Monitoring ankylosing spondylitis: clinically useful markers and prediction of clinical outcomes

Abstract

Patient assessment in axial spondyloarthritis (axSpA) is multidimensional, and monitoring of disease activity, function and radiographic progression is complex. There is no simple ‘gold standard’ for measuring disease activity in all individual patients, as disease activity in axSpA is the sum of many different aspects and a complexity that cannot be represented by a single variable. Limited spinal mobility is a cardinal sign of ankylosing spondylitis and loss of spinal mobility has been reported to be a prognostic factor and most often evaluated with the Bath Ankylosing Spondylitis Functional Index. Imaging of the spine and assessment of safety aspects plays an important role in the monitoring of patients with axSpA. The timeframe for collecting information regarding disease activity, function and radiographic progression are recommended on an individual basis.

Keywords:

• ankylosing spondylitis
• disease activity
• imaging
• mobility
• monitoring

Financial and competing interests disclosure

J Braun has received honoraria for talks, advisory boards, paid consultancies and grants from studies from AbbVie, Amgen, Bristol-Myers Squibb, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, UCB. X Baraliakos has received grant and research support and consultancy fees from AbbVie (Abbot), Amgen, Centocor, Chugai, MSD, Novartis, Pfizer, UCB and Wyeth. U Kiltz has received grant and research support and consultancy fees from AbbVie, MSD, Pfizer and USB. F Heldmann has received honoraria for being on advisory boards from USB, Chugai, and Jannsen-Cilag and has received honoraria for talks from UCB, Chugai and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Monitoring of disease activity, function, mobility and radiographic progression is of critical importance for the management of patients with spondyloarthritis.

• Safety monitoring of drug therapy with NSAIDs and TNF blocker is relevant for clinical routine.

• Evaluation of disease activity is complex and composite measures are superior in assessing multifactorial domains as disease activity.

• As spinal mobility is known to be a prognostic factor, it should be assessed regularly on an individual basis.

• Monitoring of patients treated with NSAIDs should focus on cardiovascular and gastrointestinal toxicity.

• Monitoring of patients treated with TNF blocker should focus on recognition of infectious diseases.