Abstract
This study focuses on describing full spectrum of clinical, laboratory, and radiological characterization of ankylosing spondylitis (AS) patients in India. Data on 70 consecutive AS patients, seen at the rheumatology clinic in India, was prospectively obtained using investigator-administered questionnaires. Diagnosis was made according to the modified New York criteria. The core set of variables selected by Assessment in AS International society were obtained. The differences in clinical characteristics based on presence or absence of peripheral arthritis, gender, and juvenile (JOAS) vs. adult onset AS (AOAS) were evaluated. The male/female ratio was 5:1. The mean age of onset of symptoms and diagnosis were 23.6 and 32.5 years, respectively. Females had similar spinal indices and radiological damage as male counterpart. However, they had more common extra-articular manifestations and root joint involvement. The majority of patients consisted of AOAS (78.5%) and was clinically similar to JOAS. One or more peripheral joints were involved in 65.7% of patients, affecting predominantly the lower extremity (90.6%, knee 47.1%, and ankle 35.7%) in asymmetrical pattern (78%). Patients with peripheral arthritis had higher erythrocyte sedimentation rate, more frequent enthesitis, root joint, and whole spine involvement, suggesting more aggressive disease. Most common site of enthesitis was chondro-sternal junction (30%) and Achilles tendonitis (24.3%). The root joints frequently involved extra-axial joints. Uveitis was the most common extra-articular manifestation (25.7%). The predominant initial symptom was typical inflammatory low back pain (87.1%). Assessment in ankylosing spondylitis indices showed a moderately severe disease activity and damage with following values: mean Bath Ankylosing Spondylitis Disease Activity Index, 3.2 (±1.8); mean Bath Ankylosing Spondylitis Functional Index, 2.3 (±2.0); and mean Bath Ankylosing Spondylitis Metrology Index, 3.15 (±2.3). Majority of the patients had bilateral sacroiliitis (grades 2–4) on radiographs (87.1%). In conclusion, the features of AS in Indian patients were broadly similar to other part of world, with the exception of increased frequency of peripheral arthritis.
Similar content being viewed by others
References
Gorman JD, Sack KE, Davis JC Jr (2002) Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor alpha. N Engl J Med 346(18):1349–1356
Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369(9570):1379–1390
Sengupta R, Stone MA (2007) The assessment of ankylosing spondylitis in clinical practice. Nat Clin Pract Rheumatol 3(9):496–503
Rudwaleit M, Listing J, Brandt J, Braun J, Sieper J (2004) Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis 63(6):665–670
Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136(12):896–907
Aggarwal R, Malaviya AN (2009) Diagnosis delay in patients with ankylosing spondylitis: factors and outcomes-an Indian perspective. Clin Rheumatol 28:327–31
Khan MA (1977) Ankylosing spondylitis and HLA-B27 in Punjabis. Lancet 2(8036):504
Prasad P, Singh RP (1982) Ankylosing spondylitis in tribal belt of Chhotanagpur region. J Indian Med Assoc 78(7):108–112
Prakash S, Mehra NK, Bhargava S, Vaidya MC, Malaviya AN (1984) Ankylosing spondylitis in North India: a clinical and immunogenetic study. Ann Rheum Dis 43(3):381–385
Achuthan K, Porkodi R, Ramakrishnan S, Krishnamurthy V, Madhavan R, Parthiban M et al (1990) Pattern of rheumatic diseases in south India. V. Ankylosing spondylitis. A clinical and radiological study. J Assoc Physicians India 38(10):774–776
van der Heijde D, Bellamy N, Calin A, Dougados M, Khan MA, van der Linden S (1997) Preliminary core sets for endpoints in ankylosing spondylitis. Assessments in ankylosing spondylitis working group. J Rheumatol 24(11):2225–2229
van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368
Lopez-Larrea C, Sujirachato K, Mehra NK, Chiewsilp P, Isarangkura D, Kanga U et al (1995) HLA-B27 subtypes in Asian patients with ankylosing spondylitis. Evidence for new associations. Tissue Antigens 45(3):169–176
Kanga U, Mehra NK, Larrea CL, Lardy NM, Kumar A, Feltkamp TE (1996) Seronegative spondyloarthropathies and HLA-B27 subtyes: a study in Asian Indians. Clin Rheumatol 15(Suppl 1):13–18
