Relationship between certainty of axSpA and treatemnt response

Abstract

Objective: The objective of this study was to investigate, if there was a difference in treat-ment outcome, when comparing patients with ‘certain’ axSpA, who fulfil the ASAS classification criteria, and patients with clinical axSpA, who do not meet these crite-ria. Methods: A retrospective cohort study reviewing medical records, where clinical information was collected from electronic journal systems and a clinical online database, DANBIO. Additionally, MRI was reviewed by a specialist in radiology. Clinical and imaging in-formation was collected to determine, if patients received a ‘certain’ or a clinical axSpA diagnosis. This study employed various statistical methods. Logistic regression analysis was used to evaluate the presence of a reduction in BASDAI ≥ 20, and exam-ined the potential disparities between the two groups. A linear mixed-effects model was utilised to understand the disease burden for each course of treatment, and was calculated as a linear normalised time-weighted BASDAI average. A Kaplan Meier plot was computed for treatment adherence. Results: Out of the 129 patients included in this study, 71 were classified as having a 'cer-tain' diagnosis and 58 were classified as having a clinical diagnosis. No statistically significant difference in treatment response was found, when comparing patients in the two groups. Further, it was found that patients with a ‘certain’ diagnosis adhere to treatment for a longer period of time compared to patients with a clinical diagno-sis, though this finding was not significant (p = 0.078). Nevertheless, generally, treatment was associated with a decline in BASDAI scores for both groups, but over-lapping confidence intervals indicate no statistically significant differences. However, treatment with bDMARDs resulted in a greater reduction in BASDAI score than treat-ment with NSAIDs, regardless of the axSpA diagnosis (p < 0.05). Conclusion: This study found no discernible difference in treatment response between patients with ‘certain’ and clinical axSpA diagnoses. While ‘certain’ diagnoses appeared to have longer treatment adherence and potentially more effectiveness, this finding also lacks statistical significance. Nevertheless, treatment decreased disease activity for both groups, questioning the relevance of strict adherence to classification criteria.

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A master thesis from Aalborg University

Relationship between certainty of axSpA and treatemnt response