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Effect of enthesitis on 1505 Brazilian patients with spondyloarthritis
Sueli Carneiro1, Adriana Bortoluzzo, Celio Gonçalves
1From the Brazilian Registry of Spondyloarthritis: Universidade Federal do Rio de Janeiro, Universidade Estadual do Rio de Janeiro, Santa Casa do Rio de Janeiro, and Faculdade de Medicina Souza Marques, Rio de Janeiro; Insper Institute of Education and Research, and Division of Rheumatology and Instituto de Ortopedia e Traumatologia, Universidade de São Paulo, and Santa Casa de São Paulo, and Hospital do Servidor Público Estadual, São Paulo; Universidade de Brasília, and Hospital de Base, Brasília; Hospital Geral de Goiânia, Goiânia; Universidade de Campinas, and Pontifícia Universidade Católica, Campinas; Universidade Federal do Amazonas, Manaus; Pontifícia Universidade Católica, Porto Alegre; Hospital Evangélico de Curitiba, and Universidade Federal do Paraná, Curitiba; Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto; Hospital Geral de Fortaleza, and Universidade Federal do Ceará, Fortaleza; Universidade Federal do Mato Grosso do Sul, Campo Grande; Universidade Federal de Pernambuco, Recife; Universidade Federal do Rio Grande do Sul, Porto Alegre; Universidade Federal de Santa Catarina, Florianópolis; Santa Casa de Belo Horizonte, and Universidade Federal de Minas Gerais, Belo Horizonte; Escola de Medicina e Saúde Pública, Salvador; Universidade Federal do Pará, Belém; and Universidade Federal do Espírito Santo, Vitória, Brazil.
Objective:
To analyze the clinical effect of enthesitis in a large Brazilian cohort of patients with spondyloarthritis (SpA).
Methods:
A common protocol of investigation was prospectively applied to 1505 patients with SpA in 29 centers in Brazil. Clinical and demographic variables and disease indexes were investigated. The Maastricht Ankylosing Spondylitis Enthesitis Score was used to investigate the enthesitis component. Ankylosing spondylitis was the most frequent disease in the group (65.4%). Others were psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), and enteropathic arthritis (3.2%).
Results:
At least 1 affected enthesis was observed in 54% of the patients with SpA, with a mean of 2.12 ± 2.98 entheses affected. According to the clinical presentation, enthesitis was significantly more frequent in patients with axial + peripheral joint involvement compared to isolated axial or peripheral involvement (p < 0.001). There was a statistical association between the presence of enthesites and axial symptoms (buttock pain, cervical pain, and hip pain), and peripheral symptoms (lower limb arthritis, number of painful and swollen joints; p < 0.05). Patients with enthesitis also presented higher mean scores of Bath Ankylosing Spondylitis Functional Index (BASFI; p < 0.001), Bath Ankylosing Spondylitis Disease Activity Index (p < 0.001), and Ankylosing Spondylitis Quality of Life (ASQoL; p < 0.001). Multivariate logistic regression showed that BASFI (p < 0.0001; OR 74.839), ASQoL (p = 0.0001; OR 14.645), and Achilles tendonitis (p = 0.0059; OR 7.593) were associated with work incapacity.
Conclusion:
The clinical presence of enthesitis in this large cohort of patients with SpA was frequent and was associated with a significant increase in disease activity and decline in functional capacity and quality of life.
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