THU0269 Development of ankylosing spondylitis in patients with reactive arthritis and peripheral spondyloarthropathy: hospital based study in north india
Authors: R. Misra, S. Ahmed, A. Chaudhury, A. Lawrence, V. Agarwal, A. Aggarwal
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Reactive arthritis (ReA) is a seronegative spondyloarthropathy (SpA) that is precipitated by urogenital or gastrointestinal infection. Undifferentiated Peripheral spondyloarthropathy (UpSpA) may be indistinguishable from ReA except known preceding infection. It is stated that two-thirds of ReA resolve within three months while a third develop chronic or recurrent course. However, there is a paucity of data on the long-term outcome. Thus, it is difficult to justify treatment decisions like the use of biologicals in ReA <h3>Objectives</h3> To determine the outcome of ReA/upSpA patients attending a referal rheumatology centre in North India. <h3>Methods</h3> ReA was classifed as per Braun's criteria, while UpSpA were included as meeting ASAS criteria but not criteria for psoriatic arthrtis or inflammatory bowel disease associated arthritis. Data on this retrospective cohort was updated with telephonic interviews. Follow-up of less than 1 year were excluded. Patients with persistent inflammatory back pain (IBP) were reviewed in the clinic. Radiographs assessed progression to AS (modified New York criteria). <h3>Results</h3> Follow-up data on 85 patients (63 ReA; 22 pSpA) was obtained. Median (IQR) age at presentation was 24.5 (20–33) years. 14 (16.5%) were female. At presentation, 23 (30%) had monoarthritis, 44 (57%) had oligoarthritis, 10 (13%) had polyarthritis (data missing for eight). Enthesitis and dactylitis were documented in 20 and 5 respectively. Keratoderma and balanitis were seen in one each. 40 (80%) out of 50 were positive for HLA-B27. Median (IQR) follow-up was 2 (1–5.25) years. 22 had monophasic illness of which 13 had acute arthritis (&lt;12 weeks). Seven had two episodes, 27 had polycyclic course while 29 had persistent arthritis. 26 had inflammatory back pain (IBP) at any time and eight had persistent symptoms. Out of these, three (3.5%) met criteria for AS (disease duration: 1, 3 and 10 years) while two had unilateral grade 2 sacroiliitis. Three patients without IBP also had sacroiliitis on radiographs. Logistic regression revealed no significant parameter that could predict progression to AS <h3>Conclusions</h3> In contrast to general opinion that two thirds attend remission, this study showed that one third undergo drug free remisson. Of the remaining, half deveop recurrent and half persistent arthritis. 3.5% progressed to AS. As duration of follow-up increases, a greater proportion may progress to AS. <h3>References</h3> [1] Brinster A, Guillot X, et al. Evolution over thirty years of the profile of inpatients with reactive arthritis in a tertiary rheumatology unit. Reumatol. Clin2016. [2] Leirisalo-Repo M, et al. Long-term prognosis of reactive salmonella arthritis. Ann. Rheum. Dis1997;56,516–520. [3] Kaarela K, et al. Similarity between chronic reactive arthritis and ankylosing spondylitis.A 32–35-year follow-up study. Clin. Exp. Rheumatol2009;27:325–328. <h3>Disclosure of Interest</h3> None declared