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RESUMEN Introducción: El uso de TNFi es cada vez más frecuente en los pacientes con espondiloartritis. Identificar tempranamente aquellos que los requerirán o poder predecir su uso puede ayudar a hacer un tratamiento más efectivo y oportuno racionalizando su uso. Objetivo: Determinar los factores qué mejor explican la indicación de TNFi en la población en estudio. Material y métodos: La asociación entre el uso de medicamentos anti-TNFα y las variables categóricas demográficas, clínicas, de laboratorio, radiológicas y de tratamiento se exploró por prueba exacta de Fisher. La asociación con las variables cuantitativas fue evaluada con t de Student o U de Mann Withney, de acuerdo con su distribución. Aquellas variables con p < 0,25 fueron ingresadas a modelos univariante de regresión logística explicativa para construir los OR crudos; aquellas con p < 0,25 se incluyeron en el modelo multivariante para construir OR ajustados. Resultados y discusión: La población está constituida por 181 pacientes. Modelo univariante: la artritis reactiva, uretritis y compromiso periférico fueron factores protectores para el uso de TNFi. Espondiloartritis axial, lumbalgia inflamatoria, dolor glúteo alternante, rigidez matinal sacroilitis demostrada por cualquier método, tratamiento con inhibidores COX-2, tiempo de evolución de tres arios o más y los puntajes de BASDAI y BASFI se asociaron con el uso de TNFi. Modelo multivariante: artritis reactiva (OR 0,1, IC 95% 0,012-0,86, p = 0,036), lumbalgia inflamatoria (OR 13,63, IC 95% 1,36-136, p = 0,026), sacroilitis (OR 7,71, IC 95% 1,04-57, p = 0,045, uso de coxib (OR 10,1, IC 95% 2,71-37,62, p = 0,001) y el puntaje máximo de BASDAI (4-6: OR 6,1, IC 95% 1,3-28,7, p = 0,022, mayor de 6: OR 15,8, IC 95% 2,2-113, p = 0,006) se asociaron independientemente con el uso de TNFi. El uso de coxib se asoció con la indicación de usar TNFi tanto en los pacientes con espondiloartritis axial (OR 4,2, IC 95% 1,74-10,11, p = 0,001) como periférica (OR 4, IC 95% 1,85-8,62, p < 0,001). Conclusiones: El inicio de la enfermedad en la forma de artritis reactiva se comportó como un factor protector para la necesidad posterior de usar TNFi, mientras que presentar lumbalgia inflamatoria, sacroilitis demostrada por cualquier método, el tratamiento con coxib y el puntaje máximo de BASDAI mayor de 4 se asociaron con el uso de estos medicamentos.
ABSTRACT Introduction: The use of tumor necrosis factor (TNF) alpha inhibitors is increasing in patients with spondyloarthritis. Early identification of those that would require them, or the ability to predict their use, could lead to a more effective and timely treatment by rationalizing their use. Objective: To determine factors that better explain the indication of TNFi in the study population. Material and methods: The association between anti-TNFα use and categorical demographic, clinical, laboratory, radiological and treatment variables was explored using Pearson's Chi2 or Fisher's exact test. The association with the quantitative variables was evaluated using Student's t test or Mann Whitney U test, depending on their distribution. Those variables with P < 0.25 were entered into univariate models of explanatory logistic regression to cons truct crude ORs, and those with P < 0.25 were included in the multivariate model to construct adjusted ORs. Results and discussion: The study population includes 181 patients. In the univariate model: reactive arthritis, urethritis, and peripheral involvement were protective factors for the use of TNFi. Axial spondyloarthritis, inflammatory lumbalgia, alternating gluteal pain, morning stiffness, sacroiliitis demonstrated by any method, treatment with COX-2 inhibitors, evolu tion time of three years or more, and BASDAI and BASFI scores were associated with the use of TNFi. Multivariate model: reactive arthritis (P = 0.036), inflammatory back pain (P = 0.026), sacroiliitis (P = 0.045), use of coxibs (P = 0.001) and the maximum score of BASDAI (P = 0.022, P = 0.006) were independently associated with the use of TNFi. The use of coxibs was associa ted with the indication of using TNFi in both patients with axial spondyloarthritis (P = 0.001) and peripheral (P < 0.001). Conclusions: The onset of the disease in the form of reactive arthritis behaved as a protective factor for the subsequent need to use TNFi, while presenting with inflammatory back pain, sacroiliitis, demonstrated by any method, treatment with coxibs, and the maximum score of BASDAI greater than 4 associated with the use of these medications.
