Characteristics associated with the presence and development of extra-articular manifestations in ankylosing spondylitis: 12-year results from OASIS

Ivette Essers; Sofia Ramiro; Carmen Stolwijk; Marc Blaauw; Robert Landewé; Désirée van der Heijde; Filip Van den Bosch; Maxime Dougados; Astrid van Tubergen

doi:10.1093/rheumatology/keu388

Characteristics associated with the presence and development of extra-articular manifestations in ankylosing spondylitis: 12-year results from OASIS

Rheumatology (Oxford). 2015 Apr;54(4):633-40. doi: 10.1093/rheumatology/keu388. Epub 2014 Sep 17.

Authors

Ivette Essers¹, Sofia Ramiro², Carmen Stolwijk², Marc Blaauw³, Robert Landewé², Désirée van der Heijde³, Filip Van den Bosch³, Maxime Dougados³, Astrid van Tubergen²

Affiliations

¹ Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. ivette.essers@maastrichtuniversity.nl.
² Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
³ Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.

PMID: 25234663
DOI: 10.1093/rheumatology/keu388

Abstract

Objective: The aim of this study was to identify characteristics associated with the presence and development of extra-articular manifestations (EAMs) in a prevalence cohort of patients with AS.

Methods: Twelve-year follow-up data from the Outcome in Ankylosing Spondylitis International Study (OASIS) were used. In addition, medical charts were checked for the presence of acute anterior uveitis (AAU), IBD and psoriasis. Demographic, clinical and radiographic characteristics associated with the presence of (any) EAM at baseline or new development during follow-up were identified.

Results: Two hundred and sixteen patients were included [mean age 43.6 years (s.d. 12.7), 154 (71%) men, mean symptom duration 20.5 years (s.d. 11.7), mean follow-up 8.3 years (s.d. 4.3)]. At baseline, 39 (18%) patients had AAU, 15 (7%) had IBD and 9 (4%) had psoriasis. The history of AAU was univariably associated with increased age [odds ratio (OR) 1.04 (95% CI 1.01, 1.07)], longer symptom duration [OR 1.05 (95% CI 1.02, 1.08)] and more radiographic damage [OR 1.02 (95% CI 1.00, 1.04)]. The history of psoriasis was associated with greater age [OR 1.05 (95% CI 1.00, 1.11)] and lower CRP [OR 0.77 (95% CI 0.59, 1.00)]. At follow-up, 27 patients developed a new EAM. Newly developed IBD was associated with a higher time-varying AS Disease Activity Score [hazard ratio (HR) 2.80 (95% CI 1.43, 5.52)], worse physical function [HR 1.40 (95% CI 1.09, 1.80)] and worse patient global well-being [HR 1.46 (95% CI 1.10, 1.93)]. Newly developed AAU was associated with an elevated time-varying CRP [HR 1.02 (95% CI 1.01, 1.04)].

Conclusion: Development of EAMs was infrequent in this cohort, despite relatively long follow-up. In particular, markers of disease activity were associated with the development of IBD.

Keywords: ankylosing spondylitis; anterior uveitis; inflammatory bowel disease; psoriasis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Adult
Age Factors
Cohort Studies
Female
Genetic Predisposition to Disease
HLA-B27 Antigen / genetics
Humans
Inflammatory Bowel Diseases / epidemiology*
Male
Middle Aged
Odds Ratio
Psoriasis / epidemiology*
Psoriasis / genetics
Retrospective Studies
Severity of Illness Index
Spondylitis, Ankylosing / epidemiology*
Spondylitis, Ankylosing / genetics
Time Factors
Uveitis, Anterior / epidemiology*

Substances

HLA-B27 Antigen