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POS0975 (2021)
CLINICAL CHARACTERISTICS OF NONRADIOGRAPHIC AXIAL SPONDYLOARTHRITIS IN ASIAN COUNTRIES COMPARED TO OTHER REGIONS: RESULTS OF THE INTERNATIONAL CROSS-SECTIONAL ASAS-COMOSPA STUDY
K. Ono1, M. Kishimoto1, S. Fukui2, S. Kawaai2, G. A. Deshpande3, K. Yoshida4, N. Ichikawa5, Y. Kaneko6, T. Kawasaki7, K. Matsui8, M. Morita9, K. Tada10, N. Takizawa11, N. Tamura10, A. Taniguchi5, Y. Taniguchi12, S. Tsuji13, S. Kobayashi14, M. Okada2, C. López-Medina15, A. Moltó15, D. Van der Heijde16, M. Dougados15, Y. Komagata1, T. Tomita17, S. Kaname1
1Kyorin University School of Medicine, Department of Nephrology and Rheumatology, Tokyo, Japan
2St. Luke’s International Hospital, St Luke`s International University, Immuno-Rheumatology Center, Tokyo, Japan
3Juntendo University School of Medicine, Department of General Internal Medicine, Tokyo, Japan
4Brigham and Women’s Hospital and Harvard Medical School, Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Boston, Massachusetts, United States of America
5Tokyo Women’s Medical University, Institute of Rheumatology, Tokyo, Japan
6Keio University School of Medicine, Division of Rheumatology, Department of Internal Medicine, Tokyo, Japan
7Shiga University of Medical Science, Department of Orthopedic Surgery, Shiga, Japan
8Teine Keijinkai Hospital, Department of Rheumatology, Hokkaido, Japan
9Fujita Health University, Department of Orthopaedic Surgery, Aichi, Japan
10Juntendo University School of Medicine, Department of Internal Medicine and Rheumatology, Tokyo, Japan
11Chubu Rosai Hospital, Department of Rheumatology, Aichi, Japan
12Kochi Medical School, Department of Endocrinology, Metabolism and Nephrology, Kochi, Japan
13National Hospital Organization Osaka Minami Medical Center, Department of Orthopedics and Rheumatology, Osaka, Japan
14Juntendo University Koshigaya Hospital, Department of Internal Medicine, Saitama, Japan
15University of Paris, Cochin Hospital, Department of Rheumatology, Paris, France
16Leiden University Medical Center, Department of Rheumatology, Leiden, Netherlands
17Osaka University Graduate School of Medicine, Department of Orthopaedic Biomaterial Science, Osaka, Japan

Background: Clinical characteristics of nonradiographic axial spondyloarthritis (nr-ax-SpA) are highly variable across patients, and may potentially vary across patient populations, particularly due to differing distributions of human leukocyte antigens (HLA) and other genetic factors. The majority of nr-ax-SpA studies have been conducted in Europe, the United States, and small studies are reported from Asia [1].


Objectives: To delineate clinical characteristics of patients with nr-ax-SpA in Asian countries in comparison to other areas of the world.


Methods: Utilizing the ASAS-COMOSPA data, an international cross-sectional observational study of SpA patients, we analyzed information on demographics, disease characteristics, comorbidities, and risk factors. Patients were classified by region: Asia (China, Japan, Singapore, South Korea, and Taiwan), and non-Asian countries (Europe, Americas, and Africa); patient characteristics, including diagnosis and treatment, were compared.


Results: Among 3984 SpA patients included in the study, 1094 were from centers in Asian countries, and 2890 from other regions. 112/780 (14.4%) of axial SpA patients in Asian countries were nr-ax-SpA, substantially less than in other countries (486/1997, 24.3%). Nr-ax-SpA patients in Asian countries compared to nr-ax-SpA in other countries were more likely male (75.9 vs 47.1%), have onset (22.8 vs 27.8 years) and diagnosis (27.2 vs 34.5 years) at younger age, and experience less diagnostic delay (1.88 vs 2.92 years) ( Table 1 ). Nr-ax-SpA patients in Asian countries have higher prevalence of positive HLA-B27 (90.6% vs 61.9%) and fewer peripheral signs such as arthritis, enthesitis, or dactylitis (53.6% vs 66.3%) but have similar rate of extra-articular manifestations (psoriasis, IBD, or uveitis) and co-morbidities. Disease activity, functional impairment, and inflammation on MRI were less in nr-ax-SpA patients in Asian countries. NSAIDs response was higher and use of methotrexate and b-DMARDs were lower among nr-ax-SpA in Asian countries.


