AB0505 DISEASE FEATURES ASSOCIATED WITH A HIGH DISEASE IMPACT IN AXIAL SPONDYLOARTHRITIS: POST HOC ANALYSIS OF A SINGLE-CENTER CROSS-SECTIONAL STUDY
Authors: R. Queiró Silva, S. Alonso Castro, L. C. Charca Benavente, M. Pino Martínez, S. Burger, M. Alperi-López
Journal: Annals of the Rheumatic Diseases (2021)

Background: Currently available information on disease factors associated with a high life impact on axial spondyloarthritis (axSpA) is still very limited. Therefore, information on disease factors associated with a high life impact is crucial for the optimal management of this condition. Objectives: To define disease factors associated with a high disease impact (HDI) in axSpA. Methods: Post hoc analysis of a cross-sectional observational study conducted in 111 consecutive patients diagnosed with axSpA 1 . We defined the Assessment of SpondyloArthritis international Society-Health Index (ASAS HI) functioning and health status groups thresholds using the Ankylosing Spondylitis Disease Activity Score (ASDAS) as external anchor. To establish the ASAS HI cut-off, receiver operating characteristic (ROC) curves of the different activity categories of the ASDAS were constructed. A multivariate analysis was carried out to evaluate the disease factors associated with HDI. Results: Median ASDAS was 2.1 (IQR: 1.5-2.7). Average score for ASAS-HI was 5.4 ± 3.8 (IQR: 3-8). ASAS HI values &gt; 6, area under the ROC curve 0.86 (95%CI: 0.78-0.92), identified the patients belonging to the groups of high-very high disease activity. Among the study population, 69 patients had an ASAS HI ≤ 6 while 42 showed an ASAS HI &gt; 6 (Table 1). In the multivariate regression model, HLA-B27 [OR 0.15 (95%CI: 0.05-0.48), p=0.001], NSAID intake [OR 5.4 (95%CI: 1.2-23.3), p=0.023, and a family history of SpA [OR 3.1 (95%CI: 1.01-10.6), p=0.043] were independently related to HDI. Table 1. Disease features among patients with and without high disease impact Feature ASAS HI ≤ 6 (n: 69) ASAS HI &gt; 6 (n: 42) P-values Age, yrs (SD ) 42.7 (11.2) 44.3 (9.8) NS Disease duration, yrs (SD ) 7.6 (7.5) 7.8 (5.2) NS Men, n (% ) 49 (71) 25 (59.5) NS Women, n (% ) 20 (29) 17 (40.5) NS AS, n (% ) 47 (68.1) 27 (64.3) NS Family history, n (% ) 6 (8.7) 10 (23.8) 0.040 HLA-B27, n (% ) 62 (89.9) 26 (61.9) 0.001 Education level: -Primary, n (% ) 25 (36.2) 18 (42.9) NS -Secondary, n (% ) 20 (29) 14 (33.3) -University, n (% ) 24 (34.8) 10 (23.8) CVRF: -Smoking, n (% ) 25 (36.2) 19 (45.2) NS -Obesity, n (% ) 8 (11.6) 10 (23.8) -Diabetes, n (% ) 3 (4.3) 3 (7.1) -HBP, n (% ) 9 (13) 5 (11.9) -Dyslipidemia, n (% ) 17 (24.6) 9 (21.4) Radiographic features: -Bilateral SI, n (% ) 57 (82.6) 30 (71.4) NS -Squaring, n (% ) 13 (18.8) 9 (21.4) -Syndesmophytes, n (% ) 12 (17.4) 9 (21.4) SpA-associated features: -Enthesitis, n (% ) 7 (10.1) 1 (2.4) NS -Anterior uveitis, n (% ) 12 (17.4) 2 (2.8) 0.045 -IBD, n (% ) 2 (2.9) 4 (9.5) NS Fibromyalgia, n (% ) 0 (0) 3 (7.1) 0.052 Depression, n (% ) 2 (2.9) 6 (14.3) 0.032 Treatments: -NSAID, n (% ) 50 (72.5%) 39 (92.9) 0.013 -DMARDs, n (% ) 4 (5.8%) 2 (4.8) NS -Biologic therapy, n (% ) 40 (58) 27 (64.3) NS ASAS HI: Assessment of SpondyloArthritis international Society -Health Index, yrs: years, SD: standard deviation, AS: ankylosing spondylitis, HLA: human leukocyte antigen, CVRF: cardiovascular risk factors, HBP: high blood pressure, SI: sacroiliitis, SpA: spondyloarthritis, IBD: inflammatory bowel disease, NSAID: non-steroidal anti-inflammatory drugs, DMARDs: disease modifying antirheumatic drugs. Conclusion: In this study, patients with regular NSAID intake and those with a positive family history of SpA were more likely to be in a high-impact category according to the ASAS HI. On the other hand, HLA-B27 carriers reduced that possibility by 85%. Our data may contribute to providing more personalized attention focused on patients` needs. References: [1]Alonso S, Pardo E, Charca L, et al. Performance of the ASAS health index for the evaluation of spondyloarthritis in daily practice. J Rheumatol 2020; 47: 1483-1489. Disclosure of Interests: None declared.