Gender characterization in a large series of Brazilian patients with spondyloarthritis

An increasing number of women have been diagnosed with spondyloarthritis (SpA) in recent decades. While a few studies have analyzed gender as a prognostic factor of the disease, no studies have addressed this matter with a large number of patients in South America, which is a peculiar region due to its genetic heterogeneity. The aim of the present study was to analyze the influence of gender on disease patterns in a large cohort of Brazilian patients with SpA. A prospective study was carried out involving 1,505 patients [1,090 males (72.4%) and 415 females (27.6%)] classified as SpA according to the European Spondyloarthropaties Study Group criteria who attended at 29 reference centers for rheumatology in Brazil. Clinical and demographic variables were recorded and the following disease indices were administered: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and Ankylosing Spondylitis Quality of Life (ASQoL). Ankylosing spondylitis (AS) was the most frequent disease in the group (65.4%), followed by psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), arthritis associated to inflammatory bowel disease (3.2%), and juvenile SpA (2.9%). The male-to-female ratio was 2.6:1 for the whole group and 3.6:1 for AS. The females were older (p<0.001) and reported shorter disease duration (p=0.002) than the male patients. The female gender was positively associated to peripheral SpA (p<0.001), upper limb arthritis (p<0.001), dactylitis (p=0.011), psoriasis (p<0.001), nail involvement (p<0.001), and family history of SpA (p=0.045) and negatively associated to pure axial involvement (p< 0.001), lumbar inflammatory pain (p=0.042), radiographic sacroiliitis (p<0.001), and positive HLA-B27 (p=0.001). The number of painful (p<0.001) and swollen (p=0.006) joints was significantly higher in the female gender, who also achieved higher BASDAI (p<0.001), BASFI (p=0.073, trend), MASES (p=0.019), ASQoL (p=0.014), and patient's global assessment (p=0.003) scores, whereas the use of nonsteroidal anti-inflammatory drugs (p<0.001) and biological agents (p=0.003) was less frequent in the female gender. Moreover, BASRI values were significantly lower in females (p<0.001). The female gender comprised one third of SpA patients in this large cohort and exhibited more significant peripheral involvement and less functional disability, despite higher values in disease indices.314687695Wyeth/Pfizer BrazilFederico Foundation, Switzerlan

Effect of Enthesitis on 1505 Brazilian Patients with Spondyloarthritis

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.Wyeth/Pfizer BrazilFederico FoundationUniv Fed Rio de Janeiro, BR-21941 Rio de Janeiro, BrazilUniv Estado Rio de Janeiro, Rio de Janeiro, BrazilUniv São Paulo, Div Rheumatol, BR-05508 São Paulo, BrazilUniv Brasilia, BR-70910900 Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilUniv Estadual Campinas, Campinas, BrazilUniv Fed Amazonas, Porto Alegre, RS, BrazilPontificia Univ Catolica, Porto Alegre, RS, BrazilFac Med Sao Jose Rio Preto, Sao Jose Dos Campos, BrazilUniv Fed Parana, BR-80060000 Curitiba, Parana, BrazilHosp Geral Fortaleza, Fortaleza, Ceara, BrazilSanta Casa Rio de Janeiro, Rio de Janeiro, BrazilSanta Casa São Paulo, São Paulo, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Fed Rio Grande do Sul, BR-90046900 Porto Alegre, RS, BrazilUniv São Paulo, Inst Ortoped & Traumatol, BR-05508 São Paulo, BrazilUniv Fed Santa Catarina, BR-88040900 Florianopolis, SC, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilSanta Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilFed Univ Para, BR-66059 Belem, Para, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Gender characterization in a large series of Brazilian patients with spondyloarthritis

