Characteristics of Patients with Psoriatic Arthritis Presenting with Axial Involvement: Results of a Prospective International Multicenter Study (AXIS)

Murat Torgutalp¹, Valderilio Azevedo², Xenofon Baraliakos³, Filip Van den Bosch⁴, Jürgen Braun⁵, Alberto Cauli⁶, Laura Coates⁷, Vinod Chandran⁸, Torsten Diekhoff⁹, Floris van Gaalen¹⁰, Rodrigo Garcia Salinas¹¹, Lianne S Gensler¹², Niti Goel¹³, Alice Gottlieb¹⁴, Desiree van der Heijde¹⁵, Philip Helliwell¹⁶, Kay Geert Hermann¹⁷, Umut Kalyoncu¹⁸, Uta Kiltz¹⁹, Robert Lambert²⁰, Ying Ying Leung²¹, Maria Llop²², Alejandra Lopez²³, Miranda van Lunteren²⁴, Ajesh Maharaj²⁵, Walter Maksymowych²⁶, Helena Marzo-Ortega²⁷, Ashish J Mathew²⁸, Philip Mease²⁹, Peter Nash³⁰, Mikkel Ostergaard³¹, Fabian Proft³², Mikhail Protopopov³³, Sherry Rohekar³⁴, RUXANDRA ELENA SCHIOTIS³⁵, Joachim Sieper³⁶, Enrique R. Soriano³⁷, Lai-shan Tam³⁸, James Wei³⁹, Nelly Ziade⁴⁰, Dafna Gladman⁴¹ and Denis Poddubnyy⁴², and AXIS Cohort Investigators, ¹Charite Universitatsmedizin - Berlin, Berlin, Germany, ²Department of Internal Medicine, Universidade Federal of Paraná, Curitiba, Brazil, Curitiba, Brazil, ³Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany, ⁴Ghent University Hospital, Ghent, Belgium, ⁵Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany., Herne, Germany, ⁶University of Cagliari, Cagliari, Italy, ⁷University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom, ⁸University of Toronto, Toronto, ON, Canada, ⁹Charite Universitatsmedizin Berlin, Berlin, Germany, ¹⁰LUMC, Leiden, Zuid-Holland, Netherlands, ¹¹Hospital Italiano La Plata, La Plata, Argentina, ¹²Department of Medicine/Rheumatology, University of California, San Francisco, San Francisco, CA, ¹³Caduceus Biomedical Consulting, Duke University, Durham, NC, ¹⁴Department of Dermatology, Icahn School of Medicine, New York, NY, USA., New York, NY, ¹⁵Department of Rheumatology, Leiden University Medical Center, Meerssen, Netherlands, ¹⁶Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK., Leeds, United Kingdom, ¹⁷Charite Medical School, Berlin, Germany, ¹⁸Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey, ¹⁹Rheumazentrum Ruhrgebiet Herne, Ruhr-University, D-44649 Herne, Germany, ²⁰University of Alberta, Edmonton, AB, Canada, ²¹Singapore General Hospital, Singapore, Singapore, ²²Hospital Parc Tauli, Sabadell, Spain, ²³Centro Dermatológico del Country, Guadalajara, Jalisco, Mexico, Guadalajara, Mexico, ²⁴Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, ²⁵Department of Internal Medicine & Therapeutics, Faculty of Health Sciences. Walter Sisulu University, Eastern Cape, South Africa, Eastern Cape, South Africa, ²⁶Department of Medicine, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada, Edmonton, Canada, ²⁷NIHR Leeds BRC, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK., Leeds, United Kingdom, ²⁸Christian Medical College, Vellore, Tamil Nadu, India, ²⁹Swedish Medical Center/Providence St. Joseph Health; University of Washington School of Medicine, Seattle, WA, ³⁰School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia, ³¹Department of Clinical Medicine, University of Copenhagen and Center for Rheumatology, Copenhagen Center for Arthritis Research, Glostrup, Denmark, ³²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, ³³Charite – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, ³⁴Western University, London, Ontario, Canada, London, Canada, ³⁵SPITAL CLINIC DE BOLI INFECTIOASE CLUJ NAPOCA, Cluj-Napoca, Romania, ³⁶Charité University Medicine Berlin, Berlin, Germany, ³⁷Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, ³⁸The Chinese University of Hong Kong, New Territories, Hong Kong, ³⁹Chung Shan Medical University Hospital; China Medical University, Taichung, Taiwan (Republic of China), ⁴⁰Saint-Joseph University, Beirut, Lebanon, ⁴¹University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ⁴²Charite-Universitatsmedizin Berlin, Berlin, Germany

