PT  - JOURNAL ARTICLE
AU  - Daniel Wendling
AU  - Clément Prati
AU  - Christophe Demattei
AU  - Damien Loeuille
AU  - Pascal Richette
AU  - Maxime Dougados
TI  - Anterior Chest Wall Pain in Recent Inflammatory Back Pain Suggestive of Spondyloarthritis. Data from the DESIR Cohort
AID  - 10.3899/jrheum.121460
DP  - 2013 May 15
TA  - The Journal of Rheumatology
PG  - jrheum.121460
4099  - http://www.jrheum.org/content/early/2013/05/13/jrheum.121460.short
4100  - http://www.jrheum.org/content/early/2013/05/13/jrheum.121460.full
AB  - Objective To determine the prevalence of anterior chest wall (ACW) pain in patients with recent inflammatory back pain (IBP) suggestive of spondyloarthritis (SpA), and to investigate the influence of ACW pain on the overall features of these patients. Methods The DESIR cohort is a prospective, multicenter French cohort of patients with early IBP suggestive of SpA, including 708 patients (mean age 33.8 yrs, 53.8% females, 57.3% HLA-B27-positive). ACW pain was defined by at least 1 episode of chest wall pain attributed to SpA by the rheumatologist, after ruling out other causes of chest pain. Data on the baseline demographic characteristics, functional status and quality of life, imaging features, bone mineral density, and blood tests were compared in patients with and those without ACW pain. Factors associated with ACW pain were identified by univariate and multivariate analysis (logistic regression). Results The prevalence of ACW pain in the DESIR cohort (n = 316/708 patients) was 44.6% (95% CI 40.9–48.3). ACW pain occurred after the first symptoms of IBP in 62%. Localization was diffuse in 41% of the positive cases. A stepwise multivariate analysis found an association between ACW pain and the enthesitis score, involvement of thoracic spine, diagnosis of ankylosing spondylitis (AS), and radiographic abnormalities of sacroiliac joints. Conclusion In recent IBP suggestive of SpA, presence of ACW pain is associated with enthesitis, thoracic spine involvement, radiographic sacroiliitis, diagnosis of AS, and with a more severe disease. ACW pain could be interpreted as a diagnostic feature for AS.