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Kenyon M, Gallagher P, Dinneen B, O'Shea F, McManus R. Distinct clinical outcomes linked to peripheral arthritis and dactylitis in axial spondyloarthritis: findings from a retrospective Irish cohort. Rheumatol Int 2024; 44:2517-2525. [PMID: 39251445 PMCID: PMC11424673 DOI: 10.1007/s00296-024-05707-0] [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: 04/30/2024] [Accepted: 08/19/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Axial spondyloarthritis (AxSpA) is a chronic inflammatory condition primarily affecting the axial skeleton. Peripheral features such as peripheral arthritis (PA) and dactylitis are common in AxSpA disease. This study aimed to investigate the independent impact of these manifestations on patient presentation and disease outcomes within an Irish AxSpA cohort. METHODS 912 Irish AxSpA patients were analyzed in this study. Disease outcomes in patients with and without peripheral arthritis or dactylitis were compared using univariate and multivariate methods. The prevalence of extra-spinal manifestations was further assessed in relation to AxSpA disease duration. RESULTS 30.2% of patients reported PA, while 6.6% had dactylitis. PA and dactylitis were strongly linked, with 70% of patients presenting with dactylitis also showing features of PA. Psoriasis was more common in both patients with PA (OR 2.2, P < 0.001) and dactylitis (OR 3.38, P < 0.001). Dactylitis, but not PA was strongly linked to uveitis (OR 2.91, P < 0.001) and inflammatory bowel disease (OR 3.15, P < 0.001), while PA was associated with worse patient functioning and reduced quality of life. PA, but not dactylitis was linked with increased AxSpA disease duration. DISCUSSION Despite high concurrence of PA and dactylitis in AxSpA patients, each manifestation is independently associated with worse outcomes. While some of these overlapped, several outcomes are specific to either PA or dactylitis. Due to its strong association with uveitis and inflammatory bowel disease, an early presentation of dactylitis may represent a unique subset of patients and serve as a valuable predictive marker for the later onset of these conditions.
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Affiliation(s)
- Marcus Kenyon
- Dept. of Clinical Medicine, Trinity Translational Medicine Institute, James's St, Dublin, Dublin 8, Ireland.
| | - Phil Gallagher
- Department of Rheumatology, St James' Hospital, Dublin, Ireland
| | - Brona Dinneen
- Department of Rheumatology, St James' Hospital, Dublin, Ireland
| | - Finbar O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland
| | - Ross McManus
- Dept. of Clinical Medicine, Trinity Translational Medicine Institute, James's St, Dublin, Dublin 8, Ireland
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Sieiro Santos C, Sendino-Tenorio I, Álvarez Castro C, Moriano Morales C, Cordero Coma M, Díez Álvarez E. Factors Associated With Adverse Outcomes in Uveitis Related to Spondyloarthritis: Development of an Outcome Score (SpA-U). J Clin Rheumatol 2023; 29:132-138. [PMID: 36728382 DOI: 10.1097/rhu.0000000000001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evaluating the efficacy and refractoriness to treatment and determining factors associated with adverse outcomes in uveitis associated with spondylarthritis (SpA) are complicated by the lack of validated outcome measures. OBJECTIVES The aims of this study were to develop an outcome score SpA-U in patients with uveitis associated with SpA and to determine factors associated with adverse outcomes in patients with uveitis under systemic treatment. METHODS The outcome score SpA-U was defined by best-corrected visual acuity, anterior chamber inflammation, macular edema and inflammation of posterior chamber, global assessment, and refractoriness to treatment. Factors associated with adverse outcomes in uveitis were studied using linear regression. For categorical factors, marginal averages and their SEs are displayed together with linear regression coefficients with 95% confidence intervals. For continuous factors, averages and SDs are reported in addition to linear regression coefficients with 95% confidence interval. Two regression coefficients are reported for each variable: unadjusted and adjusted for age at diagnosis and sex. RESULTS One hundred ninety-seven uveitis outbreaks were included. Sixty-two uveitis outbreaks (31%) were classified as severe, 42 as moderate (21%), and 93 as mild (47%) based on the definition and construction of outcome score. The results of the linear regression model revealed that the uveitis activity was more severe in patients with smoking history ( β = 0.34), axial and peripheral involvement ( β = 0.43), Ankylosing Spondylitis Disease Activity Score >2.1 ( β = 0.45), positive HLA-B27 ( β = 0.29), female sex ( β = 0.19), patients with C-reactive protein elevation ( β = 0.002), and bilateral ocular involvement ( β = 0.32). At the same time, shorter disease evolution ( β = -0.02) was associated with less severe uveitis activity. CONCLUSION We have determined factors associated with adverse outcomes in patients with uveitis associated with SpA by developing an outcome score SpA-U that integrates ocular inflammatory activity, visual acuity, global assessment, and refractoriness to treatment.
