Session Information
Date: Monday, October 22, 2018
Session Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Enthesitis is a key feature in psoriatic arthritis (PsA) affecting approximately a third of the patients. Ultrasound improves the detection of enthesitis compared to clinical examination. However, there is little information about the construct validity of sonographic enthesitis scores in PsA. We aimed to evaluate the correlation between the severity of sonographic enthesitis and measures of disease activity in patients with early PsA.
Methods: Sixty-four patients with early PsA (duration <5 years) who were naïve to biologic medications, were enrolled. PsA disease activity was assessed in each of the key domains using validated measures of disease activity, laboratory markers of inflammation and patient reported outcomes. The severity of sonographic enthesitis was assessed in 14 entheseal sites using a modification of the Madrid Enthesitis Scoring Index (MASEI) with power Doppler scored on a scale of 0 to 3. We considered the total score of modified MASEI (mod-MASEI) and the total Doppler scores (mod-MASEI-Dop) as the outcomes of interest. Pearson correlation coefficients were calculated between sonographic enthesitis scores and measure of disease activity. Since sonographic enthesitis is confounded by aging and mechanical stress we used regression analysis to evaluate the association between disease related measures and sonographic enthesitis after adjusting for age, sex and BMI.
Results: The mean age was 46.6±13.7 (53.1% males) and mean disease duration was 1±1.3 years. Clinical enthesitis was found in 51.6% (≥1 tender entheseal site) and active sonographic enthesitis was found in 57.8% of the patients. A mild to moderate correlation was found between sonographic enthesitis and tender and swollen joint counts, damaged joint count, clinical enthesitis count, physician global assessment and health assessment questionnaire (HAQ) (Table 1). In multivariable analysis the following variable were associated with higher sonographic enthesitis score (Table 2): nail pitting (β 9.3, 95% confidence interval (CI) 1.7, 16.8), physician global assessment (β 1.9, 95% CI 0.3, 3.5), HAQ (β 9.7, 95% CI 3.9, 15.5), swollen joint count (β 1.3, 95% CI 0.6, 1.8) and tender joint count (β 1.2, 95% CI 0.6, 1.8).
Conclusion: The severity of sonographic enthesitis correlates with measures of disease activity, joint damage and patient function in early PsA. These findings suggest that sonographic enthesitis has construct validity and may be considered as a marker of severity in early PsA.
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Table 1 – The correlation sonographic enthesitis and measures of PsA disease activity |
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|
|
Modified MASEI – Total |
Modified MASEI – Doppler score |
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|
|
r |
P value |
N |
r |
P value |
N |
|
Swollen joint count |
0.44 |
<0.001 |
64 |
0.36 |
0.004 |
64 |
|
Tender joint count |
0.44 |
<0.001 |
64 |
0.34 |
0.005 |
64 |
|
Damaged joint count |
0.31 |
0.01 |
64 |
0.25 |
0.05 |
64 |
|
Tender enthesitis count |
0.25 |
0.048 |
64 |
0.16 |
0.20 |
64 |
|
Dactylitis count |
0.03 |
0.83 |
64 |
-0.02 |
0.86 |
64 |
|
Nail pitting |
0.36 |
0.004 |
64 |
0.24 |
0.05 |
64 |
|
Nail onycholysis |
0.02 |
0.89 |
64 |
0 |
0.94 |
64 |
|
PASI |
0.09 |
0.47 |
64 |
0.06 |
0.62 |
64 |
|
MD global assessment |
0.36 |
0.003 |
64 |
0.28 |
0.02 |
64 |
|
CRP |
0.12 |
0.35 |
60 |
