RESUMO
PURPOSE OF REVIEW: The body composition and fat distribution is different between men and women, with different levels of circulating adipokines. These differences become more evident when suffering from an inflammatory disease, such as spondyloarthritris. In this review, we will explore the influence of obesity, body composition and adipokines on the differences in disease activity, progression and response to treatment, between men and women with spondyloarthritis. RECENT FINDINGS: Obesity, mainly determined by the body fat content, which is higher in women, is related to worse disease activity scores. Men with higher disease activity lose more muscle mass than women. Leptin, which is usually found at higher levels in overweight women, seems to be associated with greater spinal radiographic progression when it rises during the course of the disease. Being a woman and obesity, mainly because of the body fat content, are related to a worse response to TNF-α blockers. SUMMARY: Overlooking biological sex variation in body composition, circulating adipokines and hormonal levels, and the subsequent differences in clinical presentation, may ultimately hamper clinical treatment.
Assuntos
Composição Corporal/fisiologia , Obesidade/fisiopatologia , Espondilartrite/fisiopatologia , Adipocinas/sangue , Tecido Adiposo/fisiopatologia , Distribuição da Gordura Corporal , Índice de Massa Corporal , Progressão da Doença , Feminino , Humanos , Leptina/sangue , Masculino , Obesidade/sangue , Obesidade/complicações , Índice de Gravidade de Doença , Fatores Sexuais , Espondilartrite/sangue , Espondilartrite/diagnóstico , Espondilartrite/tratamento farmacológicoRESUMO
BACKGROUND: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. METHODS: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. RESULTS: The mean weight reduction after BS was 49.3 ± 21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n = 8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. CONCLUSION: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Dor Pós-Operatória/etiologia , Espondilartrite/etiologia , Adulto , Idade de Início , Dor nas Costas/etiologia , Cirurgia Bariátrica/métodos , Dor Crônica/etiologia , Feminino , Antígeno HLA-B27/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Dor Pós-Operatória/sangue , Estudos Retrospectivos , Espondilartrite/sangue , Redução de PesoRESUMO
ABSTRACT Objective: The development of anti-drug antibodies against tumor necrosis factor inhibitors is a likely explanation for the failure of TNF-inhibitors in patients with spondyloarthritis. Our study determined the existence and clinical implications of ADAbs in axial spondyloarthritis patients. Methods: According to the Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis, patients treated with adalimumab or infliximab were recruited consecutively. Serum samples were collected at enrollment to measure anti-drug antibodies and drug levels. Results: Of 100 patients, the mean duration of current TNF inhibitor use was 22.3 ± 17.9 months. Anti-drug antibodies were detected in 5 of 72 adalimumab users compared to 5 of 28 infliximab users (6.9% vs. 17.9%). Anti-drug antibodies-positive patients had a significantly higher body mass index than anti-drug antibodies-negative patients among both adalimumab (28.4 ± 5.9 kg/m2 vs. 24.3 ± 2.9 kg/m2, respectively, p = 0.01) and infliximab users (25.9 ± 2.8 kg/m2 vs. 22.6 ± 2.8 kg/m2, respectively, p = 0.02). During the median 15-month follow-up period, drug discontinuation occurred more frequently in the anti-drug antibodies-positive group than the anti-drug antibodies-negative group (30.0% vs. 6.5%, respectively, p = 0.04). In logistic regression, anti-drug antibodies positivity (OR = 5.85, 95% CI 1.19-28.61, p = 0.029) and body mass index (OR = 4.35, 95% CI 1.01-18.69, p = 0.048) were associated with a greater risk of stopping TNF inhibitor treatment. Conclusions: Our result suggests that the presence of anti-drug antibodies against adalimumab and infliximab as well as a higher body mass index can predict subsequent drug discontinuation in axial spondyloarthritis patients.
