Clinical Spectrum and Subtypes of Spondyloarthritis: A Hospital-Based Observational Study from Kashmir
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Background: Spondyloarthritis (SpA) represents a spectrum of inflammatory rheumatic disorders with overlapping clinical features, genetic associations, and extra-articular manifestations. Data from South Asia, particularly Kashmir, remains limited. Objectives: To evaluate the clinical presentation and subtypes of spondyloarthritis in patients attending a tertiary care center in Kashmir. Methods: This hospital-based observational study was conducted over two years at SKIMS Soura, Srinagar. Seventy patients fulfilling classification criteria for SpA or suspected cases of undifferentiated SpA were included. Detailed clinical assessment, laboratory investigations including HLA-B27, radiological imaging, and disease activity scoring were performed. Results: Ankylosing spondylitis (AS) was the most common subtype (54%), followed by psoriatic arthritis (19%), undifferentiated SpA (14%), reactive arthritis (9%), and enteropathic arthritis (4%). The mean age of presentation was 33.8 ± 9.4 years with a male-to-female ratio of 1.6:1. Inflammatory back pain was the predominant symptom (76%), while peripheral arthritis was seen in 61% of patients, most commonly involving the knee and ankle. Enthesitis was observed in 33%, dactylitis in 16%, and ocular involvement (mainly uveitis) in 21%. Skin and nail manifestations were frequent among psoriatic arthritis patients. Elevated ESR and CRP were present in 73% and 66% of cases, respectively, though not directly correlated with disease activity. Overall, 61% were HLA-B27 positive, with a strong association in AS patients (74%). Conclusion: SpA in Kashmir demonstrates male predominance and a relatively young age at onset. AS is the most frequent subtype, with inflammatory back pain and peripheral arthritis being common presentations. Enthesitis was the leading extra-articular manifestation, and HLA-B27 positivity correlated with uveitis in AS. Early recognition of clinical patterns may aid timely diagnosis and improved outcomes.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Dr Aabid Manzoor, Dr Mustafa Bashir, Dr Tavseef Ahmad Tali, Dr Fiza Amin
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Dr Aabid Manzoor, Post Graduate, Department of Internal Medicine, SKIMS Soura, Srinagar, J&K, India.
Post Graduate, Department of Internal Medicine, SKIMS Soura, Srinagar, J&K, India.
Dr Mustafa Bashir, Senior Resident, Department of Cardiology, Government Medical College Baramulla, J&K, India.
Senior Resident, Department of Cardiology, Government Medical College Baramulla, J&K, India.
Dr Tavseef Ahmad Tali, Assistant Professor, Department of Radiation oncology, Government Medical College Baramulla, J&K, India.
Assistant Professor, Department of Radiation oncology, Government Medical College Baramulla, J&K, India.
Dr Fiza Amin, Consultant, Department of Gynaecology & Obstetrics, Ramzaan Hospital Gogji Bagh, Srinagar, J&K, India.
Consultant, Department of Gynaecology & Obstetrics, Ramzaan Hospital Gogji Bagh, Srinagar, J&K, India.
[1] Khan MA. Update on spondyloarthropathies. Ann Intern Med 2002;136(12):896–907.
[2] Abdelsalam A, Tharwat S, Abo Almauty M, Barakat AF, Enein AF, Abdelsalam N, et al. Demographic, clinical and radiological characteristics of seronegative spondyloarthritis Egyptian patients: A rheumatology clinic experience in Mansoura. Egypt Rheumatol 2017;39(2):109–14.
[3] Gheita TA, Azkalany GS, Kenawy SA, Kandeel AA. Bone scintigraphy in axial seronegative spondyloarthritis patients: role in detection of subclinical peripheral arthritis and disease activity. Int J Rheum Dis 2015;18(5):553–9.
[4] Van Tubergen A. The changing clinical picture and epidemiology of spondyloarthritis. Nat Rev Rheumatol 2015;11(2):110–8.
[5] Malaviya AN. Spondyloarthritis in India. Indian. J Rheumatol 2020;15:S2–5.
[6] Chopra A, Patil J, Billempelly V, Relwani J, Tandle HS; WHO-ILAR COPCORD Study. WHO International League of Associations from Rheumatology Community Oriented Program from Control of Rheumatic Diseases. Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD Study. J Assoc Physicians India. 2001;49:240-6.
