title: Human brucellosis mimicking axial spondyloarthritis: a challenge for rheumatologists when applying the 2009 ASAS criteria.
abstract: Although the development of the 2009 SpA classification criteria by Assessment of SpondyloArthritis international Society (ASAS) represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis (axSpA), the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including SpA. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having axSpA in central China. The results showed that clinical manifestations of axSpA could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from axSpA according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Ye
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Gui-Fen
authors.initials: GF
authors.lastname: Shen
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Shou-Xin
authors.initials: SX
authors.lastname: Li
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Ling-Li
authors.initials: LL
authors.lastname: Dong
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Yi-Kai
authors.initials: YK
authors.lastname: Yu
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Tu
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Ying-Zi
authors.initials: YZ
authors.lastname: Zhu
authors.affiliation: Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. sxianhu@139.com.
authors.forename: Shao-Xian
authors.initials: SX
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001416:Back Pain / Q000503:physiopathology; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002681:China; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D000072140:Rheumatologists / Q000941:ethics*; D058566:Sacroiliitis / Q000503:physiopathology; D025241:Spondylarthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D018501:Antirheumatic Agents; D000068800:Etanercept
keywords: ASAS classification criteria; Assessment of SpondyloArthritis international Society; axial spondyloarthritis; human brucellosis