Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Probiotic Therapy for the Treatment of Spondyloarthritis: A Randomized Controlled Trial Efficacy of certolizumab pegol on signs and symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week results of a double-blind randomised placebo-controlled Phase 3 study Efficacy and drug survival of anti-tumour necrosis factor-alpha therapies in patients with non-radiographic axial spondyloarthritis: an observational cohort study from Southern Sweden Augmentation index in patients with rheumatoid arthritis and ankylosing spondylitis treated with infliximab Clinical relevance of C-reactive protein in ankylosing spondylitis and evaluation of the NSAIDs/coxibs' treatment effect on C-reactive protein. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity within and outside the home in patients with axial spondyloarthritis, including nonradiographic axial spondyloarthritis and ankylosing spondylitis
OBJECTIVE To study the usefulness of erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , and serum amyloid A ( SAA ) for response prediction and monitoring of anti-tumor necrosis factor ( anti-TNF ) treatment in ankylosing spondylitis ( AS ) patients . METHODS Patients were included consecutively before starting etanercept or infliximab treatment .  ASsessment in Ankylosing Spondylitis ( ASAS ) response , defined as a 50 % improvement or an absolute improvement of 2 points of the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ; 0 - 10 scale ) , was assessed at 3 months . Inflammatory markers and the BASDAI were collected at baseline and 1 and 3 months . Longitudinal data analysis was performed to compare associations between inflammatory markers and the BASDAI over time by calculating st and ardized betas . Predictive values of baseline levels of inflammatory markers for ASAS response were calculated . RESULTS In total , 155 patients were included , of whom , after 3 months of treatment , 70 % in the etanercept cohort and 71 % in the infliximab cohort responded . All markers , notably SAA , decreased significantly ( P < 0.0001 ) . St and ardized betas were 0.49 for ESR , 0.43 for CRP , and 0.39 for SAA . Normal baseline levels of CRP and SAA were significantly associated with nonresponse . A combination of elevated CRP and SAA levels at baseline revealed the highest predictive value ( 81 % ) for ASAS response . CONCLUSION ESR , CRP , and SAA were significantly associated with the BASDAI over 3 months , and the association with ESR was the strongest . Elevated baseline CRP and SAA levels revealed the highest predictive value for response . Together , this study demonstrates that inflammatory markers , and notably CRP and SAA , may facilitate patient selection and monitoring of efficacy of anti-TNF treatment in AS , and could be added to response criteria Objective . To investigate the effect of an orally administered probiotic on disease activity , fatigue , quality of life , and intestinal symptoms in patients with active spondyloarthritis . Methods . Patients with active spondyloarthritis [ defined as Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) ≥ 3 , Bath Ankylosing Spondylitis Functional Index ( BASFI ) ≥ 3 , Maastricht Ankylosing Spondylitis Enthesitis Score ( MASES ) ≥ 2 , or peripheral joint count ≥ 2 ] were r and omized to oral probiotic or placebo for 12 weeks . Patients and assessors were blinded to treatment allocation . The primary outcome measure was 10 % improvement in the BASFI . Additional outcome measures were improvements in the ASsessment s in Ankylosing Spondylitis (ASAS)-endorsed core domains : pain , spinal mobility , patient global , peripheral joint and entheseal scores , stiffness , C-reactive protein , and fatigue . The ASAS20 criteria , a composite measure of response , were also applied . Quality of life and bowel symptoms were quantified using the Ankylosing Spondylitis Quality of Life Question naire ( ASQoL ) and Dudley Inflammatory Bowel Symptom Question naire ( DISQ ) . Results . Sixty-three patients were r and omized to oral probiotic ( n = 32 ) or placebo ( n = 31 ) . All patients completed the trial . No significant difference was noted between groups in any of the core domains . The mean BASFI fell from 3.5 ± 2.0 to 2.9 ± 1.9 in the probiotic group and from 3.6 ± 1.9 to 3.1 ± 2.2 in the placebo group ( p = 0.839 ) . The mean BASDAI fell from 4.2 ± 2.2 to 3.2 ± 2.1 in the probiotic group and 4.5 ± 2.0 to 3.9 ± 2.2 in the placebo group ( p = 0.182 ) . No significant adverse events were recorded in the probiotic-treated group . Conclusion . In this r and omized controlled trial , the probiotic combination administered did not demonstrate significant benefit over placebo , despite a theoretical rationale for this therapy Objectives To evaluate the efficacy and safety of certolizumab pegol ( CZP ) after 24 weeks in RAPID-axSpA ( NCT01087762 ) , an ongoing Phase 3 trial in patients with axial spondyloarthritis ( axSpA ) , including patients with ankylosing spondylitis ( AS ) and non-radiographic axSpA ( nr-axSpA ) . Methods Patients with active axSpA were r and omised 1:1:1 to placebo , CZP 200 mg every 2 weeks  ( Q2W ) or  CZP 400 mg every 4 weeks ( Q4W ) . In total 325 patients were r and omised . Primary endpoint was ASAS20 ( Assessment of SpondyloArthritis international Society 20 ) response at week 12 . Secondary outcomes included change from baseline in Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , and Bath Ankylosing Spondylitis Metrology Index ( BASMI ) linear . Results Baseline disease activity was similar between AS and nr-axSpA. At week 12 , ASAS20 response rates were significantly higher in CZP 200 mg Q2W and CZP 400 mg Q4W arms versus placebo ( 57.7 and 63.6 vs 38.3 , p≤0.004 ) . At week 24 , combined CZP arms showed significant ( p<0.001 ) differences in change from baseline versus placebo in BASFI ( −2.28 vs −0.40 ) , BASDAI ( −3.05 vs −1.05 ) , and BASMI ( −0.52 vs −0.07 ) . Improvements were observed as early as week 1 . Similar improvements were reported with CZP versus placebo in both AS and nr-axSpA sub population s. Adverse events were reported in 70.4 % vs 62.6 % , and serious adverse events in 4.7 % vs 4.7 % of All CZP versus  placebo groups . No deaths or malignancies were reported . Conclusions CZP rapidly reduced the signs and symptoms of axSpA , with no new safety signals observed compared to the safety profile of CZP in RA . Similar improvements were observed across CZP dosing regimens , and in AS and nr-axSpA patients Objectives : To evaluate the efficacy and drug survival of anti-tumour necrosis factor ( anti-TNF ) therapy in non-radiographic axial spondyloarthritis ( nr-axSpA ) patients treated in clinical practice in Southern Sweden . Method : In this cohort study we prospect ively included 112 patients with nr-axSpA and high disease activity as well as inadequate response or intolerance to non-steroidal anti-inflammatory drugs ( NSAIDs ) receiving their first course of anti-TNF therapy . Patients fulfilling modified New York criteria for ankylosing spondylitis ( AS ) were excluded . The Assessment of SpondyloArthritis International Society ( ASAS ) criteria for axial SpA were fulfilled by 77 % ( n = 86 ) of the included patients . Results : At baseline , the median age of the cohort was 38 years , 59 % were males , 79 % of the patients had imaging suggestive of sacroiliitis ( primarily inflammation on magnetic resonance imaging , MRI ) , 71 % were HLA-B27 positive , and the median disease duration was 6 years and 10 months . At 6 months of follow-up , the median Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) decreased from 5.6 to 3.2 ( p = 0.002 ) , the Bath Ankylosing Spondylitis Functional Index ( BASFI ) decreased from 3.9 to 1.8 ( p = 0.005 ) , and C-reactive protein ( CRP ) level decreased from 4.4 to 1.7 mg/L ( p = 0.001 ) . After 1 year of treatment the Kaplan – Meier estimated drug survival was 76 % , and at 2 years of follow-up this value decreased to 65 % . Patients with inflammatory MRI findings at baseline had significantly better drug survival [ hazard ratio ( HR ) 0.24 , 95 % confidence interval ( CI ) 0.10–0.55 , p = 0.001 ] . Male sex was also associated with higher drug survival ( HR 0.45 , 95 % CI 0.24–0.85 , p = 0.011 ) . CRP level at baseline was not associated with drug survival . Conclusions : Anti-TNF treatment of patients with nr-axSpA in clinical practice result ed in reduced BASDAI and BASFI scores and good drug survival . The results from this study suggest that male gender and positive imaging at baseline are associated with a favourable treatment course Premature atherosclerosis is linked to inflammation . Arterial stiffness is a marker of vascular dysfunction . We tested the hypothesis that treatment with infliximab , which is effective in reducing inflammation in rheumatoid arthritis ( RA ) and ankylosing spondylitis ( AS ) , also lowers the augmentation index ( AIx ) in patients with active disease . We also analyzed the subendocardial viability ratio ( SEVR ) , which is a measure of myocardial perfusion relative to cardiac workload . Included in the study were 30 patients ( 17 RA , 13 AS ) .  Conventional treatment failed in all patients . The AIx and SEVR were determined by radial applanation tonometry before and after treatment with infliximab , at baseline and at week 7 . After treatment with infliximab , Disease Activity Score for 28 joints ( RA patients ) , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Functional Index ( AS patients ) , erythrocyte sedimentation rate ( ESR ) , and C-reactive protein ( CRP ) improved significantly ( p < 0.001 ) . The AIx for all patients increased from 22.0 ± 14.0 % to 24.6 ± 13.0 % ( p = 0.03 ) . The increase in the RA sub-group ( p = 0.01 ) was also significant . The SEVR decreased from 148.6 ± 23.7 % to 141.2 ± 23.7 % ( p = 0.04 ) . Infliximab did not reduce the AIx in patients with RA and AS , although there were clinical improvements and CRP and ESR decreased . Instead , the AIx