{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:36:45Z","timestamp":1760060205998,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial skeletal involvement and systemic metabolic changes. While inflammation is central to its pathophysiology, the potential role of thyroid hormones, particularly free triiodothyronine (FT3), in disease risk and activity remains underexplored. The objective of this study is to evaluate the relationship between serum FT3 levels and both the presence and clinical activity of AS, while also examining other endocrine-metabolic parameters. In this cross-sectional study, 120 AS patients and 117 healthy controls were assessed. Demographic, anthropometric, hematologic, and biochemical parameters were recorded. Disease activity was determined using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), with BASDAI \u2265 4 indicating active disease. Logistic regression models adjusting for age, sex, BMI, and other relevant covariates were applied to identify independent predictors. FT3 levels were significantly lower in AS patients compared to controls (3.25 [3.01\u20133.58] vs. 3.44 [3.16\u20133.69] pg\/mL, p = 0.037) and in patients with BASDAI \u2265 4 versus BASDAI &lt; 4 (3.20 [2.94\u20133.48] vs. 3.44 [3.19\u20133.83] pg\/mL, p = 0.004). The reduction was more evident in women, where it reflected disease presence, whereas in men it was associated with high disease activity. Low FT3 independently predicted both AS (OR 0.50, 95% CI 0.28\u20130.92, p = 0.026) and active disease (OR 0.48, 95% CI 0.24\u20130.99, p = 0.047). Lower HDL-C, BMI, and creatinine, and higher leukocyte counts were also associated with AS, but not with disease activity. Low-normal FT3 is independently associated with both the presence and activity of AS, reflecting disease presence in women and disease activity in men. This is the first study to demonstrate this sex-specific association after adjusting for metabolic parameters and multiple covariates, highlighting FT3\u2019s potential as a marker of inflammation-driven metabolic dysregulation.<\/jats:p>","DOI":"10.3390\/ijms26167862","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T15:44:21Z","timestamp":1755186261000},"page":"7862","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Low Free T3 with Disease Presence and Activity in Ankylosing Spondylitis"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1431-5663","authenticated-orcid":false,"given":"Enver","family":"Ciftel","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Sivas Numune Hospital, 58060 Sivas, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7870-0996","authenticated-orcid":false,"given":"Aleksandra","family":"Klisic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Montenegro, 81000 Podgorica, Montenegro"},{"name":"Center for Laboratory Diagnostics, Primary Health Care Center, 81000 Podgorica, Montenegro"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bayram","family":"Kizilkaya","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Recep Tayyip Erdogan University Training and Research Hospital, 53100 Rize, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5848-6363","authenticated-orcid":false,"given":"Osman","family":"Cure","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4325-1534","authenticated-orcid":false,"given":"Filiz","family":"Mercantepe","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7147-5087","authenticated-orcid":false,"given":"Sibel Mataraci","family":"Karakas","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3838-1606","authenticated-orcid":false,"given":"Ana","family":"Nini\u0107","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Klisic, A., Kotur-Stevuljevic, J., Cure, O., Kizilkaya, B., Beyazal Celiker, F., Er, H., and Mercantepe, F. (2024). Cardiovascular Risk in Patients with Ankylosing Spondylitis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206064"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1007\/s10067-017-3623-8","article-title":"Metabolic Syndrome in Patients with Ankylosing Spondylitis Receiving Anti-TNF\u03b1 Therapy: Association with Predictors of Cardiovascular Risk","volume":"36","author":"Maia","year":"2017","journal-title":"Clin. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E31764","DOI":"10.1097\/MD.0000000000031764","article-title":"Ankylosing Spondylitis Disease Activity and Serum Vitamin D Levels: A Systematic Review and Meta-Analysis","volume":"101","author":"Chen","year":"2022","journal-title":"Medicine"},{"key":"ref_4","first-page":"20","article-title":"Oxidative Stress and Related Factors in Patients with Ankylosing Spondylitis","volume":"3","author":"Solmaz","year":"2016","journal-title":"Eur. J. