Serum levels of matrix metalloproteinase 3 and macrophage colony-stimulating factor 1 correlate with disease activity in ankylosing spondylitis

OBJECTIVE: To assess the usefulness of measuring serum matrix metalloproteinase 3 (MMP-3) and macrophage colony-stimulating factor (M-CSF) in patients with ankylosing spondylitis (AS). METHODS: Serum levels of MMP-3 and M-CSF were measured in AS patients who did and did not receive infliximab treatment. These were compared with those of 28 healthy subjects. RESULTS: In the group of AS patients not treated with biologics, both M-CSF and MMP-3 correlated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) values, but not with each other. Logistic regression analysis showed that MMP-3 values were high in those with severely active disease. Infusions of infliximab in AS patients led to a significant decrease in the values of the BASDAI as well as the serum MMP-3, but no change in the serum M-CSF values. CONCLUSION: MMP-3 and M-CSF are potentially useful markers of AS disease activity.     

Evaluation of clinical activity and functional impairment in smokers with ankylosing spondylitis

Background Ankylosing spondylitis (AS), a rheumatic disease, incapacitates human beings during the most productive stage of their lives, causes functional disturbances, and thus affects both patients and their relatives. Disease activity, functional impairment, and efficacy of treatment are affected by various environmental and genetic factors, one of which is smoking. We investigated smokings effect on clinical activity and functional impairment in AS.Patients and methods Forty-eight patients with back pain and limited movements, diagnosed with AS based on clinical, radiological, and laboratory examinations and referred to the Trakya University School of Medicine Physical Medicine and Rehabilitation Department in Turkey were included in this study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and functional impairment with the Bath Ankylosing Spondylitis Functional Index (BASFI). The Mann-Whitney U test was used to determine relationships between smoking and physical findings, laboratory results, and BASDAI and BASFI scores.Results Twenty-four patients were smokers. They had significantly higher BASDAI and BASFI scores and significantly lower forced vital capacity values than nonsmokers (P=0.000, P=0.002, and P=0.001, respectively) (Mann-Whitney U test).Conclusion Smoking is associated with poor clinical aspect and functional impairment in AS. The underlying mechanism can be the physical incapacity caused by smoking.     

Infliximab improves productivity and reduces workday loss in patients with ankylosing spondylitis: Results from a randomized,placebo‐controlled trial

Objective

To examine whether clinical benefits observed after treatment with infliximab were accompanied by improvement in productivity and reduction in time lost from work in a randomized, double‐blind, placebo‐controlled, multicenter trial of patients with ankylosing spondylitis (AS).

Methods

Adults with active AS receiving standard antiinflammatory treatment were randomly assigned in a 3:8 ratio to receive infusions of placebo or 5 mg/kg infliximab at weeks 0, 2, 6, and every 6 weeks thereafter through week 24. Physical function was measured using the Bath Ankylosing Spondylitis Functional Index. The impact of disease on productivity was measured using a visual analog scale (range 0–10). Self‐reported employment status and time lost at work before and during the trial were collected. Spearman's correlation coefficient was used to examine factors associated with productivity.

Results

Patients treated with infliximab had a more significant reduction in limitations of work and daily activity due to physical or emotional problems than patients treated with placebo. Of the subset of patients employed full time, patients in the infliximab group had a significantly greater improvement in productivity as early as week 6 compared with the placebo group. The median change from baseline in the productivity score at week 24 was 0.7 (median percent change 11%) in the placebo group compared with 2.1 (62%) in the infliximab group (P < 0.05). Daily productivity was significantly correlated with physical function and disease activity at baseline and week 24.

Conclusion

The daily productivity of patients with active AS was significantly associated with functional impairment and disease activity. Infliximab treatment significantly improved productivity and reduced workday loss among employed patients with AS.

