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Butcher AJ, Ward S, Clissold T, Richards J, Hébert-Losier K. Maturation and biomechanical risk factors associated with anterior cruciate ligament injury: Is there a link? A systematic review. Phys Ther Sport 2024; 68:31-50. [PMID: 38908221 DOI: 10.1016/j.ptsp.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To establish the potential link between sex-specific maturation and biomechanical factors associated with ACL injury during dynamic tasks. DESIGN Systematic review. LITERATURE SEARCH Five databases (CINHAL®, Cochrane Library, PubMed®, Scopus®, and SPORTDiscus) were searched and monitored until 27 May 2024. STUDY SELECTION CRITERIA Cross-sectional, cohort, case-control, or interventional studies reporting one or more biomechanical variable linked with ACL injury and which assessed participants across two or more maturation phases were considered eligible. DATA SYNTHESIS Studies were assessed for risk of bias using a modified version of the Newcastle Ottawa Scale and overall quality of evidence was rated using GRADE. Metrics and effect sizes were presented where available. RESULTS Eighteen included studies examined 400 males, 1377 females, and 315 participants of undefined sex across various maturation phases. The methodological quality of most studies (n = 16) was considered good, and satisfactory for two. Knee abduction angle, knee abduction moment, knee flexion angle, and ground reaction forces were most commonly reported. Knee abduction angles and moments and knee flexion angles were greater in late and post-pubertal females than males and pre-pubertal females during both landing and cutting tasks. When normalised for body mass, ground reaction forces were generally greater in males compared to females overall and for less mature participants for both sexes. Overall quality of evidence was low or medium across the four biomechanical measures. CONCLUSION Sex-specific maturation considerations are important in the targeted development and implementation of ACL injury risk identification and prevention strategies.
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Affiliation(s)
- Anna J Butcher
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, 52 Miro Street, 3116, Tauranga, New Zealand.
| | - Sarah Ward
- Department of Exercise Sciences, University of Auckland, Suiter Street, Newmarket, New Zealand. https://twitter.com/sarahward_nz
| | - Tracey Clissold
- Toi Ohomai Institute of Technology, 70 Windermere Drive, Poike, 3112, Tauranga, New Zealand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, England, United Kingdom. https://twitter.com/ProfJimRichards
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Adams Centre for High Performance, 52 Miro Street, 3116, Tauranga, New Zealand. https://twitter.com/KimHebertLosier
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de Wolff L, Arends S, Brouwer E, Bootsma H, Spoorenberg A. High BMI is associated with lower TNF-α inhibitor serum trough levels and higher disease activity in patients with axial spondyloarthritis. Arthritis Res Ther 2023; 25:202. [PMID: 37848964 PMCID: PMC10580642 DOI: 10.1186/s13075-023-03187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND TNF-α inhibitor (TNFi) serum trough levels have previously been found to be related to disease activity in axial spondyloarthritis (axSpA). However, most research regarding serum trough levels has been conducted in patients who only recently started TNFi therapy. Therefore, our objective was to explore TNFi serum trough level measurements in relation to disease activity and BMI in the total axSpA population in daily clinical practice, also including patients on long-term TNFi therapy. METHODS Consecutive patients from the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort were approached for a TNFi serum trough level measurement during their regular outpatient visit at the UMCG. Spearman's correlation coefficient was used to analyse the relation of serum trough levels with disease activity and BMI. Logistic regression was performed to analyse the relation between therapeutic drug levels and disease activity, corrected for potential confounders, including BMI. RESULTS Thirty-four patients on adalimumab and 21 patients on etanercept were included. Mean age was 45 ± 12 years, 47% were male, median BMI was 26.4 (IQR 23.9-32.5) and median treatment duration was 41 months (range 2-126). According to definitions of Sanquin, 47% of patients had therapeutic serum trough levels. No significant correlations were found between TNFi levels and disease activity (ASDAS-CRP: adalimumab: ρ = -0.16, p = 0.39; etanercept: ρ = -0.29, p = 0.20). TNFi levels were moderately correlated with BMI (adalimumab: ρ = -0.48, p = 0.004; etanercept: ρ = -0.50, p = 0.021). Patients with active disease (ASDAS ≥ 2.1) showed higher BMI than patients with inactive disease (median 29.7 vs. 24.6, p = 0.015). In multivariable regression analyses, BMI was identified as the only confounder for the relationship between therapeutic drug levels and ASDAS. CONCLUSION In this cross-sectional, observational study of axSpA patients mainly on long-term treatment with TNFi, higher BMI was significantly associated with lower adalimumab and etanercept serum trough levels and higher disease activity.
