ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2002

Differences in Features of Chronic Back Pain in First Degree Relatives of Patients with Ankylosing Spondylitis (AS) Compared to the U.S. Population

David Kung1, Michael Weisman2, MinJae Lee3, Lianne S. Gensler4, Michael Ward5, Amirali Tahanan3, Laura A. Diekman1, Shervin Assassi6, Mohammad H. Rahbar3 and John D. Reveille1, 1Rheumatology, University of Texas-McGovern Medical School, Houston, TX, 2Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 3Biostatistics/Epidemiology/Research Design (BERD) Core | Center for Clinical and Translational Sciences, University of Texas-McGovern Medical School, Houston, TX, 4Medicine/Rheumatology, UCSF, San Francisco, CA, 5NIH/NIAMS, Bethesda, MD, 6Department of Internal Medicine - Rheumatology, University of Texas-McGovern Medical School, Houston, TX

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Monday, November 14, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment III: Axial Spondyloarthritis – Clinical

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:  To compare the clinical features of spondyloarthritis in first degree relatives (FDRs) of patients with ankylosing spondylitis (AS) with chronic back pain (CBP) with those participants in a nationally representative sample of US adults examined in 2009-2010 US National Health and Nutrition Examination Survey (NHANES) who also had CBP.

Methods: Non-Hispanic White FDRs of AS patients, without a prior diagnosis of AS, between the ages of 20-69 were included in a prospective cohort study. A questionnaire was used to obtain demographic and clinical data focusing on features of spondyloarthritis. We compared demographic and clinical features between FDR and NHANES cohorts using both univariable and multivariable regression analyses, controlling for age and gender. We focused on non-Hispanic whites because of the limited number of nonwhite FDRs available from the family study. Excluded from the analysis were 20 FDRs and 12 participants in the 2009-2010 NHANES study with CBP who carried a diagnosis of AS.

Results: This study of non-Hispanic White FDRs with chronic back pain without a prior AS diagnosis between 20-69 years of age, including 67 FDRs from 60 families from a total of 499 FDRs examined and 722 with chronic back pain of the 2244 white participants in the 2009-2010 NHANES cohort. Significant results are shown in Table 1. FDRs of AS patients were more likely to have neck, buttock and hip pain. They were also more likely to have alternating buttock pain, pain that improves with activity and worsens with rest as well as pain that awakens them at night and morning stiffness of >30 minutes. Of particular interest was a higher frequency of heel pain and ulcerative colitis and marginal increases in uveitis and psoriasis. Of note, there were no significant differences in the frequencies of upper, mid or low back pain (data not shown). Also, although FDRs of AS patients were more likely to use non-steroidal anti-inflammatory drugs (NSAIDs) for their back pain, there were no differences in response to NSAIDs compared to the US population (data not shown).

Table 1. Comparison of AS-FDR and NHANES Non-Hispanic Whites Aged 20-69 Years with Chronic Back Pain Based on Univariable/Multivariable Regression Models
Variable FDR’s n=67 NHANES n=772 Univariable P value Multivariable P value
Male, % 43.3 45.9 0.685 0.683
Age (±SD in years) 45.2 (± 13.5) 45.1 (± 13.6) 0.933 0.934
Age Onset (±SD in years) 26.1 (± 12.3) 32.6 (± 14.1) <0.0001 <0.0001
Neck pain, % 52.2 36.1 0.009 0.011
buttock pain, % 49.3 30.7 0.001 0.002
hip pain, % 43.3 15.9 0.0006 0.001
Alternating buttock pain, % 57.4 32.5 <0.0001 <0.0001
Pain improves with activity,% 86.9 65.4 0.002 0.003
Pain worsens with rest,% 31.8 23.6 <0.0001 0.0002
Pain awakens from sleep,% 61.9 48.1 0.036 0.046
Morning stiffness >30 minutes,% 74.6 48.6 0.0003 0.001
Heel pain not due to trauma,% 49.2 19.6 <0.0001 <0.0001
Uveitis, % 3.1 0.65 0.039 0.068
Ulcerative colitis,% 4.6 1.0 0.015 0.030
Crohn’s disease,% 0 0.4 0.615 0.989
Psoriasis,% 11.1 5.3 0.057 0.065

  

Conclusion:   Chronic back pain in FDRs of non-Hispanic White AS patients not carrying a diagnosis of AS shares significantly more features of axial spondyloarthritis than chronic back pain in the general population. The clinician should have a high index of suspicion of axial spondyloarthritis in the clinical evaluation and treatment of chronic back pain in this group.

Disclosure: D. Kung, None; M. Weisman, None; M. Lee, None; L. S. Gensler, AbbVie, Amgen, Janssen, Novartis, UCB, 5; M. Ward, None; A. Tahanan, None; L. A. Diekman, None; S. Assassi, Boehringer Ingelheim, 5,Genentech and Biogen IDEC Inc., 2,Bayer HealthCare, 2; M. H. Rahbar, None; J. D. Reveille, None.

To cite this abstract in AMA style:

Kung D, Weisman M, Lee M, Gensler LS, Ward M, Tahanan A, Diekman LA, Assassi S, Rahbar MH, Reveille JD. Differences in Features of Chronic Back Pain in First Degree Relatives of Patients with Ankylosing Spondylitis (AS) Compared to the U.S. Population [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/differences-in-features-of-chronic-back-pain-in-first-degree-relatives-of-patients-with-ankylosing-spondylitis-as-compared-to-the-u-s-population/. Accessed .

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