Ankylosing Spondylitis Disease Activity Research Articles

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.

Therapeutic considerations in spondyloarthritis patients who fail tumour necrosis factor antagonists

The tumour necrosis factor (TNF) antagonists have significantly improved quality of life and functional status in patients with spondyloarthritis (SpA). The excitement regarding the remarkable success of these agents is justified but challenges remain. In particular, alternative systemic therapies with proven efficacy for patients who fail TNF antagonists have been developed in rheumatoid arthritis but are not yet available in SpA. In this article, the approach to patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) who fail TNF antagonists will be discussed with the goal of providing a path to the clinician, who must manage these patients amidst uncertainty. Three central questions will be addressed. Why does a particular SpA patient not respond to a TNF antagonist? How can the clinician improve the probability of treatment response in patients who fail a TNF antagonist? What specific approaches can be taken to control disease activity in PsA or AS following treatment failure with a TNF antagonist? Data from controlled trials, registries and pilot studies will be combined with expert opinion to address these important questions.

Description of the registry of patients with ankylosing spondylitis in Turkey: TRASD-IP

A web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 ± 10.7 years). Mean disease duration was 12.1 ± 8.5 years, and mean time from initial symptom to diagnosis was 5 ± 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index was ≥4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses.

Soluble receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin in ankylosing spondylitis: OPG is associated with poor physical mobility and reflects systemic inflammation

The objective of the study was to investigate the role of receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) in ankylosing spondylitis (AS). Serum levels of soluble RANKL (sRANKL) and OPG were measured in 42 AS patients and 26 healthy controls. We evaluated the AS patient's disease activity, functional ability, global assessment, and physical mobility and tested markers of systemic inflammation, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. Serum levels of sRANKL [mean (SD), 4.75 (1.88) vs. 3.70 (1.14) pmol/l, p = 0.015] and OPG [mean (SD), 5.18 (1.19) vs. 4.52 (0.85) pmol/l, p = 0.026] were significantly higher in the 42 AS patients than the 26 healthy controls. Interestingly, serum OPG levels correlated significantly with ESR (r = 0.417, p = 0.007), CRP (r = 0.524, p < 0.001), tragus-to-wall distance (r = 0.556, p < 0.001), fingertip-to-floor distance (r = 0.423, p = 0.007), and occiput-to-wall distance (r = 0.465, p = 0.002) and correlated inversely with modified Schober index (r = -0.525, p = 0.001), cervical rotation (r = -0.403, p = 0.022), lateral lumbar flexion (r = -0.587, p < 0.001), and chest expansion (r = -0.553, p < 0.001). Moreover, in the AS patients with higher (> or =4.925 pmol/l, n = 21) serum OPG levels, there were significant increases in the tragus-to-wall distance (p = 0.007), fingertip-to-floor distance (p = 0.023), and CRP levels (p = 0.014) and decreased in the modified Schober index (p = 0.012), lateral lumbar flexion (p = 0.019), and chest expansion (p = 0.005). Serum levels of sRANKL and OPG are increased in the AS patients and may participate in the disease process of AS. Production of OPG has association with poor physical mobility and may reflect systemic inflammation in AS.

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.

Osteoporosis in Ankylosing Spondylitis

Osteoporosis (OP) is a frequent complication of ankylosing spondylitis (AS), even in early stages of the disease, and is associated with elevated levels of biochemical markers of bone turnover, proinflammatory cytokines, and acute-phase reactants. This suggests that systemic inflammatory mediators, such as interleukin-6 and tumor necrosis factor-alpha, may be involved. Various factors that conceivably work in conjunction with one another also cause bone loss in AS (eg, genetic polymorphisms of vitamin D, low levels of osteoprotegerin and sex steroid hormones, and impaired calcium and vitamin D absorption). Dual x-ray absorptiometry for assessing bone mineral density (BMD) has limitations in patients with AS because of unreliability of spinal measurements, particularly in advanced disease with new bone formation. Femoral neck BMD is reduced and correlates with increased risk of vertebral fractures. Hence, measurement of BMD at the femoral neck may provide the most accurate means of detecting osteopenia and OP and could assess fracture risk in AS patients. No guidelines are available for detection and treatment of OP in AS, and most patients are young men, who are less likely to be screened. The only evidence-based recommendation is that optimal control of disease activity in AS prevents bone loss. A recent study showed a beneficial effect of infliximab therapy on bone turnover markers and BMD in AS. Also, bisphosphonates may be useful in managing OP in AS.

Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL): Reliability and Validity of a New Patient-reported Outcome Measure

There is currently no universally accepted measure of quality of life in ankylosing spondylitis (AS). Our objective was to develop and evaluate a patient-reported outcome measure of quality of life in AS, EASi-QoL. We used patient interviews, a literature review, and completion of an individualized measure of AS quality of life during clinic-based and pilot surveys to derive questionnaire content. Classical and modern psychometrics were then used to evaluate the questionnaire using data from a large UK-based postal survey of 1000 patients with AS. Data analysis from the interviews and clinic-based and postal surveys produced a 57-item self-completed questionnaire. Fifteen items were removed as a result of patient interviews and the pilot survey. In total, 612 (64.0%) patients responded to the main postal survey. After assessment of data quality, confirmatory factor analysis, and Rasch analysis, 20 items were found to contribute to 4 domains of AS-related quality of life: physical function, disease activity, emotional well-being, and social participation. Item-total correlations ranged from 0.66 to 0.84. Cronbach's alpha and test-retest reliability estimates were 0.88-0.92 and 0.88-0.93, respectively. Confirmed hypothesized correlations with the AS Quality of Life questionnaire, the Bath AS Disease Activity Index, Bath AS Functional Index, SF-36, EQ-5D, and the Hospital Anxiety and Depression Scale were evidence for the construct validity of the EASi-QoL. The EASi-QoL has good evidence of data quality, internal reliability, test-retest reliability, and content and construct validity, and should be considered for use with patients in routine practice settings and in evaluative studies including clinical trials. Measurement responsiveness and minimal important change are currently being assessed.

Evaluation of therapeutic effects on sacroiliitis and enthesopathy in ankylosing spondylitis patients by color ultrasound

To explore the value of color Doppler ultrasound in evaluating the therapeutic effects on ankylosing spondylitis (AS) patients. Color Doppler high-frequency ultrasound images and blood flow in 30 healthy volunteers and 50 AS patients, changes of high-frequency ultrasound images and blood flow of involved sites in AS patients pre- and after-Etanercept treatments, as well as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and the Bath AS disease activity indices pre- and post-treatment were compared. Positive rates were significantly different between healthy volunteers and AS patients in terms of sacroiliac joints, Achilles tendon attachments, patellar ligament attachments, and rectus femoris tendon attachments by ultrasonograph (P < 0.05); and the fibular collateral ligament attachments positive rates had no significant difference with those at pre-treatment (P > 0.05). There was significant difference between patients with Bath AS disease activity index (BASDAI) ≥ 4 and those with BASDAI < 4 with respects to peripheral enthesis positive rate, Bath AS functional index (BASFI), patient's global assessment VAS (PGA), nocturnal back pain and general back pain VAS, morning stiffness duration, ESR and CRP (P < 0.05). Positive rates of sacroiliac joints, Achilles tendon attachments, patellar ligament attachments and rectus femoris tendon by ultrasonograph significantly decreased at Weeks 12 and 24 at post-treatment compared to that at pre-treatment (P < 0.05); there was significant difference for patient's BASDAI, BASFI, ESR and CRP at pre-treatment and weeks 12 and 24 post-treatment (P < 0.05). Ultrasound can sensitively detect the pathological changes of joint synovium and entheses so that it may be used as a routine method of monitoring diseases in these soft tissues, following up AS patients and evaluating clinical efficacy.

The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis

SummaryOsteoporosis is a well recognized complication of ankylosing spondylitis (AS). This study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis, and that bone turnover markers (BTM) are valuable markers to detect bone loss in AS.IntroductionThe aim of this study was to elucidate the pathophysiology of AS-related osteoporosis by investigating the relation between bone mineral density (BMD), BTM, vitamin D, and clinical assessments of disease activity and physical function, as well as to identify parameters that are related to low BMD (osteopenia or osteoporosis) in AS patients with active disease.MethodsOne hundred twenty-eight consecutive Dutch AS outpatients were included in this cross-sectional study. Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), C-reactive protein, ASAS-endorsed disease activity score (ASDAS), Bath AS Functional Index (BASFI), bone formation markers procollagen type 1 N-terminal peptide (PINP) and osteocalcin (OC), bone resorption marker serum C-telopeptides of type I collagen (sCTX), 25-hydroxyvitamin D (25OHvitD), lumbar spine and hip BMD, and vertebral fractures were assessed. Z-scores of BTM were calculated using matched 10-year cohorts of a Dutch reference group to correct for the normal influence that age and gender have on bone turnover.ResultssCTX Z-score, OC Z-score, BASDAI, age, and gender were independently related to low BMD. In addition, PINP Z-score, ESR, 25OHvitD, age, and gender were independently related to sCTX and/or OC Z-score.ConclusionsThis study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis. Furthermore, sCTX and OC Z-scores seem to be valuable markers to detect bone loss in AS patients in daily clinical practice where BMD of the lumbar spine, measured by DXA, may be overestimated due to osteoproliferation in patients with advanced AS.