RESUMO Objetivo: O desenvolvimento de anticorpos antifármacos (ADAb) contra o fator de necrose tumoral (TNF) é uma explicação provável para a falha dos anti-TNF em pacientes com espondiloartrites (EspA). O presente estudo determinou a presença e as implicações clínicas dos ADAb em pacientes com EspA axiais. Métodos: De acordo com os critérios de classificação para EspA axial da Assessment of SpondyloArthritis International Society, recrutaram-se consecutivamente pacientes tratados com adalimumabe ou infliximabe. Coletaram-se amostras de soro no momento da entrada no estudo para medir os níveis de ADAb e de fármaco. Resultados: Dos 100 pacientes, a duração média de uso dos anti-TNF atuais foi de 22,3 ± 17,9 meses. Os ADAb foram detectados em cinco de 72 pacientes em uso de adalimumabe, em comparação com cinco de 28 usuários de infliximabe (6,9% vs. 17,9%). Os pacientes ADAb-positivos tinham um índice de massa corporal maior do que aqueles ADAb-negativos, tanto entre indivíduos em uso de adalimumabe (28,4 ± 5,9 kg/m2 vs. 24,3 ± 2,9 kg/m2, respectivamente, p = 0,01) quanto de infliximabe (25,9 ± 2,8 kg/m2 vs. 22,6 ± 2,8 kg/m2 respectivamente, p = 0,02). Durante o período médio de seguimento de 15 meses, a suspensão do fármaco ocorreu com maior frequência no grupo ADAb-positivo do que no grupo ADAb-negativo (30,0% vs. 6,5%, respectivamente, p = 0,04). Na regressão logística, a positividade no ADAb (OR = 5,85, IC 95% 1,19 a 28,61, p = 0,029) e o IMC (OR = 4,35, IC 95% 1,01 a 18,69, p = 0,048) esteve associada a um maior risco de interromper o tratamento com anti-TNF. Conclusões: Os resultados do presente estudo sugerem que a presença de ADAb contra o adalimumabe e o infliximabe, bem como um IMC mais alto, pode predizer a subsequente interrupção do fármaco em pacientes com EspA axial.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Antirreumáticos/imunologia , Espondilartrite/sangue , Adalimumab/imunologia , Infliximab/imunologia , Índice de Massa Corporal , Modelos Logísticos , Antirreumáticos/sangue , Espondilartrite/tratamento farmacológico , República da Coreia , Adalimumab/sangue , Infliximab/sangue , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The development of anti-drug antibodies against tumor necrosis factor inhibitors is a likely explanation for the failure of TNF-inhibitors in patients with spondyloarthritis. Our study determined the existence and clinical implications of ADAbs in axial spondyloarthritis patients. METHODS: According to the Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis, patients treated with adalimumab or infliximab were recruited consecutively. Serum samples were collected at enrollment to measure anti-drug antibodies and drug levels. RESULTS: Of 100 patients, the mean duration of current TNF inhibitor use was 22.3±17.9 months. Anti-drug antibodies were detected in 5 of 72 adalimumab users compared to 5 of 28 infliximab users (6.9% vs. 17.9%). Anti-drug antibodies-positive patients had a significantly higher body mass index than anti-drug antibodies-negative patients among both adalimumab (28.4±5.9kg/m2 vs. 24.3±2.9kg/m2, respectively, p=0.01) and infliximab users (25.9±2.8kg/m2 vs. 22.6±2.8kg/m2, respectively, p=0.02). During the median 15-month follow-up period, drug discontinuation occurred more frequently in the anti-drug antibodies-positive group than the anti-drug antibodies-negative group (30.0% vs. 6.5%, respectively, p=0.04). In logistic regression, anti-drug antibodies positivity (OR=5.85, 95% CI 1.19-28.61, p=0.029) and body mass index (OR=4.35, 95% CI 1.01-18.69, p=0.048) were associated with a greater risk of stopping TNF inhibitor treatment. CONCLUSIONS: Our result suggests that the presence of anti-drug antibodies against adalimumab and infliximab as well as a higher body mass index can predict subsequent drug discontinuation in axial spondyloarthritis patients.
