Background Although it has been hypothesized that dactylitis and enthesitis are associated with higher clinical disease activity in patients with psoriatic arthritis (PsA), few studies have evaluated the disease burden associated with these clinical domains in PsA.
Objectives To evaluate the disease burden associated with dactylitis and enthesitis in a US population of patients with PsA using data from a multi-center observational registry (the Consortium of Rheumatology Researchers of North America-CORRONA).
Methods Patients with a visit with reported dactylitis were matched with a random visit from control patients with no history of dactylitis. Patients were matched based on age, gender, duration of PsA, BMI and year of visit. Differences in disease burden (based on disease activity measures) were estimated using mixed model regression clustering on practice. Estimates represent increase in each measure associated with dactylitis. A separate analysis was carried out for enthesitis and controls with no reported enthesitis.
Results There were 3,900 patients identified with a diagnosis of PsA, of whom 928 (23.8%) have a report of any history of dactylitis and 407 (10.4%) patients ever reported incident enthesitis during follow-up. Estimated increases in disease burden are presented in the table. Patients with dactylitis compared to matched controls demonstrated significantly higher mean values of CDAI but not mHAQ scores. In addition, dactylitis patients demonstrated significantly higher values of patient pain, DAS28(ESR), DAS28(CRP), CRP and each of the components of CDAI. Enthesitis was also associated with higher CDAI values but not mHAQ, and higher patient pain and DAS28(CRP), and CDAI components except swollen joints.
Conclusions The presence of dactylitis and enthesitis, in patients with PsA, is correlated with higher disease burden versus patients without these clinical domains, as measured by several disease activity measures in the CORRONA registry. Further studies are necessary to ascertain if this finding has implications for therapeutic decision-making.
Disclosure of Interest P. Mease Grant/Research support from: Abbott, Amgen, Biogen Idec, BMS, Janssen, Genentech, Lilly, Novartis, Pfizer, UCB, Celgene, Consultant for: Abbott, Amgen, Biogen Idec, BMS, Janssen, Genentech, Lilly, Novartis, Pfizer, UCB, Celgene, Speakers Bureau: Abbott, Amgen, Biogen Idec, BMS, Janssen, Genentech, Lilly, Pfizer, UCB, K. Saunders Employee of: CORRONA, S. Bolge Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLD (Johnson & Johnson), R. Bolce Shareholder of: Johnson & Johnson, Employee of: Janssen Services, D. Decktor Shareholder of: Johnson & Johnson, Employee of: Janssen Services, LLC, G. Reed Grant/Research support from: CORRONA, Consultant for: CORRONA, Employee of: University of Massachusetts Medical School, Paid Instructor for: Harvard Medical School, J. Greenberg Shareholder of: CORRONA, Consultant for: AstraZeneca, Novartis, Pfizer, CORRONA
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