Abstract
To determine whether the first presenting symptoms, the main problem that the disease is causing to patients, and the employment status at presentation of patients with early spondyloarthritis (SpA) in a multicultural/multiracial patient cohort are different between gender, race, and disease subgroups of the SpA spectrum (ankylosing spondylitis, enteropathic arthritis, psoriatic arthritis, or undifferentiated arthritis). All patients above the age of 16 years, with disease duration of less than 3 years since symptom onset, seen in clinic between 2004 and 2008 with spondyloarthritis (SpAs) were assessed regarding their first presenting symptom, the main problem caused by the disease, and their employment status. In addition, clinical parameters such as the degree of disease activity (measured by BASDAI, ESR, and CRP), functional ability (measured by BASFI), night pain, sleep disturbance, well-being over past week, and over past 6 months prior to assessment (measured by a 10 cm VAS; 0 = good health, 10 = worst possible) were obtained. Statistical analysis with Pearson’s χ2 test compared and correlated two groups, and one-way analysis of variance (ANOVA) was used when more than two groups were compared and correlated. A total of 96 patients [(male:female = 33:63; (34.4:65.6%), (mean age 43.8 ± (SD) 13.9)] with early SpA were assessed. They were of multiethnic background representing Caucasians (n = 52; 54.2%), Asians (n = 33; 34.4%), and Africans (n = 10; 10.4%) mixed race (n = 1; 1%). The disease spectrum consisted of ankylosing spondylitis (AS) (n = 12; 12.7%), enteropathic arthritis or SpA associated with inflammatory bowel disease (IBD) (n = 9; 9.4%), psoriatic arthritis (PsA) (n = 47; 49%), undifferentiated spondyloarthritis (USpA) (n = 27; 28.2%), reactive arthritis (n = 1;1%), and juvenile SpA (n = 1;1%). Back pain stated as the first presenting symptom by 45 patients (46.8%) (followed by knee pain) and joint pains as the main problem by 49 patients (51.7%), while 47 patients of 93 who replied on the employment section (50.5%) were working. The total group had BASDAI score of 5.91 (±2.1), ESR of 19.65 (±19.4) mmHg/h, CRP of 8.10 (±9.2) mmol/L, BASFI score of 4.51 (±2.57), night pain of 5.26 (±3.2), sleep disturbance of 5.24 (±3.03) well-being over past week of 5.9 (±2.7), and well-being over past 6 months of 6.4 (±2.5). Most patients had PsA at presentation. Comparisons between genders showed significantly more women to have knee pain as first presenting symptom than men. No differences between races found in the first presenting symptom, main problem caused to patients by disease, and employment, but Africans have significantly more sleep disturbance than other races. Comparisons between disease subgroups showed patients with AS to have significantly more back pain and hip pain as first presenting symptom and patients with IBD to have more joint pain as main problem caused by the disease.
Similar content being viewed by others
References
Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136:896–907
Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63:535–543
Rudwaleit M, Metter A, Listing J et al (2006) Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 54:569–578
Dougados M, van der Linden S, Juhlin R, Amor B, Calin A (1991) The European Spondyloarthropathy Study Group (ESSG) preliminary criteria for the classification of spondyloarthropathies. Arthritis Rheum 34:1218–1227
Calin A, Porta J, Fries JF et al (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237:2613–2614
Rudwaleit M, van der Heijde D, Landewe R et al (2009) The development of Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthritis (part II). Validation and final selection. Ann Rheum Dis 68:777–783
Heuft-Dorenbosch L, Landewe R, Weijers R, Houben H, Van der Linden S, Jacobs P, Van der Heijde D (2007) “Performance of various criteria sets in patients with inflammatory back pain of short duration; The Maastricht early spondyloarthritis clinic”. Ann Rheum Dis 66:92–98
Hermann J, Giessauf H, Schaffler G, Ofner P, Graninger W (2009) Early spondyloarthritis: usefulness of clinical screening. Rheumatology 48:812–816
Rojas-Vargas M, Munoz-Gomariz E, Escudero A et al (2009) First signs and symptoms of spondyloarthritis—data from an inception cohort with a disease course of 2 years or less (REGISPONSER Early)”. Rheumatology 48:404–409
Londoner (2004) The world in one city. January 2004, p 4. http://www.london.gov.uk
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis—development of new criteria from a large international study. Arthritis Rheum 54:2665–2673
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gainsford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis disease activity index. J Rheumatol 21:2286–2291
Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: The development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285
Roussou E, Sultana S, Malik K (2008) The development of a simple acculturation index and its use in spondyloarthritides. Clin Exp Rheumatol 26:749
Helliwell PS, GRAPPA Group (2007) GRAPPA—Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, Stockholm, May/June 2006. J Rheumatol 34:214–219
Chandran V, Schentag CT, Gladman DD (2007) Sensitivity of the classification of Psoriatic Arthritis Criteria in Early Psoriatic Arthritis. Arthritis Rheum 57:1560–1563
Ward MM (1998) Quality of life in patients with Ankylosing Spondylitis. Rheum Dis Clin North A 24:815–827
Zink A, Braun JM, Listing JM, Wollenhaupt J (2000) Disability ad handicap in rheumatoid arthritis and ankylosing spondylitis: results from the German rheumatological data base. German collaborative arthritis centres. J Rheumatol 27:613–622
Boonen A, Chorus A, Miedema H, Van de Heijde D, Van der Temple H, Van der Linden S (2001) Employment work disability and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis 60:353–358
Boonen A, van der Linden SM (2006) The burden of Ankylosing Spondylitis. J Rheumatol 78(suppl):4–11
Barlow JH, Wright CC, Williams B, Keat A (2001) Work disability among people with Ankylosing Spondylitis. Arthr Rheum 45:424–429
Ward MM (2002) Functional disability predicts total costs in patients with ankylosing spondylitis. Arthritis Rheum 46:223–231
Boonen A, Chorus A, Miederma H et al (2001) Withdrawal from labour force due to work disability in patients with ankylosing spondylitis. Ann Rheum Dis 60:1033–1039
Conflict of interest
No conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Roussou, E., Sultana, S. Early spondyloarthritis in multiracial society: differences between gender, race, and disease subgroups with regard to first symptom at presentation, main problem that the disease is causing to patients, and employment status. Rheumatol Int 32, 1597–1604 (2012). https://doi.org/10.1007/s00296-010-1680-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-010-1680-2