ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1509

Similarities and Differences between Non-Radiographic and Radiographic Axial Spondyloarthritis

Denis Poddubnyy1, Robert D Inman2, Joachim Sieper1, Servet Akar3, Santiago Muñoz-Fernández4 and Maja Hojnik5, 1Charité Universitätsmedizin Berlin, Berlin, Germany, 2Toronto Western Hospital, Toronto, ON, Canada, 3Rheumatology, Izmir Katip Celebi University, School of Medicine, Rheumatology, Izmir, Turkey, 4Hospital Universitario Infanta Sofía, Universidad Europea, Mardid, Spain, 5AbbVie, Ljubljana, Slovenia

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Monday, November 6, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Differences between non-radiographic and radiographic axial spondyloarthritis (axSpA) – such as a higher prevalence of females and lower level of acute phase reactants in non-radiographic axSpA (nr-axSpA) – have been reported in national observational studies, mostly from Europe. This analysis compared demographic and clinical characteristics of patients (pts) with nr-axSpA and radiographic axSpA (ankylosing spondylitis, AS) in a large multinational cohort of pts with recently diagnosed axSpA.

Methods: PROOF is a prospective observational study evaluating clinical and radiographic outcomes in axSpA pts in rheumatology clinical practice in 29 countries. Pts with axSpA fulfilling ASAS classification criteria were eligible if diagnosed ≤1 year prior to study enrolment. Investigator‘s confidence with the axSpA diagnosis was ascertained on a numeric rating scale (NRS 0-10) at enrolment and end of follow-up. At baseline, demographic and clinical data related to the diagnosis, disease activity, quality of life and work productivity, as well as conventional radiographs of the sacroiliac joints were collected. Classification as nr-axSpA or AS was based on results of the assessment of sacroiliac radiographs. Available radiographs were assessed by a local reader and then by a central reader according to grading system of modified New York criteria. In the case of a disagreement in classification (nr- axSpA or AS), the radiograph was evaluated by the 2nd central reader, who was blinded to previous assessments and final classification was made based on the decision of 2 out of 3 readers.

Results: Of the 2126 pts enrolled in PROOF, 1281 (60.3%) pts were classified as AS and 845 (39.7%) as nr-axSpA according to investigators. Confidence with the diagnosis of axSpA was 8.7±1.8. Final classification according to central assessment of sacroiliac radiographs was confirmed in1583 pts included in this analysis. A total of 987 pts (62.3%) were classified as AS and 596 (37.7%) as nr-axSpA. AS pts expectedly had longer symptom duration, more frequently had elevated and higher CRP and were more often male and treated with TNF inhibitors (Table). In addition, HLA-B27 positivity was more frequent among AS pts, while pts with nr-axSpA had a significantly higher prevalence of enthesitis, psoriasis, and inflammatory bowel disease (IBD). Prevalence of other SpA features was comparable between the two subgroups of axSpA. MMostly, pt-reported outcomes reflecting burden of disease were comparable between the two subgroups, but BASDAI was significantly higher in the nr-axSpA subgroup (Table).

Conclusion: There were a few differences between nr-axSpA and AS pts in the PROOF cohort. Clinical constellation of female sex, low CRP, enthesitis, psoriasis, and IBD in nr-axSpA pts appears to reflect a phenotype less prone to structural damage in the sacroiliac joints. However, clinical burden of disease was comparable between the two subgroups of axSpA.

Table. Baseline demographic and clinical characteristics of patients from PROOF cohort.

Characteristic

nr-axSpA

(N = 544)

AS

(N = 1039)

P-valuea

Age, years, mean ± SD

35.5 ± 9.8

34.5 ± 11.1

.070

Duration since back pain onset, months, mean ± SD

48.7 ± 69.2

62.4 ± 90.9

.001

Duration since diagnosis, months, mean ± SD

2.8 ± 5.6

4.0 ± 20.2

.119

Male sex, n (%)

264 (48.5)

737 (71.0)

<.001

SpA parameters

HLA-B27 (+), n (%)

254 (55.3)b

591 (69.0)c

<.001

Inflammatory back pain, n (%)

512 (94.1)

991 (95.4)

.279

Peripheral arthritis, n (%)

171 (31.4)

343 (33.0)

.535

Enthesitis (heel), n (%)

214 (39.3)

348 (33.5)

.023

Dactylitis, n (%)

