Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Probiotic Therapy for the Treatment of Spondyloarthritis: A Randomized Controlled Trial Efficacy of certolizumab pegol on signs and symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week results of a double-blind randomised placebo-controlled Phase 3 study Efficacy and drug survival of anti-tumour necrosis factor-alpha therapies in patients with non-radiographic axial spondyloarthritis: an observational cohort study from Southern Sweden Augmentation index in patients with rheumatoid arthritis and ankylosing spondylitis treated with infliximab Clinical relevance of C-reactive protein in ankylosing spondylitis and evaluation of the NSAIDs/coxibs' treatment effect on C-reactive protein. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity within and outside the home in patients with axial spondyloarthritis, including nonradiographic axial spondyloarthritis and ankylosing spondylitis Predictors of treatment response and drug continuation in 842 patients with ankylosing spondylitis treated with anti-tumour necrosis factor: results from 8 years' surveillance in the Danish nationwide DANBIO registry Changes of clinical response and bone biochemical markers in patients with ankylosing spondylitis taking etanercept. The Effectiveness of Exergames in Patients with Ankylosing Spondylitis: A Randomized Controlled Trial. Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1) Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis. ASDAS, BASDAI and different treatment responses and their relation to biomarkers of inflammation, cartilage and bone turnover in patients with axial spondyloarthritis treated with TNFα inhibitors Disparate effects of anti-TNF-α therapies on measures of disease activity and mediators of endothelial damage in ankylosing spondylitis. Establishment of the minimum clinically important difference for the bath ankylosing spondylitis indices: a prospective study. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Stanger bath therapy for ankylosing spondylitis: illusion or reality? Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument? Baseline predictors of response and discontinuation of tumor necrosis factor-alpha blocking therapy in ankylosing spondylitis: a prospective longitudinal observational cohort study Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Effects of Aerobic Training in Patients with Ankylosing Spondylitis
OBJECTIVE To study the usefulness of erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , and serum amyloid A ( SAA ) for response prediction and monitoring of anti-tumor necrosis factor ( anti-TNF ) treatment in ankylosing spondylitis ( AS ) patients . METHODS Patients were included consecutively before starting etanercept or infliximab treatment .  ASsessment in Ankylosing Spondylitis ( ASAS ) response , defined as a 50 % improvement or an absolute improvement of 2 points of the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ; 0 - 10 scale ) , was assessed at 3 months . Inflammatory markers and the BASDAI were collected at baseline and 1 and 3 months . Longitudinal data analysis was performed to compare associations between inflammatory markers and the BASDAI over time by calculating st and ardized betas . Predictive values of baseline levels of inflammatory markers for ASAS response were calculated . RESULTS In total , 155 patients were included , of whom , after 3 months of treatment , 70 % in the etanercept cohort and 71 % in the infliximab cohort responded . All markers , notably SAA , decreased significantly ( P < 0.0001 ) . St and ardized betas were 0.49 for ESR , 0.43 for CRP , and 0.39 for SAA . Normal baseline levels of CRP and SAA were significantly associated with nonresponse . A combination of elevated CRP and SAA levels at baseline revealed the highest predictive value ( 81 % ) for ASAS response . CONCLUSION ESR , CRP , and SAA were significantly associated with the BASDAI over 3 months , and the association with ESR was the strongest . Elevated baseline CRP and SAA levels revealed the highest predictive value for response . Together , this study demonstrates that inflammatory markers , and notably CRP and SAA , may facilitate patient selection and monitoring of efficacy of anti-TNF treatment in AS , and could be added to response criteria Objective . To investigate the effect of an orally administered probiotic on disease activity , fatigue , quality of life , and intestinal symptoms in patients with active spondyloarthritis . Methods . Patients with active spondyloarthritis [ defined as Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) ≥ 3 , Bath Ankylosing Spondylitis Functional Index ( BASFI ) ≥ 3 , Maastricht Ankylosing Spondylitis Enthesitis Score ( MASES ) ≥ 2 , or peripheral joint count ≥ 2 ] were r and omized to oral probiotic or placebo for 12 weeks . Patients and assessors were blinded to treatment allocation . The primary outcome measure was 10 % improvement in the BASFI . Additional outcome measures were improvements in the ASsessment s in Ankylosing Spondylitis (ASAS)-endorsed core domains : pain , spinal mobility , patient global , peripheral joint and entheseal scores , stiffness , C-reactive protein , and fatigue . The ASAS20 criteria , a composite measure of response , were also applied . Quality of life and bowel symptoms were quantified using the Ankylosing Spondylitis Quality of Life Question naire ( ASQoL ) and Dudley Inflammatory Bowel Symptom Question naire ( DISQ ) . Results . Sixty-three patients were r and omized to oral probiotic ( n = 32 ) or placebo ( n = 31 ) . All patients completed the trial . No significant difference was noted between groups in any of the core domains . The mean BASFI fell from 3.5 ± 2.0 to 2.9 ± 1.9 in the probiotic group and from 3.6 ± 1.9 to 3.1 ± 2.2 in the placebo group ( p = 0.839 ) . The mean BASDAI fell from 4.2 ± 2.2 to 3.2 ± 2.1 in the probiotic group and 4.5 ± 2.0 to 3.9 ± 2.2 in the placebo group ( p = 0.182 ) . No significant adverse events were recorded in the probiotic-treated group . Conclusion . In this r and omized controlled trial , the probiotic combination administered did not demonstrate significant benefit over placebo , despite a theoretical rationale for this therapy Objectives To evaluate the efficacy and safety of certolizumab pegol ( CZP ) after 24 weeks in RAPID-axSpA ( NCT01087762 ) , an ongoing Phase 3 trial in patients with axial spondyloarthritis ( axSpA ) , including patients with ankylosing spondylitis ( AS ) and non-radiographic axSpA ( nr-axSpA ) . Methods Patients with active axSpA were r and omised 1:1:1 to placebo , CZP 200 mg every 2 weeks  ( Q2W ) or  CZP 400 mg every 4 weeks ( Q4W ) . In total 325 patients were r and omised . Primary endpoint was ASAS20 ( Assessment of SpondyloArthritis international Society 20 ) response at week 12 . Secondary outcomes included change from baseline in Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , and Bath Ankylosing Spondylitis Metrology Index ( BASMI ) linear . Results Baseline disease activity was similar between AS and nr-axSpA. At week 12 , ASAS20 response rates were significantly higher in CZP 200 mg Q2W and CZP 400 mg Q4W arms versus placebo ( 57.7 and 63.6 vs 38.3 , p≤0.004 ) . At week 24 , combined CZP arms showed significant ( p<0.001 ) differences in change from baseline versus placebo in BASFI ( −2.28 vs −0.40 ) , BASDAI ( −3.05 vs −1.05 ) , and BASMI ( −0.52 vs −0.07 ) . Improvements were observed as early as week 1 . Similar improvements were reported with CZP versus placebo in both AS and nr-axSpA sub population s. Adverse events were reported in 70.4 % vs 62.6 % , and serious adverse events in 4.7 % vs 4.7 % of All CZP versus  placebo groups . No deaths or malignancies were reported . Conclusions CZP rapidly reduced the signs and symptoms of axSpA , with no new safety signals observed compared to the safety profile of CZP in RA . Similar improvements were observed across CZP dosing regimens , and in AS and nr-axSpA patients Objectives : To evaluate the efficacy and drug survival of anti-tumour necrosis factor ( anti-TNF ) therapy in non-radiographic axial spondyloarthritis ( nr-axSpA ) patients treated in clinical practice in Southern Sweden . Method : In this cohort study we prospect ively included 112 patients with nr-axSpA and high disease activity as well as inadequate response or intolerance to non-steroidal anti-inflammatory drugs ( NSAIDs ) receiving their first course of anti-TNF therapy . Patients fulfilling modified New York criteria for ankylosing spondylitis ( AS ) were excluded . The Assessment of SpondyloArthritis International Society ( ASAS ) criteria for axial SpA were fulfilled by 77 % ( n = 86 ) of the included patients . Results : At baseline , the median age of the cohort was 38 years , 59 % were males , 79 % of the patients had imaging suggestive of sacroiliitis ( primarily inflammation on magnetic resonance imaging , MRI ) , 71 % were HLA-B27 positive , and the median disease duration was 6 years and 10 months . At 6 months of follow-up , the median Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) decreased from 5.6 to 3.2 ( p = 0.002 ) , the Bath Ankylosing Spondylitis Functional Index ( BASFI ) decreased from 3.9 to 1.8 ( p = 0.005 ) , and C-reactive protein ( CRP ) level decreased from 4.4 to 1.7 mg/L ( p = 0.001 ) . After 1 year of treatment the Kaplan – Meier estimated drug survival was 76 % , and at 2 years of follow-up this value decreased to 65 % . Patients with inflammatory MRI findings at baseline had significantly better drug survival [ hazard ratio ( HR ) 0.24 , 95 % confidence interval ( CI ) 0.10–0.55 , p = 0.001 ] . Male sex was also associated with higher drug survival ( HR 0.45 , 95 % CI 0.24–0.85 , p = 0.011 ) . CRP level at baseline was not associated with drug survival . Conclusions : Anti-TNF treatment of patients with nr-axSpA in clinical practice result ed in reduced BASDAI and BASFI scores and good drug survival . The results from this study suggest that male gender and positive imaging at baseline are associated with a favourable treatment course Premature atherosclerosis is linked to inflammation . Arterial stiffness is a marker of vascular dysfunction . We tested the hypothesis that treatment with infliximab , which is effective in reducing inflammation in rheumatoid arthritis ( RA ) and ankylosing spondylitis ( AS ) , also lowers the augmentation index ( AIx ) in patients with active disease . We also analyzed the subendocardial viability ratio ( SEVR ) , which is a measure of myocardial perfusion relative to cardiac workload . Included in the study were 30 patients ( 17 RA , 13 AS ) .  Conventional treatment failed in all patients . The AIx and SEVR were determined by radial applanation tonometry before and after treatment with infliximab , at baseline and at week 7 . After treatment with infliximab , Disease Activity Score for 28 joints ( RA patients ) , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Functional Index ( AS patients ) , erythrocyte sedimentation rate ( ESR ) , and C-reactive protein ( CRP ) improved significantly ( p < 0.001 ) . The AIx for all patients increased from 22.0 ± 14.0 % to 24.6 ± 13.0 % ( p = 0.03 ) . The increase in the RA sub-group ( p = 0.01 ) was also significant . The SEVR decreased from 148.6 ± 23.7 % to 141.2 ± 23.7 % ( p = 0.04 ) . Infliximab did not reduce the AIx in patients with RA and AS , although there were clinical improvements and CRP and ESR decreased . Instead , the AIx increased . This could negatively influence cardiac workload OBJECTIVE To evaluate the clinical relevance of CRP in AS and investigate the treatment effect of NSAIDs/coxibs on CRP . METHODS Data of 851 patients with painful axial AS participating in two r and omized controlled trials evaluating coxibs ( celecoxib ) and NSAIDs ( naproxen/ketoprofen )  were used . The clinical relevance of CRP in AS was studied : the number of patients with abnormal CRP at baseline was expressed as a percentage , and the correlation among CRP , patient ( age and gender ) and disease [ Bath AS Disease Activity Index ( BASDAI ) , Bath AS Functional Index ( BASFI ) ] characteristics was investigated . The st and ardized response mean ( SRM ) over placebo was used to detect the treatment effect of NSAIDs/coxibs on CRP . RESULTS The 851 enrolled patients ( 73 % of whom were men ) had an active disease , as assessed through functional impairment .  