, the AS quality of life questionnaire (ASQoL), and the evaluation of AS quality of life measures (EASi-QoL) were analyzed in terms of smoking status and relationship with pack-year history. The influence of potential confounding factors [age, sex, disease duration, and social deprivation (Townsend Index)] were tested in multivariate logistic regression analyses. Median scores of BASFI, pain NRS, ASQoL, and the 4 EASi-QoL domains were all higher in the group that had ever smoked compared to those who had never smoked (p < 0.0001, p = 0.04, p = 0.003, p < 0.02, respectively). In stepwise multivariate logistic regression analyses, high disease activity and more severe pain were associated primarily with current smoking, disease duration, and Townsend Index score, while decreased function and poor quality of life measures were associated more closely with increasing pack-year history, disease duration, and Townsend Index score. These associations were independent of age and sex. Smoking has a dose-dependent relationship with measures of disease severity in AS. The association with increased disease activity, decreased function, and poor quality of life in smokers was independent of age, sex, deprivation level, and disease duration.

Levels of lipid peroxidation and antioxidant vitamins in plasma and erythrocytes of patients with ankylosing spondylitis

Objectives The aim of this study was to investigate plasma and erythrocytes antioxidant vitamins and lipid peroxidation (LP) levels in patients with ankylosing spondylitis (AS) and controls. Methods The study was performed on the blood of 13 AS patients and 13 controls. Plasma and erythrocyte samples were obtained from blood of the patients and controls. Results Erythrocyte sedimentation ratio, C-reactive protein level, Bath AS disease activity index and bath AS functional index were higher in patients with AS than in controls. Vitamins A, C, E and β-carotene concentrations in plasma, reduced glutathione (GSH) and glutathione peroxidase values in erythrocyte were lower in patients with AS than in controls. LP concentrations were higher in the plasma and erythrocyte of the patients than in controls. Conclusion These results provide some evidence for a potential role of increased lipid peroxidation and decreased antioxidant vitamins in ankylosing spondylitis.

Effect of Pregnancy on Ankylosing Spondylitis: A Case-Control Study

To evaluate the effect of pregnancy on ankylosing spondylitis (AS). Our study aimed to determine the severity of back pain and stiffness pre-, during, and postpartum in patients with AS and controls, and corresponding extraarticular symptoms. Nineteen female patients with AS (35 pregnancies) and 33 controls (77 pregnancies) were studied. Improvement in pain was reported in 51% of AS patients, predominantly in the first trimester, with significant improvement in pain than stiffness. In both groups, pain worsened in later stages, likely secondary to biomechanical loading. Postpartum pain scores in AS returned to prepartum levels in general. Pregnancy does not substantially aggravate disease activity or severity in AS.

Treatment of Ankylosing Spondylitis by Extracorporeal Photochemotherapy Given for Mycosis Fungoides

We describe a patient with cutaneous T-cell lymphoma (CTCL), in association with concurrent ankylosing spondylitis (AS), who achieved a long-lasting complete remission of both diseases after 3 cycles of extracorporeal photochemotherapy (ECP). The combination of CTCL with AS is very rare. In our patient, the CTCL was refractory to psoralen-UVA. He was unable to continue with administration of interferon α because of exacerbation of his back, anterior chest, and bilateral heel pain. The Bath AS Functional Index and Bath AS Disease Activity Index scores were determined to be 2.2 and 5.8, respectively. Extracorporeal photochemotherapy has been shown to be effective in the treatment of CTCL consisting of reinfusion of 3 to 9 × 10 leukocytes, taken from the patient by leukopheresis and treated in an extracorporeal system with 8-methoxypsoralen and UVA. There is a strong suggestion that ECP as a monotherapy can provide a significant benefit for other T-cell-mediated diseases including rheumatoid arthritis and psoriatic arthritis. This is the first report describing an effective treatment of AS in which pain, inflammatory response, Bath AS Disease Activity Index, and Bath AS Functional Index improved after initiation of ECP.

A Case with Familial Mediterranean Fever which Responds Well to Adalimumab Treatment

Ankylosing spondylitis (AS) may accompany Familial Mediterranean fever (FMF). In this article, we present a 48-year-old male FMF case with accompanying AS who was successfully treated with a tumor necrosis factoralpha (TNF-α) inhibitor (adalimumab). Colchicine and other disease modifying antirheumatic drug (sulfasalazine and leflunomide) treatments had been given before the initiation of the TNF-α inhibitor, but FMF attacks could not be adequately controlled by these treatments. When adalimumab was coadministered with colchicine, the disease activity of AS was improved and the frequency and the severity of the FMF attacks were reduced during the one-year follow-up. We conclude that TNF-α blockers may be a therapeutic option when conventional treatment is ineffective in patients with FMF.

