Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
The natural history of axial spondyloarthritis (axSpA) has not been clearly established yet. The aim of this study is to evaluate the natural course of axSpA patients and compare it between radiographic [(ankylosing spondylitis (AS)] and non-radiographic (nr-axSpA) sub-groups of the Turkish population of the PROOF study.
Methods:
PROOF is a large observational study, ongoing in 29 countries, aiming to reveal the long-term clinical and radiographic outcomes of patients classified as axSpA according to ASAS criteria. Patients were eligible if diagnosed within ≤1 year prior to the study initiation. Besides assessing disease activity, function, productivity and quality of life (QoL), nr-axSpA patients were followed up annually with sacroiliac joint (SIJ) radiographs. In addition to the treating physician, a central evaluator assessed the SIJ images. In the presence of discrepancy between the two readings, the images were inspected third time by the 2nd central reader and the final result corresponded to 2/3 readings.
Results:
PROOF cohort is consisted of 2126 participants worldwide and 274 axSpA patients were included from 24 centers in Turkey. In total 167 (60.9%) patients were classified as AS and 107 (39%) as nr-axSpA by local investigator. According to the central SIJ readings (n=229), 146 patients (63.8%) were evaluated as AS and 83 (36.2%) as nr-axSpA. The demographic and disease-related characteristics of the study groups are summarized in Table 1. In the first visit, patients were under non-steroidal anti-inflammatory drugs (78.5%), sulfasalazine (22.6%), corticosteroids (5.5%), and TNF inhibitors (9.9%) treatment. In one-year follow-up visit, disease activity measures (physician assessed or patients reported and composite outcome measures) and the percentage of current smokers showed a similar decrease independent of disease subgroup. QoL was improved and overall total activity impairment was decreased during one year of observation. Based on local X-ray grading 1/23 (4.3%) of AS patients are reclassified as nr-axSpA and 9/39 (23.1%) of nr-axSpA patients as AS.
Conclusion:
Although there were differences between the AS and nr-axSpA groups, such as female gender and CRP, baseline disease burden of AS and nr-axSpA patients were quite similar. During one-year follow-up; disease activity and QoL were improved similarly in both subgroups. Based on local X-ray readings, substantial proportion of nr-axSpA patients seemed to be progressed to AS, even in one-year period.
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Table 1: Demographic and disease related characteristics of ankylosing spondylitis and non-radiographic axial spondyloarthritis patients on baseline and one year of follow-up. |
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Characteristics |
Ankylosing Spondylitis (n=146) |
Non-radiographic axSpA (n=83) |
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|
|
Baseline |
One year follow-up |
Baseline |
One year follow-up |
|
Age in years, mean ±SD |
33.1 ± 9.5 |
|
32.8 ± 8.0 |
|
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Gender, % Male |
57.5 |
|
43.4 |
|
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HLA-B27 positivity, % |
44.4 |
|
33.3 |
|
|
Time since diagnosis in months, mean ± SD |
2.4 ± 3.1 |
Not applicable |
2.0 ± 3.1 |
Not applicable |
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Time since beginning of chronic lumbar pain in months, mean ± SD |
67.7 ± 83.9 |
Not applicable |
40.7 ± 43.0 |
Not applicable |
|
Current smoker, % |
41.8 |
30.4 |
35.4 |
32.6 |
|
Inflammatory back pain, % |
94.5 |
43.8 |
96.4 |
44.6 |
|
Arthritis, % |
21.9 |
5.5 |
19.3 |
4.8 |
|
Enthesitis, % |
46.6 |
21.9 |
54.2 |
14.5 |
|
Dactylitis, % |
2.7 |
2.1 |
1.2 |
1.2 |
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Uveitis, % |
8.2 |
2.7 |
3.6 |
3.6 |
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Psoriasis, % |
0.7 |
0.7 |
6.0 |
4.8 |
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Inflammatory bowel disease, % |
0 |
0.7 |
0 |
0 |
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CRP, mg/L, mean± SD |
19.1 ± 26.7 |
10.0 ± 18.4 |
8.9 ± 14.4 |
5.2 ± 7.7 |
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ESR, mm/h, mean ± SD |
22.2 ± 17.5 |
13.7 ± 10.0 |
15.4 ± 12.7 |
13.0 ± 10.9 |
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ASDAS (CRP and ESR combined), mean ± SD |
3.3 ± 1.0 |
2.2 ± 1.1 |
2.9 ± 0.9 |
2.2 ± 1.1 |
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BASDAI, mean ± SD |
4.7 ± 2.3 |
3.3 ± 2.2 |
5.1 ± 2.3 |
3.7 ± 2.3 |
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BASFI, mean ± SD |
3.3 ± 2.4 |
2.3 ± 2.2 |
2.7 ± 2.3 |
2.2 ± 2.1 |
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SF-12v2 physical component score, mean ± SD |
41.1 ± 8.8 |
46.9 ± 9.1 |
41.0 ± 8.5 |
45.7 ± 7.3 |
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SF-12v2 mental component score, mean± SD |
40.0 ± 11.9 |
44.6 ± 11.0 |
39.6 ± 11.1 |
42.1 ± 9.9 |
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WPAI-SHP, Total activity impairment, %, mean ± SD |
46.5 ± 29.5 |
31.3 ± 27.7 |
48.3 ± 30.3 |
32.6 ± 24.6 |
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CRP: C-Reactive Protein; ESR: Erythrocyte Sedimentation Rate; ASDAS: Ankylosing Spondylitis Disease Activity Score; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BASFI: Bath Ankylosing Spondylitis Functional Index; SF-12v2: Short Form 12 Item Version 2 Health Survey; WPAI-SHP: Work Productivity and Activity Impairment Questionnaire Specific Health Problem; SD: Standard deviation
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To cite this abstract in AMA style:
Akar S, Sezer I, Yumusakhuylu Y, Akinci A, Erol K, Akgun K, Bodur H, Ataman S, Kuru O, Melikoglu M, Karkucak M, Bugdayci ND, Ersozlu Bakirli D, Birtane M, Duruoz T, Erten S, Dalkilic E, KINIKLI G, Bes C, Omma A, Rezvani A. The Disease Course in Daily Clinical Practice in Radiographic and Non-Radiographic Axial Spondyloarthritis Patients; One-Year Follow-up Results of National-Subgroup of a Worldwide Observational Cohort Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-disease-course-in-daily-clinical-practice-in-radiographic-and-non-radiographic-axial-spondyloarthritis-patients-one-year-follow-up-results-of-national-subgroup-of-a-worldwide-observational-c/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-disease-course-in-daily-clinical-practice-in-radiographic-and-non-radiographic-axial-spondyloarthritis-patients-one-year-follow-up-results-of-national-subgroup-of-a-worldwide-observational-c/