Search Results (82)

Background/Objectives: The therapeutic arsenal for axial spondyloarthritis (axSpA) now includes multiple biologic and targeted synthetic DMARDs (b/tsDMARDs). Following the failure of an advanced therapy, clinicians may either cycle (switch to another drug with the same mechanism of action) or swap (switch to a drug with a different mechanism). The optimal strategy remains unclear. This study aimed to compare the real-world effectiveness of cycling versus swapping in axSpA patients. Methods: This mono-centric, retrospective observational study included axSpA patients who failed ≥1 line of b/tsDMARD therapy. Subsequent treatment courses were classified as cycling (CG) or swapping (SG). Drug retention rates were compared using Kaplan–Meier analysis. A Cox proportional hazards model identified factors associated with treatment persistence. Results: We analyzed 156 patients (59 radiographic, 97 non-radiographic), corresponding to 343 treatment courses (CG: 213; SG: 130). Retention rates at 1, 2, and 3 years were 62.7%, 49.3%, and 39.2% (CG) versus 69.8%, 47.8%, and 31.8% (SG) (HR: 1.13, 95% CI: 0.83–1.53; p = 0.442). In the multivariable model, only a more recent prescription year was associated with higher discontinuation risk (HR: 1.08 per year, 95% CI: 1.03–1.12; p < 0.001). Conclusions: In this real-world cohort, cycling and swapping strategies demonstrated comparable treatment persistence over three years following advanced therapy failure in axSpA. The choice of subsequent therapy should be individualized, as no strategy proved superior. Full article

Background: Central sensitization (CS) has been held responsible for both persistent pain and high disease activity scores in Spondyloarthritis (SpA). The Central Sensitization Inventory (CSI) is a questionnaire used to determine CS frequency: a score of at least 40 is associated with a high likelihood of CS. Objectives: To investigate the prevalence of CS in our cohort and its association with clinical characteristics of patients and their quality of life. Methods: Adult patients with a diagnosis of Psoriatic Arthritis (PsA) or Axial Spondyloarthritis (AxSpA) who were also classifiable according to ClASsification criteria for Psoriatic Arthritis (CASPAR) and Assessment of SpondyloArthritis international Society (ASAS) criteria respectively, and regularly followed at the SpA outpatient clinic of our Unit were consecutively enrolled from April to November 2023. Their epidemiologic, clinical and clinimetric data were collected, as well as patient-reported outcome measures (PROMs) [CSI, Health Assessment Questionnaire (HAQ), FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36), and Hospital Anxiety and Depression Scale (HADS)]. Considering the definition of “difficult-to-treat” rheumatoid arthritis, we defined as “multi-failure” those patients who were treated with more than two biologic disease-modifying anti-rheumatic drugs (bDMARDs) with different mechanisms of action. Intergroup comparisons were assessed by using Chi-square, t-test and ANOVA. p-values < 0.05 were considered significant. Results: A total of 100 patients were enrolled, 46 male (46.0%) and 54 female (54.0%), with a mean age of 59.4 ± 9.8 years and a mean disease duration of 14.8 ± 10.1 years; 79 patients (79%) had a diagnosis of PsA and 21 (21%) of AS. Forty-two patients (42.0%) had a CSI score ≥ 40. Significant correlations were found between a CSI score ≥ 40 and female sex (p = 0.004), the occurrence of enthesitis (p = 0.05), DAPSA-CRP (p = 0.02) and ASDAS scores (p = 0.03), a multi-failure condition (p = 0.01), fibromyalgia (FM) (p = 0.004), thyroid disease (p = 0.016) and obesity (p = 0.047). Regarding PROMs, significant correlations were found between CSI and values of HADS (both anxiety and depression), FACIT-F, HAQ and all the domains of SF-36 (p-value < 0.0001). Conclusions: Our data confirmed that more than 40% of SpA patients had CSI values ≥ 40 and underlined how CS could widely impair their disease burden. A routinary evaluation of CS and a multifactorial biopsychosocial perspective in the diagnosis and management of chronic pain in patients with SpA could help rheumatologists in improving their quality of care. Full article