Mean ( s.d . ) baseline CRP was 14 ( 19 ) ( median 7.2 ) mg/l ; 61 % of patients had an increased CRP . The CRP levels were correlated positively with male sex , BASDAI and BASFI and negatively with age ( multivariate analysis ) . There was a significant difference in the changes of CRP between placebo and NSAIDs/coxibs group ( P = 0.003 ; SRM over placebo : 0.25 ) . Such a treatment effect was of higher magnitude in the subgroup of patients with increased CRP and usually of lower magnitude than the treatment effect of other outcome variables such as BASDAI and BASFI . CONCLUSIONS Increased CRP was frequently observed in patients with painful axial AS and was correlated both with activity and functional severity of the disease . The treatment effect of NSAIDs/coxibs was relevant in the subgroup of patients with increased CRP at baseline Introduction The arthritis-specific Work Productivity Survey ( WPS ) was developed to evaluate productivity limitations associated with arthritis within and outside the home . There is an unmet need for an instrument assessing similar productivity limitations in axial spondyloarthritis ( axSpA ) , including nonradiographic axSpA and ankylosing spondylitis . Following its validation in rheumatoid and psoriatic arthritis , we aim ed to assess psychometric properties of WPS in adult-onset active axSpA in this analysis . Methods Psychometric properties were assessed using data from the RAPID-axSpA trial ( NCT01087762 ) in which research ers investigated certolizumab pegol efficacy and safety in axSpA. WPS was completed at baseline and every 4 weeks until week 24 . Validity was evaluated at study baseline via known-groups defined by the first and third quartile cutoffs of patient scores to Ankylosing Spondylitis Disease Activity Score ( ASDAS ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , back pain , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Short Form 36 health survey ( SF-36 ) and Ankylosing Spondylitis Quality of Life Scale ( ASQoL ) . Responsiveness and reliability were assessed by comparing WPS mean changes in ASAS 20 % improvement criteria ( ASAS20 ) , BASDAI50 , ASDAS clinical ly important improvement/major improvement ( CII/MI ) and BASFI minimum clinical ly important difference ( MCID ) responders versus nonresponders at week 12 . All comparisons were conducted on observed cases in the r and omized set using a nonparametric bootstrap-t method . Results The results confirmed the psychometric properties of WPS . AxSpA patients with a worse health state had significantly more days of household work lost , household work with reduced productivity , social activities missed and outside help hired , as well as a higher interference rate of arthritis , than patients with a better health state . Similarly , employed patients with a worse health state had significantly more work days lost or with productivity reduced , and a higher interference of arthritis on work productivity . Similar findings were also observed in the nonradiographic ( nr ) axSpA and AS sub population s. The WPS was responsive to clinical changes , with responders reporting larger improvements at week 12 in WPS scores versus nonresponders . Effect sizes in responders were generally moderate to large ( st and ardized response mean > 0.5 ) . Conclusions These analyses demonstrate that WPS is a valid , responsive and reliable instrument for the measurement of productivity within and outside the home in adult-onset axSpA , as well as the in sub population s of AS and Objectives To use prospect ively registered data from the Danish nationwide rheumatological data base ( DANBIO ) to describe disease activity , clinical response , treatment duration and predictors of drug survival ( ie , number of days individual patients maintained treatment ) and clinical response among patients with ankylosing spondylitis ( AS ) receiving their first treatment series with a tumour necrosis factor α ( TNFα ) inhibitor .  Methods 842 TNFα inhibitor naive patients with AS were identified in DANBIO .  Clinical response , drug survival and predictors thereof were investigated . ‘ Clinical response ’ was defined as a 50 % or 20 mm reduction in Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) within 6 months compared with baseline . Achievement of a BASDAI < 40 mm within 6 months was used as a second response parameter . Results 603 patients ( 72 % ) were men , disease duration 5 ( 1–13 ) years ( median ( IQR ) , age 41 ( 32–50 ) years . 