Rheumatology and Therapy (Feb 2024)

Anemia and Low Body Mass Index in Axial Spondyloarthritis: Results from ChinaSpA, the Chinese Spondyloarthritis Registry

  • Hailong Li,
  • Qingyang Li,
  • Xinwang Duan,
  • Shangzhu Zhang,
  • Yanhong Wang,
  • Jian Xu,
  • Qin Li,
  • Lijun Wu,
  • Zhenbiao Wu,
  • Min Yang,
  • Shengyun Liu,
  • Jinmei Su,
  • Mengtao Li,
  • Xiaofeng Zeng,
  • Xiang Gao

DOI
https://doi.org/10.1007/s40744-024-00646-5
Journal volume & issue
Vol. 11, no. 2
pp. 397 – 409

Abstract

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Abstract Introduction Anemia and malnutrition are recognized indicators of suboptimal physical condition in chronic inflammatory diseases. This study aimed to examine the association between anemia, low body mass index (BMI), and clinical outcomes in axial spondyloarthritis (axSpA). Method This cross-sectional analysis utilized data from the multicenter ChinaSpA cohort. A total of 4146 participants with axSpA were categorized into four groups based on BMI and hemoglobin levels: those with both anemia and low BMI, those with anemia only, those with low BMI only, and those with neither condition. Logistic regression analyses were performed to analyze the association between anemia, low BMI, inflammation status, functional impairment, and disease activity. Results Anemia was present in 13.94%, low BMI in 11.99%, and both conditions in 2.15% of axSpA participants. Those with both anemia and low BMI showed significantly higher levels of inflammation (hypersensitive C-reactive protein [hsCRP] 30.60 mg/L vs. 8.44 mg/L), functional impairment (Bath Ankylosing Spondylitis Functional Index [BASFI] 3.80 vs. 2.10), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] 4.52 ± 2.04 vs. 3.67 ± 2.21; Ankylosing Spondylitis Disease Activity Score calculated with C-reactive protein [ASDAS_CRP] 3.51 ± 1.10 vs. 2.62 ± 1.21) compared to those without these conditions. After adjusting for sex and age, significant associations were observed between elevated hsCRP levels and the presence of low BMI (odds ratio [OR] 1.44, 95% CI 1.17–1.78), anemia (OR 1.91, 95% CI 1.56–2.32), and their concurrent presence (OR 3.59, 95% CI 2.22–5.80). Similarly, increased BASFI was significantly associated with low BMI (OR 1.57, 95% CI 1.25–1.97), anemia (OR 1.47, 95% CI 1.19–1.80), and their combination (OR 3.11, 95% CI 2.02–4.78). Conclusion All-cause anemia and low BMI are prevalent complications in patients with axSpA, exhibiting a significant correlation with elevated inflammation status and functional impairment. The simultaneous occurrence of anemia and low BMI particularly exacerbates clinical outcomes, emphasizing the critical role of comprehensive nutritional assessment and management in the therapeutic strategy for axSpA.

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