Undifferentiated Spondyloarthritis Research Articles

South African Rheumatism and Arthritis Association 2024 guidelines for the management of peripheral spondyloarthritis.

Peripheral spondyloarthritis (SpA) includes psoriatic arthritis (PsA), inflammatory bowel disease (IBD)-associated arthritis, reactive arthritis and undifferentiated peripheral SpA. These South African guidelines offer information on diagnosis, assessment and therapy of peripheral SpA. Emphasis is placed on a multidisciplinary team, and a treat-to-target strategy with escalation of therapy if the target of minimal or very low disease activity is achieved. Screening for and treatment of comorbidities are paramount.

Gut microbiota in axial spondyloarthritis : genetics, medications and future treatments.

Axial spondyloarthritis, also referred to as ankylosing spondylitis, is a chronic inflammatory condition that predominantly affects the axial spine but may also present with peripheral arthritis. It falls within the umbrella of disorders known as spondyloarthropathies. In addition to axial spondyloarthritis, this group includes psoriatic arthritis, enteropathic arthritis, reactive arthritis, and undifferentiated spondyloarthropathy, with axial spondyloarthritis being one of the most common. The overall mechanisms underlying the development of axial spondyloarthritis are complex and multifactorial. There is a significant and well-recognized association between axial spondyloarthritis and the HLA-B27 gene, but there have also been non-HLA genes identified in the disease process, as well as certain inflammatory cytokines that play a role in the inflammatory process, such as tumor necrosis factor (TNF). More recently, there has been research and new evidence linking changes in the gut microbiota to the disease process of axial spondyloarthritis. Research into the role of the gut microbiota and gut dysbiosis is a large, ever-growing field. It has been associated with a multitude of conditions, including axial spondyloarthritis. This mini-review highlights the symbiotic relationship of the gut microbiota with the pathogenesis, therapeutic agents and future treatments of axial spondyloarthritis.

Neuropathic pain in spondyloarthritis: Decoding its prevalence, risk factors, and impact on disease activity

ObjectivesThis study aimed to evaluate the prevalence and characteristics of neuropathic pain in patients with various subtypes of spondyloarthritis (SpA), including axial SpA (axSpA), psoriatic arthritis (PsA), and undifferentiated peripheral SpA (p-SpA). Additionally, the study sought to identify potential risk factors associated with the presence or severity of neuropathic pain and to investigate its impact on clinical disease activity assessment. MethodsWe conducted a cross-sectional study at two tertiary rheumatology centers, enrolling patients diagnosed with SpA. Data on demographic and clinical characteristics, comorbidities, and current therapies were collected. Neuropathic pain was assessed using the PainDETECT Questionnaire (PD-Q) and the Neuropathic Pain Symptom Inventory (NPSI). Statistical analyses included descriptive statistics, t-tests, and Pearson's correlations to evaluate the relationships between neuropathic pain scores and clinical disease activity indices. ResultsThe study included 177 patients. Of these, 22.2% had a PD-Q score ≥19, showing a high likelihood of neuropathic pain, while 64.9% scored ≤12, suggesting the absence of significant neuropathic components. The mean PD-Q score was 11.5 ± 10.1. Subgroup analyses showed that females had significantly higher scores for paroxysmal and evoked pain (p < 0.05), and obese patients had significantly higher scores across all NPSI subscores (p < 0.05). Moderate positive correlations were found between neuropathic pain scores and clinical disease activity indices, such as DAPSA (r = 0.46, p < 0.0001) and ASDAS-CRP (r = 0.42, p < 0.01). ConclusionsNeuropathic pain is prevalent among patients with SpA and is significantly associated with disease activity assessments and management. This study highlights the importance of integrating neuropathic pain evaluation into the clinical assessment of SpA to tailor treatment approaches effectively and improve patient outcomes.

