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
Citation: 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

Clinical characteristics of patients with ankylosing spondylitis combined enthesitis

More Information
  •   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.
  • [1]
    Taurog JD,Chhabra A,Colbert RA. Ankylosing spondylitis and axial spondyloarthritis[J]. N Engl J Med,2016,375(13): 1303. doi: 10.1056/NEJMc1511695
    [2]
    Benjamin M,McGonagle D. Entheses: tendon and ligament attachment sites[J]. Scand J Med Sci Sports,2009,19(4): 520-527. doi: 10.1111/j.1600-0838.2009.00906.x
    [3]
    Schett G,Lories RJ,D'Agostino MA,et al. Enthesitis: from pathophysiology to treatment[J]. Nat Rev Rheumatol,2017,13(12): 731-741. doi: 10.1038/nrrheum.2017.188
    [4]
    Kristensen S,Christensen JH,Schmidt EB,et al. Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound[J]. Muscles Ligaments Tendons J,2016,6(2): 241-247.
    [5]
    De Winter JJ,Paramarta JE,De Jong HM,et al. Peripheral disease contributes significantly to the level of disease activity in axial spondyloarthritis[J]. RMD Open,2019,5(1): e000802. doi: 10.1136/rmdopen-2018-000802
    [6]
    Falcao S,Castillo-Gallego C,Peiteado D,et al. Can we use enthesis ultrasound as an outcome measure of disease activity in spondyloarthritis?A study at the Achilles level[J]. Rheumatology (Oxford),2015,54(9): 1557-1562. doi: 10.1093/rheumatology/keu399
    [7]
    Laatiris A,Amine B,Ibn Yacoub Y,et al. Enthesitis and its relationships with disease parameters in Moroccan patients with ankylosing spondylitis[J]. Rheumatol Int,2012,32(3): 723-727. doi: 10.1007/s00296-010-1658-0
    [8]
    Benegas M,Muñoz-Gomariz E,Font P,et al. Comparison of the clinical expression of patients with ankylosing spondylitis from Europe and Latin America[J]. J Rheumatol,2012,39(12): 2315-2320. doi: 10.3899/jrheum.110687
    [9]
    Braun J,Brandt J,Listing J,et al. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial[J]. Lancet,2002,359(9313): 1187-1193. doi: 10.1016/S0140-6736(02)08215-6
    [10]
    Fournié B. Pathology and clinico-pathologic correlations in spondyloarthropathies[J]. Jo Bone Spine,2004,71(6): 525-529. doi: 10.1016/j.jbspin.2004.02.002
    [11]
    Turan Y,Duruöz MT,Cerrahoglu L. Relationship between enthesitis, clinical parameters and quality of life in spondyloarthritis[J]. Joint Bone Spine,2009,76(6): 642-647. doi: 10.1016/j.jbspin.2009.03.005
    [12]
    Mease PJ. Measures of psoriatic arthritis: tender and swollen joint assessment, psoriasis area and severity index (PASI), nail psoriasis severity index (NAPSI), modified nail psoriasis severity index (mNAPSI), mander/Newcastle enthesitis index (MEI), Leeds enthesitis index (LEI), spondyloarthritis research consortium of Canada (SPARCC), maastricht ankylosing spondylitis enthesis score (MASES), Leeds dactylitis index (LDI), patient global for psoriatic arthritis, dermatology life quality index (DLQI), psoriatic arthritis quality of life (PsAQOL), functional assessment of chronic illness therapy-fatigue (FACIT-F), psoriatic arthritis response criteria (PsARC), psoriatic arthritis joint activity index (PsAJAI), disease activity in psoriatic arthritis (DAPSA), and composite psoriatic disease activity index (CPDAI)[J]. Arthritis Care Res (Hoboken), 2011, 63(Suppl 11): S64-S85.
    [13]
    Mease PJ,Van den Bosch F,Sieper J,et al. Performance of 3 enthesitis indices in patients with peripheral spondyloarthritis during treatment with adalimumab[J]. J Rheumatol,2017,44(5): 599-608. doi: 10.3899/jrheum.160387
    [14]
    Sieper J,Poddubnyy D. Axial spondyloarthritis[J]. Lancet,2017,390(10089): 73-84. doi: 10.1016/S0140-6736(16)31591-4
    [15]
    Solmaz D,Bakirci S,Jibri Z,et al. Psoriasis is an independent risk factor for entheseal damage in axial spondyloarthritis[J]. Semin Arthritis Rheum,2020,50(1): 42-47. doi: 10.1016/j.semarthrit.2019.06.016
    [16]
    Mease PJ,Heijde DV,Karki C,et al. Characterization of patients with ankylosing spondylitis and nonradiographic axial spondyloarthritis in the US-based corrona registry[J]. Arthritis Care Res (Hoboken),2018,70(11): 1661-1670. doi: 10.1002/acr.23534
    [17]
    De Winter JJ,Van Mens LJ,Van der Heijde D,et al. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis[J]. Arthritis Res Ther,2016,18(1): 196. doi: 10.1186/s13075-016-1093-z
    [18]
    Rezvani A,Bodur H,Ataman S,et al. Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis[J]. Mod Rheumatol,2014,24(4): 651-656. doi: 10.3109/14397595.2013.850182
    [19]
    Bowness P. Hla-b27[J]. Annu Rev Immunol,2015,33: 29-48. doi: 10.1146/annurev-immunol-032414-112110
    [20]
    López-Medina C,Moltó A,Dougados M. Peripheral manifestations in spondyloarthritis and their effect: an ancillary analysis of the ASAS-COMOSPA study[J]. J Rheumatol,2020,47(2): 211-217. doi: 10.3899/jrheum.181331
    [21]
    Mease PJ,Liu M,Rebello S,et al. Characterization of patients with axial spondyloarthritis by enthesitis presence: data from the corrona psoriatic arthritis/spondyloarthritis registry[J]. ACR Open Rheumatol,2020,2(7): 449-456. doi: 10.1002/acr2.11154
    [22]
    Baraliakos X,Van den Berg R,Braun J,et al. Update of the literature review on treatment with biologics as a basis for the first update of the ASAS/EULAR management recommendations of ankylosing spondylitis[J]. Rheumatology (Oxford),2012,51(8): 1378-1387. doi: 10.1093/rheumatology/kes026
    [23]
    D'Agostino MA,Olivieri I. Enthesitis[J]. Best Pract Res Clin Rheumatol,2006,20(3): 473-486. doi: 10.1016/j.berh.2006.03.007
    [24]
    Nadon V,Moltó A,Etcheto A,et al. Clinical peripheral enthesitis in the DESIR prospective longitudinal axial spondyloarthritis cohort[J]. Clin Exp Rheumatol,2019,37(4): 561-565.
    [25]
    Zhang HY,Liang J,Qiu JL,et al. Ultrasonographic evaluation of enthesitis in patients with ankylosing spondylitis[J]. J Biomed Res,2017,31(2): 162-169.
  • Cited by

