title: Early spondyloarthritis in multiracial society: differences between gender, race, and disease subgroups with regard to first symptom at presentation, main problem that the disease is causing to patients, and employment status.
abstract: To determine whether the first presenting symptoms, the main problem that the disease is causing to patients, and the employment status at presentation of patients with early spondyloarthritis (SpA) in a multicultural/multiracial patient cohort are different between gender, race, and disease subgroups of the SpA spectrum (ankylosing spondylitis, enteropathic arthritis, psoriatic arthritis, or undifferentiated arthritis). All patients above the age of 16 years, with disease duration of less than 3 years since symptom onset, seen in clinic between 2004 and 2008 with spondyloarthritis (SpAs) were assessed regarding their first presenting symptom, the main problem caused by the disease, and their employment status. In addition, clinical parameters such as the degree of disease activity (measured by BASDAI, ESR, and CRP), functional ability (measured by BASFI), night pain, sleep disturbance, well-being over past week, and over past 6 months prior to assessment (measured by a 10 cm VAS; 0 = good health, 10 = worst possible) were obtained. Statistical analysis with Pearson's χ(2) test compared and correlated two groups, and one-way analysis of variance (ANOVA) was used when more than two groups were compared and correlated. A total of 96 patients [(male:female = 33:63; (34.4:65.6%), (mean age 43.8 ± (SD) 13.9)] with early SpA were assessed. They were of multiethnic background representing Caucasians (n = 52; 54.2%), Asians (n = 33; 34.4%), and Africans (n = 10; 10.4%) mixed race (n = 1; 1%). The disease spectrum consisted of ankylosing spondylitis (AS) (n = 12; 12.7%), enteropathic arthritis or SpA associated with inflammatory bowel disease (IBD) (n = 9; 9.4%), psoriatic arthritis (PsA) (n = 47; 49%), undifferentiated spondyloarthritis (USpA) (n = 27; 28.2%), reactive arthritis (n = 1;1%), and juvenile SpA (n = 1;1%). Back pain stated as the first presenting symptom by 45 patients (46.8%) (followed by knee pain) and joint pains as the main problem by 49 patients (51.7%), while 47 patients of 93 who replied on the employment section (50.5%) were working. The total group had BASDAI score of 5.91 (±2.1), ESR of 19.65 (±19.4) mmHg/h, CRP of 8.10 (±9.2) mmol/L, BASFI score of 4.51 (±2.57), night pain of 5.26 (±3.2), sleep disturbance of 5.24 (±3.03) well-being over past week of 5.9 (±2.7), and well-being over past 6 months of 6.4 (±2.5). Most patients had PsA at presentation. Comparisons between genders showed significantly more women to have knee pain as first presenting symptom than men. No differences between races found in the first presenting symptom, main problem caused to patients by disease, and employment, but Africans have significantly more sleep disturbance than other races. Comparisons between disease subgroups showed patients with AS to have significantly more back pain and hip pain as first presenting symptom and patients with IBD to have more joint pain as main problem caused by the disease.
authors.affiliation: Department of Rheumatology and Rehabilitation, Barking Havering and Redbridge University NHS Trust, King George Hospital, Barley Lanes, Goodmayes, Ilford, Essex, London, IG3 8YB, UK. thaliaroussou@hotmail.com
authors.forename: Euthalia
authors.initials: E
authors.lastname: Roussou
authors.forename: Shahzabeen
authors.initials: S
authors.lastname: Sultana
mesh_terms: D000069:Acculturation; D000328:Adult; D000704:Analysis of Variance; D018771:Arthralgia / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology; D044466:Asian People / Q000706:statistics & numerical data; D001416:Back Pain / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology; D044383:Black People / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003466:Cultural Characteristics; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D044469:Racial Groups / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology; D025241:Spondylarthritis / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology*; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data