High frequency of inflammatory back pain and other features of spondyloarthritis in patients with rheumatoid arthritis

Abstract

The aim of this study was to investigate the frequency of patients with rheumatoid arthritis (RA) who have inflammatory back pain (IBP) and meet the existing classification criteria for ankylosing spondylitis (AS) and spondyloarthritis (SpA). We included 167 patients fulfilling the ACR 1987 revised criteria for RA. After obtaining a medical history and performing a physical examination, standard pelvic X-rays for examination of the sacroiliac joints (SIJ) were ordered in all patients. A computed tomography (CT) or magnetic resonance imaging (MRI) of SIJ was performed in patients with suspected radiographic sacroiliitis and MRI of SIJ in those who have IBP but no radiographic sacroiliitis. IBP was defined according to both Calin and experts' criteria. The modified New York (mNY) criteria were used to classify AS, both ESSG and Amor criteria for SpA and ASAS classification criteria for axial SpA. There were 135 female and 32 male patients with a mean age of 54.8 years. The mean disease duration was 9.8 years. RF was positive in 128 patients (79.2 %) and anti-CCP in 120 patients (81.1 %). Twenty-eight patients with RA (16.8 %) had IBP (Calin criteria), and four (2.4 %) had radiographic sacroiliitis of bilateral grade 3. Three patients (1.8 %) fulfilled the mNY criteria for AS, 31 (18.6 %) ESSG and 26 (15.6 %) Amor criteria for SpA. Nine patients (five with MRI sacroiliitis) (5.3 %) were classified as having axial SpA according to new ASAS classification criteria. This study suggests that the prevalence of SpA features in patients with RA may be much higher than expected.

Coexistence of rheumatoid arthritis and ankylosing spondylitis

“…The research by Toussirot et al [ 4 ] shows that 6.6% of patients with RA may have positive HLA-B27, which is comparable to the general population, wherein the expression of this antigen is 5–8%. The presence of HLA-B27 in patients with RA does not increase the incidence of enthesitis or sacroiliac joint inflammation [ 4 , 8 , 9 ]. The percentage of people with positive HLA-B27 who can develop AS did not exceed 5%, whereas this antigen is detected in up to 90–95% of Caucasians suffering from AS [ 1 ].…”

“…Among the described patients, radiological changes were typical for both RA and AS. According to some authors, in doubtful cases, in order to confirm the coexistence of both diseases, magnetic resonance imaging, scintigraphy and computed tomography may be useful in detecting early changes in the sacroiliac joints, not only in AS, but also in patients with RA [ 9 , 15 ].…”

“…In 2013, Can et al [ 9 ] determined the incidence of IBP and other symptoms characteristic of SpA in a group of 167 patients diagnosed with RA. The criteria for IBP by Calin were met in 16.8% of patients, and enthesitis was reported in 41.9% of patients.…”

“…In the group of 167 patients surveyed, 1.8% met the modified New York criteria for AS diagnosis, 18.6% met the criteria of the European Spondyloarthropathy Study Group, 15.6% met the Amor criteria and 5.3% met the criteria of axial spondyloarthropathies according to the ASAS (Assessment of SpondyloArthritis International Society). All patients with coexistence of RA and AS had positive RF and anti-CCP [ 9 ].…”

Magnetic Resonance Imaging of the Sacroiliac Joint in Differential Diagnosis of Early Polyarticular Psoriatic and Rheumatoid Arthritis (Study Data Remarka)

“…[15], в которое было включено 167 пациентов с РА (135 женщин и 32 мужчины, средний возраст 54,8 года, средняя дли-тельность болезни 9,8 года, позитивных по РФ в 79,2% и по АЦЦП -в 81,1% случаев), соответствующих критери-ям Американской коллегии ревматологов (ACR) 1987 г., изучали частоту ВБС, состояние КПС методом рентгено-графии (у всех больных), а также КТ и МРТ КПС у паци-ентов с ВБС и подозрением на СИ при рентгенографии. ВБС выявлена у 28 (16,8%), двусторонний СИ 3-й стадии по данным рентгенографии -у 4 (2,4%), а признаки АСИ на МРТ -у 5 больных.…”