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Affiliation(s)
- Liseth de Wolff
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Zhong Y, Chen Y, Zhang X, Cai W, Zhao C, Zhao W. No evidence of a causal relationship between ankylosing spondylitis and cardiovascular disease: a two-sample Mendelian randomization study. Front Cardiovasc Med 2023; 10:1243867. [PMID: 37900560 PMCID: PMC10600491 DOI: 10.3389/fcvm.2023.1243867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Observational studies have suggested an increased risk of cardiovascular disease in individuals with ankylosing spondylitis. However, these studies are prone to confounding factors and reverse causality. To address these limitations, we conducted a Mendelian randomization study to assess the causal relationship between AS and CVD. Methods The study population comprises 9,069 individuals with ankylosing spondylitis and 509,093 individuals with either of six common cardiovascular diseases and a related indicator. Causal analysis using summary effect estimates and inverse variance weighting were employed as the main methods. Results The CAUSE analysis showed no evidence of a causal relationship between AS and CVD. The odds ratios for total CVD, heart failure, myocardial infarction, valvular heart disease, ischemic heart disease, and venous thromboembolism, Arterial stiffness index, were as follows: OR, 1.01; 95% confidence interval, 0.96-1.05; P = 0.91; OR, 1.03; 95% CI, 0.99-1.08; P = 0.50; OR, 0.94; 95% CI, 0.86-1.03; P = 0.53; OR, 0.99; 95% CI, 0.94-1.04; P = 0.99; OR, 0.98; 95% CI, 0.91-1.04; P = 0.94; OR, 0.98; 95% CI, 0.91-1.04; P = 0.99; β, -0.0019; 95% CI, 0.97-1.01; P = 0.99. The IVW and weighted median methods also yielded consistent results, and no heterogeneity or pleiotropy was found. Likewise, a reverse Mendelian randomization analysis did not uncover a heritable causal relationship between AS and CVD. Conclusion This Mendelian randomization study does not support a causal relationship between AS and CVD. Further research is needed to confirm this association.
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Affiliation(s)
- Yan Zhong
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - YingWen Chen
- College of Traditional Chinese Medicine, Tianjin University of Chinese Medicine, Tianjin, China
| | - XinYue Zhang
- College of Integrated Chinese and Western Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - WenJun Cai
- Department of Orthopedics, The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - ChangWei Zhao
- Department of Orthopedics, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - WenHai Zhao
- Department of Orthopedics, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
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Bosch P, Zhao SS, Nikiphorou E. The association between comorbidities and disease activity in spondyloarthritis - A narrative review. Best Pract Res Clin Rheumatol 2023; 37:101857. [PMID: 37541813 DOI: 10.1016/j.berh.2023.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
Comorbidities, including cardiovascular disease, osteoporosis, and depression, are more prevalent in patients with spondyloarthritis (SpA) than in the general population. Clinical and laboratory markers of disease activity are associated with numerous of these comorbidities, and studies suggest that the treatment of SpA can have a positive impact on comorbidities; conversely, managing comorbidities can improve disease activity. Therefore, the screening of comorbidities is considered a core component of a rheumatology consultation, and treatment should be performed in liaison with other health professionals (e.g. general physicians). Validated tools and questionnaires can be used for not only the detection but also the monitoring of potential comorbidities. Understanding whether a comorbidity is a separate disease entity, linked to SpA or its treatment, or an extra-musculoskeletal manifestation of the disease is important to identify the most appropriate treatment options.
