Selection of a genetically engineered biological drug for ankylosing spondylitis with extra-skeletal manifestations

2021 ◽  
Vol 7 (1) ◽  
pp. 18-23
Author(s):  
E. Tushnikova
Keyword(s):  
Ankylosing Spondylitis ◽  
Inflammatory Disease ◽  
Aortic Root ◽  
Clinical Remission ◽  
Clinical Case ◽  
Inflammatory Diseases ◽  
Genetically Engineered ◽  
Hla B27 ◽  
Biological Drug ◽  
Selection Of

Ankylosing spondylitis (AS) is a chronic, gradually progressive inflammatory disease of the spine, which in some patients can occur simultaneously with lesions of entheses and peripheral joints, and in some cases the eyes (uveitis) and the aortic root (aortitis). In more than 90% of cases, the genetic marker HLA-B27 is detected. This article presents a clinical case of ankylosing spondylitis in a man who received regular GEBD therapy, against the background of which uveitis recurred. After changing the drug, the inflammatory diseases of the eyes did not recur, and clinical remission was achieved.

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

2015 ◽  
Vol 42 (8) ◽  
pp. 1418-1426 ◽  
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.

Rare Clinical Case of Cryopyrin-Associated Periodic Syndrome Presented with Ankylosing Spondylitis: A Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Anna A. Zayaeva ◽  
Lyudmila V. Sokolova ◽  
Denis V. Shaduro ◽  
Andrey V. Petrov ◽  
Shanmugaraj Kulanthaivel ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Clinical Case ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Treatment Method ◽  
Genetically Engineered ◽  
Periodic Syndrome ◽  
Biological Drugs ◽  
Nlrp3 Gene ◽  
Long Time

Background: Cryopyrin-Associated Periodic Syndrome (CAPS) is a variety of clinical variants of autoinflammatory diseases. The pathology is based on a mutation in the NLRP3 gene encoding the cryopyrin protein, which leads to the uncontrolled production of interleukin-1β. Particular attention should be paid to the rarity of this disease and the lack of clinical knowledge about it in therapeutic and rheumatological practice, which leads to an erroneous diagnosis and the appointment of ineffective treatment for a long time, leading to the progression of the disease and disability of the patient. Case Presentation: This article describes a clinical case of this disease. The first manifestations of the disease in a woman appeared from the age of 2 years, in the form of a rash and fever. Since school age, there have been signs of arthritis. By the age of 24, sensorineural hearing loss and pain in the spine were evident. The disease occurred under the clinical manifestations of spondyloarthritis. Its treatment with anti-inflammatory therapy did not give a stable result. Conclusion: From the analysis, we can conclude that patient M. from early childhood suffers from a severe Neonatal-onset Multisystem Inflammatory Disease of a genetic nature. For a long time, the patient was diagnosed with ankylosing spondylitis, and appropriate treatment was carried out without significant success. The correct diagnosis of CAPS was made only in 2018. This patient has conditions of both CAPS and AS together, which is a very rare association in rheumatological practice. The only treatment method that could stop the manifestations of the disease and prevent life-threatening kidney damage (amyloidosis) is the use of genetically engineered biological drugs, i.e., IL-1β inhibitors. The only drug of this group registered in Russia is canakinumab (Ilaris ®). From the moment of diagnosis to the present day, the patient is treated with the genetically engineered drug canakinumab (Ilaris ®) at a dose of 150 mg once every 8 weeks. 6 months after taking the drug, the patient went into complete clinical and laboratory remission.

scholarly journals Ankylosing Spondylitis

2021 ◽  
Author(s):  
Nazanin Ebrahimiadib ◽  
Sahar Berijani ◽  
Mohammadreza Ghahari ◽  
Fatemeh Golsoorat Pahlaviani
Keyword(s):  
Ankylosing Spondylitis ◽  
Inflammatory Diseases ◽  
Strong Association ◽  
Joint Destruction ◽  
Human Leukocyte ◽  
Axial Skeleton ◽  
Term Treatment ◽  
Joint Involvement ◽  
Hla B27 ◽  
Short Term Treatment

The seronegative spondyloarthropathies are a group of autoimmune inflammatory diseases lacking rheumatoid factor or antinuclear antibody in their serum. They include ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, spondylitis associated with Crohn’s disease and ulcerative colitis, and undifferentiated spondyloarthropathies. Inflammation mostly affects the axial joints, entheses, and extra-articular structures such as uveal tract, gastrointestinal tract, mucocutaneous tissue, and heart. Uveitis is the most common extra-articular manifestation. Spondyloarthropathies, especially AS, have a strong association with the presence of Human Leukocyte Antigen (HLA)-B27 gene. AS happens earlier in HLA-B27 patients and men are more prone to the disease. Uveitis, typically unilateral nongranulomatous acute anterior uveitis, occurs in up to 50% of the patients with AS. HLA-B27 positivity correlates with more frequent flare-ups. Conjunctivitis and scleritis are rare ocular manifestations of AS. To establish the diagnosis of AS, at least one clinical and one radiologic parameter are required for definitive diagnosis. Magnetic resonance imaging (MRI) or bone scan can help early detection of the axial skeleton inflammation. The course of eye and joint involvement are not correlated. Short-term treatment with topical corticosteroids and cycloplegic agents control the uveitis attack. In resistant cases, local or systemic therapy with corticosteroids are recommended. NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs), methotrexate, azathioprine, anti-IL-17A monoclonal antibodies, and TNF- α antagonists are effective treatments for ocular and systemic manifestations of AS. If not treated adequately, uveitis may become recalcitrant and extend posteriorly. Functional impairment due to joint destruction can also occur as a result of undertreatment.