445 ( 53 % ) received infliximab , 247 ( 29 % ) adalimumab and 150 ( 18 % ) etanercept . Parameters at baseline/1-year follow-up were : C-reactive protein ( CRP ) : 14 (7–27)/5 ( 2–10 ) mg/l , BASDAI 59 (44–72)/21 ( 8–39 ) mm , Bath Ankylosing Spondylitis Functional Index ( BASFI ) 50 (34–67)/24 ( 9–45 ) mm , Bath Ankylosing Spondylitis Metrology Index 40 (20–50)/20 ( 10–40 ) mm . Within 6 months , 407/644 patients ( 63 % ) achieved a clinical response . Median drug survival was 4.3 years . One- and 2-year survival rates were 74 % and 63 % , respectively . Baseline characteristics associated with longer drug survival were male gender , CRP > 14 mg/l and low visual analogue scale fatigue ( Cox regression analysis ) . Age , TNFα inhibitor and methotrexate use were insignificant . CRP > 14 mg/l , lower BASFI and younger age at baseline was associated with clinical response and achievement of a BASDAI < 40 mm ( logistic regression analysis ) . Conclusion TNFα inhibitors provide a rapid and sustained decrease of disease activity among patients with AS in clinical practice . Factors associated with continued treatment , clinical response and achievement of a BASDAI < 40 mm were identified OBJECTIVE Tumor necrosis factor-alpha has a prominent role in the inflammatory process and bone resorption in patients with ankylosing spondylitis ( AS ) . We evaluated the markers of clinical efficacy and bone biochemical changes in Korean patients with AS treated with etanercept therapy .  METHODS Serum sample s from 26 patients receiving etanercept for refractory AS were obtained at baseline and 12 weeks after treatment . Clinical measures and serum levels of transforming growth factor-Beta ( TGF-Beta ) , matrix metalloproteinase-3 ( MMP-3 ) , macrophage-colony stimulating factor ( M-CSF ) , bone-specific alkaline phosphatase ( BALP ) , osteocalcin , C-telopeptide ( CTX ) , receptor activator of nuclear factor-kB lig and ( RANKL ) , and osteoprotegerin ( OPG ) were measured at each timepoint . RESULTS Significant improvement of the Bath AS Disease Activity Index ( BASDAI ) and Functional Index ( BASFI ) was achieved after 12 weeks ( p < 0.001 ) . ASsessment s in Ankylosing Spondylitis Working Group ( ASAS ) 20 criteria were achieved by 22 patients ( 84.6 % ) after 12 weeks ' treatment . ASAS 50 and 70 were achieved by 10 ( 38.5 % ) and 7 patients ( 26.9 % ) . Serum levels of BALP and osteocalcin were significantly increased after 12 weeks of treatment ( p < 0.05 ) . Serum levels of CTX were not changed after treatment . Serum levels of TGF-Beta , MMP-3 , and M-CSF were significantly decreased after 12 weeks of treatment ( p < 0.05 ) . Serum levels of OPG and RANKL were not changed . Change of MMP-3 had a high correlation coefficient with changes of C-reactive protein ( CRP ) and erythrocyte sedimentation rate ( ESR ) upon etanercept treatment ( CRP , r = 0.446 , p = 0.022 ; ESR , r = 0.449 , p = 0.021 ) . CONCLUSION In patients with AS , etanercept therapy may be effective for reducing disease activity and improving bone biochemical markers . MMP-3 may be a useful biomarker for monitoring etanercept therapy BACKGROUND Exergames are a well-known type of game based on a virtual avatar 's body movements . This hightech approach promotes an active lifestyle . OBJECTIVES The aim of this r and omized controlled trial was to evaluate the effects of exergames on pain , disease activity , functional capacity and quality of life in patients with ankylosing spondylitis ( AS ) . MATERIAL AND METHODS The study involved 60 patients , who were r and omized into either the exergame group ( EG ) or the control group ( CG ) . The EG patients engaged in exergaming , and CG patients did not engage in any exercises . The exergaming sessions were performed five times a week for eight weeks ( 40 sessions in total ) . The patients were assessed before and after the eight-week program on a visual analog scale ( VAS ) , the Bath Ankylosing Spondylitis Functional Index ( BASFI ) , the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) and the Ankylosing Spondylitis Quality of Life ( ASQOL ) question naire . RESULTS A statistically significant improvement was observed in VAS , BASFI , BASDAI and ASQoL scores in the EG group after completion of the exercise program ( p < 0.05 ) . CONCLUSIONS This study is a first step in investigating the possibilities of using an exergame platform to help patients with spondyloarthropathies to adopt a more physically active lifestyle . The results of this study suggest that exergames increase physical activity and decrease the pain scores in AS patients and also could , therefore , be feasible and safe The optimal management of ankylosis spondylitis ( AS ) involves a combination of nonpharmacologic and pharmacologic treatment aim ing to maximize health-related quality of life . The primary objective of our study was to demonstrate the benefits of an original multimodal exercise program combining Pilates , McKenzie and Heckscher techniques on pulmonary function in patients with AS , while secondary objectives were to demonstrate the benefits of the same program on function and disease activity . This is a r and omized controlled study on ninety-six consecutive patients with AS ( axial disease subset ) , assigned on a 1:1 rationale into two groups based on their participation in the Pilates , McKenzie and Heckscher ( group I ) or in the classical kinetic program ( group II ) . The exercise program consisted of 50-min sessions performed 3 times weekly for 48 weeks . St and ard assessment s were done at week 0 and 48 and included pain , modified Schober test ( mST ) and finger – floor distance ( FFD ) , chest expansion ( CE ) and vital capacity ( VC ) , as well as disease activity Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , functional Bath Ankylosing Spondylitis Functional Index ( BASFI ) and metrology index Bath Ankylosing Spondylitis Metrology Index ( BASMI ) . Groups were comparable at baseline ; we demonstrated significant improvement between baseline and after 48 weeks of regular kinetic training for all AS-related parameters in both groups . However , significant improvement was found in pain , lumbar spine motility ( mST , FFD ) , BASFI , BASDAI and BASMI in AS performing the specific multimodal exercise program at the end of study ( p = 0.001 ) . Although there were significant improvements