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However, the specific risk factors and clinical patterns heralding this shift are poorly understood. This study aimed to identify stage-dependent risk factors for BrSpA and to elucidate the paradoxical clinical signs associated with its development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective, multicenter study, we analyzed data from 642 participants, comprising a BrSpA group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009187), a non-osteoarticular brucellosis group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009176), and a healthy control group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009279). Baseline data, clinical symptoms and laboratory findings were collected, summarized and analyzed. The significance of the data was determined using t-test or Pearson chi-square test, and logistic regression test was used to calculate the odds ratio (OR) to characterize the relevant risk factors affecting the development of BrSpA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>When compared to the non-osteoarticular brucellosis group, progression to the subacute\/chronic stages, lower educational attainment, fatigue, and musculoskeletal pain were independent risk factors for BrSpA. In this same comparison, factors reflecting acute systemic inflammation (e.g., anorexia, elevated C-reactive protein [CRP]) were paradoxically associated with a lower risk of BrSpA (OR\u2009&lt;\u20091). In contrast, when the BrSpA group was compared to healthy controls, these same factors were confirmed as significant risk factors (OR\u2009&gt;\u20091).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The development of BrSpA in brucellosis is marked by a paradoxical clinical profile. Our findings demonstrate that the resolution of systemic inflammatory signs should not be uniformly interpreted as recovery. Instead, this pattern may represent a critical transition to focal disease, serving as a key warning sign for clinicians to heighten vigilance and initiate proactive diagnosis to prevent long-term complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-13685-w","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T17:16:02Z","timestamp":1780420562000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Shifting risk profiles in the systemic-to-focal transition of brucellosis: a multicenter analysis of spondyloarthritis development"],"prefix":"10.1186","volume":"26","author":[{"given":"Meng","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefeng","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abudusalamu","family":"Alimujiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junru","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junchao","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiyu","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuang","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"issue":"2","key":"13685_CR1","doi-asserted-by":"publisher","first-page":"2295398","DOI":"10.1080\/07853890.2023.2295398","volume":"55","author":"KA Qureshi","year":"2023","unstructured":"Qureshi KA, Parvez A, Fahmy NA, Abdel Hady BH, Kumar S, Ganguly A, Atiya A, Elhassan GO, Alfadly SO, Parkkila S, Aspatwar A. 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The studies were conducted in accordance with the local legislation and institutional requirements. The ethics committee\/institutional review board waived the requirement of written informed consent for participation from the participants or the participants\u2019 legal guardians\/next of kin because (1) Retrospective Data: The data used in this study is derived from previously collected clinical records. These materials were obtained during routine clinical diagnosis and treatment, and no additional procedures or interventions were performed specifically for this research. Therefore, obtaining written informed consent from each individual patient is not feasible or necessary. (2) No Adverse Impact: The waiver of written informed consent does not pose any adverse effects on the rights, welfare, or health of the subjects involved. The study solely relies on de-identified and anonymized data, ensuring the privacy and confidentiality of the individuals\u2019 personal information. The analysis and interpretation of the data do not involve any interventions, risks, or potential harm to the participants. (3) Minimal Risk: The research poses minimal risk to the subjects, as it is based on retrospective data analysis. There are no interventions, treatments, or experimental procedures involved that could potentially harm the participants. The study strictly adheres to ethical guidelines and regulations to ensure the protection and wellbeing of the subjects. (4) Confidentiality: All data used in this study will be handled with strict confidentiality. Any personal identifiers will be removed or anonymized to ensure the privacy and confidentiality of the subjects. The research findings will be reported in an aggregated and de-identified manner to maintain the anonymity of the participants. Overall, given the retrospective nature of the study, the absence of interventions or risks, and the protection of subject confidentiality, the waiver of written informed consent is justified and will not compromise the rights or health of the individuals involved. Written informed consent was not obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article because The Ethics Committee of The First Affiliated Hospital of Xinjiang Medical University approved the study with an informed consent exemption (12.12.2024\/K202412-36).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1442"}}