Effects of ustekinumab on spondylitis-associated endpoints in TNFi-naïve active psoriatic arthritis patients with physician-reported spondylitis: pooled results from two phase 3, randomised, controlled trials

BackgroundThe interleukin-12/23p40-subunit-inhibitor ustekinumab significantly improved spondylitis-related symptoms through Week 24 in psoriatic arthritis (PsA) patients with peripheral arthritis and physician-reported spondylitis (PA-PRS) in PSUMMIT-1&2. We further evaluated ustekinumab’s effect on spondylitis-related endpoints in PSUMMIT-1&2 tumour necrosis factor-inhibitor (TNFi)-naïve patients with PA-PRS.MethodsPatients with active PsA (≥5 swollen and ≥5 tender joints, C-reactive-protein ≥ 3.0 mg/L) despite conventional (PSUMMIT-1&2) and/or prior TNFi (PSUMMIT-2) therapy received subcutaneous ustekinumab 45 mg, 90 mg or placebo (Week 0, Week 4, Week 16). Changes in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) neck/back/hip pain question (#2) and modified BASDAI (mBASDAI, excluding PA) scores and Ankylosing Spondylitis Disease Activity Score (ASDAS) responses were assessed at Weeks 12 and 24.ResultsThe pooled PSUMMIT-1&2, TNFi-naïve (n=747), PA-PRS (n=223) subset (158 with human-leucocyte-antigen (HLA)-B27 results) presented with moderate-to-severe spondylitis-related symptoms (mean BASDAI-neck/back/hip pain-6.51, mBASDAI-6.54, BASDAI-6.51, ASDAS-3.81). Mean Week 24 changes were larger among ustekinumab than placebo-treated patients for both neck/back/hip pain (−1.99 vs −0.18) and mBASDAI (−2.09 vs −0.59). Improvements in neck/back/hip pain and fatigue appeared numerically greater in HLA-B27+ than HLA-B27– patients; those for other domains were generally consistent. Greater proportions of ustekinumab versus placebo-treated patients achieved ASDAS clinically important improvement at Week 24 (decrease ≥ 1.1; 49.6% vs 12.7%; nominal p<0.05).ConclusionsImprovements in BASDAI neck/back/hip pain and mBASDAI among ustekinumab-treated, TNFi-naïve, PsA patients with PA-PRS were clinically meaningful and consistent across assessment tools. Numerically greater improvements in neck/back/hip pain in HLA-B27+ than HLA-B27– patients, noted in the context of similar overall mBASDAI improvements between the subgroups, suggest ustekinumab may improve disease activity in TNFi-naïve PsA patients likely to exhibit axial disease.Clinical trial registration numbersPSUMMIT 1, NCT01009086; PSUMMIT 2, NCT01077362.

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Efficacy and safety of ustekinumab in psoriatic arthritis patients with peripheral arthritis and physician-reported spondylitis: post-hoc analyses from two phase III, multicentre, double-blind, placebo-controlled studies (PSUMMIT-1/PSUMMIT-2)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-209068 ◽

2016 ◽

Vol 75 (11) ◽

pp. 1984-1988 ◽

Cited By ~ 80

Author(s):

