Portier Elodie, Benattar Leslie, Resche-Rigon Matthieu, Dougados Maxime, Gossec Laure, Molto Anna
Rheumatology, Hopital Cochin, Université Paris Descartes Faculté de Médecine, Paris, France
Rheumatology, Hopital Cochin, Université Paris Descartes Faculté de Médecine, Paris, France.
RMD Open. 2024 Dec 22;10(4):e004910. doi: 10.1136/rmdopen-2024-004910.
The study aimed to identify and describe disease activity trajectories over 10 years in patients with recent-onset axial spondyloarthritis (axSpA) and determine their impact on long-term outcomes.
This prospective, multicentre study (Devenir des Spondylarthropathies Indifférenciées Récentes cohort, ClinicalTrials.gov NCT) followed patients with early axSpA for 10 years. Only patients with at least three Axial Spondylitis Disease Activity Score (ASDAS) values were included. Long-term outcomes assessed were TNF inhibitors (TNFi) exposure, structural progression, function (Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index), quality of life (36-items Short Form Survey), sick leave days and cardiovascular (CV) events. ASDAS trajectories were identified using k-means clustering. Multinomial multivariable regression estimated associations between baseline characteristics and trajectories. Long-term outcomes for each trajectory were described.
Among 601 patients, five ASDAS trajectories were identified: persistent low disease activity/remission (tA), clinically important improvement (tD) and persistent moderate (tB), high (tC) or very high (tE) disease activity. Patients in tA were more likely to be male, have a university degree, have white-collar jobs, have positive HLA B27 status and have less fibromyalgia. Trajectory tE was linked to poorer function (BASFI 50/100 vs 7/100 for lower ASDAS trajectory), higher TNFi exposure (74% vs 29%) and more CV events (5.7% vs 0). Structural progression was low but comparable across trajectories, except for higher sacroiliac joint progression in tB.
The k-means method revealed distinct disease activity trajectories in axSpA. Higher disease activity trajectories were associated with a higher prevalence of fibromyalgia and poorer outcomes, except for structural progression, which was comparable across trajectories.
本研究旨在识别和描述近期发病的轴性脊柱关节炎（axSpA）患者10年中的疾病活动轨迹，并确定其对长期结局的影响。
这项前瞻性多中心研究（新发未分化脊柱关节炎队列研究，ClinicalTrials.gov NCT）对早期axSpA患者进行了10年随访。仅纳入至少有三个轴性脊柱关节炎疾病活动评分（ASDAS）值的患者。评估的长期结局包括肿瘤坏死因子抑制剂（TNFi）暴露、结构进展、功能（巴斯强直性脊柱炎功能指数（BASFI）和巴斯强直性脊柱炎测量指数）、生活质量（36项简明健康调查问卷）、病假天数和心血管（CV）事件。使用k均值聚类法识别ASDAS轨迹。多项多变量回归估计基线特征与轨迹之间的关联。描述了每个轨迹的长期结局。
在601例患者中，识别出五条ASDAS轨迹：持续低疾病活动/缓解（tA）、临床上有显著改善（tD）以及持续中度（tB）、高度（tC）或极高（tE）疾病活动。tA组患者更可能为男性，拥有大学学位，从事白领工作，HLA B27状态为阳性且纤维肌痛较少。轨迹tE与较差的功能（较低ASDAS轨迹组的BASFI为7/100，而tE组为50/100）、更高的TNFi暴露（74%对29%）和更多的CV事件（5.7%对0）相关。结构进展较低，但各轨迹间相当，tB组骶髂关节进展较高除外。
k均值法揭示了axSpA中不同的疾病活动轨迹。较高的疾病活动轨迹与纤维肌痛患病率较高和结局较差相关，但结构进展在各轨迹间相当。