Meeting: ACR Convergence 2024

Keywords: Back pain, Demographics, Psoriatic arthritis, spondyloarthritis, Spondyloarthropathies

Session Information

Date: Monday, November 18, 2024

Title: SpA Including PsA – Diagnosis, Manifestations, & Outcomes Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Axial involvement, affecting the sacroiliac joints (SIJ) and/or spine, is a clinically relevant manifestation of psoriatic arthritis (PsA) that can influence management strategies. Previous studies have reported a wide range (25% to 70%) of axial involvement prevalence due to differing definitions and detection methods. The Axial Involvement in Psoriatic Arthritis (AXIS) cohort, a collaborative project of ASAS and GRAPPA, aimed to systematically evaluate the clinical and imaging characteristics of axial involvement in individuals with PsA.

Methods: AXIS was a prospective, multicenter, multinational, cross-sectional study conducted across 19 countries globally. Eligible participants (pts) were individuals with PsA meeting the Classification Criteria for Psoriatic Arthritis (CASPAR) with musculoskeletal symptom duration of ≤10 years, who had not received biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Pts underwent standardized clinical assessments and radiography and magnetic resonance imaging (MRI) of the SIJ and spine. Imaging studies were evaluated both locally and centrally for the presence of imaging signs indicative of axial involvement. The primary outcome, determined by investigators’ judgment, was the presence of axial involvement, assessed both before and after the central imaging review.

Results: Of the 409 enrolled individuals with PsA, initial evaluation by local investigators identified likely axial involvement in 153 pts (37.4%). This decreased to 112 pts(27.4%) after final evaluation incorporating expert assessment of imaging (Figure 1). Of the 112, pts with axial involvement were slightly younger (average 45.2 vs. 47.6 years), were more frequently males (56.3% vs. 51.5%), and had a higher frequency of HLA-B27 (22.4% vs. 10.8%), inflammatory back pain (IBP) (74.7% vs. 43.4%), and elevated C-reactive protein (CRP) levels (52.7% vs. 37.4%)(Table 1). Active inflammatory and structural changes on imaging clearly discriminated between pts with and without axial involvement (Table 2). Central imaging review identified imaging findings indicative of axial involvement in 95 of 409 pts (23.2%). Among the 112 pts classified as having axial involvement, 66 (58.9%) showed findings indicative of axial involvement on at least one imaging modality by central review. In contrast, only 29 pts (9.8%) without axial involvement had any positive imaging findings by central review

Conclusion: After local investigators’ final assessment, axial involvement was detected in 27.4% of pts with PsA. The presence of IBP, HLA-B27 positivity, higher CRP levels, and the presence of active inflammatory and structural changes in the SIJs and spine were associated with axial involvement in PsA pts. Further work is underway to develop classification criteria for axial involvement in PsA.

Figure 1. Parallel set plot for the diagnostic evaluation of patients across different stages

Table 1. Demographic and clinical characteristics of patients with and without axial involvement

Table 2. Local investigator imaging assessment.

