1
|
Uslu S, Gulle S, Sen G, Cefle A, Yilmaz S, Kocaer SB, Yuce Inel T, Koca SS, Yolbas S, Ozturk MA, Senel S, Inanc N, Dalkilic HE, Soysal Gunduz O, Tufan A, Akar S, Birlik AM, Sari I, Akkoc N, Onen F. Assessing safety and efficacy of TNFi treatment in late onset ankylosing spondylitis: a TURKBIO registry study. Sci Rep 2024; 14:14194. [PMID: 38902436 PMCID: PMC11190278 DOI: 10.1038/s41598-024-65180-4] [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: 01/09/2024] [Accepted: 06/18/2024] [Indexed: 06/22/2024] Open
Abstract
Clinical data on the use of tumour necrosis factor inhibitors (TNFi) in late-onset ankylosing spondylitis (LoAS) are limited. The present study aimed to evaluate efficacy, safety, and treatment adherence associated with the initial use of TNFi therapy in biologic naive patients diagnosed with LoAS. Patients whose age of onset was ≥ 45 years and < 45 years were classified as having LoAS and YoAS, respectively, based on the age of symptom onset. There were 2573 patients with YoAS and 281 LoAS. Baseline disease activity measures were similar between the groups. No significant differences were seen between the two groups in response to treatment and in remaining on the first TNFi at 6, 12 and 24 months. In the LoAS group, the analysis showed that TNFi discontinuation was linked to VAS pain score (HR 1.04; 95% CI 1.01-1.06). Patient groups had similar rates of adverse events (YoAS: 8.7% vs. LoAS: 11.7%). In both biologic naive LoAS and YoAS patients, the study showed that the initial TNFi therapy was equally effective and safe.
Collapse
Affiliation(s)
- Sadettin Uslu
- Division of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey.
| | - Semih Gulle
- Division of Rheumatology, Batman Training and Research Hospital, Batman, Turkey
| | - Gercek Sen
- Division of Rheumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sema Yilmaz
- Division of Rheumatology, Selcuk University School of Medicine, Konya, Turkey
| | - Sinem Burcu Kocaer
- Division of Rheumatology, Faculty of Medicine, Izmir University of Economics, Izmir, Turkey
| | - Tuba Yuce Inel
- Division of Rheumatology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Servet Yolbas
- Division of Rheumatology, Inonu University School of Medicine, Malatya, Turkey
| | - Mehmet Akif Ozturk
- Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Soner Senel
- Division of Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Nevsun Inanc
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Ozgul Soysal Gunduz
- Division of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Servet Akar
- Division of Rheumatology, Izmir Kâtip Celebi University School of Medicine, İzmir, Turkey
| | - Ahmet Merih Birlik
- Division of Rheumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ismail Sari
- Division of Rheumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Nurullah Akkoc
- Division of Rheumatology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Fatos Onen
- Division of Rheumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| |
Collapse
|
2
|
Uslu S, Gülle S, Urak Ö, Şen G, Dalkılıç E, Şenel S, Akar S, İnanç N, Cefle A, Köken Avşar A, Yolbaş S, Yılmaz S, Soysal Gündüz Ö, Sarı İ, Birlik M, Akkoç N, Önen F. Biological treatment in elderly and young patients with ankylosing spondylitis: TURKBIO real-life data results. Arch Rheumatol 2024; 39:232-241. [PMID: 38933720 PMCID: PMC11196228 DOI: 10.46497/archrheumatol.2024.10391] [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: 06/17/2023] [Accepted: 11/02/2023] [Indexed: 06/28/2024] Open
Abstract
Objectives This study aims to investigate the effect of age on disease activity and biological treatment in patients with ankylosing spondylitis (AS). Patients and methods A total of 811 AS patients registered in the TURKBIO registry database between 2011 and 2019 were categorized according to their age at the time of entry into the registry and assigned to one of two groups: young patients, defined as <60 years of age (n=610), and those aged ≥60 years (n=201) were recorded as elderly patients. Demographic, clinical, and laboratory characteristics, along with disease activity markers and other follow-up parameters, as well as current and prior treatments, were electronically recorded during each visit using open-source software. Results The mean age of the elderly patients was 67±5.8 years, while the mean age of the younger patients was 49.2±10.9 years. Male predominance was lower in the older AS group compared to the younger AS group (p=0.002). During follow-up period, 397 patients (comprising 318 young and 79 elderly individuals) had a history of using at least one biological disease-modifying agent (bDMARD). There was no significant difference between the groups in terms of DMARD and bDMARD-use distributions. First tumor necrosis factor inhibitor (TNFi) retention rates were found to be similar in both groups over 10 years of follow-up. Adverse events were found to be similar in young (19.9%) and elderly (26.8%) AS patients. Conclusion Research in the TURKBIO cohort reveals that both older and younger patients with AS exhibited similar disease activity levels with comparable treatment approaches. Moreover, the results of TNFi treatments in elderly patients were the same as those observed in younger patients, with no notable increase in safety concerns.
