{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:21Z","timestamp":1792787301965,"version":"4.5.0"},"reference-count":39,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T00:00:00Z","timestamp":1593043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"British Society of Rheumatology","award":["20665"],"award-info":[{"award-number":["20665"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2020,6,7]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec id=\"s1\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Extra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a \u2018real-world\u2019 cohort of patients with axSpA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s2\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0.55 to 0.92). For both psoriasis and IBD, there was an inverse relationship with HLA-B27 (IRR 0.54, 95% CI 0.36 to 0.79 and IRR 0.63, 95% CI 0.43 to 0.91, respectively). A diagnosis of either AAU (OR 3.79, 95% CI 2.11 to 6.80) or IBD (OR 5.50, 95% CI 2.09 to 14.46) was associated with preference for adalimumab versus others. In contrast, a diagnosis of either AAU (OR 0.14, 95% CI 0.06 to 0.33) or IBD (OR 0.17, 95% CI 0.05 to 0.57) was associated with less preference for etanercept over other TNFi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"s4\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The higher occurrence of AAU and lower occurrence of psoriasis and IBD in HLA-B27-positive patients with axSpA are consistent with current pathophysiology. Patients with previous AAU and IBD are more likely to be prescribed adalimumab and less likely to receive etanercept, consistent with the superior efficacy of monoclonal TNFi for these indications. Future work will determine whether EAMs influence TNFi survival, or effectiveness, and whether this varies between agents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2020-001206","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T20:45:22Z","timestamp":1594241122000},"page":"e001206","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Predictors of extra-articular manifestations in axial spondyloarthritis and their influence on TNF-inhibitor prescribing patterns: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2549-7100","authenticated-orcid":false,"given":"Mohammad H","family":"Derakhshan","sequence":"first","affiliation":[{"name":"Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7667-5352","authenticated-orcid":false,"given":"Linda","family":"Dean","sequence":"additional","affiliation":[{"name":"Epidemiology Group, Univesity of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0016-7591","authenticated-orcid":false,"given":"Gareth T","family":"Jones","sequence":"additional","affiliation":[{"name":"Epidemiology Group, Univesity of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1802-7311","authenticated-orcid":false,"given":"Stefan","family":"Siebert","sequence":"additional","affiliation":[{"name":"Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7863-9176","authenticated-orcid":false,"given":"Karl","family":"Gaffney","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Norfolk and Norwich University Hospital, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"key":"2025090313422466000_6.2.e001206.1","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s13075-016-1093-z","article-title":"Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis","volume":"18","author":"de Winter","year":"2016","journal-title":"Arthritis Res Ther"},{"key":"2025090313422466000_6.2.e001206.2","unstructured":"Spondyloarthritis in over 16s: diagnosis and management. 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