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Axial involvement in PsA linked to greater risk for moderate, severe psoriasis
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Axial involvement in psoriatic arthritis is associated with a greater risk for moderate-to-severe psoriasis, with higher disease activity and a more pronounced impact on the patient’s quality of life, according to findings published in the Journal of Rheumatology.
“The characteristics of psoriatic arthritis (PsA) patients with and without axial spondyloarthritis (SpA) have not been well characterized,” Philip J. Mease, MD, of the University of Washington, told Healio Rheumatology. “In previously published series, SpA, defined by features such as sacroiliitis and inflammatory spine lesions seen on MRI and inflammatory back pain clinical features, occurs in up to 40% of PsA patients. In 1,530 PsA patients in the Corrona registry, 12.5% were classified as having spondylitis based on investigator evaluation and/or imaging of the spine and sacroiliac joints.”
To evaluate the traits of patients with PsA with and without axial involvement, the researchers studied data in the Corrona PsA/Spondyloarthritis Registry, a large, independent, prospective observational cohort of patients with PsA and SpA. The database includes information on 7,476 patient visits, as well as data on 2,330 patients from 28 private and academic practices in 25 states. In total, the researchers identified 1,530 patients with PsA who had corresponding data on physician-reported axial involvement. Of those patients, 12.5% had axial involvement, and 87.5% did not.
Axial involvement was defined as physician-reported presence of spinal involvement at enrollment, or radiograph or MRI showing sacroiliitis. Both groups of patients were similar in sex, race, BMI, disease duration, presence of dactylitis and prevalence of most comorbidities. Mease and colleagues analyzed patient data on demographics, clinical measures, patient-reported outcomes and treatment.
According to the researchers, patients with axial involvement were generally younger and more likely to have enthesitis, a history of depression and used biologics more frequently at baseline, compared with those without involvement. In addition, those with axial involvement were more likely to have moderate-to-severe psoriasis. They also demonstrated significantly worse disease, based on a lower prevalence of minimal disease activity — 30.1% compared to 46.2% — as well as higher nail psoriasis scores, enthesitis counts, Bath Ankylosing Spondylitis Disease Activity Index scores, Bath Ankylosing Spondylitis Functional Index scores, C-reactive protein levels, physical function, pain and fatigue.
“Inflammation of the spine in PsA can be considered a biomarker of greater overall disease severity and as such, the presence of spondylitis should be looked for in order to treat this aspect of PsA effectively,” Mease said. “Rheumatologists should assess for spondylitis involvement in their PsA patients. In addition, dermatologists and primary care physicians should include questions about spinal symptoms when assessing psoriasis patients for the presence of PsA.” – by Jason Laday
Disclosure: Mease reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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