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Abstract
Objective
Acute anterior uveitis (AAU) is the most common extra-articular manifestation in patients with axial spondyloarthritis (axSpA). However, the relationship between AAU and radiographic progression in axSpA remains unclear. Hence, we investigated whether the presence of AAU is associated with radiographic structural damage in patients with axSpA.
Methods
Clinical and radiographic data were obtained from 253 patients with axSpA. Radiographic progression over 2 years was assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Progression was defined as mSASSS worsening by ≥ two units. Using propensity score (PS) matching, differences between patients with and without AAU were analyzed.
Results
The proportion of progressors among patients with AAU was lower than that of patients without AAU (13.6% vs. 29.5%, p=0.058). The rate of increase in mSASSS and number of syndesmophytes were lower in patients with AAU than patients without AAU (0.57±1.37 vs. 1.02±1.79, p=0.085 and 0.46±1.45 vs. 0.83±1.62, p=0.158). In multivariate regression analysis, presence of AAU was independently associated with slowed radiographic progression (odds ratio [95% confidence interval] 0.21 [0.07, 0.67], p=0.004).
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Figure 1.
Radiographic progression over 2 years in axSpA patients with AAU and those without AAU. Upper panel indicates the result after PS matching and lower panel before PS matching. (A, D) Proportion of progressors. Comparison by chi-square test. (B, E) Change in mSASSS. Comparison by t-test. (C, F) Change in number of syndesmophytes. Comparison by t-test. axSpA: axial spondyloarthritis, AAU: acute anterior uveitis, PS: propensity score, mSASSS: modified Stoke Ankylosing Spondylitis Spine Score.
Figure 2.
Cumulative probability plot of 2-year progression in the modified Stoke Ankylosing Spine Score (mSASSS), illustrating the change (Δ) in mSASSS values from baseline of each individual radiographic interval to 2 years in patients with acute anterior uveitis (AAU) and those without AAU. Radiographic progression was defined as an increase in mSASSS ≥2 in 2 years. The effect size was computed by Cohen's d method. (A) After propensity score (PS) matching, (B) Before PS matching.
Table 1.
Baseline characteristics of axSpA patients with and without AAU after propensity score matching
| Variable | Patients with AAU (n=44) | Patients without AAU | |||
|---|---|---|---|---|---|
| After PS matching (n=132) | p-value† | Before PS matching (n=209) | p-value‡ | ||
| Male | 34 (77.3) | 107 (81.1) | 0.744 | 153 (73.2) | 0.712 |
| Age at diagnosis (yr) | 34.2±12.6 | 33.3±12.4 | 0.672 | 32.7±12.1 | 0.190 |
| Disease duration (yr) | 4.48±4.96 | 4.61±5.46 | 0.878 | 3.88±5.18 | 0.227 |
| BMI (kg/m2) | 0.794 | ||||
| Underweight, <18.5 | 0 (0.0) | 1 (0.8) | 9 (4.3) | ||
| Normal, 18.5∼25 | 24 (54.5) | 80 (60.6) | 133 (63.6) | ||
| Overweight, 25∼30 | 16 (36.4) | 39 (29.5) | 52 (24.9) | ||
| Obese, <30 | 4 (9.1) | 12 (9.1) | 15 (7.2) | ||
| HLA-B27 | 42 (95.5) | 126 (95.5) | 1.000 | 175 (83.7) | 0.074 |