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Affiliation(s)
- Philipp Bosch
- Clinical Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elena Nikiphorou
- Center for Rheumatic Diseases, King's College London, London, United Kingdom; Rheumatology Department, King's College Hospital, London, United Kingdom
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Queiro R, Aurrecoechea E, Alonso Castro S, Villa Blanco I, Brandy-Garcia A, Linge R. Interleukin-17-targeted treatment in patients with spondyloarthritis and associated cardiometabolic risk profile. Front Immunol 2023; 14:1203372. [PMID: 37533855 PMCID: PMC10391638 DOI: 10.3389/fimmu.2023.1203372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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Affiliation(s)
- Rubén Queiro
- Rheumatology and Health Research Institute of the Principality of Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- Oviedo University School of Medicine, Oviedo, Spain
| | - Elena Aurrecoechea
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sara Alonso Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa Blanco
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Ortolan A, Felicetti M, Lorenzin M, Cozzi G, Ometto F, Striani G, Favero M, Doria A, Ramonda R. The impact of diet on disease activity in spondyloarthritis: A systematic literature review. Joint Bone Spine 2023; 90:105476. [PMID: 36404571 DOI: 10.1016/j.jbspin.2022.105476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Our study aimed to systematically review the evidence about the effect of diet or dietary supplements on spondyloarthritis (SpA) disease activity. METHODS a systematic literature review (SLR) was conducted in MEDLINE, EMBASE, Cochrane and SCOPUS according to the "PEO" format (Population, Exposure, Outcome). The population was SpA (axial or peripheral, axSpA/pSpA, including Psoriatic Arthritis-PsA); the intervention any kind of diet/dietary supplement; the outcome disease activity. Inclusion criteria were: adult patients, Randomized Controlled Trials (RCTs) and longitudinal studies (so that a pre-and post-intervention assessment were available), papers in English. Risk of bias (RoB) was conducted with different tools according to the design of the study. RESULTS Literature search yielded 1390 publications, of which 15 were finally inlcuded: 12 interventional and 3 observational studies. Among those with the lower RoB: a) 2 RCTs, one at unclear and one at low RoB, failed to show benefit of probiotics in SpA b) Two RCTs at unclear RoB provided evidence that weight loss, but not hypocaloric diet, was associated to MDA achievement in PsA. The remaining interventional studies were at high RoB. Among the observational studies, one study on Mediterranean diet demonstrated an association between diet adherence and a ≥ 20% decrease of ASDAS in axSpA. The other two observational studies were judged of poor quality. CONCLUSIONS weight loss seem to be able to impact disease activity in PsA, while probiotics do not seem useful in SpA; evidence for dietary behaviors is scarce and heterogeneous.
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Affiliation(s)
- Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Francesca Ometto
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy; ULSS 6 Euganea Company, Padova, Italy
| | - Giovanni Striani
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy; Internal Medicine Unit I, Ca' Foncello Hospital, Treviso, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy.
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No Evidence of a Genetic Causal Relationship between Ankylosing Spondylitis and Gut Microbiota: A Two-Sample Mendelian Randomization Study. Nutrients 2023; 15:nu15041057. [PMID: 36839415 PMCID: PMC9965834 DOI: 10.3390/nu15041057] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Objective: Ankylosing spondylitis (AS) is associated with a variety of gut microbiotas. We aim to analyze the causal relationship between the two at the genetic level. Methods: Mendelian randomization (MR) is a type of instrumental variables (IVs) analysis; MR follows the Mendelian genetic rule of "parental alleles are randomly assigned to offspring" and takes genetic variation as IVs to infer the causal association between exposure factors and study outcome in observational studies. Genome-wide association study (GWAS) summary data of AS were from the FinnGen consortium, and the gut microbiota (Bacteroides, Streptococcus, Proteobacteria, Lachnospiraceae) were from the MiBioGen consortium. The TwoSampleMR and MRPRESSO packages of the R were used to perform a two-sample MR study. Random-effects inverse variance weighted (IVW) was the main analysis method, and MR Egger, weighted median, simple mode, and weighted mode were used as supplementary methods. We examined heterogeneity and horizontal pleiotropy, and examined whether the analysis results were influenced by a single SNP. We applied radial variants of the IVW and MR-Egger model for the improved visualization of the causal estimate. We further examined the causal relationship between AS and gut microbiota, and the robustness of the analysis results. Finally, we performed maximum likelihood, penalized weighted median, and IVW (fixed effects) to further identify the potential causal association. Results: The random-effects IVW results showed that Bacteroides (p = 0.965, OR 95% confidence interval [CI] = 0.990 [0.621-1.579]), Streptococcus (p = 0.591, OR 95% CI = 1.120 [0.741-1.692]), Proteobacteria (p = 0.522, OR 95% CI = 1.160 [0.737-1.826]), and Lachnospiraceae (p = 0.717, OR 95% CI = 1.073 [0.732-1.574]) have no genetic causal relationship with AS. There was no heterogeneity, horizontal pleiotropy or outliers, and results were normally distributed. The MR analysis results were not driven by a single SNP. Conclusions: This study showed that Bacteroides, Streptococcus, Proteobacteria and Lachnospiraceae, four common gut microbiotas associated with AS, had no causal relationship with AS at the genetic level. This study makes a positive contribution to the genetics of AS, but the insufficient number of gut microbiota included is a limitation.
