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Abstract Number: 2220

Development of the Pulsar (Program to Understand the Longterm Outcomes in Spondyloarthritis) Registry

Andreas M. Reimold1, Liron Caplan2, Daniel O. Clegg3, Gail S. Kerr4, Elizabeth Chang5, Lisa A. Davis6, Prashant Kaushik7, Vikas Majithia8, J. Steuart Richards9, Joel D. Taurog10 and Jessica Walsh11, 1Rheumatology, Dallas VA and University of Texas Southwestern, Dallas, TX, 2Div of Rheumatology, Denver VA and Univ of Colorado School of Medicine, Aurora, CO, 3Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, UT, 4Rheumatology, Washington DC VAMC, Georgetown and Howard University, Washington, DC, 5Phoenix VAHCS, Phoenix, AZ, 6Division of Rheumatology, Denver Health and Hospital Authority, Denver, CO, 7Department of Medicine, Sratton VAMC, Albany, NY, 8Div of Rheumatology, University of Mississippi Medical Center, Jackson, MS, 9Rheumatology, Washington DC VA and Georgetown University, Washington, DC, 10Internal Medicine, Rheumatic Diseases Division, UT Southwestern Medical Center, Dallas, TX, 11Rheumatology, University of Utah Hospital, Salt Lake City, UT

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS), Anti-TNF therapy and spondylarthropathy

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Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment

Session Type: Abstract Submissions (ACR)

Background/Purpose: The spondyloarthritides are a group of conditions characterized by inflammation in the axial skeleton or peripheral joints.  The arthritis may present as the primary manifestation (e.g. ankylosing spondylitis, reactive arthritis), or a related condition may predominate (inflammatory bowel disease (IBD), uveitis, or cutaneous psoriasis). To better characterize the clinical and pathophysiologic aspects of these diseases, a registry for veterans with spondyloarthritis and related conditions was initiated in 2007.

 Methods: A set of electronic medical record templates was developed for standardizing collection of clinical information at outpatient visits for spondyloarthritis patients. Internal Review Board (IRB) approval for the PULSAR registry was obtained at 7 VA sites (Albany, NY, Dallas, TX, Denver, CO, Jackson, MS, Phoenix, AZ, Salt Lake City, UT, Washington, DC). Data collected includes demographics (age, gender, race/ethnicity, education, smoking status, comorbidities) and disease-specific features (disease classification, disease activity measures (BASDAI, BASFI, pain and global assessments, psoriasis area and global assessments), medications, laboratory and imaging results, and HLA-B27 status).  Each patient’s DNA, RNA, serum, and plasma are stored in a biorepository.

Results: The PULSAR registry has enrolled 513 patients, whose diagnoses are psoriatic arthritis (29.2%), ankylosing spondylitis (20.7%), reactive arthritis (6.2%), anterior uveitis (5.5%), and IBD-related arthritis (3.7%). Patients without arthritis but with IBD or cutaneous psoriasis make up the rest of the registry and are available as controls. To date, 3677 clinic visits have been recorded, representing 2246 patient years of observation. Patients are 92% male, with mean age of 58.5 years and 13 or more years of schooling in 61.7% of the cohort. Current tobacco use is present in 24% while 62% are former smokers. Of 275 patients tested to date, 58.5% are HLA-B27 positive. The most common comorbidities are hypertension, hyperlipidemia, osteoarthritis, diabetes, and obesity.   Forty percent are currently on biologic medication, 39% take an analgesic or NSAID, 36% are on a traditional DMARD, and 29% take an osteoporosis medication.  The five most commonly used medications are adalimumab, methotrexate, etanercept, hydrocodone, and ibuprofen (Table).

Conclusion: The PULSAR registry is a growing resource for study of spondyloarthritis and related conditions. Anti-TNFa medications are the most commonly prescribed drugs in the registry. Standardized multi-site data collection allows for improved disease characterization and assessment of disease activity. As most participants receive all their medical care in the VA system, a particular strength of PULSAR is the comprehensive acquisition of pharmacy and comorbidity data.

 

Medication Use

Current

Ever

Adalimumab

17%

Methotrexate

28%

Methotrexate

16%

Etanercept

25%

Etanercept

15%

Adalimumab

23%

Hydrocodone

15%

Etodolac

21%

Ibuprofen

11%

Hydrocodone

20%

Tramadol

11%

Acetaminophen

18%

Etodolac

10%

Ibuprofen

17%

Acetaminophen

10%

Sulfasalazine

16%

Sulfasalazine

9%

Tramadol

15%

Infliximab

8%

Infliximab

14%

 


Disclosure:

A. M. Reimold,
None;

L. Caplan,
None;

D. O. Clegg,
None;

G. S. Kerr,
None;

E. Chang,
None;

L. A. Davis,
None;

P. Kaushik,
None;

V. Majithia,
None;

J. S. Richards,
None;

J. D. Taurog,
None;

J. Walsh,
None.

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