Subscribe

Disease Activity Linked to Radiographic Progression in Ankylosing Spondylitis

VBCR - October 2014, Volume 3, No 5 - Ankylosing Spondylitis
Leslie Wyatt

The association between inflammation and new bone formation in ankylosing spondylitis (AS) has been widely studied and debated in recent years. However, the studies have resulted in inconclusive data about the inhibition and progression of radiographic progression.

In a recent study, researchers examined the long-term relationship between disease activity and radiographic spine progression in patients with AS and found that higher disease activity leads to more structural damage in the spine of these patients (Ramiro S, et al. Ann Rheum Dis. 2014;73:1455-1461). This is the first study to show that disease activity contributes longitudinally to the radiographic progression in the spine of patients with AS, according to Sofia Ramiro, MD, MSc, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, the Netherlands, and colleagues.

“The effect of disease activity on radiographic damage is stronger in men than in women, and in the earlier phases of the disease,” they added.

Clinical and Radiographic Assessment

Measurement of radiographic progression in patients with AS is a slow and difficult process that requires long-term patient follow-up and recurring assessments, according to the authors.

Disease activity was measured with either acute-phase response or patient-reported outcomes, which have provided disparate results in previous studies. To circumvent these uncertain outcomes, Dr Ramiro and colleagues used a newly developed AS Disease Activity Index (ASDAS), which combines patient-reported outcomes and acute-phase response, and offers a more ideal method to measure disease activity.

Using the Outcome in Ankylosing Spondylitis International Study (OASIS)—a cohort study of patients with AS from the Netherlands, Belgium, and France—the study authors analyzed the clinical and radiographic assessments of 184 patients during the span of 12 years, at 2-year intervals. Seventy percent of the patients were men, with a mean age of 43 years, and mean symptom duration of 20 years.

Investigators blinded to clinical and demographic data scored radiographs using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Disease activity measures included the Bath AS Disease Activity Index and ASDAS-C-reactive protein. On average, patients at baseline had an ASDAS of 2.6 with an increase of 1.9 mSASSS units every 2 years.

For every ASDAS unit increase, a progression of 0.72 mSASSS units can be expected during the course of 2 years, the study authors found. Patients with very high activity disease states (ASDAS >3.5) had an additional 2-year progression of 2.3 mSASSS units compared with patients with inactive disease states (ASDAS <1.3).

Gender Disparity and Disease Duration

Disease activity was shown to have a stronger effect on radiographic progression in men than in women. At each 2-year interval, approximately 1 mSASSS of additional progression was seen in male patients using the ASDAS. However, the authors note that less than a third of the patients included in the study were women, most of whom had little structural progression.

Dr Ramiro and colleagues also found that disease activity had a stronger impact on radiographic progression in the earlier phases of AS (patients with <18 years of symptom duration). This may be attributed to the increased likelihood of patients doing vigorous exercises more often in the early phases of the disease compared with the later phases, although more data are needed, the authors noted.

“The biggest challenge for the near future will…be to design a clinical study that takes all these different aspects into consideration,” Dr Ramiro and colleagues concluded. “The next question will be whether lower disease activity by drugs with various modes of action will result into less radiographic damage.”

Related Items
Using Preference Phenotypes to Enhance Communication, Facilitate Treatment Decision-Making, and Personalize Care
Leslie Wyatt
VBCR - April 2018, Vol 7, No 1 published on April 17, 2018 in Rheumatoid Arthritis
Detecting Early Rapidly Progressing RA Is Feasible, and May Contribute to Reduced Healthcare Resource Use
Leslie Wyatt
VBCR - December 2017, Vol 6, No 5 published on December 19, 2017 in AMCP News
Joint Activity Linked to Skin Severity in Patients with Psoriatic Arthritis and Psoriasis
Leslie Wyatt
VBCR - December 2017, Vol 6, No 5 published on December 19, 2017 in AMCP News
Use of Conventional Synthetic versus Biologic Disease-Modifying Antirheumatic Drugs May Reduce Costs in Treatment of RA
Leslie Wyatt
VBCR - December 2017, Vol 6, No 5 published on December 19, 2017 in Health Policy
Increased Risk for Bone Fracture Is Similar Among Men and Women with Rheumatoid Arthritis
Leslie Wyatt
VBCR - October 2017, Vol 6, No 4 published on October 20, 2017 in Rheumatic Diseases
Caffeine Consumption May Decrease Pain in Patients with Fibromyalgia Taking Opioids
Leslie Wyatt
VBCR - October 2017, Vol 6, No 4 published on October 20, 2017 in Fibromyalgia
Rheumatology Experts Hold Briefing to Educate Congressional Leaders on Arthritis and Its Effects
Leslie Wyatt
VBCR - April 2017, Vol 6, No 1 published on May 3, 2017 in ACR News
ACR and EULAR Develop Guidelines for Classifying Patients with Primary Sjögren’s Syndrome
Leslie Wyatt
VBCR - April 2017, Vol 6, No 1 published on May 3, 2017 in Sjögren’s syndrome
FDA Releases Draft Guidances on Sharing Healthcare Economic Information, Industry Communication Regulations
Leslie Wyatt
VBCR - April 2017, Vol 6, No 1 published on May 3, 2017 in FDA Approvals, News & Updates
Patients with Gout and Poorly Controlled Comorbid Osteoarthritis Can Benefit from Earlier Treatment
Leslie Wyatt
VBCR - April 2017, Vol 6, No 1 published on May 3, 2017 in Gout
Last modified: May 21, 2015
  • Rheumatology Practice Management
  • Lynx CME
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology