After the earthquake: clinical observations in axial spondyloarthritis patients receiving biologic therapy

To evaluate the medium- and long-term effects of a major earthquake epicenter in Kahramanmaras, Turkey, on Axial Spondyloarthritis (axSpA) patients receiving biological therapy in the affected region.

A single-center retrospective observational study included 159 patients with axSpA receiving biologic therapy who applied to our outpatient rheumatology department between February 2023 and October 2024. Clinical, laboratory and disease-related parameters pre- and post-earthquake were retrieved from the hospital database.

The median age of patients with axSpA was 41 (IQR:14) (female 43, male 40) years, 73.6% were male, and the disease duration was 8 (IQR:7) years. The median follow-up duration for patients in the post-earthquake period was 16 months. Fifty-five patients (34.6%) had discontinued their treatment due to the earthquake and remained without treatment for a median of 75 (IQR:58) days. When patients who discontinued treatment were compared with those who continued, the mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after the earthquake were 5.6 and 3.3, respectively, and the difference was statistically significant (p = 0.01). The duration of treatment discontinuation showed a significant positive correlation with post-earthquake BASDAI scores (r = 0.603, p = 0.01). When evaluating the effect of treatment discontinuation duration on clinical outcomes, a longer duration of treatment discontinuation was significantly associated with increased disease activation (p = 0.001) and treatment non-response (p = 0.013).

This study, highlights the significant impact of treatment discontinuation on disease activity and response in patients with axSpA receiving biologic therapy. AxSpA inherently presents complex challenges in monitoring and treatment, which are exacerbated in disaster settings. Therefore, there is a need for disaster action plans that incorporate a multidisciplinary approach adapted to the management of chronic rheumatic diseases such as axSpA. Key points • Disease control in axSpA patients is critical to prevent complications. • Disasters like earthquakes are difficult to manage chronic diseases such as axSpA. • Emergency action plans need to be established to ensure the effective management of axSpA patients during disaster situations.