Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR) / 中华医学杂志(英文版)

BACKGROUND@#The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.@*METHODS@#Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.@*RESULTS@#In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use.@*CONCLUSIONS@#Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.

Prevalence, demographics, and clinical characteristics of Latin American patients with spondyloarthritis

Abstract Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.(AU)

Abordaje práctico de la espondiloartritis / Practical approach to spondyloarthritis

Introducción: la espondiloartritis, es una forma de artritis inflamatoria que, generalmente comienza entre los 17 y los 45 años. La inflamación sistémica es una característica clave que ayuda a distinguirla de otros tipos de artritis, incluida la artritis por desgaste y desgarro, como la osteoartritis. Objetivo: brindar información sobre el abordaje práctico de la espondiloartritis para contribuir a esclarecer puntos que, a juicio de los autores de este trabajo, son importantes para el manejo de la misma. Desarrollo: en poco tiempo han tenido lugar inusitados avances que abarcan todos los aspectos de su manejo, incluidos el diagnóstico y el seguimiento, pero sobre todo en su tratamiento. Algunas presentaciones engañosas son propias del comienzo retardado, como la espondiloartritis periférica de inicio tardío (LOPS), que se caracteriza por una oligoartritis inflamatoria que contrasta con los signos generales, un importante síndrome inflamatorio y, a veces, edema asimétrico de las extremidades inferiores. Conclusiones: el papel de los reumatólogos es esencial en el manejo de esta enfermedad, pues son los especialistas mejor calificados para tener a su cargo a estos pacientes, mientras que los generalistas participan más en la detección de la misma(AU)

Introduction: spondyloarthritis, or SpA, is a form of inflammatory arthritis that usually begins between 17 and 45 years. Systemic inflammation is a key feature that helps distinguish it from other types of arthritis, including arthritis by tearing and tearing, such as osteoarthritis. Objective: to provide information on the practical approach of spondyloarthritis to help clarify points that, in the opinion of the authors of this work, are important for the management of it. Development: in a short time, there have been unusual advances that cover all aspects of its management, including diagnosis and monitoring, but especially in its treatment. Some deceptive presentations are typical of delayed onset, such as late-onset peripheral spondyloarthritis (LOPS), which is characterized by an inflammatory oligoarthritis that contrasts with the general signs, an important inflammatory syndrome and, sometimes, asymmetric edema of the lower extremities. Conclusions: the role of rheumatologists is essential in the management of this disease, as they are the best qualified specialists to be in charge of these patients, while the generalists participate more in the detection of it(AU)

Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients / Alterações eletrocardiográficas em espondiloartrites e uso de anti-TNF-α: estudo retrospectivo em 100 pacientes

ABSTRACT Objective To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. Methods Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. Results Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. Conclusion Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.

RESUMO Objetivo Avaliar a prevalência de alterações eletrocardiográficas em pacientes com espondiloartrites, correlacionando-as com o uso de medicações antifator de necrose tumoral alfa (TNF-α) e presença do HLA-B27. Métodos Estudo retrospectivo com 100 pacientes com diagnóstico de espondiloartrites pelo critério Assessment of SpondyloArthritis International Society (ASAS) e 50 controles. Foram coletados nos prontuários dos pacientes, dados epidemiológicos, clínicos, exames de atividade inflamatória, presença do HLA-B27, e uso de medicamentos. A atividade de doença foi avaliada pelo Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Todos foram submetidos a eletrocardiograma realizado com aparelho de 12 derivações, sendo analisados ritmo, frequência cardíaca, distúrbios de condução e intervalo QT corrigido pela fórmula de Bazett. Resultados Dos 100 pacientes com espondiloartrites, 49 não usavam anti-TNF-α e 51 utilizavam este medicamento. O HLA-B27 estava presente em 53,1% da amostra. A frequência cardíaca foi mais baixa (p=0,06), o intervalo QT foi mais prolongado (p<0,0001) e existia mais perturbação de condução do ramo direito (p=0,014) nos pacientes com espondiloartrites do que nos controles. Uma modesta correlação de tempo de doença com frequência cardíaca foi encontrada (Rho=0,26; IC95%: 0,06-0,44; p=0,008). A presença do HLA-B27 aumentou a prevalência de perturbação de condução do ramo direito. Nenhum dos parâmetros eletrocardiográficos analisados alterou-se com uso de anti-TNF-α. Conclusão Pacientes com espondiloartrites tiveram frequência cardíaca menor, maior intervalo QT e prevalência maior de perturbação de condução do ramo direito do que controles. O HLA-B27 influi no aparecimento de perturbação de condução do ramo direito. O uso de anti-TNF-α não influiu nos achados eletrocardiográficos.