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Yang M, Yu H, Xu K, Xie J, Zheng H, Feng R, Wang J, Xu P. No evidence of a genetic causal relationship between ankylosing spondylitis and iron homeostasis: A two-sample Mendelian randomization study. Front Nutr 2023; 10:1047640. [PMID: 37032771 PMCID: PMC10077893 DOI: 10.3389/fnut.2023.1047640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Background Ankylosing spondylitis (AS) is an immune-mediated chronic inflammatory disease that leads to bone hyperplasia and spinal ankylosis. Iron homeostasis plays a very important role in the inflammatory response and is closely related to the pathogenesis of AS. This study aimed to use large-scale genome-wide association study (GWAS) summary data to study the genetic causal relationship between AS and iron homeostasis using Mendelian randomization (MR). Methods Genome-wide association study summary data of AS and iron homeostasis-related indicators were obtained from the FinnGen consortium and the DeCODE genetics database, respectively. We used four iron homeostasis-related indicators: ferritin, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TSAT) for two-sample MR analyses to test for genetic causal association with AS using the "TwoSampleMR" package of the R software (version 4.1.2). The random-effects inverse variance weighted (IVW) method was the main analysis method used for MR. We examined the MR analysis results for heterogeneity, horizontal pleiotropy, and possible outliers. In addition, we confirmed the robustness of the MR analysis by testing whether the results were affected by a single SNP and whether they followed a normal distribution. Results The random-effects IVW results showed that ferritin [p = 0.225, OR 95% confidence interval (CI) = 0.836 (0.627-1.116)], serum iron [p = 0.714, OR 95% CI = 0.948 (0.714-1.260)], TIBC [p = 0.380, OR 95% CI = 0.917 (0.755-1.113)], and TSAT [p = 0.674, OR 95% CI = 0.942 (0.713-1.244)] have no genetic causal relationship with AS. We detected no heterogeneity,horizontal pleiotropy and possible outliers in our MR analysis (p > 0.05). In addition, our MR analysis results were not affected by a single SNP, and were normally distributed. Conclusion Our study did not detect a genetic causal relationship between AS and iron homeostasis. Nonetheless, this does not rule out a relationship between the two at other mechanistic levels.
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No Evidence to Support a Causal Relationship between Circulating Adiponectin Levels and Ankylosing Spondylitis: A Bidirectional Two-Sample Mendelian Randomization Study. Genes (Basel) 2022; 13:genes13122270. [PMID: 36553537 PMCID: PMC9778096 DOI: 10.3390/genes13122270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Based on previous observational studies, the causal association between circulating adiponectin (CA) levels and ankylosing spondylitis (AS) risk remains unclear. Therefore, this study aims to investigate whether CA levels are related to the risk of AS. We carried out a bidirectional two-sample Mendelian randomization (MR) analysis to examine the causal correlation between CA levels and AS via published genome-wide association study (GWAS) datasets. Single-nucleotide polymorphisms (SNPs) related to CA levels were derived from a large GWAS that included 39,883 individuals of European descent. SNPs related to AS were obtained from the FinnGen consortium (2252 cases and 227,338 controls). The random-effects inverse variance weighted (IVW) method was the primary method utilized in our research. We also used four complementary approaches to improve the dependability of this study (MR-Egger regression, Weighted median, Weighted mode, and Simple mode). Random-effects IVW (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.79-1.27, p = 0.984) and four complementary methods all indicated that genetically predicted CA levels were not causally related to the risk of AS. In reverse MR analysis, there is little evidence to support the genetic causality between the risk of AS and CA levels.
