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Disease activity trajectories in early axial spondyloarthritis: results from the DESIR cohort
  1. Anna Molto1,2,3,
  2. Sophie Tezenas du Montcel4,5,
  3. Daniel Wendling6,
  4. Maxime Dougados2,3,
  5. Antoine Vanier4,7,
  6. Laure Gossec1,8
  1. 1Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, GRC-08, Paris, France
  2. 2Rheumatology Department, Paris Descartes University, Cochin Hospital, AP-HP, Paris, France
  3. 3Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, INSERM (U1153), Paris, France
  4. 4Department of Biostatistics Public Health and Medical Informatics, UPMC Université Paris 06, AP-HP, Pitié Salpêtrière Hospital, Paris, France
  5. 5Sorbonne University, Université Pierre et Marie Curie (UPMC) Univ Paris 6, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
  6. 6Rheumatology Department, CHRU de Besançon, Université de Franche-Comté, Besançon, France
  7. 7EA 4275 SPHERE, University of Nantes, Nantes, France
  8. 8Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France
  1. Correspondence to Dr Anna Molto, Rheumatology B Department, Cochin Hospital, 27 rue du Faubourg Saint Jacques, Paris 75014, France; anna.molto{at}aphp.fr

Abstract

Background Disease activity may change over time in axial spondyloarthritis (axSpA). The objectives were to identify patterns of disease activity evolution in patients with early axSpA.

Methods Patients from the prospective early axSpA cohort (DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR)) who fulfilled the Assessment in SpondyloArthritis Society (ASAS) criteria for axSpA at baseline and with at least three Ankylosing Spondylitis Disease Activity Score (ASDAS) values available over the 3 years of follow-up were analysed. Statistical analyses: trajectories were estimated by group-based trajectory modelling; predisposing baseline factors for such trajectories were identified by univariate and multivariable multinomial (logit) regression; work disability over time was compared between the trajectories by Cox hazard model.

Results In all, 370 patients were analysed: mean disease duration was 1.6 (±0.9) years. The five distinct trajectories of disease activity over the 3 years were (t1) ‘persistent moderate disease activity’ (n=134 (36.2%)); (t2) ‘persistent inactive disease’ (n=66 (17.8%); (t3) ‘changing from very high disease activity to inactive disease’ ((n=29 (7.8%)); (t4) ‘persistent high disease activity’ (n=126 (34.1%)) and (t5) ‘persistent very high disease activity’ (n=15 (4.1%)). After adjustment for other characteristics, t2 was associated with a white-collar job (OR=2.6 (95% CI 1.0 to 6.7)) and t3 with male gender (OR=7.1 (1.6 to 32.2)), higher education level (OR=9.4 (1.4 to 63.4)) and peripheral joint involvement (OR=6.2 (1.23 to 31.32)). Patients from (t4) and (t5) were more often declared work disabled over follow-up (HR=5.2 (1.5 to 18.0) and HR=8.0 (1.3 to 47.9), respectively).

Conclusions Trajectory modelling of disease activity was feasible in early axSpA: more than 30% patients (141/370) were in a trajectory with a persistent high disease activity. Persistent high disease activity trajectories were significantly associated with consequences on work.

Trial registration number NCT01648907.

  • Spondyloarthritis
  • Outcomes research
  • Disease Activity
  • Epidemiology

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors The authors take responsibility for the integrity of the work as a whole, from inception to published article and they should indicate that they had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding AM received a master's degree grant from the French Society of Rheumatology to perform these analyses.

  • Competing interests None declared.

  • Ethics approval The DESIR cohort was approved by an Ethics Committee (Comité de Protection des Personnes Ile de France) and all patients gave their informed consent at the inclusion on the cohort.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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