Clinical characteristics of patients with ankylosing spondylitis combined enthesitis

ZHANG Yi'nan; JI Xiaojian; HU Jiawen; WANG Yiwen; ZHANG Jianglin; HUANG Feng; ZHU Jian

doi:10.3969/j.issn.2095-5227.2022.03.005

Volume 43 Issue 3

Jun. 2022

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ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL > 2022 > 43(3): 264-269. > DOI: 10.3969/j.issn.2095-5227.2022.03.005

ZHANG Yi'nan, JI Xiaojian, HU Jiawen, WANG Yiwen, ZHANG Jianglin, HUANG Feng, ZHU Jian. Clinical characteristics of patients with ankylosing spondylitis combined enthesitis[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2022, 43(3): 264-269. DOI: 10.3969/j.issn.2095-5227.2022.03.005

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Clinical characteristics of patients with ankylosing spondylitis combined enthesitis

ZHANG Yi'nan^{1, 2, 冀,},
JI Xiaojian^{2, 张,},
HU Jiawen^{1, 2},
WANG Yiwen²,
ZHANG Jianglin²,
HUANG Feng^2, ,,
ZHU Jian^2, ,

1.
Chinese PLA Medical School, Beijing 100853, China
2.
Department of Rheumatology and Immunology, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China

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Corresponding author:
HUANG Feng. Email: frankfhuang@126.com

ZHU Jian. Email: jian_jzhu@126.com
Received Date: November 14, 2021
Available Online: June 07, 2022

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Abstract

Abstract

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily involves the axial bones. Enthesitis, which is the most important pathological feature of AS, distinguishes it from other inflammatory joint diseases such as rheumatoid arthritis. However, there are few clinical studies on AS patients with enthesitis in China.
Objective To explore the significance of enthesitis in evaluating the condition and prognosis of AS patients by comparing the clinical manifestations of AS patients with or without enthesitis.
Methods A total of 1 083 AS patients with complete assessment of enthesitis were recruited from Smart phone Spondyloarthritis management system (SpAMS) from April 13, 2016 to January 15, 2019 in the Department of Rheumatology and Immunology of the First Medical Center of Chinese PLA General Hospital. The differences in demographic characteristics, clinical manifestations, laboratory data and disease severity between patients with or without enthesitis were analyzed.
Results Of the 1 083 patients with AS, there were 890 males and 193 females with the average age of 29.0 (24.0, 35.0) years. There were 304 patients with enthesitis and 779 patients without enthesitis. The age of disease onset was younger in patients with enthesitis than patients without enthesitis (Md [IQR]: 20.0 [17.0, 25.0] years vs 21.0 [17.0, 27.0] years, P=0.022). Compared with patients without enthesitis, patients with enthesitis had more frequent involvement of anterior chest wall (52.0% [156/300] vs 43.7% [330/755], P= 0.015) and heel (38.3% [115/300] vs 31.1% [235/755], P=0.025) during the course of disease. Peripheral arthritis (22.7% [69/304] vs 12.2% [95/779], P ＜ 0.001) were more common in patients with enthesitis. AS patients with enthesitis had higher degree of general back pain (Md[IQR]: 3.0 [2.0, 4.0] vs 2.0 [1.0, 4.0], P ＜ 0.001), dorsalgia at night (Md[IQR]: 2.0 [1.0, 4.0]vs 2.0 [1.0, 4.0],P=0.001), limitation of thoracic dilatation (21.4% [65/304] vs 14.9% [116/779], P=0.010), Patient Global Assessment (Md[IQR]: 3.0 [2.0, 5.0] vs 2.0 [1.0, 4.0], P ＜ 0.001), Physician Global Assessment (Md[IQR]: 2.0 [2.0, 3.0] vs 2.0 [1.0, 3.0], P=0.024), Bath Ankylosing Spondylitis Metrology Index (Md[IQR]: 1.0 [0.0, 3.0] vs 1.0 [0.0, 3.0], P=0.049], Bath Ankylosing Spondylitis Disease Activity Index (Md[IQR]: 2.7 [1.5, 4.0] vs 1.9 [1.0, 3.1], P＜0.001), Bath Ankylosing Spondylitis Functional Index (Md[IQR]: 1.5 [0.4, 2.9] vs 1.2 [0.2, 2.4], P=0.008) and the Assessment of Spondyloarthritis international Society Health Index (Md[IQR]: 6.0 [3.3, 9.0] vs 5.0 [2.0, 8.0], P ＜ 0.001) than those without enthesitis. Logistic regression analysis showed that history of anterior chest pain (OR=1.428, 95% CI: 1.084-1.881, P=0.011) and peripheral arthritis (OR=2.166, 95% CI: 1.521-3.086, P ＜ 0.001) were risk factors for the enthesitis.
Conclusion Compared with patients without enthesitis, AS patients combined with enthesitis have a younger age of onset and a greater risk for occurrence of peripheral arthritis. AS patients with enthesitis have more severe disease activity and body disfunction, so clinicians should pay more attention to it.
- spondylitis, ankylosing,
- enthesitis,
- clinical characteristics,
- disease activity,
- questionnaire

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Clinical characteristics of patients with ankylosing spondylitis combined enthesitis

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