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Characterization of ankylosing spondylitis in Upper Egypt

Abdelhafeez Moshrif, Ahmed Mosallam, Mohamed Rayan, Hamid Khalifa & Ali Sobhy

Objective: To explore the features of ankylosing spondylitis (AS) in Upper Egypt which has been under estimated in this area known for its lower socioeconomic status (SES).

Methods: Seventy patients with a definite diagnosis of AS were prospectively evaluated. Information about human leukocyte antigen (HLA-B27) status, pattern of axial and peripheral involvement, inflammatory markers, extra axial features and axial radiographic findings together with other demographic variables were recorded. Bath AS disease activity and functional status (BASDAI and BASFI) were also assessed.

Results: The mean age at onset was 24.9 ± 7.5 years and at diagnosis was 35.46 ± 12.1 years, with a diagnostic delay of 9.9 years on average. The male to female ratio was 2.9:1. HLA-B27 was positive in 38 of 51 patients (74.5%). Eighteen patients (25.7%) had a family history of AS. Peripheral arthritis was present in 14 patients (20%). Anterior uveitis was present in 5 patients (7.1%). The mean radiographic sacroiliitis grade was 2.42 ± 0.59. Lumbar syndesmophytes were present in 45 patients (64.3%) and bamboo spine was present in 13 (18.6%). Thirty (42.9%) patients had radiographic hip abnormalities, of whom 6 had received hip replacement surgery. Of 65 patients examined by bone densitometry, osteoporosis was diagnosed in 26 patients (40%). The mean BASDIA and BASFI were 4.8 ± 1.18 and 5.4 ± 1.5, respectively. Axial radiographic damage was significantly greater in men (P >0.001). Only 6 patients (8.6%) were aware of the nature of the disease and were maintained on regular treatment.

Conclusion: The characteristics of AS in Upper Egypt were revealed. Noticeable radiographic damage with a high BASFI and BASDAI indicated a more severe disease than that reported in other Middle Eastern populations with a higher SES.