Spondyloarthropathy in the community: Clinical syndromes and disease manifestations in Alaskan Eskimo populations

Objective. To define the clinical spectrum and disease manifestations of sp ondyloarthropathy (SpA) as seen in a community, rather than a referral sett ing. Methods. Eighty percent (83/104) of all individuals identified as having Sp A in a community wide epidemiologic study of Alaskan Eskimos and 83 age and sex matched controls from the same regions participated in a 5 year clinic al study. The study included baseline and followup interviews, physical, ra diographic, and electrocardiographic examinations, record reviews, and func tional assessment. The medical records of an additional 83 age and sex matc hed controls were reviewed and followed over the same 5 year period. Results. The spectrum of disease varied from very mild undifferentiated SpA (USpA) to incapacitating ankylosing spondylitis (AS). Most cases were mild . Overlapping clinical features were common in the different syndromes; 10% of the cases met more than 1 set of disease criteria. Axial signs and symp toms were more frequent in patients with AS, but occurred in over half of t he patients with USpA and reactive arthritis (ReA) also. Peripheral joint i nvolvement was noted in 85% of the AS cases, usually early in the course of disease. The patterns of joint involvement and enthesopathy were similar i n SpA subjects with different syndromes and significantly different from th ose in control subjects, Patients with AS had a higher frequency of uveitis and of aortic root disease than patients with other syndromes. Conclusion. The results illustrate the extent of shared clinical features i n the different SpA syndromes, and describe the frequency of different feat ures associated with SpA in patients and matched controls in a community se tting. ReA and USpA were more prevalent and less severe than AS in these po pulations.