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and 0&#46;29&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> quite similar to other European<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> and Asian countries&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Assessment of SpondyloArthritis International Society-European League Against Rheumatism &#40;ASAS-EULAR&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> and Spanish Society of Rheumatology &#40;SER&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> recommendations established as treatment goals for axSpA patients the reduction and&#47;or control of inflammation&#44; pain&#44; stiffness and fatigue&#44; maintenance of spinal flexibility and normal posture&#44; reduction of functional limitations&#44; maintenance of social relationships and work ability and lessening disease complications&#46; To deal with these objectives&#44; ASAS Group defined a core set of measures recommended for patients follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> Also&#44; ASAS-EULAR recommendations did recommend a treat-to-target approach&#44; but ACR&#47;SAA&#47;SPARTAN did not&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> In clinical practice&#44; ASAS-EULAR and SER recommend Bath Ankylosing Spondylitis Disease Activity Index &#40;BASDAI&#41; and Ankylosing Spondylitis Disease Activity Score preferentially using C-reactive protein &#40;ASDAS-CRP&#41; to assess disease activity in axSpA patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;12&#8211;14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Biologic disease-modifying antirheumatic drugs &#40;bDMARDs&#41; as tumor necrosis factor inhibitors &#40;TNFi&#41; and interleukin 17 inhibitors have transformed the treatment options especially for those patients with high disease activity&#46; ASAS&#47;EULAR and SER recommend the use of biologics for patients with high disease activity despite conventional treatment&#44; which includes non-steroidal anti-inflammatory drugs &#40;NSAIDs&#41; and non-biologic disease-modifying antirheumatic drugs &#40;nbDMARDs&#41;&#44; in case of some concomitant peripheral or extraarticular manifestations&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> However&#44; not all patients have their disease controlled&#44; indicating a need for alternative therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The Atlas 2017 survey<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> contributed to the understanding of the reality of people suffering from axSpA and revealed a long diagnostic delay&#44; high disease activity&#44; psychological distress and an important proportion of these patients being undertreated&#46; Also REGISPONSER&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> a Spanish registry of axSpA patients&#44; provided data on the clinical and demographic profile of these patients&#44; including disease activity&#44; in clinical practice&#46; However&#44; data from this type of research is complemented by Real-World Evidence &#40;RWE&#41; studies&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some studies in AS patients have been carried out regarding different outcomes &#40;disease burden&#44; physical function&#44; quality of life&#44; etc&#46;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;18</span></a> but disease progression remains poorly characterized due to the lack of studies focused on long-term outcomes in clinical practice settings&#46; As a result&#44; the accurate prediction of the AS patients&#8217; outcomes still is an ongoing challenge for clinicians&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> MiDAS emerged from the need to assess the level of disease activity control in AS patients treated in the everyday clinical practice&#46; This data may allow rheumatologists to improve their treatment strategies&#46; The aim of this study was to assess the percentage of AS patients treated in clinical practice who reached low disease activity or remission&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">MIDAS is a non-interventional&#44; cross-sectional&#44; retrospective&#44; and multicenter study conducted in 36 centers with outpatient rheumatology clinics in Spanish public hospitals between December 10th&#44; 2018 and August 14th&#44; 2019&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Two different cohorts including patients with AS and patients with psoriatic arthritis were studied&#59; here&#44; we present the results of the AS population&#46; The main objective was to evaluate the percentage of AS patients with low disease activity and remission in clinical practice based on the BASDAI and ASDAS-CRP scores&#44; according to present recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Cross-sectional data were collected during a single routine clinical visit including the primary endpoints as well as patients&#8217; questionnaires and questions about their perception on disease and pain control &#40;secondary endpoints&#41;&#46; Retrospective data from medical records and laboratory tests performed prior to patient&#39;s inclusion&#44; were also used and were recorded in an electronic Case Report Form specifically designed for MIDAS study&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Eligible patients were &#8805;18 years