Is Axial Involvement Underestimated in Patients with Psoriatic Arthritis? Data from the Bepas Cohort

Kurt de Vlam¹, Rik Lories², Serge Steinfeld³, Filip van Den Bosch⁴, Adrien Nzeusseu Toukap⁵, Michel G. Malaise⁶, Veerle Taelman⁷, Filip van Bruwaene⁸, Marc Vanden Bergh⁹, Rik Joos¹⁰, Jan Lenaerts¹¹, Piet Geusens¹², Silvano Dalli'Armelina¹³, Isabelle Peene¹⁴, Griet De Brabanter¹⁵, Marthe van den Berghe¹⁶, Jiangang Qu¹⁷, Martin Maertens¹⁸ and Hermine Leroi¹⁹, ¹Katholieke Universiteit Leuven, Leuven, Belgium, ²university hospitals leuven, Leuven, Belgium, ³clinique saint jean, bruxelles, Belgium, ⁴Rheumatology, Ghent University Hospital, VIB, Ghent, Belgium, ⁵Department of Rheumatology, Cliniques Universitaires St Luc, Brussels, Belgium, ⁶Department of Rheumatology- GIGA Research - Arthropôle - University of Liège - CHU Liège, Liège, Belgium, ⁷Heilig Hart ziekenhuis, Leuven, Belgium, ⁸H.H. Ziekenhuis, Roeselare, Belgium, ⁹Grand Hôpital de Charleroi Saint Joseph, Charleroi, Belgium, ¹⁰ZNA Jan Palfijn, Antwerpen, Belgium, ¹¹Reuma Instituut, Hasselt, Belgium, ¹²reumaclinic, Genk, Belgium, ¹³Notre Dame de Grace, Gosselies, Belgium, ¹⁴Rheumatology, AZ sint Jan Brugge, 8000 Brugge, Belgium, ¹⁵AZ St Lucas, Assebroek, Belgium, ¹⁶ASZ, Aalst, Belgium, ¹⁷Iris Sud, Bruxelles, Belgium, ¹⁸AZ Damiaan, Oostende, Belgium, ¹⁹MSD Belgium, Bruxelles, Belgium

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: inflammatory back pain, psoriatic arthritis and spine involvement

Session Information

Date: Sunday, November 8, 2015

Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment Poster I: Clinical Aspects and Assessments

Session Type: ACR Poster Session A

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

Background/Purpose:

Psoriatic arthritis (PsA) is a common form of
chronic arthritis strongly associated with the skin disease psoriasis. Although
PsA has been included in the spondyloarthritis
concept, PsA is often considered to be predominantly
peripheral and may be characterized by arthritis, dactylitis
and enthesitis. Consequently randomized controlled
trials, screening procedures for early detection and treatment strategies
largely focus on peripheral disease. Axial involvement is considered less
common and is often treated as a variant of ankylosing spondylitis. The BEPAScohort (Belgian Epidemiological Psoriatic Arthritis
Study) is a large prospective multicenter real life cohort set up in 17 Belgian
large academic and non academic rheumatology practices that offers a unique
opportunity to study the axial involvement in this patient group. Purpose:(1)
To estimate the prevalence of axial involvement in patients with PsA in general and in the different subtypes; (2) to
estimate the prevalence of inflammatory back pain in patients with PsA; (3) to estimate gender differences in spinal
involvement in patients with PsA; (4) to estimate the
influence of disease duration on spinal manifestations.

Methods:

Patients
included in the BEPAS cohort were evaluated for the presence of a clinical
phenotype indicating axial involvement, the specific presence of spinal complaints(reported
by patients) and the presence of inflammatory back pain according the Rudwaleit
criteria. Demographics and clinical features were recorded. BASDAI and BASMI were
calculated. Spinal radiographs are collected at entry and after 2 years.

Results:

461
patients (mean age: 52.79 years (+/-12.29), male 57%) were recruited in the 17
centers from December 2012 to July 2014.
A spinal phenotype was identified in 342 patients: 0.7% has pure axial
disease whereas 73.7% of the the total patient
population has combined peripheral and
axial involvement. At entry, 159 patients reported spinal pain with no gender
difference. Inflammatory back pain (fulfilling at least 2 out of 4 criteria)
was present in 243 patients. BASMI in the overall population cohort (n=440) was
3.76 and BASDAI overall population (n=456) was 1.86 with slightly higher values
in female than in male patients. 90% of the patients reported a BASDAI lower
than 3.5. A family history of ankylosing spondylitis is reported in 3.3% of the
patients. Clinical characteristics and demographics are listed in table 1.

