Differences in Clinical Presentation Between Israeli and United States Children with Juvenile Spondyloarthritis

Nassem Ghantous¹, Merav Heshin Bekenstein ², Kimberly DeQuattro ³, Yaniv Lakovsky ⁴, amir hendel ⁵, Nadav Rappoport ⁶, Yonatan Butbul Aviel ⁷, Irit Tirosh ⁸, Liora Harel ⁹, Pamela Weiss ¹⁰, Lianne Gensler ¹¹ and Gil Amarilyo ¹², ¹Sackler School of Medicine, Tel Aviv University, Sakhnin, Israel, ²Dana Children’s Hospital of Tel Aviv Medical Center, Binyamina, Israel, ³UCSF, San Francisco, ⁴Schneider Children's Hospital, Petach Tikva, Israel, ⁵tel aviv university, kibbutz lohame hagetaot, Israel, ⁶Ben-Gurion University of the Negev, Beer-Sheva, Israel, ⁷Rambam Medical center, Haifa, Hefa, Israel, ⁸, ⁹Schneider Hospital, Tel Aviv University, Petah-Tiqva, Israel, ¹⁰Children's Hospital of Philadelphia, Philadelphia, ¹¹University of California San Francisco, San Francisco, ¹²Schneider Hospital, Tel Aviv University, Kibbutz Magal, Israel

Meeting: 2020 Pediatric Rheumatology Symposium

Keywords: Enthesitis Related Arthritis, HLA B27, Juvenile Sacroiliitis, Juvenile Spondyloarthritis

Session Information

The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.

Date: Thursday, April 30, 2020

Title: Poster Session 1

Session Type: ACR Abstract Session

Session Time: 6:00PM-7:00PM

Background/Purpose: Observations among Israeli pediatric rheumatologists reveal pediatric Juvenile Spondyloarthritis (JSpA) may present differently compared to patients from the United States (US). This study aimed to compare the demographic and clinical variables of Israeli and US JSpA patients upon presentation.

Methods: We performed a retrospective, cross-sectional, multicenter comparison of JSpA patients from 3 large Israeli pediatric rheumatology centers (Schneider, Tel-Hashomer, Rambam) and a large US pediatric rheumatology center cohort (University of California San Francisco). The demographic, clinical and imaging features of the subjects upon presentation were compared, including MRI of the sacroiliac joints. Inter Center Comparison (ICC) between the Israeli and US musculoskeletal radiologists was conducted.

Results: Overall 87 patients met the inclusion criteria (39 Israeli, 48 US). As compared to the US population, the Israeli population was less likely to be male (56.4% vs. 75%, p=0.11), and more likely to be older at time of diagnosis (14.3 vs. 11.9 years, p< 0.001). Upon presentation, axial symptoms (inflammatory back pain) and physical examination findings consistent with sacroiliitis (SIJ tenderness, modified Schober test), were significantly more prevalent among Israeli patients (59% vs. 35.4%, 48.7% vs. 16.7%, and 41.2% vs. 21.5%, respectively, all p< 0.05), whereas peripheral arthritis and enthesitis were significantly more prevalent among the US patients (43.6% vs. 91.7% and 7.7% vs. 39.6% in Israeli patients vs. US patients, p< 0.05). In addition, of those who had imaging (N= 30 and N=37 for Israeli and US cohorts) 96.7% of the Israeli patients versus 29.7% of the US patients demonstrated positive MRI findings that were consistent with sacroiliitis (p< 0.001, overall N=67). For HLA-B27, 32% of the Israeli patients vs. 66.7% of the US patients were positive (p=0.007). A high level of agreement ( >90%) was observed between the Israeli and US musculoskeletal radiologists.

Conclusion: Israeli children with JSpA presented almost exclusively with axial disease compared to US patients who were more likely to present with peripheral symptoms. Moreover, HLA B27 prevalence was significantly lower in the Israeli cohort compared to the US cohort. Further studies are needed to unravel the genetic and environmental factors associated with these findings. Further studies are needed to unravel the genetic and environmental factors associated with these findings.

Demographic and clinical features of patients from both the Israeli and the US cohorts upon presentation. *P_value of <0.05 is considered statistically significant. SD Standard deviation, IL Israel, FHx family history, HLA Human leukocyte antigen, FDR first degree relative, FABER Flexion Abduction External Rotation, ANA Antinuclear antibody, CRP C_reactive protein, ESR Erythrocyte sedimentation rate, MRI Magnetic resonance imaging.

Criteria fulfilled upon disease presentation by country. ERA Enthesitis_related arthritis, JAS Juvenile ankylosing spondylitis. * Statistically significant differences (p<0.05) between groups.

Disclosure: N. Ghantous, None; M. Heshin Bekenstein, None; K. DeQuattro, None; Y. Lakovsky, None; a. hendel, None; N. Rappoport, None; Y. Butbul Aviel, None; I. Tirosh, None; L. Harel, None; P. Weiss, Lily, 1; L. Gensler, AbbVie, 1, Eli Lilly, 1, GSK, 1, Novartis, 1, 2, Pfizer, 1, UCB, 1, 2; G. Amarilyo, None.

To cite this abstract in AMA style:

Ghantous N, Heshin Bekenstein M, DeQuattro K, Lakovsky Y, hendel a, Rappoport N, Butbul Aviel Y, Tirosh I, Harel L, Weiss P, Gensler L, Amarilyo G. Differences in Clinical Presentation Between Israeli and United States Children with Juvenile Spondyloarthritis [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/differences-in-clinical-presentation-between-israeli-and-united-states-children-with-juvenile-spondyloarthritis/. Accessed .

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