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4274\/tod.galenos.2023.14892","article-title":"Systemic Immune Inflammation Index in Ankylosing Spondylitis Patients","volume":"30","author":"Alp","year":"2024","journal-title":"Turk. J. Osteoporos."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Moon, D.H., Kim, A., Song, B.W., Kim, Y.K., Kim, G.T., Ahn, E.Y., So, M.W., and Lee, S.G. (2023). High Baseline Neutrophil-to-Lymphocyte Ratio Could Serve as a Biomarker for Tumor Necrosis Factor-Alpha Blockers and Their Discontinuation in Patients with Ankylosing Spondylitis. Pharmaceuticals, 16.","DOI":"10.3390\/ph16030379"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5606\/ArchRheumatol.2015.5061","article-title":"Serum Fetuin-a Level in Patients with Ankylosing Spondylitis and Its Relationship with Clinical Parameters","volume":"30","author":"Akbal","year":"2015","journal-title":"Arch. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5606\/ArchRheumatol.2015.5451","article-title":"Cardiometabolic Risk Factors in Patients with Ankylosing Spondylitis","volume":"30","author":"Sarikaya","year":"2015","journal-title":"Arch. Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"M111.013904","DOI":"10.1074\/mcp.M111.013904","article-title":"Discovery of Candidate Serum Proteomic and Metabolomic Biomarkers in Ankylosing Spondylitis","volume":"11","author":"Fischer","year":"2012","journal-title":"Mol. Cell. Proteom."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/BF03346548","article-title":"Impaired Hypothalamo-Pituitary-Adrenal Axis in Patients with Ankylosing Spondylitis","volume":"33","author":"Kebapcilar","year":"2010","journal-title":"J. Endocrinol. Investig."},{"key":"ref_11","first-page":"8","article-title":"An Assessment of Thyroid Dysfunction and Related Parameters in Patients with Systemic Autoimmune Disorders","volume":"15","author":"Pawar","year":"2023","journal-title":"Cureus"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhang, K., Luo, Z., and Wang, X. (2024). The Association of Common Autoimmune Diseases with Autoimmune Thyroiditis: A Two-Sample Mendelian Randomization Study. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1383221"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.3899\/jrheum.101012","article-title":"Prevalence of Thyroid Autoimmunity in Patients with Spondyloarthropathies","volume":"38","author":"Peluso","year":"2011","journal-title":"J. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s00296-012-2438-9","article-title":"Thyroid Involvement in Ankylosing Spondylitis and Relationship of Thyroid Dysfunction with Anti-TNF \u03b1 Treatment","volume":"33","author":"Tarhan","year":"2013","journal-title":"Rheumatol. Int."},{"key":"ref_15","first-page":"468","article-title":"Thyroid Disorders in Female Patients with Ankylosing Spondylitis","volume":"22","author":"Lange","year":"1999","journal-title":"Eur. J. Med. Res."},{"key":"ref_16","first-page":"304","article-title":"\u00bfPueden los niveles de T3L facilitar la detecci\u00f3n de estados inflamatorios o de catabolismo y desnutrici\u00f3n en enfermos en di\u00e1lisis? [Can FT3 levels facilitate the detection of inflammation or catabolism and malnutrition in dialysis patients?]","volume":"29","author":"Heras","year":"2009","journal-title":"Nefrologia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.nefro.2017.07.001","article-title":"Prevalencia Del S\u00edndrome Complejo de Malnutrici\u00f3n e Inflamaci\u00f3n y Su Correlaci\u00f3n Con Las Hormonas Tiroideas En Pacientes En Hemodi\u00e1lisis Cr\u00f3nica","volume":"38","year":"2018","journal-title":"Nefrolog\u00eda"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/5584_2015_180","article-title":"Thyroid Hormone Levels and TSH Activity in Patients with Obstructive Sleep Apnea Syndrome","volume":"878","author":"Bielicki","year":"2016","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Feng, X.L., Chen, H.M., Yin, L.J., Chen, J., and Chen, L.L. (2025). Developing a Nomogram for Risk Prediction of the Low T3 Syndrome. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-89484-1"},{"key":"ref_20","unstructured":"Ganesan, K., Anastasopoulou, C., and Wadud, K. (2025). Euthyroid Sick Syndrome. StatPearls, StatPearls Publishing."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1210\/er.2011-0007","article-title":"Beyond Low Plasma T 3: Local Thyroid Hormone Metabolism during Inflammation and Infection","volume":"32","author":"Boelen","year":"2011","journal-title":"Endocr. Rev."