A Case of Undifferentiated Spondyloarthropathy- HLA B 27 Positive

Undifferentiated arthritis / Undifferentiated spondyloarthropathy are terms used to describe inflammatory arthritis which has not differentiated into a specific rheumatic disease . UA can either describe a patient of early onset rheumatic disease who might progress to specific rheumatic disorder or describe patients who fail to differentiate into another rheumatic disease , despite prolonged follow up . There are no clinical , laboratory or radiographic features that are consistently found in all patients with undifferentiated arthritis.

16s RNA-based metagenomics reveal previously unreported gut microbiota associated with reactive arthritis and undifferentiated peripheral spondyloarthritis.

Reactive arthritis (ReA) provides a unique opportunity to comprehend how a mucosal infection leads to inflammatory arthritis at a distant site without the apparent invasion of the pathogen. Unfortunately, conventional stool cultures after ReA provide limited information, and there is a dearth of metagenomic studies in ReA. The objective of this study was to identify gut microbiota associated with the development of ReA. Patients with ReA or undifferentiated peripheral spondyloarthritis (UpSpA) were included if they presented within 4 weeks of the onset of the current episode of arthritis. Metagenomic DNA was extracted from the stools of these patients and of 36 age- and sex-similar controls. Sequencing and analysis were done using a standard 16S ribosomal pipeline. Of 55 patients, there was no difference between the gut microbiota of postdiarrheal ReA(n = 20) and of upSpA (n = 35). Comparing the gut microbiota of patients vs healthy controls, the patients had significantly higher alpha and beta diversity measures. After stringency filters, Proteobacteria had high abundance while Firmicutes had lesser as compared with the controls. Six families were overexpressed in patients, while another five were overexpressed in controls. Sixteen genera and 18 species were significantly different between patients and controls. At the species level there was strong association of Staphylococcus aureus, Clostridium septicum Klebsiella pneumoniae, Escherichia coli, Empedobacter brevis, Roseburia hominis, Bacillus velezensis, and Crassaminicella with ReA. The microbiota of classical gut-associated ReA and upSpA is similar. Patients have higher diversities in their gut microbiota compared with healthy controls. Both known and previously unreported species associated with ReA/upSpA were identified.

Dynamic thiol-disulfide homeostasis as an oxidative stress marker in ankylosing spondylitis and undifferentiated spondyloarthropathy.

Seronegative spondyloarthropathies (SpA) are a group of chronic diseases characterized by axial inflammation, oligoarthritis, and enthesitis. Oxidative stress may contribute to a wide range of rheumatologic diseases, including SpA. This prospective case-control study was designed to compare thiol-disulfide levels as a marker of oxidative stress between SpA patients and healthy controls. A total of 144 patients diagnosed with undifferentiated spondyloarthropathy (USpA, n = 97) or ankylosing spondylitis (AS, n = 47) were included along with 80 healthy controls. Serum native thiol (NT), total thiol (TT), and disulfide (D) levels were measured using the fully automated Erel method. The ratios NT/TT, D/TT, and D/NT were calculated. Thiol-disulfide levels were compared between the SpA groups and the healthy controls. The NT and NT/TT ratios were found to be significantly lower in the SpA group (p < 0.001). The disulfide, D/NT, and D/TT ratios were found to be significantly higher in the SpA group (p < 0.001). In pairwise comparisons between the SpA subgroups, the NT and TT levels were lower in the USpA group than in the AS group (p = 0.021), but serum disulfide levels were higher in the USpA group than in the AS group (p = 0.004). Among the patients with SpA, the group taking antitumor necrosis factor (anti-TNF) had lower TT measurements compared to the group taking conventional disease modifying antirheumatic drugs (DMARD) (p = 0.039). The thiol-disulfide balance is disturbed in favor of disulfide in SpA patients compared to healthy volunteers. Native and total thiol measurements correlate with acute phase reactants and might be used to monitor disease activity. Anti-TNF therapy might control the oxidative degenerative process better than the conventional DMARD in SpA patients.

