Peripheral manifestations are major determinants of disease phenotype and outcome in new onset spondyloarthritis

被引：16

作者：

De Craemer, Ann-Sophie ^{[1
,2
]}

Renson, Thomas ^{[1
,2
]}

Deroo, Liselotte ^{[1
,2
]}

Van Praet, Liesbet ^{[3
]}

Cypers, Heleen ^{[4
]}

Varkas, Gaelle ^{[1
]}

Joos, Rik ^{[1
,5
]}

Devinck, Mieke ^{[6
]}

Gyselbrecht, Lieve ^{[7
]}

Peene, Isabelle ^{[1
,8
]}

Thevissen, Kristof ^{[4
,9
]}

Costantino, Felicie ^{[10
,11
]}

D'Agostino, Maria-Antonietta ^{[10
,11
,12
]}

Lenaerts, Jan ^{[13
,14
]}

Carron, Philippe ^{[2
,15
]}

Van den Bosch, Filip ^{[1
,2
]}

Elewaut, Dirk ^{[1
,2
]}

机构：

[1] Ghent Univ Hosp, Div Rheumatol, Dept Internal Med & Pediat, C Heymanslaan 10, B-9000 Ghent, Belgium

[2] VIB UGent, Ctr Inflammat Res, Zwijnaarde, Belgium

[3] AZ Maria Middelares, Dept Rheumatol, Ghent, Belgium

[4] Reumactr Genk, Genk, Belgium

[5] ZNA Jan Palfijn, Dept Rheumatol, Merksem, Belgium

[6] AZ St Lucas, Dept Rheumatol, Assebroek, Belgium

[7] Algemeen Stedelijk Ziekenhuis ASZ, Dept Rheumatol, Aalst, Belgium

[8] AZ Sint Jan Brugge, Rheumatol, Brugge, Belgium

[9] Ziekenhuis Oost Limburg ZOL, Dept Rheumatol, Genk, Belgium

[10] Univ Paris Saclay, Lab Excellence INFLAMEX, UVSQ, INSERM, Montigny Le Bretonneux, France

[11] Ambroise Pare Hosp, AP HP, Dept Rheumatol, Boulogne, France

[12] Univ Cattolica Sacro Cuore, Policlin Univ Agostino Gemelli IRCSS, Dept Rheumatol, Rome, Italy

[13] AZ Jessa Hosp, Reuma Inst, Hasselt, Belgium

[14] AZ Jessa Hosp, Dept Rheumatol, Hasselt, Belgium

[15] AZ Alma, Dept Rheumatol, Eeklo, Belgium

来源：

RHEUMATOLOGY | 2022年 / 61卷 / 08期

关键词：

spondyloarthritis; peripheral manifestations; clusters; trajectories; SOCIETY CLASSIFICATION CRITERIA; INFLAMMATORY BACK-PAIN; AXIAL SPONDYLOARTHRITIS;

D O I：

10.1093/rheumatology/keab887

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives To delineate the impact of peripheral musculoskeletal manifestations on stratification of disease phenotype and outcome in new-onset spondyloarthritis (SpA), using a prospective observational nationwide inception cohort, the BelGian Inflammatory Arthritis and spoNdylitis cohorT (Be-Giant). Methods Newly diagnosed adult SpA patients, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial or peripheral SpA, were included in Be-Giant and prospectively followed every six months. Peripheral involvement (defined as arthritis, enthesitis and/or dactylitis) was determined in relation to clinically similar patient subsets at baseline and disease activity patterns during two-year follow-up, identified through K-means cluster analysis and latent class growth analysis. Results From November 2010 to March 2020, 367 patients were enrolled in Be-Giant, of whom 162 (44%) had peripheral manifestations. Two patient clusters [A, axial predominant (n = 248) and B, peripheral predominant (n = 119)] were identified at diagnosis. Longitudinal analysis (n = 115) revealed two trajectories of disease activity in each cluster: one with persistently high disease activity over time ('High'), the other rapidly evolving to low disease activity ('Low'). In cluster A patients, peripheral manifestations predisposed to the 'High' trajectory [odds ratio (OR) = 2.0, 95% CI: 1.3, 3.1, P = 0.001], despite more rapid initiation of biologics compared with patients without peripheral manifestations (hazard ratio (HR) = 2.1, 95% CI: 1.0, 4.4, P = 0.04 - Cox proportional-hazards model). Conclusion Peripheral musculoskeletal manifestations are major determinants of phenotypical diversity in new-onset SpA. Intriguingly, stratification of axial SpA according to concomitant peripheral involvement identified an endotype with an unfavorable outcome despite more prompt therapeutic intensification with biologics. These observations justify an endotype-tailored approach beyond current ASAS/EULAR management recommendations.

引用

页码：3279 / 3288

页数：10

共 27 条

[1] Two Phenotypes Are Identified by Cluster Analysis in Early Inflammatory Back Pain Suggestive of Spondyloarthritis Results From the DESIR Cohort [J].