In the clinical context of the new medical concept of diseases related to the Major Histocompatibility Complex class I (MHC-I-opathy), contrasting data are available on the possible association among HLA-B*51, Behcet’s disease (BD), and spondyloarthritis (SpA). The aim of this retrospective study on a cohort of HLA-B*51-positive patients who were clinically observed for almost 5 years is primarily to evaluate which classification criteria they satisfy among BD, axial (ax) or peripheral (p) SpA, and psoriatic arthritis (PsA). Furthermore, we characterized the possible impact of different arthritis phenotypes on the most frequent extra-articular clinical manifestations in BD, ax-SpA, p-SpA, and PsA. A comparison with HLA-B*51-negative patients (matched with HLA-B*51-positive patients for age, gender, and diagnosis, by mean propensity score) was also performed to evaluate the true impact on clinical manifestations of HLA-B*51. We conducted a monocentric retrospective study from 2013 to 2025. The inclusion criteria were HLA-B*51 positivity, the availability of the entire MHC-I class test, and rheumatological clinical follow-up of at least 5 years. The exclusion criterion was positivity for clinically important MCH-I loci other than HLA-B*51. A total of 105 patients met the inclusion criteria in an average clinical observation period of 8.4 ± 2.9 years. All patients were Apulian and were HLA-B* 51 positive. During the follow-up, 32 patients (31%) met the BD criteria, 17 (16%) met the PsA criteria, 25 (24%) met the p-SpA criteria, and 13 (12%) met the ax-SpA criteria. Of note, 16% and 34% of BD patients met the ax-SpA and p-SpA ASAS criteria, respectively. Prevalent articular phenotypes in this HLA-B*51 cluster of patients are a polyarticular pattern and enthesis involvement in all disease groups. In BD patients, axial involvement was associated with a significantly higher percentage of neurological manifestations (40% vs. 7%, p = 0.043) and inflammatory bowel disease (IBD) (100% vs. 15%, p = 0.0001), compared to patients with exclusive peripheral joint involvement. This latest data on IBD remains significant, even in comparison with HLA-B*51 negative patients (33%; p = 0.035). In the p-SpA group, a significantly higher rate of uveitis (28%) was observed compared to both ax-SpA with HLA-B*51-positive (0%, p = 0.035) and p-SpA with HLA-B*51-negative patients (4%, p = 0.030). A high percentage of multi-drug failures was highlighted in patients with PsA (60%) and p-SpA (40%). This study provides new data on the association between HLA-B*51 and the onset of BD and/or SpA or PsA, and its possible impact on extra-articular manifestations. We confirm the higher prevalence of the peripheral articular phenotype in BD, but we also highlight a specific association between the rarer axial involvement and gastrointestinal involvement in HLA-B*51 patients. In SpA, the peripheral articular phenotype appears to be associated with a higher occurrence of uveitis in the presence of HLA-B*51. Full article

