Evaluation of Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis in Chinese patients with chronic back pain: results of a 2-year follow-up study.

OBJECTIVE: To evaluate the diagnotic value of the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthritis (SpA) in Chinese patients with chronic back pain and without radiographic sacroiliitis in a 2-year follow-up study. METHODS: Patients with chronic back pain ≥ 3 months, onset age ≤ 45 years and without radiographic sacroiliitis were enrolled, and then received 2-year follow-up. All the clinical parameters associated with SpA were recorded. The patients were followed for 2 years and the final diagnosis of axial SpA or non-SpA was confirmed by rheumatologists. Diagnostic concordance between the initial classification according to three classification criteria (ASAS criteria for axial SpA, European Spondylarthropathy Study Group (ESSG) criteria and Amor criteria) and final diagnosis was compared. Diagnostic sensitivity and specificity were compared between the two subsets of ASAS criteria (set 1: sacroiliitis plus more than one SpA feature; set 2: HLA-B27 plus two more SpA features). RESULT: One thousand and sixty-eight patients entered the study and 867 completed the 2-year follow-up (455 axial SpA and 412 non-SpA). The concordance of ASAS criteria was better than ESSG and Amor criteria. Three hundred and thirty-three patients and 335 patients were classified as axial SpA according to the ASAS set 1 and set 2 of criteria, respectively. Further, set 1 of criteria (318/333) showed higher specificity than set 2 critera (279/335) (P = 0.000). CONCLUSION: The ASAS classification criteria for axial SpA showed good concordance in diagnosing Chinese axial SpA patients in this prospective study. Set 1 criteria involving sacroiliitis plus more than one SpA feature had better diagnosing value.

Clinical presentation and disease course of inflammatory bowel disease differs by race in a large tertiary care hospital.

BACKGROUND: While the incidence of inflammatory bowel disease (IBD) among African-Americans (AAs) is increasing, there is limited understanding of phenotypic differences and outcomes by race. AIM: To describe disease characteristics of AA patients compared to Caucasian (Ca) patients in a tertiary care population. METHODS: We performed a cross-sectional review of the IBD registry at the University of Chicago from January 2008 to January 2013. Data regarding race, phenotype, disease onset, disease duration, medical therapy, and surgical treatment were abstracted from the database, then compared via Pearson's chi-square analysis, Kruskal-Wallis analysis, and logistic regression with a significance level of p < 0.05. RESULTS: A total of 1,235 patients with Crohn's disease (CD) and 541 patients with ulcerative colitis (UC) included 108 AA CD patients and 28 AA UC patients. AA CD patients had an increased rate of IBD-related arthralgias (36.5 vs. 23.9 %, p < 0.01) and surgery (p < 0.01), less ileal involvement (57.8 vs. 71.0 %, p < 0.01), and no differences for other extraintestinal manifestations or disease locations compared to Ca CD patients. AA UC patients were older at diagnosis, had an increased rate of arthralgias (28.6 vs. 14.6 %, p = 0.047) and ankylosing spondylitis/sacroiliitis (7.1 vs. 1.6 %, p = 0.035), with no differences for disease extent or rate of IBD-related surgeries compared to Ca UC patients. There were no differences in medication usage by race for CD and UC patients. CONCLUSION: We identified significant differences in disease characteristics and extraintestinal manifestations between AA and Ca IBD patients in a large tertiary care population. These results have implications for future genotype-phenotype studies.

Brief report: the IL23R nonsynonymous polymorphism rs11209026 is associated with radiographic sacroiliitis in spondyloarthritis.

OBJECTIVE: Spondyloarthritis (SpA) is a group of inflammatory articular disorders sharing a genetic background. The nonsynonymous single-nucleotide polymorphism (SNP) rs11209026 (Arg381Gln) in the IL23R gene has reproducibly been shown to be associated with ankylosing spondylitis (AS). We undertook this study to examine the association between rs11209026 and SpA as a whole, with particular attention devoted to genotype/phenotype correlation. METHODS: The SNP rs11209026 was genotyped in a French cohort of 415 patients/372 controls, with replication analysis performed in 383 "trios," each consisting of 1 patient with SpA and both parents. Association analysis was carried out in SpA as a whole group and then separately in AS and non-AS patients. Phenotype/genotype correlations were examined using logistic regression analysis. RESULTS: A significant association between rs11209026 and SpA overall was identified only in the familial data set (odds ratio 0.57, P=0.028). Strong association with AS was observed in both the case-control and familial data sets (P=4.5×10(-4) and P=4.0×10(-3), respectively). In contrast, such association was not detected in the non-AS group. Furthermore, rs11209026 frequency was significantly different between AS and non-AS patients (P=1.5×10(-3)). Phenotype/genotype correlation study revealed that both radiographic sacroiliitis and early age at onset were independently associated with a lower frequency of the rare protective rs11209026 allele A in patients (P=9×10(-3) and P=8×10(-3), respectively). CONCLUSION: Our study replicated the robust association between rs11209026 and AS in the French population. However, such association was restricted to AS, as compared to SpA without radiographic sacroiliitis. The fact that it was independently conditional on radiographic sacroiliitis and age at onset suggests that rs11209026 could affect disease severity rather than susceptibility.