Arthur Kavanaugh ◽

Lluis Puig ◽

Alice B Gottlieb ◽

Christopher Ritchlin ◽

Yin You ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Phase Iii ◽

Efficacy And Safety ◽

Peripheral Arthritis ◽

Link Type ◽

Study Results ◽

Post Hoc

ObjectiveTo evaluate ustekinumab efficacy and safety in psoriatic arthritis (PsA) patients with peripheral arthritis and physician-reported spondylitis (termed the ‘spondylitis subset’).MethodsAdults with active PsA (PSUMMIT-1/PSUMMIT-2, n=615/312) were randomised to ustekinumab 45 mg, 90 mg or placebo at week 0/week 4/q12 week. At week 16, patients with <5% improvement in tender and swollen joints entered blinded early escape. A subset of patients with physician-identified spondylitis was evaluated with spondylitis-specific assessments, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score employing C reactive protein (ASDAS-CRP), through week 24.Results256/927 (27.6%) PSUMMIT-1/PSUMMIT-2 patients (placebo/ustekinumab, n=92/164) comprised the evaluable spondylitis subset. At week 24, in this analysis subset, significantly more patients achieved BASDAI20/50/70 responses (54.8%/29.3%/15.3% vs 32.9%/11.4%/0%; p≤0.002), improvement in BASDAI question 2 concerning axial pain (1.85 vs 0.24; p<0.001) and mean per cent ASDAS-CRP improvements (27.8% vs 3.9%; p<0.001) for ustekinumab versus placebo recipients, respectively. Comparable to the overall study population, significant improvements were also achieved in psoriasis, peripheral arthritis, enthesitis, dactylitis, physical function and peripheral joint radiographs in the spondylitis subset.ConclusionsIn this post-hoc analysis of PsA patients with baseline peripheral arthritis and physician-reported spondylitis, ustekinumab-treated patients demonstrated significant improvements in axial signs and symptoms through week 24.Trial registration numberPSUMMIT-1 (NCT01009086, EudraCT 2009-012264-14) and PSUMMIT-2 (NCT01077362, EudraCT 2009-012265-60); post-study results.

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Comparison of Different Remission and Low Disease Definitions in Psoriatic Arthritis and Evaluation of Their Prognostic Value

The Journal of Rheumatology ◽

10.3899/jrheum.180249 ◽

2018 ◽

Vol 46 (2) ◽

pp. 160-165 ◽

Cited By ~ 8

Author(s):

Laura C. Coates ◽

Alice B. Gottlieb ◽

Joseph F. Merola ◽

Caroline Boone ◽

Annette Szumski ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Residual Disease ◽

Activity Index ◽

Skin Lesions ◽

Tender Joint Count ◽

Tender Joint ◽

Clinical Trial Registration ◽

Low Disease Activity ◽

Link Type

Objective.There is no agreement on the optimal definitions for assessing disease state in patients with psoriatic arthritis (PsA), and some of the commonly used definitions do not include assessment of skin lesions. We investigated the performance of various definitions in patients with PsA and psoriasis.Methods.This was a posthoc analysis of data from the PRESTA study. The remission definitions analyzed were very low disease activity (VLDA) index, defined as 7/7 of the minimal disease activity (MDA) cutoffs; Disease Activity Index for PsA (DAPSA); and clinical (c-) DAPSA. The low disease activity (LDA) definitions analyzed were as follows: MDA defined as 5/7 cutoffs; MDA joint with both the tender joint count (TJC) and swollen joint count (SJC) cutoffs mandated; MDA skin where skin cutoff was mandated; MDA joint + skin where TJC, SJC, and skin cutoffs were mandated; DAPSA LDA; and cDAPSA LDA.Results.At Week 24, the proportions of patients achieving VLDA, DAPSA, and cDAPSA remission were 10%, 35%, and 37%, respectively. Of the patients achieving DAPSA and cDAPSA remission, 55% and 56%, respectively, had Psoriasis Area and Severity Index > 1. The proportions of patients achieving MDA 5/7, MDA skin, MDA joint, and MDA joint + skin were 44%, 19%, 36%, and 14%, respectively, versus 70% achieving DAPSA and cDAPSA LDA. Notable residual levels of psoriasis were observed in patients achieving the definitions that did not require skin disease control.Conclusion.VLDA and MDA definitions are more stringent than DAPSA and cDAPSA definitions for the assessment of PsA. The relevance of residual disease to patients, however, remains to be determined. [Clinical Trial registration:ClinicalTrials.govNCT00245960]

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Efficacy and safety of a single switch from etanercept originator to etanercept biosimilar in a cohort of inflammatory arthritis

Scientific Reports ◽

10.1038/s41598-020-73183-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Maria Chiara Ditto ◽

