Journal Article

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

Marsal, Jan, Lindqvist, Elisabet, Mogard, Elisabeth, Olofsson, Tor, Sagard, Jonas, Geijer, Mats, Kristensen, Lars Erik, Wallman, Johan K., Andréasson, Kristofer

2022

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: activity / Ankylosing spondylitis / Ankylosing spondylitis (AS) / Arthritis / Autoimmunitet och inflammation / Autoimmunity and Inflammation / Axial Spondyloarthritis / back-pain / Bacteria / Body mass index / bowel inflammation / classification criteria / Clinical Medicine / Diagnosis / Disease / Disease activity / Dysbiosis / Exercise / fecal microbiota / Feces / genetics / Gut inflammation / Health aspects / Humans / Inflammation / Inflammatory bowel disease / Irritable bowel syndrome / Klinisk medicin / Leukocyte L1 Antigen Complex / Medical and Health Sciences / Medicin och hälsovetenskap / Medicine / Medicine & Public Health / Microbiota / Microbiota (Symbiotic organisms) / Non-radiographic axial / Non-radiographic axial spondyloarthritis (nr-axSpA) / Orthopedics / Pain / pathogenesis / Physical function / Questionnaires / Research Article / reveals / Rheumatology / Risk factors / Spondylarthritis - diagnosis / Spondylitis, Ankylosing - diagnosis / Spondyloarthritis / spondyloarthritis (nr-axSpA) / Tumor necrosis factor-TNF / Variance analysis