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Affiliation(s)
| | | | | | | | - Miguel Cordero Coma
- Ophthalmology Department, Complejo Asistencial Universitario de León, León, Spain
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Gómez-Garcia I, García-Puga T, Font-Ugalde P, Puche-Larrubia MA, Barbarroja N, Ruiz-Limón P, Escudero-Contreras A, Collantes-Estévez E, López-Medina C. Relationship between onset of psoriasis and spondyloarthritis symptoms with clinical phenotype and diagnosis: data from REGISPONSER registry. Ther Adv Musculoskelet Dis 2022; 14:1759720X221118055. [PMID: 36051633 PMCID: PMC9424886 DOI: 10.1177/1759720x221118055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The relationship of psoriasis and spondyloarthritis (SpA) is well-known, and the age of appearance of different manifestations has been described as a determinant of SpA phenotype. However, differences between Spa with psoriasis and psoriatic arthritis (PsA) are still controversial. Objectives To evaluate whether the time of onset of psoriasis relative to the appearance of rheumatic symptoms in patients with SpA is associated with a clinical phenotype, a rheumatologist's diagnosis and the evolution of the disease. Design This was a cross-sectional study with data extracted from the REGISPONSER (Spondyloarthritis Registry of the Spanish Rheumatology Society) registry. Methods All patients had data available for both psoriasis and SpA dates of onset. Patients were classified into two groups depending on the time of appearance of psoriasis: psoriasis before or after rheumatic symptoms. The clinical characteristics, disease activity, radiographic damage, functional ability and received treatments were compared between the two groups. Moreover, the rheumatologists' diagnoses were compared between the two groups. Univariate and multivariate logistic regressions were conducted to evaluate the factors associated with each group. Results A total of 433/2367 (18.3%) patients included in the REGISPONSER database had psoriasis: 330 (76.2%) patients had psoriasis before rheumatic symptoms, and 103 (23.8%) had psoriasis after rheumatic symptoms. Patients with psoriasis before rheumatic symptoms had a shorter disease duration and a lower body mass index, a lower prevalence of both HLA-B27 antigens and anterior uveitis, a higher prevalence of dactylitis and an increase in levels of the erythrocyte sedimentation rate (ESR). Furthermore, a higher prevalence of PsA diagnoses (78.1% versus 56.4%) and a more frequent fulfilment of the CASPAR criteria (57.5% versus 42.2%) were found in these patients. The use of DMARDs was not significantly different between the two groups. Conclusion The time of appearance of psoriasis is associated with the clinical phenotype of SpA and could determine a diagnosis of PsA by rheumatologists.
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Affiliation(s)
- Ignacio Gómez-Garcia
- Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal s/n. Hospital Provincial, 14004 Córdoba, Spain.,Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain. University of Córdoba, Córdoba, Spain
| | | | - Pilar Font-Ugalde
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain.,Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain
| | - Maria Angeles Puche-Larrubia
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain.,Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain
| | - Nuria Barbarroja
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain; University of Córdoba, Córdoba, Spain
| | - Patricia Ruiz-Limón
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain.,CIBER in Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Alejandro Escudero-Contreras
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain.,Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain
| | - Eduardo Collantes-Estévez
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain.,Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain
| | - Clementina López-Medina
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain; Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
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