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Abstract Number: 1311

Identification of Clinical Phenotypes in Patients with Axial Spondyloarthritis, Peripheral Spondyloarthritis and Psoriatic Arthritis According to Peripheral Musculoskeletal Manifestations: A Cluster Analysis in the International ASAS-PerSpA Study

Clementina Lopez-Medina1, Sylvie Chevret2, Anna Molto1, Joachim Sieper3, Mehmet Tuncay Duruöz4, Uta Kiltz5, Bassel El-Zorkany6, Najia Hajjaj-Hassouni7, Ruben Burgos-Vargas8, Jose Maldonado-Cocco9, Nelly Ziade10, Meghna Gavali11, Victoria Navarro-Compán12, Shue Fen Luo13, Alessandro Biglia14, Tae-Jong Kim15, Mitsumasa Kishimoto16, Fernando Pimentel-Santos17, Jieruo Gu18, Laura Muntean19, Floris van Gaalen20, Pál Géher21, Marina Magrey22, Sebastian Ibanez23, Wilson Bautista-Molano24, Walter Maksymowych25, Pedro M Machado26, Robert Landewé27, Désirée van der Heijde28 and Maxime Dougados29, 1Rheumatology Department, Cochin Hospital, Paris, Paris, France, 2INSERM (U1153): Clinical Epidemiology and Biostatistics, University of Paris, Paris, France, 3Charité Universitätsmedizin Berlin, Berlin, Germany, 4Marmara University School of Medicine, PMR Department, Rheumatology Division, Istanbul, Turkey, 5Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany, 6Cairo University, Cairo, Egypt, 7Health Sciences College, International University of Rabat (UIR), Rabat, Morocco, 8Department of Rheumatology, General Hospital of Mexico, Ciudad de Mexico, Mexico, 9Buenos Aires School of Medicine, Buenos Aires, Argentina, 10Saint-Joseph University, Beirut, Lebanon, Beirut, Lebanon, 11Nizam’s Institute of Medical Sciences, Hyderabad, India, 12Hospital Universitario La Paz IdiPaz, Madrid, Pais Vasco, Spain, 13Chang Gung Memorial Hospital-Linkou, Taoyuan, Taipei, Taiwan (Republic of China), 14Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy, 15Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea, 16Department Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan, 173.CEDOC, NOVA Medical School, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal; 7.Hospital Egas Moniz (CHLO) (Rheumatology Department), Lisboa, Portugal, Lisbon, Portugal, 18Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, guangzhou, China (People's Republic), 19Rheumatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, 20Leiden University Medical Center (LUMC), Leiden, Netherlands, 21Semmelweis University, Budapest, Budapest, Hungary, 22Case Western Reserve University School of Medicine, Cleveland, OH, 23Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Region Metropolitana, Chile, 24University Hospital Fundación Santa Fé de Bogotá and Universidad El Bosque, Bogotá, Colombia, 25University of Alberta, Edmonton, AB, Canada, 26University College London, London, United Kingdom, 27Amsterdam University Medical Center & Zuyderland Hospital, Amsterdam, Netherlands, 28Leiden University Medical Center, Leiden, Netherlands, 29Department of Rheumatology, Hopital Cochin, Université de Paris, Paris, France

Meeting: ACR Convergence 2020

Keywords: Psoriatic arthritis, spondyloarthritis

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Session Information

Date: Sunday, November 8, 2020

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster II: Extra-MSK & Comorbidities

Session Type: Poster Session C

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

Background/Purpose: Patients with a clinical diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or predominant peripheral symptoms. However, a huge clinical overlap exists and clear patterns of distribution are lacking. The objective of this study was to identify patterns of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA.

Methods: International, cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA), peripheral SpA (pSpA), inflammatory bowel disease (IBD)-related SpA, reactive arthritis or juvenile SpA were enrolled. A specific cluster analysis for each peripheral musculoskeletal manifestation (i.e., peripheral articular involvement, enthesitis and dactylitis) was conducted using data concerning the specific location of these symptoms at any time during the course of the disease. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.

