Predictors of remission in people with axial spondyloarthritis: A systematic literature review

Ana Sofia Pinto; Bayram Farisogullari; Pedro M Machado

doi:10.1016/j.semarthrit.2022.152078

Predictors of remission in people with axial spondyloarthritis: A systematic literature review

Semin Arthritis Rheum. 2022 Oct:56:152078. doi: 10.1016/j.semarthrit.2022.152078. Epub 2022 Jul 27.

Authors

Ana Sofia Pinto¹, Bayram Farisogullari², Pedro M Machado³

Affiliations

¹ Department of Rheumatology, Unidade Local de Saúde da Guarda, Guarda, Portugal. Electronic address: anapinto1_2@hotmail.com.
² Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey. Electronic address: bayramfarisogullari@gmail.com.
³ Centre for Rheumatology & Department of Neuromuscular Diseases, University College London; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom. Electronic address: p.machado@ucl.ac.uk.

PMID: 35944350
DOI: 10.1016/j.semarthrit.2022.152078

Abstract

Background: Achievement of remission is a desirable outcome and the identification of predictors of remission may aid in the clinical management of axial spondyloarthritis (axSpA). Our aim was to summarise predictors of remission in people with axSpA.

Methods: In this systematic literature review (SLR), we searched MEDLINE, EMBASE, and Cochrane CENTRAL from their inception to May 20, 2022, and 2020-2021 American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) meeting abstracts. We included randomized controlled trials and cohort studies in which prognostic factors associated with remission were investigated by multivariable analysis.

Results: The SLR comprised 21 articles from 4592 citations. Three studies investigated "sustained remission" (≥3 consecutive visits), while the other assessed "point remission" (at single points in time, varying from 12 weeks to 8 years). The most used remission criteria were Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease (14 studies) and Assessment of SpondyloArthritis international Society partial remission criteria (11 studies). Younger age, HLA-B27 positivity, male gender, lower baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), lower baseline Bath Ankylosing Spondylitis Functional Index (BASFI), lower baseline ASDAS-C-reactive protein, treatment with tumour necrosis factor inhibitors (TNFi), and concomitant use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), were the most consistent predictors of remission. Additionally, shorter disease duration, lower Health Assessment Questionnaire for the spondyloarthropathies and TNFi naivety were predictors of remission in two studies. Other factors were found to be predictors of remission in one study only.

Conclusions: Predictors of remission in axSpA were identified. However, many of these predictors were only identified in 1-2 studies. Considering the differences in study design, further well-designed prognostic studies are needed to confirm and allow generalisation of these predictors to the general axSpA population.

Keywords: Ankylosing spondylitis; Biological therapies; Predictors; Prognosis; Remission; Spondyloarthritis; Systematic review.

Publication types

Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / therapeutic use
Axial Spondyloarthritis*
Humans
Male
Severity of Illness Index
Spondylarthritis* / drug therapy
Spondylitis, Ankylosing* / drug therapy
Tumor Necrosis Factor Inhibitors

Substances

Antirheumatic Agents
Tumor Necrosis Factor Inhibitors

Grants and funding

DH_/Department of Health/United Kingdom