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Hay CA, Packham J, Prior JA, Mallen CD, Ryan S. Barriers and facilitators in diagnosing axial spondyloarthritis: a qualitative study. Rheumatol Int 2024; 44:863-884. [PMID: 38472441 PMCID: PMC10980652 DOI: 10.1007/s00296-024-05554-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Diagnosis of axial spondyloarthritis (axSpA) is frequently delayed for years after symptom onset. However, little is known about patient and healthcare professional (HCP) perspectives on barriers and facilitators in axSpA diagnosis. This study explored the experiences and perceptions of both groups regarding the factors affecting the timely diagnosis of axSpA. METHOD Semi-structured interviews with patients with axSpA and axSpA-interested HCPs from the United Kingdom (UK) were performed by telephone or Microsoft Teams and focussed on the individuals' perspective of the diagnostic journey for axSpA. Interview transcripts were thematically analysed. RESULTS Fourteen patients with axSpA (10 female, 4 male) and 14 UK based HCPs were recruited, the latter comprising of 5 physiotherapists, 4 General Practitioners, 3 rheumatologists, a nurse, and an occupational therapist. Barriers to diagnosis identified by patients and HCPs were: difficult to diagnose, a lack of awareness, unclear referral pathways, patient behaviour and patient/HCP communication. Patient-identified facilitators of diagnosis were patient advocacy, clear referral processes and pathways, increased awareness, and serendipity. HCPs identified promoting awareness as a facilitator of diagnosis, along with symptom recognition, improvements to healthcare practice and patient/HCP communications. CONCLUSION Poor communication and a lack of understanding of axSpA in the professional and public spheres undermine progress towards timely diagnosis of axSpA. Improving communication and awareness for patients and HCPs, along with systemic changes in healthcare (such as improved referral pathways) could reduce diagnostic delay.
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Affiliation(s)
| | - Jon Packham
- School of Medicine, Keele University, Keele, UK
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - James A Prior
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, UK
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Sarah Ryan
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
- School of Nursing and Midwifery, Keele University, Keele, UK
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Costantino F, Breban M. Family studies: A useful tool to better understand spondyloarthritis. Joint Bone Spine 2023; 90:105588. [PMID: 37201576 DOI: 10.1016/j.jbspin.2023.105588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
Spondyloarthritis (SpA) is an immune-mediated disease characterized by a high heritability, reflected by strong familial aggregation. Therefore, family studies are a powerful tool for elucidating the genetic basis of SpA. First, they helped to assess the relative importance of genetic and environmental factors and established the polygenic character of the disease. Family-based designs were also historically used to identify genetic factors of susceptibility through linkage analyses. In SpA, three whole-genome linkage studies were published in the 1990's, unfortunately with few consistent results. After having been put aside for several years in favour of case-control GWAS, there is a renewed interest in family-based designs in particular to detect rare variant associations. This review aims at summarizing what family studies have brought to the field of SpA genetics, from genetic epidemiology studies to the most recent rare variant analyses. It also highlights the potential interest of family history of SpA to help diagnosis and detection of patients at high risk to develop the disease.
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Affiliation(s)
- Félicie Costantino
- Rheumatology Department, AP-HP, Ambroise-Paré Hospital, 92100 Boulogne-Billancourt, France; Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, 78180 Montigny-Le-Bretonneux, France; Laboratory of Excellence INFLAMEX, Université Paris-Centre, Paris, France.
