Baas, W. (Wineke) (2017) HiSpA-2: De prevalentie van zelf-gerapporteerde klinische kenmerken van spondylartritis (SpA) in patiënten met Hidradenitis Suppurativa (HS). thesis, Medicine.
Full text available on request.Abstract
Objective: The main objective of this study was to determine the self-reported prevalence of clinical SpA manifestations in patients with hidradenitis suppurativa (HS), a chronic inflammatory and recurrent skin disease. Our second goal was to investigate the consultation of a rheumatologist and the disease diagnosed by the rheumatologist. Materials: All patients diagnosed with HS between January 2010 until 4 January 2017 of the outpatient clinic of the dermatology department received a self-reporting questionnaire containing questions about demographics, the present and the past state of HS severity and the presence of SpA manifestations according to the classification criteria of the ASsessment in Ankylosing Spondylitis (ASAS) working group. In order to distinguish between axial and peripheral SpA the presence of entry criteria has to be evaluated. SpA manifestations assessed, include: presence of inflammatory back pain according to the Calin criteria, and reaction on NSAID’s, presence of peripheral SpA manifestations: arthritis, enthesitis of the heel and dactylitis. The presence of extra-articular SpA manifestations: the presence of inflammatory bowel disease, psoriasis and uveitis. A positive family history for SpA related disease has also been assessed. Results: 360 questionnaires (55%) of 654 were returned and analyzed. Axial SpA:182 of 360 (51,0%) HS patients reported the entry criterion for axial SpA: chronic low back pain for three months or longer, starting before the age of 45. 75 patients reported back pain only. 107 patients (30%) also reported peripheral SpA manifestations, including arthritis (n=90) and/or an enthesitis of the heel (n=21) and/or a dactylitis (n=32). Of the 182 patients with chronic low back pain, 39 (23.5%) had inflammatory back pain, of which 11 (28.9%) responded well to NSAIDs. Of 182 patients 11 patients (6.1%) reported Crohn's disease, four (2.2%) ulcerative colitis, 18 (9.9%) psoriasis and eight (4.5%) uveitis. A family history for SpA related diseases was reported in 68 patients (39.8%). Peripheral SpA: 64 patients (17.9%) reported only peripheral manifestations, including arthritis (n = 57 (67.0%)) and /or enthesitis of the heel (n = 12 (14.2%)) and /or dactylitis 16 (18.8%)). Two (3.2%) patients reported Crohn's disease, three (4.8%) ulcerative colitis, three (4.8%) psoriasis and none uveitis. 21 patients (35%) reported a positive family history for SpA related diseases in a first or second degree relative. No entry criterion: In 111 patients, no entry criterion was present. In three patients, data was lacking to divide patients in either the group for the classification of peripheral SpA or the group of having no entry criterion. Rheumatologist: Of all HS 360 patients included, 260 (72.2%) had one or more SpA manifestation. Of these 260 patients, 74 patients (28.5%) consulted a rheumatologist. In 13 patients (18.6%) a SpA related disease was diagnosed. 57 (81.4%) had a non-SpA related disease, of which 26 patients had a diagnosis tendomyogenic disease, like fibromyalgia. Conclusion: Entry criteria for axial and peripheral SpA were investigated in this study. More than half of the patients experienced chronic back pain before the age of 45, of which almost a quarter reported inflammatory back pain. The prevalence of self-reported SpA manifestations varied and were present in more than half of the patients. Of all included HS patients with SpA manifestations, only a small part had consulted a rheumatologist. Because of the high prevalences mentioned before, dermatologists should be aware of possible SpA in HS patients. On top of that, early referral to a rheumatologist of patients suspected for SpA is desirable because adequate treatment with TNF-α inhibitors is available. An externally validated referral rule developed for general practitioners can be used as a tool in dermatology for referral of HS patients. The questionnaire developed for this research can be used as a guide, but validation of the questionnaire is necessary before implementation in daily practice is possible.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Horváth, Dr. B. and (Dermatologie) and Dagelijkse begeleider: and Rondags, Drs. A. L.V. and (Dermatologie) |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1715 |
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