Qualidade de vida em pacientes com espondiloartrites: análise comparativa entre as formas axial, periférica pura e mista / Quality of life in spondyloarthritis: a comparison among axial, peripheric and mixed forms

Introdução: As espondiloartrites são doenças musculoesqueléticas crônicas que podem ter envolvimento axial, periférico ou misto. Devido ao grande comprometimento físico esta doença causa importante redução da qualidade de vida, mas não se sabe se isto acontece de igual maneira nas 3 formas. Objetivo: Estudar a associação entre qualidade de vida e formas de espondiloartrites. Método: Coletaram-se dados acerca de epidemiologia, perfil clínico, comorbidades e de qualidade de vida (através do SF-12 ou Short Form Health Survey­12 questions). Resultados: Incluíram-se 120 indivíduos: 60 EpA e 60 controles. O SF-12 físico tinha mediana de 38,05 para espondiloartrites e 55,1 para controle (p<0,0001). No quesito mental as medianas foram de 42,1 e 50,1 com p=0,04. Não foi possível demonstrar diferenças nos subgrupos de espondiloartrites, tanto no aspecto físico como mental (p=0,33 e 0,30 respectivamente). Conclusão: Existem diferenças significativas na qualidade de vida entre espondiloartrites e controles, mas não entre os subgrupos das espondiloartrites.

Introduction: Spondyloarthritis are chronic musculoskeletal diseases divided as axial, peripherical and mixed diseases. Due to a great physical involvement, it reduces patients' quality of life, but it is unknown how the 3 forms of the disease behave in such context. Objective: To study the quality of life association with spondyloarthritis forms. Methods: Data collection included: epidemiologic data, clinical profile, and quality of life data evaluated through the SF-12 (Short Form Health Survey­12 questions). Results: About 120 individuals were included: 60 spondyloarthritis and 60 controls. The physical SF-12 showed median of 38.05 for spondyloarthritis and 55.1 for controls (p<0.0001). The medians in mental SF-12 were 42.1 and 50.1 with p= 0.04. No differences in quality of life in the spondyloarthritis subgroups could be detected (with p=0.33 and 0.30 for physical and mental aspects). Conclusion: There was a significant difference in quality of life between spondyloarthritis sample and controls but not among the spondyloarthritis subgroups.

El déficit de vitamina D en pacientes con espondiloartritis en un hospital de Castilla-La Mancha / Vitamin D deficiency in patients with spondylarthritis in a Spanish (Castilla-La Mancha) hospital

RESUMEN Introducción: Las espondiloartritis son un grupo de enfermedades inflamatorias crónicas con afectación principalmente del esqueleto axial y también de articulaciones periféricas. En cuanto al metabolismo óseo de estos pacientes, se ha observado en algunos estudios que existen niveles más bajos de vitamina D en pacientes con espondiloartritis. Objetivo: Estimar la prevalencia de déficit/insuficiencia de vitamina D, el metabolismo fosfocálcico y sus implicaciones en una cohorte de pacientes con espondiloartritis. Metodología: Estudio observacional, descriptivo y transversal. Se llevó a cabo una revisión retrospectiva de la base de datos de pacientes con espondiloartritis que fueron atendidos en las consultas externas del Servicio de Reumatología del Hospital General Universitario de Ciudad Real entre junio del 2018 y junio del 2019. Las variables se describieron usando medidas de frecuencia o medidas de tendencia central/dispersión según correspondiera. Resultados: Se analizaron 115 pacientes, de los cuales 64 fueron hombres y 51 mujeres, con una edad media de 45,97 años (± 13,41 DE). Del total de los pacientes, 59 presentaron espon dilitis anquilosante, 24 artropatía psoriásica, 9 artritis asociada a enfermedad inflamatoria intestinal, 12 espondiloartritis axial no radiográfica y 11 artritis reactiva. Los niveles de vitamina D fueron de 23,81 ng/ml (±10,5 DE), con un 77,4% de los pacientes con cifras de déficit/insuficiencia de vitamina D. Agrupados por el subtipo de espondiloartritis y según las cifras de déficit/insuficiencia de vitamina D, 45 pacientes tenían espondilitis anquilo sante, 19 artropatía psoriásica, 9 artritis asociada a enfermedad inflamatoria intestinal, 7 espondiloartritis axiales no radiográficas y 9 artritis reactivas. Además, el déficit de vita mina D (< 20 ng/ml) se presentaba la mayoría de las veces en las estaciones de primavera e invierno, con 31 y 26 pacientes respectivamente. Conclusiones: Una optimización de los niveles de vitamina D puede implicar una mejoría en la situación clínica del paciente, medida tanto por BASDAI y DAPSA como por PCR y VSG. En consecuencia, se recomienda la monitorización y suplementación de vitamina D en pacientes con hipovitaminosis D.

