Comparison of Clinical Manifestations in Rheumatoid Arthritis vs. Spondyloarthritis: A Systematic Literature Review

• Published in: Rheumatology and therapy. 2022-04, Vol.9 (2), p.331-378
• Main Authors: Mease, Philip J., Bhutani, Mohit Kumar, Hass, Steven, Yi, Esther, Hur, Peter, Kim, Nina
• Format: Article
• Language: English
• Subjects: Family Medicine; General Practice; Internal Medicine; Literature reviews; Medicine; Medicine & Public Health; Orthopedics; Pain; Psoriasis; Quality of Life Research; Review; Rheumatoid arthritis; Rheumatology; Systematic review
• ISSN: 2198-6576; 2198-6584
• DOI: 10.1007/s40744-021-00407-8

Introduction Misclassification of spondyloarthritis (SpA) as rheumatoid arthritis (RA) may lead to delayed SpA diagnosis and suboptimal therapeutic outcomes. Here, we evaluate the literature on clinical manifestations in patients with SpA and RA, particularly seronegative RA, to understand the potential overlap, distinctions, and most reliable approaches to accurate diagnosis. Methods In this systematic literature review, conducted according to PRISMA guidelines, we searched key biomedical databases for English-language publications of original research articles (up to July 23, 2020) and rheumatology conference abstracts (January 1, 2018–July 31, 2020) reporting key SpA clinical presentations in patients with SpA or RA. Publications were assessed for eligibility by two independent reviewers; discrepancies were resolved by a third. Studies were evaluated for publication quality using the Downs and Black checklist. Results Of 4712 records retrieved, 79 met the inclusion criteria and were included in the analysis. Of these, 54 included study populations with SpA and RA, and 25 with seropositive and/or seronegative RA. Entheseal abnormalities were more frequently reported among patients with SpA than RA and with seronegative vs. seropositive RA. Psoriasis, nail psoriasis, and dactylitis were exclusively seen in SpA vs. RA. In most publications (70 of 79), advanced imaging techniques allowed for more accurate distinction between SpA and RA. Overlapping clinical characteristics occur in SpA and RA, including inflammation and destruction of joints, pain, diminished functional ability, and increased risk for comorbidities. However, of 54 studies comparing SpA and RA populations, only seven concluded that no distinction can be made based on the SpA manifestations and outcomes examined. Conclusions Typical SpA-related clinical symptoms and signs were observed in patients with RA, suggesting that misclassification could occur. Availability of advanced imaging modalities may allow for more prompt and comprehensive evaluation of peripheral manifestations in SpA and RA, reducing misclassification and delayed diagnosis. Plain Language Summary Spondyloarthritis (SpA) is a group of chronic, inflammatory diseases that includes axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), in addition to other peripheral forms of SpA. AxSpA primarily affects the spine and can cause chronic back pain. PsA occurs in patients with the skin condition psoriasis and patients often