old with confirmed diagnosis of AS&#47;r-axSpA for &#8805;6 months before the inclusion&#44; were classified by the modified New York criteria and ASAS criteria&#44; were treated for &#8805;3 months and had a record of C-reactive protein &#40;CRP&#41; available in the month prior to the study visit&#46; Patients with severe concomitant diseases that could influence the evaluation of the rheumatic disease &#40;neoplasia&#44; other inflammatory diseases&#44; etc&#46;&#41; were excluded&#44; as well as those participating in any other clinical trial at the time of the inclusion&#46; Patients were required to provide informed consent prior to the study inclusion&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Each center included patients from its databases who met all the selection criteria&#44; in a randomized way&#46; For those centers where random selection was not possible&#44; inclusion was carried out consecutively according to the scheduled visits&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Spanish version of BASDAI<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> was used to assess the percentage of AS patients who presented controlled disease activity&#46; According to this version and following the system adopted by some authors&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> the average punctuation for each of the 6 questions was considered as final score&#44; with a resulting index score &#40;from 0 to 60&#41; which was divided by 6 to obtain a final BASDAI score &#40;from 0 to 10&#41;&#46; In MiDAS study&#44; BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 was considered as low disease activity and BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2 as remission&#59; since SER recommendations considered BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 as an acceptable control of the disease&#44; this cutoff was used to define controlled disease&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> For ASDAS-CRP score&#44; the cutoffs for low disease activity &#40;ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#41; and inactive disease &#40;ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#41; were applied&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study was performed according to the guidelines on observational post-authorization studies for medicinal products for human use specified in Order SAS&#47;3470&#47;2009 of the Spanish Agency of Medicines and Medical Devices and conducted according to Good Clinical Practice &#40;International Conference of Harmonization&#41; guidelines&#44; the Declaration of Helsinki and local regulations&#44; including privacy laws&#44; at the time of the initiation of the study&#46; The study protocol&#44; informed consent forms and information for patients were approved by the Ethical and Clinical Research Committee of the 12 de Octubre Hospital &#40;approval number 18&#47;437&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">National prevalence for AS was estimated around 0&#46;29&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> and internal data estimated that 50&#37; of AS patients were on treatment&#46; The proportion of patients with BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 was expected in a conservative estimation to be close to 50&#37; to allow the maximum sample size&#46; A minimum of 267 patients was considered necessary to estimate the primary endpoint with a precision of &#177;6&#37; in its 95&#37; confidence interval&#59; assuming that 15&#37; of patients may not meet the inclusion&#47;exclusion criteria&#44; a predicted number of 315 patients should be recruited to ensure enough power and a good precision&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Continuous variables were described by mean&#44; standard deviation &#40;SD&#41;&#44; median&#44; minimum&#44; maximum and&#44; depending on the distribution of the analyzed variable&#44; quartiles&#46; Descriptive analysis was based on evaluable data per parameter&#44; excluding patients with missing values&#46; Data were analyzed with Statistical Analysis System Enterprise Guide 7&#46;15&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">A total of 336 subjects were included in the study&#44; 313 &#40;93&#46;2&#37;&#41; of them evaluable&#46; 23 patients were considered non-evaluable due to not meeting inclusion and&#47;or exclusion criteria and&#47;or incomplete study data&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Baseline characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">Mean &#40;SD&#41; age of the patients was 50&#46;4 &#40;12&#46;0&#41; years&#44; mainly male &#40;75&#46;7&#37; &#91;237&#47;313&#93;&#41;&#44; 39&#46;9&#37; &#40;116&#47;313&#41; were overweight and 75&#47;313 &#40;24&#46;0&#37;&#41; patients were active smokers&#46; Mean &#40;SD&#41; disease duration was 15&#46;5 &#40;11&#46;6&#41; years and mean time &#40;SD&#41; between symptoms&#8217; onset and diagnosis was 5&#46;0 &#40;7&#46;2&#41; years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">At baseline&#44; 158&#47;313 &#40;50&#46;5&#37;&#41; patients had comorbidities&#44; the most frequent being hypertension &#40;21&#46;1&#37; &#91;66&#47;313&#93;&#41;&#44; dyslipidemia &#40;19&#46;5&#37; &#91;61&#47;313&#93;&#41; and diabetes mellitus &#40;8&#46;0&#37; &#91;25&#47;313&#93;&#41;&#46; Human