Session Type: Abstract Submissions (ACR)
The aim of this study is to describe early X-ray findings in psoriatic arthritis (PsA) patients from the SwePsA registry using the Wassenberg score, evaluate progression of structural damage, analyze correlations to clinical disease parameters and identify predictors of progressive radiographic joint disease.
Out of 197 SwePsA patients followed for 5 years, 72 (38% of the women and 35% of the men) had radiographs of hands and feet performed at the 5-year follow-up. According to the SwePsA protocol hand and feet radiographs should be performed in polyarticular disease or when these joints showed signs of inflammation at baseline, and repeated during follow-up. Reading (MG) in chronological order was centralized. Clinical data were collected according to the SwePsA protocol.
Mean (SD) baseline age of the 43 women and 29 men was 48.7 (15.0) and 46.4 (14.5) years respectively. While in the total SwePsA cohort women had higher clinical disease activity (Theander et al, ARD 2014), in this sub-cohort mean baseline DAS28 / DAPSA were similar in women and men (3.94 / 22.27 and 3.73 / 21.63, respectively, ns). However, radiographic abnormalities were more pronounced in men:
Baseline x-rays: Total Wassenberg score was 0 (no abnormalities) in 55% of women and 46% of men. Scores over 10 were unusual and only found in one women and one man. Mean (SD) total scores for women and men at baseline were 1.38 (2.44) vs 3.05 (4.04) respectively, p=0.044, erosion scores 0.30 (0.88) vs 1.17 (2.27), p=0.025, proliferation scores 1.30 (1.99) vs 1.79 (2.41), p=0.35. Feet scores at baseline were 0.30 (0.74) vs 0.93 (1.69), p = 0.039.
5-year follow-up x-rays: Total score was 0 in 42% of women but only in 17% of men (p=0.018). Scores over 10 were now found in 7.2% of women and in 17% of men. Mean (SD) total scores for women and men were 3.37 (4.85) vs 7.79 (12.46), p=0.034, erosion scores 0.86 (1.68) vs 3.41 (8.20), p=0.051, proliferation scores 2.56 (3.49) vs 4.62 (4.92), p=0.041. Feet scores at 5-year follow-up were 0.84 (2.13) vs 2.35 (3.92), in women and men, p=0.028, hand scores 2.58 (3.74) vs 5.55 (8.53), p=0.047.
Baseline and 5-year scores were highly correlated (for total scores: Spearman rho 0.752, p=0.000). Baseline total score correlated with ESR (rho: 0.364, p=0.004) and 5-year score with swollen joint count (rho 0.310, p=0.016), higher BASDAI showed a trend to be associated with lower total score (rho -0.285, p= 0.058).
Male gender and higher total baseline score were the only predictors of radiographic abnormalities after 5 years: OR (male/female): 4.42 (95% CI: 0.35-8.49) p=0.034. Baseline total score: OR: 2.23 (1.80-2.65), p=0.000. Only the baseline Wassenberg score was an independent predictor of radiographic progression.
Disease activity, inflammatory markers, joint counts, delay before inclusion and smoking did not predict 5-year Wassenberg score. None of the 15 patients with the highest scores/progression had received TNF-blockers.
Radiographic progression in early PsA is slow in general, early prevalent in male feet and predicted by baseline radiographic findings. Thus scoring of hand and feet X-rays at baseline cannot be substituted by clinical signs, especially not in men.
P. T. Larsson,
G. M. Alenius,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-swedish-early-psoriatic-arhtritis-swepsa-registry-5-yeear-follow-up-slow-radiographic-progression-with-highest-scores-in-male-feet-and-in-patients-with-baseline-x-ray-abnormalities/