The relationship between plasma homocysteine level and different treatment modalities in patients with ankylosing spondylitis

To determine plasma homocysteine levels in ankylosing spondylitis (AS) and their correlation with disease activity measurements. To examine the effects of different treatment modalities on homocysteine levels. One hundred eight patients diagnosed with AS according to New York criteria and 65 healthy individuals matched in terms of age and gender were enrolled in the study. Patients were given detailed physical examinations. The Bath AS Disease Activity Index (BASDAI) was used for disease activity, the Bath AS Metrology Index (BASMI) for spinal mobility, the Bath AS Functional Index (BASFI) to determine functional status and the Bath AS Radiological Index (BASRI) for radiological analysis. Sedimentation rate (ESR) and C reactive protein (CRP) levels, acute phase reactants, were measured. Plasma homocysteine levels, serum interleukin (IL) -6 and serum tumor necrosis factor- α (TNF- α) levels were investigated using the enzyme-linked immunosorbent assay (ELISA) method. Plasma homocysteine levels in AS patients were statistically significantly lower compared with those in the healthy control group (P = 0.0001). There was no significant difference among sub-groups established on the basis of medical treatments and disease activity (BASDAI ≤4 and >4). No statistically significant correlation was determined between homocysteine level and disease activity parameters, radiological score and functional indices. A significant negative correlation was, however, established between age and homocysteine level in the AS group (P < 0.05, r = -0.426). Plasma homocysteine was lower in AS patients compared with the control group. This is not correlated with disease activation and medical treatment employed.

Assessment of the efficacy of pulse Ibandronate therapy in non-steroidal anti-inflammatory drug refractory ankylosing spondylitis: An open prospective study

Background Amino-bisphosphonates like Pamidronate, having weak anti-Tumour Necrosis factor (TNF)-alpha property is effective in ankylosing spondylitis (AS). Objective To assess the efficacy of intravenous pulse Ibandronate, another bisphosphonate, in non-steroidal anti-inflammatory drug (NSAID) refractory/intolerant AS, as it is cheaper, requires less frequent dosing and is easily available. Methods Thirty-four patients, diagnosed as AS by Modified New York Criteria, having Bath AS Disease Activity Index (BASDAI) ≥ 4 (i.e. active disease) and NSAID refractory/intolerant, received six doses of injection Ibandronate (3 mg) intravenously, three monthly, for 15 months. Patients with peripheral arthritis were given sulfasalazine along with Ibandronate. Outcome assessed comparing baseline and final BASDAI, Bath AS metrology index (BASMI), Bath AS functional index (BASFI), Bath AS global score (BAS-G), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Response defined according to assessments in ankylosing spondylitis (ASAS)-20 and BASDAI-50, and, reduction in tender and swollen joint counts in patients with peripheral arthritis. Results Twenty-eight patients received all six doses. Twenty-one (75%) and 23 (82%) patients achieved BASDAI-50 and ASAS-20 responses, respectively. Significant reductions in mean BASDAI (48.36%), BASMI (55.08%), BASFI (47.03%), BASG (47.47%), ESR (49.24%) and CRP (66.38%) were noted after 15 months. Ten patients having peripheral joint involvement had significant decrement in swollen (67.74%) and tender (57.14%) joint counts. Conclusion Intravenous Ibandronate has reasonable efficacy in the treatment of AS.