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Humans , Adult , Bone Diseases , Musculoskeletal Diseases , SpondylarthritisABSTRACT
Abstract Background: The neutrophil/ lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have the potential to be inflammatory markers that reflect the activity of many inflammatory diseases. The aim of this study was to evaluate the NLR and PLR as potential markers of disease activity in patients with ankylosing spondylitis. Methods: The study involved 132 patients with ankylosing spondylitis and 81 healthy controls matched in terms of age and gender. Their sociodemographic data, disease activity scores using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and white blood cell, neutrophil, lymphocyte and platelet counts were recorded. The patients with ankylosing spondylitis were further divided according to their BASDAI scores into patients with inactive disease (BASDAI < 4) and patients with active disease (BASDAI ≥4). The correlations between the NLR, PLR and disease activity were analysed. Results: There was a statistically significant difference in the NLR and PLR between the active and inactive ankylosing spondylitis patients (2.31 ± 1.23 vs. 1.77 ± 0.73, p = 0.002), (142.04 ± 70.98 vs. 119.24 ± 32.49, p < 0.001, respectively). However, there was no significant difference in both the NLR and PLR between the healthy control group and ankylosing spondylitis patients (p > 0.05). In addition, the PLR was significantly higher in both the active and inactive groups compared to those in the healthy control group (142.04 ± 70.98 vs. 99.32 ± 33.97, p = 0.014), (119.24 ± 32.49 vs. 99.32 ± 33.97, p = 0.019). The BASDAI scores were positively correlated with the PLR (r = 0.219, p = 0.012) and the NLR, but they were not statistically significant with the later (r = 0.170, p = 0.051). Based on the ROC curve, the best NLR cut-off value for predicting severe disease activity in ankylosing spondylitis patients was 1.66, with a sensitivity of 61.8% and a specificity of 50.6%, whereas the best PLR cut-off value was 95.9, with a sensitivity of 70.9% and a specificity of 55.5%. Conclusion: The PLR may be used as a useful marker in the assessment and monitoring of disease activity in AS together with acute phase reactants such as the ESR.
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Adult , Female , Humans , Male , Spondylitis, Ankylosing/blood , Platelet Count , Biomarkers/blood , Case-Control Studies , ROC Curve , Sensitivity and Specificity , Lymphocyte Count , Area Under Curve , Leukocyte Count , NeutrophilsABSTRACT
Objective: To observe the effects of Biqi Capsules on clinical efficacy and cytokines of patients with ankylosing spondylitis. Methods: Patients (120 cases) with ankylosing spondylitis were randomly divided into control group and treatment group for 60 cases in each group. Patients in the control group were po administered with Sulfasalazine Tablets, four tablets twice a day. Patients in the treatment group were po administered with Biqi Capsules, 1.2 g for each time, three times daily. Four weeks were a course. Patients in two groups were treated for three courses. After treatment, the clinical efficacy was evaluated, and visual analog scales (VAS), Bath ankylosing spondylitis disease active index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) in two groups before and after treatment were compared. Enzyme linked immunosorbent assay (ELISA) were employed to measure the expression levels of cytokines IL-1β, TNF-α, IL-4, and IL-10. Erythrocyte sedimentation rate (ESR) was detected by instrument method and hs-CRP was detected by automatic biochemical analyzer. Results: After treatment, the compliance rate of ASAS20 (20%) and BASDAI50 (50%) in the treatment group was higher than that in the control group, but the difference was not statistically significant. After treatment, VAS, BASDAI, BASFI, BASMI, ESR, and hs-CRP in two groups were significantly decreased, with significantly difference between two groups before and after treatment (P < 0.01). And BASDAI and hs-CRP were significantly lower than those in the control group (P < 0.05). After treatment, IL-4 and IL-10 were significantly increased, but TNF-α and IL-1β were significantly decreased, with significantly difference between two groups before and after treatment (P < 0.01). And IL-10 was significantly higher than that in the control group (P < 0.05). Conclusion: Biqi Capsules has certain therapeutic effect on ankylosing spondylitis, and it may be associated with increasing anti-inflammatory factors, decreasing inflammatory factors and regulating inflammatory immunity.
