title: Characteristics associated with the presence and development of extra-articular manifestations in ankylosing spondylitis: 12-year results from OASIS.
abstract: OBJECTIVE
  The aim of this study was to identify characteristics associated with the presence and development of extra-articular manifestations (EAMs) in a prevalence cohort of patients with AS.
  
  
  METHODS
  Twelve-year follow-up data from the Outcome in Ankylosing Spondylitis International Study (OASIS) were used. In addition, medical charts were checked for the presence of acute anterior uveitis (AAU), IBD and psoriasis. Demographic, clinical and radiographic characteristics associated with the presence of (any) EAM at baseline or new development during follow-up were identified.
  
  
  RESULTS
  Two hundred and sixteen patients were included [mean age 43.6 years (s.d. 12.7), 154 (71%) men, mean symptom duration 20.5 years (s.d. 11.7), mean follow-up 8.3 years (s.d. 4.3)]. At baseline, 39 (18%) patients had AAU, 15 (7%) had IBD and 9 (4%) had psoriasis. The history of AAU was univariably associated with increased age [odds ratio (OR) 1.04 (95% CI 1.01, 1.07)], longer symptom duration [OR 1.05 (95% CI 1.02, 1.08)] and more radiographic damage [OR 1.02 (95% CI 1.00, 1.04)]. The history of psoriasis was associated with greater age [OR 1.05 (95% CI 1.00, 1.11)] and lower CRP [OR 0.77 (95% CI 0.59, 1.00)]. At follow-up, 27 patients developed a new EAM. Newly developed IBD was associated with a higher time-varying AS Disease Activity Score [hazard ratio (HR) 2.80 (95% CI 1.43, 5.52)], worse physical function [HR 1.40 (95% CI 1.09, 1.80)] and worse patient global well-being [HR 1.46 (95% CI 1.10, 1.93)]. Newly developed AAU was associated with an elevated time-varying CRP [HR 1.02 (95% CI 1.01, 1.04)].
  
  
  CONCLUSIONS
  Development of EAMs was infrequent in this cohort, despite relatively long follow-up. In particular, markers of disease activity were associated with the development of IBD.
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. ivette.essers@maastrichtuniversity.nl.
authors.forename: Ivette
authors.initials: I
authors.lastname: Essers
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stolwijk
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Blaauw
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Filip
authors.initials: F
authors.lastname: Van den Bosch
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France. Department of Medicine, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, University of Amsterdam, Amsterdam, The Netherlands, Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal, Department of Medicine, Catherina Hospital, Eindhoven, Department of Rheumatology, Atrium Medical Center, Heerlen, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands, Department of Rheumatology, Ghent University Hospital and University of Ghent, Ghent, Belgium and Rheumatology Department, Paris-Descartes University, Cochin Hospital, Paris, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: van Tubergen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D015796:HLA-B27 Antigen / Q000235:genetics; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011565:Psoriasis / Q000453:epidemiology* / Q000235:genetics; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000453:epidemiology* / Q000235:genetics; D013997:Time Factors; D014606:Uveitis, Anterior / Q000453:epidemiology*
chemical_list: D015796:HLA-B27 Antigen
keywords: ankylosing spondylitis; anterior uveitis; inflammatory bowel disease; psoriasis