Prevalence Of Extra-articular Manifestations Research Articles

Clinical correlates of lifetime and current comorbidity patterns in autoimmune and inflammatory diseases

BackgroundAutoimmune and inflammatory diseases (AIDs) are a heterogeneous group of disorders with diverse etiopathogenic mechanisms. This study explores the potential utility of family history, together with present and past comorbidities, in identifying distinct etiopathogenic subgroups. This approach may facilitate more accurate diagnosis, prognosis and personalized therapy. MethodsWe performed a multiple correspondence analysis on patients' comorbidities, followed by hierarchical principal component clustering of clinical data from 48 healthy volunteers and 327 patients with at least one of 19 selected AIDs included in the TRANSIMMUNOM cross-sectional study. ResultsWe identified three distinct clusters characterized by: 1) the absence of comorbidities, 2) polyautoimmunity, and 3) polyinflammation. These clusters were further distinguished by specific comorbidities and biological parameters. Autoantibodies, allergies, and viral infections characterized the polyautoimmunity cluster, while older age, BMI, depression, cancer, hypertension, periodontal disease, and dyslipidemia characterized the polyinflammation cluster. Rheumatoid arthritis patients were distributed across all three clusters. They had higher DAS28 and prevalence of extra-articular manifestations when belonging to the polyinflammation and polyautoimmunity clusters, and also lower ACPA and RF seropositivity and higher pain scores within the polyinflammation cluster. We developed a model allowing to classify AID patients into comorbidity clusters. ConclusionsIn this study, we have uncovered three distinct comorbidity profiles among AID patients. These profiles suggest the presence of distinct etiopathogenic mechanisms underlying these subgroups. Validation, longitudinal stability assessment, and exploration of their impact on therapy efficacy are needed for a comprehensive understanding of their potential role in personalized medicine.

Comparison of clinical characteristics between adult-onset and juvenile-onset non-radiographic axial spondyloarthritis in Chinese patients: results from the COCAS cohort

BackgroundAxial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease predominantly affecting the axial skeleton. We aimed to describe the clinical characteristics of patients with non-radiographic axSpA (nr-axSpA) in China and compare the differences between adult- and juvenile-onset cases.MethodsA cross-sectional study was conducted using data from 776 patients with nr-axSpA in the Clinical Characteristic and Outcome in Chinese Axial Spondyloarthritis (COCAS) study cohort. Patients were divided into two groups including the adult-onset group (n = 662) and the juvenile-onset group (n = 114) according to age at disease onset. Baseline demographics and clinical characteristics were compared between patients with adult-onset and juvenile-onset nr-axSpA.ResultsOverall, the male-to-female ratio was 1.26:1, the prevalence of HLA-B27 positivity was 72.2%, and the median age at disease onset of nr-axSpA was 22 years. Nearly 75% of nr-axSpA patients had peripheral arthritis in the disease course, and the prevalence of extra-articular manifestations was 10.4%. The juvenile-onset group contained a higher proportion of men (66.7% vs. 53.9%, P = 0.011) and a longer baseline disease duration (4.0 [4.0] vs. 1.6 [3.5], P < 0.001) than the adult-onset group. A family history of spondyloarthritis was more frequent in the juvenile-onset group than in the adult-onset group (23.7% vs. 15.4%, P = 0.028), but no significant difference in the prevalence of HLA-B27 positivity was observed between the two groups (P = 0.537). Regarding initial symptoms, peripheral arthritis occurred more often in patients with juvenile-onset nr-axSpA, whereas patients with adult-onset nr-axSpA presented more frequently with axial involvement. The prevalence of inflammatory back pain (IBP) was higher in the adult-onset group than in the juvenile-onset group (85.0% vs. 75.4%, P = 0.010), whereas the juvenile-onset group showed a higher prevalence of peripheral arthritis and enthesitis than the adult-onset group (67.5% vs. 48.5%, P < 0.001; 35.1% vs. 23.3%, P = 0.007, respectively).ConclusionsCompared with adult-onset nr-axSpA, juvenile-onset nr-axSpA was more common in men and those with a family history of spondyloarthritis. Juvenile-onset nr-axSpA presents with a “peripheral predominant” mode at disease onset and a higher frequency of peripheral arthritis and enthesitis during the disease course.