| | - Maxime Breban
- Rheumatology Department, AP-HP, Ambroise-Paré Hospital, 92100 Boulogne-Billancourt, France; Infection & Inflammation, UMR 1173, Inserm, UVSQ/Université Paris Saclay, 78180 Montigny-Le-Bretonneux, France; Laboratory of Excellence INFLAMEX, Université Paris-Centre, Paris, France
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Ziade N. Human leucocyte antigen-B27 testing in clinical practice: a global perspective. Curr Opin Rheumatol 2023; 35:235-242. [PMID: 37115941 DOI: 10.1097/bor.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
PURPOSE OF REVIEW The association between human leucocyte antigen (HLA)-B27 and spondyloarthritis (SpA) was described half a century ago. New insights about pathophysiologic pathways and their role in bone formation were reported in recent years and will be discussed in this review. RECENT FINDINGS There is a considerable variation in the association between HLA-B27 and SpA across the globe, with the strongest association reported in populations of Northern European and Asian descent and the lowest in the Middle East and Africa. Other genes are also involved in disease susceptibility, highlighting the importance of newly proposed weighted genetic scores to support the diagnosis. On the global level, the interaction between genetic background and gut dysbiosis seems critical for disease predisposition. As for the individual patient, the presence of HLA-B27 can have a significant influence on SpA diagnosis and disease phenotype. More importantly, new studies suggested a role for HLA-B27 in radiographic damage in the sacroiliac joints and the progression of bone formation in the spine. SUMMARY Findings in recent years have enhanced our understanding of the role of HLA-B27 in the pathophysiology and in disease-related bone formation in SpA, which may pave the way for new therapeutic targets.
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Affiliation(s)
- Nelly Ziade
- Saint-Joseph University
- Hotel-Dieu de France Hospital, Beirut, Lebanon
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Carrillo I, López-Pineda A, García-Díaz S, López A, Valencia Muntalà L, Juanola X, Zarco P, Ignacio E, Mira JJ. Proposals for the incorporation of the nursing role in the certification of axial spondyloarthritis units. Literature review and expert consensus. REUMATOLOGIA CLINICA 2022; 18:580-586. [PMID: 35469782 DOI: 10.1016/j.reumae.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyse the role of nursing in the approach to axial spondyloarthritis (axSpA) and to make proposals to include the role of rheumatology nursing consultations (RECs) in the quality certification of these specialized units. METHODS A systematic review of the nursing role in quality certification systems in the management of axSpA was conducted. Subsequently a consensus conference was held with the participation of three rheumatology nurses to determine elements that should be considered in future revisions of certification standards. RESULTS The systematic review yielded five papers as relevant. None of the publications reviewed explicitly proposed standards applicable to nursing care in the management of patients with axSpA, although they contemplated the activities of this professional group. The proposals agreed upon to incorporate the role of RECs in the certification standards for axSpA monographic units included the following: basic equipment and resources, organization, administration of pharmacological treatments and promotion of adherence, standardized programmes for axSpA, telematic consultation for monitoring the stable patient, registry of patient-reported outcome measures and e-consultation. CONCLUSIONS The literature on quality standards and certification standards for axSpA monographic units is scarce and hardly reflects the role of RECs in providing quality care. The consensus proposals in this study would incorporate RECs into quality certification standards. In the future, the increased presence of RECs in Spain should be accompanied by a review of the indicators regarding their role.
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Affiliation(s)
- Irene Carrillo
- Departamento de Psicología de la Salud, Universidad Miguel Hernández de Elche, Elche, Spain.