Clinical Correlates of Urolithiasis in Ankylosing Spondylitis

To determine the association between urolithiasis and syndesmophyte formation and the effect of urolithiasis on ankylosing spondylitis (AS) disease activity. In a longitudinal cohort of 504 patients with AS, we conducted an analysis of all patients with AS who have a history of urolithiasis. All patients met the modified New York criteria for AS. Demographics, clinical characteristics, extraarticular features, and comorbidities are systematically recorded in the database. We compared disease activity, functional indices, medical therapy and radiographic damage between AS patients with (Uro+) and without urolithiasis (Uro-) using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Thirty-eight patients with AS (7.5%) had a history of urolithiasis in our cohort. Seventy-six patients with AS who did not have urolithiasis, matched for age, sex, and ethnicity, were selected as controls. Patients who were Uro+ were more likely to have more functional disability, based on the Bath AS Functional Index (BASFI; mean 5.3 vs 3.6 in control group, p = 0.003). Trends were noted in the Uro+ group toward higher Bath AS Disease Activity Index (BASDAI; mean 4.9 vs 4.0, p = 0.09), more peripheral joint involvement (p = 0.075), and higher frequency of biologic therapy (p = 0.09). No significant difference was detected in mSASSS or the Bath AS Metrology Index (BASMI). Significant association with diabetes mellitus (DM; p = 0.016) and Crohn's disease (p = 0.006) was noted in the Uro+ group. Although there is no acceleration of syndesmophyte formation or spinal mobility restriction, more functional disability was detected in the urolithiasis group. The higher risk with concomitant DM or Crohn's disease should alert clinicians to these comorbidities in Uro+ patients with AS.

No effect of physiotherapy on the serum levels of adipocytokines in patients with ankylosing spondylitis

To investigate the effect of intensive physiotherapy on disease activity and serum levels of adipocytokines in patients with ankylosing spondylitis (AS). Twenty-six patients with AS were included in this study. Intensive physiotherapy was performed twice a week for a period of 3months. The Bath AS Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI) were assessed at inclusion and after 3months. Leptin, adiponectin, resistin and visfatin serum levels were analysed by ELISA assays. Patients had mild to moderate disease activity. Baseline levels of adipocytokines did not correlate with indicators of disease activity, functional status or acute-phase reactants. After the 3months of intensive physiotherapy, BASDAI significantly decreased from 2.98 to 1.8 (p = 0.01) and BASFI improved from 2.31 to 1.37 (p = 0.05), while there were no changes in serum levels of CRP, ESR and adipocytokines. In addition, baseline levels of adipocytokines did not predict the change of disease activity or functional ability. Intensive physiotherapy effectively reduces all clinical measures of disease activity, but it is not associated with a significant change in acute-phase reactants or serum levels of adipocytokines.

Comparison of radiological indices (SASSS, M-SASSS, BASRI-s, BASRI-t) in patients with ankylosing spondylitis

This study was performed to compare radiologic methods of Bath Ankylosing Spondilitis Radiology Index-spine (BASRI-s), Bath Ankylosing Spondilitis Radiology Index-total (BASRI-t), Stoke Ankylosing Spondilitis Spine Score (SASSS) and Modified Stoke Ankylosing Spondilitis Spine Score (M-SASSS) and to test their superiority over each other. Eighty-one patients (60 males, 21 females) with ankylosing spondylitis (AS) were included in the study. Patients were evaluated for their functional status, disease activity, quality of life, and spinal mobility using Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), AS Quality of Life Index (ASQoL) scale, and Bath AS Metrology Index (BASMI), respectively. Radiographs of the patients were evaluated using BASRI-s, BASRI-t, SASSS, and M-SASSS methods. Spearman's correlation test was used for the correlation analysis. Significant correlations were found between the duration of disease with radiological indices (P < 0.05), BASMI with SASSS (P < 0.01), M-SASSS (P < 0.01), BASRI-s (P < 0.01), and BASRI-t (P < 0.01). Furthermore, there were correlations between BASFI with SASSS (P < 0.05), M-SASSS (P < 0.05), BASRI-s (P < 0.05). and BASRI-t (P < 0.05). According to the results of our study, among these four radiological measuring methods, SASSS appears to be the one that is the least reflective of patient status. The reason to that is the fact that while in SASSS method only lumbosacral radiography is evaluated, in other methods one more area is evaluated. However, the disadvantages of BASRI methods relative to others, in BASRI methods, patients are exposed to more radiation.

