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

Öz

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.  

Anahtar Kelimeler

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

Kaynakça

1. 1. Keser G. Spondiloartritlerin sınıflandırılması. Türkiye Klinikleri İmmünoloji Romatoloji. 2004;4(1):1-12.
2. 2. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016; 374(26): 2563-2574.
3. 3. Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998;41(1):58-67.
4. 4. Guillemin F, Briancon S, Pourel J, Gaucher A. Long-term disability and prolonged sick leaves as outcome measurements in ankylosing spondylitis. Possible predictive factors. Arthritis Rheum. 1990;33(7):1001-6.
5. 5. B Elbey. Ankilozan spondilitli hastalarda güncel tedavi yaklaşımları. Dicle Tıp Dergisi. 2015;42(1):123-127.
6. 6. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009;68(6):777-783.
7. 7. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21(12):2286-91.
8. 8. Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21(12):2281-5.

9. 9. Raychaudhuri SP, Deodhar A. The classification and diagnostic criteria of ankylosing spondylitis. J Autoimmun. 2014;48(49): 128-33.
10. 10. Gran JT, Husby G. The Epidemiology of ankylosing spondylitis. Semin Arthritis Rheum. 1993;22(5):319-34.
11. 11. Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009. Arthritis Rheum. 2012;64(5):1407.
12. 12. Kidd B, Mullee M, Frank A, Cawley M. Disease expression of ankylosing spondylitis in males and females. J Rheumatol. 1988;15(9):1407-1409.
13. 13. Çağlar N, Burnaz Ö, Akın T, Özgönenel L, Çetin E, Aytekin E, ve ark. Ankilozan spondilitli hastalara ait demografik veriler, klinik özellikler ve medikal tedavileri. İstanbul Tıp Dergisi. 2011;12(1):19-2.
14. 14. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34(10):1218.
15. 15. Ginsburg WW, Cohen MD. Peripheral arthritis in ankylosing spondylitis. A review of 209 patients followed up for more than 20 years. Mayo Clin Proc. 1983;58(9):593–6.
16. 16. Kim TJ, Kim TH. Clinical spectrum of ankylosing spondylitis in Korea. Joint Bone Spine. 2010;77(3):235-40.
17. 17. Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25-31.
18. 18. Vander Cruyssen B, Muñoz-Gomariz E, Font P, Mulero J, Vlam K, Boonen A, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford). 2010;49(1):73-81.
19. 19. Sampaio-Barros PD, Conde RA, Bonfiglioli R, Bertolo MB, Samara AM. Characterization and outcome of uveitis in 350 patients with spondyloarthropahies. Rheumatol Int. 2006;26(12): 1143-1146.
20. 20. Akar S, Igci YZ, Sari I, Geyik E, Tas M, Solmaz D, et al. Do major histocompatibility complex tag single nucleotide polymorphisms accurately identify HLA-B27 in the Turkish population? Int J Rheum Dis. 2017;20(12):2035-2039.
21. 21. Breban M, Said-Nahal R, Hugot JP, Miceli-Richard C. Familial and genetic aspects of spondyloarthropathy. Rheum Dis Clin North Am. 2003;29(3): 575–94.
22. 22. Kaşifoğlu T, Çalışır C, Cansu D, Korkmaz C. The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis. Clin Rheumatol. 2009;28(1):41–46.
23. 23. Lee W, Reveille JD, Weisman MH. Women with ankylosing spondylitis. Arthritis Rheum. 2008;59(3):449-454.
24. 24. Lavie F, Pavy S, Dernis E, Goupille P, Cantagrel A, Tebib J, et al. Pharmacotherapy (excluding biotherapies) for ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion. Joint Bone Spine. 2007;74(4):346-352.
25. 25. Ozgocmen S, Akgul O, Altay Z, Altindag O, Baysal O, Calis M, et al. Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. Int J Rheum Dis. 2012;15(3):229-38.
26. 26. Baraliakos X, Listing J, Brandt J, Zink A, Alten R, Burmester G, et al. Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Research & Therapy. 2005;7(3):439-44.