ABSTRACT Introduction: Spondyloarthritis is a group of chronic inflammatory diseases that mainly affect the axial skeleton, and also the peripheral joints. In bone metabolism studies on these patients, it has been observed that there are lower levels of vitamin D in patients with spondyloarthritis. Objective: To estimate the prevalence of vitamin D deficiency / insufficiency, as well as calcium/ phosphate metabolism and their implications in a cohort of patients with spondyloarthritis. Methodology: Observational, descriptive, and cross-sectional study. A retrospective review of the databases was carried out on patients with spondyloarthritis who were treated in the outpatient clinics of the Rheumatology Department of the General University Hospital of Ciudad Real between June 2018 and June 2019. Variables are described using frequency and central tendency / dispersion measurements as appropriate. Results: The study included 115 patients, of whom 64 were men and 51 women, with a mean age of 45.97 years (± 13.41 SD). They included 59 patients with ankylosing spondylitis, 24 with psoriatic arthropathy, 9 arthritis associated with inflammatory bowel disease, 12 non-radiographic axial spondylarthritis, and 11 reactive arthritis. Vitamin D levels were 23.81 ng/ml (± 10.5 SD), with 77.4% of patients with vitamin D deficiency / insufficiency levels. Grouped by the spondylarthritis subtype, and according to vitamin D deficiency / insufficiency, 45 patients had ankylosing spondylitis, 19 psoriatic arthropathy, 9 arthritis associated with inflammatory bowel disease, 7 non-radiographic axial spondyloarthritis, and 9 reactive arthritis. Furthermore, vitamin D deficiency (< 20 ng/ml) mainly occurred in the spring and winter seasons, with 31 and 26 patients, respectively. Conclusions: An optimization of vitamin D levels may lead to an improvement in the clinical situation of the patients, as measured by both BASDAI and DAPSA, as well as by PCR and ESR. Therefore, vitamin D monitoring and supplementation is recommended in patients with vitamin D deficiency.

Factores asociados con el uso de inhibidores del factor de necrosis tumoral alfa en una población de pacientes colombianos con espondiloartritis / Factors associated with the use of tumor necrosis factor alpha inhibitors in a population of Colombian patients with spondyloarthritis

RESUMEN Introducción: El uso de TNFi es cada vez más frecuente en los pacientes con espondiloartritis. Identificar tempranamente aquellos que los requerirán o poder predecir su uso puede ayudar a hacer un tratamiento más efectivo y oportuno racionalizando su uso. Objetivo: Determinar los factores qué mejor explican la indicación de TNFi en la población en estudio. Material y métodos: La asociación entre el uso de medicamentos anti-TNFα y las variables categóricas demográficas, clínicas, de laboratorio, radiológicas y de tratamiento se exploró por prueba exacta de Fisher. La asociación con las variables cuantitativas fue evaluada con t de Student o U de Mann Withney, de acuerdo con su distribución. Aquellas variables con p < 0,25 fueron ingresadas a modelos univariante de regresión logística explicativa para construir los OR crudos; aquellas con p < 0,25 se incluyeron en el modelo multivariante para construir OR ajustados. Resultados y discusión: La población está constituida por 181 pacientes. Modelo univariante: la artritis reactiva, uretritis y compromiso periférico fueron factores protectores para el uso de TNFi. Espondiloartritis axial, lumbalgia inflamatoria, dolor glúteo alternante, rigidez matinal sacroilitis demostrada por cualquier método, tratamiento con inhibidores COX-2, tiempo de evolución de tres arios o más y los puntajes de BASDAI y BASFI se asociaron con el uso de TNFi. Modelo multivariante: artritis reactiva (OR 0,1, IC 95% 0,012-0,86, p = 0,036), lumbalgia inflamatoria (OR 13,63, IC 95% 1,36-136, p = 0,026), sacroilitis (OR 7,71, IC 95% 1,04-57, p = 0,045, uso de coxib (OR 10,1, IC 95% 2,71-37,62, p = 0,001) y el puntaje máximo de BASDAI (4-6: OR 6,1, IC 95% 1,3-28,7, p = 0,022, mayor de 6: OR 15,8, IC 95% 2,2-113, p = 0,006) se asociaron independientemente con el uso de TNFi. El uso de coxib se asoció con la indicación de usar TNFi tanto en los pacientes con espondiloartritis axial (OR 4,2, IC 95% 1,74-10,11, p = 0,001) como periférica (OR 4, IC 95% 1,85-8,62, p < 0,001). Conclusiones: El inicio de la enfermedad en la forma de artritis reactiva se comportó como un factor protector para la necesidad posterior de usar TNFi, mientras que presentar lumbalgia inflamatoria, sacroilitis demostrada por cualquier método, el tratamiento con coxib y el puntaje máximo de BASDAI mayor de 4 se asociaron con el uso de estos medicamentos.

ABSTRACT Introduction: The use of tumor necrosis factor (TNF) alpha inhibitors is increasing in patients with spondyloarthritis. Early identification of those that would require them, or the ability to predict their use, could lead to a more effective and timely treatment by rationalizing their use. Objective: To determine factors that better explain the indication of TNFi in the study population. Material and methods: The association between anti-TNFα use and categorical demographic, clinical, laboratory, radiological and treatment variables was explored using Pearson's Chi2 or Fisher's exact test. The association with the quantitative variables was evaluated using Student's t test or Mann Whitney U test, depending on their distribution. Those variables with P < 0.25 were entered into univariate models of explanatory logistic regression to cons truct crude ORs, and those with P < 0.25 were included in the multivariate model to construct adjusted ORs. Results and discussion: The study population includes 181 patients. In the univariate model: reactive arthritis, urethritis, and peripheral involvement were protective factors for the use of TNFi. Axial spondyloarthritis, inflammatory lumbalgia, alternating gluteal pain, morning stiffness, sacroiliitis demonstrated by any method, treatment with COX-2 inhibitors, evolu tion time of three years or more, and BASDAI and BASFI scores were associated with the use of TNFi. Multivariate model: reactive arthritis (P = 0.036), inflammatory back pain (P = 0.026), sacroiliitis (P = 0.045), use of coxibs (P = 0.001) and the maximum score of BASDAI (P = 0.022, P = 0.006) were independently associated with the use of TNFi. The use of coxibs was associa ted with the indication of using TNFi in both patients with axial spondyloarthritis (P = 0.001) and peripheral (P < 0.001). Conclusions: The onset of the disease in the form of reactive arthritis behaved as a protective factor for the subsequent need to use TNFi, while presenting with inflammatory back pain, sacroiliitis, demonstrated by any method, treatment with coxibs, and the maximum score of BASDAI greater than 4 associated with the use of these medications.