Identification of the first signs or symptoms in different spondyloarthritis subtypes and their association with HLA-B27: data from REGISPONSER and RESPONDIA registries

ObjectiveTo describe and analyse the initial symptoms attributable to patients with spondyloarthritis (SpA) and their association with HLA-B27 status.MethodsThis was an observational, cross-sectional and multicentre study with patients who fulfilled...

Specific Cellular and Humoral Response after the Third Dose of Anti-SARS-CoV-2 RNA Vaccine in Patients with Immune-Mediated Rheumatic Diseases on Immunosuppressive Therapy.

Data on cellular and humoral immunogenicity after the third dose of anti-SARS-CoV-2 vaccines in patients with immune-mediated rheumatic diseases (IMRDs) are scarce. Herein, we evaluated the adaptive immune response in IMRD patients treated with different immunosuppressive therapies (conventional synthetic disease-modifying antirheumatic drugs [csDMARDs], biological disease-modifying antirheumatic drugs [bDMARDs], and targeted synthetic disease-modifying antirheumatic drugs [tsDMARDs]) after the booster of the anti-SARS-CoV-2 vaccine to determine whether any drug reduced the vaccine's response. A single-center prospective study was conducted, including patients presenting with IMRD and healthy controls (HC). Specific anti-SARS-CoV-2 interferon-gamma (IFN-γ) production was evaluated between 8-12 weeks after the third dose of the SARS-CoV-2 vaccine. In addition, anti-Spike IgG antibody titers were also measured. Samples were obtained from 79 IMRD patients (51 women, 28 men; mean age 57 ± 11.3 years old): 43 rheumatoid arthritis, 10 psoriatic arthritis, 14 ankylosing spondylitis, 10 undifferentiated spondyloarthritis, and 2 inflammatory bowel disease-associated spondyloarthritis (IBD-SpA). In total, 31 HC (mean age 50.9 ± 13.1 years old, 67.7% women) were included in the study. Post-vaccine results displayed positive T-cell immune responses in 68 out of 79 (86.1%) IMRD patients (82.3% of those without prior COVID-19). All HC and IMRDs patients had an antibody response against the SARS-CoV-2 receptor-binding domain; however, the HC response was significantly higher (median of 18,048 AU/mL) than in IMRDs patients (median of 6590.3 AU/mL, p < 0.001). MTX and leflunomide were associated with lower titers of IgG and IFN-γ responses. Among bDMARDs, adalimumab, etanercept, and guselkumab are associated with reduced cellular responses. Our preliminary data show that the majority of our IMRD patients develop cellular and humoral responses after the SARS-CoV-2 booster vaccination, emphasizing the relevance of vaccination in this group. However, the magnitude of specific responses was dependent on the immunosuppressive therapy administered. Specific vaccination protocols and personalized decisions about boosters are essential for these patients.

Correlation of Interleukin-17 and 23 Inflammatory Markers with Genetically Transmitted Spondyloarthritis Patients at a Tertiary Care Facility, South India

Human leukocyte antigens (HLA) are genetically derived proteins in the major histocompatibility complex. They help distinguish “self” and “non-self” antigens and are essential in interacting with the immune cells inside the body. The present research work examines the prevalence of HLA-B27 among patients suspected of Spondyloarthritis (SpA), which has also been correlated with Interleukin-17/23 Inflammatory Markers and other clinical manifestations and was carried out between August 2017 to January 2021. The patient’s blood samples were collected and tested for HLA-B27 and Interleukin-17/23 inflammatory markers. Among 289 SpA patients, 60% (172) were males, and 40% (117) were females, with a ratio of 1.5:1. Ankylosing Spondylitis (65.1%) was found to be the most prevalent subgroup of SpA among the patients, closely followed by reactive arthritis (21%), psoriatic arthritis (10.7%), undifferentiated spondyloarthritis (2.1%), and inflammatory bowel disease with associated arthritis (1%). HLA-B27 was found to be positive in 54% (156) out of 289 patients. Normal IL-17 ranges were seen in 42% of HLA-B27- positive patients, while increased IL-17 was seen in 58% of the population with positive HLA-B27 cases. IL-23 was found within normal ranges in 40% of positive HLA-B27 cases, while it was found to be increased in 60% of the positive HLA-B27 positive subjects. We concluded that HLA-B27 was found to be positive among more than half of the patient population with SpA. The early detection of HLA-B27 may aid in changing lifestyle to prevent Spondyloarthritides.

