Prevalence and Distribution of Peripheral Musculoskeletal Manifestations in Axial Spondyloarthritis, Peripheral Spondyloarthritis and Psoriatic Arthritis: Results of the International, Cross-sectional ASAS-PerSpA Study

Clementina Lopez-Medina¹, Anna Molto¹, Joachim Sieper², Mehmet Tuncay Duruöz³, Uta Kiltz⁴, Bassel El-Zorkany⁵, Najia Hajjaj-Hassouni⁶, Ruben Burgos-Vargas⁷, Jose Maldonado-Cocco⁸, Nelly Ziade⁹, Meghna Gavali¹⁰, Victoria Navarro-Compán¹¹, Shue Fen Luo¹², Sara Monti¹³, Tae-Jong Kim¹⁴, Mitsumasa Kishimoto¹⁵, Fernando Pimentel-Santos¹⁶, Jieruo Gu¹⁷, Ruxandra Schiotis¹⁸, Floris van Gaalen¹⁹, Pál Géher²⁰, Marina Magrey²¹, Sebastian Ibanez²², Wilson Bautista-Molano²³, Walter Maksymowych²⁴, Pedro M Machado²⁵, Robert Landewé²⁶, Désirée van der Heijde²⁷ and Maxime Dougados²⁸, ¹Rheumatology Department, Cochin Hospital, Paris, Paris, France, ²Charité Universitätsmedizin Berlin, Berlin, Germany, ³Marmara University School of Medicine, PMR Department, Rheumatology Division, Istanbul, Turkey, ⁴Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany, ⁵Cairo University, Cairo, Egypt, ⁶Health Sciences College, International University of Rabat (UIR), Rabat, Morocco, ⁷Department of Rheumatology, General Hospital of Mexico, Ciudad de Mexico, Mexico, ⁸Buenos Aires School of Medicine, Buenos Aires, Argentina, ⁹Saint-Joseph University, Beirut, Lebanon, Beirut, Lebanon, ¹⁰Nizam’s Institute of Medical Sciences, Hyderabad, India, ¹¹Hospital Universitario La Paz IdiPaz, Madrid, Pais Vasco, Spain, ¹²Chang Gung Memorial Hospital-Linkou, Taoyuan, Taipei, Taiwan (Republic of China), ¹³Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy, ¹⁴Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea, ¹⁵Department Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan, ¹⁶3.CEDOC, NOVA Medical School, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal; 7.Hospital Egas Moniz (CHLO) (Rheumatology Department), Lisboa, Portugal, Lisbon, Portugal, ¹⁷Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, guangzhou, China (People's Republic), ¹⁸Pharmacology Department Department, Iuliu Hatieganu University of Medicine and Pharmacy, SCBI-Rheumatology Department, Cluj-Napoca, Romania, ¹⁹Leiden University Medical Center (LUMC), Leiden, Netherlands, ²⁰Semmelweis University, Budapest, Hungary, ²¹Case Western Reserve University School of Medicine, Cleveland, OH, ²²Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Region Metropolitana, Chile, ²³University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia, ²⁴University of Alberta, Edmonton, AB, Canada, ²⁵University College London, London, United Kingdom, ²⁶Amsterdam University Medical Center & Zuyderland Hospital, Amsterdam, Netherlands, ²⁷Leiden University Medical Center, Leiden, Netherlands, ²⁸Department of Rheumatology, Hopital Cochin, Université de Paris, Paris, France

Meeting: ACR Convergence 2020

Keywords: Psoriatic arthritis, spondyloarthritis

Session Information

Date: Monday, November 9, 2020

Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes II (2013–2017)

Session Type: Abstract Session

Session Time: 12:00PM-12:50PM

Background/Purpose: Peripheral musculoskeletal manifestations in patients with Psoriatic Arthritis (PsA) have been widely studied. However, there is a lack of knowledge on the distribution of such manifestations in the whole group of spondyloarthritis (SpA) and specifically in axial SpA (axSpA), even though an important overlap exists between SpA subtypes and PsA. The ASAS-PerSpA study aimed to evaluate the prevalence, characteristics and treatment of peripheral musculoskeletal manifestations in patients with axSpA and peripheral SpA (pSpA) as well as in PsA across regions of the world.

