Disease Activity Score Research Articles

Prevalence of Frailty in Geriatric People with Rheumatoid Arthritis and its Relationship with Disease Activity

Background: Frailty, a condition of reduced physiological resilience, is common in older adults and is particularly prevalent among patients with rheumatoid arthritis (RA). RA's chronic inflammation can exacerbate frailty, leading to worse outcomes in the geriatric population. Aim of the study: This study aims to assess the prevalence of frailty in geriatric patients with RA and investigate its relationship with RA disease activity, measured by the Disease Activity Score in 28 joints (DAS28), as well as inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF). Methods: A cross-sectional study was conducted involving geriatric RA patients. Frailty was measured using a frailty index, while RA disease activity was assessed using DAS28. Clinical markers including CRP, ESR, and RF were also analyzed. According to frailty status, patients were divided into Robust (24) and prefrail/frail (76). Data was compared between subgroups. Results: The study found a significant prevalence of frailty among the geriatric RA population (76.0%) and there was female sex predilection. All patients were in normal or overweight groups according to their body mass index (BMI), and the majority of them were widows. In addition, drug therapy, grip strength score and MMSE were comparable between Robust and prefrail/frail subgroups. Higher RA disease activity (DAS28) (β=0.379, P = 0.001) and disease duration (β= 0.232, p = 0.008) were strongly associated with increased frailty Additionally, elevated levels of CRP and ESR were correlated with frailty, highlighting the link between inflammation and frailty in these patients. Conclusion: Disease activity and duration are key drivers of frailty in patients with RA. Managing RA effectively, particularly by achieving and maintaining low disease activity or remission, could significantly reduce the risk of frailty.

Association between disease activity and HALP score in ankylosing spondylitis patients

Association between disease activity and HALP score in ankylosing spondylitis patients

Comparison of the efficacy and safety of methotrexate injection and methotrexate tablets in active active rheumatoid arthritis.

This study aimed to compare the efficacy and safety of subcutaneous methotrexate (SC MTX) and oral MTX (OR MTX) in treating Chinese patients with active rheumatoid arthritis (RA). This study included patients with active RA in China. All patients were randomly assigned to receive SC MTX or OR MTX. The primary end point was Disease Activity Score-28 for erythrocyte sedimentation rate (DAS28-ESR) after 12 weeks of treatment. DAS28-ESR scores of the SC MTX and OR MTX groups significantly decreased compared with baseline at week 12. The least squares mean (± standard error) of the change in DAS28-ESR scores were -1.972 ± 0.1448 and -1.800 ± 0.1438 in the SC MTX and OR MTX groups. The intergroup difference was -0.173 ± 0.2041, indicating that the SC MTX group was not inferior to the OR MTX group. With respect to the secondary endpoints of ACR20/50/70, DAS28-CRP, and the proportion of patients in disease remission by DAS28(CRP) but not with DAS28(ESR), SC MTX was numerically better than OR MTX during the first 8 weeks but not all by week 12. The safety profile of SC MTX is similar to that of OR MTX in general, and the incidence, occurrences and Preferred Term types of drug-related TEAE of gastrointestinal system disorders were lower. SC MTX had similar overall therapeutic effects compared with OR MTX and was generally well tolerated. Some efficacy results showed greater improvement during the first 8 weeks of SC MTX vs OR MTX but not by week 12. https://www.chictr.org.cn, identifier ChiCTR2200066425.

Genetic Susceptibility and Disease Activity in Ankylosing Spondylitis: The Role of G Protein-Coupled Receptor 35rs4676410Polymorphism in a Turkish Population.