Conclusion: Among axial SpA patients, substantially lower frequency of nr-ax-SpA was observed in Asian countries compared to other regions of the world. Nr-ax-SpA patients in Asian countries were predominantly male, and had younger disease onset with higher HLA-B27 positivity rate and less peripheral signs, and better response to NSAIDs. These results offer an opportunity to improve both early diagnosis and treatment of nr-ax-SpA patients in Asian countries.

Characteristics of nonradiographic axial SpA in Asia versus non-Asian regions

Variables Asia non-Asian regions p value
N 112 486
Age at disease diagnosis, yrs 27.2 [21.1, 39.6] 34.5 [27.7, 41.7] <0.001
Diagnostic delay, yrs 1.88 [0.27, 5.56] 2.92 [0.59, 9.58] 0.011
Male (%) 85 (75.9) 229 (47.1) <0.001
Sacroiliitis on MRI among tested (%) 49 (67.1) 341 (82.2) 0.005
HLA B27 positivity among measured (%) 96 (90.6) 273 (61.9) <0.001
Inflammatory Back Pain (%) 107 (95.5) 478 (98.4) 0.076
Arthritis, enthesitis, or dactylitis (%) 60 (53.6) 322 (66.3) 0.016
Psoriasis (%) 12 (10.7) 82 (16.9) 0.142
Uveitis (%) 20 (17.9) 81 (16.7) 0.870
Inflammatory bowel disease (%) 5 (4.5) 27 (5.6) 0.817
Elevated CRP (%) 37 (33.0) 213 (43.8) 0.048
Physician global assessment (0-10) 2.0 [1.0, 5.0] 2.0 [1.0, 4.0] 0.741
Patient global assessment (0-10) 3.0 [1.0, 6.0] 4.0 [2.0, 6.0] 0.012
ASDAS-CRP 1.40 [0.95, 2.08] 1.97 [1.21, 2.78] <0.001
BASFI 0.8 [0.05, 2.65] 2.9 [0.8, 5.6] <0.001
Good response to NSAIDs (%) 80 (71.4) 272 (56.0) 0.004
Methotrexate use (%) 18 (16.1) 134 (27.6) 0.016
Biological DMARDs use (%) 27 (24.1) 191 (39.3) 0.004

REFERENCES:

[1]López-Medina C, Ramiro S, van der Heijde D, et al. Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: a comparison by systematic literature review and meta-analysis. RMD Open. 2019 Nov 21;5(2): e001108.


Acknowledgements: This study was conducted under the umbrella of the International Society for Spondyloarthritis Assessment (ASAS) and COMOSPA study was supported by unrestricted grants from Pfizer, AbbVie and UCB.


Disclosure of Interests: Keisuke Ono: None declared, Mitsumasa Kishimoto Speakers bureau: AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma, Consultant of: AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma, Sho Fukui: None declared, Satoshi Kawaai: None declared, Gautam A. Deshpande: None declared, Kazuki Yoshida Consultant of: OM1, Inc., Grant/research support from: Corrona, LLC, Naomi Ichikawa: None declared, Yuko Kaneko Speakers bureau: AbbVie, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Hisamitsu, Jansen, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi, and UCB, Taku Kawasaki: None declared, Kazuo Matsui: None declared, Mitsuhiro Morita: None declared, Kurisu Tada: None declared, Naoho Takizawa: None declared, Naoto Tamura: None declared, Atsuo Taniguchi: None declared, Yoshinori Taniguchi: None declared, Shigeyoshi Tsuji: None declared, Shigeto Kobayashi: None declared, Masato Okada: None declared, Clementina López-Medina: None declared, Anna Moltó Consultant of: AbbVie, Pfizer, MSD, Novartis, Gilead, Lilly and UCB, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Gilead, Lilly and UCB, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma, Employee of: Imaging Rheumatology bv. (Director), Maxime Dougados: None declared, Yoshinori Komagata: None declared, Tetsuya Tomita: None declared, Shinya Kaname: None declared.

Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 753
Session: Spondyloarthritis - clinical aspects (other than treatment) (POSTERS only)