Collapse
Affiliation(s)
- Sadettin Uslu
- Department of Internal Medicine, Division of Rheumatology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Semih Gülle
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Özkan Urak
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Gerçek Şen
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Ediz Dalkılıç
- Department of Internal Medicine, Division of Rheumatology, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Soner Şenel
- Department of Internal Medicine, Division of Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, Katip Çelebi University Faculty of Medicine, Izmir, Türkiye
| | - Nevsun İnanç
- Department of Internal Medicine, Division of Rheumatology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Ayşe Cefle
- Department of Internal Medicine, Division of Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Aydan Köken Avşar
- Department of Internal Medicine, Division of Rheumatology, Kocaeli City Hospital, Kocaeli, Türkiye
| | - Servet Yolbaş
- Department of Internal Medicine, Division of Rheumatology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Sema Yılmaz
- Department of Internal Medicine, Division of Rheumatology, Selçuk University Faculty of Medicine, Konya, Türkiye
| | - Özgül Soysal Gündüz
- Department of Internal Medicine, Division of Rheumatology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - İsmail Sarı
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Merih Birlik
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| | - Nurullah Akkoç
- Department of Internal Medicine, Division of Rheumatology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Fatoş Önen
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Türkiye
| |
Collapse
|
3
|
Mougui A, Baba Z, Hmamouchi I, Abouqal R, Bezza A, Allali F, Bahiri R, Ghozlani I, Hassikou H, Ichchou L, Janani S, Harzy T, Niamane R, El Maghraoui A, El Bouchti I. Characteristics of Late-Onset Spondyloarthritis: Data from the Moroccan Registry of Biological Therapies in Rheumatic Diseases. Cureus 2023; 15:e39100. [PMID: 37273389 PMCID: PMC10234029 DOI: 10.7759/cureus.39100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction The Assessment of SpondyloArthritis International Society (ASAS) criteria for axial and peripheral spondyloarthritis (SpA) allow for the classification of patients with an age of onset of disease of less than 45 years. However, SpA can start after this age. This study aimed to assess the characteristics of late-onset SpA (SpA>45 years) in the Moroccan registry of biological therapies in rheumatic diseases (RBSMR). Methods A cross-sectional study was conducted using the baseline data of the RBSMR. The protocol for the original RBSMR study was reviewed and approved by the Ethics Committee for Biomedical Research Mohammed V University - Rabat, Faculty of Medicine and Pharmacy of Rabat (approval number for the study was 958/09/19, and the date of approval was September 11, 2019), and all patients had given their written consent. Patients who met the 2009 ASAS criteria for SpA were included. They were divided into two groups: early-onset SpA (≤ 45 years) and late-onset SpA (>45 years). Clinical, biological, radiological, and therapy data of the two groups were compared. Statistical analysis was performed using SPSS v25 software (IBM Corp. Armonk, NY). Parameters with a p-value ≤0.05 were considered significant. Results Our population consisted of 194 patients. Thirty-one patients (16%) had late-onset SpA. Comparison between patients with early-onset (≤45 years) and late-onset SpA (>45 years) revealed that late-onset SpA had a higher tender joint count (p=0.01), a higher swollen joint count (p=0.02), depression (p=0.00), fibromyalgia (p=0.001), hypercholesterolemia (p=0.01), and a lower frequency of coxitis (p=0.008). Logistic regression analysis confirmed that late-onset SpA was associated with a higher tender joint count (OR=0.93, CI 95%: 0.88-0.98), a higher swollen joint count (OR=0.92, CI 95%: 0.85-0.99), depression ( OR=0.19, CI 95%:0.04-0.38), fibromyalgia (OR=1.75, CI 95%: 1.74-17.85), and a lower frequency of coxitis ( OR=0.29, CI 95%: 0.11-0.75). Conclusion As life expectancy increases, late-onset SpA will become increasingly common. It is therefore imperative to determine its characteristics. In the RBSMR study, late-onset SpA was associated with a high number of tender and swollen joints, depression, fibromyalgia, and a lower frequency of coxitis.
