Clinical Disease Pattern and Drug Evaluation of Patients with Seronegative Spondyloarthritis at the Outpatient Department

Abstract

Objective: There are a number of diseases in the spondyloarthritis (SpA) family. In this study, we evaluated the clinical disease pattern and drug use of outpatient department (OPD) patients with SpA. Methods: During a one-month period, we consecutively enrolled 100 patients with SpA. The diagnosis of ankylosing spondylitis (AS) was based on the modified New York criteria and that of psoriatic arthritis (PsA) followed The ClASsification of Psoriatic ARthritis (CASPAR) criteria. The new Assessment of SpondyloArthritis international Society (ASAS) classification criteria were used for the diagnosis of axial or peripheral SpA. Patients’ demographic characteristics, disease activity and laboratory tests were fully assessed. Medications currently used with the SpA family include non-steroidal anti-inflammatory drugs (NSAIDs) and TNF-α blockers. Results: A total of 100 SpA patients were consecutively enrolled in this short-term OPD survey. The male-to-female ratio of the enrolled patients was about 2:1 (66 males, 34 females). The clinical disease patterns of the 100 patients included 69 AS, 15 PsA, 12 non-radiographic axial SpA and 4 peripheral SpA. Uveitis was the most common extraarticular feature. Patients with positive HLA-B27 had higher Bath Ankylosing Spondylitis Functional Index (BASFI) scores, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores and CRP. Male AS patients seemed to have a higher CRP level and more severe sacroiliitis. AS patients receiving anti-TNFa therapy had significantly higher BASFI and BASDAI scores. AS patients had higher BASFI scores, and erythrocyte sedimentation rate (ESR) and CRP levels but no difference in BASDAI scores when compared to non-radiographic axial SpA patients. In terms of NSAIDs use, 45% of patients took cyclooxygenase-2 (COX-2) inhibitors (celecoxib, etoricoxib), 18% preferential COX-2 inhibitors (meloxicam), 30% nonselective NSAIDs (diclofenac, etodolac, naproxen), and 5% of patients used no NSAIDs. Besides, a higher percentage (33%) of our patients with SpA received regular anti-TNFα therapy (etanercept 17, adalimumab 15, golimumab 1). Conclusion: This OPD survey of Taiwan SpA patients disclosed not a small percentage (16%) of Taiwan SpA patients had either axial or peripheral SpA. The lack of significant difference in the BASDAI between AS and axial SpA suggests anti-TNFα therapy is indicated when traditional NSAIDs fail in axial SpA patients.