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Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis

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Abstract

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 ± 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) ≥1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 ± 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was ≥4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI ≥4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

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References

  1. Akar S, Birlik M, Gurler O et al (2004) The prevalence of rheumatoid arthritis in an urban population of Izmir Turkey. Clin Exp Rheumatol 22:416–420

    PubMed  CAS  Google Scholar 

  2. Kacar C, Gilgil E, Tuncer T et al (2005) Prevalence of rheumatoid arthritis in Antalya, Turkey. Clin Rheumatol 24(3):212–214

    Article  PubMed  CAS  Google Scholar 

  3. Onen F, Akar S, Birlik M et al (2006) Prevalence of ankylosing spondylitis and related spondyloarthritis in an urban area of Izmir Turkey. EULAR, Amsterdam

    Google Scholar 

  4. Arnett F, Edworthy S, Bloch D et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  5. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  PubMed  Google Scholar 

  6. Gülfe A, Geborek P, Saxne T (2005) Response criteria for rheumatoid arthritis in clinical practice: how useful are they. Ann Rheum Dis 64:1186–1189

    Article  PubMed  Google Scholar 

  7. Kucukdeveci AA, Sahin H, Ataman S (2004) Issues in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum 51(1):14–19

    Article  PubMed  Google Scholar 

  8. Hochberg MC, Chang RW, Dwash I et al (1992) The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum 35:498–502

    Article  PubMed  CAS  Google Scholar 

  9. Sany J, Bourgeois P, Saraux A et al (2004) Characteristics of patients with rheumatoid arthritis in France: a study of 1109 patients managed by hospital based rheumatologist. Ann Rheum Dis 63:1235–1240

    Article  PubMed  CAS  Google Scholar 

  10. Heuft-Dorenbosch L, Spoorenberg A, von Tubergen A et al (2003) Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 62(2):127–132

    Article  PubMed  CAS  Google Scholar 

  11. Bostan EE, Borman P, Bodur H (2003) Functional disability and quality of life in patients with ankylosing spondylitis. Rheumatol Int 23(3):121–126

    PubMed  Google Scholar 

  12. Akkoç Y, Karatepe AG, Asar S et al (2005) A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 25(4):280–284

    Article  PubMed  Google Scholar 

  13. Yanık B, Gürsel YK, Kutlay S et al (2005) Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and validity: functional assessment in AS. Clin Rheumatol 24(1):41–47

    Article  PubMed  Google Scholar 

  14. Braun J, Dougados M, Sieper J et al (2006) First update of the international ASAS consensus statement for the use of anti-TNF agents in patients with ankylosing spondylitis. Ann Rheum Dis 65:316–320

    Article  PubMed  CAS  Google Scholar 

  15. Conover WJ (1980) Practical nonparametric statistics, 2nd edn. Wiley, New York, p 229–239

    Google Scholar 

  16. Çalgüneri M, Üreten K, Öztürk A et al (2006) Extraarticular manifestation of rheumatoid arthritis: results of a university hospital of 562 patients in Turkey. Clin Exp Rheumatol 24(3):305–308

    PubMed  Google Scholar 

  17. Carmona L, Gonzalez-Alvaro I, Balsa A (2003) Rheumatoid arthritis in Spain: occurrence of extraarticular manifestations and estimates of disease severity. Ann Rheum Dis 62:897–900

    Article  PubMed  CAS  Google Scholar 

  18. Aletaha D, Smolen JS (2002) The rheumatoid arthritis patient in the clinic: comparing more than 1300 consecutive DMARD courses. Rheumatology 41:1367–1374

    Article  PubMed  CAS  Google Scholar 

  19. Zink A, Listing J, Niewerth M et al (2001) The national database of the German Collaborative Arthritis Centres: II. Treatment of patients with rheumatoid arthritis. Ann Rheum Dis 60:207–213

    Article  PubMed  CAS  Google Scholar 

  20. Baek HJ, Shin KC, Lee YJ et al (2004) Clinical features of adult-onset ankylosing spondylitis in Korean patients: patients with peripheral joint disease (PJD) have less severe spinal disease course than those without PJD. Rheumatology 43:1526–1531

    Article  PubMed  CAS  Google Scholar 

  21. Uppal SS, Abraham M, Chowdhury RI et al (2006) Ankylosing spondylitis and undifferentiated spondyloarthritis in Kuwait: a comparison between Arabs and South Asians. Clin Rheumatol 25(2):219–224

    Article  PubMed  CAS  Google Scholar 

  22. Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63:535–543

    Article  PubMed  CAS  Google Scholar 

  23. Sampaio-Barros PD, Bertolo MB, Kraemer MH et al (2001) Primary ankylosing spondylitis: patterns of disease in a Brazilian population of 147 patients. J Rheumatol 28(3):560–565

    PubMed  CAS  Google Scholar 

  24. Spoorenberg A, van Tubergen A, Landewe R et al (2005) Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology 44:789–795

    Article  PubMed  CAS  Google Scholar 

  25. Maksymowych WP (2004) Ankylosing spondylitis. Not just another pain in the back. Can Fam Physician 50:257–262

    PubMed  Google Scholar 

  26. Dagfinrud H, Kjeken I, Mowinckel P et al (2005) Impact of functional impairment in ankylosing spondylitis: impairment, activity limitation, and participation restriction. J Rheumatol 32:516–523

    PubMed  Google Scholar 

  27. Oniankitan O, Ranaivo N, Carton L et al (2005) Poorly and well controlled spondyloarthropathies: a comparison of 2 groups of patients. J Rheumatol 32:77–79

    PubMed  Google Scholar 

  28. Akkoç N, van der Linden S, Khan MA (2006) Ankylosing spondylitis and symptom-modifying vs disease-modifying therapy. Best Pract Res Clin Rheumatol 20(3):539–557

    Article  PubMed  Google Scholar 

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Bodur, H., Ataman, Ş., Akbulut, L. et al. Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis. Clin Rheumatol 27, 1119–1125 (2008). https://doi.org/10.1007/s10067-008-0877-1

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  • DOI: https://doi.org/10.1007/s10067-008-0877-1

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