Hematological Parameters in Axial Spondyloarthritis

Study Overview
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Brief Summary
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Axial spondyloarthritis is an inflammatory disease characterized by the involvement of the sacroiliac joints and the spine. Disease activity and structural changes are determined by using physical examination, imaging studies, laboratory parameters, and patient-reported indices. Among laboratory studies, Erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) are the most commonly utilized parameters. However, the level of ESR and CRP are inadequate in demonstrating disease activity and inflammation compared to other diseases. In this study, the investigators aimed to analyze and compare the systemic inflammatory index (SII), which is a hematologic parameter between subjects with radiographic axial spondyloarthritis, non-radiographic axial spondyloarthritis, and healthy controls. Secondarily, the relationship between disease activity and enthesitis score and SII scores in patients with radiographic and non-radiographic axial spondyloarthritis will be investigated.

Detailed Description
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Axial spondyloarthritis is an inflammatory disease characterized by the involvement of the sacroiliac joints and the spine. Disease activity and structural changes are determined by using physical examination, imaging studies, laboratory parameters, and patient-reported indices. Among laboratory studies, Erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) are the most commonly utilized parameters. ESR and CRP are within the normal range in 40-50% of patients with spondyloarthritis and may remain within the normal range even during active disease. Therefore, the use of biomarkers suitable for the pathophysiology of the disease have been recommended. However, these tests are difficult to access and there is no consensus on showing disease activity. Systemic inflammatory index (SII) is a novel hematologic parameter and previous studies reported the relationship with disease activity in rheumatologic diseases, but the results are inconsistent. This study will compare the SII between subjects with radiographic and non-radiographic axial spondyloarthritis with healthy subjects. Secondly, the study will investigate the relationship between SII, a new inflammation parameter, and disease activity in patients diagnosed with radiographic and non-radiographic axial spondyloarthritis.

Official Title
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Relationship Between Systemic Inflammatory Index and Disease Activity in Axial Spondyloarthritis

Conditions
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Ankylosing Spondylitis

Intervention / Treatment
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* Other: Systemic inflammatory index
* Other: BASDAI
* Other: ASDAS-ESR
* Other: ASDAS-CRP
* Other: MASES


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with axial spondyloarthritis according to the ASAS classification criteria Exclusion Criteria: Acute/chronic infections Presence of other autoimmune diseases Diabetes mellitus Coronary arterial disease Hypertension Malignancy Hematological diseases Liver diseases Pregnancy/Lactation Renal diseases

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| R-ax-Spa<br>Radiographic axial spondyloarthritis | Other: Systemic inflammatory index<br>* neutrophil count x platelet count/lymphocyte count<br>Other: BASDAI<br>* Bath Ankylosing Spondylitis Disease Activity Index includes six questions which includes the following six parameters: fatigue, spinal pain, peripheral joint pain, attachment point inflammation, and duration and severity of morning stiffness. A total score, ranging from 0 to 10, was calculated according to the patients' responses to six questions, with a higher score indicating more severe illness.<br>* Other names: Bath Ankylosing Spondylitis Disease Activity Index;Other: ASDAS-ESR<br>* The ASDAS-ESR is deduced using formula that is chosen by the ASAS group. ASDAS-ESR is calculated with the answers of spinal, peripheral pain, morning stiffness on BASDAI, the patient global assessment, and erythrocyte sedimentation rate (mm/h).<br>* Other names: Ankylosing Spondylitis Disease Activity Score-ESR;Other: ASDAS-CRP<br>* The ASDAS-CRP is deduced using formula that is chosen by the ASAS group. ASDAS-CRP is calculated with the answers of spinal, peripheral pain, morning stiffness on BASDAI, the patient global assessment, and erythrocyte C-reactive protein (mg/dl).<br>* Other names: Ankylosing Spondylitis Disease Activity Score-CRP;Other: MASES<br>* It is used to evaluate the sensitivity of enthesis points by palpation in patients with ankylosing spondylitis. Scoring is done by giving 1 point for sensitive areas and 0 points if there is no sensitivity on the fifth lumbar spinous process, bilateral first and seventh costochondral joints, iliac crystals, posterior and anterior iliac spines, attachment sites of achilles tendon to the calcaneus.<br>* Other names: Maastricht Ankylosing Spondylitis Entheses Score;|
| nR-ax-Spa<br>Non-radiographic axial spondyloarthritis | Other: Systemic inflammatory index<br>* neutrophil count x platelet count/lymphocyte count<br>Other: BASDAI<br>* Bath Ankylosing Spondylitis Disease Activity Index includes six questions which includes the following six parameters: fatigue, spinal pain, peripheral joint pain, attachment point inflammation, and duration and severity of morning stiffness. A total score, ranging from 0 to 10, was calculated according to the patients' responses to six questions, with a higher score indicating more severe illness.<br>* Other names: Bath Ankylosing Spondylitis Disease Activity Index;Other: ASDAS-ESR<br>* The ASDAS-ESR is deduced using formula that is chosen by the ASAS group. ASDAS-ESR is calculated with the answers of spinal, peripheral pain, morning stiffness on BASDAI, the patient global assessment, and erythrocyte sedimentation rate (mm/h).<br>* Other names: Ankylosing Spondylitis Disease Activity Score-ESR;Other: ASDAS-CRP<br>* The ASDAS-CRP is deduced using formula that is chosen by the ASAS group. ASDAS-CRP is calculated with the answers of spinal, peripheral pain, morning stiffness on BASDAI, the patient global assessment, and erythrocyte C-reactive protein (mg/dl).<br>* Other names: Ankylosing Spondylitis Disease Activity Score-CRP;Other: MASES<br>* It is used to evaluate the sensitivity of enthesis points by palpation in patients with ankylosing spondylitis. Scoring is done by giving 1 point for sensitive areas and 0 points if there is no sensitivity on the fifth lumbar spinous process, bilateral first and seventh costochondral joints, iliac crystals, posterior and anterior iliac spines, attachment sites of achilles tendon to the calcaneus.<br>* Other names: Maastricht Ankylosing Spondylitis Entheses Score;|
| Control<br>Healthy Controls | Other: Systemic inflammatory index<br>* neutrophil count x platelet count/lymphocyte count<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Systemic inflammatory index | neutrophils * platelets/lymphocytes | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) | The overall BASDAI score ranges from 0 to 10. Lower scores indicate less disease activity. | Baseline | 
| Ankylosing Spondylitis Disease Activity Score (ASDAS)-ESR | <1.3 between inactive disease and low disease activity, <2.1 between moderate disease activity and high disease activity, and >3.5 between high disease activity and very high disease activity. | Baseline | 
| Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP | <1.3 between inactive disease and low disease activity, <2.1 between moderate disease activity and high disease activity, and >3.5 between high disease activity and very high disease activity. | Baseline | 
| Maastricht Ankylosing Spondylitis Entheses Score (MASES) | Maastricht Ankylosing Spondylitis Entheses Score MASES ranging from 0 (0 sites with tenderness) to 13 (worst possible score; 13 sites with tenderness). Negative values indicate better outcome. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ankylosing Spondylitis, Disease activity, Inflammatory marker