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      The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations: a nationwide register study

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          Abstract

          Introduction

          Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment.

          Methods

          All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers.

          Results

          A total of 11,030 cases with an ankylosing spondylitis diagnosis (alive, living in Sweden, and 16 to 64 years old in December 2009) were identified in the National Patient Register, giving a point prevalence of 0.18% in 2009. The prevalence was higher in northern Sweden, and lower in those with a higher level of education. Men had a higher prevalence of ankylosing spondylitis (0.23% versus 0.14%, P < 0.001), a higher frequency of anterior uveitis (25.5% versus 20.0%, P < 0.001) and were more likely to receive tumor necrosis factor inhibitors than women (15.6% versus 11.8% in 2009, P < 0.001). Women were more likely than men to have peripheral arthritis (21.7% versus 15.3%, P < 0.001), psoriasis (8.0% versus 6.9%, P = 0.03), and treatment with oral corticosteroids (14.0% versus 10.4% in 2009, P < 0.001).

          Conclusion

          This nationwide, register-based study demonstrated a prevalence of clinically diagnosed ankylosing spondylitis of 0.18%. It revealed phenotypical and treatment differences between the sexes, as well as geographical and socio-economic differences in disease prevalence.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13075-015-0627-0) contains supplementary material, which is available to authorized users.

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          Most cited references21

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          Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors.

          J. Braun, M Bollow, G Remlinger … (1998)
          To determine the overall prevalence of spondylarthropathy (SpA) among whites. To screen for SpA symptoms, such as inflammatory back pain (IBP), joint swelling, psoriasis, and uveitis, or a specific family history, questionnaires were mailed to 348 blood donors (174 HLA-B27 positive and 174 HLA-B27 negative). From the responding 273 persons (78%; 140 B27 positive, 133 B27 negative), 126 were selected for further evaluation based on the symptoms reported. Of this group, 90 persons agreed to undergo physical examination (71.4%; 46 B27 positive, 44 B27 negative). There was no difference between the B27-positive and -negative groups in terms of age (mean +/- SD 38.4 +/- 10 versus 39.5 +/- 11 years) and sex ratio (67% versus 68% were men). In addition, 58 donors (32 B27 positive, 26 B27 negative) agreed to undergo magnetic resonance imaging (MRI) of the sacroiliac joints. A diagnosis of SpA and ankylosing spondylitis (AS) was made according to the European Spondylarthropathy Study Group criteria and the New York criteria. SpA was diagnosed in 20 persons: 19 of 140 B27-positive (13.6%) and 1 of 133 B27-negative (0.7%) subjects (15 male and 5 female). AS was diagnosed in 9 persons (7 male and 2 female; 45%), undifferentiated SpA (USpA) in 7 (5 male and 2 female; 35%), psoriatic arthritis (PsA) in 3 (2 male and 1 female; 15%), and chronic reactive arthritis (ReA; Reiter's syndrome) in 1 (male; 5%). On the basis of a B27 frequency of 9.3% among the population of Berlin (3.47 million persons), the estimated prevalence of SpA was 1.9%, AS was 0.86%, USpA was 0.67%, and PsA was 0.29%. The relative risk of developing SpA in B27-positive subjects was calculated as 20.7 (95% confidence interval 4.6-94.2; P = 0.001). Of 58 persons with IBP, sacroiliitis was detected by MRI in 15 of 32 B27-positive (46.9%) and 1 of 26 B27-negative (3.9%) subjects (P = 0.002). Four of these 16 donors did not fulfill diagnostic criteria for SpA. With a calculated prevalence of 1.9%, spondylarthropathies are among the most frequent rheumatic diseases in the white population. HLA-B27 positive persons carry a 20-fold increased risk of developing SpA. AS and USpA are the most frequent SpA subtypes. Persons with IBP who are B27 positive have a 50% likelihood of having sacroiliitis.
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            Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden.

