Introduction 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.Methods This prospective, multicentre study (Devenir des Spondylarthropathies Indiff & eacute;renci & eacute;es R & eacute;centes 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.Methods This prospective, multicentre study (Devenir des Spondylarthropathies Indiff & eacute;renci & eacute;es R & eacute;centes 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.Results 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.Conclusion 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.
