Flare in axial spondyloarthritis. The dark side of the outcome

Wendling, Daniel; Prati, Clément

doi:10.1136/annrheumdis-2016-209218

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…Recently, the ASAS group identified some definitions of flares based on changes in pain and the ASDAS and BASDAI indices 28 , and in another study, Godfrin-Valnet, et al defined flares as a variation of ≥ 2.1 units in BASDAI, 0.8 units in ASDAS-ESR, or 1.3 units in ASDAS-CRP, using a different approach 29 . In this context, some authors consider relative variations and others absolute values above a significant threshold to define disease flares 30 . In our study, we identified patients with axSpA in remission with a similar disease activity at baseline, and for this reason we chose an absolute value to identify a flare.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Loss of Remission and Disease Flares in Patients with Axial Spondyloarthritis Receiving Antitumor Necrosis Factor Treatment: A Retrospective Study

Lubrano

Perrotta²,

Manara³

et al. 2016

J Rheumatol

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Section: Discussionmentioning

confidence: 99%

Predictors of Loss of Remission and Disease Flares in Patients with Axial Spondyloarthritis Receiving Antitumor Necrosis Factor Treatment: A Retrospective Study

Lubrano

Perrotta²,

Manara³

et al. 2016

J Rheumatol

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“…Axial SpA (axSpA) is a chronic, inflammatory, rheumatic disease, characterized by fluctuating periods of flare and remission [ 1 ], often resulting in spine fusion and significant disability. The term axSpA encompasses both AS, whereby clear structural changes to the spine and/or SI joints can be observed via X-ray, and non-radiographic axSpA (nr-axSpA), whereby axSpA is instead diagnosed from other clinical features and MRI [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Axial spondyloarthritis 10 years on: still looking for the lost tribe

2020

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Despite the publication of various recommendations, quality standards and referral strategies to promote early diagnosis in axial SpA (axSpA) over the last decade, there remains a significant delay to diagnosis, leading to a lost tribe of undiagnosed, untreated patients with persistent back pain and axSpA symptoms. This review discusses the various factors contributing to diagnostic delay in axSpA, while providing recommendations to improve the diagnostic pathway, for example use of the online Spondyloarthritis Diagnosis Evaluation (SPADE) tool (http://www.spadetool.co.uk/). Significant shortcomings exist at both the primary and secondary care level, with healthcare professionals often lacking knowledge and awareness of axSpA. Myths regarding the classical signs and symptoms still prevail, including the perception of axSpA as a male disease, only occurring in individuals who are HLA-B27 positive with raised inflammatory markers. Individuals within this lost tribe of undiagnosed patients are likely lacking adequate treatment and are thereby at risk of worse clinical outcomes. It is therefore vital that public health initiatives are implemented to improve education of healthcare professional and to ensure early specialist referral, to ultimately improve the lives of patients with axSpA.

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“…This lack of standardisation and variability in flare definition impaired comprehension and comparisons between different clinical trials and rendered translation for clinical practice difficult [2]. Therefore, in 2016, the Assessment of SpondyloArthritis international Society (ASAS), an international group of experts in the field of spondyloarthritis, developed a consensual definition of flare/disease worsening [2]. After a systematic literature review and a case vignette study, 12 preliminary definitions of flares were proposed, relying on validated composite scores (Ankylosing Spondylitis Disease Activity Score (ASDAS); Bath Ankylosing Spondylitis Disease Activity Index, BASDAI) and patient-reported outcomes (e.g.…”

Section: Definition Of Flare In Clinical Trialsmentioning

confidence: 99%

“…The main definitions used are summarised in Table 1. This lack of standardisation and variability in flare definition impaired comprehension and comparisons between different clinical trials and rendered translation for clinical practice difficult [2]. Therefore, in 2016, the Assessment of SpondyloArthritis international Society (ASAS), an international group of experts in the field of spondyloarthritis, developed a consensual definition of flare/disease worsening [2].…”

Section: Composite Scoresmentioning

confidence: 99%

“…Flares were defined by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group in 2008 as ‘a cluster of symptoms of sufficient duration and intensity that cannot be self-managed by the patient and require initiation, change or increase in therapy’ [1]. A flare is a change in status, with a worsening of symptoms and/or disease activity [2]. Fluctuations in disease activity reflect systemic inflammation which may cause deleterious effects on long-term outcomes [3].…”

Section: Introductionmentioning

confidence: 99%

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Defining and managing flares in axial spondyloarthritis

Aouad

Gossec

2022

Current Opinion in Rheumatology

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Purpose of reviewFlares correspond to fluctuations in disease activity or symptoms. They should be avoided in chronic inflammatory diseases. In axial spondyloarthritis (axSpA), work is ongoing to better conceptualise and treat flares. This review highlights recent data on the definition and management of flares in axSpA.Recent findingsMany definitions of flares have been used in clinical trials, limiting the interpretation and comparison of studies. The expert group Assessment of SpondyloArthritis International Society (ASAS) developed a data-driven definition of flares/disease worsening: an increase in Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) of at least 0.9 points, for use in axSpA clinical trials. Flares are more challenging to define in clinical practice because of their multifaceted nature. Qualitative studies have shown that flares from the patient's perspective are related not only to disease activity, but also to fatigue, mood, sleep and general well-being. The management of axSpA relies on a treat-to-target (T2T) strategy and aims at reaching clinical remission while monitoring closely disease activity to prevent and shorten flares.SummaryThe concept of flares has been clarified, and definitions have been developed for use in trials. The T2T approach aims at minimising flares in axSpA. The early recognition of flares and their severity may lead to better management.

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Flare in axial spondyloarthritis. The dark side of the outcome

Cited by 8 publications

References 19 publications

Predictors of Loss of Remission and Disease Flares in Patients with Axial Spondyloarthritis Receiving Antitumor Necrosis Factor Treatment: A Retrospective Study

Predictors of Loss of Remission and Disease Flares in Patients with Axial Spondyloarthritis Receiving Antitumor Necrosis Factor Treatment: A Retrospective Study

Axial spondyloarthritis 10 years on: still looking for the lost tribe

Defining and managing flares in axial spondyloarthritis

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