TOPLINE

Patients with axial spondyloarthritis (axSpA) who presented with diffuse initial axial involvement, affecting both cervicothoracic and lumbosacral regions, faced more than 60% higher risk for developing peripheral arthritis over 10 years compared with those whose initial pain was confined to the lumbosacral region, a study shows.

METHODOLOGY

• A post hoc analysis of the prospective Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohort included 662 patients with early axSpA followed for 10 years in France.
• Patients were classified by the initial anatomical distribution of inflammatory axial pain: cervicothoracic (cervical and/or thoracic spine; n=94), lumbosacral (lumbar spine and/or buttock; n=466), or diffuse axial involvement (both regions; n=102).
• Primary outcomes were the first occurrence of extra-axial manifestations (arthritis, dactylitis, enthesitis) and extra-rheumatological manifestations (psoriasis, uveitis, chronic inflammatory bowel disease [IBD]) following the onset of inflammatory axial pain.
• At baseline, 88/662 patients (13.3%) were receiving conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs: 12.8% in the cervicothoracic group, 13.5% in the lumbosacral group, and 12.7% in the diffuse group.
• Median age at first axial pain was 32.1 years; 46.2% were male; 62.6% fulfilled the 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria at baseline.

TAKEAWAY

• During follow-up, 37% of patients developed arthritis, 21.6% dactylitis, and 71.4% enthesitis; 14% developed uveitis, 18% psoriasis, and 6.6% IBD. Diffuse initial axial involvement was associated with a significantly higher risk for developing arthritis compared with lumbosacral involvement (adjusted hazard ratio [aHR], 1.61; P = .0012).
• No significant associations were observed between initial cervicothoracic involvement and any subsequent extra-axial or extra-rheumatological manifestations.
• Exposure to conventional synthetic DMARDs during follow-up was strongly associated with the development of arthritis (aHR, 2.97; 95% CI, 2.13-4.14), dactylitis (aHR, 2.35; 95% CI, 1.53-3.60), and enthesitis (aHR, 1.55; 95% CI, 1.15-2.11).
• Exposure to biologic DMARDs during follow-up was significantly associated with the development of psoriasis (aHR, 2.82; 95% CI, 1.80-4.41).

IN PRACTICE

"Our findings suggest that the initial distribution of inflammatory axial pain may carry prognostic value, particularly for identifying patients at increased risk of peripheral arthritis," the authors wrote.

SOURCE

The study was led by Audrey-Anne Couture, Service de Rhumatologie, CHU Henri-Mondor, AP-HP, Université Paris Est Créteil, Créteil, France. It was published online on August 5 in RMD Open.

LIMITATIONS

The limitations included observational design, missing treatment data, and reliance on patient-reported symptom localization, which could have introduced subjectivity.

DISCLOSURES

The study did not receive any funding. Several authors reported receiving honoraria, consulting fees, investigator fees, and other financial support from multiple drug companies, including AbbVie, Celltrion, Novartis, and UCB. Additional author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.