Current Rheumatology Reviews - Online First

Earlier treatment in axial spondyloarthritis (axSpA) was proposed to alter disease prognosis in this often-challenging condition. We aimed to assess the proportion of patients and prognostic factors associated with axSpA remission.

The aim was to determine the number of patients with Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) of <2.1 (inactive/moderate disease activity). We also evaluated global functioning and health using the Assessment of Spondyloarthritis International Society-Health Index (ASAS-HI).

Patients with axSpA who were receiving targeted synthetic/biological disease-modifying anti-rheumatic drug (ts/bDMARDs) treatments and visited the rheumatology units at two tertiary-care centers between December 2021 and December 2022 were prospectively interviewed. Data regarding patient demographics, disease features, active and previous ts/bDMARDs treatments, and disease activity scores were obtained. Patients were assessed using the ASDAS-CRP, ASDAS-erythrocyte sedimentation rate (ASDAS-ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and ASAS-HI.

Overall, 60 patients with axSpA were included in this study (women, n = 35); 25 (41.7%) and 36 (62.1%) achieved an ASDAS-CRP of <2.1 and an ASAS-HI of ≤5 (good health), respectively. Out of the 60 patients, 75% (n = 45) were treated with anti-tumor necrosis factor. Factors associated with achieving the target ASDAS-CRP included age (p = 0.019), sex (p = 0.015), employment status (p = 0.015), education level (p = 0.030), and the number of previous ts/bDMARDs treatments (p = 0.019). Additionally, the ASDAS-CRP strongly correlated with spinal pain and moderately correlated with the ASAS-HI, BASDAI, and the number of previous ts/bDMARDs treatments.

Remission was observed in 41.7% of patients, indicating a challenge in achieving target disease activity. However, 62.1% attained good health. Achieving remission was associated with younger age, male sex, a higher level of education, lower level of spinal pain, better global function by ASAS-HI, employment, and receiving their first ts/bDMARDs treatment. Our findings may potentially improve disease prognosis with the earlier use of ts/bDMARDs in those without favorable features by implementing an early axSpA intervention strategy.

The aim of this study is to investigate the effect of a high oral dose of omega-3 on serum magnesium (Mg) and calcium (Ca) levels and their effects on clinical measures of pain threshold.

One hundred twenty patients were recruited and randomized 1:1 to omega-3 or placebo and blinded to their treatment group. At baseline and after 8 weeks of treatment, the Widespread Pain Index (WPI), the Symptom Severity Scale (SSS), the Visual Analogue Scale (VAS), and the FM Impact Questionnaire (FIQ) were completed. In addition, serum was taken for Ca and Mg analysis at the same time point.

The WPI, SSS, VAS, and FIQ scores improved significantly in the omega-3 group compared to the placebo group (P < 0.001). Serum Ca levels correlated negatively with WPI (r = - 0.308), SSS (r = -0.28), VAS (r = -0.311), and FIQ (r= -0.348) scores (P < 0.001) after 8 weeks of treatment. Serum Mg levels were negatively correlated with SSS (r = -0.212) and VAS (r = -0.231) scores after 8 weeks of treatment. The difference between serum Ca levels before and after 8 weeks of omega-3 treatment and serum Mg levels increased significantly compared to 8 weeks of placebo treatment.

The results of this study showed that a high dose of omega-3 could have a positive effect on the relief of FM pain, which could be due to an increase in serum Mg and Ca levels.