leukocyte antigen-B&#42;27 &#40;HLA-B&#42;27&#41; was available in 92&#46;3&#37; &#40;289&#47;313&#41; of the patients and was positive in 78&#46;5&#37; &#40;245&#47;313&#41;&#46; The most recent mean &#40;SD&#41; CRP value was 5&#46;1 &#40;8&#46;2&#41; mg&#47;dl &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Monotherapy with biologicals and non-biologicals was used in 29&#46;7&#37; &#40;93&#47;313&#41; and 26&#46;8&#37; &#40;84&#47;313&#41; of the patients&#44; respectively&#44; while 43&#46;5&#37; &#40;136&#47;313&#41; received a combination of both therapies&#46; Overall&#44; alone or in combination&#44; 73&#46;2&#37; &#40;229&#47;313&#41; of the patients were treated with biologicals and 70&#46;3&#37; &#40;220&#47;313&#41; with non-biologicals &#40;53&#46;7&#37; &#91;168&#47;313&#93; with NSAIDs and 22&#46;4&#37; &#91;70&#47;313&#93; with nbDMARDs&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Regarding prescription of bDMARDs&#44; the most frequently used were TNFi &#40;87&#46;8&#37; &#91;201&#47;229&#93;&#41;&#44; followed by secukinumab &#40;11&#46;4&#37; &#91;26&#47;229&#93;&#41;&#59; adalimumab &#40;31&#46;9&#37; &#91;73&#47;229&#93;&#41; and etanercept &#40;19&#46;2&#37; &#91;45&#47;229&#93;&#41; were the most frequently used among TNFi users&#46; On the other hand&#44; the most prescribed non-biological treatments alone or combination with bDMARDs were NSAIDs &#40;76&#46;4&#37; &#91;168&#47;220&#93;&#59; COX-2 selective inhibitors were the most frequently used NSAIDs&#58; 51&#46;2&#37; &#91;86&#47;168&#93;&#41;&#44; followed by DMARDs &#40;31&#46;8&#37; &#91;70&#47;220&#93;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Mean &#40;SD&#41; time elapsed from the start of treatment to the study visit was 65&#46;6 &#40;51&#46;9&#41; months for biological treatments and 75&#46;2 &#40;77&#46;3&#41; months for nbDMARDs&#44; 74&#46;3 &#40;93&#46;4&#41; months for NSAIDs and 64&#46;8 &#40;92&#46;9&#41; months for corticosteroids&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Disease activity control</span><p id="par0105" class="elsevierStylePara elsevierViewall">According to BASDAI&#44; 64&#46;5&#37; &#40;202&#47;313&#41; of the patients showed adequate disease control &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; 38&#37; &#40;119&#47;313&#41; were in remission &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2&#41; and 26&#46;5&#37; with controlled disease &#40;2<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Overall&#44; mean &#40;SD&#41; BASDAI score was 3&#46;1 &#40;2&#46;2&#41;&#46; The single BASDAI items with highest scores were fatigue and spinal pain&#44; followed by morning stiffness &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Mean &#40;SD&#41; ASDAS-CRP score was 1&#46;9 &#40;1&#46;1&#41;&#59; 29&#46;4&#37; &#40;92&#47;313&#41; of the patients reached inactive disease status &#40;ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#41; and 28&#46;1&#37; &#40;88&#47;313&#41; low disease activity &#40;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#41;&#44; while 33&#46;5&#37; &#40;105&#47;313&#41; had high disease activity &#40;2&#46;1<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#41; and 8&#46;9&#37; &#40;28&#47;313&#41; very high disease activity &#40;ASDAS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">When analyzing subgroups according to the presence&#47;absence of peripheral disease&#44; the percentage of disease control according to BASDAI was lower for patients with peripheral involvement &#40;41&#46;9&#37; &#91;26&#47;62&#93;&#41; versus the subgroup without peripheral manifestations &#40;70&#46;1&#37; &#91;176&#47;251&#93;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Both&#44; BASDAI and ASDAS-CRP&#44; showed a higher value in those patients with peripheral arthritis&#44; mean &#40;SD&#41; of 4&#46;2 &#40;2&#46;4&#41; and 2&#46;4 &#40;1&#46;1&#41;&#44; respectively&#46; In patients without peripheral manifestations&#44; mean &#40;SD&#41; BASDAI and ASDAS-CRP scores were 2&#46;8 &#40;2&#46;1&#41; and 1&#46;8 &#40;1&#46;0&#41;&#44; respectively&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">It should be noted that&#44; each of the 6 items evaluated by BASDAI were higher in the subgroup with peripheral disease versus the subgroup without peripheral arthritis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">MiDAS study was designed to assess the disease activity state of AS patients treated in routine clinical practice in Spain&#46; The study shows that 64&#46;5&#37; of the patients achieved low disease activity status &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41; and 38&#46;0&#37; were in remission &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; while 57&#46;5&#37; and 29&#46;4&#37; of the patients had low disease or inactive disease&#44; respectively&#44; according to ASDAS-CRP&#46; This data is essential for the treating rheumatologist to understand the need for treatment optimization and continuous improvement of patient care&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Treatment target for AS patients is to achieve a state of inactive disease or low disease activity&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10</span></a> In clinical practice&#44; disease activity assessment is usually estimated by