in CE in both groups as compared to baseline ( group I , p = 0.001 ; group II , p = 0.002 ) , this parameter increased significantly only in group I ( p = 0.001 ) . VC measurements were not significantly changed at the end of the study ( group I , p = 0.127 ; group II , p = 0.997 ) , but we found significant differences within groups ( p = 0.011 ) . A multimodal training combining Pilates , McKenzie and Heckscher exercises performed regularly should be included in the routine management of patients with AS for better control of function , disease activity and pulmonary function Purpose To evaluate the efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis ( nr-axSpA ) . Methods Patients fulfilled Assessment of Spondyloarthritis international Society ( ASAS ) criteria for axial spondyloarthritis , had a Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) score of ≥ 4 , total back pain score of ≥ 4 ( 10 cm visual analogue scale ) and inadequate response , intolerance or contraindication to non-steroidal anti-inflammatory drugs ( NSAIDs ) ; patients fulfilling modified New York criteria for ankylosing spondylitis were excluded . Patients were r and omised to adalimumab ( N=91 ) or placebo ( N=94 ) . The primary endpoint was the percentage of patients achieving ASAS40 at week 12 . Efficacy assessment s included BASDAI and Ankylosing Spondylitis Disease Activity Score ( ASDAS ) . MRI was performed at baseline and week 12 and scored using the Spondyloarthritis Research Consortium of Canada ( SPARCC ) index . Results Significantly more patients in the adalimumab group achieved ASAS40 at week 12 compared with patients in the placebo group ( 36 % vs 15 % , p<0.001 ) . Significant clinical improvements based on other ASAS responses , ASDAS and BASDAI were also detected at week 12 with adalimumab treatment , as were improvements in quality of life measures . Inflammation in the spine and sacroiliac joints on MRI significantly decreased after 12 weeks of adalimumab treatment . Shorter disease duration , younger age , elevated baseline C-reactive protein or higher SPARCC MRI sacroiliac joint scores were associated with better week 12 responses to adalimumab . The safety profile was consistent with what is known for adalimumab in ankylosing spondylitis and other diseases . Conclusions In patients with nr-axSpA  , adalimumab treatment result ed in effective control of disease activity , decreased inflammation and improved quality of life  compared with placebo . Results from ABILITY-1 suggest that adalimumab has a positive benefit – risk profile in active nr-axSpA patients with inadequate response to NSAIDs OBJECTIVE The aim of this study was to evaluate the impact of two different home-based daily exercise programs on pulmonary functions in the patients with ankylosing spondylitis ( AS ) . METHODS Fifty-one patients with AS were distributed into three groups . Group 1 ( n=19 ) was given a conventional exercise regimen . Group 2 ( n=19 ) received exercises based on the Global Posture Reeducation ( GPR ) method . Group 3 ( n=13 ) was accepted as the control group . Patients were assessed according to pain , functional capacity ( The Bath Ankylosing Spondylitis Functional Index - BASFI ) , disease activity ( The Bath Ankylosing Spondylitis Disease Activity Index - BASDAI ) , chest expansion , pulmonary function parameters , and 6-min walk distance ( 6MWD ) test . RESULTS Although there were significant improvements for BASDAI and BASFI scores in all groups , significant improvements in the VAS pain , chest expansion , pulmonary function parameters and 6MWD test were observed in the exercise groups . The improvements in pain , functional capacity , disease activity , chest expansion , pulmonary function parameters and 6MWD test were better in the exercise groups than in the control group . The GPR method result ed in greater improvements than the conventional exercise program in specific pulmonary function parameters like forced vital capacity , forced expiratory volume in 1s , and peak expiratory flow parameters . CONCLUSION Both exercises are efficient in improving pulmonary functions . Since the improvements in pulmonary function tests were greater in the patients who performed the exercise according to GPR method , motivated patients should be encouraged to perform this exercise program Objectives To investigate the relation between ankylosing spondylitis disease activity score ( ASDAS ) , Bath ankylosing spondylitis disease activity index ( BASDAI ) and treatment response and biomarkers of inflammation ( C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , YKL-40 ) , angiogenesis ( vascular endothelial growth factor ( VEGF ) ) , cartilage ( C-terminal crosslinking telopeptide of type II collagen ( CTX-II ) , matrix metalloproteinase-3 ( MMP-3 ) , total aggrecan , cartilage oligomeric matrix protein ) and bone ( C-terminal crosslinking telopeptide of type I collagen , osteocalcin ) turnover in 60 patients with axial spondyloarthritis initiating tumour necrosis factor alpha ( TNFα ) inhibitor therapy . Methods ASDAS ( CRP-based ) , BASDAI and biomarkers were determined before and seven times during 46 weeks of TNFα inhibitor therapy . Results Very high ASDAS were associated with high levels of inflammatory biomarkers , while high BASDAI were not related to any biomarkers . Mixed modeling demonstrated significant longitudinal associations between ASDAS and IL-6 , VEGF , MMP-3 and osteocalcin and between BASDAI and CRP , IL-6 and VEGF . Major improvement in ASDAS was associated with larger percentage decreases in biomarkers of inflammation , angiogenesis , MMP-3 and increases in aggrecan and osteocalcin . BASDAI response was associated with larger decreases in CRP and IL-6 . Biomarkers with moderate/high differences in responsiveness for major versus no/ clinical ly important improvement in ASDAS were CRP , IL-6 , VEGF , aggrecan and osteocalcin , and VEGF and CTX-II for BASDAI response versus non-response . Conclusion Levels and changes of 10 biomarkers in patients with axial spondyloarthritis during anti-TNFα therapy were documented . Construct validity and responsiveness of IL-6 , VEGF , MMP-3 , total aggrecan and osteocalcin were demonstrated . ASDAS was more associated with these biomarkers than BASDAI , and may better reflect the inflammatory disease processes . Clinical Trials.gov identifier NCT00133315 BACKGROUND  Asymmetric dimethylarginine ( ADMA ) is associated with endothelial injury . Increased ADMA levels are found in rheumatoid arthritis ( RA ) and ankylosing spondylitis ( AS ) . We set out to assess the  ADMA and symmetric dimethylarginine ( SDMA ) levels in AS , RA , and healthy controls , and in the anti-TNF treated patients with active AS . METHODS In 78AS patients and 29 RA patients who were anti-TNF treatment naive at baseline , along with 23 healthy control subjects , we assessed erythrocyte sedimentation rate ( ESR ) , high-sensitivity C-reactive protein ( hsCRP ) , ADMA , and SDMA . For AS patients , the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , back pain VAS and patient 's global activity of disease were calculated . After 6 months , we repeated the assessment in 30 out of the 78 AS patients in whom the anti-TNF treatment was initiated . RESULTS The baseline mean ( SD ) plasma ADMA concentration of AS patients was 0.64 ( 0.19 ) μmol/l and did not differ from controls ( 0.65 [ 0.19 ] μmol/l , p > 0.05 ) . In the RA group , ADMA concentration was higher than in controls ( 0.77 vs. 0.65 μmol/l , p < 0.05 ) . Both at baseline and at follow-up , ADMA levels correlated positively with BASDAI ( R = 0.52 , p = 0.02 , and R = 0.47 , p = 0.04 , baseline and follow-up , respectively ) . Six months of anti-TNF treatment did not influence ADMA concentration ( 0.51 [ 0.12 ] vs. 0.51 [ 0.11 ] μmol/l , p = 0.70 ) . CONCLUSION An absence of changes in plasma ADMA levels in the anti-TNF treated AS group despite the improvement in disease activity ( BASDAI ) and inflammation ( ESR , CRP ) may suggest either a lack of effect , or , even if such an effect were to take place , it needs not imply measurable changes in blood ADMA OBJECTIVE The minimum clinical ly important difference ( MCID ) is the minimum level of change of an outcome measure that is considered to be clinical ly relevant . This prospect i ve study was conducted to establish the minimum level of change in the Bath Ankylosing Spondylitis ( BAS ) indices that is meaningful for both the patient and the clinician . METHODS The BAS question naires [ i.e. , Bath Ankylosing Spondylitis Functional Index ( BASFI ) ; Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) ; and Bath Ankylosing Spondylitis patient Global score ( BAS-G ) ] were administered to 125 patients with ankylosing spondylitis ( AS ) at baseline and at the end of a 2-week intensive physiotherapy program . Together with the final assessment , a global vali date d rating scale was used to examine each domain . Receiver operating characteristic ( ROC ) curves were plotted to determine the BAS change score that most accurately classified patients with respect to a clinical ly meaningful change . This analysis was repeated to investigate whether the estimate of change was dependent upon the patients ' baseline scores . RESULTS According to analyses of ROC curves , the MCID are 7 mm or 17.5 % for BASFI : sensitivity = 0.60/specificity = 0.85 ; 10 mm or 22.5 % for BASDAI : sensitivity = 0.65/specificity = 0.82 ; and 15 mm or 27.5 % for BAS-G : sensitivity = 0.61/specificity = 0.74 . MCID values were independent of the patients ' baseline scores ( p = 0.09 to 0.72 ) by regression analysis . CONCLUSION This prospect i ve study gives MCID values for BASFI , BASDAI , and BAS-G that allow translation from the BAS indices to readily understood values for both patients and clinicians OBJECTIVE To assess prospect ively the rates and to explore predictors of spinal radiographic progression over 2 years in a cohort of patients with early axial spondylarthritis ( SpA ) . METHODS Two hundred ten patients with axial SpA from the German Spondyloarthritis Inception Cohort were selected for this analysis based on the availability of radiographs at baseline and after 2 years of followup . Spinal radiographs were scored by 2 trained readers in a blinded , r and omly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ) . Spinal radiographic progression was defined as worsening of the mean mSASSS by ≥2 units over 2 years . RESULTS Among the patients with axial SpA , 14.3 % showed spinal radiographic progression after 2 years ( 20 % of those with AS and 7.4 % of those with nonradiographic axial SpA ) . The following parameters were independently associated with spinal radiographic progression : presence of syndesmophytes at baseline ( odds ratio [ OR ] 6.29 , P < 0.001 ) , elevated levels of markers of systemic inflammation ( for the erythrocyte sedimentation rate , OR 4.04 , P = 0.001 ; for C-reactive protein level time-averaged over 2 years , OR 3.81 , P = 0.001 ) , and cigarette smoking ( OR 2.75 , P = 0.012 ) . These associations were confirmed by multivariate logistic regression analysis . No clear association with spinal radiographic progression was observed for HLA-B27 status , sex , age , disease duration , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Functional Index , presence of peripheral arthritis , enthesitis , psoriasis , treatment with nonsteroidal antiinflammatory drugs , or treatment with disease-modifying antirheumatic drugs at baseline . CONCLUSION The presence of radiographic damage at baseline ( syndesmophytes ) , elevated levels of acute-phase reactants , and