Definition of disease duration in ankylosing spondylitis: reassessing the concept

Characteristics of Late-Onset Spondyloarthritis: Data from the Moroccan Registry of Biological Therapies in Rheumatic Diseases

Introduction The Assessment of SpondyloArthritis International Society (ASAS) criteria for axial and peripheral spondyloarthritis (SpA) allow for the classification of patients with an age of onset of disease of less than 45 years. However, SpA can start after this age. This study aimed to assess the characteristics of late-onset SpA (SpA>45 years) in the Moroccan registry of biological therapies in rheumatic diseases (RBSMR). Methods A cross-sectional study was conducted using the baseline data of the RBSMR. The protocol for the original RBSMR study was reviewed and approved by the Ethics Committee for Biomedical Research Mohammed V University - Rabat, Faculty of Medicine and Pharmacy of Rabat (approval number for the study was 958/09/19, and the date of approval was September 11, 2019), and all patients had given their written consent. Patients who met the 2009 ASAS criteria for SpA were included. They were divided into two groups: early-onset SpA (≤ 45 years) and late-onset SpA (>45 years). Clinical, biological, radiological, and therapy data of the two groups were compared. Statistical analysis was performed using SPSS v25 software (IBM Corp. Armonk, NY). Parameters with a p-value ≤0.05 were considered significant. Results Our population consisted of 194 patients. Thirty-one patients (16%) had late-onset SpA. Comparison between patients with early-onset (≤45 years) and late-onset SpA (>45 years) revealed that late-onset SpA had a higher tender joint count (p=0.01), a higher swollen joint count (p=0.02), depression (p=0.00), fibromyalgia (p=0.001), hypercholesterolemia (p=0.01), and a lower frequency of coxitis (p=0.008). Logistic regression analysis confirmed that late-onset SpA was associated with a higher tender joint count (OR=0.93, CI 95%: 0.88-0.98), a higher swollen joint count (OR=0.92, CI 95%: 0.85-0.99), depression ( OR=0.19, CI 95%:0.04-0.38), fibromyalgia (OR=1.75, CI 95%: 1.74-17.85), and a lower frequency of coxitis ( OR=0.29, CI 95%: 0.11-0.75). Conclusion As life expectancy increases, late-onset SpA will become increasingly common. It is therefore imperative to determine its characteristics. In the RBSMR study, late-onset SpA was associated with a high number of tender and swollen joints, depression, fibromyalgia, and a lower frequency of coxitis.

Propensity-matched Comparison Between Chronic Nonspecific Low Back Pain and Axial Spondyloarthritis: Impact on patient-perceived Quality of Life

STUDY DESIGN

Prospective study.

OBJECTIVE

To compare the burden between chronic nonspecific low back pain (LBP) and axial spondyloarthropathy (SpA).

SUMMARY OF BACKGROUND DATA

Chronic nonspecific LBP and SpA are two debilitating yet different chronic musculoskeletal disorders. To compare their burden, propensity score matching is used to control for potential confounders and match the study subjects.

MATERIALS AND METHODS

Two prospectively collected cohorts of LBP (n=269) and SpA (n=218) patients were studied. Outcomes included current LBP, 36-item Short Form Questionnaire, Oswestry Disability Index, EuroQol 5-dimension 5-level Questionnaire, and EuroQol Visual Analog Scale. With the inherent differences between the two types of patients, propensity score matching was performed for comparing the two groups. Baseline covariates of age, sex, education level, occupation, smoking, and drinking history were selected for the estimation of propensity scores for each subject with the logistic regression model. Significant independent variables for the outcome of current back pain were included in the multivariate logistic regressions.

RESULTS

A total of 127 matched pairs were identified, with 254 patients. In the matched cohort, more patients with chronic LBP had current back pain (95.3%) as compared with SpA (71.7%). Patients with SpA were younger ( P <0.001), with more males ( P <0.001), and better educated ( P =0.001). There was less current back pain and higher nonsteroidal anti-inflammatory drug use ( P <0.001). Most SpA patients had lower Oswestry Disability Index than LBP patients and with low disease activity. Patients with LBP had worse outcome scores as compared with SpA patients given the same Visual Analog Scale. LBP patients had 8.6 times the odds (95% CI: 3.341-20.671; P <0.001) of experiencing current back pain compared with SpA patients.