scholarly journals Aortic root diameter is associated with HLA-B27: identifying the patient with ankylosing spondylitis at risk for aortic valve regurgitation

2021 ◽  
Author(s):  
M. Baniaamam ◽  
S. C. Heslinga ◽  
T. C. Konings ◽  
M. L. Handoko ◽  
O. Kamp ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Aortic Valve ◽  
Aortic Root ◽  
Root Diameter ◽  
Hla B27 ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Elderly Male ◽  
Cross Sectional ◽  
Color Flow

AbstractTo assess the association between the aortic root diameter in HLA-B27 positive (+) and HLA-B27 negative (−) ankylosing spondylitis (AS) patients from the CARDAS cohort. The CARDAS study is a cross-sectional study in AS patients between 50 and 75 years who were recruited from a large rheumatology outpatient clinic. Patients underwent cardiovascular screening including echocardiography, with 2D, spectral, and color flow Doppler measurements. The aortic root was measured at sinuses of Valsalva during diastole. The aortic root diameter was adjusted for body surface area (BSA) (aortic root index, cm/m2). 193 Consecutive AS patients were included of whom 158 (82%) were HLA-B27 positive. The aortic root index was significantly higher in HLA-B27 + patients compared to HLA-B27− patients, respectively, 1.76 cm ± 0.21 vs. 1.64 cm ± 0.14, p < 0.001. No difference was seen in the prevalence of aortic valve regurgitation (AVR), p = 0.8. Regression analysis showed a significant association between HLA-B27 and aortic root index corrected for age, sex and cardiovascular risk factors (β 0.091, 95% CI 0.015–0.168, p = 0.02). Especially, male HLA-B27 + patients had a significantly increased aortic root index compared to male HLA-B27− AS patients, respectively, 1.76 cm (1.63–1.88) and 1.59 cm (1.53–1.68), p < 0.001. We found an increased aortic root index in elderly HLA-B27 + AS patients compared to HLA-B27− AS patients, especially in male patients. No difference was seen in the prevalence of AVR. However, as AVR can be progressive, echocardiographic monitoring in elderly male HLA-B27 + AS might be considered.

scholarly journals Ulcerative colitis in combination with ankylosing spondylitis: clinical case

2020 ◽  
Vol 183 (11) ◽  
pp. 147-150
Author(s):  
D. D. Tarasova ◽  
L. N. Shilova ◽  
M. V. Korolyova ◽  
E. G. Korenskaya ◽  
A. V. Feoktistova
Keyword(s):  
Ulcerative Colitis ◽  
Ankylosing Spondylitis ◽  
Inflammatory Bowel Diseases ◽  
Clinical Case ◽  
Modern Medicine ◽  
Genetically Engineered ◽  
Topical Problem ◽  
Biologic Drugs ◽  
Bowel Diseases ◽  
Inflammatory Bowel

The combination of inflammatory bowel diseases with lesions of the spine and joints is an topical problem for modern medicine. A case of combination of ulcerative colitis and sacroiliitis is presented. The patient is recommended the therapy of genetically engineered biologic drugs.

P022 Genetic background predicts the extra-articular involvement in patients with enthesitis related arthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Hanene Ferjani ◽  
Cherif Ines ◽  
Kaouther Maatallah ◽  
Wafa Triki ◽  
Dorra Ben Nessib ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Family History ◽  
Disease Activity ◽  
Genetic Background ◽  
Morning Stiffness ◽  
Inflammatory Diseases ◽  
Hla B27 ◽  
Familial History ◽  
Enthesitis Related Arthritis ◽  
History Of