two scores&#58; BASDAI&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> which contains only subjective clinical elements&#44; and ASDAS-CRP&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;13</span></a> which incorporates one objective inflammation measure&#46; In this sense&#44; SER indicated that BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2 can be considered as remission&#44; while BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 is considered a reasonable control of disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Even though BASDAI has been historically widely used to define disease activity in AS patients&#44; ASAS-EULAR consider ASDAS score as the preferred measure since it combines patient-reported outcomes and CRP&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Also&#44; SER considers ASDAS-CRP as the main index to monitor disease activity&#44; considering acceptable an ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#44; although the therapeutic objective is to achieve an ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Different studies have compared and correlated the two outcomes measures used in our study&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23</span></a> The evidence accumulated supports the better discriminatory ability of ASDAS-CRP as a measure of disease activity in AS patients&#44; as well as for selecting patients for TNFi treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23</span></a> In our study&#44; ASDAS-CRP revealed a lower proportion of patients with low disease activity than those determined by BASDAI &#40;57&#46;5&#37; versus 64&#46;5&#37;&#44; respectively&#41;&#44; aligned with a study performed in real world setting&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The percentage of patients with BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 &#40;64&#46;5&#37;&#41; is higher than what has been previously reported ranging from 42&#37; to around 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;27</span></a> Similarly&#44; the proportion of patients reaching low disease activity based on the ASDAS-CRP score &#40;57&#46;5&#37;&#41; is slightly higher than the reported in previous studies&#44; ranging from 42&#37; to 52&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28&#44;29</span></a> These results could be explained by a higher introduction of the treat to target strategies in clinical practice or a higher use of bDMARDs in active AS patients&#44; aligned with the results of a recent RWE study which showed a better control of clinical symptoms in patients under TNFi treatment than those treated with NSAIDs&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The limitations of the MiDAS study include the retrospective&#44; cross-sectional design which does not collect longitudinal data to assess changes over time&#46; Furthermore&#44; since various treatments were not equally distributed within the study population&#44; the effectiveness of the most frequently used would have influenced the results significantly&#59; however&#44; this reflects the reality of the current clinical practice in Spain&#46; Finally&#44; as the patients included in this study were attending outpatient clinics from tertiary reference hospitals&#44; they may represent a population with more comorbidities and higher disease severity&#59; therefore&#44; cautious generalizability to the broader&#44; average AS population&#44; is needed&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">The MiDAS study&#44; by applying widely accepted outcome measures for disease control and remission as BASDAI and ASDAS-CRP&#44; showed that two thirds of the AS patients achieved low disease activity&#44; with one third being in remission&#46; These findings highlight that there is still room for improvement in the management of these patients in the everyday clinical practice in Spanish public hospitals and raise awareness that treatment optimization strategies are needed to improve patient care&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding statement</span><p id="par0160" class="elsevierStylePara elsevierViewall">This study was funding by <span class="elsevierStyleGrantSponsor" id="gs1">Novartis Farmac&#233;utica&#44; S&#46;A&#46;</span>&#44; who has been involved during all the process of the study&#44; including this manuscript&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Eugenio de Miguel</span> reports personal fees from Novartis&#44; during the conduct of the study&#59; grants and personal fees from Novartis&#44; grants and personal fees from Abbvie&#44; grants and personal fees from Pfizer&#44; personal fees from MSD&#44; personal fees from BMS&#44; personal fees from Janssen&#44; grants and personal fees from Roche&#44; personal fees from UCB&#44; personal fees from Lilly&#44; personal fees from Galapagos&#44; outside the submitted work&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Cristina Fern&#225;ndez-Carballido</span> reports personal fees from Novartis&#44; during the conduct of the study&#59; personal fees from Abbvie&#44; personal fees from Celgene&#44; personal fees from Janssen&#44; personal fees from Lilly&#44; personal fees from MSD&#44; personal fees from Novartis&#44; personal fees from Pfizer&#44; personal fees from Roche&#44; personal fees from