Background Patients with psoriasis (PsO) are at an increased risk of developing psoriatic arthritis (PsA).1 It has been observed that scalp PsO is indicative of more severe PsO, and increased PsO severity plus scalp PsO are associated with an increased risk of PsA.2,3 Objectives To determine if baseline scalp PsO is associated with baseline severity of PsA and if it is predictive of treatment response to etanercept (ETN). Methods In the PRESTA study (clinicaltrials.gov NCT00245960), patients with PsA plus PsO received either ETN 50 mg twice weekly for 12 wks followed by ETN 50 mg once weekly (QW; n=379) or ETN 50 mg QW for 24 wks (n=373). For this analysis, patients who received ETN 50 mg QW were analyzed by their scalp PsO status (scalp+ versus scalp–). Baseline characteristics investigated in scalp+ vs scalp– patients included age, gender, race, family history of PsO and PsA, and PsA subtype. The following treatment outcomes were compared in scalp+ vs scalp– patients at baseline and in improvements at Wks 12 and 24: C-reactive protein levels and fatigue score; skin involvement measures including body surface area, PsO area severity index, and physician global assessment (PGA) PsO; joint involvement outcomes including the disease activity score in 28-joints, duration of morning stiffness, PGA arthritis, subject global assessment (SGA) of disease activity, subject assessment of joint pain, painful joints (28/68 joint counts), swollen joints (28/66 joint counts), digits with dactylitis, and points with enthesitis; quality of life (QoL) EuroQoL-5D (EQ-5D) and health assessment questionnaire (HAQ) scores. The % of patients achieving dactylitis ≤1, enthesitis ≤1, and HAQ ≤0.5 at Wks 12 and 24 were also calculated. Results In the ETN QW cohort, 273/373 (73.2%) patients had scalp PsO. Spondyloarthropathy was the only PsA subtype shown to be significantly higher in scalp+ vs scalp– patients: 43/49 (87.8%) vs. 521/702 (74.2%; P=0.03). At baseline, scalp– patients were older (49.4 years vs 46.0; P=0.010), with more females (52% vs 33%; P=0.001), and a significantly higher number of painful joints (28-joint count; Table). Scalp+ patients had a significantly higher baseline SGA of disease activity. Improvements from baseline at Wks 12 and 24 for both fatigue and subject assessment of joint pain were significantly higher for scalp+ patients with significantly better final Wk 12 and 24 results. However, only improvement in the number of painful joints (28-joint count) was significantly greater for the scalp– group with similar final Wk 12 and 24 results for scalp+ and scalp– patients. Significantly more patients in the scalp– group had dactylitis ≤1 at Wk 24 and enthesitis ≤1 at Wk 12, but significantly more scalp+ patients had HAQ ≤0.5 at Wk 12. No significant differences were observed between the scalp+ and scalp– patients in the other baseline values or in the improvements from baseline for the other treatment outcomes tested. Conclusions Significant differences were observed in joint involvement and QoL in pa...
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Background Polyarthritis (PA) is defined by inflammation of ≥5 joints differentiating it from oligoarthritis (OA) which affects 2-4 joints. There are limited data on the demographic and disease characteristics of psoriasis patients with either OA or PA. Objectives Our analyses examined and characterized the baseline attributes of psoriasis subjects with PA and OA in the PREPARE trial. Methods PREPARE was a multicenter non-interventional study conducted to estimate PsA prevalence in patients with psoriasis. Diagnosis of PA and OA was based on clinical examination by rheumatologists. Demographic and disease characteristics were assessed among patients with PA or OA at baseline. Results A total of 406 subjects were included in these analyses; of these 222 (54.7%) had PsA following rheumatologist assessment (based on physical examination, medical history and laboratory analysis). At baseline, 253 patients had PA and 153 had OA. A significantly greater proportion of patients with PA (161/252; 63.9%) had PsA than those with OA (61/152; 40.1%) (P<0.001). Among patients with PsA, CASPAR scores were significantly higher among the PA group than the OA group (P=0.0128); 54.6% of PA patients had a CASPAR score ≥4 compared with 41.0% of AO patients. Extent of skin disease was similar for PA vs OA patients (BSA: 9.9% vs 8.9%; NAPSI: 2.2 vs 2.0; PASI: 7.0 vs 6.7). Patients with PA had significantly higher DAS28 and HAD Anxiety and Depression Scores and a significantly lower EQ-5D score than those with OA (Table 1). Percent of activity impaired and work time missed was also significantly higher in the PA group than the OA group. Table 1 Clinical endpoint Polyarthritis (N=253) Oligoarthritis (N=153) P-value Baseline – Mean (SD) DAS28 3.9 (1.4) 2.6 (0.9) <0.0001 EQ-5D 0.6 (0.3) 0.7 (0.2) <0.0001 HAD Anxiety Score 7.6 (4.2) 6.3 (4.4) 0.003 HAD Depression Score 6.1 (4.2) 4.3 (3.7) <0.0001 % Activity Impairment 25.1 (27.8) 19.6 (25.0) <0.05 % Work Time Missed 8.2 (22.6) 2.5 (9.9) 0.03 Conclusions Psoriasis patients with OA and PA exhibit different phenotypes. Patients with PA had a significantly higher burden of disease and work impairment than those with OA as demonstrated by the baseline outcome data presented here. Similar levels of skin disease were observed for psoriasis patients with PA and OA. Acknowledgements The PREPARE study (ClinTrials.gov NCT01147874) was sponsored by Pfizer Inc. Medical writing support was provided by John Bilbruck of Engage Scientific and was funded by Pfizer Inc. Disclosure of Interest P. Helliwell Grant/research support: Pfizer, Abbie, Consultant for: Abbvie, Celgene, Pfizer, Novartis, Janssen, UCB, BMS, Eli-Lilly and Merck, H. Jones Employee of: Pfizer, A. Szumski Employee of: Pfizer, L. Marshall Employee of: Pfizer DOI 10.1136/annrheumdis-2014-eular.2110
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