Department of Rheumatology, Zurich University Hospital, University of Zurich, Gloriastrasse 25, CH-8091, Zurich, Switzerland.
Swiss Clinical Quality Management Foundation, Zurich, Switzerland.
Clin Rheumatol. 2023 Sep;42(9):2377-2385. doi: 10.1007/s10067-023-06662-0. Epub 2023 Jun 8.
As anaemia represents a biomarker for increased radiographic damage in rheumatoid arthritis, we aimed to investigate whether it independently predicts spinal radiographic progression in axial spondyloarthritis (axSpA).
AxSpA patients with available haemoglobin levels from the prospective Swiss Clinical Quality Management Registry were included for comparison of patients with and without anaemia. Spinal radiographic progression was assessed according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) in patients with ankylosing spondylitis (AS) if ≥ 2 sets of spinal radiographs were available every 2 years. The relationship between anaemia and progression (defined as an increase ≥ 2 mSASSS units in 2 years) was analysed with generalized estimating equation models after adjustment for the Ankylosing Spondylitis Disease Activity Score (ASDAS) and potential confounding, as well as after multiple imputations of missing values.
A total of 212/2522 axSpA patients presented with anaemia (9%). Anaemic patients had higher clinical disease activity, higher acute phase reactants and more severe impairments in physical function, mobility and quality of life. In the subgroup of patients with AS (N = 433), a comparable mSASSS progression was found in anaemic and non-anaemic patients (OR 0.69, 95% CI 0.25 to 1.96, p = 0.49). Age, male sex, baseline radiographic damage and ASDAS were associated with enhanced progression. The results were confirmed in complete case analyses and with progression defined as the formation of ≥ 1 syndesmophyte in 2 years.
Although anaemia was associated with higher disease activity in axSpA, it did not additionally contribute to the prediction of spinal radiographic progression. Key Points • Anaemia is associated with higher disease activity and more severely impaired physical function, mobility and quality of life in axSpA. • Anaemia does not provide an additional value to ASDAS for prediction of spinal radiographic progression.
由于贫血是类风湿关节炎放射学损伤增加的生物标志物，我们旨在研究其是否独立预测强直性脊柱炎（axSpA）的脊柱放射学进展。
纳入前瞻性瑞士临床质量管理注册中心有血红蛋白水平的 axSpA 患者，比较贫血患者和无贫血患者。对于有 2 年以上连续脊柱影像学资料的强直性脊柱炎（AS）患者，根据改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）评估脊柱放射学进展。采用广义估计方程模型，在校正强直性脊柱炎疾病活动度评分（ASDAS）和潜在混杂因素后，以及对缺失值进行多次插补后，分析贫血与进展（定义为 2 年内 mSASSS 增加≥2 个单位）的关系。
共有 212/2522 axSpA 患者出现贫血（9%）。贫血患者的临床疾病活动度更高，急性期反应物更高，身体功能、移动性和生活质量的严重受损程度更高。在 AS 患者亚组（N=433）中，贫血和非贫血患者的 mSASSS 进展相似（比值比 0.69，95%置信区间 0.25 至 1.96，p=0.49）。年龄、男性、基线放射学损伤和 ASDAS 与进展增强相关。在完全案例分析和将 2 年内形成≥1 个骨桥作为进展的定义中，结果得到了证实。
尽管贫血与 axSpA 患者的更高疾病活动度相关，但它并未额外有助于预测脊柱放射学进展。
贫血与 axSpA 患者的更高疾病活动度和更严重的身体功能、移动性和生活质量受损相关。
贫血对 ASDAS 预测脊柱放射学进展没有额外价值。
