Abstract
The classification of Spondyloarthritis (SpA) has been revised with the introduction of the ASAS classification criteria. Although this has best been described in ankylosing spondylitis and psoriatic arthritis, there are population studies evaluating the epidemiology of the different subgroups of SpA. In this paper, we present data on the incidence and prevalence of the subgroups of SpA in different populations, and point to data indicating how the introduction of new classification criteria, with the altered perception of the SpA entity, might impact on the epidemiology.
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Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis [Multicenter Study Research Support, Non-US Gov't Validation Studies]. 2009;68(6):777–83.
McEwen C, DiTata D, Lingg C, et al. Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study. Arthritis Rheum. 1971;14(3):291–318.
Hart FD. The ankylosing spondylopathies. Clin Orthop Relat Res. 1971;74:7–13.
Moll JM, Haslock I, Macrae IF, et al. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Med (Baltimore) [Review]. 1974;53(5):343–64.
Amor B, Dougados M, Mijiyawa M. Criteria of the classification of spondylarthropathies. Rev Rhum Mal Osteoartic [Clinical Trial Multicenter Study]. 1990;57(2):85–9.
Amor B, Dougados M, Listrat V, et al. Evaluation of the Amor criteria for spondylarthropathies and European Spondylarthropathy Study Group (ESSG). A cross-sectional analysis of 2,228 patients]. Ann Med Interne (Paris) [Clinical Trial Multicenter Study]. 1991;142(2):85–9.
Nash P, Mease PJ, Braun J, et al. Seronegative spondyloarthropathies: to lump or split? Ann Rheum Dis. 2005;64 Suppl 2:ii9–13.
Brandt J, Haibel H, Cornely D, et al. Successful treatment of active ankylosing spondylitis with the anti-tumor necrosis factor alpha monoclonal antibody infliximab. Arthritis Rheum. 2000;43(6):1346–52.
Braun J, Bollow M, Sieper J. Radiologic diagnosis and pathology of the spondyloarthropathies. Rheum Dis Clin North Am. 1998;24(4):697–735.
Sidiropoulos PI, Hatemi G, Song IH, et al. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists. Rheumatology (Oxford). 2008;47(3):355–61.
Bennett AN, McGonagle D, O'Connor P, et al. Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum. 2008;58(11):3413–8.
Mathieu A, Paladini F, Vacca A, et al. The interplay between the geographic distribution of HLA-B27 alleles and their role in infectious and autoimmune diseases: a unifying hypothesis. Autoimmun Rev. 2009;8(5):420–5.
Gofton JP, Lawrence JS, Bennett PH, et al. Sacro-ilitis in eight populations. Ann Rheum Dis. 1966;25(6):528–33.
Gofton JP, Chalmers A, Price GE, et al. HL-A 27 and ankylosing spondylitis in B.C. Indians. J Rheumatol. 1984;11(5):572–3.
Gofton JP, Robinson HS, Trueman GE. Ankylosing spondylitis in a Canadian Indian population. Ann Rheum Dis. 1966;25(6):525–7.
Erdesz S, Shubin SV, Shoch BP, et al. Spondyloarthropathies in circumpolar populations of Chukotka (Eskimos and Chukchi): epidemiology and clinical characteristics. J Rheumatol. 1994;21(6):1101–4.
Gran JT, Husby G, Hordvik M. Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Tromso, northern Norway. Ann Rheum Dis [Research Support, Non-US Gov't]. 1985;44(6):359–67.
Johnsen K, Gran JT, Dale K, et al. The prevalence of ankylosing spondylitis among Norwegian Samis (Lapps). J Rheumatol [Research Support, Non-US Gov't]. 1992;19(10):1591–4.
Gran JT, Mellby AS, Husby G. The prevalence of HLA-B27 in Northern Norway. Scand J Rheumatol [Comparative Study Research Support, Non-US Gov't]. 1984;13(2):173–6.
Bakland G, Nossent HC, Gran JT. Incidence and prevalence of ankylosing spondylitis in Northern Norway. Arthritis Rheum [Research Support, Non-US Gov't]. 2005;53(6):850–5.
Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum [Research Support, Non-US Gov't]. 1998;41(1):58–67.
• Haglund E, Bremander AB, Petersson IF, et al. Prevalence of spondyloarthritis and its subtypes in southern Sweden. Ann Rheum Dis [Research Support, Non-US Gov't]. 2011;70(6):943–8. This paper gives an estimation of the prevalence of different subtypes of SpA in the southern part of Sweden. Patients are identified using a public registry of diagnosis (ICD10), and includes a population of 1.2 million.
• Geirsson AJ, Eyjolfsdottir H, Bjornsdottir G, et al. Prevalence and clinical characteristics of ankylosing spondylitis in Iceland - a nationwide study. Clin Exp Rheumatol [Research Support, Non-US Gov't]. 2010;28(3):333–40. Prevalence estimated on the bases of a nationwide identification of AS patients using hospital records. Only includes patients fulfilling modified New York criteria.
