Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
NIHR Leeds BRC, Leeds Teaching Hospitals NHS Trust and School of Medicine, University of Leeds, Leeds, UK.
Rheumatology (Oxford). 2024 Feb 1;63(2):430-435. doi: 10.1093/rheumatology/kead225.
To examine the prevalence of extra-musculoskeletal manifestations (EMM) and the association between diagnostic delay and their incidence in AS and PsA.
This was a retrospective, cohort study comprising two single centre cohorts in Europe and one multicentre cohort in Latin America (RESPONDIA). Crude prevalence of EMMs (uveitis, IBD and psoriasis) was calculated across geographic area and adjusted by direct standardization. Cox proportional hazard analysis was performed to assess the association between diagnostic delay and EMM incidence.
Of 3553 patients, 2097 had AS and 1456 had PsA. The overall prevalence of uveitis was 22.9% (95% CI: 21.1, 24.8) in AS and 3.8% (95% CI: 2.9, 5.0) in PsA; 8.1% (95% CI: 7.0, 9.4) and 2.1% (1.3, 2.9), respectively, for IBD; and 11.0% (95% CI: 9.7, 12.4) and 94.6% (93.0, 95.9), respectively, for psoriasis. The EMM often presented before the arthritis (uveitis 45.1% and 33.3%, and IBD 37.4% and 70%, in AS and PsA, respectively). In the multivariable model, longer diagnostic delay (≥5 years) associated with more uveitis (hazard ratio [HR] 4.01; 95% CI: 3.23, 4.07) and IBD events (HR 1.85; 95% CI: 1.28, 2.67) in AS. Diagnostic delay was not significantly associated with uveitis (HR 1.57; 95% CI: 0.69, 3.59) or IBD events (HR 1.59; 95% CI: 0.39, 6.37) in PsA.
EMMs are more prevalent in AS than PsA and often present before the onset of the articular disease. A longer diagnostic delay is associated with the 'de novo' appearance of uveitis and IBD in AS, highlighting the need to enhance diagnostic strategies to shorten the time from first symptom to diagnosis in SpA.
研究肌骨外表现（EMM）的患病率，以及在 AS 和 PsA 中诊断延迟与这些表现发生率之间的关联。
这是一项回顾性队列研究，包括欧洲的两个单中心队列和拉丁美洲的一个多中心队列（RESPONDIA）。通过直接标准化计算 EMM（虹膜炎、IBD 和银屑病）的粗患病率。采用 Cox 比例风险分析评估诊断延迟与 EMM 发生率之间的关联。
在 3553 名患者中，2097 名患有 AS，1456 名患有 PsA。AS 中虹膜炎的总体患病率为 22.9%（95%CI：21.1，24.8），PsA 中为 3.8%（95%CI：2.9，5.0）；IBD 分别为 8.1%（95%CI：7.0，9.4）和 2.1%（1.3，2.9）；银屑病分别为 11.0%（95%CI：9.7，12.4）和 94.6%（93.0，95.9）。EMM 通常在关节炎之前出现（AS 中虹膜炎为 45.1%和 33.3%，IBD 为 37.4%和 70%；PsA 中分别为 45.1%和 33.3%，IBD 为 37.4%和 70%）。在多变量模型中，较长的诊断延迟（≥5 年）与 AS 中更多的虹膜炎（风险比 [HR] 4.01；95%CI：3.23，4.07）和 IBD 事件（HR 1.85；95%CI：1.28，2.67）相关。诊断延迟与 PsA 中虹膜炎（HR 1.57；95%CI：0.69，3.59）或 IBD 事件（HR 1.59；95%CI：0.39，6.37）的发生均无显著相关性。
EMM 在 AS 中的患病率高于 PsA，且通常在关节疾病出现之前出现。较长的诊断延迟与 AS 中虹膜炎和 IBD 的“新发”出现相关，这突出表明需要加强诊断策略，以缩短 SpA 患者从首发症状到确诊的时间。
