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Tada K, Dobashi H, Taniguchi Y, Shuto T, Hagimori K, Hayashi E, Inoue H, Kobayashi S, Ymaji K, Tamura N. A multicentre study of clinical features and HLA typing in Japanese patients with ankylosing spondylitis. Mod Rheumatol 2023; 33:392-397. [PMID: 35137159 DOI: 10.1093/mr/roac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Due to the low prevalence of HLA-B27 and ankylosing spondylitis (AS) in Japan, rheumatologists have little experience with AS. We conducted a multicentre study to identify the characteristics and frequency of HLA-B types. METHODS We analysed epidemiological and clinical data, blood tests, spine radiographs, and HLA-B types in Japanese AS patients. RESULTS We evaluated 111 AS patients, predominantly men (82.9%). The mean age, disease onset, diagnosis, and time from onset to diagnosis were 43.7, 24.2, 36.0, and 11.6 years, respectively. Inflammatory low back pain was found in 96 cases (86.5%); peripheral arthritis in 59 (53.2%), enthesitis in 35 (31.5%), and dactylitis in 6 (5.4%). Extra-articular symptoms included uveitis, psoriasis, and inflammatory bowel disease in 41 (36.9%), 1 (0.9%), and 5 (4.5%) cases, respectively. HLA-B27 was positive in 83 cases (74.8%; odds ratio, 1146.0); and HLA-B48 in 9 (8.1%; odds ratio, 3.0). HLA-B27-positive patients were younger at onset and had a shorter diagnostic delay. CONCLUSIONS AS clinical symptoms were almost the same as other countries except for the low coexistence of psoriasis. HLA-B27 positivity in Japanese patients was 78%. HLA-B27-positive patients were younger and diagnosed earlier. In addition to HLA-B27, a relationship with HLA-B48 was suggested.
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Affiliation(s)
- Kurisu Tada
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Toshihide Shuto
- Department of Rheumatology and Orthopaedics Surgery, Chiyoda Hospital, Miyazaki, Japan
| | - Kohei Hagimori
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Eri Hayashi
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hisashi Inoue
- Department of Orthopedic Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shigeto Kobayashi
- Department of Internal Medicine, Juntendo Koshigaya Hospital, Saitama, Japan
| | - Ken Ymaji
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Kim HA, Lee E, Park SY, Lee SS, Shin K. Clinical Characteristics of Patients With Psoriatic Spondylitis Versus Those With Ankylosing Spondylitis: Features at Baseline Before Biologic Therapy. J Korean Med Sci 2022; 37:e253. [PMID: 35996930 PMCID: PMC9424747 DOI: 10.3346/jkms.2022.37.e253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Clinical characteristics and manifestations of psoriatic arthritis (PsA) have been extensively studied in western countries, yet data of Korean patients with PsA are very limited. We aimed to investigate the clinical traits of patients with PsA and dissect the characteristics of those with axial involvement. METHODS In this observational study, we analyzed clinical data of 109 patients with PsA who were enrolled in the Korean College of Rheumatology Biologics and Targeted Therapy registry between December 2012 and March 2022 at the time point of initiating or switching to a biologic agent. Data from 2,221 patients with ankylosing spondylitis (AS) registered during the same period were also analyzed. We divided patients with PsA into patients with or without axial involvement and then added AS patients with psoriasis (total three subgroups) for comparative analyses. RESULTS Asymmetric oligoarthritis was the most common clinical manifestation in patients with PsA, followed by symmetric polyarthritis and spondylitis. Our analysis indicated that methotrexate and sulfasalazine were the two most prescribed disease-modifying antirheumatic drugs for patients with PsA before starting biologic therapy. The patients with psoriatic spondylitis had more peripheral joint involvement (P = 0.016), less prior uveitis (P < 0.001), and lower human leukocyte antigen B27 (HLA-B27) positivity (P < 0.001) than the AS patients with psoriasis. Furthermore, syndesmophytes and radiographic sacroiliitis were prevalent among patients with PsA and AS patients with psoriasis who had the HLA-B27 gene. CONCLUSION Our study shows that the degree of peripheral arthritis is less severe in Korean patients with PsA who require biologics and reestablishes that psoriatic spondylitis is a common and important clinical pattern in Korean patients with PsA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01965132.
