Background/Purpose: The Ankylosing Spondylitis Registry of Ireland (ASRI) was established in 2013. The objectives of ASRI are to provide descriptive epidemiological data on the axial spondyloarthropathy (axSpA) population in Ireland and to establish a registry for potential future studies of genetics, aetiology and therapeutics. Extra-articular manifestations (EAM), comprising uveitis, psoriasis and inflammatory bowel disease (IBD), commonly occur in axSpA and contribute to the burden of disease. They may also impact choice of treatment. Knowledge regarding the characteristics associated with EAM is limited. The aim of this study is to evaluate the prevalence of EAM in a well characterised axSpA patient cohort, in particular identifying differences in early versus late disease and associated characteristics.

Methods: A standardised detailed clinical assessment is performed on each patient and entered in a database. Disease activity is assessed by Bath AS Disease Activity Index (BASDAI), spinal mobility by Bath AS Metrology Index (BASMI), function by the Bath AS Functional Index (BASFI) and Health Assessment Questionnaire (HAQ) and quality of life by AS Quality of Life (ASQoL). Structured interviews provide patient-reported data, which include the presence of EAM. Statistical analysis is performed using SPSS.

Results: As of June 2016, 564 patients have been entered into the database: 78.2% (n=441) males, mean age 47.1 (SD 12.4), mean disease duration 20.8 years (SD 12.2), mean delay to diagnosis of 8.6 years (SD 7.97), 78% fulfil modified New York criteria. Mean BASDAI is 3.9 (SD2.4), BASFI 3.7 (SD2.6), BASMI 3.2 (SD 2.5), HAQ 0.55 (SD 0.52) and ASQoL 6.4 (SD 5.5). When stratified by disease duration, 23.9% have early disease (less than 10 years). The prevalence of uveitis is 35.5%, psoriasis is 17.8% and IBD is 9.7%. Prevalence of uveitis is significantly higher in women (46.7% versus 32.3%, p=0.003), late disease (39.8% versus 21.7%, p<0.001) and presence of peripheral arthritis (42.4% versus 30.9%, p=0.007). There is a trend towards more prevalent uveitis in non-smokers (40.1%) compared to current (28.3%) or past (35.8%) smokers (p=0.06). The prevalence of IBD is significantly higher in women (16.5% versus 7.7%, p=0.004), patients with elevated CRP at baseline (11.9% versus 5.8%, p=0.045), peptic ulcer disease (21.7% versus 8.6%, p=0.004) and osteoporosis (23.5% versus 8.8%, p=0.005). The prevalence of IBD is not affected by disease duration or smoking status. The prevalence of psoriasis is not affected by early versus late disease, gender or smoking. HLA-B27 status and measures of disease severity have no impact on the presence of any EAM. In regression analysis, being female and disease duration > 10 years are predictive of uveitis. Female gender, elevated CRP at baseline and peptic ulcer disease are predictive of IBD.

Conclusion: EAM are common in this axSpA population. Thirty-six percent of the population have uveitis and 18% have psoriasis. Female gender and late disease predict uveitis. It is important to regularly screen for EAM. Predictive factors may guide screening.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gender-and-disease-duration-are-associated-with-extra-articular-manifestations-in-axial-spondyloarthropathy/