Objective. To evaluate the association of the Assessment of Spondyloarthritis international Society Health Index (ASAS-HI) with disease activity and disease burden in patients with spondyloarthritis (SpA). Methods. Observational, cross-sectional and single-centre study from the Córdoba AxSpA Task force, Registry and Outcomes (CASTRO). Scores related to disease activity (BASDAI and ASDAS), functionality (BASFI), structural damage, mobility, health and the presence of concomitant fibromyalgia (FM) were obtained from all patients. ASAS-HI score was considered the main outcome. Pearson's r statistic, Student's t test, and univariate and multivariate linear regressions were performed to assess the association between the ASAS-HI score and the studied covariates. Results. A total of 126 SpA patients were included. The mean ASAS-HI score was 4.6±3.9, showing a "strong" positive linear correlation (r>0.60) with the BASDAI and BASFI and a "moderate" positive linear correlation (r=0.40 to 0.60) with the global VAS and ASDAS. Patients with FM showed a significantly higher ASAS-HI score than patients without FM (9.5±3.2 vs. 3.7±3.4, respectively, p<0.01). Multiple linear regression showed that 57.4% of the ASAS-HI variability (R 2 =0.574) was explained by the presence of concomitant FM (β=2.23, 95% CI 0.73 to 3.80, p=0.004), higher scores on the BASDAI (β=0.62, 95% CI 0.25 to 0.97, p=0.001) and BASFI (β=0.57, 95% CI 0.26 to 0.88, p=0.001). Conclusion. The impairment of health in patients withSpA was mainly associated with high disease activity, worsening functionality and with the presence of a possible concomitant FM. Therefore, in patients with high ASAS-HI scores we must evaluate the presence of concomitant FM.
BackgroundThe prevalence of late-onset psoriatic arthritis (PsA) is increasing in parallel with the progressive aging of the population. The elderly population presents a greater functional deterioration and a greater number of comorbidities than the young people. With this study we aim to find clinically relevant differences to predict the evolution and prognosis of the disease depending on the onset of the symptoms to carry out a more exhaustive follow-up.ObjectivesTo evaluate the association of the age at onset of PsA symptoms with the characteristics and burden of the disease.MethodsObservational study that includes a subgroup of 231 patients with Psoriatic Arthritis (PsA) from the REGISPONSER study (Registry of Spondyloarthritis of Spanish Rheumatology) and the RESPONDIA study (Ibero-American Registry of Spondyloarthropathies). Patients with less than 10 years of disease duration (since the first symptom) were selected so that the sample was homogeneous. Patients were divided into two groups according to the age of PsA onset (early-onset: ≤40 years old and late-onset: ≥60 years old). The characteristics and burden of the disease were compared using the Student’s t-test/Mann-Whitney U test for quantitative variables or using the chi-square/Fisher test for qualitative variables.Results411 patients were included [early-onset 179 (77.5%); late-onset 52 (22.5%)]. There was a higher percentage of men in the late-onset group compared to the early-onset group [94 (62.3%) vs. 38 (86.4%), p = 0.003]. The diagnostic delay was shorter in those whose onset of the disease was late [1.5 (2.7) vs 4 (7.7), p=0.036], as well as the duration of the disease [2.9 (2.4) vs 4.2 (2.7), p= 0.012]. A lower presence of sacroiliitis was found in patients with late-onset PsA [6 (12.2%) vs 58 (32.6%), p=0.005] as well as enthesitis [5 (9.8%) vs 44 (24.6%), p =0.023]. Regarding the comorbidities, there was a higher frequency of heart disease among patients with late-onset PsA [4 (7.8) vs 0 (0), p=0.000]. No statistically significant differences were found between kidney and lung disease. Regarding the outcome measures, the BASFI score was higher in the late-onset group [3.3 (2.5) vs. 2.2 (2.2), p=0.002]. The late-onset group had a lower FSF12 component [34.6 (8.7) vs. 38.7 (10.5), p = 0.001]. The radiographic indices measured by BASRI showed worse results in those patients with late-onset disease both in the spine [2.9 (3) vs 1.6 (2), p=0.020] and in the total BASRI [3.4 (3 .4) vs 1.9 (2.4), p=0.012].ConclusionOur study suggests that the age of onset of PsA was associated with the different characteristics of the disease. Patients with late-onset PsA were more frequently males, showed worse functionality and more structural damage in comparison with