Session Information
Date: Monday, October 22, 2018
Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Diagnosis of axial spondyloarthritis (axSpA) often relies on a positive MRI of the SI joints. However, pitfalls in interpretation of MRI images were recently acknowledged (1). Thus reader’s expertise might be a source of heterogeneity in patient populations diagnosed with non-radiographic axSpA. Therefore we compared clinical characteristics between axSpA patients diagnosed in general (secondary) hospitals (MRI evaluation by local experts) versus a university-affiliated (tertiary) hospital (MRI central reading by trained radiologists and rheumatologists). In all centers, patients were free to visit a rheumatologist of their choice without necessity for referral by a general practitioner.
Methods:
Patients originate from the Be-Giant cohort, a nationwide observational registry of axSpA patients diagnosed by expert opinion. Included patients fulfill the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA (2) and are anti-TNF-α naïve prior to inclusion. Patient enrollment started in 2010 and 2012 at the outpatient clinic of 1 tertiary and 7 secondary centers respectively. An extensive patient description was performed at baseline, followed by a 6-monthly follow-up.
Results:
By June 2018, 223 axSpA patients were included. Demographic and clinical features are presented according to the diagnostic echelon (Table 1). The HLA B27 positivity rate was 52,9% and 74,6% in secondary versus tertiary centers (p = 0,013). The patient fraction fulfilling the imaging arm of the ASAS classification criteria was similar in both (89,9% vs. 85,3%, p = 0,418), but significantly more patients both fulfilled the imaging and the clinical arm in the tertiary versus secondary centers (64,5% vs. 38,2%, p = 0,004).
Conclusion:
Patients diagnosed with axSpA in secondary versus a tertiary hospital generally show similar demographic and clinical characteristics. For axSpA patients diagnosed in a tertiary center, fulfillment of both ASAS classification arms and HLA B27 positivity rate was significantly higher, indicating that rheumatologists in secondary hospitals seem to assign more value to MRI findings compared to HLA B27 status in the diagnostic process.
1. Varkas G, de Hooge M, Renson T, De Mits S, Carron P, Jacques P, et al. Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: assessment of military recruits by magnetic resonance imaging study. Rheumatology (Oxford). 2018;57(3):508-13.
2. Rudwaleit M, Van Der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis. 2009;68(6):777-83.
|
|
Secondary centers (n = 34) |
Tertiary center (n = 189) |
p-value (α = 0.05) |
|
Age at diagnosis (years) * |
32,7 (7,19) |
30,5 (9,32) |
0,070 |
|
Male gender ** |
14 (41,2) |
100 (52,9) |
0,208 |
|
Caucasian ethnicity ** |
33 (97,1) |
179 (94,7) |
0,560 |
|
HLA B27 positivity ** |
18 (52,9) |
141 (74,6) |
0,013 |
|
Symptom duration at time of diagnosis (months) * |
58,2 (68,54) |
52,3 (67,55) |
0,747 |
|
ASAS classification criteria: |
|
|
|
|
fulfilling the imaging arm ** |
29 (85,3) |
170 (89,9) |
0,418 |
|
fulfilling the clinical arm ** |
18 (52,9) |
141 (74,6) |
0,010 |
|
fulfilling both the imaging and the clinical arm ** |
13 (38,2) |
122 (64,5) |
0,004 |
|
Family history of SpA (1st or 2nd degree relative) ** |
12 (35,3) |
77 (40,7) |
0,549 |
|
Peripheral manifestations: |
|
|
|
|
Arthritis (history or current) ** |
5 (14,7) |
34 (18,0) |
0,643 |
|
Dactylitis (history or current) ** |
0 (0) |
9 (4,8) |
0,194 |
|
Enthesitis (history or current) ** |
4 (11,8) |
18 (9,5) |
0,687 |
|
Extra-articular manifestations: |
|
|
|
|
Psoriasis (history or current)** |
6 (17,6) |
19 (10,1) |
0,196 |
|
Inflammatory bowel disease (history or current) ** |
1 (2,9) |
8 (4,2) |
0,725 |
|
Acute anterior uveitis (history or current) ** |
4 (11,8) |
28 (14,8) |
0,640 |
|
Clinical measurements: |
|
|
|
|
BMI (kg/m²) * |
23,6 (3,63) |
24,6 (4,16) |
0,169 |
|
BASMI * |
1,5 (1,52) |
1,5 (1,40) |
0,865 |
|
Maastricht Ankylosing Spondylitis Enthesitis Score + fascia plantaris (/15) * |
1,7 (3,05) |
0,9 (1,56) |
0,397 |
|
Patient reported outcomes: |
|
|
|
|
BASDAI (/100) * |
42 (19,3) |
42 (19,9) |
0,956 |
|
BASFI (/100) * |
26 (21,7) |
27 (21,8) |
0,785 |
|
HAQ (/60) * |
4,7 (5,07) |
4,8 (5,69) |
0,826 |
|
Ankylosing Spondylitis Disease Activity Score – CRP * |
2,43 (1,022) |
2,57 (0,961) |
0,405 |
Table 1: * Numbers indicate mean (SD). ** Numbers indicate absolute counts (%).
To cite this abstract in AMA style:
De Craemer AS, Renson T, Carron P, Jacques P, Joos R, Lenaerts J, Gyselbrecht L, van Den Bosch F, Elewaut D. Clinical Features of Axial Spondyloarthritis Patients Diagnosed in Secondary Versus a Tertiary Hospital [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/clinical-features-of-axial-spondyloarthritis-patients-diagnosed-in-secondary-versus-a-tertiary-hospital/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-features-of-axial-spondyloarthritis-patients-diagnosed-in-secondary-versus-a-tertiary-hospital/