Clinical Characteristics of Importance to Outcome in Patients with Axial Spondyloarthritis: A Prospective Cohort Study

Rikke Asmussen Andreasen¹, Xenofon Baraliakos², Lars Erik Kristensen³, Kenneth Egstrup⁴, Vibeke Strand⁵, Hans Christian Horn⁶, Jimmi Wied⁶, Berit Schiøttz-Christensen⁷, Claus Aalykke¹, Inger Marie Hansen¹, Torkell Juulsgaard Ellingsen⁸ and Robin Christensen⁹, ¹Odense University Hospital, Svendborg, Svendborg, Denmark, ²Rheumazentrum Ruhrgebiet-Ruhr-University Bochum, Herne, Germany, ³The Parker Institute Copenhagen Denmark, Copenhagen, Denmark, Bispebjerg and Frederiksberg, Denmark, ⁴Odense University Hospital Svendborg, Svendborg, Denmark, ⁵Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, ⁶Odense University Hospital, Odense, Denmark, ⁷Spine Centre of Southern Denmark. Hospital lillebaelt, Middelfart, Denmark, ⁸Rheumatology Research Unit, Dept of Rheumatology Odense University Hospital, Odense C, Denmark, ⁹Musculoskeletal Statistics Unit, The Parker Institute/Odense University Hospital, Copenhagen F, Denmark

Meeting: ACR Convergence 2020

Keywords: pain, prognostic factors, spondyloarthritis

Session Information

Date: Monday, November 9, 2020

Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster III: Axial SpA

Session Type: Poster Session D

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

Background/Purpose: Despite better control of inflammation, many patients with axial spondyloarthritis (axSpA) still report pain, although they could be in remission. This suggests that in these patients chronic pain may prompt central sensitization. Our objective was to explore the prognostic value of the painDETECT questionnaire (PDQ) in relation to treatment outcomes in axSpA

Methods: AxSpA patients with high disease activity as an indication to initiate or switch a bDMARD were eligible. The PDQ score was used to distinguish participants with nociceptive pain (NcP) mechanisms from participants with mixed pain (MP); NcP was defined by a PDQ score < 13 vs. ≥13. The primary outcome was BASDAI50 responses at 12 weeks; logistic regression analysis models were used to determine the prognostic value of the NcP. Changes in continuous outcomes such were analyzed using analysis of covariance. Health related quality of life (HR-QoL) was addressed using SF-36.

Results: 49 axSpA patients were included; twenty (41%) had an NcP phenotype according to the PDQ score. BASDAI50 responses were reported by 40% (8/20) and 28% (8/29) NcP and MP groups, respectively. However, a prognostic value was not found in relation to the primary outcome (crude odds ratio [95% confidence interval] 1.75 [0.52 to 5.87]. Across most of the secondary outcomes, axSpA NcP phenotype patients reported to have the most improvements in the HR-QoL measures.

Conclusion: These data indicate influence of personalized management strategies according to patients’ pain phenotypes for stratification of axSpA patients in RCTs.

Flow chart 1Did not fulfill axSpA classification criteria. 2Resons for drop out: One participant moved to another hospital and one participant was hospitalized. 3As observed refers to participants with available data for analyses, and per protocol to participants with available data for analyses and adherence to the pre-specified protocol.

Mean SF-36 scores for Danish axSpA patients stratified by pain profiles. (A) axSpA patients classified as pure nociceptive pain (NcP) profile at baseline (B) axSpA patients classified as mixed pain (MP) profile. Mean SF-36 scores for Danish norms are also shown. PF, physical function; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health.

Disclosure: R. Andreasen, None; X. Baraliakos, AbbVie, 2, 5, Celgene, 2, 5, Galapagos, 2, 5, Janssen, 2, 5, Eli Lilly, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5, Bristol-Myers Squibb, 2, 5, Chugai, 2, 5, MSD, 2, 5, Sandoz, 2, 5, Hexal, 2, 5; L. Kristensen, AbbVie, 2, 8, Amgen Inc., 2, 8, Biogen, 2, 8, BMS, 2, 8, Eli Lilly, 2, 8, Janssen, 2, 8, Novartis, 2, 8, Pfizer, 2, 8, UCB Pharma, 2, 8, Sanofi, 2, 5, 8; K. Egstrup, None; V. Strand, AbbVie, 5, Amgen, 5, Celltrion, 5, Janssen, 5, Merck, 5, Novartis, 5, Regeneron, 5, Sanofi, 5, UCB, 5, Genentech/Roche, 5, GSK, 5, Pfizer, 5, Bayer, 5, Bristol-Myers Squibb, 5, Boehringer Ingelheim, 5, Galapagos, 5, Lilly, 5, Gilead, 5, Samsung, 5, Servier, 5, Setpoint, 5, Arena, 5, AstraZeneca, 5, Horizon, 5, Ichnos, 5, Inmedix, 5, Sandoz, 5; H. Horn, None; J. Wied, None; B. Schiøttz-Christensen, None; C. Aalykke, None; I. Hansen, None; T. Ellingsen, None; R. Christensen, None.

To cite this abstract in AMA style:

Andreasen R, Baraliakos X, Kristensen L, Egstrup K, Strand V, Horn H, Wied J, Schiøttz-Christensen B, Aalykke C, Hansen I, Ellingsen T, Christensen R. Clinical Characteristics of Importance to Outcome in Patients with Axial Spondyloarthritis: A Prospective Cohort Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/clinical-characteristics-of-importance-to-outcome-in-patients-with-axial-spondyloarthritis-a-prospective-cohort-study/. Accessed .

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