| | - Adriana López-Pineda
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan (Alicante), Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), San Juan (Alicante), Spain
| | - Silvia García-Díaz
- Departamento de Reumatología, Complex Hospitalari Moisès Broggi, CSI, Sant Joan Despí (Barcelona), Spain
| | - Amparo López
- Departamento de Enfermería de Práctica Avanzada, CEIMI, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lídia Valencia Muntalà
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Hospitalet de Llobregat (Barcelona), Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat (Barcelona), Spain
| | - Pedro Zarco
- Unidad de Reumatología, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Emilio Ignacio
- Gestión Sanitaria y Calidad Asistencial, Universidad de Cádiz, Cádiz, Spain
| | - José Joaquín Mira
- Departamento de Psicología de la Salud, Universidad Miguel Hernández de Elche, Elche, Spain; Departamento de Salud Alicante-Sant Joan d'Alacant, San Juan (Alicante), Spain
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5
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Boel A, van Lunteren M, López-Medina C, Sieper J, van der Heijde D, van Gaalen FA. Geographical prevalence of family history in patients with axial spondyloarthritis and its association with HLA-B27 in the ASAS-PerSpA study. RMD Open 2022; 8:rmdopen-2021-002174. [PMID: 35301267 PMCID: PMC8932257 DOI: 10.1136/rmdopen-2021-002174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/23/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND A positive family history (PFH) of spondyloarthritis (SpA) consists of five SpA-related entities, of which a PFH of axial spondyloarthritis (axSpA) is most common in European patients with axSpA. Moreover, a PFH of axSpA is associated with human leucocyte antigen B27 (HLA-B27) positivity in these patients. It is unknown if this holds true in patients with axSpA in other parts of the world. OBJECTIVE To investigate the geographical prevalence of a PFH of SpA and its association with HLA-B27 positivity in patients with axSpA worldwide. METHODS Cross-sectional analyses included patients from the ASAS peripheral involvement in Spondyloarthritis (PerSpA) study from 24 countries worldwide with an axSpA diagnosis, known HLA-B27 status and family history. Logistic regression models were built to assess the effect of HLA-B27 status on the occurrence of PFH. This was repeated for each of the five SpA entities in a PFH. RESULTS Among 2048 patients, axSpA was the most common SpA entity in a PFH in all geographical regions (Asia 28%, Europe and North America 27%, Latin America 20%, Middle East and North Africa 41%). A PFH of axSpA was associated with HLA-B27 positivity in Asia (OR 4.19), Europe and North America (OR 2.09) and Latin America (OR 3.95), but not in the Middle East and North Africa (OR 0.98), which has a lower prevalence of HLA-B27 positivity. A PFH of other SpA entities was less prevalent and not consistently associated with HLA-B27 positivity. CONCLUSION In patients with axSpA worldwide, axSpA was consistently the most common SpA entity in a family history and was associated with HLA-B27 positivity in all geographical regions but one.
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Affiliation(s)
- Anne Boel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Miranda van Lunteren
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Clementina López-Medina
- Department of Rheumatology, Hospital Cochin, Paris, France.,Department of Rheumatology, Reina Sofia University Hospital, Cordoba, Spain.,INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France
| | - Joachim Sieper
- Department of Rheumatology, Charite Universitätsmedizin Berlin, Berlin, Germany.,Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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6
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van der Linden SM, Khan MA, Li Z, Baumberger H, Zandwijk HV, Khan K, Villiger PM, Brown MA. Factors predicting axial spondyloarthritis among first-degree relatives of probands with ankylosing spondylitis: a family study spanning 35 years. Ann Rheum Dis 2022; 81:831-837. [DOI: 10.1136/annrheumdis-2021-222083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/22/2022] [Indexed: 12/27/2022]
Abstract
ObjectiveFactors predicting axial spondyloarthritis (axSpA) among first-degree relatives (FDRs) of ankylosing spondylitis (AS) patients need to be defined. We investigated the predictive value of the probands’ HLA-B27 and radiographic sacroiliitis status on disease occurrence among their FDR. We also assessed the predictive value of features of the clinical history, including chronic inflammatory back pain (CIBP) and acute anterior uveitis (AAU), among the FDR and how they can be used to improve classification and diagnosis of axSpA.MethodsIn 1985, we studied 363 AS probands and 806 FDR who underwent rheumatologic examination, completed questionnaires, provided blood samples for HLA-typing and underwent radiography of sacroiliac joints. At follow-up in 2018–2019, 125 patients and 360 FDR were available for study, and completed a postal questionnaire about axSpA features. FDRs were asked to report whether after 1985 they had been diagnosed by Swiss rheumatologists as having axSpA.ResultsAmong HLA-B27(+) FDR, axSpA occurred in 25.4%–26.3%, independent of the radiographic sacroiliitis status of the proband. AAU occurred in 13/34 (38.2%) FDR with axSpA vs 29/251 (11.6%) FDR without axSpA (p=0.00004, OR=4.74 95% CI 2.15 to 10.47). The presence of CIBP at baseline did not predict later occurrence of axSpA but combining CIBP and pain/discomfort at the thoracic spine and at anterior (ventral) chest wall ever, assessed at follow-up in 2018–2019, provided 83.1% sensitivity and 87.2% specificity for current axSpA.ConclusionOccurrence of AAU among FDR of axSpA probands should prompt screening for axSpA. Moreover, co-occurrence of CIBP and pain/discomfort in the thoracic spine and at anterior chest wall as a three-question tool may further enhance clinical suspicion of axSpA among these FDR.