Evaluation on short-term efficacy of cervus and cucumis polypeptide injection in treatment of ankylosing spondylitis

Objective To evaluate the short-term efficacy and safety of cervus and cucumis polypeptide injection(CCPI) in treatment of ankylosing spondylitis(AS).Methods 108 patients with AS were randomized into two groups :54 patients took NSAIDs and leflunomide (LEF) (control group),and 54 patients were treated with NSAIDs,LEF and CCPI(test group).The treatment was lasted for three weeks.The observation included the prevalence of low back pain,time of morning stiffness,Bath AS disease activity index (BASDAI),Bath AS functional index (BASFI) ,ESR,C-reactive protein(CRP) and side effects.SPSS16.0 statistics software was used to analyze the data.Results After treatment for three weeks,the prevalence of low back pain,the time of morning stiffness,BASDAI,BASFI,ESR and CRP were significantly lower than those at administration (P ＜ 0.05),and there were no table differences between the two groups too,(P ＜ 0.05).Gastrointestinal symptoms were the main side effects,but there were no significance between the two groups.Conclusion CCPI is an effective medicine in the treatment of AS,which could modify the disease activities,and its side effect is mild.It is suggested that CCPI can be used as an adjuvant medication in the treatment of AS. Key words: Spondylitis; Ankylosing; Cervus and cucumis polypeptide injection; Leflunomide

PMS2 ESTIMATING HEALTH-RELATED UTILITY FROM CLINICALLY ASSESSED DISEASE SEVERITY IN ANKYLOSING SPONDYLITIS

OBJECTIVES: We sought to conduct a statistical mapping analysis between a standard investigator assessment of disease severity in ankylosing spondylitis (AS) and domain responses in a standard index of health utility; and secondly, to implement the above mapping in an optimised algorithm to estimate utility. METHODS: Multinomial logistic regression was used to estimate response probabilities to each domain of the EQ5D from the Bath Ankylosing Spondylitis Metrology Index (BASMI) among patients enrolled into an RCT studying the use of either etanercept infusion vs. oral sulphasalazine (ASCEND). Other covariates tested were gender, age, co-morbidity, AS duration, DMARD history, and concurrent medications. Predicted EQ5Dindex was estimated by Monte Carlo bootstrap simulation. The predictive ability of the response mapping was assessed by comparing estimated and directly measured utility derived from the UK tariff. RESULTS: Evaluable data were available for 566 predominantly white (87%) patients, 74% of whom male, with a mean baseline age of 41 years (sd 12) and median AS duration 4 years (IQR 1 to 11). Average BASMIlinear was 4.1 (sd 1.8) whilst median observed EQ5D utility was 0.587 (IQR 0.193 to 0.691). The linear definition of the BASMI was optimal in an algorithm that also adjusted for gender, AS duration, number of co-morbid body systems, number of historic DMARDs, number of current non-DMARD drugs, and current NSAID use. The mean utility predicted by the optimized algorithm was 0.552 (sd 0.101) and 0.559 (sd 0.295) by estimation directly from EQ5D responses (p = 0.238). The mean squared error between the actual and predicted utilities was 0.076 (sd 0.111). Adjusted utility was defined by −0.044*BASMIlinear+0.715, with an R2 of 0.62. CONCLUSIONS: In this study, response mapping of AS disease activity to the EQ5Dindex produced reliable estimates of preference-based health-related utility. Future analysis will compare the relative ability of patient-reported, AS-specific, functional assessment measures in predicting health-related utility.

Assessing Back Pain: Does the Oswestry Disability Questionnaire Accurately Measure Function in Ankylosing Spondylitis?