cigarette smoking were all independently associated with spinal radiographic progression in patients with early axial We compared the short-term effects of Stanger bath therapy and conventional exercises on spinal mobility , functional capacity , disease activity , and quality of life with conventional exercise alone in ankylosing spondylitis ( AS ) patients . A total of 58 patients with a diagnosis of AS according to the modified New York criteria were included in this r and omized prospect i ve study . The patients were divided into two groups . Patients in group I ( n = 30 ) received Stanger bath therapy and an exercise program . Group II ( n = 28 ) patients were given the same exercise program but did not receive Stanger bath therapy . Patients were evaluated before ( T0 ) and at the end of the treatments ( T1 ) . Evaluation parameters were the Bath AS Metrology Index ( BASMI ) , Bath AS Functional Index ( BASFI ) , Bath AS Disease Activity Index ( BASDAI ) , and AS Quality of Life ( ASQoL ) . In both patient groups , a significant improvement was determined in all clinical outcomes between T0 and T1 except for BASMI in group II . Comparison of the groups showed significantly superior results in group I parameters of BASMI , BASFI , BASDAI , and ASQoL.  Stanger bath therapy showed beneficial effects in spinal mobility , functional capacity , disease activity , and quality of life in AS patients immediately after the treatment period . We recommend Stanger bath therapy for AS patients in the short-term , but further research is imperative to assess whether improvement is sustained over a long-term follow-up The objective of this non-r and omised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices , depression and quality of life in patients with ankylosing spondylitis ( AS ) . Approximately 41 patients in a rehabilitation unit were divided into two groups , either group- or home-based exercise programme . Exercise sessions were performed three times a week for a period of 6 weeks . The patients were compared before and after the rehabilitation programme , with respect to Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Disease Assessment Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Beck Depression Inventory ( BDI ) and The Nottingham Health Profile ( NHP ) . A statistically significant improvement was observed on BASDAI , BASMI and energy , pain , reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme ( p < 0.05 ) . No statistically significant changes were detected in BASFI , BDI and social and mobility subscores of NHP in both exercise groups ( p > 0.05 ) . No statistically significant differences were found between the two exercise programmes ( p > 0.05 ) . Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS . Home-based exercise programme , as it is cheaper , more easily performed and efficient , may be preferable for the management programme in AS OBJECTIVE Disease activity has been defined using a self-administered instrument , focusing on fatigue , axial pain , peripheral pain , enthesopathy and morning stiffness [ Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) ] . This vali date d instrument is simple and takes 40 s to complete , but whether the index is an accurate expression of the component parts , or whether additional weighting would enhance its efficacy , is unclear . METHODS Four hundred and seventy-three patients with ankylosing spondylitis received placebo or active non-steroidal anti-inflammatory drug ( NSAID ) for 6 weeks , and changes between entry and completion were captured by BASDAI and the individual components . Principle component analysis ( PCA ) was used to explore the best combinations of variables in decreasing order of explained total dispersion and to assess whether a single sum ( or algebraic expression ) best defined disease activity status . RESULTS At entry , the correlation between BASDAI and the first axis was 0.99 , 0.11 with the second , and zero thereafter . Data at study end and relating to change revealed a 100 % correlation ( R = 1 ) between the first axis and the sum , with zero for the remainder . CONCLUSIONS The data support BASDAI as being a valid and appropriate composite to define disease activity in ankylosing spondylitis . Developed as a simple sum of its components , BASDAI has excellent content validity Introduction Identifying ankylosing spondylitis ( AS ) patients who are likely to benefit from tumor necrosis factor-alpha ( TNF-α ) blocking therapy  is important , especially in view of the costs and potential side effects of these agents . Recently , the AS Disease Activity Score ( ASDAS ) has been developed to assess both subjective and objective aspects of AS disease activity . However , data about the predictive value of the ASDAS with respect to clinical response to TNF-α blocking therapy are lacking . The aim of the present study was to identify baseline predictors of response and discontinuation of TNF-α blocking therapy in AS patients in daily clinical practice . Methods AS out patients who started TNF-α blocking therapy were included in the Groningen Leeuwarden Ankylosing Spondylitis ( GLAS ) study , an ongoing prospect i ve longitudinal observational cohort study with follow-up visits according to a fixed protocol . For the present analysis , patients were excluded if they had previously received anti-TNF-α treatment .  