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).
|Variable||FDR’s n=67||NHANES n=772||Univariable P value||Multivariable P value|
|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|
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.
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 August 4, 2021.
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