Prevalence Of Peri-Articular Manifestations (Enthesitis and Dactylitis) and Disease Activity In Psoriatic Arthritis Patients: Impact Of Treatment With TNF Inhibitors In a Real-World Canadian Population

Proton Rahman¹, Denis Choquette², William G. Bensen³, Majed M. Khraishi⁴, Isabelle Fortin⁵, Andrew Chow⁶, Maqbool K. Sheriff⁷, Julie Vaillancourt⁸, John S. Sampalis⁸, Susan M. Otawa⁹, Allen J. Lehman⁹ and May Shawi¹⁰, ¹Faculty of Medicine, Memorial University of Newfoundland, St. John's, NF, Canada, ²Rheumatology, Institut de rhumatologie de Montréal (IRM), Montréal, QC, Canada, ³Department of Medicine, Division of Rheumatology, Clinical Professor, McMaster University, Hamilton, ON, Canada, ⁴Nexus Clinical Research, St John's, NF, Canada, ⁵Centre de rhumatologie de l'est du Québec (CREQ), Rimouski, QC, Canada, ⁶University of Toronto, McMaster University, Credit Valley Rheumatology, Mississauga, ON, Canada, ⁷Nanaimo Regional General Hospital, Nanaimo, BC, Canada, ⁸JSS Medical Research, Montreal, QC, Canada, ⁹Medical Affairs, Janssen Inc., Toronto, ON, Canada, ¹⁰Medical Affairs, Janssen Canada Inc, Toronto, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Disease Activity, Enthesitis, extraarticular manifestations, psoriatic arthritis and spondylarthropathy

Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment: Psoriatic Arthritis: Clinical Aspects and Treatment I

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To determine the point prevalence of peri-articular manifestations (PAMs) in psoriatic arthritis (PsA) patients treated with anti-TNF in a real-world, Canadian, routine clinical practice setting.

Methods:

BioTRAC is an ongoing, prospective, registry of patients initiating treatment for PsA, AS or RA with infliximab or golimumab as first biologics or after having been treated with a biologic for < six months. In this analysis of data collected since 2010, 91 PsA patients with available baseline information on PAMs were included: enthesitis (n=62), dactylitis of hands (n=76) or feet (n=77), nail pitting of hands (n=76) or feet (n=75).

Results:

Baseline characteristics included mean (SD) age, disease duration of 48.7 (10.3), 6.5 (6.9) years, respectively, and mean (SD) DAS28-CRP score of 4.1 (1.2).

Among all patients at baseline, 50 (54.9%) had a PAM. Dactylitis (feet – 39.0%; hands – 15.8%) was the most common PAM followed by enthesitis (27.4%), and nail pitting (hands – 26.3%; feet – 24.0%). Patients with enthesitis had greater mean (SD) DAS28-CRP (4.7 (1.0) vs. 3.9 (1.3); P=0.042) and HAQ-DI (1.33 (0.73) vs. 0.94 (0.77); P=0.076) compared to patients without enthesitis. However, mean (SD) age (47.0 (10.0) vs. 48.8 (9.5) years; P=0.544), disease duration (6.1 (7.3) vs. 6.0 (6.2) years; P=0.937), and morning stiffness (52.6 (43.4) vs. 56.7 (45.2) min; P=0.750) were comparable between-groups. Among patients with/without dactylitis, baseline mean (SD) parameters were: age (46.8 (12.5) vs. 50.5 (8.9) years; P=0.145), disease duration (6.2 (6.8) vs. 7.0 (7.7) years; P=0.666), DAS28-CRP (4.5 (0.9) vs. 4.0 (1.4); P=0.105), HAQ-DI (1.08 (0.69 vs. 1.09 (0.69); P=0.925), and morning stiffness (73.2 (44.8 vs. 51.6 (42.0) min; P=0.033).

Upon six months of treatment, significant improvement in all disease activity parameters studied was observed. Six-month PAM data were available for 50 (54.9%) patients. Overall, the prevalence of PAMs decreased from baseline to six months post-treatment (P=0.001). Among patients with available six-month information that had a PAM at baseline (n=33), (48.5%) did not present any manifestation after six months. The incidence of new PAMs by six months was minimal.

Conclusion:

In this Canadian real-world cohort of PsA patients, a high prevalence of PAMs was observed at treatment initiation. Patients with enthesitis or dactylitis had increased disease activity compared to patients without PAMs. Infliximab or golimumab treatment for six months was associated with a significant improvement in patient parameters and reduction in the prevalence of PAMs.

Disclosure:

P. Rahman,

Amgen, Abbott, BMS, Merck, Pfizer, Janssen, Hoffman-La Roche, UCB, Novartis, Sanofi-Aventis,

D. Choquette,
None;

W. G. Bensen,
None;

M. M. Khraishi,

Hoffman-La Roche Canada, Amgen and Pfizer Canada, and Abbott Canada.,

I. Fortin,
None;

A. Chow,
None;

M. K. Sheriff,
None;

J. Vaillancourt,

JSS ,

J. S. Sampalis,
None;

S. M. Otawa,

Janssen Canada,

A. J. Lehman,

Janssen Canada,

M. Shawi,

Janssen Canada,

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