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Ankylosing spondylitis (AS) is a chronic and progressive inflammatory disorder that primarily affects the axial skeleton. Unfortunately, diagnosis of AS is often delayed compared to other rheumatologic conditions. It is not uncommon for patients to already have an advanced disease when the correct diagnosis is eventually made. TNF inhibitors are we...
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Objectives: The study aimed to evaluate biomarkers facilitating early axial-spondyloarthritis (axSpA) diagnosis and disease activity and imaging indices correlated.
Materials and Methods: Seventy-five patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years) participating in the Italian arm of the SpondyloArthritis-Caught-Early (SPAC...
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Citations
... In this disease, there is spinal inflammation in which the sacroiliac joints are primarily affected. With the progression of the disease, the fusion that starts in the sacroiliac joint progresses to the spine (28). There are data suggesting that increased serum eta levels in RA patients may also be associated with peripheral arthralgia and joint damage (22). ...
Aim: The 14-3-3η (eta) protein has been associated with the severity of the disease and joint destruction in patients with rheumatoid arthritis (RA). It has also been shown to be likely to be effective in inflammatory events. We aimed to investigate whether eta levels could be a potential biomarker in the diagnosis of ankylosing spondylitis (AS) and in the determination of disease activity in patients with AS.Methods: This study included 51 patients diagnosed with AS and 49 healthy controls aged 20-65 years. The routine hemogram, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were measured and the neutrophil/lymphocyte ratio (NLR) was calculated in the patients. The serum eta levels were also measured in the patient and healthy control groups. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) were used to assess disease activity. Sacroiliac joint radiographs of the patients were evaluated and the sacroiliitis was graded.Results: There was no statistically significant correlation between the degree of sacroiliitis, disease activity indices, and eta levels. There was no statistically significant correlation between eta levels and hematological parameters except for CRP. There was a negative, weak, and statistically significant relationship between the patients’ eta levels and CRP (r=-0.277; p=0.049). We could not find any correlation between the degree of sacroiliitis, disease activity indexes, and serum eta levels in AS patients.Conclusion: Serum eta levels are not a good biomarker for detecting disease activity in patients with ankylosing spondylitis. The 14-3-3η protein may play a more active role in rheumatic diseases where peripheral joint involvement is prominent.
... Baseline BASDAI and CRP scores appear to predict the clinical response to TNF inhibitors. Several cases have been found that have proven the success of anti-TNF, one of which is from Man R Shim 2019 with the Efficacy of TNF inhibitors in advanced ankylosing spondylitis with total spinal fusion [16], a case report from Gabriel Ceobanu in 2020 with ankylosing spondylitis [17] and a case report from Azizah Mounach in 2014 with the efficacy and safety of adalimumab in ankylosing spondylitis [18]. ...
Introduction: Axial spondyloarthritis is a chronic inflammatory disease that mainly affects the axial skeleton. Anti-TNF can be a therapy of choice for ankylosing spondylitis. Case Illustration: A 33-year-old male patient complained of chronic low back pain. The patient is diagnosed with ankylosing spondylitis based on New York Criteria 84. Initial therapy included NSAIDs for six months but showed no response. After we initiated the TNF inhibitor therapy, patients showed significant clinical improvement: BASDAI scores improved from 4.9 to 1.1, BASFI from 3.1 to 1.0, and ASDAS-CRP from 3.2 to 2.0. Conclusions: Patient with ankylosing spondylitis who have no response to NSAIDs should be considered for TNF inhibitor administration. After six months of TNF inhibitor therapy, the patient responded well. Keywords: Axial spondyloarthritis, ankylosing spondylitis, NSAIDs, Tumor Necrosis Factor.
... 271 Like IL-1R antagonist, antagonists of TNFa, including etanercept (soluble TNFa decoy receptor), adalimumab and infliximab (both monoclonal TNFa antibodies), are used clinically to alleviate pain and symptoms of RA, psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel diseases. [272][273][274][275][276][277] The combination of TNFa antagonists with methotrexate is the most potent therapy against RA. [279][280] TNFa antagonists are also beneficial for the treatment in disc-related pain including radicular and axial back/neck pain. ...
Chronic pain remains a public health problem and contributes to the ongoing opioid epidemic. Current pain management therapies still leave many patients with poorly controlled pain, thus new or improved treatments are desperately needed. One major challenge in pain research is the translation of preclinical findings into effective clinical practice. The local neuroimmune interface plays an important role in the initiation and maintenance of chronic pain and is therefore a promising target for novel therapeutic development. Neurons interface with immune and immunocompetent cells in many distinct microenvironments along the nociceptive circuitry. The local neuroimmune interface can modulate the activity and property of the neurons to affect peripheral and central sensitization. In this review, we highlight a specific subset of many neuroimmune interfaces. In the central nervous system, we examine the interface between neurons and microglia, astrocytes, and T lymphocytes. In the periphery, we profile the interface between neurons in the dorsal root ganglion with T lymphocytes, satellite glial cells, and macrophages. To bridge the gap between preclinical research and clinical practice, we review the preclinical studies of each neuroimmune interface, discuss current clinical treatments in pain medicine that may exert its action at the neuroimmune interface, and highlight opportunities for future clinical research efforts.
