Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Previous studies have shown associations between swelling or tenderness of specific joints in RA patients and patient pain. This analysis aimed to describe the impact of enthesitis count and enthesitis profile on functional status (HAQ) and patient global assessment of disease activity (PtGA) among SpA patients treated with anti-TNFs under Canadian routine clinical care.
Methods: BioTRAC is an ongoing, prospective registry of patients initiating treatment with infliximab (IFX) or golimumab (GLM) for RA, AS, or PsA, or with ustekinumab (UST) for PsA. In this analysis, AS and PsA patients treated with IFX between 2005-2016 or GLM between 2010-2016, and PsA patients treated with UST between 2014-2016, were included. Based on enthesitis location 8 groups were created: suprapsinatus, medial epicondyle humerus, lateral epinondyle humerus, greater trochanter, quadriceps patella, achilles, plantar fascia, and patellar-tibia. The impact of specific entheseal points on HAQ, PtGA, and pain (only for PsA) was assessed with the independent-samples t-test; general linear models were used to assess the relative impact of each location on these outcomes.
Results: A total of 503 AS patients and 330 PsA patients with 1669 and 1126 assessments, respectively, were included. At baseline, mean (SD) age was 45.4 (13.0) and 51.0 (12.3) years for AS and PsA patients, respectively, and disease duration was 6.6 (9.6) and 5.4 (7.1) years. In terms of disease activity, mean (SD) ASDAS and BASDAI were 3.5 (1.0) and 6.1 (2.2), respectively, whereas, among PsA patients, DAS28 was 4.3 (1.4). Overall, a weak correlation (r<0.4) was observed between enthesitis count and HAQ, PtGA and pain in both AS and PsA patients. Presence of enthesitis at all sites, however, was associated with significantly (P<0.05) higher HAQ and PtGA irrespective of SpA type. Upon adjusting for age and gender, among AS patients, enthesitis at supraspinatus, greater trochanter, and achilles were the main predictors of higher HAQ and PtGA whereas enthesitis at plantar fascia was associated with higher HAQ only. Among PsA patients, medial or lateral epicondyle humerus and greater trochanter were the main predictors of increased HAQ and PtGA, while patellar/tibia was associated with significantly HAQ only.
Conclusion: Although enthesitis at all sites was associated with significantly higher HAQ and PtGA, individual sites were differentially associated with these outcomes. In AS, supraspinatus, greater trochanter, and achilles were identified as the main predictors of poor patient outcomes, while, among PsA patients, medial/lateral epicondyle humerus and greater trochanter were the most important sites. These results suggest that, in addition to the presence of enthesitis, location of enthesitis may have an impact on patient reported outcomes.
To cite this abstract in AMA style:Kelsall J, Boulos P, Arendse R, Teo M, Jaroszynska A, Starr M, Tsoukas A, Rampakakis E, Psaradellis E, Maslova K, Tkaczyk C, Nantel F, Osborne B, Lehman AJ. Do Specific Entheseal Points in Spa Patients Impact Patient Reported Outcomes? Implications for Clinical Practice [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/do-specific-entheseal-points-in-spa-patients-impact-patient-reported-outcomes-implications-for-clinical-practice/. Accessed November 27, 2021.
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