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  1. D. Poddubnyy1,2,
  2. F. Sommerfleck3,
  3. V. Navarro-Compán4,
  4. C. Bundy5,
  5. S. Makri6,
  6. S. M. Akerkar7,
  7. L. Wermskog8,9,
  8. E. Karam10,
  9. J. Correa-Fernández11,
  10. A. Siddiqui12,
  11. M. Garrido-Cumbrera11,13
  1. 1Charité-Universitätsmedizin Berlin, Rheumatology Department, Berlin, Germany
  2. 2German Rheumatism Research Centre, Rheumatology Department, Berlin, Germany
  3. 3Sanatorio Julio Mendez, Rheumatology Department, Buenos Aires, Argentina
  4. 4IdiPaz, Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain
  5. 5Cardiff University, Rheumatology Department, Cardiff, United Kingdom
  6. 6Cyprus League for People with Rheumatism (CYLPER), Patient Advocacy, Nicosia, Cyprus
  7. 7Mumbai Arthritis Clinic, Rheumatology Department, Mumbai, India
  8. 8Spondyloarthritis Association of Norwary (SPAFO), Patient Advocacy, Oslo, Norway
  9. 9Axial Spondyloarthritis International Federation (ASIF), Patient Advocacy, London, United Kingdom
  10. 10Canadian Spondylitis Association (CSA), Patient Advocacy, Toronto, Canada
  11. 11Universidad de Sevilla, Health & Territory Research (HTR), Seville, Spain
  12. 12Novartis Pharma AG, Patient Engagement, Basel, Switzerland
  13. 13Spanish Federation of Spondyloarthritis Associations (CEADE), Patient Advocacy, Madrid, Spain


Background Previous studies have suggested there could be regional differences in clinical phenotype of axial spondyloarthritis (axSpA).

Objectives This analysis aims to explore differences in axSpA clinical phenotype around the world in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS).

Methods IMAS was a cross-sectional online survey (2017-2022) of 5,557 unselected axSpA patients from 27 countries. We analysed across 5 geographic regions the age at onset of symptoms, classification as radiographic or non-radiographic, gender, HLA-B27, axSpA family history, extra-musculoskeletal manifestations (uveitis, inflammatory bowel disease and psoriasis), presence of comorbidities, disease activity (BASDAI), level of spinal stiffness, and treatment (NSAIDs, csDMARDs and bDMARDs). Kruskal-Wallis and chi-square test were used to compare axSpA characteristics across the regions.

Results 5,557 patients participated in IMAS survey of which 3,493 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America, and 146 from Africa. Results showed statistically significant differences between regions, except for the classification status (radiographic or non-radiographic). Age at onset of symptoms ranged between 25-30 years, and was higher in Latin America as compared to other regions. Diagnostic delay was longest in South Africa and lowest in Asia. The lowest frequency of HLA-B27 positivity was observed in Latin America and the highest in Asia. Family history of SpA was most often recorded in Europe and less often in Asia. All extra-musculoskeletal manifestations included were lowest in Europe compared with other regions. Physical and mental comorbidities were frequent in African patients and less common in Europe and Asia. Mean disease activity (BASDAI) was 5.4, with highest values in South Africa and lowest in Asia. Spinal stiffness was highest in South Africa and lowest in Latin America. Functional limitation was higher in North America and Europe and lower in Asia. Most of the patients had used NSAIDs for their condition and less than half had ever taken csDMARDS; both were more frequent in Latin America and South Africa. Almost half of the patients had ever taken bDMARDs, more frequent being in the Americas (Map 1).

Conclusion There is great heterogeneity of axSpA clinical phenotype presentation around the world. Further understanding of these differences is needed to achieve early diagnosis and initiation of disease treatment in axSpA.

Map 1.

The clinical phenotype of axial spondyloarthritis stratified by region (N= 5,557)

Acknowledgements This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Fernando Sommerfleck Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Consultant of: Abbvie, Novartis, Janssen, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Souzi Makri Consultant of: Novartis, GSK and Bayer, SHASHANK MURLIDHAR AKERKAR Speakers bureau: Pfizer, Novartis, Eli Lilly, Jansen, Lillann Wermskog Grant/research support from: No personal funding, but ASIF has received funding from Novartis, UCB, Lilly, Abbvie, Boehringer Ingleheim, Pfizer, Janssen, Elie Karam: None declared, José Correa-Fernández: None declared, Asif Siddiqui Employee of: Novartis employment and stock ownership, Marco Garrido-Cumbrera Grant/research support from: Novartis.

  • Spondyloarthritis
  • bDMARD
  • Geographical differences

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