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Objective: To observe the effect of Yaotongning Capsules combined with Imrecoxib Tablets in the treatment of ankylosing spondylitis with cold-dampness and blood-stasis syndrome. Methods: A total of 120 cases with ankylosing spondylitis were randomly divided into two groups: treatment group and control group, with 60 patients in each group. The control group was given Imrecoxib Tablets, and the treatment group was given Imrecoxib Tablets and Yaotongning Capsules. The levels of ESR, CRP, and the scores of BASDAI, BASFI, TCM syndrome were compared before and after treatment, the treatment effect of two groups were evaluated. Results: There was no significant difference in the levels of ESR, CRP and the scores of BASDAI, BASFI, TCM syndrome between two groups before treatment. After treatment, the levels of ESR, CRP and the scores of BASDAI, BASFI, TCM syndrome of the two groups were decreased (P < 0.05), and all the indexes in treatment group were lower than those in control group (P < 0.05), the total effective rate in treatment group (86.67%) was better than that in control group (65.00%) (P < 0.01). Conclusion: Yaotongning Capsules can effectively improve TCM syndrome and functional activity indexes, reduce inflammatory indexes and disease activity, has definite clinical effect on ankylosing spondylitis.
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Objective: To assess the clinical features of SpA including BATH indices and to compare clinical data of male and femalespondyloarthropathy patients.Methods: The study included male and female patients (60 each) fulfilling the European Spondyloarthropathy StudyGroup (ESSG) or assessment of ankylosing spondylitis (ASAS) criteria for SpA and the CASPER criteria for PsA or themodified New York criteria for AS. The subjects completed initial clinical evaluation and radiological and laboratoryassessment.Results: The mean age of presentation was found to be higher in females (34.6± 9.6 years). Backache was the mostcommon features identified in both the groups. Peripheral arthritis was present in 51.7% of total patients (56.7% malesand 46.7% females). Asymmetrical lower limb arthritis was found to be more predominant; however, 10% of the patientsreported involvement of wrist. Psoriasis and inflammatory bowel disease, and uveitis were noted in 13 (7 males and 6females), three (1 male and 2 females) and 14 patients (9 males and 5 females) respectively. Dorsal and neck pain werefrequently prevalent among the patients.Conclusion: Though the severity of symptoms and disability are comparable across both the genders, females haveincreasingly been diagnosed with SpA. Most common symptom of presentation is low back pain followed by gluteal pain.Peripheral arthritis, predominantly lower limb oligoarthritis is common in Indian population when compared to theirwestern counterparts.
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Introduction: Spondyloarthritis (or spondyloarthropathy) is the overall name for a family of inflammatory rheumatic diseases that can affect the spine and joints, ligaments and tendons These diseases can cause fatigue and pain or stiffness in the back, neck, hands, knees, and ankles as well as inflammation of the eyes, skin, lungs, and heart valves While there is no course of prevention at this time treatment can reduce discomfort and delay the development of spinal deformities Aim of the study: The aim of the study was to differentiate gender difference at presentation of spondyloarthritis and to identify markers in determining the severity of disease Materials and methods: This was a prospective observational study conducted for a period of 6 months at Institute of Rheumatology, Government KAPV Medical College and MGM Government Hospital Totally 62 patients were included in the study 31 males and 31 consecutive females with features of spondyloarthritis per ASAS (Assessment of Spondyloarthritis international Society) at first presentation to our clinic were enrolled and their clinical characteristics were analyzed Results: On comparing disease activity and functional indices between males and females, mean BASDAI was 466±18 versus 498±194 (p=05), mean BASFI was 46±23 versus 48±23 (p=07), TN Tamil Selvam, VA Sowndhariya, NK Senthil Nathan A study on comparison of gender-based prevalence and severity at presentation in spondyloarthritis in a tertiary care rheumatic center IAIM, 2018; 5(12): 35-39 Page 36 mean BASMI was391±194 versus 418±206 (p=04) Out of 31 males, 17 were positive for HLA B27 and 6 out of 31 females were positive for HLA B27 (p=004) Conclusion: The pathogenesis of SpA is multifactorial and not yet fully understood Genetic factors (HLA-B27 and non– HLA-B27 related genes), inflammatory cytokines (eg TNF-alpha, IL-1, IL-6, IL-7, IL-17, and IL-23) and environmental triggers (infections, mechanical stress, abnormal intestinal microbiota) play an important role These different factors and their complex interaction can lead to activation of autoinflammation and autoimmunity and to the new bone formation Men are more prone to spondyloarthritis when compared with women