Methods: Data was collected cross-sectionally in an international multicentre study with 24 participating countries. Consecutive patients diagnosed as having axSpA, pSpA, PsA, inflammatory bowel disease-associated SpA (SpA-IBD), reactive arthritis (ReA), juvenile SpA (JuvSpA) or other form of SpA were eligible for the study. Data concerning the presence of peripheral musculoskeletal manifestations, their localization and specific treatments were collected.

Results: A total of 4465 patients were included (61% men, mean (SD) age of 45 (14) years). Patients came from four geographic areas: Latin America (12.0%), Europe and North America (37.6%), Asia (21.8%) and Middle East and North Africa (28.6%). The most prevalent clinical diagnosis was axSpA (60.9%), followed by PsA (23.1%), pSpA (9.7%), SpA-IBD ( 2.5%), ReA (1.3%), JuvSpA (1.2%) and others (1.3%).
The prevalence of musculoskeletal manifestations were plotted against geographic area and diagnosis in Figures 1 and 2. The most prevalent peripheral manifestation was peripheral articular involvement (excluding root joints) (56.9%) (Figure 1, whole population), with polyarticular involvement more often found in PsA (58.9%) and monoarticular involvement in axSpA (20.1%) (Fig.2). Predominantly upper limb- and small joint involvement were found more often in PsA (52.0%). Predominantly lower limb- and large joint involvement were found more often in ReA and IBD-SpA (55.9%) and in pSpA (51.2%) (Figure 2). Root joint (i.e., hip or shoulder) involvement was found in 33.7% and, of these, 21.8% had both hip and shoulder involvement. Among the total patients with root joint disease, hip involvement alone was found in 57.1%, being most frequent in axSpA (65.0%). Enthesitis in the different groups ranged between 40.9% and 65.9%, with the lowest prevalence found for axSpA; PsA showed the highest mean number of locations of all episodes of enthesitis (4.3 (4.6)). Finally, the prevalence of dactylitis was 15.3%. Dactylitis of the fingers was more prevalent in the group of ReA and IBD-SpA (75.0%), but a higher prevalence of toe-involvement was found in Juv-SpA (66.7%). Only 8.1%, 12.1% and 14.3% of patients had received local injections of corticosteroids for peripheral enthesitis, dactylitis and root joint involvement, respectively.

Conclusion: Although all types of peripheral manifestations are present in the different subtypes of SpA, this study suggests a high inter-region and inter-diagnosis variability of the prevalence of the various peripheral musculoskeletal manifestations in patients with either SpA or PsA.

Figure 1. Peripheral musculoskeletal manifestations with regard to the geographic area.

Figure 2. Peripheral musculoskeletal manifestations with regard to the diagnosis.

