Achilles enthesitis on physical examination leads to worse outcomes after 2 years of follow up in patients with ankylosing spondylitis from REGISPONSER-AS registry

Abstract

Background Enthesitis represents one of the most important peripheral musculoskeletal manifestations in patients with axial spondyloarthritis (axSpA). However, studies specifically evaluating Achilles tendon enthesitis and its impact over time are scarce. The objectives of this study were to evaluate the impact of Achilles’ tendon enthesitis found at baseline during physical examination on the outcome measures after 2 years of follow-up in patients with ankylosing spondylitis (AS). Methods This was an observational and prospective study conducted during 2 years of follow-up in the REGISPONSER-AS registry. Linear regression models adjusted for age, body mass index (BMI), and anti-TNF intake were conducted to evaluate the association between the presence of Achilles enthesitis at baseline and the patient-reported outcome (PRO) scores at baseline. The impact of this feature on PROs over 2 years of follow-up was evaluated using mixed models for repeated measures adjusted for age, BMI, and anti-TNF intake. Results Among the 749 patients included, 46 patients (6.1%) showed Achilles’ tendon enthesitis during physical examination at the baseline study visit. Patients with Achilles enthesitis had an increase in the global VAS score, BASDAI, mBASDAI, ASDAS-CRP, and BASFI scores in comparison with patients without this feature. In addition, the mean global VAS, BASDAI, and ASDAS-CRP scores were significantly higher among patients with Achilles enthesitis over the 2 years of follow-up after adjusting for age, BMI, and current anti-TNF intake. The percentage of patients achieving ASDAS low disease activity (ASDAS < 2.1) after 2 years of follow-up was 15.9% and 31.5% for patients with and without Achilles enthesitis, respectively (p = 0.030). Conclusions In patients with AS, the presence of Achilles’ tendon enthesitis was associated with worse scores on the outcome measures after 2 years of follow-up, leading to a lower probability of achieving low disease activity.

Validation of diagnosis algorithms for ankylosing spondylitis in claim‐based database

“…Due to improved screening and social awareness, a recent study reported a numerical increase in AS incidence from 2007 to 2017 3 . AS symptoms include chronic inflammation, morning stiffness, low back pain, as well as enthesitis that can lead to painfulness or swelling in various joints and bones, significantly affecting patients' prognosis and quality of life 4–7 …”

“…3 AS symptoms include chronic inflammation, morning stiffness, low back pain, as well as enthesitis that can lead to painfulness or swelling in various joints and bones, significantly affecting patients' prognosis and quality of life. [4][5][6][7] Due to the inflammatory reaction in AS patients, various comorbidities of AS are also identified in previous studies. Real-world evidence indicated that AS is associated with multi-system comorbidities, including cardiovascular system, musculoskeletal system,…”