Disclosures: M. Torgutalp: None; V. Azevedo: AbbVie/Abbott, 2, 5, Amgen, 1, 2, Eli Lilly, 1, 2, 5, Janssen, 1, 5, Novartis, 1, 2; X. Baraliakos: AbbVie, 2, 6, 12, Paid instructor, BMS, 2, 6, 12, Paid instructor, Chugai, 2, 6, 12, Paid instructor, Eli Lilly, 2, 6, 12, Paid instructor, Galapagos, 2, 6, 12, Paid instructor, Gilead, 2, MSD, 6, 12, Paid instructor, Novartis, 2, 5, 6, 12, Paid instructor, Pfizer, 2, 6, 12, Paid instructor, UCB Pharma, 2, 5, 6, 12, Paid instructor; F. Van den Bosch: AbbVie/Abbott, 2, 6, Amgen, 6, Eli Lilly, 2, Fresenius Kabi, 6, Galapagos, 2, Janssen, 6, Novartis, 6, UCB, 6; J. Braun: None; A. Cauli: None; L. Coates: AbbVie, 2, 5, 6, Amgen, 2, 5, 6, Biogen, 6, Bristol Myers Squibb, 2, Celgene, 2, 5, 6, Eli Lilly, 2, 5, 6, Galapagos, 2, 6, Gilead, 2, 6, GSK, 6, Janssen, 2, 5, 6, Medac, 6, MoonLake, 2, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, UCB Pharma, 2, 5, 6; V. Chandran: AbbVie/Abbott, 1, 5, AstraZeneca, 12, Spousal employment, Bristol-Myers Squibb(BMS), 1, Eli Lilly, 1, Janssen, 1, Novartis, 1, UCB, 1; T. Diekhoff: Eli Lilly, 5, Merck/MSD, 5, Novartis, 5, UCB, 5, 6; F. van Gaalen: AbbVie, 12, Personal fees, BMS, 12, Personal fees, Eli Lilly, 12, Personal fees, Jacobus Stichting, 5, MSD, 12, Personal fees, Novartis, 2, 5, Stichting ASAS, 5, Stichting Vrienden van Sole Mio, 5, UCB Pharma, 5; R. Garcia Salinas: AbbVie/Abbott, 2, 6, Amgen, 6, Bristol-Myers Squibb(BMS), 6, Eli Lilly, 6, Janssen, 2, 6, Novartis, 6, Pfizer, 6, Roche, 6; L. Gensler: AbbVie/Abbott, 2, Acelyrin, 2, Eli Lilly, 2, Fresenius Kabi, 2, Janssen, 2, MoonLake, 2, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5; N. Goel: UCB, 12, Own stocks; A. Gottlieb: Boehringer-Ingelheim, 6, Bristol-Myers Squibb(BMS), 5, 6, Eli Lilly, 6, Janssen, 5, 6, Novartis, 6, UCB, 5, 6; D. van der Heijde: AbbVie, 2, ArgenX, 2, BMS, 2, Eli Lilly, 2, Galapagos, 2, GSK, 2, Imaging Rheumatology BV, 3, Janssen, 2, Novartis, 2, Pfizer, 2, Takeda, 2, UCB Pharma, 2; P. Helliwell: Amgen, 1, Novartis, 1; K. Hermann: AbbVie/Abbott, 2, MSD, 6, Novartis, 6, Pfizer, 6; U. Kalyoncu: AbbVie/Abbott, 6, Pfizer, 6, UCB, 6; U. Kiltz: AbbVie, 2, 5, 6, Amgen, 5, Biocad, 2, 6, Biogen, 5, Chugai, 2, 6, Eli Lilly, 2, 6, Fresenius, 5, 6, Grünenthal, 2, 6, GSK, 5, Hexal, 5, Janssen, 2, 6, MSD, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, Roche, 2, 6, UCB, 2, 6; R. Lambert: CARE Arthritis, 2, Image Analysis Group, 2; Y. Leung: None; M. Llop: AbbVie/Abbott, 6, Amgen, 6, Eli Lilly, 6, Janssen, 6, Novartis, 6, Pfizer, 6; A. Lopez: None; M. van Lunteren: None; A. Maharaj: None; W. Maksymowych: AbbVie/Abbott, 5, 6, Bristol-Myers Squibb(BMS), 6, Eli Lilly, 6, Janssen, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, UCB, 6; H. Marzo-Ortega: Amgen, 2, Janssen, 5, 6, Merck/MSD, 2, 6, Novartis, 5, 6, Pfizer, 5, 6, Roche, 2, 6, UCB, 5, 6; A. Mathew: Novartis, 5; P. Mease: AbbVie, 2, 5, Aclaris Therapeutics, 2, 5, Aclyrin, 