Value of HRCT of the chest in evaluation of ankylosing spondylitis: correlation between pleuro-parenchymal abnormalities and disease activity

Abstract Background Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine. It is associated with both articular and extra-articular clinical manifestations. Pulmonary involvement is a well-recognized comorbidity of AS, even among patients with early disease. The availability of high-resolution computed tomography (HRCT) has enabled better visualization of the entire lung parenchyma and earlier identification of lung pathologies, ranging from mild to more severe involvement, which were previously missed on X-rays. The aim of the study is to establish the role of HRCT in the detection of pleuro-parenchymal manifestations of AS and to look for correlations between these findings and AS activity. Results Lung CT scans were done for all our patients and 27 patients (90%) had positive HRCT thoracic findings, while the remaining 3 patients (10%) had a normal HRCT thoracic study. Lower lobe fibrotic changes were the most common finding seen in 20 patients (66.7%) followed by bronchial wall thickening in 13 patients (43.3%) and upper and lower fibrotic changes seen in 9 patients (30%). HRCT thoracic findings were more prominent in late AS (disease duration ≥ 10 years) (13 of 13 patients); while 14 of 17 patients with early AS (disease duration < 10 years) had mildly abnormal HRCT findings. The result of statistical analysis showed that there was negative correlation between thoracic findings and disease activity assessed by BASDAI and this correlation was insignificant (p value = 0.5). Conclusion HRCT offers an accurate and safe method of assessment of lung disease in patients with AS and without respiratory symptoms. Although there was no correlation between pulmonary findings and AS activity assessed by BASDAI, a positive correlation, albeit insignificant, between pulmonary involvement and disease duration had been found.

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POS0369 ELEVATED EXPRESSION OF TIM-3 ON NEUTROPHILS CORRELATES WITH DISEASE ACTIVITY AND SEVERITY OF ANKYLOSING SPONDYLITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3516 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 414.2-415

Author(s):

X. Huang ◽

T. W. Li ◽

J. Chen ◽

Z. Huang ◽

S. Chen ◽

...

Keyword(s):

Flow Cytometry ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Immune Cells ◽

