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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 987-993. doi: 10.19723/j.issn.1671-167X.2024.06.007

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Assessment of residual symptoms in patients with axial spondyloarthritis with low disease activity and analysis of its related factors

Jiayu ZHAI, Jinxia ZHAO, Zhuo AN, Rui LIU*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-08-22 Online:2024-12-18 Published:2024-12-18
  • Contact: Rui LIU E-mail:maryllr@163.com

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Abstract:

Objective: To comprehensively assess the occurrence of residual symptoms in patients with axial spondyloarthritis who have successfully attained the treatment goal of low disease activity, and to conduct a thorough analysis of the related factors. Methods: An analysis was performed on axial spondyloarthritis patients who achieved low disease activity for the first time during their visits at the Rheumatology and Immunology Department of Peking University Third Hospital, spanning from May 1, 2021, to February 29, 2024. Based on the ankylosing spondylitis disease activity score-C-reactive protein (ASDAS-CRP), the patients who achieved low disease activity were divided into a non-remission low disease activity group and a remission group. The occurrence of residual fatigue and pain symptoms in both groups was assessed, and binary Logistic regression analysis was used to evaluate the related factors. Results: In the study, 201 patients achieved low disease activity during treatment. The gender distribution was skewed towards males, with 151 male patients (75.1%) and 50 female patients (24.9%). The median age of the patients who achieved low disease activity was 32.0 (28.0, 37.0) years, and the median disease duration was 6.7 (3.8, 11.5) years. Notably, 140 patients (69.7%) achieved low disease activity but did not experience complete remission, while 61 patients (30.3%) attained remission. A substantial proportion of the patients, 45.8%, reported residual fatigue visual analogue scale (VAS) ≥4, with a marked difference between the non-remission low disease activity group and the remission group (53.6% vs. 27.9%, P=0.001). Similarly, 24.4% of the patients had residual pain VAS ≥4, with a significant disparity between the non-remission low disease activity group and the remission group (30.0% vs. 11.5%, P=0.005). Binary Logistic regression analysis revealed that C-reactive protein levels had a notable negative influence on residual fatigue symptom (B=-0.142, P=0.008, OR=0.868), whereas ASAS-HI had a positive effect on residual fatigue (B=0.288, P < 0.001, OR=1.334). Gender was found to have a significant impact on residual pain symptoms, with females exhibiting a higher risk (B=1.135, P=0.002, OR=3.112). Conclusion: The residual fatigue and pain symptoms are common in axial spondyloarthritis patients who have achieved low disease activity, particularly among female patients. More assessment and recognition of the residual disease burden in these patients will be needed to optimize the treatment strategies.

Key words: Axial spondyloarthritis, Disease activity, Pain, Fatigue, Related factors

CLC Number: 

  • R593.2

Table 1

Comparison of clinical characteristics between patients achieving non-remission LDA and those achieving remission"

Items Total LDA (ASDAS-CRP＜2.1) (n=201) Remission (ASDAS-CRP＜1.3) (n=61) Non-remission LDA (1.3≤ASDAS-CRP＜2.1) (n=140) Z/χ2 P
Male, n(%) 151 (75.1) 46 (75.4) 105 (75.0) 0.004 0.951
Age/years, M(P25, P75) 32.0 (28.0, 37.0) 30.0 (26.5, 36.0) 33.0 (28.3, 37.0) -1.708 0.088
Symptom duration/years, M(P25, P75) 6.7 (3.8, 11.5) 6.8 (3.8, 10.5) 6.5 (3.8, 11.9) -0.334 0.739
Higher educationa, n(%) 163 (81.1) 56 (91.8) 107 (76.4) 6.551 0.010
BMI≥24 kg/m2, n(%) 86 (42.8) 20 (32.8) 66 (47.1) 3.577 0.059
Positive HLA-B27, n(%) 169 (84.1) 50 (82.0) 119 (85.0) 0.292 0.589
History of EMMs, n(%)
  Uveitis 46 (22.9) 13 (21.3) 33 (23.6) 0.123 0.726
  IBD 3 (1.5) 1 (1.6) 2 (1.4) 0.013 0.910
  PsO 5 (2.5) 2 (3.3) 3 (2.1) 0.226 0.635
Smoking, n(%) 1.375 0.241
  Never 147 (73.1) 48 (78.7) 99 (70.7)
  Occasional 11 (5.5) 0 11 (7.9)
  Frequent 21 (10.4) 6 (9.8) 15 (10.7)
  Second hand 7 (3.5) 2 (3.3) 5 (3.6)
  Former 15 (7.5) 5 (8.2) 10 (7.1)
Medication use, n(%)
  NSAIDs 147 (73.1) 36 (59.0) 111 (79.3) 8.884 0.003
  csDMARDs 37 (18.4) 10 (16.4) 27 (19.3) 0.237 0.627
  TNF inhibitor 77 (38.3) 29 (47.5) 48 (34.3) 3.159 0.076
  IL-17 inhibitor 35 (17.4) 11 (18.0) 24 (17.1) 0.023 0.878
ASDAS, M(P25, P75) 1.5 (1.2, 1.8) 1.0 (0.7, 1.1) 1.7 (1.5, 1.9) -11.299 ＜0.001
BASDAI, M(P25, P75) 1.6 (1.0, 2.4) 1.0(0.5, 1.8) 2.0 (1.2, 2.6) -5.109 ＜0.001
BASFI, M(P25, P75) 0.6 (0.1, 1.2) 0.3 (0.0, 0.9) 0.8 (0.2, 1.3) -2.912 0.004
ASAS-HI, M(P25, P75) 2 (0, 4) 1 (0, 2) 2 (1, 4) -2.992 0.003
CRP/(mg/L)，M(P25, P75) 2.9 (1.8, 6.1) 1.9 (1.2, 2.7) 4.9 (2.1, 7.0) -6.622 ＜0.001
Fatigue VAS≥4, n(%) 92 (45.8) 17 (27.9) 75 (53.6) 11.308 0.001
Pain VAS≥4, n(%) 49 (24.4) 7 (11.5) 42 (30.0) 7.909 0.005
ASAS-HI＞5, n(%) 38 (18.9) 8 (13.1) 30 (21.4) 1.916 0.166

