Kommineni Krishna, Abutineh Iman, Chapman Cathy, Pattanaik Debendra, Bittar Mohamad
The University of Tennessee Health Service Center, Memphis.
Oregon Health & Science University, Portland.
ACR Open Rheumatol. 2025 Jan;7(1):e11769. doi: 10.1002/acr2.11769. Epub 2024 Nov 27.
Axial spondyloarthritis (axSpA) is an immune-mediated disease that predominantly affects the axial skeleton. The objective of this study was to describe the frequency and clinical characteristics of axSpA in Black Americans in Shelby County. We also aimed to report diagnostic delays, disease severity, and health disparities in this population.
This was a retrospective observational study in which electronic records of patients with axSpA were reviewed across five centers in Shelby County. Patients were identified using International Classification of Diseases codes. Data on demographics, clinical characteristics, and imaging were collected. The frequency was reported. Two-group comparisons were done using the chi-square test and two-sample t-test. Multivariable logistic and linear regression methods were used to compare sacroiliitis grades and delay in diagnosis, respectively, after adjusting for confounders.
Black Americans constituted 32% (n = 78) of the 244 patients with axSpA identified. Black Americans had significantly more hip involvement, more elevations in C-reactive protein, less HLA-B27 positivity, and less family history positivity when compared with White patients. After adjusting for age, sex, and HLA-B27, Black Americans had twice as higher odds of having advanced grades of sacroiliitis on x-rays compared to White Americans (odds ratio 2.32 [95% confidence interval 1.23-4.44]). AxSpA was associated with significant diagnostic delays in both races.
A significant proportion of patients with axSpA in Shelby County were Black Americans. The study identified that Black Americans have more odds of having advanced sacroiliitis on x-rays, more hip involvement, and higher markers of inflammation. It also showed that, regardless of race or ethnicity, there is a significant diagnostic delay.
轴性脊柱关节炎（axSpA）是一种主要影响中轴骨骼的免疫介导性疾病。本研究的目的是描述谢尔比县非裔美国人中axSpA的发病率及临床特征。我们还旨在报告该人群的诊断延迟、疾病严重程度及健康差异。
这是一项回顾性观察研究，对谢尔比县五个中心的axSpA患者电子记录进行了回顾。使用国际疾病分类代码识别患者。收集了人口统计学、临床特征及影像学数据，并报告了发病率。采用卡方检验和两样本t检验进行两组比较。在调整混杂因素后，分别使用多变量逻辑回归和线性回归方法比较骶髂炎分级和诊断延迟情况。
在确诊的244例axSpA患者中，非裔美国人占32%（n = 78）。与白人患者相比，非裔美国人髋关节受累更多，C反应蛋白升高更明显，HLA-B27阳性率更低，家族史阳性率更低。在调整年龄、性别和HLA-B27后，与美国白人相比，非裔美国人X线显示骶髂炎高级别病变的几率高出两倍（优势比2.32 [95%置信区间1.23 - 4.44]）。两个种族的axSpA均与显著的诊断延迟相关。
谢尔比县相当一部分axSpA患者是非裔美国人。该研究发现，非裔美国人X线显示骶髂炎进展、髋关节受累更多及炎症标志物更高的几率更大。研究还表明，无论种族或民族，均存在显著的诊断延迟。