To determine whether the Oswestry Disability Questionnaire (ODQ) can be used to assess the degree of pain or disability in patients with ankylosing spondylitis (AS). The ODQ was administered to a cohort of patients with AS. The resulting pain scores were correlated to the conventional measures in AS, the Bath AS Disease Activity Index and Functional Index (BASDAI and BASFI), as well as the Total and Nocturnal Back Pain scores, and the patient global assessment score. A total of 49 patients with AS were assessed (38 men, 11 women), mean age 40 years (range 17-68). The mean ODQ score was 40/100 (range 0-92), the mean BASDAI 3.7/10 (range 0-9.5), the mean BASFI 3.3/10 (range 0-9.7), the mean total back pain score 3.7/10 (range 0-10), and the mean patient global assessment score 3.6/10 (range 0-10). Correlation between the ODQ and the traditional AS outcome measures was very good, with a correlation coefficient of r = 0.73 (BASFI) and r = 0.70 (BASDAI). Correlations between the ODQ and the total back pain score (r = 0.70) and the patient self-reported global assessment (r = 0.61) were good. The strong correlations between the ODQ and BASFI and BASDAI indicate that it identifies both activity and function domains in AS. This is the first demonstration of a role for this outcome measure in the assessment of patients with AS.

Sexual functions in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the axial skeleton. In recent years, several authors reported an increased prevalence of sexual dysfunction among AS patients. We aimed to find out, whether the prevalence of erectile dysfunction among AS patients is different from age-matched healthy controls. Thirty-seven male patients with AS who were diagnosed according to the modified New York criteria and 67 normal healthy controls (NHC) were included in this study. Clinical characteristics of patients including age, disease duration and morning stiffness were noted. Disease activity was evaluated by using Bath AS disease activity index (BASDAI), functional statement was evaluated by using Bath AS functional index, and scores of spinal measurements were done by using Bath AS metrology index. Erectile function is evaluated using the International Index of Erectile Function (IIEF) scoring system. Health-related quality of life was assessed by short form 36. The mean age of the patients and controls were 42.8 + 10.8 and 43.6 + 5.9 years (P = 0.666). The prevalence of erectile dysfunction in AS patients and NHC were 35.1 and 26.9%, respectively (P = 0.335). There was no statistically significant difference between IIEF domain scores of AS patients and NHC except for the sexual desire domain (P = 0.014). Duration of morning stiffness and BASDAI was negatively correlated with sexual desire and overall satisfaction; however, they have no negative impact on erectile function, orgasmic function and intercourse satisfaction domains of IIEF. In this report, we showed that only the sexual desire domain of IIEF was significantly lower in AS patients. The prevalence of erectile dysfunction among AS patients is similar to NHC, which is a finding contrary to previous reports. AS patients do not suffer from erectile dysfunction, they rather have problems of satisfaction from the intercourse.

Psychological Correlates of Self-reported Disease Activity in Ankylosing Spondylitis

To investigate the role of psychological variables in self-reported disease activity in patients with ankylosing spondylitis (AS), while controlling for demographic and medical variables. Patients with AS (n = 294) meeting modified New York criteria completed psychological measures evaluating depression, resilience, active and passive coping, internality, and helplessness. Demographic, clinical, and radiologic data were also collected. Univariate and multivariate analyses were completed to determine the strength of the correlation of psychological variables with disease activity, as measured by the Bath AS Disease Activity Index (BASDAI). In the multivariate regression analysis, the psychological variables contributed significantly to the variance in BASDAI scores, adding an additional 33% to the overall R-square beyond that accounted for by demographic and medical variables (combined R-square 18%). Specifically, arthritis helplessness and depression accounted for the most significant portion of the variance in BASDAI scores in the final model. Arthritis helplessness and depression accounted for significant variability in self-reported disease activity beyond clinical and demographic variables in patients with AS. These findings have important clinical implications in the treatment and monitoring of disease activity in AS, and suggest potential avenues of intervention.

THE FIRST EXPERIENCE IN USING ADALIMUMAB IN PATIENTS WITH ANKYLOSING SPONDYLITIS: CLINICAL AND MRICOMPARISONS OF THE RESULTS OF THERAPY

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Disease Severity in Ankylosing Spondylitis: Variation by Region and Local Area Deprivation

To investigate whether patient disease severity in ankylosing spondylitis (AS) varies among regions or by local area social deprivation. 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. 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. 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.

