Spondyloarthritis (SpA)*:
Different than RA but just as prevalent1-4
*Specifically, psoriatic arthritis (PsA) and ankylosing spondylitis (AS).
SpA targets different sites than RA1,5-8
Spondyloarthritis prevalence comparable to RA
†Combined data for PsA (whites ≥20 years of age) and AS (nationally representative, males ≥25 years of age, females ≥50 years of age).3
Many patients with psoriatic arthritis (PsA) remain undiagnosed
Nearly one-third (29%) of patients with psoriasis had undiagnosed PsA in a dermatology clinic study.9
Many patients with psoriatic arthritis (PsA) remain undiagnosed
Nearly one-third (29%) of patients with psoriasis had undiagnosed PsA in a dermatology clinic study.9
Ankylosing spondylitis (AS) is largely undiagnosed
Radiographic diagnosis of AS may be delayed in more than half of patients for 5 years.10
Diagnostic delays of 8 years and longer have been reported.11
Unlike RA, SpA symptoms can appear earlier in life
RA can develop at any age, with 2 main onsets: age 42 and age 60.12
RA prevalence is declining.12
RA affects 2.5 times more women than men.13
RA prevalence is declining.12
PsA usually appears between the ages of 30 and 50.14
PsA affects men and women equally.15
AS usually surfaces between the ages of 20 and 30.12
AS prevalence is rising.12
AS affects up to 3 times more men than women.16
AS prevalence is rising.12
Psoriatic arthritis (PsA) can be aggressive, erosive, and deforming17
Nearly half of patients with PsA had at least 1 eroded joint at a median follow-up of 24 months.18
Key PsA Fact:
PsA may progress undiagnosed for approximately 10 years from psoriasis onset, and may even precede it.15
PsA strikes different sites than RA
The pain and disability caused by PsA may be as severe as RA, despite the involvement of fewer joints.19-21
Axial: 40% of patients with PsA may exhibit spine involvement15
Dactylitis: 29% of patients with PsA had dactylitis and 39% had distal interphalangeal (DIP) joint involvement18
Enthesitis: 38% of patients with PsA may have enthesitis18
Skin and nails: More than 80% of patients with PsA may have nail changes (psoriatic onycholysis), which may signal functional impairment 22
Joints: 67% of patients with PsA develop erosive and deforming joint damage15
PsA advances rapidly after onset, and may progress undiagnosed for approximately 10 years.15,23
- Peripheral joint damage occurred most rapidly in the first year of PsA onset, according to a hospital referral study23
Ankylosing spondylitis (AS) is progressive and disabling
Key AS Fact:
Diagnostic delays of 8 years and longer have been reported.11
Key AS Fact:
Diagnostic delays of 8 years and longer have been reported.11
In AS, joint erosion and osteogenesis may lead to severe disability25
≥1 Syndesmophyte: 23% of AS patients exhibited syndesmophytes within 5 years of disease onset26 – before many patients are diagnosed11
Sacroiliitis: In AS patients with a disease course of under 2 years, 39% of patients with AS demonstrated grade III sacroiliitis (ie, erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis)27,28
Peripheral arthritis: Seen in 37% of patients with AS26
Compression fractures: 7.6 times as prevalent in patients with AS as in the general population29
Inflammatory back pain: Reported by up to 99% of patients with AS as a symptom during their disease, with 82% reporting symptoms occurring during the last week26
Enthesitis: Seen in 39% of patients with AS. Commonly occurs in Achilles tendon and plantar fascia7,26
How AS may progress
Ankylosing spondylitis affects the spine, sacroiliac joints, hips, shoulders, and entheses.7
Inflammatory back pain is a hallmark symptom of AS.10
Chronic inflammation may lead to syndesmophyte formation.28
Syndesmophyte bridging may progress to fusion, or “bamboo” spine.28
RA=rheumatoid arthritis.
