ABSTRACT Objectives Early diagnosis is crucial in disease management and improving patient outcomes in axial spondyloarthritis (axSpA). Patients with early axSpA may have distinct clinical profiles. We aim to evaluate factors associated with early axSpA in a multiethnic Asian cohort in Singapore. Methods A cross‐sectional analysis of a prospective cohort was performed. Patients diagnosed with axSpA by a rheumatologist and fulfilling the 2009 ASAS classification criteria for axSpA were included. Patients were classified as early axSpA if the duration of their axial symptoms was 2 years or shorter. We compared disease characteristics, comorbidities, and patient‐reported outcomes for early and non‐early axSpA patients. Univariable analyses were conducted, and factors with p < 0.1 were included in the multivariable logistic regressions to identify factors associated with early axSpA. Results A total of 360 patients were included, 83 (23%) female and 322 (89%) Chinese. Only 49 (14%) were classified as early axSpA. Patients with early axSpA were younger [mean (SD) age: 34.7 (11.6) vs. 41.9 (13.5) years, p < 0.01], has a higher proportion of female patients (41% vs. 20%, p < 0.01), and were less likely to be HLA‐B27 positive (74% vs. 86%, p = 0.03), and having radiographic sacroiliitis (52% vs. 83%, p < 0.01). Patients with early axSpA had higher disease activity [mean ASDAS (S.D.): 2.6 (1.2) vs. 2.1 (0.9), p = 0.02] and reported worse health and functioning [mean ASAS HI (S.D.): 6.1 (3.8) vs. 4.8 (3.7), p = 0.03]. Younger age (OR 0.95 95% CI: 0.92–0.99, p < 0.01), higher proportion of female patients (OR 3.69, 95% CI: 1.59–8.61, p < 0.01), lower prevalence of radiographic sacroiliitis (OR 0.20, 95% CI: 0.09–0.45, p < 0.01), and higher ASDAS (OR 1.87, 95% CI: 1.22–2.85, p < 0.01) were found to be associated with early axSpA in multivariable analysis. Conclusion About 1 in every 7 patients with axSpA presented early in the course of their disease. Patients with early axSpA were more likely females, younger, less likely to have radiographic sacroiliitis, but had higher disease activity.
ABSTRACT Background This study aimed to explore the associations of the oxidative balance score (OBS) and all‐cause and cardiovascular disease (CVD) mortality in patients with rheumatoid arthritis (RA), and to analyze the mediating role of the neutrophil‐to‐lymphocyte ratio (NLR). Methods Data were obtained from the National Health and Nutrition Examination Survey. Cox proportional hazards models were used to assess the associations of total OBS, dietary OBS, and lifestyle OBS with all‐cause and CVD mortality. Restricted cubic spline (RCS) analysis was performed to explore dose–response relationships, while subgroup analysis was conducted to verify the robustness of the results. Mediation analysis examined NLR‐mediated association between OBS and all‐cause mortality. Results 887 RA patients were analyzed, with 79 deaths during follow‐up. In the fully adjusted model, each 1‐unit increase in total OBS, dietary OBS, and lifestyle OBS was associated with a 6%, 7%, and 25% lower risk of all‐cause mortality, respectively. Total OBS was negatively associated with CVD mortality when analyzed as a continuous variable, but not when categorized into tertiles. RCS analysis confirmed linear dose–response relationships between total OBS, dietary OBS, lifestyle OBS, and all‐cause mortality. NLR mediated a small proportion of the associations of total OBS (5.47%) and dietary OBS (4.89%) with all‐cause mortality. Subgroup analysis showed that the negative association between total OBS and all‐cause mortality across several subgroups. Conclusion Higher total OBS, dietary OBS, and lifestyle OBS were significantly associated with reduced all‐cause mortality in RA patients, with a linear dose–response relationship.