Conclusion:

This large cohort reports a higher frequency of spinal complaints than that
reported in other cohorts. A considerable number of patients have inflammatory
back pain suggesting that inflammatory axial involvement in PsA
should not be underestimated. Surprisingly BASDAI are rather low. This may
indicate a lower severity as compared to other forms of spondyloarthritis.

Table1

global

male

female

Age

52.79 (+/- 12.29)

53.05 (+/- 12.23)

52.43 (+/- 12.41)

Gender

461

263

198

Symptoms duration

450

11.91 +/-10.83

11.37 +/- 9.79

12.64 +/- 12.08

Disease duration

459

8.60 +/- 9.30

8.46 +/- 8.74

8.79 +/- 10.00

Family history PsA/Spa

456

227 (49.8%)

127 (48.5%)

135 (51.5%)

Ankylosing Spondylitis

15 (3.3%)

5 (1.9%)

10 (5.2%)

HLA B27

158

26 (16.5%)

12 (13%)

14 (21.2%)

Joint involvement currently

reported spinal pain currently

457

34.8%

hiparthritis

351

IBP (Rudwaleit =>2/4 criteria)

423

57.4%

132/243(54.3%)

111/180(61,6%)

Cutaneous involvement currently

BSA (%)

279

5,25 (+/- 10,50)

6,10(+/-12,11)

3,99(+/-7,35)

PASI

302

2,38(+/-4,31)

2,94(+/-4,98)

1,66(+/-3,12)

Nail

459

122 (26,6%)

85 (32,3%)

37 (18,9%)

Clinical involvement at entry

N of total

N of male(263)

N of female(198)

BASMI

440

3,76 (+/-1,21)

3,65 (+/-1,24)

3,90 (+/-1,16)

tender/swollen joints

461

275(59,65%)

149(56,65%)

126(63,63%)

dactylitis

461

64(13,9%)

41(15,58%)

23(11,61%)

enthesitis

461

111(24,1%)

51(19,39%)

60(30,30%)

Disease activity

abnormal CRP (=>5mg/l)

430

125(29,1%)

64 (25,3%)

61(34,5%)

abnormal ESR (>10mm/h)

391

102(26,1%)

50(22,5%)

52(30,8%)

BASDAI

456

1,86(+/-1,18)

1,70(+/-1,17)

2,07(+/-1,17)

Disclosure: K. de Vlam, None; R. Lories, None; S. Steinfeld, None; F. van Den Bosch, AbbVie, Celgene, Janssen, Merck, Novartis, Pfizer, and UCB, 2,AbbVie, Celgene, Janssen, Merck, Novartis, Pfizer, and UCB, 8,AbbVie, Celgene, Janssen, Merck, Novartis, Pfizer, and UCB, 5; A. Nzeusseu Toukap, None; M. G. Malaise, None; V. Taelman, None; F. van Bruwaene, None; M. Vanden Bergh, None; R. Joos, None; J. Lenaerts, None; P. Geusens, Pfizer, Abbott, Lilly, Amgen, MSD, Will, and Roche, 2,Amgen, 5,Amgen and Lilly, 8; S. Dalli'Armelina, None; I. Peene, None; G. De Brabanter, None; M. van den Berghe, None; J. Qu, None; M. Maertens, None; H. Leroi, MSD belgium, 3.

To cite this abstract in AMA style:

de Vlam K, Lories R, Steinfeld S, van Den Bosch F, Nzeusseu Toukap A, Malaise MG, Taelman V, van Bruwaene F, Vanden Bergh M, Joos R, Lenaerts J, Geusens P, Dalli'Armelina S, Peene I, De Brabanter G, van den Berghe M, Qu J, Maertens M, Leroi H. Is Axial Involvement Underestimated in Patients with Psoriatic Arthritis? Data from the Bepas Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/is-axial-involvement-underestimated-in-patients-with-psoriatic-arthritis-data-from-the-bepas-cohort/. Accessed .

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