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Gut inflammation is associated with structural spinal damage in axial spondyloarthritis – results from the observational SPARTAKUS cohort

Wallman, Johan Karlsson LU ; Mogard, Elisabeth LU orcid ; Sagard, Jonas LU orcid ; Andréasson, Kristofer LU ; Marsal, Jan LU orcid ; Inci, Fatih ; Geijer, Mats LU ; Olofsson, Tor LU and Lindqvist, Elisabet LU orcid (2025) In Arthritis Research and Therapy 27(1).
Abstract

Background: In axial spondyloarthritis (axSpA), 5–10% of patients have comorbid inflammatory bowel disease (IBD). Beyond that, 50–60% display histologic inflammation in ileum/colon biopsies, and fecal calprotectin (F-calprotectin) is elevated in relation to healthy controls. Prior studies have shown such, often subclinical, gut inflammation in axSpA to be associated with more active disease, as measured by clinical indices as well as magnetic resonance imaging – both known risk factors for structural spinal damage development. In light of this, in the current study we aimed to examine whether gut inflammation, assessed by F-calprotectin, is associated with more structural spinal damage in axSpA. Methods: Patients with well-characterized... (More)

Background: In axial spondyloarthritis (axSpA), 5–10% of patients have comorbid inflammatory bowel disease (IBD). Beyond that, 50–60% display histologic inflammation in ileum/colon biopsies, and fecal calprotectin (F-calprotectin) is elevated in relation to healthy controls. Prior studies have shown such, often subclinical, gut inflammation in axSpA to be associated with more active disease, as measured by clinical indices as well as magnetic resonance imaging – both known risk factors for structural spinal damage development. In light of this, in the current study we aimed to examine whether gut inflammation, assessed by F-calprotectin, is associated with more structural spinal damage in axSpA. Methods: Patients with well-characterized non-radiographic or radiographic axSpA (nr-axSpA/r-axSpA; n = 76/152), according to ASAS or modified New York criteria, enrolled in a population-based cohort study in southern Sweden, were assessed for structural spinal damage (modified Stoke ankylosing spondylitis spinal score [mSASSS]) and gut inflammation (F-calprotectin). mSASSS values were compared between patients with normal (< 50 mg/kg), moderately elevated (50–149 mg/kg) or distinctly elevated (≥ 150 mg/kg) F-calprotectin, reflecting no/some/evident gut inflammation, respectively (one-way ANOVA). Moreover, logistic regression was applied to explore if elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, adjusted for sex, symptom duration, HLA-B27 status, smoking, CRP, NSAID and anti-TNF therapy. Analyses limited to r-axSpA were also performed. Results: In both axSpA patients overall and separately in r-axSpA, mSASSS distributions differed significantly between subjects with normal/moderately/distinctly elevated F-calprotectin, with more damage observed in those with higher F-calprotectin levels. Furthermore, elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, in both the entire axSpA group (adjusted odds ratio [OR] 2.2 [95%CI 1.1–4.2]); and in r-axSpA alone (adjusted OR 2.9 [1.2–7.1]). Conclusion: In the current study, the presence of gut inflammation, assessed by F-calprotectin, was cross-sectionally associated with more structural damage in the spine in patients with axSpA, even after adjustments for known risk factors for spinal damage. Prospective studies are, however, needed to investigate whether gut inflammation may be a predictor of spinal radiographic progression in axSpA.

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; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ankylosing spondylitis, Calprotectin, Gut inflammation, Inflammatory bowel disease, Non-radiographic axial spondyloarthritis, Radiographic progression, Spondyloarthritis, Structural damage
in
Arthritis Research and Therapy
volume
27
issue
1
article number
195
publisher
BioMed Central (BMC)
external identifiers
  • scopus:105019327655
  • pmid:41121409
ISSN
1478-6354
DOI
10.1186/s13075-025-03663-z
language
English
LU publication?
yes
id
4508417f-302a-4d13-a9c6-9b9e36fe3796
date added to LUP
2025-12-10 15:42:04
date last changed
2025-12-11 03:05:59
@article{4508417f-302a-4d13-a9c6-9b9e36fe3796,
  abstract     = {{<p>Background: In axial spondyloarthritis (axSpA), 5–10% of patients have comorbid inflammatory bowel disease (IBD). Beyond that, 50–60% display histologic inflammation in ileum/colon biopsies, and fecal calprotectin (F-calprotectin) is elevated in relation to healthy controls. Prior studies have shown such, often subclinical, gut inflammation in axSpA to be associated with more active disease, as measured by clinical indices as well as magnetic resonance imaging – both known risk factors for structural spinal damage development. In light of this, in the current study we aimed to examine whether gut inflammation, assessed by F-calprotectin, is associated with more structural spinal damage in axSpA. Methods: Patients with well-characterized non-radiographic or radiographic axSpA (nr-axSpA/r-axSpA; n = 76/152), according to ASAS or modified New York criteria, enrolled in a population-based cohort study in southern Sweden, were assessed for structural spinal damage (modified Stoke ankylosing spondylitis spinal score [mSASSS]) and gut inflammation (F-calprotectin). mSASSS values were compared between patients with normal (&lt; 50 mg/kg), moderately elevated (50–149 mg/kg) or distinctly elevated (≥ 150 mg/kg) F-calprotectin, reflecting no/some/evident gut inflammation, respectively (one-way ANOVA). Moreover, logistic regression was applied to explore if elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, adjusted for sex, symptom duration, HLA-B27 status, smoking, CRP, NSAID and anti-TNF therapy. Analyses limited to r-axSpA were also performed. Results: In both axSpA patients overall and separately in r-axSpA, mSASSS distributions differed significantly between subjects with normal/moderately/distinctly elevated F-calprotectin, with more damage observed in those with higher F-calprotectin levels. Furthermore, elevated F-calprotectin (≥ 50 mg/kg) was associated with mSASSS values above the median, in both the entire axSpA group (adjusted odds ratio [OR] 2.2 [95%CI 1.1–4.2]); and in r-axSpA alone (adjusted OR 2.9 [1.2–7.1]). Conclusion: In the current study, the presence of gut inflammation, assessed by F-calprotectin, was cross-sectionally associated with more structural damage in the spine in patients with axSpA, even after adjustments for known risk factors for spinal damage. Prospective studies are, however, needed to investigate whether gut inflammation may be a predictor of spinal radiographic progression in axSpA.</p>}},
  author       = {{Wallman, Johan Karlsson and Mogard, Elisabeth and Sagard, Jonas and Andréasson, Kristofer and Marsal, Jan and Inci, Fatih and Geijer, Mats and Olofsson, Tor and Lindqvist, Elisabet}},
  issn         = {{1478-6354}},
  keywords     = {{Ankylosing spondylitis; Calprotectin; Gut inflammation; Inflammatory bowel disease; Non-radiographic axial spondyloarthritis; Radiographic progression; Spondyloarthritis; Structural damage}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Arthritis Research and Therapy}},
  title        = {{Gut inflammation is associated with structural spinal damage in axial spondyloarthritis – results from the observational SPARTAKUS cohort}},
  url          = {{http://dx.doi.org/10.1186/s13075-025-03663-z}},
  doi          = {{10.1186/s13075-025-03663-z}},
  volume       = {{27}},
  year         = {{2025}},
}