Physical Function and Spinal Mobility Remain Stable Despite Radiographic Spinal Progression in Patients with Ankylosing Spondylitis Treated with TNF-α Inhibitors for Up to 10 Years

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.

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AYURVEDIC MANAGEMENT OF ANKYLOSING SPONDYLITIS – A CASE REPORT

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj3809072021 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1555-1559

Author(s):

Saurav Verma

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Structural Damage ◽

Activity Index ◽

Present Report ◽

Modern Science ◽

Disease Activity Index ◽

Spinal Mobility ◽

Systemic Inflammatory Disease ◽

Ayurvedic Treatment

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)

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Assessment of Preclinical Atherosclerosis in Patients with Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.110792 ◽

2012 ◽

Vol 39 (2) ◽

pp. 322-326 ◽

Cited By ~ 30

Author(s):

WAFA HAMDI ◽

MOUNA CHELLI BOUAZIZ ◽

IMEN ZOUCH ◽

MOHAMED MEHDI GHANNOUCHI ◽

MANEL HAOUEL ◽

...

Keyword(s):

Risk Factors ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Structural Damage ◽

Activity Index ◽

Age At Onset ◽

Disease Activity Index ◽

Mobility Limitations ◽

Increased Risk ◽

Preclinical Atherosclerosis

Objective.Epidemiological studies recently confirmed the increased risk of vascular morbidity and mortality during ankylosing spondylitis (AS). Increase of intima-media thickness (IMT) of the common carotid artery is a useful and noninvasive marker of preclinical atherosclerosis. The aim of our study was to compare IMT in patients with AS with matched controls and to determine risk factors of atherosclerosis related to AS.Methods.We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS, compared to 60 controls matched for age and sex. Disease-specific measures were determined. Measurement of IMT was performed by the same radiologist using the same machine and probe in right and left common carotid arteries, and the average of the 2 measurements was considered.Results.In total 48 male and 12 female patients were recruited, and 60 corresponding controls; mean age was 36 ± 11 years. We found significantly increased IMT in the AS group (0.51 ± 0.12 mm) compared with controls (0.39 ± 0.09 mm; p = 0.001). After adjustment for confounding factors, increased IMT was still present (p = 0.003). Age at onset of AS (p = 0.001), Bath AS Disease Activity Index (p = 0.002), AS Disease Activity Score (ASDAS) erythrocyte sedimentation rate (ESR; p = 0.047), ASDAS C-reactive protein (CRP; p = 0.012), Bath AS Functional Index (p = 0.008), global spine visual analog scale for pain (p = 0.000), Schober index (p = 0.039), Bath AS Metrology Index (p = 0.028), modified Stoke Ankylosing Spondylitis Spine Score (p = 0.035), and high ESR (p = 0.001) and CRP (p = 0.000) were correlated with high IMT in patients with AS. Otherwise, status of arthritis (p = 0.442), enthesitis (p = 0.482), and HLA-B27 (p = 0.528) seemed to have no effect on IMT.Conclusion.AS is associated with an increased risk of atherosclerosis independent of traditional risk factors. Disease activity, functional and mobility limitations, structural damage, and inflammation are the most incriminated risk factors.

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Maintained Clinical Remission in Ankylosing Spondylitis Patients Switched from Reference Infliximab to Its Biosimilar: An 18-Month Comparative Open-Label Study

Journal of Clinical Medicine ◽

10.3390/jcm8070956 ◽

2019 ◽

Vol 8 (7) ◽

pp. 956 ◽

Cited By ~ 3

Author(s):

Kaltsonoudis Evripidis ◽

Pelechas Eleftherios ◽

Voulgari V. Paraskevi ◽

Drosos A. Alexandros

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Clinical Remission ◽

Activity Index ◽

Disease Activity Index ◽

Control Group ◽

Nocebo Effect ◽

Open Label

Background: Switching from reference infliximab (RI) to biosimilar infliximab (BI) had no detrimental effects on efficacy and safety. However, long-term follow-up data is missing. Objective: To evaluate patients with Ankylosing Spondylitis (AS) in clinical remission who were switching from RI to BI, in terms of the safety and efficacy of this, in a long-term fashion. Methods: One hundred and nine consecutive unselected AS patients were investigated. All were naïve to other biologics and were followed-up at predefined times receiving RI. Patients in clinical remission were asked to switch from RI to BI. Those who switched to BI were compared with a matched control-group receiving continuous RI. During follow-up, several parameters were recorded for at least 18 months. Disease activity was measured using the Bath Ankylosing Spondylitis disease activity index (BASDAI), and the Ankylosing Spondylitis disease activity score (ASDAS), using the C-reactive protein. Remission was defined as BASDAI < 4 and ASDAS < 1.3. Results: Eighty-eight patients were evaluated (21 excluded for different reasons). From those, 45 switched to BI, while 43 continued receiving RI. No differences between groups regarding demographic, clinical and laboratory parameters were observed. All patients were in clinical remission. During follow-up, five patients from the BI-group and three from the maintenance-group discontinued the study (4 patients nocebo effect, 1 loss of efficacy). After 18 months of treatment, all patients in both groups remained in clinical remission. No significant adverse events were noted between groups. Conclusion: BI is equivalent to RI in maintaining AS in clinical remission for at least 18 months.