Mercury Exposure in a Riverside Amazon Population, Brazil: A Study of the Ototoxicity of Methylmercury

Introduction Mercury poisoning causes hearing loss in humans and animals. Acute and long-term exposures produce irreversible peripheral and central auditory system damage, and mercury in its various forms of presentation in the environment is ototoxic. Objective We investigated the otoacoustic emissions responses in a riverside population exposed to environmental mercury by analyzing the inhibitory effect of the medial olivocochlear system (MOCS) on transient otoacoustic emissions (TEOAE). Methods The purpose of the research was to evaluate the entire community independently of variables of sex and age. All of the participants were born and lived in a riverside community. After otolaryngologic evaluation, participants were received tympanometry, evaluation of contralateral acoustic reflexes, pure tone audiometry, and recording of TEOAEs with nonlinear click stimulation. Hair samples were collect to measure mercury levels. Results There was no significant correlation between the inhibitory effect of the MOCS, age, and the level of mercury in the hair. Conclusions The pathophysiological effects of chronic exposure may be subtle and nonspecific and can have a long period of latency; therefore, it will be important to monitor the effects of mercury exposure in the central auditory system of the Amazon population over time. Longitudinal studies should be performed to determine whether the inhibitory effect of the MOCS on otoacoustic emissions can be an evaluation method and diagnostic tool in populations exposed to mercury. .

Perfil epidemiológico da espondiloartrite de início juvenil comparada com a espondiloartrite de início na vida adulta em uma grande coorte brasileira / Epidemiologic profile of juvenile-onset compared to adult-onset spondyloarthritis in a large Brazilian cohort

Objetivo Analisar as características clínicas e epidemiológicas das espondiloartrites (EpA) de início juvenil (< 16 anos) e compará-las com um grupo de pacientes com EspA de início na vida adulta (≥ 16 anos). Pacientes e métodos Coorte prospectiva, observacional e multicêntrica com 1.424 pacientes com diagnóstico de EspA de acordo com o European Spondyloarthropathy Study Group (ESSG) submetidos a um protocolo comum de investigação e recrutados em 29 centros de referência participantes do Registro Brasileiro de Espondiloartrites (RBE). Os pacientes foram divididos em dois grupos: idade no início<16 anos (grupo EspAiJ) e idade no início ≥ 16 anos. Resultados Entre os 1.424 pacientes, 235 manifestaram o início da doença antes dos 16 anos (16,5%). As variáveis clínicas e epidemiológicas associadas com a EspAiJ foram: gênero masculino (p<0,001), artrite em membro inferior (p=0,001), entesite (p=0,008), uveíte anterior (p=0,041) e HLA-B27 positivo (p=0,017), em associação com escores mais baixos de atividade da doença (Bath Ankylosing Spondylitis Disease Activity Index – BASDAI; p=0,007) e de capacidade funcional (Bath Ankylosing Spondylitis Functional Index – BASFI; p=0,036). A psoríase cutânea (p<0,001), a doença inflamatória intestinal (p=0,023), a dactilite (p=0,024) e o envolvimento ungueal (p=0,004) foram mais frequentes em pacientes com EspA de início na vida adulta. Conclusões Nessa grande coorte brasileira, os pacientes com EspAiJ se caracterizavam predominantemente pelo gênero masculino, envolvimento periférico (artrite e entesite), HLA-B27 positivo e escores de doença mais baixos. .

