scholarly journals Male smokers with HLA-B27 positivity, SI joints inflammation have more radiological damages and higher prevalence of AS while females have higher BASDAI scores: observations from cluster analyses of a group of SpA patients

2016 ◽  
Vol 16 (2) ◽  
pp. 42-47
Author(s):  
Shirley Chiu Wai Chan ◽  
Helen Hoi Lun Tsang ◽  
Chak Sing Lau ◽  
Ho Yin Chung

AbstractObjectivesTo describe the clinical characteristics and the relations with disease activity, functional status, and syndesmophytes formation in patients with axial spondyloarthritis (AxSpA) by categorizing them into different groups.MethodsOne hundred and sixty three patients with AxSpA were recruited. Clinical and blood parameters were collected. Patients were asked to complete the self-assessment questionnaires, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal mobility was measured according to Bath Ankylosing Spondylitis Metrology Index (BASMI). Radiographs of cervical and lumbosacral spine were performed for modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Radiological sacroiliitis was scored for ankylosing spondylitis (AS). Magnetic resonance imaging (MRI) of the sacroiliac (SI) joints was performed for spondyloarthritis research consortium of Canada (SPARCC) MRI inflammation score. Two-way cluster analyses were performed to determine the relationships between the parameters.ResultsTwo cluster models were built using SPARCC scores of different scorers. Results were similar. The group of patients with highest mSASSS (20.33 vs 20.33) and prevalence radiological AS (85% vs 86%) were male patients (75% vs 75%), positive for HLA-B27 (70.0% vs 66.7%), smokers (87.5% vs 97.2%), and higher SPARCC SI joints score (5.32 vs 3.17). Higher BASDAI was observed among female sex. BASMI varies little but the group with highest BASMI (3.60 vs 3.62) also had highest mSASSS (20.33 vs 20.33).ConclusionOur data showed that male smokers with HLA-B27 positivity and SI joints inflammation have more radiological damage and higher prevalence of AS, consistent with known poor prognosis factors.

2016 ◽  
Vol 43 (12) ◽  
pp. 2142-2148 ◽  
Author(s):  
Denis Poddubnyy ◽  
Aleksandra Fedorova ◽  
Joachim Listing ◽  
Hildrun Haibel ◽  
Xenofon Baraliakos ◽  
...  

Objective.The aim of the study was to investigate the effect of radiographic spinal progression and disease activity on function and spinal mobility in patients with ankylosing spondylitis (AS) treated with tumor necrosis factor-α (TNF-α) inhibitors for up to 10 years.Methods.Patients with AS who participated in 2 longterm open-label extensions of clinical trials with TNF-α inhibitors (43 receiving infliximab and 17 receiving etanercept) were included in this analysis based on the availability of spinal radiographs performed at baseline and at a later timepoint (yr 2, 4, 6, 8, and 10) during followup. Spinal radiographs were scored according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Function was assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI), spinal mobility by the Bath Ankylosing Spondylitis Metrology Index (BASMI), and disease activity by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).Results.After the initial improvement, BASFI and BASMI remained remarkably stable at low levels over up to 10 years despite radiographic spinal progression. In the generalized mixed effects model analysis, no association between the mSASSS and the BASFI change (β = 0.0, 95% CI −0.03 to 0.03) was found, while there was some effect of mSASSS changes on BASMI changes over time (β = 0.05, 95% CI 0.01–0.09). BASDAI showed a strong association with function (β = 0.64, 95% CI 0.54–0.73) and to a lesser extent, with spinal mobility (β = 0.14, 95% CI 0.01–0.26).Conclusion.Functional status and spinal mobility of patients with established AS remained stable during longterm anti-TNF-α therapy despite radiographic progression. This indicates that reduction and continuous control of inflammation might be able to outweigh the functional effect of structural damage progression in AS.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
James T. Rosenbaum ◽  
Michael H. Weisman ◽  
Hedley Hamilton ◽  
Cassie Shafer ◽  
Elin Aslanyan ◽  
...  

