Sabrina Dadoun

Primary inefficacy of TNF inhibitors in patients with axial spondyloarthritis: a long-term follow-up of 25 patients

Objectives Primary inefficacy of TNF inhibitors (TNFi) for axial spondyloarthritis (axSpA) is infrequent. The objective of this study was to assess the long-term evolution and final diagnosis of patients with primary inefficacy of TNFi for axSpA. Methods This was a systematic retrospective study of all patients receiving a TNFi for axSpA in one tertiary referral centre. Patients had axSpA confirmed by a rheumatologist and were started on a first course of TNFi according to usual practice. If the rheumatologist interrupted treatment at 3 months for inefficacy, this was defined as primary inefficacy. Five to 10 years later, these patients were re-evaluated. Results Of 222 patients receiving a first TNFi for axSpA, 27 (12%) were considered as having primary inefficacy. These patients were more often females (48 vs 27%, P = 0.04), had higher functional impairment [BASDAI (0-100) 68 vs 42, P = 0.001] and less increased CRP (50 vs 78%, P = 0.008.) At the follow-up, 25 (92%) patients were re-evaluated: the diagnosis of axSpA was confirmed for 21/25 (84%) patients according to the Assessment of SpondyloArthritis criteria and 20/25 (80%) patients according to the rheumatologist; but 18/25 (72%) had at least one other cause of their symptoms from among OA, widespread pain syndrome or depression. A second TNFi was prescribed for 16 patients and was efficacious for 9 (56%). Conclusion Most patients with primary inefficacy had a confirmed diagnosis of axSpA, but they often had other causes of pain. We suggest that patients with primary inefficacy to TNFi should be screened for comorbidities that may interfere with axSpA activity assessment.

Functional restoration programs in patients with chronic low back pain and body composition: No change in muscle mass assessed through Dual X-ray absorptiometry in 94 patients, a monocenter longitudinal study

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 12 mars 2016

AB0791 Why Do Patients with Axial Spondyloarthritis (AXSPA) Perform Little Aerobic Exercise? A Study of Perceived Barriers and Benefits in 153 Axspa Patients

Background Regular exercise is considered a cornerstone of axSpA treatment, together with medication (1). However, only around half the patients reach the levels of physical activity recommended for health-enhancement and very few regularly perform aerobic exercise (2). Understanding why could help motivate axSpA patients to exercise more. Objectives To explore the benefits and barriers to physical exercise in axSpA patients. Methods A cross-sectional study was performed in two tertiary care hospitals and one office-based practice in France (2). Patients had definite axSpA according to the rheumatologist. Auto-questionnaires evaluating the frequency and type of aerobic exercise, and perceived benefits of and barriers to exercising through the Exercise Benefits/Barriers Score (EBBS) (3), were collected. EBBS comprises 43 items categorised into 5 subscales for benefits (life enhancement, physical performance, psychological outlook, social interaction and preventive health) and 4 subscales for barriers (exercise milieu, time expenditure, physical exertion, family discouragement). Analyses were comparative between men and women. Results In all, 153 patients were analysed: mean age, 45.7±11.1 years, mean disease duration 14.2±9.7 yrs, mean BASDAI (0-100) 36.7±20.7, mean BASFI (0-100) 28.1±25.5, mean BMI 25.2±4.8 kg/m2; 56.2% were men. The main benefits of exercise (for which more than 90% of patients agreed or strongly agreed with the item) were all in the ‘physical performance’ subscale. Highest agreement was found for: improving functioning of cardiovascular system (94.8%), increasing muscle strength (93.5%), level of physical fitness (92.8%), stamina (90.9%), and for women: flexibility (91.0%). The three main barriers were ‘people looking funny in exercise clothes’ (87.6%), ‘too few places to exercise’ (80.4%), and ‘lack of encouragement from family members’ (81.1%). Results were similar for men and women. Conclusions The main barriers to exercising for axSpA patients were ‘exercise milieu’ problems and ‘family discouragement’ while the main perceived benefit was a better physical performance. These findings could be helpful when encouraging physical activity in axSpA patients. References Braun J et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011;70:896–904. Fabre S, et al. Do Patients with Axial Spondyloarthritis (AxSpA) Perform Enough Physical Activity? a Cross-Sectional Study of 207 Patients. Arthritis Rheum 2014, 66(suppl):S1125. Sechrist KR, et al. Development and psychometric evaluation of the exercise benefits/barriers scale, Res Nurs Health 1987;10:357-65. Disclosure of Interest None declared