COMPARATIVE EVALUATION OF PATIENTS WITH ANKYLOSING SPONDYLITIS AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Objective: to study clinical presentations, disease activity, and functional impairments  in patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis  (nr-axSpA).

Subjects and methods. A total of 153 patients were examined in the period 2010 to 2013. They were divided into two groups: 1) 119 patients with a valid diagnosis of AS; 2) 34 with nr-axSpA. BASDAI, BASFI, BASMI, MASES, erythrocyte sedimentation rate, and HLA-B27 antigen were determined  in both groups. The mean age of the patients was 36.5±0.7 years and 27.0±1.2 years and the disease duration 14.7±0.6 and 4.1±0.5 years in Groups 1 and 2, respectively.

Results and discussion. Among the patients with AS and those with nr-axSpA, men accounted  for 68.9 and 70.6%, respectively. The axial type was predominant in both groups (53.7% in Group 1 and 67.6% in Group 2). The mean visual analogue scale (VAS) pain score was 40.6±1.6 mm in Group 1 and 31.6±2.4 mm in Group 2 (p < 0.01). High BASDAI was seen in 51.2% of the patients with AS and 41.1% of those with nr-axSpA. Group 2 had significantly lower mean BASDAI values (3.4±0.2)  than Group 1 (4.0±0.1).  Functional impairments  by BASFI were more obvious in the patients with AS ((3.2±0.2) than in those with nr-axSpA (1.5±0.2).  BASFI >4 was not noted in Group 2. Higher BASMI scores were found in the patients with AS (1.9±0.1)  than in those with nr-axSpA (0.5±0.1). Conclusion. The ASAS criteria for axSpA enable one to establish its diagnosis in the early stage until stable functional impairments  emerge. In the pre-radiographic stage, the patients have lower disease activity and pain.

1. Насонов ЕЛ, редактор. Ревматология: Клинические рекомендации. 2-е изд. Москва: ГЭОТАР-Медиа; 2010. 752 c. [Nasonov EL, editor. Revmatologiya: Klinicheskie rekomendatsii. [Rheumatology: Clinical guidelines]. 2nd ed. Moscow: GEOTARMedia; 2010. 752 p.].

2. Rudwaleit M, van der Heijde D, Khan MA, et al. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004;63:535-43. doi: 10.1136/ard.2003.011247

3. Волнухин ЕВ, Галушко ЕА, Бочкова АГ и др. Клиническое многообразие анкилозирующего спондилита в реальной практике врача-ревматолога в России (часть 1). Научнопрактическая ревматология. 2012;50(2):44-9 [Volnukhin EV, Galushko EA, Bochkova AG, et al. Clinical diversity of ankylosing spondylitis in the real practice of a rheumatologist in Russia (Part 1). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2012;50(2):44-9. (In Russ.)]. doi: 10.14412/1995-4484-2012-1272

4. Mau W, Zeidler H, Mau R, et al. Clinical features and prognosis of patients with possible ankylosing spondylitis: results of a 10-year followup. J Rheumatol. 1988;15(7):1109-14.

5. Van der Linden S, Valkenburg H, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361-8. doi: 10.1002/art.1780270401

6. Rudwaleit M, Landewe R, van der Heijde D, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770-6. doi: 10.1136/ard.2009.108217

7. Эрдес ШФ, Бочкова АГ, Дубинина ТВ и др. Проект рабочей классификации анкилозирующего спондилита. Научно-практическая ревматология. 2013;51(6):604-8 [Erdes ShF, Bochkova AG, Dubinina TV, et al. Project of working classification of ankylosing spondilytis. NauchnoPrakticheskaya Revmatologiya = Rheumatology Science and Practice. 2013;51(6):604-8 (In Russ.)]. doi: 10.14412/1995-4484-2013-604-8

8. Braun J, Pincus T. Mortality. Course of disease and prognosis of patients with ankylosing spondylitis. Clin Exp Rheumatol. 2002;20(6 Suppl. 28):16-22.

9. Дубинина ТВ, Эрдес ШФ. Причины поздней диагностики анкилозирующего спондилита в клинической практике. Научно-практическая ревматология. 2010;48(2):43-8 [Dubinina TV, Erdes SF. Reasons for late diagnosis of ankylosing spondylitis in clinical practice. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2010;48(2):43-8 (In Russ.)]. doi: 10.14412/1995-4484-2010-1415

10. Мясоутова ЛИ, Лапшина СА, Васильев АГ, Салихов ИГ. Диагностика и клиническая характеристика анкилозирующего спондилита по данным Городского ревматологического центра г. Казани. Научно-практическая ревматология. 2012;50(1):38-41 [Myasoutova LI, Lapshina SA, Vasilyev AG, Salikhov IG. The diagnosis and clinical characteristics of ankylosing spondylitis according to the data of the Kazan city rheumatology center. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2012;50(1):38-41 (In Russ.)]. doi: 10.14412/1995-4484-2012-502

11. Губарь ЕЕ, Бочкова АГ, Дубинина ТВ и др. Клиническая характеристика больных ранним аксиальным спондилоартритом (российская когорта пациентов). Научнопрактическая ревматология. 2014;52(5):507-12 [Gubar’ EE, Bochkova AG, Dubinina TV, et al. Clinical profile of patients with early axial spondyloarthritis (Russian cohort of patients). Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2014;52(5):507-12 (In Russ.)]. doi: 10.14412/1995-4484-2014-507-512

12. Kiltz U, Baraliakos X, Karakostas P, et al. Do patients with nonradiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res. 2012;64:1415-22. doi: 10.1002/acr.21688

13. Rudwaleit M, Haibel H, Baraliakos X, et al. The early disease stage in axial spondyloarthritis. Results from the German spondyloarthritis inception cohort. Arthritis Rheum. 2009;(60):717-27. doi: 10.1002/art.24483

14. Башкова ИБ, Кичигин ВА, Баимкина ЭВ, Устинова АИ. Особенности диагностики и клинических проявлений анкилозирующего спондилита. Вестник Чувашского университета. 2014;(2):186-94 [Bashkova IB, Kichigin VA, Baimkina EV, Ustinova AI. The diagnosis and clinical manifestations of ankylosing spondylitis. Vestnik Chuvashskogo Universiteta. 2014;(2):186-94 (In Russ.)].