Background Spondyloarthritis (SpA) is a set of auto-immune and auto-inflammatory diseases that share similar manifestations of axial spine and sacroiliac, peripheral joint including oligoarthritis predominantly of lower limbs, dactylitis, enthesitis and fasciitis, and extraarticular manifestations involvement eyes, skin, nails, bowel and the presence of high c-reactive protein (CRP) levels and Human Leucocyte Antigen (HLA)-B27 seropositivity. Peripheral manifestations such tarsitis (mid-foot arthritis) has been reported associated to ankle arthritis, Achilles tendon enthesitis and plantar fasciitis, besides linked mainly to juvenile-onset forms of SpA (18.1%) in contrast with peripheral adult form (13.6%) [1,2]. Tarsitis occurs more frequently in SpA patients of Latin American (23.6%), Asia (9.1%) and less commonly in SpA patients of Europe and North America (5%) and middle-East and North Africa (3.5%) [1,2]. This mid-foot inflammation has not been completely well described in the adult population with SpA, specifically in Mexican adult population [3]. Here is presented the frequency and factors associated to tarsitis in Mexican adult patients with SpA.
Objectives To determinate the frequency and factors associated to tarsitis in Mexican SpA patients.
Methods That is a cross-sectional, comparative a retrospective study including 211 (≥18 years) Mexican SpA patients recruited from 2012 to 2021 that fulfilled ASAS criteria. Patients with or without presence of tarsitis are included. This work explores demographic factors, clinical features, c-reactive protein levels and pharmacologic treatments in Spa patients with or without tarsitis. It use Chi-square, Student´s-t, U Mann-Whitney tests to univariate analysis and logistic regression to multivariate analysis adjusted for age and gender. The level of significance of statistical tests is less of 5%.
Results The present investigation involves 211 patients with SpA and 62.6% of them are men. The mean age [standard deviation (SD)] is 43.72 (13.5) years. The mean of age at onset of SpA (SD) is 31.93 (11.3) years. The SpA distribution is axial (42.2%), peripheral (27%) and both (30.8%). A total of 63 (29.9%) patients has tarsitis; of them 63.5% are men and the mean age at onset of tarsitis (SD) is 26.52 (10.2) years. The seronegative spondyloarhtropathies associated to tarsitis are ankylosing spondylitis (81%), psoriatic arthritis (9.5%), undifferentiated spondyloarthropathy (7.9%), and reactive arthritis (1.6%). In the univariate analysis SpA patients with tarsitis are likely younger at onset of manifestations and diagnosis of disease, present peripheral distribution and unilateral tarsitis, show more frequently knee and ankle arthritis, Achilles and calcaneus tendon enthesitis and plantar fasciitis, have more probably HLA-B27 seropositivity and higher c-reactive protein levels, and use more often oral and intraarticular corticosteroids. On the other hand, SpA patients with tarsitis are less frequently smokers and exhibit less probably cervical and lumbar involvement, dactylitis and family history of SpA. In multivariate analysis, use of intraarticular corticosteroids (OR 61.75, 95% CI 8.46–450, p=<0.001) and calcaneus tendon enthesitis (OR 31.40, 95% CI 4.42–223, p=0.001) remain significant in SpA patients with tarsitis.
Conclusion This study suggests that SpA patients from Mexico have high prevalence of the tarsitis (29.9%) compare to other populations. Those with tarsitis use more intraarticular corticosteroids and present more often calcaneus tendon enthesitis. However, these observations must be confirmed in larger and prospective studies.
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