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Vergne-Salle P, Salle L, Fressinaud-Marie AC, Descamps-Deplas A, Montestruc F, Bonnet C, Bertin P. Diet and Disease Activity in Patients with Axial Spondyloarthritis: SpondyloArthritis and NUTrition Study (SANUT). Nutrients 2022; 14:nu14224730. [PMID: 36432416 PMCID: PMC9695957 DOI: 10.3390/nu14224730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Axial Spondyloarthritis (axSpA) patients with inflamed intestines have higher SpA activity. Diets that modulate microbiota may influence inflammation and SpA activity. Today, data concerning the impact of diet on SpA activity are scarce. SANUT was a single-center, noninterventional, cohort study that assessed dietetic profiles associated with SpA activity in axSpA. Demographic, clinical, SpA-related, quality of life (QoL), fatigue, physical activity, and dietary data were collected. SpA activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) and by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). We assessed whether high SpA activity was associated with nutriment consumption. Between 12 February 2018 and 12 February 2020, 278 patients participated. High SpA activity, as measured by ASDAS and BASDAI, was significantly associated with higher body mass index and waist circumference, negative HLA-B27, lower QoL, higher fatigue, and higher digestive-symptom scores. Furthermore, high SpA activity, as measured by BASDAI, was associated with female sex, smoking status, patients who were not actively employed, reduced physical activity, and high intake of ultra-transformed foods, while high SpA activity, as measured by ASDAS, was associated with low intake of omega-3 PUFAs and fiber. Therefore, low intakes of omega-3 PUFAs and fiber, and high intake of ultra-transformed foods, are associated with high SpA activity.
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Affiliation(s)
- Pascale Vergne-Salle
- Rheumatology Department, University Hospital of Limoges and Laboratory PEIRENE UR 22722 Institut OmegaHealth, 87042 Limoges, France
- Correspondence:
| | - Laurence Salle
- Endocrinology Department, University Hospital of Limoges and Inserm U1094, EpiMaCT—Epidemiology of Chronic Diseases in Tropical Zone, 87042 Limoges, France
| | - Anne Catherine Fressinaud-Marie
- Rheumatology Department, University Hospital of Limoges and Laboratory PEIRENE UR 22722 Institut OmegaHealth, 87042 Limoges, France
| | - Adeline Descamps-Deplas
- Rheumatology Department, University Hospital of Limoges and Laboratory PEIRENE UR 22722 Institut OmegaHealth, 87042 Limoges, France
| | | | - Christine Bonnet
- Rheumatology Department, University Hospital of Limoges and Laboratory PEIRENE UR 22722 Institut OmegaHealth, 87042 Limoges, France
| | - Philippe Bertin
- Rheumatology Department, University Hospital of Limoges and Laboratory PEIRENE UR 22722 Institut OmegaHealth, 87042 Limoges, France
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Hu S, Xing H, Wang X, Zhang N, Xu Q. Causal Relationships Between Total Physical Activity and Ankylosing Spondylitis: A Mendelian Randomization Study. Front Immunol 2022; 13:887326. [PMID: 35865535 PMCID: PMC9294357 DOI: 10.3389/fimmu.2022.887326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Currently, there is little literature about the association between physical activity (PA) and the risk of ankylosing spondylitis (AS). The present study aimed to understand the causal relationships between PA and AS. Methods We performed two-sample Mendelian randomization (MR) using publicly released genome-wide association studies summary statistics to estimate the causal associations of PA with AS risk. The inverse variance weighted (IVW) method was utilized as primary MR analysis. Furthermore, sensitivity, pleiotropy, and heterogeneity analyses were then conducted to assess the robustness of the findings of the present study. Results Results of the IVW analysis suggested a protective relationship between accelerometer-based PA and AS (average acceleration, odds ratio [OR] = 0.9995, 95% CI, 0.9988-0.9999, P = 0.014). On the contrary, there was no causal relationship between accelerometer-based PA (acceleration fraction >425 mg; OR = 0.9981, 95% CI = 0.9936-1.0026, P = 0.402) and AS. Furthermore, there was no significant relationship between self-reported vigorous PA and AS (OR = 1.0005, 95% CI = 0.9875-1.0136, P = 0.943), or even between self-reported moderate-to-vigorous PA and AS (OR = 1.0000, 95% CI, 0.9947-1.0052; P = 0.990). Conclusions The use of genetic approach in the present study revealed that total physical activity (TPA) has a protective relationship with AS risk. Furthermore, it was evident that vigorous PA or moderate-to-vigorous physical levels are not causally associated with AS. Therefore, the present study evidently supports the hypothesis that enhancing TPA rather than PA intensity is an effective prevention strategy for AS.
