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Abstract Number: 1112

Examining Phenotypes Of Patients With Psoriasis In The Prepare Study For Similarities Between Diagnosed Psoriatic Arthritis and Those With Signs Of Subclinical Psoriatic Arthritis Detected By Imaging

Philip Mease1, Javier Coindreau2, Lotus Mallbris2, Annette Szumski3 and Heather Jones2, 1Division of Rheumatology Research, Swedish Medical Center and University of Washington, Seattle, WA, 2Pfizer Inc., Collegeville, PA, 3Specialty Care, Pfizer Inc., Collegeville, PA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Imaging, joint damage, psoriatic arthritis and radiology

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Session Information

Title: Imaging of Rheumatic Diseases II: Imaging in Spondyloarthritis and Osteoarthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Progression of psoriatic arthritis (PsA) has traditionally been evaluated using clinical assessments. However, a strong relationship between clinical and radiological outcomes has been shown, as radiological changes often precede clinical damage detection.  Our post-hoc analysis examines the characteristics of plaque psoriasis (Ps) patients without diagnosed PsA, but with imaging evidence of damage (possible early signs of PsA). The objective was to determine whether these patients have a phenotype more similar to patients diagnosed with PsA than to patients confirmed non-PsA who exhibit no evidence of damage.  

Methods: In the PREPARE study, all subjects were initially seen by a dermatologist and assessed for Ps. Subjects determined to have Ps, regardless of severity, were randomized to receive one of three PsA screening questionnaires. Following questionnaire completion, patients were evaluated by rheumatologists to establish or exclude a clinical diagnosis of PsA based on the subject’s medical history and physical examination. Designated site imaging assessments (magnetic resonance imaging [MRI] and ultrasound) were performed in a subset of subjects to confirm the absence or presence of abnormalities. Continuous parameters were analyzed using one-way ANOVA while categorical parameters were analyzed using chi-square tests.

Results: In these analyses, 285 patients were diagnosed with PsA and 115 were determined not to have PsA (non-PsA) by clinical assessment. Baseline demographic and disease characteristics of non-PsA patients ± imaging abnormalities were similar to one another and tended to be different to those of PsA patients.  At baseline, PsA patients were significantly older, with a higher proportion of whites, higher DAS28 and had more swollen/tender joints, higher ESR, worse HAQ,  longer Ps duration and worse EQ-5D than non-PsA patients either ± imaging abnormalities (Table). For most radiological measures the proportions of patients with abnormalities were similar between PsA and non-PsA groups, with the exception of dactylitis (Table). Of the imaged patients, PsA patients have a significantly greater likelihood of dactylitis than non-PsA patients (44.3% vs 9.2%; OR=7.81; P<0.0001), while the association was more muted (90.9% vs 79.1%;OR=2.65; P=0.0301) when combining all imaging abnormalities in the ‘any abnormality’ group.

Baseline Demographics and Disease Characteristics

Characteristic

Non-PsA

PsA

n=285

P-value†

+ imaging result for “any abnormality”

n=91

– imaging result for “any abnormality”

n=24

Age, years

47.5

46.6

51.5

0.014

Race, white (%)

87.9

91.7

97.2

0.007

Duration Ps, years

16.5

17.1

21.7

0.011

DAS28

2.1

2.1

3.3

<0.001

Swollen joint count

0.03

0.08

2.7

<0.001

Tender joint count

1.5

1.2

5.0

<0.001

Erythrocyte sedimentation rate (ESR)

10.1

11.8

15.5

0.009

Health assessment questionnaire disability index (HAQ)

0.3

0.3

0.7

<0.001

EuroQol-5 dimensions utility score (EQ5D)

0.8

0.8

0.7

0.003

Radiological measure

Patients with imaging abnormalities

PsA (%)

Non-PsA (%)

Any abnormality¶

90.9

79.1*

Enthesitis (Ultrasound)

70.1

61.1

Abnormality of foot joint (Ultrasound)

5.3

2.7

Abnormality of hand joint (Ultrasound)

5.3

0.9

Abnormality of sacroiliac joint (MRI)

61.3

54.0

Abnormality of spine (MRI)

50.7

45.0

Dactylitis‡ (Ultrasound)

44.3

9.2**

*P<0.05, **P<0.0001 vs patients with PsA, †Overall P-value indicates whether at least one of the three groups are statistically different.

‡The number of subjects with ultrasound imaging of dactylitis (n=126) was smaller than other imaging studies (n=172-188) because at 2 sites dactylitis imaging was performed only in those with a suspected problem. This may have introduced some bias in the ultrasound evaluation and analyses of dactylitis.

¶Combines the data of patients with any of the abnormalities listed in the table.

 

Conclusion: A higher proportion of patients diagnosed with PsA had subclinical imaging abnormalities than non-PsA patients. Radiological detection of ‘any abnormality’ confirmed a significant difference in the extent of joint abnormalities in diagnosed PsA patients to those with imaging detected subclinical joint damage. The baseline results indicate a phenotypic difference between PsA patients and non-PsA patients, but a lack of distinction between non-PsA patients with and without imaging detected abnormalities.


Disclosure:

P. Mease,

AbbVie, Amgen, BiogenIdec, BMS, Celgene, Crescendo, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer, UCB, Vertex,

2,

AbbVie, Amgen, BiogenIdec, BMS, Celgene, Crescendo, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer, UCB, Vertex,

5,

AbbVie, Amgen, BiogenIdec, BMS, Crescendo, Genentech, Janssen, Lilly, Pfizer, UCB,

8;

J. Coindreau,

Pfizer Inc.,

3;

L. Mallbris,

Pfizer Inc.,

3;

A. Szumski,

Pfizer Inc.,

3;

H. Jones,

Pfizer Inc.,

3.

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