Clinical Manifestations ◽

Innate Immune ◽

Innate Immune Cells ◽

Bacterial Killing ◽

Markers Of Inflammation ◽

Significant Difference

Background:Ankylosing spondylitis (AS) is a type of common, chronic inflammatory disease that compromises the axial skeleton and sacroiliac joints, causing inflammatory low back pain and progressive spinal stiffness, over time some patients develop spinal immobility and ankylosis which can lead to a decrease in quality of life. The last few decades, evidence has clearly indicated that neutrophil also plays key roles in the progression of AS. However, the immunomodulatory roles and mechanisms of neutrophils in AS are poorly understood. T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) has been reported as an important regulatory molecule, expressed and regulated on different innate immune cells, plays a pivotal role in several autoimmunity diseases. Recent study indicates that Tim3 is also expressed on neutrophils. However, the frequency and roles of Tim3-expressing neutrophils in AS was not clear.Objectives:In this study, we investigated the expression of Tim3 on neutrophils in AS patients and explored the correlation between the level of Tim3-expressing neutrophils and the disease activity and severity of AS.Methods:Patients with AS were recruited from Guangdong Second Provincial General Hospital (n=62). Age/sex-matched volunteers as Healthy controls (HC) (n=39). The medical history, clinical manifestations, physical examination, laboratory measurements were recorded. The expression of costimulatory molecules including programmed death 1 (PD-1), Tim-3 on neutrophils were determined by flow cytometry. The mRNA expression of PD-1 and Tim-3 was determined by real-time PCR. The levels of Tim3-expressing neutrophils in AS patients were further analyzed for their correlation with the markers of inflammation such as ESR,CRP,WBC and neutrophil count(NE), as well as disease activity and severity of AS. The expression of Tim3 on neutrophils was monitored during the course of treatment (4 weeks).Results:The expression of Tim3 on neutrophils in patients with AS was increased compared to the HC (Figure 1A). However, significant difference was observed in the frequency of PD-1-expressing neutrophils between AS patients and HC (Figure 1B). The expression analysis of Tim-3 mRNA, but not PD-1, confirmed the results obtained from flow cytometry (Figure 1C). The level of Tim3-expressing neutrophils in patients with AS showed an positive correlation with ESR, CRP and ASAS-endorsed disease activity score (ASDAS) (Figure 1D). Moreover, the frequency of Tim3-expressing neutrophils in active patients(ASDAS≥1.3) was increased as compare with the inactive patients (ASDAS<1.3) (Figure 1E). As shown in Figure 1F, the frequency of Tim3-expressing neutrophils decreased after the treatment.Conclusion:Increased Tim-3 expression on neutrophils may be a novel indicator to assess disease activity and severity in AS, which may serves as a negative feedback mechanism preventing potential tissue damage caused by excessive inflammatory responses in AS patients.References:[1]Han, G., Chen, G., Shen, B. & Li, Y., Tim-3: an activation marker and activation limiter of innate immune cells. FRONT IMMUNOL 4 449 (2013).[2]Vega-Carrascal, I. et al., Galectin-9 signaling through TIM-3 is involved in neutrophil-mediated Gram-negative bacterial killing: an effect abrogated within the cystic fibrosis lung. J IMMUNOL 192 2418 (2014).Figure 1.(A,B)The expression of Tim3 and PD-1 on neutrophils in AS and HC were determined by flow cytometry.(C) The expression of Tim3 and PD-1 on neutrophils in AS and HC were determined by RT-PCR.(D)The correction between Tim3-expressing neutrophils and ESR,CRP,ASDAS.(E) The expression of Tim3 on neutrophils in active and inactive patients.(F) Influence of treatment on the frequency of Tim3-expressing neutrophils.Disclosure of Interests:None declared

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Significance of asymptomatic hyperuricemia in ankylosing spondylitis

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-3-57-61 ◽

2021 ◽

Vol 15 (3) ◽

pp. 57-61

Author(s):

R. M. Balabanova ◽

E. V. Ilyinykh ◽

M. V. Podryadnova ◽

S. I. Glukhova ◽

M. M. Urumova

Keyword(s):

Rheumatoid Arthritis ◽

Ankylosing Spondylitis ◽

Blood Serum ◽

Disease Activity ◽

Filtration Rate ◽

Metabolic Disorders ◽

Clinical Manifestations ◽

The Past ◽

The Metabolic Syndrome ◽

Medical Histories

Over the past decades, there has been an increase in the incidence of asymptomatic hyperuricemia (AHU), which includes an increased level (>360 μmol/L) of uric acid (UA) in the blood serum of patients with no clinical manifestations of gout. AHU is reported in various rheumatic diseases, mainly in osteoarthritis, in which AHU is one of the manifestations of the metabolic syndrome. There is relationship between AHU and pulmonary hypertension in systemic sclerosis, arterial hypertension (AH) in men with seronegative rheumatoid arthritis, extensive cutaneous psoriasis and metabolic disorders in psoriatic arthritis. There are almost no data on AHU in ankylosing spondylitis (AS), which served objective for this work.Objective: to assess the association of AHU with AS duration and activity and the presence of comorbid diseases.Patients and methods. A retrospective analysis of 48 medical histories of patients with diagnosed AS, who were treated in V.A. Nasonova Research Institute of Rheumatology from 2015 to 2019 years, whose serum UA level was >360 μmol/L.Results and discussion. More than half of patients with AS and AHU were overweight, 21% were obese. AH was diagnosed in 43.7% of patients. Stage II–III chronic kidney disease was detected in 16.7% of patients, urolithiasis – in 18.8%. 4 (8.3%) patients had diabetes mellitus. The serum UA level in patients with AS was 422.0 ± 61.6 μmol/L. In patients with AS, an association between AHU and age, duration and disease activity was noted. There was no statistically significant rela- tionship between HG and blood glucose, cholesterol, creatinine levels, body mass index. Correlation analysis revealed a statistically significant relationship between the glomerular filtration rate (GFR) and the age of patients (r=-0.54, p<0.001), the duration of the disease (r=-0.40, p<0.05), cholesterol level (r=-0.48, p=0.01), UA level (r=-0.45, p=0.03) and blood pressure (r=-0.54, p<0.001). There was no association between disease activity and GFR (p>0.05).Conclusion. In AS, an association between an increased level of UA in the blood serum and the duration and activity of the disease, and patient's age, was established.

