CHANGE OF ACTIVITY, FUNCTIONAL CLASS, AND SPINAL MOBILITY IN ANKYLOSING SPONDYLOSIS DURING THERAPY WITH DIFFERENT PHARMACOLOGICAL AGENTS
https://doi.org/10.14412/1995-4484-2014-290-294
Abstract
Objective: To assess change of disease activity and the functional status of patients with ankylosing spondylitis (AS) during treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), synthetic disease-modifying antirheumatic drugs (DMARDs), and tumor necrosis factor-α (TNF-α) inhibitors in a Bulgarian population.
Subjects and methods. Sixty-six patients with AS were examined at baseline and after 6 months 25 (37.9%) from them received NSAIDs, 14 (21.2%) – synthetic DMARDs (sulfasalazine and methotrexate), and 27 (40.9%) – TNF-α inhibitors (adalimumab and etanarcept). The disease activity was assessed by BASDAI, ASDAS-CRP, ASDAS-ESR, ESR, and C-reactive protein (CRP), as well as by physician's and patient's assessments. Functional failure was deter- mined by BASFI, DFI, HAQ-S, and BASMI. ASAS improvement criteria and ASDAS changes (clinical improvement Δ ≥1.1 units and considerable improvement Δ ≥2.0 units) were used to assess response to therapy. ASAS criteria were employed to confirm remission.
Results. After 12 months of NSAID therapy, there was a statistically significant decrease of CRP level (p < 0.05) and an increase of DFI (p < 0.05). ASAS and ASDAS-ESR 20% improvement Δ ≥1.1 was noted in one case; ASAS 5/6 in 8% of cases. There was a 40% improvement and partial remission in ASAS, as well as in ASDAS Δ ≥2.0 in none patient. Treatment with synthetic DMARDs showed no statistically significant changes in activity and functional sta- tus and ASAS 20% response in 14.3% of the patients. A 40% response in ASAS, ASAS5/6, ASDAS Δ ≥1.1 and ASDAS-ERS Δ ≥2.0 was seen in 7.1%. No partial remission was observed. TNF-α inhibitor treatment provided sig- nificant improvement of all activity and function indicators (Δ ≤ 0.001). There was ASAS 20% response in 63% of cases, 40% response in 48.1%, ASAS5/6 in 59.3%, partial remission in 33.3%, ASDAS-CRP Δ ≥1.1 in 66.7%, ASDAS-CRP 2.0 in 48.1%, ASDAS-ESR Δ≥1.1 in 63% and ASDAS-ESR Δ≥2.0 in 37% of cases. Comparison of therapy response showed that the use of TNF-α inhibitors provided better results (p <0.001).
Conclusion. TNF-α inhibitors are the most effective agent to suppress disease activity and to improve functional status in AS.
About the Authors
M. Ivanova
Rheumatology Clinic, Saint Ivan Rilski University Multiprofile Hospital for Active Treatment, Sofia, Bulgaria
Russian Federation
Russian Federation
R. Stoilov
Rheumatology Clinic, Saint Ivan Rilski University Multiprofile Hospital for Active Treatment, Sofia, Bulgaria
Russian Federation
Russian Federation
S. G. Radenska-Lopovok
Nasonova Research Institute of Rheumatology, Moscow, Russia
Russian Federation
Russian Federation
I. Manolova
Department of Social Medicine, Medical Faculty, Thracian University, Stara Zagora, Bulgaria
Russian Federation
Russian Federation
References
1. Braun J, van den Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylos- ing spondylitis. Ann Rheum Dis. 2011;70(6):896–904. DOI: 10.1136/ard.2011.151027.
2. Van der Heijde D, Sieper J, Maksymowych WP, et al.; Assessment of SpondyloArthritis international Society. 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis. 2011;70(6):905–8. DOI: 10.1136/ard.2011.151563.
3. Garrett S, Jenkinson T, Kennedy G, et al. A new approach to defin- ing disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheum. 1994;21(12):2286–91.
4. Lukas C, Landewe R, Sieper J, et al.; Assessment of SpondyloArthritis international Society. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68(1):18–24. DOI: 10.1136/ard.2008.094870. Epub 2008 Jul 14.
5. Calin A, Garrett S, Whitelock H, et al. A new approach to defin- ing functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281–5.
6. Dougados M, Gueguen A, Nakache JP, et al. Evaluation of a func- tonal index and an articular index in ankylosing spondylitis.