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Biosimilars in Saudi Arabia: a single-centre, open-label case series examining infliximab switching

Generics and Biosimilars Initiative Journal ◽

10.5639/gabij.2021.1002.007 ◽

2021 ◽

Vol 10 (2) ◽

pp. 68-71

Author(s):

Mansour Somaily ◽

Hana Alahmari ◽

Wejdan Abbag ◽

Shahenda Yousif ◽

Nawar Tayfour ◽

...

Keyword(s):

Saudi Arabia ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Case Series ◽

Disease Activity Index ◽

Local Data ◽

Open Label ◽

One Year

Background: A biosimilar version of infliximab ( CT-P13) was recently approved for use in Saudi Arabia. Clinical data support its use in the treatment of rheumatic disease, however, there is a lack of local data regarding the efficacy and tolerability of CT-P13 among patients with rheumatological disorders in Saudi Arabia. Objectives: To investigate the feasibility, tolerability and immunogenicity of switching from originator infliximab to biosimilar infliximab, CT-P13, in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and Behçet’s disease (BD). Methodology: The study included patients who were being treated with originator infliximab in the Department of Rheumatology in Khamis Mushayt General Hospital, Saudi Arabia, and were required to switch to biosimilar infliximab (CT-P13) between January 2018 and June 2019. Patient follow-up was carried out every three months for one year. The disease activity score 28 (DAS28) was used to assess RA severity. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was used to measure disease activity in patients with AS, while BD disease activity was based on clinical assessment. Results: In total, 13 patients (six with RA, five with AS and two with BD) were switched to biosimilar infliximab. The majority (n = 11/13) remained on biosimilar infliximab throughout the follow-up period with no reported major adverse events. Overall, there was a significant improvement in RA disease activity following biosimilar treatment, with the mean DAS28 decreasing from 3.61±1.24 before biosimilar therapy to 2.63±1.54 one year after switching. Conclusion: In patients with AS, BD, or RA who switched from originator infliximab to the biosimilar, CT-P13, we did not observe any significant differences in tolerability or efficacy between biosimilar and originator. Furthermore, disease activity significantly declined in RA patients following biosimilar treatment

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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

Hong Kong Bulletin on Rheumatic Diseases ◽

10.1515/hkbrd-2016-0012 ◽

2016 ◽

Vol 16 (2) ◽

pp. 42-47

Author(s):

Shirley Chiu Wai Chan ◽

Helen Hoi Lun Tsang ◽

Chak Sing Lau ◽

Ho Yin Chung

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Blood Parameters ◽

Spinal Mobility ◽

Lumbosacral Spine ◽

Hla B27 ◽

Cluster Analyses ◽

Magnetic Resonance Imaging Mri

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.

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Early response to adalimumab predicts long-term remission through 5 years of treatment in patients with ankylosing spondylitis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2011-200358 ◽

2011 ◽

Vol 71 (5) ◽

pp. 700-706 ◽

Cited By ~ 61

Author(s):

Joachim Sieper ◽

Désirée van der Heijde ◽

Maxime Dougados ◽

L Steve Brown ◽

Frederic Lavie ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Early Response ◽

Inactive Disease ◽

Sustained Remission ◽

Efficacy And Safety ◽

Open Label

ObjectivesTo describe the efficacy and safety through 5 years of adalimumab treatment in patients with ankylosing spondylitis (AS), and to identify predictors of remission.MethodsPatients with active AS were followed up to 5 years during a 24-week randomised, controlled period, followed by an open-label extension. Disease activity and clinical improvement were evaluated by Assessment in Spondyloarthritis International Society (ASAS) responses, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Kaplan–Meier was used to identify patients with sustained ASAS partial remission (PR) or ASDAS inactive disease (ID) for three or more consecutive visits spanning ≥6 months. Logistic regression was used to identify factors associated with remission. Explanatory variables included baseline demographic and disease characteristics and week 12 responses.ResultsOf the 311 patients who received at least one dose of adalimumab, 202 (65%) completed the 5-year study. Among 125 patients who received 5 years of adalimumab, 70%, 77%, 51% and 61% achieved ASAS40, BASDAI 50, ASAS PR and ASDAS ID, respectively. Of 311 adalimumab-treated patients, 45% and 55% achieved sustained ASAS PR and ASDAS ID at any time during study participation. The strongest predictor of remission at years 1 and 5 and of sustained remission was achieving remission at 12 weeks of treatment; baseline characteristics showed weaker associations. Adverse events were comparable with previous reports on adalimumab safety.ConclusionsIn patients with active AS, the efficacy and safety of adalimumab were maintained through 5 years with about half of the patients experiencing sustained remission at any time during the study. Early achievement of remission was the best predictor of long-term and sustained remission.

