The novel coronavirus infection COVID-19 (SARS-CoV-2) is now known to cause a variety of extrapulmonary complications, including cardiovascular, neurological and dermatological complications, many of which occur or last several weeks after infection. We present a clinical case of a patient who first developed symptoms of ankylosing spondylitis 2 weeks after recovering from COVID-19. The patient was prescribed therapy in accordance with international and Russian recommendations for the management of patients with ankylosing spondylitis with a positive effect in the form of absence arthritis, enthesitis and reducing the inflammatory back pain.
BackgroundPrevious studies showed that the impairment of hip joints (HJ) - coxitis leads to a hip replacement and it is a frequent cause of early disability in patients (pts) with spondyloarthritis (SpA). Early detection of coxitis have a great clinical importance.ObjectivesTo study the incidence and character of the impairment of HJ involvement in patients with early axial SpA (axSpA).MethodsThe study include 65 patients with axSpA (ASAS 2009) with disease duration <5 years and age at onset <45 years, mean age 28,5 (5,8) y., 32 (49,2%) males, 60 (92,2%) pts were HLAB27-positive, average disease duration was 24,1 (15,4) mo. The following evaluations were made: HJ pain (numerical rating scale – NRS - from 0 to 10), inter-malleolar distance (IMD), radiological HJ changes (BASRI-hip), ultrasound examination (US) and pts who had US evidence or/and clinical coxitis - MRI of hip joints. For 2 years pts taking NSAIDs at therapeutic doses. The dosages of NSAIDs accounted by the ASAS NSAID index.ResultsAfter 2 years follow-up reduce HJ functional limitations and pain in the left HJ (Table 1). There were no statistical differences between MRI symptoms of the impairment HJ and US symptoms of coxitis at baseline and after 2 years (Table 2).Table 1.Clinical characteristics of imparment HJ at baseline and after 2 yearsBaselineAfter 2 yearsP Bilateral HJ pain, % pts22 (33,8%)17 (26,1%)0,2Pain in the right HJ, % pts6 (9,2%)5 (7,6%)0,5Pain in the left HJ, % pts32 (49,2%)8 (12,3%)0,000003HJ funcional limitations, % pts13 (20,0%)3 (4,6%)0,007Bilateral HJ funcional limitations, % pts8 (12,3%)3 (4,6%)0,1IMD, mean (s.d.)110,8 (11,0)110,8 (11,0)1,0Table 2.MRI symptoms of the impairment HJ and US symptoms of coxitis at baseline and after 2 yearsBaselineAfter 2 yearsP MRI symptoms of the defeat HJ, % pts22 (68,7%)14 (43,7%)0,08Bilateral synovitis, % pts17 (77,2%)10 (71,4%)0,5One-side synovitis, % pts4 (18,1%)2 (14,2%)0,5Bilateral swelling of bone marrow in femoral head, % pts1 (4,5%)00,5One-side swelling of bone marrow in femoral head, % pts2 (9,0%)00,2Bilateral swelling of acetabular roof, % pts2 (9,0%)3 (21,4%)0,3One-side swelling of acetabular roof, % pts01 (7,1%)0,5US symptoms* of coxitis, % pts14 (21,5%)11 (16,9%)0,3Bilateral US symptoms of coxitis, % pts2 (14,2%)4 (28,5%)0,3One-side US symptoms of coxitis, % pts12 (85,7%)7 (50,0%)0,9*The distance between the anterior joint capsule and the femoral neck, capsular-neck distance CND >7 mm.Radiographic progression (BASRI-hip≥1 stage) after 2 years follow-up founded in 7 (31,8%) pts with MRI symptoms of the impairment HJ. There are radiographic progression from normal HJ to bilateral stage 1 in 5 (71,4%) pts, from bilateral stage 1 to bilateral stage 2 in 2 (28,6%) pts. Mean NSAID index in pts with radiographic progression (31,8%) amount 62,2%, while in pts without radiographic progression – 72,5% (p=0,2).Conclusions1. In patients with early axial spondyloarthritis in two years of observation radiographic progression observed in 31,7% patients despite on regular intake of NSAIDs. 2. Fur...