Background/Objectives: This study aims to develop a comprehensive Clinical Decision Support System (CDSS) that integrates multi-sequence sacroiliac joint (SIJ) MRIs with rheumatological, clinical, and laboratory findings into the decision-making process for the early diagnosis of axial spondyloarthritis (axSpA), incorporating segmentation-supported explainability. Methods: Multi-sequence SIJ MRI data (T1-WI, T2-WI, STIR, and PD-WI) were analysed from 367 participants (n = 193 axSpA; n = 174 non-axSpA controls). Sequence-based classification was performed using VGG16, ResNet50, DenseNet121, and InceptionV3 models; additionally, a lightweight and parameter-efficient SacroNet architecture was developed. Slice-level probability scores were converted to patient-level scores using the Dynamic Top-K Averaging method. Image-based scores were combined with a logistic regression-based clinical risk score using weighted linear integration (0.60 image/0.40 clinical) and a conservative threshold (τ = 0.70). Grad-CAM was applied for visual interpretability. Furthermore, to support the diagnostic outcomes with precise spatial data, active inflammation in STIR and T2-WI sequences was segmented. For this purpose, the MDC-UNet model was employed and compared with baseline U-Net derivatives. Results: Sequence-specific analysis showed VGG16 performing best on T1-WI (AUC = 0.920; Accuracy = 0.878) and DenseNet121 on STIR (AUC = 0.793; Accuracy = 0.771). The SacroNet architecture provided competitive classification performance at the patient level despite its low number of parameters (~110 K). Furthermore, MDC-UNet successfully segmented active inflammation, yielding Dice scores of 0.752 (HD95: 19.25) for STIR and 0.682 (HD95: 26.21) for T2-WI. Conclusions: The findings demonstrate that patient-level decision integration based on multi-sequence MRI, when used in conjunction with clinical risk scoring and segmentation-assisted interpretability, can provide a feasible and interpretable DSS framework for the early diagnosis of axSpA. Full article

Background and Objective: Axial spondyloarthritis (axSpA) is a group of chronic inflammatory diseases that primarily affect the sacroiliac joints. Early diagnosis is crucial for preventing irreversible structural damage. Magnetic Resonance Imaging (MRI) is the gold standard for detecting early inflammatory changes such as sacroiliitis. However, conventional MRI interpretation is inherently subjective and susceptible to both intra- and inter-observer variability. Therefore, artificial intelligence (AI)-driven diagnostic solutions are increasingly being explored. Among them, the Gated Attention Multiple Instance Learning (MIL) framework holds strong potential in modeling heterogeneous inflammatory distributions, thanks to its slice-level attention mechanism. This study aims to evaluate the diagnostic performance of a deep learning model based on Gated Attention MIL for automated sacroiliitis detection. Furthermore, its results are compared with a baseline deep learning architecture (standard ResNet-18), and its consistency with radiologist annotations is analyzed. Materials and Methods: The dataset included 554 subjects, comprising 276 patients diagnosed with axSpA and 278 healthy controls. All MRI data were derived from axial T2-weighted fat-suppressed (T2_TSE_TRA_FS) sequences. Patient-wise data splitting was employed to construct training, validation, and independent test sets. The proposed model architecture integrates ResNet-18-based feature extraction, a gated attention mechanism for instance-level weighting, and bag-level classification. Additionally, Test-Time Augmentation (TTA) was implemented to enhance robustness during inference. Results: On the independent test set, the model achieved an accuracy of 85.88%, sensitivity of 92.86%, specificity of 79.07%, and an F1-score of 86.67%. Attention heatmaps generated by the MIL module showed strong spatial overlap with bone marrow edema regions annotated by expert radiologists. Implementation of TTA led to an approximate 10% improvement in overall classification accuracy. Conclusions: The Gated Attention MIL framework demonstrated high diagnostic performance for sacroiliitis detection, indicating its value as a reliable decision support tool for early axSpA diagnosis. Validation on larger, multi-center datasets is warranted to ensure generalizability and to support clinical integration in routine radiology workflows. Full article

