Clinical Rheumatology

, Volume 32, Issue 5, pp 591–599 | Cite as

Phenotypic and clinical differences between Caucasian and South Asian patients with psoriatic arthritis living in North East London

  • Euthalia Roussou
  • Sunil Chopra
  • Danny Lunda Ngandu
Original Article

Abstract

To test for demographic and clinical differences between Caucasian and South Asian patients with psoriatic arthritis (PsA) living in the same environment and for differences between sexes. The demographic characteristics of patients attending outpatient clinics were obtained using a semi-structured questionnaire. Clinical parameters included disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), C-reactive protein), function (Bath Ankylosing Spondylitis Functional Index (BASFI)) and visual analogue scale (VAS) scores for well-being and night pain (10 cm, where 10 = worst possible response). The first symptom experienced at disease onset and the main symptoms during the disease course were recorded in the questionnaire. A total of 217 patents were assessed of whom 151 were Caucasians and 66 were Asians. South Asian patients were significantly younger [(mean) 45.9 years [(SD)(±11.4)] for Asians and 53.1 years (±14.2) for Caucasians (p < 0.005)] and were diagnosed at an earlier age [40.7 years (±11.7) for Asians and 46.7 years (±15.8) for Caucasians (p < 0.05)] compared to Caucasians patients. Asian females with PsA had worse disease in terms of activity (ESR = 23.9 mmHg/h; BASDAI = 6.7), function (BASFI = 5.5), night pain (7.1 on VAS) and well-being (6.6 on VAS) compared with Asian males (13.2 mmHg/h, 5.3, 3.6, 4.1, 4.6, respectively) or Caucasian males and females (15.8 mmHg/h, 5.9, 5.3, 5.4, 5.4; 18.9 mmHg/h, 6.1, 6.1, 5.3, 5.8, respectively). There were no significant differences in symptoms at disease onset or the main symptoms during the disease course between Caucasian and Asian patients, although there was a trend towards more frequent enthesitis in Asian females during the course of disease suggested by pain with pressure compared to Asian males. South Asian patients may develop PsA earlier in life than Caucasian patients do, but their clinical characteristics are generally similar. Asian females with PsA have worse disease activity, function, night pain and well-being than Asian males and Caucasian males and females.

Keywords

Caucasians Ethnic differences PsA South Asians 

Notes

Disclosures

None.