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Louis-Sidney F, Kahn V, Suzon B, De Bandt M, Deligny C, Arfi S, Jean-Baptiste G. Epidemiology and Characteristics of Spondyloarthritis in the Predominantly Afro-Descendant Population of Martinique, a French Caribbean Island. J Clin Med 2022; 11:jcm11051299. [PMID: 35268390 PMCID: PMC8910895 DOI: 10.3390/jcm11051299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: The prevalence of Spondyloarthritis (SpA) varies significantly in different regions and ethnic groups due several factors such as heterogeneity in study populations, the diversity of classification criteria used in epidemiological studies, the prevalence variability of HLA-B27 or disparity in healthcare access. To our knowledge, there is no data on SpA in Martinique, a French region in the Caribbean with a predominantly Afro-descendant population and a high level of healthcare. (2) Methods: This was a retrospective study of all SpA patients treated at the Fort de France University Hospital between 1 January 1997 and 1 January 2008. (3) Results: In our cohort of 86 SpA patients, age at diagnosis was late (41 years old), ankylosing spondylitis (AS) was the most frequent sub-type (60.5%), inflammatory bowel disease was the most frequent extra articular feature (23.3%) and no one had personal familial history of the disease. Inflammatory syndrome concerned 55.6% of patients, no one was positive for HIV and HLA-B27 positivity was low (42.2%). However, HLA-B27 was statistically associated with AS. Out of 64 patients, 41 had sacroiliitis. (4) Conclusion: To our knowledge, this is the first comprehensive descriptive study of SpA subtypes in Martinique, a French region in the Caribbean. We report clinical and biological similarities in our SpA cohort with those of sub-Saharan Africa and with SpA subtypes reported in Afro-descendant populations.
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Affiliation(s)
- Fabienne Louis-Sidney
- Service de Rhumatologie, CHU de Fort de France, 97200 Fort de France, Martinique, France; (V.K.); (M.D.B.); (G.J.-B.)
- Correspondence:
| | - Valentine Kahn
- Service de Rhumatologie, CHU de Fort de France, 97200 Fort de France, Martinique, France; (V.K.); (M.D.B.); (G.J.-B.)
| | - Benoit Suzon
- Service de Médecine Interne, CHU de Fort de France, 97200 Fort de France, Martinique, France; (B.S.); (C.D.); (S.A.)
| | - Michel De Bandt
- Service de Rhumatologie, CHU de Fort de France, 97200 Fort de France, Martinique, France; (V.K.); (M.D.B.); (G.J.-B.)
| | - Christophe Deligny
- Service de Médecine Interne, CHU de Fort de France, 97200 Fort de France, Martinique, France; (B.S.); (C.D.); (S.A.)
| | - Serge Arfi
- Service de Médecine Interne, CHU de Fort de France, 97200 Fort de France, Martinique, France; (B.S.); (C.D.); (S.A.)
| | - Georges Jean-Baptiste
- Service de Rhumatologie, CHU de Fort de France, 97200 Fort de France, Martinique, France; (V.K.); (M.D.B.); (G.J.-B.)
