Peripheral Manifestations in Spondyloarthritis and their Effect: An Ancillary Analysis of the ASAS-COMOSPA Study

To determine the factors associated with the presence of peripheral manifestations in patients with spondyloarthritis (SpA) from the Assessment in SpondyloArthritis international Society (ASAS)-COMOSPA study, and to evaluate the effect of these symptoms on treatment and patient-reported outcomes (PRO).

All patients from the ASAS-COMOSPA study were included. All patients had an SpA diagnosis according to the rheumatologist. Patients and disease characteristics associated with the presence of these peripheral manifestations (peripheral arthritis, peripheral enthesitis, or dactylitis) were analyzed by univariate and multivariate logistic regression. Patients who reported peripheral manifestations were divided into 3 categories: current, history, and no history. The effect of peripheral involvement on PRO was evaluated through the use of 1-factor ANOVA.

Out of the 3984 patients included in ASAS-COMOSPA, 2562 (64.3%) reported at least 1 peripheral manifestation, with a prevalence of 51.5%, 37.8%, and 15.6% for peripheral arthritis, peripheral enthesitis, and dactylitis, respectively. Being from South America, having a history of uveitis, having a current case or history of psoriasis, and the absence of HLA-B27 were associated with higher prevalence of peripheral manifestations. Patients with peripheral involvement showed greater use of drugs, and those with "current" peripheral manifestations showed higher levels in all PRO, in contrast to those with past or no history.

Peripheral manifestations appear in 64% of patients with SpA. Psoriasis and the absence of HLA-B27 are associated with the development of peripheral symptoms. The presence of any peripheral symptom at the time of the visit was associated with higher scores in all PRO.