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Assessment of Subclinical Vascular Disease Associated with Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.100668 ◽

2011 ◽

Vol 38 (4) ◽

pp. 723-729 ◽

Cited By ~ 61

Author(s):

NÓRA BODNÁR ◽

GYÖRGY KEREKES ◽

ILDIKÓ SERES ◽

GYÖRGY PARAGH ◽

JÁNOS KAPPELMAYER ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Vascular Disease ◽

Aortic Stiffness ◽

Disease Duration ◽

Activity Index ◽

Disease Activity Index ◽

Intima Media Thickness ◽

Diagnostic Tools ◽

Spine Mobility

Objective.Studies indicate that ankylosing spondylitis (AS), as well as rheumatoid arthritis, may be associated with accelerated atherosclerosis and vascular disease. We assessed endothelial dysfunction, carotid atherosclerosis, and aortic stiffness in AS in context with clinical and laboratory measurements.Methods.Forty-three patients with AS and 40 matched healthy controls were studied. We assessed common carotid intima-media thickness (ccIMT), flow-mediated vasodilation (FMD), and pulse-wave velocity (PWV) in association with age, disease duration, smoking habits, body mass index, patient’s assessment of pain and disease activity, Bath AS Disease Activity Index, Bath AS Functional Index (BASFI), metric measurements, erythrocyte sedimentation rate, C-reactive protein, and HLA-B27 status.Results.We found impaired FMD (6.85 ± 2.98% vs 8.30 ± 3.96%; p = 0.005), increased ccIMT (0.65 ± 0.15 vs 0.54 ± 0.15 mm; p = 0.01), and higher PWV (8.64 ± 2.44 vs 8.00 ± 1.46 m/s; p = 0.03) in patients with AS compared to controls, respectively. We also found that ccIMT negatively correlated with FMD (r = −0.563; p = 0.0001) and positively correlated with PWV (r = 0.374; p = 0.018). Both ccIMT and PWV correlated with disease duration (r = 0.559; p = 0.013 and r = 0.520; p = 0.022, respectively), BASFI (r = 0.691; p = 0.003 and r = 0.654; p = 0.006), decreased lumbar spine mobility (r = −0.656; p = 0.006 and r = −0.604; p = 0.013), chest expansion (r = −0.502; p = 0.047 and r = −0.613; p = 0.012), and increased wall-occiput distance (r = 0.509; p = 0.044 and r = 0.614; p = 0.011).Conclusion.In this well characterized AS population, impaired FMD and increased ccIMT and PWV indicate abnormal endothelial function and increased atherosclerosis and aortic stiffness, respectively. The value of noninvasive diagnostic tools needs to be further characterized.

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Predictors of Clinical Remission under Anti-tumor Necrosis Factor Treatment in Patients with Ankylosing Spondylitis: Pooled Analysis from Large Randomized Clinical Trials

The Journal of Rheumatology ◽

10.3899/jrheum.141278 ◽

2015 ◽

Vol 42 (8) ◽

pp. 1418-1426 ◽

Cited By ~ 14

Author(s):

Xenofon Baraliakos ◽

Andrew S. Koenig ◽

Heather Jones ◽

Annette Szumski ◽

David Collier ◽

...

