Clinical, Functional, and Radiological Profile of Patients With Spondyloarthritis: A Cross-Sectional Study From a Tertiary Care Center in Central India.

BACKGROUND AND

objectivesSpondyloarthritis (SpA) includes a group of chronic inflammatory rheumatic disorders, such as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, and undifferentiated SpA, unified by shared genetic, clinical, and immunopathological features. Comprehensive clinical profiling of SpA patients, including disease activity, functional status, and structural complications such as vertebral fracture, remains limited in Indian tertiary care settings. This study aims to describe the sociodemographic, clinical, radiological, and biochemical profile of patients with SpA, including disease activity and functional status using validated indices (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), and Bath Ankylosing Spondylitis Functional Index (BASFI)), and to assess associations between these measures, inflammatory markers, and the presence of vertebral fractures, a structural complication anticipated to be uncommon in this cohort.

methodsThis hospital-based, cross-sectional, observational study was conducted in the Department of General Medicine of a tertiary care teaching hospital. Fifty adult patients diagnosed with SpA per the European Spondyloarthropathy Study Group (ESSG) criteria were enrolled by consecutive sampling. We performed detailed clinical evaluation, radiological assessment (modified New York criteria for sacroiliitis and vertebral fracture), and laboratory investigations (including HLA-B27 typing). Disease activity and function were assessed using BASDAI, ASDAS-CRP, and BASFI. Data were analyzed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA); categorical variables were compared using the chi-square/Fisher's exact test and continuous variables using the Student's t-test/Mann-Whitney U test, with p<0.05 considered statistically significant. Given the anticipated small number of vertebral fracture events, all fracture-related comparisons were pre-specified as exploratory.

resultsThe cohort had a mean age of 41.8 ± 10.9 years with a male predominance (74%). Ankylosing spondylitis was the most common subtype (54%), and axial involvement was present in 56% of patients; HLA-B27 was positive in 80%. Musculoskeletal (enthesitis, dactylitis) and extra-articular manifestations were noted in 64% of patients overall, most commonly enthesitis (38%) and uveitis (16%). Radiologically, 54% had grade III-IV sacroiliitis, and 12% (n=6) had vertebral fractures (predominantly thoracic, 50%). Fracture prevalence was numerically higher with longer disease duration (p=0.018) and higher erythrocyte sedimentation rate (ESR)/C-reactiive protein (CRP) (p=0.038 and p=0.021, respectively). High disease activity was observed in 72% of patients (BASDAI ≥4.0) and 74% (ASDAS-CRP >2.1); 68% had moderate-to-severe functional limitation (BASFI ≥4.0).

conclusionSpondyloarthritis in this cohort predominantly affected young to middle-aged men from rural and lower socioeconomic backgrounds, with a high burden of active disease and structural damage. Vertebral fractures were more frequent with longer disease duration and higher inflammatory markers in this exploratory analysis. The need for early diagnosis, routine disease-activity monitoring, and clinical vigilance for vertebral fracture as an under-recognized structural complication is imperative in resource-limited settings.