Introduction: Chronic inflammation in axial spondyloarthritis (axSpA) promotes osteoclast formation and bone resorption, leading to osteoporosis and an increased risk of fragility fractures. Osteoporotic fractures significantly impact the quality of life in patients with axSpA. While the Fracture Risk Assessment Tool (FRAX) is widely used to evaluate fracture risk, data on FRAX-based fracture risk assessment in axSpA, particularly in German patients, are limited. Objective: The primary objective of this study was to assess the prevalence of low bone mineral density (BMD) and fracture risk using FRAX for major osteoporotic fractures (MOF) and hip fractures (HF) in German patients with axSpA. Secondary objectives were to compare FRAX scores and BMD between genders and between patients with and without previous fractures, and to identify which FRAX parameters were most frequently abnormal. Materials and Methods: This retrospective study analyzed demographic and clinical data, along with DXA-measured BMD, T-scores and Z-scores of the lumbar spine and femoral neck in 58 axSpA patients aged 43–81 years from routine clinical practice. Calculations for MOF and HF were performed using the FRAX model for Germany. Low BMD was defined as a T-score < −1 SD or a Z-score < −2 SD. Statistical analyses included independent t-tests and chi-square tests. Results: The mean age of patients was 65 years with a mean BMI of 29.5 kg/m². The prevalence of low BMD was 44.8% at the lumbar spine and 60.4% at the femoral neck. Overall, 10 (17.2%) patients reported previous fractures of the spine, forearm, hip, or shoulder. Female patients had higher FRAX scores for MOF (8.2%) than males (6.8%, p = 0.02), while male patients had higher FRAX scores for HF (2.8% vs. 2%, p = 0.04). There was no significant difference in BMD between patients with or without a history of fracture. However, patients with previous fractures had significantly higher FRAX scores for MOF (10.2%) compared to those without fractures (7.3%, p = 0.030); the difference in HF scores was not statistically significant (3.5% vs. 2%, p = 0.056). Conclusions: This study highlights the elevated fracture risk in axSpA patients assessed with FRAX. In this cohort, BMD alone was not associated with fracture history, suggesting that other factors—such as age, sex, glucocorticoid exposure, and prior fractures—may play a more prominent role. FRAX provides a valuable tool for evaluating fracture risk in axSpA, emphasizing the importance of a comprehensive assessment that incorporates both clinical risk factors and BMD. Full article

Background and Objectives: Psoriatic arthritis (PsA) is a chronic inflammatory arthritis characterized by marked clinical heterogeneity and variable disease trajectories, underscoring the need for robust biomarkers of inflammatory burden. Serum calprotectin, a neutrophil- and monocyte-derived protein, has been proposed as a surrogate marker of active inflammation in inflammatory arthritis due to its close association with innate immune activation. In this study, we compare serum calprotectin levels among patients with PsA, axial spondyloarthritis (AxSpA), and healthy controls and evaluate their association with disease activity. Materials and Methods: This single-center, cross-sectional study included 123 patients with PsA, 119 patients with AxSpA, and 77 healthy controls. Serum calprotectin levels were measured by enzyme-linked immunosorbent assay, and their associations with disease activity were evaluated using correlation, multivariable regression, and receiver operating characteristic analyses. Results: Serum calprotectin levels were significantly higher in PsA and AxSpA patients compared with healthy controls (p < 0.001 for both) and were higher in PsA than in AxSpA (p = 0.022). In PsA, serum calprotectin levels showed significant correlations with ASDAS-CRP, DAS28-CRP, and DLQI, but not with CRP or ESR. In contrast, in AxSpA, calprotectin showed only a weak association with CRP and was not related to disease activity indices. In multivariable analysis, serum calprotectin was independently associated with ASDAS-CRP in PsA (B = 0.704, p = 0.003), but not in AxSpA. Receiver operating characteristic analysis demonstrated that serum calprotectin discriminated high disease activity in PsA with an area under the curve of 0.669 (95% CI: 0.563–0.775; p = 0.003). Conclusions: Serum calprotectin levels are elevated in patients with PsA and are associated with disease activity, supporting its potential role as a biomarker in this condition. In contrast, serum calprotectin does not appear to reflect disease activity in AxSpA, suggesting disease-specific differences in its clinical utility. Full article

