Background/Purpose: Extra-articular manifestations (EAMs) in rheumatic diseases have been previously found to negatively impact health outcomes including quality of life and work capacity. Even though EAMs may be directly associated with worse response to treatment, differences in patient-reported outcomes (PROs) based on the presence of EAMs could be an important contributory variable. The objective of this study was to assess the impact of EAMs on PROs among patients with active AS or PsA followed in Canadian routine clinical care.

Methods: Patients eligible for the COMPLETE studies are anti-TNFα naïve adults, with active AS or PsA per the judgment of the treating physician, who require change in their treatment regimen. In the current analysis, patients enrolled between July 2011 and June 2017 were included. The EAMs were defined as the presence of the following at baseline: enthesitis, uveitis, IBD or psoriasis (EAM_AS1 for AS); enthesitis, uveitis, or IBD (EAM_AS2 for AS); enthesitis or dactylitis (EAM_PsA for PsA). The PROs included the Short Form Health Survey (SF-12), Work Limitations Questionnaire (WLQ), and Beck’s Depression Inventory (BDI). The PROs were compared between patients with and without EAMs using the independent samples t-test. The independent association between presence of EAMs and PROs at baseline was assessed with multivariate generalized linear models adjusting for disease state (high/very high vs. inactive/low/moderate disease based on the BASDAI for AS and the DAS28 for PsA), disease type, and ever smoking.

Results:

A total of 609 AS and 406 PsA patients were included with a mean (SD) age of 43.1 (13.4) and 51.3 (12.3) years, respectively. The EAM_AS1 and EAM_AS2 prevalence among AS patients was 33.9% and 25%, respectively, while among PsA patients EAM_PsA prevalence was 45.4%.

In univariate analysis, presence of EAMs in AS was associated with significantly higher disease activity, BDI total score, WLQ mental interpersonal demands (only for EAM_AS1), WLQ physical demands, WLQ time demands, SF-12 physical function, SF-12 role physical, SF-12 bodily pain, SF-12 vitality, SF-12 mental health (only for EAM_AS1), and the SF-12 physical component summary score (PCS). Among PsA patients, patients with EAM_PsA had higher disease activity but no significant association was observed between EAM_PsA and PROs.

Upon adjusting for disease state, disease type, and ever smoking, presence of EAM_AS1/EAM_PsA for AS/PsA patients was associated with significantly higher BDI total score (14.0 vs. 12.6, p=0.046) and lower SF-12 physical function (38.4 vs. 44.8, p=0.047). When evaluating the impact of EAM_AS2/EAM_PsA for AS/PsA patients no significant differences were observed in PROs; however, BDI was notably higher among patients with EAMs (14.1 vs. 12.7, p=0.056).

Conclusion: In a Canadian routine clinical care setting, a substantial proportion of AS and PsA patients requiring a change in treatment report EAMs. Presence of EAMs, particularly psoriasis for AS patients, was found to be a significant independent predictor of depressive symptoms and reduced quality of life due to worse physical functioning.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-extra-articular-manifestations-on-patient-reported-outcomes-in-ankylosing-spondylitis-and-psoriatic-arthritis-interim-results-from-the-complete-studies/