Simone Parisi ◽

Marta Priora ◽

Silvia Sanna ◽

Clara Lisa Peroni ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Inflammatory Arthritis ◽

Health Assessment Questionnaire ◽

Activity Index ◽

Health Assessment ◽

Disease Activity Index ◽

Clinical State ◽

Assessment Questionnaire

Abstract AntiTNF-α biosimilars are broadly available for the treatment of inflammatory arthritis. There are a lot of data concerning the maintenance of clinical efficacy after switching from originators to biosimilars; therefore, such a transition is increasingly encouraged both in the US and Europe. However, there are reports about flares and adverse events (AE) as a non-medical switch remains controversial due to ethical and clinical implications (efficacy, safety, tolerability). The aim of our work was to evaluate the disease activity trend after switching from etanercept originator (oETA-Enbrel) to its biosimilar (bETA-SP4/Benepali) in a cohort of patients in Turin, Piedmont, Italy. In this area, the switch to biosimilars is stalwartly encouraged. We switched 87 patients who were in a clinical state of stability from oETA to bETA: 48 patients were affected by Rheumatoid Arthritis (RA),26 by Psoriatic Arthritis (PsA) and 13 by Ankylosing Spondylitis (AS).We evaluated VAS-pain, Global-Health, CRP, number of swollen and tender joints, Disease Activity Score on 28 joints (DAS28) for RA, Disease Activity in Psoriatic Arthritis (DAPSA) for PsA, Health Assessment Questionnaire (HAQ) and Health Assessment Questionnaire for the spondyloarthropathies (HAQ-S),Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for AS patients. 11/85 patients (12.6%) stopped treatment after switching to biosimilar etanercept. No difference was found between oETA and bETA in terms of efficacy. However, some arthritis flare and AE were reported. Our data regarding maintenance of efficacy and percentage of discontinuation were in line with the existing literature.

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AB0830 LIPID PROFILE IN PSORIATIC ARTHRITIS. FREQUENCY AND ASSOCIATION WITH DISEASE ACTIVITY.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2185 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1719.1-1720

Author(s):

V. Savio ◽

Y. Tissera ◽

M. I. Quaglia ◽

J. A. Albiero ◽

C. G. Alonso ◽

...

Keyword(s):

Cardiovascular Risk ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Lipid Profile ◽