     

Serum hyaluronic acid levels in patients with ankylosing spondylitis

Our aim in this study was to investigate serum hyaluronic acid (HA) levels and the relationship between clinical parameters in ankylosing spondylitis (AS). Approximately 30 patients with AS and 30 healthy individuals were recruited in this study consecutively. Cross-sectional study was planned, and demographic, clinical, functional, radiological, and laboratory data of patients were evaluated. Disease activity, functional status, and quality of life were assessed, respectively, with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Short-Form 36 (SF-36). Mander Enthesis Index (MEI) was used for evaluation of enthesis involvement. We examined serum concentrations of HA (ng/ml) in patients with AS and controls. The mean ages of patients and control group were 38.3 (SD=10.8) and 42.7 (SD=10.6) years, respectively. The mean of serum HA levels in AS patients was 40.4 (SD=34.8) ng/ml and in controls was 24.9 (SD=20.2). There was significant difference of HA levels between two groups (p=0.04). Furthermore, there was a significant correlation between HA level and distance of hand-floor (r=0.444, p=0.014), modified lumbar Schober's (r= -0.413, p=0.023), distance of chin to chest (r=0.436, p=0.016), right sacroiliit grade (r=0.601, p<0.001), left sacroiliit grade (r=0.610, p<0.001), C reactive protein level (r=0.404, p=0.027), albumin (r= -0.464, p=0.010), C3 (p=0.449, p=0.013), and IgA levels (r=0.369, p=0.045). However, there was no significant correlation between HA levels with MEI, BASFI, BASDAI, and SF-36 (p >or= 0.05). Serum HA level was significantly higher in AS patients than controls. However, there was no significant correlation between serum HA level and disease-specific measures as BASFI and BASDAI; it had significant relation with spinal mobility limitation, sacroiliitis, and laboratory parameters related with acute inflammation. The serum HA level may be a potential biomarker of axial inflammation and disease severity in AS.     

Fluctuations in plasma macrophage colony‐stimulating factor levels during autologous peripheral blood stem cell transplantation for haematologic diseases

Plasma macrophage colony‐stimulating factor (M‐CSF) levels were measured in 13 haematologic patients treated with autologous peripheral blood stem cell transplantation (PBSCT). Six of the patients showed an increase in M‐CSF peak levels (> 3000 pg/ml) during the conditioning and stem cell infusion period. The peak levels of M‐CSF in this phase correlated with thrombomodulin levels, indicating the endothelial origin of plasma M‐CSF. However, the M‐CSF levels were not influenced by TNFα. More patients with high M‐CSF levels (> 5000 pg/ml) suffered from organ failure than those with lower M‐CSF levels. These results suggest that high M‐CSF levels may correlate with cellular or organ damage in patients treated with PBSCT.     

Identification of acute phase reactants and cytokines useful for monitoring infliximab therapy in ankylosing spondylitis

Although most ankylosing spondylitis patients show an apparent clinical response to infliximab therapy, there is considerable individual variation. Because current clinical assessment relies heavily on subjective patient self-evaluation, biomarkers of high sensitivity and specificity are much needed. Here, we assessed potential biomarkers in 47 ankylosing spondylitis patients who received three standard pulses of infliximab. Before each infusion and at week 10, the following were measured: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet count, serum levels of metalloproteinase-3 (MMP-3), and 22 different cytokines. We discovered that, 2 weeks after the first infusion, the combination of ESR, CRP, and platelet count distinguished responders from non-responders with 81.3% sensitivity and 72.7% specificity. The distinguishing power was much less when each acute phase reactant was used alone. Among the 22 cytokines, serum IL-1α was able to distinguish responders from non-responders at week 6, with sensitivity of 84.9% and specificity of 53.8%. Serum IL-1α was probably generated from the joint compartments, as synovial fluid levels were much higher than corresponding serum levels. Although infliximab infusions led to rapid and significant suppression of serum MMP-3 levels, serum MMP-3 levels did not distinguish responders from non-responders. Besides identifying potential biomarkers, our results also demonstrate the usefulness of using sensitivity and specificity to assess usefulness of potential biomarkers.     

