scholarly journals AB0664 DIAGNOSIS DELAY IN ANKYLOSING SPONDYLITIS PATIENTS IN EGYPT: FACTORS, SOCIOECONOMIC AND CLINICAL OUTCOME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1627.2-1627
Author(s):  
F. I. Abdelrahman ◽  
M. Mortada
Keyword(s):  
Ankylosing Spondylitis ◽  
Social Life ◽  
Activity Index ◽  
Diagnostic Delay ◽  
Disease Activity Index ◽  
Diagnosis Delay ◽  
Functional Index ◽  
Delay In Diagnosis ◽  
Significant Difference ◽  
The Mean

Background:Ankylosing spondylitis (AS) is a destructive inflammatory disease which was reported to have the longest diagnostic delay among the inflammatory rheumatic disease. This lag period have a great impact on the clinical outcome and socioeconomic state of the patients. With the advent of tumor necrosis factor-α (TNF-α) inhibitors, early diagnosis in AS has become important(1).Objectives:to evaluate the period from symptom onset to diagnosis of AS in Egyptian patients and to examine possible reasons for delayed diagnosis and its impact on the economic and social life of the patients.Methods:The study included 87 AS patients diagnosed according to the Assessment of Spondyloarthritis international Society (ASAS) criteria (2). A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first AS symptom and correct diagnosis of AS. Clinical and functional assessment of axial SpA measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI). The direct medical cost during years of delay (including costs of medical consultations, medications, investigations, physiotherapy and surgical treatment) had been estimated by Egyptian pound.Results:The study included 87 AS patients with mean age (30.03±8.3), 70 male (80.5%) and 17 female (19.5%).Mean delay in diagnosis was(5.7 ±4.9) years. Mean of diagnostic delay for patient diagnosed before 2010 is (14±4.4) and that of patients diagnosed after 2010 is (3.5±1.8) with significant difference between both (p value<0.0001). The main cause of delay was incorrect diagnosis as follow degenerative disc disease (43/87, 49.4%), non-specific back pain (31/87, 35.6%), rheumatoid arthritis (10/87,11.5%), rheumatic fever (2/87, 2.3%) and tuberculosis of spine (1/87, 1.1%). The mean of the medical visits was (6±5.4). Most incorrect initial diagnoses were made by orthopedicians (57.9%), followed by neurologists (22.2%) followed by rheumatologist (10%) and general phyisicians (9.9%). Absence of extra-articular manifestations, negative family history and juvenile age are significantly associated with diagnostic delay. Delay in diagnosis is significantly associated with higher disease activity index(BASDAI), functional index (BASFI), and damage index(BASMI). The mean of the costs during years of delay is (15671.3±546.1) with the mean of cost per each year delay (660.9±6.6) with high significant association between the cost and longer delay in diagnosis (<0.0001). Regarding work ability, we found that(32.2%) are fit for work, unfit (29.9%), partially fit (37.9%) with high significant difference between ability of work and shorter delay. Regarding social effect, 40.2 % of patients developed negative effect on social life with significant association to diagnostic delay (0.004).Conclusion:Our study confirmed the importance of early diagnosis of AS due to its impact on patient’s health outcome and socioeconomic state.We recommend to increase the awareness about the disease among healthcare professionals in our region.References:[1]Sykes M. et al: Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis; Ann Rheum Dis.2015;74:e44.[2]Rudwaleit M. et al: The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis; Ann Rheum Dis, 68 (2009), pp.777-783.Disclosure of Interests:None declared

scholarly journals AB0669 PARTICULARITIES OF TUNISIAN FEMALE AXIAL SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1629.2-1629
Author(s):  
K. Ben Abdelghani ◽  
Y. Gzam ◽  
A. Fazaa ◽  
S. Miladi ◽  
K. Ouenniche ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Activity Index ◽  
Age At Onset ◽  
Disease Onset ◽  
Disease Activity Index ◽  
Reactive Protein ◽  
Significant Difference ◽  
The Mean

