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Abstract Number: 1796

Early Identification of Psoriatic Arthritis with Axial Involvement Among Patients with Psoriasis: A Prospective Multicenter Study

Fabian Proft1, Susanne Lüders2, Theresa Hunter3, Gustavo Luna4, Valeria Rios Rodriguez1, Mikhail Protopopov1, Katharina Meier5, Georgios Kokolakis5, Kamran Ghoreschi5 and Denis Poddubnyy6, 1Charité University Medicine Berlin, Berlin, Germany, 2Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, Berlin, Germany, 3Eli Lilly and Company, Indianapolis, IN, USA, Indianapolis, IN, 4ICON plc, Stockholm, Sweden, 5Department of Dermatology, Venereology and Allergology – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, Berlin, Germany, 6Department of Rheumatology, Charité – Universitätsmedizin, Berlin, Germany

Meeting: ACR Convergence 2021

Keywords: Dermatology, Imaging, Psoriatic arthritis

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Session Information

Date: Tuesday, November 9, 2021

Session Title: Spondyloarthritis Including PsA – Diagnosis, Manifestations, & Outcomes Poster IV: Clinical Aspects of PsA & Peripheral SpA (1773–1800)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: In the absence of reliable serological and/or imaging biomarkers for early psoriatic arthritis (PsA) and an existing diagnostic delay there is a need for screening tools for detection of early PsA. While different validated screening/referral tools focusing on peripheral manifestations of PsA exist1, validated referral algorithms for PsA with axial involvement (axPsA) are missing. In this prospective, multicenter study we applied a dermatologist-centered screening tool to identify signs of axial involvement among patients with psoriasis (PsO) attending dermatology clinics.

Methods: Consecutive patients with PsO were screened by their dermatologist for eligibility for referral to a specialized rheumatology clinic. Eligible patients were ≥ 18 years with a confirmed diagnosis of PsO who reported having chronic back pain (≥ 3 months) with onset prior to 45 years of age and who had not been treated with any biologic or targeted synthetic DMARD in the 12 weeks prior to screening. For those patients who qualified for referral and attended the rheumatology clinic, a rheumatologic investigation including clinical, laboratory and genetic assessments as well as imaging with conventional radiography and MRI of sacroiliac joints and spine was performed. The primary outcome of the study was the proportion of patients diagnosed with axPsA among all referred PsO patients.

Results: In total 355 patients were screened at 14 dermatology sites, of whom 151 (42.5%) qualified for referral to rheumatology clinic. Rheumatologists ultimately examined 100 (28.2%) patients (Figure 1). The diagnosis of axPsA was confirmed in 14 patients (14%) (3/14 with both, axial and peripheral involvement) and the diagnosis of peripheral PsA (pPsA) without axial involvement was made in five patients (5%). 81 (81%) patients were diagnosed with neither pPsA nor axPsA. Clinical, lab and imaging characteristics of the study population, as well as subgroups with and without axial involvement, are presented in Table 1. All patients diagnosed with axPsA had active inflammatory and/or structural (post) inflammatory changes in the sacroiliac joints and/or spine on imaging. In five (35.7%) patients, MRI changes indicative of axial involvement were found only in the spine. The Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA were fulfilled in nine (64.3%) of the patients diagnosed with axPsA. All but one patient diagnosed with PsA (13/14 with axPsA and 5/5 with pPsA) fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) for PsA as illustrated in Figure 1.

Conclusion: Our study revealed that applying a dermatologist-centered screening tool is useful for the detection of axPsA and pPsA in PsO patients at-risk. These results provide valuable real-world insights into the possibility of diagnosing axPsA and pPsA early with the ultimate goal of improving the care and quality of life of patients living with the disease.

Mishra S et al. BR J Dermatol. 2017;176(3):765-770.

Acknowledgements: C. Höppner, R. Bolce, D. Sandoval, H. Russ, B. Muche, J. Rademacher, H. Haibel, L. Spiller and all cooperating dermatologists.


Disclosures: F. Proft, Novartis, 1, 5, 6, Eli Lilly and Company, 1, 5, UCB, 1, 5, 6, AbbVie, 1, 6, Amgen, 1, 6, Bristol-Myers Squibb, 1, 6, Hexal, 1, 6, MSD, 1, 6, Pfizer, 1, 6, Roche, 1, 6; S. Lüders, None; T. Hunter, Eli Lilly and Company, 3, 11; G. Luna, Eli Lilly and Company, 2, AbbVie, 2, Pfizer, 2, Takeda, 2; V. Rios Rodriguez, None; M. Protopopov, Novartis, 1, 5, 6; K. Meier, AbbVie, 2, 6, Amgen, 2, 6, Biogen, 2, 6, Celgene, 6, Janssen-Cilag, 6, UCB Pharma, 6; G. Kokolakis, G.K. Pharma, 5, AbbVie, 2, 6, Actelion Pharmaceuticals, 2, 6, Basilea Pharmaceutica, 2, 6, Biogen, 2, 6, Celgene, 2, 6, Hexal-Sandoz, 2, 6, Janssen-Cilag, 2, 6, LEO Pharma, 2, 6, Eli Lilly and Company, 2, 6, MSD, 2, 6, Novartis, 2, 6, Pfizer, 2, 6, UCB Pharma, 2, 6; K. Ghoreschi, AbbVie, 2, 6, 12, Clinical study investigator, Boehringer Ingelheim, 2, 12, Clinical study investigator, Bristol-Myers Squibb, 2, 6, 12, Clinical study investigator, Eli Lilly and Company, 2, 6, 12, Clinical study investigator, Janssen-Cilag, 2, 6, 12, Clinical study investigator, LEO Pharma, 2, 6, Viatris, 2, Novartis, 2, 6, 12, Clinical study investigator, Pfizer, 2, 6, 12, Clinical study investigator, UCB Pharma, 2, 6, 12, Clinical study investigator; D. Poddubnyy, AbbVie, 2, 5, 6, Eli Lilly and Company, 2, 5, 6, MSD, 2, 5, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, UCB, 2, 6, BMS, 2, 6, Roche, 2, 6.

To cite this abstract in AMA style:

Proft F, Lüders S, Hunter T, Luna G, Rios Rodriguez V, Protopopov M, Meier K, Kokolakis G, Ghoreschi K, Poddubnyy D. Early Identification of Psoriatic Arthritis with Axial Involvement Among Patients with Psoriasis: A Prospective Multicenter Study [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/early-identification-of-psoriatic-arthritis-with-axial-involvement-among-patients-with-psoriasis-a-prospective-multicenter-study/. Accessed February 2, 2023.
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