We have put together a selection of some of the latest research findings in AS. We will update this page each month so that you can keep up to date with research into AS.
The most recent papers were included in April 2012.
IL-6 in ankylosing spondylitis
In this clinical paper the authors note that in AS, as with other rheumatic diseases, the complex interplay of cytokines such as tumour necrosis factor alpha, interleukin-6 (IL 6) and interleukin-10 (IL 10) have been implicated in the pathogenesis of the disease. Despite extensive research over the past decades, the treatment options for AS remain limited. Non steroidal anti-inflammatory drugs are the first line of therapy, whereas anti TNF drugs are administered for cases which fail to respond to the treatment. There have been conflicting views on the correlation of IL 6 with disease activity in AS and the debate on the role of anti IL6 in AS is still ongoing. Anti IL 6 such as tocilizumab and siltuximab have proven efficacy based on the large randomized controlled trials. The Food and Drug Administration (FDA) has approved these drugs for treating rheumatoid arthritis and systemic juvenile idiopathic arthritis. Researchers have experimented with anti IL 6 therapy in AS but the conclusions made have not been not consolidated into international guidelines or consensus statement for clinical practice. In this review, the authors explore the role of anti IL6 in the treatment of AS based on the cumulative evidence over recent years.
IL-6 promise in AS
In further news on IL-6, Dr Paul Emery from the University of Leeds presented information at the British Society of Rheumatology conference in Glasgow, indicating the IL-6 has shown promise in an initial small group of patients.
Diagnosis and classification in spondyloarthritis: identifying a chameleon
This paper was written by the department of medicine at Maastricht University Medical Center, The Netherlands. In it the authors explain that spondyloarthritis (SpA) defines a group of interrelated diseases, including ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis, enteropathic-related spondylitis and arthritis, and undifferentiated SpA. They highlight that the clinical presentation of SpA is heterogeneous, and no single shared distinguishing feature exists for the conditions comprising SpA; in daily practice, diagnosis is usually made on the basis of a combination of symptoms, the findings of physical examination, imaging and laboratory investigations. They note that several classification criteria have been developed for AS and SpA, which are useful in a research setting but cannot be automatically applied to the diagnosis of individual patients. Currently, MRI is the most sensitive imaging modality available for detection of sacroiliitis, often enabling detection of axial inflammation long before structural lesions are observed radiographically, thus facilitating early diagnosis of axial SpA. However, MRI will never capture all facets of SpA and the expert opinion of a rheumatologist will remain the crucial step in recognition of this disease. In this review, the authors discuss diagnosis and classification of AS and SpA, and highlight how MRI might facilitate both processes.
Treatment of ankylosing spondylitis in patients refractory to TNF-inhibition: are there alternatives?
This paper from Kiltz U, Heldmann F, Baraliakos X and Braun J looks at the current evidence for the use of alternatives to NSAIDs and anti TNF therapy for people with AS. The authors found data for abatacept, anakinra, apremilast, bisphosphonates, rituximab, secukinumab, sulfasalazine, thalidomide and tocilizumab but concluded that all the studies had problems with design and methodology. They conclude that, although some trends for efficacy were seen, there is at present insufficient evidence to support a recommendation for any of these compounds. So far, none of these new drugs has been shown to reach response rates compared to TNF-blockers.
Update of the literature review on treatment with biologics as a basis for the first update of the ASAS/EULAR management recommendations of AS
A literature search of all publications on biologics and AS was carried out. Researchers concluded the overall evidence was very high for anti-TNF treatment with respect to efficacy and safety, while it was low for biologic treatment other than anti-TNF.
Clinical, Functional, and Radiographic Differences Among juvenile-onset, adult-onset, and late-onset AS
The aim of this study, which appeared in the Journal of Rheumatology, was to compare the clinical, functional, and radiographic outcomes at different ages of onset in patients with AS. Researchers enrolled 546 patients and classified into 3 groups based on their age at symptom onset: juvenile-onset AS (age ≤ 16 years); adult-onset AS (> 16 but < 40 years); and late-onset AS (≥ 40 years). They compared the differences among the 3 groups. The results showed that sex and HLA-B27 were significantly associated with age at onset of AS.
