Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Few studies have compared the clinical and imaging (x-ray and MRI) characteristics between axial psoriatic arthritis (axPsA) and axial spondyloarthritis patients without psoriasis (axSpA). We compared the clinical and imaging characteristics in these two groups.
Methods
AxSpA patients were identified by searching electronic medical records of our university, and axPsA patients were identified from our existing cohort. Demographic and clinical data were collected by chart review. Disease activity was measured using BASDAI and RAPID3. For imaging comparisons, the patients were divided into 2 gender and disease duration matched subgroups – 1) AS: ankylosing spondylitis patients without psoriasis fulfilling mNY criteria 2) axPsA: PsA patients fulfilling mNY criteria. Symmetry of sacroiliitis was defined as having same grade of sacroiliitis on each side. Bilateralism was defined as having any grade sacroiliitis on either side. Categorical and continuous variables were reported using proportions and means. Statistical significance was estimated using Mann-Whitney, two mean comparison t-tests, and two sample proportion comparison tests as applicable.
Results
Of 168 SpA patients, 135 axSpA patients were compared with 33 axPsA patients (Table1). Mean age, symptom duration, BMI were similar between the two groups. axSpA had lesser number of females compared to axPsA (33% vs. 57%, p<0.01), higher prevalence of uveitis (29% vs. 12%, p<0.04), higher HLA B27 (80% vs. 50%, p<0.007) and higher BASDAI and RAPID3 scores (BASDAI 4.4 vs 3.8, RAPID3 4.3 vs 3.6, p = ns). These scores were numerically higher in HLA-B27 positive compared to HLA-B27 negative patients (4.3 vs. 3.7, and 4.4 vs. 3.6, respectively; p = ns). Eighteen patients with axPsA were gender and disease duration matched with 86 patients with AS. Radiographic grading of sacroiliitis, symmetry or bilateralism were not significantly different between AS and axPsA. RAPID 3 and BASDAI scores did not correlate with radiographic grading in any group. No significant clinical or imaging differences were found between patients positive and negative for HLA B27.
Conclusion
In this comparative study between axPsA and axSpA patients, we found a higher prevalence of female gender, uveitis and positive HLA-B27 in the axSpA group. Our findings do not confirm the previous reports of more symmetry and more severe disease in AS compared to axPsA patients.
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Table1: Demographic and clinical characteristics of axSpA and axPsA patients |
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All patients N=168 % or means (standard deviation) |
axSpA N=135 (80.4%) % or means (standard deviation) |
axPsA N=33 (19.6%) % or means (standard deviation) |
P value |
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Age (years) |
39.6 (13.4) |
38.7 (13.7) |
43.1 (11.2) |
0.09 |
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Female |
64 (38.1%) |
45 (33.3%) |
19 (57.6%) |
0.01 |
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Symptom duration (years) |
12.8 (10.6) |
13 (10.9) |
12.2 (9.6) |
0.87 |
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BMI (kg/m2) |
27.5 (6.8) |
27.7 (6.9) |
26.85 (6) |
0.54 |
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Smoking status |
60 (35.7%) |
47 (34.8%) |
10 (30.3%) |
0.14 |
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Sacroiliitis on x-rays* |
150/163(92%) |
118/131(90.1%) |
32/32 (100%) |
<0.0001 |
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Sacroiliitis on MRI** |
49/54 (90.7%) |
33/37 (89.2%) |
16/17 (94.1%) |
0.56 |
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HLA B27 |
91/119 (76.5%) |
83/103 (80.6%) |
8/16 (50%) |
0.007 |
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BASDAI |
4.31 (2.4) |
4.41 (2.5) |
3.82 (2) |
0.4 |
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RAPID 3 |
4.18 (2.20) |
4.32 (2.21) |
3.67 (2.16) |
0.15 |
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ESR mm/hr |
28 (25.7) |
27.4 (24.8) |
29.5 (28.4) |
0.81 |
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CRP mg/dl |
2.6 (5.8) |
2.89 (6.5) |
1.88 (3) |
0.28 |
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Peripheral arthritis Uveitis IBD Depression Fibromyalgia Spinal Fractures Ischemic Heart Disease |
42 (25%) 44 (26.2%) 26 (15.5%) 44 (26.2%) 15 (8.9%) 7 (4.2%) 5 (2.9%) |
31 (22.9%) 40 (29.6%) 22 (16.3%) 34 (25.2%) 11 (8.2%) 7 (5.2%) 5 (3.7%) |
11 (33%) 4 (12.1%) 4 (12.1%) 10 (30.3%) 4 (12.1%) 0 (0%) 0 (0%) |
0.22 0.04 0.55 0.55 0.47 0.18 0.26 |
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NSAIDs DMARDs any TNF inhibitors (%) |
129 (77.7%) 68 (40.5%) 70.8 |
109 (81.9%) 51 (37.8%) 95 (70.4%) |
20 (60.6%) 17 (51.5%) 24 (72.7%) |
0.008 0.15 0.79 |
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*Sacroiliitis on X-Ray defined as either present or absent irrespective of Modified NY grading. **Sacroiliitis on MRI defined as presence of edema, erosions, sclerosis or ankylosis as reported by the radiologist |
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Table 2: Comparison of data for radiographic disease: AS vs axPsA, gender and duration matched |
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Variable |
AS (N=86) N (%); Mean (SD) |
axPsA (N=18) N (%); Mean (SD) |
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X ray Grade Right 1 2 3 4 |
100% 3 (3.5) 22 (25.6) 41 (47.7) 20 (23.3) |
100% 0 3 (16.7) 10 (55.6) 5 (27.8) |
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X ray Grade Left 1 2 3 4 |
88% 1 (1.2) 18 (20.9) 48 (55.8) 17 (19.8) |
100% 0 5 (29.4) 8 (47.1) 4 (23.5) |
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Symmetry on x-ray |
63/86 (73.3) |
13/17 (76.5) |
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Bilateral on x-ray |
84/86 (97.7) |
17/17 (100) |
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Sacroiliitis on x ray* |
86/86 (100) |
18/18 (100) |
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Sacroiliitis on MRI** |
18/21 (85.7) |
6/6 (100) |
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MRI fatty change Right b/l |
12% 1 (5.9) 1 (5.9) |
16% 0 1 (16.7) |
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MRI edema Left Right b/l |
66% 1 (5.6) 1 (5.6) 10 (55.6) |
100% 0 2 (33.3) 4 (66.7) |
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MRI structural changes β Right b/l |
78% 1 (5.6) 13 (72.2) |
50% 0 3 (50) |
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*Sacroiliitis on X-Ray defined as either present or absent irrespective of Modified NY grading. **Sacroiliitis on MRI defined as presence of edema, erosions, sclerosis or ankylosis as reported by the radiologist |
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Disclosure:
N. Garg,
None;
A. Danve,
None;
K. Vakil-Gilani,
None;
A. A. Deodhar,
Abbott, Amgen, Janssen, Novartis, Pfizer and UCB Pharma,
2,
Abbott, Amgen, Janssen, Novartis, Pfizer and UCB Pharma,
5.
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