Predictor analyses of response and treatment discontinuation were performed using logistic and Cox regression models , respectively . Results Between November 2004 and April 2010 , 220 patients started treatment with infliximab ( n = 32 ) , etanercept ( n = 137 ) , or adalimumab ( n = 51 ) . At three and six months , 68 % and 63 % of patients were Assessment s in Ankylosing Spondylitis (ASAS)20 responders , 49 % and 46 % ASAS40 responders , and 49 % and 50 % Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)50 responders , respectively . Baseline predictors of response were younger age , male gender , higher ASDAS score , higher erythrocyte sedimentation rate ( ESR ) level , higher C-reactive protein ( CRP ) level , presence of peripheral arthritis , higher patient 's global assessment of disease activity , and lower modified Schober test . In August 2010 , 64 % of patients were still using their TNF-α blocking agent with a median follow-up of 33.1 months ( range 2.4 to 68.2 ) . Baseline predictors of discontinuation of TNF-α blocking therapy were female gender , absence of peripheral arthritis , higher BASDAI , lower ESR level , and lower CRP level . Conclusions Besides younger age and male gender , objective variables such as higher inflammatory markers or ASDAS score were identified as independent baseline predictors of response and /or continuation of TNF-α blocking therapy . In contrast , higher baseline BASDAI score was independently associated with treatment discontinuation . Based on these results , it seems clinical ly relevant to include more objective variables in the evaluation of anti-TNF-α treatment OBJECTIVE The signs and symptoms of ankylosing spondylitis ( AS ) respond inadequately to nonsteroidal antiinflammatory drugs , corticosteroids , and disease-modifying antirheumatic drugs in quite a number of patients . Tumor necrosis factor inhibitors have demonstrated success in reducing AS disease activity in a limited number of clinical trials . The objective of this multicenter , r and omized , placebo-controlled study was to evaluate the efficacy and safety of infliximab in patients with AS . METHODS Patients were r and omly assigned to receive infusions of placebo or 5 mg/kg infliximab at weeks 0 , 2 , 6 , 12 , and 18 . Efficacy was assessed using the ASsessment in Ankylosing Spondylitis ( ASAS ) International Working Group criteria , the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , night pain , patient 's global assessment , the Bath Ankylosing Spondylitis Functional Index ( BASFI ) , the Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , chest expansion , the M and er enthesis index , the total swollen joint index , the C-reactive protein level , and the Short Form 36 ( SF-36 ) health survey question naire . The primary end point in this study was the proportion of patients with a 20 % improvement response according to the ASAS International Working Group criteria ( ASAS20 responders ) at week 24 . RESULTS Of the 357 patients screened , 201 were assigned to receive 5 mg/kg infliximab and 78 were assigned to receive placebo . After 24 weeks , 61.2 % of patients in the infliximab group were ASAS20 responders compared with 19.2 % of patients in the placebo group ( P < 0.001 ) . Clinical benefit was observed in patients receiving infliximab as early as week 2 and was maintained over the 24-week study period . Patients receiving infliximab also showed significant improvements in the BASDAI , BASFI , BASMI , chest expansion , and physical component summary score of the SF-36 . Adverse events were reported by 82.2 % of patients receiving infliximab and by 72.0 % of patients receiving placebo ; however , most adverse events in both treatment groups were mild or moderate in severity . CONCLUSION Infliximab was well tolerated and effective in a large cohort of patients with AS during a 24-week study period Objective . To evaluate the effects of aerobic exercise in patients with ankylosing spondylitis ( AS ) . Methods . Seventy patients classified with AS by the modified New York criteria were included . The patients were r and omly assigned into 2 groups . The intervention group ( IG ) performed 50 min of walking followed by stretching exercises 3 times a week for 12 weeks . The control group ( CG ) performed only stretching exercises . The outcome measurements were the Bath indexes [ Bath AS Functional Index ( BASFI ) , Bath AS Disease Activity Index ( BASDAI ) , and Bath AS Metrology Index ( BASMI ) ] , Health Assessment Question naire for the Spondyloarthropathies ( HAQ-S ) , AS Disease Activity Score ( ASDAS ) , the 6-min walk test ( 6MWT ) , chest expansion , and the Medical Outcomes Study Short Form-36 . Aerobic capacity was assessed by ergospirometry on a treadmill . Routine laboratory techniques were used in determining lipid levels . Assessment s were performed immediately before r and omization and after 6 , 12 , and 24 weeks . Results . Thirty-five patients were r and omized to the IG and 35 to the CG . There was significant improvement in the BASFI , HAQ-S , BASMI , BASDAI , and ASDAS in both groups ( p < 0.05 ) , but did not differ between groups . There was a significant increase in the walking distance in the 6MWT in the IG compared with CG ( p < 0.001 ) . The IG showed significant improvement in cardiopulmonary capacity compared with CG . Cholesterol and triglyceride levels did not change in either group . Conclusion . In patients with AS , aerobic training improved walking distance and aerobic capacity . Aerobic training did not provide additional benefits in functional capacity , mobility , disease activity , quality of life , and lipid levels when compared with stretching exercises alone
Aerobic exercise did not improve BASFI , CRP or ESR .
CONCLUSION Aerobic exercise did not provide beneficial effects either on disease activity or on physical function and biological parameters when compared to a control group in axial spondyloarthritis
AIM To evaluate the impact of an aerobic fitness program on disease activity , defined by the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) and on C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR ) and the Bath Ankylosing Spondylitis Functional Index ( BASFI ) in case of axial spondyloarthritis .