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Affiliation(s)
- Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Eunyoung Lee
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - So Young Park
- Division of Rheumatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kichul Shin
- Division of Rheumatology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea.
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3
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Ono K, Kishimoto M, Deshpande GA, Fukui S, Kawaai S, Sawada H, Matsuura M, Rodriguez VR, Proft F, Tada K, Tamura N, Taniguchi Y, Hirata A, Kameda H, Tsuji S, Kaneko Y, Dobashi H, Okano T, Haji Y, Morita A, Okada M, Komagata Y, Medina CL, Molto A, Dougados M, Hisamatsu T, Tomita T, Kaname S. Clinical characteristics of patients with spondyloarthritis and inflammatory bowel disease versus inflammatory bowel disease-related arthritis. Rheumatol Int 2022; 42:1751-1766. [DOI: 10.1007/s00296-022-05117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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4
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Ziade N, Rassi J, Elzorkany B, Lopez-Medina C, Gamal SM, Hlais S, Dougados M, Baraliakos X. What is peripheral spondyloarthritis? Identifying proportion, phenotype and burden in post hoc analysis of the ASAS-PerSpA study. Semin Arthritis Rheum 2022; 55:152012. [PMID: 35489171 DOI: 10.1016/j.semarthrit.2022.152012] [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: 02/15/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Little is known about the prevalence, phenotype, and burden of peripheral spondyloarthritis (pSpA). The objective of the study is to compare the phenotype and burden of disease of pure pSpA to that of pure psoriatic arthritis (PsA), pure axial SpA (axSpA), and combined forms of SpA. METHODS This is a post hoc analysis of 4,185 patients from the cross-sectional ASAS-Peripheral involvement in SpA (PerSpA) study. Patients were approached in 2 ways: the first approach was based on the rheumatologist's diagnosis (diagnostic approach) and the second one was based on the fulfillment of ASAS or CASPAR classification criteria (classification criteria approach). Demographics, disease phenotype, and burden were compared among pure pSpA, PsA, axSpA, and the combined forms. FINDINGS The proportion of pSpA was 31.5% of SpA using the classification criteria approach and 10.3% using the diagnostic approach. pSpA was pure (i.e. without axSpA or PsA) in 16.8% of pSpA using the criteria, and in 62.3% using the diagnostic approach. Using classification criteria and diagnostic approach, respectively, pure pSpA patients had a high prevalence of peripheral joint disease (86 and 96%), synovitis (76 and 91%), and enthesitis (57 and 55%), a positive HLA-B27 in 65 and 59%, a high C-Reactive Protein level in 51% and inflammatory back pain in 52 and 42%. However, compared to pure PsA and pure axSpA, they had a significantly higher disease burden, but lower use of biologics using both approaches. INTERPRETATION The proportion of pSpA varies when using the classification criteria or the diagnostic approach. pSpA occurred in a pure form less frequently than PsA and axSpA and had intermediate features but a higher disease burden. FUNDING The PerSpA main study has been conducted under the umbrella of ASAS thanks to unrestricted grants from PFIZER, LILLY, ABBVIE, NOVARTIS, UCB, JANSSEN, MERCK.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Joe Rassi
- Surgery Department, Saint-Joseph University, Beirut, Lebanon; Orthopedic Surgery Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Bassel Elzorkany
- Rheumatology Department, Kasr Alaini Hospitals, Cairo University, Egypt.
| | - Clementina Lopez-Medina
- Rheumatology Department, Cochin Hospital, Paris, France; Rheumatology Department, Reina Sofia University Hospital / IMIBIC/ University of Cordoba, Cordoba, Spain.
| | - Sherif M Gamal
- Rheumatology Department, Kasr Alaini Hospitals, Cairo University, Egypt.
| | - Sani Hlais
- Family Medicine Department, Saint-Joseph University, Beirut, Lebanon; Family Medicine Department, American University of Beirut, Lebanon.