Kaipiainen-Seppanen O, Aho K, Heliovaara M. Incidence and prevalence of ankylosing spondylitis in Finland. J Rheumatol [Research Support, Non-US Gov't]. 1997;24(3):496–9.
Hanova P, Pavelka K, Holcatova I, et al. Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic. Scand J Rheumatol [Research Support, Non-US Gov't]. 2010;39(4):310–7. Patients identified after referrals from GPs to specialist care. Estimates of PsA, AS, and ReA prevalence and incidence.
De Angelis R, Salaffi F, Grassi W. Prevalence of spondyloarthropathies in an Italian population sample: a regional community-based study. Scand J Rheumatol [Research Support, Non-US Gov't]. 2007;36(1):14–21.
Onen F, Akar S, Birlik M, et al. Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir. Turkey J Rheumatol. 2008;35(2):305–9.
Reveille JD. Epidemiology of spondyloarthritis in North America. Am J Med Sci [Research Support, NIH, Extramural]. 2011;341(4):284–6.
•• Reveille JD, Witter JP, Weisman MH. Prevalence of axial spondylarthritis in the United States: estimates from a cross-sectional survey. Arthritis Care Res (Hoboken) [Research Support, US Gov't, PHS]. 2012;64(6):905–10. Estimates of SpA prevalence based on true population surveys (NHANES) using the ESSG and Amor classification criteria. Estimates also given for different ethnic groups.
Weisman MH, Witter JP, Reveille JD. The prevalence of inflammatory back pain: population-based estimates from the US National Health and Nutrition Examination Survey, 2009–10. Ann Rheum Dis [Research Support, Non-US Gov't]. 2013;72(3):369–73.
Zeng QY, Chen R, Darmawan J, et al. Rheumatic diseases in China. Arthritis Res Ther [Research Support, Non-US Gov't]. 2008;10(1):R17.
Joshi VL, Chopra A. Is there an urban–rural divide? Population surveys of rheumatic musculoskeletal disorders in the Pune region of India using the COPCORD Bhigwan model. J Rheumatol [Research Support, Non-US Gov't]. 2009;36(3):614–22.
Hukuda S, Minami M, Saito T, et al. Spondyloarthropathies in Japan: nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society. J Rheumatol [Research Support, Non-US Gov't]. 2001;28(3):554–9.
• Mustafa KN, Hammoudeh M, Khan MA. HLA-B27 Prevalence in Arab Populations and Among Patients with Ankylosing Spondylitis. J Rheumatol. 2012;39(8):1675–7. This paper presents a survey of HLA-B27 in a Jordanian population, and a review of the current litterature of HLA-B27 prevalence in Arab populations.
Brown MA, Jepson A, Young A, et al. Ankylosing spondylitis in West Africans--evidence for a non-HLA-B27 protective effect. Ann Rheum Dis [Research Support, Non-US Gov't]. 1997;56(1):68–70.
Mijiyawa M, Oniankitan O, Khan MA. Spondyloarthropathies in sub-Saharan Africa. Curr Opin Rheumatol [Review]. 2000;12(4):281–6.
Carbone LD, Cooper C, Michet CJ, et al. Ankylosing spondylitis in Rochester, Minnesota, 1935–1989. Is the epidemiology changing? Arthritis Rheum [Research Support, Non-US Gov't Research Support, US Gov't, PHS]. 1992;35(12):1476–82.
Kaipiainen-Seppanen O, Aho K. Incidence of chronic inflammatory joint diseases in Finland in 1995. J Rheumatol [Comparative Study Review]. 2000;27(1):94–100.
Alamanos Y, Papadopoulos NG, Voulgari PV, et al. Epidemiology of ankylosing spondylitis in Northwest Greece, 1983–2002. Rheumatology. 2004;43(5):615–8.
Palm O, Moum B, Ongre A, et al. Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (the IBSEN study). J Rheumatol [Research Support, Non-US Gov't]. 2002;29(3):511–5.
Loftus Jr EV. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterol [Research Support, Non-US Gov't]. 2004;126(6):1504–17.
Madland TM, Apalset EM, Johannessen AE, et al. Prevalence, disease manifestations, and treatment of psoriatic arthritis in Western Norway. J Rheumatol [Research Support, Non-US Gov't]. 2005;32(10):1918–22.
Nossent JC, Gran JT. Epidemiological and clinical characteristics of psoriatic arthritis in northern Norway. Scand J Rheumatol. 2009;38(4):251–5.
Love TJ, Gudbjornsson B, Gudjonsson JE, et al. Psoriatic arthritis in Reykjavik, Iceland: prevalence, demographics, and disease course. J Rheumatol [Research Support, Non-US Gov't]. 2007;34(10):2082–8.
