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Gut dysbiosis associated with worse disease activity and physical function in axial spondyloarthritis

Sagard, Jonas LU orcid ; Olofsson, Tor LU ; Mogard, Elisabeth LU orcid ; Marsal, Jan LU ; Andréasson, Kristofer LU ; Geijer, Mats LU ; Kristensen, Lars Erik LU ; Lindqvist, Elisabet LU orcid and Wallman, Johan K LU (2022) In Arthritis Research & Therapy 24. p.1-14
Abstract

BACKGROUND: Based on clinical and genetic associations, axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) are suspected to have a linked pathogenesis. Gut dysbiosis, intrinsic to IBD, has also been observed in axSpA. It is, however, not established to what degree gut dysbiosis is associated with axSpA disease severity. The objective of this study was to compare gut dysbiosis frequency between controls, non-radiographic axial spondyloarthritis (nr-axSpA), and ankylosing spondylitis (AS) patients and investigate whether gut dysbiosis is cross-sectionally associated with axSpA disease activity, physical function, mobility, or pain.

METHODS: Gut dysbiosis was assessed by 16SrRNA analysis of feces from 44/88... (More)

BACKGROUND: Based on clinical and genetic associations, axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) are suspected to have a linked pathogenesis. Gut dysbiosis, intrinsic to IBD, has also been observed in axSpA. It is, however, not established to what degree gut dysbiosis is associated with axSpA disease severity. The objective of this study was to compare gut dysbiosis frequency between controls, non-radiographic axial spondyloarthritis (nr-axSpA), and ankylosing spondylitis (AS) patients and investigate whether gut dysbiosis is cross-sectionally associated with axSpA disease activity, physical function, mobility, or pain.

METHODS: Gut dysbiosis was assessed by 16SrRNA analysis of feces from 44/88 nr-axSpA/AS patients (ASAS/mNY criteria) without inflammatory bowel disease (IBD) and 46 controls without IBD or rheumatic disease. The GA-map™ Dysbiosis Test was used, grading gut microbiota aberrations on a 1-5 scale, where ≥3 denotes dysbiosis. Proportions with dysbiosis were compared between the groups. Furthermore, standard axSpA measures of disease activity, function, mobility, and pain were compared between patients (nr-axSpA and AS combined) with and without dysbiosis, univariately, and adjusted for relevant confounders (ANCOVA).

RESULTS: Gut dysbiosis was more frequent in AS than controls (36% versus 17%, p=0.023), while nr-axSpA (25% dysbiosis) did not differ significantly from either AS or controls. Univariately, most axSpA measures were significantly worse in patients with dysbiosis versus those without: ASDAS-CRP between-group difference 0.6 (95% CI 0.2-0.9); BASDAI 1.6 (0.8-2.4); evaluator's global disease activity assessment (Likert scale 0-4) 0.3 (0.1-0.5), BASFI 1.5 (0.6-2.4), and VAS pain (cm) 1.3 (0.4-2.2). Differences remained significant after adjustment for demographics, lifestyle factors, treatments, gut inflammation (fecal calprotectin ≥50 mg/kg), and gut symptoms, except for VAS pain. BASMI and CRP were not associated with dysbiosis.

CONCLUSION: Gut dysbiosis, more frequent in AS patients than controls, is associated with worse axSpA disease activity and physical function, seemingly irrespective of both gut inflammation and treatments. This provides further evidence for an important link between disturbances in gastrointestinal homeostasis and axSpA.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Axial Spondyloarthritis, Dysbiosis, Humans, Leukocyte L1 Antigen Complex, Spondylarthritis/diagnosis, Spondylitis, Ankylosing/diagnosis
in
Arthritis Research & Therapy
volume
24
article number
42
pages
1 - 14
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85124614782
  • pmid:35151357
ISSN
1478-6354
DOI
10.1186/s13075-022-02733-w
language
English
LU publication?
yes
additional info
© 2022. The Author(s).
id
00b249b5-973d-402a-a81a-2b8cd4da54d0
date added to LUP
2022-03-17 11:39:14
date last changed
2024-06-13 11:31:04
@article{00b249b5-973d-402a-a81a-2b8cd4da54d0,
  abstract     = {{<p>BACKGROUND: Based on clinical and genetic associations, axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) are suspected to have a linked pathogenesis. Gut dysbiosis, intrinsic to IBD, has also been observed in axSpA. It is, however, not established to what degree gut dysbiosis is associated with axSpA disease severity. The objective of this study was to compare gut dysbiosis frequency between controls, non-radiographic axial spondyloarthritis (nr-axSpA), and ankylosing spondylitis (AS) patients and investigate whether gut dysbiosis is cross-sectionally associated with axSpA disease activity, physical function, mobility, or pain.</p><p>METHODS: Gut dysbiosis was assessed by 16SrRNA analysis of feces from 44/88 nr-axSpA/AS patients (ASAS/mNY criteria) without inflammatory bowel disease (IBD) and 46 controls without IBD or rheumatic disease. The GA-map™ Dysbiosis Test was used, grading gut microbiota aberrations on a 1-5 scale, where ≥3 denotes dysbiosis. Proportions with dysbiosis were compared between the groups. Furthermore, standard axSpA measures of disease activity, function, mobility, and pain were compared between patients (nr-axSpA and AS combined) with and without dysbiosis, univariately, and adjusted for relevant confounders (ANCOVA).</p><p>RESULTS: Gut dysbiosis was more frequent in AS than controls (36% versus 17%, p=0.023), while nr-axSpA (25% dysbiosis) did not differ significantly from either AS or controls. Univariately, most axSpA measures were significantly worse in patients with dysbiosis versus those without: ASDAS-CRP between-group difference 0.6 (95% CI 0.2-0.9); BASDAI 1.6 (0.8-2.4); evaluator's global disease activity assessment (Likert scale 0-4) 0.3 (0.1-0.5), BASFI 1.5 (0.6-2.4), and VAS pain (cm) 1.3 (0.4-2.2). Differences remained significant after adjustment for demographics, lifestyle factors, treatments, gut inflammation (fecal calprotectin ≥50 mg/kg), and gut symptoms, except for VAS pain. BASMI and CRP were not associated with dysbiosis.</p><p>CONCLUSION: Gut dysbiosis, more frequent in AS patients than controls, is associated with worse axSpA disease activity and physical function, seemingly irrespective of both gut inflammation and treatments. This provides further evidence for an important link between disturbances in gastrointestinal homeostasis and axSpA.</p>}},
  author       = {{Sagard, Jonas and Olofsson, Tor and Mogard, Elisabeth and Marsal, Jan and Andréasson, Kristofer and Geijer, Mats and Kristensen, Lars Erik and Lindqvist, Elisabet and Wallman, Johan K}},
  issn         = {{1478-6354}},
  keywords     = {{Axial Spondyloarthritis; Dysbiosis; Humans; Leukocyte L1 Antigen Complex; Spondylarthritis/diagnosis; Spondylitis, Ankylosing/diagnosis}},
  language     = {{eng}},
  pages        = {{1--14}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Arthritis Research & Therapy}},
  title        = {{Gut dysbiosis associated with worse disease activity and physical function in axial spondyloarthritis}},
  url          = {{http://dx.doi.org/10.1186/s13075-022-02733-w}},
  doi          = {{10.1186/s13075-022-02733-w}},
  volume       = {{24}},
  year         = {{2022}},
}