An increasing number of women have been diagnosed with spondyloarthritis (SpA) in recent decades. While a few studies have analyzed gender as a prognostic factor of the disease, no studies have addressed this matter with a large number of patients in South America, which is a peculiar region due to its genetic heterogeneity. The aim of the present study was to analyze the influence of gender on disease patterns in a large cohort of Brazilian patients with SpA. A prospective study was carried out involving 1,505 patients [1,090 males (72.4%) and 415 females (27.6%)] classified as SpA according to the European Spondyloarthropaties Study Group criteria who attended at 29 reference centers for rheumatology in Brazil. Clinical and demographic variables were recorded and the following disease indices were administered: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and Ankylosing Spondylitis Quality of Life (ASQoL). Ankylosing spondylitis (AS) was the most frequent disease in the group (65.4%), followed by psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), arthritis associated to inflammatory bowel disease (3.2%), and juvenile SpA (2.9%). The male-to-female ratio was 2.6:1 for the whole group and 3.6:1 for AS. The females were older (p&lt;0.001) and reported shorter disease duration (p=0.002) than the male patients. The female gender was positively associated to peripheral SpA (p&lt;0.001), upper limb arthritis (p&lt;0.001), dactylitis (p=0.011), psoriasis (p&lt;0.001), nail involvement (p&lt;0.001), and family history of SpA (p=0.045) and negatively associated to pure axial involvement (p&lt; 0.001), lumbar inflammatory pain (p=0.042), radiographic sacroiliitis (p&lt;0.001), and positive HLA-B27 (p=0.001). The number of painful (p&lt;0.001) and swollen (p=0.006) joints was significantly higher in the female gender, who also achieved higher BASDAI (p&lt;0.001), BASFI (p=0.073, trend), MASES (p=0.019), ASQoL (p=0.014), and patient's global assessment (p=0.003) scores, whereas the use of nonsteroidal anti-inflammatory drugs (p&lt;0.001) and biological agents (p=0.003) was less frequent in the female gender. Moreover, BASRI values were significantly lower in females (p&lt;0.001). The female gender comprised one third of SpA patients in this large cohort and exhibited more significant peripheral involvement and less functional disability, despite higher values in disease indices.Wyeth/Pfizer BrazilWyeth/Pfizer BrazilFederico Foundation, SwitzerlandFederico Foundation, Switzerlan

Ethnic Influence in Clinical and Functional Measures of Brazilian Patients with Spondyloarthritis

Objective. Spondyloarthritides (SpA) can present different disease spectra according to ethnic background. The Brazilian Registry of Spondyloarthritis (RBE) is a nationwide registry that comprises a large databank on clinical, functional, and treatment data on Brazilian patients with SpA. The aim of our study was to analyze the influence of ethnic background in SpA disease patterns in a large series of Brazilian patients. Methods. A common protocol of investigation was prospectively applied to 1318 SpA patients in 29 centers distributed through the main geographical regions in Brazil. The group comprised whites (65%), African Brazilians (31.3%), and people of mixed origins (3.7%). Clinical and demographic variables and various disease index scores were compiled. Ankylosing spondylitis (AS) was the most frequent disease in the group (65.1%); others were psoriatic arthritis (18.3%), undifferentiated SpA (6.8%), enteropathic arthritis (3.7%), and reactive arthritis (3.4%). Results. White patients were significantly associated with psoriasis (p = 0.002), positive HLA-B27 (p = 0.014), and use of corticosteroids (p 0.05). Schober test and thoracic expansion were similar in the 3 groups, whereas African Brazilians had higher Maastricht Ankylasing Spondylitis Enthesitis Scores (p = 0.005) and decreased lateral lumbar flexion (p = 0.003), while whites had a higher occiput-to-wall distance (p = 0.02). African Brazilians reported a worse patient global assessment of disease (p = 0.011). Other index scores and prevalence of work incapacity were similar in the 3 groups, although African Brazilians had worse performance in the Ankylosing Spondylitis Quality of Life questionnaire (p < 0.001). Conclusion. Ethnic background is associated with distinct clinical aspects of SpA in Brazilian patients. African Brazilian patients with SpA have a poorer quality of life and report worse disease compared to whites, (First Release Nov 1 2011; J Rheumatol 2012;39:141-7; doi:10.3899/jrheum.110372)391141147Wyeth/Pfizer BrazilFederico Foundatio

Ethnic Influence in Clinical and Functional Measures of Brazilian Patients with Spondyloarthritis

