Regional Trends and Patterns of Axial Spondyloarthritis in Latin America: A Study From the ESPALDA Registry (2019-2024).
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Mesa-Pedraza Cristian, García-Salinas Rodrigo, Sommerfleck Fernando, Bautista-Molano Wilson, Guaracha Basañez Guillermo Arturo, Casasola Vargas Julio César, Fernández-Ávila Daniel, Vila Diego, Brance María Lorena, Báez Jossiell Then, Miranda Francisco Zevallos, Oviedo Lysseth Macías, Peralta Marilú Mestanza, Sánchez Cantos Daisy Yelena, Chinchay Lyn, Melgarejo Patricia, Castillo Ortiz Ángel Alejandro, Gómez Gimena, Ferreyra Garrot Leandro Grabiel, Candia Zúñiga Dora Liliana, Medina Gustavo, Egüez Del Pozo María Fernanda, Prado Einer Sánchez, Palleiro Daniel, Londoño John
Аннотация
METHODS: This cross-sectional study included 418 patients diagnosed with axSpA who fulfilled the Assessment of SpondyloArthritis international Society classification criteria. Participants were recruited from 3 Latin American regions: northern (Mexico), Andean (Colombia, Ecuador, Peru, Venezuela), and southern (Argentina, Chile, Paraguay, Uruguay). Collected data included demographic characteristics, HLA-B27 status, extraarticular manifestations, disease activity, radiographic damage, and treatments.
RESULTS: The northern region showed the highest prevalence of HLA-B27 (81%) and uveitis (36.3%), along with lower frequencies of peripheral involvement and fewer patients with magnetic resonance imaging-defined sacroiliitis (7.3%; all P ≤ 0.003). In contrast, the southern region reported a later onset of inflammatory back pain (median 39 vs 22 years; P = 0.01), higher Bath Ankylosing Spondylitis Functional Index scores (median 4.6 vs 3.3, P = 0.005), and a lower response to nonsteroidal antiinflammatory drugs (59.8% vs 79%; P = 0.001). Use of biologic disease-modifying antirheumatic drugs was lowest in the northern region (34.7%) compared with the Andean (57.9%) and southern (53.8%) regions (P ≤ 0.002 for northern vs other regions). The median diagnostic delay was 40.9 (IQR 12.0-121.1) months, with no significant regional differences.
CONCLUSION: Two clinical phenotypes of axSpA appear to exist in Latin America: a predominantly axial, HLA-B27-positive phenotype in the northern region, and a second phenotype in the Andean and southern regions characterized by greater peripheral involvement and, in the southern region, later symptom onset and worse functional status.