Skip to main content

Advertisement

SpringerLink
Log in

Clinical patterns and characteristics of ankylosing spondylitis in China

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

The study aimed to determine whether unique clinical patterns of AS may exist in China, specifically to explore the different clinical manifestations caused by gender, HLA-B27 status, and age at disease onset. The multicenter cross-sectional survey was conducted and 1251 patients were enrolled across China, representing a broad spectrum of Chinese AS patients. The mean age at onset and diagnosis were 29.2 (11.4) and 33.5 (12.6) years, respectively. The male/female ratio was 2.7:1. Acute anterior uveitis (AAU) was experienced in 10.3% of AS patients and 9.1% patients had juvenile-onset AS (JoAS). Men were significantly younger at onset and diagnosis and showed a higher frequency of HLA-B27 positivity, JoAS, and AAU than women. HLA-B27-positive patients had a younger age of onset than HLA-B27-negative patients. HLA-B27-positive patients were nearly three times as likely to develop AAU than negative patients (P = 0.04). JoAS patients had a family history of AS more often than adult-onset AS (AoAS) patients, and 4.9% of JoAS patients underwent surgical treatments, a rate more than six times that of AoAS patients (P = 0.01). Men had higher levels of C-reactive protein than women, as did HLA-B27 positives compared to negative patients, and JoAS compared to AoAS (all P < 0.05). The clinical patterns of our AS patients were similar to those in other studies in non-Chinese cohort: (1) the age at onset was 29.2 (11.4) years, which was older than found in other studies; (2) men were more likely be HLA-B27 carriers than women; and (3) AAU was less common in Chinese patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Corona-Sanchez EG, Munoz-Valle JF, Gonzalez-Lopez L, Sanchez-Hernandez JD, Vazquez-Del Mercado M, Ontiveros-Mercado H, Huerta M, Trujillo X, Rocha-Munoz AD, Celis A, Ortega-Flores R, Gamez-Nava JI (2012) 383 A/C tumor necrosis factor receptor 1 polymorphism and ankylosing spondylitis in Mexicans: a preliminary study. Rheumatol Int 32(8):2565–2568. doi:10.1007/s00296-011-1997-5

    Article  CAS  PubMed  Google Scholar 

  2. Jimenez-Balderas FJ, Mintz G (1993) Ankylosing spondylitis: clinical course in women and men. J Rheumatol 20(12):2069–2072

    CAS  PubMed  Google Scholar 

  3. Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD, Macfarlane GJ (2014) Global prevalence of ankylosing spondylitis. Rheumatology (Oxford, England) 53(4):650–657. doi:10.1093/rheumatology/ket387

    Article  Google Scholar 

  4. Khan MA, Kushner I, Braun WE (1977) Comparison of clinical features in HLA-B27 positive and negative patients with ankylosing spondylitis. Arthritis Rheum 20(4):909–912

    Article  CAS  PubMed  Google Scholar 

  5. Lee W, Reveille JD, Davis JC Jr, Learch TJ, Ward MM, Weisman MH (2007) Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis 66(5):633–638. doi:10.1136/ard.2006.060293

    Article  PubMed  Google Scholar 

  6. Gran JT, Ostensen M, Husby G (1985) A clinical comparison between males and females with ankylosing spondylitis. J Rheumatol 12(1):126–129

    CAS  PubMed  Google Scholar 

  7. Robertson LP, Davis MJ (2004) A longitudinal study of disease activity and functional status in a hospital cohort of patients with ankylosing spondylitis. Rheumatology (Oxford, England) 43(12):1565–1568. doi:10.1093/rheumatology/keh386

    Article  CAS  Google Scholar 

  8. Ozgocmen S, Ardicoglu O, Kamanli A, Kaya A, Durmus B, Yildirim K, Baysal O, Gur A, Karatay S, Altay Z, Cevik R, Erdal A, Ersoy Y, Sarac AJ, Tekeoglu I, Ugur M, Nas K, Senel K, Ulusoy H (2009) Pattern of disease onset, diagnostic delay, and clinical features in juvenile onset and adult onset ankylosing spondylitis. J Rheumatol 36(12):2830–2833. doi:10.3899/jrheum.090435

