Factors Explaining Patient Perspective in Psoriasis and Psoriatic Arthritis: The Role of Inflammation and Structural Damage Detected by Ultrasound

Tania Gudu¹, Ilaria Padovano ¹, Hélène Gouze ², François Vidal ¹, Emmanuel Mahé ³, Leire Lara Gonzalez ⁴, Alexis Guyot ⁴, Philippe Saiag ⁴, Isabelle Bourgault Villada ⁴, Sophie Ruel-Gagné ¹, Gilles Hayem ¹, Félicie Costantino ⁵, Maxime Breban ⁶ and Maria-Antonietta D’Agostino ⁷, ¹Rheumatology Department, APHP, Ambroise Paré Hospital, Boulogne Billancourt, France, ²Rheumatology Department, APHP, Ambroise Paré Hospital, Bolougne Billancourt, France, ³Dermatology Department, Victor Dupouy Hospital, Argenteuil, France, ⁴Dermatology Department, Ambroise Paré Hospital, Boulogne Billancourt, France, ⁵UMR1173, INSERM/Versailles-Saint Quentin University, France Ambroise Paré Hospital (AP-HP) Department of Rheumatology, Boulogne-Billancourt, France, Boulogne Billancourt, France, ⁶UMR1173, INSERM/Versailles-Saint Quentin University, France Ambroise Paré Hospital (AP-HP) Department of Rheumatology, Boulogne-Billancourt, France, Boulogne Billancourt, ⁷Department of Rheumatology, APHP, Hôpital Ambroise Paré, Paris, France

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: patient outcomes and ultrasound, psoriasis, Psoriatic arthritis

Session Information

Date: Sunday, November 10, 2019

Title: Imaging Of Rheumatic Diseases Poster I

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Patient reported outcomes (PROs) reflect patients’ opinion on disease activity, impact of disease, quality of life (QoL), disability and are essential in the assessment of PsA patients. PROs may be influenced by several factors other than disease activity and severity. US is an objective tool to evaluate inflammation and structural damage in PsA. This cross-sectional study aimed at evaluating the role of US-detected inflammation (synovitis, tenosynovitis, enthesitis, dactylitis) and structural damage (erosions, enthesophytes, osteophytes and cortical irregularities), according to the OMERACT definitions and scoring [1], to explain PROs in PsA and to compare that to psoriasis (PsO) patients with and without musculoskeletal (MSK) symptoms.

Methods: PsA (CASPAR criteria) [2], PsO with MSK symptoms without fulfilling CASPAR criteria (symptoPsO) and PsO with no MSK symptoms (asymptoPsO) were included. Socio-demographic characteristics, comorbidities, disease duration and treatment were collected. All patients underwent dermatological and rheumatologic assessment: PsO severity, swollen joint count (SJC), tender JC (TJC), number of dactylitis and enthesitis, fibromyalgia criteria; and US evaluation on joints, tendons and entheses as shown in figure 1. PROs were evaluated in all patients: assessment of skin psoriasis and of fatigue on a numeric rating scale (NRS), HAQ and QoL assessed by SF36. Variables were compared across groups (chi square or one-way ANOVA test). Correlations were evaluated using Spearman’s test.

Results: One hundred fifty eight patients (54 PsA, 52 symptoPsO and 52 asymptoPsO) with similar socio-demographic characteristics and PsO duration were included (table 1). Most of PsA patients had low/moderate disease activity. With the exception of US enthesophytes, all US changes were significantly higher in PsA, followed by symptoPsO patients.

Across all 3 groups, all PROs correlated mainly with demographic variables, comorbidities, TJC, number of enthesitis, skin severity, depression and fibromyalgia (r=0.29-0.66). SymptoPsO and PsA reported similar scores of fatigue and impact on some QoL domains (vitality, pain, general health, social and mental), significantly higher than asymptoPsO. Only in PsA, HAQ correlated with the total number of US enthesitis (r=0.35, p=0.01) and of joints with ostheophytes/cortical irregularities (r=0.28, p=0.04) as well as the physical function domain of SF36 with the number of joints with ostheophytes/cortical irregularities (r=-0.33, p=0.02).

Conclusion: Quality of life, disability and fatigue were more impaired in PsA and symptoPsO patients than asymptoPsO. In all groups, PROs were mostly associated with socio-demographic characteristics, comorbidities and some clinical variables rather than objective measures such as US changes.

Acknowledgement: The study was supported by a grant from The PARTNER Psoriatic Arthritis Network fellowship.

References:

Bruyn GA et al. J Rheumatol 2019

Taylor W et al. Arthritis Rheum 2006

Figure 1. Anatomical sites of US evaluation: joints, entheses and tendons

table 1

Table 1. Characteristics of the patients included in the 3 groups: PsA patients, patients with psoriasis with MSK symptoms -symptoPsO- and patients with psoriasis and no MSK symptoms -asymptoPsO-

PsA: psoriatic arthritis; PsO: psoriasis; PASI: Psoriasis Area and Severity Index; TJC: total tender joint count; SJC: total swollen joint count; N: number; SD: standard deviation; NRS: numeric rating scale; SF36: Medical Outcome Study Short Form-36; PF: Physical Functioning; RP: Physical Role functioning; BP: Bodily Pain; GH: General Health; VT: Vitality; SF: Social role Functioning; MH: Mental Health; RE: Emotional Role functioning
* Number of enthesitis was calculated according to the Spondyloarthritis Research Consortium of Canada -SPARCC- Enthesitis Index

Disclosure: T. Gudu, None; I. Padovano, None; H. Gouze, None; F. Vidal, None; E. Mahé, None; L. Lara Gonzalez, None; A. Guyot, None; P. Saiag, None; I. Bourgault Villada, None; S. Ruel-Gagné, None; G. Hayem, None; F. Costantino, None; M. Breban, None; M. D’Agostino, None.

To cite this abstract in AMA style:

Gudu T, Padovano I, Gouze H, Vidal F, Mahé E, Lara Gonzalez L, Guyot A, Saiag P, Bourgault Villada I, Ruel-Gagné S, Hayem G, Costantino F, Breban M, D’Agostino M. Factors Explaining Patient Perspective in Psoriasis and Psoriatic Arthritis: The Role of Inflammation and Structural Damage Detected by Ultrasound [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/factors-explaining-patient-perspective-in-psoriasis-and-psoriatic-arthritis-the-role-of-inflammation-and-structural-damage-detected-by-ultrasound/. Accessed .

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