Background/Objectives: Axial spondyloarthritis (axSpA) is a chronic systemic inflammatory disease that adversely affects both physical and mental health. This cross-sectional study aimed to examine the associations between spondyloarthritis features (SpA-fs) and disease-related variables (DRVs: disease duration, Visual Analogue Scale, Ankylosing Spondylitis Disease Activity Score [ASDAS], Bath Ankylosing Spondylitis Disease/Functional Activity Index), as well as potential correlations with quality of life (QoL) and symptoms of anxiety and depression in women with non-radiographic axSpA (nr-axSpA). Methods: This study included 78 women with nr-axSpA. Data were obtained from medical records and assessed using two validated instruments: the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results: The mean age of the cohort was 39.8 ± 7.8 years, with a mean disease duration of 4.80 ± 5.37 years and a mean ASDAS of 2.09 ± 1.14. DRVs, correlated positively with HADS scores and negatively with SF-36 scores. Patients with family histories of SpA had significantly lower mental-component SF-36 scores and higher HADS-D scores. Lower quality of life was associated with DRVs, particularly disease duration. Significant associations with depressive symptoms were observed for both SpA features and DRVs. Conclusions: In women with nr-axSpA, both SpA-fs and DRVs are associated with reduced QoL and elevate the risk of anxiety and depression, underscoring the need for thorough patient evaluation that encompasses psychological health. Full article

Background/Objectives: Interleukin-17A (IL-17A) is a key pathogenic cytokine in autoimmune arthropathies. Current monoclonal antibody inhibitors targeting the IL-17/IL-17RA axis demonstrate clinical efficacy but face significant limitations, including immunogenicity, the loss of therapeutic response, and cold-chain storage. Our study evaluated oligonucleotide aptamers targeting IL-17A and its receptor as an alternative to monoclonal antibodies to suppress an IL-17A-induced inflammatory response in cell models relevant to immunoinflammatory rheumatic diseases. Methods: We examined three aptamers: 2′-F-RNA aptamers Apt21-2 and Apt3-4 specific to IL-17A and DNA aptamer RA10-6 targeting the receptor of IL-17A. Their ability to suppress IL-17A functional activity was assessed in peripheral blood mononuclear cells (PBMCs) from healthy donors and personalized fibroblast-like synoviocytes (FLSs) from patients with axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA). Inhibition was measured by quantifying IL-6 and MMP-13 secretion using ELISA and flow cytometry, using secukinumab as a reference control. Results: In PBMC, all aptamers suppressed IL-17A-stimulated IL-6 secretion and cell proliferation in a concentration-dependent manner (17–200 nM), with a 65–85% efficacy, comparable to that of secukinumab. In axSpA-derived FLS, we observed time-dependent efficacy: At 4 h, all three aptamers suppressed IL-6 to the same extent as secukinumab; at 24 h, RA10-6 maintained high efficacy while Apt21-2 and Apt3-4 showed reduced activity. A combination of receptor-targeting RA10-6 with anti-IL-17A aptamers resulted in synergistic IL-6 suppression. All aptamers reduced MMP-13 to basal levels. RA-derived FLS showed diminished responses to all inhibitors. Conclusions: Aptamers demonstrate high specificity and sustained efficacy in suppressing IL-17A signaling for an in vitro model of spondyloarthritis, with superior performance over antibodies. Disease-dependent differential efficacy in RA FLS reflects heterogeneity consistent with limited clinical anti-IL-17 efficacy in RA. These findings show the strong potential of the studied aptamers as an alternative to monoclonal antibodies for IL-17-associated inflammatory arthropathies, particularly spondyloarthritis. Full article

Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder causing structural spinal damage and pathological thoracic kyphosis. Accurate quantification of spinal curvature is crucial for monitoring disease progression and guiding treatment. Conventional Cobb angle measurement on radiographs or DEXA images is widely used but is time-consuming and prone to inter-observer variability. This study evaluates an automated deep learning-based approach using a You Only Look Once (YOLO) model for vertebral detection on lateral morphometric DEXA scans and estimation of thoracic kyphosis angles. A dataset of 512 annotated DEXA images, including 182 from axSpA patients, was used to train and test the model. Kyphosis angles were computed by fitting a circle through detected vertebral centroids (Th4–Th12) and calculating the corresponding curvature angle. Model-predicted angles demonstrated strong agreement with physician-measured Cobb angles (r = 0.92, p < 0.001), low mean squared error (4.2°) and high sensitivity and specificity for detecting clinically significant kyphosis. Automated lateral DEXA morphometry provides a rapid, reproducible and clinically interpretable method for assessing thoracic kyphosis and bone density in axSpA, representing a practical tool for integrated structural and metabolic evaluation. Full article

