ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1581

Inflammatory Back Pain in Psoriasis and Psoriatic Arthritis Is Suggestive of Undiagnosed Spondyloarthropathies

Majed Khraishi1, Heather Jones2,3 and Annette Szumski4, 1Clinical Professor of Medicine (Rheumatology), Memorial University of Newfoundland, St. John's, NF, Canada, 2Inflammation & Immunology, Pfizer Inc., Collegeville, PA, 3Pfizer Inc., Collegeville, PA, 4Specialty Care, Pfizer Inc., Collegeville, PA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Spondyloarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment II

Session Type: Abstract Submissions (ACR)

Background/Purpose: Patients with psoriasis (Ps) and/or psoriatic arthritis (PsA) may have clinical features suggestive of axial skeletal abnormalities and should be assessed for the presence of spondyloarthropathies (SpA). The purpose of this post-hoc analysis from 2 clinical trials is to assess the prevalence, demographic and disease characteristics of Ps patients with and without PsA with MRI evidence of sacroiliitis (SI) abnormalities or axial involvement. We also investigated how common screening questionnaires perform in detecting inflammatory back pain (IBP) that may be suggestive of other SpAs. 

Methods: From the PRESTA trial, the medical history of patients with Ps and PsA were analyzed for axial involvement. From the PREPARE trial, patients with Ps who had baseline MRIs were analyzed and characteristics assessed between those with and without MRI evidence of SI abnormalities (SI +/–). Results of the PASQi and TOPAS questionnaires in the PREPARE trial were assessed for patient-reported IBP and compared with their respective patients’ SI findings to determine possible trends in each IBP +/– and SI +/– group.

Results: In the PRESTA trial, 747 patients with Ps/PsA were evaluated and 41% (304/747) had axial involvement. Those with axial involvement had a longer duration of PsA, greater Ps-affected BSA, and higher PASI, DAS28, TJC, SJC, HAQ, EQ-5D scores than those without (Table 1). A total of 186 Ps patients with MRIs were analyzed in the PREPARE trial; 47% were SI+ who tended to be older with a lower Ps-affected BSA than those who were SI– (Table 1). Only 43% (38/88) of Ps patients who were SI+ were also diagnosed with PsA. IBP was evaluated in 128 patients from the PREPARE trial with the PASQi and ToPAS questionnaires of which 45% (57/128) were IBP+ and 33% (19/57) of those were also SI+. These patients tended to be older, have a higher Ps-affected BSA, and higher PASI compared to 38 patients who were IBP+/SI– (Table 2). 58% (41/71) of patients who were IBP– were SI+ and have the fewest number of females versus the 2 IBP+ groups. 47% (9/19) of Ps patients who were IBP+/SI+ did not have PsA.

Conclusion: Patients with spinal involvement tended to be older with longer disease duration. Patients with Ps, with or without a PsA diagnosis, may exhibit clinical features of SpAs. These findings suggest that patients should be evaluated carefully for the presence of entities such as non-radiographic axial SpA and radiologic evidence of SI regardless of PsA diagnosis or reported IBP. The PASQi and TOPAS questionnaires detected 1/3 of Ps/PsA patients who reported IBP were SI+ which may be useful in detecting the possibility of SpAs.

Table 1: Baseline characteristics for patients with and without SI and axial involvement in the PRESTA  and PREPARE and clinical trials

 

PRESTAa

PREPAREb

 

Axial involvement
  n=304

Non-axial involvement
  n=443

P-valuec

SI+
  n=88

SI–
  n=98

P-valuec

Age, years

47.33 (11.1)

45.9 (11.6)

0.086

52.2 (11.7)

44.6 (13.1)

<0.001

Male gender, n (%)

197 (64.8)

275 (62.1)

0.487

59 (67.0)

54 (55.1)

0.101

Race

 

 

0.098

 

 

0.092

   White

260 (85.5)

403 (91.0)

82 (93.2)

85 (86.7)

   Asian

21 (6.9)

22 (5.0)

4 (4.5)

12 (12.2)

   Otherd

21 (6.9)

17 (3.8)

