ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1473

Juvenile Psoriatic Arthritis Manifestations in a Cohort of 361 Patients from US and Canada

Devy Zisman1,2, Matthew L Stoll3, Dafna D. Gladman4, Vibeke Strand5, Idit Lavi6, Joyce Hsu7, Elizabeth D. Mellins8 and for the CARRA Registry Investigators, 1Technion, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel, 2Rheumatology Unit, Carmel Medical Center, Haifa, Israel, 3Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham AL, Alabama, AL, 4Toronto Western Hospital, Toronto, ON, Canada, 5Stanford University, Palo Alto, CA, 6Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel, 7Pediatric Rheumatology, Stanford University, Palo Alto, CA, 8Dept of Pediatrics CCSR, Stanford University Med Ctr, Stanford, CA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Monday, November 9, 2015

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects Posters. Juvenile Arthritis and Miscellaneous Rheumatic Diseases

Session Type: ACR Poster Session B

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

Background/Purpose: To assess the demographic, clinical, and radiographic manifestations, health questionnaire (HQ) scores (physician global assessment, Health-related Quality of Life, parent/subject overall well-being and parent/subject pain), family history and drug regimens at enrollment and after one year follow up (F/U), in children with juvenile psoriatic arthritis (JPsA) in an international registry.

Methods: The study population included all JPsA patients in the registry between May 2010 – December 2013. We analyzed cross-sectional data at enrollment visit, stratified according to the age at disease onset (< or ≥ 6 years) and compared with information at 1 year F/U. Chi square or Fisher’s exact tests were used for categorical characteristics, t-tests for continuous variables, and Mann-Whitney-U tests for non-normally distributed variables.  Comparison of binary variables between enrollment and F/U was performed using McNemar Test, and Wilcoxon Signed Rank Test for continuous variables. A multivariable logistic regression model was used to assess the influence of 1 year of treatment with DMARDs, biological DMARDs, NSAIDS or glucocorticoids (GCs) on objective outcome (improvement in ≥ 5 from the following: arthritis, dactylitis, enthesitis, skin psoriasis, sacroiliitis and  nail pitting), and on subjective outcome (improvement in all 4 HQ scores) adjusted for age, gender, race and ethnicity.

Results: 361 children with JPsA were entered in the registry. The majority (93.9%) were white and not Hispanic (91.7%); 68.14% had symptom onset ≥ 6 years. Comparison between data in the two age groups at disease onset is presented in Table 1. Data after 1 year F/U were available for 222 patients. Statistically significant improvements were noted in the number of patients with ≥ 5 joints involved, nail pitting, dactylitis, psoriasis, enthesitis, sacroiliitis and uveitis [(126 (61.8%) vs 21 (10.2%,),  (70 (35.9%) vs 31 (15%), (60 (30.9%) vs 5 (2.4%), (137 (68.2%) vs 73 (34.8%), (57 (29.5%) vs 17 (8.1%), (35 (18.1%) vs 13 (6.2%) (27 (15.1%) vs 8 (4.3%) P<0.0001 respectively]. Improvement in objective outcome was associated with disease onset < 6 years (OR 3.69, 95% CI 1.3-10.48), female gender (OR 2.44, 95% CI 1.07-5.56) and lack of biological DMARD (bDMARDS) therapy (OR 2.73 95% CI 1.16-6.44). Improvement in subjective outcome was associated with the presence of enthesitis (OR 4.14, 95% CI 1.12-15.25).

Conclusion: JPsA onset at or after age 6 is diagnosed earlier after symptom onset, with a male predominance and higher prevalence of psoriasis, nail pitting, enthesitis, sacroiliitis and less uveitis. This group is treated more often with daily NSAIDS and MTX and less often with intraarticular GCs. Females with disease onset before age 6 and not receiving bDMARDs have a better objective outcome, while patients with enthesitis had a better subjective outcome.