AbstractHLA-B27 is associated with increased susceptibility and disease activity of ankylosing spondylitis, but the effect of HLA-B27 on the activity of the broader category now called axial spondyloarthritis (AxSpA) is apparently the opposite. A modified Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess disease activity among 3435 patients with spondyloarthritis (SpA) who participated in a survey designed to assess the effect of their disease and its treatment on the susceptibility and severity of Covid-19. Chi square testing was used to compare BASDAI scores between HLA-B27 positive and negative subjects. 2836 survey respondents were HLA B27 positive. The average BASDAI for the HLA-B27 negative cohort was 4.92 compared to 4.34 for the HLA-B27 positive subjects. Based on linear regression, a subject’s sex could not fully account for the differing BASDAI score in HLA-B27 negative subjects compared to those who are HLA-B27 positive. The difference between B27 positive and negative subjects was skewed by those with a BASDAI score of one or two. HLA-B27 positive subjects were more than twice as likely to have a BASDAI score of 1 compared to HLA B27 negative subjects and about 60% more likely to have a BASDAI score of 2 (p < 0.0001). HLA-B27 positive subjects have less active spondyloarthritis compared to HLA-B27 negative subjects as measured by a BASDAI score. Our data indicate that patients with mild back pain and a diagnosis of AxSpA are disproportionately HLA-B27 positive. The HLA-B27 test facilitates the diagnosis of axial spondyloarthritis such that patients from a community survey with mild back pain may be disproportionately diagnosed as having AxSpA if they are HLA-B27 positive. The test result likely introduces a cognitive bias into medical decision making and could explain our observations.


2021 ◽  
Vol 9 (7) ◽  
pp. 1555-1559
Author(s):  
Saurav Verma

Ankylosing spondylitis (AS) is a chronic, systemic, inflammatory disease that affects primarily sacroiliac joints and the spine. It is a gradually progressive condition over several years until structural damage manifests clinical- ly as sacroiliitis, loss of spinal mobility, extra-articular symptoms, peripheral arthritis and reduced quality of life. The onset is typically between the ages of 20 to 30, with a male preponderance of about 3:1. Modern science has very limited options to treat Ankylosing spondylitis. So, the necessity of management through Ayurveda is very much essential. Various Panchakarma procedures and internal Ayurvedic medicines have been proved beneficial in the management of Ankylosing spondylitis. The present report deals with a case of ‘Ankylosing spondylitis came to our hospital for Ayurvedic treatment. The patient was diagnosed as having 'Asthi-Majja Gata Vata’ ac- cording to Ayurveda and treated with various Panchakarma procedures and internal medicines for 60 days. A cri- terion of assessment was based on the scoring of 'Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)'. Total two assessments were carried out before and after 60 days of treatment. The patient has shown good improvement on BASDAI (80% relief). Improvement was found in signs and symptoms like fa- tigue/tiredness, back/hip pain, tenderness and intensity as well as the duration of morning stiffness. Ayurvedic treatment seems to be promising in the management of Ankylosing spondylitis without causing any adverse effects. Keywords: Ankylosing spondylitis; Asthi-Majja Gata Vata; Panchakarma; Ayurveda; Bath ankylosing spondyli- tis disease activity index (BASDAI)


2007 ◽  
Vol 67 (4) ◽  
pp. 511-517 ◽  
Author(s):  
S Visvanathan ◽  
C Wagner ◽  
J C Marini ◽  
D Baker ◽  
T Gathany ◽  
...  

Objective:To evaluate the relationship between biomarker levels and disease activity and the spinal inflammation detected by magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS).Methods:Patients with AS were randomly assigned in a 3:8 ratio to receive infusions of placebo or 5 mg/kg infliximab at weeks 0, 2, 6, 12 and 18. Sera were collected for biomarker analysis at weeks 0, 2 and 24 and were analysed for levels of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) and C-reactive protein (CRP). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores and pre- and post-gadolinium T1 and short τ inversion recovery MRIs were collected at baseline and week 24.Results:Significantly greater reductions in IL-6, VEGF and CRP were observed at weeks 2 and 24 in the infliximab group compared with the placebo group (all p<0.001). Baseline IL-6 levels >7.38 pg/ml and CRP levels >1.5 mg/dl were associated with increased rates of clinical response after 24 weeks. Multiple regression analyses showed that reductions from baseline to week 2 in IL-6, but not CRP or VEGF, were significantly associated with reductions in MRI activity and BASDAI scores from baseline to week 24 in the infliximab group (p<0.001).Conclusions:Significant reductions in IL-6, VEGF and CRP were observed with infliximab compared with placebo. High levels of baseline IL-6 and CRP were associated with clinical response after infliximab treatment. Early reductions in IL-6 were significantly associated with improvements in disease activity and the spinal inflammation detected by MRI.


Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Nibha Jain ◽  
Swetha Byravan Byravan ◽  
Jenna Stairs ◽  
Winston Rennie ◽  
Moorthy Arumugam

Abstract Background/Aims  The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is routinely used subjective outcome measurement of disease activity in Ankylosing Spondylitis (AS). BASDAI &gt; 4 is used as a criterion for commencing anti-TNF therapy. Previous studies shown BASDAI correlation with MRI has been proven to be weak. We did this study to systemically compare clinical and radiological data of patients with AS and to look for the degree of correlation between BASDAI score and MRI changes positive for spondyloarthritis in our cohort of patients. Methods  A retrospective analysis of AS patients attending Leicester spondylarthritis service at University Hospitals Leicester Trust (UHL) was carried out. Clinical characteristics such as HLA-B27 status, extra-articular features, family history of AS and CRP measurement were obtained from online systems and clinic letters. Online records were reviewed to see if patients had a MRI of the sacroiliac joints along with a BASDAI score at the time of MRI. Medcalc calculator was used for statistical analysis. Results  A total of 106 patients were analysed with a mean age of 45.6 +/- 11.6 years (M = 62, F = 44) with mean BASDAI of 5.0 +/- 2.5. Mean CRP was 17.01+/- 30.4 (median CRP 6.5). 61% (n = 65) were HLA-B27 positive. 70 of 106 patients had a sacroiliac MRI scan which could be reviewed to a satisfactory level to determine whether disease is present or not. Two results were statistically significant when comparing active versus no active lesions on MRI: inflammatory back pain and anti-TNF therapy (Table 1). P185 Table 1:Comparison of clinical features in patients with active versus inactive lesions on MRI sacroiliac joint.Active lesions on MRI N = 45No active lesions on MRI N = 25P valueMean BASDAI (SD)5.0 (2.6)5.4(2.6)0.5Mean ASDAS CRP (SD)2.14(1.1)2.04(0.6)0.73Mean CRP (SD) mg/l14.7(21)17.8(33)0.645.5HLA-B2731180.Uveitis1190.3Inflammatory back pain40170.03Enthesitis820.3Peripheral Arthritis670.1Dactylitis010.2Psoriasis211Inflammatory bowel disease710.1Ethnicity: Caucasian37230.2Ethnicity: Asian820.3Age45.5 (10.2)50.5(11.3)0.06M: F26:1916:90.7Anti-TNF therapy1840.03BASDAI &gt;428150.8BASDAI &lt;417100.8BASDAI= Bath ankylosing spondylitis disease activity index, ASDAS= Ankylosing Spondylitis disease. CRP=C-reactive protein, HLA= human leucocyte antigen. Conclusion  BASDAI score did not statistically correlate with the severity of inflammation as objectively observed on MRI. Only inflammatory back pain and anti-TNF therapy correlated with MRI disease activity. There was no difference in clinical features including HLA-B27 between patients with active and inactive MRI. Thus, BASDAI as a criterion for biologic therapy may need re-considering. Disclosure  N. Jain: None. S. Byravan: None. J. Stairs: None. W. Rennie: None. M. Arumugam: Other; Speaker and Conference Fee MSD, Novartis, Abbvie.


