Background/Purpose: Efficacy of biological treatment in patients with axial spondyloarthritis (SpA) varies and is dependent on both disease-related and patient-related factors. The goal of this study was to examine variables correlating with patient-reported performance of biologic agents in an Israeli cohort of patients with axial SpA.

Methods: Patients with a clinical diagnosis of axial SpA, either followed in the Rheumatology Unit of Bnai Zion Medical Center (BZMC) or members of the Mifrakim Tz’eirim, the Israeli Association of Young Patients with Rheumatic Diseases (MT), were requested to fill out questionnaires concerning the efficacy of their current treatment, clinical symptoms, dietary habits, mood status, physical activity, working status and basic demographic and disease-related data. Efficacy of treatment was estimated as percentage of global improvement in the disease status. Improvement of 70% or more was considered as clinically significant. Variables of interest were compared between groups of patients, those who achieved or failed to achieve clinically significant improvement. t-test or chi square test were used for group comparisons, as appropriate. Values of p<0.05 were considered significant.

Results: A total of 197 patients with axial SpA filled out the questionnaires by phone or via e-mail. Of 107 patients followed in BZMC, 73 were diagnosed with ankylosing spondylitis and 34 with non-radiographic axial SpA. Details of the diagnosis of axial SpA in the 90 patients enrolled from MT were not available, but these patients did not differ from BZMC patients by reported disease-related features, except from the prevalence of uveitis (15% vs 28%, p=0.02). Ninety-one patients (85%) from the BZMC cohort and 63 patients (70%) from the MT cohort had received biological therapy. Of these, treatment-induced global improvement in the disease status of ³70% was reported by 100 patients: 64 patients from BZMC and 36 from MT cohorts, respectively (p=0.14). These 100 patients were compared to the second group of 54 patients who failed to achieve 70% improvement. The groups did not differ significantly in age, gender ratio, body mass index, presence of family history of SpA, symptom duration, diagnostic delay, prevalence of peripheral joint involvement, diarrhea, uveitis, psoriasis, self-reported stress or depression, dietary preferences, smoking, insomnia or physical activity (p>0.05 for all comparisons). Patients from the group with limited response to biological therapy were older at the time of diagnosis (37.4±10.6 vs 32.3±10.0 years old, p=0.004), had lower education level (13.1±3.4 vs 14.9±3.2 years schooling, p=0.001), reported more heel pain (p<0.001), widespread pain (p<0.001), unexplained fatigue (p=0.002), consumed less alcohol (p=0.016) and were less employed during the study period (p=0.009).

Conclusion: Improvement after administration of biological treatment in patients with axial SpA correlates with some well-defined disease and patient-related factors. Awareness of these factors may enable refinement of treatment when matched for treatment expectations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-patient-reported-improvement-after-administration-of-biological-treatment-in-axial-spondyloarthritis-a-cross-sectional-study/