Clinical phenotype, disease burden and inter-regional heterogeneity of axial spondyloarthritis in 1112 patients across 15 Arab countries: the PROSPA study

@article{ziade2026clinical,
  title = {{Clinical phenotype, disease burden and inter-regional heterogeneity of axial spondyloarthritis in 1112 patients across 15 Arab countries: the PROSPA study}},
  author = {Nelly Ziade and Farid Abou Abdallah and Riwa Kfoury and Rawdha Tekaya and Avin Maroof and Fatma Zohra Yasmina Heddi and Krystel Aouad and Sahar Saad and Suad Hannawi and Chafia Makhloufi-Dahou and Rachid Bahiri and Fatima Alnaimat and Wafa Hamdi and Bassel Elzorkany and Sherif Gamal and Salma Zemrani and Selma Abdellaoui and Nesreen Mohamed Ismail Moustafa and Nada Alchamaa and Chafika Haouichet and Safa Rahmouni and Noora Rashed Al Khater and Nizar Abdulateef Al-Ani and Kawther Ben Abdelghani and Antonella Abi Najm and Laila Ayoub and Rachida Allat and Laila Aljazwi and Malik Djennane and Dhouha Khalifa and Ziryab Mahmoud and Ines Mahmoud and Asal Ridha Adnan and Hanan Alrayes and Saed I Y Attawna and Faiq I Gorial and Nabaa Ihsan Awadh and Hiba Boussaa and Maxime Dougados and Ihsane Hmamouchi},
  journal = {RMD Open},
  year = {2026},
  month = nov,
  doi = {10.1136/rmdopen-2026-007136},
  url = {https://doi.org/10.1136/rmdopen-2026-007136},
  note = {CC BY-NC 4.0},
}

TY  - JOUR
TI  - Clinical phenotype, disease burden and inter-regional heterogeneity of axial spondyloarthritis in 1112 patients across 15 Arab countries: the PROSPA study
AU  - Nelly Ziade
AU  - Farid Abou Abdallah
AU  - Riwa Kfoury
AU  - Rawdha Tekaya
AU  - Avin Maroof
AU  - Fatma Zohra Yasmina Heddi
AU  - Krystel Aouad
AU  - Sahar Saad
AU  - Suad Hannawi
AU  - Chafia Makhloufi-Dahou
AU  - Rachid Bahiri
AU  - Fatima Alnaimat
AU  - Wafa Hamdi
AU  - Bassel Elzorkany
AU  - Sherif Gamal
AU  - Salma Zemrani
AU  - Selma Abdellaoui
AU  - Nesreen Mohamed Ismail Moustafa
AU  - Nada Alchamaa
AU  - Chafika Haouichet
AU  - Safa Rahmouni
AU  - Noora Rashed Al Khater
AU  - Nizar Abdulateef Al-Ani
AU  - Kawther Ben Abdelghani
AU  - Antonella Abi Najm
AU  - Laila Ayoub
AU  - Rachida Allat
AU  - Laila Aljazwi
AU  - Malik Djennane
AU  - Dhouha Khalifa
AU  - Ziryab Mahmoud
AU  - Ines Mahmoud
AU  - Asal Ridha Adnan
AU  - Hanan Alrayes
AU  - Saed I Y Attawna
AU  - Faiq I Gorial
AU  - Nabaa Ihsan Awadh
AU  - Hiba Boussaa
AU  - Maxime Dougados
AU  - Ihsane Hmamouchi
PY  - 2026
DA  - 2026/11/04
JO  - RMD Open
DO  - 10.1136/rmdopen-2026-007136
UR  - https://doi.org/10.1136/rmdopen-2026-007136
AB  - Objectives: To characterise the phenotype, disease burden, comorbidities, patient-reported outcomes (PROs) and treatment patterns of axial spondyloarthritis (axSpA) across Arab countries and evaluate regional heterogeneity.  Methods: Profile of Axial Spondyloarthritis in Arab Countries (PROSPA), a cross-sectional, multinational study by the ArLAR Research Group across 33 rheumatology centres in 15 countries, enrolled adults with axSpA during a routine visit. Standardised data on validated PROs, disease characteristics, comorbidities and treatment were collected. Patients were stratified by Arab subregion (North Africa, the Levant and the Gulf). Between-group comparisons used Welch analysis of variance, Kruskal-Wallis and χ2 tests. Mixed-effects modelling tested whether regional differences in Assessment of SpondyloArthritis international Society Health Index (ASAS-HI) remained independent after adjustment.  Results: Of 1112 patients (mean age 42.6 years, median disease duration 10 years, 63.8% male), radiographic (r) predominated over non-radiographic (nr) axSpA (r/nr ratio 3.7). Peripheral arthritis occurred in 45.7%, coxitis in 31.7%, uveitis in 16.7% and psoriasis in 17.4%. Human leucocyte antigen B27 was positive in 51.5% of 615 tested. Disease activity was moderate to high; biologic disease-modifying antirheumatic drugs (bDMARDs) were used in 70.1%, 36.4% were people who smoke and 5.2% had a tuberculosis history. North Africa had the highest r/nr ratio, worst PROs and lowest bDMARD use, despite comparable disease activity. Regional differences in ASAS-HI did not persist after adjustment; disease activity and function accounted for most explained variance.  Conclusions: 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.
SN  - 2056-5933
ER  -