Anaemia is associated with higher disease activity in axial spondyloarthritis but is not an independent predictor of spinal radiographic progression: data from the Swiss Clinical Quality Management Registry

Abstract

Objective As anaemia represents a biomarker for increased radiographic damage in rheumatoid arthritis, we aimed to investigate whether it independently predicts spinal radiographic progression in axial spondyloarthritis (axSpA). Methods AxSpA patients with available haemoglobin levels from the prospective Swiss Clinical Quality Management Registry were included for comparison of patients with and without anaemia. Spinal radiographic progression was assessed according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) in patients with ankylosing spondylitis (AS) if ≥ 2 sets of spinal radiographs were available every 2 years. The relationship between anaemia and progression (defined as an increase ≥ 2 mSASSS units in 2 years) was analysed with generalized estimating equation models after adjustment for the Ankylosing Spondylitis Disease Activity Score (ASDAS) and potential confounding, as well as after multiple imputations of missing values. Results A total of 212/2522 axSpA patients presented with anaemia (9%). Anaemic patients had higher clinical disease activity, higher acute phase reactants and more severe impairments in physical function, mobility and quality of life. In the subgroup of patients with AS (N = 433), a comparable mSASSS progression was found in anaemic and non-anaemic patients (OR 0.69, 95% CI 0.25 to 1.96, p = 0.49). Age, male sex, baseline radiographic damage and ASDAS were associated with enhanced progression. The results were confirmed in complete case analyses and with progression defined as the formation of ≥ 1 syndesmophyte in 2 years. Conclusion Although anaemia was associated with higher disease activity in axSpA, it did not additionally contribute to the prediction of spinal radiographic progression. Key Points• Anaemia is associated with higher disease activity and more severely impaired physical function, mobility and quality of life in axSpA.• Anaemia does not provide an additional value to ASDAS for prediction of spinal radiographic progression.

Mechanistic study on the improvement of immune inflammation in ankylosing spondylitis through regulation of the PI3K/AKT signaling pathway by Huangqin Qingre Chubi capsules

“…Various factors, including genetics, infections, environment, and immuno-inflammatory processes, have been implicated in the development of AS. [6][7][8][9] Currently, Western medicine treatment for AS mainly focuses on inflammation control and symptom reduction, utilizing nonsteroidal anti-inflammatory drugs (NSAIDs), biological agents, and immunosuppressants, [10][11][12] which have demonstrated not only immune-inflammation inhibition but also come with potential side effects. [13][14][15] Conversely, traditional Chinese medicine (TCM) has been increasingly utilized in AS treatment, offering unique advantages over Western medicine, such as fewer side effects, better prognosis, and significant improvements in AS symptoms and inflammation markers.…”

“…In China, the incidence rate of AS is approximately 0.3%, primarily affecting young adults, with a higher prevalence among males. Various factors, including genetics, infections, environment, and immuno‐inflammatory processes, have been implicated in the development of AS 6–9 . Currently, Western medicine treatment for AS mainly focuses on inflammation control and symptom reduction, utilizing nonsteroidal anti‐inflammatory drugs (NSAIDs), biological agents, and immunosuppressants, 10–12 which have demonstrated not only immune‐inflammation inhibition but also come with potential side effects 13–15 .…”