Wilson FC, Icen M, Crowson CS, et al. Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study. J Rheumatol [Research Support, Non-US Gov't]. 2009;36(2):361–7.
• Soriano ER, Rosa J, Velozo E, et al. Incidence and prevalence of psoriatic arthritis in Buenos Aires, Argentina: a 6-year health management organization-based study. Rheumatology. 2011;50(4):729–34. The authors presents data of PsA incidence and prevalence in a relatively large population in South America, based on participation in a health management program including more than 130,000 individuals.
Liao ZT, Pan YF, Huang JL, et al. An epidemiological survey of low back pain and axial spondyloarthritis in a Chinese Han population. Scand J Rheumatol [Comparative Study Research Support, Non-US Gov't]. 2009;38(6):455–9.
Soderlin MK, Borjesson O, Kautiainen H, et al. Annual incidence of inflammatory joint diseases in a population based study in southern Sweden. Ann Rheum Dis [Multicenter Study Research Support, Non-US Gov't]. 2002;61(10):911–5.
Kvien TK, Glennas A, Melby K, et al. Reactive arthritis: incidence, triggering agents and clinical presentation. J Rheumatol [Research Support, Non-US Gov't]. 1994;21(1):115–22.
Savolainen E, Kaipiainen-Seppanen O, Kroger L, et al. Total incidence and distribution of inflammatory joint diseases in a defined population: results from the Kuopio 2000 arthritis survey. J Rheumatol [Research Support, Non-US Gov't]. 2003;30(11):2460–8.
Townes JM, Deodhar AA, Laine ES, et al. Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study. Ann Rheum Dis [Multicenter Study Research Support, Non-US Gov't Research Support, US Gov't, PHS]. 2008;67(12):1689–96.
Boyer GS, Templin DW, Cornoni-Huntley JC, et al. Prevalence of spondyloarthropathies in Alaskan Eskimos. J Rheumatol [Comparative Study Research Support, Non-US Gov't Research Support, US Gov't, PHS]. 1994;21(12):2292–7.
Poddubnyy D, Brandt H, Vahldiek J, et al. The frequency of non-radiographic axial spondyloarthritis in relation to symptom duration in patients referred because of chronic back pain: results from the Berlin early spondyloarthritis clinic. Ann Rheum Dis [Research Support, Non-US Gov't]. 2012;71(12):1998–2001.
Zochling J, Smith EU. Seronegative spondyloarthritis. Best Pract Res Clin Rheumatol [Review]. 2010;24(6):747–56.
•• Kiltz U, Baraliakos X, Karakostas P, et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken) [Comparative Study Research Support, Non-US Gov't]. 2012;64(9):1415–22. This is an important paper, pointing to clinical similarities and differences between patients fulfilling the ASAS axial SpA classification criteria as non-radiographic and radiographic axial SpA, respectively.
•• Bakland G, Alsing R, Singh K, et al. Assessment of spondyloarthritis international society criteria for axial spondyloarthritis in chronic back pain patients with high HLA B27 prevalence. Arthritis Care Res (Hoboken). 2012 Jul 25. In this paper, the authors point to the possible increase in patients diagnosed with axial SpA compared to AS in a population with chronic back pain, with the application of the ASAS axial SpA classification criteria compared to the modified New York criteria
•• Strand V, Rao SA, Shillington AC, et al. Prevalence of axial SpA in US rheumatology practices: Assessment of ASAS criteria vs. rheumatology expert clinical diagnosis. Arthritis Care Res (Hoboken). 2013 Feb 22. A systematic application of the ASAS axial SpA classification criteria to estimate the population frequency of this disease
Sieper J, van der Heijde D, Dougados M, et al. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis. 2012 Jul 7
Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, et al. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum [Review]. 2004;34(3):585–92.
• Bakland G, Gran JT, Nossent JC. Increased mortality in ankylosing spondylitis is related to disease activity. Ann Rheum Dis [Research Support, Non-US Gov't]. 2011;70(11):1921–5. This study demostrates the increased mortality in AS, identifies inflammation as a predictor of reduced survival, and correlates mortality inversly to the use of NSAIDs.
Kroon F, Landewe R, Dougados M, et al. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis [Randomized Controlled Trial]. 2012;71(10):1623–9.
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Gunnstein Bakland declares that she/he has no conflict of interest.
Hans C. Nossent declares that she/he has no conflict of interest.
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This article is part of the Topical Collection on Seronegative Arthritis
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Bakland, G., Nossent, H.C. Epidemiology of Spondyloarthritis: A Review. Curr Rheumatol Rep 15, 351 (2013). https://doi.org/10.1007/s11926-013-0351-1
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DOI: https://doi.org/10.1007/s11926-013-0351-1