Features of Axial Spondyloarthritis in Two Multicenter Cohorts of Patients with Psoriasis, Uveitis, and Colitis Presenting with Undiagnosed Back Pain.

IF 11.4 1区医学 Q1 RHEUMATOLOGY Arthritis & Rheumatology Pub Date : 2025-01-01 Epub Date: 2024-09-03 DOI:10.1002/art.42967

Walter P Maksymowych, Raj Carmona, Ulrich Weber, Sibel Zehra Aydin, James Yeung, Jodie Reis, Ariel Masetto, Sherry Rohekar, Dianne Mosher, Olga Zouzina, Liam Martin, Stephanie O Keeling, Joel Paschke, Rana Dadashova, Amanda Carapellucci, Stephanie Wichuk, Robert G Lambert, Jonathan Chan

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Abstract

Objective: We aimed to assess the following: (1) the frequency of axial spondyloarthritis (axSpA) according to extra-articular presentation and HLA-B27 status, (2) clinical and imaging features that distinguish axSpA from non-axSpA, and (3) the impact of magnetic resonance imaging (MRI) on diagnosis and classification of axSpA.

Methods: The Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) study enrolled patients in two multicenter cohorts. Consecutive patients with undiagnosed chronic back pain attending dermatology, ophthalmology, and gastroenterology clinics with psoriasis (PsO), acute anterior uveitis (AAU), or inflammatory bowel disease (IBD) were referred to a local rheumatologist with special expertise in axSpA for a structured diagnostic evaluation. The primary outcome was the proportion of patients diagnosed with axSpA by the final global evaluation.

Results: Frequency of axSpA was 46.7%, 61.6%, and 46.8% in patients in SASPIC-1 (n = 212) and 23.5%, 57.9%, and 23.3% in patients in SASPIC-2 (n = 151) with PsO, AAU, or IBD, respectively. Among those who were B27 positive, axSpA was diagnosed in 70%, 74.5%, and 66.7% of patients in SASPIC-1 and in 71.4%, 87.8%, and 55.6% of patients in SASPIC-2 with PsO, AAU, or IBD, respectively. All musculoskeletal clinical features were nondiscriminatory. MRI was indicative of axSpA in 60% to 80% of patients and MRI in all patients (SASPIC-2) versus on-demand (SASPIC-1) led to 25% fewer diagnoses of axSpA in patients who were HLA-B27 negative with PsO or IBD. Performance of the Assessment of SpondyloArthritis International Society classification criteria was greater with routine MRI (SASPIC-2), though sensitivity was lower than previously reported.

Conclusion: Optimal management of patients presenting with PsO, AAU, IBD, and undiagnosed chronic back pain should include referral to a rheumatologist. Conducting MRI in all patients enhances diagnostic accuracy.

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牛皮癣、葡萄膜炎和结肠炎患者伴有未确诊背痛的两个多中心队列中轴性脊柱关节炎的特征。

目标我们旨在评估1.轴性脊柱关节炎（axSpA）在关节外表现和 HLA-B27 状态下的发病率；2.区分 axSpA 和非 axSpA 的临床和影像学特征；3.磁共振成像对 axSpA 诊断和分类的影响：银屑病、关节炎、结肠炎轴性脊柱关节炎筛查（SASPIC）研究在两个多中心队列中招募患者。在皮肤科、眼科和消化科门诊就诊的未确诊慢性背痛的连续性银屑病、AAU 或 IBD 患者被转诊至当地具有 axSpA 专业知识的风湿病专家处，接受结构化诊断评估。主要结果是通过最终全面评估确诊为 axSpA 的患者比例：结果：在SASPIC-1病例（n=212）中，axSpA的发病率分别为46.7%、61.6%和46.8%；在SASPIC-2病例（n=151）中，PsO、AAU或IBD的发病率分别为23.5%、57.9%和23.3%。在 B27 阳性病例中，SASPIC-1 中 70%、74.5% 和 66.7% 的 PsO、AAU 或 IBD 患者被诊断为 axSpA，SASPIC-2 中 71.4%、87.8% 和 55.6% 的 PsO、AAU 或 IBD 患者被诊断为 axSpA。所有肌肉骨骼临床特征均无差别。60%-80%的患者的核磁共振成像显示为axSpA，在所有患者中进行核磁共振成像（SASPIC-2）与按需进行核磁共振成像（SASPIC-1）相比，在HLA B27阴性的PsO或IBD患者中，axSpA的诊断率降低了25%。ASAS分类标准在常规磁共振成像（SASPIC-2）中的表现更好，但灵敏度低于之前的报告：结论：PsO、AAU、IBD 和未确诊的慢性背痛患者的最佳治疗方法应包括转诊至风湿免疫科医生。对所有患者进行磁共振成像可提高诊断的准确性。

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来源期刊

Arthritis & Rheumatology RHEUMATOLOGY-

CiteScore

20.90

自引率

3.00%

发文量

371

期刊介绍： Arthritis & Rheumatology is the official journal of the American College of Rheumatology and focuses on the natural history, pathophysiology, treatment, and outcome of rheumatic diseases. It is a peer-reviewed publication that aims to provide the highest quality basic and clinical research in this field. The journal covers a wide range of investigative areas and also includes review articles, editorials, and educational material for researchers and clinicians. Being recognized as a leading research journal in rheumatology, Arthritis & Rheumatology serves the global community of rheumatology investigators and clinicians.