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5
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Kameda H, Kishimoto M, Kobayashi S, Tomita T, Morita A, Yamamura M. Axial Spondyloarthritis in Japan. Curr Rheumatol Rep 2022; 24:149-155. [PMID: 35380380 DOI: 10.1007/s11926-022-01068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW The differences in the epidemiology and management of patients with axial spondyloarthritis (axSpA) among regions and countries largely depend on the positivity of human leukocyte antigen (HLA)-B27 and the health care system. This review article focused on axSpA in Japan, where the prevalence of HLA-B27 is extremely low (0.3%) and the universal health insurance system typically provides a 70% or more copayment by the government. RECENT FINDINGS A nationwide survey was conducted in Japan in 2018, which estimated that there were 3200 patients (95% confidence interval [CI]: 2400-3900) with ankylosing spondylitis (AS), a term interchangeable with radiographic axSpA (r-axSpA), and 800 patients (95% CI: 530-1100) had non-radiographic (nr)-axSpA. These data indicate a prevalence of 2.6/100,000 or 0.0026% for AS and 0.6/100,000 or 0.0006% for nr-axSpA. Patients with AS, but not those with nr-axSpA, are designated as suffering from intractable diseases in Japan; thus, their medical expenses are reduced by grant under the Act on Medical Care for Patients with Intractable Diseases. As of February 2022, infliximab, adalimumab, secukinumab, ixekizumab, and brodalumab have been approved for AS, and secukinumab, ixekizumab, and brodalumab have been approved for nr-axSpA. An algorithm for nr-axSpA in Japan has been developed for the proper diagnosis and use of these therapeutic agents. A low prevalence of axSpA, especially that of nr-axSpA, was found in Japan. Early referral and the resultant diagnosis and appropriate treatment of these patients by rheumatologists are crucial issues in Japan, as in other countries.
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Affiliation(s)
- Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center), 2-22-36 Ohashi, Meguro-ku, Tokyo, Japan.
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shigeto Kobayashi
- Department of Internal Medicine and Rheumatology, Juntendo University Koshigaya Hospital, Saitama, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Yamamura
- Center for Rheumatology, Okayama Saiseikai General Hospital, Okayama, Japan
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Bittar M, Yong WC, Magrey M, Khan MA. Worldwide Differences in Clinical Phenotype of Axial Spondyloarthritis. Curr Rheumatol Rep 2021; 23:76. [PMID: 34586533 DOI: 10.1007/s11926-021-01043-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to describe the variations in the clinical presentation of axial spondyloarthritis (axSpA) across the globe. RECENT FINDINGS We searched the PubMed database and screened more than 1360 articles; 60 of them were selected based on relevance to the topic being discussed and the goals of the review. Most of the clinical manifestations, including IBP, peripheral arthritis, and extra-articular involvement are seen in different regions of the world, but with appreciable clinical heterogeneity, possibly related to a smaller number of patients from some countries, and global variation in the prevalence of HLA-B27. For example, HLA-B27-positive patients have an earlier age of onset, higher prevalence of acute anterior uveitis, and greater familial occurrence. Peripheral arthritis and enthesitis are most commonly seen among axSpA patients from Latin America and Asia, whereas IBD appears to be slightly more common among Middle Eastern and North African patients. The main weakness encountered while reviewing these data is that some studies were small, and others were cross-sectional and retrospective; hence the inferences may have a selection bias. AxSpA is a very heterogenous disease with varied presentation across the globe, in part related to HLA-B27 positivity. It is imperative to further investigate the key regional differences as they impact timely disease recognition and initiation of early treatment. Therefore, there is a need for a large worldwide systematic study to capture the clinical picture of AxSpA in a more uniform manner.
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Affiliation(s)
- Mohamad Bittar
- Division of Connective Tissue Disease (Rheumatology), Department of Medicine, The University of Tennessee Health Science Center, 956 Court Avenue, Coleman Building, Suite G326, Memphis, TN, 38163, USA.
| | - Wai Chung Yong
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Marina Magrey
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Muhammad Asim Khan
- Division of Rheumatology, The MetroHealth System Campus of Case Western Reserve University, Cleveland, OH, USA
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7
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Kishimoto M, Ono K, Fukui S, Kawaai S, Deshpande GA, Yoshida K, Ichikawa N, Kaneko Y, Kawasaki T, Matsui K, Morita M, Tada K, Takizawa N, Tamura N, Taniguchi A, Taniguchi Y, Tsuji S, Okada M, Kobayashi S, Komagata Y, López-Medina C, Molto A, van der Heijde D, Dougados M, Tomita T, Kaname S. Clinical characteristics of non-radiographic versus radiographic axial spondyloarthritis in Asia and non-radiographic axial spondyloarthritis in other regions: results of the cross-sectional ASAS-COMOSPA study. RMD Open 2021; 7:rmdopen-2021-001752. [PMID: 34531305 PMCID: PMC8449957 DOI: 10.1136/rmdopen-2021-001752] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/28/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives To delineate characteristics of non-radiographic axial spondyloarthritis (nr-axSpA) in Asia versus non-Asian regions, and compare radiographic axSpA (r-axSpA) with nr-axSpA within Asia. Methods Data were collected from the Assessment of SpondyloArthritis international Society-COMOrbidities in SPondyloArthritis database. Categorising patients by region, we compared clinical characteristics between nr-axSpA from Asia vs elsewhere (Europe, the Americas and Africa). Within Asians, we additionally compared patient characteristics of those with nr-axSpA versus r-axSpA. Results Among 3984 SpA cases, 1094 were from Asian countries. Of 780 axSpA patients in Asia, 112 (14.4%) had nr-axSpA, less than in non-Asian countries (486/1997, 24.3%). Nr-axSpA patients in Asia were predominantly male (75.9% vs 47.1%), younger at onset (22.8 vs 27.8 years) and diagnosis (27.2 vs 34.5 years), and experienced less diagnostic delay (1.9 vs 2.9 years) compared with nr-axSpA in non-Asian countries. Nr-axSpA in Asia exhibited higher human leucocyte antigens-B27 prevalence (90.6% vs 61.9%), fewer peripheral SpA features (53.6% vs 66.3%) and similar extra-articular and comorbid disease rates compared with those with nr-axSpA in non-Asian countries. Disease activity, functional impairment and MRI sacroiliitis were less in nr-axSpA in Asia, with higher rates of non-steroidal anti-inflammatory drug response and less methotrexate and biological disease-modifying antirheumatic drugs use. Within Asia, r-axSpA showed higher disease activity and structural damage compared with nr-axSpA, with no differences in other features. Conclusion Among axSpA, lower frequency of nr-axSpA was observed in Asia. Our results offer an opportunity to better understand clinical characteristics and optimise diagnostic strategies, such as ensuring access and availability of MRI resources for accurate diagnosis of nr-axSpA in Asia.
