Session Information
Date: Monday, November 9, 2015
Title: Spondylarthropathies and Psoriatic Arthritis - Comorbidities and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Psoriatic arthritis (PsA) is a heterogeneous disease presenting with musculoskeletal and extra-articular manifestation. Enthesitis is a well-known component of PsA. However, little is known about the disease association and risk factors of clinical enthesitis in patients with PsA.
Aim: To evaluate the disease association and risk factors of clinical enthesitis in patients with PsA.
Methods:
The study population included patients with PsA who were followed at 6 months interval according to a standard protocol from January 2008 to December 2014. Enthesitis was defined as the presence of at least one painful entheseal site of the 18 entheseal insertion locations of the SPARCC (Spondyloarthritis Research Consortium of Canada) enthesitis index. Logistic regression was used to analyze baseline characteristics associated with enthesitis and a Cox regression analysis was used to identify predictors for the development of enthesitis in those without enthesitis at baseline.
Results:
Of 803 patients who were seen during this period 281 (35%) had clinical enthesitis on at least one visit, while 522 (65%) did not. The enthesitis group was significantly younger at baseline and was younger at psoriasis diagnosis. The mean active joint count as well as the presence of tenosynovitis were significantly higher in the enthesitis group. The damaged joint count and the mean Steinbrocker score were significantly lower in the enthesitis group. Fibromyalgia was more prevalent in the enthesitis group. Quality of life and function were significantly poorer in the enthesitis group. The enthesitis group used significantly more NSAIDS. Multivariate logistic regression analysis showed that the following variables were independently associated with the presence of enthesitis: younger age (OR 0.98, p=0.03), higher mean active joints (OR 1.06, p<0.0001), less damaged joints (OR 0.97, p=0.01), presence of tenosynovitis (OR 2.75, p=0.0008) and NSAIDS use (OR 1.6, p=0.01). 128 (16%) patients were diagnosed with new clinical enthesitis during follow-up. Predictive factors for development of enthesitis are shown in the table 1.
able 1: Multivariate cox regression analysis risk factors for enthesitis in PsA patients
|
Variable |
Hazard Ratio |
Lower C.I |
Higher C.I |
P-value |
|
Age at baseline |
0.98 |
0.97 |
0.99 |
0.007 |
|
Age at psoriasis diagnosis |
0.99 |
0.98 |
1.004 |
0.2 |
|
Gender |
1.01 |
0.8 |
1.3 |
0.92 |
|
BMI |
1.02 |
0.99 |
1.04 |
0.1 |
|
Active joint count |
1.02 |
1.007 |
1.03 |
0.003 |
|
Presence of tenosynovitis |
2.1 |
1.45 |
3.01 |
<0.0001 |
|
Damaged joint counts |
0.97 |
0.95 |
0.99 |
0.003 |
|
Steinbrocker score |
0.99 |
0.98 |
1.02 |
0.9 |
|
PASI |
1.009 |
0.99 |
1.03 |
0.4 |
|
Presence of nail lesions |
1.09 |
0.82 |
1.44 |
0.5 |
|
Presence of sacroiliitis |
1.06 |
0.8 |
1.4 |
0.7 |
|
Presence of fibromyalgia |
1.2 |
0.82 |
1.8 |
0.3 |
|
HAQ |
1.5 |
1.2 |
1.8 |
0.0009 |
|
NSAIDS use |
1.3 |
0.96 |
1.74 |
0.08 |
Conclusion: PsA patients with enthesitis are younger, have higher active joint counts, more tenosynovitis, less damage and worse quality of life. The same variables are predictive of developing enthesitis during the course of PsA.
To cite this abstract in AMA style:
Polachek A, Li S, Chandran V, Gladman D. Enthesitis in Psoriatic Arthritis – Disease Association and Risk Factors [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/enthesitis-in-psoriatic-arthritis-disease-association-and-risk-factors/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/enthesitis-in-psoriatic-arthritis-disease-association-and-risk-factors/