Jones Gareth T, Rotariu Ovidiu, MacDonald Ross, Michelsen Brigitte, Glintborg Bente, van der Horst-Bruinsma Irene, Gudbjornsson Bjorn, Geirsson Arni Jon, Relas Heikki, Isomäki Pia, Závada Jakub, Pavelka Karel, Rotar Ziga, Tomšič Matija, Nissen Michael J, Ciurea Adrian, Codreanu Catalin, Wallman Johan K, Kristianslund Eirik Klami, Rasmussen Simon Horskjaer, Ørnbjerg Lykke Midtbøll, Santos Maria José, Østergaard Mikkel, Hetland Merete Lund, Macfarlane Gary J
Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
BMC Rheumatol. 2025 Jul 11;9(1):88. doi: 10.1186/s41927-025-00529-4.
To quantify the influence of lifestyle factors on tumour necrosis factor inhibitor (TNFi) treatment response, in axial spondyloarthritis (axSpA).
Data on biologics-naïve adults with axSpA were captured from European rheumatology registries. Information on lifestyle factors (smoking, overweight/obesity, and/or alcohol consumption) were identified ± 30 days of commencing their first TNFi. Treatment response (BASDAI-50, ASDAS or ASAS response criteria) was determined at 3 and 12 months. In separate models, the relationship between treatment response and baseline smoking, BMI and alcohol was assessed using logistic regression, adjusted for age, sex, country, calendar year of treatment initiation, disease duration and baseline disease activity.
From 14 registries, 14,885 patients were included. Of those with available data, 29% were current smokers, 49% current drinkers, 37% were overweight and 21% were obese. At 12 months, smokers were less likely to achieve BASDAI-50 treatment response compared to non-smokers (adjusted odds ratio: 0.77; 95%CI: 0.68-0.86). A similar effect was observed among overweight (0.76; 0.66-0.87) or obese patients (0.53; 0.45-0.63). In contrast, alcohol drinkers experienced a seemingly beneficial effect (1.47; 1.16-1.87). These associations were also observed with other measures of treatment response and were robust to further adjustment for clinical characteristics.
Smoking and high BMI decrease the odds of bDMARD treatment success in axSpA. Rheumatologists should consider referral to smoking cessation and/or weight management interventions at the time of commencing therapy, to enhance treatment response. The relationship between alcohol and treatment response is unlikely to be causal and warrants further investigation.
量化生活方式因素对轴性脊柱关节炎（axSpA）中肿瘤坏死因子抑制剂（TNFi）治疗反应的影响。
从欧洲风湿病登记处收集初治生物制剂的axSpA成年患者的数据。在开始首次TNFi治疗前±30天确定生活方式因素（吸烟、超重/肥胖和/或饮酒）的信息。在3个月和12个月时确定治疗反应（BASDAI-50、ASDAS或ASAS反应标准）。在单独的模型中，使用逻辑回归评估治疗反应与基线吸烟、BMI和饮酒之间的关系，并对年龄、性别、国家、治疗开始的日历年、疾病持续时间和基线疾病活动进行调整。
纳入了来自14个登记处的14885名患者。在有可用数据的患者中，29%为当前吸烟者，49%为当前饮酒者，37%超重，21%肥胖。在12个月时，与非吸烟者相比，吸烟者达到BASDAI-50治疗反应的可能性较小（调整后的优势比：0.77；95%CI：0.68-0.86）。在超重（0.76；0.66-0.87）或肥胖患者（0.53；0.45-0.63）中观察到类似的效果。相比之下，饮酒者似乎有有益的效果（1.47；1.16-1.87）。在其他治疗反应指标中也观察到了这些关联，并且在进一步调整临床特征后仍然稳健。
吸烟和高BMI降低了axSpA中生物改善病情抗风湿药（bDMARD）治疗成功的几率。风湿病学家应在开始治疗时考虑转诊至戒烟和/或体重管理干预措施，以增强治疗反应。饮酒与治疗反应之间的关系不太可能是因果关系，值得进一步研究。