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disorder with a significant genetic predisposition. Genome-wide association studies (GWAS) have identified immune-related loci, including the G Protein-Coupled Receptor 35 (GPR35) gene, as potential contributors to AS pathogenesis. This study aimed to evaluate the association between the rs4676410 polymorphism in the GPR35 gene and both AS susceptibility and disease activity in a Turkish population. Methods: This case-control study included 200 participants (100 AS patients and 100 healthy controls). DNA was isolated from blood samples, and the rs4676410 polymorphism was analyzed using real-time polymerase chain reaction (PCR). Disease activity in AS patients was assessed using the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), and disease activity scores including C-reactive protein (ASDAS-CRP) scores. Statistical analyses were conducted using IBM SPSS 26. Results: The rs4676410 polymorphism was significantly associated with AS susceptibility. The AA genotype and A allele were more prevalent in AS patients, indicating an increased risk of developing AS. Among disease activity measures, ASDAS-CRP scores were significantly higher in patients with the AA genotype (p = 0.043), while no significant differences were observed for BASFI and BASDAI scores across genotypes. Conclusion: The findings suggest that the rs4676410 polymorphism in the GPR35 gene is associated with AS susceptibility and may influence disease activity through elevated inflammatory responses. These results highlight the potential of the AA genotype and A allele as genetic markers for AS and underscore the importance of integrating genetic insights into personalized treatment approaches.

Real-world effectiveness and retention rate of upadacitinib in patients with rheumatoid arthritis: results from a multicentre study

This study evaluates upadacitinib (UPA) effectiveness and drug retention rate (DRR) in patients with rheumatoid arthritis (RA). Multicentre prospective observational study. Consecutive patients with RA receiving UPA were evaluated at 0, 3, 6, 12, 18, and 24 months of treatment. Key outcomes included UPA DRR and changes in clinical and serological measures over time. The study included 215 patients (72.6% female sex, mean age 60.1 ± 11.7 years). The DRR of UPA was 91.6% (95% CI 88.0–95.4%) at 6 months, 84.6% (95% CI 79.8–89.7%) at 12 months, 80.3% (95% CI 75.0–86.0%) at 18 months and 80% (95% CI 75.0–86.0%) at 24 months. UPA DRR was similar between monotherapy and methotrexate combination (p = 0.47), and across different treatment lines (p = 0.58). A statistically significant improvement from baseline was observed over 24 months considering erythrocyte sedimentation rate, C-reactive protein (CRP), Health Assessment Questionnaire (HAQ), Disease Activity Score (DAS)28-CRP, Physician’s (Ph) and Patient’s (Pt) Global Assessment (GA), Visual Analogue Scale (VAS) Pain, Simplified and Clinical Disease Activity Index (SDAI and CDAI) (p < 0.00 for all of them). Patients discontinuing UPA were more likely to be male (p = 0.02), with a longer disease duration (p = 0.03), higher baseline values of VAS Pain (p < 0.00), PtGA (p < 0.00), PhGA (p < 0.00), CDAI (p < 0.00), SDAI (p < 0.00) and corticosteroid dosage (p = 0.04). This study confirms UPA effectiveness in managing RA in the real-world practice, demonstrating sustained drug retention and improvements in clinical and laboratory measures over time. Also, UPA could be a valuable option for patients with multi-refractory RA and when monotherapy is preferred.

Retinal Vascular Parameters Changes (by Optical Coherence Tomography Angiography) in Early Rheumatoid Arthritis: A Hospital-Based Study

ABSTRACT Purpose To evaluate the retinal vascular changes related to early Rheumatoid Arthritis (RA) and to correlate these changes with disease activity. Methods 108 eyes of 54 early RA patients and 66 eyes of 33 age and sex-matched healthy participants underwent Optical Coherence Tomography Angiography (OCTA) examination to evaluate superficial (SCP), deep retinal capillary plexus (DCP), and radial peripapillary capillaries (RPC), we collected Values of the vessel density (VD) of SCP and DCP, central foveal thickness (CFT), foveal avascular zone (FAZ) along with a full rheumatological examination and disease activity score by (DAS28). Results RPC values were significantly lower among RA patients in all subfields apart from the temporal one. There was a significant difference between RA patients and healthy controls in foveal and all perifoveal measurements, except the nasal perifoveal region. Also, the FAZ value was significantly higher in RA patients. We performed Spearman’s correlation between OCTA and RA disease parameters and detected a negative correlation between the duration of disease-related symptoms and RPC and parafoveal measurements and between DAS-28 and foveal measurements. A significant positive correlation between anti-CCP titer and FAZ measurements was detected among RA patients. Conclusion OCTA can detect early retinal microcirculation affection in RA patients in the form of a reduction in the vascular density in most of the subfields of the peripapillary area as well as the fovea, perifoveal, and parafoveal areas. The results of the current study can provide new insight into the applications of OCTA as a diagnostic tool in RA patients’ assessment and follow-up.

