AB0926 The relationship between disease activity indices in patients with psoriatic arthritis

Abstract

Background Psoriatic arthritis (PA) is a chronic inflamatory joint diseasewhich combines skin disease (psoriasis) with various joint manifestations (spondylitis, peripheral arthritis, dactilytis and enthesitis) (1). Some authors said that 11% of individuals with psoriasis had PA, but with more severe psoriasis the number rose to 56% (2). There are many composite instruments used for assessment of disease activity, most of them borrowed from another inflammatory disease, particularly rheumatoid arthritis, but none has been firmily established yet (1,3). Disease heterogeneity makes failure use of a single instrument to assess the whole spectrum of clinical feature requiring a separate assessement of the disease manifestation. Objectives To compare different tools and methods for assessing disease activity in patient with PA. Methods A cohort study was performed in our rheumatology department on 33 patients with PA, consecutively included from august 2011 to december 2011. All patients met the CASPAR criteria for PA. The assessment included clinical (tender joint, swollen joint, VAS score, patient global assessment, MASES score) and laboratory variables (ESR,CRP). Also imaging (limb joint X-ray and enthesis ultrasound) and clinical evaluation on skin disease (with PASI score) was made. Moreover, we used a composite index originally developed for reactive arthritis (DAPSA) to express the disease activity. Results The cohort included 18 men and 15 women with mean age 56.55±8.83 years, with family history of psoriasis in about 18.2% of cases. 33.3% had early disease and 27.3% had a disease older than 10 year. Majority of patients (87.9%) following DMARD therapy and 63.6% had erosive disease. Patients with family history of psoriasis had more biological active disease with mean of CRP 6.67±2.65 (p=0.03). Related to disease activity scores, DAPSA score is more increased in polyarticular and decreased when co-exist axial involvement (29.38±17.65 and 15.01±6.10, respectively) (p=0.05). Moreover, DAPSA score had good correlation with clinical indices used in practice (tender joints, swollen joints, VAS score, ESR and CRP), but no correlation with PASI score, entheseal scores (MASEI, MASES) and erosive peripheral disease. PASI score had good correlation only with MASES score (p=0.009, r=0.4). Moreover, MASES score is related with axial involvement (6.71±2.13, p=0.05). Conclusions The DAPSA score reflects the global activity of peripheral joint disease, but when coexist whit axial involvment we need to use suplimentarly indices like MASES and PASI score. References Shoels M et al. Application of the DAREA/DAPSA score for assessmentof disease activity in psoriatic arthritis. Ann Rheum Dis 201 69(8):1441-7 Gladman DD. Psoriatic arthritis Clinical features. In Ritchlin CT, Fitzgerald O. (Eds) Psoriatic arthritis and reactive arthritis. Mosby Elsevier 2007;9-18. De Miguel E et al. Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis, AnnRheumDis 2011, 70: 434-9 Disclosure of Interest None ...

Measuring Outcomes in Psoriatic Arthritis

“…However, it does not include measures of other disease domains, such as psoriasis and enthesitis. It shows good correlation with other joint measures (114,117) but not with other domains (116,118). Remission is associated with low residual articular disease, but other domains can remain active (104–106,119).…”