Enthesitis Associated With Worse Disease Activity and Quality of Life in Psoriatic Arthritis

Clinical enthesitis is associated with worse disease activity and outcomes regardless of site of manifestation in patients with psoriatic arthritis (PsA), according to study results published in The Journal of Rheumatology.

It is unclear whether the location of enthesitis affects disease activity or quality of life in patients with PsA. Using real-world data obtained from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry from March 2018 to 2018, investigators aimed to evaluate the effect of clinical enthesitis in PsA by site manifestation.

Enthesitis was assessed using the Spondyloarthritis Research Consortium of Canada Enthesitis Index and was classified based on location (upper sites only, lower sites only, or both). Disease activity was assessed using multiple measures, including the Clinical Disease Activity Index. Quality of life was assessed based on patient-reported pain, fatigue, and work productivity. Multivariable-adjusted linear or logistic regression analyses were used to determine associations of enthesitis with disease activity and patient-reported outcome measures.

Of the 2003 patients with PsA in the registry, 391 (63.0% women) had enthesitis; enthesitis occurred in upper sites only in 80 (20.5%) patients, in lower sites only in 137 (35.05%) patients, and in both upper and lower sites in 174 (44.5%) patients. Regardless of enthesitis location, patients with vs without enthesitis had worse disease activity and patient-reported outcomes (P <.05). Increased prevalence of enthesitis at any site was significantly correlated with higher disease activity and worse quality of life (P <.001 for all).

In the adjusted models, compared with no enthesitis, enthesitis in upper sites only (β coefficient, 3.1; 95% CI, 1.1-5.2), lower sites only (β, 5.4; 95% CI, 3.8-7.0), or both (β, 7.9; 95% CI, 6.4-9.4) was associated with worse disease activity (P <.05 for all). Compared with patients without enthesitis, those with pain in lower sites or in both upper and lower sites also reported higher pain and fatigue scores as well as greater work impairment (P <.05 for all).

Investigators noted that the study cohort was routinely observed and treated by rheumatologists, which may lower the prevalence of enthesitis, as a result of which findings may not be generalizable to all populations with PsA.

“[T]he presence of clinically defined enthesitis is associated with worse PsA disease severity, regardless of enthesitis location,” the researchers concluded. “Assessing enthesitis in both upper and lower sites may improve our understanding of the full scope of PsA disease activity. Furthermore, management of enthesitis is important for ameliorating overall disease activity.”

Disclosure: This study was supported by Corrona, LLC and Novartis. Please see the original reference for a full list of authors’ disclosures.

Reference

Mease PJ, Liu M, Rebello S, et al. Disease characteristics, quality of life, and work productivity by enthesitis site: Real- world data from the US Corrona Psoriatic Arthritis/Spondyloarthritis Registry [published online June 1, 2020]. J Rheumatol. doi:10.3899/jrheum.191117