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When brucellosis met the Assessment of SpondyloArthritis international Society classification criteria for spondyloarthritis: a comparative study

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Abstract

Objectives

To distinguish brucellosis patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) from SpA patients.

Methods

Brucellosis patients diagnosed from September 2012 to December 2017 who met the ASAS classification criteria for SpA were analyzed with clinical characteristics and laboratory and imaging examinations. Axial or peripheral SpA patients were respectively included into the comparative analysis with a 4:1 ratio.

Results

Twenty-two brucellosis (10 axial and 12 peripheral) patients (male, 16 cases; 72.72%; mean (S.D.) age, 40.23 (16.49) years) and 88 SpA patients were included. All brucellosis patients had been misdiagnosed or considered as SpA before admission to our center. The brucellosis patients had shorter disease duration (axial, P = 0.001; peripheral, P = 0.108). More than half (59.09%) of the patients had contact history with livestock. The low back pain (LBP) of brucellosis patients was generally less improved with exercise (axial, P = 0.001; peripheral, P = 0.008). More brucellosis patients had myalgia (axial, P < 0.001; peripheral, P = 0.071) or fever (axial, P < 0.001; peripheral, P = 0.107). None of them had positive HLA-B27. Blood culture tests were performed in all brucellosis patients and only 4 (18.18%) were positive. Twenty (90.91%) brucellosis patients were gold-immunochromatographic assay (GICA) positive. Bone marrow edema and bone erosion in sacroiliac joints were respectively detected in 100% (10/10) and 90% (9/10) axial brucellosis patients by MRI. Adjacent muscle involvement was found in 80% (8/10) of the patients.

Conclusions

Indicators including disease duration, contact history of livestock, features of LBP, myalgia, fever, and HLA-B27 can help the differential diagnosis of brucellosis and SpA. GICA test and sacroiliac joints MRI can furtherly confirm the diagnosis of brucellosis.

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Funding

This work were supported by the Key Projects in the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (2014BAI07B05) and the National Basic Research Program of China (973 program) (2014CB541806).

Author information

Author notes

  1. Yiwen Wang and Dai Gao contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing, 100853, China

    Yiwen Wang, Dai Gao, Xiaojian Ji, Jie Zhang, Xiuru Wang, Jingyu Jin, Zheng Zhao, Xiaohu Deng, Chunhua Yang, Jian Zhu, Jianglin Zhang & Feng Huang

  2. State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing, 100853, China

    Feng Huang

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  1. Yiwen Wang
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  2. Dai Gao
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  11. Jianglin Zhang
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  12. Feng Huang
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Corresponding authors

Correspondence to Jian Zhu or Feng Huang.

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This study was approved by the Ethics Committee at Chinese PLA General Hospital (S2016-049-02).

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Wang, Y., Gao, D., Ji, X. et al. When brucellosis met the Assessment of SpondyloArthritis international Society classification criteria for spondyloarthritis: a comparative study. Clin Rheumatol 38, 1873–1880 (2019). https://doi.org/10.1007/s10067-019-04481-w

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  • DOI: https://doi.org/10.1007/s10067-019-04481-w

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