Regional Difference in Disease Burden Among Patients with Psoriatic Arthritis: A Multi-Center Study

Erkan Kilic¹, Gamze Kilic ², Kemal Nas ³, Betul Sargin ⁴, Sevtap Acer Kasman ⁵, Hakan Alkan ⁶, Nilay Sahin ⁷, Gizem Cengiz ⁸, Nihan Cuzdan ⁹, Ilknur Albayrak Gezer ¹⁰, Dilek Keskin ¹¹, Cevriye Mulkoglu ¹², Hatice Resorlu ¹³, Ismihan Sunar ¹⁴, Ajda Bal ¹⁵, Mehmet Tuncay Duruoz ⁵, Okan Kucukakkas ¹⁶, Ozan Volkan Yurdakul ¹⁶, Meltem Alkan Melikoglu ¹⁷, Yildiray Aydin ³, Fikriye Figen Ayhan ¹⁸, Hatice Bodur ¹⁹, Mustafa Calis ⁸, Erhan Capkin ²⁰, Gul Devrimsel ²¹, Kevser Gök ²², Sami Hizmetli ²³, Ayhan Kamanli ³, Yasar Keskin ¹⁶, Hilal Kocabas ²⁴, Oznur Kutluk ²⁵, Nesrin Sen ²⁶, Omer Faruk Sendur ²⁷, Ibrahim Tekeoglu ³, Sena Tolu ²⁸, Murat Toprak ²⁹ and Tiraje Tuncer ²⁵, ¹Afyonkarahisar State Hospital, Afyonkarahisar, Turkey, ²Karadeniz Technical University School of Medicine, Department of Physical Medicine and Rehabilitation, Trabzon, ³Sakarya University School of Medicine, PMR Department, Rheumatology and Immunology Division, Sakarya, Turkey, ⁴Adnan Menderes University School of Medicine, PMR Department, Rheumatology Division, Aydın, Turkey, ⁵Marmara University School of Medicine, PMR Department, Rheumatology Division, İstanbul, Turkey, ⁶Pamukkale University School of Medicine, PMR Department, Rheumatology Division, Denizli, Turkey, ⁷Balıkesir University School of Medicine, PMR Department, Balıkesir, Turkey, ⁸Erciyes University School of Medicine, PMR Department, Rheumatology Division, Kayseri, Turkey, ⁹Şanlıurfa Training and Research Hospital, Rheumatology Clinic, Şanlıurfa, Turkey, ¹⁰Selçuk University School of Medicine, PMR Department, Konya, Turkey, ¹¹Kırıkkale University School of Medicine, PMR Department, Kırıkkale, Turkey, ¹²Ankara Training and Research Hospital, PMR Clinic, Ankara, Turkey, ¹³Çanakkale Onsekiz Mart University School of Medicine, PMR Department, Çanakkale, Turkey, ¹⁴Ankara Unversity School of Medicine, Physical Medicine and Rehabilitation, Rheumatology Department, Ankara, Turkey, ¹⁵Dışkapı Yıldırım Beyazıt Training and Research Hospital, PMR Clinic, Ankara, Turkey, ¹⁶Bezmialem Vakıf University School of Medicine, PMR Department, İstanbul, Turkey, ¹⁷Atatürk University School of Medicine, PMR Department, Rheumatology Division, Erzurum, Turkey, ¹⁸Uşak University School of Health Sciences, PMR Department, Uşak, Turkey, ¹⁹Yıldırım Beyazıt University School of Medicine, PMR Department, Ankara, Turkey, ²⁰Karadeniz Teknik University School of Medicine, PMR Department, Trabzon, Turkey, ²¹Recep Tayyip Erdoğan University School of Medicine, PMR Department, Riza, Turkey, ²²Numune Training and Research Hospital, Rheumatology Clinic, Ankara, Turkey, ²³Cumhuriyet University School of Medicine, PMR Department, Rheumatology Division, Sivas, Turkey, ²⁴Necmettin Erbakan University Meram School of Medicine, PMR Department, Rheumatology Division, Konya, Turkey, ²⁵Akdeniz University School of Medicine, PMR Department, Rheumatology Division, Antalya, Turkey, ²⁶Kartal Dr. Lütfi Kırdar Training and Research Hospital, Rheumatology Clinic, İstanbul, Turkey, ²⁷Adnan Menderes University School of Medicine, PMR Department, Aydın, Turkey, ²⁸Medipol University School of Medicine, PMR Department, İstanbul, Turkey, ²⁹Yüzüncü Yıl University School of Medicine, PMR Department, Van, Turkey

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: disease burden and climate, Psoriatic arthritis, regional difference

Session Information

Date: Tuesday, November 12, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Psoriatic Arthritis, Clinical Features

Session Type: Poster Session (Tuesday)

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

Background/Purpose: Psoriatic arthritis (PsA) has been defined as an inflammatory arthritis associated with psoriasis. The disease activity can be evaluated using many scales in patients with PsA. There is a great temperature difference between geographic region in Turkey. For example,the average annual air temperature in Erzurum (one of the Eastern Anatolian cities) is 5.7° C whereas in Antalya (one of the Mediterranean region cities) average temperature is 18.7° C. Furthermore, altitude of Eastern Anatolian cities is higher than Mediterranean cities.
The aim of this study was to assess whether there are regional differences in disease burden in patients with PsA.