BackgroundCurrently non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line drugs for treatment of axial spondyloarthritis (axSpA) and much discussed question of influence frequency of intake NSAIDs on axSpA disease activity.ObjectivesTo compare the frequency of intake NSAIDs with early axSpA disease activity.MethodsThe research included 65 patients (pts) with axSpA (criteria ASAS 2009) with disease duration <5 years and age at onset <45 years. Pts at least 2 years follow up, 32 (49,2%) males, pts mean age was 28,5 (5,8) y., average disease duration - 24,1 (15,4) mo, 60 (92,3%) pts were HLA-B27 positive. At baseline all pts were NSAID-naïve, DMARD-naïve, anti-TNF-naïve. For 2 years pts taking NSAIDs at therapeutic doses. The dosages of NSAIDs accounted by the ASAS NSAID index. 1 year after baseline – 9 (13,8%) pts started treatment with anti – TNF because of high activity of the disease and absence of effect from 2 NSAIDs. 2 years after baseline number of pts with anti-TNF equal - 15 (23,0%).ResultsCompared with baseline characteristic after 2 years have significantly reduced disease activity and increased the number of ASAS partial remission (PR) in patients with axSpA (Table 1).Table 1.Outcome parameters at baseline and after 2 years of NSAID treatmentBaseline, NSAID naïve2 years after baseline with NSAIDsp (n=65)(n=50) BASDAI, mean (s.d)3,6 (1,9)2,4 (1,9)0,6BASDAI≥4, % pts29 (44,6%)10 (20,0%)0,05BASDAI <3, % pts26 (40,0%)46 (92,0%)0,01ASDAS-CRP, mean (s.d)2,4 (1,1)1,7 (1,1)0,0009ASDAS-CRP≥2,1, % pts39 (62,9%)22 (44,0%)0,4ASDAS<1,3, % pts11 (16,9%)27 (54,0%)0,004There were no statistical differences between the frequency of NSAIDs intake and early axSpA disease activity (Table 2).Table 2.Outcome parameters at 1 and 2 years after baseline depend on NSAID index >50 or NSAID index <501 year after baseline (n=56)2 years after baseline (n=50) NSAID indexNSAID indexPNSAID indexp >50<50>50<50 n=40 (61,5%)n=16 (23,0%)n=28 (56,0%)n=22 (44,0%) BASDAI, mean (s.d)2,3 (1,5)1,9 (1,8)0,42,3 (1,5)1,8 (1,3)0,6BASDAI≥4, % pts3 (7,5%)1 (6,2%)1,04 (14,2%)2 (9,1%)0,8BASDAI <3, % pts28 (70,0%)12 (75,0%)0,820 (71,4%)21 (95,4%)0,5ASDAS-CRP, mean (s.d)1,6 (0,7)1,3 (0,8)0,41,7 (0,9)1,4 (0,7)0,2ASDAS-CRP≥2,1, % pts12 (30,0%)3 (18,7%)0,79 (32,1%)8 (36,3%)0,7ASDAS<1,3, % pts15 (37,5%)6 (37,5%)0,813 (46,4%)10 (45,4%)0,9ASAS PR, % pts15 (37.5%)8 (50,0%)0,612 (42,8%)9 (40,9%)1,0ConclusionsLong reception of NSAIDs in patients with early axSpA reduces disease activity, however, the receive frequency does not affect the activity of the disease.Disclosure of InterestNone declared
Background:Inhibitors of interleukin 6 (IL6) have been found to be ineffective in ankylosing spondylitis (AS) based on the results of randomized clinical trials (RCTs) on tocilizumab (TCZ) and sarilimumab [1, 2]. However, there is evidence that IL6 is actively involved in the pathogenesis of the disease [3]. In addition, the efficacy of IL6 inhibitors has been shown in patients with secondary AA amyloidosis [4].Objectives:to analyze the effectiveness of IL6 inhibitor - TCZ in patients with AS with high disease activity and secondary AA-amyloidosis.Methods:The analysis included 10 patients with AS receiving TCZ therapy, of which 8 (80%) men, 2 (20%) women, and 100% HLA B27 positive. The average age of the patients was 40 ± 8.6 years, the average age of disease onset was 13.4 ± 7.5 years, the average duration of AS was 25.6 ± 6.5 years. 