AB0922 Metabolic syndrome is associated with active disease in psoriatic arthritis and may contribute to development of syndesmophytes

Abstract

BackgroundAn increased prevalence of metabolic syndrome (MetS) has been reported in psoriatic arthritis (PsA) suggesting an association between the inflammation and MetS.ObjectivesThe aim of this study is to investigate its relationship with disease activity in patients with PsA. We also evaluated whether an association exists between MetS and axial involvement in PsA.MethodsThis study included patients with PsA followed in the Rheumatology outpatient clinic at Dokuz Eylul University. Age-matched patients with Takayasu arteritis (TA), an inflammatory systemic disease, were enrolled as diseased controls. The NCEP-ACT III criteria were used to identify subjects with MetS. Disease activity was assessed in patients with PsA by using several parameters including BASDAI, ASDAS, VAS patients’ and physician’ global, Tender and Swollen joint assessment (28/68), DAS28, DAPSA, CPDAI and SPARCC Enthesitis Index. ESR and serum CRP levels were measured. BASFI and BASMI were used to evaluate functional status and HAQ, ASQoL and DLQI to evaluate health and PASI to measure the severity of psoriasis. Hand and pelvis X-rays and sacroiliac joint MRIs were performed when indicated.ResultsThere were 104 PsA patients (63.5% F; mean age: 50.9±13.0 years) who fulfilled the CASPAR criteria and 28 TA patients (89% F, mean age: 46.3±9.1) who fulfilled the ACR 1990 criteria. The prevalence of MetS was found to be considerably higher in PsA patients compared to TA patients (45.2% and 21.4% respectively, p<0.001). In the comparison of PsA patients with and without MetS, no differences were found regarding treatment frequencies of NSAIDs, glucocorticoids, DMARDs and anti-TNFs and also mean glucocorticoid dosages. PsA patients with MetS had higher BASDAI, BASFI, BASMI, VAS, ASqOL, CPDAI, ASDAS and HAQ scores compared to PsA patients without MetS (table 1). More patients with syndesmophytes were found among PsA patients with MetS compared to those without MetS (p=0.027). There were no differences in indexes related predominantly peripheral involvement, such as tender and swollen joint counts, enthesitis score and presence of dactylitis. In multivariable regression analysis, presence of syndesmophytes had no relationship with MetS, but still related with ESR and BASMI.Abstract AB0922 – Table 1Clinical features and disease activity parameters in PsA patients with and without MetS.ConclusionsThis study demonstrates a higher prevalence of MetS in PsA patients compared to TA. It also suggests that MetS might be associated with high disease activity and more severe disease especially in patients with axial involvement.Disclosure of InterestNone declared

The Impact of Comorbidity on Patient-Reported Outcomes in Psoriatic Arthritis: A Systematic Literature Review

“…1). Ultimately, 66 of the 84 studies were excluded from inclusion in the systematic literature review (Table 1) [12,, and 18 articles were included [9,14,[83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98], one of which had been identified from the hand search (see Tables 2 and 3 for more detail).…”

“…Most of the studies included in the systematic literature review were cross-sectional [9,84,85,[87][88][89][90][92][93][94][95][96][97], although prospective observational studies were also found [14,83,86,91,98], and most were of moderate quality (predominantly Oxford CEBM levels of evidence 2b or 4). The total number of PsA patients included in each study ranged from 3571 [91] to 40 [97].…”

“…The most frequently analysed PROs were function [83,84,86,89,92,94], quality of life [9,14,84,[91][92][93] and fatigue [83,85,87,93], but some studies evaluated the impact of comorbidity on pain [83,84,91,98], work disability [88] or sleep quality [93,96,97] The impact of comorbidity on PROs of PsA patients was examined using the CCI in two large, high-quality prospective cohorts [83,86]. In the first study (using DANBIO, a nationwide registry of biological therapies in Denmark), the authors noted that a higher score on the CCI was associated with worse function, pain, fatigue and PGA (univariate analyses) [83].…”

“…The impact of the metabolic syndrome on PROs of PsA patients, according to the National Commission for Employment Policy (NCEP)-ACT III guidelines, was evaluated in two crosssectional studies, which recruited more than 150 patients with PsA [90,92]. In one of these studies [90], no statistically significant association was found between the metabolic syndrome and the BASDAI, HAQ and Routine Assessment of Patient Index Data 3 (RAPID3) index, although it should be noted that the small size of the study sample (50 patients) may have influenced this result [90].…”

“…In one of these studies [90], no statistically significant association was found between the metabolic syndrome and the BASDAI, HAQ and Routine Assessment of Patient Index Data 3 (RAPID3) index, although it should be noted that the small size of the study sample (50 patients) may have influenced this result [90]. In the second study, the authors observed a negative impact of metabolic syndrome (compared with patients without it; higher values indicating more active disease/worse function/great disability) on the BASDAI (22 vs. 11, p = 0.042), BASFI (18 vs. 5, p = 0.009), HAQ (0.375 vs. 0.125, p = 0.011), PGA (31 vs. 20, p = 0.030), and ASQoL (7 vs. 3, p = 0.017) [92].…”