References: 1. Schett G, Coates LC, Ash ZR, Finzel S, Conaghan PG. Structural damage in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: traditional views, novel insights gained from TNF blockade, and concepts for the future. Arthritis Res Ther. 2011;13(suppl 1):S4. 2. National Psoriasis Foundation. Statistics. http://www.psoriasis.org/research/science-of-psoriasis/statistics. Accessed March 3, 2015. 3. Helmick CG, Felson DT, Lawrence RC, et al; for the National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008;58(1):15-25. 4. Akkoc N. Are spondyloarthropathies as common as rheumatoid arthritis worldwide? A review. Curr Rheumatol Rep. 2008;10(5):371-378. 5. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-2581. 6. Lories RJ, Baeten DL. Differences in pathophysiology between rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27(4 suppl 55):S10-S14. 7. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379-1390. 8. Lories RJ, Luyten FP, de Vlam K. Progress in spondylarthritis: mechanisms of new bone formation in spondyloarthritis. Arthritis Res Ther. 2009;11(2):221. 9. Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis. 2013;72(5):736-740. 10. Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum. 2005;52(4):1000-1008. 11. Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 2003;23(2):61-66. 12. Cross MJ, Smith EU, Zochling J, March LM. Differences and similarities between ankylosing spondylitis and rheumatoid arthritis: epidemiology. Clin Exp Rheumatol. 2009;27(4 suppl 55):S36-S42. 13. Centers for Disease Control and Prevention. Rheumatoid arthritis. 2011. http://www.cdc.gov/arthritis/basics/rheumatoid.htm. Accessed July 16, 2015. 14. National Psoriasis Foundation. Facts about psoriatic arthritis. National Psoriasis Foundation website. https://www.psoriasis.org/Doent.Doc?id=1493. Accessed September 17, 2015. 15. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(suppl 2):ii14-ii17. 16. Chen H-H, Chen T-J, Chen Y-M, Ying-Ming C, Chen D-Y. Gender differences in ankylosing spondylitis-associated cumulative healthcare utilization: a population-based cohort study. Clinics. 2011;66(2):251-254. 17. Veale D, Rogers S, FitzGerald O. Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol. 1994;33(2):133-138. 18. Kane D, Stafford L, Bresnihan B, FitzGerald O. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology. 2003;42(12):1460-1468. 19. Sokoll KB, Helliwell PS. Comparison of disability and quality of life in rheumatoid and psoriatic arthritis. J Rheumatol. 2001;28(8):1842-1846. 20. Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. P T. 2010;35(12):680-689. 21. Rahman P, Nguyen E, Cheung C, Schentag CT, Gladman DD. Comparison of radiological severity in psoriatic arthritis and rheumatoid arthritis. J Rheumatol. 2001;28(5):1041-1044. 22. Williamson L, Dalbeth N, Dockerty JL, Gee BC, Weatherall R, Wordsworth BP. Extended report: nail disease in psoriatic arthritis—clinically important, potentially treatable and often overlooked. Rheumatology. 2004;43(6):790-794. 23. McHugh NJ, Balachrishnan C, Jones SM. Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study. Rheumatology. 2003;42(6):778-783. 24. Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of even more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis [abstract]. Arthritis Rheum. 2013;65(suppl 10):309. 25. Ward MM, Reveille JD, Learch TJ, Davis JC Jr, Weisman MH. Impact of ankylosing spondylitis on work and family life: comparisons with the US population. Arthritis Rheum. 2008;59(4):497-503. 26. Rudwaleit M, Haibel H, Baraliakos X, et al. The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum. 2009;60(3):717-727. 27. Rojas-Vargas M, Muñoz-Gomariz E, Escudero A, et al. First signs and symptoms of spondyloarthritis—data from an inception cohort with a disease course of two years or less (REGISPONSER-Early). Rheumatology. 2009;48(4):404-409. 28. Paparo F, Revelli M, Semprini A, et al. Seronegative spondyloarthropathies: what radiologists should know. Radiol Med. 2014;119(3):156-163. 29. Cooper C, Carbone L, Michet CJ, Atkinson EJ, O'Fallon WM, Melton LJ III. Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol. 1994;21(10):1877-1882.
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