Undifferentiated spondyloarthritis in a heterogeneous Brazilian population: an eight-year follow-up study

Abstract

The aim of the present study was to describe the outcomes of Brazilian patients with undifferentiated spondyloarthritis during an eight-year follow-up period. Patients fulfilling the European Spondyloarthritis (SpA) Study Group Classification Criteria were enrolled. Forty patients were seen at baseline, and 36 participated in the follow-up study. Twenty-three (58%) were female, and there were 24 (60%) African Brazilians enrolled. HLA-B27 was positive in 18 (45%) patients. At disease onset, the first presenting symptoms were pure peripheral manifestations in 26 (72.2%) patients. After the study period, mixed disease (axial + peripheral) predominated occurring in 25 (69.4%) patients. The Assessment of SpA International society (ASAS) classification criteria for axial SpA were fulfilled by 77% of patients, and the ASAS criteria for peripheral SpA were fulfilled by 59% of patients. After 2.5 years, 6 (16.7%) of the 36 patients fulfilled the modified New York Criteria for ankylosing spondylitis and 1 (2.7%) progressed to psoriatic arthritis. A total of 10 (27.8%) patients progressed to definite SpA during the eight-year study period. Buttock pain (p = 0.006, OR 10.55; 95% CI 2.00-65.90) and low-grade radiographic sacroiliitis (p = 0.025, OR = 11.50; 95% CI 1.33-83.39) at baseline were associated with definite SpA. Thus, in this Brazilian cohort, which had a predominance of female African-Brazilian patients, prevalent peripheral onset symptoms were followed by a high frequency of axial manifestations during the follow-up period. Evidence of clinical or radiological sacroiliitis was associated with progression to definite SpA.

Progression rate of ankylosing spondylitis in patients with undifferentiated spondyloarthritis

“…The summaries of 16 eligible studies were shown in Table 1 and all studies were prospective. Of the 16 studies included in present study, 3 from Latin America (2 from Brazil [ 16 , 28 ] and 1 from Mexico [ 27 ] ), 3 from Europe (1 from Spain [ 17 ] and 2 form Germany [ 15 , 30 ] ), and 10 from Asia (1 from India [ 29 ] and 9 from China [ 14 , 31 – 38 ] ). The total number of patients with uSpA participated in follow-up was 2134, with sample sizes ranged from 35 to 648.…”

“…[ 17 ] The progression rate of 8 years was robust because of the low heterogeneity. Irrespective of the discrepancy of the number of subjects between the 2 studies, [ 28 , 32 ] the enrollment of study subjects in these 2 studies was almost synchronous, which may improve the rationality of data merging. Higher heterogeneity was detected in the rate of 10 years, and it maybe accounts for the 3 studies [ 14 – 16 ] which come from different regions.…”

SAT0280 Rapamycin restores the balance between th17 and regulatory t cells in uspa patients

“…Jinnan 1 , X. Dan 1 , G. Chong 2 , L. Xiaofeng 1 . 1 The Second hospital of Shanxi Medical University, Taiyuan, China; 2 Brigham and Women's Hospital, Boston, USA Background: The association of undifferentiated spondyloarthritis (uSpA) with the imbalance of Th17/Treg cells is still unclear. By inhibiting mTOR, rapamycin promotes the proliferation of Treg cells and inhibits the growth of Th17 cells.…”