Methods: Patients with PsA over the age of 18 who met the CASPAR classification criteria were enrolled consequently in this multicenter cross-sectional observational study. Turkish League Against Rheumatism (TLAR)- Network was formed with the participation of 25 different centers. Patients were grouped for 7 geographic regions (Marmara, Aegean, Mediterranean, Central Anatolia, Black Sea, Eastern Anatolia and southeastern Anatolia) in Turkey. Clinical and laboratory data were recorded. PsQoL; HAQ; BASFI, VAS-fatigue, VAS-pain, patient and physician GA; DAPSA, DAS28, BASDAI, and PASI scores were assessed. Statistical analysis was performed using the SPSS v22 package program. One-way ANOVA test were used to compare 7 geographic regions. Regression analysis was used to calculate adjusted disease measures. p˂0.05 was considered statistically significant.

Results: A total 1130 patients (36% male, 64% female) with PsA included in this study. The mean age was 46.96 ± 12.25 years. The mean symptom duration was 9.40 ± 8.88 years. Crude results related to disease activity, quality of life and disability were summarized in table 1. Statistically significant differences observed for age, sex and BMI between groups. Thus, adjusted values of disease activity, quality of life and disability were calculated (table 2). Eastern Anatolian patients were youngest whereas Mediterranean patient were oldest (40.03 ± 13.19 vs 50.42 ± 11.47, p< 0.0001). Diagnostic delay time similar between groups (p:0.096). Crude VAS-pain, fatigue, PtGA, PhGA were significantly different between groups whereas this difference disappeared when adjustment for age, sex and BMI were made in table 2. Disease activity score were highest in Mediterranean region and lowest in eastern Anatolia region according to adjusted DAPSA (17.72 ± 1.75 vs 16.35 ± 1.62, p< 0.0001), DAS28 (3.53 ± 0.29 vs 3.25 ± 0.28 p< 0.0001) and BASDAI (4.12 ± 0.48 vs 3.80 ± 0.49, p:0.080). Adjusted BASFI (2.83 ± 0.52 vs 2.28 ± 0.51, p< 0.0001), PsAQoL (7.54 ± 1.48 vs 6.07 ± 1.44, p< 0.0001) and HAQ (0.48 ± 0.11 vs 0.36 ± 0.13, p< 0.0001) score were highest in Mediterranean region and lowest in Eastern Anatolia region. Additionally, PASI score lowest in Mediterranean region and highest in Eastern Anatolia region.

Conclusion: This is the first study reporting that geographic region differences may affect disease activity as well as patient characteristic in patients with PsA. Regional weather conditions such as temperature, humidity and altitude may explain the regional differences in disease activities and other clinical characteristics.

tablo1

Table 1 Comparison of crude disease activity, quality of life and disability measures between 7 geographic regions of Turkey in patients with PsA -mean ± SD –

tablo2

Table 2 Comparison of adjusted disease activity, quality of life and disability measures between 7 geographic regions of Turkey in patients with PsA [mean ± SD–adjustment for age, sex and BMI-

Disclosure: E. Kilic, None; G. Kilic, None; K. Nas, None; B. Sargin, None; S. Acer Kasman, None; H. Alkan, None; N. Sahin, None; G. Cengiz, None; N. Cuzdan, None; I. Albayrak Gezer, None; D. Keskin, None; C. Mulkoglu, None; H. Resorlu, None; I. Sunar, None; A. Bal, None; M. Duruoz, İbrahim etem, 8, Abdi İbrahim, 8, Abdi Ibrahim, 8, Abvie, 2, 8, AMGEN, 8, AMGEN, Novartis, ILKO, ONKO, İbrahim Ethem, Abdi İbrahim, 8, Ibrahim Ethem, 8, ILKO, 8, Novartis, 8, ONKO, 8; O. Kucukakkas, None; O. Yurdakul, None; M. Alkan Melikoglu, None; Y. Aydin, None; F. Ayhan, None; H. Bodur, None; M. Calis, None; E. Capkin, None; G. Devrimsel, None; K. Gök, None; S. Hizmetli, None; A. Kamanli, None; Y. Keskin, None; H. Kocabas, None; O. Kutluk, None; N. Sen, None; O. Sendur, None; I. Tekeoglu, None; S. Tolu, None; M. Toprak, None; T. Tuncer, None.

To cite this abstract in AMA style:

Kilic E, Kilic G, Nas K, Sargin B, Acer Kasman S, Alkan H, Sahin N, Cengiz G, Cuzdan N, Albayrak Gezer I, Keskin D, Mulkoglu C, Resorlu H, Sunar I, Bal A, Duruoz M, Kucukakkas O, Yurdakul O, Alkan Melikoglu M, Aydin Y, Ayhan F, Bodur H, Calis M, Capkin E, Devrimsel G, Gök K, Hizmetli S, Kamanli A, Keskin Y, Kocabas H, Kutluk O, Sen N, Sendur O, Tekeoglu I, Tolu S, Toprak M, Tuncer T. Regional Difference in Disease Burden Among Patients with Psoriatic Arthritis: A Multi-Center Study [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/regional-difference-in-disease-burden-among-patients-with-psoriatic-arthritis-a-multi-center-study/. Accessed .

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