The Interleukine-17 Cytokine Family: Role in Development and Progression of Spondyloarthritis, Current and Potential Therapeutic Inhibitors.

Spondyloarthritis (SpA) encompasses a group of chronic inflammatory rheumatic diseases with a predilection for the spinal and sacroiliac joints, which include axial spondyloarthritis, psoriatic arthritis, reactive arthritis, arthritis associated with chronic inflammatory bowel disease, and undifferentiated spondyloarthritis. The prevalence of SpA in the population varies from 0.5 to 2%, most commonly affecting young people. Spondyloarthritis pathogenesis is related to the hyperproduction of proinflammatory cytokines (TNFα, IL-17A, IL-23, etc.). IL-17A plays a key role in the pathogenesis of spondyloarthritis (inflammation maintenance, syndesmophites formation and radiographic progression, enthesites and anterior uveitis development, etc.). Targeted anti-IL17 therapies have established themselves as the most efficient therapies in SpA treatment. The present review summarizes literature data on the role of the IL-17 family in the pathogenesis of SpA and analyzes existing therapeutic strategies for IL-17 suppression with monoclonal antibodies and Janus kinase inhibitors. We also consider alternative targeted strategies, such as the use of other small-molecule inhibitors, therapeutic nucleic acids, or affibodies. We discuss advantages and pitfalls of these approaches and the future prospects of each method.

The microbiome in HLA-B27-associated disease: implications for acute anterior uveitis and recommendations for future studies.

The pathogenesis of human leukocyte antigen (HLA)-B27-associated diseases such as acute anterior uveitis (AAU) and ankylosing spondylitis (AS) remains poorly understood, though Gram-negative bacteria and subclinical bowel inflammation are strongly implicated. Accumulating evidence from animal models and clinical studies supports several hypotheses, including HLA-B27-dependent dysbiosis, altered intestinal permeability, and molecular mimicry. However, the existing literature is hampered by inadequate studies designed to establish causation or uncover the role of viruses and fungi. Moreover, the unique disease model afforded by AAU to study the gut microbiota has been neglected. This review critically evaluates the current literature and prevailing hypotheses on the link between the gut microbiota and HLA-B27-associated disease. We propose a new potential role for HLA-B27-driven altered antibody responses to gut microbiota in disease pathogenesis and outline recommendations for future well-controlled human studies, focusing on AAU.

Ankylosing Spondylitis in a West African Hospital

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by predominant axial and peripheral (enthesitis, sacroiliitis) involvement affecting young subjects aged 30 to 40 years, 80% to 98% of cases are associated with HLA-B27. Objective: To determine the epidemiological profile of ankylosing spondylitis in the rheumatology department of the Ignace Deen National Hospital in Conakry (Guinea). Materials and Methods: This was a descriptive cross-sectional study carried out within the said department over a period of 18 months from July 1, 2018 to December 31, 2020, including all patients seen in consultation and/or hospitalized in the department in which the diagnosis of ankylosing spondylitis had been retained according to the modified New York criterion. The parameters studied were sociodemographic, clinical, paraclinical and therapeutic. Result: We collected 73 cases or 4.1% of ankylosing spondylitis out of a total of 1781 patients seen during the study period. The male gender was represented with 54.8% for a sex ratio of 1.2 M/F. The average age of our patients was 32.18 ± 12.44 years with extremes ranging from 17 to 54 years. Axial involvement was present in 89.9% of cases with a lumbar predominance (95.2%), followed by the sacroiliac seat (35.5%), cervical (14.5%) and dorsal at 4.8%. The pain was chronic in 93.2% of cases. The most common drug treatment was taking analgesics and NSAIDs (100%) followed by cortisone infiltration (41.1%), corticosteroids (30%), and physiotherapy (21.9%). Ankylosing spondylitis represents 83% of spondyloarthritis followed by undifferentiated spondyloarthritis (9.1%) and juvenile spondylitis (3.4%) were the most common conditions.