Collapse
Affiliation(s)
- Ahmed Mougui
- Rheumatology, EzarriHospital, Faculty of Medicine and Pharmacy of Marrakech, Mohammed VI University Hospital, Marrakech, MAR
| | - Zineb Baba
- Rheumatology, Arrazi Hospital, Faculty of Medicine and Pharmacy of Marrakech, Mohammed VI University Hospital, Marrakech, MAR
| | - Ihsane Hmamouchi
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Mohammed V University, Rabat, MAR
| | - Redouane Abouqal
- Laboratory of Biostatistics, Clinical Research and Epidemiology., Mohammed V University, Rabat, MAR
| | - Ahmed Bezza
- Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, MAR
| | - Fadoua Allali
- Rheumatology B, El Ayachi Hospital, Ibn Sina University Hospital, University Mohamed V, Rabat, MAR
| | - Rachid Bahiri
- Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, University Mohamed V, Rabat, MAR
| | - Imad Ghozlani
- Rheumatology, Faculty of Medicine and Pharmacy, University Ibn Zohr, Agadir, MAR
| | - Hasna Hassikou
- Rheumatology, Military Hospital Moulay Ismail, Hassan II University Hospital, Meknes, MAR
| | - Linda Ichchou
- Rheumatology, Mohammed VI University Hospital, Mohammed I University, Oujda, MAR
| | - Saadia Janani
- Rheumatology, Ibn Rochd University Hospital, Casablanca, Morocco, Casablanca, MAR
| | - Taoufik Harzy
- Rheumatology, Hassan II University Hospital, Fes, MAR
| | - Redouane Niamane
- Rheumatology, Military Hospital Avicenne, Mohammed VI University Hospital, Marrakech, MAR
| | | | - Imane El Bouchti
- Rheumatology, Ezarri Hospital, Faculty of Medicine and Pharmacy of Marrakech, Mohammed VI University Hospital, Marrakech, MAR
| |
Collapse
|
4
|
The frequency of sacroiliitis on MRI in subjects over 55 years of age. Skeletal Radiol 2022; 51:1595-1601. [PMID: 35094157 DOI: 10.1007/s00256-022-04001-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the frequency of sacroiliitis in older subjects. MATERIALS AND METHODS Consecutive MRI examinations of the sacroiliac joints (SIJs) performed for suspected sacroiliitis (2005-2019) in patients ≥ 18 years were retrospectively evaluated for the presence of active/structural lesions and were categorized for the presence/absence of sacroiliitis. Clinical and imaging parameters were compared between subjects with sacroiliitis according to age groups < 40 years, 40-55, and > 55 years. Clinical parameters including inflammatory back pain (IBP) and other spondyloarthritis (SpA) features were retrieved from the medical records. RESULTS A total of 431 patients with SIJs MRI were evaluated: median age, 44 [IQR 35-54]; female:male 267(62%):164(38%). Sacroiliitis was diagnosed in 89 (20.6%) subjects-median age, 41 years [IQR 32-54], 52% females- and was equally prevalent among the different age groups: > 40 years old, 23.6%; 40-55, 20%; and > 55 years old, 17%, p = 0.43, with active/structural lesions equally dispersed. Older patients (> 55) started suffering from back pain at an older age and had a longer delay in diagnosis. Gender distribution, the presence of IBP, and other SpA features were no different in patients < 45 and > 55 years of age. CONCLUSIONS The frequency of sacroiliitis on SIJs-MRI in subjects > 55 years is similar to its frequency in younger subjects and is associated with the same type and magnitude of active and structural MRI lesions. Clinical parameters such as IBP and additional SpA features are similarly prevalent in older and younger subjects suggesting they suffer from the same disease and differing only in age of presentation.
