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Abstract Number: 2334

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

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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.

Supporting image 1

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

Supporting image 2

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

Supporting image 3

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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