Rendimiento del ASAS Health Index en pacientes con Espondiloartritis de la vida real / Performance of ASAS Health Index in real life spondyloarthritis patients

Introducción: El cuestionario "Assessment of Spondyloarthritis International Society Health Index" (ASAS-HI) fue desarrollado para medir de manera global la funcionalidad y el estado de salud en pacientes con espondiloartritis (EspA). Se han propuesto puntos de corte para determinar diferentes estados de salud que fueron poco evaluados en pacientes de la vida real. Objetivos: Describir el estado de salud medido por ASAS-HI en pacientes argentinos con EspA axial (EspAax) y periférica (EspAp) en la práctica diaria y evaluar los factores asociados al pobre estado de salud. Materiales y métodos: Estudio de corte transversal, analítico y multicéntrico. Se incluyeron consecutivamente pacientes con EspAax y EspAp según criterios ASAS, de 15 centros argentinos. Análisis estadístico: Se realizó estadística descriptiva, análisis bivariado y multivariado (regresión logística múltiple) para evaluar los factores asociados al pobre estado de salud (ASAS-HI ≥12). Para analizar la validez de constructo de la herramienta se realizó correlación de Spearman entre el ASAS-HI y otros parámetros de evaluación de la enfermedad. Resultados: Se incluyeron 274 pacientes con EspA, con una edad media de 49 (±14) años y una duración mediana de la enfermedad de 62 meses (p25-75: 24-135), 155 (56,6%) de los pacientes eran de sexo masculino, 129 pacientes (47%) con EspAax y 145 (52,9%) EspAp. Según el ASAS-HI 119 pacientes (43,4%) presentaban buen estado de salud, 117 (42,7%) tenían estado de salud moderado y 38 (13.9%) pobre estado de salud. En los pacientes con EspAp el valor de ASAS-HI mediano fue de 7 (p25-75: 3-10). El ASAS-HI correlacionó positivamente con: DAS28: rho: 0.5 (p<0.001) y HAQ: rho: 0.54 (p<0.001). La variable asociada de manera independiente con pobre estado de salud fue el DAS28 (OR: 1.9, IC95% 1.1-3.4, p: 0.029). En los pacientes con EspAax el valor de ASAS-HI mediano fue de 6 (p25-75: 2.75-10). El ASAS-HI mostró correlación con: BASDAI: rho: 0.7 (p<0.001), ASDAS-ERS: rho: 0.7 (p<0,001), ASQoL: rho: 0.8 (p<0.001), BASFI rho: 0.75 (p<0.001). La variable que se asoció de manera independiente a pobre estado de salud fue el ASDAS-ERS (OR 6.6, IC95% 2-22, p 0.002). Conclusión: Un pobre estado de salud se asoció independientemente a mayor actividad de la enfermedad en pacientes con EspAax y EspAp. El ASAS-HI correlacionó con otros parámetros de la enfermedad, lo que refuerza la validez de constructo de esta nueva herramienta.

Introduction: The "Assessment of Spondyloarthritis International Society Health Index" (ASAS-HI) questionnaire was developed to globally measure function and health status in patients with spondyloarthritis (SpA). Cut-off points have been proposed to determine different health states that were poorly evaluated in real-life patients. Objectives: To describe the health status measured by ASAS-HI in Argentine patients with axial SpA (AxSpA) and peripheral SpA (SpAp) in daily practice and to evaluate the factors associated with poor health. Materials and methods: Cross-sectional, analytical and multicenter study. Patients with SpAax and SpAp were consecutively included according to ASAS criteria, from 15 Argentine centers. Statistical analysis: Descriptive statistics, bivariate and multivariate analysis (multiple logistic regression) were performed to evaluate the factors associated with poor health status (ASAS-HI ≥12). To analyze the construct validity of the tool, Spearman correlation was performed between the ASAS-HI and other disease evaluation parameters. Results: 274 patients with SpA were included, with a mean age of 49 (± 14) years and a median duration of the disease of 62 months (p25-75: 24-135), 155 (56.6%) were male, 129 patients (47%) with AxSpA and 145 (52.9%) SpAp. According to the ASAS-HI, 119 patients (43.4%) had good health, 117 (42.7%) had moderate health and 38 (13.9%) had poor health. In patients with SpAp, the mean ASAS-HI value was 7 (p25-75: 3-10). The ASAS-HI positively correlated with: DAS28: rho: 0.5 (p <0.001) and HAQ: rho: 0.54 (p <0.001). The variable independently associated with poor health status was DAS28 (OR: 1.9, 95% CI 1.1-3.4, p: 0.029). In patients with AxSpA, the mean ASAS-HI value was 6 (p25-75: 2.75-10). The ASAS-HI showed correlation with: BASDAI: rho: 0.7 (p <0.001), ASDAS-ERS: rho: 0.7 (p <0.001), ASQoL: rho: 0.8 (p <0.001), BASFI rho: 0.75 (p <0.001). The variable that was independently associated with poor health was the ASDAS-ERS (OR 6.6, 95% CI 2-22, p 0.002). Conclusion: Poor health status was independently associated with higher disease activity in patients with AxSpA and SpAp. The ASAS-HI correlated with other parameters of the disease, which reinforces the construct validity of this new tool.