Collapse
|
5
|
Chung HY, Huang JX, Chan SCW, Lee KH, Tsang HHL, Lau CS. Clinical, radiological, and magnetic resonance imaging characteristics of axial spondyloarthritis with late onset. Medicine (Baltimore) 2022; 101:e29523. [PMID: 35866796 PMCID: PMC9302308 DOI: 10.1097/md.0000000000029523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We aimed to investigate the clinical, diagnostic, and imaging features of patients with late onset axial spondyloarthritis (SpA) with initial symptom manifestation aged over 45 years. Participants with axial SpA were consecutively recruited. Clinical, demographic, blood, and imaging parameters were compared between the groups with early (≤45 years) and late onset (>45 years) at a cross-sectional level. Logistic regressions were used to determine the independent associations with axial SpA with late onset. A total of 455 participants were recruited. Among them, 70 (15.4%) had late onset disease. Multivariate analyses showed that axial SpA with late onset was associated with higher C-reactive protein based ankylosing spondylitis disease activity index (ASDAS-CRP) (B = 0.10; P = .04), higher intensity of spinal inflammation as measured by maximum apparent diffusion coefficient (spinal ADC max) (B = 0.27; P = .03) and mean ADC (spinal ADC mean) (B = 0.30; P = .004), lower modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) (B = -0.12; P = .02), more tender joint count (B = 0.12; P = .02), and fewer inflammatory back pain (IBP) (OR = 0.26; P < .001). Axial SpA with late onset had higher clinical disease activity, higher intensity of spinal MRI inflammation, less radiographic damage, and more tender joint count. There was also less inflammatory back pain, which could make the diagnosis more difficult.
Collapse
Affiliation(s)
- Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
- Chrion Medical Hong Kong
- *Correspondence: Ho Yin Chung, Division of Rheumatology and Clinical Immunology, the University of Hong Kong, Hong Kong, China (e-mail: )
| | - Jin Xian Huang
- Division of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Kam Ho Lee
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Helen Hoi Lun Tsang
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| |
Collapse
|
6
|
Matsubara Y, Nakamura Y, Tamura N, Kameda H, Otomo K, Kishimoto M, Kadono Y, Tsuji S, Atsumi T, Matsuno H, Takagi M, Kobayashi S, Fujio K, Nishimoto N, Okamoto N, Nakajima A, Matsui K, Yamamura M, Nakashima Y, Kawakami A, Mori M, Tomita T. A Nationwide Questionnaire Survey on the Prevalence of Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis in Japan. Mod Rheumatol 2021; 32:960-967. [PMID: 34755187 DOI: 10.1093/mr/roab096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This nationwide study aimed to reveal the prevalence of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-ax SpA), and the positive rate of human leukocyte antigen (HLA) among these patients in Japan. METHODS The first survey was conducted in 2221 randomly selected facilities (26.3%) in September, 2018, where the patients with AS/nr-ax SpA were taken care of from January to December, 2017. We estimated the total number of these patients using response and extraction rate. A second survey was conducted in 117 facilities (49.8%) to assess for HLA-B 27 positivity rate and clinical features. RESULTS The estimated total number of the patients with AS and nr-ax SpA were 3200 (95% confidence interval [CI]: 2400-3900) and 800 (530-1100), suggesting that the prevalence of AS and nr-ax SpA in general population were 2.6/100,000 (0.0026%) and 0.6/100,000 (0.0006%), respectively. Although 55.5 % (76/137) of patients with AS were HLA-B27 positive, those whose age of onset was estimated to be over 50 years tended to undergo less HLA-B27 testing. CONCLUSION This study revealed the lower prevalence of AS/nr-ax SpA in Japan, compared to those in other countries. Further studies are required to reveal the association of HLA-B27 with the clinical features.