... Bu durum ileri evre (bambu kamışlı) AS olarak tanımlanır. [3] SpA'da predominant semptom ve bulgular farklılık gösterebilir: aksiyel tutulumda bel-kalça ağrısı ve sabah tutukluğu; periferal tutulumda artrit veya entezit hakim tablo söz konusu olabilir. SpA'ların tedavi yönetiminde enflamasyonun baskılanması, yeni kemik oluşumunun önlenmesinin yanı sıra komorbidite ve komplikasyonların önlenmesi de hedefler arasındadır. ...
... Lomber omurgada iki bitişik vertebrada köprüleşme şeklinde sindesmofit ve/veya füzyon olması ileri evre AS olarak tanımlanır. [3] AxSpA çalışmalarının aksine ileri evre AS için bDMARD çalışmaları çok azdır, çünkü sıklıkla bu hastalar klinik çalışmalardan dışlanmaktadır. ...
... The first-line drugs are non-steroidal anti-inflammatory drugs (NSAIDs), and when the Bath Ankylosing Spondylitis Disease Activity Index (BAS-DAI) is more than 4 despite the use of more than two NSAIDs, the administration of tumour necrosis factor alpha (TNFa) inhibitors is considered [2]. The efficacy of TNFa inhibitors such as infliximab, adalimumab, etanercept, and golimumab for AS has been reported [3,4], but the efficacy and continuation rate of TNFa inhibitors in cases of progressive AS are not known, and there are only a few reports on the subject [5]. In addition, the lives of patients with AS are complicated by impairment of activities of daily living due to associated limitation of the range of motion of the spine caused by ossification [1]. ...
... In a previous report, etanercept was effective for treating advanced AS [5]. BAS-DAI decreased from 5.0 to 1.7 after the administration of etanercept in that patient. ...
There is minimal information available about bone histomorphometric findings in patients with ankylosing spondylitis (AS). Herein, we report a case of advanced AS complicated with cervical myelopathy due to ossification of yellow ligament (OYL). A 37-year-old Japanese man who had been diagnosed with AS was administered adalimumab. Thirty-four months after adalimumab treatment, he reported upper extremity numbness, dexterity impairment and a spastic gait. Magnetic resonance imaging and computed tomography of the cervical spine revealed cervical cord compression at the C5/6 level due to OYL. After surgery including posterior spinal fusion and cervical cord decompression with iliac bone graft at C5 and C6 arches, these symptoms improved. Bone histomorphometry of his ilium revealed marked osteoid formation and reduced mineral apposition, suggesting a calcification disorder. In addition, 25-hydroxy vitamin D was abnormally low (<4 ng/mL), and at 148 pg/mL parathyroid hormone was higher than the reference value, indicating secondary hyperparathyroidism. This case warrants reporting because OYL was complicated with AS and bone histomorphometric findings in AS were evaluated.
Introduction:
The management of specific clinical scenarios is not adequately addressed in national and international guidelines for axial spondyloarthritis (axSpA). Expert opinions could serve as a valuable complement to these documents.
Methods:
Seven expert rheumatologists identified controversial areas or gaps of current recommendations for the management of patients with axSpA. A systematic literature review (SLR) was performed to analyze the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs (csDMARDs, b/tsDMARDs) in axSpA regarding controversial areas or gaps. In a nominal group meeting, the results of the SLR were discussed and a set of statements were proposed. A Delphi process inviting 150 rheumatologists was followed to define the final statements. Agreement was defined as if at least 70% of the participants voted ≥ 7 (from 1, totally disagree, to 10, totally agree).
Results:
Three overarching principles and 17 recommendations were generated. All reached agreement. According to them, axSpA care should be holistic and individualized, taking into account objective findings, comorbidities, and patients' opinions and preferences. Integrating imaging and clinical assessment with biomarker analysis could also help in decision-making. Connected to treatments, in refractory enthesitis, b/tsDMARDs are recommended. If active peripheral arthritis, csDMARD might be considered before b/tsDMARDs. The presence of significant structural damage, long disease duration, or HLA-B27-negative status do not contraindicate for the use of b/tsDMARDs.
Conclusions:
These recommendations are intended to complement guidelines by helping health professionals address and manage specific groups of patients, particular clinical scenarios, and gaps in axSpA.
