Peripheral Disease Contributes Significantly to the Level of Disease Activity in Axial Spondyloarthritis

Overview

Journal RMD Open

Publisher BMJ Publishing Group

Specialty Rheumatology

Date 2019 Feb 5

PMID 30713720

Citations 13

Authors

Janneke J de Winter

Jacqueline E Paramarta

Henriette M de Jong

Marleen G van de Sande

Dominique L Baeten

Affiliations

Soon will be listed here.

Abstract

Objective: Spondyloarthritis (SpA) can encompass axial, peripheral and extra-articular disease manifestations. Patients are classified as axial or peripheral SpA depending on the presence or absence of current back pain, independently of the other disease manifestations. Therefore, we aimed to assess the percentage of patients with axial SpA with peripheral disease and how this peripheral disease contributes to the overall disease activity.

Methods: Prevalence and disease activity of peripheral disease manifestations were assessed in a real-life observational cohort of 314 patients with the clinical diagnosis of SpA and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria.

Results: Of the 314 patients fulfilling the ASAS criteria, 230 fulfilled the axial and 84 the peripheral SpA criteria. Of the 230 patients with axial SpA, 49% had purely axial disease without peripheral disease manifestations whereas 51% had combined axial (back pain) and peripheral (arthritis, enthesitis and/or dactylitis) disease. The latter group had the highest disease activity in comparison with pure axial SpA as well as with peripheral SpA.

Conclusion: Half of the patients classified as axial SpA according to the ASAS criteria also have peripheral disease manifestations such as arthritis, enthesitis and/or dactylitis. These peripheral disease manifestations contribute significantly to overall disease activity.

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References

van den Berg R, van Gaalen F, van der Helm-van Mil A, Huizinga T, van der Heijde D . Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden Early Arthritis cohort. Ann Rheum Dis. 2012; 71(8):1366-9. DOI: 10.1136/annrheumdis-2011-201081. View

Poddubnyy D, Hermann K, Callhoff J, Listing J, Sieper J . Ustekinumab for the treatment of patients with active ankylosing spondylitis: results of a 28-week, prospective, open-label, proof-of-concept study (TOPAS). Ann Rheum Dis. 2014; 73(5):817-23. DOI: 10.1136/annrheumdis-2013-204248. View

Gottlieb A, Menter A, Mendelsohn A, Shen Y, Li S, Guzzo C . Ustekinumab, a human interleukin 12/23 monoclonal antibody, for psoriatic arthritis: randomised, double-blind, placebo-controlled, crossover trial. Lancet. 2009; 373(9664):633-40. DOI: 10.1016/S0140-6736(09)60140-9. View

Rahman P, Inman R, Gladman D, Reeve J, Peddle L, Maksymowych W . Association of interleukin-23 receptor variants with ankylosing spondylitis. Arthritis Rheum. 2008; 58(4):1020-5. DOI: 10.1002/art.23389. View

Haglund E, Bremander A, Petersson I, Strombeck B, Bergman S, Jacobsson L . Prevalence of spondyloarthritis and its subtypes in southern Sweden. Ann Rheum Dis. 2011; 70(6):943-8. DOI: 10.1136/ard.2010.141598. View

Braun J, Zochling J, Baraliakos X, Alten R, Burmester G, Grasedyck K . Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomised controlled trial. Ann Rheum Dis. 2006; 65(9):1147-53. PMC: 1798286. DOI: 10.1136/ard.2006.052878. View

Gladman D . Toward Treating to Target in Psoriatic Arthritis. J Rheumatol Suppl. 2015; 93:14-6. DOI: 10.3899/jrheum.150626. View

Coates L, Helliwell P . Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data. Arthritis Care Res (Hoboken). 2010; 62(7):965-9. DOI: 10.1002/acr.20155. View

van Mens L, van de Sande M, van Kuijk A, Baeten D, Coates L . Ideal target for psoriatic arthritis? Comparison of remission and low disease activity states in a real-life cohort. Ann Rheum Dis. 2017; 77(2):251-257. DOI: 10.1136/annrheumdis-2017-211998. View

10.

Said-Nahal R, Miceli-Richard C, DAgostino M, Dernis-Labous E, Berthelot J, Duche A . Phenotypic diversity is not determined by independent genetic factors in familial spondylarthropathy. Arthritis Rheum. 2002; 45(6):478-84. DOI: 10.1002/1529-0131(200112)45:6<478::aid-art372>3.0.co;2-i. View

11.

van der Heijde D, Ramiro S, Landewe R, Baraliakos X, Van den Bosch F, Sepriano A . 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017; 76(6):978-991. DOI: 10.1136/annrheumdis-2016-210770. View

12.

Vandooren B, Noordenbos T, Ambarus C, Krausz S, Cantaert T, Yeremenko N . Absence of a classically activated macrophage cytokine signature in peripheral spondylarthritis, including psoriatic arthritis. Arthritis Rheum. 2009; 60(4):966-75. DOI: 10.1002/art.24406. View

13.

Garrett S, Jenkinson T, Kennedy L, Whitelock H, Gaisford P, Calin A . A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994; 21(12):2286-91. View

14.

Chandran V, Schentag C, Gladman D . Reappraisal of the effectiveness of methotrexate in psoriatic arthritis: results from a longitudinal observational cohort. J Rheumatol. 2007; 35(3):469-71. View

15.

Kavanaugh A, van der Heijde D, McInnes I, Mease P, Krueger G, Gladman D . Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial. Arthritis Rheum. 2012; 64(8):2504-17. DOI: 10.1002/art.34436. View

16.

Said-Nahal R, Miceli-Richard C, Berthelot J, Duche A, Dernis-Labous E, Le Blevec G . The familial form of spondylarthropathy: a clinical study of 115 multiplex families. Groupe Français d'Etude Génétique des Spondylarthropathies. Arthritis Rheum. 2000; 43(6):1356-65. DOI: 10.1002/1529-0131(200006)43:6<1356::AID-ANR20>3.0.CO;2-Y. View

17.

Sieper J, Lenaerts J, Wollenhaupt J, Rudwaleit M, Mazurov V, Myasoutova L . Efficacy and safety of infliximab plus naproxen versus naproxen alone in patients with early, active axial spondyloarthritis: results from the double-blind, placebo-controlled INFAST study, Part 1. Ann Rheum Dis. 2013; 73(1):101-7. PMC: 3888606. DOI: 10.1136/annrheumdis-2012-203201. View

18.

Anderson C, Boucher G, Lees C, Franke A, DAmato M, Taylor K . Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 47. Nat Genet. 2011; 43(3):246-52. PMC: 3084597. DOI: 10.1038/ng.764. View

19.

Noordenbos T, Yeremenko N, Gofita I, van de Sande M, Tak P, Canete J . Interleukin-17-positive mast cells contribute to synovial inflammation in spondylarthritis. Arthritis Rheum. 2011; 64(1):99-109. DOI: 10.1002/art.33396. View

20.

Burton P, Clayton D, Cardon L, Craddock N, Deloukas P, Duncanson A . Association scan of 14,500 nonsynonymous SNPs in four diseases identifies autoimmunity variants. Nat Genet. 2007; 39(11):1329-37. PMC: 2680141. DOI: 10.1038/ng.2007.17. View