Elevated spine symptoms in psoriatic arthritis linked to worse quality of life, disease activity
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Patients with self-reported elevated spine symptoms in psoriatic arthritis, with or without a diagnosis of axial disease, had worse quality of life and disease activity overall versus patients without axial manifestations, according to data.
“Axial PsA (axPsA) is generally diagnosed based on patient history, physical examination, imaging, and laboratory testing,” Alexis Ogdie, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania, in Philadelphia, and colleagues wrote in The Journal of Rheumatology. “However, no consensus currently exists on criteria to define axPsA. Back pain is highly prevalent in the general population and can result from numerous causes, including injury, occupational conditions, chronic pain disorders, or other conditions that affect the spine.”
“Additionally, up to 30% of patients with PsA with visible structural damage on imaging have no axial symptoms,” they added. “Together, these factors can result in missed or delayed diagnosis of axial disease in patients with PsA. The lack of validated classification criteria for axPsA also limits consistent evaluation and meaningful comparison of treatment efficacies for patients with axPsA in clinical research.”
To examine the presence of axial symptoms in PsA, and analyze the differences between patients with and without a diagnosis of axial PsA, Ogdie and colleagues studied data from the CorEvitas (formerly Corrona) PsA/Spondyloarthritis Registry. According to the researchers, this registry is a large, independent, prospective observational cohort of 4,683 patients with PsA or SpA, representing 20,230 patient visits, across 40 U.S. states as of Jan. 1.
For their study, Ogdie and colleagues stratified 3,393 patients with PsA at enrollment into four mutually exclusive groups based on axial manifestations. Among these patients, 226 were assigned to the group with physician-diagnosed axial PsA only (Dx+Sx–), 698 were defined as patient-reported elevated spine symptoms only (Dx–Sx+), 165 were physician-diagnosed and patient-reported (Dx+Sx+), and 2,304 demonstrated no axial manifestations (Dx–Sx–). The elevated spine symptoms-only group was defined as patients with a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least four and a spine pain visual analog scale at least 40.
The researchers then compared patient characteristics, disease activity and patient-reported outcomes at enrollment in each axial manifestation group to those in the Dx–Sx– group. Multinomial logistic regression, with Dx–Sx– as a reference group, was used to determine associations between patient characteristics and the odds of demonstrating axial manifestations.
According to the researchers, patients with Dx–Sx+ or Dx+Sx+ were more frequently women and demonstrated prior depression and fibromyalgia, compared with those who with Dx–Sx–. Meanwhile, patients with Dx+Sx– or Dx+Sx+ were more frequently HLA-B27 positive versus those in the Dx–Sx– group. Fibromyalgia was significantly associated with increased odds of Dx+Sx– or Dx+Sx+. Lastly, disease activity and patient-reported outcomes were worse among patients with Dx–Sx+ or Dx+Sx+, compared with in those with Dx–Sx–.
“In CorEvitas’ PsA/SpA Registry, a higher prevalence of [elevated spine symptoms] than [physician-diagnosed axial PsA] was observed,” Ogdie and colleagues wrote. “Patients with [elevated spine symptoms] or [physician-diagnosed and patient-reported symptoms] had significantly higher disease activity and worse PRO scores than those with [no axial manifestations] and numerically worse scores than those with [physician-diagnosed axial PsA only].”
“Although patients with [elevated spine symptoms only] may have had other reasons for back pain, such as degenerative spine disease or central sensitization, it is possible that axPsA was present in some of these patients, which warrants further evaluation,” they added. “These findings highlight the need to establish standardized assessment tools for axPsA to facilitate the accurate identification and effective management of axial disease in patients with PsA.”
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