Uveitis in spondyloarthropathies

Background: Uveitis is associated with several systemic disorders. It may be the initial presentation or manifestation of a systemic disease. It is the most common ocular complication and is sometimes the earliest manifestation of spondyloarthropathies. This study aimed to review the current literature on spondyloarthropathies and associated uveitis.&#x0D; Methods: A narrative review was performed using various combinations of the keywords spondyloarthropathies, seronegative spondylarthritis-related uveitis, and human leukocyte antigen-associated uveitis using PubMed/MEDLINE and Google Scholar from January 1, 2000, to September 30, 2022. We describe the disease mechanisms, genetics, and classification of spondyloarthropathies, the clinical patterns of their related ocular diseases, and the current modalities for the management of their ocular or systemic manifestations.&#x0D; Results: Seronegative spondyloarthropathies are a group of rheumatic disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease-related spondyloarthropathy, juvenile-onset spondyloarthritis, and undifferentiated spondyloarthritis. These are characterized by enthesitis in the absence of serum rheumatoid factor and have a strong association with human leukocyte antigen B27. The clinical courses and features of spondyloarthropathies are remarkably diverse. Ocular inflammation is common in spondyloarthropathies, often precedes the onset or diagnosis of systemic disease, and responds well to topical therapy. Timely diagnosis of systemic diseases may improve quality of life and help avoid ocular and skeletal complications. Recurrence of ocular inflammation is frequent; on occasion, it may be associated with etanercept administration.&#x0D; Conclusions: Eye care professionals should be able to recognize spondyloarthropathies, manage ocular disease, and collaborate with related specialties for modification of systemic treatment if associated with ocular complications. Timely referral and early management could attenuate or prevent ocular or systemic morbidities associated with spondyloarthropathies.

Diffusion Tensor and Dynamic Contrast-Enhanced Magnetic Resonance Imaging Correlate with Molecular Markers of Inflammation in the Synovium.

It is difficult to capture the severity of synovial inflammation on imaging. Herein we hypothesize that diffusion tensor imaging (DTI) derived metrics may delineate the aggregation of the inflammatory cells and expression of inflammatory cytokines and dynamic contrast-enhanced (DCE) imaging may provide information regarding vascularity in the inflamed synovium. Patients with knee arthritis (&gt;3-months duration) underwent conventional (T2-weighted fast spin echo and spin echo T1-weighted images) as well as DTI and DCE MRI and thereafter arthroscopic guided synovial biopsy. DCE and DTI metrics were extracted from the masks of the segments of the inflamed synovium which enhanced on post-contrast T1-weighted MRI. These metrics were correlated with immunohistochemistry (IHC) parameters of inflammation on synovium. Pearson's correlation was performed to study the relationship between DTI- and DCE-derived metrics, IHC parameters, and post-contrast signal intensity. Linear regression model was used to predict the values of IHC parameters using various DTI and DCE derived metrics as predictors. There were 80 patients (52 male) with mean age 39.78 years and mean disease duration 19.82 months. Nineteen patients had tuberculosis and the rest had chronic undifferentiated monoarthritis (n = 31), undifferentiated spondyloarthropathy (n = 14), rheumatoid arthritis (n = 6), osteoarthritis (n = 4), reactive arthritis (n = 3), ankylosing spondylitis (n = 2), and juvenile idiopathic arthritis (n = 1). Fractional anisotropy (FA), a metric of DTI, had significant correlation with number of immune cells (r = 0.87, p &lt; 0.01) infiltrating into the synovium and cytokines (IL-1β, r = 0.55, p &lt; 0.01; TNF-α, r = 0.42, p &lt; 0.01) in all patients and also in each group of patients and adhesion molecule expressed on these cells in all patients (CD54, r = 0.51, p &lt; 0.01). DCE parameters significantly correlated with CD34 (blood flow, r = 0.78, p &lt; 0.01; blood volume, r = 0.76, p &lt; 0.01) in each group of patients, a marker of neo-angiogenesis. FA was the best predictor of infiltrating inflammatory cells, adhesion molecule and proinflammatory cytokines. Amongst the DCE parameters, blood volume, was best predictor of CD34. DTI and DCE metrics capture cellular and molecular markers of synovial inflammation in patients with chronic inflammatory arthritis.