Epidemiology of Spondyloarthritis in Argentina

IntroductionSpondyloarthritis (SpA) includes a group of diseases that share immunogenetic, clinical and radiologic findings, with a particular involvement of the axial skeleton and the entheses. MethodsSpA patients attending ambulatory care in 11 rheumatology services located in 6 Argentine provinces were included in a prospective, observational multicentre cohort of SpA in Argentina (Iberoamerican Spondyloarthritis Registry [RESPONDIA]). Data collected were transmitted online and stored in the Spanish spondyloarthritis registry (REGISPONSER) Web site. Sociodemographic, clinical features and diagnosis, disease activity, functional status, quality of life, work status, radiographic changes and treatment data were collected by means of validated tools. ResultsA total of 402 patients were included; 59% were male, with median age of 48.3 years and median disease duration of 8 years; 68.7% of patients belonged to middle and lower-middle social classes. Eighty-six patients were diagnosed with ankylosing spondylitis (AS), 242 with psoriatic arthritis, 25 with reactive arthritis, 10 with SpA associated with inflammatory bowel disease, 33 with undifferentiated SpA and 6 with juvenile AS. The median score was 2.6 for the Bath AS Functional Index, 3.8 for the Bath AS Disease Activity Index and 5 for the Bath AS Radiology Index. The lower social class patients achieved a worse Bath AS Functional Index than other social classes and a worse Bath AS Disease Activity Index, compared with upper-middle class. ConclusionsThe sociodemographic distribution pattern observed in these SpA patients was similar to that expected in the general population of Argentina, with worse functional capacity and higher disease activity observed in the lower social classes.

Baseline predictors of response and discontinuation of tumor necrosis factor-alpha blocking therapy in ankylosing spondylitis: a prospective longitudinal observational cohort study

IntroductionIdentifying ankylosing spondylitis (AS) patients who are likely to benefit from tumor necrosis factor-alpha (TNF-α) blocking therapy is important, especially in view of the costs and potential side effects of these agents. Recently, the AS Disease Activity Score (ASDAS) has been developed to assess both subjective and objective aspects of AS disease activity. However, data about the predictive value of the ASDAS with respect to clinical response to TNF-α blocking therapy are lacking. The aim of the present study was to identify baseline predictors of response and discontinuation of TNF-α blocking therapy in AS patients in daily clinical practice.MethodsAS outpatients who started TNF-α blocking therapy were included in the Groningen Leeuwarden Ankylosing Spondylitis (GLAS) study, an ongoing prospective longitudinal observational cohort study with follow-up visits according to a fixed protocol. For the present analysis, patients were excluded if they had previously received anti-TNF-α treatment. Predictor analyses of response and treatment discontinuation were performed using logistic and Cox regression models, respectively.ResultsBetween November 2004 and April 2010, 220 patients started treatment with infliximab (n = 32), etanercept (n = 137), or adalimumab (n = 51). At three and six months, 68% and 63% of patients were Assessments in Ankylosing Spondylitis (ASAS)20 responders, 49% and 46% ASAS40 responders, and 49% and 50% Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)50 responders, respectively. Baseline predictors of response were younger age, male gender, higher ASDAS score, higher erythrocyte sedimentation rate (ESR) level, higher C-reactive protein (CRP) level, presence of peripheral arthritis, higher patient's global assessment of disease activity, and lower modified Schober test. In August 2010, 64% of patients were still using their TNF-α blocking agent with a median follow-up of 33.1 months (range 2.4 to 68.2). Baseline predictors of discontinuation of TNF-α blocking therapy were female gender, absence of peripheral arthritis, higher BASDAI, lower ESR level, and lower CRP level.ConclusionsBesides younger age and male gender, objective variables such as higher inflammatory markers or ASDAS score were identified as independent baseline predictors of response and/or continuation of TNF-α blocking therapy. In contrast, higher baseline BASDAI score was independently associated with treatment discontinuation. Based on these results, it seems clinically relevant to include more objective variables in the evaluation of anti-TNF-α treatment.

Better short-term clinical response to etanercept in Chinese than Caucasian patients with active ankylosing spondylitis