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Affiliation(s)
- Shaojun Hu
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongyuan Xing
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingchen Wang
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ning Zhang
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiang Xu
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, China
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12
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Axiale Spondyloarthritis: Beeinflusst der Bodymassindex die
Krankheitsaktivität? AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1737-1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Es wird vermutet, dass im Fettgewebe produzierte proinflammatorische
Mediatoren die Entzündungsaktivität der axialen
Spondyloarthritis unterhalten. Übergewicht und Adipositas stellen
für die erkrankten Strukturen ferner eine starke biomechanische
Belastung dar. Leiden übergewichtige bzw. adipöse
Patientinnen und Patienten unter einer stärkeren
Krankheitsaktivität als normalgewichtige Betroffene?
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13
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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14
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Roberts MJ, Leonard AN, Bishop NC, Moorthy A. Lifestyle modification and inflammation in people with axial spondyloarthropathy-A scoping review. Musculoskeletal Care 2022; 20:516-528. [PMID: 35179819 DOI: 10.1002/msc.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION People with axial spondyloarthritis (AS) have an inflammatory profile, increasing the risk of hypertension, type 2 diabetes, obesity, and dyslipidaemia. Consequently, AS is linked with co-morbidities such as cardiovascular disease (CVD). Physical inactivity, diet, smoking, alcohol consumption, and obesity influence inflammation, but knowledge of the interaction between these with inflammation, disease activity, and CVD risk in AS is dominated by cross-sectional research. METHODS A review of the literature was conducted between July 2020 and December 2021. The focus of the scoping review is to summarise longitudinal and randomised control trials in humans to investigate how tracking or modifying lifestyle influences inflammation and disease burden in patients with AS. KEY MESSAGES: (1) Lifestyle modifications, especially increased physical activity (PA), exercise, and smoking cessation, are critical in managing AS. (2) Smoking is negatively associated with patient reported outcome measures with AS, plus pharmaceutical treatment adherence, but links with structural radiographic progression are inconclusive. (3) Paucity of data warrant structured studies measuring inflammatory cytokine responses to lifestyle modification in AS. CONCLUSION Increased PA, exercise, and smoking cessation should be supported at every given opportunity to improve health outcomes in patients with AS. The link between smoking and radiographic progression needs further investigation. Studies investigating the longitudinal effect of body weight, alcohol, and psychosocial factors on disease activity and physical function in patients with AS are needed. Given the link between inflammation and AS, future studies should also incorporate markers of chronic inflammation beyond the standard C-reactive protein and erythrocyte sedimentation rate measurements.
