Global epidemiology of spondyloarthritis

The worldwide epidemiology of axial spondyloarthritis (axSpA), psoriatic arthritis (PsA) and peripheral spondyloarthritis, as well as of HLA-B27 and other MHC and non-MHC genes in these diseases, is reviewed herein. The frequency of axSpA is highest in circumpolar groups (such as Sami people and certain Indigenous American groups) and lowest in those of Japanese and African ancestry. The same pattern holds for PsA, although the overall prevalence of PsA seems much lower in East Asia, where it is less frequent than axSpA. The prevalence of PsA in people with psoriasis is increased where rheumatological assessment was carried out and seems to be increasing over time. HLA-B27 remains the most important genetic factor in axSpA susceptibility, although its frequency is lower in African American, South American and Middle Eastern populations than in others. The presence of HLA-B27 and other HLA alleles seems to be important in discerning clinical subsets of SpA and PsA, particularly those characterized by acute anterior uveitis or by axSpA with psoriasis, although these HLA-B27 and other MHC and non-MHC associations are derived from genome-wide association studies and other chip-based studies in large populations. These studies have been carried out mainly in populations of European and East Asian ancestry, and similar data from Latin America, sub-Saharan Africa and South Asia are lacking. This under-representation is an unmet need in applying genetic factors to understand the pathogenesis, diagnosis and classification of SpA and PsA.