Feldtkeller E, Erlendsson J (2008) Definition of disease duration in ankylosing spondylitis. Rheumatol Int 28:693–696
Rudwaleit M, Metter A, Listing J, Sieper J, Braun J (2006) Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 54(2):569–578
van der Heijde D, van der Linden S, Bellamy N, Calin A, Dougados M, Khan MA (1999) Which domains should be included in a core set for endpoints in ankylosing spondylitis? Introduction to the ankylosing spondylitis module of OMERACT IV. J Rheumatol 26(4):945–947
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291
Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285
Jones SD, Porter J, Garrett SL, Kennedy LG, Whitelock H, Calin A (1995) A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol 22(8):1609
Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23(2):61–66
Carette S, Graham D, Little H, Rubenstein J, Rosen P (1983) The natural disease course of ankylosing spondylitis. Arthritis Rheum 26(2):186–190
Calin A (2004) Ankylosing spondylitis, 3rd edn. Oxford University Press, Oxford
Reveille J (2008) Clinical features of ankylosing spondylitis, 4th edn. Mosby-Elsevier, London
Feldtkeller E (1999) Age at disease onset and delayed diagnosis of spondyloarthropathies. Z Rheumatol 58(1):21–30
Zink A, Braun J, Listing J, Wollenhaupt J (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis–results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol 27(3):613–622
Feldtkeller E, Braun J (2000) Impact of sex on inheritance of ankylosing spondylitis. Lancet 355(9209):1096–1097 author reply 1098
Jimenez-Balderas FJ, Mintz G (1993) Ankylosing spondylitis: clinical course in women and men. J Rheumatol 20(12):2069–2072
Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002) Ankylosing spondylitis: an overview. Ann Rheum Dis 61(Suppl 3):iii8–iii18
Marks SH, Barnett M, Calin A (1983) Ankylosing spondylitis in women and men: a case–control study. J Rheumatol 10(4):624–628
Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H et al (1999) Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 26(4):980–984
Singh G, Lawrence A, Agarwal V, Misra R, Aggarwal A (2008) Higher prevalence of extra-articular manifestations in ankylosing spondylitis with peripheral arthritis. J Clin Rheumatol 14(5):264–266
Heuft-Dorenbosch L, van Tubergen A, Spoorenberg A, Landewe R, Dougados M, Mielants H et al (2004) The influence of peripheral arthritis on disease activity in ankylosing spondylitis patients as measured with the Bath Ankylosing Spondylitis Disease Activity Index. Arthritis Rheum 51(2):154–159
Lambert RG, Dhillon SS, Jhangri GS, Sacks J, Sacks H, Wong B et al (2004) High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease. Arthritis Rheum 51(5):681–690
Eshed I, Bollow M, McGonagle DG, Tan AL, Althoff CE, Asbach P et al (2007) MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis 66(12):1553–1559
Linder R, Hoffmann A, Brunner R (2004) Prevalence of the spondyloarthritides in patients with uveitis. J Rheumatol 31(11):2226–2229
Rosenbaum JT (1989) Characterization of uveitis associated with spondyloarthritis. J Rheumatol 16(6):792–796
Rothova A, Buitenhuis HJ, Meenken C, Brinkman CJ, Linssen A, Alberts C et al (1992) Uveitis and systemic disease. Br J Ophthalmol 76(3):137–141
Tay-Kearney ML, Schwam BL, Lowder C, Dunn JP, Meisler DM, Vitale S et al (1996) Clinical features and associated systemic diseases of HLA-B27 uveitis. Am J Ophthalmol 121(1):47–56
Garcia-Morteo O, Maldonado-Cocco JA, Suarez-Almazor ME, Garay E (1983) Ankylosing spondylitis of juvenile onset: comparison with adult onset disease. Scand J Rheumatol 12(3):246–248
Riley MJ, Ansell BM, Bywaters EG (1971) Radiological manifestations of ankylosing spondylitis according to age at onset. Ann Rheum Dis 30(2):138–148
Martinez-Borra J, Gonzalez S, Lopez-Vazquez A, Gelaz MA, Armas JB, Kanga U et al (2000) HLA-B27 alone rather than B27-related class I haplotypes contributes to ankylosing spondylitis susceptibility. Hum Immunol 61(2):131–139
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aggarwal, R., Malaviya, A.N. Clinical characteristics of patients with ankylosing spondylitis in India. Clin Rheumatol 28, 1199–1205 (2009). https://doi.org/10.1007/s10067-009-1227-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-009-1227-7