CONCLUSIONS

The disease activity of SpA patients is well controlled. However, patients with chronic LBP have worse pain severity, disability, and health-related quality of life. This has implications on resource utilization and the necessity of advancing LBP understanding and management.

LEVEL OF EVIDENCE

Type I prognostic study.

Delayed treatment with a tumor necrosis factor alpha blocker associated with worse outcomes in patients with spondyloarthritis: data from the Czech National Registry ATTRA

Introduction:

The administration of biologic disease-modifying antirheumatic drugs, including tumor necrosis factor (TNF)-α inhibitors, is observed to interfere with the disease activity and progression. In this study, we aimed to assess the effectiveness and response predictors of adalimumab (ADA), a TNF-α blocker, in patients with axial spondyloarthritis (AxSpA).

Methods:

This study was a historical prospective, registry-based observational study on patients with AxSpA treated with first-line ADA after conventional drug failure. For evaluation and comparison, patients were divided into three groups according to the number of years from AxSpA diagnosis to initiation of ADA treatment: (A) <5 years, (B) 5–10 years, and (C) >10 years. The assessment instruments ankylosing spondylitis disease activity score (ASDAS), Bath ankylosing spondylitis activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), health assessment questionnaire (HAQ), Short Form 36 questionnaire (SF-36), and EuroQoL 5 dimension questionnaire (EQ-5D) were regularly administered for up to 24 months of follow-up.

Results:

This study included 1043 patients with AxSpA (9.2% with non-radiographic AxSpA, 68.9% men). By month 6, a significantly higher proportion of patients with ASDAS remission (<1.3) was achieved upon earlier intervention in group A (30.1%) and B (32.9%) than in the late intervention group C (22.6%) (p ⩽ 0.05). At month 6, lower age and better BASFI at treatment initiation were identified as the strongest predictors of ASDAS remission in both univariable [odds ratio (OR): 0.956, p ⩽ 0.001; OR: 0.834, p ⩽ 0.001, respectively] and multivariable analyses (OR: 0.963, p ⩽ 0.001; OR: 0.859, p ⩽ 0.001, respectively). Earlier intervention also led to improvement in most patient-reported outcomes (PROs) based on HAQ, SF-36, and EQ-5D.

Conclusion:

Results from the ATTRA registry concur with previous clinical trials that supported efficacy of TNF-α blockers and showed better treatment outcomes with early interventions, including reduction of disease activity and improvement in PROs. We identified age and BASFI as the main factors influencing treatment effectiveness.

Immunoglobulin A antibodies to oxidized collagen type II as a potential biomarker for the stratification of spondyloarthritis from rheumatoid arthritis

OBJECTIVES

The discovery of diseased tissue-specific neoantigens offers the opportunity to develop important disease tissue-specific biomarkers that can help in the prediction, diagnosis, and stratification of diseases. This opportunity is specifically significant for autoimmune diseases where diagnostic biomarkers are not available. Inflammatory autoimmune diseases are commonly associated with local generation of large amounts of reactive oxidants. We have previously identified oxidative post-translationally modified (oxPTM) tissue-specific neoantigens in rheumatoid arthritis (RA) and type 1 diabetes that elicit an immune response. In the current study, we studied the presence and clinical significance of antibodies to oxPTM collagen type II (CII) in patients with spondyloarthritis (SpA).

METHOD

Levels of antibodies specific to native CII and oxPTM-CII were assessed by enzyme-linked immunosorbent assay.

RESULTS

Immunoglobulin G (IgG) binding to oxPTM-CII was observed in 52%, 83%, and 28% of serum samples from patients with axial spondyloarthritis (axSpA), RA, and psoriatic arthritis (PsA), respectively. Importantly, while strong IgA anti-oxPTM-CII responses were detected in axSpA and PsA patients, with 47% and 84% respective binders, no IgA anti-oxPTM-CII was detected in RA patients. IgA anti-oxPTM-CII reactivity in axSpA patients treated with biologics was higher and more frequent, with 85% binders compared to 9% binders in patients treated with synthetic disease-modifying anti-rheumatic drugs.