Effects of plant active substances in rheumatoid arthritis—a systematic review and network meta-analysis

BackgroundPlant active substances are extensively utilized in treating rheumatoid arthritis (RA). Despite numerous experimental and clinical studies on plant active substances their efficacy remains largely unsubstantiated. The widespread use of these extracts as therapeutic measures for RA is problematic due to the lack of compelling evidence.ObjectiveOur research aims to assess the impact of plant active substances on RA by conducting a network meta-analysis.MethodsWe systematically searched four electronic databases—PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science—from their inception to August 2024. The main focus was on assessing primary outcomes, including the Visual Analogue Scale (VAS), inflammatory markers, Swollen Joint Count (SJC), Tender Joint Count (TJC), and Disease Activity Score on 28 joints (DAS28). We performed data analysis using StataMP 15.1 software and ranked the therapeutic effects based on the Surface Under the Cumulative Ranking Curve (SUCRA) probability values.ResultsBased on screening procedures, 18 eligible studies were incorporated into the analysis. These studies encompassed a total of 1,674 RA patients and investigated 10 different plant active substance therapies. Specifically, 10 studies included VAS indicators, 17 studies included inflammatory marker indicators, 14 studies included DAS28 indicators, 13 studies included SJC indicators, and 13 studies included TJC indicators. Based on SUCRA values, quercetin appeared to be the most effective treatment for decreasing serum VAS levels (67.3%). Furthermore, curcumin emerged as the most promising option for reducing inflammatory marker levels (72.3%), SJC (75.6%), and TJC (76.2%). Lastly, with respect to DAS28, resveratrol emerged as the optimal choice (74.3%).ConclusionAccording to the network meta-analysis (NMA), curcumin exhibited superior efficacy compared to placebo in decreasing SJC and TJC. Additionally, curcumin demonstrated greater effectiveness in reducing inflammatory markers. Quercetin was more effective in reducing VAS, and resveratrol was more effective in reducing DAS28. Patients with RA may benefit from these findings. Insightful information from this study is helpful for RA patients to consider using plant active substance therapies. For their efficacy and safety to be confirmed, more proof is needed.

Evaluation of patient-based disease activity score (PDAS) in the Japanese rheumatoid arthritis patient registry (NinJa registry).

Patient-reported outcomes (PROs) should be regarded as an important factor in the management of rheumatic diseases. The Patient-based disease activity score (PDAS) was developed as a clinically reliable composite measure for evaluating PROs in rheumatoid arthritis (RA) patients. To replicate and further characterize PDAS, we analyzed PDAS and its clinical relevancy in the National Database of Rheumatic Diseases in Japan (NinJa). Clinical data from the 2022 version of NinJa were analyzed. PDAS1 was calculated for each patient, and statistical analyses, including correlation analyses and multiple regression analysis, were conducted to evaluate the relationship between PDAS1 and other clinical measures. Propensity score (PS) matching was used to compare patients treated with different types of disease-modifying anti-rheumatic drugs (DMARDs). The number of included patients was 11983. PDAS1 demonstrated strong correlations with DAS28(ESR) (R = 0.89, p< 2.2x1016) and CDAI, indicating its utility in assessing disease activity. The majority of patients (71.8%) achieved PDAS1-defined remission, aligning closely with DAS28 and CDAI remission. PDAS1 was significantly associated with serum rheumatoid factor (RF) titers (R = 0.25, p< 0.001), and RF-positive patients exhibited higher PDAS1 scores. Notably, PS matched comparison revealed that PDAS1 was lower in patients treated with IL-6 inhibitors, compared with those treated with TNF inhibitors, reflecting differences in lower patient global assessment. PDAS1 is a reliable and useful tool for evaluating both disease activity and the functional state of RA patients, particularly from the perspective of PROs. Additionally, PDAS1 can be used for conducting clinical studies in RA patients.

