Session Information
Date: Monday, November 6, 2017
Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Timely identification of nr-axSpA may lead to earlier intervention to reduce symptoms, improve function, and reduce disease burden. The purpose of this study was to compare the clinical characteristics that are present at the time of diagnosis of nr-axSpA patients in the US and EU.
Methods: Nr-axSpA patients from the 2015 SpA Disease Specific Programme, a cross-sectional, multi-national survey of patients and rheumatologists conducted in France, Germany, Italy, Spain, United Kingdom, and the United States were analyzed. Rheumatologists completed patient record forms containing patient demographics, clinical measurements and symptomology at diagnosis.
Results: Data from 391 rheumatologists (299 EU/92 US) and 1,995 patients with nr-axSpA (1513 EU/482 US) were included in this analysis. In the US and EU, at the time of diagnosis patients had similar rates of IBP, back pain for more than 3 months, and a family history of SpA (Table 1). Patients in the US were significantly more likely to have peripheral joint involvement at diagnosis than patients in the EU. In the US, patients that had peripheral joint involvement at diagnosis were significantly more likely to have had IBP that was previously diagnosed as mechanical back pain (p=0.002) and have back pain for greater than 3 months (p=0.035) at diagnosis when compared to patients that did not have peripheral joint involvement at diagnosis. In the EU, patients that had peripheral joint involvement at diagnosis were significantly more likely to have elevated ESR (p<0.001) and alternating buttock pain (p=0.002) when compared to patients that did not have peripheral joint involvement at diagnosis. In the US and EU, patients that had peripheral joint involvement at diagnosis were significantly more likely to have elevated CRP, morning stiffness for more than 30 minutes, dactylitis, enthesitis, tendonitis, synovitis, and arthritis at diagnosis when compared patients that did not have peripheral joint involvement at diagnosis (Table 2).
Conclusion: Nr-axSpA patients in the US and EU share a range of clinical features at diagnosis. However, patients in the US were more likely to have peripheral joint involvement at diagnosis than patients in the EU. Furthermore, nr-axSpA patients in the US and EU with peripheral joint involvement at diagnosis were associated with a worse symptom profile versus patients without peripheral joint involvement.
Table 1. Comparison of symptoms of nr-axSpA patients at diagnosis in the US vs. EU
|
Symptoms at Diagnosis |
USA |
EU |
p-value |
|
% with symptom |
% with symptom |
||
|
Peripheral joint involvement |
50.8 |
23.3 |
<0.0001 |
|
IBP or spinal pain |
69.3 |
67.6 |
0.5016 |
|
Age of onset of IBP less than 45 years |
48.5 |
48.2 |
0.9167 |
|
Back pain for more than 3 months |
56.0 |
54.9 |
0.7128 |
|
IBP that was previously diagnosed as mechanical back pain |
27.4 |
27.3 |
1.0000 |
|
Family history of spondyloarthritis |
20.7 |
20.9 |
1.0000 |
|
Morning stiffness for more than 30 minutes |
57.9 |
51.8 |
0.0210 |
|
Elevated CRP |
37.1 |
37.1 |
1.0000 |
|
Elevated ESR |
37.3 |
25.4 |
<0.0001 |
|
HLA-B27 positive |
46.5 |
49.5 |
0.2293 |
Table 2. Comparison of symptoms of nr-axSpA patients with peripheral joint involvement at diagnosis vs. nr-axSpA patients without peripheral joint involvement at diagnosis
|
Symptoms at Diagnosis |
USA |
EU |
||
|
% With Symptoms |
p-value |
% With symptoms |
p-value |
|
|
Back pain for < 3 months |
60.8 |
0.0348 |
59.1 |
0.0764 |
|
IBP previously diagnosed as mechanical back pain |
33.9 |
0.0015 |
30.1 |
0.1943 |
|
Morning stiffness for more than 30 minutes |
63.3 |
0.0165 |
61.6 |
<0.0001 |
|
Alternating buttock pain |
15.9 |
1.0000 |
40.3 |
0.0020 |
|
Elevated ESR |
40.8 |
0.1108 |
42.3 |
<0.0001 |
|
Elevated CRP |
45.3 |
0.0002 |
48.3 |
<0.0001 |
|
Dactylitis |
10.6 |
0.0451 |
12.5 |
<0.0001 |
|
Enthesitis |
26.1 |
0.0004 |
28.1 |
<0.0001 |
|
Tendonitis |
22.0 |
<0.0001 |
14.2 |
<0.0001 |
|
Active Synovitis |
23.3 |
<0.0001 |
21.6 |
<0.0001 |
|
Arthritis |
42.4 |
<0.0001 |
27.8 |
<0.0001 |
To cite this abstract in AMA style:
Deodhar AA, Hunter T, Calderon DS, Lobosco S, Moon R, Milligan G. Clinical Characteristics and Peripheral Joint Involvement at the Time of Diagnosis of Non-Radiographic Axial Spondyloarthritis Patients in the United States and Europe [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/clinical-characteristics-and-peripheral-joint-involvement-at-the-time-of-diagnosis-of-non-radiographic-axial-spondyloarthritis-patients-in-the-united-states-and-europe/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-and-peripheral-joint-involvement-at-the-time-of-diagnosis-of-non-radiographic-axial-spondyloarthritis-patients-in-the-united-states-and-europe/