Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose : The Spondyloarthropathy (SpA) that affect in many aspects of life of the patients, either for their musculoskeletal or extra-articular manifestations (EAM). EAM vary in frequency and severity, the most common are: uveitis, inflammatory bowel disease and skin diseases. Some epidemiological studies have found increased incidence of EAM as a consequence of disease activity. This study aims to analyze the relationship between the EAM with disease activity in patients with new onset SpA.
Methods: This is a longitudinal study, for which the ESPERANZA Program database from Spanish Society of Rheumatology was analyzed. Database includes SpA patients with aged between 18 and 45 years, with duration of disease between 3 and 25 months, belonging to 25 health centers in Spain. The primary endpoint were all the EAM analyzed together and by themselves. The independent variables were: demographics; disease activity parameters as BASDAI, at least one painful and swollen joints, at least one enthesitis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR); metrological parameter (BASMI), quality parameter (ASQoL) and functionality parameter (BASFI); HLA-B27, duration of disease at the diagnoses and the presence of sacroiliitis on magnetic resonance. The quantitative variables were described as mean and standard deviation (SD) if distributed symmetrically and if distributed asymmetrically by the median and interquartile ranges (IR), qualitative were described with percentages accompanied by absolute value. The Pearson or Spearman correlation, Student t test, analysis of variance and chi square test were used for bivariate analysis according to the variables to be analyzed. For multivariate analysis the variables analyzed were those that had P <0.20, or those that had clinical relevance for the study, we used multiple linear regression analysis or logistic regression model.
Results: 698 patients [426 men (61%)] with median age of 32.9 years (CI: 27.5–38.9) were studied. Table 1 shows the EAM studied. Table 2 shows the independent variables, which were analyzed with the EAM (table 3).
Conclusion: The presence of enthesitis, tender and swollen joint favors the appearance of EAM. The presence of HLA B27 and sacroiliitis are protective factors of occurrence of EAM. These are raw data, to be wanting to adjust for covariates and potential confounders.
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Table 1: Extra-articular manifestations in patients diagnosed with new-onset spondyloarthropathy (n=698).
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Patient without EAM
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Patient with EAM |
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At least one EAM
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406 (41.8%) |
292 (58.2%) |
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Psoriasis
|
577 (82,7%) |
121 (17.3%) |
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Urethritis
|
685 (98.1%) |
13 (1.9%) |
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Uveitis / Iritis
|
656 (94%) |
42 (6%) |
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Pustulosis
|
694 (99.4%) |
4 (6%) |
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Acne
|
692 (99.1%) |
6 (0.9%) |
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Inflammatory bowel disease
|
654 (93.7%) |
44 (6.3%) |
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Nail psoriasis
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670 (96%) |
28 (4%) |
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Dactylitis
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625 (89.5%) |
73 (10.5%) |
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Enthesopathy
|
634 (90.8%) |
64 (9.2%) |
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Tabla 2: Demographic, measurement parameters, markers of activity, presence of sacroiliitis on MRI, presence of HLA B27, according to the presence of extra-articular manifestations in patients diagnosed with new-onset spondyloarthropathy (n=698).
