Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Progression of psoriatic arthritis (PsA) has traditionally been evaluated using clinical assessments. However, a strong relationship between clinical and radiological outcomes has been shown, as radiological changes often precede clinical damage detection. Our post-hoc analysis examines the characteristics of plaque psoriasis (Ps) patients without diagnosed PsA, but with imaging evidence of damage (possible early signs of PsA). The objective was to determine whether these patients have a phenotype more similar to patients diagnosed with PsA than to patients confirmed non-PsA who exhibit no evidence of damage.
Methods: In the PREPARE study, all subjects were initially seen by a dermatologist and assessed for Ps. Subjects determined to have Ps, regardless of severity, were randomized to receive one of three PsA screening questionnaires. Following questionnaire completion, patients were evaluated by rheumatologists to establish or exclude a clinical diagnosis of PsA based on the subject’s medical history and physical examination. Designated site imaging assessments (magnetic resonance imaging [MRI] and ultrasound) were performed in a subset of subjects to confirm the absence or presence of abnormalities. Continuous parameters were analyzed using one-way ANOVA while categorical parameters were analyzed using chi-square tests.
Results: In these analyses, 285 patients were diagnosed with PsA and 115 were determined not to have PsA (non-PsA) by clinical assessment. Baseline demographic and disease characteristics of non-PsA patients ± imaging abnormalities were similar to one another and tended to be different to those of PsA patients. At baseline, PsA patients were significantly older, with a higher proportion of whites, higher DAS28 and had more swollen/tender joints, higher ESR, worse HAQ, longer Ps duration and worse EQ-5D than non-PsA patients either ± imaging abnormalities (Table). For most radiological measures the proportions of patients with abnormalities were similar between PsA and non-PsA groups, with the exception of dactylitis (Table). Of the imaged patients, PsA patients have a significantly greater likelihood of dactylitis than non-PsA patients (44.3% vs 9.2%; OR=7.81; P<0.0001), while the association was more muted (90.9% vs 79.1%;OR=2.65; P=0.0301) when combining all imaging abnormalities in the ‘any abnormality’ group.
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Baseline Demographics and Disease Characteristics
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Characteristic
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Non-PsA
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PsA n=285
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P-value†
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+ imaging result for “any abnormality” n=91
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– imaging result for “any abnormality” n=24
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Age, years |
47.5 |
46.6 |
51.5 |
0.014 |
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Race, white (%) |
87.9 |
91.7 |
97.2 |
0.007 |
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Duration Ps, years |
16.5 |
17.1 |
21.7 |
0.011 |
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DAS28 |
2.1 |
2.1 |
3.3 |
<0.001 |
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Swollen joint count |
0.03 |
0.08 |
2.7 |
<0.001 |
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Tender joint count |
1.5 |
1.2 |
5.0 |
<0.001 |
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Erythrocyte sedimentation rate (ESR) |
10.1 |
11.8 |
15.5 |
0.009 |
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Health assessment questionnaire disability index (HAQ) |
0.3 |
0.3 |
0.7 |
<0.001 |
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EuroQol-5 dimensions utility score (EQ5D) |
0.8 |
0.8 |
0.7 |
0.003 |
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Radiological measure
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Patients with imaging abnormalities
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PsA (%)
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Non-PsA (%)
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Any abnormality¶ |
90.9 |
79.1* |
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Enthesitis (Ultrasound) |
70.1 |
61.1 |
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Abnormality of foot joint (Ultrasound) |
5.3 |
2.7 |
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Abnormality of hand joint (Ultrasound) |
5.3 |
0.9 |
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Abnormality of sacroiliac joint (MRI) |
61.3 |
54.0 |
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Abnormality of spine (MRI) |
50.7 |
45.0 |
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Dactylitis‡ (Ultrasound) |
44.3 |
9.2** |
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*P<0.05, **P<0.0001 vs patients with PsA, †Overall P-value indicates whether at least one of the three groups are statistically different. ‡The number of subjects with ultrasound imaging of dactylitis (n=126) was smaller than other imaging studies (n=172-188) because at 2 sites dactylitis imaging was performed only in those with a suspected problem. This may have introduced some bias in the ultrasound evaluation and analyses of dactylitis. ¶Combines the data of patients with any of the abnormalities listed in the table.
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Conclusion: A higher proportion of patients diagnosed with PsA had subclinical imaging abnormalities than non-PsA patients. Radiological detection of ‘any abnormality’ confirmed a significant difference in the extent of joint abnormalities in diagnosed PsA patients to those with imaging detected subclinical joint damage. The baseline results indicate a phenotypic difference between PsA patients and non-PsA patients, but a lack of distinction between non-PsA patients with and without imaging detected abnormalities.
Disclosure:
P. Mease,
AbbVie, Amgen, BiogenIdec, BMS, Celgene, Crescendo, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer, UCB, Vertex,
2,
AbbVie, Amgen, BiogenIdec, BMS, Celgene, Crescendo, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer, UCB, Vertex,
5,
AbbVie, Amgen, BiogenIdec, BMS, Crescendo, Genentech, Janssen, Lilly, Pfizer, UCB,
8;
J. Coindreau,
Pfizer Inc.,
3;
L. Mallbris,
Pfizer Inc.,
3;
A. Szumski,
Pfizer Inc.,
3;
H. Jones,
Pfizer Inc.,
3.
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