Safety of Gam-COVID-Vac (Sputnik V) Combined Vector Vaccine in Patients With Immunoinflammatory Rheumatic Diseases: Preliminary Data

Background . Patients with autoimmune and inflammatory rheumatic diseases (AIRDs) are at high risk of developing COVID-19. Vaccination is an effective method of preventing this disease, which may be unsafe for patients with AIRDs. The aim of the study is to assess the safety of Gam-COVID-Vac in patients with IVRD in real clinical practice. Material and methods . A cross-sectional study was carried out. The main group consisted of patients with AIRDs, the control group consisted of individuals without AIRDs. All participants were interviewed by the research physician using a unified questionnaire, additional information was obtained from medical records. Results . The study included 222 patients with AIRDs (119 with rheumatoid arthritis, 36 with ankylosing spondylitis, 17 with psoriatic arthritis, 17 with Sjögren's disease, 10 with undifferentiated spondyloarthritis, 8 with systemic lupus erythematosus, 4 with metabolic arthritis, 3 with systemic scleroderma, 3 with systemic vasculitis, 2 with polymyalgia rheumatica, 2 with undifferentiated systemic connective tissue disease, 1 with adult Still's disease) and 111 patients without AIRDs. The number of patients with AIRDs who had a combination of local and systemic adverse events (AE) on the introduction of the first component of the vaccine was significantly less than in the control group (22.1 and 44.1%, respectively, P&lt;0.001). Similar differences were also noted after the introduction of the second component (14.0 and 29.7%, respectively, P&lt;0.001). AEs such as pain at the injection site without restriction of movement, weakness, fever, arthralgia/myalgia, headache, and chills were significantly more common in the control group after the introduction of the first component of the vaccine. After complete immunization, AEs were absent in 35.6% of patients with AIRDs and in 21.6% of control group patients (P=0.01). Exacerbations of AIRDs and new autoimmune phenomena were not registered in any cases. Conclusions . According to preliminary data, immunization of patients with AIRDs with the Gam-COVID-Vac combined vector vaccine appears to be quite safe.

Comorbid infections in patients with spondyloarthritis who received modern antirheumatic therapy (preliminary data)

Actuality. Data on the prevalence of comorbid infections (CI) in patients with spondyloarthritis (SpA) are few. Risk factors for CI has not been sufficiently studied.Objective. To evaluate the frequency of comorbid infections in patients with spondyloarthritis treated with biological drugs in the form of monotherapy or in combination with DMARD and/or GC.Subjects and methods. The study included 93 patients (55 men, 38 women; average age – 37.0±11.5 years). In 59 patients, AS was diagnosed, in 32 – PsA, in 2 – undifferentiated SpA and SpA associated with nonspecific ulcerative colitis. All patients received biological drugs in combination with DMARD and/or GC or without them. The patients were interviewed by a research doctor with fi lling out a unified questionnaire. Additional information was obtained from medical records.Results. The leading place in the structure of CI was occupied by respiratory tract infections and ENT organs, the 2nd place belonged to herpes viral infections, the 3rd to mycotic infection. Serious CI (SCI) were also represented mainly by injections of respiratory tract infections and ENT organs. A tendency to an increase in the frequency of pneumonia, tuberculosis, acute bronchitis, skin infections, genital organs and mycoses against the background of SpA compared to the period preceding the development of the disease (no significant differences were found) was revealed. 69% of patients noted a more severe course of previously observed CI. 47 patients reported the temporary cancellation of therapy due to the development of CI. 49% of patients have documented exacerbation of SpA. The number of cases of SCI against the background of SpA doubled (p=0.03). There was a positive correlation between the intake of GC and the development of mycoses (r=0.216; p=0.04); between the duration of taking GC and the development of eye infections (r=0.385; p=0.01); between the duration of taking methotrexate and the development of tonsillitis (r=0.25; p=0.03); between taking interleukin 12/23 inhibitors and the development of tonsillitis (r=0.261; p=0.01); between the duration of taking tumor necrosis factor α inhibitors (iTNF-α) and the development of otitis (r=0.287; p=0.01); between the number of consistently used iTNF-α and the development of otitis (r=0.273; p=0.02).Conclusion. The data obtained indicate the relevance of the problem of CI in SpA. Further studies are needed on a larger cohort of patients with an assessment of the effect of therapy on the incidence of CI and the search for risk factors for CI.