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Objective To investigate the clinical efficacy of superficial needling therapy for early ankylosing spondylitis and its effect on tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6).Methods Eighty patients with early ankylosing spondylitis meeting the inclusion criteria were randomly allocated to treatment and control groups using random number card method with the ratio of 1:1, 40 cases each. The treatment group received superficial needling therapy alone and the control group, conventional treatment with celecoxib capsules, methotrexate tablets and sulfasalazine enteric-coated tablets. Treatment was given for a total of 24 weeks. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 were observed in the two groups before and after treatment.Results The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 improved in the two groups after treatment compared with those before the treatment (P<0.05). The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 in the treatment group superior to those in the control group after the treatment (P<0.05).Conclusions Superficial needling therapy can relieve the clinical symptoms in patients with early ankylosing spondylitis and improve spinal joint function with good safety. Its mechanism may be related to reducing inflammatory cytokines TNF-α, IL-1 and IL-6.
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Objective To investigate the clinical efficacy of superficial needling therapy for early ankylosing spondylitis and its effect on tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6).Methods Eighty patients with early ankylosing spondylitis meeting the inclusion criteria were randomly allocated to treatment and control groups using random number card method with the ratio of 1:1, 40 cases each. The treatment group received superficial needling therapy alone and the control group, conventional treatment with celecoxib capsules, methotrexate tablets and sulfasalazine enteric-coated tablets. Treatment was given for a total of 24 weeks. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 were observed in the two groups before and after treatment.Results The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 improved in the two groups after treatment compared with those before the treatment (P<0.05). The BASDAI, BASFI, lumbago, TCM syndrome score, TNF-α, IL-1 and IL-6 in the treatment group superior to those in the control group after the treatment (P<0.05).Conclusions Superficial needling therapy can relieve the clinical symptoms in patients with early ankylosing spondylitis and improve spinal joint function with good safety. Its mechanism may be related to reducing inflammatory cytokines TNF-α, IL-1 and IL-6.
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Objetivo Avaliar os resultados da aplicação do Índice de Atividade de Doença da Espondilite Anquilosante de Bath (BASDAI) numa série de pacientes brasileiros com EpA e estabelecer suas correlações com as variáveis específicas do grupo. Métodos Um protocolo comum de investigação foi prospectivamente aplicado em 1.492 pacientes brasileiros classificados como EpA pelos critérios do Grupo Europeu de Estudo das Espondiloartropatias (ESSG), acompanhados em 29 centros de referência em reumatologia no Brasil. Variáveis clínicas, demográficas e índices de doença foram colhidos. Os valores totais do BASDAI foram comparados com a presença das diferentes variáveis. Resultados O valor médio do BASDAI foi de 4,20 ± 2,38. Os escores médios do BASDAI foram mais elevados nos pacientes com forma clínica combinada, comparado às formas axiais e periféricas isoladas, nos pacientes do sexo feminino e nos sedentários. Com relação ao componente axial, valores mais altos do BASDAI estiveram significativamente associados à lombalgia inflamatória, à dor alternante em nádegas, à dor cervical e ao acometimento de coxofemorais. Houve associação estatística entre os valores do BASDAI e o comprometimento periférico, relacionado ao número de articulações inflamadas, tanto dos membros inferiores quanto dos membros superiores, e às entesites. A positividade do HLA-B27 e a presença de manifestações extra-articulares não estiveram correlacionadas com os valores médios do BASDAI. Valores mais baixos do BASDAI estiveram associados ao uso de agentes biológicos (p < 0,001). Conclusão Nesta série heterogênea de pacientes brasileiros com EpA, o BASDAI conseguiu demonstrar “atividade de doença” tanto nos pacientes com acometimento axial quanto naqueles com envolvimento periférico. .