Wnt signaling as a translational target in rheumatoid and psoriatic arthritis.

Rheumatoid arthritis (RA) and Psoriatic arthritis (PsA) are chronic inflammatory diseases mainly affecting joints. RA primarily targets the synovial joints and is characterized by cartilage and bone erosion, whereas PsA is associated with skin and nail psoriasis and is characterized by erosive bone damage with an exuberant bone formation and soft tissue involvement. Recent evidence described the involvement of the Wnt pathway in the pathogenesis of these diseases. Thus, we aimed to analyze some components of Wnt signaling, i.e. DKK1, Wnt 5a and β-catenin, and their association with disease activity indices, investigating possible differences between the two diseases. Sera from 18 RA patients naïve for biological therapy, 18 PsA patients and 20 matched healthy donors (HD) were tested for DKK1 by ELISA, Wnt 5a and β-catenin by Immunoblotting. Values were correlated with CTX-1, detected by ELISA, and with disease activity indices: Disease Activity Score on 28 joints (DAS28-CRP) for RA and the Disease Activity in Psoriatic Arthritis (DAPSA) score for PsA. This study highlights significant increase in DKK1, Wnt 5a, and β-catenin levels in RA and PsA patients compared to HD, with distinct patterns of correlation with disease activity indices. Indeed, in RA patients, DKK1 levels positively correlated with DAS28-CRP score, whereas in PsA patients, DKK1 levels negatively correlated with DAPSA score. Our findings showed a strong correlation between DKK1 and CTX-1 levels in RA patients, supporting the relationship between DKK1 levels and the presence of joint erosions. Furthermore, a significant positive correlation was found between β-catenin and IL-6 levels in RA, indicating that β-catenin may be involved in the inflammatory cascade. This study compares the involvement of Wnt signaling in RA and PsA, suggesting that Wnt signaling may represent a possible mechanism of disease activity. In particular, it indicates that DKK1 levels are correlated with CTX-1, a marker of bone resorption, and with disease activity in RA patients. These findings underscore the importance of these biomarkers in the potential monitoring of patients, offering insights into disease mechanisms and potential therapeutic targets.

Upadacitinib in active non-radiographic axial spondyloarthritis: 2-year data from the phase 3 SELECT-AXIS 2 study

BackgroundIn SELECT-AXIS 2, upadacitinib improved the signs and symptoms of active non-radiographic axial spondyloarthritis (nr-axSpA) through 52 weeks versus placebo and was well tolerated. Here, we evaluated the efficacy and safety of upadacitinib through 2 years.MethodsThe study enrolled eligible adult patients with a clinical diagnosis of nr-axSpA who met the 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria and had objective signs of active inflammation on magnetic resonance imaging (MRI) of sacroiliac joints and/or high-sensitivity C-reactive protein. Patients were randomized 1:1 to receive double-blinded treatment with upadacitinib 15 mg once daily (QD) or placebo for 52 weeks, after which all patients received open-label treatment with upadacitinib 15 mg QD. Efficacy results over 104 weeks were reported as observed (AO) and either AO with non-responder imputation (AO-NRI; binary endpoints) or AO with mixed-effect model for repeated measures (continuous endpoints). Treatment-emergent adverse events (TEAEs) were summarized through week 104.ResultsOf 313 patients randomized and treated, 224 (continuous upadacitinib n = 117; placebo/upadacitinib n = 107) completed 104 weeks of treatment. In patients who received continuous upadacitinib, sustained improvement was observed through 2 years of treatment across efficacy endpoints including disease activity, pain, function, enthesitis, quality of life, and MRI measures of inflammation. At week 104, 57.1%, 59.0%, and 31.4% of patients achieved ASAS40 response, and low disease activity and inactive disease (as defined by Axial Spondyloarthritis Disease Activity Score), respectively (AO-NRI); week 104 outcomes were generally similar in patients who initially received placebo and were switched to upadacitinib at week 52. In total, 286 patients were exposed to ≥ 1 dose of upadacitinib, comprising 378.3 patient-years (PY) of exposure. Upadacitinib was generally well tolerated, with exposure-adjusted event rates (EAERs) for TEAEs, serious adverse events (AEs), and AEs leading to study drug discontinuation of 207.5, 8.7, and 5.3 events/100 PY, respectively. EAERs of TEAEs of special interest were broadly consistent with those reported through week 52.ConclusionsTreatment with upadacitinib demonstrated consistent improvement and maintenance of treatment effect across efficacy endpoints through 2 years; no new safety signals were identified with additional exposure.Trial registrationNCT04169373.