2 (2.3)

1 (1.0)

BMI, kg/m2

27.6 (5.1)

28.2 (5.6)

0.105

28.9 (4.9)

29.4 (6.1)

0.534

PsA diagnosis,e n (%)

–

–

–

38 (43.2)

37 (37.8)

0.764

Duration of PsA, yearsf

8.3 (7.7)

6.3 (3.6)

<0.001

9.4 (8.1)

9.4 (7.8)

0.976

Duration of Ps

19.7 (11.6)

18.3 (11.6)

 0.102

19.3 (13.6)

17.7 (12.0)

0.376

Ps affected BSA, %

33.4 (24.6)

28.9 (20.2)

0.007

5.3 (8.3)

8.6 (12.7)

0.036

PASI

20.6 (11.1)

18.6 (9.6)

0.007

4.5 (5.8)

5.6 (5.7)

0.185

DAS28

4.6 (1.32)

4.3 (1.3)

0.008

–

–

–

TJC

21.1 (19.9)

18.0 (11.2)

0.018

–

–

–

SJC

12.2 (15.2)

9.9 (11.1)

0.019

–

–

–

HAQ

1.1 (0.7)

0.8 (0.7)

<0.001

–

–

–

EQ-5D

0.4 (0.3)

0.5 (0.3)

<0.001

–

–

–

All values mean (standard deviation) unless otherwise specified. aAxial/non-axial involvement determined by medical history. bSI abnormalities determined by MRI. cP-values for continuous values are calculated using ANOVA comparing means between groups; P-values for categorical values use the chi-square test. dIncludes those with missing values. eBased on physical exam, medical history, and laboratory findings. fBased on medical history. BSA=body surface area; PASI=psoriasis area severity index; Ps=psoriasis;   PsA=psoriatic arthritis; SI=sacroiliitis

 

Table 2: Baseline characteristics for the presence/absence of IBP and/or SI abnormalities in the PREPARE study

 

IBP+/SI+
  (n=19)

IBP–/SI+
  (n=41)

IBP+/ SI–
  (n=38)

IBP–/SI–
  (n=30)

P-valuea

Age, years

54.4 (10.4)

51.2 (12.9)

45.2 (11.9)

44.9 (12.5)

0.010

Male gender, n (%)

8 (42.1)

31 (75.6)

17 (44.7)

17 (56.7)

0.018

Race, n (%)

 

 

 

 

0.369

   White

18 (94.7)

39 (95.1)

32 (84.2)

25 (83.3)

   Asian

1 (5.3)

2 (4.9)

5 (13.2)

5 (16.7)

   Otherb

–

–

1 (2.6)

–

BMI, kg/m2

28.1 (4.9)

29.2 (5.1)

30.4 (6.4)

27.2 (5.2)

0.120

PsA diagnosis,c n (%)

10 (52.6)

16 (42.1)

10 (33.3)

15 (36.6)

0.723

Duration of PsA,d years

7.1 (5.9)

11.6 (6.8)

9.9 (7.2)

10.1 (9.9)

0.668

Duration of Ps

21.1 (13.7)

18.4 (13.8)

16.0 (11.0)

20.4 (12.2)

0.399

Ps affected BSA, %

7.5 (15.5)

4.9 (4.7)

6.3 (10.8)

10.0 (16.4)

0.341

PASI

5.9 (10.8)

4.4 (3.6)

4.2 (4.8)

6.1 (7.0)

0.492

All values mean (standard deviation) unless otherwise specified. IBP is based on inflammatory back pain obtained either from PASQi or ToPAS. Any SI abnormalities +/– determined by MRI. aP-values for continuous values are calculated using ANOVA comparing means between groups; P-values for categorical values use the chi-square test. bIncludes those with missing values. cBased on physical exam, medical history, and laboratory findings. dBased on medical history. BMI=body mass index; PASI=psoriasis area severity index; Ps=psoriasis; PsA=psoriatic arthritis

Disclosure:

M. Khraishi,
None;

H. Jones,

Pfizer Inc,

3;

A. Szumski,

Pfizer Inc,

3.

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