Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: It is possible to classify patients as having spondyloarthritis (SpA) according to the ASAS axial SpA (axSpA) criteria HLA-B27+ arm without any signs of sacroiliitis on MRI or X-ray. The question arises whether patients fulfilling the HLA-B27+ arm reflect a group of patients similar to those fulfilling the imaging-arm of the ASAS axSpA criteria1. Therefore, we compared demographics, number of SpA-features and level of disease activity in patients fulfilling the imaging-arm to patients fulfilling the HLA-B27+ arm of the ASAS axSpA criteria.
Methods: The SPondyloArthritis Caught Early (SPACE)-cohort is set-up in the Leiden University Medical Center (LUMC) aiming to diagnose and treat patients with axSpA at an earlier stage. Patients with back pain (≥3 months, but ≤2 years, onset <45 years) visiting the rheumatology outpatient clinic were included. All patients of the SPACE-cohort (n=157) fulfilling the ASAS axSpA criteria were included in this analysis (n=60). Patients were compared on demographics, presence of SpA-features and level of disease activity.
Results: Of those 60 patients, 30 fulfilled the imaging-arm (11 patients fulfilling the modified New York (mNY) criteria; 19 patients had sacroiliitis on MRI only); 30 fulfilled the HLA-B27+ arm. Patients fulfilling the HLA-B27+ arm have significantly more often a positive family history for SpA (p=0.001), are more frequently female (p=0.04) and have a significantly shorter symptom duration (p=0.02). Moreover, there was a trend toward more uveitis (p=0.07). Patients in both arms are very similar with respect to all other SpA-features and level of disease activity (BASDAI and ASDAS). Within the imaging-arm, patients with sacroiliitis on X-ray did not differ significantly from patients with sacroiliitis on MRI in any of the tested variables including symptom duration and disease activity.
Conclusion: Patients with sacroiliitis on X-ray have the same level of disease activity and symptom duration as patients with sacroiliitis on MRI only. Patients fulfilling the HLA-B27+ arm are remarkably similar to patients fulfilling the imaging-arm of the ASAS axSpA criteria, with respect to the presence of most SpA-features and level of disease activity.
References :
1Rudwaleit M et al. ARD 2009;68:777-83
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Imaging-arm, n=30 |
HLA-B27+ arm, n=30 |
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mNY+, n=11 |
mNY-, n=19 |
Total, n=30 |
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Age (years) at inclusion, mean ± SD |
28.6 ± 9.6 |
32.9 ± 8.7 |
31.2 ± 9.0 |
28.2 ± 8.4 |
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Male, n (%) |
8 (72.7) |
11 (57.9) |
19 (63.3)# |
10 (33.3)# |
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Duration of back pain (months), mean ± SD |
15.6 ± 8.5 |
16.0 ± 6.9 |
15.5 ± 7.6# |
11.4 ± 7.3# |
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HLA-B27 positive, n (%) |
6 (54.5) |
11 (61.1) |
17 (58.6)# |
30 (100)# |
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Pos. fam. history SpA, n (%) |
4 (36.4) |
5 (26.3) |
9 (30.0)# |
22 (73.3)# |
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IBP, n (%) |
9 (81.8) |
14 (73.7) |
23 (76.7) |
27 (90.0) |
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Psoriasis, n (%) |
2 (18.2) |
2 (10.5) |
4 (13.3) |
4 (13.3) |
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Dactylitis, n (%) |
0 (0.0) |
2 (10.5) |
2 (6.7) |
1 (3.3) |
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Enthesitis, n (%) |
2 (18.2) |
2 (10.5) |
4 (13.3) |
4 (13.3) |
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Uveitis, n (%) |
1 (9.1) |
1 (5.3) |
2 (6.7) |
7 (23.3) |
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IBD, n(%) |
2 (18.2) |
1 (5.3) |
3 (10.0) |
0 (0.0) |
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Preceding infection, n (%) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
1 (3.3) |
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CRP (mg/l), mean ± SD |
6.9 ± 7.2 |
7.6 ± 8.6 |
7.3 ± 8.0 |
15.6 ± 18.9 |
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ESR (mm/h), mean ± SD |
11.4 ± 13.9 |
14.2 ± 14.8 |
13.2 ± 14.3 |
9.4 ± 14.9 |
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Alternating buttock pain, n (%) |
6 (54.5) |
5 (26.3) |
11 (36.7) |
5 (16.7) |
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Good response to NSAIDs, n (%) |
6 (54.5) |
10 (52.6) |
16 (53.3) |
13 (43.3) |
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Elevated CRP/ESR, n (%) |
4 (36.4) |
5 (26.3) |
9 (30.0) |
7 (23.3) |
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Asymmetric lower limb arthritis, n (%) |
0 (0.0) |
4 (21.1) |
4 (13.3) |
4 (13.3) |
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Sacroiliitis X-ray, n (%) |
11 (100) |
0 (0.0) |
11 (36.7)# |
0 (0.0)# |
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Sacroiliitis MRI, n (%) |
6 (60.0) |
19 (100) |
25 (86.2)# |
0 (0.0)# |
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BASDAI |
3.71 ± 1.8 |
4.01 ±2.5 |
3.90 ± 2.3 |
3.92 ± 1.9 |
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ASDAS |
2.37 ± 0.7 |
2.46 ± 0.9 |
2.43 ± 0.8 |
4.44 ± 0.9 |
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IBP, Inflammatory Back Pain; IBD, Inflammatory Bowel Disease; age, age at baseline; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HLA-B27, Human Leukocyte Antigen; preceding infection can be balinitis, urethritis, cervicitis and/or acute diarrhea; mNY, modified New York criteria. # represent a statistical significant difference between patients fulfilling the imaging-arm and patients fulfilling the HLA-B27+ arm (p-value <0.05) |
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Disclosure:
R. van den Berg,
None;
M. de Hooge,
None;
F. van Gaalen,
None;
M. Reijnierse,
None;
T. Huizinga,
None;
D. van der Heijde,
None.
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