},{"key":"ref_22","first-page":"262","article-title":"Low T3 Syndrome as a Prognostic Factor in Patients in the Intensive Care Unit: An Observational Cohort Study","volume":"34","author":"Costa","year":"2022","journal-title":"Rev. Bras. Ter. Intensiv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15330338221094422","DOI":"10.1177\/15330338221094422","article-title":"The Association Between Low T3 Syndrome and Survival in Patients With Newly Diagnosed Multiple Myeloma: A Retrospective Study","volume":"21","author":"Pan","year":"2022","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mantzouratou, P., Malaxianaki, E., Cerullo, D., Lavecchia, A.M., Pantos, C., Xinaris, C., and Mourouzis, I. (2023). Thyroid Hormone and Heart Failure: Charting Known Pathways for Cardiac Repair\/Regeneration. Biomedicines, 11.","DOI":"10.3390\/biomedicines11030975"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e005266","DOI":"10.1161\/CIRCHEARTFAILURE.118.005266","article-title":"Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes","volume":"11","author":"Kannan","year":"2018","journal-title":"Circ. Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.cardfail.2019.01.007","article-title":"Low T3 Syndrome Is Associated With High Mortality in Hospitalized Patients With Heart Failure","volume":"25","author":"Sato","year":"2019","journal-title":"J. Card. Fail."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"184","DOI":"10.5152\/eurjrheum.2019.19073","article-title":"The Role of Smoking in the Development and Progression of Structural Damage in Axial SpA Patients: A Systematic Review and Meta-Analysis","volume":"6","author":"Akar","year":"2019","journal-title":"Eur. J. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"970","DOI":"10.55730\/1300-0144.5661","article-title":"The Impact of Smoking on Response to Tumor Necrosis Factor-\u03b1 Inhibitor Treatment in Patients with Ankylosing Spondylitis","volume":"53","author":"Kenar","year":"2023","journal-title":"Turk. J. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"53","DOI":"10.2174\/1874312901711010053","article-title":"Axial Spondyloarthritis and Cigarette Smoking","volume":"11","author":"Kaut","year":"2017","journal-title":"Open Rheumatol. J."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Barone, M., Viggiani, M.T., Anelli, M.G., Fanizzi, R., Lorusso, O., Lopalco, G., Cantarini, L., Di Leo, A., Lapadula, G., and Iannone, F. (2018). Sarcopenia in Patients with Rheumatic Diseases: Prevalence and Associated Risk Factors. J. Clin. Med., 7.","DOI":"10.3390\/jcm7120504"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.rdc.2012.09.003","article-title":"Epidemiology of Spondyloarthritis","volume":"38","author":"Stolwijk","year":"2012","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bandinelli, F., Martinelli-Consumi, B., Manetti, M., and Vallecoccia, M.S. (2024). Sex Bias in Diagnostic Delay: Are Axial Spondyloarthritis and Ankylosing Spondylitis Still Phantom Diseases in Women? A Systematic Review and Meta-Analysis. J. Pers. Med., 14.","DOI":"10.3390\/jpm14010091"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Cz\u00f3kolyov\u00e1, M., Pusztai, A., V\u00e9gh, E., Horv\u00e1th, \u00c1., Szentp\u00e9teri, A., Hamar, A., Szamosi, S., Hodosi, K., Domj\u00e1n, A., and Sz\u00e1nt\u00f3, S. (2021). Changes of Metabolic Biomarker Levels upon One-Year Anti-Tnf-\u03b1 Therapy in Rheumatoid Arthritis and Ankylosing Spondylitis: Associations with Vascular Pathophysiology. Biomolecules, 11.","DOI":"10.3390\/biom11101535"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Bonek, K., Warnawin, E.K., Kornatka, A., Pleba\u0144czyk, M., Burakowski, T., Ma\u015bli\u0144ski, W., Wis\u0142owska, M., G\u0142uszko, P., and Ciechomska, M. (2022). Circulating MiRNA Correlates with Lipid Profile and Disease Activity in Psoriatic Arthritis, Rheumatoid Arthritis, and Ankylosing Spondylitis Patients. Biomedicines, 10.","DOI":"10.3390\/biomedicines10040893"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Bilski, R., Kami\u0144ski, P., Kupczyk, D., Jeka, S., Baszy\u0144ski, J., Tkaczenko, H., and Kurhaluk, N. (2024). Environmental and Genetic Determinants of Ankylosing Spondylitis. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25147814"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1677\/JOE-09-0412","article-title":"Mechanisms behind the Non-Thyroidal Illness Syndrome: An Update","volume":"205","author":"Warner","year":"2010","journal-title":"J. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Yan, Y., Wang, J., Wang, Y., Liu, J., Yang, W., Niu, M., Yu, Y., and Zhao, H. (2025). Proteomic Profiling of Inflammatory Protein Dysregulation in HLA-B27-Positive Ankylosing Spondylitis: Molecular Signatures and Potential Biomarkers. Biomolecules, 15.","DOI":"10.3390\/biom15040516"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Ramos, S., Rafael-Vidal, C., Pego-Reigosa, J.M., and Garc\u00eda, S. (2022). Monocytes and Macrophages in Spondyloarthritis: Functional Roles and Effects of Current Therapies. Cells, 11.","DOI":"10.3390\/cells11030515"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Martelli-Garcia, A., Esparza-Guerrero, Y., Jacobo-Cuevas, H., Salda\u00f1a-Cruz, A.M., Gonzalez-Montoya, N.G., Nava-Valdivia, C.A., Gomez-Ramirez, E.E., Vazquez-Villegas, M.L., Ponce-Guarneros, J.M., and