Good correlation between changes in objective and subjective signs of inflammation in patients with short- but not long duration of axial spondyloarthritis treated with tumor necrosis factor-blockers

Anja Weiß, In-Ho Song, Hildrun Haibel, Joachim Listing, Joachim Sieper, Anja Weiß, In-Ho Song, Hildrun Haibel, Joachim Listing, Joachim Sieper

Abstract

Introduction: The aim of this study was to investigate the influence of symptom duration on treatment response and on the correlation between improvements in patient reported outcomes (PRO) and objective inflammation in patients with axial spondylarthritis (SpA) treated with etanercept (ETA) or adalimumab (ADA).

Methods: Data from 112 patients with axial SpA originally enrolled in two randomized controlled clinical trials were pooled and analyzed after one year of treatment with ETA (n = 66) or ADA (n = 46). Patients with <4 years and ≥4 years of disease were compared for improvement in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS), C-reactive protein (CRP) and magnetic resonance imaging (MRI) score for sacroiliac joints (SIJ).

Results: Patients with <4 years of disease showed a significantly better improvement than longer diseased patients in BASDAI (3.2 (95% confidence interval (CI): 2.7 to 3.7) vs. 1.7 (1.1 to 2.2)), BASFI, BASMI and ASDAS (1.6 (1.4 to 1.8) vs. 0.9 (0.7 to 1.1)). The change in BASDAI showed a significant correlation with the change in SIJ score (Spearman's rank correlation coefficient (rho) = 0.37, P = 0.01) and the change in CRP (rho = 0.45, P = 0.001) in patients with <4 years of disease. For long diseased patients this correlation was poor and did not achieve statistical significance (rho = 0.13, P = 0.46; rho = 0.22, P = 0.13 respectively).

Conclusion: The low correlation between change of PROs and change of objective signs of inflammation seen in axial SpA patients with longer symptom duration treated with tumor necrosis factor-blocker seems to indicate that inflammation is not the only cause of the patients' symptoms, while inflammation seems to be the major cause in short diseased patients.

Trial registration: Clinical Trials.gov NCT00844142 (Trial 1); NCT00235105 (Trial 2).

Figures

Figure 1
Figure 1
Adjusted mean changes from baseline. Adjusted mean changes from baseline are shown for two (<4 and ≥4 years) and four groups of symptom duration (<4, 2 to 4, 4 to 8 and ≥8 years). BASDAI, Bath ankylosing spondylitis disease activity index; BASFI, Bath ankylosing spondylitis functional index; ASDAS, ankylosing spondylitis disease activity score; CRP, C-reactive protein and SIJ, sacroiliac joint.
Figure 2
Figure 2
Correlation between change in Bath ankylosing spondylitis disease activity index (BASDAI) and change in sacroiliac joints (SIJs) (A), and change in C-reactive protein (CRP) score (B). (A) Improvement in BASDAI and SIJ score is presented after one year of treatment adjusted for baseline. (B) Improvement in BASDAI and log CRP values is presented for CRP-positive patients after one year of treatment adjusted for baseline.

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