Background:Axial spondyloarthritis (ax-SpA) is a chronic rheumatic disease that mainly affects men. However, the female form of ax-SpA remains insufficiently studied.Objectives:The aim of this study was to determine the clinical characteristics, the disease activity and the functional impact of female ax-SpA in comparison with male ax-SpA.Methods:This is a retrospective study including patients diagnosed with ax-SpA fulfilling the criteria of the Assessment of SpondyloArthritis international Society (ASAS) 2009.Clinical parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath ankylosing spondylitis disease activity index (BASDAI) and Bath ankylosing spondylitis functional index (BASFI) were compared between groups of female and male ax-SpA.Results:Two hundred ax-SpA patients were included with 31% of female (n=62) and a mean age of 43,3 ± 11,2 years.The mean age at onset of symptoms was 31,8 ± 8,9 years for women and 25,3 ± 9,1 years for men (p <0,0001). The mean age at diagnosis was 36,4 ± 9,6 years for women and 31,7 ± 10,4 years for men (p = 0,003). Ax-SpA with juvenile onset was noted in 1,7% of women and 12,1% of men (p = 0,02). Male ax-SpA were significantly more smokers (46.8% vs 5.4%; p <0.001). The mean duration of morning stiffness was 11,3 ± 9,2 minutes for women versus 21,6 ± 19,3 minutes for men (p = 0,005).The mean ESR was 42,4 ± 29,8 mm for women and 28,3 ± 23,4 mm for men (p = 0,001). Radiographic sacroiliitis was present in 69,3% of women versus 84,7% of men (p = 0,01). The use of anti-TNF alpha was less frequent in women (29% vs 48,5%; p = 0,01).Our study didn’t found a statistically significant difference in peripheral manifestations, extraarticular manifestations, CRP, BASDAI and BASFI between the two groups.Conclusion:Female ax-SpA seems to have a better prognosis than male with older age in disease onset, less inflammation, less radiographic sacroiliitis and less use of biological treatments.References:[1]Rusman T, et al. Curr Rheumatol Rep. 2018; 20(6).[2]Siar N, et al. Curr Rheumatol Rev. 2019;Disclosure of Interests:None declared

scholarly journals Usporedba učinkovitosti i trogodišnjeg preživljenja TNF-α inhibitora u liječenju ankilozantnog spondilitisa

2020 ◽  
Vol 56 (1) ◽  
pp. 51-58
Author(s):  
Filip Mirić ◽  
Srđan Novak
Keyword(s):  
Ankylosing Spondylitis ◽  
Analogue Scale ◽  
Activity Index ◽  
Disease Activity Index ◽  
C Reactive Protein ◽  
Functional Index ◽  
Reactive Protein ◽  
Tnf Α ◽  
Factor Α ◽  
Necrosis Factor

Cilj: Svrha rada bila je utvrditi i usporediti učinkovitost te preživljenje TNF-α (engl. tumor necrosis factor-α) inhibitora (adalimumab, golimumab, infliksimab) tijekom trogodišnjeg praćenja u liječenju ankilozantnog spondilitisa. Materijali i metode: Ovim retrospektivnim istraživanjem obuhvaćena je skupina od 29 ispitanika koji su primili prvi biološki lijek na Odjelu reumatologije i kliničke imunologije Kliničkog bolničkog centra Rijeka. Započeli su s biološkim lijekom u razdoblju od siječnja 2009. do lipnja 2015. godine i bili praćeni tri godine nakon početka terapije. Parametri kojima se pratila aktivnost bolesti bili su BASDAI (engl. Bath Ankylosing Spondylitis Disease Activity Index), BASFI (engl. Bath Ankylosing Spondylitis Functional Index), CRP (engl. C reactive protein) i VAS (engl. Visual Analogue Scale), a mjereni su prije početka terapije te nakon 3 i 36 mjeseci od njenog uvođenja. Rezultati: Od ukupno 29 ispitanika, 11 ih je bilo na adalimumabu, 10 na golimumabu, a 8 na infliksimabu. Analizirajući parametre uključene u ovo istraživanje (BASDAI, BASFI, CRP, VAS), ni u jednom promatranom periodu nije zabilježena statistički značajna razlika između ispitanika s obzirom na primijenjeni TNF-α inhibitor (svi p &gt; 0,05). Ukupno trogodišnje preživljenje TNF-α inhibitora iznosilo je 75,8 %. Kod ispitanika liječenih adalimumabom trogodišnje preživljenje iznosilo je 72,8 %, za golimumab 80 % te infliksimab 75 % (svi p &gt; 0,05). Zaključci: Uspoređujući ispitanike liječene adalimumabom, golimumabom i infliksimabom u prvoj liniji biološke terapije, naše istraživanje na malom broju ispitanika pokazalo je kako nema značajne razlike u njihovoj učinkovitosti i preživljenju.