强直性脊柱炎新的疾病活动性指数在中国患者中的应用价值研究

目的 验证新的强直性脊柱炎(AS)疾病活动性指数(ASDAS)在中国的AS患者中的辨别能力,评估其临床应用价值.方法 本研究共纳入AS患者129例,分别为参加依那西普临床试验的活动期AS患者(87例)和使用类克治疗的AS患者(42例).分别以4个ASDAS、毕氏AS疾病活动指数(BASDA1)及患者总体评价来评价患者的疾病活动性水平和治疗效果.计算标准化的均数差(SMD)分析指标的辨别能力,运用Pearson相关分析.两独立样本t检验与一元线性回归进行统计学处理.结果 无论是基线水平还是治疗6周后的变化程度,4个新的ASDAS均与患者总体评价(r=0.56～0.74)、红细胞沉降率(ESR)(r=0.50～0.80)及C反应蛋白(CRP)(r=0.50～0.69)有较好的相关性.4个ASDAS对AS患者的疾病活动性水平及治疗前后病情变化程度的辨别能力均优于BASDA1、患者总体评价、ESR和CRP.4个ASDAS之间差异无统计学意义.结论 新的ASDAS用于评价我国AS患者的疾病活动性和药物疗效有较高的辨别能力,值得临床推广和应用.     

‘It's magic stuff’: The experiences of patients with ankylosing spondylitis taking anti‐TNF‐α medication

Introduction: Several studies have identified the efficacy of anti‐tumour necrosis factor‐alpha (anti‐TNF‐α) treatment in ankylosing spondylitis (AS). However, few studies have explored the perceptions of patients taking this new medication. The aim of this study was to explore the impact of anti‐TNF‐α on the quality of life of people with AS. Methods: A qualitative approach was adopted to provide a holistic understanding of participants' views and experiences in the context of their overall lives. Semi‐structured interviews were undertaken and transcribed verbatim. Data were analysed using thematic analysis. Ethical approval and informed consent were obtained. Results: Eight people participated and described a significant improvement in their physical and psychological status, leading to a more positive outlook on their life. Specific areas highlighted were employment, activities of daily living, hobbies and relationships with partners and family, some of which are not captured by current AS‐specific outcome measures. Negative aspects of anti‐TNF‐α use were described as the inconvenience of monitoring and issues relating to travelling abroad. All participants expressed concern about the possibility of being withdrawn from treatment and the perceived impact this would have on their lives. Conclusions: Anti‐TNF‐α treatment has a positive impact on the lives of people with AS, such that a major concern is being withdrawn from treatment, highlighting the need to provide tailored support to people being withdrawn from treatment. To capture the full impact of anti‐TNF‐α treatment, further consideration needs to be given to the choice of appropriate outcome measures. Copyright © 2008 John Wiley & Sons, Ltd.     

Effects of dynamic exercise on circulating IGF-1 and IGFBP-3 levels in patients with rheumatoid arthritis or ankylosing spondylitis

This study was performed to determine the effects of short-term dynamic exercise on serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in the patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Patients with RA or AS and healthy controls were recruited. Dynamic treadmill exercise therapy was accomplished for 20 min/session with all of the participants. There were five sessions per week for 2 weeks. Morning stiffness duration, body pain, Stanford health assessment questionnaire, Ritchie articular index, Bath ankylosing spondylitis disease activity index (BASDAI), and Bath ankylosing spondylitis functional index (BASFI) were evaluated in the RA and AS patients. Laboratory assessments included: erythrocyte sedimentation rate, serum C-reactive protein, IGF-1, and IGFBP-3. Clinical and laboratory assessments were recorded at baseline and during exercise treatment on days 7 and 15. Twenty patients with RA, 15 with AS, and 14 healthy controls were included in this study. The pain evaluation, Ritchie, BASDAI, and BASFI scores were significantly improved by the exercise treatment in both patient groups. The important increases were found in circulating IGF-1 in RA (p < 0.001) and AS (p = 0.001) at the end of 2 weeks. In control individuals, serum IGF-1 levels showed a significant decline in the first week (p < 0.05). No significant changes were observed on serum IGFBP-3 levels. Our data suggest that serum IGF-1 levels are increased by the dynamic exercise program in RA and AS patients. The increased IGF-1 may play an important role in the beneficial effects of dynamic exercise therapy in these patients.     