A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis: a cross-sectional study

BackgroundThere is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA).MethodsA population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as “healthy” or “unhealthy”, summarized for each patient and stratified into four groups (0–3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis.ResultsOut of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors—more frequently patients with PsA (48%) than AS (39%) or USpA (38%)—and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes.ConclusionReporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health.

Association of Genetic Marker HLA-B27 with Spondyloarthritis In A Tertiary Care Centre In South India

Human leukocyte antigens (HLA) are gene products found in the major histocompatibility complex, aiding in differentiation of “self” from “non-self” antigens, and is crucial for the communication between immune cells of the human body. HLA-B27, in specific, has a strong interrelation with different types of Spondyloarthritis (SpA). The aim of this study is to study the frequency of HLA-B27 in suspected Spondyloarthritis patients presenting with axial and peripheral joint involvement, who attended our tertiary care centre from August-2017 to January-2021. Patients fulfilling Assessment of Spondyloarthritis International Society (ASAS) criteria for Spondyloarthritis were included in the study, and were further classified into Spondyloarthritis sub-groups. Blood samples were collected for CRP and ESR tests along with HLA-B27 detection by RT-PCR method. Magnetic resonance imaging was done for sacroiliac joints in patients with lower back pain. Analysis of 289 samples of SpA patients revealed 156 (54%) to be HLA-B27 positive and 133 (46%) to be HLA-B27 negative. There were 98 patients (63%) with Ankylosing spondylitis, 33 (21%) had Reactive arthritis, 19 (12%) had Psoriatic arthritis, 6 (4%) had Undifferentiated Spondyloarthritis, and inflammatory bowel disease was diagnosed in 0% in HLA-B27 positive Spondyloarthritis patients. The frequency of HLA-B27 among the Spondyloarthritis (SpA) patients in our study was found to be 54% (156), more common clinical manifestation in men belonging to the age group of 16-25 years positive patients. Ankylosing spondylitis (AS) was found to be the most common sub-groups observed among the SpA patients.

