Peripheral manifestations of disease appear in more than 64% of individuals with spondyloarthritis (SpA). Further, the presence of psoriasis and absence of the HLA-B27 antigen are both associated with the development of peripheral symptoms, according to results from an ancillary analysis of the observational, cross-sectional, multicenter, international Assessment in Spondyloarthritis International Society-Comorbidities in Spondyloarthritis (ASAS-COMOSPA) study published in The Journal of Rheumatology.
The investigators sought to establish the factors associated with the presence of peripheral manifestations in patients with SpA from the ASAS-COMOSPA study, and to assess the effect of these symptoms on treatment and patient-reported outcomes (PROs). A case report form was used to compile data during a face-to-face patient interview at each center.
All of the 3984 patients from the ASAS-COMOSPA study were included in this analysis. Results showed that 64.3% (2562 of 3984) reported ≥1 peripheral manifestation — with a prevalence of 51.5% for peripheral arthritis, 37.8% for peripheral enthesitis, and 15.6% for dactylitis. Of the participants who presented with ≥1 peripheral manifestation of disease, 1875 also experienced axial involvement. Of these, 26.1% demonstrated ≥1 peripheral manifestation prior to axial symptoms, 27.6% concomitantly with axial symptoms and 61.3% following axial involvement.
Peripheral manifestations of disease were more common among patients from South American countries, those with current or prior history of psoriasis, individuals with a history of uveitis, and those with absence of the HLA-B27 antigen. Moreover, patients with peripheral disease involvement demonstrated a greater use of medication. Those with “current” peripheral manifestations exhibited higher levels in all PROs, compared with those with a past history or no history.
The investigators concluded that the presence of any peripheral symptoms at the time of the patient’s visit was associated with higher scores on all PROs. Additional studies that focus on the presence of peripheral symptoms in patients with SpA are warranted to more precisely identify the relationship between these clinical manifestations and psoriasis, and to better analyze the clinical presentation of disease and therapeutic possibilities.
López-Medina C, Moltó A, Dougados M. Peripheral manifestations in spondyloarthritis and their impact: an ancillary analysis of the ASAS-COMOSPA study [published online April 15, 2019]. J Rheumatol. doi:10.3899/jrheum.181331