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Affiliation(s)
- Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Keisuke Ono
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Sho Fukui
- Immuno-Rheumatology Center, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Satoshi Kawaai
- Immuno-Rheumatology Center, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Gautam A Deshpande
- Center for Clinical Epidemiology, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naomi Ichikawa
- Department of Rheumatology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Minato-ku, Tokyo, Japan
| | - Taku Kawasaki
- Orthopedics, Shiga University of Medical Science, Otsu, Japan
| | - Kazuo Matsui
- Department of Rheumatology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Mitsuhro Morita
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Kurisu Tada
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | | | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Atsuo Taniguchi
- Department of Rheumatology, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School, Nankoku, Kochi, Japan
| | | | - Masato Okada
- Immuno-Rheumatology Center, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Shigeto Kobayashi
- Department of Internal Medicine and Rheumatology, Juntendo University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | | | - Anna Molto
- Rheumatology Department, Hôpital Cochin - APHP Centre, Paris, France
| | | | - Maxime Dougados
- Rheumatology Department, Hôpital Cochin - APHP Centre, Paris, France
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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8
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López-Medina C, Molto A, Sieper J, Duruöz T, Kiltz U, Elzorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compan V, Luo SF, Monti S, Tae-Jong K, Kishimoto M, Pimentel-Santos FM, Gu J, Schiotis R, van Gaalen FA, Geher P, Magrey M, Ibáñez Vodnizza SE, Bautista-Molano W, Maksymowych W, Machado PM, Landewé R, van der Heijde D, Dougados M. Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open 2021; 7:rmdopen-2020-001450. [PMID: 33462157 PMCID: PMC7816910 DOI: 10.1136/rmdopen-2020-001450] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world. METHODS Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated. RESULTS A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%). CONCLUSION These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France .,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.,Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University, Berlin, Germany
| | - Tuncay Duruöz
- PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey
| | - Uta Kiltz
- Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | - Najia Hajjaj-Hassouni
- Rheumatology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
| | - Ruben Burgos-Vargas
- Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico
| | - José Maldonado-Cocco
- Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University and Mount Lebanon Hospital, Beirut, Lebanon
| | - Meghna Gavali
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Sara Monti
- Rheumatology Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy
| | - Kim Tae-Jong
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - F M Pimentel-Santos
- Rheumatology, NOVA Medical School, Nova University of Lisbon, Lisboa, Portugal
| | - Jieruo Gu
- Rheumatology Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ruxandra Schiotis
- Pharmacology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Rheumatology Department, SCBI, Cluj-Napoca, Romania
| | - Floris A van Gaalen
- Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands
| | - Pál Geher
- Rheumatology Department, Semmelweis Egyetem, Budapest, Hungary
| | - Marina Magrey
- Rheumatology Department, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Wilson Bautista-Molano
- Rheumatology Department, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College of London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Robert Landewé
- Rheumatology, Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands.,Rheumatology Department, Zuyderland MC, Heerlen, The Netherlands
| | | | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.,Rheumatology, Université de Paris Descartes, Paris, France
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9
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Soejima Y, Kirino Y, Takeno M, Kurosawa M, Takeuchi M, Yoshimi R, Sugiyama Y, Ohno S, Asami Y, Sekiguchi A, Igarashi T, Nagaoka S, Ishigatsubo Y, Nakajima H, Mizuki N. Changes in the proportion of clinical clusters contribute to the phenotypic evolution of Behçet's disease in Japan. Arthritis Res Ther 2021; 23:49. [PMID: 33522943 PMCID: PMC7851921 DOI: 10.1186/s13075-020-02406-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background We hypothesized that Behçet’s disease (BD) consists of several clinical subtypes with different severity, resulting in heterogeneity of the disease. Here, we conducted a study to identify clinical clusters of BD. Methods A total of 657 patients registered in the Yokohama City University (YCU) regional BD registry between 1990 and 2018, as well as 6754 patients who were initially registered in the Japanese Ministry of Health, Labour and Welfare (MHLW) database between 2003 and 2014, were investigated. The YCU registry data regarding the clinical manifestations of BD, human leukocyte antigen (HLA) status, treatments, and hospitalizations were analyzed first, followed by similar analyses of the MHLW for validation. A hierarchical cluster analysis was independently performed in both patient groups. Results A hierarchical cluster analysis determined five independent clinical clusters in the YCU cohort. Individual counterparts of the YCU clusters were confirmed in the MHLW registry. Recent phenotypical evolutions of BD in Japan, such as increased gastrointestinal (GI) involvement, reduced complete type according to the Japan Criteria, and reduced HLA-B51 positivity were associated with chronologically changing proportions of the clinical clusters. Conclusions In this study, we identified independent clinical clusters among BD patients in Japan and found that the proportion of each cluster varied over time. We propose five independent clusters namely “mucocutaneous”, “mucocutaneous with arthritis”, “neuro”, “GI”, and “eye.”
