Real-world experience of secukinumab treatment for ankylosing spondylitis at the Royal National Hospital for Rheumatic Diseases, Bath.

We reviewed our experience of treating ankylosing spondylitis patients with the IL-17 inhibitor secukinumab at the Royal National Hospital for Rheumatic Diseases, Bath. A total of 76 patients were included, of whom secukinumab was the first-line biologic drug used in 24, second line in 23, and third line in 29 patients, respectively. Only 5 patients discontinued the drug due to side effects before their first outpatient review, including 1 new case of inflammatory bowel disease. Significant improvements were seen in all disease outcome measures in patients receiving secukinumab as their first-line biologic agent, with a trend to improved mean BASDAI and BASFI even in patients receiving it as a second- or third-line biologic agent. This real-world analysis adds to the evidence recommending secukinumab as a largely safe and effective treatment for ankylosing spondylitis.Key Points• Secukinumab was efficacious for improving short-term mean disease activity and function in our cohort of ankylosing spondylitis patients, regardless of whether used as the first-, second-, or third-line biologic disease-modifying drug.• There were very low rates of discontinuation due to side effects in our cohort of secukinumab-treated ankylosing spondylitis patients.

Sleep in ankylosing spondylitis and non-radiographic axial spondyloarthritis: associations with disease activity, gender and mood.

The study aims were to assess the prevalence of good or poor sleep in a cohort of axial spondyloarthritis patients and to investigate its correlation with a range of objectively and subjectively measured variables in order to develop a model for distinguishing good from poor sleepers. Five hundred ninety-eight patients with ankylosing spondylitis and 61 with non-radiographic axial spondyloarthritis completed the Jenkins Sleep Evaluation Questionnaire. Measures of disease activity, mobility, function, mood, fatigue, quality of life, work productivity, night-time pain and general health were gathered. Patients with ankylosing spondylitis or non-radiographic axial spondyloarthritis were initially compared. With the exception of waking up tired less often and having lower mobility and functioning, the two groups were similar so were combined for subsequent analysis. Twenty-nine percent of all patients were classified as good sleepers and 19% as poor sleepers. Poor sleepers had higher disease activity and fatigue scores and more night-time back pain than good sleepers. They reported poorer quality of life, general health, mood and work-related measures. A model incorporating mood, gender, fatigue and objective and subjective judgements of disease activity correctly classified 87.3% of good and poor sleepers. Poor sleep was strongly associated with poor mood, female gender, greater fatigue, greater disease activity (specifically, spinal pain and stiffness) and better mobility; however, the direction of causality between poor sleep and markers of active disease was undetermined. This study also highlights the need to standardise the measurement of sleep disturbance in axSpA to facilitate comparisons between patient groups and interventions.

Short-term Repeat Magnetic Resonance Imaging Scans in Suspected Early Axial Spondyloarthritis Are Clinically Relevant Only in HLA-B27-positive Male Subjects.

OBJECTIVE: Our study investigated the natural history of magnetic resonance imaging (MRI)-determined bone marrow edema over a 12-week period in individuals with suspected axial spondyloarthritis. METHODS: There were 109 MRI scans performed on 30 patients who fulfilled the Assessment of Spondyloarthritis international Society inflammatory back pain criteria at baseline and at 4, 8, and 12 weeks. RESULTS: There were 29 patients who completed the study. Only 4 (14%) patients changed from MRI-negative to MRI-positive (all HLA-B27-positive, OR 2.74). Three of 7 (43%) male HLA-B27-positive patients, 1 of 8 (12.5%) HLA-B27-positive female patients, and no HLA-B27-negative patients changed from MRI- negative to -positive. CONCLUSION: Repeat MRI scans within a 12-week period should be considered in HLA-B27-positive males.

Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review.

This review explores the prevalence and factors associated with disturbed sleep for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis in order to clarify consistent findings in this otherwise disparate research field. The association of physical, demographic and psychological factors correlating with poor sleep was explored, and the effectiveness of interventions assessed. Ten electronic databases were searched: AMED, CINAHL, Embase, Medline, PsycINFO, PubMed, Scopus, Web of Science, OpenGrey and BASE. Following application of inclusion and exclusion criteria, 29 articles were critically assessed on the basis of methodology, experimental design, ethics and quality of sleep data, leading to the selection of 15 studies for final review. Poor sleep was reported in 35-90% of patients with axial spondyloarthritis and is more prevalent within this clinical population compared to healthy control subjects. Disturbed sleep is an important aspect of disease for patients and reflects the severity of disease activity, pain, fatigue and functional disability. However, the direction of this relationship is undetermined. Associations with age, gender, years spent in education, quality of life and depression have also been demonstrated. Anti-TNF medication is effective in reducing poor sleep, and exercise has also produced beneficial results. Future research into poor sleep should take account of its multifactorial nature. There is also a current lack of research investigating non-pharmacological interventions or combination therapies. A standardised, validated measurement of poor sleep, appropriate for regular patient screening, would be a useful first step for future research.