Table 1: Comparison between JPsA onset before and after the age of 6

Parameter

Total  JPsA

361 patients

JPsA < 6

115 patients

JPsA ≥ 6

227 patients

P value

Demographics

Age at onset of symptoms (years)

8.34±4.57

2.78±1.61

11.04±2.74

 

Age at  first rheumatology visit  (years)

9.37±4.54

4.22±2.83

11.88±2.74

 

Time between symptom onset and first rheumatology visit   (years)

1.04±1.46

1.43±2.04

0.84±1.02

<0.0001

Gender (Male)

137 (38%)

35 (30.4%)

93 (227) 41%

0.057

Family History  of psoriasis

113 (31.3%)

42 (36.5%)

67 (29.5%)

NS

Clinical Characteristics

Oligoarthritis (N) (%)

160 (358) (44.7%)

56 (115) (48.7%)

96 (224) (42.9%)

NS

Polyarthritis (N) (%)

 

198 (358) (55.3%)

59 (115) (51.3%)

128 (224) (57.1%)

NS

Nail Pitting (N) (%)

128 (341) (37.5%)

30 (107) (28%)

86 (215) (40.0%)

0.023

Dactylitis (N) (%)

102 (344) (29.7%)

39 (108) (36.1%)

58 (217) (26.7%)

0.082

Psoriasis (N) (%)

233 (349) (66.8%)

60 (109) (55.0%)

164 (222) (73.9%)

0.001

Enthesitis (N) (%)

112 (342) (32.7%)

25 (107) (23.4%)

79 (217) (36.4%)

0.018

Sacroiliitis (N) (%)

57 (342) (16.7%)

9 (108) (8.3%)

44 (216) (20.4%)

0.006

Uveitis

39 (348) (11.2%)

 

19 (112) (17%)

 

18 (217) (8.3%)

 

0.018

 

Subjective Questionnaires

Health Related Quality of life score

2.17±0.84

2.07±0.86

2.22±0.84

NS

Parent/subject overall well-being score

2.33±2.20

2.05±2.0

2.52±2.3

0.09

Parent/Subject pain scale score

2.58±2.64

2.23±2.5

2.78±2.73

0.06

Physician global assessment score

1.50±1.71

1.53±1.83

1.49±1.68

NS

Radiographic Characteristics

Imaging evidence of joint damage (N) (%)

74 (301) (24.6%)

21(94) (22.3%)

46(189) (24.3%)

NS

Medications

Non-biologics DMARDs ever (N) (%)

294 (361) (81.4%)

96 (115) (83.5%)

181 (227) (79.7%)

NS

Biological DMARDS ever (N) (%)

191 (361) (52.9%)

62 (115) (53.9%)

114 (227) (50.2%)

NS

Glucocorticosteroids (N) (%)

188 (361) (52.1%)

68 (115) (59.1%)

107 (227) (47.1%)

NS

Daily NSAIDs (N) (%)

160 (361) (44.3%)

40 (115) (34.8%)

116 (227) (51.1%)

0.004

Methotrexate (N) (%)

181 (361) (50.14%)

52(115) 45.2%

129 (227)56.8%

0.042

Intraarticular  glucocorticosteroids  (N) (%)

118 (361) (32.7%)

49(115) (42.6%)

59 (227) (26%)

0.002

N-actual number of patients

Disclosure: D. Zisman, None; M. L. Stoll, None; D. D. Gladman, None; V. Strand, Abbvie, Alder, Amgen, Anthera, AstraZeneca, BiogenIdec, Bristol-Myers Squibb, Genentech, GSK, Janssen, MerckSerono, Novartis, Pfizer Inc, Sanofi-Aventis, and UCB, 2; I. Lavi, None; J. Hsu, None; E. D. Mellins, Novartis, Glaxo-Smith-Kline, 2,Ascendent, Codexis, 5.

To cite this abstract in AMA style:

Zisman D, Stoll ML, Gladman DD, Strand V, Lavi I, Hsu J, Mellins ED. Juvenile Psoriatic Arthritis Manifestations in a Cohort of 361 Patients from US and Canada [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/juvenile-psoriatic-arthritis-manifestations-in-a-cohort-of-361-patients-from-us-and-canada/. Accessed .

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