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Abstract Number: 2475

Relationship Between Extra-Articular Manifestations and Disease Activity In Patients Diagnosed With New-Onset Spondyloarthropathy In a Cohort In Spain

César Antonio Egües Dubuc1, Maria Martin Martinez2, Joaquin Belzunegui Otano1, Miren Uriarte Ecenarro1, Juan Mulero3, Eugenio de Miguel4, Santiago Muñoz5, Pedro Zarco6, Eduardo Collantes7, Sabina Perez Vicente2 and Milena Gobbo2, 1Rheumatology, Donostia University Hospital, San Sebastián, Spain, 2Research Unit, Spanish Society of Rheumatology., Madrid, Spain, 3Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda (Madrid), Spain, 4Rheumatology, University Hospital La Paz - IdiPaz, Madrid, Spain, 5Rheumatology, Hospital Infanta Sofia, Madrid, Spain, 6Rheumatology Service, Fundación Hospital Alcorcon, Alcorcon, Madrid, Spain, 7Rheumatology, Hospital Reina Sofia, Cordoba, Spain

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Activity score, extraarticular manifestations, spondylarthritis and spondylarthropathy

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Session Information

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

Session Type: Abstract Submissions (ACR)

Background/Purpose : The Spondyloarthropathy (SpA) that affect in many aspects of life of the patients, either for their musculoskeletal or extra-articular manifestations (EAM). EAM vary in frequency and severity, the most common are: uveitis, inflammatory bowel disease and skin diseases. Some epidemiological studies have found increased incidence of EAM as a consequence of disease activity. This study aims to analyze the relationship between the EAM with disease activity in patients with new onset SpA.

Methods: This is a longitudinal study, for which the ESPERANZA Program database from Spanish Society of Rheumatology was analyzed. Database includes SpA patients with aged between 18 and 45 years, with duration of disease between 3 and 25 months, belonging to 25 health centers in Spain. The primary endpoint were all the EAM analyzed together and by themselves. The independent variables were: demographics; disease activity parameters as BASDAI, at least one painful and swollen joints, at least one enthesitis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR); metrological parameter (BASMI), quality parameter (ASQoL) and functionality parameter (BASFI); HLA-B27, duration of disease at the diagnoses and the presence of sacroiliitis on magnetic resonance. The quantitative variables were described as mean and standard deviation (SD) if distributed symmetrically and if distributed asymmetrically by the median and interquartile ranges (IR), qualitative were described with percentages accompanied by absolute value. The Pearson or Spearman correlation, Student t test, analysis of variance and chi square test were used for bivariate analysis according to the variables to be analyzed. For multivariate analysis the variables analyzed were those that had P <0.20, or those that had clinical relevance for the study, we used multiple linear regression analysis or logistic regression model.

Results: 698 patients [426 men (61%)] with median age of 32.9 years (CI: 27.5–38.9) were studied. Table 1 shows the EAM studied. Table 2 shows the independent variables, which were analyzed with the EAM (table 3).

Conclusion: The presence of enthesitis, tender and swollen joint favors the appearance of EAM. The presence of HLA B27 and sacroiliitis are protective factors of occurrence of EAM. These are raw data, to be wanting to adjust for covariates and potential confounders.

Table 1: Extra-articular manifestations in patients diagnosed with new-onset spondyloarthropathy (n=698).

Patient without EAM

Patient with EAM

At least one EAM

406 (41.8%)

292 (58.2%)

Psoriasis

577 (82,7%)

121 (17.3%)

Urethritis

685 (98.1%)

13 (1.9%)

Uveitis / Iritis

656 (94%)

42 (6%)

Pustulosis

694 (99.4%)

4 (6%)

Acne

692 (99.1%)

6 (0.9%)

Inflammatory bowel disease

654 (93.7%)

44 (6.3%)

Nail psoriasis

670 (96%)

28 (4%)

Dactylitis

625 (89.5%)

73 (10.5%)

Enthesopathy

634 (90.8%)

64 (9.2%)

Tabla 2:  Demographic, measurement parameters, markers of activity, presence of sacroiliitis on MRI, presence of HLA B27, according to the presence of extra-articular manifestations in patients diagnosed with new-onset spondyloarthropathy (n=698).

