Evaluation of Clinical Features, Prognostic Factors, and Treatment Responses of Patients with Axial Spondyloarthritis in Southeastern Anatolia

Abstract

Background: Spondyloarthritis represents a group of diseases with common clinical, epidemiological, and genetic features, such as involvement of axial skeleton. To understand the etiopathogenesis of spondyloarthritis, we need to know its clinical, genetic, and environmental factors. Our country's data on axial spondyloarthritis is limited. In this study, we aimed to present the data of axial spondyloarthritis in Adıyaman in the Southeastern Anatolia region.
Materials and Methods: The medical records of patients diagnosed with axial spondyloarthritis were retrospectively reviewed according to the Assessment of SpondyloArthritis international Society classification criteria in the rheumatology clinic of Adıyaman Training and Research Hospital. The Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate, and c-reactive protein data were collected during the follow-up period. Bath AS Functional Index (BASFI) was used to evaluate the functional status of the patients.
Results: The study included a total of 308 patients, including 181 (58.8%) males and 127 (41.2%) females. The median (25-75 IQR) age was 36 (31-45) years. The median (25-75 IQR) time from the onset of symptoms to diagnosis (delay time in diagnosis) was 4 (3-5,5) years. HLA-B27 was found positive in 43.6% of 110 patients studied. There was a significantly higher percentage of male patients (66.7%, p = 0.025) and a higher BASFI score (p = 0.019) among the HLA-B27-positive patients, and the delay time in diagnosis was lower (p = 0.015). There were no significant differences in the clinical, laboratory, BASDAI, and BASFI parameters between patients receiving nonsteroidal anti-inflammatory drugs and tumor necrosis factor inhibitors (anti-tumor necrosis factor [anti-TNF]).
Conclusion: Spondyloarthritis affects young adults more frequently. HLA-B27 status and male gender are important for prognosis. Anti-TNF therapy is a good option when there is no response to conventional treatment in spondyloarthritis. Disease activity is controlled and patients’ functional capacities are increased with anti-TNF treatment.
Key words: Spondyloarthritis, anti-TNF, HLA-B27, Turkey

Güneydoğu Anadolu Bölgesinde Aksiyel Spondiloartrit Hastalarının Klinik Özellikleri, Prognostik Faktörler ve Tedavi Yanıtlarının Değerlendirilmesi

Abstract

Amaç: Spondiloartritler ; aksiyel tutulumun ön planda olduğu, ortak klinik, epidemiyolojik ve genetik özellikleri bulunan bir grup hastalığı tanımlar. Spondiloartritlerde klinik, genetik ve çevresel faktörleri araştırmak etyopatogenezi anlamak açısından önemlidir. Aksiyel spondiloartritin ülkemiz verileri kısıtlıdır. Biz bu çalışmada aksiyel spondiloartritin Güneydoğu Anadolu bölgesinde yer alan Adıyaman ili verilerini sunmayı amaçladık.
Materyal ve metod: Adıyaman Eğitim ve Araştırma Hastanesi romatoloji kliniğinde takipli ASAS aksiyel spondiloartrit sınıflama kriterlerine göre tanı konulmuş hastaların dosyaları retrospektif olarak tarandı. Hastalık takibinde Bath AS Hastalık Aktivite İndeksi (BASDAI), eritrosit sedimantasyon hızı (ESR) ve c-reaktif protein (CRP) kullanıldı. Hastaların fonksiyonel durum değerlendirmesinde Bath AS Fonksiyonel İndeksi (BASFI) kullanıldı.
Bulgular: Çalışmaya toplam 308 hasta dahil edildi. Hastaların 181’i (%58,8) erkek, 127’si (%41,2) kadındı. Medyan (25-75 IQR) yaş 36 (31-45) idi. İlk semptomdan tanı almalarına kadar geçen süre (tanıda gecikme süresi) medyan (25-75 IQR) 4 (3-5,5) yıldı. 110 hastada çalışılan HLA-B27 %43,6 oranında pozitifti. HLA-B27 pozitif olan hastalarda istatiksel anlamlı olarak erkek oranı (%66,7, p=0,025) ve BASFI skoru daha yüksek (p=0,019), tanıda gecikme süresi ise daha düşüktü (p=0,015). Tümör nekrozis faktör inhibitörleri (Anti-TNF) ve Nonsteroid antiinflamatuar ilaç alan hasta grupları arasında klinik, laboratuvar, BASDAI ve BASFI parametrelerinde anlamlı farklılık yoktu.
Sonuç: Spondiloartritler genç erişkinleri daha fazla etkiler. HLA-B27 ve erkek cinsiyet prognoz açısından önemlidir. Spondiloartritte konvansiyonel tedaviye yanıt olmadığında anti-TNF iyi bir seçenektir. Anti-TNF tedavi ile hastalık aktivitesi kontrol altına alınmakta ve hastaların fonksiyonel kapasiteleri artmaktadır.  

Keywords

• Spondilartrit
• Türkiye
• HLA-B27
• anti-TNF

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