Background Prevalence of flares/worsening of the disease in axSpA is not well known, with prevalences ranging from 10 to 40%.
Objectives To evaluate the prevalence of disease worsening according to the patient's perception in an axSpA population with stable disease and its correlation with disease activity parameters.
Methods Study: International multicentric (20 countries) longitudinal (2 visits: 1 week – 6 months) observational in 2016, under the guidance of ASAS. Patients: axSpA patients with stable disease according to the rheumatologist. Data on disease characteristics were collected at baseline, and data on disease activity were collected at both visits. Disease worsening was defined at the follow-up visit by the patient using the MCID question (“Think about all the ways your spondyloarthritis has affected you during the last 48 hours. Compared to the last visit how did you feel during the last 48 hours? Improved/No change/Worse”). If patients answered “worse”, they marked if they considered themselves in an acceptable symptoms state (PASS) and whether they considered treatment intensification was necessary. Analyses were descriptive and changes in disease activity were calculated according to patient-reported worsening.
Results Among the 1639 patients included, 1169 patients had complete data. Patients were predominantly males (64.8%), had a mean age and disease duration of of 41.7 (SD 12.4) and 12.6 (9.9) years, respectively. History of X-ray sacroiliitis, MRI sacroiliitis and HLAB27+ were present in 944 (80.8%), 471 (40.6%) and 807 (69.0%) patients, respectively. 56% (n=655) patients were receiving a biologic treatment. At the baseline visit, mean BASDAI (0–10) was 3.1 (2.3), mean ASDAS 2.3 (1.0) and mean CRP 8.4mg/L (14.5). Mean interval between both visits was 91.2 (51.0) days. At the follow-up visit, 590 (50.5%), 388 (33.2%) and 191 (16.3%) patients considered their condition had improved, not changed and worsened, respectively. Among the 191 patients reporting a worsening, 123 (64.4%) considered their symptom status unacceptable, and 127 (66.5%) judged their state required treatment intensification. BASDAI, ASDAS and CRP significantly increased in patients considering themselves worsening (Table).
Conclusions in this real-life study of stable axSpA, worsening, as defined by the patient, was not frequent, but was significantly associated with increase in disease activity measures, including objective parameters such as CRP and not only patient-reported outcomes.
Acknowledgements This study was supported by ASAS (Assessment in SpondyloArthritis international Society)
Disclosure of Interest None declared