Healthcare costs and productivity losses directly attributable to ankylosing spondylitis
This study was conducted by the University of Sheffield and its aim was to examine the healthcare resource use and productivity losses associated with patients with ankylosing spondylitis (AS) and explore the relationship between disease severity and total costs. Researchers sent a postal survey to a sample of 1,000 patients with AS randomly selected from registries at 10 secondary care rheumatology centres in the UK. Information on demographic characteristics, disease and functional activity, healthcare use and work status (presenteeism and absenteeism) during the previous three months was collected. The study results show that direct healthcare costs alone do not describe the total costs associated with AS and that productivity losses associated with AS are considerable.
Early diagnosis is crucial in AS
This clinical paper from the Rheumatology Clinical Research Unit, Addenbrooke's Hospital, Cambridge appeared in a GP magazine called Practitioner and highlighted to GPs that patients with a suspected diagnosis should be referred to secondary care in order to confirm the diagnosis and commence treatment. It's great to see this message being communicated to GPs.
Restricted lung function in AS
This paper appeared in Arthritis Research and Therapy and showed there is significantly impaired lung function in AS patients. It also demonstrated a clear relationship between reduced spinal mobility and restrictive lung function in AS patients. The results support the assumption of an association between musculoskeletal limitations and restrictive respiratory impairment in AS, emphasizing the importance of maintained spinal flexibility in the management of the disease. The authors recommend that patients with severely reduced spinal mobility should be referred for pulmonary function examination and relevant follow-up treatment.
Efficacy of etanercept versus sulfasalazine in AS patients with peripheral joint involvement
This clinical paper appeared in the Journal of Rheumatology and was based on a study of more than 500 people with AS. The findings indicate that AS patients treated with etanercept showed significantly greater improvement than those treated with sulfasalazine in all joint assessments regardless of swollen joint involvement. The researchers conclude that in this analysis, etanercept was significantly more effective than sulfasalazine for management of patients with AS and peripheral joint involvement.
Sexual function in women with AS
Researchers in Turkey looked at sexual function in women with AS. They did not find any relationship between AS quality of life scale and sexual functions. Sexual dysfunctions were not found to be different in female patients with AS when compared with healthy controls. Sexual problems in female patients with AS seem to be associated with higher depression level, increased disease activity, decreased functionality, higher pain scores and decreased quality of life.
Loneliness in patients with rheumatic diseases
Researchers at Utrect University in The Netherlands researched loneliness in rheumatic diseases and the resulting clinical paper was published in the Journal of Psychology. Researchers compared across a whole range of rheumatic diseases and found those who are younger, having lower education, and not working, are more likely to feel lonely. People with AS were less likely to feel lonely than those with fibromyalgia. The authors suggest that to decrease loneliness, therapeutic attention should be given to both increasing social support as well as decreasing invalidation in patients with rheumatic diseases, especially in patients with fibromyalgia.
Rehabilitation for ankylosing spondylitis in the era of biologics
The editorial (full text) in the Journal of Rheumatology discusses the role of physiotherapy in AS. The authors discuss the concept of combinining anti TNF therapy and physiotherapy as a way of better managing AS.
Prevalence and factors associated with uveitis in spondyloarthropathies patients in France: Results from the EXTRA observational survey
The objective of this survey was to accurately estimate, in France, the prevalence and the factors associated with uveitis in spondyloarthropathies (SpA) patients. From September 2008 to January 2009, 202 rheumatologists participated in the survey and recruited 902 patients (males: 61%), with a mean age of 45 years and mean disease duration of 10 years. SpA diagnoses included ankylosing spondylitis (71%), psoriatic arthritis (PsA) (18%) or other SpA (11%). HLA-B27-positivity rate was 76%.