Prevalence of extraarticular manifestations in rheumatoid arthritis and their relationship with serological status and disease severity

Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that attacks the synovial joints. It affects body systems, such as the skin, cardiovascular, respiratory systems, and other systems, which manifest as extraarticular manifestations. This study aimed to correlate RA with extraarticular manifestations and its relationship with serological status.Methods: One hundred fifty patients (30 male and 120 female) RA patients with a mean age of 49.9±11.9 attending the Rheumatology outpatient department and biological therapy center in Basrah Teaching Hospital were enrolled in the study and fulfilled the 2010 RA classification criteria of the American college of rheumatology/European league against rheumatism for RA. All the subjects underwent a thorough history, clinical examination, and laboratory investigations. Body mass index (BMI), the severity of pain using a visual analog scale (VAS) and disease activity using 28 joints (DAS28), and erythrocyte sedimentation rate were calculated for all patients. The relevant data were analyzed with appropriate statistical methods after 12 months.Results: The mean age, age at onset, disease duration, and BMI were 49.9±11.9, 41±2.1, 14.6±5.8, and 26.8±4.8 respectively. The disease onset was acute in 45 (30%) and insidious in 105 (70%) patients. Anemia, rheumatoid nodule, sicca syndrome, Felty syndrome, Sjogren syndrome, and joint erosions were more frequent in seropositive than seronegative patients. There is no difference in joint deformities between seropositive and seronegative patients. DAS28, VAS, ESR, and CRP were higher in patients with extraarticular manifestations.Conclusions: Extraarticular manifestations are significantly associated with seropositive disease and correlate to disease severity.

P174 HLA B27 status and disease phenotype: a cohort study of 223 patients with enthesitis-related arthritis

Abstract Background/Aims Enthesitis-related arthritis (ERA) is a subtype of juvenile idiopathic arthritis (JIA) accounting for 10-20% of patients with JIA. ERA is associated with a poor prognosis compared to other JIA subtypes. Whilst a high proportion of patients with ERA are HLA-B27 positive, the correlation between HLA-B27 status and disease phenotype is not well described. The aim of our study was to investigate the influence of HLA-B27 status on ERA phenotype. Methods Demographic and clinical data were collected and HLA-B27 positive and negative patients were compared. All subjects included met ILAR classification criteria. The data were analysed using R software (R version 4.0.4). Median and interquartile range (IQR) were calculated for continuous variables and frequency and percentage for categorical variables. Subgroup comparison was performed using the chi-squared test for qualitative variables, and Wilcoxon rank-sum for quantitative variables. P values less than 0.05 were considered significant. Results 223 patients were included in this study. The median age of symptom onset was 12 years (IQR: 9-14). The median disease duration was 11 years (IQR: 7-14). 18% of patients had family history of HLA-B27-related disease and 67% had positive HLA-B27. 54% of patients were on conventional disease modifying anti-rheumatic drugs (cDMARDs). 80% were on biologic DMARDs (bDMARD). HLA-B27 positive patients (n = 148) and negative patients (n = 68) were compared. Our analysis revealed a higher proportion of male patients in the HLA-B27 positive cohort (74% [n = 111] versus 59% [n = 39], p = 0.02). HLA-B27 positive subjects developed ERA at an older age compared to the HLA-B27 negative group at 12 versus 11 years, respectively (p = 0.02). HLA-B27 positive patients also had a higher probability of an axial phenotype within 12 months of disease onset 51% (n = 75) in the HLA-B27 positive group versus 32% (n = 22) in the HLA-B27 negative group (p = 0.01). At any point of disease course, sacroiliitis was also more common in the HLA-B27 positive group (78% [n = 116] versus 63% [n = 43], p = 0.01), who also had a higher usage of bDMARDS (74% [n = 110] versus 56% [n = 38], p = 0.006). There was no significant difference between the two groups in terms of ethnicity, family history of HLA-B27 disease or the prevalence of extra-articular manifestations, including uveitis. Conclusion Our study revealed that patients with ERA who were HLA-B27 positive, were more likely to be male, developed disease at an older age and had a higher probability of axial phenotype at onset and later in disease. They also had an increased bDMARD requirement. These data suggest that HLA-B27 confers a worse prognosis clinically which is consistent with findings from other studies. Disclosure A. Bouraoui: None. C. Fisher: None. J. Glanville: None. D. Sen: None.

Clinical significance of a self-reported familial occurrence of rheumatoid arthritis among patients with recent-onset arthritis: data from the ESPOIR cohort.