Table 2

Univariate analysis of residual fatigue symptom"

Items Fatigue VAS＜4 (n=109) Fatigue VAS≥4 (n=92) Z/χ2 P
Sex, n(%) 7.062 0.008
Male 90 (82.6) 61 (66.3)
Female 19 (17.4) 31 (33.7)
Age/years, M(P25, P75) 33.0 (28.0, 37.0) 32.0 (27.0, 36.0) -1.064 0.287
Symptom duration/years, M(P25, P75) 7.0 (3.9, 11.4) 6.0 (3.8, 11.6) -0.651 0.515
History of EMMs, n(%)
Uveitis 20 (18.3) 26 (28.3) 2.778 0.096
IBD 2 (1.8) 1 (1.1) 0.190 0.663
PsO 2 (1.8) 3 (3.3) 0.418 0.518
Smoking, n(%) 1.749 0.782
Never 80 (73.4) 67 (72.8)
Occasional 5 (4.6) 6 (6.5)
Frequent 10 (9.2) 11 (12.0)
Secondhand 5(4.6) 2 (2.2)
Former 9 (8.3) 6 (6.5)
Medication use, n(%)
NSAIDs 79 (72.5) 68 (73.9) 0.052 0.819
csDMARDS 25 (22.9) 12 (13.0) 3.251 0.071
TNF inhibitor 40 (36.7) 37 (40.2) 0.262 0.609
IL-17 inhibitor 18 (16.5) 17 (18.5) 0.134 0.714
BASFI, M (P25, P75) 0.4 (0.0, 1.1) 0.7 (0.2, 1.5) -2.001 0.045
ASAS-HI, M (P25, P75) 1.0 (0.0, 3.0) 3.0 (1.0, 5.0) -4.981 0.000
CRP/(mg/L), M (P25, P75) 4.1 (1.9, 7.0) 2.3 (1.6, 5.0) -2.777 0.005

Table 3

Binary Logistic analysis of residual fatigue symptom"

Items B S.E. Wald P OR (95%CI)
Sex (Female) 0.581 0.371 2.450 0.118 1.787 (0.864-3.697)
CRP -0.142 0.053 7.070 0.008 0.868 (0.782-0.963)
BASFI 0.012 0.222 0.003 0.956 1.012 (0.655-1.566)
ASAS-HI 0.288 0.080 12.989 ＜0.001 1.334 (1.141-1.561)
Constant -0.425 0.340 1.564 0.211 0.654

Table 4

Univariate analysis of residual pain symptom"

Items Pain VAS＜4 (n=152) Pain VAS≥4 (n=49) Z/χ2 P
Sex, n (%) 8.811 0.003
Male 122 (80.3) 29 (59.2)
Female 30 (19.7) 20 (40.8)
Age/years, M (P25, P75) 32.0 (28.0, 37.0) 32.0 (26.5, 37.0) -2.557 0.011
Symptom duration/years, M (P25, P75) 7.2 (4.0, 11.6) 4.5 (3.5, 10.0) -2.071 0.038
History of EMMs, n (%)
Uveitis 33 (21.7) 13 (26.5) 0.488 0.485
IBD 3 (2.0) 0 (0) 0.982 0.322
PsO 4 (2.6) 1 (2.0) 0.053 0.817
Smoking, n (%) 3.812 0.432
Never 110 (72.4) 37 (75.5)
Occasional 9 (5.9) 2 (4.1)
Frequent 18 (11.8) 3 (6.1)
Secondhand 6 (3.9) 1 (2.0)
Former 9 (5.9) 6 (12.2)
Medication use, n (%)
NSAIDs 109 (71.7) 38 (77.6) 0.643 0.423
csDMARDS 30 (19.7) 7 (14.3) 0.733 0.392
TNF inhibitor 59 (38.8) 18 (36.7) 0.068 0.794
IL-17 inhibitor 30 (19.7) 5 (10.2) 2.342 0.126
BASFI, M (P25, P75) 0.5 (0.1, 1.2) 0.7 (0.2, 1.3) -1.041 0.298
ASAS-HI, M (P25, P75) 1.0 (0.0, 3.0) 3.0 (0.5, 5.0) -0.527 0.598
CRP/(mg/L), M (P25, P75) 3.9 (1.8, 6.4) 2.3 (1.7, 5.7) -1.787 0.074

Table 5

Binary Logistic analysis of residual pain symptom"

Items B S.E. Wald P OR (95%CI)
Sex (Female) 1.135 0.372 9.314 0.002 3.112 (1.501-6.453)
Age -0.021 0.025 0.732 0.392 0.979 (0.933-1.027)
Symptom duration -0.031 0.035 0.795 0.373 0.969 (0.905-1.038)
Constant -0.519 0.711 0.534 0.465 0.595
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