Sobrevida, eficacia y seguridad de Golimumab en pacientes con Artritis Reumatoidea y Espondiloartritis: Datos de una cohorte argentina / Survival, efficacy and safety of Golimumab in patients with Rheumatoid Arthritis and Spondyloarthritis: Data from an Argentine cohort

Objetivos: Golimumab ha sido aprobado para el tratamiento de pacientes con artritis reumatoidea (AR), artritis psoriásica (APs) y espondiloartritis axial. Sin embargo, los datos provenientes de nuestra región son escasos. El objetivo de este estudio fue evaluar la eficacia, seguridad y sobrevida acumulada de golimumab en pacientes de la vida real con AR, APs y espondilitis anquilosante (EA) de diferentes centros de Argentina. Material y métodos: Se llevó a cabo un estudio longitudinal, en el que se incluyeron pacientes consecutivos mayores de 18 años con diagnóstico de AR (criterios ACR/EULAR 2010), APs (criterios CASPAR) y Espax (criterios ASAS 2009), que hayan iniciado tratamiento con golimumab de acuerdo a la indicación médica. Se obtuvieron los datos por revisión de historias clínicas. Se consignaron características sociodemográficas, clínicas, comorbilidades y tratamientos previos. Con respecto al golimumab, se registraron fecha de inicio, vía de administración y tratamientos concomitantes. Se determinó la actividad de la enfermedad mediante DAS28 en el caso de la AR, por DAPSA y MDA para APs y por BASDAI en el caso de Espax. Se consignó la presencia de eventos adversos (EA). En el caso de suspensión del tratamiento, se identificaron la fecha y motivo del mismo. Los pacientes fueron seguidos hasta la suspensión del golimumab, pérdida de seguimiento, muerte, o finalización del estudio (30 de noviembre de 2020). Resultados: Se incluyeron 182 pacientes, 116 con diagnóstico de AR, 30 con APs y 36 con Espax. La mayoría de ellos (70.9%) eran mujeres con una edad mediana (m) de 55 años (RIC 43.8-64) y una duración de la enfermedad m de 7 años (RIC 4-12.7) al inicio del tratamiento. El 34.6% de los mismos habían recibido al menos una droga modificadora de la enfermedad (DME) biológica (-b) o sintética dirigida (-sd) previamente. El seguimiento total fue de 318.1 pacientes/año. El tratamiento con golimumab mostró mejoría clínica en los tres grupos de pacientes. La incidencia de eventos adversos fue de 6.6 por 100 pacientes/año, siendo las infecciones las más frecuentes. Durante el seguimiento, 50 pacientes (27.5%) suspendieron golimumab, la causa más frecuente fue el fracaso del tratamiento (68%), seguida de la falta de cobertura (16%) y el desarrollo de eventos adversos (10%). La persistencia de golimumab fue del 76% y 68% a los 12 y 24 meses, respectivamente. Se registró una sobrevida de 50.2 meses (IC 95% 44.4-55.9). Los pacientes que habían recibido tratamiento previo con DME-b y/o -sd mostraron una menor sobrevida (HR 2.4, IC 95% 1.3-4.4). Conclusiones: El tratamiento con golimumab en pacientes de la vida real en Argentina ha demostrado una buena eficacia y seguridad. La sobrevida del fármaco fue de más de 4 años y casi el 80% seguía usando golimumab después de un año. El tratamiento previo con otros DME-b o -sd se asoció con una menor sobrevida al tratamiento.

Objectives: Golimumab is approved for patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis. However, data from our region are scarce. The aim of this study was to evaluate the efficacy, safety, and cumulative survival of golimumab in real-life patients with RA, PsA and axial spondyloarthritis (axSpa) from different rheumatology centers in Argentina. Material and methods: We performed a longitudinal study of consecutive adults with RA (ACR/EULAR 2010 criteria), PsA (CASPAR criteria) and axSpa (ASAS 2009 criteria), who have started treatment with golimumab according to medical indication. Data was obtained by review of medical records. Sociodemographic and clinical data, musculoskeletal manifestations, comorbidities and previous treatments were recorded. In reference to golimumab treatment, start date, route of administration and concomitant treatments were identified. Disease activity was assessed using DAS28 for RA patients, DAPSA and MDA for PsA and BASDAI for axSpa. The presence of adverse events was recorded. If golimumab was stopped, date and cause was documented. Patients were followed up until golimumab discontinuation, loss of follow-up, death, or study completion (November 30, 2020). Results: In total 182 patients were included, 116 with a diagnosis of RA, 30 with PsA and 36 with axSpa. Most of them (70.9%) were female with a median (m) age of 55 years (IQR 43.8-64) and m disease duration of 7 years (IQR 4-12.7) at treatment initiation. Al least one prior biological (-b) and/or targeted synthetic (-ts) disease modifying antirheumatic drug (DMARD) was received by 63 patients (34.6%). Total follow-up was 318.1 patients/year. Golimumab treatment showed clinical improvement in all three groups of patients. The incidence of AE was 6.6 per 100 patients/year, being infections the most frequents ones. During follow-up, 50 patients (27.5%) discontinued golimumab, the most frequent cause was treatment failure (68%), followed by lack of health insurance (16%) and adverse events (10%). Golimumab persistence was 76% and 68% at 12 and 24 months, respectively. Treatment survival was 50.2 months (95% CI 44.4-55.9). Patients who had received prior treatment with b- or ts-DMARDs showed lower survival (HR 2.41, 95% CI 1.3-4.4). Conclusions: Golimumab treatment in real life patients in Argentina has shown good efficacy and safety. Drug survival was over 4 years and almost 80% were still using golimumab after one year. Prior treatment with other b- or ts-DMARDs was associated with lower treatment survival.

