Comparison of Clinical Manifestations in Rheumatoid Arthritis vs. Spondyloarthritis: A Systematic Literature Review

Abstract

Introduction: Misclassification of spondyloarthritis (SpA) as rheumatoid arthritis (RA) may lead to delayed SpA diagnosis and suboptimal therapeutic outcomes. Here, we evaluate the literature on clinical manifestations in patients with SpA and RA, particularly seronegative RA, to understand the potential overlap, distinctions, and most reliable approaches to accurate diagnosis. Methods: In this systematic literature review, conducted according to PRISMA guidelines, we searched key biomedical databases for Englishlanguage publications of original research articles (up to July 23, 2020) and rheumatology conference abstracts (January 1, 2018-July 31, 2020) reporting key SpA clinical presentations in patients with SpA or RA. Publications were assessed for eligibility by two independent reviewers; discrepancies were resolved by a third. Studies were evaluated for publication quality using the Downs and Black checklist. Results: Of 4712 records retrieved, 79 met the inclusion criteria and were included in the analysis. Of these, 54 included study populations with SpA and RA, and 25 with seropositive and/or seronegative RA. Entheseal abnormalities were more frequently reported among patients with SpA than RA and with seronegative vs. seropositive RA. Psoriasis, nail psoriasis, and dactylitis were exclusively seen in SpA vs. RA. In most publications (70 of 79), advanced imaging techniques allowed for more accurate distinction between SpA and RA. Overlapping clinical characteristics occur in SpA and RA, including inflammation and destruction of joints, pain, diminished functional ability, and increased risk for comorbidities. However, of 54 studies comparing SpA and RA populations, only seven concluded that no distinction can be

Comparison of immune cells and diagnostic markers between spondyloarthritis and rheumatoid arthritis by bioinformatics analysis

“…Because of the continuous destruction of joints, early diagnosis and treatment are particularly important [ 13 ]. However, the clinical manifestations of early diseases are similar, the diagnosis time is too long, and there is no effective biomarker, especially the negative serum rheumatoid factor and anti-cyclic citrulline antibody, which bring great difficulties to the treatment [ 14 ]. Increasing number of studies have shown that the inflammatory microenvironment and inflammatory cells of synovium play an indispensable role in diseases [ 15 , 16 ].…”

Rheumatoid arthritis as a clinical and immunological syndrome: focus on the seronegative subtype of the disease

“…Во-вторых, диагностика серонегативного РА, основанная на классификационных (а не диагностических) критериях, может быть затруднена, особенно на ранних стадиях заболевания [17]. Диагноз нередко верифицируется только в процессе длительного наблюдения пациентов [18][19][20]. Это затрудняет своевременное назначение адекватной противовоспалительной терапии в рамках стратегии «лечение до достижения цели» (treat-to-target) [21].…”

Mucosa‐associated lymphoid tissue lymphoma translocation protein 1 in rheumatoid arthritis: Longitudinal change after treatment and correlation with treatment efficacy of tumor necrosis factor inhibitors

“… 1 , 2 Clinically, RA not only causes swollen and tender joints, but also affects other systems or organs apart from the joints including skin, eyes, cardiovascular system, neuron system, etc. 3 Fortunately, with the induction of tumor necrosis factor (TNF) inhibitors, the most commonly used biologics, the treatment approaches of RA have been greatly enriched. 4 , 5 , 6 For RA patients who may not respond to conventional disease‐modifying anti‐rheumatoid drugs (cDMARDs), using TNF inhibitors is a promising option; meanwhile, it is also reported that using TNF inhibitors as the first‐line therapy is a cost‐effective strategy.…”

“…Rheumatoid arthritis (RA) is an autoimmune disease that affects approximately 1% of the entire human beings with the incidence ranging from 8 to 45 per 100,000 populations per year 1,2 . Clinically, RA not only causes swollen and tender joints, but also affects other systems or organs apart from the joints including skin, eyes, cardiovascular system, neuron system, etc 3 . Fortunately, with the induction of tumor necrosis factor (TNF) inhibitors, the most commonly used biologics, the treatment approaches of RA have been greatly enriched 4–6 .…”