Outcome of active disease in ankylosing spondylitis: A prospective study

Background: People with ankylosing spondylitis (AS) typically experience episodic exacerbations, but the extent to which they subsequently experience a sustained reduction in disease markers below recognized thresholds for active disease is unclear. Objective: To investigate changes in, and associations between, disease markers over 18 months in people with active AS. Methods: Within a cohort of 89 participants with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores of 4 or higher were used to identify those with active disease. Standard assessment tools were used to monitor participants prospectively at four consecutive six‐monthly intervals. Participants received standard treatments but none received anti‐tumor necrosis factor‐alpha (TNFα) medication during the study. Results: The median age of the cohort was 50 years (inter‐quartile range [IQR] 38.5–55.5), the median age of disease onset was 25 years (IQR 18–33) and the median disease duration was 18 years (IQR 13–27). Forty‐seven (53%) participants had a BASDAI score of 4 or higher on the first assessment, of whom 45 (51%) scored 4 or higher on all subsequent assessments. Furthermore, 38 (43%) and 16 (18%) participants scored BASDAI 5 or 6, respectively, or higher, throughout. BASDAI scores correlated strongly with Bath Ankylosing Spondylitis Functional Index (BASFI) scores. Compared with 19 (21%) participants whose BASDAI scores were consistently below 4 throughout, participants with persistently high BASDAI scores showed higher scores for anxiety and depression, and some evidence of functional deterioration during the study period. Conclusions: In this cohort, disease markers in most people with active AS were sustained above the standard threshold for active disease. This has important implications for planning care pathways and for optimal utilization of anti‐TNFα treatment. Copyright © 2009 John Wiley & Sons, Ltd.     

Factors influencing health status and disability of patients with ankylosing spondylitis in the Czech Republic

The aim of the study was to evaluate factors that influence health status and work disability in patients with ankylosing spondylitis (AS) in the Czech Republic. Data were collected in a retrospective fashion directly from patients with AS using mailed questionnaires containing questions regarding sociodemographic characteristics of patients, the course of their disease, therapy, rehabilitation, quality of life, and ability to work. HAQ-DI (Health Assessment Questionnaire-Disability Index) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) were also included in the questionnaires; 1,008 questionnaires were suitable for further statistical analysis. The average age +/- SD of patients was 50.2 +/- 10.7 years, the average symptom duration was 23.0 +/- 11.6 years. Mean time from first symptoms to diagnosis was 9.1 years. Full disability had been awarded to 303 patients (30%) at some point of their disease. Twenty seven percent of patients reported receiving full disability pension for 10 or more years. Four hundred fifty six subjects (45%) were currently or had been previously receiving partial disability pension. Receiving disability pension was more frequent among men (64%) compared to women (56%) (P = 0.012), despite the fact that women had higher BASDAI (P < 0.001) and HAQ-DI (P = 0.004) scores. Patients with a family history of AS had higher BASDAI and HAQ-DI scores (P = 0.001 and P = 0.008, respectively) compared to patients without a family history of AS. BASDAI and HAQ-DI scores correlated with age and duration of illness, younger patients and those with shorter disease duration had lower values. Fifty eight percent of patients reported a BASDAI score >/=4 (current cutoff value for initiation of biological therapy), but only 1% of patients were treated by anti TNF alpha agents within the last year. Seven hundred ninety one patients underwent spa treatment in the previous year; 96% of them experienced improvement of their health condition.     

