ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1231

The Prevalence of Non-Radiographic Axial Spondyloarthritis Among Patients with Inflammatory Back Pain in Rheumatology Practices

Rubén Burgos-Vargas1, James Wei2, Mahboob U Rahman3, Nurullah Akkoc4, Syed A. Haq5, Mohammed Hammoudeh6, Ehab Mahgoub7, Ena Singh8, Lyndon Llamado9, Khalid Shirazy10, Sameer Kotak11, Connie Hammond7, Ronald Pedersen12, Qi Shen13 and Bonnie Vlahos13, 1Rheumatology, Hospital General de Mexico, Mexico city, Mexico, 2Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan, 3Perelman School of Medicine, University of Pennsylvania, Philadephia, PA, 4Department of Rheumatology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey, 5Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 6Medicine, Hamad Medical Corporation, Doha, Qatar, 7Pfizer, Collegeville, PA, 8500 Arcola Road, Pfizer, Collegeville, PA, 9Pfizer, Makati, Philippines, 10Pfizer, Dubai, United Arab Emirates, 11Global Health and Value, Pfizer, New York, NY, 12Department of Biostatistics, Pfizer, Collegeville, PA, 13GIPB - Clinical Sciences, Pfizer, Collegeville, PA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: , ,

Session Information

Date: Monday, November 9, 2015

Title: Epidemiology and Public Health Poster II: Pathogenesis and Treatment of Systemic Inflammatory Diseases

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The diagnosis of Ankylosing
Spondylitis (AS) is delayed by >10 years after the symptoms develop, as by
definition the modified NY criteria for classification of AS requires
radiographic sacroiliitis (X-ray SI). However, patients continue to suffer and
have similar disease burden even before radiographic changes are evident. The
new Assessment of SpondyloArthritis international Society (ASAS) classification
criteria for non-radiographic axial spondyloarthritis (nr-axSpA) helps to
identify many of these patients. The purpose of this
epidemiological study was to estimate the prevalence of nr-axSpA among patients
with inflammatory back pain (IBP) presenting to rheumatology clinics in Latin
America, Africa, Europe, and Asia.

Methods: Consecutive patients with
IBP from 51 participating rheumatology clinics in 19 countries were enrolled.
Data were collected using medical records, self-completed questionnaires,
physician evaluation (for SpA features), magnetic resonance imaging (MRI),
X-ray SI, human leukocyte antigen B27 (HLA-B27), and CRP results. Patients with
IBP were classified as nr-axSpA or AS using the ASAS and modified New York
criteria, respectively. In addition, ASDAS – ESR and CRP, BASDAI, BASFI, and
BASMI were evaluated.

Results: Data from 914 patients with
IBP were collected; of which 266 (27.3%) had nr-axSpA with the highest
prevalence in Asia (36.5%). HLA-B27 results were available for 544 (59.5%)
patients with IBP; 135/189 (71.4%) with nr-axSpA patients were HLA-B27 positive.
Baseline characteristics of patients with nr-axSpA, and the efficacy
assessments are shown in Table 1. The BASFI and BASMI scores were lower among
patients with nr-axSpA than those observed in patients with AS. However, considerable
disease burden (as measured by ASDAS and BASDAI) was noted in patients with
nr-axSpA (Table 1).

Conclusion: Approximately 30% of patients
referred to rheumatology clinics with IBP in all regions studied met the
classification criteria for nr-axSpA. The prevalence of nr-axSpA varies by
region, with the highest in Asia and the lowest in Africa, possibly due to
limited access to MRI and HLA-B27 testing in these regions. The overall disease
burden in nr-axSpA is substantial and similar to AS. These findings justify the
need for intensive therapy, which may have positive long-term benefits.
However, as this was an epidemiological study, these data may have some
selection bias and should be interpreted with caution.

 

 Table 1. Baseline characteristics, and clinical and patient-reported outcomes among patients with inflammatory back pain

Parameter

Total IBP

(n=914)

nr-axSpA

(n=266)

AS

(n=491)

Other IBP

(n=157)

P-valuea

Age, years

38.7±12.0

34.8±10.0

39.0±11.4

44.3±14.5

<0.001

Males, n (%)

588 (64.3)

169 (63.5)

350 (71.3)

69 (44.0)

<0.001

Duration of IBP, years

5.4±8.0

5.2±7.7

6.5±8.5

5.2±8.3

0.747

Age of IBP onset, years

28.8±9.7

27.8±7.3

27.0±7.7

36.2±14.2

<0.001

Positive HLA-B27, n/N* (%)**

397/544 (73.0)

135/189 (71.4)

250/302 (82.8)

12/53 (22.6)

<0.001

Family history of SpA, n/N* (%)**

220/870 (25.3)

70/250 (28.0)

132/475 (27.8)

18/145 (12.4)

<0.001

ASDAS score – ESR

2.9±1.1

2.6±1.2

3.0±1.1

2.9±1.0

0.003

ASDAS score – CRP

2.8±1.2

2.5±1.2

2.9±1.2

2.8±1.2

0.002

BASDAI

4.4±2.2

4.0±2.3

4.6±2.2

4.8±2.3

0.010

BASFI

4.1±2.6

3.20±2.5

4.4±2.6

4.4±2.5

<0.001

BASMI (11-point)

3.6±2.0

2.4±1.5

4.1±2.1

3.3±1.8

<0.001

AS, ankylosing spondylitis; ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index, BASFI, Bath Ankylosing Spondylitis Functional Index; BASMI, Bath Ankylosing Spondylitis Metrology Index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HLA-B27, human leukocyte antigen B27; IBP, inflammatory back pain; nr-axSpA, non-radiographic axial spondyloarthritis; SpA, spondyloarthritis

Data are mean (±SD) unless stated otherwise.

aAcross group comparison

*N represents number of patients with available data. **Percentage calculated based on the number of patients

 

Disclosure: R. Burgos-Vargas, None; J. Wei, None; M. U. Rahman, Pfizer, 1,Pfizer, 9; N. Akkoc, None; S. A. Haq, None; M. Hammoudeh, None; E. Mahgoub, Pfizer, 1,Pfizer, 3; E. Singh, Pfizer, 1,Pfizer, 3; L. Llamado, Pfizer, 1,Pfizer, 3; K. Shirazy, Pfizer, 1,Pfizer, 3; S. Kotak, Pfizer, 1,Pfizer, 3; C. Hammond, Pfizer, 1,Pfizer, 3; R. Pedersen, Pfizer, 1,Pfizer, 3; Q. Shen, Pfizer, 1,Pfizer, 3; B. Vlahos, Pfizer, 1,Pfizer, 3.

To cite this abstract in AMA style:

Burgos-Vargas R, Wei J, Rahman MU, Akkoc N, Haq SA, Hammoudeh M, Mahgoub E, Singh E, Llamado L, Shirazy K, Kotak S, Hammond C, Pedersen R, Shen Q, Vlahos B. The Prevalence of Non-Radiographic Axial Spondyloarthritis Among Patients with Inflammatory Back Pain in Rheumatology Practices [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-prevalence-of-non-radiographic-axial-spondyloarthritis-among-patients-with-inflammatory-back-pain-in-rheumatology-practices/. Accessed .

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