Background: Upadacitinib (UPA), a selective Janus kinase 1 (JAK1) inhibitor, is an established therapeutic option for spondyloarthritis (SpA). Although its clinical efficacy has been demonstrated in randomized trials, real-world evidence regarding its early metabolic effects—particularly in the context of the inflammatory “lipid paradox”—remains limited. This study aimed to evaluate the short-term impact of UPA on inflammatory, hematologic, and metabolic parameters in a biologic-refractory SpA cohort. Methods: This retrospective cohort study included 61 patients (51 with ankylosing spondylitis and 10 with psoriatic arthritis) who had an inadequate response to tumor necrosis factor inhibitors (TNFi-IR). The study evaluated the short-term effects of UPA treatment on disease activity, inflammatory markers, and lipid-related atherogenic risk, as assessed using the LDL/HDL ratio, over a three-month period. Demographic characteristics, disease activity (BASDAI), inflammatory markers (CRP, ESR), safety parameters (creatine kinase CK, ALT, AST), and lipid profiles were assessed at baseline, Month 1, and Month 3. Results: The mean age was 42.6 ± 10.8 years. By Month 3, UPA treatment resulted in significant reductions in BASDAI (5.8 ± 1.4 to 3.6 ± 1.2, p 0.05). No significant differences in inflammatory or metabolic responses were observed between ankylosing spondylitis and psoriatic arthritis subgroups (p > 0.05). Conclusions: In biologic-refractory SpA patients, upadacitinib provides rapid anti-inflammatory and clinical benefits. Although quantitative increases in lipid subfractions were observed, the stability of the LDL/HDL ratio suggests a balanced metabolic recalibration consistent with inflammation control rather than an immediate pro-atherogenic shift. These findings highlight the importance of early lipid monitoring and individualized cardiovascular risk assessment while maintaining the therapeutic advantages of JAK1 inhibition in complex SpA populations.
Akar et al. (Sun,) studied this question.