Disease duration in AxSpA ups risk of acute anterior uveitis, inflammatory bowel disease
The risk of developing acute anterior uveitis or inflammatory bowel disease (IBD), but not psoriasis, appears to increase with disease duration in axial spondyloarthritis (AxSpA), and this risk is associated with higher cumulative exposure to inflammation, as reported in a study.
The study drew data from the (Be)Giant cohort, which included consecutive patients with AxSpA since 2010, and the ASPECT cohort, which provided information on consecutive patients with ankylosing spondylitis (AS) and probable AS.
A total of 1,250 Belgian AxSpA patients were included in the analysis: 928 patients who fulfilled the New York modified criteria for AS (847 ASPECT; 81 (Be)GIANT) and 322 nonradiographic-AxSpA patients (176 ASPECT; 146 [Be]Giant).
In multiple logistic regression models, disease duration in AxSpA was associated with acute anterior uveitis and IBD risks. Specifically, 10-year disease duration was associated with a 20-percent increase in the risk of acute anterior uveitis (relative risk [RR], 1.2; p<0.001) and a 30-percent increase in the risk of IBD (RR, 1.3; p=0.026).
In a subgroup of 171 newly diagnosed AxSpA patients, those with acute anterior uveitis or IBD exhibited higher mean C-reactive protein (CRP) levels over time compared with those who did not have extra-articular manifestations (EAMs) or who had psoriasis alone (p=0.01).
Researchers warned that the present data, although indicative of an association between the presence of certain EAMs and CRP, do not necessarily represent a causal relationship. It is possible that the appearance of IBD or acute anterior uveitis may just as well be an expression of cumulative exposure to systemic inflammation.
Rather, the data support the hypothesis that the overall exposure to systemic inflammation varies according to the spectrum of EAM in AxSpA, potentially involving a higher risk of structural progression in patients with IBD and/or acute anterior uveitis vs psoriasis. Researchers pointed out that because such EAMs appear to occur early and prior to diagnosis, they may be an early indication of progressive disease risk.