Summary:
Objectives: To compare the demographic and clinical
characteristics of juvenile onset refractory spondyloarthritis
(JOSpA) with a group of adult-onset refractory
spondyloarthritis (AOSpA) patients.
Methods: In this real-life, cross-sectional study, a total of
215 SpA patients (refractory to two NSAIDs and/or
DMARDs) were enrolled following ASAS classification
criteria from a rheumatology center in Dhaka, Bangladesh.
Based on age, the patients were divided into JOSpA group
and AOSpA group for analysis. The patients’ demographics,
quality of life, laboratory and clinical characteristics were
compared and analyzed between the two groups using chisquare
and independent sample t-test.
Results: Among 215 patients, 57 (53 males, 4 females) were
in JOSpA group, and 158 (126 males, 32 females) were in
AOSpA group. Most patients were male in both groups
(P=0.02). The mean age at diagnosis for JOSpA and AOSpA
were 27.68±9.5 and 40.28±10 years respectively (P=0.00),
and mean age at onset of disease in JOSpA and AOSpA were
12.33±3.62 and 29.58±96.5 years respectively. The mean
disease duration was 15.36±9.3 months in JOSpA compared
to 10.70±7.1 months in AOSpA group (P=0.00). Sixteen
(28.1%) JOSpA and 9 (5.7%) AOSpA patients were
undernourished, (P=0.00). On the contrary, obesity was more
prevalent in AOSpA patients (41.1%) than those in JOSpA
patients (21.1%) (P=0.00). There were significant differences
in mean haemoglobin (11.38±1.7 and 10.94±1.3 g/dl)
(P=0.05) and mean serum creatinine (0.94±0.2 and 0.86±0.2
mg/dl) (P=0.03) levels in AOSpA and JOSpA groups
respectively. HLA-B27 was done in 20 JOSpA and 61 AOSpA
patients. Among them, 19 (95%) were positive in JOSpA
and 55 (90.16%) were positive in AOSpA groups. Similarly,
hips involvement was higher in JOSpA group 19 (33.3%)
compared to the AOSpA group 21 (13.3%) (P=0.004).
Significant differences were observed in mean disease activity
parameters, patient global assessment (PGA) (7.86±1.2 vs
7.38±1.4, P=0.02), ASDAS-CRP (4.60±0.8 vs 4.33±0.9,
P=0.05), and ASDAS-ESR (4.49±0.8 vs 4.17±1.0, P=0.02)
in JOSpA and AOSpA groups respectively. The modified
Stoke AS Spinal Score (mSASSS) in AOSpA group was
higher (24.18±17.22) than that of JOSpA group (17.10±9.6)
(P=0.00).
Conclusions: In JOSpA patients, under nutrition, hip
involvement, longer disease duration, uveitis, PGA, low Hb
level and ASDAS-ESR disease activity scores were higher.
On the contrary in AOSpA group, male gender, married
subjects, obesity, higher creatinine level and mSASSS scores
were higher.
Keywords: Juvenile-onset, Adult-onset, Refractory
Spondyloarthritis
(J Bangladesh Coll Phys Surg 2020; 38: 79-85)
DOI: https://doi.org/10.3329/jbcps.v38i2.45631