title: Ethnic influence in clinical and functional measures of Brazilian patients with spondyloarthritis.
abstract: OBJECTIVE
  Spondyloarthritides (SpA) can present different disease spectra according to ethnic background. The Brazilian Registry of Spondyloarthritis (RBE) is a nationwide registry that comprises a large databank on clinical, functional, and treatment data on Brazilian patients with SpA. The aim of our study was to analyze the influence of ethnic background in SpA disease patterns in a large series of Brazilian patients.
  
  
  METHODS
  A common protocol of investigation was prospectively applied to 1318 SpA patients in 29 centers distributed through the main geographical regions in Brazil. The group comprised whites (65%), African Brazilians (31.3%), and people of mixed origins (3.7%). Clinical and demographic variables and various disease index scores were compiled. Ankylosing spondylitis (AS) was the most frequent disease in the group (65.1%); others were psoriatic arthritis (18.3%), undifferentiated SpA (6.8%), enteropathic arthritis (3.7%), and reactive arthritis (3.4%).
  
  
  RESULTS
  White patients were significantly associated with psoriasis (p = 0.002), positive HLA-B27 (p = 0.014), and use of corticosteroids (p < 0.0001). Hip involvement (p = 0.02), axial inflammatory pain (p = 0.04), and radiographic sacroiliitis (p = 0.025) were associated with African Brazilian descent. Sex distribution, family history, and presence of peripheral arthritis, uveitis, dactylitis, urethritis, and inflammatory bowel disease were similar in the 3 groups, as well as age at disease onset, time from first symptom until diagnosis, and use of anti-tumor necrosis factor-α agents (p > 0.05). Schober test and thoracic expansion were similar in the 3 groups, whereas African Brazilians had higher Maastricht Ankylosing Spondylitis Enthesitis Scores (p = 0.005) and decreased lateral lumbar flexion (p = 0.003), while whites had a higher occiput-to-wall distance (p = 0.02). African Brazilians reported a worse patient global assessment of disease (p = 0.011). Other index scores and prevalence of work incapacity were similar in the 3 groups, although African Brazilians had worse performance in the Ankylosing Spondylitis Quality of Life questionnaire (p < 0.001).
  
  
  CONCLUSIONS
  Ethnic background is associated with distinct clinical aspects of SpA in Brazilian patients. African Brazilian patients with SpA have a poorer quality of life and report worse disease compared to whites.
authors: Disciplina de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455-3, Andar, Cerqueira César, São Paulo SP, Brasil, CEP 01246-903.
authors: Thelma L
authors: TL
authors: Skare
authors: Adriana B
authors: AB
authors: Bortoluzzo
authors: Célio R
authors: CR
authors: Gonçalves
authors: José Antonio
authors: JA
authors: Braga da Silva
authors: Antonio Carlos
authors: AC
authors: Ximenes
authors: Manoel B
authors: MB
authors: Bértolo
authors: Sandra L E
authors: SL
authors: Ribeiro
authors: Mauro
authors: M
authors: Keiserman
authors: Rita
authors: R
authors: Menin
authors: Sueli
authors: S
authors: Carneiro
authors: Valderílio F
authors: VF
authors: Azevedo
authors: Walber P
authors: WP
authors: Vieira
authors: Elisa N
authors: EN
authors: Albuquerque
authors: Washington A
authors: WA
authors: Bianchi
authors: Rubens
authors: R
authors: Bonfiglioli
authors: Cristiano
authors: C
authors: Campanholo
authors: Hellen M S
authors: HM
authors: Carvalho
authors: Izaias P
authors: IP
authors: Costa
authors: Angela P
authors: AP
authors: Duarte
authors: Maria Bernadete O
authors: MB
authors: Gavi
authors: Charles L
authors: CL
authors: Kohem
authors: Nocy H
authors: NH
authors: Leite
authors: Sonia A L
authors: SA
authors: Lima
authors: Eduardo S
authors: ES
authors: Meirelles
authors: Ivânio A
authors: IA
authors: Pereira
authors: Marcelo M
authors: MM
authors: Pinheiro
authors: Elizandra
authors: E
authors: Polito
authors: Gustavo G
authors: GG
authors: Resende
authors: Francisco Airton C
authors: FA
authors: Rocha
authors: Mittermayer B
authors: MB
authors: Santiago
authors: Maria de Fátima L C
authors: Mde F
authors: Sauma
authors: Percival D
authors: PD
authors: Sampaio-Barros
mesh_terms: D015535:Arthritis, Psoriatic / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology / Q000503:physiopathology; D016918:Arthritis, Reactive / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology / Q000503:physiopathology; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005006:Ethnicity; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D025241:Spondylarthritis / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology / Q000503:physiopathology*; D013167:Spondylitis, Ankylosing / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology / Q000503:physiopathology; D011795:Surveys and Questionnaires