OP0244 Family matters: value of family history of spondyloarthritis in the diagnostic work-up of patients with chronic back pain: results from the space and desir cohorts. (15th June 2017)

• Record Type: Journal Article
• Authors: Ez-Zaitouni, Z; Hilkens, A; Gossec, L; Berg, IJ; Landewé, R; Ramonda, R; Dougados, M; Heijde, D van der; Gaalen, F van
• Is Part Of: Annals of the rheumatic diseases. Volume 76(2017)Supplement 2
• Page Start: 156
• Page End: 157
• Publication Date: 2017-06-15
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2017-eular.4671
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: A positive family history (PFH) of spondyloarthritis (SpA) is considered a risk indicator for the presence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP). In the ASAS classification criteria, a PFH of SpA is defined as the presence of any of the following diseases in first- or second-degree relatives: ankylosing spondylitis (AS), acute anterior uveitis (AAU), reactive arthritis (ReA), inflammatory bowel disease (IBD), and psoriasis. It is however not known if a PFH for each of these diseases contributes equally well to making a diagnosis of axSpA in patients presenting with CBP. Objectives: To assess which SpA diseases in family members are associated with HLA-B27 and axSpA in patients with CBP. Methods: The SPACE cohort includes patients with CBP (≥3 months, ≤2 years, onset <45 years) from various European rheumatology centers. DESIR is a French prospective multicenter cohort of patients with inflammatory back pain (IBP; ≥3 months, <3 years, onset <50 years), suggestive of axSpA. Patients underwent a full diagnostic work-up at baseline including MRI and radiographs of sacroiliac joints (local reading), laboratory assessments (e.g. HLA-B27), and assessment of all other SpA features. Patients were asked about the presence of SpA diseases in first- or second-degree relatives (AS, AAU, ReA, IBD, and psoriasis). The associations between a PFH and HLA-B27, sacroiliitis, axSpA diagnosis by the rheumatologist, and fulfilment of the ASAS classification criteria in CBP patients were assessed. Results: In 438 patients from the SPACE cohort and 647 patients from the DESIR cohort, a PFH of AS (odds ratio (OR) 5.9 (3.5–9.9) and OR 3.3 (2.1–5.2), respectively for SPACE and DESIR) and a PFH of AAU (OR 9.8 (3.3–28.9) and OR 21.6 (2.9–160.1)) were significantly associated with presence of HLA-B27 (Table 1 ).Furthermore, in both cohorts a PFH of AS and a PFH of AAU were positively associated with fulfilment of the ASAS-criteria, but not with sacroiliitis on imaging (data not shown). In SPACE, but not in DESIR, a PFH of AS or AAU was associated with axSpA diagnosis (data not shown). In both cohorts, a PFH of ReA, IBD, or psoriasis was not positively associated with HLA-B27 positivity, sacroiliitis on imaging, axSpA diagnosis or meeting the ASAS criteria for axSpA. Conclusions: In two recent CBP cohorts, a PFH of ReA, IBD, or psoriasis did not contribute to identifying axSpA in CBP patients indicating these family elements may not be very useful for diagnosis. A PFH of AS or AAU however may be useful in finding cases in low prevalence settings as these were correlated with HLA-B27 carriership. Disclosure of Interest: None declared