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Research ArticleSpondyloarthritis

Extraskeletal Manifestations in Axial Spondyloarthritis Are Associated With Worse Clinical Outcomes Despite the Use of Tumor Necrosis Factor Inhibitor Therapy

Rienk van der Meer, Suzanne Arends, Sandra Kruidhof, Reinhard Bos, Hendrika Bootsma, Freke Wink and Anneke Spoorenberg
The Journal of Rheumatology February 2022, 49 (2) 157-164; DOI: https://doi.org/10.3899/jrheum.210308
Rienk van der Meer
1R. van der Meer, MD, S. Kruidhof, MD, H. Bootsma, MD, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen;
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  • ORCID record for Rienk van der Meer
  • For correspondence: r.g.van.der.meer@umcg.nl
Suzanne Arends
2S. Arends, PhD, A. Spoorenberg, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, and Rheumatology, Medical Center Leeuwarden, Leeuwarden;
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Sandra Kruidhof
1R. van der Meer, MD, S. Kruidhof, MD, H. Bootsma, MD, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen;
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Reinhard Bos
3R. Bos, MD, F. Wink, MD, Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
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Hendrika Bootsma
1R. van der Meer, MD, S. Kruidhof, MD, H. Bootsma, MD, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen;
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Freke Wink
3R. Bos, MD, F. Wink, MD, Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
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Anneke Spoorenberg
2S. Arends, PhD, A. Spoorenberg, PhD, Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, and Rheumatology, Medical Center Leeuwarden, Leeuwarden;
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Abstract

Objective To investigate the prevalence and 4-year incidence of acute anterior uveitis (AAU), inflammatory bowel disease (IBD) and psoriasis (PsO), and to explore associations of newly developed extraskeletal manifestations (ESMs) with clinical disease outcome in a large cohort of patients with axial spondyloarthritis (axSpA).

Methods All consecutive patients included in the Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort between 2004 and 2011 were analyzed. History of ESMs at baseline and newly developed ESMs during 4-year follow-up were only recorded when diagnosis by an ophthalmologist, gastroenterologist, or dermatologist was present.

Results Of the 414 included patients with axSpA, 31.4% had a positive history of ≥ 1 ESMs: 24.9% AAU, 9.4% IBD, and 4.3% PsO. History of PsO was significantly associated with more radiographic damage, especially of the cervical spine. Of the 362 patients with 4-year follow-up data, 15.7% patients developed an ESM: 13.3% patients had AAU (of which 3.6% had a first episode and 9.7% had recurrent AAU), 1.9% developed IBD, and 0.8% developed PsO. Patients with newly developed ESMs (without history of ESMs) had worse Ankylosing Spondylitis Quality of Life scores (mean 10.0 vs. 5.8, P = 0.001), larger occiput-wall distance (median 6.3 vs. 2.0, P = 0.02) and more limited modified Schober test (mean 12.6 vs. 13.6, P = 0.01) after 4 years of follow-up. The majority of patients developing an ESM used anti–tumor necrosis factor therapy.

Conclusion History of ESMs was present at baseline in one-third of patients with axSpA. The 4-year incidence of ESMs was relatively low, but patients who developed a new ESM reported worse quality of life.

Key Indexing Terms:
  • ankylosing spondylitis
  • outcomes
  • quality of life
  • spondyloarthropathy
  • Accepted for publication August 3, 2021.
  • © 2022 by the Journal of Rheumatology
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Extraskeletal Manifestations in Axial Spondyloarthritis Are Associated With Worse Clinical Outcomes Despite the Use of Tumor Necrosis Factor Inhibitor Therapy
Rienk van der Meer, Suzanne Arends, Sandra Kruidhof, Reinhard Bos, Hendrika Bootsma, Freke Wink, Anneke Spoorenberg
The Journal of Rheumatology Feb 2022, 49 (2) 157-164; DOI: 10.3899/jrheum.210308

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Extraskeletal Manifestations in Axial Spondyloarthritis Are Associated With Worse Clinical Outcomes Despite the Use of Tumor Necrosis Factor Inhibitor Therapy
Rienk van der Meer, Suzanne Arends, Sandra Kruidhof, Reinhard Bos, Hendrika Bootsma, Freke Wink, Anneke Spoorenberg
The Journal of Rheumatology Feb 2022, 49 (2) 157-164; DOI: 10.3899/jrheum.210308
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Keywords

ANKYLOSING SPONDYLITIS
OUTCOMES
QUALITY OF LIFE
SPONDYLOARTHROPATHY

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  • Mortality Rates in Patients With Ankylosing Spondylitis With and Without Extraarticular Manifestations and Comorbidities: A Retrospective Cohort Study
  • Central Obesity in Axial Spondyloarthritis: The Missing Link to Understanding Worse Outcomes in Women?
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Keywords

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  • outcomes
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