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Background: Treatment of axial spondyloarthritis (axSpA) has been shown to improve symptoms of the disease such as back pain (BP) and morning stiffness (MS). As a result, early referral of patients suspected of having axSpA is strongly recommended. However, little data is available on the disease course of early axSpA in clinical practice, particularly in comparison to referred patients who have chronic BP (CBP) but not axSpA. Objectives: To compare spinal symptoms at baseline and after 2 years (2y) in early axSpA and non-axSpA CBP patients. Methods: The population consisted of adults (≥16 years) with CBP lasting ≥3 months and ≤2y and starting Results: A total of 434 patients (303 axSpA; 131 non-axSpA) had undergone baseline and 2y visits. Data was available at both timepoints on ≥1 of the assessed outcomes in 267 axSpA and 110 non-axSpA patients. AxSpA (vs non-axSpA) patients were more frequently male (52% vs 25%) and had more SpA features (mean SD: 5 2 vs 3 1). Age (mean SD: 29 8 vs 31 8 years) and symptom duration (mean SD: 13 7 vs 13 7 months) were similar between groups. Overall, at baseline, higher levels of spinal symptoms were observed in non-axSpA (vs axSpA) patients (Figure 1). After 2y, BP and MS significantly improved in both groups (mean SD improvement axSpA vs non-axSpA: overall BP 1.4 2.5 vs 1.6 2.4; BP at night 1.4 2.9 vs 1.0 2.7; MS intensity 1.6 3.2 vs 1.9 2.9; MS duration 1.2 3.0 vs 1.5 3.1; all p≤0.001). However, substantial symptoms persisted at 2y, mainly in non-axSpA patients. In adjusted multivariable linear regression analysis, axSpA (vs non-axSpA) was an independent predictor of lower BP at night at 2y (Figure 2, β 95% CI -0.85 -1.47; -0.23; p=0.007). No significant differences were found for overall BP, MS intensity or MS duration. Conclusion: Overall, non-axSpA (vs axSpA) patients experience worse spinal symptoms. After 2 years, although BP and MS significantly improve in both groups, substantial symptoms persist, mainly in non-axSpA patients. AxSpA is an independent predictor of a larger improvement in BP at night, but not in overall BP or MS. REFERENCES: 1 Marques ML et al. Ann Rheum Dis 2024 (epub ahead of print). Acknowledgements: The authors would like to acknowledge the Assessment of Spondyloarthritis International Society (ASAS) for having supported Ana Bento da Silva research fellowship. Disclosure of Interests: Ana Bento da Silva: None declared, Sofia Ramiro AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB, Sanofi, AbbVie, Galapagos, MSD, Novartis, Pfizer, UCB, Miranda van Lunteren: None declared, Mary Lucy Marques: None declared, Camilla Fongen: None declared, Marleen G.H. van de Sande Janssen, Novartis, UCB, Beneke, Janssen, Novartis, Abbvie, UCB, Janssen, Novartis, UCB, Roberta Ramonda: None declared, Sofia Exarchou Amgen, Janssen, Novartis, UCB Pharma, Désirée van der Heijde Abbvie, ArgenX, BMS, Galapagos, GSK, Jansen, Lilly, Novartis, Pfizer, Takeda, UCB Pharma. Director Imaging Rheumatology bv., F. A. van Gaalen Novartis, BMS, AbbVie, Galapagos, Janssen, Lily, UCB, Pfizer, Stichting ASAS, Novartis, UCB.
Silva et al. (Sat,) studied this question.