Prevalence, demographics, and clinical characteristics of Latin American patients with spondyloarthritis

Abstract Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.(AU)

Espondiloartrosis cervical e hipertrofia del ligamento amarillo / Cervical Spondyloarthrosis and Hypertrophy of the Yellow Ligament

RESUMEN Introducción: La espondiloartrosis cervical es una enfermedad articular crónica degenerativa, es la afección articular más frecuentemente observada en la población madura y una de las principales causas de discapacidad en todo el mundo, por lo que es importante el diagnóstico y tratamiento en las fases tempranas. Objetivo: Informar un caso clínico representativo de espondiloartrosis cervical e hipertrofia del ligamento amarillo. Presentación del caso: Paciente femenina de 49 años que seis años atrás sufrió una caída, y se golpeó el occipucio contra la pared, lo que le provocó pérdida transitoria del conocimiento y dolor en la región cervical; tres años después comenzó con limitación a los movimientos laterales del cuello, malestar y dolor sordo, referido a la nuca y al cuello. Conclusiones: El diagnóstico de espondiloartrosis cervical e hipertrofia del ligamento amarillo representa un desafío clínico, por lo poco común de la enfermedad a esta edad. El caso presentado es una paciente con alteraciones estructuradas en el esqueleto axial y gran repercusión anatómica y funcional debido a un relativo diagnóstico tardío, con evolución insatisfactoria. Por tanto, conviene conocer la enfermedad para realizar una detección precoz y ofrecer mejor atención terapéutica(AU)

ABSTRACT Introduction: Cervical spondyloarthrosis is a chronic degenerative joint disease, it is the most frequent joint condition in the mature population and one of the main causes of disability throughout the world, so diagnosis and treatment in the early stages are important. Objective: To report a representative clinical case of cervical spondyloarthrosis and hypertrophy of the yellow ligament. Case presentation: A 49-year-old female patient suffered a fall six years ago, hitting her occiput against the wall, causing her temporary loss of consciousness and pain in the cervical region. Three years later, she began with limitation of lateral neck movements, discomfort and dull pain, referred to the nape and neck. Conclusion: The diagnosis of cervical spondyloarthrosis and hypertrophy of the yellow ligament represents a clinical challenge, due to the rare nature of the disease at this age. The case reported is a patient with structured alterations in the axial skeleton and great anatomical and functional repercussions due to a relatively late diagnosis, with unsatisfactory evolution. Therefore, it is convenient to know the disease in order to early detect it and to offer better therapeutic care(AU)

Preferencias del tratamiento en pacientes con Espondiloartritis axial / Treatment preferences in patients with axial spondyloarthritis

Introducción: Una de las premisas del Treat to Target (T2T) es la decisión conjunta del tratamiento entre el reumatólogo y el paciente. Por esta razón las preferencias del paciente juegan un rol fundamental en el éxito del tratamiento a corto y largo plazo. El objetivo de este estudio fue evaluar las preferencias de tratamiento de los pacientes con Espondiloartritis axial (EsPax) e identificar factores asociados a su elección. Material y métodos: Estudio de corte transversal de la cohorte ESPAXIA de pacientes ≥18 años de edad con EsPax (según criterios ASAS 2009). Se consignaron datos sociodemográficos, comorbilidades, características de la enfermedad, y tratamientos recibidos. Se administró un cuestionario especialmente diseñado, en modalidad de elección múltiple y/o respuesta categorizada según orden de importancia de los enunciados. Análisis estadístico: Estadística descriptiva. Test T de Student, test de Chi2 y análisis de regresión logística múltiple. Se consideró significativo un valor de p<0,05. Resultados: Se incluyeron 70 pacientes con una edad mediana (m) de 46,5 años (RIC: 38-57) y un tiempo m de evolución de 13,5 años (RIC: 7,75-23,25). Los aspectos más importantes en la elección del tratamiento fueron: la capacidad de mejoría en la calidad de vida, seguido por mejoría en la inflamación articular, el dolor y la función física. Las vías de administración elegidas en orden decreciente de frecuencia fueron: vía oral (VO) 51,4%, subcutánea (SC) 41,4%, intramuscular (IM) 4,3% y endovenosa (EV) 2,9%. El intervalo entre dosis más votado en la VO fue 1 comprimido semanal (61,1%), y en la SC, 1 aplicación mensual (34,5%). La elección de la VO, se asoció con: preferencia por la autoaplicación, preferencia de aplicación en el hogar y mayor nivel de escolaridad. La elección de la vía SC, fue más frecuente en los pacientes con EA. Los pacientes que recibían tratamiento biológico por vía SC, así como aquellos que tenían la actividad de su enfermedad más controlada, tuvieron mayor conformidad con el tratamiento. Conclusión: La vía de administración de la medicación preferida en nuestra cohorte de pacientes con EsPax fue la oral. Los pacientes con mayor conformidad de tratamiento fueron aquellos que recibían el tratamiento biológico por vía SC y los que tenían menor actividad de la enfermedad.

Background: One of the premises of the Treat to Target (T2T) is the shared treatment decision between the rheumatologist and the patient. For this reason, patient preferences play a fundamental role in the success of treatment in the short and long term. The aims of this study were to evaluate the treatment preferences of patients with Axial Spondyloarthritis (axSpA) and to identify the factors associated with their choice. Material and methods: Cross sectional study. Patients ≥18 years old that fulfilled the ASAS 2009 criteria for axSpA were included. Sociodemographic data, comorbidities, disease characteristics, and treatments received were recorded. A specially designed questionnaire in both, multiple choice modality and response mode listed in order of priority of the statements was administered. Statistical analysis: Descriptive statistics. Student's T-test, Chi2 test and multiple logistic regression analysis. A value of p <0.05 was considered significant. Results: Seventy patients were included with a median age (m) of 46.5 years (IQR: 38-57), 55 males (78.6%) and a median disease duration of 13.5 years (IQR: 7.75-23.25). The relevant aspects for choosing a treatment were: the ability to improve the quality of life (32.9%), followed by improvement in joint inflammation (22.9%), pain (21.4%) and physical function (14.3%). The chosen administration routes in decreasing order of frequency were: oral (51.4%), subcutaneous (SC) (41.4%), intramuscular (IM) 4.3% and intravenous (IV) 2.9%. The preferred frequency of oral administration was one tablet per week (61.1%) and SC administration, once a month (34.5%). The choice of oral route was associated with: preference for self-administration, preference for receiving the medication at home and higher level of education. The choice of the SC route was independently associated with the type of axSpA (AS) and a lower educational level. The patients under biological SC treatment and with lower disease activity, showed higher level of treatment satisfaction. Conclusion: The most preferred way of administration by patients with axSpA was the oral route. Lower disease activity and SC biological treatment were associated with treatment greater compliance.