Objectives: To assess the incidence rate of anterior acute uveitis (AAU) in patients with longstanding axial spondyloarthritis (axSpA); to evaluate demographic and clinical characteristics associated with AAU development; and to determine the influence of AAU on bDMARD initiation and retention in this population. Methods: This two-timepoint cohort study analysed data from patients enrolled in the Spanish SpA registry REGISPONSER (2004–2007), who were re-evaluated 17 years later in the REGISPON-3 follow-up study (2021–2023). Information on the date of first AAU episode and bDMARD initiation was collected. Kaplan–Meier and Cox proportional hazards models were used to assess AAU incidence, predictors, and its association with time to bDMARD initiation and treatment retention. Results: A total of 299 patients with longstanding axSpA were included, of whom 33.4% experienced at least one episode of AAU, corresponding to an incidence rate of 1.15 per 100 person-years. The cumulative probability of a first episode of AAU increased with disease duration. The relative risk for developing a second episode after the first, compared to the overall risk of any episode in the total population, was 1.85 (95% CI: 1.34–2.57). In multivariable cox analysis, female sex and baseline enthesitis were independently associated with a higher risk of AAU. AAU did not significantly affect the likelihood of subsequent bDMARD initiation, with similar cumulative treatment probabilities in patients with and without AAU. Among treated patients, adalimumab was more frequently prescribed in those with a history of AAU. bDMARD retention rates at two and five years were comparable regardless of AAU status, suggesting that AAU was not associated with long-term treatment persistence. Conclusions: In patients with longstanding axSpA, the incidence of AAU increased steadily over time. However, the presence of AAU did not significantly influence bDMARD initiation or long-term retention in routine clinical practice. Full article

Background: Nurses play a central role in the management of inflammatory joint diseases (IJD), of which the success depends on patient adherence to treatment, self-monitoring, timely detection of adverse drug reactions (ADRs), and adopting a healthy lifestyle. This study sought to examine the opinions of patients with IJD regarding the educational and supportive contributions of nurses. Methods: The research is based on a cross-sectional survey of patients with IJD treated with biologic disease-modifying antirheumatic drugs (bDMARDs) in two rheumatology clinics in Plovdiv, Bulgaria, from the beginning of August 2024 to the end of January 2025. The group included patients of three diagnoses: (1) rheumatoid arthritis (RA), (2) psoriatic arthritis (PsA), and (3) axial spondyloarthritis (axSpA). Results: Regardless of the diagnosis, and after adjusting for covariates, patients rated the roles of nurses in disease treatment and management, the acquisition of self-injection skills for bDMARDs, the implementation of a healthy lifestyle, and the maintenance of psychological well-being at the higher end of the 0 to 4 scale. However, the axSpA patients were less affirmative in their responses compared to the RA and PsA patients. In the RA and PsA groups, the working patients were associated with the lowest ratings, followed by retirees with disability. Conclusions: Our findings indicate that nurse-led education in patient self-management skills is greatly appreciated by patients with IJD. Further developments in specialized training programs tailored to the specific needs of different diagnoses and in consideration of patients’ social status will lead to increased patient satisfaction and a better overall quality of life. Full article

