ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 668

Progression of Unilateral Grade 2 Sacroiliitis in a Psoriatic Arthritis Cohort

Joy Feld1, Justine Y. Ye2, Vinod Chandran2, Robert D Inman3, Nigil Haroon4, Richard J. Cook5 and Dafna D Gladman6, 1Toronto Psoriatic Arthritis Research Program, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 2Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 3Toronto Western Hospital, University of Toronto, Spondylitis Clinic, Toronto, ON, Canada, 4Rheumatology, Toronto Western Hospital, Toronto, ON, Canada, Toronto, ON, Canada, 5Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada, 6Department of Medicine, Toronto Psoriatic Arthritis Research Program, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Sunday, October 21, 2018

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Imaging, Clinical Studies, and Treatment

Session Type: ACR Poster Session A

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

Background/Purpose: Axial psoriatic arthritis (axPsA) lacks a universally accepted definition. Initial studies required ≥ unilateral grade 2 sacroiliitis (Uni2SI) but recent studies have required the modified radiographic New York ankylosing spondylitis criteria (NYC) ( bilateral grade 2 or unilateral grade 3 or 4 sacroiliitis). Our aims were: 1) assess the prevalence of axial involvement in a PsA cohort according to “at least Uni2SI”, 2) assess the radiographic progression of Uni2SI, 3) identify risk factors associated with progression, 4) define axPsA.

Methods: PsA patients participating in a prospective observational cohort were classified according to their worst sacroiliitis ever observed during their follow-up. The baseline features of patients with only uni2SI were compared to patients with NYC. The progression of Uni2SI was assessed in a sub-group of patients with: uni2SI on one of their radiographs and following x-rays. A comparison was made between the “non-progressors” and “progressors” (=patients who developed NYC over time). T-test, Wilcoxon rank sum test and Chi-square tests were used for descriptive analyses. Logistic regression identified risk factors associated with NYC compared to Uni2SI. Risk factors associated with radiographic progression of Uni2SI were identified in a survival analysis with interval censoring. P<0.05 was considered statistically significant.

Results:

At least Uni2SI was detected in 612/1354 patients (45%). NYC sacroiliitis was observed in 477 patients (35%). Radiographic progression of Uni2SI was assessed in 154 patients, 80 (52%) progressed to NYC sacroiliitis within 5.5 years. The progressors were diagnosed at a younger age (35.6, 38.9, p=0.05), had less degenerative disc disease (DDD) (OR= 0.47, p=0.02), worse peripheral radiographic damage (OR=1.02, p=0.03) and psoriasis (OR=1.09, p=0.01) compared to non-progressors. Other demographic, clinical and radiographic variables were not associated with NYC sacroiliitis (table). In a survival analysis, patients with an elevated erythrocyte sedimentation rate (ESR) were more likely to progress (HR = 1.83, p=0.02), while patients with longer disease duration were less likely to progress (HR=0.95, p=0.02).

Patients with NYC vs “non-progressors”

(unilateral grade 2 as reference group)

Regression Analysis

Univariate

multivariate

Variable at baseline

OR

95% CI

P value

OR

95% CI

P value

Age of diagnosis

0.98

0.96-1

0.05

Age at x ray *

0.99

0.97-1

0.23

0.99

0.97- 1.01

0.45

Male sex*

1.54

0.93-2.54

0.09

1.67

0.94- 2.95

0.08

HLA-B*27 positivity

1.11

0.59-2.09

0.75

Smoking

0.93

0.56-1.54

0.78

Tender and swollen joints

1

0.98-1.03

0.86

Clinically damaged joints

1.01

0.98-1.04

0.33

Modified Steinbrocker score

1.01

1-1.02

0.03

1.02

1- 1.03

0.03

Inflammatory back pain

1.29

0.59-2.81

0.53

Syndesmophytes

1.46

0.87-2.45

0.15

Degenerative disc disease

0.47

0.28-0.79

0.004

0.47

0.25- 0.87

0.02

SPARCC enthesitis score

0.83

0.64-1.09

0.19

PASI

1.07

1.02-1.13

0.01

1.09

1.02- 1.17

0.01

Nail disease

0.86

0.48-1.53

0.61

Elevated ESR

1.48

0.9-2.45

0.12

Biologics

1.86

0.78-4.46

0.16

NSAIDS

1.06

0.62-1.82

0.82

*adjusted variables

PASI=psoriasis area severity index; ESR=erythrocyte sedimentation rate; SPARCC=spondyloarthritis Research Consortium of Canada; NSAIDS=non-steroidal anti-inflammatory drugs

Conclusion:

Only half of patients with Uni2SI progressed to NYC sacroiliitis. Young patients with a short disease duration elevated ESR and with less DDD are at increased risk of progressing. Therefore, we recommend using the NYC for the definition of axPsA.

Disclosure: J. Feld, None; J. Y. Ye, None; V. Chandran, AbbVie Inc., 2,AbbVie Inc., amgen, celgene, eli lilly, Janssen, Novartis, Pfizer and UCB, 5,Eli Lilly and Co., 9; R. D. Inman, None; N. Haroon, AbbVie Inc., Amgen, Janssen, Novartis, UCB, 5; R. J. Cook, None; D. D. Gladman, Abbvie, Amgen, BMS, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, UCB, 5,Abbvie, Amgen, Celgene, Janssen, Novartis, Pfizer and UCB, 2.

To cite this abstract in AMA style:

Feld J, Ye JY, Chandran V, Inman RD, Haroon N, Cook RJ, Gladman DD. Progression of Unilateral Grade 2 Sacroiliitis in a Psoriatic Arthritis Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/progression-of-unilateral-grade-2-sacroiliitis-in-a-psoriatic-arthritis-cohort/. Accessed .

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