7. J Rheumatol. 1988;15(2):302–7.
8. Daltroy LH, Larson MG, Roberts WN, Liang MH. A modifica- tion of the Health Assessment Questionnaire for the Spondyloarthropathies. J Rheumatol. 1990;17(7):946–50.
9. Jenkinson TR, Mallorie PA, Whitelock HC, et al. Defining spinal mobility in ankylosing spondylitis (AS): the Bath AS metrology index. J Rheumatol. 1994;21(9):1694–8.
10. Anderson JJ, Baron G, van der Heijde, et al. Ankylosing spondyli- tis assessment group preliminary definition of short-term improve- ment in ankylosing spondylitis. Arthritis Rheum. 2001;44(8):1876–86. DOI: http://dx.doi.org/10.1002/1529- 0131(200108)44:8%3C1876::AID-ART326%3E3.0.CO;2-F.
11. Brandt J, Listing J, Sieper J, et al. Development and preselection of criteria for short term improvement after anti-TNF alpha treatment in ankylosing spondylitis. Ann Rheum Dis. 2004;63(11):1438–44. DOI: http://dx.doi.org/10.1136/ard.2003.016717. Epub 2004 Mar 25.
12. Machado P, Landewe R, Lie E, et al.; Assessment of SpondyloArthritis international Society. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011;70(1):47–53. DOI: 10.1136/ard.2010.138594. Epub 2010 Nov 10.
13. Landewe R, Dougados M, Mielants H, et al. Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis. 2009;68(6):863–7. DOI: 10.1136/ard.2008.091793. Epub 2008 Jul 15.
14. Van der Heijde D, Baraf HS, Ramos-Remus C, et al. Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study. Arthritis Rheum. 2005;52(4):1205–15. DOI: http://dx.doi.org/10.1002/art.20985.
15. Jarrett SJ, Sivera F, Cawkwell LS, et al. MRI and clinical findings in patients with ankylosing spondylitis eligible for anti-tumour necrosis factor therapy after a short course of etoricoxib. Ann Rheum Dis. 2009;68(9):1466–9. DOI: 10.1136/ard.2008.092213. Epub 2008 Oct 24.
16. Wanders AJ, van der Heijde D, Landewe R, et al. Nonsteroidal anti- inflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum. 2005;52(6):1756–65. DOI: http://dx.doi.org/10.1002/art.21054.
17. Braun J, van der Horst-Bruinsma IE, Huang F, et al. Clinical effica- cy and safety of etanercept versus sulfasalazine in patients with anky- losing spondylitis: a randomizes, double-blind trial. Arthritis Rheum. 2011;63(6):1543–51. DOI: http://dx.doi.org/10.1002/art.30223.
18. Haibel H, Brandt HC, Song IH, et al. No efficacy of subcutaneous methotrexate in active ankylosing spondylitis: a 16-week open- label trial. Ann Rheum Dis. 2007;66(3):419–21. Epub 2006 Aug 10. DOI: http://dx.doi.org/10.1136/ard.2006.054098.
19. Davis JC Jr, van der Heijde D, Braun J, et al. Efficacy and safety of up to 192 weeks of etanercept therapy in patients with ankylosing spondylitis. Ann Rheum Dis. 2008;67(30:346–52. Epub 2007 Oct 29.
20. Van der Heijde D, Kivitz A, Schiff MH, et al.; ATLAS Study Group. Efficacy and safety of adalimumab in patients with anky- losing spondylitis: results of a multicenter, randomized, double- blind, placebo-controlled trial. Arthrits Rheum. 2006;54(7):2136–46. DOI: http://dx.doi.org/10.1002/art.21913.
21. Van der Heijde D, Maksymowych W. Spondyloarthritis: state of the art and future perspectives. Ann Rheum Dis. 2010;69(6):949–54. DOI: 10.1136/ard.2009.119529. Epub 2010 May 5.
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For citations:
Ivanova M., Stoilov R., Radenska-Lopovok S.G., Manolova I. CHANGE OF ACTIVITY, FUNCTIONAL CLASS, AND SPINAL MOBILITY IN ANKYLOSING SPONDYLOSIS DURING THERAPY WITH DIFFERENT PHARMACOLOGICAL AGENTS. Rheumatology Science and Practice. 2014;52(3):290-294. (In Russ.) https://doi.org/10.14412/1995-4484-2014-290-294
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