    Periodical cited type(9)

    1. 李玲,申英灏,杨洁,马雯娟,张学兰. 高频超声对强直性脊柱炎亚临床附着点炎的筛查评估价值. 分子影像学杂志. 2024(02): 196-200 .
    2. 申悦,罗丽平,苗婕妤,赵旭,马伶俐,徐胜前. 附着点炎在脊柱关节炎患者中的表现及其对生物制剂治疗的反应. 临床内科杂志. 2024(06): 384-389 .
    3. 张强,邓伟哲,魏博,沈正东,张皓. 110例强直性脊柱炎患者骨密度下降的特征及其危险因素. 武警医学. 2024(06): 488-492 .
    4. 钟琳,马蓉,李清音,杨裕佳. 肌骨超声在附着点炎评估中的应用进展. 临床超声医学杂志. 2024(07): 611-615 .
    5. 刘健,赵恒立. 从肝论治强直性脊柱炎思路探讨. 风湿病与关节炎. 2024(08): 58-61 .
    6. 芦栋生,杨娟娟,李浩林,吕彩虹,高艳花,王雨薇,王海东. 王海东教授针刀松解足太阳经筋治疗强直性脊柱炎临证萃要. 风湿病与关节炎. 2024(10): 43-47 .
    7. 张强,张旭日,师国洋,钱春生,邓伟哲. 误诊为Haglund综合征的强直性脊柱炎临床分析. 临床误诊误治. 2024(18): 11-15 .
    8. 孙文婷,李斌,韩淑花. 房定亚教授从肝论治强直性脊柱炎经验. 中国中西医结合杂志. 2023(08): 992-995 .
    9. 马小霞,刘宏潇,冯兴华,姜泉,文天才,徐晓涵,张新路. 强直性脊柱炎肾虚瘀阻证与湿热瘀阻证患者临床特征的多中心横断面调查. 中医杂志. 2023(18): 1890-1896 .

    Other cited types(1)

Catalog

    Article Metrics

    Article views (254) PDF downloads (13) Cited by(10)
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return