| Smoking | 0.861 | 0.578 | |||
| Non-smoker | 25 (56.8) | 71 (53.8) | 131 (62.7) | ||
| Smoker | 19 (43.2) | 61 (46.2) | 78 (37.3) | ||
| Peripheral arthritis | 8 (18.2) | 27 (20.5) | 0.913 | 77 (36.8) | 0.027 |
| Enthesitis | 0 (0.0) | 0 (0.0) | 1.000 | 13 (6.2) | 0.186 |
| Psoriasis | 1 (2.3) | 3 (2.3) | 1.000 | 3 (1.4) | 1.000 |
| Inflammatory bowel disease | 1 (2.3) | 1 (1.5) | 1.000 | 5 (2.4) | 1.000 |
| ESR (mm/h) | 30.2±21.4 | 31.5±25.1 | 0.768 | 36.1±27.6 | 0.122 |
| CRP (mg/dL) | 2.1±3.8 | 1.8±2.9 | 0.616 | 1.8±2.7 | 0.542 |
| ASDAS-CRP | 3.0±1.0 | 3.0±0.9 | 0.974 | 3.1±0.9 | 0.650 |
| Use of TNF inhibitor* | 25 (56.8) | 76 (57.6) | 1.000 | 114 (54.5) | 0.913 |
| Continuous use of NSAIDs | 17 (61.4) | 89 (67.4) | 0.582 | 140 (67.0) | 0.589 |
| mSASSS, units | 8.3±13.0 | 8.7±13.1 | 0.891 | 8.4±13.9 | 0.962 |
| Presence of syndesmophyte(s) | 19 (43.2) | 52 (39.4) | 0.790 | 82 (39.2) | 0.751 |
| Number of syndesmophyte(s) | 2.3±4.5 | 2.5±4.3 | 0.835 | 2.6±4.8 | 0.781 |
| Sacroiliac joint | 0.859/0.746 | 0.552/0.560 | |||
| Grade 0 (right/left) | 7 (15.9)/7 (15.9) | 16 (12.1)/18 (13.6) | 39 (18.7)/46 (22.0) | ||
| Grade 1 (right/left) | 6 (13.6)/6 (13.6) | 24 (18.2)/25 (18.9) | 45 (21.5)/38 (18.2) | ||
| Grade 2 (right/left) | 12 (27.3)/13 (29.3) | 42 (31.8)/35 (26.5) | 59 (28.2)/53 (25.4) | ||
| Grade 3 (right/left) | 8 (18.2)/7 (15.9) | 23 (17.4)/29 (22.0) | 32 (15.3)/38 (18.2) | ||
| Grade 4 (right/left) | 11 (25.0)/11 (25.0) | 27 (20.5)/25 (18.9) | 34 (16.3)/34 (16.3) | ||
| Hip involvement | 0.056/0.793 | 0.036/0.469 | |||
| Grade 0 (right/left) | 39 (88.6)/40 (90.9) | 121 (91.7)/123 (93.2) | 192 (91.9)/192 (91.9) | ||
| Grade 1 (right/left) | 2 (4.5)/1 (2.3) | 3 (2.3)/4 (3.0) | 7 (3.3)/9 (4.3) | ||
| Grade 2 (right/left) | 1 (2.3)/2 (4.5) | 8 (6.1)/3 (2.3) | 9 (4.3)/4 (1.9) | ||
| Grade 3 (right/left) | 0 (0.0)/0 (0.0) | 0 (0.0)/1 (0.8) | 1 (0.5)/3 (1.4) | ||
| Grade 4 (right/left) | 2 (4.5)/1 (2.3) | 0 (0.0)/1 (0.8) | 0 (0.0)/1 (0.5) | ||
| BMD (g/cm2) | |||||
| Lumbar spine | 1.050±0.136 | 1.060±0.168 | 0.932 | 1.060±0.157 | 0.802 |
| Femoral neck | 0.862±0.096 | 0.856±0.131 | 0.733 | 0.847±0.117 | 0.384 |
| Total hip | 0.942±0.104 | 0.924±0.119 | 0.337 | 0.907±0.107 | 0.047 |
| Z score | |||||
| Lumbar spine | −0.173±0.917 | −0.227±1.210 | 0.754 | −0.220±1.130 | 0.768 |
| Femoral neck | −0.118±0.900 | −0.264±0.852 | 0.350 | −0.386±0.804 | 0.073 |
| Total hip | −0.207±0.793 | −0.304±0.817 | 0.488 | −0.434±0.726 | 0.085 |
Values are presented as number (%) or mean±standard deviation. axSpA: axial spondyloarthritis, AAU: acute anterior uveitis, PS: propensity score, BMI: body mass index, ESR, erythrocyte sedimentation rate, CRP: c-reactive protein, ASDAS: Ankylosing Spondylitis Disease Activity Score, TNF: tumor necrosis factor, NSAIDs: non-steroidal anti-inflammatory drugs, mSASSS: modified Stoke Ankylosing Spondylitis Spine Score, BMD: bone mineral density.
Table 2.
Multivariable logistic regression analysis for radiographic progression in patients with axial spondyloarthritis
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