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Title: | Peripheral manifestations are major determinants of disease phenotype and outcome in new onset spondyloarthritis | Authors: | De Craemer, Ann-Sophie Renson, Thomas Deroo, Liselotte VAN PRAET, Liesbet Cypers, Heleen Varkas, Gaelle JOOS, Rik Devinck, Mieke Gyselbrecht, Lieve Peene, Isabelle THEVISSEN, Kristof Costantino, Felicie D'Agostino, Maria-Antonietta LENAERTS, Jan Carron, Philippe VAN DEN BOSCH, Filip Elewaut, Dirk |
Issue Date: | 2022 | Publisher: | OXFORD UNIV PRESS | Source: | RHEUMATOLOGY, 61 (8) , p. 3279-3288 | Abstract: | Objectives To delineate the impact of peripheral musculoskeletal manifestations on stratification of disease phenotype and outcome in new-onset spondyloarthritis (SpA), using a prospective observational nationwide inception cohort, the BelGian Inflammatory Arthritis and spoNdylitis cohorT (Be-Giant). Methods Newly diagnosed adult SpA patients, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial or peripheral SpA, were included in Be-Giant and prospectively followed every six months. Peripheral involvement (defined as arthritis, enthesitis and/or dactylitis) was determined in relation to clinically similar patient subsets at baseline and disease activity patterns during two-year follow-up, identified through K-means cluster analysis and latent class growth analysis. Results From November 2010 to March 2020, 367 patients were enrolled in Be-Giant, of whom 162 (44%) had peripheral manifestations. Two patient clusters [A, axial predominant (n = 248) and B, peripheral predominant (n = 119)] were identified at diagnosis. Longitudinal analysis (n = 115) revealed two trajectories of disease activity in each cluster: one with persistently high disease activity over time ('High'), the other rapidly evolving to low disease activity ('Low'). In cluster A patients, peripheral manifestations predisposed to the 'High' trajectory [odds ratio (OR) = 2.0, 95% CI: 1.3, 3.1, P = 0.001], despite more rapid initiation of biologics compared with patients without peripheral manifestations (hazard ratio (HR) = 2.1, 95% CI: 1.0, 4.4, P = 0.04 - Cox proportional-hazards model). Conclusion Peripheral musculoskeletal manifestations are major determinants of phenotypical diversity in new-onset SpA. Intriguingly, stratification of axial SpA according to concomitant peripheral involvement identified an endotype with an unfavorable outcome despite more prompt therapeutic intensification with biologics. These observations justify an endotype-tailored approach beyond current ASAS/EULAR management recommendations. | Notes: | De Craemer, AS (corresponding author), Ghent Univ Hosp, Div Rheumatol, Dept Internal Med & Pediat, C Heymanslaan 10, B-9000 Ghent, Belgium. annsophie.decraemer@ugent.be |
Keywords: | spondyloarthritis;peripheral manifestations;clusters;trajectories | Document URI: | http://hdl.handle.net/1942/37430 | ISSN: | 1462-0324 | e-ISSN: | 1462-0332 | DOI: | 10.1093/rheumatology/keab887 | ISI #: | WOS:000789261800001 | Rights: | The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com Free access | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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