Tumor necrosis factor-alpha (TNF-α) inhibitors including etanercept have been demonstrated to be very effective in severe ankylosing spondylitis (AS) in Caucasian patients. However, clinical efficacy of etanercept to treat active AS in Chinese patients has not been reported. In this study, a prospective, open-label trial of etanercept (25 mg BIW), involving 46 AS patients from 16 medical centers of Taiwan, was conducted. Questionnaire was utilized to record demographic data and clinical parameters, including Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Global Index (BASGI), Assessment in Ankylosing Spondylitis (ASAS) 20, 50, and 70, and others, before and at different time intervals after etanercept treatment. Laboratory tests including blood chemistry, hematology, urine analysis, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were done at baseline and at weeks 4, 8, and 12. In this 12-week study, etanercept demonstrated rapid and significant improvement in the ASAS20 response criteria (91.3%), at as early as 2 weeks of therapy (71.3%). Partial remission of AS was achieved in 49.3% of patients after 12 weeks of treatment. Disease activity (BASDAI) and function (BASFI) were also significantly improved after 12 weeks etanercept treatment (p < 0.0001 and p < 0.0001, respectively). In addition, significant increase of chest expansion (2.77 ± 1.69 cm versus 3.56 ± 1.82 cm, p = 0.0004) and lumbar flexion (2.11 ± 2.76 cm versus 2.58 ± 3.42 cm, p = 0.0075) and significant reduction of occiput-to-wall distance (6.59 ± 7.14 cm versus 5.32 ± 6.65 cm, p = 0.0006) were also demonstrated. Both ESR and CRP declined significantly after patients were treated with etanercept. There were no severe adverse effects during the treatment period. Etanercept is generally safe, well tolerated, and effective in Chinese patients with severe AS. Clinical efficacy, including partial remission and BASDAI, is even better in Chinese than in Caucasian patients. Further study is required to assess long-term efficacy and safety in Chinese patients with AS.

Adalimumab Improves Sleep and Sleep Quality in Patients with Active Ankylosing Spondylitis

fatigue and sleep problems are significant in patients with ankylosing spondylitis (AS). This subanalysis of the RHAPSODY study (Review of Safety and Effectiveness with Adalimumab in Patients with Active Ankylosing Spondylitis) was conducted to evaluate the effect of adalimumab on sleep in patients with active AS. all patients (n = 1250) had active AS and received adalimumab 40 mg every other week during the 12-week open-label treatment period. Sleep was assessed by the Medical Outcomes Study Sleep Scale (MOS-SS) at screening and Weeks 6, 12, and 20 (optional continuation period). Effect sizes were calculated to determine clinical significance. Paired Student t tests compared the change in the MOS-SS domains from Week 12 to baseline. Correlation coefficients were calculated to determine the relationship between change in sleep domains and other Week 12 clinical and patient-reported outcomes (Bath AS Disease Activity Index, C-reactive protein, nocturnal pain, total back pain, Bath AS Functional Index, patient's global assessment of disease activity, morning stiffness, Short Form-36 Health Survey, and Work Productivity and Activity Impairment questionnaire components). at week 12, adalimumab significantly improved sleep in each of the MOS-SS domains (p < 0.001). Effect sizes for 3 of the 6 domains (disturbance, -0.69; adequacy, 0.55; somnolence, -0.52) and both sleep problems indices (Index I, -0.68; Index II, -0.77) were moderate, suggesting clinical significance. Change in the MOS-SS Sleep Problem Index II was moderately correlated with change in most clinical and patient-reported outcomes. Sleep improvements were similar in patients with and without radiographically advanced AS. adalimumab improves overall sleep and sleep quality in patients with active AS.

Psychological Status and Patient-Assessed Health Instruments in Ankylosing Spondylitis

Determination of the relationships between disease and psychological status in ankylosing spondylitis (AS) is needed for clinical assessment and management, as well as selection and monitoring of AS patients for biological therapy. The study aimed to describe associations between self-reported health status and psychological factors in AS patients and to compare the Symptom Checklist 90-Revised (SCL-90-R) profiles of the AS patients and the control subjects. Disease status was determined through the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and the Bath AS Metrology Index (BASMI). Psychological status was measured using the SCL-90-R. BASDAI and BASFI scores correlated with somatization, anxiety, obsessive-compulsive, depression, and hostility subscales of SCL-90-R (P ≤ 0.05). BASFI scores were significantly correlated with interpersonal sensitivity and phobic anxiety subscales of SCL-90-R (P < 0.05), whereas no correlation was observed between BASDAI and interpersonal sensitivity and phobic anxiety subscales. BASMI scores were significantly correlated with somatization and interpersonal sensitivity subscales (P < 0.05). After age and sex adjustments, a statistically significant difference was determined between the somatization scores of the AS patients and control subjects (P = 0.005). AS is a chronic disease, which causes deformities and workforce decline. This, in turn, might lead to psychological distress. There is a need to assess the mood of patients with AS. Completion of self-report assessment tools are potentially confounded by reporting biases that result from psychological factors. Some patients may overreport symptoms or disability because of a tendency to somatize. Thus, during interpretation of these tools, psychological status should be taken into account especially deciding the treatment regimen including biologic therapies.