Collapse
Affiliation(s)
- Yuri Matsubara
- Department of Public Health, Jichi Medical University, Tochigi, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Tochigi, Japan
| | - Naoto Tamura
- Department of Rheumatology and Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kotaro Otomo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuho Kadono
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
| | - Shigeyoshi Tsuji
- Department of Orthopaedics and Rheumatology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Hokkaido, Japan
| | | | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shigeto Kobayashi
- Department of Internal Medicine and Rheumatology, Juntendo University Koshigaya Hospital, Saitama, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihiro Nishimoto
- Department of Molecular Regulation for Intractable Diseases, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan.,Osaka Rheumatology Clinic, Osaka, Japan
| | - Nami Okamoto
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Ayako Nakajima
- Center for Rheumatic Diseases, Mie University Hospital, Mie, Japan
| | - Kiyoshi Matsui
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masahiro Yamamura
- Center for Rheumatology, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
7
|
Kim SH, Kim HR, Lee SH, Shin K, Kim HA, Min HK. Effectiveness and drug retention of biologic disease modifying antirheumatic drugs in Korean patients with late onset ankylosing spondylitis. Sci Rep 2021; 11:21555. [PMID: 34732807 PMCID: PMC8566570 DOI: 10.1038/s41598-021-01132-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
The clinical data on the biologic disease-modifying antirheumatic drug (bDMARD) use in late-onset ankylosing spondylitis (LOAS) is limited. Thus, this study aimed to evaluate the drug efficacy and retention rate of bDMARDs in LOAS and compare it to young-onset ankylosing spondylitis (YOAS). Data of patients with AS receiving bDMARDs were extracted from the Korean College of Rheumatology Biologics and Targeted Therapy registry. Patients whose age of onset was > 50 years and ≤ 50 years were classified as having LOAS and YOAS, respectively. Their baseline characteristics and disease-associated parameters were evaluated. Drug efficacy [Ankylosing Spondylitis Disease Activity Score (ASDAS)-clinically important improvement (CII), ASDAS-major improvement (MI), Assessment of SpondyloArthritis International Society (ASAS) 20, and ASAS 40] at 1-year follow-up and drug retention rates were assessed. A total of 1708 patients (comprising 1472 patients with YOAS and 236 patients with LOAS) were included in this analysis. The LOAS group had a lower prevalence among males, lower HLA-B27 positivity and a higher prevalence of peripheral arthritis. Patients with LOAS were more likely to have higher disease-associated parameters (inflammatory reactants, patient global assessment, ASDAS-erythrocyte sedimentation rate, and ASDAS-C-reactive protein). LOAS was negatively associated with achieving ASDAS-CII, ASAS 20, and ASAS 40. The drug retention rate was lower in LOAS; however, the propensity score-matched and covariate-adjusted hazard ratios for bDMARD discontinuation were comparable to YOAS. There were no differences in the drug retention rates based on the type of bDMARD used in LOAS. Inferior clinical efficacy and shorter drug retention time were found in patients with LOAS receiving bDMARDs using real-world nationwide data. There were no differences among each bDMARD type.
Collapse
Affiliation(s)
- Se Hee Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea.
| |
Collapse
|
8
|
Bittar M, Yong WC, Magrey M, Khan MA. Worldwide Differences in Clinical Phenotype of Axial Spondyloarthritis. Curr Rheumatol Rep 2021; 23:76. [PMID: 34586533 DOI: 10.1007/s11926-021-01043-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to describe the variations in the clinical presentation of axial spondyloarthritis (axSpA) across the globe. RECENT FINDINGS We searched the PubMed database and screened more than 1360 articles; 60 of them were selected based on relevance to the topic being discussed and the goals of the review. Most of the clinical manifestations, including IBP, peripheral arthritis, and extra-articular involvement are seen in different regions of the world, but with appreciable clinical heterogeneity, possibly related to a smaller number of patients from some countries, and global variation in the prevalence of HLA-B27. For example, HLA-B27-positive patients have an earlier age of onset, higher prevalence of acute anterior uveitis, and greater familial occurrence. Peripheral arthritis and enthesitis are most commonly seen among axSpA patients from Latin America and Asia, whereas IBD appears to be slightly more common among Middle Eastern and North African patients. The main weakness encountered while reviewing these data is that some studies were small, and others were cross-sectional and retrospective; hence the inferences may have a selection bias. AxSpA is a very heterogenous disease with varied presentation across the globe, in part related to HLA-B27 positivity. It is imperative to further investigate the key regional differences as they impact timely disease recognition and initiation of early treatment. Therefore, there is a need for a large worldwide systematic study to capture the clinical picture of AxSpA in a more uniform manner.