Activity Index ◽

Laboratory Data ◽

Disease Index ◽

Interleukin 12 ◽

Joint Involvement ◽

Apo B

Background:Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with higher risk of cardiovascular events and metabolic syndrome. The inflammation not only accelerates atherosclerosis, but also may influence cardiovascular (CV) risk factors such as lipid profile, blood pressure and insulin resistance. Lipid profile has previously been studied in PsA, however this association is still controversial.Objectives:To study the frequency of altered lipid profile in patients with PsA and its association with disease activity.Methods:We studied all the patients with diagnosis of PsA who consecutively attended to Rheumatology Unit at Cordoba Hospital from July 2018 to December 2019. PsA was diagnosed according CASPAR criteria. Clinical and laboratory data were collected. The activity of the disease was evaluated by PASI, MDA and DAPSA. Quantitative variables will be expressed in median and 1st and 3rd interquartile; qualitative variables expressed in frequency and percentage. Correlation analysis was calculated using Spearman’s rank correlation coefficient. P<0.05 was considered statistically significant.Results:42 PsA patients were included. Mean age was 56 years old (47.25-62.75) and 54.76% were female (n=23). 92.86% (n=39) of the patients had plaque Psoriasis and 87.8% (n=36) had peripheral joint involvement.Frequency of comorbidities in PsA are shown in Graphic 1. 31 (73.8%) of the patients were treated with topical therapy, 3 (7.14%) with phototherapy, 31 (73.8%) with Methotrexate and 17 (41.46%) with biologics and JAK inhibitor. Activity Disease Index and Lipid profile are shown in Table 1 and 2.There was not association between Apo B/Apo A coefficient with DAPSA (rho=0.013; p=0.940) and MDA (rho=-0.029; p=0.867).Conclusion:In spite of the presence of cardiovascular factors in the majority of PsA patients, lipid profile is not correlated with disease activity in this population.References:[1]Ahlehoff O, Gislason GH, Charlot M, et al. Psoriasis is associated with clinically significant cardiovascular risk: A Danish nationwide cohort study. J Intern Med 2011;270:147-57.[2]Mallbris, L., Ritchlin, C.T., Ståhle, M. “Metabolic disorders in patients with psoriasis and psoriatic arthritis.” Curr RheumatolRep.8(5): 355–363. 2006[3]Ng CY, Tzeng I-S, Liu S-H, Chang Y-C, Huang Y-H. Metabolic parameters in psoriatic patients treated with interleukin-12/23 blockade (Ustekinumab). J Dermatol 2018; 45:309–313[4]Kaur S, Kingo K, Zilmer M. Psoriasis and cardiovascular risk – do promising new biomarkers have clinical impact? Mediators Inflamm 2017; 2017: 7279818[5]Gentile M, Peluso R, Di Minno MN, et al. Association between small dense LDL and sub-clinical atherosclerosis in patients with psoriatic arthritis. ClinRheumatol 2016; 35: 2023-9.Graphic 1.Comorbidities in PsATable. 1.Activity Disease Index in PsAACTIVITY INDEXn=42DAPSA14.45 (9.72-23.92)DAPSA≤4 REMISSION3>4 y ≤14 low disease activity16>14 y ≤28 moderate disease activity17>28 high disease activity3cDAPSA14.00 (8.00-23.00)/41*MDA9 (25)/36PASI2.20 (0.20-6.80)/41**Expressed in median and interquartiles.Qualitative variables expressed in frequency and percentage.Table. 2.Lipid Profile in PsA patients.Cholesterol (mg/dl)194.5 (164.8-218.2)HDL (mg/dl)48.00 (37.00-57.00)LDL (mg/dl)114.5 (78.5-140.8)TG (mg/dl)139.50 (89.25-191.20)Expressed in median and interquartiles.Disclosure of Interests:None declared

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Discriminant Capacity of Clinical Efficacy and Nonsteroidal Antiinflammatory Drug-sparing Endpoints, Alone or in Combination, in Axial Spondyloarthritis

The Journal of Rheumatology ◽

10.3899/jrheum.150378 ◽

2015 ◽

Vol 42 (12) ◽

pp. 2361-2368 ◽

Cited By ~ 3

Author(s):

Maxime Dougados ◽

Emily Wood ◽

Laure Gossec ◽

Arnaud Dubanchet ◽

Isabelle Logeart ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Activity Index ◽

Statistical Significance ◽

Antiinflammatory Drug ◽

Nonsteroidal Antiinflammatory Drug ◽

Controlled Study ◽

Biologic Treatment ◽

Link Type

Objective.Using data from a randomized, double-blind, placebo-controlled study, we assessed the capacity of clinical and nonsteroidal antiinflammatory drug (NSAID)-sparing endpoints, alone and in combination, to discriminate between treatment effects in axial spondyloarthritis (axSpA).Methods.Patients with active NSAID-resistant axSpA received etanercept (ETN) 50 mg/week or placebo for 8 weeks and tapered/discontinued NSAID. In posthoc logistic regression analyses, OR were calculated that indicated the capacity of the following endpoints to discriminate between the effects of ETN and placebo at Week 8: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50; BASDAI ≤ 3; Assessment of Spondyloarthritis international Society (ASAS) 20; ASAS40; Ankylosing Spondylitis Disease Activity Score (ASDAS) with C-reactive protein (CRP) < 1.3 and ASDAS-CRP < 2.1; ≥ 50% decrease from baseline in ASAS-NSAID score, score < 10, and score = 0; and each clinical and/or each NSAID measure.Results.In 90 randomized patients (ETN, n = 42; placebo, n = 48), disease activity was similar between groups at baseline: mean (± SD) BASDAI (ETN vs placebo) 6.0 ± 1.6 versus 5.9 ± 1.5. NSAID intake was high: ASAS-NSAID score 98.2 ± 39.0 versus 93.0 ± 23.4. OR ranged from 1.6 (95% CI 0.5–5.4) for ASDAS-CRP < 1.3 to 5.8 (95% CI 1.2–29.1) for BASDAI50 and NSAID score of 0; most measures (34/45) reached statistical significance (α = 0.05) favoring ETN. Most combined outcome variables using OR were more discriminant than single outcome measures.Conclusion.These findings suggest that changes in NSAID intake during treatment do not prevent demonstration of clinically relevant effects of biologic treatment, and combined (i.e., clinical with NSAID-sparing) endpoints were frequently more discriminant than single (i.e., clinical) endpoints. ClinicalTrials.gov (NCT01298531).

