Frequency and characteristics of disease flares in ankylosing spondylitis

• Published in: Rheumatology (Oxford, England) England), 2010-05, Vol.49 (5), p.929-932
• Main Authors: Cooksey, Roxanne, Brophy, Sinead, Gravenor, Mike B., Brooks, Caroline J., Burrows, Claire L., Siebert, Stefan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ankylosing spondylitis; Biological and medical sciences; Clinical Science; Cohort Studies; Disease activity; Diseases of the osteoarticular system; Diseases of the spine; Female; Functional impairment; Humans; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Randomized Controlled Trials as Topic; Severity of Illness Index; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - physiopathology; Statistics as Topic; Surveys and Questionnaires; Time Factors; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - therapeutic use; Young Adult
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kep435

Objective. To examine the characteristics and frequency of disease flares in a cohort of people with AS. Methods. A prospective data set from a randomized controlled trial (RCT) of a probiotic treatment/placebo was utilized to examine disease flares in 134 people with AS. Disease flares were defined as either minor/localized flares (pain/swelling localized to one area with fatigue and stiffness) or major/generalized flares (generalized pain, hot burning joints, muscle spasm, fever, sweating, extreme fatigue and stiffness). Results. One hundred and thirty-four people were followed up for 1216 person follow-up weeks and there were 71.4 flares per 100 person-weeks. Of these, 12 were major/generalized flares and 59.4 were minor/localized flares. People who experienced at least one major/generalized flare during the study period had worse disease during flare-free periods in terms of disease activity, impaired function, self-reported night pain and iritis compared with those who did not experience any major/generalized flares during the study. Major/generalized flares lasted for an average of 2.4 weeks (s.d. 2.7), and were preceded by and followed by a minor/localized flare in 92% (55/60) of cases. Conclusion. Seventy per cent of people with AS felt they had a flare in any given week. Those who experienced major/generalized flares appear to have more severe and active disease even during periods when not in flare, compared with those who do not experience major/generalized flares. These results have implications for the timing of assessments prior to starting anti-TNF therapy and suggest that the presence of major flares may be helpful in identifying patients with severe disease.