Keyword(s):

Clinical Trials ◽

Ankylosing Spondylitis ◽

Tumor Necrosis Factor ◽

Disease Activity ◽

Clinical Remission ◽

Partial Remission ◽

Tumor Necrosis ◽

Disease Duration ◽

Hla B27 ◽

Necrosis Factor

Objective.Investigate the role and relation of disease duration of different factors for achieving clinical remission with anti-tumor necrosis factor (TNF) treatment in patients with active ankylosing spondylitis (AS).Methods.Data pooled from 4 large (n = 1281) clinical trials were used to compare disease duration subgroups for placebo or sulfasalazine (SSZ) versus etanercept (ETN), which, in turn, were analyzed by age of diagnosis ≤ 40 versus > 40 years, HLA-B27 status, and baseline C-reactive protein (CRP) ≤ upper limit of normal (ULN) versus > ULN using chi-square tests, and ANCOVA. The primary efficacy measure was Assessments of SpondyloArthritis international Society (ASAS) partial remission (PR) after 12 weeks of treatment. Also analyzed were Bath AS Disease Activity Index and Functional Index, AS Disease Activity Scores, and ASAS response rates.Results.Overall, a larger percentage of patients achieved ASAS-PR with ETN versus SSZ or placebo. More patients with ≤ 2-year disease duration treated with ETN experienced partial remission (34%) versus longer disease duration (30%, 27%, and 22% for > 2–5, > 5–10, and > 10 yrs, respectively; all p < 0.05). In the subgroup of patients with both disease duration ≤ 2 years and aged ≤ 40 years at diagnosis, the treatment response was even more pronounced. Similar results were seen in HLA-B27–positive patients in the disease duration ≤ 2-year subgroup. Overall, patients with high CRP at baseline had better treatment responses compared with patients with normal CRP.Conclusion.Treatment response under anti-TNF treatment with ETN at 12 weeks was greatest among patients with disease duration ≤ 2 years and even more pronounced in subgroups of patients ≤ 40 years old or HLA-B27–positive at diagnosis.

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Influence of Environmental Factors on Disease Activity in Spondyloarthritis: A Prospective Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.121081 ◽

2013 ◽

Vol 40 (4) ◽

pp. 469-475 ◽

Cited By ~ 8

Author(s):

Nadine Zeboulon-Ktorza ◽

Pierre Yves Boelle ◽

Roula Said Nahal ◽

Maria Antonietta D'agostino ◽

Jean François Vibert ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Environmental Factors ◽

Disease Activity ◽

Life Events ◽

Repeated Measures ◽

Prospective Cohort ◽

Activity Index ◽

Stressful Events ◽

Outcome Variable ◽

Inflammatory Disorder

Objective.Spondyloarthritis (SpA) is a complex inflammatory disorder. We investigated the influence of environmental factors on SpA disease activity.Methods.A prospective cohort of adults with SpA was followed for 3 years. Patients logged on to a secured Website every 3 months to complete a questionnaire. They reported whether they had been exposed to environmental factors such as stressful or traumatic life events, infections, or vaccinations. Outcome variables included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and pain and patient global assessment (PGA) on visual numerical scales (each rated 0–10). Analyses were performed using a generalized estimating equation for repeated measures, adjusted for the outcome variable collected by the previous questionnaire.Results.In total, 272 patients were included in the analysis, completing the questionnaire on 2240 occasions. The average time (mean ± SD) between 2 connections to the Website was 4.0 ± 2.0 months. Occurrence of life events was followed by an increase of 0.5 (95% CI 0.4–0.7) in the BASDAI, 0.5 (95% CI 0.3–0.6) in the BASFI, 0.7 (95% CI 0.5–0.9) in the PGA, and 0.8 (95% CI 0.6–1.0) for pain (p < 0.0001 for all variations). A moderately statistically significant link was found between vaccination and an elevation of the BASDAI of 0.3 (95% CI 0.0–0.5; p = 0.032). No influence of other factors was detected.Conclusion.This prospective study in a dedicated SpA cohort shows for the first time a link between stressful events and disease activity. Although this link was statistically highly significant, its clinical meaning remains to be determined because the average magnitude of variation of the different variables studied was rather mild.

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Concomitant Diagnosis of Fibromyalgia and Ankylosing Spondylitis: Relation to Clinical Features and Plasma Pentraxin -3 Level.

