Clinical Characteristics and Disease Activity in Psoriatic Arthritis Patients with Dactylitis or Enthesitis: Results from Corrona Registry

Philip J. Mease¹, Chitra Karki², Carol J. Etzel^2,3, Arthur Kavanaugh⁴, Christopher T. Ritchlin⁵, Wendi Malley², Vivian Herrera⁶, Jacqueline B. Palmer⁶ and Jeffrey D. Greenberg^2,7, ¹Swedish Medical Center and University of Washington School of Medicine, Seattle, WA, ²Corrona, LLC, Southborough, MA, ³The University of Texas MD Anderson Cancer Center, Houston, TX, ⁴University of California San Diego, La Jolla, CA, ⁵Allergy, Immunology and Rheumatololgy Division, University of Rochester Medical Center, Rochester, NY, ⁶Novartis Pharmaceuticals Corporation, East Hanover, NJ, ⁷New York University School of Medicine, Millburn, NJ

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Disease Activity, Enthesitis, psoriatic arthritis and registries

Session Information

Date: Sunday, November 8, 2015

Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment Poster I: Clinical Aspects and Assessments

Session Type: ACR Poster Session A

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

Background/Purpose: Psoriatic arthritis (PsA) exhibits considerable heterogeneity in its presentation and course, which contributes to the complexity of diagnosis and assessment. Enthesitis, inflammation at the insertion sites of tendons and ligaments, and dactylitis, the diffuse swelling of digits, are important extra-articular manifestations of PsA and are present in many patients. The objective of this analyses was to characterize the demographic and clinical characteristics of PsA patients with dactylitis or enthesitis and evaluate the association with outcomes such as minimal disease activity (MDA) and functional status, measured by health assessment questionnaire (HAQ) in a large national observational cohort of PsA and spondyloarthritis patients (Corrona).

Methods: All PsA patients ≥18 years enrolled in the Corrona registry were included in the study. Descriptive analyses of patient characteristics, disease activity, and functionality measures at registry enrollment were assessed for patients with and without enthesitis and dactylitis. Regression models were used to evaluate the associations of enthesitis and dactylitis status, separately, with the clinical outcome measures MDA and HAQ (0-3); adjusted for age, gender, race, BMI, disease duration, history of biologic use, history of conventional synthetic DMARD use, and history of prednisone use.

Results: Of the 1567 PsA patients included in the analysis, 228 (14.6%) had dactylitis and 420 (26.8%) had enthesitis at enrollment. Patients with enthesitis or dactylitis had greater disease activity, as reflected in swollen and tender joint count, DAS28-CRP,and CDAI; a lower percentage were in minimal disease activity (MDA) and higher pain and fatigue compared to those who did not have dactylitis or enthesitis (Table). Multivariable analysis showed patients with dactylitis were almost 3 times (OR=2.53, 95% CI=1.55, 4.15) more likely to not be in MDA compared to patients with no dactylitis and patients with enthesitis were over 4 times (OR=4.38, 95% CI=2.77, 6.95) more likely to not be in MDA compared to patients with no enthesitis. Sensitivity analysis evaluating the associations between enthesitis and a modified MDA (5/6 criteria excluding enthesitis) showed consistent results (OR=1.88, 95% CI=1.23, 2.86). Adjusted models showed a mean difference of 0.08 (95% CI= -0.02, 0.17) in HAQ in patients with dactylitis compared to patients with no dactylitis, although not statistically significant. A significant difference of 0.16 (95% CI=0.09, 0.24) in HAQ was seen in patients with enthesitis compared to those who did not have enthesitis.

Conclusion: PsA patients with enthesitis or dactylitis are more likely to have elevated disease activity than patients without these manifestations and have less likelihood of being in MDA and to have worse functional status as assessed by the HAQ.