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P088 Multidisciplinary working in the management of axial and peripheral spondyloarthritis

Rheumatology ◽

10.1093/rheumatology/keab247.086 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Tania Gudu ◽

Deepak R Jadon

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Outcome Measures ◽

Activity Index ◽

Diagnostic Delay ◽

Disease Activity Index ◽

Performance Measure ◽

Time Interval ◽

Multidisciplinary Working

Abstract Background/Aims Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA), but evidence supporting its effectiveness and benefits in SpA is scarce.The objectives of this review were to describe the characteristics, effectiveness and feasibility of MD working compared to uni-disciplinary approach in studies of patients with SpA. Methods A literature review was conducted according to the PICO framework. We included studies on patients with axial and/or peripheral SpA, and we assessed several outcomes such as diagnosis, treatment, feasibility, disease and patient-related outcomes (Table 1). Results Fifteen articles met the review’s eligibility criteria, including 13 observational studies and two randomised controlled trials. In total 4,312 patients were analysed, including patients with psoriatic arthritis, enteropathic SpA, ankylosing spondylitis, and SpA with anterior uveitis. Most of the studies included a combined clinic encompassing a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, working in tandem according to predefined referral criteria and treatment algorithms. The main outcomes assessed in studies on MD working in SpA, matched with their outcome measures are depicted in Table 1. MD working was reported to lead to better outcomes in all studies, including: better identification and diagnosis of the disease; earlier and more comprehensive treatment approach; and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. However, these results are mostly derived from studies with design issues and without a uni-disciplinary care comparator arm. Conclusion Despite the lack of strong and reliable evidence to support its benefits compared to standard care, MD working is an essential part of the care of patients with SpA. Further studies and initiatives should be developed so that the challenges and limits of MD care can be improved upon. P088 Table 1:Outcomes and outcome measures evaluated in studies of multidisciplinary working in spondyloarthritisOutcomesOutcome measuresDiagnosisEarly diagnosisAssessment of SpondyloArthritis Society (ASAS) criteria; New York criteria The Classification Criteria for Psoriatic Arthritis (CASPAR); Moll and Wright criteria Rheumatologist’s / dermatologist’s (clinical) judgment Not defined ("standard diagnostic criteria for inflammatory bowel diseases and rheumatic diseases")Diagnosis delayThe total lag time from joint symptom onset to the first rheumatologic assessment Diagnostic delay: the time interval between the onset of the symptoms and the correct diagnosis being made Physician-related diagnostic delay: the time interval between the initial visit to a physician and the time of diagnosisReclassification of diagnosisNumber of patients, N (%)Disease relatedDisease activityMusculoskeletal: - The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) - The Ankylosing Spondylitis Disease Activity Score- C-reactive protein (ASDAS-CRP) - Disease Activity in PSoriatic Arthritis (DAPSA) Gastroenterology: - Crohn''s disease activity index (CDAI) - the partial Mayo (pMAYO) Psoriasis: - Psoriasis Area Severity Index (PASI)Physical functionBath AS Metrology Index (BASMI) Bath AS Functional Index (BASFI) Bath Ankylosing Spondylitis Patient Global Score (BAS-G) Health Assessment Questionnaire (HAQ)ComorbiditiesPrevalence of diabetes, hypertension, hyperlipidaemia, and current/past smoking statusComplications during FU/ adverse eventsPrevalence of infection and adverse medication effects (i.e., elevated liver function test, headache).TreatmentTherapeutic adjustmentNumber of patients, N (%) having had their treatment changedPatient reported outcomesQuality of lifeInflammatory Bowel Disease Questionnaire (IBDQ) Short Form (SF36) Dermatology Life Quality Index (DLQI) Psoriatic Arthritis Impact of Disease (PsAID-12)Global wellness• HAQ • SF36 • Patient Global Assessment (PGA)Patient global assessmentPGAActivity limitations and participation restrictionsThe Canadian Occupational Performance Measure (COPM)Patient satisfactionSatisfaction questionnaire (developed by the multidisciplinary team)Feasibility/ costsHealth service utilisationquestionnaire developed by the Stanford University School of Medicine with four indicators (outpatient visits, emergency visits, hospitalizations, and hospitalization days) Disclosure T. Gudu: None. D.R. Jadon: None.

