Peripheral Arthritis

Among patients with recent-onset axial spondyloarthritis, 36% report developing peripheral arthritis; at any time during their disease duration, with these patients demonstrating a greater disease burden than those without peripheral arthritis; according to recent findings in Arthritis Research & Therapy.

“Arthritis and enthesitis are the most common peripheral features in axSpA; and can be found predominantly in the lower limbs,” Clementina López-Medina, MD, PhD,of Cochin Hospital, Paris, and colleagues wrote. “The prevalence of peripheral arthritis has been well described in [ankylosing spondylitis] patients; with percentages ranging between 22 and 30%.

Incidence of peripheral arthritis

However, the prevalence of this manifestation in the whole group of axSpA; varies between the different cohorts.  The majority of these data refer only to baseline visits; and very few studies evaluate the time of onset of this clinical feature during follow-up.”

To characterize the prevalence and incidence of peripheral arthritis; during 5 years of follow-up from recent-onset axSpA, and to examine the factors linked to their development; and measure their impact on treatment and outcomes, Lopez-Medina and colleagues reviewed data; from the Devenir des Spondylarthropathies Indifferenciées Récentes (DESIR) cohort.

According to the researchers, the DESIR cohort includes 708 patients aged; between 18 and 50 years with early inflammatory back pain, recruited from 25 centers across France. Patients with previous treatment with biologics exclude. Visits with these patients scheduled; for every 6 months for the first 2 years, and annually thereafter.

Multivariate analysis

The researchers focused on the first 5 years of follow-up from the DESIR cohort. For each visit, they calculated the prevalence and incidence of peripheral arthritis; and used multivariate analysis to analyze the baseline factors associated with the arthritis. In addition, they compared drug use; patient-reported outcomes and sick-leave use between those with and without peripheral arthritis.

According to López-Medina and colleagues, 36% of the 708 include patients demonstrate; at least one case of arthritis, including 151 who had the condition prior to the inclusion visit; and 104 who developed it during the follow-up period. This corresponds to an incidence rate of 3.7 cases per 100 person-years, the researchers wrote.

Greater use of TNF inhibitors

The researchers also found that patients with peripheral arthritis were more likely to be aged 33years or older; nonsmokers  and HLAB27-negative . They are also more likely to have presented with at least one case of dactylitis and enthesitis . In addition; patients with peripheral arthritis demonstrated a significant greater use of TNF inhibitors; conventional synthetic DMARDs and corticosteroids during the follow-up, compared with those without.

They also scored higher on BASDAI and BASFI indices; demonstrate poorer quality of life and reported taking more sick days from work. “In this study; we observed that peripheral arthritis can appear at any time during the disease and has a high burden of disease (deteriorating quality of life and causing days of sick leave),” Lopez-Medina and colleagues wrote.

“This finding is the reason why rheumatologists should check systematically; this clinical feature during the monitoring of these patients. Other studies are required in order to confirm; or not these results and to better understand the underlying pathological process.”