32 (5.9)

57 (5.5)

.732

Uveitis, n (%)

49 (9.0)

106 (10.2)

.477

Psoriasis, n (%)

54 (9.9)

59 (5.7)

.003

IBD, n (%)

23 (4.2)

18 (1.7)

.004

Good response to NSAIDs, n (%)

324 (59.6)

636 (61.2)

.551

Family history of SpA, n (%)

101 (18.6)

196 (18.9)

.946

Elevated CRP, n (%)

178 (32.7)

555 (53.4)

<.001

Number of positive SpA parameters, mean ± SD

3.5 ± 1.4

3.8 ± 1.4

.001

CRP, mg/l, mean ± SD

11.5 ± 19.5

17.6 ± 24.3

<.001

ASDAS-CRP, mean ± SD

2.8 ± 1.1

3.0 ± 1.1

.004

BASDAI, points NRS (0-10), mean ± SD

4.8 ± 2.4

4.3 ± 2.3

<.001

Patient global, points NRS (0-10), mean ± SD

5.0 ± 4.8

4.8 ± 4.6

.183

BASFI, points NRS (0-10), mean ± SD

3.4 ± 2.5

3.3 ± 2.5

.815

SF-12v2, physical component score, mean ± SD

40.9 ± 8.9

41.0 ± 8.8

.698

SF-12v2, mental component score, mean ± SD

42.9 ± 10.9

43.7 ± 10.4

.166

WPAI-SHP – total activity impairment, mean ± SD

44.9 ± 28.1

43.1 ± 27.4

.208

Current Treatment

NSAIDs, n (%)

428 (78.7)

800 (77.0)

.485

Methotrexate, n (%)

40 (7.4)

63 (6.1)

.335

Sulfasalazine, n, (%)

117 (21.5)

253 (24.4)

.212

Steroids, n (%)

40 (7.4)

85 (8.2)

.624

Analgesics, n (%)

98 (18.0)

144 (13.9)

.033

TNF α inhibitors, n (%)

48 (8.8)

165 (15.9)

<.001

aP-values from two-sided t-test for scale variables and Fisher’s exact test for categorical variables.

bN = 459; cN = 856.

nr-axSpA = non-radiographic axial spondyloarthritis; AS = Ankylosing spondylitis; SD= standard deviation; SpA = spondyloarthritis; HLA-B27 = human leukocyte antigen B27; IBD = inflammatory bowel disease; NSAIDs = non-steroidal anti-inflammatory drugs; CRP=C-reactive protein; ASDAS-CRP = Ankylosing Spondylitis Disease Activity Score containing CRP; BASDAI = Bath Ankylosing Spondylitis Disease Activity Index; NRS = numeric rating scale; BASFI = Bath Ankylosing Spondylitis Functional Index; SF-12v2=Short form 12-item health survey; WPAI-SHP = Work productivity impairment Questionnaire–specific health problem; TNF = tumor necrosis factor.

Disclosure: D. Poddubnyy, AbbVie, Janssen, MSD, Novartis, Pfizer,, 2,AbbVie, BMS, Boehringer, MSD, Novartis, Pfizer, and UCB,, 5,AbbVie, BMS, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, 8; R. D. Inman, AbbVie, Amgen, and Janssen,, 2,AbbVie, Amgen, Janssen, Lilly, Novartis, and Pfizer, 5; J. Sieper, AbbVie, Merck, and Pfizer, 2,AbbVie, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, 5,AbbVie, Janssen, Merck, Novartis, Pfizer, Roche, and UCB., 8; S. Akar, AbbVie, BMS, MSD, Novartis, Pfizer, Roche, and UCB, 2,AbbVie, BMS, MSD, Novartis, Pfizer, Roche, and UCB, 5,AbbVie, BMS, MSD, Novartis, Pfizer, Roche, and UCB, 9; S. Muñoz-Fernández, Abbvie, BMS, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, 2,Abbvie, BMS, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, 5,Abbvie, BMS, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, 9; M. Hojnik, Abbvie, 1,abbvie, 3.

To cite this abstract in AMA style:

Poddubnyy D, Inman RD, Sieper J, Akar S, Muñoz-Fernández S, Hojnik M. Similarities and Differences between Non-Radiographic and Radiographic Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/similarities-and-differences-between-non-radiographic-and-radiographic-axial-spondyloarthritis/. Accessed .

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