Background/Purpose: The classification criteria for spondyloarthritis (SpA) intend to identify patients with this disease from the initial stages.  The nonspecific characteristics,  symptoms, signs, and additional tests found in many patients at the onset of SpA, and the limitations of the classification criteria explain the delayed diagnosis.  In Spain, the delay for the diagnosis is about 6 years[1]. Recently, the Assessment of SpA international Society (ASAS) has developed new criteria that try to reduce the time to diagnosis for axial SpA[2] and peripheral SpA[3]. In 2008 a SpA unit of recent onset was created in the General Hospital of Mérida (Spain) in order to establish an early diagnosis of this pathology. We describe the demographic and clinical characteristics of this population. 

Methods: Between 2008 and 2013, we included patients aged from 18 to 45 years  with symptoms for more than 3 months and less than 2 years including inflammatory back pain, asymmetric  arthritis and/or mechanical low back pain (LBP)  or arthralgias accompanied by at least one of the following: psoriasis, uveitis, inflammatory bowel disease, enthesitis, sacroiliitis imaging, positive HLAB27 or family history of SpA. Patients with previous diagnosis of SpA were excluded.

Results: The most common reason for consultation was LBP (76%). We studied 121 patients: 54 patients (45%) met ASAS criteria for SpA, 31 patients had axial SpA, and 23 patients had peripheral SpA. The gender distribution was similar in both groups. In axial SpA, 25.8% met NY criteria and most of these patients  were  men, the  other 74,2% were non-radiological SpA with a female predominance. In the peripheral SpA, the most frequent was Psoriatic arthritis (PsA)  (56.5%). The mean age at diagnosis was  lower for axial SpA (30 years), undifferentiated  SpA (uSpA 27.9 years) and AS (29 years) compared to peripheral SpA (35.7 years). HLA B27 was positive in 63% of patients with SpA and in 10.4% of no-SpA subjects.  HLAB27 was more prevalent in axial SpA (84%), especially in AS (100%), compared to  peripheral SpA (34%). It should be noted that 87.5% of the peripheral uSpA were positive HLAB27. The 39% of patients with SpA had family history, being more frequent in axial (55.5%) and peripheral (57%) uSpA and PsA (30%). Arthritis was present  in 37% of SpA and 100% of PsA.  Enthesitis was observed in 38% of SpA, in 50% of axial uSpA and 100% of the peripheral uSpA. There was one Dactylitis in a patient with peripheral uSpA and 5 cases of uveitis, all in axial SpA.

Conclusion: The creation of units of recent onset could help us to select patients fulfilling ASAS criteria. We achieved a diagnostic rate of 45% of patients referred. Axial SpA was more frequent (57.4%) and especially the non-radiological (74.2% of the axial). The most frequent peripheral SpA presentation was PsA (24%). Axial SpA, and especially axial uSpA, appears at a younger age than peripheral SpA. The gender distribution was similar for SpA, but non-radiographic axial SpA were more common in women. We found a family history of SpA more frequently in both axial and peripheral uSpA and a strong association between HLA B27 and AS (100%) and both axial and peripheral uSpA. In contrast, we found no association between HLA B27 and PsA or enteropathic arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-of-patients-with-early-spondyloarthritis-results-from-a-specialized-consultation-in-a-clinical-hospital/