2021 ◽  
Author(s):  
Ozkan Yukselmis ◽  
Pelin Oktayoğlu ◽  
Mehmet Caglayan ◽  
Nuriye Mete

Abstract Objectives Spondyloarthritis refers to a group of chronic inflammatory diseases that particularly involve the sacroiliac joints and spine but may also have an influence on extra-articular involvement in some patients. Oxytocin is a peptide hormone released from the hypothalamus and stored in the pituitary gland. It is known to have anti-inflammatory effects. The aim of this study was to investigate the serum levels of oxytocin and their potential association with disease activity and spinal mobility in patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA). Material and Methods Seventy-one patients with nrAxSpA, 38 patients with AS and 67 healthy control subjects were included in this study. Disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index, and spinal mobility by the Bath Ankylosing Spondylitis Metrologic Index. Laboratory examinations included complete blood count, ESR, CRP and oxytocin tests. Results There was no significant difference in serum levels of oxytocin among the 3 groups (p=0.973). However, serum levels of oxytocin correlated negatively with both ESR (r=− 0.359, p=0.027), CRP (r=− 0.316, p=0.056) and BASDAI scores (r=− 0,448, p=0.005) in patients with AS. On the other hand, serum levels of oxytocin had a negative correlation only with ESR in patients with nrAxSpA (r=− 0.321 p=0.009).Conclusion This study lays the foundation for further studies that may aim to investigate how addition of oxytocin to the treatment regimen impacts on disease activity in patients with AS who exhibit particularly low levels of oxytocin during the active disease period.


2012 ◽  
Vol 39 (3) ◽  
pp. 594-599 ◽  
Author(s):  
ISMAIL SARI ◽  
GIRAY BOZKAYA ◽  
HALIL KIRBIYIK ◽  
AHMET ALACACIOGLU ◽  
HALIL ATES ◽  
...  

Objective.To evaluate the profiles of endothelial microparticles (EMP) and platelet microparticles (PMP) in men with ankylosing spondylitis (AS) and healthy subjects. We also aimed to determine whether microparticles (MP) correlate with disease activity, function, and spinal mobility indices.Methods.There were 82 men with AS and 53 healthy controls. Subjects with a history of chronic diseases including coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia were excluded. MP were stained with monoclonal antibodies against platelets and endothelial cells and quantified using flow cytometry. MP that were positive for both CD42a+/CD31+ and total CD42a+ were identified as PMP; and MP consisting of CD42a–/CD31+ and total CD144+ were considered EMP.Results.EMP and PMP were similar between the patient and control groups (p > 0.05). Comparison of patients with AS in the active disease state (BASDAI ≥ 4) and in the inactive state showed that EMP and PMP were not different between the groups (p > 0.05). Correlation analysis revealed no correlation with Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, or Bath Ankylosing Spondylitis Metrology Index. C-reactive protein was significantly correlated with PMP and CD42a–/CD31+ EMP (p < 0.05). Comparison of patients with AS treated with anti-tumor necrosis factor (anti-TNF) drugs, subjects treated conventionally, and healthy controls revealed that PMP and CD42a–/CD31+ EMP were significantly downregulated in patients receiving biological agents.Conclusion.Circulating EMP and PMP, known to be indicators and mediators of vascular injury, were not significantly altered in men with AS who did not have classical cardiovascular risk factors. Significantly downregulated MP in patients receiving biological agents suggested that anti-TNF treatment may have a beneficial effect on vascular function in AS.


2010 ◽  
Vol 37 (4) ◽  
pp. 829-834 ◽  
Author(s):  
TAMAR F. BRIONEZ ◽  
SHERVIN ASSASSI ◽  
JOHN D. REVEILLE ◽  
CHARLES GREEN ◽  
THOMAS LEARCH ◽  
...  

Objective.To investigate the role of psychological variables in self-reported disease activity in patients with ankylosing spondylitis (AS), while controlling for demographic and medical variables.Methods.Patients with AS (n = 294) meeting modified New York criteria completed psychological measures evaluating depression, resilience, active and passive coping, internality, and helplessness. Demographic, clinical, and radiologic data were also collected. Univariate and multivariate analyses were completed to determine the strength of the correlation of psychological variables with disease activity, as measured by the Bath AS Disease Activity Index (BASDAI).Results.In the multivariate regression analysis, the psychological variables contributed significantly to the variance in BASDAI scores, adding an additional 33% to the overall R-square beyond that accounted for by demographic and medical variables (combined R-square 18%). Specifically, arthritis helplessness and depression accounted for the most significant portion of the variance in BASDAI scores in the final model.Conclusion.Arthritis helplessness and depression accounted for significant variability in self-reported disease activity beyond clinical and demographic variables in patients with AS. These findings have important clinical implications in the treatment and monitoring of disease activity in AS, and suggest potential avenues of intervention.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1129.1-1129
Author(s):  
A. Baillet ◽  
X. Romand ◽  
A. Pfimlin ◽  
M. Dalecky ◽  
M. Dougados

