The Prevalence of Atopy in Biologically Treated Spondyloarthropathies: A Retrospective Study of 200 Patients

Abstract

(1) Background: Recent data shed light on the association between atopic disorders (ADs) (atopic dermatitis, allergic asthma, allergic rhinitis) and spondyloarthropathies (SpAs), underpinning the critical role of T helper (Th)1-Th17/Th2-T regulatory cells disbalance. We evaluated the prevalence of AD in axial SpAs (axSpAs) and psoriatic arthritis (PsA) and explored the potential association between atopic status, disease-related parameters, and biological therapy. (2) Methods: A monocentric, retrospective study was conducted that enrolled 200 patients taking biologics. Demographics, disease, and drug-related variables, along with a screening questionnaire focused on Ads, were systematically collected. (3) Results: Overall, 51 patients (25.5%) had atopy—namely, 24.4% of axSpA and 28% of PsA, with a higher frequency of rhinitis (43%) vs. atopic dermatitis (37.2%) or asthma (21.5%). We failed to demonstrate any statistically significant difference in demographics, SpA-related parameters excepting concomitant inflammatory bowel disease, and biologic drug exposure in patients with and without atopy (p > 0.05). However, significantly more non-atopic patients need only one TNF inhibitor (54%) vs. atopic patients (28%) (p < 0.05) to control active SpA. (4) Conclusions: We successfully demonstrated that AD is associated with one out of four SpA. Irrespective of the SpA subtype, atopic patients require more frequent switching among biologics, as significantly more non-atopic patients remain on their first anti-TNF.

Long-Term Outcomes of Patients with Biologically Treated Psoriatic Arthritis and Atopic Dermatitis—A Single-Center Experience

“…Atopy has a wavy course, not parallel with PsA, and is influenced by external factors. Atopy is not associated with a better response to biologics, and the rate of non-responders in these cases is higher than patients with SpA in general or patients with PsA [12]. More than 30% of patients biologically treated for rheumatic immunoinflammatory diseases do not respond to biologics after the first year [1].…”

“…long-term use of TNF inhibitors has been correlated with either the development or worsening of clinical manifestations of various forms of atopy [12]. Given this, for many rheumatologists, choosing the optimal biological molecule as the first treatment line has been difficult, especially with many available molecules.…”

“…Atopy is the main immune system disorder in which type 2 inflammation plays a pivotal role [8]. It has been recognized that atopy is associated with immune-inflammatory rheumatic diseases [9][10][11] and this association is not altered by biological treatment [12]. Atopic disorders, which include atopic dermatitis (AD), allergic asthma (AA), and hay fever or atopic rhinitis (AR), are disorders known as type 2-dominated immune responses, where Th2 is the primary ruler along with eosinophils, mastocytes, and lymphocytes B [13].…”

“…Recent studies have already proved that anti-TNFs in patients with SpA are able to alter the innate immune system, but not the Th1/Th17 immune network [1]. Furthermore, longterm use of TNF inhibitors has been correlated with either the development or worsening of clinical manifestations of various forms of atopy [12]. Given this, for many rheumatologists, choosing the optimal biological molecule as the first treatment line has been difficult, especially with many available molecules.…”

Lumbar Paravertebral Muscle Pain Management Using Kinesitherapy and Electrotherapeutic Modalities

“…Other studies demonstrate that patients with spinal disorders presented several factors of poor prognosis, such as the presence of chronic conditions [46,47], severe initial pain [48], the influence of mental status and, last but not least, female sex [49], in which it seems that sleep disorders are more evident [50][51][52], sleep being one of the adjustable risk factors [46]. Currently, exercise-based physical therapy is the primary initial treatment for musculoskeletal disorders [44,[53][54][55] and improves sleep quality.…”