Background/Objectives: Axial spondyloarthritis (axSpA) is a chronic immune-mediated inflammatory disorder affecting the spine and sacroiliac joints, with variable clinical expression. This study assessed serum levels of inflammatory (TNF-α, IL-17A) and metabolic (leptin, adiponectin) biomarkers and their associations with disease activity, inflammation, structural damage, and comorbidities. Methods: This prospective cross-sectional study assessed 89 axSpA patients using clinical, laboratory, and radiological evaluations. Disease activity was measured using ASDAS-CRP and BASDAI scores. Radiographic damage was quantified using the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Serum concentrations of TNF-α, IL-17A, leptin, and adiponectin were quantified by enzyme-linked immunosorbent assay (ELISA). Clinical and imaging correlations were analyzed. Results: Serum leptin levels correlated significantly with higher disease activity scores, inflammatory markers (CRP, ESR), radiographic progression (syndesmophyte formation, mSASSS), and arterial hypertension. Adiponectin levels were inversely associated with disease activity, structural damage, and arterial hypertension, suggesting anti-inflammatory, bone- and cardio-protective properties. TNF-α levels showed an association with inflammatory markers and were higher in patients with peripheral enthesitis. IL-17A levels were weakly correlated with disease activity and structural severity and were significantly lower in patients with a history of anterior uveitis. Conclusions: Leptin and adiponectin may serve as complementary biomarkers in axSpA, reflecting both inflammatory burden and structural damage. While TNF-α and IL-17A remain key therapeutic targets, their correlation with structural changes appears limited. Biomarker profiling could support personalized disease monitoring. Longitudinal studies are needed to validate prognostic implications. Full article

Background: Personalized medicine in axial spondyloarthritis (axSpA) requires accurate tools to assess inflammation and tailor disease monitoring. The role of traditional biomarkers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) remains controversial due to limited sensitivity and variability across disease profiles. Objective: To compare the performance of ESR and CRP in different clinical scenarios of axSpA, including disease activity, functional impact, severity, disease duration, and exposure to biologic therapy. Methods: We conducted a cross-sectional analysis of 330 patients with axSpA. Correlations among ESR, CRP, and composite disease indices were evaluated. The discriminatory capacity of each biomarker for relevant clinical thresholds was analyzed using ROC curves and optimal cut-offs identified by the Youden index. Results: ESR showed broader correlations with disease impact and activity scores than CRP. While both markers had low sensitivity overall, they were highly specific for identifying patients with very high disease activity in select scenarios. ESR ≥ 8.5 mm/h and CRP ≥ 1.88 mg/dL were strongly discriminatory in patients not exposed to biologics. CRP ≥ 0.56 mg/dL showed good performance in early disease. Conclusions: Both ESR and CRP provide complementary insights into disease activity in axSpA. ESR may offer a broader reflection of disease burden beyond inflammation. These results support a more personalized biomarker strategy in real-world axSpA management, adapted to patient profile and treatment context. Full article

Background: Secukinumab is a fully human monoclonal antibody that targets interleukin (IL)-17A and is used to treat axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Treating axSpA and PsA can be challenging in patients with comorbidities. In this multicenter retrospective study, we aimed to evaluate the efficacy and safety of secukinumab treatment in patients with axSpA and PsA who had a history of tuberculosis, multiple sclerosis (MS), or congestive heart failure (CHF). Methods: The study included 44 patients with a diagnosis of axSpA and PsA and a history of tuberculosis, MS, or CHF who received secukinumab treatment at 13 centers in our country. Erythrocyte sedimentation rate, C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score CRP, visual analog scale, and Disease Activity Score-28 CRP markers at months 0, 3, and 12 of secukinumab treatment were analyzed. Alongside this, tuberculosis, MS, and CHF were evaluated at follow-up using clinical assessments and imaging methods such as chest radiographs, brain magnetic resonance, and echocardiography. Results: A statistically significant improvement in inflammatory markers and disease activity scores was observed in patients treated with secukinumab. There was no reactivation in patients with a history of tuberculosis. In most MS patients, the disease was stable, while clinical and radiological improvement was observed in one patient. No worsening of CHF stage was observed in patients with a history of CHF. Conclusions: With regular clinical monitoring, secukinumab may be an effective and safe treatment option for axSpA and PsA patients with a history of tuberculosis, MS, or CHF. Full article