Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

Clementina López-Medina; Anna Molto; Joachim Sieper; Tuncay Duruöz; Uta Kiltz; Bassel Elzorkany; Najia Hajjaj-Hassouni; Ruben Burgos-Vargas; José Maldonado-Cocco; Nelly Ziade; Meghna Gavali; Victoria Navarro-Compan; Shue-Fen Luo; Sara Monti; Kim Tae-Jong; Mitsumasa Kishimoto; F M Pimentel-Santos; Jieruo Gu; Ruxandra Schiotis; Floris A van Gaalen; Pál Geher; Marina Magrey; Sebastián E Ibáñez Vodnizza; Wilson Bautista-Molano; Walter Maksymowych; Pedro M Machado; Robert Landewé; Desirée van der Heijde; Maxime Dougados

doi:10.1136/rmdopen-2020-001450

Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

RMD Open. 2021 Jan;7(1):e001450. doi: 10.1136/rmdopen-2020-001450.

Authors

Clementina López-Medina^{1

2

3}, Anna Molto^{4

2}, Joachim Sieper⁵, Tuncay Duruöz⁶, Uta Kiltz⁷, Bassel Elzorkany⁸, Najia Hajjaj-Hassouni⁹, Ruben Burgos-Vargas¹⁰, José Maldonado-Cocco¹¹, Nelly Ziade¹², Meghna Gavali¹³, Victoria Navarro-Compan¹⁴, Shue-Fen Luo¹⁵, Sara Monti¹⁶, Kim Tae-Jong¹⁷, Mitsumasa Kishimoto¹⁸, F M Pimentel-Santos¹⁹, Jieruo Gu²⁰, Ruxandra Schiotis^{21

22}, Floris A van Gaalen²³, Pál Geher²⁴, Marina Magrey²⁵, Sebastián E Ibáñez Vodnizza²⁶, Wilson Bautista-Molano²⁷, Walter Maksymowych²⁸, Pedro M Machado^{29

30

31}, Robert Landewé^{32

33}, Desirée van der Heijde²³, Maxime Dougados^{4

2

34}

Affiliations

¹ Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France [email protected].
² ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.
³ Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain.
⁴ Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
⁵ Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University, Berlin, Germany.
⁶ PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey.
⁷ Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany.
⁸ Rheumatology Department, Cairo University, Cairo, Egypt.
⁹ Rheumatology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco.
¹⁰ Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico.
¹¹ Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina.
¹² Rheumatology Department, Saint-Joseph University and Mount Lebanon Hospital, Beirut, Lebanon.
¹³ Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
¹⁴ Rheumatology Department, University Hospital La Paz, IdiPaz, Madrid, Spain.
¹⁵ Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
¹⁶ Rheumatology Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy.
¹⁷ Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
¹⁸ Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan.
¹⁹ Rheumatology, NOVA Medical School, Nova University of Lisbon, Lisboa, Portugal.
²⁰ Rheumatology Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
²¹ Pharmacology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
²² Rheumatology Department, SCBI, Cluj-Napoca, Romania.
²³ Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands.
²⁴ Rheumatology Department, Semmelweis Egyetem, Budapest, Hungary.
²⁵ Rheumatology Department, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
²⁶ Rheumatology, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.
²⁷ Rheumatology Department, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia.
²⁸ Medicine Department, University of Alberta, Edmonton, Alberta, Canada.
²⁹ Centre for Rheumatology and Department of Neuromuscular Diseases, University College of London, London, UK.
³⁰ Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
³¹ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
³² Rheumatology, Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands.
³³ Rheumatology Department, Zuyderland MC, Heerlen, The Netherlands.
³⁴ Rheumatology, Université de Paris Descartes, Paris, France.

Abstract

Objectives: To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.

Methods: Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.

Results: A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).

Conclusion: These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.

Keywords: ankylosing; arthritis; juvenile; psoriatic; spondylitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Arthritis, Psoriatic* / epidemiology
Cross-Sectional Studies
Female
Humans
Male
Prevalence
Spondylarthritis* / epidemiology
Spondylitis, Ankylosing*