¿Permiten los entrenamientos de resonancia magnética en espondiloartritis mejorar la performance de los reumatólogos para el reconocimiento de secuencias y lesiones? / Does MRI training in spondyloarthritis improve the performance of rheumatologists on the recognition of sequences and lesions?

Introducción: La resonancia magnética (RM) es una herramienta diagnóstica fundamental en la espondiloartritis (EspA) axial. Objetivo: Estimar el porcentaje de aciertos en el reconocimiento de lesiones en RM de EspA y conocimientos teóricos, antes y después de realizar una intervención educativa. Estimar si la buena performance en los test se asocia a características individuales de los médicos. Materiales y métodos: Estudio analítico, con intervención activa, se midieron los resultados antes y después de un test con 10 preguntas antes y después del desarrollo de un taller de imágenes de RM en EspA en ciudades distintas de Argentina. Se consideró buena performance a quienes lograron más de 12 puntos entre las dos evaluaciones. Resultados: Se evaluaron en total 106 médicos. Los resultados de los test (total 10 preguntas) antes y después del taller fueron 53% de respuestas correctas y 68% respectivamente (p: 0.000). El 65% de los médicos alcanzaron una buena performance (más de 12 respuestas correctas). Conclusión: El porcentaje de aciertos fue mayor después del taller en forma general, la buena performance no se asoció a ninguna característica especifica de los médicos evaluados.

Introduction: Magnetic resonance imaging (MRI) is a fundamental diagnostic tool in axial spondyloarthritis, it has allowed us, unlike radiography, to diagnose this pathology much earlier. Objective: To estimate the percentage of correct answers in the recognition of SpA MRI lesions and theoretical knowledge, before and after performing an educational intervention. Estimate if the good performance in the tests is associated with individual characteristics of the doctors. Methods: A test was carried out with 10 questions (7 for image recognition and 3 for theoretical knowledge) before and after the development of an MRI image workshop in EspA in diferents cities in Argentina. The correct response number was considered before and after the workshop, and those who achieved more than 12 points between the two evaluations were considered good performance. The following physician characteristics were collected. Results: A total of 106 physicians were evaluated. The results of the tests (total 10 questions) before and after the workshop were 53% and 68% correct, respectively (p:0.000). 65% of the physicians achieved a good performance (more than 12 correct).

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019

Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

¿Permiten los entrenamientos de resonancia magnética en espondiloartritis mejorar la performance de los reumatólogos para el reconocimiento de secuencias y lesiones? / Do magnetic resonance training in spondyloarthritis improve the performance of rheumatologists for the recognition of sequences and lesions?

Introducción: La resonancia magnética (RM) es una herramienta diagnóstica fundamental en la espondiloartritis (EspA) axial. Objetivo: Estimar el porcentaje de aciertos en el reconocimiento de lesiones en RM de EspA y conocimientos teóricos, antes y después de realizar una intervención educativa. Estimar si la buena performance en los test se asocia a características individuales de los médicos. Materiales y métodos: Estudio analítico, con intervención activa, se midieron los resultados antes y después de un test con 10 preguntas antes y después del desarrollo de un taller de imágenes de RM en EspA en ciudades distintas de Argentina. Se consideró buena performance a quienes lograron más e 12 puntos entre las dos evaluaciones. Resultados: Se evaluaron en total 106 médicos. Los resultados de los test (total 10 preguntas) antes y después del taller fueron 53% de respuesta correctas y 68% respectivamente (p: 0.000). El 65% de los médicos alcanzaron una buena performance (más de 12 respuesta correctas). Conclusión: El porcentaje de aciertos fue mayor después del taller en forma general, la buena performance no se asoció a ninguna característica especifica de los médicos evaluados.

Introduction: Magnetic resonance imaging (MRI) is a fundamental diagnostic tool in axial spondyloarthritis, it has allowed us, unlike radiography, to diagnose this pathology much earlier. Objective: To estimate the percentage of correct answers in the recognition of SpA MRI lesions and theoretical knowledge, before and after performing an educational intervention. Estimate if the good performance in the tests is associated with individual characteristics of the doctors. Methods: A test was carried out with 10 questions (7 for image recognition and 3 for theoretical knowledge) before and after the development of an MRI image workshop in EspA in diferents cities in Argentina. The correct response number was considered before and after the workshop, and those who achieved more than 12 points between the two evaluations were considered good performance. The following physician characteristics were collected. Results: A total of 106 physicians were evaluated. The results of the tests (total 10 questions) before and after the workshop were 53% and 68% correct, respectively (p:0.000). 65% of the physicians achieved a good performance (more than 12 correct)

Incidence of tuberculosis infection in spondyloarthritis patients treated with biological and conventional disease-modifying anti-rheumatic drugs in an endemic area