    Article  PubMed  Google Scholar 

  9. Geirsson AJ, Eyjolfsdottir H, Bjornsdottir G, Kristjansson K, Gudbjornsson B (2010) Prevalence and clinical characteristics of ankylosing spondylitis in Iceland - a nationwide study. Clin Exp Rheumatol 28(3):333–340

    PubMed  Google Scholar 

  10. Feldtkeller E, Bruckel J, Khan MA (2000) Scientific contributions of ankylosing spondylitis patient advocacy groups. Curr Opin Rheumatol 12(4):239–247

    Article  CAS  PubMed  Google Scholar 

  11. Koko V, Ndrepepa A, Skenderaj S, Ploumis A, Backa T, Tafaj A (2014) An epidemiological study on ankylosing spondylitis in southern Albania. Materia socio-medica 26(1):26–29. doi:10.5455/msm.2014.26.26-29

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aggarwal R, Malaviya AN (2009) Clinical characteristics of patients with ankylosing spondylitis in India. Clin Rheumatol 28(10):1199–1205. doi:10.1007/s10067-009-1227-7

    Article  PubMed  Google Scholar 

  13. Kim TJ, Kim TH (2010) Clinical spectrum of ankylosing spondylitis in Korea. Joint, Bone, Spine : revue du rhumatisme 77(3):235–240. doi:10.1016/j.jbspin.2009.11.015

    Article  Google Scholar 

  14. Baek HJ, Shin KC, Lee YJ, Kang SW, Lee EB, Yoo CD, Song YW (2002) Juvenile onset ankylosing spondylitis (JAS) has less severe spinal disease course than adult onset ankylosing spondylitis (AAS): clinical comparison between JAS and AAS in Korea. J Rheumatol 29(8):1780–1785

    PubMed  Google Scholar 

  15. Yi L, Wang J, Guo X, Espitia MG, Chen E, Assassi S, Jin L, Zou H, Reveille JD, Zhou X (2013) Profiling of hla-B alleles for association studies with ankylosing spondylitis in the chinese population. The Open Rheumatology Journal 7:51–54. doi:10.2174/1874312920130628001

    Article  PubMed  PubMed Central  Google Scholar 

  16. Davidson SI, Wu X, Liu Y, Wei M, Danoy PA, Thomas G, Cai Q, Sun L, Duncan E, Wang N, Yu Q, Xu A, Fu Y, Brown MA, Xu H (2009) Association of ERAP1, but not IL23R, with ankylosing spondylitis in a Han Chinese population. Arthritis Rheum 60(11):3263–3268. doi:10.1002/art.24933

    Article  CAS  PubMed  Google Scholar 

  17. Lin Z, Bei JX, Shen M, Li Q, Liao Z, Zhang Y, Lv Q, Wei Q, Low HQ, Guo YM, Cao S, Yang M, Hu Z, Xu M, Wang X, Wei Y, Li L, Li C, Li T, Huang J, Pan Y, Jin O, Wu Y, Wu J, Guo Z, He P, Hu S, Wu H, Song H, Zhan F, Liu S, Gao G, Liu Z, Li Y, Xiao C, Li J, Ye Z, He W, Liu D, Shen L, Huang A, Wu H, Tao Y, Pan X, Yu B, Tai ES, Zeng YX, Ren EC, Shen Y, Liu J, Gu J (2011) A genome-wide association study in Han Chinese identifies new susceptibility loci for ankylosing spondylitis. Nat Genet 44(1):73–77. doi:10.1038/ng.1005

    Article  PubMed  Google Scholar 

  18. Yang M, Xu M, Pan X, Hu Z, Li Q, Wei Y, Zhang Y, Rong J, Zhai J, He P, Hu S, Song H, Wu H, Zhan F, Liu S, Gao G, Liu Z, Li Y, Shen L, Huang A, Lin Z, Liao Z, Cao S, Wei Q, Li Q, Lv Q, Qi J, Li T, Jin O, Pan Y, Gu J (2013) Epidemiological comparison of clinical manifestations according to HLA-B*27 carrier status of Chinese ankylosing spondylitis patients. Tissue Antigens 82(5):338–343. doi:10.1111/tan.12186

