Extraskeletal Manifestations in Axial Spondyloarthritis Are Associated With Worse Clinical Outcomes Despite the Use of Tumor Necrosis Factor Inhibitor Therapy

Objective. To investigate the prevalence and 4-year incidence of acute anterior uveitis (AAU), inflammatory bowel disease (IBD) and psoriasis (PsO), and to explore associations of newly developed extraskeletal manifestations (ESMs) with clinical disease outcome in a large cohort of patients with axial spondyloarthritis (axSpA). Methods. All consecutive patients included in the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort between 2004 and 2011 were analyzed. History of ESMs at baseline and newly developed ESMs during 4-year follow-up were only recorded when diagnosis by an ophthalmologist, gastroenterologist, or dermatologist was present. Results. Of the 414 included patients with axSpA, 31.4% had a positive history of ≥ 1 ESMs: 24.9% AAU, 9.4% IBD, and 4.3% PsO. History of PsO was significantly associated with more radiographic damage, especially of the cervical spine. Of the 362 patients with 4-year follow-up data, 15.7% patients developed an ESM: 13.3% patients had AAU (of which 3.6% had a first episode and 9.7% had recurrent AAU), 1.9% developed IBD, and 0.8% developed PsO. Patients with newly developed ESMs (without history of ESMs) had worse Ankylosing Spondylitis Quality of Life scores (mean 10.0 vs. 5.8, P = 0.001), larger occiput-wall distance (median 6.3 vs. 2.0, P = 0.02) and more limited modified Schober test (mean 12.6 vs. 13.6, P = 0.01) after 4 years of follow-up. The majority of patients developing an ESM used anti–tumor necrosis factor therapy. Conclusion. History of ESMs was present at baseline in one-third of patients with axSpA. The 4-year incidence of ESMs was relatively low, but patients who developed a new ESM reported worse quality of life

Although female patients with ankylosing spondylitis score worse on disease activity than male patients and improvement in disease activity is comparable, male patients show more radiographic progression during treatment with TNF-alpha inhibitors

Background: The clinical presentation of ankylosing spondylitis (AS) differs between genders. Our aim was to investigate differences in disease activity, disease outcome and treatment response between male and female AS patients before and after starting tumor necrosis factor (TNF)-alpha inhibitors in daily clinical practice.Methods: Patients from the Groningen Leeuwarden AS (GLAS) cohort who started TNF-alpha inhibitors and who had visits at baseline and after 3 months and/or 2 years of follow-up were included.Results: Of 254 included AS patients, 69% were male. At baseline, female patients scored significantly higher on BASDAI, ASDAS, and tender entheses than male patients. In contrast, CRP, swollen joints, and history of extra-articular manifestations were comparable between genders. Women experienced significantly worse physical function and QoL, whereas men showed significantly more kyphosis and spinal radiographic damage. After 3 months and 2 years of follow-up, all clinical assessments improved significantly, with comparable mean change scores for female and male patients; mean 2-year change in BASDAI -2.7 vs. -2.7, ASDAS -1.50 vs. -1.68, tender entheses -2.4 vs. -1.4, CRP -8 vs. -8, BASFI -2.2 vs. -2.1 and ASQoL -5 vs. -4, respectively. Radiographic progression was significantly higher in male patients. Female patients switched more frequently to another TNF-alpha inhibitor during 2 years of follow-up (32% vs. 14%).Conclusion: Although female patients experienced higher disease activity, worse physical function and quality of life, and switched TNF-alpha inhibitors more often, clinical improvement during treatment with TNF-alpha inhibitors was comparable between genders. However, male patients showed more radiographic spinal damage after 2 years. (C) 2018 Elsevier Inc. All rights reserved.</p

Central sensitization has major impact on quality of life in patients with axial spondyloarthritis

Introduction: Persistent pain has large potential impact on quality of life (QoL). During the course of the disease, many patients with axial spondyloarthritis (axSpA) report persistent pain. Central sensitization (CS) may explain part of this chronic pain. However, the role of CS in relation to QoL has been sparsely studied in axSpA. Therefore, our aim was to explore the relationship between CS and QoL in patients with axSpA. Methods: Consecutive outpatients from the Groningen Leeuwarden axSpA (GLAS) cohort completed the Central Sensitization Inventory (CSI; range 0–100) and the AS Quality of Life (ASQoL; range 0–18). Multivariable linear regression analysis was used to explore the relationship between CSI and ASQoL scores correcting for potential confounders. Results: Of the 178 included axSpA patients, mean CSI score was 38.0 ± 14.1 and 45% scored ≥40, which indicates a high probability of CS. Mean ASQoL score was 6.0 ± 5.3 and mean ASDASCRP 2.1 ± 1.0. A CSI score ≥40 was significantly associated with higher ASQoL score (mean 9.7 vs. 3.3), higher ASDASCRP (mean 2.6 vs. 1.7), female gender (60% vs. 29%) and more often entheseal involvement (61% vs. 26%). In univariable analysis, CSI score explained a large proportion of the variation in ASQoL (B = 0.06, 95%CI: 0.05–0.07; R2=0.46). This association remained significant after correction for ASDASCRP, gender, entheseal involvement, comorbidities, symptom duration, smoking status, BMI class and educational level (B = 0.04, 95%CI: 0.03–0.05). Conclusion: CS is strongly related to patient-reported QoL in patients with axSpA independently from other patient- and disease-related aspects

Bone mineral density improves during 2 years of treatment with bisphosphonates in patients with ankylosing spondylitis