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Total Spa patients (n = 698)
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Spa patients with at least one EAM (n=292)
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Spa patients without EAM (n=406)
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N
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Lost
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Mean (SD)
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Median (IR)
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N
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Lost
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Mean (SD)
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Median (IR)
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N
|
Lost
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Mean (SD)
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Median (IR)
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|
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Men
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426 (61%) |
180 (61.6%) |
246 (60.6%) |
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Women
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272 (39%) |
112 (38.4%) |
160 (39.4%) |
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Age at diagnosis of Spa
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698 |
0 |
32.92 (27.6-38.8) |
292 |
0 |
– |
34.14 (28.66-39.75) |
406 |
0 |
– |
31.98 (26.61-38.27) |
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BASDAI
|
597 |
101 |
– |
4.7 (2.8-6.2) |
252 |
40 |
– |
4.8 (3-6.38) |
345 |
61 |
– |
4.4 (2.75-6.05) |
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BASMI
|
698 |
0 |
1.09 (1.06) |
– |
292 |
0 |
1.05 (1.02) |
– |
406 |
0 |
1.12 (1.09) |
– |
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BASFI
|
574 |
124 |
2.65 (2.22) |
– |
244 |
48 |
2.57 (2.21) |
– |
330 |
76 |
2.58 (2.21) |
– |
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ASQoL
|
519 |
179 |
6.96 (2.22) |
– |
231 |
61 |
7.14 (4.92) |
– |
288 |
118 |
6.74 (4.83) |
– |
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ESR
|
578 |
120 |
16.98 (7.42) |
– |
237 |
55 |
19.25 (18.9) |
– |
341 |
65 |
15.4 (16.15) |
– |
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CRP (mg/dl)
|
633 |
65 |
10.08 (18.36) |
– |
262 |
30 |
11.9 (18.6) |
– |
371 |
35 |
– |
3 (1-9) |
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Evolution of the disease (month)
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698 |
0 |
11.77 (6.67) |
– |
292 |
0 |
11.02 (6.46) |
– |
406 |
0 |
– |
12.17 (6-17.7) |
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Presence of swollen joint
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181 (25.9%) |
0 |
120 (41.1%) |
61 (15%) |
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Absence of swollen joint
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517 (74.1%) |
0 |
172 (58.9%) |
345 (85%) |
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Presence of painful joint
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165 (23.6%) |
0 |
108 (37%) |
349 (86%) |
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Absence of painful joint
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533 (76.4%) |
0 |
184 (63%) |
57 (14%) |
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Presence of enthesitis
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253 (36.2%) |
0 |
124 (42.5%) |
129 (31.8%) |
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Absence of enthesitis
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445 (63.8%) |
0 |
168 (57.5%) |
277 (68.2%) |
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Positive HLA B27
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363 (52%) |
51 |
112 (38.4%) |
251 (61.8%) |
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Negative HLA B27
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284 (40.7%) |
149 (51%) |
135 (33.3%) |
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Sacroiliitis on MRI
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159 (22.8%) |
397 |
37 (12.7%) |
122 (30%) |
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Absence of sacroiliitis on MRI
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142 (20.3%) |
62 (21.2%) |
80 (19.7%) |
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Table 3: Relationship of the appearance of extra-articular manifestations with: disease activity parameters; metrological, functionality and quality parameters; HLA-B27, duration of disease at the diagnoses and the presence of sacroiliitis on magnetic resonance.
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C.I. 95%
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OR
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Lower limit
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Upper Limit
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p value
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Age
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1.036 |
1.013 |
1.058 |
0.002 |
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BASDAI
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1.067 |
0.991 |
1.148 |
0.084 |
|||
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BASMI
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0.937 |
0.812 |
1.082 |
0.376 |
|||
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BASFI
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0.973 |
0.902 |
1.048 |
0.467 |
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ASQoL
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0.983 |
0.949 |
1.019 |
0.349 |
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ESR
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1.013 |
1.003 |
1.022 |
0.01 |
|||
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CRP
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1.01 |
1 |
1.019 |
0.045 |
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Evolution of the disease (month)
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0.971 |
0.949 |
0.994 |
0.012 |
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Woman
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0.957 |
0.703 |
1.303 |
0.778 |
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Positive HLA B27
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0.404 |
0.293 |
0.558 |
0 |
|||
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Sacroiliitis on MRI
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0.391 |
0.238 |
0.642 |
0 |
|||
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Presence of swollen joint
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3.946 |
2.757 |
5.647 |
0 |
|||
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Presence of painful joint
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3.564 |
2.489 |
5.188 |
0 |
|||
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Presence of enthesitis
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1.585 |
1.16 |
2.166 |
0.004 |
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Disclosure:
C. A. Egües Dubuc,
None;
M. Martin Martinez,
None;
J. Belzunegui Otano,
None;
M. Uriarte Ecenarro,
None;
J. Mulero,
None;
E. de Miguel,
None;
S. Muñoz,
None;
P. Zarco,
None;
E. Collantes,
None;
S. Perez Vicente,
None;
M. Gobbo,
None.
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