P. Karakostas

St. Josefs Hospital, Клоппенбург, Lower Saxony, Germany

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Publications (4)20.75 Total impact

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    ABSTRACT: Background The main symptom of patients with axial spondyloarthritis (axSpA), chronic inflammatory back pain, has been traditionally evaluated from a biomedical perspective but coping strategies may also have an important role in patients’ adjustment to back pain. Objectives To examine differences in coping strategies in patients with axSpA in a 6-month longitudinal study. Methods A total of 100 consecutive patients diagnosed with axSpA according to the ASAS classification criteria including patients with ankylosing spondylitis (AS, n=56) and non-radiographic axSpA (nr-axSpA, n=44) completed clinical and psychological assessments at baseline and after 6 months. At baseline, the patients were informed about their disease in a similar way by the same physician. The vast majority of patients (>90%) was treated with NSAIDs. Standardized clinical assessment tools evaluated pain (numerical rating scale), disease activity (BASDAI), physical functioning (BASFI), coping strategy (Trier scale for coping), quality of life (QoL) (ASQoL), health status (SF-36) and patient acceptable symptom state (PASS). Results A total of 92 patients completed the follow-up examination. The majority of patients (55.6%) did not report to have a preferred coping strategy. The other patients indicated to prefer the following strategies at baseline: spiritual resources (12%), rumination (10.8%), information seeking (9.7%), withdrawal from society (3.3%), social embedding (2.2%) and fight back (2.2%). At baseline, only 38% of patients rated their disease status as acceptable (PASS+). Most patients who preferred rumination rated their disease status as not acceptable (PASS -) (88.9%). Almost no PASS+ patient reported to prefer rumination (2.9%). At follow-up, the proportion of PASS+ patients had not changed much, and most patients had not changed their coping strategy. However, PASS+ patients reported use of the strategy social embedding more often after 6 months (25.7%) as compared to baseline (11.4%), and this strategy was also more often used by the PASS+ as compared to PASS- patients: 25.7% vs 7%, respectively (p<0.001). However, a change in strategy was only reported by 7.6% of the patients with no preferred strategy at baseline (mostly to information seeking). Regarding coping no major differences between patients with AS and nr-axSpA were noted. Conclusions Most patients with axSpA did not prefer one coping strategy. Our findings suggest that negative emotion focused coping styles (e.g. rumination) were associated with non-acceptance of the current health status. Whereas, active coping styles (e.g. social embedding) seem to have a rather positive influence on disease acceptance. However, the PASS concept and use of coping styles need to be further analysed and evaluated. Our findings suggest to study the potential benefit of standardized active interventions aimed at improvement and change of coping strategies. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):567-568. DOI:10.1136/annrheumdis-2012-eular.3230 · 10.38 Impact Factor
  • X. Baraliakos · B. Kask · P. Karakostas · J. Braun · K. Kisters
    Nieren- und Hochdruckkrankheiten 01/2013; 42(01):27-28. DOI:10.5414/NHX01464
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    ABSTRACT: Patients with axial spondylarthritis (SpA) who have structural changes in the sacroiliac joints and/or the spine have been classified as having ankylosing spondylitis (AS), while those without such changes are now classified as having nonradiographic axial SpA (nr-axSpA). The differentiating features are incompletely understood. Data from 100 consecutive patients with axial SpA not treated with tumor necrosis factor antagonists were compared clinically and with laboratory parameters, spinal radiographs, and magnetic resonance imaging (MRI) of the spine. Standardized clinical assessment tools were used to assess health status. AS was diagnosed in 56 patients and nr-axSpA in 44 patients. Signs of inflammation were significantly higher in patients with AS than in patients with nr-axSpA, with a median C-reactive protein level of 8.0 versus 3.8 mg/liter, a median Ankylosing Spondylitis Disease Activity Score of 2.2 versus 2.8, respectively, and a median amount of spinal inflammatory lesions on MRI of 2.0 versus 0.0, respectively. Significant differences between these 2 groups were seen in sex (76.8% male AS patients versus 31.8% male nr-axSpA patients). Clinical variables did not differ between patients with AS and nr-axSpA (Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life questionnaire, Short Form 36 health survey). Patients with nr-axSpA were characterized by the low proportion of male patients and the low burden of inflammation compared to patients with AS. While both groups did not differ regarding health status, disease activity, and physical function, they did differ in signs of inflammation; all were higher in patients with AS. Since many patients with nr-axSpA had not developed structural changes after years of symptoms, we propose that those patients should not be regarded as having preradiographic AS but rather as having nr-axSpA.
    09/2012; 64(9):1415-22. DOI:10.1002/acr.21688
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    ABSTRACT: The threshold for disease activity required to start antitumour necrosis factor (TNF) therapy has been arbitrarily set in patients with axial spondyloarthritis (axSpA) at Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4. How this relates to spinal inflammation is unknown. To systematically compare the clinical, laboratory and imaging data of patients with axSpA with respect to their BASDAI level. A total of 100 consecutive patients with axSpA who had never been treated with TNF blockers were included. Laboratory parameters, spinal MRI and x-rays were quantified. Data were stratified according to BASDAI ≥ 4. 44 patients were diagnosed as non-radiographic axSpA (nraxSpA) and 56 patients as ankylosing spondylitis (AS): median age 40.3 ± 10.4 years; 57% male, mean disease duration since diagnosis 6.4 ± 8.4 years, 88% HLA-B27+, mean modified Stokes Ankylosing Spondylitis Spinal Score 8.3 ± 16.4. 60% of patients had spinal inflammation by MRI. The stratification based on BASDAI ≥ 4 disclosed significant differences in most clinical parameters but not for inflammation: patients with nraxSpA and BASDAI < 4 versus ≥ 4 had 0.9 ± 1.4 and 0.5 ± 0.6 inflammatory lesions/patient, respectively (p=0.6), while patients with AS had 3.6 ± 3.7 and 2.7 ± 3.0 inflammatory lesions/patient, respectively (p=0.4). The burden of inflammation is quite comparable in patients with axSpA-regardless of disease activity. These data clearly challenge the concept of the recommended cut-off point of BASDAI ≥ 4.
    Annals of the rheumatic diseases 04/2012; 71(7):1207-11. DOI:10.1136/annrheumdis-2011-200508 · 10.38 Impact Factor

Publication Stats

55 Citations
20.75 Total Impact Points


  • 2012
    • St. Josefs Hospital
      Клоппенбург, Lower Saxony, Germany