Axial SpondyloarthritisEpidemiology in South East Asia
and Patient JourneyJames Cheng-Chung WEI, MD, PhD
Chief, Division of Allergy, Immunology and RheumatologyDirector, Chinese Medicine Clinical Trial Center
Associate Professor, Chung Shan Medical University
Outline
Concept of SpA• and non-radiographic axial
spondyloarthritis (nr-axSpA) Epidemiology of SpA in South East
Asia Patient journey Take home message
AS, ankylosing spondylitis; PsA, psoriatic arthritis; ReA, reactive arthritis; IBD, inflammatory bowel diseases-associated arthritis; USpA, undifferentiated spondyloarthritis.JC Wei. Chronic Inflammation: Causes, Treatment Options and Role in Disease. Nova Science Publishers, Inc. 2013
Spectrum of Spondyloarthritis.(seronenative spondyloarthropathies)
ASAS, 2009 ASAS, 2011
MNY, 1984
Non-radiographic axial spondyloarthritis
(nr-axSpA) Fit axial SpA (ASAS classification criteria for
axSpA, Rudwaleit et al 2009)), but not radiographic criteria of AS (Modified New York criteria, Calin et al 1984).
Usually early or mild or atypical cases Some of them might develop AS and have
similar health burden. New disease entity
• Adalimumab in nx-axSpA: approved by EMEA, but not FDA• Certolizumab Pegol in axSpA approved by EMEA & FDA
Outline
Concept of SpA• and non-radiographic axial
spondyloarthritis (nr-axSpA) Epidemiology of SpA in South East
Asia Patient journey Take home message
Epidemiological survey in China
N=10 921 , aged >16 years; of these, 7.21% had LBP 0.78% axial SpA(12% in subjects with LBP) 0.25% ankylosing spondylitis (AS) 0.50% undifferentiated axial SpA (USpA) 0.02% psoriatic arthritis (PsA) Of the axial SpA patients, 82.67% were HLA-B27
positive, clearly a greater percentage than those (11.65%) in other LBP groups.
Liao, Gu. Scand J Rheumatol. 2009 Nov-Dec;38(6):455-9.
AS in Taiwan
Population: 23 million 5% were HLA-B27 positive 92% HLA-B27 positive AS prevalence: 0.2-0.4 % Sex ratio (M:F) was 2.8 : 1 Delay diagnosis 5.9 years 42.6 % have family history of
SpA
JC Wei, PhD thesis, 2007, Clinical Rheumatology (2007) 26:1685–1691
Variables Patient (%)
History of uveitis, no. (%) 24.1
History of psoriasis, no. (%) 13.9
History of hematuria no. (%) 6.8
History of oral ulcer, no. (%) 11.6
Onset symptom, no. (peripheral arthritis / IBD / uveitis) (%)
21.5/2.9/2.5
Extra-articular manifestations of AS in Taiwan, n=805
JC Wei. Clinical Rheumatology (2007) 26:1685–1691
Outline
Concept of SpA• and non-radiographic axial
spondyloarthritis (nr-axSpA) Epidemiology of SpA in South East
Asia Patient journey Take home message
12% in 2 years
Non-radiographic axial SpA Ankylosing spondylitis
no definite radiographic sacroiliitis (grade 0 at the right side, grade 1 – possible subchondral sclerosis – at the left side)
definite radiographic sacroiliitis (grade 2 bilaterally) fulfilling the radiographic criterion of the modified New York criteria
Progression of Non-radiographic Axial SpA to AS: Data from GESPIC*
Main predictor:elevated CRP**
*GESPIC = GErman Spondyloarthritis Inception Cohort
**Odds ratio for progression in patients with elevated serum C-reactive protein level (>6 mg/l) was: 4.11 (95% CI 1.13-14.95).
Poddubnyy D et al. Ann Rheum Dis 2011;70:1369-74
How to identify SpA pts?
LBPLow back pain
IBPInflammatory back pain
SpASpondyloarthritis
IBP Dx by general physicians
SpA Dx by rheumatologists
Referral
Unmet Needs of SpA in Asia
Unmet needs Actions to doDelayed diagnosis 1. Educate GP and rheumatologist
about new concepts of SpA2. When to see a rheumatologist,
ie. Refer strategy for GP and Pt3. When and how to test X-ray,
HLA-B27, MRI
Inadequate treatment 1. Educate Pt and GP2. Accessibility and cost of TNFi 3. Safety, esp TB and HepB
Take Home Message
1. SpA affect 1% of population with variable features.
2. SpA cause severe health burden due to delay diagnosis and inadequate treatment in Asia.
3. Need practical referral strategy to identify patients.
4. ASAS criteria for IBP and axSpA is useful for clinical studies and daily practice
5. Diagnose nr-axSpA by HLA-B27 and/or MRI.
6. Accessibility of TNFi and safety, esp TB and HepB are major concerns in SEA.
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