Aim:The hip joint is the most commonly affected non-axial joint in ankylosing spondylitis (AS). Data on the effects of tumor necrosis factorα inhibitors (TNFi) in AS patients with coxitis are limited. The aim of this study was evaluation of coxitis treated with the TNFi golimumab in real-world settings.Methods: This study was a prospective non-interventional cohort study. A total of 39 patients newly prescribed with golimumab were enrolled and followed for up to 24 months. The data collected included BASFI, BASMI, ASDAS-CRP, BASDAI indices. BASRI-hip X-ray score was assessed at baseline, and at 12 and 24 months. Magnetic resonance imaging (MRI) and ultrasound examination data were obtained at baseline, and at 6 and 12 months.Results: Significant improvements in BASFI, BASMI, ASDAS-CRP, BASDAI scores were observed (P ≤ 0.0001), but the BASRI-hip score remained stable. After 6 months of treatment, MRI signs of joint effusion were found in a smaller percentage of patients compared with baseline (P = 0.005 for the right and P = 0.015 for the left hip joints). After 12 months, this percentage was significantly lower than at baseline for the right hip joint (P = 0.005) and numerically lower for the left hip joint (P = 0.098).Ultrasound showed a significant increase in the percentage of patients without inflammatory changes after 6 and 12 months compared with baseline (right hip joint: P = 0.026 and P = 0.045, respectively; left hip joint: P = 0.026 for both time points). Conclusion:Golimumab therapy in AS patients with coxitis was accompanied by improvement in clinical scores, and in MRI and ultrasound findings without obvious radiographic progress.
Background. According to the treat-to-target strategy for spondyloarthritis (SpA), the main goal is to achieve clinical remission or inactive disease. In 2001, the Assessment of Spondyloarhtritis International Society (ASAS) formulated the ASAS criteria for partial remission, and the Russian expert group for the study of SpA identified clinical-laboratory remission (no clinical manifestations of the disease that persists for 6 months in the presence of normal values of C-reactive protein and erythrocyte sedimentation rate), magnetic resonance imaging (MRI) remission and complete remission (a combination of clinical-laboratory and MRI remission). Aim. To determine the frequency of achieving clinical-laboratory and ASAS partial remission in patients with early axial SpA (axSpA) at the 3rd year of follow-up. Materials and methods. The study included patients from the ESAC cohort (Early SpondyloArthritis Cohort), formed at the Nasonova Research Institute of Rheumatology (Moscow). Currently, the cohort includes 175 patients with axSpA. The analysis included 66 patients followed for at least 3 years, of which 37 (56%) were men and 29 (44%) were women. The average age of the patients was 31.5 (5.7) years, the average duration of the disease was 22.1 (17.0) months, 63 (95.4%) patients had HLA-B27 antigen. Results. Clinical-laboratory remission was achieved by 21 (31.8%) patients with early axSpA at the 3rd year of follow-up, ASAS partial remission by 29 (44.0%) patients. Conclusion. In the 3rd year of follow-up of patients with early axSpA, 32% of patients achieved clinical-laboratory remission, and 44% of patients achieved ASAS partial remission. More than 40% of patients with early axial spondyloarthritis achieve remission while taking non-steroidal anti-inflammatory drugs.
BackgroundThe main goal of “T2T” strategy for spondyloarthritis (SpA) is to achieve clinical remission or inactive disease. In 2001, the ASAS formulated criteria for partial remission [1], and the Russian Expert Group for Study of SpA (ExSpA) in 2018 identified clinical-laboratory remission (absence of clinical manifestations of the disease that persists for 6 months with normal values of CRP and ESR) [2].Objectivesto analyze the therapy in patients with early axial spondyloarthritis who achieved the ASAS partial remission and the clinical-laboratory remission at the 3rd year of follow-up.MethodsThe study included patients with early axSpA (ASAS criteria 2009 with inflammation back pain duration less than 5 years) from the CORSAR cohort (Cohort of Early SpondyloArthritis), formed at the V.A. Nasonova Research Institute of Rheumatology. The cohort includes 175 patients with axSpA. The analysis included 66 patients followed for at least 3 years, of which 37 (56%) were men. The average age of patients was 31.5 (5.7) years, the average duration of the disease was 22.1 (17.0) months, 63 (95.4%) patients were HLA B27 positive. The criteria for clinical-laboratory remission include the following indicators (at least during 6 month): ASDAS≤1,3, BASDAI ≤1,0, morning stiffness<30 min., absence of swollen joints, absence of enthesitis, nocturnal pain ≤1,0 (NRS), spinal pain≤1,0 (NRS), no active extra-articular manifestations, normal levels of CRP and ESR [2]. The criteria for ASAS partial remission include a value not above 2 units in