Rheumatology Advance Access originally published online on August 16, 2005
Rheumatology 2005 44(10):1277-1281; doi:10.1093/rheumatology/keh713
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The unmet need for anti-tumour necrosis factor (anti-TNF) therapy in ankylosing spondylitis
Academic Unit of Musculoskeletal Disease, Department of Rheumatology, First Floor, The General Infirmary, Great George Street, Leeds LS1 3EX and 1 Academic Unit of Musculoskeletal Disease, Department of Rehabilitation, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, UK.
Correspondence to: P. Emery, arc Professor of Rheumatology, Clinical Director—Leeds Teaching Hospitals Trust, Academic Unit of Musculoskeletal Disease, Department of Rheumatology, 1st Floor, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. E-mail: p.emery{at}leeds.ac.uk
Objectives. Anti-tumour necrosis factor (anti-TNF) therapy is effective in the treatment of ankylosing spondylitis (AS), but guidelines are needed because of the cost. The primary aim of this study was to evaluate the proportion of patients with AS who meet the criteria for anti-TNF therapy as well as to explore the relationship between disease activity, health status and quality of life in patients with AS who would potentially meet the criteria compared with those who would not.
Methods. All patients with a confirmed diagnosis of AS were identified via a search through the clinic correspondence database and sent postal questionnaires. Data captured included demographics, disease activity, aspects of functional impairment, activity limitation and quality of life using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), pain scores (using a visual analogue scale), the Bath Ankylosing Spondylitis Functional Index (BASFI), Health Assessment Questionnaire (HAQ), short-form 36 (SF-36) and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. The unpaired Student's t-test, 
2 test and Mann–Whitney U-test were performed for comparisons of groups where appropriate.
Results. Out of 325 mailed questionnaires, 246 (76%) were returned. The mean age of the patients who replied to the questionnaire was 52 yr (±12 yr) and 25% (62) were females. Mean BASDAI was 49 (±24) and 64% had a BASDAI 
40. There were significant differences between the groups with a BASDAI above and below 40 in pain by VAS, functional ability (BASFI, HAQ), health status (SF-36) and quality of life (ASQoL). Almost two-thirds (64%) of patients would meet the criteria for anti-TNF therapy under recommended guidelines.
Conclusion. Patients with AS demonstrated poor functional status and poor quality of life. There is a large unmet need for effective therapy in AS, with almost two-thirds of patients meeting the proposed criteria for biological therapy. Patients with a BASDAI 40 had a worse functional status and quality of life than those who have a BASDAI of <40. These results indicate that the need for effective intervention for AS is a priority area.
KEY WORDS: Ankylosing spondylitis, Anti-tumour necrosis factor therapy, Disease activity, Functional status, Quality of life
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