Background Anterior chest wall pain (ACW) may be suggestive of spondyloarthritis (SpA), but little is known about this clinical feature in recent inflammatory back pain (IBP).
Objectives To determine the prevalence of ACW in patients with recent IBP suggestive of SpA, and to investigate the influence of ACW on the overall features of patients presenting with recent IBP.
Methods The DESIR cohort is a prospective, multicenter French cohort of patients with early IBP (Calin or Berlin criteria) (>3 months and <3 years of duration) suggestive of SpA according to the investigator, including 708 patients (mean age 33.8 years, 53.8% female, 57.3% HLA B27 positive). ACW was defined by at least one episode of chest wall pain attributed to SpA by the rheumatologist, after ruling out other causes of chest pain. Data on the baseline demographic characteristics, functional status and quality of life, imaging features (standard X-Rays, MRI, Ultrasounds), BMD, and blood tests were compared in patients with and without ACW. Both the date of the first symptom of IBP and the symptoms of ACW were recorded, as well as the date of the visit. Factors associated with ACW were identified both by uni and multivariate analysis (logistic regression).
Results The prevalence of ACW in the DESIR cohort was 44.6 % [95%CI 40.9-48.3] (n=316/708 patients). ACW occurred after the first symptoms of IBP in 62 %, before in 14 %, and simultaneously (±1month) in 24 % of the cases. Localization was diffuse in 41% of the positive cases, sterno costal (35%), manubrio sternal (29%) or sterno clavicular (26%). Presence of ACW was significantly associated in univariate analysis with pain in cervical and thoracic spine, buttock, peripheral arthritis and enthesitis, fulfilment of ASAS and ESSG criteria, associated reactive arthritis and SAPHO, increased BASDAI, ASDAS, BASFI, BASG, SF-36, BASMI, articular index, increased CRP, radiographic sacro iliac involvement and reduced BMD. ACW was not associated with HLA-B27, uveitis, psoriasis, smoking, age and MRI findings. A stepwise multivariate analysis found an association between ACW and (Table): the enthesitis score, involvement of the thoracic spine, diagnosis of ankylosing spondylitis and radiographic abnormality of the sacro iliac joints.
Conclusions In recent IBP suggestive of SpA, presence of ACW is associated with enthesitis, thoracic spine involvement, radiographic sacro iliitis and the diagnosis of ankylosing spondylitis, and with a more severe disease. Since there are no differences in symptoms duration between ACW positive and ACW negative patients, ACW could be interpreted as an independent diagnosis feature for ankylosing spondylitis.
Disclosure of Interest None Declared
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