early-onset PsA. Sacroiliitis and enthesitis were found less frequently in the late-onset group. Quality of life, disease activity and treatments taken were not associated significantly with age of onset.Table 1.Description of different characteristics across two groups: early and late onsetEarly-onset N=179 n (%)=77.5Late-onset N=52 n (%)=22.5p-valueSex (male)94 (62.3)38 (86.4)0.003Age (SD)38.7 (9.3)71.3 (7.5)0.000Enthesitis44 (24.6)5 (9.8)0.023Dactilytis36 (20.1)9 (17.6)0.695Sacroiliitis58 (32.6)6 (12.2)0.005Diagnostic Delay, mean (SD)4 (7.7)1.5 (2.7)0.036Disease Duration, mean (SD)4.2 (2.7)2.9 (2.4)0.012Arthritis (lower limbs)118 (65.9)33 (64.7)0.872Arthritis (upper limbs)82 (45.8)31 (60.8)0.059BASDAI, mean (SD)3.9 (2.5)3.8 (2.4)0.932BASFI, mean (SD)2.2 (2.2)3.3 (2.5)0.002ASDAS, mean (SD)2.3 (1.1)2.3 (0.9)0.894FSF12, mean (SD)38.7 (10.5)34.6 (8.7)0.001MSF12, mean (SD)47.7 (10.6)49.3 (9.2)0.341BASRI spine1.6 (2)2.9 (3)0.020BASRI total1.9 (2.4)3.4 (3.4)0.012ESR mm/h, mean (SD)17.2 (14.2)23.9 (19.1)0.005csDMARDs (ever)111 (62.7)31 (63.3)0.943bDMARDs (ever)21 (11.9)3 (6)0.234Disclosure of InterestsNone declared
Background:The ASAS Health Index (ASAS-HI) questionnaire, a tool that measures the impact of the disease on the health in patients with Spondyloarthritis (SpA), has been recently validated. However, there are still no studies evaluating the utility of this questionnaire in daily clinical practice.Objectives:The objective of this study is to evaluate the association of ASAS-HI with disease activity, functionality, mobility, and structural damage in patients with SpA.Methods:This is an observational, cross-sectional and single-center study in which 126 consecutive patients with SpA were included. Sociodemographic data, scores related to disease activity (BASDAI and ASDAS), functionality (BASFI), structural damage (cervical, lumbar and total mSASSS), mobility (BASMI and UCOASMI), quality of life (ASAS-HI) and the presence of concomitant fibromyalgia (evaluated with the FIRST questionnaire) were obtained from all patients. The ASAS-HI questionnaire was considered as the main outcome (scale from 0 to 17). Pearson’s correlation coefficient was used to evaluate the association of the different continuous variables with each other. Student’s t-test was used to compare the ASAS-HI between different subgroups of patients (men vs. women, ASDAS>2,1 vs. ASDAS≤2,1 and fibromyalgia + vs. fibromyalgia-). Finally, a multivariate linear regression was performed to determine which factors explain the variability of ASAS-HI in these patientsResults:Among the 126 patients included, 83 (65.9%) were men, with a mean age of 45.1±12.3 years and a mean disease duration of 18.7±14.5 years. The mean ASAS-HI score in all patients was 4.7±4.0, showing a “strong” positive linear correlation (r>0.60) with BASDAI and BASFI, and “moderate” positive (r=0.40 to 0.60) with Global VAS and ASDAS (Figure 1). Patients with fibromyalgia showed a significantly higher ASAS-HI score compared with patients without fibromyalgia (9.5±3.2 vs 3.7±3.4, respectively). In addition, patients with high disease activity (ASDAS>2,1) showed a higher mean score in ASAS-HI compared with those with low activity (ASDAS≤2,1) (5.8 ± 3.8 vs 2.0 ± 2.4, p<0,001).Figure 1.Simple linear correlation (Pearson’s r) between the different variables studied.Finally, multiple linear regression showed that 57,4% (R2=0,574) of the ASAS-HI variability is explained by the presence of concomitant fibromyalgia (β = 2.23, 95%IC 0.73 to 3.80, p=0.004), BASDAI (β = 0.62, 95%IC 0.25 to 0.97, p=0.001) and BASFI (β = 0.57, 95%IC 0.26 to 0.88, p=0.001).Conclusion:In our study, the impairment of the quality of life in patients with SpA was mainly associated with a high disease activity (BASDAI), worsening functionality (BASFI) and with the presence of concomitant fibromyalgia. Neither mSASSS nor UCOASMI was associated with a change in ASAS-HI; thus, in our patients neither structural damage nor mobility seem to influence the quality of life. In a patient with a high ASAS-HI we must evaluate the presence of concomitant fibromyalgia.Acknowledgments:The authors wish to thank all patients who participated in the study.Disclosure of Interests:María Ángeles Puche Larrubia: None declared, Clementina López-Medina: None declared, María del Carmen Castro Villegas: None declared, Rafaela Ortega Castro: None declared, MLourdes Ladehesa Pineda: None declared, Pérez Sánchez Laura: None declared, Gómez García Ignacio: None declared, José Miguel Sequí-Sabater: None declared, Maria del Carmen Abalos-Aguilera: None declared, Inmaculada Concepcion Aranda-Valera: None declared, Garrido Castro Juan Luis: None declared, Alejandro Escudero Contreras Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene., Eduardo Collantes-Estevez: None declared