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Serum Oxytocin Levels in Patients with Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis and their Association with Disease Activity

Aktuelle Rheumatologie ◽

10.1055/a-1330-7020 ◽

2021 ◽

Author(s):

Ozkan Yukselmis ◽

Pelin Oktayoğlu ◽

Mehmet Caglayan ◽

Nuriye Mete

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Complete Blood Count ◽

Inflammatory Diseases ◽

Activity Index ◽

Disease Activity Index ◽

Serum Levels ◽

Spinal Mobility ◽

Significant Difference

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.

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miRNA-451a and miRNA-125a Expression Levels in Ankylosing Spondylitis: Impact on Disease Diagnosis, Prognosis, and Outcomes

Journal of Immunology Research ◽

10.1155/2020/2180913 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Dina Salem Fotoh ◽

Rasha Ibrahim Noreldin ◽

Mohamed Soliman Rizk ◽

Maha Mohamed Elsabaawy ◽

Heba Ahmed Esaily

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Expression Profile ◽

Structural Damage ◽

Activity Index ◽

Disease Activity Index ◽

Disease Diagnosis ◽

Cross Sectional ◽

Expression Levels ◽

Therapeutic Implications

Background. Early diagnosis of ankylosing spondylitis (AS) is yet not elucidated, with a potential diagnostic glance of microRNAs (miRNAs). Aim. Study the expression profile of miRNA-451a and miRNA-125a in AS patients and their impact on disease activity and prognosis. Methods. A cross-sectional study included 55 AS patients diagnosed according to modified New York criteria in 1984 with 55 matched healthy controls. History, clinical examination, and disease activity assessment with Bath ankylosing spondylitis disease activity index (BASDAI) were done. Full laboratory and radiological assessment along with expression profile of m iRNA-451a and miRNA-125a were tabulated and analyzed. Results. Higher expression levels of miRNA-125a and lower of miRNA-451a in AS patients compared to controls. Furthermore, miRNA-125a expression was high in active AS patients compared to inactive patients and controls ( 7.0 ± 3.4 vs. 4.1 ± 2.1 vs. 2.6 ± 0.6 , p < 0.001 , respectively). miRNA-451a was significantly lower in active AS patients compared to inactive patients and controls ( 2.2 ± 1.1 vs. 4.1 ± 2.3 vs. 7.1 ± 4.5 , respectively). Both miRNAs (miRNA-125a and miRNA-451a) had evident accuracy for AS diagnosis with areas under the curve (AUC) of 0.788 and 0.802, respectively. miRNA-125a had potential impact on AS activity with AUC of 0.777. Plasma levels of both miRNAs were able to distinguish AS patients with structural damage with AUCs 0.775 and 0.692, respectively. Conclusions. Both miRNA-451a and miRNA-125a were found to be of great value as sensitive noninvasive diagnostic, prognostic, and disease burden biomarker of AS patients in Egypt with suggested further studies for future therapeutic implications.

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Evaluation of Circulating Endothelial and Platelet Microparticles in Men with Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.111073 ◽

2012 ◽

Vol 39 (3) ◽

pp. 594-599 ◽

Cited By ~ 8

Author(s):

ISMAIL SARI ◽

GIRAY BOZKAYA ◽

HALIL KIRBIYIK ◽

AHMET ALACACIOGLU ◽

HALIL ATES ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Vascular Function ◽

Activity Index ◽

Disease Activity Index ◽

Biological Agents ◽

Spinal Mobility ◽

Healthy Controls ◽

Artery Disease ◽

Platelet Microparticles

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.

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ASAS Health Index as an Addition to Routine Clinical Practice

The Journal of Rheumatology ◽

10.3899/jrheum.201440 ◽

2021 ◽

pp. jrheum.201440

Author(s):

Rubén Queiro ◽

Sara Alonso-Castro ◽

Mercedes Alperi

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Structural Damage ◽

Activity Index ◽

Functional Limitations ◽

Disease Activity Index ◽

Health Index ◽

Quality Of Life Scale

We have read with great interest the recent editorial published in The Journal by Dr. Kiltz, et al, referring to the possibility of using the Spondyloarthritis international Society Health Index (ASAS HI) as an all-in-one in the assessment of axial spondyloarthritis (axSpA)1. AxSpA has been evaluated over the years with different tools that have tried to determine the degree of activity [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)/Ankylosing Spondylitis Disease Activity Score (ASDAS)], functional limitations (Bath Ankylosing Spondylitis Functional Index), mobility restrictions (Bath Ankylosing Spondylitis Metrology Index), structural damage accumulated over time (Bath Ankylosing Spondylitis Radiology Index/modified Stoke Ankylosing Spondylitis Spinal Score), or quality of life (Ankylosing Spondylitis Quality of Life scale) of these patients.

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