Factors Associated with Axial Spondyloarthritis Remission in a Cohort of Saudi Patients with Longstanding Disease: A Multicenter Prospective Cohort Study.

BACKGROUND/AIM: Earlier treatment in axial spondyloarthritis (axSpA) was proposed to alter disease prognosis in this often-challenging condition. We aimed to assess the proportion of patients and prognostic factors associated with axSpA remission.

OBJECTIVE

The aim was to determine the number of patients with Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) of <2.1 (inactive/moderate disease activity). We also evaluated global functioning and health using the Assessment of Spondyloarthritis International Society-Health Index (ASAS-HI).

PATIENTS AND METHODS

Patients with axSpA who were receiving targeted synthetic/biological disease- modifying anti-rheumatic drug (ts/bDMARDs) treatments and visited the rheumatology units at two tertiary-care centers between December 2021 and December 2022 were prospectively interviewed. Data regarding patient demographics, disease features, active and previous ts/bDMARDs treatments, and disease activity scores were obtained. Patients were assessed using the ASDAS- CRP, ASDAS-erythrocyte sedimentation rate (ASDAS-ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and ASAS-HI.

RESULTS

Overall, 60 patients with axSpA were included in this study (women, n = 35); 25 (41.7%) and 36 (62.1%) achieved an ASDAS-CRP of <2.1 and an ASAS-HI of ≤5 (good health), respectively. Out of the 60 patients, 75% (n = 45) were treated with anti-tumor necrosis factor. Factors associated with achieving the target ASDAS-CRP included age (p = 0.019), sex (p = 0.015), employment status (p = 0.015), education level (p = 0.030), and the number of previous ts/bDMARDs treatments (p = 0.019). Additionally, the ASDAS-CRP strongly correlated with spinal pain and moderately correlated with the ASAS-HI, BASDAI, and the number of previous ts/bDMARDs treatments.

CONCLUSIONS

Remission was observed in 41.7% of patients, indicating a challenge in achieving target disease activity. However, 62.1% attained good health. Achieving remission was associated with younger age, male sex, a higher level of education, lower level of spinal pain, better global function by ASAS-HI, employment, and receiving their first ts/bDMARDs treatment. Our findings may potentially improve disease prognosis with the earlier use of ts/bDMARDs in those without favorable features by implementing an early axSpA intervention strategy.