Objective To analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. Methods A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applied. The total values of BASDAI were compared to the presence of the different variables. Results The mean score of BASDAI was 4.20 ± 2.38. The mean scores of BASDAI were higher in patients with the combined (axial + peripheral + entheseal) (4.54 ± 2.38) clinical presentation, compared to the pure axial (3.78 ± 2.27) or pure peripheral (4.00 ± 2.38) clinical presentations (P < 0.001). BASDAI also presented higher scores associated with the female gender (P < 0.001) and patients who did not practice exercises (P < 0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (P < 0.049), alternating buttock pain (P < 0.001), cervical pain (P < 0.001) and hip involvement (P < 0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (P = 0.004) and upper limbs (P = 0.025). The presence of enthesitis was also associated to higher scores of BASDAI (P = 0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (P < 0.001). Conclusion In this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate “disease ...
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Humans , Male , Female , Spondylarthritis/diagnosis , Brazil , Prospective Studies , Registries , Severity of Illness Index , Spondylitis, Ankylosing/diagnosisABSTRACT
Objective To investigate the values of ASAS-endorsed disease activity score (ASDAS) and routine assessment of patient index data 3 (RAPID3) in assessing disease activity of patients with ankylosing spondylitis (AS) in China. Methods Questionnaires were used to obtain the general information and disease activity of 82 AS patients; and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured in the venous blood samples. Correlation analysis and kappa consistency test were used to compare the value of traditional measures for assessing disease activity of AS including Bath ankylosing spondylitis disease activity index (BASDAI) with the new measures including ASDAS and RAPID3. Results ASDAS-CRP and RAPID3 had a good consistency in assessing AS activity (kappa value: 0.788), but both of them had poor consistency with BASDAI (kappa values: 0.342, 0.367). BASDAI, ASDAS and RAPID3 were well correlated with doctor global assessment (DOCGL) and patient global assessment (PATGL), and ASDAS and RAPID3 had stronger correlation with DOCGL and PATGL than BASDAI did (the r values of ASDAS-CRP, ASDAS-ESR, RAPID3, and BASDAI with DOCGL were 0.684, 0.720, 0.642 and 0.576; and those with PATGL were 0.822, 0.816, 0.851 and 0.725, respectively). Conclusion ASDAS is superior to BASDAI in assessing the disease activity of AS, making it a new promising index for evaluating disease activity and worth promoting. RAPID3 is convenient, simple, and independent to laboratory findings, and it has a good reliability and validity in evaluating disease activity of AS.
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Objective To assess the efficacy and safety of leflunomide in active ankylosing spondylitis.Methods Totally 62 cases of active ankylosing spondylitis were included,and divided randomly into leflunomide group(n=26)and methotrexate group(n=36).The patients in leflunomide group received an oral leflunomide loading dose of 50 mg or 40 mg once daily for the first 3 days followed by a maintenance dose of 50 mg or 40 mg once weekly,according to whether the bodyweight was more than 50 kg or less than 50 kg,respectively.The patients in methotrexate group were prescribed oral methotrexate 5 mg once in the first week,10 mg once in the second week,15 mg once in the third week and thereafter weekly.Sulfasalazine was prescribed 0.75 three times daily in both groups.The Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)and The Bath Ankylosing Spondylitis Metrology Index(BASIM)scoring instruments were used to assess the responsiveness to leflunomide and methotrexate at entry,three months,six months,twelve months and eighteen months after treatment,respectively.Laboratory data including peripheral blood counts(WBC,HGB,RBC),erythrocyte sedimentation rates(ESR),liver enzymes,serum creatinine,urinary sediments were detected at the same time.Sacroiliac joints CT scan and other involved joints x-ray radiograph examinations were taken at entry,six months,twelve months and eighteen months after treatment,respectively.Results Twenty-two cases in leflunomide group and 29 cases in methotrexate group were followed up to eighteen months.BASDAI in leflunomide group was significantly lower(P