Results: A total of 4465 patients were included in the analysis. Three clusters were found with regard to the location of peripheral articular involvement (Fig. 1), labelled as “infrequent arthritis (a)”, “predominantly lower limbs (b)” and “predominantly hands (c)”. Patients from the “a” group showed, in comparison with “b” and “c” groups, a higher prevalence of males (63.9% vs 51.3% vs 41.5%), HLA-B27 positivity (79.8% vs 48.2% vs 34.8%) and SpA diagnosis (axSpA or pSpA) (76.7% vs 30.6% vs 35.2%), but lower prevalence of psoriasis (23.2% vs 67.8% vs 59.6%) and PsA diagnosis (17.2% vs 61.7% vs 58.5%). Between “b” and “c” clusters, the first one showed a higher prevalence of uveitis (15.7% vs 8.7%), and a lower prevalence of IBD (3.5% vs 6.7%).
With regard to the location of enthesitis (Fig. 2), 3 clusters were also found, labelled as “predominantly heel enthesitis (d)”, “predominantly axial enthesitis (e)” and “polyenthesitis (f)”. Patients from the “f” group showed a higher prevalence of fibromyalgia according to the FiRST questionnaire (41.3% vs 17.4% vs 31.3%), psoriasis (48.3% vs 28.4% vs 23.4%) and PsA diagnosis than in the “d” and “e” groups (40.8% vs 22.7% vs 21.5%), and a lower prevalence of males (40% vs 61.9% vs 56.2%) and SpA diagnosis (52.5% vs 71.0% vs 73.1%).

Finally, 3 clusters were found with regard to the location of dactylitis, labelled as “absence of dactylitis (g)”, “predominantly toes (h)” and “predominantly fingers (i)”. The “g” group showed in comparison with the other two groups, the highest prevalence of males (61.4% vs 51.4% vs 52.9%), HLA-B27+ (66.6% vs 52.5% vs 50.0%) and SpA diagnosis (72.1% vs 30.7% vs 41.2%), and the lowest prevalence of psoriasis (26.9% vs 68.6% vs 79.4%) and PsA diagnosis (21.5% vs 65.7% vs 52.9%).

Conclusion: These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying rheumatological diseases.

Figure 1. Cluster analysis for peripheral articular involvement: distribution of the affected joints with regard to the cluster.

Figure 2. Cluster analysis for enthesitis: distribution of the affected enthesis with regard to the cluster.