Introduction: Registries of spondyloarthritis (SpA) patients' follow-up provided evidence that tumor necrosis factor inhibitors (TNFi) increase the incidence of active tuberculosis infection (TB). However, most of these registries are from low burden TB areas. Few studies evaluated the safety of biologic agents in TB endemic areas. This study compares the TB incidence rate (TB IR) in anti-TNF-naïve and anti-TNF-experienced subjects with SpA in a high TB incidence setting.Methods: In this retrospective cohort study, medical records from patients attending a SpA clinic during 13 years (2004 to 2016) in a university hospital were reviewed. The TB IR was calculated and expressed as number of events per 105 patients/year; the incidence rate ratio (IRR) associated with the use of TNFi was calculated.Results: A total of 277 patients, 173 anti-TNF-naïve and 104 anti-TNF-experienced subjects, were evaluated; 35.7% (N = 35) of patients who were prescribed an anti-TNF drug were diagnosed with latent tuberculosis infection (LTBI). Total follow-up time (person-years) was 1667.8 for anti-TNF-naïve and 394.9 for anti-TNF-experienced patients. TB IR (95% CI) was 299.8 (37.4-562.2) for anti-TNF naïve and 1012.9 (25.3-2000.5) for anti-TNF experienced subjects. The IRR associated with the use of TNFi was 10.4 (2.3- 47.9).Conclusions: In this high TB incidence setting, SpA patients exposed to anti-TNF therapy had a higher incidence of TB compared to anti-TNF-naïve subjects, although the TB incidence in the control group was significant.(AU)

Abordaje práctico de la espondiloartritis / Practical approach to spondyloarthritis

Introducción: la espondiloartritis, es una forma de artritis inflamatoria que, generalmente comienza entre los 17 y los 45 años. La inflamación sistémica es una característica clave que ayuda a distinguirla de otros tipos de artritis, incluida la artritis por desgaste y desgarro, como la osteoartritis. Objetivo: brindar información sobre el abordaje práctico de la espondiloartritis para contribuir a esclarecer puntos que, a juicio de los autores de este trabajo, son importantes para el manejo de la misma. Desarrollo: en poco tiempo han tenido lugar inusitados avances que abarcan todos los aspectos de su manejo, incluidos el diagnóstico y el seguimiento, pero sobre todo en su tratamiento. Algunas presentaciones engañosas son propias del comienzo retardado, como la espondiloartritis periférica de inicio tardío (LOPS), que se caracteriza por una oligoartritis inflamatoria que contrasta con los signos generales, un importante síndrome inflamatorio y, a veces, edema asimétrico de las extremidades inferiores. Conclusiones: el papel de los reumatólogos es esencial en el manejo de esta enfermedad, pues son los especialistas mejor calificados para tener a su cargo a estos pacientes, mientras que los generalistas participan más en la detección de la misma(AU)

Introduction: spondyloarthritis, or SpA, is a form of inflammatory arthritis that usually begins between 17 and 45 years. Systemic inflammation is a key feature that helps distinguish it from other types of arthritis, including arthritis by tearing and tearing, such as osteoarthritis. Objective: to provide information on the practical approach of spondyloarthritis to help clarify points that, in the opinion of the authors of this work, are important for the management of it. Development: in a short time, there have been unusual advances that cover all aspects of its management, including diagnosis and monitoring, but especially in its treatment. Some deceptive presentations are typical of delayed onset, such as late-onset peripheral spondyloarthritis (LOPS), which is characterized by an inflammatory oligoarthritis that contrasts with the general signs, an important inflammatory syndrome and, sometimes, asymmetric edema of the lower extremities. Conclusions: the role of rheumatologists is essential in the management of this disease, as they are the best qualified specialists to be in charge of these patients, while the generalists participate more in the detection of it(AU)

Poliartritis asimétrica con distribución en rayo / Asymmetrical arthritis with ray pattern distribution

Resumen Se presenta una imagen gammagráfica que muestra en forma didáctica características típicas de la artritis psoriásica.

Abstract A scintigraphic image is presented that shows the typical characteristics of psoriatic arthritis as a teaching aid.

Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients / Alterações eletrocardiográficas em espondiloartrites e uso de anti-TNF-α: estudo retrospectivo em 100 pacientes

ABSTRACT Objective To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. Methods Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. Results Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. Conclusion Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.

RESUMO Objetivo Avaliar a prevalência de alterações eletrocardiográficas em pacientes com espondiloartrites, correlacionando-as com o uso de medicações antifator de necrose tumoral alfa (TNF-α) e presença do HLA-B27. Métodos Estudo retrospectivo com 100 pacientes com diagnóstico de espondiloartrites pelo critério Assessment of SpondyloArthritis International Society (ASAS) e 50 controles. Foram coletados nos prontuários dos pacientes, dados epidemiológicos, clínicos, exames de atividade inflamatória, presença do HLA-B27, e uso de medicamentos. A atividade de doença foi avaliada pelo Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Todos foram submetidos a eletrocardiograma realizado com aparelho de 12 derivações, sendo analisados ritmo, frequência cardíaca, distúrbios de condução e intervalo QT corrigido pela fórmula de Bazett. Resultados Dos 100 pacientes com espondiloartrites, 49 não usavam anti-TNF-α e 51 utilizavam este medicamento. O HLA-B27 estava presente em 53,1% da amostra. A frequência cardíaca foi mais baixa (p=0,06), o intervalo QT foi mais prolongado (p<0,0001) e existia mais perturbação de condução do ramo direito (p=0,014) nos pacientes com espondiloartrites do que nos controles. Uma modesta correlação de tempo de doença com frequência cardíaca foi encontrada (Rho=0,26; IC95%: 0,06-0,44; p=0,008). A presença do HLA-B27 aumentou a prevalência de perturbação de condução do ramo direito. Nenhum dos parâmetros eletrocardiográficos analisados alterou-se com uso de anti-TNF-α. Conclusão Pacientes com espondiloartrites tiveram frequência cardíaca menor, maior intervalo QT e prevalência maior de perturbação de condução do ramo direito do que controles. O HLA-B27 influi no aparecimento de perturbação de condução do ramo direito. O uso de anti-TNF-α não influiu nos achados eletrocardiográficos.

Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a crosssectional study comparing MASES, SPARCC and LEI

Abstract Background: The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA. Methods: A cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman's Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease. Results: Two hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034). Conclusion: In this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.(AU)

Patrones de tratamiento con agentes biológicos, eficacia y sobrevida a largo plazo en pacientes con espondiloartritis axial: Impacto de los factores sociodemográficos en Latinoamérica / Patterns of treatment with biological agents, efficacy and long-term survival in patients with axial spondyloarthritis: Impact of sociodemographic factors in Latin America

Objetivos: Evaluar y comparar la eficacia y la sobrevida a largo plazo de las Drogas Modificadoras de la Enfermedad-biológicas (DME-b) en Espondiloartritis Axial (EsPax) mediante el índice LUNDEX y determinar las variables asociadas a la discontinuación de las mismas. Material y métodos: Estudio multicéntrico de corte transversal. Se incluyeron pacientes con EsPax en tratamiento con DME-b. Se registraron variables sociodemográficas, terapéuticas y clínicas. Se consignaron fechas de inicio del tratamiento con DME-b, tratamiento concomitante, suspensión o cambio de tratamiento, y causas de suspensión. La eficacia terapéutica se definió según BASDAI a los 6, 12 meses y luego anualmente a partir del inicio de la DME-b. Se calculó el índice LUNDEX en estos períodos. Análisis estadístico: Estadística descriptiva. Test de Student y test Chi² o test exacto de Fisher. Curvas de Kaplan-Meier y Log-Rank. Análisis de regresión proporcional de Cox. Resultados: Se estudiaron 101 pacientes con EsPax, 80,2% varones, con una edad mediana de 42 años (RIC 35-54,5) y un tiempo mediano de evolución de la enfermedad de 19,3 años (RIC 9,4-28,8). El 26,7% de los pacientes no tenían seguro de salud. Los agentes anti-TNFα utilizados como 1º DME-b en orden de frecuencia fueron: Etanercept (ETN) 44,6%, Adalimumab (ADA) 41,6%, Infliximab 7,9% y Certolizumab 5,9%. En el 32,7% de los casos, la DME-b se administró en combinación con una droga modificadora de enfermedad convencional. La sobrevida media fue de 66,2 meses (IC 95%: 51,8-80,5). Debido a que ETN y ADA se utilizaron en el 85% de los pacientes estudiados, se realizaron comparaciones solamente entre estos agentes. El tiempo medio de supervivencia acumulada fue significaticamente menor para ETN versus ADA (X 53,18±8,8 vs X 74,8±8,9, Log-Rank p=0,02), siendo la causa principal de suspensión, la falta de provisión de la medicación. El tiempo promedio de supervivencia para aquellos que no tenían seguro de salud fue significativamente menor X 31,9 meses (IC 95%: 19-45) con respecto a aquellos pacientes con dicho seguro X 72,3 meses (IC 95%: 55,3-89,3), p=0,03. Luego de ajustar por factores confundidores, la falta de un seguro de salud fue la única variable asociada en forma independiente con menor supervivencia del DME-b (HR 2,54, IC 95%: 1,18-5,75). El LUNDEX global fue del 52,7% a los 6 meses y del 46,9% a los 12 meses. Conclusiones: La sobrevida promedio del 1º DME-b fue de 5,5 años. La falta de cobertura de salud fue la única variable que influyó negativamente en la sobrevida del tratamiento con el 1º DME-b en pacientes con EsPax.

Objectives: To evaluate and compare the efficacy and long-term survival of biological disease-modifying drugs (b-DMARDs) in Axial Spondyloarthritis (axSpA) using the LUNDEX index and to determine the variables associated with the discontinuation of these drugs. Material and methods: Cross-sectional multicenter study. Patients with axSpA in treatment with b-DMARDs were included. Sociodemographic, therapeutic and clinical variables were recorded. The dates of initiation of treatment with b-DMARDs, concomitant treatment, suspension or change of treatment, and causes of suspension were recorded. Therapeutic efficacy was defined according to BASDAI at 6, 12 months and then annually from the initiation of b-DMARDs. The LUNDEX index was calculated in these periods. Statistical analysis: Descriptive statistics. Student's test and Chi² test or Fisher's exact test. Curves of Kaplan-Meier and Log-Rank. Proportional regression analysis of Cox. Results: 101 patients with axSpA were studied, 80.2% men, with a median age of 42 years (IQR 35-54.5) and a median disease duration of 19.3 years (IQR 9.4-28.8). 26.7% of patients didn´t have health insurance. The frequency of the anti-TNFα agent used as 1st b-DMARD was: Etanercept (ETA) 44.6%, Adalimumab (ADA) 41.6%, Infliximab 7.9%, and Certolizumab 5.9%. In 32.7% of the cases, the b-DMARD was administered in combination with a c-DMARD (conventional disease-modifying drug). The mean survival was 66.2 months (95% CI: 51.8-80.5). As ETA and ADA were used in 85% of the patients, comparisons were made only between these two agents. The mean survival time was significantly lower for ETA vs ADA (X 53.18 ±8.8 vs X 74.8±8.9, Log-Rank p=0.02), being the main cause of suspension, the lack of drug provision. The average survival time for those who didn´t have health insurance was significantly lower X 31.9 months (95% CI: 19-45) in comparison to those patients who had health insurance X 72.3 months (95% CI: 55.3-89.3), p=0.03. After adjusting for confounding factors, the lack of health insurance was the only variable independently associated with a lower survival of the b-DMARD (HR 2.54, 95% CI: 1.18 to 5.75). The global LUNDEX was 52.7% at 6 months and 46.9% at 12 months. Conclusions: The average survival of the 1st b-DMARD was 5.5 years. The lack of health insurance was the only variable that negatively influenced the survival of the treatment with the 1st b-DMARD in patients with axSpA.