Assessment of widespread and extra-articular pain in psoriatic arthritis: a case-control study

Objective A remarkable lack of detailed knowledge on pain areas in Psoriatic Arthritis (PsA) is present, and their clinical relevance is quite unknown. The main aim of the study was to explore pain areas in PsA, comparing them with those involved in Fibromyalgia (FM) patients. In addition, to investigate any possible association between pain areas and outcome measures in PsA. Methods Case-control study on PsA patients satisfying CASPAR criteria and FM. In all PsA and FM patients a body chart filled in by the patient in 80 body locations was performed. The Widespread Pain Index (WPI) was performed in all PsA and FM patients. In all PsA patients, an assessment of disease activity, treatment target, function, and impact of disease were carried out. Results 50 PsA patients and 50 FM controls with FM were evaluated. A significantly higher number of pain areas at body chart and WPI score were found in FM patients when compared to PsA patients. In PsA, the number of areas reported at body chart significantly correlated with DAPSA, HAQ-DI and PsAID. Patients who were not in remission/MDA or have a greater impact of disease or reduced function showed a significant high number of extra-articular pain areas involved. Conclusion The main results showed that widespread and extra-articular pain was present in PsA patients, showing that this non-articular pain had an impact on important disease domains. The present study could contribute to an important aspect of this challenging and multifaceted disease, such as the assessment of widespread pain.

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Relation of therapies for ankylosing spondylitis and psoriatic arthritis to risk of myocardial infarction: a nested case control study

BMC Rheumatology ◽

10.1186/s41927-021-00207-1 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Rachael Stovall ◽

Christine Peloquin ◽

David Felson ◽

Tuhina Neogi ◽

Maureen Dubreuil

Keyword(s):

Myocardial Infarction ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Case Control Study ◽

Tumor Necrosis Factor Inhibitor ◽

The United States ◽

Case Control ◽

Geographical Regions ◽

Nested Case Control ◽

Control Study

Abstract Background Risk of myocardial infarction (MI) is elevated in ankylosing spondylitis and psoriatic arthritis (AS/PsA) compared to the general population. We evaluated the risk of MI related to the use of tumor necrosis factor inhibitor (TNFi) and other therapies in AS/PsA. Methods We conducted a nested case-control study using 1994–2018 data from OptumLabs® Data Warehouse, which includes de-identified medical and pharmacy claims, laboratory results, and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on enrollees and patients, representing a diverse mixture of ages, ethnicities and geographical regions across the United States. Assessing AS/PsA separately, MI cases were matched to 4 controls by sex, age, diagnosis year and insurance type. We evaluated treatment within 6 months prior to MI including NSAIDs (AS referent), disease-modifying anti-rheumatic drug (DMARDs; PsA referent) and TNFi alone or in combinations. We evaluated the relation of treatment categories to MI risk using conditional logistical regression adjusting for confounders. Results Among 26,648 AS subjects, there were 237 MI cases and 894 matched controls. Among 43,734 PsA subjects, there were 404 cases and 1596 controls. In AS, relative to NSAID use, the adjusted odds ratio (aOR) for MI among TNFi only users was 0.85 (95% CI 0.39–1.85) and for DMARD only users was 1.04 (95% CI 0.65–1.68). In PsA, relative to DMARD use, the aOR among TNFi only was 1.09 (95% CI 0.74–1.60). Combination therapies also had no effect. Conclusions Among AS/PsA, no combination of therapies appeared to be protective or harmful with regards to MI. Future studies should capture more AS and PsA patients and include longer term follow up to further investigate this question.

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