Background:Comorbidities have been reported to be more prevalent in patients with Spondyloarthritis (SpA) compared to the general population. Previous studies have suggested that patients with peripheral phenotypes exhibit a higher prevalence of traditional cardiovascular risk (CV) factors compared to those with a predominantly axial phenotype. However, the role of psoriasis in such differences has not been deeply studied.Objectives:To compare the prevalence of comorbidities (CV, malignancies and osteoporosis (vertebral or peripheral fracture, or low bone mineral density)) between patients with axial and peripheral phenotypes and to evaluate the role of psoriasis in such comorbidities in the whole spectrum of SpA (including psoriatic arthritis).Methods:Patients from the cross-sectional ASAS-COMOSPA study were classified as having either axial (presence of sacroiliitis on x-ray or MRI) or peripheral phenotype (absence of sacroiliitis AND presence of arthritis, enthesitis or dactylitis). Patients with each phenotype were divided into two groups depending on the presence or history of psoriasis. Pair-wise comparisons among the four groups (axial and peripheral with psoriasis/without psoriasis phenotypes) were conducted through univariate logistic regressions and generalized linear mixed models using disease duration and country as fixed and random effects, respectively. Multivariate analysis using were used to evaluate whether psoriasis and the phenotype are independently associated with each comorbidity.Results:A total of 3291 patients were included in this analysis (mean age 43.6 years, 65% males). The peripheral phenotype with psoriasis showed the highest prevalence of hypertension (44.9%), dyslipidaemia (34%) and diabetes (8.8%), while axial phenotype without psoriasis exhibited the lowest prevalence of dyslipidaemia (14.2%), diabetes (4.1%) and stroke (0.9%) (Table 1). Among patients with psoriasis, the axial phenotype showed a significantly [OR, 95%CI] lower prevalence of hypertension [OR 0.5, 0.4-0.8] and lower Framingham score [OR 0.97, 0.95-0.99] compared to peripheral patients even after adjusting for disease duration and country. Among patients with axial phenotype, patients with psoriasis showed higher prevalence of hypertension [OR 1.8, 1.4-2.2], dyslipidaemia [OR 2.0, 1.7-2.5], diabetes [OR 2.1, 1.4-3.0] and Framingham score [OR 1.0, 1.0-1.1] than non-psoriatic patients. Multivariate analysis confirmed that hypertension, dyslipidaemia and the Framingham score are independently associated with both the psoriasis and the peripheral phenotype.Prostatic cancer and colon cancer were independently associated with the presence of psoriasis but not with the phenotype. No differences were found across groups concerning osteoporosis.Conclusion:Both a peripheral phenotype and the presence of psoriasis were independently associated with an increased CV risk. Psoriasis seems to be associated with a higher prevalence of some malignant diseases, while osteoporosis do not seem to be associated with either phenotype or the presence of cutaneous involvement.Table 1.Description of comorbidities across the four groups.Psoriatic axialN = 460n (%)Non-psoriatic axialN = 2541n (%)Psoriatic peripheralN = 147n (%)Non-psoriatic peripheralN = 136n (%)p-value*BMI, mean (SD)27.4 (5.5)25.5 (5.5)27.3 (5.7)26.6 (5.3)<0.001Hypertension135 (29.5)487 (19.2)66 (44.9)25 (18.4)<0.001Dyslipidemia113 (24.8)359 (14.2)50 (34)23 (17)<0.001Diabetes37 (8.1)104 (4.1)13 (8.8)7 (5.2)<0.001Ischemic heart disease16 (3.5)51 (2)5 (3.4)2 (1.5)0.162Stroke11 (2.4)22 (0.9)3 (2)2 (1.5)0.028Framingham score, mean (SD)9.6 (8.7)6.6 (7.5)11.8 (8.8)5.8 (6)<0.001Prostatic cancer5 (1.8)5 (0.3)0 (0)0 (0)0.006Breast cancer (1.7)3 (0.4)1 (1.4)0 (0)0.181Colon cancer4 (0.9)4 (0.2)1 (0.7)1 (0.7)0.046Basal cell carcinoma6 (1.3)9 (0.4)1 (0.7)4 (3)<0.001Lymphoma0 (0)4 (0.2)3 (2)0 (0)<0.001*ANOVA or chi-square for continuous and qualitative variables, respectively.Acknowledgements:This study was conducted under the umbrella of the International Society for Spondyloarthritis Assessment (ASAS).Disclosure of Interests:None declared
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