. 2021 Jan;7(1):e001450.

doi: 10.1136/rmdopen-2020-001450.

Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

Clementina López-Medina^{1

2

3}, Anna Molto^{4

2}, Joachim Sieper⁵, Tuncay Duruöz⁶, Uta Kiltz⁷, Bassel Elzorkany⁸, Najia Hajjaj-Hassouni⁹, Ruben Burgos-Vargas¹⁰, José Maldonado-Cocco¹¹, Nelly Ziade¹², Meghna Gavali¹³, Victoria Navarro-Compan¹⁴, Shue-Fen Luo¹⁵, Sara Monti¹⁶, Kim Tae-Jong¹⁷, Mitsumasa Kishimoto¹⁸, F M Pimentel-Santos¹⁹, Jieruo Gu²⁰, Ruxandra Schiotis^{21

22}, Floris A van Gaalen²³, Pál Geher²⁴, Marina Magrey²⁵, Sebastián E Ibáñez Vodnizza²⁶, Wilson Bautista-Molano²⁷, Walter Maksymowych²⁸, Pedro M Machado^{29

30

31}, Robert Landewé^{32

33}, Desirée van der Heijde²³, Maxime Dougados^{4

2

34}

Affiliations

¹ Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France clementinalopezmedina@gmail.com.
² ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.
³ Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain.
⁴ Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
⁵ Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University, Berlin, Germany.
⁶ PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey.
⁷ Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany.
⁸ Rheumatology Department, Cairo University, Cairo, Egypt.
⁹ Rheumatology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco.
¹⁰ Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico.
¹¹ Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina.
¹² Rheumatology Department, Saint-Joseph University and Mount Lebanon Hospital, Beirut, Lebanon.
¹³ Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
¹⁴ Rheumatology Department, University Hospital La Paz, IdiPaz, Madrid, Spain.
¹⁵ Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
¹⁶ Rheumatology Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy.
¹⁷ Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
¹⁸ Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan.
¹⁹ Rheumatology, NOVA Medical School, Nova University of Lisbon, Lisboa, Portugal.
²⁰ Rheumatology Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
²¹ Pharmacology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
²² Rheumatology Department, SCBI, Cluj-Napoca, Romania.
²³ Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands.
²⁴ Rheumatology Department, Semmelweis Egyetem, Budapest, Hungary.
²⁵ Rheumatology Department, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
²⁶ Rheumatology, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.
²⁷ Rheumatology Department, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia.
²⁸ Medicine Department, University of Alberta, Edmonton, Alberta, Canada.
²⁹ Centre for Rheumatology and Department of Neuromuscular Diseases, University College of London, London, UK.
³⁰ Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
³¹ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
³² Rheumatology, Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands.
³³ Rheumatology Department, Zuyderland MC, Heerlen, The Netherlands.
³⁴ Rheumatology, Université de Paris Descartes, Paris, France.

PMID: 33462157
PMCID: PMC7816910
DOI: 10.1136/rmdopen-2020-001450

Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

Clementina López-Medina et al. RMD Open. 2021 Jan.

. 2021 Jan;7(1):e001450.

doi: 10.1136/rmdopen-2020-001450.

Authors

Affiliations

¹ Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France clementinalopezmedina@gmail.com.
² ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France.
³ Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain.
⁴ Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
⁵ Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité University, Berlin, Germany.
⁶ PMR Department, Rheumatology Division, Marmara University School of Medicine, Istanbul, Turkey.
⁷ Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany.
⁸ Rheumatology Department, Cairo University, Cairo, Egypt.
⁹ Rheumatology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco.
¹⁰ Rheumatology Department, Hospital General de México Eduardo Liceaga, Mexico City, Mexico.
¹¹ Rheumatology, Buenos Aires University School of Medicine, Buenos Aires, Argentina.
¹² Rheumatology Department, Saint-Joseph University and Mount Lebanon Hospital, Beirut, Lebanon.
¹³ Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
¹⁴ Rheumatology Department, University Hospital La Paz, IdiPaz, Madrid, Spain.
¹⁵ Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
¹⁶ Rheumatology Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia, Italy.
¹⁷ Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
¹⁸ Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan.
¹⁹ Rheumatology, NOVA Medical School, Nova University of Lisbon, Lisboa, Portugal.
²⁰ Rheumatology Department, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
²¹ Pharmacology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
²² Rheumatology Department, SCBI, Cluj-Napoca, Romania.
²³ Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands.
²⁴ Rheumatology Department, Semmelweis Egyetem, Budapest, Hungary.
²⁵ Rheumatology Department, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
²⁶ Rheumatology, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.
²⁷ Rheumatology Department, University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia.
²⁸ Medicine Department, University of Alberta, Edmonton, Alberta, Canada.
²⁹ Centre for Rheumatology and Department of Neuromuscular Diseases, University College of London, London, UK.
³⁰ Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
³¹ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
³² Rheumatology, Amsterdam Rheumatology Center, AMC, Amsterdam, Netherlands.
³³ Rheumatology Department, Zuyderland MC, Heerlen, The Netherlands.
³⁴ Rheumatology, Université de Paris Descartes, Paris, France.