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Affiliation(s)
- Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School, Musashi Kosugi Hospital, 1-396 Kosugi-machi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yumiko Sugiyama
- Yokohama City University Medical Center, Center for Rheumatic Diseases, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan
| | - Shigeru Ohno
- Yokohama City University Medical Center, Center for Rheumatic Diseases, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yukiko Asami
- Yokosuka Center for Rheumatic Diseases, Yokosuka City Hospital, 1-3-2 Nagasaka, Yokosuka, 240-0101, Japan
| | - Akiko Sekiguchi
- Department of Hematology and Rheumatology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, 251-8550, Japan
| | - Toshihisa Igarashi
- Department of Rheumatology, Yamato City Hospital, Fukaminishi, Yamato, 242-8602, Japan
| | - Shohei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura Higashi, Yokohama, 236-0037, Japan
| | - Yoshiaki Ishigatsubo
- Yokohama City University, Yokohama, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Michelena X, López-Medina C, Marzo-Ortega H. Non-radiographic versus radiographic axSpA: what's in a name? Rheumatology (Oxford) 2021; 59:iv18-iv24. [PMID: 33053190 PMCID: PMC7566325 DOI: 10.1093/rheumatology/keaa422] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Indexed: 01/15/2023] Open
Abstract
Axial spondyloarthritis is a heterogeneous inflammatory condition with variable clinical presentations and outcomes. The complexity of its diagnosis and absence of biomarkers hamper the development of diagnostic criteria with the risk of misuse of the available classification criteria in clinical practice and its consequences. Axial spondyloarthritis should be regarded as a continuum in which some patients, but not all, will have a more severe phenotype characterized by progression into new bone formation and joint fusion. Growing understanding of the factors that might drive disease progression and treatment response will allow for better characterization of treatment options and outcome for each affected individual. The aim of this review is to update the current evidence of what is axial spondyloarthritis and to highlight the need to focus on the concept rather than its classification.
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Affiliation(s)
- Xabier Michelena
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Clementina López-Medina
- Department of Rheumatology, Hospital Cochin, Paris, France.,Department of Medicine, University of Córdoba/IMIBIC/University Hospital Reina Sofía, Córdoba, Spain
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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11
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Do geography and ethnicity play a role in juvenile Spondyloarthritis? A multi-center binational retrospective study. Pediatr Rheumatol Online J 2021; 19:4. [PMID: 33407634 PMCID: PMC7788991 DOI: 10.1186/s12969-020-00489-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/09/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Observations among Israeli pediatric rheumatologists reveal that pediatric Juvenile Spondyloarthritis (JSpA) may present differently compared to patients from the United States (US). This study is aimed to compare the demographic and clinical variables of Israeli and US JSpA patients upon presentation. METHODS We performed a retrospective, cross-sectional, multicenter comparison of JSpA patients among 3 large Israeli pediatric rheumatology centers and a large US pediatric rheumatology center. Patients with diagnosis of Juvenile Ankylosing Spondylitis (JAS) and/or Enthesitis-related Arthritis (ERA) were included. The demographic, clinical and radiologic features were compared. RESULTS Overall 87 patients were included (39 Israeli, 48 US patients). Upon presentation, inflammatory back pain, sacroiliac joint tenderness and abnormal modified Schober test, were significantly more prevalent among Israeli patients (59% vs. 35.4, 48.7% vs. 16.7, and 41.2% vs. 21.5%, respectively, all p < 0.05), whereas peripheral arthritis and enthesitis were significantly more prevalent among US patients (43.6% vs. 91.7 and 7.7% vs. 39.6% in Israeli patients vs. US patients, p < 0.05). In addition, 96.7% of the Israeli patients versus 29.7% of the US patients demonstrated sacroiliitis on MRI (p < 0.001, N = 67). Less than one-third of the Israeli patients (32%) were HLA-B27 positive vs. 66.7% of US patients (p = 0.007). CONCLUSION Israeli children with JSpA presented almost exclusively with axial disease compared to US patients who were more likely to present with peripheral symptoms. HLA B27 prevalence was significantly lower in the Israeli cohort compared to the US cohort. Further studies are needed to unravel the genetic and possibly environmental factors associated with these findings.