CONCLUSION

Our data imply that SpA and PsA are associated with the presence of antibodies to oxPTM-CII, suggesting that there may be a humoral component that may distinguish patients with SpA from RA. Our approach could be adapted to other diseases, particularly to inflammatory autoimmune diseases.

Association of HLA-DP/DQ and STAT4 polymorphisms with ankylosing spondylitis in Southwest China

Ankylosing spondylitis (AS) is a highly heritable complex inflammatory arthritis disease. Genetic factors are thought to be crucial in the pathogenesis of AS. However, few data are available on the relationship between HLA-DP/DQ and STAT4 polymorphisms and AS susceptibility in the Chinese population. Therefore, we examined HLA-DP/DQ and STAT4 polymorphisms (rs3077, rs9277535, rs7453920 and rs7574865) in a total of 779 subjects, including 400 AS and 379 age- and sex-matched healthy controls in Chinese. No significant difference was observed between AS patients and healthy controls in the allele frequency of rs3077, rs9277535 and rs7574865. However, there was a significant association between the HLA-DQ rs7453920 G/A variant and AS patients, with minor allele A correlated with a reduced risk of AS (allelic frequency, adjusted OR=0.66, 95% CI=0.55-0.78, p=4.0E-06; dominant model, adjusted OR=0.75, 95% CI=0.66-0.85, p=1.1E-05). Moreover, the haplotypes block AAA and GGA in the HLA gene significantly correlated with reduced risk of AS. This is the first study demonstrating the significant associations of SNP rs7453920 and the haplotypes in the HLA gene with the risk of AS in Southwest Chinese population. This research sheds new light on the significant relationship between HLA polymorphisms and AS.

Demographic, clinical, and laboratory features of Turkish patients with late onset ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease, which typically begins in early decades of life with primarily axial joints involvement. This disease rarely affects patients older than 50 years of age. The aim of this study was to compare and evaluate the demographic, clinical, and laboratory features of late onset and early onset AS patients who were followed up in a single rheumatology center. A total of 339 patients who have been diagnosed with AS according to modified New York criteria were included in the study. The patients whose initial symptoms were observed after 50 years of age were accepted as late onset AS. Out of 339 patients, 27 (7.9%) were diagnosed as late onset AS and 312 (92.3%) patients were evaluated as early onset AS. Of 27 late onset patients, 10 were male and 17 were female. Delay in the diagnosis was 5.8 years for early onset AS, while it was 3.8 years for late onset AS (p = 0.001). Higher levels of acute phase reactants and more methotrexate (MTX) use were detected in early onset AS patients compared to late onset AS (p = 0.001, p = 0.007, respectively). Statistically, there was no difference between these two groups, with regard to disease clinical activity indexes, anthropometric measurement parameters, uveitis and peripheral joint involvement. In this study, we showed that early and late onset AS patients may present with different clinical, genetic, and laboratory features. Late onset AS patients are characterized with lower human leukocyte antigen-B27 sequence, less inflammatory sign, delayed diagnosis, and less MTX and anti-tumor necrosis factor alpha drug usage.

Clinical Features of Late-onset Ankylosing Spondylitis: Comparison with Early-onset Disease

Objective.

Ankylosing spondylitis (AS) is generally observed in young patients but can occur later in life or in persons ≥ 50 years of age. Our objective was to characterize the clinical features of late-onset AS in a large multicenter national cohort.

Methods.

We studied late-onset AS in the National Registry of Spondyloarthritis of the Spanish Society of Rheumatology (REGISPONSER database) cohort (n = 1257), of whom 3.5% had onset at age ≥ 50 years versus a control group with onset at < 50 years.

Results.

There were no differences between late-onset and early-onset AS according to sex and family history of spondyloarthropathies. Patients in the late-onset group more often showed involvement of the cervical spine (22.7% vs 9.7%; p = 0.03) and arthritis of the upper (13.6% vs 3.0%; p = 0.002) and lower limbs (27.3% vs 15.2%; p = 0.03) as first manifestations than did patients in the early-onset group. A higher percentage of mixed forms (axial and peripheral joint disease) during the course of the disease was also recorded in the late-onset group (50% vs 24%; p = 0.0001).

