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Original Investigation
DOI: 10.1016/j.rcreue.2020.09.003
Factors associated with the use of tumor necrosis factor alpha inhibitors in a population of Colombian patients with spondyloarthritis
Factores asociados con el uso de inhibidores del factor de necrosis tumoral alfa en una población de pacientes colombianos con espondiloartritis
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Luis Fernando Pinto-Peñarandaa,b, Andrés Felipe Echeverri-Garcíaa, Mauricio Restrepo-Escobarb,c, María Fernanda Álvarez Barreneched, Alejandro Hurtadoe, Javier D. Márquez-Hernándeza,
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Jadamarq@yahoo.com

Corresponding author.
a Internal Medicine and Rheumatology, Pablo Tobón Uribe Hospital, Medellín, Colombia
b Internist and Rheumatologist with a Master's Degree in Epidemiology, Pablo Tobón Uribe Hospital, Medellín, Colombia. University of Antioquia, Medellín, Colombia
c Internal Medicine and Rheumatology, University of Antioquia, Medellín, Colombia
d Department of Internal Medicine, Faculty of Medicine, Clínica Cardiovid, Medellín, Colombia
e Faculty of Medicine, CES University, Medellín, Colombia
Received 09 September 2019. Accepted 16 September 2020
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Tables (4)
Table 1. Demographic, clinical and treatment characteristics of a population of 181 patients with spondyloarthritis.
Table 2. Categorical variables associated with the use of TNFi.
Table 3. Factors that best explain the use of TNFi in 181 patients with spondyloarthritis. Univariate analysis.
Table 4. Factors independently associated with the use of TNFi.
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Abstract
Introduction

The use of tumor necrosis factor (TNF) alpha inhibitors is increasing in patients with spondyloarthritis. Early identification of those that would require them, or the ability to predict their use, could lead to a more effective and timely treatment by rationalizing their use.

Objective

To determine factors that better explain the indication of TNFi in the study population.

Material and methods

The association between anti-TNFα use and categorical demographic, clinical, laboratory, radiological and treatment variables was explored using Pearson's Chi2 or Fisher's exact test. The association with the quantitative variables was evaluated using Student's t test or Mann Whitney U test, depending on their distribution. Those variables with P < .25 were entered into univariate models of explanatory logistic regression to construct crude ORs, and those with P < .25 were included in the multivariate model to construct adjusted ORs.

Results and discussion

The study population includes 181 patients. In the univariate model: reactive arthritis, urethritis, and peripheral involvement were protective factors for the use of TNFi. Axial spondyloarthritis, inflammatory lumbalgia, alternating gluteal pain, morning stiffness, sacroiliitis demonstrated by any method, treatment with COX2 inhibitors, evolution time of three years or more, and BASDAI and BASFI scores were associated with the use of TNFi. Multivariate model: reactive arthritis (P = .036), inflammatory back pain (P = .026), sacroiliitis (P = .045), use of coxibs (P = .001) and the maximum score of BASDAI (P = .022, P = 006) were independently associated with the use of TNFi. The use of coxibs was associated with the indication of using TNFi in both patients with axial (P = .001) and peripheral spondyloarthritis (P < .001).

Conclusions

The onset of the disease in the form of reactive arthritis behaved as a protective factor for the subsequent need to use TNFi, while presenting with inflammatory back pain, sacroiliitis, demonstrated by any method, treatment with coxibs, and the maximum score of BASDAI greater than 4 associated with the use of these medications.

Keywords:
Spondyloarthritis
BASDAI
BASFI
NSAIDs
Cyclooxygenase 2 inhibitors
Tumor necrosis factor inhibitors
Resumen
Introducción

El uso de TNFi es cada vez más frecuente en los pacientes con espondiloartritis. Identificar tempranamente aquellos que los requerirán o poder predecir su uso puede ayudar a hacer un tratamiento más efectivo y oportuno racionalizando su uso.

Objetivo

Determinar los factores que mejor explican la indicación de TNFi en la población de estudio.

Material y métodos

La asociación entre el uso de medicamentos anti-TNFα y las variables categóricas demográficas, clínicas, de laboratorio, radiológicas y de tratamiento se exploró por prueba exacta de Fisher. La asociación con las variables cuantitativas fue evaluada con T de Student o U de Mann Withney de acuerdo a su distribución. Aquellas variables con P < .25 fueron ingresadas a modelos univariante de regresión logística explicativa para construir los OR crudos y aquellas con P < .25 se incluyeron en el modelo multivariante para construir OR ajustados.

Resultados y discusión

La población está constituida por 181 pacientes. Modelo univariante: la artritis reactiva, uretritis y compromiso periférico fueron factores protectores para el uso de TNFi. Espondiloartritis axial, lumbalgia inflamatoria, dolor glúteo alternante, rigidez matinal, sacroilitis demostrada por cualquier método, tratamiento con inhibidores COX2, tiempo de evolución de tres años o más y los puntajes de BASDAI y BASFI se asociaron al uso de TNFi. Modelo multivariante: artritis reactiva (OR 0.1, IC95% 0.012–0.86, P = .036), lumbalgia inflamatoria (OR 13.63, IC95% 1.36–136, P = .026), sacroilitis (OR 7,71, IC95% 1.04–57, P = .045, uso de coxibs (OR 10.1, IC95% 2.71–37.62, P = .001) y el puntaje máximo de BASDAI (4–6: OR 6.1, IC95% 1.3–28.7, P = .022, mayor de 6: OR 15.8, IC95% 2.2–113, P = .006) se asociaron independientemente con el uso de TNFi. El uso de coxibs se asoció a la indicación de usar TNFi tanto en los pacientes con espondiloartritis axial (OR 4.2, IC95% 1.74–10.11, P = .001 como periférica (OR 4, IC95% 1.85–8.62, P < .001).

Conclusiones

El inicio de la enfermedad en la forma de artritis reactiva se comportó como un factor protector para la necesidad posterior de usar TNFi mientras que presentar lumbalgia inflamatoria, sacroilitis demostrada por cualquier método, el tratamiento con coxibs y el puntaje máximo de BASDAI mayor de 4 se asociaron al uso de estos medicamentos.

Palabras claves:
Espondiloartritis
BASDAI
BASFI
AINE
Inhibidores de ciclooxigenasa 2
Inhibidores del factor de necrosis tumoral

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