9 patients had histologically confirmed secondary AA-amyloidosis: 100% had kidney amyloidosis, 6 (66.6%) patients also had gastrointestinal amyloidosis and 3 (33.4%) patients had heart amyloidosis. All patients had arthritis and coxitis.Results:As the first biological drug, TCZ was prescribed to 2 patients due to the presence of manifestations of secondary AA-amyloidosis, and 8 patients had previous experience of treatment with one or more inhibitors of tumor necrosis factor-α (TNF-α). The average duration of TCZ treatment was 22.0 months [1.0; 36.0]. 8 (80%) patients continue to take TCZ therapy to date, and 2 (20%) - are transferred to TNF-α inhibitors. Table 1 shows the main clinical and laboratory characteristics of patients at the initiation of TCZ therapy and during the last hospitalization at the V.A. Nasonova Research Institute of Rheumatology. As you can see, against the background of TCZ therapy, both the level of CRP, proteinuria and the indices of AS activity (BASDAI, ASDAS CRP) significantly decreased. The number of patients with inflammatory back pain (IBP), arthritis and coxitis also decreased significantly.Table 1.The main clinical and laboratory characteristics of patients at the initiation and after of TCZ therapy.Before TCZAfter TCZрCRP, Ме [25‰; 75‰], mg/l95.2 [52.2; 189.0]10,8 [0.8; 8.0]р<0,05Proteinuria, Ме [25‰; 75‰], g/day.1,6 [1,0; 2,1]0,08 [0; 0,3]р<0,05BASDAI, Мean (SD)6,1 (1,6)3,3 (0,9)р<0,05ASDAS CRP, Мean (SD)4,3 (1,1)2,2 (0,7)р<0,05IBP, N (%)10 (100%)2 (20%)р<0,05Arthritis, N (%)10 (100%)2 (20%)р<0,05Cocxitis, N (%)10 (100%)5 (50%)р<0,05Enthesitis, N (%)7 (70%)6 (60%)р>0,05Conclusion:The above data showed that the method of treating AS with IL6 inhibitors, in certain clinical situations, primarily such as ineffectiveness of TNF-α inhibitors, high CRP level and the development of secondary AA-amyloidosis, can be highly effective. Therefore, it is advisable to continue the set of clinical observations on the treatment of especially severe patients with AS treated with non-standard methods.References:[1]Sieper J, Porter-Brown B, Thompson L, et al. Assessment of short-term symptomatic efficacy of tocilizumab in ankylosing spondylitis: results of randomised, placebo-controlled trialsAnn Rheum Dis 2014; 73: 95–100. doi:10.1136/annrheumdis-2013-203559.[2]Sieper J, Braun J, Kay J, et al. Sarilumab for the treatment of ankylosing spondylitis: results of a Phase II, randomised, double-blind, placebo-controlled study (ALIGN). Ann Rheum Dis. 2015; 74: 1051–1057. doi:10.1136/annrheumdis-2013-204963.[3]Londono J, Romero-Sanchez MC, Torres VG, et al. The association between serum levels of potential biomarkers with the presence of factors related to the clinical activity and poor prognosis in spondyloarthritis. Rev Bras Reumatol 2012; 52: 536-44.[4]Yilmaz S, Tekgöz E, Çinar M. Recurrence of proteinuria after cessation of tocilizumab in patients with AA amyloidosis secondary to FMF. Eur J Rheumatol. 2018; 5: 278-80. DOI: 10.5152/eurjrheum.2018.17183.Disclosure of Interests:None declared.
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