Uveitis prevalence was 32%. Recurrence of uveitis occurred in 52.3% and complications in 11.7%.
Results indicate that uveitis is the most common extra-articular feature of SpAs and that it occurs preferentially in HLA-B27 positive patients and over all the course of the disease.
Ankylosing spondylitis refractory to Tumor Necrosis Factor blockade responds to tocilizumab
This is not a clinical study but a letter to the editor of the Journal of Rheumatology from 3 rheumatologists who wanted to highlight a case history of a patient who has been sucessfully treated with tocilizumab after anti TNF therapy failed. The authors of the letter ask for clinical research to be conducted in the area.
Improvement in pain intensity, spine stiffness, and mobility during a controlled individualized physiotherapy program in ankylosing spondylitis
This study appeared in Rheumatology International and was conducted by the department of physiotherapy in the university of Debrecen in Hungary. It involved 75 people with AS and aimed to look at the effectiveness of individualised physiotherapy over a 3 month period. Results showed a reduction in the intensity of pain and spinal stiffness leading the researchers to conclude that a complex, individualized physical therapy program may be useful and should be introduced to AS patients in order to maintain and increase spine mobility, preserve functional capacity, decrease the pain and stiffness.
Celecoxib: a review of its use for symptomatic relief in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis
The clinical evidence for Celecoxib (Celebrex®) was reviewed in this study. It was concluded that in randomised controlled trials, celecoxib, at the recommended dosages of 200 or 400 mg/day, was significantly more effective than placebo, at least as effective as or more effective than paracetamol and as effective as nonselective NSAIDs and the coxibs etoricoxib and lumiracoxib for the symptomatic treatment of patients with active osteoarthritis, rheumatoid arthritis or ankylosing spondylitis.
Celecoxib was generally well tolerated, with mild to moderate upper GI complaints being the most common body system adverse events. In meta-analyses and large safety studies, the incidence of upper GI ulcer complications with recommended dosages of celecoxib was significantly lower than that with nonselective NSAIDs and similar to that with paracetamol and other coxibs. However, concomitant administration of celecoxib with low-dose cardioprotective aspirin often appeared to negate the GI-sparing advantages of celecoxib over NSAIDs.
The researchers conclude that Celecoxib would appear to be a useful option for therapy in patients at high risk for NSAID-induced GI toxicity, or in those responding suboptimally to or intolerant of NSAIDs. They highlight that, to minimize any risk, particularly the cardiovascular risk, celecoxib, like all coxibs and NSAIDs, should be used at the lowest effective dosage for the shortest possible duration after a careful evaluation of the GI, cardiovascular and renal risks of the individual patient.
AS found in medieval skeletons
The Department of Archaeology at the Croatian Academy of Sciences and Arts found changes consistent with ankylosing spondylitis in three males and one female skeleton recovered from four medieval sites (Velim, Koprivno, Buje, and Rijeka) on Croatia's eastern Adriatic coast. These are the first cases of ankylosing spondylitis identified in Croatian archaeological series.
Increased mortality in ankylosing spondylitis is related to disease activity
This paper appeared in the Annals of the Rheumatic Diseases and was written by the Department of Rheumatology at the University Hospital of Northern Norway.
677 patients with AS followed at the university hospital since 1977 were matched by gender, age and postal area to three controls from the general population and standardised mortality rates (SMRs) were calculated. Cause of death was established using patients' hospital records. In a subset of 360 patients, clinical and demographic data collected during an earlier research visit (1998-2000) were used in a prospective multivariate analysis of predictors for mortality in AS.
The researchers concluded that mortality is increased in patients with AS and circulatory disease is the most frequent cause of death. Parameters reflecting the duration and intensity of inflammation are associated with reduced survival. These results indicate that, to improve long-term survival in AS, there is a need for early detection and anti-inflammatory treatment as well as a vigilant approach for cardiovascular risk factors.
Last reviewed: April 2012