Assuntos
Adalimumab/imunologia , Antirreumáticos/imunologia , Infliximab/imunologia , Espondilartrite/sangue , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/sangue , Adulto , Antirreumáticos/sangue , Índice de Massa Corporal , Feminino , Humanos , Infliximab/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia , Espondilartrite/tratamento farmacológico , Adulto JovemRESUMO
Viral agents have been suspected as participants of immune-mediated disorders. In the case of rheumatic diseases, the synovial joint cavity represents a secluded area of inflammation which could harbor etiological agents. We analyzed by polymerase chain reaction the possible presence of DNA from various herpes viruses in blood and synovial fluid from patients with either rheumatoid arthritis (n = 18), axial spondyloarthritis (n = 11), or osteoarthritis (n = 8). Relevant findings were as follows: DNA from varicella zoster virus was found in synovial fluid but not in blood mononuclear cells from 33 % of patients with rheumatoid arthritis and in 45 % of patients with axial spondyloarthritis but not in patients with osteoarthritis. Also, DNA from herpes simplex viruses 1 and 2 was found both in the blood and in the synovial fluid from 33 % of patients with rheumatoid arthritis. Our results indicate the occasional presence of DNA from herpes viruses in patients with rheumatoid arthritis or with axial spondyloarthritis. However, these findings might represent a parallel epiphenomenon of viral activation associated either with immunosuppressive therapy or with primary immune disturbances, rather than the etiological participation of herpes viruses in these disorders.
Assuntos
Artrite Reumatoide/sangue , Artrite Reumatoide/virologia , Herpesviridae , Espondilartrite/sangue , Espondilartrite/virologia , Líquido Sinovial/virologia , Adulto , Idoso , Anticorpos Antivirais/análise , Estudos Transversais , DNA Viral/análise , Feminino , Herpesvirus Humano 1 , Herpesvirus Humano 2 , Herpesvirus Humano 3 , Herpesvirus Humano 4 , Herpesvirus Humano 6 , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Leucócitos Mononucleares/virologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/virologia , Reação em Cadeia da Polimerase em Tempo Real , Adulto JovemRESUMO
BACKGROUND: Serum biomarkers traditionally associated with inflammatory activity and a poor prognosis in rheumatic diseases do not show the same relationship in spondyloarthritis. OBJECTIVE: To establish the association between serum levels of potential biomarkers with the presence of factors related to clinical activity and poor prognosis in spondyloarthritis. METHODS: Sixty-two patients were included: 13 with reactive arthritis, 19 with ankylosing spondylitis, and 30 with undifferentiated spondyloarthritis. The results were compared with those from 46 healthy controls. Clinical, radiological, and laboratory characteristics were assessed. The results were analyzed based on the presence of uveitis, enthesitis, inflammatory back pain, arthritis, HLA-B27 and sacroiliac involvement. The analyzed biomarkers included ESR, US-CRP, SAA, LBP, FSC-M, and MMP-3; and cytokine serum levels measured were: IL-17, IL-6, IL-1α , TNF-α , IFN-γ, and IL-23. RESULTS: Forty-three (69.4%) patients were male. The average age was 31.9 ± 9.9 years and the age at the onset of symptoms was 26.9 ± 7.3 years. HLA-B27 was positive in 26 (41.9%) patients, inflammatory back pain in 42 (67.7%), arthritis in 44 (71.0%), and enthesitis in 34 (54.8%). IL-17, IL-23, TNF-α , IL-6, IL-1α , and US-CRP levels were significantly higher in patients with SpA when compared to controls. US-CRP (P = 0.04), IL-6 (P = 0.003), IL-1α (P = 0.03), and LBP (P = 0.03) levels were associated with presence of HLA-B27, inflammatory back pain, and arthritis. CONCLUSION: An increase in serum levels of US-CRP, IL-6, IL-1α , and LBP was correlated with factors associated with clinical activity and poor prognosis in spondyloarthritis.
