Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Axial spondylarthritis (AxSpA) has been proposed as an umbrella term for ankylosing spondylitis (AS) and non-radiographic (nr) AxSpA). This new concept makes diagnosis of AS possible at an early stage in the absence of radiographic sacroiliitis. Disease burden in AxSpA patients with or without radiographic sacroiliitis have been shown to be similar in different cohorts, which suggest that both diseases should be treated with the same approach. Recent randomized clinical trials showed that TNF inhibitors (TNFi) are effective also in treating signs and symptoms of nr-AxSpA. However, the efficacy of anti-TNF agents in patients with nr-AxSpA remains to be shown in daily rheumatology practice. The objective of this study is to compare the efficacy of TNF inhibitors in patients with AS and nr-AXSpA in daily clinical setting.
Methods
A total of 326 patients with AxSpA (195 M; 39.8 ±10.6) from four centers, who contribute to TURKBIO, a biological database in Turkey, and who could provide detailed data on imaging for patients with AxSpA, were included in this study. Of these patients 208 had AS according to the modified New York criteria and 118 patients had nr-ax SPA. (20% fulfilling the clinical arm, 80% fulfilling the imaging arm)
Results
Baseline demographics and clinical characteristics are summarized in the table-1. Patients with nr-AxSpA were significantly younger, had a shorter disease duration and had a higher female predominance than patients with AS. After three months of treatment with TNF inhibitors, mean BASDAI and ASDAS decreased significantly (Table 1). The response rates for minimal clinical improvement (ΔASDAS ≥1.1) and major clinical improvement (ΔASDAS ≥2 ) were similar in patients with nr-AxSpA (66% vs 72%) and those with AS (43.8% vs 39.1% ). Similarly good response rates were observed for BASDAI 50 in the two groups; 56.8 % and 58.5%, respectively.
Conclusion
The results of our study suggest that TNFi, which have been clearly shown to be effective in treating signs and symptoms of AS, seem to be equally effective in the treatment of nr-AxSPA.
Table 1. Demographics and clinical characteristics of the AxSpA and AS patients.
|
|
Non-radiographic axial spondylarthritis (n=118) |
Ankylosing spondylitis (n:208) |
p value |
|
|
Age |
36.8 (± 9.6) |
41.5 (± 10.7) |
p<0.001 |
|
|
Disease Duration (years) |
7.22 (±6.4) |
12.56 (±8.4) |
p<0.001 |
|
|
Diagnosis Duration (years) |
3.6(±3.3) |
7.51 (±6.4) |
p<0.001 |
|
|
Female (%) |
53.4 |
32.7 |
p<0.001 |
|
|
Mean CRP mg/l (baseline) |
20.1(± 32) |
24.9(± 32.9) |
p:0.213 |
|
|
Mean ESR (baseline) |
28.2 (± 24.5) |
35.5 (± 24.9) |
p:0.050 |
|
|
HLA B27 positivity (%)* |
53% |
74% |
p:0.02 |
|
|
Mean BASFI (baseline) |
5.33(±2.88) |
5.06(±2.58) |
p:0.414 |
|
|
Mean BASDAI (baseline) |
6.43(±1.9) |
5.93(±1.8) |
p:0.02 |
|
|
Mean ASDAS-CRP (baseline) |
3.7(±0.98) |
3.65(±1.08) |
p:0.689 |
|
|
Mean ΔBASDAI (at month 3) |
3.4(±2.37) |
3.1(±2.24) |
p:0.261 |
|
|
Mean ΔASDAS (at month 3) |
1.74(±1.2) |
1.75(±1.1) |
p:0.951 |
|
|
Biologic drugs used |
||||
|
Infliximab (%) |
26.3 |
25.5 |
|
|
|
Etanercept (%) |
33.1 |
31.3 |
|
|
|
Adalimumab (%) |
27.9 |
27.4 |
|
|
|
Golimumab (%) |
12.7 |
15.9 |
|
|
*In the patients with available data
Disclosure:
P. Cetin,
None;
U. Kalyoncu,
None;
B. Kisacik,
None;
I. Sari,
None;
D. Solmaz,
None;
O. Karadag,
None;
A. M. Onat,
None;
G. Kimyon,
None;
L. Kilic,
None;
F. Onen,
None;
S. Kiraz,
None;
M. Birlik,
None;
I. Ertenli,
None;
O. N. Pamuk,
None;
N. Akkoc,
None.
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