scholarly journals P088 Multidisciplinary working in the management of axial and peripheral spondyloarthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Tania Gudu ◽  
Deepak R Jadon
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Outcome Measures ◽  
Activity Index ◽  
Diagnostic Delay ◽  
Disease Activity Index ◽  
Performance Measure ◽  
Time Interval ◽  
Multidisciplinary Working

Abstract Background/Aims  Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA), but evidence supporting its effectiveness and benefits in SpA is scarce.The objectives of this review were to describe the characteristics, effectiveness and feasibility of MD working compared to uni-disciplinary approach in studies of patients with SpA. Methods  A literature review was conducted according to the PICO framework. We included studies on patients with axial and/or peripheral SpA, and we assessed several outcomes such as diagnosis, treatment, feasibility, disease and patient-related outcomes (Table 1). Results  Fifteen articles met the review’s eligibility criteria, including 13 observational studies and two randomised controlled trials. In total 4,312 patients were analysed, including patients with psoriatic arthritis, enteropathic SpA, ankylosing spondylitis, and SpA with anterior uveitis. Most of the studies included a combined clinic encompassing a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, working in tandem according to predefined referral criteria and treatment algorithms. The main outcomes assessed in studies on MD working in SpA, matched with their outcome measures are depicted in Table 1. MD working was reported to lead to better outcomes in all studies, including: better identification and diagnosis of the disease; earlier and more comprehensive treatment approach; and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. However, these results are mostly derived from studies with design issues and without a uni-disciplinary care comparator arm. Conclusion  Despite the lack of strong and reliable evidence to support its benefits compared to standard care, MD working is an essential part of the care of patients with SpA. Further studies and initiatives should be developed so that the challenges and limits of MD care can be improved upon. P088 Table 1:Outcomes and outcome measures evaluated in studies of multidisciplinary working in spondyloarthritisOutcomesOutcome measuresDiagnosisEarly diagnosisAssessment of SpondyloArthritis Society (ASAS) criteria; New York criteria The Classification Criteria for Psoriatic Arthritis (CASPAR); Moll and Wright criteria Rheumatologist’s / dermatologist’s (clinical) judgment Not defined ("standard diagnostic criteria for inflammatory bowel diseases and rheumatic diseases")Diagnosis delayThe total lag time from joint symptom onset to the first rheumatologic assessment Diagnostic delay: the time interval between the onset of the symptoms and the correct diagnosis being made Physician-related diagnostic delay: the time interval between the initial visit to a physician and the time of diagnosisReclassification of diagnosisNumber of patients, N (%)Disease relatedDisease activityMusculoskeletal: - The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) - The Ankylosing Spondylitis Disease Activity Score- C-reactive protein (ASDAS-CRP) - Disease Activity in PSoriatic Arthritis (DAPSA) Gastroenterology: - Crohn''s disease activity index (CDAI) - the partial Mayo (pMAYO) Psoriasis: - Psoriasis Area Severity Index (PASI)Physical functionBath AS Metrology Index (BASMI) Bath AS Functional Index (BASFI) Bath Ankylosing Spondylitis Patient Global Score (BAS-G) Health Assessment Questionnaire (HAQ)ComorbiditiesPrevalence of diabetes, hypertension, hyperlipidaemia, and current/past smoking statusComplications during FU/ adverse eventsPrevalence of infection and adverse medication effects (i.e., elevated liver function test, headache).TreatmentTherapeutic adjustmentNumber of patients, N (%) having had their treatment changedPatient reported outcomesQuality of lifeInflammatory Bowel Disease Questionnaire (IBDQ) Short Form (SF36) Dermatology Life Quality Index (DLQI) Psoriatic Arthritis Impact of Disease (PsAID-12)Global wellness• HAQ • SF36 • Patient Global Assessment (PGA)Patient global assessmentPGAActivity limitations and participation restrictionsThe Canadian Occupational Performance Measure (COPM)Patient satisfactionSatisfaction questionnaire (developed by the multidisciplinary team)Feasibility/ costsHealth service utilisationquestionnaire developed by the Stanford University School of Medicine with four indicators (outpatient visits, emergency visits, hospitalizations, and hospitalization days) Disclosure  T. Gudu: None. D.R. Jadon: None.