Table: Baseline characteristics of PsA patients by dactylitis/enthesitis status
Patient characteristics	Dactylitis (n = 228)	No Dactylitis (n = 1339)	Enthesitis (n = 420)	No Enthesitis (n = 1147)
Demographics
Age (years, mean [SD])	51.8 (13.3)	54.2 (13.3)^†	52.5 (13.5)	54.3 (13.2)^†
Sex (% female)	48.2%	53.2%	59.2	50^†
BMI (kg/m², mean [SD])	32 (7.2)	31.5 (7.2)	31.7 (6.9)	31.5 (7.3)
Disease characteristics
BSA >3% (%)	41.6%	35.5%	37.2%	36.1%
Disease duration (years, mean [SD])	7.7 (8.9)	8.7 (8.9)	7.5 (8.9)	9 (8.9)^†
68 Tender joint count (n, median [IQR])	2 (0 – 8)	1 (0 – 5)^*	6 (1 – 14)	0 (0 – 3)^*
66 Swollen joint count (n, median [IQR])	2 (0 – 6)	0 (0 – 2)^*	1 (0 – 4)	0 (0 – 2)^*
DAS28-CRP (mean [SD])	3.1 (1.2)	2.7 (1)^*	3.2 (1.1)	2.6 (1)^*
CDAI (mean [SD])	14.7 (10.9)	11.4 (8.2)^*	14.8 (10.8)	10.9 (7.6)^*
CRP (mg/L, mean [SD])	4.4 (10.7)	6.9 (16.1)^†	3.5 (7.7)	6.3 (13.4)
MDA (%)	13.5%	34.2%^*	11.1%	37.1%^*
History of comorbidities
Cardiovascular disease (%)	53.5%	60.6%^†	58.1%	60.2%
Any cancer (%)	6.1%	7.5%	6.7%	7.6%
Serious infections (%)	6.6%	4.6%	5.2%	4.8%
Patient reported outcome measures
HAQ (0-3) (mean [SD])	0.7 (0.7)	0.6 (0.6)	0.8 (0.7)	0.6 (0.6)^*
Pain VAS (0-100) (mean [SD])	42 (29.2)	36.8 (29.1)^†	44.3 (28.8)	35.1 (28.9)^*
Fatigue (0-100) (mean [SD])	43.5 (28.6)	40 (29.4)	46.7 (28.7)	38.2 (29.2)^*
*p-value <0.0001; †p-value<0.05. BMI: Body mass index; BSA: Body Surface Area; SD: Standard deviation; IQR: Interquartile range; CDAI: clinical disease activity index; CRP: C – reactive protein; MDA: minimal disease activity; HAQ: Health assessment questionnaire; VAS: Visual Analogue Scale. History of any cancer excludes non-melanoma skin cancer; serious infections: those infections that led to hospitalization to IV antibiotics.

Disclosure: P. J. Mease, Celgene, 2,Merck Pharmaceuticals, 2,Novartis Pharmaceutical Corporation, 2,AbbVie, 2,Amgen, 2,Biogen Idec, 2,Bristol-Myers Squibb, 2,Genentech and Biogen IDEC Inc., 2,Janssen Pharmaceutica Product, L.P., 2,Lilly, 2,Pfizer Inc, 2,UCB, 2,Celgene, 5,Merck Pharmaceuticals, 5,Novartis Pharmaceutical Corporation, 5,AbbVie, 5,Amgen, 5,Biogen Idec, 5,Bristol-Myers Squibb, 5,Crescendo, 5,Genentech and Biogen IDEC Inc., 5,Janssen Pharmaceutica Product, L.P., 5,Lilly, 5,Pfizer Inc, 5,UCB, 5,Vertex, 5,AbbVie, 8,Amgen, 8,Biogen Idec, 8,Bristol-Myers Squibb, 8,Crescendo, 8,Genentech and Biogen IDEC Inc., 8,Janssen Pharmaceutica Product, L.P., 8,Lilly, 8,Pfizer Inc, 8; C. Karki, Corrona, LLC, 3; C. J. Etzel, Corrona, LLC., 3; A. Kavanaugh, AbbVie, 2,Amgen, 2,Janssen Pharmaceutica Product, L.P., 2,UCB, 2; C. T. Ritchlin, Amgen, 2,Janssen Pharmaceutica Product, L.P., 2,UCB, 2,AbbVie, 5,Amgen, 5,Janssen Pharmaceutica Product, L.P., 5,Regeneron, 5,UCB, 5; W. Malley, Corrona, LLC., 3; V. Herrera, Novartis Pharmaceutical Corporation, 1,Novartis Pharmaceutical Corporation, 3; J. B. Palmer, Novartis Pharmaceutical Corporation, 3; J. D. Greenberg, Corrona, LLC., 3,Corrona, LLC., 1,AstraZeneca, Celgene, Genentech, Janssen, Novartis, Pfizer, 5.

To cite this abstract in AMA style:

Mease PJ, Karki C, Etzel CJ, Kavanaugh A, Ritchlin CT, Malley W, Herrera V, Palmer JB, Greenberg JD. Clinical Characteristics and Disease Activity in Psoriatic Arthritis Patients with Dactylitis or Enthesitis: Results from Corrona Registry [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/clinical-characteristics-and-disease-activity-in-psoriatic-arthritis-patients-with-dactylitis-or-enthesitis-results-from-corrona-registry/. Accessed .

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