Conclusion.

Our study suggests that age at onset of AS affects the patients’ presenting clinical form. Arthritis of the upper limbs requires a differential diagnosis with other conditions frequent in patients over 50 years of age, such as rheumatoid arthritis or crystal-induced arthropathy.

Ankylosing spondylitis in a patient referred to physical therapy with low back pain

Low back pain (LBP) is one of the most common and costly medical conditions in the United States; various studies have reported up to 80% of the adult population will experience a significant episode of LBP sometime within their lifetime. Although many cases of LBP are related to the musculoskeletal system and appropriate for the care of the physical therapist (PT), some episodes of LBP have a systemic cause. Thus, it is the role of the PT to ensure each patient is appropriate for physical therapy intervention throughout the episode of care. When the patient's condition is not appropriate for physical therapy intervention, it is the PT's responsibility to refer the patient to other medical professions to ensure optimal patient care. The purpose of this case report is to describe a patient referred to PT who was diagnosed with ankylosing spondylitis. The patient presented initially to physical therapy with a diagnosis of LBP. However, after several visits her symptoms were inconsistent with mechanical LBP and thus required further medical consultation.

Low bone mineral density is related to male gender and decreased functional capacity in early spondylarthropathies

The objective of this study was to determine the prevalence and risk factors of low bone mineral density (BMD) in patients with spondylarthropathies (SpA) at an early stage of disease. In this cross-sectional study, the BMD of lumbar spine and hips was measured in 130 consecutive early SpA patients. The outcome measure BMD was defined as (1) osteoporosis, (2) osteopenia, and (3) normal bone density. Logistic regression analyses were used to investigate relations between the following variables: age, gender, disease duration, diagnosis, HLA-B27, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), extra-spinal manifestations and medication, with outcome measure low BMD (osteopenia and/or osteoporosis). The SpA population had a median time since diagnosis of 6.6 months and a disease duration of 6.3 years. In total, 9% of the early SpA patients had osteoporosis, 38% osteopenia, and 53% normal BMD. On univariate analyses, male gender, diagnosis of ankylosing spondylitis, increased CRP, high BASFI, and high BASMI were significantly associated with low BMD. Factors showing a relation with low BMD in the multivariate model were male gender (OR 4.18, 95% confidence interval (CI) 1.73–10.09), high BASMI (OR 1.54, 95% CI 1.14–2.07), and high BASFI (OR 1.18, 95% CI 1.00–1.39). In early SpA patients, a high frequency (47%) of low BMD in femur as well as in lumbar spine was found. Low BMD was associated with male gender and decreased functional capacity. These findings emphasize the need for more alertness for osteoporosis and osteopenia in spondylarthropathy patients at an early stage of the disease.

Pattern of disease onset, diagnostic delay, and clinical features in juvenile onset and adult onset ankylosing spondylitis

OBJECTIVE

To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design.

METHODS

A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey.

RESULTS

Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25-6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51-6.98, adjusted for current age; and OR 2.26, 95% CI 1.07-4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life.

CONCLUSION

JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.

First signs and symptoms of spondyloarthritis--data from an inception cohort with a disease course of two years or less (REGISPONSER-Early)

OBJECTIVE

To determine the first signs and symptoms, and the clinical, biological and radiological characteristics of patients with early SpA.

METHODS

A total of 150 SpA patients were selected from 2367 listed in REGISPONSER (Registro Español de Espondiloartritis de la Sociedad Española de Reumatología). The inclusion criterion was a disease course of

RESULTS

Forty-six patients had AS, 51 psoriatic SpA (Ps-SpA), 43 uSpA, 5 ReA, 4 IBD arthropathy and 1 JCA. The mean age at onset of symptoms and at diagnosis was higher in Ps-SpA group (48.1 +/- 13.6 and 48.5 +/- 13.6 yrs) than in AS group (38.1 +/- 12.8 and 38.9 +/- 12.7 yrs) and uSpA group (36.3 +/- 11.5 and 36.9 +/- 11.4 yrs). The most frequent signs or symptoms were back pain: 72% AS group and 56% uSpA group. Lower limb arthritis was the first symptom in 57% Ps-SpA patients, 35% uSpA patients and 20% AS patients; upper limb arthritis was the first symptom in 53% Ps-SpA group and <16% of the remainder. Compared with longer duration disease, at onset, AS patients report upper limb arthritis more frequently and uSpA patients report more of enthesitis. Early radiological sacroiliitis was observed in all AS patients, of whom 54% had Grade II, 39% had Grade III and 7% had Grade IV.