each of the 4 domains: patient global, pain, function, inflammation [1].ResultsInitially, no patients met the ASAS partial remission and the clinical-laboratory remission criteria. By the 3rd year of follow-up, the clinical-laboratory remission was achieved by 21 (31.8%) patients; the ASAS partial remission - 29 (44.0%) patients. When analyzing therapy at the 3rd year of follow-up of patients with early axSpA who achieved the clinical-laboratory and the ASAS partial remission, it was revealed that patients more often achieved remission when taking NSAIDs, a quarter of patients achieved remission on combined therapy with biologics and NSAIDs (Table 1). It is noting that a quarter of patients canceled therapy on their own.Table 1.Therapy of patients with axSpA who achieved the clinical-laboratory and the ASAS partial remission at 3 years of follow-up.The ASAS partial remission (n=29)The clinical-laboratory remission (n=21)pNSAIDs, n (%)14 (48,2%)9 (42,8%)р>0,05NSAIDs+sulfasalazine, n (%)01 (4,7%)р>0,05Biologics, n (%)2 (6,8%)0р>0,05Biologics+NSAIDs, n (%)6 (20,6%)5 (23,8%)р>0,05Biologics+sulfasalazine, n (%)01 (4,7%)р>0,05Biologics+sulfasalazine+NSAIDs, n (%)1 (3,4%)0р>0,05Without therapy, n (%)6 (20,6%)5 (23,8%)р>0,05Conclusion1. In the 3d year of follow-up 32% of patients with early axSpA achieved the clinical-laboratory remission and 44% - of the ASAS partial remission.2. More than 40% of patients with early axSpA achieved remission while taking NSAIDs.References[1]Anderson JJ, Baron G, van der Heijde D, Felson DT, Dougados M. Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis. Arthritis Rheum 2001;44:1876-86.[2]Gaidukova I.Z., Rebrov A.P., Korotaeva T.V., Dubinina T.V., Otteva E.N., Badokin V.V., Bochkova A.G., Bugrova O.V., Godzenko A.A., Dubikov A.I., Ivanova O.N., Lapshina S.A., Nesmeyanova O.B., Nikishina I.P., Raskina T.A., Rumyantseva O.A., Smirnov A.V., Sitalo A.V., Erdes S.F. REMISSION IN AXIAL SPONDYLOARTHRITIS: DEFINITION AND EVALUATION TOOLS (RECOMMENDATIONS OF THE SPONDYLOARTHRITIS STUDY GROUP OF EXPERTS, ALL-RUSSIAN PUBLIC ORGANIZATION «THE ASSOCIATION OF RHEUMATOLOGY OF RUSSIA»). Rheumatology Science and Practice. 2018;56(1):10-14. (In Russ.) https://doi.org/10.14412/1995-4484-2018-10-14Disclosure of InterestsNone declared
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease with predominant involvement of the sacroiliac joints (SIJ) and/or the spine. Despite the fact that the prevalence of axSpA is almost the same in men and women, there is evidence of a delay in diagnosis and a more severe course of the disease in females. The available reports on the progression of structural changes in the SIJ in men and women with early axSpA are contradictory. Meanwhile, the analysis of radiographic progression in the SIJ has fundamental importance both for timely diagnosis and for assessing the effectiveness of therapy in axSpA. Such studies have not yet been carried out in the Russian Federation.Objective: to assess the radiographic progression of sacroiliitis (SI) over 3 years in men and women with early axSpA.Material and methods. The study included patients from the cohort of early axSpA CORSAR, formed at the V.A. Nasonova Research Institute of Rheumatology. Currently, it includes 175 patients with axSpA. We analyzed the data of 64 patients, followed for at least 3 years. To assess the radiographic progression of the disease at baseline and after 3 years, the sum of X-ray stages of SI in the left and right SIJ was determined (the total stage of SI). Progression was assessed by the change in the total stage of SI in the right and left SIJ (0-8) during the observation period. We also calculated the proportion of patients with deterioration (increase in the total stage of SI by at least 1 stage), with improvement (decrease in the total stage of SI by at least 1 stage) and without progression. In order to fully exclude the error in measuring the radiographic progression of SI, we counted patients with “net” progression, that is, the proportion of patients with improvement was subtracted from the proportion of patients with deterioration.Results. Among 64 patients with early axSpA, there were 37 (57.8%) men and 27 (42.2%) women. For 3 years, the median of the total stage SI in men was 0 [0; 1], in women - 0 [0; 2] (p>0.05). When assessing the progression of the total stage SI over 3 years, no significant differences were found between the number of men and women with improvement, with deterioration, “net” progression and without progression. Men with early axSpA showed a higher level of C-reactive protein (CRP) at baseline, women had higher BASDAI and ASDAS CRP values after 3 years. In 8% of patients, there was a regression of X-ray signs of SI.Conclusion. The radiographic progression of SI in patients with early axSpA does not depend on gender and disease activity. In some patients with early axSpA, reverse development of structural damage to the SIJ is possible.
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