Background/Purpose: The use of synthetic DMARDS (sDMARDs) in spondyloarthritis (SpA) has been increasingly questioned and restricted to peripheral disease, on the other hand, the use of immunobiological agents for the treatment of SpA has been further improved by anti-TNF and the release of new drugs with other mechanisms such as secukinumab (anti-IL17, SEC) and ustekinumab (anti-IL12/23, UST). The objective of our study is to describe clinical and treatment data of a SpA patients cohort followed at the outpatient clinic of a Brazilian single center.

Methods: 516 SpA patients evaluated from January 2017 to January 2018. Data from electronic medical records were assessed including diagnosis, disease characteristics, treatment and disease activity at the last visit.

Results: Among all patients, 195 (37.8%) were classified as Ankylosing Spondylitis (AS), 198 (38.3%) as psoriasis arthritis (PsA), 66 (12.8%) as axial non-radiographic or peripheral SpA, 42 (8.1%) as SpA related to inflammatory bowel disease and 15 (3.0%) as reactive arthritis patients. From all SpA patients 190 (36.8%) have no axial disease, with isolated peripheral arthritis. Regarding treatment, 321 (62.2%) patients were under sDMARDs as monotherapy or in association [156/321 (48.6%) methotrexate (MTX); 125/321 (38.9%) sulfasalazine (SSZ)]; 298 (57.7%) patients used NSAIDs. Concerning biological therapy 204 (39.5%) patients received biological DMARDs (bDMARDs) [68 infliximab (IFX), 59 adalimumab (ADA), 35 etanercept (ETA), 6 golimumab (GOL), 2 certolizumab pegol (CTZ), 23 secukinumab (SEC), 10 ustekinumab (UST), 1 rituximab (RTX)]. Patients with isolated peripheral involvement presented higher frequency of sDMARD use (78.4% vs. 51.4%, P <0.001) compared to patients with axial disease, but with similar use of biological drug (37.1% vs. 45.7%, P = 0.13) and combined treatment of bDMARD and sDMARD (26.7% vs. 25%, P = 0.73). Forty-three AS patients (43/52, 82.7%) were HLA-B27 positive; 152/195 (77.9%) received NSAIDs; 95/195 (48.7%) used sDMARDs (23.1% MTX and 72.6% SSZ) and 79/195 (40.5%) used bDMARDs (31 INF, 22 ADA, 19 ETA, 3 GOL, 3 SEC, 1 UST). Among the 198 PsA patients, 148/198 (74.7%) have isolated peripheral disease; 146/198 (73.7%) used sDMARDs (78.8% MTX and 26.7% LNF) and 77/198 (38.9%) received bDMARDs (24 IFX, 18 ADA, 10 ETA, 19 SEC, 6 UST, 1 RTX). In relation to disease activity, 25/125 (20%) of AS patients had ASDAS ≥ 2.1 and 42/198 (21%) of PsA patients presented active arthritis in the last visit.

Conclusion: The description of epidemiological and clinical data of this cohort reinforces high prevalence of peripheral disease in Brazilian SpA patients. This fact could explain the wide use of sDMARDs in these patients. The frequency use of bDMARDs is in parallel with literature data including non-antiTNF drugs as SEC and UST.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-life-analysis-of-a-latin-america-tertiary-spondyloarthritis-single-center-high-frequency-of-peripheral-involvement-and-use-of-synthetic-dmard/