Department of Rheumatology, Instituto de Rehabilitación Psicofísica, CABA, Argentina.
Department of Rheumatology, Leiden University Medical Centre, Leiden and Department of Rheumatology, Zuyderland Medical Centre, Heerlen, the Netherlands.
Semin Arthritis Rheum. 2021 Jun;51(3):553-558. doi: 10.1016/j.semarthrit.2021.04.007. Epub 2021 Apr 18.
The aim of this study was to investigate whether peripheral arthritis together with disease activity independently contribute to functional impairment over time in patients with axSpA and to evaluate if there are contextual factors modifying this relationship.
Patients with axial spondyloarthritis from the ESPAXIA cohort were followed-up annually over a mean of 3.7 years. Physical function was assessed by the self-reported questionnaire BASFI, disease activity by ASDAS and peripheral arthritis was also recorded. Generalized estimating equations (GEE) were used to investigate longitudinal association between peripheral arthritis, ASDAS and BASFI as the outcome. Autoregressive models (adjusted for BASFI 1 year earlier) were run to allow for a truly longitudinal interpretation. Interactions between each of ASDAS and peripheral arthritis with contextual factors (age, gender, educational level, smoking, job type) were tested.
185 patients (77 % male, mean (SD) age 42 (13) years old and mean disease duration (SD) of 9.4 (9.6) years) were included. ASDAS and peripheral arthritis independently contributed to explaning BASFI over time. Contextual factors did not modify either of the relationships. A true longitudinal relation was proven with the autoregressive GEE model, showing that, adjusted for age, gender, spinal mobility and use of NSAIDs, an increase of one ASDAS unit led to a BASFI 0.48 units higher (ß 0.48 [95%CI 0.39, 0.57]), and the presence of peripheral arthritis, to a BASFI 0.44 units higher (ß 0.44 [95%CI 0.08, 0.8]).
Peripheral arthritis and higher disease activity independently lead to more functional impairment in axSpA over time. Contextual factors do not modify these relationships.
本研究旨在探讨外周关节炎合并疾病活动度是否独立导致 axSpA 患者随时间推移的功能障碍，并评估是否存在改变这种关系的背景因素。
ESPAXIA 队列中的轴性脊柱关节炎患者在平均 3.7 年的时间内每年进行随访。身体功能通过自我报告问卷 BASFI 进行评估，疾病活动度通过 ASDAS 评估，外周关节炎也进行了记录。广义估计方程（GEE）用于研究外周关节炎、ASDAS 和 BASFI 作为结局的纵向关联。为了进行真正的纵向解释，运行了自回归模型（调整 BASFI 1 年前）。测试了每个 ASDAS 和外周关节炎与背景因素（年龄、性别、教育水平、吸烟、工作类型）之间的交互作用。
共纳入 185 例患者（77%为男性，平均年龄（标准差）为 42（13）岁，平均病程（标准差）为 9.4（9.6）年）。ASDAS 和外周关节炎独立解释 BASFI 随时间的变化。背景因素并未改变这两种关系。自回归 GEE 模型证明了真正的纵向关系，显示在调整年龄、性别、脊柱活动度和 NSAIDs 使用后，ASDAS 增加一个单位导致 BASFI 增加 0.48 个单位（β0.48[95%CI 0.39, 0.57]），外周关节炎存在导致 BASFI 增加 0.44 个单位（β0.44[95%CI 0.08, 0.8]）。
外周关节炎和更高的疾病活动度独立导致 axSpA 患者随时间推移的功能障碍加重。背景因素不会改变这些关系。
