Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
Surgery Department, Saint-Joseph University, Beirut, Lebanon; Orthopedic Surgery Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
Semin Arthritis Rheum. 2022 Aug;55:152012. doi: 10.1016/j.semarthrit.2022.152012. Epub 2022 Apr 21.
Little is known about the prevalence, phenotype, and burden of peripheral spondyloarthritis (pSpA). The objective of the study is to compare the phenotype and burden of disease of pure pSpA to that of pure psoriatic arthritis (PsA), pure axial SpA (axSpA), and combined forms of SpA.
This is a post hoc analysis of 4,185 patients from the cross-sectional ASAS-Peripheral involvement in SpA (PerSpA) study. Patients were approached in 2 ways: the first approach was based on the rheumatologist's diagnosis (diagnostic approach) and the second one was based on the fulfillment of ASAS or CASPAR classification criteria (classification criteria approach). Demographics, disease phenotype, and burden were compared among pure pSpA, PsA, axSpA, and the combined forms.
The proportion of pSpA was 31.5% of SpA using the classification criteria approach and 10.3% using the diagnostic approach. pSpA was pure (i.e. without axSpA or PsA) in 16.8% of pSpA using the criteria, and in 62.3% using the diagnostic approach. Using classification criteria and diagnostic approach, respectively, pure pSpA patients had a high prevalence of peripheral joint disease (86 and 96%), synovitis (76 and 91%), and enthesitis (57 and 55%), a positive HLA-B27 in 65 and 59%, a high C-Reactive Protein level in 51% and inflammatory back pain in 52 and 42%. However, compared to pure PsA and pure axSpA, they had a significantly higher disease burden, but lower use of biologics using both approaches.
The proportion of pSpA varies when using the classification criteria or the diagnostic approach. pSpA occurred in a pure form less frequently than PsA and axSpA and had intermediate features but a higher disease burden.
The PerSpA main study has been conducted under the umbrella of ASAS thanks to unrestricted grants from PFIZER, LILLY, ABBVIE, NOVARTIS, UCB, JANSSEN, MERCK.
外周型脊柱关节炎（pSpA）的患病率、表型和疾病负担知之甚少。本研究的目的是比较单纯 pSpA 与单纯银屑病关节炎（PsA）、单纯中轴型脊柱关节炎（axSpA）和脊柱关节炎混合表型的表型和疾病负担。
这是横断面 ASAS-外周型 SpA 研究（PerSpA）中 4185 例患者的事后分析。患者通过两种方式入组：第一种方法基于风湿病医生的诊断（诊断方法），第二种方法基于 ASAS 或 CASPAR 分类标准（分类标准方法）。采用单纯 pSpA、PsA、axSpA 和混合表型比较患者的人口统计学、疾病表型和负担。
采用分类标准方法 pSpA 占 SpA 的 31.5%，采用诊断方法占 10.3%。采用标准方法，单纯 pSpA （即无 axSpA 或 PsA）占 pSpA 的 16.8%，而采用诊断方法占 62.3%。分别采用分类标准和诊断方法，单纯 pSpA 患者外周关节疾病（86%和 96%）、滑膜炎（76%和 91%）和附着点炎（57%和 55%）的患病率高，HLA-B27 阳性率分别为 65%和 59%，C 反应蛋白水平高（分别为 51%和 42%），炎症性背痛（分别为 52%和 42%）。然而，与单纯 PsA 和单纯 axSpA 相比，pSpA 的疾病负担明显更高，但两种方法均较少使用生物制剂。
采用分类标准或诊断方法时，pSpA 的比例不同。pSpA 以单纯形式发生的频率低于 PsA 和 axSpA，具有中间特征，但疾病负担更高。
本研究得到辉瑞、礼来、艾伯维、诺华、UCB、杨森、默克等公司的无限制资助。
