Disease course of non-radiographic axial spondyloarthritis: Data from a long-term retrospective observational cohort

Background Disease course of non-radiographic axial spondyloarthritis (axSpA) has been extensively studied in non-Asian population; however, there are limited data in Asian population. This study aimed to evaluate the long-term disease course of non-radiographic axSpA in Asian patients and identify factors associated with progression to radiographic axSpA. Methods In this retrospective observational cohort study, 56 Korean patients newly diagnosed with non-radiographic axSpA between 2006 and 2015 were included. All patients fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axSpA, and did not fulfil the radiological criterion of the 1984 modified New York criteria. Disease course was assessed by the rate of progression to radiographic axSpA. Factors associated with the risk of progression to radiographic axSpA were assessed using multivariable Cox proportional hazard regression analysis. Results The mean age at baseline was 31.4±13.3 years, and 37 (66.1%) patients were men. Over a mean observation period of 8.4±3.7 years, 28 (50.0%) patients progressed to radiographic axSpA. In multivariable Cox proportional hazard regression analysis, the presence of syndesmophytes at diagnosis (adjusted hazard ratio [HR]: 4.50, 95% confidence interval [CI]: 1.54–13.15, p = 0.006) and active sacroiliitis on magnetic resonance imaging (MRI) at diagnosis (adjusted HR: 5.88, 95% CI: 2.05–16.82, p = 0.001) were significantly associated with a higher risk of progression to radiographic axSpA, whereas longer exposure to tumor necrosis factor inhibitors (TNFis) was significantly associated with a lower risk of progression to radiographic axSpA (adjusted HR: 0.89, 95% CI: 0.80–0.98, p = 0.022). Conclusion During long-term follow-up, a substantial proportion of Asian patients with non-radiographic axSpA progressed to radiographic axSpA. The presence of syndesmophytes and active sacroiliitis on MRI at the time of non-radiographic axSpA diagnosis were associated with a higher risk of progression to radiographic axSpA, while longer exposure to TNFis was associated with a lower risk of progression to radiographic axSpA.

[1]  J. Sieper,et al.  Treatment With Tumor Necrosis Factor Inhibitors Is Associated With a Time‐Shifted Retardation of Radiographic Sacroiliitis Progression in Patients With Axial Spondyloarthritis: 10‐Year Results From the German Spondyloarthritis Inception Cohort , 2022, Arthritis & rheumatology.

[2]  M. Dougados,et al.  Clinical characteristics of non-radiographic versus radiographic axial spondyloarthritis in Asia and non-radiographic axial spondyloarthritis in other regions: results of the cross-sectional ASAS-COMOSPA study , 2021, RMD Open.

[3]  Tae-Hwan Kim,et al.  Clinical characteristics of non‐radiographic axial spondyloarthritis: Results of the Korean Nonradiographic Axial SPondyloArthritis (KONASPA) data , 2021, International journal of rheumatic diseases.

[4]  R. Inman.  Axial Spondyloarthritis: Current Advances, Future Challenges , 2021, Journal of rheumatic diseases.

[5]  A. Deodhar,et al.  Secukinumab improves signs and symptoms of non-radiographic axial spondyloarthritis: primary results of a randomized controlled phase III study. , 2020, Arthritis & rheumatology.

[6]  A. Deodhar,et al.  Improvement of Signs and Symptoms of Nonradiographic Axial Spondyloarthritis in Patients Treated With Secukinumab: Primary Results of a Randomized, Placebo‐Controlled Phase III Study , 2020, Arthritis & Rheumatology (Hoboken, N.j.).

[7]  F. Ariel,et al.  Ixekizumab for patients with non-radiographic axial spondyloarthritis (COAST-X): a randomised, placebo-controlled trial , 2019, The Lancet.

[8]  G. Tomlinson,et al.  Factors Predictive of Radiographic Progression in Ankylosing Spondylitis , 2019, Arthritis care & research.

[9]  J. Listing,et al.  Progression of Structural Damage in the Sacroiliac Joints in Patients With Early Axial Spondyloarthritis During Long‐Term Anti–Tumor Necrosis Factor Treatment: Six‐Year Results of Continuous Treatment With Etanercept , 2019, Arthritis & rheumatology.

[10]  D. Poddubnyy,et al.  Radiographic progression in non-radiographic axial spondyloarthritis , 2018, Expert review of clinical immunology.

[11]  J. Listing,et al.  Relevance of structural damage in the sacroiliac joints for the functional status and spinal mobility in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort , 2017, Arthritis Research & Therapy.

[12]  M. Dougados,et al.  Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis , 2017, Annals of the rheumatic diseases.

[13]  J. Sieper,et al.  Axial spondyloarthritis , 2017, The Lancet.

[14]  M. Dougados,et al.  Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort , 2017, Annals of the rheumatic diseases.

[15]  M. Breban,et al.  Radiographic sacroiliitis develops predictably over time in a cohort of familial spondyloarthritis followed longitudinally , 2017, Rheumatology.

[16]  D. M. van der Heijde,et al.  Effect of certolizumab pegol over 96 weeks of treatment on inflammation of the spine and sacroiliac joints, as measured by MRI, and the association between clinical and MRI outcomes in patients with axial spondyloarthritis , 2017, RMD Open.

[17]  M. Dougados,et al.  Rate and Predisposing Factors for Sacroiliac Joint Radiographic Progression After a Two‐Year Follow‐up Period in Recent‐Onset Spondyloarthritis , 2016, Arthritis & rheumatology.

[18]  Mahboob Rahman,et al.  The prevalence and clinical characteristics of nonradiographic axial spondyloarthritis among patients with inflammatory back pain in rheumatology practices: a multinational, multicenter study , 2016, Arthritis Research & Therapy.

[19]  Runsheng Wang,et al.  Progression of Nonradiographic Axial Spondyloarthritis to Ankylosing Spondylitis: A Population‐Based Cohort Study , 2015, Arthritis & rheumatology.

[20]  M. Dougados,et al.  The burden of non-radiographic axial spondyloarthritis. , 2015, Seminars in arthritis and rheumatism.

[21]  A. Deodhar,et al.  The concept of spondyloarthritis: where are we now? , 2014, Best practice & research. Clinical rheumatology.

[22]  M. Brown,et al.  Axial spondyloarthritis: a new disease entity, not necessarily early ankylosing spondylitis , 2012, Annals of the rheumatic diseases.

[23]  E. Märker-Hermann,et al.  Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. , 2012, Arthritis and rheumatism.

[24]  M. Dougados,et al.  Development of new syndesmophytes and bridges in ankylosing spondylitis and their predictors: a longitudinal study , 2011, Annals of the rheumatic diseases.

[25]  P. Emery,et al.  Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years , 2011, Annals of the rheumatic diseases.

[26]  E. Märker-Hermann,et al.  Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis , 2011, Annals of the rheumatic diseases.

[27]  M. Dougados,et al.  ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis , 2010, Annals of the rheumatic diseases.

[28]  M. Dougados,et al.  The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection , 2009, Annals of the rheumatic diseases.

[29]  M. Dougados,et al.  Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis , 2008, Annals of the rheumatic diseases.

[30]  Yong-Beom Park,et al.  Bone and Cartilage Turnover Markers, Bone Mineral Density, and Radiographic Damage in Men with Ankylosing Spondylitis , 2008, Yonsei medical journal.

[31]  A. Calin,et al.  A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. , 1994, The Journal of rheumatology.

[32]  A. Cats,et al.  Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. , 1984, Arthritis and rheumatism.