Current Rheumatology Reviews ◽

10.2174/1573397117666210114110823 ◽

2021 ◽

Vol 17 ◽

Author(s):

Eman Baraka ◽

Mona Balata ◽

Shereen Ahmed ◽

Mona El-Blbehisy ◽

Enas Elattar

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Clinical Features ◽

Predictive Value ◽

Disease Duration ◽

Rapid Screening ◽

Disease Assessment ◽

Group I ◽

Diagnostic Certainty ◽

Group Ii

Background: Ankylosing spondylitis (AS) is a chronic systemic inflammatory rheumatic disease that specifically affects the spine and sacroiliac joint. AS diagnosis is often delayed in the clinical practice and this delay may cause the patients to miss the chance of early treatment. Fibromyalgia (FM) is a frequently encountered clinical syndrome, fibromyalgianess is a term used when patients who are diagnosed with inflammatory arthropathies met the criteria for FM syndrome as shown in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome, and AS. Objectives: We aimed primarily to assess the frequency of concomitant diagnosis FM syndrome in AS patients and to study its impact on clinical disease aspects. Secondary, our aim extended as a preliminary pilot study to assess the PTX-3 as a potential marker for the diagnosis of FM syndrome in AS patients. Methods: Plasma PTX-3 in 61 AS patients was compared to 60 matched controls. FM was diagnosed by FM Rapid Screening Tool. Bath AS disease activity index (BASDAI) and AS disease assessment score using C- reactive protein (ASDAS-CRP), Bath AS functional impairment index (BASFI), Bath AS metrology index (BASMI), AS quality of life (ASQoL) scale, Beck Depression Inventory, and Bath AS Radiology Index (BASRI) were assessed. Results: The patients were categorized into two groups according to the concomitant diagnosis of FM syndrome. Group I included 14 (22.9%) AS patients who fulfilled the clinical diagnosis of FM syndrome. Group II included 47 (77.1%) patients without FM syndrome. AS patients with FM (Group I) had significantly(p<0.001) increased an average of ages, disease duration, diagnostic delay of AS, switching of bDMARDs, morning stiffness duration, ASDAS-CRP, BASFI, ASQoL score, BASDAI (p=0.008), and BDI score (p=0.005) compared to AS patients without FM (Group II). PTX-3 levels were significantly (p<0.001) higher in Group I (p<0.001) (median, 0.23; IQR, 0.15-0.41 ng/ml) than Group II (median, 0.13; IQR, 0.035-0.21ng/ml) which showed no significant differences (p>0.05) compared to the controls. PTX-3 levels had significant positive correlations (p<0.05) with disease duration, BASFI, and ASQOl. Age, female sex, switch of biologic, ASDAS -CRP, and PTX-3 were significant predictors of FM in AS patients. Conclusion: These results indicate that concomitant FM is a significant problem in patients with AS and its presence is associated with higher disease activity, impaired function as well as an overall negative impact on QoL. Easy scanning of suspicious cases of FM with FiRST questionnaire can be done in daily practice. PTX-3 is more or less accurate as the clinical features to improve the diagnostic certainty of FM in the presence of AS with a proven sensitivity of 62.3%, a specificity of 90 %, a positive predictive value of 82.75%, and a negative predictive value of 73.9%.

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Correlation of Sleep Quality in Spondyloarthritis Patients and its Association with Disease Activitiy Parameters

10.53350/pjmhs211562089 ◽

2021 ◽

Vol 15 (6) ◽

pp. 2089-2093

Author(s):

Mohamed K Bedaiwi ◽

Abdulaziz Alkhalaf ◽

Ibrahim A Almaghlouth ◽

Eman M Alqurtas ◽

Saad ‎ Almutairi ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Sleep Quality ◽