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12
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Tomita T, Sato M, Esterberg E, Parikh RC, Hagimori K, Nakajo K. Treatment patterns and health care resource utilization among Japanese patients with ankylosing spondylitis: A hospital claims database analysis. Mod Rheumatol 2020; 31:431-441. [PMID: 32476522 DOI: 10.1080/14397595.2020.1775927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To understand the current state of treatment patterns and health care resource utilization among patients in Japan with ankylosing spondylitis (AS) managed in the real-world setting. METHODS Patient records from the Medical Data Vision database were analyzed to identify patients with ICD-10 AS from April 2009 through July 2017. Measures evaluated included demographic, clinical, and other characteristics at diagnosis; treatment patterns; health care resource utilization; and costs. RESULTS Four hundred and seventeen patients met the study's inclusion criteria. Treatments observed during the first year after the initial AS diagnosis included nonsteroidal anti-inflammatory drugs (79.6%), corticosteroids (39.3%), methotrexate (22.3%), sulfasalazine (16.8%), adalimumab (14.2%), and infliximab (12.2%). At any time during the mean 33 months of study follow-up, biologic disease-modifying antirheumatic drugs (bDMARDs) were initiated by 115 patients. During the study follow-up, patients who initiated bDMARDs had higher median total per-patient annual health care costs ($26,937 vs $15,323), lower median per-patient hospitalization costs ($29,817 vs. $39,509), and fewer median hospital days per admission (7.0 vs. 11.0 days) compared with the overall group of patients diagnosed with AS. CONCLUSION This database study provides knowledge of patient characteristics, treatment patterns, HCRU, and costs for patients with AS in Japan. The study outcomes demonstrate a need for increased awareness of proper AS management.
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Affiliation(s)
- Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
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13
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Wei JCC, Chen HH, Hsieh TY, Lan HHC, Tseng JC, Liu CH, Chen YC, Tsai WC, Wu HTH, Chou CT. Clinical practice recommendations for the use of imaging in the diagnosis and management of axial spondyloarthritis in Taiwan. Int J Rheum Dis 2019; 23:24-36. [PMID: 31833212 DOI: 10.1111/1756-185x.13679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) is a chronic inflammatory disease bearing challenges in early diagnosis. To improve clinical diagnosis and management of axSpA, recommendations were developed with current axSpA classification criteria and recent advances in medical imaging applications. METHODS A systematic literature review was conducted by 10 rheumatologists and radiologists in Taiwan to retrieve research evidence on the utilization of imaging modalities, including conventional radiography (CR), magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US), quantitative sacroiliac scintigraphy (QSS), and dual-energy X-ray absorptiometry (DXA). The panel of experts proposed six key issues on the role of imaging in early diagnosis of axSpA, monitoring of disease activity and structural changes, predicting treatment effects, and assessing complications such as osteoporosis and spinal fracture. The consensus was established on the basis of research evidence, clinical experiences and expert opinions. For each recommendation statement, the level of evidence was evaluated, the strength of recommendation was graded and the final level of agreement was determined through voting. RESULTS In total, four overarching principles and 13 recommendations were formulated. These recommendations outlined different imaging approaches in the diagnosis and management of axSpA disease progression. Considering CT is easy to perform when MRI is less available in Taiwan, the expert panel proposed a concise and practical diagnostic scheme to strengthen the valuable role of MRI and CT in the diagnostic evaluation of axSpA without evident radiographic features. CONCLUSION These modified recommendations provide guidance for rheumatologists, radiologists and healthcare professionals on timely diagnosis of axSpA and disease management with appropriate imaging modalities.
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Affiliation(s)
- James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chun Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Clinical Training, Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.,Evidence-Based Medicine Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Jui-Cheng Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Buddhist Tzu Chi Medical Foundation, Taipei Tzu Chi Hospital, Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ying-Chou Chen
- Departments of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chan Tsai
- Department of Allergy, Immunology, and Rheumatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hung-Ta Hondar Wu
- Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Musculoskeletal Section, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Tei Chou
- Division of Allergy Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
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