Assuntos
Espondilartrite/sangue , Espondilartrite/imunologia , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , PrognósticoRESUMO
INTRODUÇÃO: Biomarcadores séricos, tradicionalmente associados à atividade inflamatória e mau prognóstico em doenças reumáticas, não apresentam a mesma relação nas espondiloartrites. OBJETIVO: Estabelecer uma associação entre os níveis séricos de biomarcadores com a presença de fatores associados com a atividade clínica e com o mau prognóstico nas espondiloartropatias. MÉTODOS: Sessenta e dois pacientes (13 com artrite reativa, 19 com espondilite anquilosante e 30 com espondiloartropatia indiferenciada) foram comparados a 46 controles sadios. Foram realizadas avaliações clínicas, radiológicas e laboratoriais. Os resultados foram analisados de acordo com a presença de uveíte, entesite, lombalgia inflamatória, artrite, HLA-B27 e comprometimento das articulações sacroilíacas. Os biomarcadores utilizados foram: VHS, PCRus, SAA, LBP, FSC-M e MMP-3, além da dosagem dos níveis séricos das citocinas: IL-17, IL-6, IL-1α , TNF-α , IFN-γ, e IL-23. RESULTADOS: Quarenta e três (69,4%) pacientes eram homens. A média de idades foi de 31,9 ± 9,9 anos, enquanto a idade média para o aparecimento dos sintomas foi de 26,9 ± 7,3 anos. HLA-B27 foi positivo em 26 (41,9%) dos pacientes, lombalgia inflamatória esteve presente em 42 (67,7%), artrite em 44 (71,0%) e entesite em 34 (54,8%) pacientes. Os níveis séricos de IL-17, IL-23, TNF-α , IL-6, IL-1α e PCRus foram mais elevados em pacientes com espondiloartropatia em comparação com os controles. Os valores de PCRus (P = 0,04), IL-6 (P = 0,003), IL-1α (P = 0,03), e LBP (P = 0,03) se associaram de maneira significativa com presença de HLA-B27, dor lombar inflamatória e artrite. CONCLUSÃO: O aumento dos níveis séricos de PCRus, IL-6, IL-1α e LBP apresentaram associação com fatores relacionados a atividade clínica e mau prognóstico em pacientes com espondiloartrites.
BACKGROUND: Serum biomarkers traditionally associated with inflammatory activity and a poor prognosis in rheumatic diseases do not show the same relationship in spondyloarthritis. OBJECTIVE: To establish the association between serum levels of potential biomarkers with the presence of factors related to clinical activity and poor prognosis in spondyloarthritis. METHODS: Sixty-two patients were included: 13 with reactive arthritis, 19 with ankylosing spondylitis, and 30 with undifferentiated spondyloarthritis. The results were compared with those from 46 healthy controls. Clinical, radiological, and laboratory characteristics were assessed. The results were analyzed based on the presence of uveitis, enthesitis, inflammatory back pain, arthritis, HLA-B27 and sacroiliac involvement. The analyzed biomarkers included ESR, US-CRP, SAA, LBP, FSC-M, and MMP-3; and cytokine serum levels measured were: IL-17, IL-6, IL-1α , TNF-α , IFN-γ, and IL-23. RESULTS: Forty-three (69.4%) patients were male. The average age was 31.9 ± 9.9 years and the age at the onset of symptoms was 26.9 ± 7.3 years. HLA-B27 was positive in 26 (41.9%) patients, inflammatory back pain in 42 (67.7%), arthritis in 44 (71.0%), and enthesitis in 34 (54.8%). IL-17, IL-23, TNF-α , IL-6, IL-1α , and US-CRP levels were significantly higher in patients with SpA when compared to controls. US-CRP (P = 0.04), IL-6 (P = 0.003), IL-1α (P = 0.03), and LBP (P = 0.03) levels were associated with presence of HLA-B27, inflammatory back pain, and arthritis. CONCLUSION: An increase in serum levels of US-CRP, IL-6, IL-1α , and LBP was correlated with factors associated with clinical activity and poor prognosis in spondyloarthritis.