Objective To analyze the clinical and epidemiologic characteristics of juvenile-onset spondyloarthritis (SpA) (< 16 years) and compare them with a group of adult-onset (≥ 16 years) SpA patients. Patients and methods Prospective, observational and multicentric cohort with 1,424 patients with the diagnosis of SpA according to the European Spondyloarthropathy Study Group (ESSG) submitted to a common protocol of investigation and recruited in 29 reference centers participants of the Brazilian Registry of Spondyloarthritis (RBE – Registro Brasileiro de Espondiloartrites). Patients were divided in two groups: age at onset<16 years (JOSpA group) and age at onset ≥ 16 years (AOSpA group). Results Among the 1,424 patients, 235 presented disease onset before 16 years (16.5%). The clinical and epidemiologic variables associated with JOSpA were male gender (p<0.001), lower limb arthritis (p=0.001), enthesitis (p=0.008), anterior uveitis (p=0.041) and positive HLA-B27 (p=0.017), associated with lower scores of disease activity (Bath Ankylosing Spondylitis Disease Activity Index – BASDAI; p=0.007) and functionality (Bath Ankylosing Spondylitis Functional Index – BASFI; p=0.036). Cutaneous psoriasis (p<0.001), inflammatory bowel disease (p=0.023), dactylitis (p=0.024) and nail involvement (p=0.004) were more frequent in patients with adult-onset SpA. Conclusions Patients with JOSpA in this large Brazilian cohort were characterized predominantly by male gender, peripheral involvement (arthritis and enthesitis), positive HLA-B27 and lower disease scores. .

Frecuencia de alelos HLA de clase I y II en una cohorte de pacientes con espondiloartritis provenientes del noroccidente colombiano / Frequency of HLA alleles class I and II in a cohort of northwestern Colombian patients with spondyloarthritis

Introducción. Las espondiloartritis son enfermedades reumatológicas crónicas que afectan el esqueleto axial y las articulaciones periféricas, con varias manifestaciones extraarticulares. La asociación con el HLA-B27 sigue siendo uno de los vínculos más fuertes conocidos entre estas entidades y el complejo mayor de histocompatibilidad; sin embargo, la distribución mundial del HLA-B27 varía considerablemente y se han descrito asociaciones con genes no HLA-B27. Objetivo. Conocer la frecuencia de alelos HLA de clase I y II en pacientes con espondiloartritis provenientes del noroccidente colombiano y su frecuencia en las manifestaciones clínicas y radiológicas específicas. Materiales y métodos. Se condujo un estudio descriptivo, observacional, de corte transversal, retrospectivo y prospectivo entre 2005 y 2008 de 56 pacientes colombianos con espondiloartritis. Se identificaron los alelos correspondientes a los loci HLA de clase I y II (HLA-B, HLADQB1 y HLADRB). Se analizó su frecuencia con las manifestaciones clínicas axiales, periféricas, extraarticulares y radiológicas. Resultados. Se encontró una baja frecuencia de HLA-B27 en la población total (50 %), aunque fue el alelo más frecuente, junto con HLA-DRB4*01 (35,7 %) y HLA-DQB1*0501 (28,6 %), en todos los pacientes en general y en cada una de las manifestaciones clínicas y radiológicas. Se resalta la alta frecuencia de HLA-B27 y HLA-DRB4*01 (64,3 %) en pacientes con dactilitis, hallazgo novedoso sin previa descripción. Conclusión. Los alelos HLA-B27, HLA-DRB4*01 y HLA-DQB1*0501 fueron frecuentes en los diferentes subtipos de espondiloartritis y en las manifestaciones clínicas axiales, periféricas y extraarticulares específicas, además de la sacroiliítis radiológica.