    Article  CAS  PubMed  Google Scholar 

  19. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368

    Article  PubMed  Google Scholar 

  20. Feldtkeller E, Erlendsson J (2008) Definition of disease duration in ankylosing spondylitis. Rheumatol Int 28(7):693–696. doi:10.1007/s00296-007-0499-y

    Article  PubMed  Google Scholar 

  21. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291

    CAS  PubMed  Google Scholar 

  22. Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285

    CAS  PubMed  Google Scholar 

  23. Dincer U, Cakar E, Kiralp MZ, Dursun H (2008) Diagnosis delay in patients with ankylosing spondylitis: possible reasons and proposals for new diagnostic criteria. Clin Rheumatol 27(4):457–462. doi:10.1007/s10067-007-0727-6

    Article  PubMed  Google Scholar 

  24. Brandt HC, Spiller I, Song IH, Vahldiek JL, Rudwaleit M, Sieper J (2007) Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritis. Ann Rheum Dis 66(11):1479–1484. doi:10.1136/ard.2006.068734

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sorensen J, Hetland ML (2015) Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis 74(3):e12. doi:10.1136/annrheumdis-2013-204867

    Article  PubMed  Google Scholar 

  26. Feldtkeller E, Rudwaleit M (2014) Comment on 'Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry'. Ann Rheum Dis 73(12):e77. doi:10.1136/annrheumdis-2014-206126

    Article  PubMed  Google Scholar 

  27. Hajialilo M, Ghorbanihaghjo A, Khabbazi A, Kolahi S, Rashtchizadeh N (2014) Ankylosing spondylitis in iran; late diagnosis and its causes. Iranian Red Crescent Medical Journal 16(4):e11798. doi:10.5812/ircmj.11798

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rodriguez-Polanco E, Al Snih S, Kuo YF, Millan A, Rodriguez MA (2011) Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid arthritis. Rheumatol Int 31(5):657–665. doi:10.1007/s00296-009-1358-9

    Article  PubMed  Google Scholar 

  29. Stone M, Warren RW, Bruckel J, Cooper D, Cortinovis D, Inman RD (2005) Juvenile-onset ankylosing spondylitis is associated with worse functional outcomes than adult-onset ankylosing spondylitis. Arthritis Rheum 53(3):445–451. doi:10.1002/art.21174

    Article  PubMed  Google Scholar 

  30. Will R, Edmunds L, Elswood J, Calin A (1990) Is there sexual inequality in ankylosing spondylitis? A study of 498 women and 1202 men. J Rheumatol 17(12):1649–1652

    CAS  PubMed  Google Scholar 

  31. Roussou E, Sultana S (2011) Spondyloarthritis in women: differences in disease onset, clinical presentation, and Bath Ankylosing Spondylitis Disease Activity and Functional indices (BASDAI and BASFI) between men and women with spondyloarthritides. Clin Rheumatol 30(1):121–127. doi:10.1007/s10067-010-1581-5

    Article  PubMed  Google Scholar 

  32. Doran MF, Brophy S, Mac Kay K, Taylor G, Calin A (2003) Predictors of longterm outcome in ankylosing spondylitis. J Rheumatol 30(2):316–320

    PubMed  Google Scholar 

  33. de Vries MK, van Eijk IC, van der Horst-Bruinsma IE, Peters MJ, Nurmohamed MT, Dijkmans BA, Hazenberg BP, Wolbink GJ (2009) Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Arthritis Rheum 61(11):1484–1490. doi:10.1002/art.24838

    Article  PubMed  Google Scholar 

  34. Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Marker-Hermann E, Zeidler H, Braun J, Sieper J (2011) Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 70(8):1369–1374. doi:10.1136/ard.2010.145995

    Article  PubMed  Google Scholar 

  35. Cansu DU, Calisir C, Savas Yavas U, Kasifoglu T, Korkmaz C (2011) Predictors of radiographic severity and functional disability in Turkish patients with ankylosing spondylitis. Clin Rheumatol 30(4):557–562. doi:10.1007/s10067-010-1665-2

    Article  PubMed  Google Scholar 

  36. Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23(2):61–66. doi:10.1007/s00296-002-0237-4