scholarly journals AB0724 IS THERE A LINK BETWEEN RADIOGRAPHIC SACROILIITIS AND HIP INVOLVEMENT IN SPONDYLOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1656.2-1657
Author(s):  
S. Rahmouni ◽  
M. Slouma ◽  
R. Dhahri ◽  
I. Gharsallah ◽  
N. Boussetta ◽  
...  
Keyword(s):  
New York ◽  
Ankylosing Spondylitis ◽  
Structural Damage ◽  
Multivariable Analysis ◽  
Diagnostic Delay ◽  
Symptom Duration ◽  
Sacroiliac Joints ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Mean

Background:Hip involvement is a common feature in spondyloarthritis (SpA). Whether the hip is part of the axial or appendicular skeletal is still a matter of discussion.Objectives:We aimed to assess the relationship between sacroiliitis, spinal and hip involvement in SpA.Methods:Patients with SpA diagnosed according to the assessment of Spondyloarthritis International Society criteria were included in this retrospective cross-sectional study.The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-s) were used to assess the radiographic involvement of the spine.The sacroiliac joints were scored according to the modified New York criteria.Radiological hip involvement was scored using the Bath Ankylosing Spondylitis Radiology Index hip (BASRI-h).Patients were divided into two groups: G0 including patients without hip involvement and G1 patients with hip involvement.Results:We included 112 patients with a sex ratio of 2.4. The average SpA symptom duration was 9.33 ± 8.93 years. The diagnostic delay was 42.92 ± 52 months.Radiographic hip involvement was noted in 39.28% of cases. It was bilateral in 31 patients (70.4%). The total number of coxitis was 75. Severe and moderate hip involvement (BASRI-h ≥ 3) affected 21 hips. The most common radiographic pattern was early coxitis (n=31, 41.3%) followed by the destructive form (n=22, 29.3%, mimicking-osteoarthritis form (n=15, 20%), condensing form (n=5, 6.6%) and ankylosing form (n=2, 2%).Radiographic sacroiliitis was noted in 75.8% of patients. It was bilateral in 91.7% of cases. Among the 161 sacroiliac joints fulfilling the m-New-york criteria, 32.9% had grade 4 and 37.2% had grade 3.The mean mSASSS was 10.26 ± 15. The mean BASRI-t, BASRI-C, and BASRI-L were 3.99 ± 2.9, 0.89 ± 1.3, and 1.1 ± 1.3 respectively.Radiographic sacroiliitis was more common in patients with hip involvement (G1) (90.9% vs 68.2%, p=0.00). Patients in G1 had higher mSASSS (15.78 ± 18.24 vs 6.29 ± 11.85, p=0.01), BASRI-L (1.73±1.46 vs 0.75 ± 1.131, p=0.009), and BASRI-s (5.46 ± 3.02 vs 3.19 ± 2.46, p< 10-3) than patients in G2. There was no significant difference between the two groups regarding the BASRI-C.Multivariable analysis revealed that radiographic sacroiliitis was associated with hip involvement (OR=14.81, 95%, [1.1-198], p=0.042).When comparing patients with severe and moderate hip involvement (BASRI-h ≥ 3) and those with mild involvement, we didn’t find significant differences regarding BASRIs, BASR-L, BASRI-c, mSASSS, and sacroiliac involvement.Conclusion:As reported in previous studies [1], we concluded that structural axial lesions were higher in patients with coxitis. Structural damage to the sacroiliac joint in SpA was predictive of hip involvement.We suggest that sacroiliitis, spinal and hip involvement are part of the same spectrum.References:[1]Chen H-A, Chen C-H, Liao H-T, Lin Y-J, Chen P-C, Chen W-S, et al. Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis. Semin Arthritis Rheum. 2011;40 (6):552-8Disclosure of Interests:None declared