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Hay CA, Packham J, Ryan S, Mallen CD, Chatzixenitidis A, Prior JA. Diagnostic delay in axial spondyloarthritis: a systematic review. Clin Rheumatol 2022; 41:1939-1950. [PMID: 35182270 PMCID: PMC9187558 DOI: 10.1007/s10067-022-06100-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 12/23/2022]
Abstract
Identification of axial spondyloarthritis (axSpA) remains challenging, frequently resulting in a diagnostic delay for patients. Current benchmarks of delay are usually reported as mean data, which are typically skewed and therefore may be overestimating delay. Our aim was to determine the extent of median delay patients’ experience in receiving a diagnosis of axSpA and examine whether specific factors are associated with the presence of such delay. We conducted a systematic review across five literature databases (from inception to November 2021), with studies reporting the average time period of diagnostic delay in patients with axSpA being included. Any additional information examining associations between specific factors and delay were also extracted. A narrative synthesis was used to report the median range of diagnostic delay experienced by patients with axSpA and summarise which factors have a role in the delay. From an initial 11,995 articles, 69 reported an average time period of diagnostic delay, with 25 of these providing a median delay from symptom onset to diagnosis. Across these studies, delay ranged from 0.67 to 8 years, with over three-quarters reporting a median of between 2 years and 6 years. A third of all studies reported median delay data ranging from just 2 to 2.3 years. Of seven variables reported with sufficient frequency to evaluate, only ‘gender’ and ‘family history of axSpA’ had sufficient concordant data to draw any conclusion on their role, neither influenced the extent of the delay. Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay and this remains an extensive worldwide problem. This is further compounded by a mixed picture of the disease, patient and healthcare-related factors influencing delay.Key points • Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay. • Median diagnostic delay typically ranges from 2 to 6 years globally. • Neither ‘gender’ nor ‘family history of axSpA’ influenced the extent of diagnostic delay experienced. • Diagnostic delay based on mean, rather than median, data influences the interpretation of the delay time period and consistently reports a longer delay period. |
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Affiliation(s)
- Charles A Hay
- School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - Jon Packham
- School of Medicine, Keele University, Keele, ST5 5BG, UK.,Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Sarah Ryan
- Midlands Partnership NHS Foundation Trust, Stafford, UK.,School of Nursing and Midwifery, Keele University, Keele, ST5 5BG, UK
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, ST5 5BG, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | - James A Prior
- School of Medicine, Keele University, Keele, ST5 5BG, UK. .,Midlands Partnership NHS Foundation Trust, Stafford, UK.
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Maguire S, Fitzgerald G, Gallagher P, O'Shea F. Advances in treatment of axial spondyloarthritis are associated with improved patient outcomes: data from the Ankylosing Spondylitis Registry of Ireland (ASRI). Rheumatol Int 2022; 42:831-838. [PMID: 35088133 DOI: 10.1007/s00296-021-05067-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
The Ankylosing Spondylitis Registry of Ireland (ASRI) captures both radiographic and non-radiographic axial spondyloarthritis (axSpA) in a large, well characterised cohort. This is a valuable resource for studies in therapeutics and burden of disease, following a period of rapid change in the field of axSpA. This study aims to perform a focused analysis on patient outcomes and pattern of medication usage in axSpA. This is a cross-sectional study of registry data on 885 patients with confirmed axSpA as per the ASAS criteria for axSpA, as diagnosed by a Rheumatologist. Analysis was performed using IBM SPSS version 26. Patients were analysed on the basis of treatment categorised as: no medication, NSAIDs, biologics or combination therapy. Statistical significance was indicated by p value of < 0.05. Currently 885 patients are enrolled in the ASRI, made up of 72.5% (642) males and 26.9% (238) females. The majority of the cohort was categorized as radiographic axSpA 78.3% (693), with 21.7% (192) meeting criteria for non-radiographic disease. Overall 40.6% (359) reported at least one comorbidity. Older age was associated with no medications compared to those on biologic therapy (50.3 vs 45, p = 0.01). Lower levels of disease activity and higher quality of life were noted in those on biologics as compared to NSAIDs alone. This analysis provides detailed epidemiological data on axSpA from a large national registry. These results detail significant differences in prescribing patterns and impact on patient outcomes in axSpA. Ongoing development of registries provides a valuable insight into the real-world effects of axSpA.
