Priego-Pérez Carmen, Puche-Larrubia María Ángeles, Ladehesa-Pineda Lourdes, Calvo-Guitérrez Jerusalem, Ortega-Castro Rafaela, Escudero-Contreras Alejandro, Barbarroja Nuria, Collantes-Estévez Eduardo, López-Medina Clementina
Medical and Surgical Sciences Department, University of Cordoba, 14071 Cordoba, Spain.
Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain.
J Clin Med. 2024 Mar 23;13(7):1855. doi: 10.3390/jcm13071855.
: The objectives were as follows: (a) to identify, among patients with axial spondyloarthritis (axSpA), "clusters" of patients based on the presence of peripheral and extra-musculoskeletal manifestations (EMMs) and (b) to compare the effectiveness of the first anti-TNF drugs across the different clusters after 6 months of follow-up. An observational and retrospective study of 90 axSpA patients naïve to bDMARDs was conducted. An unsupervised cluster analysis using the "k-means" technique was performed using variables of peripheral and EMMs. Baseline clinical and sociodemographic characteristics were evaluated, and the response to anti-TNF treatment (considering responders as those with an improvement ≥1.1 for the Ankylosing Spondylitis Disease Activity Score (ASDAS) or ≥2.0 for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) was compared across the clusters after 6 months of follow-up. Two clusters were identified: cluster 1 ( = 14), with a higher prevalence of peripheral manifestations, inflammatory bowel disease (IBD), and HLA-B27-positive status, and a lower prevalence of uveitis in comparison with cluster 2 ( = 76). Patients from cluster 1 experienced a more pronounced absolute improvement in ASDAS and BASDAI indices after 6 months. The percentage of responders after 6 months of follow-up was superior in cluster 1 compared to cluster 2 (85.7% vs. 48.7%, = 0.011). This study suggests the existence of two clinical profiles in axSpA patients according to the peripheral and EMMs, with higher rates of anti-TNF effectiveness after 6 months in those with a greater presence of peripheral features.
(a) 在轴向型脊柱关节炎（axSpA）患者中，根据外周和肌肉骨骼外表现（EMM）的存在情况确定患者“集群”；(b) 在随访6个月后，比较不同集群中首批抗TNF药物的疗效。对90例初治bDMARDs的axSpA患者进行了一项观察性回顾性研究。使用外周和EMM变量，采用“k均值”技术进行无监督聚类分析。评估基线临床和社会人口学特征，并在随访6个月后比较各集群对抗TNF治疗的反应（将强直性脊柱炎疾病活动评分（ASDAS）改善≥1.1或巴斯强直性脊柱炎疾病活动指数（BASDAI）改善≥2.0的患者视为反应者）。确定了两个集群：集群1（n = 14），外周表现、炎症性肠病（IBD）和HLA-B27阳性状态的患病率较高，与集群2（n = 76）相比，葡萄膜炎的患病率较低。集群1的患者在6个月后ASDAS和BASDAI指数的绝对改善更为明显。随访6个月后，集群1的反应者百分比高于集群2（85.7%对48.7%，P = 0.011）。这项研究表明，根据外周和EMM，axSpA患者存在两种临床特征，外周特征较多的患者在6个月后抗TNF疗效更高。