CONCLUSIONS

In our population, the first manifestations of SpA were low back pain and SI syndrome in AS and uSpA patients and peripheral arthritis in the Ps-SpA group. We can find early SI joint affectation in AS patients.

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Key Words

• spas
• as
• uspa
• spa's cohort
• epidemiology
• disease registry

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MESH Headings

• Adult
• Age of Onset
• Analysis of Variance
• Arthritis/diagnosis
• Arthritis/diagnostic imaging
• Arthritis, Psoriatic/diagnosis
• Arthritis, Psoriatic/diagnostic imaging
• Back Pain/diagnosis
• Back Pain/diagnostic imaging
• Cohort Studies
• Female
• Humans
• Irritable Bowel Syndrome/diagnosis
• Irritable Bowel Syndrome/diagnostic imaging
• Male
• Middle Aged
• Prohibitins
• Radiography
• Sacroiliac Joint/diagnostic imaging
• Spondylarthritis/diagnosis
• Spondylarthritis/diagnostic imaging
• Spondylitis, Ankylosing/diagnosis
• Spondylitis, Ankylosing/diagnostic imaging

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Affiliation(s)

Marena Rojas-Vargas Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Elisa Muñoz-Gomariz Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Alejandro Escudero Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Pilar Font Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Pedro Zarco Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Raquel Almodovar Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Jordi Gratacós Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Juan Mulero Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Xavier Juanola Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Carlos Montilla Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Estefanía Moreno Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
Eduardo Collantes-Estevez Rheumatology Department, Hospital Universitario Reina Sofía, Unit Methodology and Support to the Research (FIBICO), H. U. Reina Sofía, Córdoba, Rheumatology Department, H. FUNDACIÓN de Alcorcón, Madrid, Rheumatology Department, H. Parc Taulí, Badalona, Rheumatology Department, H. U. Puerta de Hierro, Madrid, Rheumatology Department, H. U. Bellvitge, Barcelona, Rheumatology Department, H. Virgen de la Vega, Salamanca and Rheumatology Department, H. San Rafael, Barcelona, Spain
on behalf of REGISPONSER working group

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Effectiveness, safety, and predictors of good clinical response in 1250 patients treated with adalimumab for active ankylosing spondylitis

OBJECTIVE

We evaluated the effectiveness and safety of adalimumab in a large cohort of patients with active ankylosing spondylitis (AS) and identified clinical predictors of good clinical response.

METHODS

Patients with active AS [Bath AS Disease Activity Index (BASDAI)>or=4] received adalimumab 40 mg every other week in addition to their standard antirheumatic therapies in a multinational 12-week, open-label study. We used 3 definitions of good clinical response: 50% improvement in the BASDAI (BASDAI=50), 40% improvement in the ASsessments of SpondyloArthritis International Society criteria (ASAS40), or ASAS partial remission. Response predictors were determined by logistic regression with backward elimination (selection level 5%).

RESULTS

Of 1250 patients, 1159 (92.7%) completed 12 weeks of adalimumab treatment. At Week 12, 57.2% of patients achieved BASDAI 50, 53.7% achieved ASAS40, and 27.7% achieved ASAS partial remission. Important predictors of good clinical response (BASDAI 50, ASAS40, and partial remission) were younger age (p<0.001), and greater C-reactive protein (CRP) concentration (p<or=0.001), HLA-B27 positivity (p<or=0.01), and tumor necrosis factor (TNF) antagonist naivety (p<0.001).

CONCLUSION

Adalimumab was effective in this large cohort of patients with AS, with more than half of patients achieving a BASDAI 50 or ASAS40 response and more than a quarter of patients reaching partial remission at Week 12.Younger age, greater CRP concentrations, HLA-B27 positivity, and TNF antagonist naivety were strongly associated with BASDAI 50, ASAS40, and partial remission responses. ClinicalTrials.gov identifier: NCT00478660.