Patients with psoriatic arthritis (PsA) with self-reported elevated spine symptoms, with or without physician-diagnosed axial PsA (axPsA), have worse quality of life (QOL) and higher disease activity than patients without axial symptoms, according to study results published in The Journal of Rheumatology.

The study was aimed at evaluating the presence of axial symptoms in PsA and examining the differences between patients with and without axPsA.

Researchers stratified patients into 4 mutually exclusive groups at their CorEvitas’ PsA/Spondyloarthritis Registry enrollment visit. Multinomial logistic regression was used to estimate associations of patient characteristics with the odds of having axial manifestations. 


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A total of 3,339 patients with PsA were enrolled in the study: 226 (6.7%) with physician-diagnosed axPsA only, 698 (20.6%) with patient-reported elevated spine symptoms only (defined as Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] ≥4 and spine pain visual analog scale [VAS] ≥40); 165 (4.9%) with physician-diagnosed and patient-reported manifestations; and 2304 (67.9%) with no axial manifestations.

Compared with patients without axial manifestations, those with both self-reported elevated spine symptoms and physician-diagnosed axPsA were more frequently women and had a history of depression and fibromyalgia. Patients with physician-diagnosed axPsA only and those with a diagnosis and self-reported manifestations vs those without axial manifestations more frequently tested positive for human leucocyte antigen (HLA)-B27. Significantly increased odds of both physician-diagnosed axial PsA and diagnosis plus self-reported manifestations were associated with fibromyalgia. Patients with self-reported manifestations only and those with both a diagnosis and self-reported manifestations had worse disease activity and patient-reported outcomes than those with no axial manifestations.

Study limitations included the fact that physician reporting of active disease manifestations at enrollment may not have reflected all PsA presentations, and the lack of laboratory tests at every visit could have led to missing data and reflect practice patterns of care providers. In addition, BASDAI is not a validated disease activity measure in patients with PsA without clearly defined axial disease; therefore, patients may have been misclassified.

Researchers concluded, “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.”

Disclosure: This research was supported by Novartis and some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Ogdie A, Blachley T, Lakin PR, et al. Evaluation of clinical diagnosis of axial psoriatic arthritis (PsA) or elevated patient-reported spine pain in CorEvitas’ PsA/Spondyloarthritis Registry. J Rheumatol. 2022;49(3):281-290. doi:10.3899/jrheum.210662