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Izci Duran T, Torgutalp M, Rios Rodriguez V, Proft F, López-Medina C, Dougados M, Poddubnyy D. The impact of psoriasis on the clinical characteristics, disease burden and treatment patterns of peripheral spondyloarthritis. Rheumatology (Oxford) 2022; 62:135-146. [PMID: 35451472 DOI: 10.1093/rheumatology/keac235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, disease burden, and treatment patterns of peripheral spondyloarthritis (pSpA) patients with and without psoriasis using data from the ASAS-perSpA study. METHODS We included 433 patients who had a diagnosis of pSpA according to the rheumatologist's diagnosis from the ASAS-PerSpA study. The presence of a personal history of psoriasis was defined as the presence of signs of psoriasis at physical examination or the presence of psoriatic nail dystrophy, including onycholysis, pitting and hyperkeratosis, or a history of psoriasis diagnosed by a physician. Clinical characteristics, patient-reported outcomes and treatment pattern were compared between subgroups with and without psoriasis. RESULTS A total of 83 patients (19.2%) had a personal history of psoriasis. Patients with psoriasis were older (48.4 vs 43.2 years) and had a longer diagnostic delay (7.4 vs 3.5 years), a higher frequency of dactylitis (36.1 vs 20.0%) and enthesitis (65.1 vs 55.4%) than patients without psoriasis. A longer diagnostic delay (odds ratio [OR] = 1.06 [95% CI 1.01, 1.11]), lower odds for HLA-B27 positivity (OR = 0.31 [95% CI 0.15, 0.65]) and higher odds for enthesitis (OR = 2.39 [95% CI 1.16, 4.93]) were associated with the presence of psoriasis in a multivariable regression analysis. While patient-reported outcomes were comparable between groups, a higher use of biologic DMARDs was observed in patients with vs without psoriasis. CONCLUSION The presence of psoriasis has an impact on clinical characteristics of pSpA. pSpA patients without psoriasis were less frequently treated with biologic DMARDs despite similar disease burden as compared with patients with psoriasis.
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Affiliation(s)
- Tugba Izci Duran
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clementina López-Medina
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,Department of Rheumatology, Reina Sofia Hospital, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Benavent D, Capelusnik D, Ramiro S, Molto A, López-Medina C, Dougados M, Navarro-Compán V. Does gender influence outcome measures similarly in patients with spondyloarthritis? Results from the ASAS-perSpA study. RMD Open 2022; 8:rmdopen-2022-002514. [PMID: 36096523 PMCID: PMC9472201 DOI: 10.1136/rmdopen-2022-002514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the influence of gender on disease outcomes in patients with spondyloarthritis (SpA), including across SpA subtypes. METHODS Data from 4185 patients of 23 countries with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or psoriatic arthritis (PsA) from the Assessment of SpondyloArthritis International Society (ASAS)-perSpA study were analysed. Associations between gender and disease activity (Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), C-reactive protein (CRP)), function (Bath Ankylosing Spondylitis Functional Index (BASFI)) and overall health (ASAS Health Index (ASAS HI), European Quality of Life Five Dimension (EQ-5D)) outcomes were investigated. Multilevel multivariable linear mixed models adjusted for relevant confounders (and stratified by disease subtype in case of a relevant interaction) were used. RESULTS In total, 65%, 10% and 25% of patients had axSpA, pSpA and PsA, respectively. axSpA was more frequent in males (68%), whereas pSpA and PsA were more frequent in females (53% and 52%, respectively). A significant interaction between gender and disease subtype was found for ASDAS, BASDAI and BASFI. While being female independently contributed to higher BASDAI across the three disease subtypes (with varying magnitude), female gender was only associated with higher ASDAS in pSpA (β (95% CI): 0.36 (0.15 to 0.58)) and PsA (0.25 (0.12 to 0.38)) but not in axSpA (0.016 (-0.07 to 0.11)). No associations were observed between gender and CRP levels. Female gender was associated with higher ASAS HI and EQ-5D, without differences across disease subtype. CONCLUSION Female gender is associated with less favourable outcome measures across the SpA spectrum. However, while female gender influences BASDAI across the three subtypes, ASDAS is associated with gender only in pSpA and PsA but not in axSpA. Therefore, ASDAS is an appropriate instrument both for females and males with axSpA.
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Affiliation(s)
- Diego Benavent
- Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Dafne Capelusnik
- Maastricht University Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute CAPHRI, Maastricht, The Netherlands.,Rheumatology, Instituto de rehabilitación psicofísica, Ciudad de Buenos Aires, Argentina
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Anna Molto
- Clinical Epidemiology and Biostatistics, INSERM U1153, Université Paris-Cité, Paris, France.,Rheumatology, Hospital Cochin, Université Paris Descartes Faculté de Médecine, Paris, France
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- Rheumatology, Hospital Cochin, Université Paris Descartes Faculté de Médecine, Paris, France
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