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Elucidating the role of a positive family history in differentiating between axial and peripheral spondyloarthritis: an ancillary analysis of the ASAS-PerSpA study


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

 

  1. Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore; and SingHealth Internal Medicine Residency Programme, Singapore. phakyh@nus.edu.sg
  2. Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
  3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
  4. Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France; ECAMO, INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, France; and Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Spain.
  5. University of Paris, Department of Rheumatology, Hôpital Cochin. Assistance Publique, Hôpitaux de Paris - INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, France.
  6. Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Germany.
  7. Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, and Clinical Research Unit, Berlin Institute of Health (BIH), Berlin, Germany.
  8. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.
  9. Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
  10. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
  11. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
  12. Department of Rheumatology and Immunology, Singapore General Hospital; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; and Duke-NUS Medical School, Singapore.

CER15135
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PMID: 34905484 [PubMed]

Received: 04/09/2021
Accepted : 08/11/2021
In Press: 10/12/2021

Abstract

OBJECTIVES:
Positive family history (PFH) of spondyloarthritis (SpA) is important in the diagnosis of SpA. However, the contribution of a PFH in differentiating the two SpA subtypes (axial and peripheral spondyloarthritis (pSpA)), in particular the importance of second-degree relative (SDR) has not been well-studied. We aimed to investigate whether PFH of radiographic axial spondyloarthritis (r-axSpA), psoriasis, uveitis, reactive arthritis and inflammatory bowel disease in first-degree relative (FDR) and second-degree relative (SDR) contributes to differentiation between axSpA and pSpA using the data from a multinational cohort study.
METHODS:
The ASAS-PerSpA study dataset was used to assess the effects of a PFH on differentiating between axSpA and pSpA via generalised structural equation modelling. Model building using backward selection was performed to obtain a final model. Direct, indirect and total effects of the path analysis were calculated.
RESULTS:
A total of 3803 patients were included: 2458 axSpA and 1345 pSpA patients. FDR (OR: 3.75, 95% CI: 2.86–4.91, p<0.001) and SDR (OR: 4.58, 95% CI: 3.19–6.59, p<0.001) with r-axSpA were positively associated while FDR (OR: 0.262, 95% CI: 0.207–0.331, p<0.001) and SDR (OR: 0.305, 95% CI: 0.221–0.420, p<0.001) with psoriasis were negatively associated with differentiating patients with axSpA from pSpA.
CONCLUSIONS:
The presence of r-axSpA and psoriasis in FDR or SDR are useful in differentiating axSpA from pSpA. SDR with r-axSpA may contribute greater towards the differentiation than FDR. Clinicians should consider taking an extensive family history of SpA and their subtypes to better differentiate the subtypes within the SpA spectrum.

DOI: https://doi.org/10.55563/clinexprheumatol/gqsd66

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