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Affiliation(s)
- Matthew J Roberts
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Amber N Leonard
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Nicolette C Bishop
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of NHS Trust, College of Life Sciences, University of Leicester, Leicester, UK
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15
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Ometto F, Ortolan A, Farber D, Lorenzin M, Dellamaria G, Cozzi G, Favero M, Valentini R, Doria A, Ramonda R. Mediterranean diet in axial spondyloarthritis: an observational study in an Italian monocentric cohort. Arthritis Res Ther 2021; 23:219. [PMID: 34416917 PMCID: PMC8377333 DOI: 10.1186/s13075-021-02600-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/03/2021] [Indexed: 02/08/2023] Open
Abstract
Background Little evidence is available about the impact of diet on disease activity of axial spondyloarthritis (axSpA). This study evaluated the impact of a 6-month nutritional advice based on the Mediterranean diet on the disease activity of axSpA. Methods We prospectively collected the information of a group of axSpA patients who were offered nutritional advice for a 6-month period, who were compared to axSpA patients followed at the same center who were not on a specific diet. A nutritionist gave suggestions for dietary modification at baseline and thereafter every 2 months until month 6. Adherence to the Mediterranean diet was evaluated with the PREDIMED questionnaire ranging from 0 (no adherence) to 10 (optimal adherence); disease activity was evaluated with ASDAS-CRP. A multivariable regression analysis was conducted to identify independent predictors of PREDIMED and of ASDAS-CRP improvement (improvement ≥ 20% of each score). Results A total of 161 patients were included: 81 receiving nutritional advice and 80 controls; 47 in the nutritional group and 63 controls had complete information until month 6. Overall, 40 (36.4%) were females, the mean age was 51.7 ± 1.3 years, and 58 (52.7%) were affected with psoriasis. No relevant change of anthropometric or laboratory measures was observed in either group. Adherence to the Mediterranean diet was moderate (PREDIMED score 6.7 ± 1.8 at baseline; 7.6 ± 2.1 at month 6) and improved more in the nutritional group compared to controls (p = 0.020). Predictors of a PREDIMED improvement ≥ 20% were receiving nutritional advice (OR 4.53, 1.36–15.1, p = 0.014), age (per 10-year increase OR 1.05, 1.02–1.68, p = 0.007), and BMI (OR 0.77, 0.63–0.9, p = 0.006). An ASDAS-CRP improvement ≥ 20% was more frequent in the nutritional group compared to controls (p = 0.020). A PREDIMED improvement ≥ 20% was associated with a ASDAS-CRP improvement ≥ 20% (OR 6.75,1.8–25.3, p = 0.005). Psoriasis and disease duration were negatively but not significantly associated to the ASDAS-CRP improvement. Conclusions Improving adherence to the Mediterranean diet may have a beneficial impact on the activity of axSpA. Patients with a lower BMI and older patients are less prone to modify their diet towards the Mediterranean diet following nutritional advice. Patients with psoriasis may have a limited benefit from dietary improvement. Study registration Protocol No. 52723, Padova Hospital Medical Ethical Committee (October 11, 2010). Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02600-0.
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Affiliation(s)
- Francesca Ometto
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Davide Farber
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Giulia Dellamaria
- Dietetics and Clinical Nutrition Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,Medicina Interna I^, Cà Foncello Hospital, Treviso, Italy
| | - Romina Valentini
- Dietetics and Clinical Nutrition Unit, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
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16
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Predictive factors for switching in patients with psoriatic arthritis undergoing anti-TNFα, anti-IL12/23, or anti-IL17 drugs: a 15-year monocentric real-life study. Clin Rheumatol 2021; 40:4569-4580. [PMID: 34136971 PMCID: PMC8519923 DOI: 10.1007/s10067-021-05799-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/13/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to evaluate the (a) potential predictors of first biological disease-modifying anti-rheumatic drug (bDMARD) failure and (b) factors associated with failure of multiple therapies in psoriatic arthritis (PsA). MATERIALS AND METHODS We enrolled consecutive PsA patients attending our unit and undergoing bDMARDs during 2004-2020. Disease characteristics, previous/ongoing treatments, comorbidities, and follow-up duration were recorded. Disease