Objectives Recognizing the clinical picture of ankylosing spondylitis (AS) in real practice would help to optimize healthcare services provided to this group of pts.
Methods A single multicenter non-interventional study was conducted in spring 2015 y in order to ascertain the clinical features of AS in the real practice of a rheumatologist. 402 consecutive AS pts (meeting modified N-Y criteria) referred to a rheumatologist were evaluated following accepted standards during 2 mo at 10 clinical centers of Russia. All pts were evaluated, including those who addressed because of deterioration, and pts coming for regular check-ups within the disease monitoring.
Results Patients' mean age was 40,8±11,5 y,. 292 (72,6%)- males, 82,6% were HLA-B27- positive. Age at AS onset was 27,6±12,3 y., in 65,4% AS onset occurred before the age of 30 y.o., and in 16,9% – before 16 y.o. Time to establishing the AS diagnosis was 85,2±86,2 mo. By the moment of evaluation inflammatory back pain was present in 55,7% pts, peripheral arthritis - in 33,1%, enthesitis – in 37,1%, dactylitis – in 1,2%. Average BASDAI disease activity score was 4,3±2,1 (in 54,2% of pts it was >4, in 12,7% - >7, and in 18,2% - <2), and BASFI score – 4,1±1,8 (in 48,0% of pts it was >4,in 17,1%,- >7, and in 26,1% - <2). Extraskeletal manifestations were documented in 13,2% AS pts (including uveitis – in 45,3%, psoriasis – in 28,3%, Chrons disease – in 7,5%, IgA-associated neuropathy – in 5,7%, aortitis – in 3,8%). Such complications as amyloidosis were registered in 6 (1,5%) pts, cardiac arrhythmias – in 10 (2,5%) pts, aortal defect – in 1 (0,2%) patient. Most common comorbidities (verified by corresponding specialists) in this population were: arterial hypertension - in 25,1% AS pts, gastric ulcer – in 9,7%, ischemic heart disease – in 4,0%, diabetes mellitus – in 3,0%, chronic bronchitis – in 2,2%, bronchial asthma – in 2,0%, HCV hepatitis – 1,7%, HBV hepatitis – in 1,5%, tuberculosis – in 1,0%, oncologic diseases – in 0,2%, demyelinating conditions – in 0,2% pts. Comorbidities were not found in more than 50% (52%) of pts. Total arthroplasty procedures were documented in 19 (4,7%) pts, including 15 (3,7%) cases of hip replacement, and knee replacement in the rest. By the moment of evaluation another 6,7% of pts required total hip replacement procedure. 92% of pts were taking NSAIDs, sulfasalazine – 31,2%, methotrexate – 11,2%, peroral GCs s - 9,3%, TNF-α inhibitors– 19,1%.
Conclusions In real clinical practice the final AS diagnosis is usually established in more than 7 years after AS onset, by that moment the disease has already reached high activity and pronounced functional impairments occurred. Various comorbidities are found in >40% of AS pts, but with much lower incidence as compared to other systemic rheumatoid diseases.
Disclosure of Interest None declared
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