Objective. Spondyloarthritides (SpA) can present different disease spectra according to ethnic background. The Brazilian Registry of Spondyloarthritis (RBE) is a nationwide registry that comprises a large databank on clinical, functional, and treatment data on Brazilian patients with SpA. The aim of our study was to analyze the influence of ethnic background in SpA disease patterns in a large series of Brazilian patients. Methods. A common protocol of investigation was prospectively applied to 1318 SpA patients in 29 centers distributed through the main geographical regions in Brazil. The group comprised whites (65%), African Brazilians (31.3%), and people of mixed origins (3.7%). Clinical and demographic variables and various disease index scores were compiled. Ankylosing spondylitis (AS) was the most frequent disease in the group (65.1%); others were psoriatic arthritis (18.3%), undifferentiated SpA (6.8%), enteropathic arthritis (3.7%), and reactive arthritis (3.4%). Results. White patients were significantly associated with psoriasis (p = 0.002), positive HLA-B27 (p = 0.014), and use of corticosteroids (p &lt; 0.0001). Hip involvement (p = 0.02), axial inflammatory pain (p = 0.04), and radiographic sacroiliitis (p = 0.025) were associated with African Brazilian descent. Sex distribution, family history, and presence of peripheral arthritis, uveitis, dactylitis, urethritis, and inflammatory bowel disease were similar in the 3 groups, as well as age at disease onset, time from first symptom until diagnosis, and use of anti-tumor necrosis factor-a agents (p &gt; 0.05). Schober test and thoracic expansion were similar in the 3 groups, whereas African Brazilians had higher Maastricht Ankylasing Spondylitis Enthesitis Scores (p = 0.005) and decreased lateral lumbar flexion (p = 0.003), while whites had a higher occiput-to-wall distance (p = 0.02). African Brazilians reported a worse patient global assessment of disease (p = 0.011). Other index scores and prevalence of work incapacity were similar in the 3 groups, although African Brazilians had worse performance in the Ankylosing Spondylitis Quality of Life questionnaire (p &lt; 0.001). Conclusion. Ethnic background is associated with distinct clinical aspects of SpA in Brazilian patients. African Brazilian patients with SpA have a poorer quality of life and report worse disease compared to whites, (First Release Nov 1 2011; J Rheumatol 2012;39:141-7; doi:10.3899/jrheum.110372)Wyeth/Pfizer BrazilWyeth/Pfizer BrazilFederico FoundationFederico Foundatio

Assessment of fatigue in a large series of 1492 Brazilian patients with Spondyloarthritis

Background. the aim of the present study was to analyze the score of fatigue in a large cohort of Brazilian patients with SpA, comparing different disease patterns and its association with demographic and disease-specific variables.Methods. A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyloarthropathies Study Group (ESSG) criteria, attended at 29 reference centers. Clinical and demographic variables were recorded. Fatigue was evaluated using the first item of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire.Results. the mean BASDAI fatigue score was 4.20 +/- 2.99. There was no significant difference in the fatigue score between the different SpA. Fatigue was higher in female patients (p < 0.001), with mixed (axial vertical bar peripheral) involvement (p < 0.001) and in those who did not practice exercises (p < 0.001). Higher scores of fatigue were significantly associated with inflammatory low back pain (p = 0.013), alternating buttock pain (p = 0.001), cervical pain (p = 0.001), and hip involvement (p = 0.005). Fatigue presented a moderate positive statistical correlation with Bath Ankylosing Spondylitis Functional Index (BASFI) (0.469; p < 0.001) and Ankylosing Spondylitis Quality of Life (0.462; p < 0.001).Conclusion. in this large series of Brazilian SpA patients, higher fatigue scores were associated with female gender, sedentary, worse functionality, and quality of life.Wyeth/Pfizer BrazilFederico Foundation, SwitzerlandSanta Casa Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Rio de Janeiro, BR-21941 Rio de Janeiro, BrazilUniv Estado Rio de Janeiro, Rio de Janeiro, BrazilInsper Inst Educ & Res, São Paulo, BrazilUniv São Paulo, Div Rheumatol, BR-01246903 São Paulo, BrazilUniv Brasilia, BR-70910900 Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilUniv Estadual Campinas, Campinas, SP, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilPontificia Univ Catolica Porto Alegre, Porto Alegre, RS, BrazilHosp Evangel Curitiba, Curitiba, Parana, BrazilFac Med Sao Jose do Rio Preto, Sao Jose Do Rio Preto, SP, BrazilUniv Fed Parana, BR-80060000 Curitiba, Parana, BrazilHosp Geral Fortaleza, Fortaleza, Ceara, BrazilPontificia Univ Catolica Campinas, Campinas, SP, BrazilSanta Casa São Paulo, São Paulo, BrazilHosp Base, Brasilia, DF, BrazilUniv Fed Mato Grosso do Sul, Universitaria, MS, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Fed Rio Grande do Sul, BR-90046900 Porto Alegre, RS, BrazilFac Med Souza Marques, Cascadura, RJ, BrazilHosp Servidor Publ Estadual, São Paulo, BrazilUniv São Paulo, Inst Ortopedia & Traumatol, BR-01246903 São Paulo, BrazilUniv Fed Santa Catarina, BR-88040900 Florianopolis, SC, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilSanta Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilEscola Med & Saude Publ Salvador, Salvador, BA, BrazilFed Univ Para, BR-66059 Belem, Para, BrazilUniv Fed Espirito Santo, Vitoria, ES, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc