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FRI0114 Reaching A Status of Low Disease Activity Spontaneously over Two Year Follow-Up in Active Patients with Non-Radiographic Axial Spondyloarthritis in Comparison to Ankylosing Spondylitis not Treated with TNF Blockers
  1. D. Poddubnyy1,
  2. H. Haibel1,
  3. J. Braun2,
  4. M. Rudwaleit3,
  5. J. Sieper1
  1. 1Charité Universitätsmedizin Berlin, Berlin
  2. 2Rheumazentrum Ruhrgebiet, Herne
  3. 3Endokrinologikum, Berlin, Germany

Abstract

Background In cross-sectional studies patients with non-radiographic axial SpA (nr-axSpA) and ankylosing spondylitis (AS) demonstrated similar characteristics regarding clinical signs of disease activity [1, 2]. Further, patients with active nr-axSpA did not differ from AS patients with respect of response rates to anti tumour necrosis factor (TNF) α treatment [3, 4]. It is however not known whether nr-axSpA is associated with higher probability of “spontaneous” remission/low disease activity state if not treated with a TNF-blocker.

Objectives To investigate the rates of remission/low disease activity states over two years without anti-TNF treatment in patients with nr-axSpA and AS who were candidates for anti-TNF treatment at baseline.

Methods In total, 210 patients with early axSpA (115 with AS according to the modified New York criteria and symptom duration ≤10 years, and 95 with nr-axSpA and symptom duration ≤5 years) from the German Spondyloarthritis Inception Cohort (GESPIC) were evaluated at baseline and every 6 months thereafter till 2 years. Patients with nr-axSpA were considered to be candidates for anti-TNF therapy at baseline if they had BASDAI ≥4 and elevated C-reactive protein (CRP, >6 mg/l). Similar criteria were applied for AS patients in order to have a comparable group. Patients who received at least one prescription of a TNF blocker were excluded. The following definitions for low disease activity were applied: BASDAI<4, BASDAI<4 and normal CRP, BASDAI ≤2, ASDAS inactive disease (<1.3). Proportions of patients achieving low disease activity at year 2 or at least at 2 time points during the follow-up were calculated.

Results Eleven patients (11.6%) with nr-axSpA and 28 patients (24.3%) with AS were considered to be candidates for the anti-TNF therapy at baseline due to elevated BASDAI and CRP. One nr-axSpA patient and 6 AS patients received anti-TNF treatment during the follow-up and were excluded. Remaining patients in both groups (10 with nr-axSpA and 22 with AS) received conventional therapy including physiotherapy, NSAIDs, DMARDs, and steroids.

At year 2 BASDAI<4 was achieved by 50% of nr-axSpA patients and 38% AS patients, BASDAI<4 and normal CRP by 29% and 16%, BASDAI≤2 by 17% and 19%, and ASDAS inactive disease by 16.7% and 6.3% of the patients, respectively.

BASDAI<4 at at least 2 time points during 2 years of the follow-up was achieved by 57% of nr-axSpA and by 40% of AS patients, BASDAI<4 and normal CRP by 25% and 13%, BASDAI≤2 by 13% and 13%, and ASDAS inactive disease by 25% and 0% of nr-axSpA and AS patients, respectively. All differences were statistically non-significant.

Conclusions Only a small proportion of patients (<25%) with nr-axSpA and AS reached a stricter definition of low disease activity over two years of follow-up without TNF-blocker treatment. The rates were numerically lower in AS if a combined definition of low disease activity with inclusion of CRP was used.

References

  1. Rudwaleit M, et al. Arthritis Rheum. 2009;60:717-27. 2. Kiltz U, et al. Arthritis Care Res (Hoboken). 2012;64:1415-22. 3. Song IH, et al. Ann Rheum Dis. 2013;72:823-5. 4. Landewé R, et al. Ann Rheum Dis. 2014;73:39-47.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.3598

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