Extraskeletal Manifestations in Axial Spondyloarthritis Are Associated With Worse Clinical Outcomes Despite the Use of Tumor Necrosis Factor Inhibitor Therapy

Rienk van der Meer; Suzanne Arends; Sandra Kruidhof; Reinhard Bos; Hendrika Bootsma; Freke Wink; Anneke Spoorenberg

doi:10.3899/jrheum.210308

Extraskeletal Manifestations in Axial Spondyloarthritis Are Associated With Worse Clinical Outcomes Despite the Use of Tumor Necrosis Factor Inhibitor Therapy

J Rheumatol. 2022 Feb;49(2):157-164. doi: 10.3899/jrheum.210308. Epub 2021 Aug 15.

Authors

Rienk van der Meer¹, Suzanne Arends², Sandra Kruidhof³, Reinhard Bos⁴, Hendrika Bootsma³, Freke Wink⁴, Anneke Spoorenberg²

Affiliations

¹ R. van der Meer, MD, S. Kruidhof, MD, H. Bootsma, MD, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen; r.g.van.der.meer@umcg.nl.
² S. Arends, PhD, A. Spoorenberg, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, and Rheumatology, Medical Center Leeuwarden, Leeuwarden.
³ R. van der Meer, MD, S. Kruidhof, MD, H. Bootsma, MD, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen.
⁴ R. Bos, MD, F. Wink, MD, Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.

PMID: 34393101
DOI: 10.3899/jrheum.210308

Abstract

Objective: To investigate the prevalence and 4-year incidence of acute anterior uveitis (AAU), inflammatory bowel disease (IBD) and psoriasis (PsO), and to explore associations of newly developed extraskeletal manifestations (ESMs) with clinical disease outcome in a large cohort of patients with axial spondyloarthritis (axSpA).

Methods: All consecutive patients included in the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort between 2004 and 2011 were analyzed. History of ESMs at baseline and newly developed ESMs during 4-year follow-up were only recorded when diagnosis by an ophthalmologist, gastroenterologist, or dermatologist was present.

Results: Of the 414 included patients with axSpA, 31.4% had a positive history of ≥ 1 ESMs: 24.9% AAU, 9.4% IBD, and 4.3% PsO. History of PsO was significantly associated with more radiographic damage, especially of the cervical spine. Of the 362 patients with 4-year follow-up data, 15.7% patients developed an ESM: 13.3% patients had AAU (of which 3.6% had a first episode and 9.7% had recurrent AAU), 1.9% developed IBD, and 0.8% developed PsO. Patients with newly developed ESMs (without history of ESMs) had worse Ankylosing Spondylitis Quality of Life scores (mean 10.0 vs. 5.8, P = 0.001), larger occiput-wall distance (median 6.3 vs. 2.0, P = 0.02) and more limited modified Schober test (mean 12.6 vs. 13.6, P = 0.01) after 4 years of follow-up. The majority of patients developing an ESM used anti-tumor necrosis factor therapy.

Conclusion: History of ESMs was present at baseline in one-third of patients with axSpA. The 4-year incidence of ESMs was relatively low, but patients who developed a new ESM reported worse quality of life.

Keywords: ankylosing spondylitis; outcomes; quality of life; spondyloarthropathy.

Publication types

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

MeSH terms

Axial Spondyloarthritis*
Humans
Immunotherapy
Inflammatory Bowel Diseases* / complications
Inflammatory Bowel Diseases* / drug therapy
Psoriasis*
Quality of Life
Spondylarthritis* / complications
Spondylarthritis* / diagnostic imaging
Spondylarthritis* / drug therapy
Spondylitis, Ankylosing* / complications
Spondylitis, Ankylosing* / drug therapy
Tumor Necrosis Factor Inhibitors / adverse effects
Uveitis, Anterior*

Substances

Tumor Necrosis Factor Inhibitors