Published Clinical Papers 2019

A selection of the latest research findings

Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice

The aim of this study was to describe 5-year treatment trajectories on a patient level, including subsequent therapy changes and dose reductions, of individual patients with ankylosing spondylitis (AS) starting a first anti TNF. Patients were identified in the nationwide Swedish Rheumatology Quality register and all changes in their treatment during follow-up were recorded.

Researchers conclude that less than half remain on their first anti TNF after 5 years, but most are still on a biologic. While patients remaining on treatment with their first anti TNF appear to be able to reduce the dose over time, a large proportion cycle through several biologics, and a third have no anti-rheumatic treatment after 5 years. This indicates the importance of thorough follow-up programs as well as a need for alternative therapeutic options.

Comparison of comorbidities and treatment between ankylosing spondylitis and non-radiographic axial spondyloarthritis in the United States

This study aimed to compare co-morbidities and biologic therapy use between AS and non-radiographic axial SpA (nr-axSpA) patients, using a large cohort of patients from routine clinical practice in the United States.

Despite age differences, nr-axSpA patients had similar co-morbidity burdens as those with AS. Both groups received comparable biologic therapy treatment.

Treat-to-target in axial spondyloarthritis: gold standard or fools’ gold?

Treat-to-target (T2T) is an emerging management strategy in axial spondyloarthritis (axSpA). The concept was originally based on evidence from other chronic conditions, such as hypertension, diabetes and hypothyroidism, as well as some rheumatic diseases, such as rheumatoid arthritis and gout.

International groups have recommended a T2T strategy in axSpA and observational evidence suggests that a T2T approach might be beneficial in axSpA. However, data from a prospective randomised study proving the efficacy of a T2T strategy compared to routine care are still lacking. Moreover, the cost-effectiveness of such strategy in clinical practice also needs to be tested. The target will need to be useful and feasible in both clinical practice and clinical trials.

The British Society for Rheumatology biologic DMARD safety guidelines

This guideline provides evidence-based recommendations for the safe use of biologic therapies in adults. It covers the safety aspects of all biologic therapies approved by the National Institute for Health and Care Excellence (NICE) as of June 2016, for the treatment of RA, PsA and axial spondyloarthritis (SpA) including AS. This group of conditions are referred to as inflammatory arthritis (IA) in the guideline. Therapies approved by NICE after June 2016, such as secukinumab (Cosentyx), are not included.

The guideline highlights several specific safety areas including recommendations for screening before a biologic is started, recommendations for monitoring, the implications of other conditions and ageing, vaccinations and the management of biologic therapies in specific situations such as infection, malignancy and surgery.

Factors associated with ASDAS remission in a long-term study of ankylosing spondylitis patients under tumor necrosis factor inhibitors

The objective of this study was to determine the clinical and demographic factors associated with disease remission and drug survival in patients with ankylosing spondylitis (AS) on  anti TNF therapy on an electronic database. Results indicated that that ASDAS-CRP remission is an achievable goal not only for people on their first anti TNF, but also for those on a second anti-TNF. This was particularly notable in younger patients and those with a lower BASDAI at baseline. Non-smokers also seemed to do better.

YouTube as a source of patient information for ankylosing spondylitis exercises

Researchers evaluated the educational quality of 56 YouTube videos offering exercises for people with AS. Of the 56 videos evaluated,  27 were  high quality, 10 were intermediate quality, and 19 were low quality. They conclude YouTube can be considered as an important source of high-quality videos as nearly half of the videos were of high quality. Physicians should inform patients about the importance of video resources during the use of YouTube and should guide patients to the accurate sources of information. Don’t forget NASS have some great exercise videos on YouTube.

Vitamin D serum concentration is not related to the activity of spondyloarthritis – preliminary study

Vitamin D plays an important role in mineral turnover and bone remodelling and there are increasing data about its immunomodulatory potential in different rheumatologic disorders. Deficiency of vitamin D is frequent in people with spondyloarthritis (SpA) and some data suggest its association with increased disease activity and structural damage. However, its exact role in the pathogenesis of SpA and its association with disease activity are still a matter of debate so researchers carried out a preliminary study of 63 patients.

The researchers concluded that their data showed no correlation between the concentration of 25(OH)D in the serum and disease activity in  SpA. However, they noted that this does not exclude the potential role of vitamin D in pathogenesis of SpA. They highlight further studies are required.