Predicting extra-musculoskeletal and peripheral manifestations and their role on biologic treatment in patients with axial spondyloarthritis: TReasure experience
Elif Durak Ediboglu1
, Umut Kalyoncu2, Dilek Solmaz1, Sule Yasar Bilge3, Sedat Yılmaz4, Cemal Bes5, Abdulsamet Erden6, Burcu Yagız7, Zehra Özsoy2, Belkıs Nihan Coskun7, Rıdvan Mercan8, Sedat Kiraz2, Emel Gönüllü9, Veli Yazısız10, Nilufer Alpay Kanıtez11, Askın Ateş12, Recep Yılmaz12, Hakan Emmungil13, Gezmiş Kimyon14, Emine Duygu Ersözlü15, Süleyman Serdar Koca16, İhsan Ertenli2, Servet Akar1
1Department of Internal Medicine, Division of Rheumatology, İzmir Katip Çelebi University, İzmir, Türkiye
2Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
3Department of Internal Medicine, Division of Rheumatology, Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
4Department of Internal Medicine, Division of Rheumatology, University of Health Science, Gülhane Faculty of Medicine, Ankara, Türkiye
5Division of Rheumatology, İstanbul Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
6Department of Internal Medicine, Division of Rheumatology, Yıldırım Bayazıt University Faculty of Medicine, Ankara, Türkiye
7Department of Internal Medicine, Division of Rheumatology, Uludağ University Faculty of Medicine, Bursa, Türkiye
8Department of Internal Medicine, Division of Rheumatology, Namık Kemal University Faculty of Medicine, Tekirdağ, Türkiye
9Department of Internal Medicine, Division of Rheumatology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
10Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Türkiye
11Department of Internal Medicine, Division of Rheumatology, Koç University Faculty of Medicine, İstanbul, Türkiye
12Department of Internal Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
13Department of Internal Medicine, Division of Rheumatology, Trakya University Faculty of Medicine, Edirne, Türkiye
14Department of Internal Medicine, Division of Rheumatology, Mustafa Kemal University Faculty of Medicine, Hatay, Türkiye
15Department of Internal Medicine, Division of Rheumatology, Adana City Hospital, Adana, Türkiye
16Department of Internal Medicine, Division of Rheumatology, Fırat University Faculty of Medicine, Elazığ, Türkiye
Keywords: Adult rheumatic disease, axial spondyloarthritis, extra-muskuloskeletal manifestations, peripheral manifestations.
Abstract
Objectives: This study aimed to examine the frequency and associated factors of extra-musculoskeletal manifestations (EMMs) and peripheral manifestations in an axial spondyloarthritis (axSpA) cohort and their impact on the choice of first biologic treatment.
Patients and methods: A total of 1,687 patients with axSpA (978 males, 709 females; mean age: 38.5±11 years) who started their first biologic disease modifying antirheumatic drug (bDMARD) were included from a national prospective database of TReasure between its inception and 2018-2021. Demographic and clinical characteristics, disease-related features, and treatment patterns were compared between patients with and without EMMs or peripheral involvement.
Results: Of the patients, 1,283 had radiographic axSpA (r-axSpA), while 404 had nonradiographic axSpA (nr-axSpA). Acute anterior uveitis (AAU) was the most common (11.4%) EMM, and older age, female sex, human leukocyte antigen B27 (HLA-B27) positivity, and a lower Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score were associated with AAU. Female sex, methotrexate use, dactylitis, and higher Ankylosing Spondylitis Disease Activity Score (ASDAS)-serum C-reactive protein (CRP) scores were related to psoriasis (PsO). Inflammatory bowel disease (IBD) and PsO were negatively associated with HLA-B27 positivity. Enthesitis was the most frequent (28.2%) peripheral manifestations, and peripheral arthritis, dactylitis, and enthesitis were independent predictor of each other. In addition, dactylitis and peripheral arthritis were related to more frequent use of conventional disease modifying antirheumatic drugs. In addition, IBD history was associated with less frequent use of etanercept. Older age, less use of sulfasalazine, the absence of enthesitis, and lower Bath Ankylosing Spondylitis Functional Disease Index (BASFI) scores were associated with secukinumab use.
Conclusion: Acute anterior uveitis was associated with HLA-B27 positivity, while PsO or IBD were negatively associated with HLA-B27 in patients with axSpA. Peripheral manifestations appeared to be related to each other. Among EMMs, we found that only IBD had an effect on the bDMARD preference.
Citation: Durak Ediboglu E, Kalyoncu U, Solmaz D, Yasar Bilge S, Yılmaz S, Bes C, et al. Predicting extra-musculoskeletal and peripheral manifestations and their role on biologic treatment in patients with axial spondyloarthritis: TReasure experience. Arch Rheumatol 2025;40(1):1-14. doi: 10.46497/ ArchRheumatol.2025.10670.
Idea/concept, supervision: S.A.; Design: S.A., E.D.E., U.K.; Data collection: E.D.E., U.K., D.S., S.Y.B., S.Y., C.B., A.E., B.Y., Z.Ö., B.N.C., R.M., S.K., E.G., Y.Y., N.A.K., A.A., R.Y., H.E., G.K., E.E., S.S.K., ‹.E., S.A.; Analysis and/or interpretation, writing the article: E.D.E., S.A.; Literature review: E.D.E., S.A.; Critical review: E.D.E, U.K., S.Y., S.A.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.