Objective To assess the association between self-reported and performance-based physical functioning and to evaluate which performance tests are most frequently impaired in patients with axSpA. Methods Consecutive axSpA patients underwent standardized assessments including patient and disease characteristics, patient-reported outcomes for disease activity, functioning, depression, mobility and physical activity and performance tests. Patients were defined as being impaired if they were not able to perform ≥ 1 of the performance tests. Validated cut-offs were used to define impaired physical performance. Impairment of performance tests as well as discrimination between subgroups were analyzed. Results A total of 200 patients (r-axSpA 65.5%, nr-axSpA 34.5%) was included: 69% males, mean age 44.3 (SD 12.5) years and mean symptom duration 17.9 (12.6) years. The two most frequently impaired performance tests were the repeated chair stand test (n=75, 37.5%) and putting on socks (n=44, 22%). An impairment in ≥ 1 performance test was seen in 91 patients (45.5%). Patients with impairments were older (48.9 vs. 40.8 years), had a higher body mass index (28.7 vs. 26.1 kg/m2), a more active disease (ASDAS 3.0 vs. 2.1), higher BASFI (5.7 vs. 2.8), BASMI (4.3 vs. 2.8) and ASAS HI scores (9.6 vs. 5.0), and higher depression screen values (PHQ 12.1 vs. 6.3), all p<0.01. Conclusion Many patients with axSpA had impairments in physical performance tests. Importantly, this was frequently seen in tasks requiring coordination and muscle power of the lower extremity. Performance tests provide qualitatively different information than BASFI and BASMI assessments in patients with axSpA.

ZUSAMMENFASSUNGOsteoporose ist eine Volkskrankheit, die sich durch niedrigtraumatische Frakturen manifestiert. Sie ist durch eine niedrige Knochendichte und verschlechterte ossäre Mikroarchitektur charakterisiert. Osteoporotische Frakturen führen zu Mobilitätsverlusten, Schmerzen und erhöhter Morbidität und Mortalität. Trotz ihrer Häufigkeit und schlimmen Konsequenzen bleibt die Osteoporose untertherapiert. Der Dachverband Osteologie (DVO) hat 2017 seine Leitlinie „Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern“ aktualisiert. Diese Übersichtsarbeit fasst die wichtigsten Empfehlungen und Neuerungen zusammen und gibt einen Ausblick auf Entwicklungen in den nächsten Jahren

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by inflammation and new bone formation in the axial skeleton. AxSpA is considered a spectrum of disease that includes two subtypes identified by the Assessment in SpondyloArthritis International Society classification criteria, namely, radiographic (r-axSpA usually referred to as ankylosing spondylitis) and non-radiographic axSpA (nr-axSpA). Although the burden of disease appears similar between the two classified subtypes, the degree of inflammation, as assessed by magnetic resonance imaging and C-reactive protein, and the degree of new bone formation are significantly higher in r-axSpA than in nr-axSpA. Nevertheless, axSpA is considered one disease with different courses. International guidelines for the management of axSpA have outlined treatment goals focused on control of signs and symptoms, inflammation, prevention of progressive structural damage, preservation of physical function, normalization of social participation and improvement of quality of life. The pathogenesis of axSpA has not been completely elucidated to date. A strong link between human leukocyte antigen B27 and axSpA, however, has been identified, and the success of anti-tumour necrosis factor and anti-interleukin (IL)-17A therapy has highlighted some of the key pro-inflammatory cytokines involved. The anti-IL-17A monoclonal antibody secukinumab is approved for the treatment of ankylosing spondylitis and nr-axSpA in the European Union and United States. In this narrative review, we discuss data for secukinumab in axSpA from randomized controlled trials, including MEASURE trials in AS and PREVENT in nr-axSpA, and real-world evidence.

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