Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Patients classified as axial spondyloarthritis (axSpA) may have ankylosing spondylitis (AS) or non-radiographic axSpA (nr-axSpA). Treatment recommendations for AS consider non-steroidal anti-inflammatory drugs (NSAIDs) as first-line therapy. After an unsatisfactory response to at least 2 non-steroidal anti-inflammatory drugs (NSAIDs) within 4 weeks (wk), anti-TNF agents are to be considered. However, it is unknown whether patients with nr-axSpA and AS respond similarly well to NSAIDs.
Methods: Consecutive patients (pts) with axSpA (both n=50 for nr-axSpA and AS, respectively) were included in a prospective study if their BASDAI level was ≥4, and if they had not received the maximally approved dose of NSAIDs nor anti-TNF agents to date. After inclusion into the study the maximal dose of NSAIDs was administered over 1wk and the dose was then adapted in case of BASDAI<4. In case of BASDAI ≥4 of in case of NSAID intolerance, the NSAID was changed and the pt was treated for another 3 wk at the maximal dose. Clinical and laboratory parameters and dosage of drugs were assessed by using the ASAS NSAID-index. Magnetic resonance images (MRI) of the sacroiliac joints including STIR sequences were performed and scored by the Berlin score. Data were collected before (BL) and after 1 and 4 wk of treatment.
Results: Nr-axSpA pts were more often female (48% vs. 30%), younger (mean age 37.6±11.0 vs. 41.9±12.3 years), and had a shorter symptom duration than AS pts (7.3±9.1 vs. 14.6±11.8 years) but were similarly often HLA-B27+ (80% vs. 74%), respectively. Significant differences were found in the mean CRP levels (0.6±0.9 vs. 1.2±1.1) and mean SIJ-MRI scores (3.1±3.0 vs. 6.7±5.4) in nr-axSpA vs. AS pts, respectively (both p<0.001). Prior to treatment, an ASDAS-CRP >2.1 was found in 76% and 74% and a positive MRI was seen in 70% and 78% of pts with nr-axSpA and AS, respectively. Both groups responded similarly well to NSAIDs: after wk1 and wk4, the NSAID-index increased similarly in both groups. Significant improvement after 4 wks were found for all assessments with the exception of CRP levels and MRI-a scores, where almost no changes were observed. Between wks 1 and 4, the ASAS20% response rate increased in the entire group from 40% to 52%. At wk 4, there was a slight difference between pts with nr-axSpA and AS: 46% vs. 58% (p=0.23), and ASAS partial remission was only found in 16% (14% nr-axSpA and 18% AS, p=0.59). However, a BASDAI ≥4 was found in 49% and 44% of pts at wks 1 and 4, respectively, while, in comparison, an ASDAS-CRP of ≥2.1 was found in 37% and 33% at wk 1 and 4. Overall, there were no major differences in response to treatment between nr-axSpA and AS pts.
Conclusion: This study confirms that there are no major differences between pts with AS and nr-axSpA in most clinical aspects. For the first time we show that pts with nr-axSpA and AS show similar response rates to NSAIDs in recommended doses. Importantly, almost 50% of pts with axSpA still have BASDAI levels ≥4 after 4wk of NSAIDs and would, thus, be eligible for anti-TNF therapy. Bone marrow edema on MRI and CRP levels were not influenced by NSAIDs.
Disclosure:
X. Baraliakos,
None;
U. Kiltz,
None;
F. Heldmann,
None;
H. Appel,
None;
F. Dybowski,
None;
M. Igelmann,
None;
L. Kalthoff,
None;
D. Krause,
None;
H. J. Menne,
None;
E. Saracbasi,
None;
E. Schmitz-Bortz,
None;
J. Braun,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-patients-with-non-radiographic-axial-spondyloarthritis-and-ankylosing-spondylitis-respond-similarly-well-to-nsaids-a-prospective-study-including-magnetic-resonance-imaging/