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HLA-B27 is associated with reduced disease activity in axial spondyloarthritis

Scientific Reports ◽

10.1038/s41598-021-91829-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

James T. Rosenbaum ◽

Michael H. Weisman ◽

Hedley Hamilton ◽

Cassie Shafer ◽

Elin Aslanyan ◽

...

Keyword(s):

Back Pain ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Activity Index ◽

Disease Activity Index ◽

Medical Decision ◽

Hla B27 ◽

Chi Square ◽

The Difference

AbstractHLA-B27 is associated with increased susceptibility and disease activity of ankylosing spondylitis, but the effect of HLA-B27 on the activity of the broader category now called axial spondyloarthritis (AxSpA) is apparently the opposite. A modified Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess disease activity among 3435 patients with spondyloarthritis (SpA) who participated in a survey designed to assess the effect of their disease and its treatment on the susceptibility and severity of Covid-19. Chi square testing was used to compare BASDAI scores between HLA-B27 positive and negative subjects. 2836 survey respondents were HLA B27 positive. The average BASDAI for the HLA-B27 negative cohort was 4.92 compared to 4.34 for the HLA-B27 positive subjects. Based on linear regression, a subject’s sex could not fully account for the differing BASDAI score in HLA-B27 negative subjects compared to those who are HLA-B27 positive. The difference between B27 positive and negative subjects was skewed by those with a BASDAI score of one or two. HLA-B27 positive subjects were more than twice as likely to have a BASDAI score of 1 compared to HLA B27 negative subjects and about 60% more likely to have a BASDAI score of 2 (p < 0.0001). HLA-B27 positive subjects have less active spondyloarthritis compared to HLA-B27 negative subjects as measured by a BASDAI score. Our data indicate that patients with mild back pain and a diagnosis of AxSpA are disproportionately HLA-B27 positive. The HLA-B27 test facilitates the diagnosis of axial spondyloarthritis such that patients from a community survey with mild back pain may be disproportionately diagnosed as having AxSpA if they are HLA-B27 positive. The test result likely introduces a cognitive bias into medical decision making and could explain our observations.

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Male smokers with HLA-B27 positivity, SI joints inflammation have more radiological damages and higher prevalence of AS while females have higher BASDAI scores: observations from cluster analyses of a group of SpA patients

Hong Kong Bulletin on Rheumatic Diseases ◽

10.1515/hkbrd-2016-0012 ◽

2016 ◽

Vol 16 (2) ◽

pp. 42-47

Author(s):