[7] Joshi VL, Chopra A. Is there an urban-rural divide? Population surveys of rheumatic musculoskeletal disorders in the Pune region of India using the COPCORD Bhigwan model. J Rheumatol 2009;36:614–22.
[8] Chandrasekaran AN, Porkodi R, Achutan K, Madhavan R, Parthiban M.Spectrum of clinical and immunological features of systemic rheumatic disorders in a referral hospital in south India: Primary ankylosing spondylitis. J Ind Rheumatol Assoc. 1994;2–4:149–52.
[9] Sallam RA, Elbahnasawy AS. Health related quality of life (HRQoL) in ankylosing spondylitis patients: Relation to clinical features, disease activity and radiographic damage. Egypt Rheumatol 2020. epub ahead of print.
[10] Saidane O, Mahmoud I, Gafsi L, Houda A, Tekaya R, Abdelmoula L. Factors leading to work absenteeism in Tunisian ankylosing spondylitis patients.Egypt Rheumatol 2018;40(3):183–5.
[11] Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 2005; 52:1000.
[12] López-Medina C, Moltó A, Dougados M. Peripheral Manifestations in Spondyloarthritis and their Effect: An Ancillary Analysis of the ASAS-COMOSPA Study. J Rheumatol 2020; 47:211.
[13] Dougados M, van der Linden S, Juhlin R, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991; 34:1218.
[14] Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70:25.
[15] D'Agostino MA, Olivieri I. Enthesitis. Best Pract Res Clin Rheumatol 2006; 20:473.
[16] Lee TH, Lee CM, Kim TH, Lee S. Anterior chest wall involvement in spondyloarthritis patients as detected by magnetic resonance imaging: A case series and literature review. J Rheum Dis 2021; 28:159.
[17] Al-Amayreh IA, Zaidat BO. Ankylosing spondylitis in Northern Jordan. Saudi Med J 2000; 21:950.
[18] Rosenbaum JT. The eye in spondyloarthritis✰. Semin Arthritis Rheum 2019; 49:S29.
[19] Hayward RJ, Machado PM. Classification Criteria in Axial Spondyloarthritis: What Have We Learned; Where Are We Going? Rheum Dis Clin North Am 2020; 46:259.
[20] Muñoz-Fernández S, Martín-Mola E. Uveitis. Best Pract Res Clin Rheumatol 2006; 20:487.
[21] Sykes MP, Hamilton L, Jones C, Gaffney K. Prevalence of axial spondyloarthritis in patients with acute anterior uveitis: a cross sectional study utilising MRI. RMD Open 2018; 4:e000553.
[22] Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis 2015; 74:65.
[23] Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore) 1976; 55:401.
[24] Eder L, Gladman DD. Psoriatic arthritis: phenotypic variance and nosology. Curr Rheumatol Rep 2013; 15:316.
[25] El Maghraoui A. Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics and therapeutic implications. Eur J Intern Med 2011; 22:554.
[26] Edmunds L, Elswood J, Kennedy LG, Calin A. Primary ankylosing spondylitis, psoriatic and enteropathic spondyloarthropathy: a controlled analysis. J Rheumatol 1991; 18:696.
[27] Ez-Zaitouni Z, Hilkens A, Gossec L, et al. Is the current ASAS expert definition of a positive family history useful in identifying axial spondyloarthritis? Results from the SPACE and DESIR cohorts. Arthritis Res Ther 2017; 19:118.
[28] Malakar A, Kakati S, Barman B, Dutta A. Clinical presentation and subtypes of spondyloarthritis patients in North East India. Egypt Rheumatol. 2020;42(4):271–274.
[29] Abdelsalam A, Tharwat S, Almauty MA, Barakat AF, Enein AF, Abdelsalam N, Awad M, Shahin D. Demographic, clinical and radiological characteristics of seronegative spondyloarthritis Egyptian patients: a rheumatology clinic experience in Mansoura. Egypt Rheumatol [The Egyptian Rheumatologist]. 2017;39(2):109–14.
[30] Houzou, P., Atake, A.-E., Kakpovi, K., Koffi-Tessio, V.E., Tagbor, K.C., Fianyo, E., Oniankitan, S., Diallo, M.L., Yibe, P., Mba, E.D., Lokou, P., Oniankitan, O. and Mijiyawa, M. (2021) Profile of Infectious Spondylodiscitis in Rheumatology Consultation at University Teaching Hospital of Kara, Togo. Open Journal of Rheumatology and Autoimmune Diseases, 11, 160-168.