SAT0367 EXTRA-ARTICULAR MANIFESTATIONS IN EARLY AXIAL SPONDYLOARTHRITIS: WHAT IS THEIR FREQUENCY? A SYSTEMATIC LITERATURE REVIEW INCLUDING 2854 PATIENTS

Abstract

Background:Extra-articular manifestations (EAMs): psoriasis, uveitis and inflammatory bowel disease (IBD) are common in patients with established spondyloarthritis (SpA), with prevalences reported around 9%, 26% and 7 % respectively (1). However, data on the prevalence of EAMs are lacking in early axial SpA (axSpA).Objectives:The aim was to assess the prevalence of EAMs in early axSpA in the published literature.Methods:Systematic literature search on Pubmed MEDLINE up to 31.12.2019 with keywords referring to EAMs (uveitis and synonyms, psoriasis and synonyms or IBD and synonyms) and early axSpA (recent, young adult, young, untreated, inception) and selection by one reader of all full-text publications in English, describing the prevalence of at least one of the EAMs in patients with early axSpA, defined here as patients fulfilling ASAS, ESSG or Amor criteria and symptom duration of less than 6 years (as this was defined by authors as early disease). Patients’ age, axSpA symptom duration, sex, HLA-B27 status, and number of patients with EAMs were recorded by one reader using a predefined extraction sheet. For longitudinal studies, baseline data was recorded. Description of patients was analysed using weighted means. Prevalences in each study according to symptom duration were graphically reported, and pooled prevalences were calculated by meta-analysis of proportions, using a random-effects model and the DerSimonian & Laird method to derive the summary estimate.Results:Of 667 articles, 17 were relevant to the research question with prevalence data of psoriasis, uveitis and IBD available in 16, 17 and 15 articles, respectively (and most studies reporting several EAMs). Of the 17 articles, 14 were cohort studies and 3 were trials in early axSpA. A total of 2854 patients with early SpA was analyzed: weighted mean age 32.3±9.1 years (range 21-42 years), weighted mean axSpA symptom duration 20.7±11.1 months (range 8-68), 40.3 % were female, and 65.1% carried HLA-B27.The pooled prevalences of psoriasis, uveitis and IBD were respectively 8.9 % (95% CI 5.0, 13.8), 13.4% (95% CI 9.5, 17.8) and 3.5% (95% CI 1.7, 5.9) (Figure 1). There was a trend towards higher prevalences in patients with longer disease duration (Figure 2).Figure 1.Meta-analysis of prevalence of each EAMFigure 2.The prevalence of each EAM according to the symptom duration in early axSpAX axis: mean symptom duration (months). Y axis: prevalence (%) of an EAM. Diameter of bubbles is proportional to sample size of each article.Conclusion:Over the first years of axSpA, EAMs are frequent, in particular psoriasis and uveitis, with prevalences up to 30% in some studies. Compared to established axSpA, the EAM which was much less frequent was uveitis, which suggests the appearance of new cases over follow-up. Physicians need to screen carefully for EAMs right from the time of diagnosis, and need to repeat this screening over follow-up.