Collapse
Affiliation(s)
- Mohamad Bittar
- Division of Connective Tissue Disease (Rheumatology), Department of Medicine, The University of Tennessee Health Science Center, 956 Court Avenue, Coleman Building, Suite G326, Memphis, TN, 38163, USA.
| | - Wai Chung Yong
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Marina Magrey
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Muhammad Asim Khan
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
9
|
Akassou A, Bakri Y. Does HLA-B27 Status Influence Ankylosing Spondylitis Phenotype? CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544117751627. [PMID: 29343996 PMCID: PMC5764146 DOI: 10.1177/1179544117751627] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/07/2017] [Indexed: 12/16/2022]
Abstract
The association of HLA-B27 with ankylosing spondylitis (AS) remains as one of the intriguing models that could exist between a molecule and human disease in medicine. Although it was reported in 1973, its contribution to AS and related spondyloarthritis continues to be a major challenge for scientific community. It is important to understand its etiopathogenic mechanism and its functions in these diseases. Although the diagnostic and prognostic roles of HLA-B27 in AS are still debated, there is an increasing interest for HLA-B27–based effects especially in HLA-B27(+) patients with AS. This review will focus in the examination of published reports regarding the influence of HLA-B27 status on the demographic and clinical features in AS, with specific interest to its role on AS severity.
Collapse
Affiliation(s)
- Amal Akassou
- Laboratory of Biochemistry and Immunology, Faculty of Sciences, Mohammed V University Agdal, Rabat, Morocco
| | - Youssef Bakri
- Laboratory of Biochemistry and Immunology, Faculty of Sciences, Mohammed V University Agdal, Rabat, Morocco
| |
Collapse
|
10
|
Kobak S, Yildiz F, Karaarslan A, Semiz H, Orman M. Characteristics of Turkish patients with elderly onset psoriatic arthritis: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e7833. [PMID: 28816983 PMCID: PMC5571720 DOI: 10.1097/md.0000000000007833] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 07/07/2017] [Accepted: 07/20/2017] [Indexed: 11/26/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflamatory disease characterized with axial and peripheral joints involvement. It rarely affects patients older than 65 years old.The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset psoriatic arthritis (EOPsA) and young-onset (YOPsA) patients.A total of 180 patients diagnosed with PsA according to CASPAR criteria and followed-up in single center were included in this study. The patients with initial symptoms started after age 65 were accepted as EOPsA. Demographic, clinic, and laboratory data and the medications which the patients received were recorded and retrospectively evaluated.Nineteen (10.5%) of 180 patients were diagnosed as EOPsA, and 161 (89.5%) patients were evaluated as YOPsA. The mean patient age was 42.1years for the YOPsA group and 68.3 years for the elderly onset group. Mean duration of disease was 5.6 years for the early onset group and 1.3 years for the elderly onset group (P = .001). Fourteen (73.3%) of 19 EOPsA patients were female and 5 of them were male. Higher rates of fatique, pain scores, comorbid diseases, and acute phase reactants elevation were detected in EOPsA patients comparing to YOPsA (P = .000, P = .000, P = .001, and P = .001, respectively). YOPsA patients have more dactilitis, nail involvement, elevated PASI scores, and smoking habitus when compared with EOPsA patients (P = .019, P = .03, P = .005, P = .004, respectively). In terms of the treatment options chosen, there was no significant difference in the use of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CS), methotrexate (MTX), and sulfasalazine (SSL), but there was a more frequent use of anti-tumor necrosis factor-alpha in the YOPsA group.YOPsA and EOPsA patients may presented with different clinical and laboratory features. EOPsA patients are characterized with higher rates of fatigue, pain scores, comorbid diseases, and acute phase reactants and less dactilitis, nail involvement, and anti-TNF-alpha usage.
Collapse
Affiliation(s)
- Senol Kobak
- Istinye University Faculty of Medicine, LIV Hospital Department of Rheumatology, Istanbul
| | - Fidan Yildiz
- Medicalpark Hospital, Department of Chest Disease
| | | | - Huseyin Semiz
- Ege University Faculty of Medicine, Department of Internal Medicine
| | - Mehmet Orman
- Ege University Faculty of Medicine, Department of Statistics, Izmir, Turkey
| |
Collapse
|