    PubMed  Google Scholar 

  37. Brewerton DA, Caffrey M, Nicholls A, Walters D, James DC (1973) Acute anterior uveitis and HL-A 27. Lancet (London, England) 302(7836):994–996

    Article  CAS  Google Scholar 

  38. Rosenbaum JT, Rosenzweig HL (2012) Spondyloarthritis: the eyes have it: uveitis in patients with spondyloarthritis. Nat Rev Rheumatol 8(5):249–250. doi:10.1038/nrrheum.2012.43

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wildner G, Diedrichs-Mohring M, Thurau SR (2002) Induction of arthritis and uveitis in Lewis rats by antigenic mimicry of peptides from HLA-B27 and cytokeratin. Eur J Immunol 32(1):299–306. doi:10.1002/1521-4141(200201)32:1&#60;299::aid-immu299&#62;3.0.co;2-q

    Article  CAS  PubMed  Google Scholar 

  40. Lin YC, Liang TH, Chen WS, Lin HY (2009) Differences between juvenile-onset ankylosing spondylitis and adult-onset ankylosing spondylitis. Journal of the Chinese Medical Association : JCMA 72(11):573–580. doi:10.1016/s1726-4901(09)70432-0

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by research grants from the National Basic Research Program (2014CB541801), National Natural Science Foundation of China (31521003), US NIH NIAID U01 (1U01AI090909), International S&T Cooperation Program of China (2013DFA30870), and 111 Project (B13016). Computational support was provided by the High-End Computing Center located at Fudan University.

Author information

Author notes

  1. Qiaoxia Qian, Xia Xu, Hongjun He, and Hengdong Ji both authors contributed equally to this work

Authors and Affiliations

  1. State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China

    Qiaoxia Qian, Hui Zhang, Yue Ding, Yuan Li, Yanyun Ma, Jingru Zhou, Li Jin & Jiucun Wang

  2. Division of Rheumatology and Immunology, Changhai Hospital, Shanghai, China

    Xia Xu, Qiang Tong & Dongbao Zhao

  3. Division of Rheumatology, Taixing People’s Hospital, Taizhou, Jiangsu Province, China

    Hongjun He

  4. Division of Rheumatology, Taizhou People’s Hospital, Taizhou, Jiangsu Province, China

    Hengdong Ji

  5. Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Sheng-Ming Dai

  6. Division of Rheumatology and Immunology, Wuxi People’s Hospital, Wuxi, Jiangsu Province, China

    Yaohong Zou

  7. Institute of Arthritis Research, Shanghai Academy of Chinese Medical Sciences, Guanghua Integrative Medicine Hospital, Shanghai, China

    Qi Zhu & Dongyi He

  8. Division of Rheumatology, Ruijin Hospital, Shanghai Jiaotong University Schools of Medicine, Shanghai, China

    Chengde Yang

  9. Division of Rheumatology, Renji Hospital, Shanghai Jiaotong University Schools of Medicine, Shanghai, China

    Shuang Ye

  10. Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China

    Lindi Jiang

  11. Division of Rheumatology and Immunology, Tongji Hospital of Tongji University School of Medicine, Shanghai, China

    Jian-Ping Tang

  12. Fudan-Taizhou Institute of Health Sciences, Taizhou, Jiangsu Province, China

    Ziyu Yuan, Juan Zhang, Li Jin & Jiucun Wang

  13. University of Texas-McGovern Medical School, Houston, TX, USA

    Xiaodong Zhou & John D. Reveille

  14. Division of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China

    Hejian Zou

  15. Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China

    Hejian Zou & Jiucun Wang

Authors
  1. Qiaoxia Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xia Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hongjun He
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hengdong Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yue Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sheng-Ming Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yaohong Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Qi Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chengde Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shuang Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lindi Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jian-Ping Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Qiang Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Dongyi He
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Dongbao Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Yuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Yanyun Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Jingru Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Ziyu Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Juan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Li Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Xiaodong Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. John D. Reveille
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Hejian Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Jiucun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Hejian Zou or Jiucun Wang.

Ethics declarations

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qian, Q., Xu, X., He, H. et al. Clinical patterns and characteristics of ankylosing spondylitis in China. Clin Rheumatol 36, 1561–1568 (2017). https://doi.org/10.1007/s10067-017-3660-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-017-3660-3

Keywords

Search

Navigation