Disease Activity ◽

Functional Status ◽

Disease Duration ◽

Quality Parameters ◽

University Hospital ◽

Sleep Medication ◽

Medical Disorders ◽

Quality Of Life Scale

Background: Patients with chronic medical disorders are substantially more likely to have sleep related issues. Previously, various authors have reported sleep disruptions to be common in rheumatic diseases, although such sleep related issues in the spondyloarthropathies have not received much attention.. Aim: The present study was aimed to assess the effect of spondyloarthropathies on sleep quality and to see whether this effect is associated with disease activity. Material and Methods: This cross-sectional study was conducted in the rheumatology clinic, King Khalid University Hospital, during the duration of two months. A total of 85 diagnosed cases of spondyloarthritis were included. All participants were interviewed regarding their Demographic details, disease duration, medications, treatment regimens and physical examination. Sleep disturbance was measured using Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index, and the Ankylosing Spondylitis Quality of Life scale. The intensity of disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and patient’s functional status was evaluated using the Bath Ankylosing Spondylitis Functional Index (BASFI). Blood inflammatory markers like ESR levels and CRP levels were also calculated for each patient. Results: Among the total 79 cases included, mean age of patients was 41.06±11.78 years, 40 (50.6%) were females, mean disease duration was 5 years. Diagnoses included Ankylosing spondylitis (48.10%), Psoriatic arthritis (43.04%), Undifferentiated spondyloarthopathy (6.33%) and IBD-related arthropathy (2.53%). Spondyloarthritis was observed to be associated with considerable impaired sleep quality on (PSQI) questionnaire. Six out of seven studied components came out to be worse and the only component which remained unaffected was “use of sleep Medication”. A significant correlation was observed between disease severity and patients ESR and CRP levels, and a significant correlation was observed between BASDAI score and all seven sleep quality parameters and overall PSQI scores. Both BASDAI score and BASFI scores correlated significantly with each other and a significant correlation was observed between the functional status (BASFI score) and Six sleep quality parameters except for use of sleep medication. Conclusion: We conclude that the sleep related problems were significantly higher in patients with spondyloarthritis and patients during active phase of disease had decreased sleep quality. Keywords: spondyloarthropathies, sleep quality, disease activity, PSQI scores.

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EFFICACY AND SAFETY OF TOFACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS IN REAL CLINICAL PRACTICE

Rheumatology Science and Practice ◽

10.14412/1995-4484-2020-268-275 ◽

2020 ◽

Vol 58 (3) ◽

pp. 268-275

Author(s):