Disclosure: C. Lopez-Medina, None; A. Molto, ABBVIE, 5, BMS, 5, 8, LILLY, 5, NOVARTIS, 5, 8, UCB, 5, GILEAD, 5; J. Sieper, AbbVie, 5, Novartis, 5, 8, Lilly, 8, Janssen, 5, Merck, 5, 8; M. Duruöz, None; U. Kiltz, Abbvie, 2, 5, Biocad, 2, 5, Biogen, 2, 5, Chugai, 2, 5, Eli Lilly, 2, 5, Grünenthal, 2, 5, Janssen, 2, 5, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Roche, 2, 5, UCB, 2, 5; B. El-Zorkany, None; N. Hajjaj-Hassouni, None; R. Burgos-Vargas, None; J. Maldonado-Cocco, None; N. Ziade, None; M. Gavali, None; V. Navarro-Compán, Novartis Pharma, 1, 5, 8, AbbVie Inc., 5, 8, Eli Lilly and Company, 5, 8, Pfizer Inc., 5, UCB, 5, 8; S. Luo, None; S. Monti, None; T. Kim, None; M. Kishimoto, AbbVie, 1, 2, Amgen-Astellas BioPharma, 1, 2, Asahi-Kasei Pharma, 1, 2, Astellas, 1, 2, Ayumi Pharma, 1, 2, BMS, 1, 2, Chugai, 1, 2, Daiichi-Sankyo, 1, 2, Eisai, 1, 2, Eli Lilly, 1, 2, Gilead, 1, 2, Janssen, 1, 2, Kyowa Kirin, 1, 2, Novartis, 1, 2, Pfizer, 1, 2, Tanabe-Mitsubishi, 1, 2, Teijin Pharma, 1, 2, UCB Pharma, 1, 2, Celgene, 5, 8; F. Pimentel-Santos, None; J. Gu, None; R. Schiotis, None; F. van Gaalen, Reuma Nederland, 1, Stichting vrienden van Sole Mio, 1, MSD, 1, Abbvie, 1, Novartis, 1; P. Géher, None; M. Magrey, Novartis, 5, Eli Lilly, 5, AbbVie, 2, UCB, 2, Amgen, 2, Pfizer, 5, Janssen, 5; S. Ibanez, Novartis, 1, Bristol Myers, 1, Abbvie, 1; W. Bautista-Molano, None; W. Maksymowych, AbbVie, 2, 5, Janssen, 5, Lilly, 5, Pfizer, 2, 5, Novartis, 2, 5, Gilead, 5, UCB Pharma, 5, Boehringer Ingelheim, 5, Galapagos, 5; P. Machado, Abbvie, 5, 8, Eli Lilly, 5, Novartis, 5, 8, UCB, 5, 8, Pfizer, 8; R. Landewé, AbbVie, 2, 5, 8, AstraZeneca, 5, Bristol-Myers Squibb, 5, 8, Eli Lilly, 5, Galapagos, 5, Novartis, 5, Pfizer Inc, 2, 5, 8, UCB, 2, 5, 8, GlaxoSmithKline, 5, Janssen, 2, 5, 8, Merck, 5, 8, Rheumatology Consultancy BV, 1, Ablynx, 5, Amgen, 2, 5, 8, Celgene, 5, Gilead, 5, Novo Nordisk, 5, Roche, 2, 5, 8, Schering, 2, 5, 8, TiGenix, 5; D. van der Heijde, AbbVie, 5, Bristol-Myers Squibb, 5, Cyxone, 5, Galapagos NV, 5, Gilead Sciences, Inc., 5, GlaxoSmithKline, 5, Eli Lilly, 5, Novartis, 5, Pfizer, 5, UCB Pharma, 5, Amgen Inc., 5, Astellas, 5, AstraZeneca, 5, Boehringer Ingelheim, 5, Celgene, 5, Daiichi-Sankyo, 5, Janssen, 5, Merck, 5, Regeneron, 5, Roche, 5, Sanofi, 5, Takeda, 5, Imaging Rheumatology bv, 3, Eisai, 5; M. Dougados, Pfizer, 1, 2, Abbvie, 1, 2, UCB, 1, 2, Merck, 1, 2, Lilly, 1, 2, BMS, 1, 2, Roche, 1, 2, Novartis, 1, 2.

To cite this abstract in AMA style:

Lopez-Medina C, Molto A, Sieper J, Duruöz M, Kiltz U, El-Zorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compán V, Luo S, Monti S, Kim T, Kishimoto M, Pimentel-Santos F, Gu J, Schiotis R, van Gaalen F, Géher P, Magrey M, Ibanez S, Bautista-Molano W, Maksymowych W, Machado P, Landewé R, van der Heijde D, Dougados M. Prevalence and Distribution of Peripheral Musculoskeletal Manifestations in Axial Spondyloarthritis, Peripheral Spondyloarthritis and Psoriatic Arthritis: Results of the International, Cross-sectional ASAS-PerSpA Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/prevalence-and-distribution-of-peripheral-musculoskeletal-manifestations-in-axial-spondyloarthritis-peripheral-spondyloarthritis-and-psoriatic-arthritis-results-of-the-international-cross-sectional/. Accessed .

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