HIV-ASSOCIATED ARTHRITIS. Review and clinical cases

Relevance. HIV infection is characterized by a wide spectrum of clinical manifestations, including musculoskeletal symptoms, which can occur at any stage of the disease.&#x0D; Objective: to analyze own clinical cases with rheumatologic manifestations of HIV infection in context of literature data on the spectrum of musculoskeletal manifestations of HIV infection, approaches to diagnosis and treatment.&#x0D; Methods. Presentation of own clinical cases and review of scientific publications in the international electronic scientometric database PubMed using keywords «HIV infection», «arthritis», «musculoskeletal manifestations» over the period 2000-2021 years.&#x0D; Results. The prevalence of musculoskeletal symptoms in HIV-infected individuals ranges from 10 to 45%. Articular manifestations of HIV infection can be divided into 3 main groups: 1) related to HIV (arthralgias, painful articular syndrome, HIV-associated arthritis, septic arthritis); 2) inflammatory arthritis (rheumatoid arthritis, reactive arthritis, psoriatic arthritis, undifferentiated spondyloarthritis); 3) associated with antiretroviral therapy (aseptic necrosis, osteoporosis, osteomalacia, immune reconstitution inflammatory syndrome, gout). For treatment of articular manifestations analgesics, nonsteroidal anti-inflammatory drugs (drug of choice - indomethacin), intraarticular or oral glucocorticoids, disease-modifying antirheumatic drugs (drug of choice - hydroxychloroquine) may be used. Conditions for initiation of therapy with disease-modifying antirheumatic drugs: a controlled steady course of HIV with antiretroviral therapy performed, the number of CD4+ cells &gt;200/ml, undetectable viral load. Our clinical cases confirm that indications for HIV testing in rheumatologic patients are reactive arthritis of unknown etiology, atypical lupus, persistent leukopenia, unreasonable weight loss, lack of an adequate response to traditional therapy of rheumatological diseases.&#x0D; Conclusions. Articular syndrome in HIV-infected individuals may be a separate manifestation of HIV infection and result of antiretroviral therapy. Treatment of articular manifestations in HIV-infected individuals primarily involves the treatment of HIV infection, and it depends on its clinical stage, use of antiretroviral therapy, the severity of articular syndrome and involvement of other organs. Our clinical observations demonstrate the possibility of articular manifestations at various stages of HIV infection: before diagnosis, during prolonged stable antiretroviral therapy, as well as after a change in antiretroviral therapy.

One-Year Treatment Outcomes of Secukinumab Versus Tumor Necrosis Factor Inhibitors in Spondyloarthritis: Results From Five Nordic Biologic Registries Including More Than 10,000 Treatment Courses.

To describe baseline characteristics and to compare treatment effectiveness of secukinumab versus tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA) using adalimumab as the main comparator. This was an observational, prospective cohort study. Patients with SpA (clinical ankylosing spondylitis, nonradiographic axial SpA, or undifferentiated SpA) starting secukinumab or a TNFi during 2015-2018 were identified from 5 Nordic clinical rheumatology registries. Data on comorbidities and extraarticular manifestations (psoriasis, uveitis, and inflammatory bowel disease) were captured from national registries (data available in 94% of patients) and included in multivariable analyses. We assessed 1-year treatment retention (crude survival curves, adjusted hazard ratios [HRadj ] for treatment discontinuation) and 6-month response rates (Ankylosing Spondylitis Disease Activity Score [ASDAS] score <2.1, Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] <40 mm, crude/LUNDEX-adjusted, adjusted logistic regression analyses with odds ratios [ORs]) stratified by line of biologic treatment (first, second, and third plus). In total, 10,853 treatment courses (842 secukinumab and 10,011 TNFi, of which 1,977 were adalimumab) were included. The proportions of patients treated with secukinumab during the first, second, and third-plus lines of treatment were 1%, 6%, and 22%, respectively). Extraarticular manifestations varied across treatments, while other baseline characteristics were largely similar. Secukinumab had a 1-year retention comparable to adalimumab as a first or second line of treatment but poorer as a third-plus line of therapy (secukinumab 56% [95% confidence interval (95% CI) 51-61%] versus adalimumab 70% [95% CI 64-75%]; HRadj 1.43 [95% CI 1.12-1.81]). Across treatment lines, secukinumab had poorer estimates for 6-month response rates than adalimumab, statistically significantly only for the third-plus line (adjusted analyses: ASDAS score <2.1 OR 0.56 [95% CI 0.35-0.90]; BASDAI <40 mm OR 0.62 [95% CI 0.41-0.95]). Treatment outcomes varied across the 5 TNFi. Secukinumab was mainly used in biologics-experienced patients with SpA. Secukinumab and adalimumab performed similarly in patients who had failed a first biologic, although with increasing prior biologic exposure, adalimumab was superior.