Session Information
Date: Monday, November 6, 2017
Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Traditionally, patients with spondyloarthritis (SpA) were classified in five subgroups: ankylosing spondylitis (AS), psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis and undifferentiated SpA (uSpA). Nowadays, the ASAS criteria classify patients in peripheral SpA and axial SpA (axSpA), being the latest classified in two groups: classical AS and non-radiographic axSpA (nr-axSpa). Whether or not patients with nr-axSpA represent the same group of patients that used to be classified as uSpA remains unclear. The purpose is to evaluate the similarities and differences between patients with predominant axial disease classified currently as nr-axSpA versus those traditionally classified as uSpA.
Methods:
Baseline data from the ESPeranza program (a multicenter national initiative to early diagnose SpA between 2008 and 2011) was used. Inclusion criteria for this program were: age <45 years, symptoms duration 3-24 months and with inflammatory back pain -IBP- or asymmetrical arthritis or spinal/joint pain plus ≥1 SpA features). For this study, only patients with predominant axial manifestation were selected. Demographic, clinic, laboratory and image results were compared between two groups: i) 182 patients with nr-axSpA according to ASAS criteria, and ii) 166 patients classified as uSpA defined as fulfilling ESSG/Amor criteria in absence of sacroiliitis (mNY), psoriasis, inflammatory bowel disease and reactive arthritis. In order to get a deeper knowledge of the differences between nr-axSpA and uSpA, we also compared: i) 88 patients only classified as nr-axSpA, ii) 72 patients only classified as uSpA; iii) 94 patients fulfilling both criteria.
Results:
Results are shown in table 1 and table 2. Compared to patients classified as uSpA patients with nr-axSpA were younger, had HLA-B27 positive more frequently and higher values of CRP. On the other hand, they had history of SpA less frequently and lower values for BASDAI, BASFI and ASQol.
Table 1: Results are presented in mean ± standard deviation for continuous variables and n (%) for categorical variables.
|
nr-axSpA N (%)= 182 |
Undifferentiated SpA N (%) = 166 |
|
|
Age (years) |
31.5 ± 7.1 |
32.8 ± 7.4 |
|
Male |
108 (61) |
95 (57.2) |
|
HLA-B27 |
142 (80.2) |
87 (52.4) |
|
Dactylitis |
11 (6.2) |
12 (7.2) |
|
Enthesitis |
46 (26.0) |
51 (30.7) |
|
BASDAI |
3.7 ± 2.2 |
4.1 ± 2.3 |
|
BASFI |
2.1 ± 2.2 |
2.5 ± 2.4 |
|
BASMI |
1.2 ± 1.1 |
1.3 ± 1.2 |
|
ASQoL |
5.6 ± 4.6 |
6.6 ± 5.0 |
|
CRP (mg/L) |
10.3 ± 15.4 |
8.2 ± 12.6 |
Table 2
|
Both, nr-axSpA & undifferentiated SpA N (%) = 94 |
Only nr-axSpA N (%)= 88 |
Only undifferentiated SpA N (%) = 72 |
p value* |
|
|
Age (years) |
30.9 ± 7.3 |
32.2 ± 6.9 |
35.2 ± 6.9 |
<0.01 |
|
Male |
61 (64.9) |
50 (56.8) |
34 (47.2) |
0.2 |
|
Family history |
48 (51.1) |
21 (23.9) |
30 (41.7) |
<0.05 |
|
HLA-B27 |
81 (86.2) |
65 (73.9) |
6 (8.3) |
<0.001 |
|
BASDAI |
3.7 ± 2.3 |
3.8 ± 2.1 |
4.7 ± 2.3 |
0.01 |
|
BASFI |
2.2 ± 2.2 |
2.1 ± 2.1 |
2.9 ± 2.5 |
<0.05 |
|
BASMI |
1.0 ± 1.2 |
1.4 ± 0.9 |
1.6 ± 1.1 |
0.2 |
|
ASQoL |
5.9 ± 4.7 |
5.2 ± 4.5 |
7.4 ± 5.2 |
0.01 |
|
CRP (mg/L) |
10.7 ± 14.3 |
9.8 ± 16.5 |
5.1 ± 9.1 |
<0.05 |
*p value for differences between nr-axSpA and undifferentiated SpA (Student-t test for continuous variables and Pearson Chi-square test for categorical variables)
Conclusion:
Compared with patients traditionally classified as uSpA, patients who are currently classified as nr-axSpA are diagnosed earlier, are more frequently HLA-B27 carriers and have higher disease activity according to objective parameters. On the other hand, they report lower values for patient reported outcomes.
To cite this abstract in AMA style:
Juan A, Juanola X, De Miguel E, Collantes-Estevez E, Quevedo JC, Alonso E, Navarro-Compán V. Similarities and Differences between Patients Fulfilling Non-Radiographic Axial Spondyloarthritis and Undifferentiated Spondyloarthritis Criteria: Results from the Esperanza Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/similarities-and-differences-between-patients-fulfilling-non-radiographic-axial-spondyloarthritis-and-undifferentiated-spondyloarthritis-criteria-results-from-the-esperanza-cohort/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/similarities-and-differences-between-patients-fulfilling-non-radiographic-axial-spondyloarthritis-and-undifferentiated-spondyloarthritis-criteria-results-from-the-esperanza-cohort/