Vitamin D level in ankylosing spondylitis male patients: A potential association with the functional status and platelet count

IntroductionsAnkylosing spondylitis (AS), spondyloarthritis (SpA) prototype characteristically involves the axial skeleton and enthesis. The pathogenesis of AS is multifactorial, however it has been reported that one important factor that might contribute is vitamin D deficiency. Vitamin D and platelets share specific roles in immune response, bone health and mineral metabolism.Aim of the workTo evaluate the serum vitamin D levels in AS patients and to study the relationship to clinical manifestations, disease activity, mobility and functionality.Patients and methodsThe study included 33 male AS patients and 33 matched control. Bath AS metrology index (BASMI), Bath AS disease activity index (BASDAI) and Bath AS functional index (BASFI) were evaluated. Serum 25-hydroxy vitamin D3 level was measured.ResultsThe 33 patients had a mean age of 37.2 ± 10.7 years, disease duration of 12.7 ± 6.8 years. 3 were ex-smokers, 15 currently and 15 never smoke. The mean BASDAI was 4.2 ± 2.1, 19 (57.6%) had BASDAI score ≥ 4 (active). The BASMI was 5.7 ± 1.4 and BASFI was 5.3 ± 2.6. Patient’s vitamin D level (7.2 ± 5.2 ng/ml) was lower significantly than in the control (21.3 ± 10.1 ng/ml) (p < 0.001). There were no differences in the level of vitamin D according to the smoking status (p = 0.9). A significant inverse relation was detected between vitamin D level and BASFI (r = -0.35, p = 0.045) and a significant correlation with the platelet level (r = 0.38, p = 0.027).ConclusionLow vitamin D level may contribute significantly to the pathogenesis of AS. It is significantly related to the impaired function in the disease and to low platelet count.     

Health related quality of life (HRQoL) in ankylosing spondylitis patients: Relation to clinical features,disease activity and radiographic damage

Aim of the workTo assess health-related quality of life (HRQoL) and associated variables in Egyptian ankylosing spondylitis (AS) patients.Patients and methods50 male patients with AS and 50 age-matched controls were enrolled. Clinical and laboratory data were examined including history for peripheral arthritis. Visual analog scale (VAS), Bath AS disease activity index (BASDAI), AS disease activity score (ASDAS)-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR), Bath AS functional index (BASFI), Bath AS metrology index (BASMI) and AS quality of life (ASQoL). Spinal radiographs were graded by the modified Stoke AS spinal score (mSASSS).ResultsThe mean age of the patients was 33.1 ± 7.4 years and disease duration of 6.8 ± 3.1 years. The mean ASQoL score in patients was significantly higher (9.4 ± 3.8; 3–15) compared to the control. 26 (52%) patients had peripheral arthritis. Of these, 17 (65.4%) had hip involvement, 6 (23.1%) had knee, 5 (19.2%) had shoulder affection and 3 (11.5%) had ankle joint involvement. Patients with peripheral joint involvement had significantly higher ASQoL score than those without (11.4 ± 3.1 and 7.3 ± 3.4 respectively, p < 0.001). ASQoL significantly correlated with BASMI (p = 0.048), BASFI (p = 0.02), BASDAI (p = 0.01), ASDAS.CRP (p = 0.02) and ASDAS.ESR (p = 0.01). The multiple regression analysis to identify the independent variables associated with the ASQoL showed a significant association with peripheral joint involvement, BASDAI, ASDAS.ESR, ASDAS.CRP and BASFI scores.ConclusionAS is a chronic inflammatory disease that affects HRQoL especially with higher disease activity, functional disability, more peripheral joint involvement and lesser spinal mobility in Egyptian patients.     

