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Clinical course over two years in patients with early non-radiographic axial spondyloarthritis and ankylosing spondylitis without anti-tumor necrosis factor α treatment: Results from the GErman SPondyloarthritis Inception Cohort (GESPIC)

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Poddubnyy D1, Haibel H1, Braun J2, Rudwaleit M3, Sieper J1. Arthritis Rheumatol. 2015 May 27. doi: 10.1002/art.39225. [Epub ahead of print]


OBJECTIVE:he aim of this analysis was to investigate the clinical course of disease over two years in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS).

METHODS:In total, 303 patients with axSpA (158 with AS and symptom duration ≤10 years, and 145 with nr-axSpA and symptom duration ≤5 years) with available follow-up data over 2 years not treated with tumor necrosis factor (TNF) α blockers were included.

RESULTS:Patients with nr-axSpA and AS did not differ in BASDAI at any time point during follow-up, BASFI was significantly higher in AS at baseline only, but spinal mobility was generally more impaired in AS patients. Patients with AS had significantly higher C-reactive protein (CRP) levels at all time-points. Accordingly, ASDAS was significantly higher in the AS subgroup at 2 out of 4 time-points. If patients having a BASDAI≥4 plus an elevated CRP at baseline were analyzed over time there were no substantial differences in the proportions of patients who had achieved low disease activity on at least 2 time-points during follow up if a clinical definition of low disease activity was used (BASDAI<4 or ≤2: 38% or 13% for nr-axSpA and 36% or 15% for AS, respectively) but numerically more patients in the nr-axSpA reached low-disease activity if definitions were applied which included CRP (BASDAI<4 plus normal CRP or ASDAS inactive disease: 25% or 13% for nr-axSpA and 10% or 3% for AS).

CONCLUSION:Patients with nr-axSpA and AS not treated with TNF α blockers demonstrated a similar clinical disease course over 2 years. Patients with nr-axSpA reached a status of low disease activity more frequently compared to AS if outcome parameters including CRP were used.