Predictors of extra-articular manifestations in axial spondyloarthritis and their influence on TNF-inhibitor prescribing patterns: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis

Abstract

<jats:sec id="s1"><jats:title>Objectives</jats:title><jats:p>Extra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a ‘real-world’ cohort of patients with axSpA.</jats:p></jats:sec><jats:sec id="s2"><jats:title>Methods</jats:title><jats:p>Clinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed.</jats:p></jats:sec><jats:sec id="s3"><jats:title>Results</jats:title><jats:p>AAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0.55 to 0.92). For both psoriasis and IBD, there was an inverse relationship with HLA-B27 (IRR 0.54, 95% CI 0.36 to 0.79 and IRR 0.63, 95% CI 0.43 to 0.91, respectively). A diagnosis of either AAU (OR 3.79, 95% CI 2.11 to 6.80) or IBD (OR 5.50, 95% CI 2.09 to 14.46) was associated with preference for adalimumab versus others. In contrast, a diagnosis of either AAU (OR 0.14, 95% CI 0.06 to 0.33) or IBD (OR 0.17, 95% CI 0.05 to 0.57) was associated with less preference for etanercept over other TNFi.</jats:p></jats:sec><jats:sec id="s4"><jats:title>Conclusion</jats:title><jats:p>The higher occurrence of AAU and lower occurrence of psoriasis and IBD in HLA-B27-positive patients with axSpA are consistent with current pathophysiology. Patients with previous AAU and IBD are more likely to be prescribed adalimumab and less likely to receive etanercept, consistent with the superior efficacy of monoclonal TNFi for these indications. Future work will determine whether EAMs influence TNFi survival, or effectiveness, and whether this varies between agents.</jats:p></jats:sec>

Metabolic dysfunction-associated fatty liver disease and liver function markers are associated with Crohn’s disease but not Ulcerative Colitis: a prospective cohort study

“…The correlation between decreased ALB levels and increased risk of incident IBD was stronger in participants of younger age, and this finding could be related to the accumulation of the metabolic risk factors with aging [45]. Consistently, a previous study indicated an inverse association between TP (composed of ALB and globulin) and risk, which was probably attributable to ALB [46].…”

The impact of extra-musculoskeletal manifestations on disease activity, functional status, and treatment patterns in patients with axial spondyloarthritis: results from a nationwide population-based study

“…We found patients with AU to be more often male and HLA-B27 positive, thus, in this sense our data are in agreement with results previously reported suggesting AU to occur more commonly among male patients [24][25][26] and its presence to be related to HLA-B27. 20,27,28 We also observed an association between current/ recent AU and lower disease activity assessed by BASDAI. This intriguing association might be indicative of a disconnection between ocular and musculoskeletal inflammation.…”

“…Furthermore, we demonstrated that history of PSO was associated with a BASDAI increase of 0.31 points and a BASFI increase of 0.37 points. Associations between PSO and increased diagnostic delay, 17 indicating a need for specific referral strategies on the level of dermatologists, and between absence of HLA-B27 and higher frequency of PSO 18 – 20 had been reported previously. Moreover, an association between diagnostic delay and worse outcomes in axSpA 21 and significantly higher BASDAI and BASFI scores in HLA-B27-negative patients with axSpA 18 , 19 had been described.…”

Inflammatory Bowel Disease Risk in Patients With Axial Spondyloarthritis Treated With Biologic Agents Determined Using the BSRBR-AS and a MetaAnalysis

“…The prevalence of IBD in the British Society for Rheumatology Biologics Register (BSRBR-AS), which comprises two cohorts of axSpA patients starting their first biologic therapy and those naïve to such therapy, has been reported as 10.2% (3). The same report found that being HLA-B27 negative was the only clinical factor associated with the diagnosis of IBD.…”