UCB&#44; outside the submitted work&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Jordi Gratac&#243;s</span> reports personal fees from Novartis&#44; during the conduct of the study&#59; grants and personal fees from MSD&#44; grants and personal fees from Pfizer&#44; grants and personal fees from Abbvie&#44; grants and personal fees from Janssen&#44; grants and personal fees from Lilly&#44; grants and personal fees from Amgen&#44; outside the submitted work&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Jos&#233; L&#46; Pablos</span> reports personal fees from Pfizer&#44; personal fees from Novartis&#44; personal fees from Roche&#44; personal fees from Abbvie&#44; personal fees from Sanofi&#44; personal fees from Bristol&#44; personal fees from Gilead&#44; personal fees from Galapagos&#44; during the conduct of the study&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Xavier Juanola</span> reports and Personal Fees&#58; Monies paid to you for services rendered&#44; generally honoraria&#44; royalties&#44; or fees for consulting&#44; lectures&#44; speakers bureaus&#44; expert testimony&#44; employment&#44; or other affiliations&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Rafael Ariza</span> has nothing to disclose&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Pau Terradas-Montana&#44; Cristina Sanabra</span> and <span class="elsevierStyleBold">Carlos Sastr&#233;</span> report personal fees from Novartis Farmac&#233;utica S&#46;A&#44; outside the submitted work&#46;</p></span></span>"
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              "titulo" => "Disease activity control"
            ]
          ]
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        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
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        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Funding statement"
        ]
        11 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interest"
        ]
        12 => array:2 [
          "identificador" => "xack650549"
          "titulo" => "Acknowledgments"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-07-29"
    "fechaAceptado" => "2022-01-18"
    "PalabrasClave" => array:2 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1605324"
          "palabras" => array:5 [
            0 => "Ankylosing spondylitis"
            1 => "Disease activity"
            2 => "BASDAI"
            3 => "ASDAS"
            4 => "Clinical practice"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1605326"
          "palabras" => array:19 [
            0 => "ACR"
            1 => "AS"
            2 => "ASAS"
            3 => "ASDAS-CRP"
            4 => "axSpA"
            5 => "BASDAI"
            6 => "bDMARD"
            7 => "BMI"
            8 => "CRP"
            9 => "EULAR"
            10 => "HLA-B&#42;27"
            11 => "nbDMARD"
            12 => "NSAID"
            13 => "RWE"
            14 => "SAA"
            15 => "SD"
            16 => "SER"
            17 => "SPARTAN"
            18 => "TNFi"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1605325"
          "palabras" => array:5 [
            0 => "Espondilitis anquilosante"
            1 => "Actividad de la enfermedad"
            2 => "BASDAI"
            3 => "ASDAS"
            4 => "Pr&#225;ctica cl&#237;nica"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Understanding the disease activity is fundamental to improve patient prognosis and patients&#8217; quality of life&#46; MiDAS study described disease activity in ankylosing spondylitis &#40;AS&#41; Spanish patients and the proportion of them with controlled disease&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational&#44; cross-sectional&#44; multicenter study carried out under conditions of routine clinical practice&#46; Adult &#40;&#8805;18 years&#41; patients with &#8805;6 months since AS diagnosis treated &#8805;3 months prior to inclusion&#46; The primary endpoint was the percentage of patients with low disease activity assessed through BASDAI &#40;primary endpoint&#41; and ASDAS-CRP &#40;secondary endpoint&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">313 AS patients included&#58; 75&#46;7&#37; male&#59; 78&#46;5&#37; HLA-B&#42;27 positive&#59; mean &#40;SD&#41; baseline age of 50&#46;4 &#40;12&#46;0&#41; years&#59; mean &#40;SD&#41; disease duration of 15&#46;5 &#40;11&#46;6&#41; years&#59; 73&#46;5&#37; were treated with biological disease-modifying antirheumatic drugs &#40;DMARDs&#41;&#44; 22&#46;4&#37; with non-biological DMARDs and 53&#46;7&#37; with non-steroidal anti-inflammatory drugs&#44; alone or in combination&#46; Monotherapy with biologics and non-biologics was used by 29&#46;7&#37; and 26&#46;8&#37; of patients&#44; respectively&#46; According to BASDAI&#44; 38&#46;0&#37; were in remission &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2&#41; and 64&#46;5&#37; showed adequate disease control &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46; According to ASDAS-CRP&#44; 29&#46;4&#37; achieved remission &#40;ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#41; and 28&#46;1&#37; low disease activity &#40;1&#46;3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Almost two thirds of the AS patients recruited had low disease activity&#44; with about one third of