PMID: 33462157
PMCID: PMC7816910
DOI: 10.1136/rmdopen-2020-001450

Abstract

Objectives: To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.

Methods: Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.

Results: A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).

Conclusion: These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.

Keywords: ankylosing; arthritis; juvenile; psoriatic; spondylitis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Prevalence of peripheral musculoskeletal manifestations in the past with regard to the geographic area.

**Figure 2**
Prevalence of peripheral musculoskeletal manifestations in the past with regard to the diagnosis. axSpA, axial spondyloarthritis; IBD-SpA, inflammatory bowel disease-associated spondyloarthritis; Juv-SpA, juvenile spondyloarthritis; PsA, psoriatic arthritis; pSpA, peripheral spondyloarthritis; ReA, reactive arthritis.

**Figure 3**
Number of affected joints in the past (excluding root joints) with regard to the diagnosis*. *Among patients with peripheral joint disease (excluding root joints) and available data concerning the number of affected joints (n=2538). axSpA, axial spondyloarthritis; IBD-SpA, inflammatory bowel disease-associated spondyloarthritis; Juv-SpA, juvenile spondyloarthritis; PsA, psoriatic arthritis; pSpA, peripheral spondyloarthritis; ReA, reactive arthritis.

**Figure 4**
Location of peripheral articular involvement in the past (excluding root joints) with regard to the diagnosis*. *Among patients with peripheral joint disease (excluding root joints) and available data concerning the location of affected joints (n=2501). axSpA, axial spondyloarthritis; IBD-SpA, inflammatory bowel disease-associated spondyloarthritis; Juv-SpA, juvenile spondyloarthritis; PsA, psoriatic arthritis; pSpA, peripheral spondyloarthritis; ReA, reactive arthritis.

**Figure 5**
Location of root joint involvement in the past with regard to the diagnosis*. *Among patients with root joint involvement and available data concerning the location (n=1372). axSpA, axial spondyloarthritis; IBD-SpA, inflammatory bowel disease-associated spondyloarthritis; Juv-SpA, juvenile spondyloarthritis; PsA, psoriatic arthritis; pSpA, peripheral spondyloarthritis; ReA, reactive arthritis.

See this image and copyright information in PMC

References

1. Dougados M, Baeten D. Spondyloarthritis. Lancet 2011;377:2127–37. 10.1016/S0140-6736(11)60071-8 - DOI - PubMed
1. Rudwaleit M, van der Heijde D, Landewé R, et al. . The assessment of spondyloarthritis international society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70:25–31. 10.1136/ard.2010.133645 - DOI - PubMed
1. Taylor W, Gladman D, Helliwell P, et al. . Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54:2665–73. 10.1002/art.21972 - DOI - PubMed
1. Benegas M, Muñoz-Gomariz E, Font P, et al. . Comparison of the clinical expression of patients with ankylosing spondylitis from Europe and Latin America. J Rheumatol 2012;39:2315–20. 10.3899/jrheum.110687 - DOI - PubMed
1. Bautista-Molano W, Landewé R, Burgos-Vargas R, et al. . Prevalence of comorbidities and risk factors for comorbidities in patients with spondyloarthritis in Latin America: a comparative study with the general population and data from the ASAS-COMOSPA study. J Rheumatol 2018;45:206–12. 10.3899/jrheum.170520 - DOI - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

Affiliations

Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Miscellaneous