Shirley Chiu Wai Chan ◽

Helen Hoi Lun Tsang ◽

Chak Sing Lau ◽

Ho Yin Chung

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Blood Parameters ◽

Spinal Mobility ◽

Lumbosacral Spine ◽

Hla B27 ◽

Cluster Analyses ◽

Magnetic Resonance Imaging Mri

AbstractObjectivesTo describe the clinical characteristics and the relations with disease activity, functional status, and syndesmophytes formation in patients with axial spondyloarthritis (AxSpA) by categorizing them into different groups.MethodsOne hundred and sixty three patients with AxSpA were recruited. Clinical and blood parameters were collected. Patients were asked to complete the self-assessment questionnaires, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal mobility was measured according to Bath Ankylosing Spondylitis Metrology Index (BASMI). Radiographs of cervical and lumbosacral spine were performed for modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Radiological sacroiliitis was scored for ankylosing spondylitis (AS). Magnetic resonance imaging (MRI) of the sacroiliac (SI) joints was performed for spondyloarthritis research consortium of Canada (SPARCC) MRI inflammation score. Two-way cluster analyses were performed to determine the relationships between the parameters.ResultsTwo cluster models were built using SPARCC scores of different scorers. Results were similar. The group of patients with highest mSASSS (20.33 vs 20.33) and prevalence radiological AS (85% vs 86%) were male patients (75% vs 75%), positive for HLA-B27 (70.0% vs 66.7%), smokers (87.5% vs 97.2%), and higher SPARCC SI joints score (5.32 vs 3.17). Higher BASDAI was observed among female sex. BASMI varies little but the group with highest BASMI (3.60 vs 3.62) also had highest mSASSS (20.33 vs 20.33).ConclusionOur data showed that male smokers with HLA-B27 positivity and SI joints inflammation have more radiological damage and higher prevalence of AS, consistent with known poor prognosis factors.

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Influence of Axial Involvement on Clinical Characteristics of Psoriatic Arthritis: Analysis from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry

The Journal of Rheumatology ◽

10.3899/jrheum.171094 ◽

2018 ◽

Vol 45 (10) ◽

pp. 1389-1396 ◽

Cited By ~ 31

Author(s):

Philip J. Mease ◽

Jacqueline B. Palmer ◽

Mei Liu ◽

Arthur Kavanaugh ◽

Renganayaki Pandurengan ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Health Assessment ◽

Disease Activity Index ◽

Severe Psoriasis ◽

Spinal Involvement ◽

Patient Reported ◽

Axial Involvement

Objective.We analyzed the characteristics of patients with psoriatic arthritis (PsA) with and without axial involvement in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry.Methods.All patients were included who had PsA and data on axial involvement, defined as physician-reported presence of spinal involvement at enrollment, and/or radiograph or magnetic resonance imaging showing sacroiliitis. Demographics, clinical measures, patient-reported outcomes, and treatment characteristics were assessed at enrollment.Results.Of 1530 patients with PsA, 192 (12.5%) had axial involvement and 1338 (87.5%) did not. Subgroups were similar in sex, race, body mass index, disease duration, presence of dactylitis, and prevalence of most comorbidities. However, patients with axial involvement were younger and more likely to have enthesitis, a history of depression, and more frequently used biologics at enrollment. They were also more likely to have moderate/severe psoriasis (body surface area ≥ 3%, 42.5% vs 31.5%) and significantly worse disease as measured by a lower prevalence of minimal disease activity (30.1% vs 46.2%) and higher nail psoriasis scores [visual analog scale (VAS) 11.4 vs 6.5], enthesitis counts (5.1 vs 3.4), Bath Ankylosing Spondylitis Disease Activity Index (4.7 vs 3.5) scores, Bath Ankylosing Spondylitis Functional Index (3.8 vs 2.5) scores, C-reactive protein levels (4.1 vs 2.4 mg/l), and scores for physical function (Health Assessment Questionnaire, 0.9 vs 0.6), pain (VAS, 47.7 vs 36.2), and fatigue (VAS, 50.2 vs 38.6).Conclusion.Presence of axial involvement was associated with a higher likelihood of moderate/severe psoriasis, with higher disease activity and greater effect on quality of life. These findings highlight the importance of monitoring patients with PsA for signs of axial symptoms or spinal involvement.

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