Durak Ediboglu Elif, Kalyoncu Umut, Solmaz Dilek, Yasar Bilge Sule, Yılmaz Sedat, Bes Cemal, Erden Abdulsamet, Yagız Burcu, Özsoy Zehra, Coskun Belkıs Nihan, Mercan Rıdvan, Kiraz Sedat, Gönüllü Emel, Yazısız Veli, Alpay Kanıtez Nilufer, Ateş Askın, Yılmaz Recep, Emmungil Hakan, Kimyon Gezmiş, Ersözlü Emine Duygu, Koca Süleyman Serdar, Ertenli İhsan, Akar Servet
Department of Internal Medicine, Division of Rheumatology, İzmir Katip Çelebi University, İzmir, Türkiye.
Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Türkiye.
Arch Rheumatol. 2025 Mar 17;40(1):1-14. doi: 10.46497/ArchRheumatol.2025.10670. eCollection 2025 Mar.
This study aimed to examine the frequency and associated factors of extra-musculoskeletal manifestations (EMMs) and peripheral manifestations in an axial spondyloarthritis (axSpA) cohort and their impact on the choice of first biologic treatment.
A total of 1,687 patients with axSpA (978 males, 709 females; mean age: 38.5±11 years) who started their first biologic disease modifying antirheumatic drug (bDMARD) were included from a national prospective database of TReasure between its inception and 2018-2021. Demographic and clinical characteristics, disease-related features, and treatment patterns were compared between patients with and without EMMs or peripheral involvement.
Of the patients, 1,283 had radiographic axSpA (r-axSpA), while 404 had nonradiographic axSpA (nr-axSpA). Acute anterior uveitis (AAU) was the most common (11.4%) EMM, and older age, female sex, human leukocyte antigen B27 (HLA-B27) positivity, and a lower Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score were associated with AAU. Female sex, methotrexate use, dactylitis, and higher Ankylosing Spondylitis Disease Activity Score (ASDAS)-serum C-reactive protein (CRP) scores were related to psoriasis (PsO). Inflammatory bowel disease (IBD) and PsO were negatively associated with HLA-B27 positivity. Enthesitis was the most frequent (28.2%) peripheral manifestations, and peripheral arthritis, dactylitis, and enthesitis were independent predictor of each other. In addition, dactylitis and peripheral arthritis were related to more frequent use of conventional disease modifying antirheumatic drugs. In addition, IBD history was associated with less frequent use of etanercept. Older age, less use of sulfasalazine, the absence of enthesitis, and lower Bath Ankylosing Spondylitis Functional Disease Index (BASFI) scores were associated with secukinumab use.
Acute anterior uveitis was associated with HLA-B27 positivity, while PsO or IBD were negatively associated with HLA-B27 in patients with axSpA. Peripheral manifestations appeared to be related to each other. Among EMMs, we found that only IBD had an effect on the bDMARD preference.
本研究旨在调查轴性脊柱关节炎（axSpA）队列中肌肉骨骼外表现（EMMs）和外周表现的频率及相关因素，以及它们对首次生物治疗选择的影响。
从TReasure全国前瞻性数据库中纳入了1687例开始使用第一种生物改善病情抗风湿药物（bDMARD）的axSpA患者（978例男性，709例女性；平均年龄：38.5±11岁），时间跨度为数据库建立之初至2018 - 2021年。比较了有或无EMMs或外周受累患者的人口统计学和临床特征、疾病相关特征及治疗模式。
患者中，1283例为放射学轴性脊柱关节炎（r-axSpA），404例为非放射学轴性脊柱关节炎（nr-axSpA）。急性前葡萄膜炎（AAU）是最常见的（11.4%）EMM，年龄较大、女性、人类白细胞抗原B27（HLA-B27）阳性以及较低的巴斯强直性脊柱炎疾病活动指数（BASDAI）评分与AAU相关。女性、使用甲氨蝶呤、指（趾）炎以及较高的强直性脊柱炎疾病活动评分（ASDAS）-血清C反应蛋白（CRP）评分与银屑病（PsO）相关。炎症性肠病（IBD）和PsO与HLA-B27阳性呈负相关。附着点炎是最常见的（28.2%）外周表现，外周关节炎、指（趾）炎和附着点炎相互之间是独立的预测因素。此外，指（趾）炎和外周关节炎与更频繁使用传统改善病情抗风湿药物有关。此外，IBD病史与较少使用依那西普有关。年龄较大、较少使用柳氮磺吡啶、无附着点炎以及较低的巴斯强直性脊柱炎功能疾病指数（BASFI）评分与使用司库奇尤单抗有关。
在axSpA患者中，急性前葡萄膜炎与HLA-B27阳性相关，而PsO或IBD与HLA-B27呈负相关。外周表现似乎相互关联。在EMMs中，我们发现只有IBD对bDMARD的偏好有影响。
