Clinical Characteristics and Treatment Outcomes of Early Axial Spondyloarthritis Patients in India: A Multicentric Prospective Observational Study

Background: This multicentre prospective observational study assessed the clinical characteristics, treatment modalities and short-term outcomes of patients diagnosed with early axial spondyloarthritis (axSpA) in India. Methods: Fourteen rheumatology outpatient clinics in India enrolled patients aged ≥18 years with axial symptoms of <2 years who met the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axSpA. Disease activity indices (Ankylosing Spondylitis Disease Activity Score [ASDAS] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), functional index (Bath Ankylosing Spondylitis Functional Index [BASFI]), non-steroidal anti-inflammatory drug (NSAID) intake scores, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were assessed at baseline, 3 months and 6 months. Correlation analysis was conducted between the study results and comparable international early axSpA inception cohorts. Results: A total of 155 patients (81% men, mean age 28 years) were included in the study. Eighty-five percent of patients were human leukocyte antigen B27 (HLA-B27) positive. Peripheral arthritis (31%), enthesitis (32%) and uveitis (14%) were common. At baseline, the mean (standard deviation ( SD ), 95% confidence interval) of the ASDAS-CRP, BASDAI and BASFI indices was 3.5 (1.1, 3.3–3.7), 4.2 (1.7, 3.9–4.5) and 3.8 (1.8, 3.5–4.2), respectively. After 6 months, these indices decreased to 1.7 (0.8, 1.5–1.8; P < .01), 2.0 (1.5, 1.7–2.2; P < .01) and 1.6 (1.2, 1.3–1.8; P < .01), respectively. The median NSAID intake score decreased from 50 to 10 ( P < .01). Radiographic sacroiliitis was observed in 54% of patients and magnetic resonance imaging (MRI) sacroiliitis was observed in 97% of patients. Conclusion: This study demonstrates that early diagnosis and treatment of axSpA significantly improved clinical outcomes and reduced NSAID use in the study participants. The genetic and clinical profiles of Indian patients with early axSpA are comparable to those of patients worldwide. The high radiographic sacroiliitis observed in this study suggests a delayed diagnosis of axSpA in Indian patients.