0.05 |
0.70 |
60 |
|
ESR |
0.25 |
0.06 |
60 |
0.08 |
0.56 |
60 |
|
HAQ |
0.31 |
0.01 |
61 |
0.21 |
0.10 |
61 |
|
Pain score |
0.04 |
0.75 |
62 |
0 |
0.99 |
62 |
|
PGA arthritis |
0 |
0.99 |
61 |
-0.04 |
0.77 |
61 |
|
PGA psoriasis |
0.03 |
0.82 |
62 |
0.06 |
0.66 |
62 |
|
FACIT |
-0.10 |
0.46 |
55 |
0 |
0.99 |
55 |
|
DLQI |
0.08 |
0.53 |
59 |
0 |
0.98 |
59 |
|
ESR: Erythrocyte Sedimentation Rate; CRP: C-Reactive Protein; DLQI: Dermatology Life Quality Index; FACIT: Fatigue Functional Assessment of Chronic Illness; HAQ: Health Assessment Questionnaire; MD: physician; PASI: psoriasis area and severity index; PGA: Patient Global Assessment |
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Table 2 – The Association Between total Modified-MASEI and PsA Disease Related Variables by Linear Regression Model (N=64) |
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|
|
Univariate |
Age-, Sex- and BMI adjusted model |
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|
|
β (95% CI) |
P value |
β (95% CI) |
P value |
|
Duration of Morning stiffness (>30 minutes) |
4.7 (-2.7, 12.1) |
0.21 |
6.3 (-0.6, 13.2) |
0.08 |
|
Inflammatory back pain (yes) |
2.7 (-5.4, 10.8) |
0.51 |
5.1 (-2.2, 12.4) |
0.17 |
|
Nail lesions (yes) |
1.6 (-5.9, 9.1) |
0.67 |
0.3 (-6.7, 7.2) |
0.94 |
|
Nail pitting (yes) |
12.2 (4.4, 20) |
0.002 |
9.3 (1.7, 16.8) |
0.02 |
|
Nail Onycholysis (yes) |
0.5 (-7.7, 8.8) |
0.89 |
-0.04 (-7.6, 7.6) |
0.99 |
|
PASI |
0.3 (-0.4, 1.0) |
0.46 |
0.2 (-0.5, 0.9) |
0.55 |
|
Dactylitis (yes) |
-4.7 (-14.6, 5.2) |
0.35 |
-2.4 (-11.6, 6.8) |
0.61 |
|
Physician global assessment (0-10) |
2.6 (1.0, 4.3) |
0.002 |
1.9 (0.3, 3.5) |
0.02 |
|
CRP (mg/dL) |
0.1 (-0.1, 0.4) |
0.33 |
0.1 (-0.1, 0.4) |
0.40 |
|
ESR (mm/hr) |
0.3 (0, 0.6) |
0.05 |
0.2 (-0.04, 0.5) |
0.09 |
|
BASDAI |
0.7 (-1.1, 2.4) |
0.47 |
0.9 (-0.7, 2.4) |
0.28 |
|
FACIT |
-0.1 (-0.4, 0.2) |
0.46 |
-0.1 (-0.4, 0.2) |
0.55 |
|
DLQI |
0.2 (-0.3, 0.6) |
0.52 |
0 (-0.4, 0.4) |
0.95 |
|
HAQ |
8.2 (1.9, 14.4) |
0.009 |
9.7 (3.9, 15.5) |
0.001 |
|
Pain (0-10) |
0.7 (-0.6, 2.1) |
0.26 |
0.8 (-0.4, 2.0) |
0.20 |
|
PGA arthritis (0-10) |
0.4 (-0.8, 1.7) |
0.48 |
0.6 (-0.6, 1.7) |
0.34 |
|
PGA skin (0-10) |
0.6 (-0.6, 1.7) |
0.35 |
0.7 (-0.4, 1.8) |
0.19 |
|
Dactylitis count (0-20) |
-0.4 (-3.9, 3.1) |
0.83 |
0.6 (-2.6, 3.9) |
0.70 |
|
Damaged joint count (0-68) |
2.3 (0.6, 4.1) |
0.008 |
1.5 (-0.3, 3.2) |
0.10 |
|
Enthesitis count (0-14) |
2.7 (0.1, 5.2) |
0.04 |
2.3 (-0.2, 4.7) |
0.07 |
|
Swollen joint count (0-66) |
1.7 (0.8, 2.5) |
<0.0001 |
1.3 (0.4, 2.1) |
0.003 |
|
Tender joint count (0-68) |
1.4 (0.7, 2.0) |
0.0001 |
1.2 (0.6, 1.8) |
0.0002 |
|
Radiographic sacroiliitis (Yes) |
0.3 (-9.4, 9.9) |
0.96 |
4.3 (-4.6, 13.1) |
0.34 |
|
BASDAI – Bath Ankylosing Spondylitis Disease Activity Index, CRP- C Reactive Protein, DLQI – Dermatology Life Quality Index, ESR – Erythrocyte Sedimentation Rate, FACIT – Functional Assessment of Chronic Illness Therapy, HAQ – Health Assessment questionnaire, PASI – psoriasis area and severity index, PGA – Patient Global Assessment |
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To cite this abstract in AMA style:
Eder L, Farrer C, Jerome D. Is Enthesitis a Marker of Disease Severity in Early Psoriatic Arthritis? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/is-enthesitis-a-marker-of-disease-severity-in-early-psoriatic-arthritis/. Accessed January 16, 2021.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-enthesitis-a-marker-of-disease-severity-in-early-psoriatic-arthritis/