Background The ASAS classification criteria for axial and peripheral spondyloarthritis have revolutionized the management of patients with suspicion of spondyloarthritis (1,2). These criteria have not been validated in sub-Saharan Africans. Moreover, the application of these new criteria on a population of sub-Saharan Africa with spondyloarthritis has not yet been published.
Objectives To classify sub-Saharan Africans followed for spondyloarthritis according to the new ASAS classification criteria for axial spondyloarthritis and peripheral spondyloarthritis (1,2).
Methods We performed a cross-sectional study among 6804 patients seen in the Rheumatology Unit of the Douala General Hospital, a tertiary healthcare centre in Cameroon, between January 2004 and December 2013. All patients followed for spondyloarthritis according to the Amor and/or ESSG criteria were collected to classify them according to the ASAS classification criteria for axial spondyloarthritis and peripheral spondyloarthritis.
Results Seventy two (27 men and 45 women) patients fulfilled Amor and/or ESSG criteria. The mean age of these patients was 34 ± 13.9 years. The diagnosis was made primarily on the basis of clinical examination and X-rays of the spine and pelvis. No patient achieved a magnetic resonance imaging (MRI). The HLA B27 was negative in all patients tested. Ankylosing spondylitis was the most common spondyloarthritis, followed by reactive arthritis. The distribution of patients according to nosological entities and the predominant topography, axial and/or peripheral are respectively shown in Table 1 and Table 2. Two patients were not classified according to the ASAS criteria.
Conclusions The ASAS criteria have not changed the epidemiology of spondyloarthritis in Cameroon (prevalence 1.05%), and probably in all the sub-Saharan Africa. The diagnosis is difficult because of the lack of biological markers (HLA B27 negative) and limited access to MRI (available since 2014 in our hospital).
Improving the performance of the ASAS criteria for axial and peripheral spondyloarthritis will require numerous other modifications.
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Acknowledgement We gratefully acknowledge Prof. Pascal Claudepierre (Rheumatology, LIC EA4393, Henri Mondor Hospital, Creteil, France) for his critical review and advice on preparing the manuscript.
Disclosure of Interest None declared