Disease characteristics, co-morbidities and treatment response in a contemporary axial spondyloarthritis cohort: Analysis of 717 patients from the Greek AxSpA registry

Abstract

Background

Significant advances have recently reshaped the management of axial spondyloarthritis (AxSpA). Real-world data from contemporary cohorts are important to capture the current landscape in AxSpA.

Methods

A prospective multicenter observational study of patients with AxSpA was undertaken supported by the Greek Rheumatology Society. Here we analyze disease characteristics, comorbidities and treatment patterns at baseline.

Results

717 patients (64.9% males) with a mean age of 50 years and a median disease duration of 13 years were included. Two thirds of patients had r-AxSpA. The prevalence of peripheral arthritis ever (45%) equaled that of enthesitis, with hip involvement affecting 28% of patients. The leading comorbidities were increased BMI (60%), dyslipidemia (30%) hypertension (30%), depression (14%) and osteoporosis (10%). Most patients (78%) received a bDMARD, while 12% received no treatment at all. Inactive disease or low disease activity was attained by 65% of patients. ASDAS, BASDAI and BASFI were comparable between r-AxSpA and nr-AxSpA, but nr-AxSpA patients reported higher Global and Pain VAS scores. In multivariable analyses, predictors of high ASDAS were dactylitis ever, current smoking and the number of previous bDMARDs, while HLA B27 positivity and low alcohol intake were associated with a lower ASDAS. Male sex, HLA B27 positivity, high CRP at diagnosis, older age and longer diagnosis delay independently predicted the presence of syndesmophytes.

Conclusion

In this sizable contemporary AxSpA cohort, one third of patients still miss treatment targets. Additional to cardiovascular risk factors, depression and osteoporosis are considerably prevalent. Smoking predicts a higher ASDAS, while HLA B27 positivity predicts syndesmophyte formation, but also better ASDAS responses.