Total Spa patients

(n = 698)

Spa patients with at least one EAM (n=292)

Spa patients without EAM

(n=406)

N

Lost

Mean (SD)

Median (IR)

N

Lost

Mean (SD)

Median (IR)

N

Lost

Mean (SD)

Median (IR)

Men

426 (61%)

180 (61.6%)

246 (60.6%)

Women

272 (39%)

112 (38.4%)

160 (39.4%)

Age at diagnosis of Spa

698

0

32.92

(27.6-38.8)

292

0

–

34.14

(28.66-39.75)

406

0

–

31.98

(26.61-38.27)

BASDAI

597

101

–

4.7

(2.8-6.2)

252

40

–

4.8

(3-6.38)

345

61

–

4.4

(2.75-6.05)

BASMI

698

0

1.09

(1.06)

–

292

0

1.05

(1.02)

–

406

0

1.12

(1.09)

–

BASFI

574

124

2.65

(2.22)

–

244

48

2.57

(2.21)

–

330

76

2.58

(2.21)

–

ASQoL

519

179

6.96

(2.22)

–

231

61

7.14

(4.92)

–

288

118

6.74

(4.83)

–

ESR

578

120

16.98

(7.42)

–

237

55

19.25

(18.9)

–

341

65

15.4

(16.15)

–

CRP (mg/dl)

633

65

10.08

(18.36)

–

262

30

11.9

(18.6)

–

371

35

–

3

(1-9)

Evolution of the disease (month)

698

0

11.77

(6.67)

–

292

0

11.02

(6.46)

–

406

0

–

12.17

(6-17.7)

Presence of swollen joint

181 (25.9%)

0

120 (41.1%)

61 (15%)

Absence of swollen joint

517 (74.1%)

0

172 (58.9%)

345 (85%)

Presence of painful joint

165 (23.6%)

0

108 (37%)

349 (86%)

Absence of painful joint

533 (76.4%)

0

184 (63%)

57 (14%)

Presence of enthesitis

253 (36.2%)

0

124 (42.5%)

129 (31.8%)

Absence of enthesitis

445 (63.8%)

0

168 (57.5%)

277 (68.2%)

Positive HLA B27

363 (52%)

51

112 (38.4%)

251 (61.8%)

Negative HLA B27

284 (40.7%)

149 (51%)

135 (33.3%)

Sacroiliitis on MRI

159 (22.8%)

397

37 (12.7%)

122 (30%)

Absence of sacroiliitis on MRI

142 (20.3%)

62 (21.2%)

80 (19.7%)

Table 3: Relationship of the appearance of extra-articular manifestations with: disease activity parameters; metrological, functionality and quality parameters; HLA-B27, duration of disease at the diagnoses and the presence of sacroiliitis on magnetic resonance.

C.I. 95%

OR

Lower limit

Upper Limit

p value

Age

1.036

1.013

1.058

0.002

BASDAI

1.067

0.991

1.148

0.084

BASMI

0.937

0.812

1.082

0.376

BASFI

0.973

0.902

1.048

0.467

ASQoL

0.983

0.949

1.019

0.349

ESR

1.013

1.003

1.022

0.01

CRP

1.01

1

1.019

0.045

Evolution of the disease (month)

0.971

0.949

0.994

0.012

Woman

0.957

0.703

1.303

0.778

Positive HLA B27

0.404

0.293

0.558

0

Sacroiliitis on MRI

0.391

0.238

0.642

0

Presence of swollen joint

3.946

2.757

5.647

0

Presence of painful joint

3.564

2.489

5.188

0

Presence of enthesitis

1.585

1.16

2.166

0.004


Disclosure:

C. A. Egües Dubuc,
None;

M. Martin Martinez,
None;

J. Belzunegui Otano,
None;

M. Uriarte Ecenarro,
None;

J. Mulero,
None;

E. de Miguel,
None;

S. Muñoz,
None;

P. Zarco,
None;

E. Collantes,
None;

S. Perez Vicente,
None;

M. Gobbo,
None.

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