increased . This could negatively influence cardiac workload OBJECTIVE To evaluate the clinical relevance of CRP in AS and investigate the treatment effect of NSAIDs/coxibs on CRP . METHODS Data of 851 patients with painful axial AS participating in two r and omized controlled trials evaluating coxibs ( celecoxib ) and NSAIDs ( naproxen/ketoprofen )  were used . The clinical relevance of CRP in AS was studied : the number of patients with abnormal CRP at baseline was expressed as a percentage , and the correlation among CRP , patient ( age and gender ) and disease [ Bath AS Disease Activity Index ( BASDAI ) , Bath AS Functional Index ( BASFI ) ] characteristics was investigated . The st and ardized response mean ( SRM ) over placebo was used to detect the treatment effect of NSAIDs/coxibs on CRP . RESULTS The 851 enrolled patients ( 73 % of whom were men ) had an active disease , as assessed through functional impairment .  Mean ( s.d . ) baseline CRP was 14 ( 19 ) ( median 7.2 ) mg/l ; 61 % of patients had an increased CRP . The CRP levels were correlated positively with male sex , BASDAI and BASFI and negatively with age ( multivariate analysis ) . There was a significant difference in the changes of CRP between placebo and NSAIDs/coxibs group ( P = 0.003 ; SRM over placebo : 0.25 ) . Such a treatment effect was of higher magnitude in the subgroup of patients with increased CRP and usually of lower magnitude than the treatment effect of other outcome variables such as BASDAI and BASFI . CONCLUSIONS Increased CRP was frequently observed in patients with painful axial AS and was correlated both with activity and functional severity of the disease . The treatment effect of NSAIDs/coxibs was relevant in the subgroup of patients with increased CRP at baseline Introduction The arthritis-specific Work Productivity Survey ( WPS ) was developed to evaluate productivity limitations associated with arthritis within and outside the home . There is an unmet need for an instrument assessing similar productivity limitations in axial spondyloarthritis ( axSpA ) , including nonradiographic axSpA and ankylosing spondylitis . Following its validation in rheumatoid and psoriatic arthritis , we aim ed to assess psychometric properties of WPS in adult-onset active axSpA in this analysis . Methods Psychometric properties were assessed using data from the RAPID-axSpA trial ( NCT01087762 ) in which research ers investigated certolizumab pegol efficacy and safety in axSpA. WPS was completed at baseline and every 4 weeks until week 24 . Validity was evaluated at study baseline via known-groups defined by the first and third quartile cutoffs of patient scores to Ankylosing Spondylitis Disease Activity Score ( ASDAS ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , back pain , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Short Form 36 health survey ( SF-36 ) and Ankylosing Spondylitis Quality of Life Scale ( ASQoL ) . Responsiveness and reliability were assessed by comparing WPS mean changes in ASAS 20 % improvement criteria ( ASAS20 ) , BASDAI50 , ASDAS clinical ly important improvement/major improvement ( CII/MI ) and BASFI minimum clinical ly important difference ( MCID ) responders versus nonresponders at week 12 . All comparisons were conducted on observed cases in the r and omized set using a nonparametric bootstrap-t method . Results The results confirmed the psychometric properties of WPS . AxSpA patients with a worse health state had significantly more days of household work lost , household work with reduced productivity , social activities missed and outside help hired , as well as a higher interference rate of arthritis , than patients with a better health state . Similarly , employed patients with a worse health state had significantly more work days lost or with productivity reduced , and a higher interference of arthritis on work productivity . Similar findings were also observed in the nonradiographic ( nr ) axSpA and AS sub population s. The WPS was responsive to clinical changes , with responders reporting larger improvements at week 12 in WPS scores versus nonresponders . Effect sizes in responders were generally moderate to large ( st and ardized response mean > 0.5 ) . Conclusions These analyses demonstrate that WPS is a valid , responsive and reliable instrument for the measurement of productivity within and outside the home in adult-onset axSpA , as well as the in sub population s of AS and
Aerobic exercise did not improve BASFI , CRP or ESR .
CONCLUSION Aerobic exercise did not provide beneficial effects either on disease activity or on physical function and biological parameters when compared to a control group in axial spondyloarthritis
AIM To evaluate the impact of an aerobic fitness program on disease activity , defined by the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) and on C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR ) and the Bath Ankylosing Spondylitis Functional Index ( BASFI ) in case of axial spondyloarthritis .