The results suggest that there are a large proportion of people with neck pain that present with signs indicating dysfunction beyond the local tissues. Ongoing exploration of these presentations may lead to more informed management and improved outcomes.

ObjectivesTo compare isolated axial psoriatic arthritis (PsA), axial PsA with peripheral involvement and isolated axial ankylosing spondylitis (AS) with psoriasis. To evaluate predictors for developing peripheral disease from isolated axial PsA over time.MethodsTwo PsA and AS cohorts identified patients with PsA with axial disease and isolated axial patients with AS with psoriasis. Logistic regression compared isolated axial PsA to axial PsA with peripheral involvement and isolated axial AS with psoriasis. Cox proportional hazards model evaluated predictors for developing peripheral disease from isolated axial PsA.ResultsOf 1576 patients with PsA, 2.03% had isolated axial disease and 29.38% had axial and peripheral disease. human leucocyte antigen HLA-B*27 positivity (OR 25.00, 95% CI 3.03 to 206.11) and lower Health Assessment Questionnaire scores (OR 0.004, 95% CI 0.00 to 0.28) were associated with isolated axial disease. HLA-B*27 also predicted peripheral disease development over time (HR 7.54, 95% CI 1.79 to 31.77). Of 1688 patients with AS, 4.86% had isolated axial disease with psoriasis. Isolated axial patients with PsA were older at diagnosis (OR 1.06, 95% CI 1.01 to 1.13), more likely to have nail lesions (OR 12.37, 95% CI 2.22 to 69.07) and less likely to have inflammatory back pain (OR 0.12, 95% CI 0.02 to 0.61) compared with patients with isolated axial AS with psoriasis.ConclusionsIsolated axial PsA and AS with psoriasis are uncommon. HLA-B*27 positivity is associated with isolated axial PsA and may identify those who develop peripheral disease over time. Isolated axial PsA is associated with better functional status. Isolated axial PsA appears clinically distinct from isolated axial AS with psoriasis.

Objective. To determine bone mineral density (BMD) in psoriatic arthritis (PsA) patients, factors associated with undergoing BMD testing, and the effect of PsA clinical activity on BMD.Methods. Patients attending the University of Toronto PsA Clinic with BMD testing results from cohort inception to January 2019 were included. Descriptive statistics summarized lumbar spine, femoral neck, and total hip T scores. Cox proportional hazards regression identified predictors for BMD testing. Logistic regression analysis determined odds of having normal (T score −1.0 or more) versus osteoporotic-range BMD (T score −2.5 or less). A multistate model determined factors associated with BMD state changes over time.Results. Of the 1,479 patients, 214 had BMD tests performed. The mean AE SD T scores at the lumbar spine, femoral neck, and total hip were −0.30 AE 0.32, −1.10 AE 1.04, and −0.45 AE 0.42, respectively. Osteopenia and osteoporosis occurred in 45.27% and 12.94% of patients. Increasing age, menopause, elevated acute-phase reactants, and biologics, methotrexate, and systemic glucocorticoids use were associated with a higher chance of undergoing BMD testing. Increased body mass index (BMI) and biologics use were associated with a lower chance of having osteoporotic-range BMD test results. In multistate analysis, polyarthritis may portend lower BMD results over time, although this did not achieve statistical significance due to low patient numbers.Conclusion. The prevalence of osteopenia and osteoporosis in the PsA cohort was similar to that of the general population. Clinicians are using osteoporosis risk factors and PsA disease severity markers to select patients for BMD testing. Polyarticular disease may portend worse BMD test results. Biologic use and increased BMI appear to have a protective effect.

Objective To describe changes in service delivery and access to rheumatologists pre- and during the COVID-19 pandemic periods. Methods We conducted a population-based study in Ontario, Canada. Patient visits with rheumatologists were ascertained using billing claims data. Contacts with rheumatologists were separately defined by the type of patient encounter (including office visits, telemedicine visits, and new patient consultations). Changes in the total weekly volume of encounters and monthly rates after COVID-19 public health measures were imposed were compared to expected baseline rates determined before pandemic onset (March 17, 2020). Results In the year prior to the pandemic, there were 289,202 patients (of which 99,641 were new consults) seen by 239 rheumatologists. In the 1 year following the pandemic onset, there were 276,686 patients (of which 88,777 were new consults) seen by 247 rheumatologists. In March 2020, there was an immediate 75.9% decrease in outpatient office visits and a rapid rise in telemedicine visits. By September 2021, 49.7% of patient encounters remained telemedicine visits. For new patient consultations, there was an immediate 50% decrease in visits at the pandemic onset, with 54.8% diverted to telemedicine visits in the first year of the pandemic versus 37.5% by September 2021. New rheumatology consultation rates continued decreasing over the study period. Conclusion Rheumatology care delivery has shifted due to the pandemic, with telemedicine sharply increasing early in the pandemic and persisting over time. The pandemic also negatively impacted access to rheumatologists resulting in fewer new consultations, raising concerns for potential delays to diagnosis.

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ObjectiveDespite medical therapy damage occurs in PsA patients requiring musculoskeletal (MSK) surgery. We aimed to describe MSK surgery in PsA patients and identify risk factors for undergoing first MSK surgery attributable to PsA.MethodsA single-center cohort identified PsA patients fulfilling CASPAR criteria who had MSK surgery from January 1978 to December 2019 inclusive. Charts were reviewed to confirm surgeries were MSK-related and attributable to PsA. Descriptive statistics determined MSK surgery prevalence and types. Cox proportional-hazards models evaluated clinical parameters for undergoing first MSK surgery using time-dependent covariates. Using a dataset with one-to-one matching on markers of PsA disease severity, a Cox proportional-hazards model evaluated the impact of targeted therapies, namely biologics on time to first MSK surgery.ResultsOf 1574 patients, 185 patients had 379 MSK surgeries related to PsA. The total number of damaged joints (HR 1.032,p< 0.001), tender/swollen joints (HR 1.037,p= 0.007), presence of nail lesions (HR 2.079,p< 0.006), higher Health Assessment Questionnaire scores (HR 2.012, p < 0.001), elevated erythrocyte sedimentation rate (HR 2.365,p= 0.017) and HLA-B*27 positivity (HR 2.217,p= 0.048) were associated with increased risk of surgery, while higher Psoriasis Area Severity Index (HR 0.881,p< 0.002) conferred a protective effect in a multivariate model. The effect of biologics did not reach statistical significance.ConclusionMSK surgery attributable to PsA is not rare, affecting 11.8% of patients. Markers of cumulative disease activity and damage are associated with a greater risk of requiring surgery.

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