Aims: To evaluate whether 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements has an effect on lumbar spine and hip bone mineral density (BMD) in ankylosing spondylitis (AS) patients starting tumour necrosis factor-α inhibitors or receiving conventional treatment. Secondly, to explore the development of radiographic vertebral fractures. Methods: Patients from the Groningen Leeuwarden AS cohort receiving bisphosphonates based on clinical indication and available 2-year follow-up BMD measurements were included. BMD of lumbar spine (L1–L4) and hip (total proximal femur) were measured using dual-energy X-ray absorptiometry. Spinal radiographs (Th4–L4) were scored for vertebral fractures according to the Genant method. Results: In the 20 included patients (median 52 years, 14 males), lumbar spine and hip BMD Z-scores increased significantly; median from −1.5 (interquartile range [IQR] −2.2 to 0.4) to 0.1 (IQR −1.5 to 1.0); P <.001 and median from −1.0 (IQR −1.6 to −0.7) to −0.8 (IQR −1.2 to 0.0); P =.006 over 2 years, respectively. In patients also treated with tumour necrosis factor-α inhibitors (n = 11), lumbar spine and hip BMD increased significantly (median 2-year change +8.6% [IQR 2.4 to 19.6; P =.009] and +3.6% [IQR 0.7–9.0; P =.007]). In patients on conventional treatment (n = 9), lumbar spine BMD increased significantly (median 2-year change +3.6%; IQR 0.7 to 9.0; P =.011) and no improvement was seen in hip BMD (median −0.6%; IQR −3.1 to 5.1; P =.61). Overall, younger AS males with limited spinal radiographic damage showed most improvement in lumbar spine BMD. Four mild radiographic vertebral fractures developed in 3 patients and 1 fracture increased from mild to moderate over 2 years in postmenopausal women and middle-aged men. Conclusion: This explorative observational cohort study in AS showed that 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements significantly improves lumbar spine BMD. Mild radiographic vertebral fractures still occurred

Instrumentanalyse natuur en landschap; een analyse naar de kansrijkheid van een aantal beleidsinstrumenten ter verbreding van financiering van natuur

Via het Ministerie van Landbouw, Natuur en Voedselkwaliteit (LNV) draagt het Rijk een onevenredig groot deel van de kosten van verwerving, beheer en inrichting van natuurterreinen. LNV wil de mogelijkheden onderzoeken om deze situatie te verbeteren via verbrede financiering van natuur. Hierbij worden meer middelen voor natuur gegenereerd en meer actoren bij natuur betrokken. De studie beoogt de instrumenten zo te beschrijven dat ze eenvoudig kunnen worden vergeleken. Hiertoe zijn de volgende stappen gezet: - het formuleren van een schema voor de uniforme beschrijving van de instrumenten - het verzamelen van informatie over en beschrijven van de instrumenten, - de invulling van het schema - het opstellen van een comparatief overzicht voor de globale vergelijking van de instrumenten Het verkregen overzicht kan samen met de uitgebreidere beschrijving van de instrumenten door beleidsmakers worden gebruikt bij de keuze een of meer van deze instrumenten in te zette

Is the uncertain self good at detecting lies?: The influence of personal uncertainty on deception detection

Five experiments (total number of judging participants = 1309, four different kinds of stimulus materials with a total of 464 messages, total number of judgements = 19,634) investigated the influence of personal uncertainty on the process of lie detection in social relationships. Building on and extending basic assumptions of uncertainty management models, we reasoned that uncertainty about themselves motivates people to evaluate the quality of their relationships. A crucial aspect of the quality of relationships with other people is the truthfulness with which they communicate verbally with you and anyone else. We proposed that if these assumptions are valid, reminding people of their personal uncertainties should lead them to use valid verbal cues in veracity judgements more. This enhanced usage of valid verbal cues should result in better accuracy in deception detection. An internal meta-analysis of the five experiments reveals only a small, not significant, overall effect of uncertainty salience on detection accuracy with larger effect sizes for experiments conducted in the laboratory than for those conducted online. Hence, if personal uncertainty plays a role in the process of deception detection, it seems to be subject to moderators such as methodological or motivational factors

Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis

OBJECTIVES: Many patients with axial spondyloarthritis (axSpA) report persistent pain even when treated with anti-inflammatory agents. Our aim was to explore the presence of central sensitization (CS) and different types of illness perceptions in patients with axSpA, and to assess their associations with disease activity assessments. METHODS: Consecutive outpatients from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort were included. Besides standardized assessments, patients filled out the Central Sensitization Inventory (CSI), Illness Perception Questionnaire (IPQ-R) and Pain Catastrophizing Scale (PCS). Univariable and multivariable linear regression analyses were used to investigate the association between questionnaire scores, patient characteristics and disease activity assessments ASDAS(CRP), BASDAI and CRP. RESULTS: We included 182 patients with a mean symptom duration of 21.6 years. Mean ASDAS(CRP) was 2.1, mean BASDAI 3.9, and median CRP 2.9. Mean CSI score was 37.8 (scale 0–100) and 45% of patients scored ≥40, indicating a high probability of CS. CSI score, IPQ-R domain identity (number of symptoms the patient attributes to their illness), and IPQ-R domain treatment control (perceived treatment efficacy), and obesity were significantly and independently associated with both ASDAS(CRP) and BASDAI, explaining a substantial proportion of variation in these disease activity scores (R(2)=0.35 and R(2)=0.47, respectively). Only obesity was also independently associated with CRP. CONCLUSION: CS may be common in patients with long-term axSpA. CS, as well as specific illness perceptions and obesity were all independently associated with the widely used (partially) patient-reported disease activity assessments ASDAS(CRP) and BASDAI. Treating physicians should take this into account in the follow-up and treatment of their patients