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Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland. .,School of Medicine, Trinity College, Dublin, Ireland.
| | - Gillian Fitzgerald
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Phil Gallagher
- Department of Rheumatology, St Vincent's Hospital, Dublin, Ireland
| | - Finbar O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
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Characteristics Associated with the Occurrence and Development of Acute Anterior Uveitis, Inflammatory Bowel Disease, and Psoriasis in Patients with Ankylosing Spondylitis: Data from the Chinese Ankylosing Spondylitis Prospective Imaging Cohort. Rheumatol Ther 2021; 8:555-571. [PMID: 33709320 PMCID: PMC7991047 DOI: 10.1007/s40744-021-00293-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/18/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction This study aimed to determine the association between extra-articular manifestations (EAMs) and baseline characteristics of patients with ankylosing spondylitis (AS) and identify their potential risk factors in an observational cohort. Methods We analyzed the data of consecutive patients with AS obtained between April 2016 and May 2019 from the ongoing Chinese Ankylosing Spondylitis Prospective Imaging Cohort. Results Among the 1414 patients with AS, 23.1% had experienced EAMs at baseline. The prevalence rates of acute anterior uveitis (AAU), inflammatory bowel disease, and psoriasis among patients with AS were 16.7, 6.9, and 2.6%, respectively, and the prevalence of AAU increased significantly with the disease duration. Patients with comorbidity of AAU and psoriasis had Ankylosing Spondylitis Disease Activity Score (ASDAS) than patients without EAMs (2.16 ± 0.984 vs. 1.99 ± 0.956 [p = 0.025] and 2.36 ± 1.01 vs. 1.99 ± 0.96 [p = 0.025]). Among the 1087 patients with AS without EAMs at baseline, 98 developed EAMs during follow-up. Long disease duration (> 10 years) and high disease activity at baseline (ASDAS > 2.1) were associated with the risk of new-onset EAMs (hazard ratio [HR] [95% confidence interval, CI], 2.150 [1.229–3.762] and 2.896 [1.509–5.561], respectively) and new-onset AAU (HR [95% CI], 2.197 [1.325–3.642] and 3.717 [1.611–8.574], respectively). Conclusions In Chinese patients with AS, patients with comorbidity of AAU and psoriasis had higher disease activity scores than patients without EAMs. Furthermore, the risk of AAU or combined EAMs increases with the duration of AS and appears to be associated with higher cumulative exposure to inflammation. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00293-0.
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Abstract
Human leukocyte antigen (HLA) B27 is the key laboratory parameter for axial spondyloarthritis (axSpA). Its prevalence is variable across different geographic zones and ethnicities, and often mirrors the prevalence of axSpA. HLA-B27 plays a role in axSpA physiopathology. It is correlated with spondyloarthritis phenotype with a consistent positive association with family history, early disease onset, shorter diagnostic delay, hip involvement, and acute anterior uveitis. HLA-B27 has a pivotal role in many referral strategies. However, these strategies were developed in European populations and need to be evaluated in populations with lower HLA-B27 background prevalence, and where additional parameters might be needed.
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12
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van Lunteren M, van der Heijde D, Sepriano A, Berg IJ, Dougados M, Gossec L, Jacobsson L, Ramonda R, Rudwaleit M, Sieper J, Landewé R, van Gaalen FA. Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known? Rheumatology (Oxford) 2020; 58:1649-1654. [PMID: 30938446 PMCID: PMC6735817 DOI: 10.1093/rheumatology/kez095] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/23/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known. Methods In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis. Results In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis. Conclusion In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.
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Affiliation(s)
- Miranda van Lunteren
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Inger J Berg
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris
| | - Laure Gossec
- Rheumatology Department, Sorbonne Université, Paris.,Rheumatology Department, Pitié Salpêtrière Hospital, Paris, France
| | - Lennart Jacobsson
- Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Martin Rudwaleit
- Department of Rheumatology, Charité Campus Benjamin Franklin, Berlin.,Department of Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld
| | - Joachim Sieper
- Department of Rheumatology, Charité Campus Benjamin Franklin, Berlin.,German Rheumatism Research Centre, Berlin, Germany
| | - Robert Landewé
- Department of Rheumatology, Amsterdam Rheumatology & Immunology Center, Amsterdam.,Department of Rheumatology, Zuyderland Hospital, Heerlen, the Netherlands
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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