Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis

Abstract

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) > or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

A Possible Correlation Among Different Disease Activity Parameters and Functional Status in Patients with Ankylosing Spondylitis

“…Previous studies have reported significantly higher BASFI scores in patients with AS who have high disease activity compared with those exhibiting low disease activity, and [25,26] our findings were consistent with these results. The BASFI score was higher in the group with BASDAI scores of ≥4, and it was significantly correlated with the BASFI.…”

Follow-Up Results of Our Patients with Rheumatoid Arthritis

“…This ratio is in keeping with previous studies. [9,10] Sany et al [10] in their study with French RA patients found the average age of disease onset to be 44 years old, and our study had a similar age of 42.…”

“…[16] Rheumatoid factor was found to be positive in 60-80% of RA patients. [17] In the aforementioned study by Calgüneri et al, [14] 68.3% of patients were found to be RF positive, whereas RF positivity was 72.2% in the multi-centered study of Bodur et al [9] In our study, RF positivity was 59.4%, which is lower than in previous studies. The lower rate of RF positivity most probably comes from the calibration difference between laboratories.…”

“…In another study conducted in our country, the nodule rate was again found to be 7.5%. [9] Carmona et al [13] reported the nodule rate in Spanish patients to be 24.5%. This data possibly suggests that RA presents with fewer nodules in Turkey and that the disease presents differently in various geographical regions.…”

“…The steroid usage rate in our cases was found to be lower than other studies. [9] Although there have been patients who used small-dose steroids for extended periods at our clinic, they are normally used as a ''bridge therapy'' until signs emerge of the efficacy of the DMARDs. Therefore, only a minority of our patients used steroids for extended periods.…”