them being in remission &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2&#44; ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#41;&#46; These results highlight the existing room for improvement in treating AS patients in clinical practice&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comprender la actividad de la enfermedad es fundamental para mejorar el pron&#243;stico y la calidad de vida de los pacientes&#46; El estudio MiDAS describi&#243; la actividad de la enfermedad en pacientes espa&#241;oles con espondilitis anquilosante &#40;EA&#41; y la proporci&#243;n de ellos con enfermedad controlada&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; transversal&#44; multic&#233;ntrico&#44; realizado en condiciones de pr&#225;ctica cl&#237;nica habitual&#46; Pacientes adultos &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; con &#8805;6<span class="elsevierStyleHsp" style=""></span>meses desde el diagn&#243;stico de EA tratados &#8805;3<span class="elsevierStyleHsp" style=""></span>meses antes de la inclusi&#243;n&#46; La variable principal fue el porcentaje de pacientes en baja actividad&#44; evaluado mediante BASDAI &#40;variable principal&#41; y ASDAS-CRP &#40;variable secundaria&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Hubo 313 pacientes con EA incluidos&#58; 75&#44;7&#37; varones&#59; 78&#44;5&#37; HLA-B&#42;27 positivos&#59; edad media &#40;DE&#41; basal de 50&#44;4 &#40;12&#44;0&#41; a&#241;os&#59; duraci&#243;n media &#40;DE&#41; de la enfermedad de 15&#44;5 &#40;11&#44;6&#41; a&#241;os&#59; el 73&#44;5&#37; fueron tratados con f&#225;rmacos antirreum&#225;ticos modificadores de la enfermedad &#40;FAME&#41; biol&#243;gicos&#44; el 22&#44;4&#37; con FAME no biol&#243;gicos y el 53&#44;7&#37; con antiinflamatorios no esteroideos&#44; solos o en combinaci&#243;n&#46; La monoterapia con biol&#243;gicos y no biol&#243;gicos fue utilizada por el 29&#44;7 y el 26&#44;8&#37; de los pacientes&#44; respectivamente&#46; Seg&#250;n BASDAI&#44; el 38&#44;0&#37; estaban en remisi&#243;n &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2&#41; y el 64&#44;5&#37; mostraron un adecuado control de la enfermedad &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46; Seg&#250;n ASDAS-CRP&#44; el 29&#44;4&#37; alcanzaron remisi&#243;n &#40;ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#44;3&#41; y el 28&#44;1&#37; baja actividad de la enfermedad &#40;1&#44;3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#44;1&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Casi dos tercios de los pacientes con EA incluidos presentaban baja actividad de la enfermedad&#44; con aproximadamente un tercio de ellos en remisi&#243;n &#40;BASDAI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>2&#44; ASDAS-CRP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#44;3&#41;&#46; Estos resultados destacan el margen de mejora existente para tratar pacientes con EA en la pr&#225;ctica cl&#237;nica&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3518
            "Ancho" => 3182
            "Tamanyo" => 382720
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Disease control in AS patients according to BASDAI &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>313&#41;&#46; &#40;A&#41; Disease control in AS patients&#46; &#40;B&#41; Disease control in AS according to presence of peripheral arthritis&#46; AS&#44; ankylosing spondylitis&#59; BASDAI&#44; Bath Ankylosing Spondylitis Disease Activity Index&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2108
            "Ancho" => 3182
            "Tamanyo" => 294088
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BASDAI index of patients with AS&#58; mean score between items according to the BASDAI Spanish version&#46; AS&#44; ankylosing spondylitis&#59; BASDAI&#44; Bath Ankylosing Spondylitis Disease Activity Index&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 554
            "Ancho" => 3182
            "Tamanyo" => 122927
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Disease control in AS patients according to the ASDAS-CRP cut-off points &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>313&#41;&#46; ASDAS-CRP&#44; Ankylosing Spondylitis Disease Activity Score-C-reactive protein&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Smoking habit</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Active smoker&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;24&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Packets&#47;year &#40;smokers&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;6 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Former smoker &#40;without smoking</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">6 months&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;25&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Non-smoker&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;43&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Not available&#44; n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Employment situation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unemployed&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Employee &#40;excluding sick leave due to AS&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;60&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">On sick leave &#40;due