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

Abstract

ObjectivesTo characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.MethodsCross-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.ResultsA 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%).ConclusionThese 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.

Association between individual and country-level socioeconomic factors and work participation in spondyloarthritis including psoriatic arthritis: analysis of the ASAS-perSpA study

“…A total of 3835 participants from 23 countries were eligible for this analysis (no participants from the UK due to administrative limitations [9]). The mean age was 42 years (SD 12) with 61% males.…”

“…The ASAS-perSpA (peripheral involvement in SpA) study design has been described previously [9]. It was an international, cross-sectional study with 24 contributing countries that recruited from 2018-2020.…”

Inflammatory Foot Involvement in Spondyloarthritis: From Tarsitis to Ankylosing Tarsitis

“…Recently, peripheral arthritis appeared again in clinical descriptions (48). An international study of 4,465 patients with SpA found that nearly 70% of the participants had at least one episode of peripheral arthritis (48,60). Data splitting yielded 57% with arthritis, enthesitis in 44%, and dactylitis in 15%.…”

Coxitis in axial spondyloarthritis: the unmeasured, yet functionally most important, radiographic progression

“…A recent worldwide survey reported that hip involvement across the spectrum of SpA varied from 27% in those with psoriatic arthritis up to 53% in juvenile SpA, being more common among Asian patients. [ 7 ] These very recent data suggest that the prevalence of hip involvement at least in SpA may not have changed over time, since previous cohorts have reported a 24% to 36% variation in prevalence of hip involvement in AS. [ 3 ] However, there are no prospectively collected data evaluating severity of hip damage in AS, let alone in the whole SpA spectrum of diseases.…”

“…[ 1 ] Despite these data, there are no explicit recommendations in the current guidelines to start bDMARDs early in a patient with AS and groin pain. [ 8 , 7 ]…”