scholarly journals The impact of extra-musculoskeletal manifestations on disease activity, functional status, and treatment patterns in patients with axial spondyloarthritis: results from a nationwide population-based study

2020 ◽  
Vol 12 ◽  
pp. 1759720X2097261
Author(s):  
Imke Redeker ◽  
Britta Siegmund ◽  
Kamran Ghoreschi ◽  
Uwe Pleyer ◽  
Johanna Callhoff ◽  
...  
Keyword(s):  
Disease Activity ◽  
Functional Status ◽  
Axial Spondyloarthritis ◽  
Population Based ◽  
Treatment Patterns ◽  
Health Insurance Data ◽  
History Of ◽  
Musculoskeletal Manifestations ◽  
Disease Modifying ◽  
Insurance Data

Objective: The aim of this study was to investigate the association of extra-musculoskeletal manifestations (EMMs) with disease activity, functional status, and treatment patterns in a large population-based cohort of patients with axial spondyloarthritis (axSpA). Methods: A stratified random sample of patients with axSpA, drawn from health insurance data, received a survey on disease-related characteristics including history (ever presence) of the following EMMs: inflammatory bowel disease (IBD), psoriasis (PSO), and anterior uveitis (AU). Survey data were linked to health insurance data, gathering additional information on current occurrence (within one year) of EMMs and drug prescriptions. Separate multivariable linear regression models were calculated to determine the association of EMMs with disease activity (Bath Ankylosing Spondylitis Disease Activity Index), and functional status (Bath Ankylosing Spondylitis Functional Index) after adjustment for relevant parameters, including treatment. Results: A total of 1729 patients with axSpA were included in the analyses (response: 47%; mean age: 56 years; 46% female) of whom 6% (9%) had current (ever) IBD, 10% (15%) had current (ever) PSO, and 9% (27%) had current (ever) AU. Ever presence of IBD and history of PSO were significantly associated with higher level of disease activity. Ever presence of PSO was also associated with higher level of functional impairment, whereas current AU was significantly associated with lower disease activity. Patients with current IBD or PSO received more frequently biological and conventional synthetic disease-modifying anti-rheumatic drugs as well as systemic steroids. AU was associated with a higher use of conventional synthetic disease-modifying anti-rheumatic drugs only. Conclusion: Disease activity is higher in patients with axSpA with history of IBD or history of PSO. Functional impairment is also higher in patients with axSpA with history of PSO. The presence of different EMMs was associated with different treatment patterns in axSpA.

scholarly journals The prevalence and impact of comorbidities on patients with axial spondyloarthritis: results from a nationwide population-based study

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Imke Redeker ◽  
Johanna Callhoff ◽  
Falk Hoffmann ◽  
Ursula Marschall ◽  
Hildrun Haibel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Pulmonary Disease ◽  
Functional Impairment ◽  
Axial Spondyloarthritis ◽  
Musculoskeletal Diseases ◽  
Large Population ◽  
Population Based ◽  
Chronic Pulmonary Disease ◽  
Collagen Vascular Diseases

Abstract Background In contrast to other chronic rheumatic musculoskeletal diseases such as rheumatoid arthritis, comorbidities in axial spondyloarthritis (axSpA) and their impact on disease outcomes are less well studied. The aim of this study was to investigate the prevalence of comorbidities and their association with disease activity and functional impairment in a large population-based cohort of patients with axSpA. Methods A random sample of patients with axSpA, stratified by age and sex, was drawn from health insurance data. Patients in the sample received a survey on demographic, socioeconomic, and disease-related parameters. Comorbidities were defined using the Elixhauser coding algorithms excluding rheumatoid arthritis/collagen vascular diseases and including osteoporosis and fibromyalgia, resulting in a set of 32 comorbidities. The prevalence of comorbidities in the axSpA patients and their pharmacological treatment were examined. Multivariable linear regression models were calculated to determine the association of comorbidities with disease activity and functional status. Results A total of 1776 axSpA patients were included in the analyses (response, 47%; mean age, 56 years; 46% female). The most prevalent comorbidities were hypertension, depression, and chronic pulmonary disorders. The number of comorbidities was significantly associated with both the BASDAI and BASFI: β (95% CI) = 0.17 (0.09–0.24) and 0.24 (0.15–0.32), respectively. When analysed separately, hypertension, depression, and chronic pulmonary disease were comorbidities with a significant and independent association with BASFI, while for BASDAI, such an association was found for depression and chronic pulmonary disease only. Conclusions Comorbidities are common in axSpA patients and are associated with higher disease activity and higher levels of functional impairment. Higher disease activity and higher levels of functional impairment might be indicators of severe disease resulting in the development of comorbidities.

