Analysis of therapy in patients with early axial spondyloarthritis who achieved the asas partial remission and the clinical-laboratory remission at the 3rd year of follow-up

BackgroundThe main goal of “T2T” strategy for spondyloarthritis (SpA) is to achieve clinical remission or inactive disease. In 2001, the ASAS formulated criteria for partial remission [1], and the Russian Expert Group for Study of SpA (ExSpA) in 2018 identified clinical-laboratory remission (absence of clinical manifestations of the disease that persists for 6 months with normal values ​​of CRP and ESR) [2].Objectivesto analyze the therapy in patients with early axial spondyloarthritis who achieved the ASAS partial remission and the clinical-laboratory remission at the 3rd year of follow-up.MethodsThe study included patients with early axSpA (ASAS criteria 2009 with inflammation back pain duration less than 5 years) from the CORSAR cohort (Cohort of Early SpondyloArthritis), formed at the V.A. Nasonova Research Institute of Rheumatology. The cohort includes 175 patients with axSpA. The analysis included 66 patients followed for at least 3 years, of which 37 (56%) were men. The average age of patients was 31.5 (5.7) years, the average duration of the disease was 22.1 (17.0) months, 63 (95.4%) patients were HLA B27 positive. The criteria for clinical-laboratory remission include the following indicators (at least during 6 month): ASDAS≤1,3, BASDAI ≤1,0, morning stiffness<30 min., absence of swollen joints, absence of enthesitis, nocturnal pain ≤1,0 (NRS), spinal pain≤1,0 (NRS), no active extra-articular manifestations, normal levels of CRP and ESR [2]. The criteria for ASAS partial remission include a value not above 2 units in each of the 4 domains: patient global, pain, function, inflammation [1].ResultsInitially, no patients met the ASAS partial remission and the clinical-laboratory remission criteria. By the 3rd year of follow-up, the clinical-laboratory remission was achieved by 21 (31.8%) patients; the ASAS partial remission - 29 (44.0%) patients. When analyzing therapy at the 3rd year of follow-up of patients with early axSpA who achieved the clinical-laboratory and the ASAS partial remission, it was revealed that patients more often achieved remission when taking NSAIDs, a quarter of patients achieved remission on combined therapy with biologics and NSAIDs (Table 1). It is noting that a quarter of patients canceled therapy on their own.Table 1.Therapy of patients with axSpA who achieved the clinical-laboratory and the ASAS partial remission at 3 years of follow-up.The ASAS partial remission (n=29)The clinical-laboratory remission (n=21)pNSAIDs, n (%)14 (48,2%)9 (42,8%)р>0,05NSAIDs+sulfasalazine, n (%)01 (4,7%)р>0,05Biologics, n (%)2 (6,8%)0р>0,05Biologics+NSAIDs, n (%)6 (20,6%)5 (23,8%)р>0,05Biologics+sulfasalazine, n (%)01 (4,7%)р>0,05Biologics+sulfasalazine+NSAIDs, n (%)1 (3,4%)0р>0,05Without therapy, n (%)6 (20,6%)5 (23,8%)р>0,05Conclusion1. In the 3d year of follow-up 32% of patients with early axSpA achieved the clinical-laboratory remission and 44% - of the ASAS partial remission.2. More than 40% of patients with early axSpA achieved remission while taking NSAIDs.References[1]Anderson JJ, Baron G, van der Heijde D, Felson DT, Dougados M. Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis. Arthritis Rheum 2001;44:1876-86.[2]Gaidukova I.Z., Rebrov A.P., Korotaeva T.V., Dubinina T.V., Otteva E.N., Badokin V.V., Bochkova A.G., Bugrova O.V., Godzenko A.A., Dubikov A.I., Ivanova O.N., Lapshina S.A., Nesmeyanova O.B., Nikishina I.P., Raskina T.A., Rumyantseva O.A., Smirnov A.V., Sitalo A.V., Erdes S.F. REMISSION IN AXIAL SPONDYLOARTHRITIS: DEFINITION AND EVALUATION TOOLS (RECOMMENDATIONS OF THE SPONDYLOARTHRITIS STUDY GROUP OF EXPERTS, ALL-RUSSIAN PUBLIC ORGANIZATION «THE ASSOCIATION OF RHEUMATOLOGY OF RUSSIA»). Rheumatology Science and Practice. 2018;56(1):10-14. (In Russ.) https://doi.org/10.14412/1995-4484-2018-10-14Disclosure of InterestsNone declared