Outcome Prediction in AS

Ankylosing spondylitis (AS) has an estimated prevalence of 0.2–0.86% for adult Caucasian populations of western European extraction [1]. The ability of anti-TNF treatment to dramatically suppress symptoms in AS [2–4] and improve quality of life [5–7] is now beyond doubt. However, the high costs and…
m.rheumatology.oxfordjournals.org

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.


Background/Purpose: Clinicians utilize several…
acrabstracts.org

Spinal mobility is better preserved in:
1) non-smokers
2) employed
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.

J Rheumatol. 2002 Jul;29(7):1420-5. Comparative Study; Research Support, Non-U.S. Gov't
www.ncbi.nlm.nih.gov|By Ward MM

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.


The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to…
www.ncbi.nlm.nih.gov

One predictor of poor structural outcome in AS is hip joint involvement.

Objective The aim of this work was to investigate the association between disease activity measured by the Ankylosing Spondylitis Disease Activity Score (ASDAS) and radiographic spinal progression in patients with early axial spondyloarthritis (axSpA).
m.ard.bmj.com

Persistently active disease (unrelenting inflammation) is another predictor for rapid structural damage in AS.

Objectives To evaluate spinal radiographic damage over time and to explore the associations of…
journals.plos.org

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).

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