Background:Standardization of clinical practice has been proven to be effective in management of chronic diseases. This is particularly true at the time where the concept of treat to target is becoming more and more important in the field of axial spondyloarthritis (ax-SpA).Objectives:To propose a list of variables to be collected at the time of the diagnosis and over the follow-up of patients with axial spondyloarthritis (ax-SpA) for an optimal management in daily practice.Methods:The process comprised (1) the evaluation of the interest of 51 variables proposed for the assessment of axSpA via a systematic literature research, (2) a consensus process involving 78 hospital-based or office-based rheumatologists, considering the collection of the variable in a 4 grade scale from ”potentially useful” to “mandatory”, (3) a consensus on optimal timeline for periodic assessment of the selected variables on a 5 grade scale from “at each visit” to “never to be re-collected”.Results:The systematic literature research retrieved a total of 14,133 abstracts, of which 213 were included in the final qualitative synthesis. Concerning the data to be collected at the time of the diagnosis and during follow-up, we proposed to differentiate the results based on a) the way of collection of the variables (e.g. questionnaires by the patient, interview by the physician, physical examination, investigations) b) the usefulness these variables in daily practice based on the opinion of the rheumatologists ” c) the optimal timeline between 2 evaluations of the variable based on the opinion of the rheumatologists. In the initial systematic review, symptoms of heart failure history of inflammatory bowel disease, psoriasis or uveitis, patient global visual analogic scale, spine radiographs, modified Schöber test, coxo-femoral rotations, swollen joint count, urine strip test, BASDAI and ASDAS global scores were considered very useful and nocturnal back pain/morning stiffness, sacro-iliac joints radiographs and CRP were considered mandatory (Figure 1). Timeline between 2 evaluations of variables to collect in the periodic review are summarized inFigure 2.Figure 1.Core sets of items to collect and report in the systematic review in axial spondyloarthritis management in daily practice ASDAS=Ankylosing Spondylitis Disease Activity Score, BASDAI=Bath Ankylosing Spondylitis Disease Activity Index, BASFI=Bath Ankylosing Spondylitis Functionnal Index, BASMI=Bath Ankylosing Spondylitis Metrology Index, CRP=C Reactive Protein, CT=computerized tomography, FIRST=Fibromyalgia Rapid Screening Tool, HLA=Human Leukocyte Antigen, MRI=Magnetic resonance imaging, PET=positron emission tomography.Figure 2.Periodic review timeline of variables to collectASDAS=Ankylosing Spondylitis Disease Activity Score, BASDAI=Bath Ankylosing Spondylitis Disease Activity Index, Spondylitis Metrology Index, CRP=C Reactive Protein, IBD = inflammatory bowel diseases, PRO = Patient Reported OutcomesConclusion:Using an evidence-based and an expert consensus approaches, this initiative defined a core set of variables to be collected and reported at the time of the diagnosis and during follow-up of patients with ax-SpA in daily practice.Acknowledgments:this study has been conducted in two parts: the first one (evidence-based) was conducted thanks to a support from Abbvie France. AbbVie did not review the content or have influence on this manuscript. The second part of this initiative (consensus) has been conducted thanks to a support from the scientific non-profit organization: Association de Recherche Clinique en RhumatologieDisclosure of Interests:Athan Baillet Consultant of: Athan BAILLET has received honorarium fees from Abbvie for his participation as the coordinator of the systematic literature review, Xavier Romand Consultant of: Xavier ROMAND has received honorarium fees from Abbvie, Arnaud Pfimlin Consultant of: Arnaud PFIMLIN has received honorarium fees from Abbvie, Mickael Dalecky Consultant of: Mickael DALECKY has received honorarium fees from Abbvie, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1629.2-1629
Author(s):  
K. Ben Abdelghani ◽  
Y. Gzam ◽  
A. Fazaa ◽  
S. Miladi ◽  
K. Ouenniche ◽  
...  

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


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