Rheumatology, Saint-Joseph University.
Rheumatology, Hotel-Dieu de France Hospital.
Rheumatology (Oxford). 2022 Feb 2;61(2):667-678. doi: 10.1093/rheumatology/keab380.
The primary objective was to compare the clinical characteristics of SpA patients with and without root joint disease (RJD+ and RJD-). The secondary objectives were to compare the prevalence of RJD across various SpA subtypes and in different world regions, and to compare the SpA axial severity and SpA burden between RJD+ and RJD-.
This is a post hoc analysis of the Assessment of Spondyloarthritis International Society PerSpA study (PERipheral involvement in SpondyloArthritis), which included 4465 patients with SpA [axial (axSpA), peripheral (pSpA), PsA, IBD, reactive and juvenile] according to the rheumatologist's diagnosis. RJD was defined as the 'ever' presence of hip or shoulder involvement related to SpA, according to the rheumatologist. Patient characteristics were compared between RJD+ and RJD-. Multivariable stepwise binary logistic regression analyses were conducted to identify factors associated with 'RJD', 'hip' and 'shoulder' involvement.
RJD was significantly associated with the SpA main diagnosis (highest in pSpA), a higher prevalence of HLA-B27 positivity, enthesitis, tender and swollen joints, CRP, conventional synthetic DMARDs, loss of lumbar lordosis and occiput-wall distance >0. RJD was more prevalent in Asia, and occurred in 1503 patients (33.7%), with more hip (24.2%) than shoulder (13.2%) involvement. Hip involvement had a distinct phenotype, similar to axSpA (including younger age at onset, HLA-B27 positivity), whereas shoulder involvement was associated with features of pSpA (including older age at onset).
RJD+ SpA patients had a distinctive clinical phenotype compared with RJD-. Hip involvement, based on the rheumatologist's diagnosis, was more prevalent than shoulder involvement and was clinically distinct.
主要目的是比较有根关节疾病（RJD+和 RJD-）和无根关节疾病的 SpA 患者的临床特征。次要目的是比较各种 SpA 亚型和不同世界区域的 RJD 患病率，以及比较 RJD+和 RJD-的 SpA 轴性严重程度和 SpA 负担。
这是 SpA 国际评估协会 PERSpA 研究（SpA 的外周累及）的事后分析，该研究纳入了 4465 名 SpA 患者[轴性（axSpA）、外周（pSpA）、PsA、IBD、反应性和青少年]，根据风湿病学家的诊断。RJD 根据风湿病学家的诊断定义为“曾经”存在与 SpA 相关的髋关节或肩部受累。比较 RJD+和 RJD-患者的特征。采用多变量逐步二元逻辑回归分析确定与“RJD”、“髋关节”和“肩部”受累相关的因素。
RJD 与 SpA 主要诊断显著相关（pSpA 最高），HLA-B27 阳性率较高，附着点炎、压痛和肿胀关节、CRP、传统合成 DMARDs、腰椎前凸丧失和枕墙距离>0。RJD 在亚洲更为普遍，发生在 1503 名患者（33.7%）中，髋关节（24.2%）受累多于肩部（13.2%）。髋关节受累具有独特的表型，类似于 axSpA（包括发病年龄较小、HLA-B27 阳性），而肩部受累与 pSpA 的特征相关（包括发病年龄较大）。
与 RJD-相比，RJD+SpA 患者具有独特的临床表型。基于风湿病学家的诊断，髋关节受累比肩部受累更为普遍，且具有独特的临床特征。