References

  1. 1.
    Tam LS, Leung YY, Li EK (2009) Psoriatic arthritis in Asia. Rheumatology (Oxford) 48:1473–1477CrossRefGoogle Scholar
  2. 2.
    Thumboo J, Tham SN, Tay YK et al (1997) Patterns of psoriatic arthritis in Orientals. J Rheumatol 24:1949–1953PubMedGoogle Scholar
  3. 3.
    Prasad PV, Bikku B, Kaviarasan PK, Selthinathan A (2007) A clinical study of psoriatic arthritis. Indian J Dermatol Venereol Leprol 73:166–170PubMedCrossRefGoogle Scholar
  4. 4.
    Rajendran CP, Ledge SG, Rani KP, Madhavan R (2003) Psoriatic arthritis. J Assoc Phys India 51:1065–1068Google Scholar
  5. 5.
    Gladman DD, Antoni C, Mease P et al (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64(suppl 2):14–17, iiGoogle Scholar
  6. 6.
    Gladman DD, Rahman P, Krueger GG et al (2008) Clinical and genetic registries in PsA. J Rheumatol 35:1458–1463PubMedGoogle Scholar
  7. 7.
    Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis—development of new criteria from a large international study. Arthritis Rheum 54:2665–2673PubMedCrossRefGoogle Scholar
  8. 8.
    Londoner. The world in one city. January 2004, page 4. www.london.gov.uk
  9. 9.
    Calin A, Porta J, Fries JF et al (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237:2613–2614PubMedCrossRefGoogle Scholar
  10. 10.
    Rudvaleit M., van der Heijde, Landewe R. et al. The development of assessment of spondyloarthritis international society (ASAS) classification criteria for Axial Spodyloarthritis (part II). Validation and final selection Annals of Rheumatic Diseases 2009; (68): 777–783Google Scholar
  11. 11.
    Rudvaleit M, van der Heijde, Landewe R et al (2011) The Assessment of SpondyloArthritis International Society (ASAS) classification criteria for peripheral spodyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70:25–31CrossRefGoogle Scholar
  12. 12.
    Roussou E, Jurik AG (2011) Difficulties for the detection of positive signs of sacroiliitis in spondyloarthritides by magnetic resonance imaging (MRI) in everyday clinical practice. Clin Exp Rheumatol 29(3):594–595PubMedGoogle Scholar
  13. 13.
    Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291PubMedGoogle Scholar
  14. 14.
    Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285PubMedGoogle Scholar
  15. 15.
    Fries JF, Spitz P, Kraines G, Holman H (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145PubMedCrossRefGoogle Scholar
  16. 16.
    Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey; construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233PubMedCrossRefGoogle Scholar
  17. 17.
    McKenna S, Doward L, Whalley D, Tennant A, Emery P, Veale D (2004) Development of the psoriatic arthritis quality of life: a quality of life instrument specific to psoriatic arthritis. Ann Rheum Dis 63(2):162–169PubMedCrossRefGoogle Scholar
  18. 18.
    Husted JA, Gladman DD, Farewell VT et al (2001) Health related quality of life in patients with psoriatic arhtritis: a comparison with patients with RA. Arthritis Care Res 45:151–158CrossRefGoogle Scholar
  19. 19.
    Blackmore M, Gladman DD, Husted J et al (1995) Measuring health status in PsA: the HAQ and its modification. J Rheumatol 22:886–893PubMedGoogle Scholar
  20. 20.
    Husted JA, Gladman DD, Farewell VT et al (1997) Validating the SF-36 health survey questionnaire in patients with psoriatic arthritis. J Rheumatol 24:511–517PubMedGoogle Scholar
  21. 21.
    Allison TR, Symmons DPM, Brammah T, Haynes P et al (2002) Musculoskeletal pain is more generalized among people from ethnic minorities than among white people in greater Manchester. Ann Rheum Dis 61:151–156PubMedCrossRefGoogle Scholar
  22. 22.
    Roussou E, Chowdry KM, Calin A (1997) Ethnic differences in Ankylosing Spondylitis: disease expression in Pakistan compared to Britain. J Rheumatol 24(3):612–613PubMedGoogle Scholar
  23. 23.
    Njobvu P, Hunt L, Pope D et al (1999) Pan amongst ethnic minority groups of South Asian origin in the UK: a review. Rheumatology 38:1184–1187PubMedCrossRefGoogle Scholar
  24. 24.
    Helliwell P, Ibrahim G (2003) Ethnic differences in response to disease modifying drugs. Reumatology 42:1197–1201CrossRefGoogle Scholar
  25. 25.
    Taylor WJ, Harrison AA (2004) Could the Bath Ankylosing Disease activity index (BASDAI) be a valid measure of disease activity in patients with psoriatic arthritis. Arthr Rheum 51:311–315CrossRefGoogle Scholar
  26. 26.
    Fernandez-Sueiro JL, Willisch A, Pertega-Diaz S et al (2010) Validity of the Bath Akylosing Spondylitis Disease Activity Index for the evaluation of axial PsA. Arthr Care Res 62:78–85CrossRefGoogle Scholar
  27. 27.
    Roussou E, Sultana S (2010) The Bath Ankylosing Spondylitis Activity and function indices (BASDAI and BASFI) and their correlation with main symptoms experienced by patients due to spondyloarthritis. Clin Rheumatol 29(8):869–874PubMedCrossRefGoogle Scholar
  28. 28.
    Leung YY, Tam LS, Kun EWL, Ho KW, Li EKM (2008) Comparison of 4 functional indexes in Psoriatic Arthritis with axial or peripheral disease subgroups using Rasch analyses. J Rheumatol 35:1613–1621PubMedGoogle Scholar
  29. 29.
    Husted JA, Brian T, Farewell VT et al (2005) Description and prediction of physical functional disability in psoriatic arthritis (PsA): a longitudinal analysis using a Markov model approach. Arthritis Rheum 53:404–409PubMedCrossRefGoogle Scholar
  30. 30.
    Brodszky V, Pentek M, Balint PV et al (2010) Comparison of the psoriatic arthritis quality of life questionnaire (PsAQoL), the functional status (HAQ) and utility (EQ-5D) measures in psoriatic arthritis. Results from a cross sectional survey. Scand J Rheumatol 39:303–309PubMedCrossRefGoogle Scholar
  31. 31.
    Helliwell PS, FitzGerald O, Fransen J et al (2012) The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project) .Ann. Rheum. Dis. PMID:22798567 July13Google Scholar

Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Euthalia Roussou
    • 1
    • 2
  • Sunil Chopra
    • 3
    • 4
  • Danny Lunda Ngandu
    • 5
  1. 1.Barking, Havering and Redbridge University Hospitals NHS Trust, Rheumatology and RehabilitationKing George HospitalIlfordUK
  2. 2.Barts and The London School of Medicine and DentistryLondonUK
  3. 3.Barking, Havering and Redbridge University Hospitals NHS Trust, Department of DermatologyKing George HospitalIlfordUK
  4. 4.London Dermatology Centre (LDC)LondonUK
  5. 5.Barking, Havering and Redbridge University Hospitals NHS Trust, Department of MedicineKing George HospitalIlfordUK

Personalised recommendations