Objective The Assessment of SpondyloArthritis international Society-Health Index (ASAS-HI) is a tool designed to assess disease impact in spondyloarthritis (SpA), but its clinical performance is barely known. We aimed to test the clinimetric properties of ASAS HI in a real clinical scenario. Methods This cross-sectional study included 111 consecutive SpA patients. The measurement properties of ASAS HI were tested against conventional assessment measures. Convergent validity was assessed by Spearman's rho correlations, while discriminative validity was analyzed through ROC curves. A multivariate regression analysis was designed to identify ASAS HI items associated with active disease. Results The average ASAS-HI was 5.4 ± 3.8 (IQR: 3-8). ASAS HI showed high convergent validity against other SpA measures (rho ≥ 0.70, p < 0.0005). The optimal criterion for detecting high / very high disease activity ASDAS categories was an ASAS-HI score > 6, area under the ROC curve 0.86 (95%CI: 0.78-0.92), +LR 7.3 (95%CI: 3.1-17.1), p < 0.0001. The ASAS-HI items significantly associated with BASDAI active disease were, "I often get frustrated" [OR 9.2 (95%CI: 1.2-69.4), p = 0.032], and, "I sleep badly at night” [OR 7.7 (95%CI: 1.4-41.6), p = 0.018). As for ASDAS, it was, “pain sometimes disrupts my normal activities” [OR 8.7 (95%CI: 1.7-45.2), p = 0.010]. Conclusion The ASAS HI is a useful and simple instrument for its application in daily practice. Given its good clinimetric properties it could be used as an additional instrument to evaluate SpA.

Non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment for spondyloarthritides (SpA), a group of entities with common clinical and pathophysiological aspects, but also with differential features. Although NSAIDs provide significant symptomatic relief, especially for joint pain and morning stiffness, their role in achieving and maintaining the treatment goals advocated by the treat to target strategy in SpA is not entirely clear. These agents can induce changes in the composition of the intestinal microbiota, also favoring an alteration of the barrier function in the gut epithelium. All of this, favored by a pre-disposing genetic background, could activate a specific type of aberrant immune response in the gut lamina propria, also known as type-3 immunity. This article offers a perspective on how NSAIDs, despite their undeniable value in the short-term SpA treatment, could hinder the achievement of medium and long-term treatment goals by compromising the barrier function of the gut mucosa and potentially altering the composition of the gut microbiota.

Background and aims: Breastfeeding is recognized as one of the most influential drivers of the gut microbiome. In turn, alterations in the gut microbiome may play a role in the development and severity of spondyloarthritis (SpA). We aimed to analyze different disease outcomes in patients with axial SpA (axSpA) based on the history of breastfeeding. Patients and methods: A random sample was selected from a large database of axSpA patients. Patients were divided based on history of breastfeeding and several disease outcomes were compared. Both groups were also compared based on disease severity. Adjusted linear and logistic regression statistical methods were used. Results: The study included 105 patients (46 women and 59 men), and the median age was 45 years (IQR: 16–72), and the mean age at diagnosis was 34.3 ± 10.9 years. Sixty-one patients (58.1%) were breastfed, with a median duration of 4 (IQR: 1–24) months. After the fully adjusted model, BASDAI [−1.13 (95%CI: −2.04, −0.23), p = 0.015] and ASDAS [−0.38 (95%CI: −0.72, −0.04), p = 0.030] scores were significantly lower in breastfed patients. Forty-two percent had severe disease. In the adjusted logistic model for age, sex, disease duration, family history, HLA-B27, biologic therapy, smoking, and obesity, breastfeeding had a protective effect against the development of severe disease (OR 0.22, 95%CI: 0.08–0.57, p = 0.003). The selected sample size was sufficient to detect this difference with a statistical power of 87% and a confidence level of 95%. Conclusion: Breastfeeding might exert a protective effect against severe disease in patients with axSpA. These data need further confirmation.

We have read with great interest the recent editorial published in The Journal by Dr. Kiltz, et al, referring to the possibility of using the Spondyloarthritis international Society Health Index (ASAS HI) as an all-in-one in the assessment of axial spondyloarthritis (axSpA)1. AxSpA has been evaluated over the years with different tools that have tried to determine the degree of activity [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)/Ankylosing Spondylitis Disease Activity Score (ASDAS)], functional limitations (Bath Ankylosing Spondylitis Functional Index), mobility restrictions (Bath Ankylosing Spondylitis Metrology Index), structural damage accumulated over time (Bath Ankylosing Spondylitis Radiology Index/modified Stoke Ankylosing Spondylitis Spinal Score), or quality of life (Ankylosing Spondylitis Quality of Life scale) of these patients.

Background and aims: The effect of smoking on disease activity and quality of life (QoL) in spondyloarthritis (SpA) is far from clear. We aimed to evaluate the relationship between smoking and these outcomes in patients with axial SpA (axSpA) and psoriatic arthritis (PsA). Patients and methods: This cross-sectional observational multicenter study included 242 patients with axSpA and 90 with PsA. The association between conventional cardiovascular risk factors and disease activity as well as QoL, in both SpA phenotypes was evaluated. For this, univariate and multivariate regression analyses were performed, as well as confirmatory meta-analyses. Results: Regardless of age, sex, or disease duration, patients with axSpA showed significantly less association with obesity (OR 0.50 (0.26–0.96), p = 0.03) and hypertension (OR 0.33 (0.18–0.62), p = 0.0005). However, axSpA was significantly associated with smoking (OR 2.62 (1.36–5.04), p = 0.004). Patients with axSpA were more likely to be in a category of high disease activity compared with PsA (OR 2.86, p = 0.0006). Regardless of sex, age, disease duration, and education level, smoking was significantly associated with higher disease activity in axSpA (OR 1.88, p = 0.027). A fixed-effects model meta-analysis (OR 1.70, p = 0.038) confirmed the association between tobacco and disease activity. No relationship was found between smoking (or other cardiometabolic risk factors) and structural damage or worse QoL in either disease. Conclusions: Although the cardiometabolic risk profile is clearly different between both SpA phenotypes, the only clear link between these factors and increased disease activity was observed between smoking and axSpA. Our findings need further confirmation.