AB0506 PREVALENCE AND CLINICAL CHARACTERISTICS OF SPONDYLOARTHRITIS IN CENTRAL AMERICA AND CARIBBEAN (PRECAES)

Abstract

Background:Spondyloarthritis (SpA) is a group of interrelated disorders: axial spondyloarthritis (Ankylosing Spondylitis [AS] /Non Radiographic Axial Spondyloarthritis [Nr-AxSpA]), psoriatic arthritis (PsA), reactive arthritis (ReA), inflammatory bowel disease-associated arthritis (IBD), and undifferentiated SpA (USpA).1Objectives:The objectives of this study were: a) to examine the epidemiology, disease subsets, and clinical characteristics of patients with SpA in Central America and the Caribbean region; and b) to describe the natural history of these conditions in their acute and chronic forms, to determine clinical sub-types and severity.Methods:PRECAES is a cross-sectional observational study, including patients from private rheumatology clinics in three Central American countries (Guatemala, Honduras and Panama) and one in the Caribbean (Dominican Republic).Patients were enrolled between April 25th, 2018 and July 31st, 2019. Inclusion criteria: SpA diagnosis fulfilling ASAS classification criteria, age 18 - 45 years, sign informed consent and willing to perform protocol procedures during a single visit. Exclusions: any other rheumatic diseases, malignancy or HIV.Results:Each center identified 50 consecutive patients with SpA. The main reason for exclusion from this analysis was not meeting the age requirement (N=94). Therefore, we analyzed 25 from Dominican Republic (DR), 25 from Guatemala, 32 from Honduras and 24 from Panama.When applying ASAS axial and peripheral SpA definitions, all countries had high number of AS Patients. Subclinical classification by country showed the most frequent diagnosis was AS (64.1%), followed by PsA (16%), ReA (9.4%), Undifferentiated SpA (7.5%), IBD associated arthritis (1.9%) and Nr-AxSpA (0.9%) (p<0.001); characteristics of patient population and sub-clinical classification by country, Table 1. When clinical manifestations were classified as axial or peripheral SpA, 70.7% were axial in the four countries.Table 1.Patient population characteristics and Sub-clinical classification by CountrySD or ± = Standard DeviationUndifferentiated SpA (USpA), Reactive Arthritis (ReA), Nonradiographic Axial SpA (Nr-AxSpa), (AS), Inflammatory Bowel Disease-Associated Arthritis (IBD), Psoriatic Arthritis (PsA)Time from onset symptoms to diagnosis ranged in years, from 3.15 (Guatemala) to 8.2 (Honduras), among the four countries. BASMI scores were higher in Honduras (mean 5.15) and lowest in Panama (mean 1.61). Of note, the time from symptom onset to diagnosis was also longest in Honduras.NSAIDs and DMARDs were used in most countries. Glucocorticoids were rarely used in this population. Biologics are mainly used in Panama (16%), and Honduras (11%); only 8% of the enrolled patients in Dominican Republic and 2% in Guatemala.Conclusion:The most prevalent SpA diagnosis in the region is Ankylosing Spondylitis. Patient diagnosis is delayed up to 8.2 years and only 2 to 16% of the patients receive a proper treatment with a biologic therapy.This data invites to further investigation and brings opportunity to improve patients care.