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Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients--baseline characteristics, treatment adherence, and development of clinical variables during three years of anti-TNF therapy in clinical practice.
Arthritis Res Ther. 2015 Dec 24; 17:378.AR

Abstract

BACKGROUND

The relationship between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) is currently debated. Using observational data from the South Swedish Arthritis Treatment Group register, we thus aimed to compare clinical development and treatment adherence between nr-axSpA and AS patients during three years of anti-TNF (tumor necrosis factor) therapy in clinical practice, and to explore the impact of inflammatory activity measured by CRP (C-reactive protein) at treatment initiation.

METHODS

Nr-axSpA and AS patients (n = 86/238) in southern Sweden, commencing anti-TNF therapy 1999-2011, were followed during three years. Anti-TNF cessation was defined as stopping therapy, without restarting another anti-TNF agent within three months. Differences in the three year developments of patient's visual analogue scale (VAS) scores for global health and pain, EuroQol 5-Dimensions utility, evaluator's global disease activity assessment, CRP, and ESR (erythrocyte sedimentation rate) were assessed by repeated ANOVA. Anti-TNF adherence was compared by Log rank test and Cox regression. In a subanalysis, the same outcomes were studied after splitting both groups into patients with/without baseline CRP elevation.

RESULTS

Nr-axSpA patients were more often female and had lower acute phase reactants at baseline. Apart from CRP, which remained lower in the nr-axSpA group throughout follow-up (p = 0.004), no between-group differences were detected regarding clinical developments (p >0.1 for all comparisons) or anti-TNF adherence (hazard ratio: 1.1 (95% CI 0.7 to 1.8) for the nr-axSpA vs. AS group) during three years. Elevated baseline CRP was similarly associated with superior clinical outcomes and treatment adherence in both groups.

CONCLUSIONS

With the exception of constantly lower CRP levels in the nr-axSpA group, three years anti-TNF therapy resulted in similar clinical outcomes and treatment adherence in nr-axSpA and AS patients, thus strengthening the hypothesis that these diagnoses represent different aspects/phases of the same disease.

Authors+Show Affiliations

Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. johan.81.karlsson@gmail.com. Reumatologiska kliniken, Skånes Universitetssjukhus Lund, Kioskgatan 3, 22185, Lund, Sweden. johan.81.karlsson@gmail.com.Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. meliha.c_kapetanovic@med.lu.se.Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. ingemar.petersson@med.lu.se. Section of Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. ingemar.petersson@med.lu.se.Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. pierre.geborek@med.lu.se.Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. larserik_kristensen@yahoo.com. The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Denmark. larserik_kristensen@yahoo.com.

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26703005

Citation

Wallman, Johan K., et al. "Comparison of Non-radiographic Axial Spondyloarthritis and Ankylosing Spondylitis Patients--baseline Characteristics, Treatment Adherence, and Development of Clinical Variables During Three Years of anti-TNF Therapy in Clinical Practice." Arthritis Research & Therapy, vol. 17, 2015, p. 378.
Wallman JK, Kapetanovic MC, Petersson IF, et al. Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients--baseline characteristics, treatment adherence, and development of clinical variables during three years of anti-TNF therapy in clinical practice. Arthritis Res Ther. 2015;17:378.
Wallman, J. K., Kapetanovic, M. C., Petersson, I. F., Geborek, P., & Kristensen, L. E. (2015). Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients--baseline characteristics, treatment adherence, and development of clinical variables during three years of anti-TNF therapy in clinical practice. Arthritis Research & Therapy, 17, 378. https://doi.org/10.1186/s13075-015-0897-6
Wallman JK, et al. Comparison of Non-radiographic Axial Spondyloarthritis and Ankylosing Spondylitis Patients--baseline Characteristics, Treatment Adherence, and Development of Clinical Variables During Three Years of anti-TNF Therapy in Clinical Practice. Arthritis Res Ther. 2015 Dec 24;17:378. PubMed PMID: 26703005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients--baseline characteristics, treatment adherence, and development of clinical variables during three years of anti-TNF therapy in clinical practice. AU - Wallman,Johan K, AU - Kapetanovic,Meliha C, AU - Petersson,Ingemar F, AU - Geborek,Pierre, AU - Kristensen,Lars Erik, Y1 - 2015/12/24/ PY - 2015/08/28/received PY - 2015/12/10/accepted PY - 2015/12/26/entrez PY - 2015/12/26/pubmed PY - 2016/9/8/medline SP - 378 EP - 378 JF - Arthritis research & therapy JO - Arthritis Res. Ther. VL - 17 N2 - BACKGROUND: The relationship between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) is currently debated. Using observational data from the South Swedish Arthritis Treatment Group register, we thus aimed to compare clinical development and treatment adherence between nr-axSpA and AS patients during three years of anti-TNF (tumor necrosis factor) therapy in clinical practice, and to explore the impact of inflammatory activity measured by CRP (C-reactive protein) at treatment initiation. METHODS: Nr-axSpA and AS patients (n = 86/238) in southern Sweden, commencing anti-TNF therapy 1999-2011, were followed during three years. Anti-TNF cessation was defined as stopping therapy, without restarting another anti-TNF agent within three months. Differences in the three year developments of patient's visual analogue scale (VAS) scores for global health and pain, EuroQol 5-Dimensions utility, evaluator's global disease activity assessment, CRP, and ESR (erythrocyte sedimentation rate) were assessed by repeated ANOVA. Anti-TNF adherence was compared by Log rank test and Cox regression. In a subanalysis, the same outcomes were studied after splitting both groups into patients with/without baseline CRP elevation. RESULTS: Nr-axSpA patients were more often female and had lower acute phase reactants at baseline. Apart from CRP, which remained lower in the nr-axSpA group throughout follow-up (p = 0.004), no between-group differences were detected regarding clinical developments (p >0.1 for all comparisons) or anti-TNF adherence (hazard ratio: 1.1 (95% CI 0.7 to 1.8) for the nr-axSpA vs. AS group) during three years. Elevated baseline CRP was similarly associated with superior clinical outcomes and treatment adherence in both groups. CONCLUSIONS: With the exception of constantly lower CRP levels in the nr-axSpA group, three years anti-TNF therapy resulted in similar clinical outcomes and treatment adherence in nr-axSpA and AS patients, thus strengthening the hypothesis that these diagnoses represent different aspects/phases of the same disease. SN - 1478-6362 UR - https://www.unboundmedicine.com/medline/citation/26703005/Comparison_of_non_radiographic_axial_spondyloarthritis_and_ankylosing_spondylitis_patients__baseline_characteristics_treatment_adherence_and_development_of_clinical_variables_during_three_years_of_anti_TNF_therapy_in_clinical_practice_ L2 - https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-015-0897-6 DB - PRIME DP - Unbound Medicine ER -