Differences Between Juvenile-onset Ankylosing Spondylitis and Adult-onset Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease, which involves the spine, peripheral joints and entheses. Juvenile-onset ankylosing spondylitis (JAS) affects children under the age of 16 years. JAS has been noted to present as clinical courses different from those of adult-onset ankylosing spondylitis (AAS). Therefore, the purpose of the present study was to compare the possible risk factors, clinical manifestations, laboratory markers, radiological changes, and functional outcome between these 2 patient groups. AS patients were enrolled from the rheumatologic clinic of a tertiary medical center from January 1 to June 30 in 2006. The demographic data, clinical symptoms/signs, Bath AS indices, HLA-B27, inflammatory markers, radiological findings, and treatment history were acquired with questionnaires, clinical evaluation, and chart review. The differences between JAS and AAS patients were evaluated and analyzed. A total of 169 patients (142 males, 27 females) were included, comprising 47 JAS and 122 AAS patients. The ages of onset were 12.8 +/- 2.7 years and 25.0 +/- 7.4 years for JAS and AAS, respectively. They had similar gender distribution, years of delay to diagnosis and disease duration. A substantial proportion of our patients (40.4% of JAS and 34.4% of AAS) had physical trauma in the 1 month before disease onset. Also, 22.7% of JAS patients had intense physical training, while 25.2% of AAS patients did heavy work during the period. The first manifestation of JAS was mainly peripheral enthesopathy or arthritis, but axial symptoms in most AAS. More JAS patients had peripheral enthesopathies and arthritis on any occasion. Although there was a trend of higher score in Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI) and Physician's Global Assessment (PGA) score, JAS patients had a comparable Bath AS Functional Index (BASFI) and Bath AS Patient's Global Assessment (BAS-G) as AAS patients. As to the laboratory and radiological tests, JAS patients had higher levels of C-reactive protein and erythrocyte sedimentation rate, and more radiographic changes of hip joints. JAS and AAS patients had distinct presentations. JAS presented more peripheral enthesopathies and arthritis at disease onset and at any time of the course. If treated effectively, JAS will not lead to a worse functional outcome than AAS. Therefore, it is mandatory to diagnose and treat JAS as early as possible.

P30 EMR implementation in rheumatology

Amino-bisphosphonates like Pamidronate, having weak anti-Tumour Necrosis factor (TNF)-alpha property is effective in ankylosing spondylitis (AS).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.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.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.Intravenous Ibandronate has reasonable efficacy in the treatment of AS.

A 2-year comparative open label randomized study of efficacy and safety of etanercept and infliximab in patients with ankylosing spondylitis

The signs and symptoms of ankylosing spondylitis (AS) respond inadequately to nonsteroidal antiinflammatory drugs, corticosteroids, and disease modifying antirheumatic drugs in quite a number of patients. Tumor necrosis factor inhibitors have demonstrated to be of value in reducing AS disease activity in clinical trials. The efficacy and safety of both etanercept and infliximab in patients with ankylosing spondylitis were compared in a 2-year open label randomised study. Our results are consistent with a significant more rapid clinical improvement in the infliximab treated group. Treatment with both etanercept and infliximab at the end of the study was effective, safe, and well tolerated.

Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis

The objective of the present study was to compare two radiographic scoring methods (the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-spine)) in terms of reliability, construct validity, and feasibility in Turkish ankylosing spondylitis (AS) patients. The study involved seventy-four patients. The patients were evaluated with 100-mm visual analog scale (VAS) for pain, global assessment of patient, and global assessment of doctor. The laboratory evaluations of patients comprised erythrocyte sedimentation rate and serum C-reactive protein. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and Bath AS Radiology Index (BASRI) were calculated. Bilateral cervical, lumbar spine, and anteroposterior pelvis radiographs of all patients were obtained and evaluated by two radiologists. Each radiograph was scored by two scoring methods, mSASSS and BASRI-spine, and these methods were tested according to the aspects of the Outcome Measures in Rheumatology Clinical Trials filter: reliability, construct validity, and feasibility. The BASRI-spine reached intra- and interobserver intraclass correlation coefficient (ICC) of 0.726 and 0.689, respectively. The mSASSS scores more reliable, with ICC of 0.831 and 0.840, respectively. The BASMI and BASFI correlated significantly with the two scoring systems, respectively (mSASSS r: 0.557, r: 0.319; BASRI-spine r: 0.605, r: 0.285). For the two methods, the magnitude of the correlation with disease duration was similar (mSASSS p < 0.01 and BASRI p < 0.01), but no significant correlation was observed when compared to the BASDAI. It is known that the BASRI-spine is a feasible method that reliably detects damage in patients with AS. However, the present authors believe that, in AS patients, mSASSS should be the radiological scoring method to choose because of less radiation exposure, along with excellent intra- and interobserver reliability.