Claudiu Popescu, Warda Abukar, Alexandra Hutan and Denisa Predeteanu

ABSTRACT

Objective. This exploratory study aimes at comparing Romanian gout patients with or without colchicine treatment in order to determine if colchicine is associated with a lower cardiovascular morbidity.
Methods. The study was cross-sectionally designed to include all the patients randomly admitted to the hospital between January and July 2015 and discharged with a diagnosis of idiopathic gout according to their attending physicians. The clinical observation sheets served as retrospective sources of information regarding study variables (demographics, addictive behavior, gout phenotype and treatment, cardiovascular morbidity). Data analysis included non-parametric tests and binary logistic regressions (significant if p < 0.05).
Results. The sample included 96 subjects, predominantly men (77.1%), with a mean age of 62.7 years. 60 (62.5%) subjects received colchicine. Compared to patients who didn‘t receive colchicine, they had a significantly lower prevalence of ischemic heart disease, chronic heart failure and atherosclerosis (p < 0.05). Colchicine was a significant protective factor for atherosclerosis (OR = 0.243; 95% CI: 0.076-0.784).
Conclusions. Primary and secondary cardiovascular prevention may benefit from low doses of colchicine. Further prospective blind randomized clinical trials are needed to test these hypotheses.

Keywords: colchicine, atherosclerosis, chronic heart failure, gout

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Claudiu Popescu, Jasmin Mehrabi, Denisa Predeteanu and Cătălin Codreanu

ABSTRACT

Objectives. The study aims at comparing classical and biological treatment of ankylosing spondylitis (AS) in terms of efficacy and to determine which treatment type is a significant predictor of low disease activity in a reallife clinical situation.
Methods. The study was cross-sectionally designed to include all the patients randomly admitted between January and July 2015 to the “Sfanta Maria” Clinical Hospital Department of Rheumatology and discharged with a diagnosis of AS according to their attending physicians. The retrospectively collected variables (demographics, disease phenotype and activity, treatment, laboratory measures) were analyzed using appropriate statistical tests (Mann Whitney, χ2, linear and logistic regression).
Results. The study sample included 105 cases of established AS with a mean age of 43.2 years: 64 patients (60.9%) were on tumor necrosis factor inhibitors (TNFi: adalimumab, etanercept or infliximab), 55 (52.4%) took non-steroidal anti-inflammatory drugs (NSAIDs) and 30 (28.6%) had sulfasalazine. TNFi were associated with lower disease activity compared to NSAIDs and sulfasalazine and they were significant predictors for low BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), either as mono-therapy or combined with NSAIDs and/or sulfasalazine.
Conclusion. TNFi are more efficacious than NSAIDs and sulfasalazine for the treatment of AS. A combination of TNFi with NSAIDs (and sulfasalazine for peripheral arthritis) would be the ideal therapeutic association.

Keywords: ankylosing spondylitis, TNF inhibitors, NSAIDs, sulfasalazine

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Claudia Deaconu, Daniela Opris, Diana Mazilu, Laura Groseanu, Andreea Borangiu, Saulescu Ioana, Alexandra Peltea, Magdalena Negru, Cosmin Constantinescu, Violeta Vlad, Violeta Bojinca, Andra Balanescu, Denisa Predeteanu and Ruxandra Ionescu

ABSTRACT

Background/Objective. Disease activity in spondyloarthritis (SpA) is evaluated through conventional scores such as BASDAI or ASDAS. The aim of this study was to determine disease activity in SpA patients under biological therapy with further assessment on the quality of each activity indicator and their clinical value together with their impact on NSAID intake.
Materials and methods. Over nine months (January–August 2015) we enrolled 100 patients with SpA on anti-TNF therapy (33% IFX; 35% ADL; 32% ETA). We collected demographic, clinical (BASDAI, ASDAS, PtGA) and laboratory data (ESR, CRP). Frequency of NSAID ingestion expressed as days per week was included in a questionnaire. Considering their biologic treatment, patients were divided into disease activity groups and sample characteristics were correlated and compared. Statistical analysis was performed with SPSS 20.0, using specific tests such as Pearson, Spearman or ANOVA.
Results. Patients with active disease, stated by both activity scores had an increased NSAID intake. Out of 86% of patients with a BASDAI under 4, only 82.6% had an ASDAS-CRP lower than 1.3. BASDAI correlated to both ASDAS scores (r = 0.65 and 0.71, P<0.001) and PtGA correlated to both disease activity scales, with a stronger correlation to BASDAI (r = 0.912, P<0.01) than ASDAS (r = 0.67 and 0.71, P<0.01 for both).
Conclusion. We proved that disease activity scores have good discriminatory power, with a strong correlation between the subjective BASDAI and PtGA. However, ASDAS-CRP proves to be more rigorous than other variables when targeting high and low disease activity, thus indicating the need of an objective component in assessing these patients.

Keywords: spondyloarthritis, disease activity scores, discriminatory power, anti-TNF therapy

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