activity and functional and clinimetric scores were recorded at baseline and yearly and were compared between switchers and non-switchers, and within switchers according to the reasons for switching. Effectiveness was evaluated over time with descriptive statistics; multivariate Cox and logistic regression models were used to evaluate predictors of response and failure of multiple bDMARDs. Kaplan-Meier curves were used to assess differences in time-to-first bDMARD discontinuation. Infections and adverse events were recorded. RESULTS Two hundred sixty-four patients were included (117 (44.32%) females, mean age 56 years, mean PsA duration 15 years); 117 (44.32%) switched bDMARDs at least once. Switchers were mostly females, with higher Psoriasis Area and Severity Index and worse Health Assessment Questionnaire at baseline. Mean time-to-first bDMARD discontinuation was 72 months; 2-year and 5-year retention rates were 75% and 60%, respectively. Survival curves for anti-TNFα/anti-IL12/23/anti-IL17 were similar (p = 0.66). Main reasons for switching were inefficacy (67.52%) and adverse events (25.7%). Female sex was associated with a higher risk of first bDMARD discontinuation (HR = 2.39; 95% CI: 1.50-3.81) and failure of multiple bDMARDs (OR = 1.99; 95% CI: 1.07-3.69); initiating therapy before 2015 was protective (HR = 0.40; 95% CI: 0.22-0.73). CONCLUSIONS Survival rate was good for anti-TNFα and other bDMARDs. Female sex was a predictor of first bDMARD discontinuation, unlike mechanism of action, comorbidities, and BMI. Key Points • Drug survival in PsA patients was confirmed be greater for the first bDMARD administered. • In case of failure of the first bDMARD, switching/swapping proved a good treatment option, as reflected by a persistent satisfactory effectiveness with second-line bDMARDs and so subsequent switches. • Female sex may constitute a predisposing risk factor for flare and therapeutic switches. • Discontinuation or switching of biologics due to mechanism of action, comorbidities tolerability and BMI did not seem to impact first bDMARD withdrawal.
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17
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Blasco-Blasco M, Castrejón I, Jovaní V, Pascual E, Ruiz-Cantero MT. Reviewing Disease Activity Indices in Spondyloarthritis From the Sex Perspective: A Systematic Review and Metaanalysis. J Rheumatol 2021; 48:1395-1404. [PMID: 33795327 DOI: 10.3899/jrheum.200967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) exhibited differences between women and men. METHODS We systematically searched MEDLINE, Embase, Web of Science, and other sources in English or Spanish from January 1, 1995, to July 31, 2020, to assess the differences according to sex in BASDAI and ASDAS. We performed a comparative analysis by sex using t test and mean difference by sex metaanalyses for BASDAI and ASDAS, as well as a random-effects model using the inverse-variance method. RESULTS Forty-one studies included BASDAI (6785 women, 12,929 men) and 16 of them included ASDAS (2046 women, 4403 men). Disease activity detected using BASDAI was significantly higher in women than in men (mean 4.9 vs 4.2, P = 0.02), whereas ASDAS did not detect differences between sexes (mean 2.8 women vs 2.8 men). In the metaanalyses, BASDAI detected significant differences between women and men (mean difference = 0.55 [95% CI 0.46-0.65], P < 0.00001), but ASDAS did not identify significant mean difference between sexes (0.04, 95% CI -0.05 to 0.12], P = 0.38). CONCLUSION The 2 most widely used indices of disease activity in spondyloarthritis (SpA) discriminate differently according to sex by their different evaluations of peripheral disease. The different components and weights in BASDAI and ASDAS influence their values. BASDAI may be affected by fatigue, and in predominantly peripheral manifestations such as enthesitis, ASDAS may not be sensitive enough to detect activity. This may represent a sex bias unfavorable to women, because peripheral SpA is more common in women than in men.
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Affiliation(s)
- Mar Blasco-Blasco
- M. Blasco-Blasco, PhD, Public Health Research Group, University of Alicante, Alicante, Spain;
| | - Isabel Castrejón
- I. Castrejón, MD, PhD, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, USA
| | - Vega Jovaní
- V. Jovaní, MD, PhD, Department of Rheumatology, Alicante University General Hospital, Alicante, Spain
| | - Eliseo Pascual
- E. Pascual, MD, PhD, Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - María Teresa Ruiz-Cantero
- M.T. Ruiz-Cantero, MD, PhD, Public Health Research Group, University of Alicante, and CIBERESP (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública), Alicante, Spain
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