            , Martin Neovius, Johan Askling … (2011)
            To provide Swedish nationwide data on the prevalence of rheumatoid arthritis (RA), including variations by age, sex, geography, demography and education level, and assess antirheumatic treatment penetration. Patients ≥16 years assigned an RA diagnosis were identified from inpatient (n=96 560; 1964-2007) and specialist outpatient care (n=56 336; 2001-2007) in the Swedish National Patient Register, and the Swedish Rheumatology Quality Register (n=21 242; 1995-2007). Data on prescriptions, demography, vital status and educational level were retrieved from national registers. A total of 58 102 individuals (mean age 66 years; 73% women) assigned an RA diagnosis were alive in Sweden in 2008, corresponding to a cumulative prevalence of 0.77% (women 1.11%, men 0.43%). The 2001-2007 period prevalence was 0.70%. Restriction to patients with ≥2 visits or diagnosis from a rheumatologist/internist reduced the overall cumulative prevalence to 0.68%. Whereas urban/rural differences (crude 0.65-1.00%) were explained by age differences, the age/sex-adjusted prevalence remained higher in patients with ≤9 years education (0.86%) than for those with 10-12 years (0.82%) and >12 years (0.65%). Treatment exposures (76% any disease-modifying antirheumatic drugs (DMARDs) or steroids, 64% any DMARD, 15% biological agents) varied with age; use of biological agents decreased from 22% in 16-59 years olds to 3% in ≥80 years olds. Any DMARD use correspondingly decreased from 71% to 43%. Applying age cut-off points from previous northern European and North American prevalence studies reduced or eliminated between-study differences. This nationwide approach yielded a prevalence of RA similar to previous regional assessments. While displaying only modest geographical variation and no urban/rural gradient, prevalence was associated with educational level. Although most patients received antirheumatic drugs, age was a strong treatment determinant.
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              Prevalence of rheumatic diseases and disability in China.

              Qiang-sheng Dai, Yao Xiang (2009)
              The objective of this study was to provide a single source for the best available estimates of the national prevalence of common rheumatic disorders and rheumatic disability by reviewing the epidemiological surveys conducted in China. Relevant publications were retrieved by search engines in both the English and the Chinese language web sites. Only community-based surveys conducted in China were included. A pooled prevalence with 95% confidence interval was calculated. Forty-one surveys met the inclusion criteria. Prevalence of rheumatic pain varied from 11.6 to 46.4%, with significantly higher rate in northern China in comparison to the southern part. Prevalence of rheumatic disability, however, did not increase with higher latitude. Limitation to daily life and work was 1-2 and 3-6%, of general population, respectively. The pooled prevalence of rheumatoid arthritis, ankylosing spondylitis, and undifferentiated spondylarthropathy is 0.37, 0.22 and 0.57%, respectively. The estimated prevalence is 37.7/100,000 for systemic lupus erythematosus, and 0.45% for primary Sjögren's syndrome. In the past decade, prevalence of gout and hyperuricemia was 0.22-0.43 and 12.1-25.2%, respectively. In elderly Chinese age >or=60, prevalence of symptomatic cervical OA, lumbar OA, knee OA and hand OA was 14.5, 24.0, 19.4, and 5.0%, respectively. Symptomatic hip OA was rare. Rheumatoid arthritis and gout are less frequent in Chinese than in Caucasians. The prevalence of ankylosing spondylitis, systemic lupus erythematosus and primary Sjögren's syndrome is comparable to that in Caucasians. In comparison to the whites, the Chinese population has a higher prevalence of knee OA, a lower prevalence of hand OA, and a much lower prevalence of hip OA.
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                Author and article information

                Contributors
                Sofia Exarchou: sofiaexar@hotmail.com
                Ulf Lindström: ulf.lindstrom@vgregion.se
                Johan Askling: Johan.Askling@ki.se
                Jonas K Eriksson: jonas.eriksson@ki.se
                Helena Forsblad-d’Elia: helena.forsblad@rheuma.gu.se
                Martin Neovius: Martin.Neovius@ki.se
                Carl Turesson: carl.turesson@med.lu.se
                Lars Erik Kristensen: larserik_kristensen@yahoo.com
                Lennart TH Jacobsson: lennart.jacobsson@gu.se
                Journal
                Journal ID (nlm-ta): Arthritis Res Ther
                Title: Arthritis Research & Therapy
                Publisher: BioMed Central (London )
                ISSN (Print): 1478-6354
                ISSN (Electronic): 1478-6362
                Publication date (Electronic): 9 May 2015
                Publication date PMC-release: 9 May 2015
                Publication date (Print): 2015
                Volume: 17
                Issue: 1
                Electronic Location Identifier: 118
                Affiliations
                [ ]Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga Marie Nilssons gata 32, 205 02 Malmö, Sweden
                [ ]Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
                [ ]Clinical Epidemiology Unit & Rheumatology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
                [ ]Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
                [ ]The Parker Institute, Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, the Capital Region of Copenhagen, Copenhagen, Denmark
                Article
                Publisher ID: 627
                DOI: 10.1186/s13075-015-0627-0
                PMC ID: 4424886
                SO-VID: 760a826a-7240-4bd2-b5ff-1e1afafae637
                Copyright © © Exarchou et al.; licensee BioMed Central. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 22 December 2014
                Date accepted : 16 April 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Orthopedics
                Data availability:
                ScienceOpen disciplines: Orthopedics

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