Circulating cell-free DNA as a potential biomarker for prediction of disease activity and prognosis among Egyptian rheumatoid arthritis patients.

Cell-free DNA (cfDNA) has emerged as a potential biomarker for assessing disease activity and prognosis in rheumatoid arthritis (RA). However, the association between cfDNA levels and the established RA markers of inflammation and disease severity remains unclear. The current study aimed to detect plasma levels of cfDNA in patients with RA and to investigate their association with RA activity indicators (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease activity score-28 (DAS28)), prognostic markers (rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA)), and the musculoskeletal ultrasonographic (US7) scores. This controlled cross-sectional study included 108 RA patients and 108 healthy controls. Plasma levels of cfDNA were quantified by real-time PCR using ALU repeats. Levels of ESR, CRP, RF, and ACPA were measured using routine laboratory assays. Synovial inflammation and joint damage evaluation was performed using the US7 scoring system. Plasma levels of cfDNA were higher in RA patients than controls (P < 0.001) and significantly increased with higher DAS28 scores among all RA activity groups. Also, cfDNA levels were significantly positively correlated with ESR, CRP, RF, and ACPA levels (P-values <0.001). Regarding US7, cfDNA was significantly positively correlated with synovitis and erosion scores (P-values <0.05) but did not correlate significantly with tenosynovitis scores (P-values >0.05). In addition, plasma cfDNA was significantly higher in seropositive RA patients than in seronegative patients (P = 0.007). The odds ratio for cfDNA as a risk factor for erosions was 2.254. This study revealed that cfDNA levels are elevated in RA patients and positively associated with disease activity indicators and prognosis markers. Further research is warranted to validate these findings in larger cohorts and explore the clinical implications of cfDNA measurement in RA management.

Predictors of secukinumab treatment response and continuation in axial spondyloarthritis: results from the EuroSpA research collaboration network.

In patients with axial spondyloarthritis (axSpA) initiating secukinumab, we aimed to identify baseline (treatment start) predictors of achieving low disease activity (LDA) after 6 months, as measured by Axial Spondyloarthritis Disease Activity Score using C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), as well as treatment continuation after 12 months. From 11 European registries, patients with axSpA, who initiated secukinumab treatment in routine care, with available data on 6-month ASDAS and BASDAI assessments were included. Logistic regression analyses on multiply imputed baseline data were performed; potential baseline predictors included demographic, diagnosis, lifestyle, clinical and patient-reported variables. In a pooled cohort of 1,174 patients with axSpA, 5 of 19 potential assessed variables were mutually predictive for achieving LDA by ASDAS-CRP and BASDAI: higher Physician Global Assessment score, non-current smoking, lack of prior exposure to biologic/targeted synthetic Disease-Modifying Anti-Rheumatic Drugs, lower Health Assessment Questionnaire scores and BASDAI scores. Moreover, radiographic axSpA and CRP ≤ 10mg/L were associated with achieving ASDAS-CRP LDA; HLA-B27 positivity and history of psoriasis with achieving BASDAI LDA; while earlier time of secukinumab initiation (2015-2017) was associated with treatment continuation. In this European real-world study of patients with axSpA initiating secukinumab, predictors of achieving LDA by ASDAS-CRP and BASDAI at 6 months and remaining on treatment at 12 months included both clinical, patient-reported and lifestyle factors, underscoring the complex mechanisms of real-world drug effectiveness.

