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Undifferentiated spondyloarthritis vs ankylosing spondylitis and psoriatic arthritis: a real-life prospective cohort study of clinical presentation and response to treatment.
Rheumatology (Oxford) 2013; 52(10):1873-8R

Abstract

OBJECTIVE

SpA is a phenotypically heterogeneous disease, with AS and PsA as its best studied subtypes. This study aimed to investigate whether, despite a different phenotypic presentation, patients with undifferentiated SpA (uSpA) have similar disease activity and response to treatment to those with AS and PsA.

METHODS

175 patients presenting at a dedicated SpA outpatient clinic were recruited in a real-life prospective cohort with follow-up every 3 months. Clinical characteristics, disease activity at presentation and response to treatment of uSpA were compared with AS and PsA.

RESULTS

Twenty-three per cent (n = 40) of the patients were classified as uSpA. These patients were younger and tended to have a shorter disease duration than AS and PsA patients. uSpA patients exhibited a mixed axial (inflammatory back pain in 87.5%) and peripheral (peripheral arthritis in 62.5%) phenotype, with almost half of the patients having low-grade sacroiliitis on conventional X-ray. The overall disease activity in uSpA was similar to AS and higher than in PsA, also when analysing only anti-TNF naive patients. Initiation of TNF blockade significantly decreased disease activity in uSpA, with a similar amplitude to that in AS and PsA.

CONCLUSION

uSpA is a frequent, severe and anti-TNF-responsive phenotypic subtype of SpA. In agreement with the new ASAS classification criteria for axial and peripheral SpA and emerging data on TNF blockade in non-radiographic axial SpA and peripheral uSpA, these data emphasize the need for early diagnosis and optimal treatment of not only AS and PsA but also other SpA subforms.

Authors+Show Affiliations

Academic Medical Center/University of Amsterdam, Department of Clinical Immunology and Rheumatology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. d.l.baeten@amc.uva.nl.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23861532

Citation

Paramarta, Jacqueline E., et al. "Undifferentiated Spondyloarthritis Vs Ankylosing Spondylitis and Psoriatic Arthritis: a Real-life Prospective Cohort Study of Clinical Presentation and Response to Treatment." Rheumatology (Oxford, England), vol. 52, no. 10, 2013, pp. 1873-8.
Paramarta JE, De Rycke L, Ambarus CA, et al. Undifferentiated spondyloarthritis vs ankylosing spondylitis and psoriatic arthritis: a real-life prospective cohort study of clinical presentation and response to treatment. Rheumatology (Oxford). 2013;52(10):1873-8.
Paramarta, J. E., De Rycke, L., Ambarus, C. A., Tak, P. P., & Baeten, D. (2013). Undifferentiated spondyloarthritis vs ankylosing spondylitis and psoriatic arthritis: a real-life prospective cohort study of clinical presentation and response to treatment. Rheumatology (Oxford, England), 52(10), pp. 1873-8. doi:10.1093/rheumatology/ket239.
Paramarta JE, et al. Undifferentiated Spondyloarthritis Vs Ankylosing Spondylitis and Psoriatic Arthritis: a Real-life Prospective Cohort Study of Clinical Presentation and Response to Treatment. Rheumatology (Oxford). 2013;52(10):1873-8. PubMed PMID: 23861532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Undifferentiated spondyloarthritis vs ankylosing spondylitis and psoriatic arthritis: a real-life prospective cohort study of clinical presentation and response to treatment. AU - Paramarta,Jacqueline E, AU - De Rycke,Leen, AU - Ambarus,Carmen A, AU - Tak,Paul P, AU - Baeten,Dominique, Y1 - 2013/07/16/ PY - 2013/7/18/entrez PY - 2013/7/19/pubmed PY - 2013/11/14/medline KW - ankylosing spondylitis KW - anti-TNF treatment KW - psoriatic arthritis KW - spondyloarthritis KW - undifferentiatied spondyloarthritis SP - 1873 EP - 8 JF - Rheumatology (Oxford, England) JO - Rheumatology (Oxford) VL - 52 IS - 10 N2 - OBJECTIVE: SpA is a phenotypically heterogeneous disease, with AS and PsA as its best studied subtypes. This study aimed to investigate whether, despite a different phenotypic presentation, patients with undifferentiated SpA (uSpA) have similar disease activity and response to treatment to those with AS and PsA. METHODS: 175 patients presenting at a dedicated SpA outpatient clinic were recruited in a real-life prospective cohort with follow-up every 3 months. Clinical characteristics, disease activity at presentation and response to treatment of uSpA were compared with AS and PsA. RESULTS: Twenty-three per cent (n = 40) of the patients were classified as uSpA. These patients were younger and tended to have a shorter disease duration than AS and PsA patients. uSpA patients exhibited a mixed axial (inflammatory back pain in 87.5%) and peripheral (peripheral arthritis in 62.5%) phenotype, with almost half of the patients having low-grade sacroiliitis on conventional X-ray. The overall disease activity in uSpA was similar to AS and higher than in PsA, also when analysing only anti-TNF naive patients. Initiation of TNF blockade significantly decreased disease activity in uSpA, with a similar amplitude to that in AS and PsA. CONCLUSION: uSpA is a frequent, severe and anti-TNF-responsive phenotypic subtype of SpA. In agreement with the new ASAS classification criteria for axial and peripheral SpA and emerging data on TNF blockade in non-radiographic axial SpA and peripheral uSpA, these data emphasize the need for early diagnosis and optimal treatment of not only AS and PsA but also other SpA subforms. SN - 1462-0332 UR - https://www.unboundmedicine.com/medline/citation/23861532/Undifferentiated_spondyloarthritis_vs_ankylosing_spondylitis_and_psoriatic_arthritis:_a_real_life_prospective_cohort_study_of_clinical_presentation_and_response_to_treatment_ L2 - https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/ket239 DB - PRIME DP - Unbound Medicine ER -