Introduction. Spondyloarthritis is a chronic rheumatic disease that affect the axial skeleton and peripheral joints, along with several extra-articular manifestations. The association with HLA-B27 remains one of the strongest known links between these entities and the major histocompatibility complex. However, the global distribution of HLA-B27 varies considerably and furthermore, associations with non-HLA-B27 genes have been described. Objective. The frequency of HLA class I and II was determined in a population of patients with spondyloarthritis with respect to detection in the clinical setting and by radiology. Materials and methods. A descriptive, observational, cross-sectional, retrospective and prospective study was conducted in 56 patients from northwestern Colombia. Each was diagnosed with spondyloarthritis between 2005 and 2008. In each case, alleles were identified for the loci HLA class I and II (HLA-B; HLADQB1 and HLADRB). The frequency of these alleles in the axial, peripheral, extraarticular and radiological manifestations. Results.The frequency of HLA-B27 was 50% overall, and it was the most frequent allele. The two other alleles were HLA.DRB4*01 at 35.7% and HLA-DQB1*0501 at 28.6%, as detected in each of the clinical and radiological manifestations. A high frequency of HLA-B27 and HLA-DRB4*01 (64.3%) was noted in patients with dactylitis. Conclusion. The alleles HLA-B27, HLA-DRB4*01 and HLA-DQB1*0501 were common in the different subtypes of spondyloarthritis and were frequent in the specific clinical axial, peripheral and extraarticular clinical manifestations, as well as radiological sacroiliitis.

Demographic, clinical, laboratory and treatment characteristics of spondyloarthritis patients with and without acute anterior uveitis / Características demográficas, clínicas, laboratoriais e de tratamento entre pacientes com espondiloartrite com e sem uveíte anterior aguda

CONTEXT AND OBJECTIVE: Acute anterior uveitis is a common extra-articular manifestation in spondyloarthritis patients. The aim of this study was to compare demographic, clinical, laboratory and treatment data among spondyloarthritis patients with and without acute anterior uveitis. DESIGN AND SETTING: This was a cross-sectional analytical study at the Rheumatology Outpatient Clinic of the Evangelical University Hospital, Curitiba, Brazil. METHODS: Spondyloarthritis patients with without acute anterior uveitis were compared regarding demographic data, spondyloarthritis subtype, peripheral arthritis, enthesitis, disease activity, functional index, physical examination, radiological involvement, HLA-B27 and treatment. RESULTS: Presence of acute anterior uveitis was not found to have any relationship with functional index, degree of radiological involvement, peripheral arthritis or enthesitis. Acute anterior uveitis showed a negative association with skin manifestations (P = 0.04) and a trend towards higher disease activity (P = 0.06). CONCLUSION: In the study sample, it could not be shown that AAU had any association with the functional and radiological prognoses. The patients with spondyloarthritis with and without acute anterior uveitis did not differ clinically except for a higher proportion of ankylosing spondylitis and smaller presence of skin involvement in those with uveitis.

CONTEXTO E OBJETIVO: Uveíte anterior aguda é uma manifestação extra-articular comum em pacientes com espondiloartrite. O objetivo deste estudo foi comparar achados demográficos, clínicos, laboratoriais e de tratamento em pacientes com espondiloartrite com e sem uveíte anterior aguda. TIPO DE ESTUDO E LOCAL: Este é um estudo transversal analítico realizado no Ambulatório de Reumatologia do Hospital Universitário Evangélico de Curitiba, Brasil. MÉTODOS: Pacientes com espondiloartrite com e sem uveíte anterior aguda foram comparados quanto a dados demográficos, subtipo de espondiloartrite, artrite periférica, entesite, atividade da doença, índice funcional, exame físico, envolvimento radiológico, HLA-B27 e tratamento. RESULTADOS: Não se encontrou associação entre presença de uveíte anterior aguda e índice funcional, grau de envolvimento radiológico, artrite periférica e entesite. Encontrou-se uma associação negativa de uveíte anterior aguda com manifestações de pele (P = 0,04) e uma tendência para maior atividade de doença (P = 0,06). CONCLUSÃO: Na amostra estudada, não foi possível demonstrar associação entre uveíte anterior aguda no prognóstico funcional e radiológico. Pacientes com espondiloartrite com e sem uveíte anterior aguda não diferem clinicamente exceto por uma maior proporção de espondilite anquilosante e uma presença menor de envolvimento cutâneo naqueles com uveíte.