To assess, in patients with recent-onset arthritis, whether a self-reported familial occurrence of rheumatoid arthritis (RA) is associated with a clinical presentation of the disease, final diagnosis, long-term outcome and treatment decisions. The study was conducted from data of patients included between 2002 and 2005 in the early arthritis ESPOIR cohort. Patients were recruited on the basis of having at least two swollen joints for >6 weeks and <6 months, no other diagnosis than RA and no previous exposure to glucocorticoids or disease-modifying antirheumatic drugs (DMARDs). Patients were stratified into two groups according to the presence of a self-reported familial occurrence of RA at baseline. Data concerning final diagnosis (2-year visit), long-term outcome (5-year visit) and therapeutic decisions were compared between the 2 groups of patients, using logistic and Cox regression models. At baseline, 115 patients (14.1%) reported a familial occurrence of RA and showed, as compared with the remaining participants, higher prevalence of extra articular manifestations (EAMs) (51.8% vs. 39.6%, p=0.01) and severe EAMs (7.9% vs. 3.1%, p 0.01). Both unadjusted (hazard ratio, 1.57; 95% CI, 1.1-2.21; p = 0.01) and adjusted analysis (hazard ratio, 1.51; 95% CI, 1.06-2.15; p=0.02) identified a higher probability for the initiation of a targeted DMARD over time among patients with a self-reported familial occurrence of RA. In the specific context of early arthritis, a self-reported familial occurrence of RA is associated with the future decision to initiate a targeted DMARD.

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

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 &amp; 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.

The impact of sex and disease classification on patient-reported outcome measures in axial spondyloarthritis: a descriptive prospective cross-sectional study

BackgroundThe aim of this study was to explore the impact of sex and disease classification on outcomes in axial spondyloarthritis (axSpA) patients, including both radiographic (r-) axSpA and non-radiographic (nr-) axSpA, in males and females, respectively.MethodsAxSpA patients were consecutively recruited from two rheumatology outpatient university clinics. We explored how sex and axSpA disease classification affected patient-reported outcome measures (PROMs). General linear models were used to investigate if there was an association between the continuous variables and each of the main effects of interest (sex and axSpA classification), as well as the possible interaction between them. Categorical outcome measures were analyzed with the use of logistic regression with the same fixed effects. We analyzed the relationship between tender point count (TPC) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The prevalence of extra-articular manifestations (EAMs) and the Charlson Comorbidity Index (CCI) were determined.ResultsAccording to the protocol, a total of 100 outpatients with axSpA were enrolled (r-axSpA males 30, r-axSpA females 10, nr-axSpA males 25, nr-axSpA females 35). The BASDAI scores appeared higher among nr-axSpA females (median [Q1; Q3], 47 [21; 60]) compared with the combined median for the 3 other subgroups 25 [12; 25]. Female sex was associated with a higher number of tender point count (TPC, P < 0.001). TPC and BASDAI were correlated for female nr-axSpA patients (r = 0.44, P = 0.008) and male nr-axSpA patients (r = 0.56, P = 0.003). Being classified as nr-axSpA was associated with a lower SF-36 Mental Component Summary (median for the 4 subgroups: nr-axSpa females 46.7, nr-axSpA males 52.3 vs. r-axSpA males 56.9 and r-axSpA females 50.4). EAMs were frequent (up to 50%). The CCI was low in all 4 subgroups, and no difference in the CCI between the subgroups was observed (P = 0.14). However, male sex had a significant impact on the CCI (P = 0.03).ConclusionsIn summary, patients with r-axSpA, regardless of sex, appeared less affected on most PROMs compared with nr-axSpA patients. However, female sex was associated with a higher number of TPC. TPC could possibly confound disease activity outcomes such as BASDAI, and one can consider different thresholds for defining high disease activity depending on the patient’s sex.Trial registrationThe trial is registered and approved by the Region of Southern Denmark’s Ethics Committee (S-20150219). Registered 19 February 2015.

AB0680 Baseline Characteristic of Newly Diagnosed Patients with Axial Spondyloarthritis: First Results from the Russian Cohort

BackgroundApplication of the new ASAS classification criteria for axial SpA has allowed defining a broader spectrum of SpA patients, ranging from non-radiographic axial SpA (nr-axSpA) to classic ankylosing spondylitis (AS)...

Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis

Uveitis, psoriasis and inflammatory bowel disease (IBD) are common extra-articular manifestations (EAM) in patients with ankylosing spondylitis (AS); however, summary data of reported prevalence are lacking. The aim of the present study was to summarise the prevalence of EAMs among patients with AS and to identify underlying factors to explain potential heterogeneity of prevalence. A systematic literature search was performed (Medline, Embase and Cochrane Library) to identify relevant articles. Risk of bias was assessed and data were extracted. Pooled prevalences were calculated. Potential sources of any observed clinical or methodological heterogeneity in the estimates were explored by subgroup and metaregression analysis. In the 156 selected articles, 143 reported the prevalence of uveitis (44 372 patients), 56 of psoriasis (27 626 patients) and 69 of IBD (30 410 patients). Substantial heterogeneity was observed in prevalence estimates among all EAMs (I(2)=84-95%). The pooled prevalence of uveitis was 25.8% (95% CI 24.1% to 27.6%), and was positively associated in multivariable metaregression with disease duration (β 0.05, 95% CI 0.03 to 0.08) and random selection of patients (β -0.24, 95% CI -0.43 to -0.04). The pooled prevalence of psoriasis was 9.3% (95% CI 8.1% to 10.6%). The pooled prevalence of IBD was 6.8% (95% CI 6.1% to 7.7%) and was positively associated with the percentage of women in the studies (β 0.02, 95% CI 0.00 to 0.03). Geographical area was associated in multivariable metaregressions with prevalence of all EAMs. EAMs are common in patients with AS. The large heterogeneity between studies can be partly explained by differences in clinical as well as methodological characteristics.

FRI0288 Baseline characteristics of newly diagnosed patients with axial spondyloarthritis: First results from the giant cohort

BackgroundRecently, the field of spondyloarthritis (SpA) has experienced major developments, among them the possibility of earlier diagnosis, particularly by the introduction of MRI of the sacroiliac joints. The application of...

Late-Onset Spondyloarthritis: Subset That Should Not Be Forgotten

The spondyloarthritis (SpA) complex embraces ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA), arthritis related to inflammatory bowel disease (IBD), and forms that do not fulfil established criteria, which are labelled as undifferentiated SpA (uSpA)1,2. In the early 1990s, 2 sets of classification criteria were suggested to encompass the clinical spectrum of SpA: the Amor criteria1 and the European Spondylarthropathy Study Group (ESSG)2 criteria. Each form of SpA may have a late onset3,4. The onset of AS, as defined by the modified New York criteria5, is unusual after the age of 50 years. In a population-based descriptive study carried out in Rochester, Minnesota, USA, the total incidence rate of AS was 7.3 per 100,000 person-years and the incidence value after age 55 years was 2.2/100,000 per year6. In a survey of a large number of members of the German Ankylosing Spondylitis Society, only 6% had the beginning of symptoms after age 40 years7. Only a few studies have compared the clinical expression of late-onset disease with that of earlier onset. In 2001, Brophy and Calin examined the influence of age at symptom onset on disease expression as measured by BASRI (Bath AS Radiology index), BASDAI (Bath AS Disease Activity Index), BASFI (Bath AS Functional index), percentage undergoing AS-related surgery, and prevalence of extraarticular manifestations (uveitis, psoriasis, IBD) in patients with earlier onset (before 21 years of age) and late onset (after 30 years of age)8. Age at onset had no significant effect on radiological progression, disease activity, need for non-hip surgical intervention, and prevalence of extraarticular manifestations. In contrast, there was a significant … Address correspondence to Dr. Olivieri. E-mail: ignazioolivieri{at}tiscalinet.it

Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis.

The aim of the study was to evaluate the frequency of extra-articular manifestations (EAMs) of rheumatoid arthritis (RA) in a series of patients from nine Italian rheumatology clinics. A total of 587 patients underwent direct questioning, complete physical evaluation, and review of medical records and laboratory data. The relationships between EAMs and the eosinophilic count, IgM rheumatoid factor (RF), and antinuclear antibodies (ANA) were studied. EAMs were present in 240/587 (40.9%) patients. The most common features were sicca syndrome (17.5%) and rheumatoid nodules (16.7%). EAMs were significantly more frequent in male patients (OR = 1.68), patients with ANA positivity (OR = 2.82), high anatomical class (OR = 2.3), and rheumatoid factor seropositivity (OR = 2.22). EAMs were more common in patients from southern Italy than in those from northern Italy (P < 0.001). EAMs seem to be rarer in Italy than in the Anglo-Saxon populations of northern Europe and the USA. Differences in prevalence of EAMs can exist even within the same country.