Background Psoriatic arthritis (PsA) is a chronic inflammatory condition affecting the skin and joints, and can lead to significant joint damage, disability and reduced quality of life. Disease severity varies among patients and is not well characterized in a real world setting.
Objectives To characterize the PsA patients by skin severity (defined by body surface area, BSA) and joint (defined by modified disease activity score, mDAS) in the Corrona PsA/Spondyloarthritis (SpA) registry, a large cohort of PsA-SpA patients in the US.
Methods PsA patients enrolled in the registry between 4/2013 and 7/2015 were included. Patients were categorized by the level of skin involvement measured by BSA (low:BSA≤3%; moderate: BSA>3% & BSA≤10%; high:>10%) and joint severity as measured by mDAS (low:mDAS≤2.7; moderate:mDAS>2.7 & mDAS≤4.1 & high:mDAS>4.1). Patient characteristics at registry enrollment and biologic use were evaluated and one-way analysis of variance/Chi-square tests were used for continuous and categorical variables to evaluate differences.
Results 1613 PsA patients were included, of which 1281 were categorized by BSA severity (low=64%, moderate=22%, high=14%) and 1331 by mDAS severity (low=21%, moderate=53%, high=26%). Overall, there were 53% females, mean (SD) age of 54 (13) yrs, mean (SD) disease duration of 12 (10) yrs. Majority of patients were referred by a primary care provider (40%) followed by self-referral (23%) or a rheumatologist (19%); 5% were referred by a dermatologist. Presence of dactylitis (10%, 13% and 22% in low, moderate and high resp.), and enthesitis (18%, 23% and 40% in low moderate and high resp.) were highly correlated with mDAS categories (p<0.0001), however similar correlation were not observed with categories of BSA. 61% of patients had prior biologic use and differences were observed in current biologic use by severity of BSA and mDAS categories: 62%, 59% and 97% (p<0.001) and 64%, 62% and 97% (p<0.0001) with low, moderate and high respectively, where app. one-third of the patients were on monotherapy. Among patients with moderate/high mDAS only 15% had high BSA (table).
Conclusions Majority of PsA patients present to the rheumatologist with moderate/severe joint symptoms and mild skin symptoms, and are primarily referred by PCPs, self-referred, or other rheumatologists. mDAS severity was correlated with presence of dactylitis/enthesitis and the number of enthesitis sites. The majority of PsA patients (60%) were treated with biologic agents regardless of joint or skin severity; however over 90% of patients with high joint or skin severity were treated with biologic therapy.
Acknowledgement This study is sponsored by Corrona, LLC. Initial funding for the Corrona SpA registry was provided by AbbVie. In the last two years, AbbVie, Amgen, BMS, Crescendo, Genentech, Horizon Pharma USA, Janssen, Eli Lilly, Novartis, Pfizer, and UCB have supported Corrona LLC. through contracted subscriptions.
Disclosure of Interest P. Mease Grant/research support from: Celgene, Novartis, Abbvie, Amgen, BMS, Janssen, Lilly, Pfizer, UCB, Consultant for: Celgene, Corrona, Merck, Novartis, Abbvie, Amgen, BMS, Crescendo, Genentech, Janssen, Lilly, Merck, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Crescendo, Genentech, Janssen, Lilly, Novartis, Pfizer, UCB, M. Skup Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., C. Karki Employee of: Corrona, LLC, C. Etzel Consultant for: Merk, Employee of: Corrona, LLC, W. Malley Employee of: Corrona, LLC, Paid instructor for: Lamar University, J. Greenberg Shareholder of: Corrona, LLC, Consultant for: AstraZeneca, Celgene, Genentech, Janssen, Novartis and Pfizer, Employee of: Corrona, LLC, A. Joshi Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc.
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