Spondyloarthritis & psoriatic arthritis
Clinical phenotype, disease burden and inter-regional heterogeneity of axial spondyloarthritis in 1112 patients across 15 Arab countries: the PROSPA study
Authors' conclusion
This largest multinational axSpA study revealed a predominantly radiographic phenotype, significant disease burden and a comorbidity profile marked by high smoking and tuberculosis rates. After adjustment, region was not independently associated with ASAS-HI; disease activity and function, rather than geography, explained most of the variance in health status.
Study context
- Population
- Adults with axial spondyloarthritis (axSpA) across Arab countries, stratified by Arab subregion (North Africa, the Levant and the Gulf)patients (mean age 42.6 years, median disease duration 10 years, 63.8% male)
- Participants
- 1,112 adults
- Exposure
- Patients stratified by Arab subregion
- Outcome
- Radiographic vs non-radiographic axSpA
Methodological details33 rheumatology centres in 15 countries, enrolled during a routine visit, mixed-effects modelling
- 33 rheumatology centres in 15 countries
- Enrolled during a routine visit
- Mixed-effects modelling
Main finding
As reported in the abstract
R/nr ratio
3.7
Observational data: associations, not effects.
Further findings
Clinical features
- Peripheral arthritis
- 45.7%
- Coxitis
- 31.7%
- Uveitis
- 16.7%
- Psoriasis
- 17.4%
- Human leucocyte antigen B27 positive, of 615 tested
- 51.5%
Disease activity, treatment and comorbidities
- bDMARD use
- 70.1%
- People who smoke
- 36.4%
- Tuberculosis history
- 5.2%
- Disease activity moderate to high
Regional heterogeneity
- North Africa had the highest r/nr ratio, worst patient-reported outcomes (PROs) and lowest bDMARD use, despite comparable disease activity
ASAS-HI by region after adjustment
- Regional differences in ASAS-HI did not persist after adjustment; disease activity and function accounted for most explained variance
- Mixed-effects modelling
Original publication
Clinical phenotype, disease burden and inter-regional heterogeneity of axial spondyloarthritis in 1112 patients across 15 Arab countries: the PROSPA study. RMD Open. Published 4 November 2026. doi:10.
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