Disclosure: C. Lopez-Medina, None; S. Chevret, None; A. Molto, ABBVIE, 5, BMS, 5, 8, LILLY, 5, NOVARTIS, 5, 8, UCB, 5, GILEAD, 5; J. Sieper, AbbVie, 5, Novartis, 5, 8, Lilly, 8, Janssen, 5, Merck, 5, 8; M. Duruöz, None; U. Kiltz, Abbvie, 2, 5, Biocad, 2, 5, Biogen, 2, 5, Chugai, 2, 5, Eli Lilly, 2, 5, Grünenthal, 2, 5, Janssen, 2, 5, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Roche, 2, 5, UCB, 2, 5; B. El-Zorkany, None; N. Hajjaj-Hassouni, None; R. Burgos-Vargas, None; J. Maldonado-Cocco, None; N. Ziade, None; M. Gavali, None; V. Navarro-Compán, Novartis Pharma, 1, 5, 8, AbbVie Inc., 5, 8, Eli Lilly and Company, 5, 8, Pfizer Inc., 5, UCB, 5, 8; S. Luo, None; A. Biglia, None; T. Kim, None; M. Kishimoto, AbbVie, 1, 2, Amgen-Astellas BioPharma, 1, 2, Asahi-Kasei Pharma, 1, 2, Astellas, 1, 2, Ayumi Pharma, 1, 2, BMS, 1, 2, Chugai, 1, 2, Daiichi-Sankyo, 1, 2, Eisai, 1, 2, Eli Lilly, 1, 2, Gilead, 1, 2, Janssen, 1, 2, Kyowa Kirin, 1, 2, Novartis, 1, 2, Pfizer, 1, 2, Tanabe-Mitsubishi, 1, 2, Teijin Pharma, 1, 2, UCB Pharma, 1, 2, Celgene, 5, 8; F. Pimentel-Santos, None; J. Gu, None; L. Muntean, None; F. van Gaalen, Reuma Nederland, 1, Stichting vrienden van Sole Mio, 1, MSD, 1, Abbvie, 1, Novartis, 1; P. Géher, None; M. Magrey, Novartis, 5, Eli Lilly, 5, AbbVie, 2, UCB, 2, Amgen, 2, Pfizer, 5, Janssen, 5; S. Ibanez, Novartis, 1, Bristol Myers, 1, Abbvie, 1; W. Bautista-Molano, None; W. Maksymowych, AbbVie, 2, 5, Janssen, 5, Lilly, 5, Pfizer, 2, 5, Novartis, 2, 5, Gilead, 5, UCB Pharma, 5, Boehringer Ingelheim, 5, Galapagos, 5; P. Machado, Abbvie, 5, 8, Eli Lilly, 5, Novartis, 5, 8, UCB, 5, 8, Pfizer, 8; R. Landewé, AbbVie, 2, 5, 8, AstraZeneca, 5, Bristol-Myers Squibb, 5, 8, Eli Lilly, 5, Galapagos, 5, Novartis, 5, Pfizer Inc, 2, 5, 8, UCB, 2, 5, 8, GlaxoSmithKline, 5, Janssen, 2, 5, 8, Merck, 5, 8, Rheumatology Consultancy BV, 1, Ablynx, 5, Amgen, 2, 5, 8, Celgene, 5, Gilead, 5, Novo Nordisk, 5, Roche, 2, 5, 8, Schering, 2, 5, 8, TiGenix, 5; D. van der Heijde, AbbVie, 5, Bristol-Myers Squibb, 5, Cyxone, 5, Galapagos NV, 5, Gilead Sciences, Inc., 5, GlaxoSmithKline, 5, Eli Lilly, 5, Novartis, 5, Pfizer, 5, UCB Pharma, 5, Amgen Inc., 5, Astellas, 5, AstraZeneca, 5, Boehringer Ingelheim, 5, Celgene, 5, Daiichi-Sankyo, 5, Janssen, 5, Merck, 5, Regeneron, 5, Roche, 5, Sanofi, 5, Takeda, 5, Imaging Rheumatology bv, 3, Eisai, 5; M. Dougados, Pfizer, 1, 2, Abbvie, 1, 2, UCB, 1, 2, Merck, 1, 2, Lilly, 1, 2, BMS, 1, 2, Roche, 1, 2, Novartis, 1, 2.

To cite this abstract in AMA style:

Lopez-Medina C, Chevret S, Molto A, Sieper J, Duruöz M, Kiltz U, El-Zorkany B, Hajjaj-Hassouni N, Burgos-Vargas R, Maldonado-Cocco J, Ziade N, Gavali M, Navarro-Compán V, Luo S, Biglia A, Kim T, Kishimoto M, Pimentel-Santos F, Gu J, Muntean L, van Gaalen F, Géher P, Magrey M, Ibanez S, Bautista-Molano W, Maksymowych W, Machado P, Landewé R, van der Heijde D, Dougados M. Identification of Clinical Phenotypes in Patients with Axial Spondyloarthritis, Peripheral Spondyloarthritis and Psoriatic Arthritis According to Peripheral Musculoskeletal Manifestations: A Cluster Analysis in the International ASAS-PerSpA Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/identification-of-clinical-phenotypes-in-patients-with-axial-spondyloarthritis-peripheral-spondyloarthritis-and-psoriatic-arthritis-according-to-peripheral-musculoskeletal-manifestations-a-cluster-a/. Accessed January 22, 2021.
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