2, 5, Amgen, 2, 5, Boehringer Ingelheim, 2, 5, Bristol Myers Squibb, 2, 5, CorEvitas, 2, 5, Galápagos, 2, 5, Gilead, 2, 5, Inmagene, 2, 5, Janssen, 2, 5, Lilly, 2, 5, MoonLake Immunotherapeutics, 2, 5, Novartis, 2, 5, Pfizer Inc, 2, 5, Sun Pharma, 2, 5, UCB, 2, 5; P. Nash: AbbVie, 5, 6, BMS, 5, 6, Boehringer Ingelheim, 5, 6, Eli Lilly, 5, 6, Gilead/Galapagos, 5, 6, GSK, 5, 6, Janssen, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, Samsung, 5, 6, Sanofi, 5, 6, UCB Pharma, 5, 6; M. Ostergaard: Abbott, 2, 5, 6, BMS, 6, Centocor, 5, Merck, 2, 6, Mundipharma, 6, Pfizer, 2, 5, 6, Roche, 2, UCB Pharma, 2, 6; F. Proft: AbbVie, 2, 6, Amgen, 2, 6, BMS, 2, 6, Celgene, 2, 6, Eli Lilly, 5, Galapagos, 2, 6, Hexal, 2, 6, Janssen, 2, 6, Medscape, 2, 5, MSD, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 6, Roche, 2, 6, UCB Pharma, 2, 5, 6; M. Protopopov: Janssen, 6, Novartis, 6; S. Rohekar: AbbVie/Abbott, 6, Amgen, 6, Bristol-Myers Squibb(BMS), 6, Celgene, 6, Eli Lilly, 6, Gilead, 6, Janssen, 6, Merck/MSD, 6, Novartis, 6, Pfizer, 6, Roche, 6, UCB, 5, 6; R. SCHIOTIS: None; J. Sieper: AbbVie/Abbott, Merck, Novartis, UCB, 1, 3; E. Soriano: AbbVie, 2, 5, 6, Amgen, 6, Bristol Myers Squibb, 6, Eli Lilly, 6, Janssen, 2, 5, 6, Novartis, 2, 5, 6, Pfizer, 5, 6, Roche, 2, 5, 6, UCB, 5, 6; L. Tam: AbbVie/Abbott, 2, Amgen, 5, Boehringer-Ingelheim, 2, 5, Eli Lilly, 2, GlaxoSmithKlein(GSK), 5, Janssen, 2, 5, Novartis, 5, Pfizer, 2, 5, Sanofi, 2; J. Wei: None; N. Ziade: AbbVie/Abbott, 1, 6, Celgene, 5, Eli Lilly, 5, 6, Gilead, 5, Janssen, 5, 6, Pfizer, 5, 6, Roche, 1, 6; D. Gladman: AbbVie, 2, 5, Amgen, 2, 5, AstraZeneca, 2, BMS, 2, Celgene, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, 5, Gilead, 2, 5, Janssen, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5; D. Poddubnyy: AbbVie, 2, 5, 6, Biocad, 2, Bristol-Myers Squibb(BMS), 2, 6, Eli Lilly, 2, 5, 6, Gilead, 2, MSD, 2, 5, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, Samsung Bioepis, 2, UCB, 2, 6.

To cite this abstract in AMA style:

Torgutalp M, Azevedo V, Baraliakos X, Van den Bosch F, Braun J, Cauli A, Coates L, Chandran V, Diekhoff T, van Gaalen F, Garcia Salinas R, Gensler L, Goel N, Gottlieb A, van der Heijde D, Helliwell P, Hermann K, Kalyoncu U, Kiltz U, Lambert R, Leung Y, Llop M, Lopez A, van Lunteren M, Maharaj A, Maksymowych W, Marzo-Ortega H, Mathew A, Mease P, Nash P, Ostergaard M, Proft F, Protopopov M, Rohekar S, SCHIOTIS R, Sieper J, Soriano E, Tam L, Wei J, Ziade N, Gladman D, Poddubnyy D. Characteristics of Patients with Psoriatic Arthritis Presenting with Axial Involvement: Results of a Prospective International Multicenter Study (AXIS) [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/characteristics-of-patients-with-psoriatic-arthritis-presenting-with-axial-involvement-results-of-a-prospective-international-multicenter-study-axis/. Accessed .

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