Fetuin‐A and interleukin‐18 levels in ankylosing spondylitis

Aim: Interleukin‐18 (IL‐18) and fetuin‐A have been implicated in atherosclerosis. Preliminary evidence suggests that ankylosing spondylitis (AS) is associated with an increased risk of atherosclerosis. The aim of the present study was to investigate possible abnormalities in IL‐18 and fetuin‐A levels in AS. Methods: Subjects without established cardiovascular (CV) risk factors were studied. Fasting glucose, serum lipids, high sensitive C‐reactive protein (hsCRP), erythrocyte sedimentation rate, IL‐18 and fetuin‐A were assessed. Patients were also evaluated with the Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, and the Bath Ankylosing Spondylitis Disease Activity Index. Results: Fourty‐five patients with AS (37.4 ± 9.7 years; 35M/10F) and 29 controls (35.5 ± 11.1 years; 21M/8F) were studied. Fetuin‐A levels were significantly higher in AS patients compared to controls (1023.5 ± 171.6 vs. 856.9 ± 207.9 μg/mL, P < 0.001). IL‐18 levels were also higher in the AS group but the difference was not significant (184 ± 186 vs. 140 ± 115, P = 0.1). Significant but weak correlations were found between fetuin‐A, IL‐18, hsCRP, low density lipoprotein cholesterol, and triglyceride levels (P < 0.05; r = 0.4, 0.3, 0.2, and 0.3 respectively). Comparison of subjects with respect to the treatment type, disease activity and history of peripheral arthritis yielded no difference regarding fetuin‐A and IL‐18 between groups. Conclusion: Fetuin‐A and IL‐18 levels seem to be increased in AS patients regardless of disease activity and treatment type.     

Serum leptin levels correlate with interleukin-6 levels and disease activity in patients with ankylosing spondylitis

OBJECTIVE: To determine whether serum leptin levels are elevated in men with ankylosing spondylitis (AS) and whether the levels correlate with serum cytokine profiles and disease activity of AS. METHODS: Forty-two male patients with newly diagnosed AS were enrolled. Their Bath AS Disease Activity Index (BASDAI), body mass index (BMI), and acute phase reactants, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, were assessed. Serum leptin levels were determined using radioimmunoassay (RIA) and serum cytokine profiles, including tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, and interferon (IFN)-gamma, were determined using enzyme-linked immunosorbent assay (ELISA). These results were compared with those from 42 age-matched healthy men. After a follow-up period of 31.0+/-20.1 months, clinical and biochemical variables were reassessed in the men with AS. RESULTS: At baseline, patients with AS had significantly elevated serum levels of leptin, leptin adjusted for BMI (leptin/BMI), TNFalpha, and IL-6, but not IFN-gamma, as compared to the controls. Serum leptin/BMI levels correlated well with IL-6 levels, and both leptin/BMI and IL-6 levels correlated well with BASDAI and CRP levels in patients with AS. The changes in leptin/BMI and IL-6 levels between the baseline and follow-up measurements correlated well with one another (p<0.05) and both correlated well with the changes in BASDAI (p<0.05). CONCLUSION: Serum leptin/BMI levels were increased and significantly associated with IL-6 levels and disease activity in men with AS, suggesting a possible role for leptin in the inflammatory reactions of AS.     

Differences in the incidence of flares or new onset of inflammatory bowel diseases in patients with ankylosing spondylitis exposed to therapy with anti–tumor necrosis factor α agents

Objective

Ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) are clinically and pathologically linked. Anti–tumor necrosis factor (anti‐TNF) agents are efficacious in treating AS, but not all are equally effective in treating IBD (Crohn's disease [CD] and ulcerative colitis [UC]). The purpose our study was to analyze the incidence of flares and new onset of IBD in patients with AS treated with anti‐TNF agents.

Methods

Data from 9 trials, 7 placebo‐controlled trials and 2 open studies, were analyzed.