Biosimilars Versus Originators in Children With Juvenile Idiopathic Arthritis: A Real-World Experience

We aimed to evaluate the efficacy, safety, and immunogenicity profile of Etanercept (ETA) and Adalimumab (ADA) biosimilars (BIOs) compared to their originators in children with juvenile idiopathic arthritis (JIA). Eighty-one JIA children treated with ETA or ADA originators or BIOs were examined at baseline (T0) and after 3- (T1), 6- (T2), 12- (T3), and 24-(T4) months after starting treatment. Lower Juvenile Arthritis Disease Activity Score 10 (JADAS-10) scores were reported at T1, T2, T3, and T4 in JIA children treated with BIOs than originators (all p < 0.05). At T1 and T3, anti-drugs antibodies levels were lower in children receiving BIOs than originators (p = 0.04 and p = 0.0007, respectively), even after adjustments (both p < 0.05). Relapses were lower for BIOs compared to originators (p < 0.001). Safety profile was comparable between the groups (p > 0.05). A better overall profile of BIOs than originators was demonstrated in JIA children, but larger confirmatory studies are needed.

Cumulative experience meets modern science: Remarkable effects of TongXieYaoFang formula on facilitating intestinal mucosal healing and secretory function.

TongXieYaoFang (TXYF), a classical formula used in Traditional Chinese Medicine, is renowned for its efficacy in treating chronic abdominal pain and diarrhoea. Modern research suggests that fundamental relief from these symptoms depends on complete intestinal mucosal healing, which normalises gut secretory functions. Consensus between traditional and modern medical theories indicates that TXYF is particularly suitable for treating the remission phase of ulcerative colitis (UC). Unfortunately, its potential in the remission phase has not received sufficient attention, and its use has been largely limited to a supportive role during the acute phase. This study aimed to elucidate the efficacy of TXYF in promoting intestinal mucosal healing and enhancing gut secretory function during the non-acute damage phase, as well as to identify the underlying mechanisms contributing to its effects. A mouse model of dextran sulphate sodium salt (DSS)-induced colitis was optimised to specifically evaluate the effects of TXYF on mucosal healing during the repair phase. The effects of TXYF on murine colon function were assessed by measuring faecal pellet count and water content, and further evaluated through immunohistochemical analyses. The underlying mechanisms of action of TXYF were elucidated using mouse intestinal organoid cultures, intestinal stem cell (ISCs) transplantation, immunofluorescence, and western blotting. Active components of TXYF were identified via LC-MS/MS analysis and integrated with network pharmacology for bioinformatics assessment. TXYF significantly promoted mucosal healing, as reflected by reduced disease activity scores, increased colon length, enhanced epithelial proliferation, and decreased histological damage. Furthermore, TXYF enhanced the recovery of critical intestinal functions, including barrier integrity, absorption, secretion, and motility. Notably, the improvement in the secretory function was particularly pronounced. Mechanistically, these therapeutic effects were mediated by the upregulation of the Atonal homolog 1/SAM pointed domain containing ETS transcription factor/Mucin 2 pathway, which facilitates the differentiation and maturation of ISCs into goblet cells, thereby contributing to both mucosal repair and enhanced secretory function. Our study demonstrated that TXYF significantly promotes intestinal mucosal healing and enhances secretory function. These findings offer a solid basis for exploring the potential applications of TXYF in UC management during the remission phase.

Assessment of choroidal vascularity index in juvenile idiopathic arthritis: implications for disease monitoring.

Juvenile Idiopathic Arthritis (JIA) can affect ocular structures, but choroidal involvement is not well understood. This study investigates the Choroidal Vascularity Index (CVI) in JIA patients compared to healthy controls and explores its relationship with disease activity. In this cross-sectional study, 35 JIA patients and 40 healthy controls underwent comprehensive ophthalmic examination and swept-source optical coherence tomography (SS-OCT). CVI, central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were measured. The Juvenile Arthritis Disease Activity Score (JADAS) was calculated for JIA patients. Statistical analysis included comparison between groups and correlation analysis. JIA patients showed significantly lower CVI compared to controls (68.3 ± 2.5% vs. 72 ± 4.6%, p < 0.001). No significant difference was found in SFCT. CVI demonstrated a moderate negative correlation with JADAS (r = -0.368, p < 0.05). However, receiver operating characteristic (ROC) analysis revealed poor diagnostic performance of CVI for detecting JIA (AUC = 0.25). The study reveals reduced choroidal vascularity in JIA patients and a correlation between CVI and disease activity. While CVI shows limited diagnostic utility, it may serve as a potential marker for monitoring inflammatory burden and treatment response in JIA. Further research is needed to establish its clinical utility fully.