Abstract Background Enthesitis-related arthritis (ERA) represents 20% of all juvenile idiopathic arthritis subtype. Among the genetic risk factors for the development of ERA, HLA-B27 has been implicated as a major contributor. The frequency of HLA-B27 varies among population. HLA-B 27 status in ERA may influence the clinical phenotype and prognosis of the disease. The main objective of this study is to determine whether genetic background including HLA B27 and familial history of spondylarthritits (SpA) may influence the clinical features of ERA patients. Methods We conducted a retrospective study including patients with ERA, all fulfilling the International League of Associations for Rheumatology (ILAR) criteria. For all patients, we collected the following data: Age, family history of rheumatic inflammatory diseases, inflammatory bowel diseases (IBD), the presence of HLA-B27 antigen, the inflammatory biomarkers: Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP), the disease activity assessed by morning stiffness, night awakenings, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the current treatment. We assessed, as well, the functional impact using the Bath Ankylosing Spondylitis Functional Index (BASFI) the Lequesne index. The population was divided into two groups: a group including patients positive to HLA-B27 antigen and/or with family history of rheumatic inflammatory diseases, psoriasis or inflammatorybowel diseases. The second group was defined as control group with patients negative to HLA-B27 antigen and without any family history of the diseases above. Results We included 40 ERA patients, mean age of onset 12,43 ± 3,003 years (6–16). The majority of them were male (n = 34). Twenty-eight patients had a genetic background. Among them, 7,5% of patients had a positive family history, 42,5% were positive to HLA-B27 antigen and 20% of them met both criteria. As shown in table 1, clinical manifestations were similar between the 2 groups. Enthesitis was more frequent in patients with HLAB27 without a significant difference. Regarding the disease activity, the number of night awakenings and the morning stiffness duration were comparable in the two groups. Six patients had a BASDAI score &gt; 4 with no difference between the two groups. Extra-articular manifestations were present in 15 patients. Among them 14 had a genetic background, reaching the significance threshold with P = 0,013. We counted 8 cases of uveitis, one case of IBD, 5 cases of lung disease and 1 case of cardiac involvement. Inflammatory markers were higher in the group with familial history of SpA and/or positive HLAB27. Indeed, the mean ESR value was 42,73 vs 29.9, P = 0,01. There were no correlations between BASFI score and a positive genetic background (P = 0,283). Only one patient was put on biologics. He has no family history and is negative to HLA-B27 antigen. Conclusion The frequency of HLAB27 was in line with the literature data. The genetic background did not influence the disease activity or the functional impairment in our population. However, a positive correlation was found between a positive familial history of SpA, HLAB27, and the presence of extra-articular manifestations as well as with a higher ESR value.

Ankylosing spondylitis in combination with Crohn's disease: clinical case

2021 ◽  
pp. 53-57
Author(s):  
D. D. Tarasova ◽  
L. N. Shilova ◽  
M. V. Koroleva
Keyword(s):  
Crohn’S Disease ◽  
Ankylosing Spondylitis ◽  
Crohn's Disease ◽  
Autoimmune Diseases ◽  
Clinical Case ◽  
Interdisciplinary Approach ◽  
Underlying Disease ◽  
Extraintestinal Manifestations ◽  
Timely Diagnosis ◽  
Selection Of

Introduction. Ankylosing spondylitis and Crohn's disease are chronic recurrent autoimmune diseases. In case of a combined course their activity tends to progress, regardless of the phase of the underlying disease.The aim of the study. To analyze the combination of ankylosing spondylitis and Crohn's disease, issues of its diagnosis and selection of therapy.Results. The combination of ankylosing spondylitis and Crohn's disease tend to progress independently, regardless of the phase of the underlying disease. The main problem that complicates diagnosis is the lack of a unifed approach to the defnition of extra skeletal and extraintestinal manifestations.Conclusion. The management of patients with a combination of ankylosing spondylitis and Crohn's disease is a common problem of rheumatologists and gastroenterologists. An interdisciplinary approach will allow timely diagnosis of extra-skeletal and extra-intestinal manifestations and correct therapy.

scholarly journals Interdisciplinary approach is a key of efficient treatment in patients with immunoinflammatory diseases. Case report

2021 ◽  
Vol 23 (5) ◽  
pp. 440-443
Author(s):  
Anna V. Kagramanova ◽  
◽  
Oleg V. Knyazev ◽  
Oleg V. Knyazev ◽  
Oleg V. Knyazev ◽  
...  
Keyword(s):  
Clinical Case ◽  
Inflammatory Diseases ◽  
Interdisciplinary Approach ◽  
Genetically Engineered ◽  
Biological Drugs ◽  
Efficient Treatment ◽  
Close Cooperation ◽  
Inflammatory Bowel ◽  
Immunological Factors

The article is devoted to clinical case of concomitant immune-inflammatory diseases: Crohn disease, ankylosing spondylitis, primary sclerosing cholangitis. Chronic immunoinflammatory diseases (CID) caused disability, characterized by similar genetic and immunological factors. The emergence of genetically engineered biological drugs has changed the prognosis for both musculo-skeletal diseases and inflammatory bowel disease (IBD). The intersection of the therapeutic spectrum in CID is a very important point in choosing the tactics of management of patients with these pathologies. This clinical case demonstrates the importance of early diagnosis of immunoinflammatory diseases and application of genetically engineered biological drugs, that contributes to prevention disability and enhancement of quality of life of IBD patients. It is concluded that treatment of immunoinflammatory diseases should be carried out taking into account the course of the IBD and the multidisciplinary approach, which requires close cooperation of doctors of various specialties.

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