Results

Data were available on 419 AS patients exposed to etanercept (625 patient‐years), 366 exposed to infliximab (618 patient‐years), 295 exposed to adalimumab (132 patient‐years), and 434 placebo patients (150 patient‐years). A history of IBD was reported in 76 of 1,130 patients (6.7%). There were 2 reports of IBD while receiving placebo (1.3 per 100 patient‐years), 1 while receiving infliximab, and 3 while receiving adalimumab. Among the 14 IBD cases receiving etanercept (2.2 per 100 patient‐years) there were 8 CD and 6 UC cases, significantly different from infliximab (P = 0.01) but not from placebo. Patients with a history of IBD had an IBD flare odds ratio of 18.0 (95% confidence interval [95% CI] 2–154) while taking etanercept and 4.2 (95% CI 0.4–44) while taking adalimumab, in comparison with infliximab. The incidence rates of new onset of IBD showed no significant difference between etanercept (0.8 per 100 patient‐years) and placebo (0.5 per 100 patient‐years).

Conclusion

New onset and flare of IBD are infrequent events in AS patients receiving anti‐TNF therapy. Infliximab (but not etanercept) largely prevents IBD activity. More data are required for adalimumab. The incidence of new onset of IBD was statistically not different from placebo for all anti‐TNF agents.     

Association of macroscopic gut inflammation with disease activity, functional status and quality of life in ankylosing spondylitis

The aim of this cross-sectional study was to evaluate the frequency of intestinal inflammation and its association with disease activity, functional status and quality of life in patients with ankylosing spondylitis (AS). A total of 25 patients with AS had undergone ileocolonoscopy and concomitant histological study. Clinical and demographical parameters, BASDAI, BASFI, and SF-36 scores were compared between patients with and without macroscopic gut inflammation (MGI). Colonoscopic study revealed MGI in 9 patients and macroscopically normal gut mucosa in 16 patients. On histological examination, of 25 patients 20 had gut inflammation, mostly in ileum. BASDAI score was higher (P < 0.05), SF-36 pain and physical scores, and chest expansion measurement were lower (P = 0.00, P = 0.01, P = 0.01), duration of morning stiffness was longer (P = 0.01) in patients with MGI. Serum C-reactive protein, erytrocyte sedimentation rate levels were similar between groups (P > 0.05). There is high prevalence of histological gut inflammation in AS patients. More active disease should suggest gut inflammation in AS patients.     

T he relationship between enthesitis indices and disease activity parameters in patients with ankylosing spondylitis

In this study, patients with ankylosing spondylitis (AS) were assessed both by patient and physician using two enthesitis indices and the relationship between these indices and disease activity parameters was investigated. The study involved 100 AS patients. The patients were evaluated with 10-cm visual analog scale (VAS) for spinal pain (VAS-S), peripheral joint pain (VAS-P), global assessment of patient, and global assessment of doctor. In the laboratory evaluations, the erythrocyte sedimentation rates (ESR) and serum C-reactive protein levels of the patients were determined. Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index, and Bath AS radiology index were calculated. The severity of enthesitis was evaluated according to Mander enthesitis index (MEI) and Maastricht ankylosing spondylitis enthesitis score applied by both the patient (MASES-P) him/herself and the physician (MASES-D). There was a correlation between BASDAI and BASFI as well as MEI, MASES-D, and MASES-P indices (r = 0.447, r = 0.342, r = 0.663, r = 0.530, r = 0.464, and r = 0.435, respectively). No correlation between the laboratory parameters and enthesitis indices were detected. In multiple linear regression analysis, BASFI, VAS-S, and female gender (41.3%) were the best predictors of MEI-D, whereas BASFI, VAS-S, female gender, and ESR (32.5%) were the best predictors for MASES-D and BASFI (18.9%) was the best predictor of MASES-P. The assessment of simple and easily applicable MASES score by a patient may be expected to help the physician in clinical practice. When the disease activity of the patients with AS are evaluated, both BASDAI, the clinical importance of which has been confirmed in numerous studies and which is recommended by ASAS, and BASFI, which is valued by patients, should be considered.