Enthesitis, Spinal Mobility Key Disability Drivers in axSpA

Investigators examined the long-term association between disease activity and disability in axSpA.

In patients with axial spondyloarthritis (axSpA), disease activity may contribute longitudinally to disability and is hierarchically superior to any other variables or disease domains. This is according to research results published in Arthritis Care & Research.

The investigators sought to evaluate the long-term association between disease activity and disability among patients with axSpA. Data were collected from the first 5 years of follow-up of a large, early axSpA cohort (DESIR), a prospective, observational study of patients with recent onset (<3 years) of inflammatory back pain suggestive of axSpA, to assess this outcome. The secondary objective was to define patient profiles according to level of disability.

In the DESIR cohort, disability was evaluated with the Ankylosing Spondylitis Health Assessment Questionnaire (HAQ-AS), a validated patient-reported outcome measure that is used to assess patient disability. The HAQ-AS has 8 main categories: dressing and grooming, rising, eating, walking, hygiene, reach, grip, and activities. Disease activity in this study was measured via use of the Ankylosing Spondylitis Disease Activity Score C-Reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Meterology Index (BASMI).

Consecutive patients (n=644) between 18 and 50 years of age from 25 centers in France were recruited for the current study. Visits were scheduled every 6 months for the first 2 years, then annually thereafter. Patients selected for the study needed to have a definite diagnosis of axSpA at the 60-month follow-up, according to the treating rheumatologist.

Data from 5152 visits were analyzed. Results showed that the HAQ-AS was longitudinally, independently, and positively associated with the ASDAS-CRP (adjusted B, 0.205; 95% CI, 0.187-0.222); the enthesitis score (adjusted B, 0.011; 95% CI, 0.008-0.015); the BASMI (adjusted B, 0.087; 95% CI, 0.069-0.105); and female gender (adjusted B, 0.172; 95% CI, 0.120-0.225).

Study limitations include the near absence of structural damage due to the early state of the disease, possible confounding because of a lack of randomization to treatments, and the need for a more robust, gold-standard external construct is needed.

Investigators concluded that in patients with early axSpA, both spinal mobility and enthesitis should be systematically evaluated, as they are also key drivers of disability in this population. The use of comprehensive and multimodal treatment strategies that address these parameters may help to reduce the overall level of disability in patients with the disease.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Carvalho PD, Ruyssen-Witrand A, Marreiros A, Machado PM.  Long-term association between disease activity and disability in early axial spondyloarthritis: results from the DESIR cohort. Arthritis Care Res (Hoboken). Published online November 18, 2020.        doi: 10.1002/acr.24515