Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: results from an 18-year longitudinal dataset

Abstract

Objectives: The clinical benefit of conventional disease-modifying antirheumatic drugs (cDMARDs) for treating ankylosing spondylitis (AS) is generally limited to improvements in peripheral arthritis. However, cDMARDs could be conditionally considered as alternatives to established drugs for improving axial manifestations in exceptional circumstances. However, there are few studies of the impact of cDMARDs on radiographic progression outcomes. Therefore, we investigated the effectiveness of cDMARDs on radiographic progression in AS. Methods: Among 1280 AS patients at a single hospital from 2000 to 2018, 301 who had been treated with sulfasalazine (SSZ) or methotrexate (MTX) were enrolled. For each patient, the entire follow-up period was split into 1-year intervals. Each interval was classified as either an “on-cDMARD” interval, which was a period of treatment with SSZ alone, MTX alone, or a combination of SSZ and MTX, or an “off-cDMARD” interval, which was a period without cDMARD treatment. Radiographic progression was scored using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). The relationship between cDMARD use and radiographic progression within the intervals, defined as the rate of mSASSS progression, was investigated using linear models with adjustment for potential confounding covariates and for clustering among observations from the same patient. Results: The 732 on-cDMARD intervals and 1027 off-cDMARD intervals were obtained from enrolled patients. In multivariable regression analysis, there was no significant association between cDMARDs and the rate of mSASSS progression (β = −0.081, p = 0.418). The mean adjusted mSASSS change per year was 0.610 from on-cDMARD intervals and 0.691 from off-cDMARD intervals. Conclusion: Treatment with cDMARDs may not reduce radiographic progression in AS patients.

2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis

“…This recommendation is unchanged for the axial phenotype. There is no recent data suggestive of an effect on symptoms or potential beneficial structural effect on radiographs [77]. Nevertheless, when used in combination with a TNF inhibitor, methotrexate (MTX) reduces the immunogenicity of the anti-TNF agent and may increase the long-term maintenance of these drugs [78].…”

Early control of C‐reactive protein levels with non‐biologics is associated with slow radiographic progression in radiographic axial spondyloarthritis

“…Longitudinal modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) data were used to evaluate the difference in radiographic progression between the controlled and uncontrolled CRP groups. According to previous studies, the intraobserver and interobserver reliability values of the mSASSS are excellent (intraclass coefficient: 0.978, 95% confidence interval [CI] 0.976 to 0.979, and 0.946, 95% CI 0.941 to 0.950, respectively) 10,11 …”

“…Data of patients who were diagnosed with r‐axSpA according to the modified New York criteria 9 at a single center between January 2001 and December 2018 were extracted from the electronic medical records (EMR) 10,11 . The inclusion criteria were as follows: (1) patients diagnosed with r‐axSpA and under follow‐up; (2) those who had 2 or more radiographs taken; (3) those who were evaluated using the Ankylosing Spondylitis Disease Activity Score and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); (4) those who underwent blood tests; (and 5) those who had 2 or more visits at the rheumatology clinic.…”

Increases in C-reactive Protein Levels are Correlated with Radiographic Progression in Patients with Ankylosing Spondylitis who Achieved Clinical Remission with Tumor Necrosis Factor Inhibitor Treatment

“…Fourth, most patients treated with TNFi had high baseline in ammation, and their changes in mSASSS were shown to be different from those who had not been treated with TNFi. 11,24 Therefore, the delayed effect of in ammation on mSASSS may be different in patients not treated with TNFi.…”

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Objectives: To determine the relationship between in ammation and radiographic progression over time in patients in clinical remission for ankylosing spondylitis (AS) after tumor necrosis factor inhibitor (TNFi) treatment.Method: Medical records data of AS patients with Bath Ankylosing Spondylitis Disease Activity Index scores <4 during TNFi treatment were analysed at 6month intervals from January 2001 to December 2018. To determine the relationship between the modi ed Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and C-reactive protein (CRP) over time, we tted linear mixed models with mSASSS as the response variable, baseline mSASSS and the cumulative sum of CRP with different lag times (6,12, 18,24, 30, and 36 months) as xed effects, and patients as random effects. Associations between mSASSS and the cumulative sum of CRP or the lag times with the highest beta coe cients were further investigated with linear mixed models that included additional clinical variables.Results: A total of 2,956 intervals were obtained from 333 patients.

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