scholarly journals Escalas de avaliação aplicadas à espondilite anquilosante pertinentes à fi sioterapia

2017 ◽  
Vol 10 (3) ◽  
pp. 203
Author(s):  
Áurea Eugênia Benchimo Ferreira
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Activity Index ◽  
Disease Activity Index ◽  
Functional Index

A espondilite anquilosante (EA) é uma doença infl amatória crônica que acomete preferencialmente o esqueleto axial. A patologia evolui de forma insidiosa e é potencialmente debilitante, levando a redução da qualidade de vida dos indivíduos acometidos. Este estudo teve como objetivo realizar uma revisão literária das escalas de avaliação em EA (BASFI - Bath Ankylosing Spondylitis Functional Index, DFI - Dougado´s Functional Index, EVA – Escala Visual Analógica e BASDAI - Bath Ankylosing Spondylitis Disease Activity Index) pertinentes à fi sioterapia, especifi camente dos domínios: função, dor, mobilidade da coluna, rigidez e avaliação global do paciente, presentes na área SM-ARD/Fisioterapia. Foi abordada também uma escala de avaliação radiológica, SASSS (Stoke Ankylosing Spondylitis Spine Score). A revisão estendeu-se de outubro a dezembro de 2006, mediante pesquisas em livros de acervos particulares e públicos e em base de dados. Constatou-se neste estudo a necessidade da realização de pesquisas, metodologias ou complementos visando à validação de instrumentos no Brasil que sirvam de esclarecimento sobre o dinamismo e comportamento da EA diante da intervenção fi sioterapêutica. Palavras-chave: espondilite anquilosante, escalas de avaliação, radiografi a.

From gene expression to serum proteins: biomarker discovery in ankylosing spondylitis

2008 ◽  
Vol 69 (01) ◽  
pp. 297-300 ◽  
Author(s):  
N Haroon ◽  
F W L Tsui ◽  
F D O’Shea ◽  
B Chiu ◽  
H W Tsui ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ankylosing Spondylitis ◽  
Biomarker Discovery ◽  
Serum Proteins ◽  
Activity Index ◽  
Disease Activity Index ◽  
Fold Change ◽  
Reactive Protein ◽  
Qrt Pcr ◽  
Significant Difference

Objectives:Studying post-infliximab gene expression changes could provide insights into the pathogenesis of ankylosing spondylitis (AS).Methods:Gene expression changes were screened by microarray on peripheral blood RNA of 16 AS patients at baseline and 2 weeks post-infliximab, and selected results were confirmed by quantitative real-time (qRT)–PCR. Corresponding serum-soluble LIGHT (sLIGHT) was estimated by ELISA and the fold change in sLIGHT was correlated to the fold change in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and the Bath AS disease activity index.Results:Post-infliximab, 69% of the patients (11/16) achieved an ASAS20 response. Six candidate genes were differentially expressed by microarray; four of which were validated by qRT–PCR. sLIGHT showed the most significant difference. There was good correlation of baseline sLIGHT with CRP (R  =  0.60; p = 0.01) and ESR (R  =  0.51; p = 0.04). The fold change in sLIGHT correlated with change in both CRP (R  =  0.71, p = 0.002) and ESR (R  =  0.77, p<0.001).Conclusion:LIGHT is significantly downregulated by infliximab. sLIGHT correlated well with changes in inflammatory markers.

Sign in / Sign up

Export Citation Format

Share Document