The epidemiology of ankylosing spondylitis, axial spondyloarthritis, and back pain

2016 ◽  
Author(s):  
Stefan Siebert ◽  
Sengupta Raj ◽  
Alexander Tsoukas
Keyword(s):  
Back Pain ◽  
Ankylosing Spondylitis ◽  
Axial Spondyloarthritis ◽  
Epidemiological Studies ◽  
Population Based ◽  
Inflammatory Back Pain ◽  
True Incidence ◽  
Primary Care Population ◽  
Prevalence Estimates ◽  
History Of

Low back pain is a leading cause of disability worldwide. The prevalence of inflammatory back pain (IBP) has been calculated to be in the range 8–15% in a UK primary care population and 5–7% in a US population-based cohort. IBP rates are significantly higher in patients with psoriasis, uveitis, or inflammatory bowel disease than the general population. There is a paucity of good epidemiological studies to define the true incidence and prevalence of ankylosing spondylitis (AS), axial spondyloarthritis (axSpA), and spondyloarthritis (SpA), with wide variation as a result of geographic, demographic and methodological factors. The global prevalence estimates range from 0.01–0.2% for AS, to 0.32–0.7% for axSpA and around 1% for SpA overall. The global incidence estimates range from 0.44–7.3 cases per 100,000 person-years for AS to 0.48–62.5 cases per 100,000 person-years in SpA. The demographics and natural history of disease progression are also discussed.

scholarly journals Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Cecilia Smith Simonsen ◽  
Heidi Øyen Flemmen ◽  
Line Broch ◽  
Cathrine Brunborg ◽  
Pål Berg-Hansen ◽  
...  
Keyword(s):  
Disease Activity ◽  
Treatment Guidelines ◽  
Population Based ◽  
World Population ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
First Choice ◽  
Disease Modifying ◽  
Population Based Registry ◽  
The Impact

Background: Moderate and high efficacy disease modifying therapies (DMTs) have a profound effect on disease activity. The current treatment guidelines only recommend high efficacy DMTs for patients with highly active MS. The objective was to examine the impact of initial treatment choice in achieving no evidence of disease activity (NEDA) at year 1 and 2.Methods: Using a real-world population-based registry with limited selection bias from the southeast of Norway, we determined how many patients achieved NEDA on moderate and high efficacy DMTs.Results: 68.0% of patients who started a high efficacy DMT as the first drug achieved NEDA at year 1 and 52.4% at year 2 as compared to 36.0 and 19.4% of patients who started a moderate efficacy DMT as a first drug. The odds ratio (OR) of achieving NEDA on high efficacy drugs compared to moderate efficacy drugs as a first drug at year 1 was 3.9 (95% CI 2.4–6.1, p < 0.001). The OR for high efficacy DMT as the second drug was 2.5 (95% CI 1.7–3.9, p < 0.001), and was not significant for the third drug. Patients with a medium or high risk of disease activity were significantly more likely to achieve NEDA on a high efficacy therapy as a first drug compared to moderate efficacy therapy as a first drug.Conclusions: Achieving NEDA at year 1 and 2 is significantly more likely in patients on high-efficacy disease modifying therapies than on moderate efficacy therapies, and the first choice of treatment is the most important. The immunomodulatory treatment guidelines should be updated to ensure early, high efficacy therapy for the majority of patients diagnosed with MS.

scholarly journals The apparently milder course of multiple sclerosis: changes in the diagnostic criteria, therapy and natural history

Brain ◽  
2020 ◽  
Vol 143 (9) ◽  
pp. 2637-2652 ◽  
Author(s):  
Per Soelberg Sorensen ◽  
Finn Sellebjerg ◽  
Hans-Peter Hartung ◽  
Xavier Montalban ◽  
Giancarlo Comi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Activity ◽  
Diagnostic Criteria ◽  
Progressive Multiple Sclerosis ◽  
Disease Modifying Therapies ◽  
Relapsing Remitting ◽  
History Of ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Abstract In the past decade, changes have occurred in the spectrum of multiple sclerosis courses. The natural history of multiple sclerosis appears milder from the first sign of demyelinating disease to the progressive course, probably as a result of an interplay between several factors including changes in the diagnostic criteria, changes in the epidemiology of multiple sclerosis, impact of early and appropriate disease-modifying treatment and improvement of the general state of health in the population. It has been suggested to regard incidental findings of demyelinating lesions in MRI in individuals without any history of clinical symptoms consistent with neurological dysfunction, so-called radiological isolated syndrome, as the initial course of multiple sclerosis. New diagnostic criteria have enabled the multiple sclerosis diagnosis in many patients at the first clinical demyelinating event, clinically isolated syndrome. The remaining patients with clinically isolated syndrome have a more benign prognosis, and for relapsing-remitting multiple sclerosis, the prognosis has become more favourable. Reduced disease activity in patients with relapsing-remitting multiple sclerosis can partly be ascribed to more efficacious new disease-modifying therapies but decrease in disease activity has also be seen in placebo-treated patients in clinical trials. This may be explained by several factors: change in the diagnostic criteria, more explicit inclusion criteria, exclusion of high-risk patients e.g. patients with co-morbidities, and more rigorous definitions of relapses and disease worsening. However, these factors also make the disease course in patients treated with disease-modifying therapies seem more favourable. In addition, change in the therapeutic target to stable disease (no evidence of disease activity = no relapses, no disease worsening and no MRI activity) could by itself change the course in relapsing-remitting multiple sclerosis. The effectiveness of disease-modifying drugs has reduced the transition from relapsing-remitting to secondary progressive multiple sclerosis. The concept of progressive multiple sclerosis has also evolved from two very distinct categories (primary progressive and secondary progressive multiple sclerosis) to a unified category of progressive multiple sclerosis, which can then be split into the categories of active or inactive. Also, an increasing tendency to treat progressive multiple sclerosis with disease-modifying therapies may have contributed to change the course in progressive multiple sclerosis. In conclusion, during the past decade the entire course of multiple sclerosis from the first sign of a demyelinating disorder through the progressive course appears to be milder due to a complex interplay of several factors.

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