to AS&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;3&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Retired&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;15&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other &#40;e&#46;g&#46; students&#44; housework&#44; etc&#46;&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Not available&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;10&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Clinical data</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Family history of AS&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;21&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time of evolution of AS&#44; years&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time from onset of AS symptoms&#44; years&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;5 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time from AS symptoms&#8217; onset to diagnosis&#44; years&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Family history of psoriasis&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;13&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time of evolution of psoriasis&#44; years&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HLA-B</span>&#42;<span class="elsevierStyleItalic">27</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Positive&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">245 &#40;78&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Negative&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;14&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Not available&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CRP&#44; mg&#47;dl&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;1 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Comorbidities&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158 &#40;50&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hypertension&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;21&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;19&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;8&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cardiovascular disease&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;5&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Osteoporosis&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Kidney disease&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hepatic steatosis&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 &#40;35&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Excluding psoriasis on the skin&#44; uveitis&#44; or inflammatory bowel disease&#46;</p> <p class="elsevierStyleNotepara" id="npar0010">AS&#44; ankylosing spondylitis&#59; BMI&#44; body mass index&#59; CRP&#44; C-reactive protein&#59; HLA-B&#42;27&#44; human leukocyte antigen-B&#42;27&#59; SD&#44; standard deviation&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline demographic and clinical characteristics of the evaluable population&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AS patients&#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>313&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Biological treatment</span>&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229 &#40;73&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Adalimumab&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;23&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Etanercept&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;14&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Golimumab&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;11&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infliximab&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Secukinumab&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Certolizumab pegol&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;5&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ustekinumab&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Non-biological treatment</span>&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220 &#40;70&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">NSAIDs&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">168 &#40;53&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>COX-2&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;27&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Propionic acid derivatives&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;11&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Acetic acid derivatives and acetamide&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;8&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oxicam&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;5&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DMARDs&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;22&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Methotrexate&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;9&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sulfasalazine&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;13&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Systemic corticosteroids&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;4&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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