The 2 main outcomes being studied are functional and structural. Functional outcomes like pain and stiffness relief, quality of life, and workforce participation are more immediately evident and relevant, but structural outcomes like ankylosis and secondary osteoarthritis determine longterm disability and, ultimately, function as well.
Efficacy of drugs or physical therapies developed for AS to address such outcomes will determine when and how long they are used.
Spinal mobility is better preserved in:
3) younger set
4) less structural damage...
5) lower disease activity.
Type of treatment did not apparently have a direct independent effect on mobility.
Take-home-message: stop smoking, stay active, control inflammation early.
To optimise function in AS, one should:
1) stop smoking
2) treat while young
3) do regular back strengthening exercises
4) develop good social support. ...
Different studies over a decade apart, saying essentially the same thing.
One predictor of poor structural outcome in AS is hip joint involvement.
Persistently active disease (unrelenting inflammation) is another predictor for rapid structural damage in AS.
In this prospective longitudinal observational study, having structural damage predicts for more structural damage (failure breeds failure), while anti-TNF therapy appears to retard damage progression.
To date, no randomized double-blind placebo-controlled trials have been performed in AS to determine if any therapeutic intervention can prevent or slow down structural damage. This is partly because structural progression in AS tends to be very slow (taking decades), and it wo...uld be unethical to keep anyone on placebo for long when treatment patently helps to alleviate pain and suffering.
Benefit is at best hinted at in such prospective longitudinal trials, comparing rates of damage progression between different active treatment arms. In this regard, treatment with Secukinumab or combination NSAID+anti-TNF appear to yield better results than NSAID or anti-TNF alone (refer to June 24th & 30th posts).