E. Yu. Loginova ◽

Yu. L. Korsakova ◽

E. E. Gubar ◽

P. L. Karpova ◽

T. V. Korotaeva

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Disease Activity Score ◽

Clinical Manifestations ◽

Activity Score ◽

Tender Joint Count ◽

Efficacy And Safety ◽

Low Disease Activity ◽

Number Of Patients

Objective: to evaluate the clinical efficacy and safety of the targeted synthetic disease-modifying anti-rheumatic drug (DMARD) tofacitinib (TOFA; Yakvinus®) in patients with active psoriatic arthritis (PsA) at 12 and 24 weeks after starting treatment. To define the place of TOFA in the therapy of PsA patients. Subjects and methods. Examinations were made in 41 patients (17 men and 24 women) with active PsA and an insufficient response to previous treatment with synthetic DMARDs and/or biological agents (BA). Before starting therapy, the median disease activity for psoriatic arthritis (DAPSA) and disease activity score (DAS28) were 44.2 [37.8; 55.3] and 5.5 [4.7; 6.1], respectively. TOFA tablets were prescribed at a dose of 5 mg twice daily for 24 weeks with possible dose escalation to 10 mg twice daily after 12 weeks. At the beginning of the investigation, at 12 and 24 weeks, the investigators assessed disease activity and TOFA therapy efficiency of according to DAPSA, DAS28 and minimal disease activity (MDA) criteria: tender joint count ≤1, swollen joint count ≤1, a psoriasis area severity index (PASI) ≤1 or body surface area (BSA) ≤3%, pain intensity ≤15 mm, patient global assessment ≤20 mm, Health Assessment Questionnaire (HAQ) ≤0.5, and enthesitis ≤1. They also determined the number of patients who had achieved remission (DAPSA ≤4, DAS28 score <2.6), low disease activity (DAPSA 5-14, ≤2.6, DAS28 <3.2) or MDA (5 out of the 7 criteria) during TOFA therapy at 24-week follow-up. The safety of therapy was evaluated by analyzing the drug-induced adverse events (AE): the frequency, severity and time of their occurrence were studied. Results and discussion. At 24 weeks after initiation of TOFA therapy, there was a significant decrease of median DAPSA and DAS28 values as compared to baseline, to 11 [4.3; 17.3] and 2.6 [1.7; 3.4] respectively. The median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) also significantly decreased from 6 [4.2; 7] and 3.8 [2.8; 4.4] to 1.4 [0.6; 3.2] and 1.5 [1; 2.1] respectively. The median BSA was significantly reduced from 3 [1; 5] to 0.5 [0.1; 2]. At 24 weeks after initiation of TOFA therapy, DAPSA and DAS28 low disease activity/remission were achieved by 38.5/23.1% and 17.9/53.9% of patients, respectively. Fifteen (38.5%) patients achieved MDA. 38 (92.7%) of the 41 patients completed a full TOFA therapy cycle. Two patients dropped out of the investigation due to ineffective therapy and one due to AE (diarrhea occurring up to 10 times daily, headache, elevated blood pressure, and lacrimation). At 24 weeks, 14 (34.2%) patients reported to have AE. The most common AE noted in 7 (17.1%) patients were infections: acute respiratory viral infection (n=3), fever (n=2), and folliculitis (n=2). In addition, two patients had diarrhea and two had headache. Conclusion. TOFA is an effective drug for the treatment of PsA patients with moderate or high inflammatory activity, has a significant effect on all clinical manifestations of PsA and has a satisfactory safety profile.

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

The Journal of Rheumatology ◽

10.3899/jrheum.090899 ◽

2010 ◽

Vol 37 (3) ◽

pp. 633-638 ◽

Cited By ~ 9

Author(s):

EMMA L. HEALEY ◽

KIRSTIE L. HAYWOOD ◽

KELVIN P. JORDAN ◽

ANDREW M. GARRATT ◽

JONATHAN C. PACKHAM

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Disease Severity ◽

Psychological Health ◽

Disease Duration ◽

Rating Scale ◽

Activity Index ◽

Local Area ◽

Area Deprivation ◽

Deprived Areas

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

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Serum IL-6 and IL-23 Levels and Their Correlation with Angiogenic Cytokines and Disease Activity in Ankylosing Spondylitis, Psoriatic Arthritis, and SAPHO Syndrome

Mediators of Inflammation ◽

10.1155/2015/785705 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Hanna Przepiera-Będzak ◽

Katarzyna Fischer ◽

Marek Brzosko

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Interleukin 6 ◽

Disease Duration ◽

Sapho Syndrome ◽

Positive Correlation ◽

Interleukin 23 ◽

Angiogenic Cytokines

Objectives.To assess serum interleukin-6 (IL-6) and interleukin-23 (IL-23) and their correlation with angiogenic cytokines and disease activity in ankylosing spondylitis (AS), psoriatic arthritis (PsA), and SAPHO syndrome.Patients and Methods.We studied 152 spondyloarthritis (SpA) patients: 69 PsA, 61 AS, 22 SAPHO, and 29 controls. We recorded age, sex, disease duration, and treatment. We assessed BASDAI, VAS, and PASI scores. Serum IL-6, IL-23, VEGF, EGF, FGFb, and FGFa levels were determined using ELISA. We estimated ESR and CRP.Results.Serum IL-6 and IL-23 levels were higher in SpA than in control (P<0.00001andP=0.0004, resp.). There was a positive correlation between serum IL-6 and CRP in AS (P=0.000001), PsA (P=0.000001), and SAPHO (P=0.0003) patients. There was a positive correlation between serum IL-6 and ESR in AS (P=0.000001), PsA (P=0.002), and SAPHO (P=0.02) patients. There was no correlation of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines in SpA.Conclusions.Serum IL-6 but not serum IL-23 correlated with ESR and CRP in SpA. No correlation was found of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines.

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