Psychometric Properties of the Persian Version of the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) and Ankylosing Spondylitis Disease Activity Score (ASDAS) Questionnaires: A Cross-Sectional Study.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects quality of life (QoL) due to its impact on physical and emotional well-being. Accurate and reliable tools are needed to assess disease activity and QoL in different cultural contexts. This study aimed to evaluate the psychometric properties of the Persian versions of the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) and Ankylosing Spondylitis Disease Activity Score (ASDAS) scales in Iranian AS patients. A cross-sectional study was conducted on 70 AS patients referred to a tertiary hospital in Tehran. Patients completed the EASi-QoL, and 39 also completed the ASDAS questionnaire. The translation followed the forward-backward method. Reliability was assessed using Cronbach's α for internal consistency and intraclass correlation coefficient (ICC) for test-retest reliability. Content validity was evaluated using the content validity ratio (CVR) and Content Validity Index (CVI). Test-retest reliability was examined using Spearman's rank correlation for non-normally distributed data. The ICC values for EASi-QoL ranged from 0.71 to 0.82, while Spearman's correlation coefficients ranged from 0.63 to 0.80. For ASDAS, all items except Question 1 had ICC and Spearman's correlation coefficients above 0.8, indicating high test-retest reliability. The average CVR for EASi-QoL was 0.56, and for ASDAS it was 0.68. The CVI for relevance, clarity, and simplicity ranged from 0.86 to 0.96 for both scales, confirming good content validity. The Persian versions of the EASi-QoL and ASDAS scales demonstrate adequate reliability and validity. These tools are suitable for assessing QoL and disease activity in Iranian AS patients, providing culturally relevant measurements for clinical and research settings.

Barriers and facilitators to treat-to-target in axial spondyloarthritis in clinical practice: a mixed methods study

This study aimed to explore the perceptions of patients and rheumatologists about a treat-to-target (T2T) strategy in axial spondyloarthritis (axSpA) and identify the barriers and facilitators to its implementation in clinical practice. A mixed methods design was applied. Patients with axSpA who visited the outpatient clinic with active disease (AxSpA Disease Activity Score [ASDAS] ≥ 2.1), but did not receive a treatment adjustment, were identified. These patient cases were discussed in individual semi-structured interviews with the respective treating rheumatologists, and a subgroup of these patients was also interviewed. In parallel, all interviewed participants completed a quantitative survey. Qualitative and quantitative data were analysed thematically and descriptively, respectively. Twenty-three patients were discussed with 11 rheumatologists, and 16 of these patients were interviewed personally. Barriers to T2T included challenges in the measurement of inflammatory disease activity using the ASDAS, and numerous patient-related factors such as concern about treatment adaptations. The limited number of viable treatment options and scarce amount of evidence supporting T2T in axSpA, as well as logistical challenges, were additional obstacles. Facilitators included patients’ broad knowledge about axSpA, rheumatologists’ awareness of T2T recommendations, and positive doctor-patient relationships with the application of shared decision-making. Moreover, a supporting infrastructure, such as one with high accessibility to the outpatient clinic between scheduled visits, was considered necessary for the application of a T2T strategy. In conclusion, numerous barriers and facilitators to the implementation of a T2T strategy in axSpA are present, which need to be considered when applying this treatment approach in clinical practice.

Long-term safety and sustained efficacy of bimekizumab in patients with ankylosing spondylitis (radiographic axial spondyloarthritis): 5-year results from BE AGILE (phase 2b) and its open-label extension

ObjectiveAssess long-term safety, tolerability and efficacy of bimekizumab in ankylosing spondylitis (radiographic axial spondyloarthritis (r-axSpA)).MethodsPatients with active r-axSpA completing the dose-ranging 48-week randomised controlled trial could enrol in the open-label...