Ramirez-Villafa\u00f1a, M. (2025). Role of High Serum Tenascin C Levels as Potential Biomarker of Persistent Inflammation in Patients with Ankylosing Spondylitis Despite Treatment with Cs-DMARDS or Anti-TNF Agents. Diagnostics, 15.","DOI":"10.3390\/diagnostics15121457"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Targo\u0144ska-St\u0119pniak, B., and Grzechnik, K. (2023). The Usefulness of Cellular Immune Inflammation Markers and Ultrasound Evaluation in the Assessment of Disease Activity in Patients with Spondyloarthritis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175463"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Berbel-Arcob\u00e9, L., Benavent, D., Valencia-Muntal\u00e0, L., G\u00f3mez-Vaquero, C., Juanola, X., and Nolla, J.M. (2025). Assessing Sarcopenia, Presarcopenia, and Malnutrition in Axial Spondyloarthritis: Insights from a Spanish Cohort. Nutrients, 17.","DOI":"10.3390\/nu17061019"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.semarthrit.2018.07.015","article-title":"Although Female Patients with Ankylosing Spondylitis Score Worse on Disease Activity than Male Patients and Improvement in Disease Activity Is Comparable, Male Patients Show More Radiographic Progression during Treatment with TNF-\u03b1 Inhibitors","volume":"48","author":"Spoorenberg","year":"2019","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.1016\/S2665-9913(23)00060-7","article-title":"The Influence of Sex Hormones on Musculoskeletal Pain and Osteoarthritis","volume":"5","author":"Gulati","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1002\/art.41042","article-title":"2019 Update of the American College of Rheumatology","volume":"71","author":"Ward","year":"2019","journal-title":"Arthritis Rheumatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1136\/ard-2022-223296","article-title":"ASAS-EULAR Recommendations for the Management of Axial Spondyloarthritis: 2022 Update","volume":"82","author":"Ramiro","year":"2022","journal-title":"Ann. Rheum. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.imlet.2010.07.001","article-title":"Sex Hormones and Autoimmunity","volume":"133","author":"Chico","year":"2010","journal-title":"Immunol. Lett."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1038\/nri.2016.90","article-title":"Sex Differences in Immune Responses","volume":"16","author":"Klein","year":"2016","journal-title":"Nat. Rev. Immunol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Langer, M.M., Bauschen, A., Guckenbiehl, S., Klauss, S., Lutz, T., Denk, G., Zwanziger, D., Moeller, L.C., and Lange, C.M. (2023). Evolution of Non-Thyroidal Illness Syndrome in Acute Decompensation of Liver Cirrhosis and Acute-on-Chronic Liver Failure. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1104388"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1507\/endocrj.EJ18-0243","article-title":"The Effect of Anti-Tnf Therapy on Thyroid Function in Patients with Inflammatory Bowel Disease","volume":"65","author":"Paschou","year":"2018","journal-title":"Endocr. J."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Lasa, M., and Contreras-Jurado, C. (2022). Thyroid Hormones Act as Modulators of Inflammation through Their Nuclear Receptors. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.937099"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"R67","DOI":"10.1530\/JOE-16-0462","article-title":"Thyroid Hormone Metabolism in Innate Immune Cells","volume":"232","author":"Fliers","year":"2017","journal-title":"J. Endocrinol."},{"key":"ref_52","first-page":"224","article-title":"Illness-Induced Changes in Thyroid Hormone Metabolism: Focus on the Tissue Level","volume":"69","author":"Kwakkel","year":"2011","journal-title":"Neth. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1136\/ard.2010.133645","article-title":"The Assessment of SpondyloArthritis International Society Classification Criteria for Peripheral Spondyloarthritis and for Spondyloarthritis in General","volume":"70","author":"Rudwaleit","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"ref_54","first-page":"251","article-title":"The BASDAI-D\u2014An Instrument to Defining Disease Status in Ankylosing Spondylitis and Related Diseases","volume":"62","year":"2003","journal-title":"Z. Rheumatol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/16\/7862\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:27:37Z","timestamp":1760034457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/16\/7862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":54,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["ijms26167862"],"URL":"https:\/\/doi.org\/10.3390\/ijms26167862","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]}}}