Espondiloartrites: análise de uma série Brasileira comparada a uma grande casuística Ibero-Americana (estudo RESPONDIA) / Spondyloarthritis: analysis of a Brazilian series compared with a large Ibero-American registry (RESPONDIA group)

Estudos recentes relatam as características clínicas e epidemiológicas das espondiloartrites nas populações de diversos países ibero-americanos. O objetivo deste trabalho foi comparar os dados obtidos em um estudo epidemiológico brasileiro com os dados encontrados em diversos países ibero-americanos, que utilizaram um mesmo protocolo de investigação. A casuística brasileira apresentou maior frequência de pacientes com diagnóstico de espondilite anquilosante (72,3 por cento brasileiros vs. 57,7 por cento ibero-americanos), estando associada ao sexo masculino (73,6 por cento vs. 66,0 por cento) e ao antígeno de histocompatibilidade HLA-B27 positivo (65,9 por cento vs. 51,8 por cento). Com relação ao tratamento, os pacientes brasileiros fizeram mais uso de anti-inflamatório não hormonal (AINH) (77,0 por cento vs. 71,2 por cento) e menor uso de esteroides (7,5 por cento vs. 18,5 por cento).

Recent studies have outlined the clinical and epidemiological profile of the spondyloarthritides in Ibero-American countries. The objective of this study was to compare the data collected in a Brazilian epidemiological study with the data obtained from other Ibero-American countries that used the same protocol of investigation. The Brazilian series presented a higher frequency of patients with ankylosing spondylitis (72.3 percent Brazilian vs. 57.7 percent Ibero-American), being associated with the male gender (73.6 percent vs. 66.0 percent) and histocompatibility antigen positive HLA-B27 (65.9 percent vs. 51.8 percent). Regarding the treatment, hormonal anti-inflammatory drugs - NSAIDS were more frequently prescribed to Brazilian patients (77.0 percent vs. 71.2 percent) and less often, corticosteroids (7.5 percent vs. 18.5 percent).

Uveíte das espondiloartropatias: prevalência e relação com doença articular / Uveitis and spondyloarthritis: prevalence and relationship with joint disease

OBJETIVOS: Estudar a prevalência de uveítes na população local de espondiloartropatias e sua relação temporal com achados articulares. MÉTODOS: Foram revisados prontuários de 77 pacientes com espondiloartropatias atendidos no ambulatório de reumatologia do Hospital Universitário Evangélico de Curitiba, para diagnóstico do tipo de espondiloartropatia, sexo, idade, presença e tipo de uveite, tempo decorrido entre as primeiras manifestações oculares e as articulares. RESULTADOS: Uveíte foi encontrada em 12 dos 77 pacientes (15,6 por cento), sendo anterior em 83,3 por cento dos casos. O aparecimento da uveíte foi semelhante em todas as formas de espondiloartropatia (p=0,27) e não sofreu influência do sexo do paciente (p=0,74). O tempo médio de aparecimento dos sintomas oculares em relação ao diagnóstico articular foi de 4,04 meses para artrite reativa e 73 meses para espondilite anquilosante (p=0,009). CONCLUSÕES: A uveíte encontrada em pacientes com espondiloartropatia é, na sua grande maioria, anterior. O aparecimento da uveíte em relação aos sintomas articulares é mais precoce em casos de artrite reativa do que em espondilite anquilosante.

PURPOSE: To study uveitis prevalence in the local population with spondyloarthritis and its temporal relationship with joint complaints. METHODS: We reviewed seventy-seven charts of spondyloarthropathy patients from the rheumatology clinic of the "Hospital Universitário Evangélico de Curitiba" for spondyloarthritis class, patients' sex and age, occurrence of uveitis and its location and relationship between the first episode of uveitis and initial joint complaints. RESULTS: Uveitis was found in 12 of 77 patients (15.6 percent) which was anterior in 83.3 percent of the cases, without preference for spondyloarthropathy class (p=0.72) and patients' sex (p=0.74). In patients with reactive arthritis, the mean time between uveitis appearance and joint complaints was 4.04 months and in ankylosing spondylitis 73 months (p=0.009). CONCLUSION: Spondyloarthropathy patients have uveitis that is anterior in most of the cases and that appears earlier in reactive arthritis than in ankylosing spondylitis.