Hernández-Breijo Borja, Novella-Navarro Marta, Genre Fernanda, Navarro-Compán Victoria, Martínez-Feito Ana, Remuzgo-Martínez Sara, González-Gay Miguel Ángel, Balsa Alejandro, Plasencia-Rodríguez Chamaida
Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain.
Immuno-Rheumatology Research Group, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, and Rheumatology Department, La Paz University Hospital, Madrid, Spain.
Clin Exp Rheumatol. 2023 Mar;41(3):565-573. doi: 10.55563/clinexprheumatol/ou570o. Epub 2022 Apr 29.
To analyse the influence of adipokines on attaining the clinical outcomes in patients with axial spondyloarthritis (axSpA) treated with TNF inhibitors (TNFi), and then, to investigate the association of patients' characteristics and adipokine concentrations.
This was a longitudinal study including 110 patients with axSpA who were initiated at TNFi and were followed-up for 6 months (m). Disease activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) at baseline and at 6 m of treatment. Clinical outcomes at 6 m of treatment were defined as remission (ASDAS <1.3) and the attainment of low disease activity (LDA; ASDAS<2.1). Leptin and adiponectin concentrations were measured in serum samples collected at baseline and after 6 m.
Both leptin and adiponectin were constitutively elevated in female axSpA patients. At time of TNFi initiation, leptin concentrations were higher in patients with high body mass index (overweight or obese). On the contrary, adiponectin was higher in normalweight patients. After 6 m of TNFi treatment, 24% of patients attained remission. They had significant lower leptin concentration at baseline compared with patients who did not attain remission. Furthermore, this difference remained significant after 6 m of treatment meaning that TNFi did not modify adipokine concentration. Similar results were found considering LDA as the clinical outcome, obtained in 48% of the patients.
The present study showed that low leptin concentrations were associated with attaining clinical outcomes in axSpA patients treated with TNFi. In addition, since leptin secretion by white adipocytes is enhanced during obesity and considering that TNFi do not seem to modulate its expression, obese patients should be encouraged to decrease BMI to attain a successful therapy.
分析脂肪因子对接受肿瘤坏死因子抑制剂（TNFi）治疗的中轴型脊柱关节炎（axSpA）患者临床结局的影响，进而研究患者特征与脂肪因子浓度之间的关联。
这是一项纵向研究，纳入110例开始接受TNFi治疗并随访6个月的axSpA患者。在基线和治疗6个月时，采用强直性脊柱炎疾病活动评分（ASDAS）评估疾病活动度。治疗6个月时的临床结局定义为缓解（ASDAS<1.3）和达到低疾病活动度（LDA；ASDAS<2.1）。在基线和6个月后采集的血清样本中测量瘦素和脂联素浓度。
女性axSpA患者的瘦素和脂联素水平均持续升高。在开始使用TNFi时，体重指数较高（超重或肥胖）的患者瘦素浓度更高。相反，体重正常的患者脂联素水平更高。TNFi治疗6个月后，24%的患者达到缓解。与未达到缓解的患者相比，他们在基线时的瘦素浓度显著更低。此外，在治疗6个月后这种差异仍然显著，这意味着TNFi并未改变脂肪因子浓度。以LDA作为临床结局时也发现了类似结果，48%的患者达到LDA。
本研究表明，低瘦素浓度与接受TNFi治疗的axSpA患者达到临床结局相关。此外，由于肥胖期间白色脂肪细胞的瘦素分泌会增加，并且考虑到TNFi似乎无法调节其表达，应鼓励肥胖患者降低体重指数以实现成功治疗。
