Department of Rheumatology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Rheumatol Int. 2023 Apr;43(4):639-649. doi: 10.1007/s00296-022-05262-6. Epub 2023 Jan 13.
To explore the proportion of axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) diagnoses within all newly referred patients visiting rheumatology outpatient clinics. And more specifically, to analyze whether there is an effect of the introduction of the ASAS and CASPAR classification criteria for axSpA and PsA. We systematically searched Embase, Medline Ovid, Cochrane Central and Web of Science from database inception to November 2022. Articles that investigated new onsets of axSpA and PsA in adults from rheumatology clinics were included. In total, 170 out of 7139 studies were found eligible for full-text review, after which 33 unique studies were included. Seventeen studies reported new onsets of axSpA, and 20 studies of PsA. The pooled proportion of axSpA within all newly referred patients was 19% (95% CI 15-23%) and 18% (95% CI 14-22%) for PsA. The proportion of axSpA before 2009 was 3% (95% CI 0-6%) and increased up to 21% (95% CI 14-28%) after 2009. For PsA, limited data were available in order to analyze the proportions of PsA before 2006. Overall, heterogeneity was high (I > 95%, p < 0.001) that was most likely caused by geographical area, study design, setting and use of different referral strategies. The pooled proportion of axSpA and PsA among patients referred to the rheumatology outpatient clinic was 19 and 18%, respectively. Although the proportion of diagnosed axSpA patients seemed to increase after the introduction of the ASAS criteria, due to the large heterogeneity our findings should be interpreted with caution.
探讨在所有新就诊于风湿病门诊的患者中，轴性脊柱关节炎（axSpA）和银屑病关节炎（PsA）的诊断比例。更具体地说，分析 ASAS 和 CASPAR 分类标准对 axSpA 和 PsA 的引入是否有影响。我们系统地检索了 Embase、Medline Ovid、Cochrane Central 和 Web of Science，从数据库建立到 2022 年 11 月。纳入了调查风湿病诊所成人新发 axSpA 和 PsA 的研究。共有 7139 项研究中有 170 项符合全文审查标准，之后有 33 项独特的研究被纳入。17 项研究报告了 axSpA 的新发病例，20 项研究报告了 PsA 的新发病例。所有新就诊患者中 axSpA 的比例为 19%（95%CI 15-23%），PsA 为 18%（95%CI 14-22%）。2009 年前 axSpA 的比例为 3%（95%CI 0-6%），2009 年后增至 21%（95%CI 14-28%）。对于 PsA，由于缺乏 2006 年前的比例数据，因此无法进行分析。总体而言，异质性很高（I>95%，p<0.001），主要原因是地理位置、研究设计、设置和使用不同的转诊策略。转诊至风湿病门诊的患者中 axSpA 和 PsA 的比例分别为 19%和 18%。尽管 ASAS 标准引入后，axSpA 患者的诊断比例似乎有所增加，但由于异质性较大，我们的研究结果应谨慎解释。
