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Axial spondyloarthritis in Asia

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  • 1. Axial Spondyloarthritis Epidemiology in South East Asia and Patient Journey James Cheng-Chung WEI, MD, PhD Chief, Division of Allergy, Immunology and Rheumatology Director, Chinese Medicine Clinical Trial Center Associate Professor, Chung Shan Medical University
  • 2. Outline  Concept of SpA • and non-radiographic axial spondyloarthritis (nr-axSpA) Epidemiology of SpA in South East Asia  Patient journey  Take home message 
  • 3. Spectrum of Spondyloarthritis. (seronenative spondyloarthropathies) AS, ankylosing spondylitis; PsA, psoriatic arthritis; ReA, reactive arthritis; IBD, inflammatory bowel diseases-associated arthritis; USpA, undifferentiated spondyloarthritis. JC Wei. Chronic Inflammation: Causes, Treatment Options and Role in Disease. Nova Science Publishers, Inc. 2013
  • 4. MNY, 1984 ASAS, 2009 ASAS, 2011
  • 5. Non-radiographic axial spondyloarthritis (nr-axSpA)     Fit axial SpA (ASAS classification criteria for axSpA, Rudwaleit et al 2009)), but not radiographic criteria of AS (Modified New York criteria, Calin et al 1984). Usually early or mild or atypical cases Some of them might develop AS and have similar health burden. New disease entity • Adalimumab in nx-axSpA: approved by EMEA, but not FDA • Certolizumab Pegol in axSpA approved by EMEA & FDA
  • 6. Outline  Concept of SpA • and non-radiographic axial spondyloarthritis (nr-axSpA) Epidemiology of SpA in South East Asia  Patient journey  Take home message 
  • 7. Epidemiological survey in China N=10 921 , aged >16 years; of these,  7.21% had LBP  0.78% axial SpA(12% in subjects with LBP)  0.25% ankylosing spondylitis (AS)  0.50% undifferentiated axial SpA (USpA)  0.02% psoriatic arthritis (PsA)  Of the axial SpA patients, 82.67% were HLA-B27 positive, clearly a greater percentage than those (11.65%) in other LBP groups. Liao, Gu. Scand J Rheumatol. 2009 Nov-Dec;38(6):455-9.
  • 8. AS in Taiwan        Population: 23 million 5% were HLA-B27 positive 92% HLA-B27 positive AS prevalence: 0.2-0.4 % Sex ratio (M:F) was 2.8 : 1 Delay diagnosis 5.9 years 42.6% have family history of SpA JC Wei, PhD thesis, 2007, Clinical Rheumatology (2007) 26:1685–1691
  • 9. Extra-articular manifestations of AS in Taiwan, n=805 Variables Patient (%) History of uveitis, no. (%) History of psoriasis, no. (%) History of hematuria no. (%) History of oral ulcer, no. (%) Onset symptom, no. (peripheral arthritis / IBD / uveitis) (%) 24.1 13.9 6.8 11.6 21.5/2.9/2.5 JC Wei. Clinical Rheumatology (2007) 26:1685–1691
  • 10. Outline  Concept of SpA • and non-radiographic axial spondyloarthritis (nr-axSpA) Epidemiology of SpA in South East Asia  Patient journey  Take home message 
  • 11. Progression of Non-radiographic Axial SpA to AS: Data from GESPIC* Non-radiographic axial SpA Ankylosing spondylitis 12% in 2 years Main predictor: elevated CRP** no definite radiographic sacroiliitis (grade 0 at the right side, grade 1 – possible subchondral sclerosis – at the left side) definite radiographic sacroiliitis (grade 2 bilaterally) fulfilling the radiographic criterion of the modified New York criteria *GESPIC = GErman Spondyloarthritis Inception Cohort **Odds ratio for progression in patients with elevated serum C-reactive protein level (>6 mg/l) was: 4.11 (95% CI 1.13-14.95). Poddubnyy D et al. Ann Rheum Dis 2011;70:1369-74
  • 12. How to identify SpA pts? LBP Low back pain IBP Dx by general physicians IBP Referral Inflammatory back pain SpA Dx by rheumatologists SpA Spondyloarthritis
  • 13. Unmet Needs of SpA in Asia Unmet needs Actions to do 1. Educate GP and rheumatologist about new concepts of SpA 2. When to see a rheumatologist, ie. Refer strategy for GP and Pt 3. When and how to test X-ray, HLA-B27, MRI Inadequate treatment 1. Educate Pt and GP 2. Accessibility and cost of TNFi 3. Safety, esp TB and HepB Delayed diagnosis
  • 14. Take Home Message 1. 2. 3. 4. 5. 6. SpA affect 1% of population with variable features. SpA cause severe health burden due to delay diagnosis and inadequate treatment in Asia. Need practical referral strategy to identify patients. ASAS criteria for IBP and axSpA is useful for clinical studies and daily practice Diagnose nr-axSpA by HLA-B27 and/or MRI. Accessibility of TNFi and safety, esp TB and HepB are major concerns in SEA.