Journal
ARTHRITIS RESEARCH & THERAPY
Volume 17, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s13075-015-0897-6
Keywords
Spondyloarthritis; Axial spondyloarthritis; Non-radiographic axial spondyloarthritis; Ankylosing spondylitis; Anti-TNF; Treatment outcome; Medication adherence; C-reactive protein
Categories
Funding
- Region Skane
- Lund University Hospital
- Swedish Research Council
- Faculty of Medicine at Lund University
- Osterlund Foundation
- Kock Foundation
- Swedish Rheumatism Association
- King Gustav V 80-year fund
- Oak Foundation
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Background: The relationship between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) is currently debated. Using observational data from the South Swedish Arthritis Treatment Group register, we thus aimed to compare clinical development and treatment adherence between nr-axSpA and AS patients during three years of anti-TNF (tumor necrosis factor) therapy in clinical practice, and to explore the impact of inflammatory activity measured by CRP (C-reactive protein) at treatment initiation. Methods: Nr-axSpA and AS patients (n = 86/238) in southern Sweden, commencing anti-TNF therapy 1999-2011, were followed during three years. Anti-TNF cessation was defined as stopping therapy, without restarting another anti-TNF agent within three months. Differences in the three year developments of patient's visual analogue scale (VAS) scores for global health and pain, EuroQol 5-Dimensions utility, evaluator's global disease activity assessment, CRP, and ESR (erythrocyte sedimentation rate) were assessed by repeated ANOVA. Anti-TNF adherence was compared by Log rank test and Cox regression. In a subanalysis, the same outcomes were studied after splitting both groups into patients with/without baseline CRP elevation. Results: Nr-axSpA patients were more often female and had lower acute phase reactants at baseline. Apart from CRP, which remained lower in the nr-axSpA group throughout follow-up (p = 0.004), no between-group differences were detected regarding clinical developments (p > 0.1 for all comparisons) or anti-TNF adherence (hazard ratio: 1.1 (95 % CI 0.7 to 1.8) for the nr-axSpA vs. AS group) during three years. Elevated baseline CRP was similarly associated with superior clinical outcomes and treatment adherence in both groups. Conclusions: With the exception of constantly lower CRP levels in the nr-axSpA group, three years anti-TNF therapy resulted in similar clinical outcomes and treatment adherence in nr-axSpA and AS patients, thus strengthening the hypothesis that these diagnoses represent different aspects/phases of the same disease.
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