Impact of the treatment with TNF inhibitors and JAK Inhibitors on arterial stiffness and lipid parameters in rheumatoid arthritis patients: a cross-sectional study

Abstract Introduction Rheumatoid arthritis (RA) is a chronic inflammatory joint disease associated with an increased cardiovascular risk. Treating disease activity with biologic and synthetic disease-modifying antirheumatic drugs (DMARDs) diminishes cardiovascular risk, but the vascular effects of different biologic and targeted synthetic drugs are poorly understood. Echo-tracking parameters of carotid artery can reveal arterial stiffness as a marker of subclinical atherosclerosis. Methods Patients with RA of at least 6 months of duration, treated with TNF inhibitors or JAK inhibitor - upadacitinib(UPA) and healthy subjects underwent ultrasound examination of carotid artery using the Aloka ProSound Alpha 7. The measurements included pulse-wave velocity (PWVβ), beta-stiffness, augmentation index (AI), arterial compliance (AC), and Ep (Elastic Modulus) and laboratory examination of lipid parameters. Disease activity of RA was measured using Disease activity scores - DAS28-CRP, DAS28-ESR, and Clinical Disease Activity Index (CDAI). Data were analyzed with SPSS v29 and the Kruskal-Wallis test was used to determine statistical differences among the three groups. Results 97 subjects, mean age 55.36±11.84, 83% females. Of them 38 on TNF inhibitors, 36 on UPA, and 23 controls. The three groups were similar in age, BMI, smoking status, and Framingham risk score. Disease activity and disease duration did not differ between the two patients groups. PWV was significantly higher in the UPA group compared to controls but not significantly different from the TNF group. (6.825 vs. 5.8022 vs. 6.468, p=0.034 UPA vs. Control, p=0.59 UPA vs. TNF) (fig.1). AC was lower and Ep was higher in the UPA group compared to controls (0.6511 vs. 0.8678, p=0.032 and132 kPa vs. 92.3, p=0.04 respectively). Total cholesterol levels were higher in the UPA group compared to TNF treated patients and to the control group (fig.2). Conclusion Echo-traching examination of the carotid artery is an easily perfomed, non-invasive and highly informative method of detecting early signs of vascular impairment in patients with RA treated with TNF inhibititors and JAK inhibitor. Treatment with UPA increases the levels of total cholesterol.

Bisdemethoxycurcumin and Curcumin Alleviate Inflammatory Bowel Disease by Maintaining Intestinal Epithelial Integrity and Regulating Gut Microbiota in Mice.

Curcuminoids, found in turmeric (Curcuma longa L.), include curcumin (CUR), demethoxycurcumin (DMC), and bisdemethoxycurcumin (BDMC). Although CUR and DMC are well-studied, the anti-inflammatory effects of BDMC remain less explored. Recent studies highlight BDMC's stronger NF-κB inhibition compared to CUR and DMC in cell models, along with its ability to target pathways associated with inflammatory bowel disease (IBD) in DSS-induced colitis mice, reflected by lower disease activity scores and reduced inflammation. This study assessed CUR and BDMC in a DSS-induced colitis mouse model. Dietary administration of CUR or BDMC strengthened tight junction (TJ) proteins, reduced inflammatory cytokine secretion, and attenuated intestinal inflammatory protein expression, thereby alleviating DSS-induced IBD in mice. Furthermore, gut microbiota and short-chain fatty acid analyses revealed that CUR and BDMC effectively regulated gut microbial imbalance and promoted the relative abundance of butyrate-producing bacteria. Furthermore, CUR showed low absorption and was primarily excreted in feces, while BDMC had higher absorption levels. In conclusion, while both BDMC and CUR have potential as adjunct therapies for IBD, BDMC at a concentration of 0.1% showed strong anti-inflammatory effects and enhanced TJ proteins, suggesting that BDMC, even at lower concentrations than CUR, holds promising therapeutic potential and prospects.