Mease Philip J, Karki Chitra, Palmer Jacqueline B, Etzel Carol J, Kavanaugh Arthur, Ritchlin Christopher T, Malley Wendi, Herrera Vivian, Tran Melody, Greenberg Jeffrey D
Swedish Medical Center and University of Washington School of Medicine, Seattle, Washington.
Corrona, Southborough, Massachusetts.
Arthritis Care Res (Hoboken). 2017 Nov;69(11):1692-1699. doi: 10.1002/acr.23249.
To characterize psoriatic arthritis (PsA) patients with dactylitis or enthesitis and evaluate the associations of these manifestations with disease activity and patient-reported outcomes.
Using the Corrona PsA/Spondyloarthritis Registry, patient characteristics, disease activity, and patient-reported outcomes at registry enrollment were assessed for PsA patients ages ≥18 years with or without dactylitis or enthesitis. Regression models were used to evaluate associations of dactylitis and enthesitis with outcomes, including minimal disease activity, Health Assessment Questionnaire scores, patient-reported pain and fatigue, and work productivity (Work Productivity and Activity Impairment questionnaire). Adjustments were made for age, sex, race, body mass index, disease duration, and history of biologic agent, disease-modifying antirheumatic drug, and prednisone use.
This analysis included 1,567 PsA patients (420 with enthesitis; 228 with dactylitis). Patients with versus without dactylitis or enthesitis had greater disease activity and were less likely to be in minimal disease activity (P < 0.05). Patients with versus without enthesitis had poorer functional status as assessed by the Health Assessment Questionnaire (adjusted P = 4.15 x 10 ), greater patient-reported pain and fatigue (adjusted P < 0.0001), and greater likelihood of any impairment while working (adjusted odds ratio [OR] 1.57, P = 0.027), overall work impairment (OR 1.85, P = 0.006), and activity impairment (OR 1.77, P = 0.008). Dactylitis was associated with similar numerical trends, but differences versus patients without dactylitis did not reach statistical significance.
Enthesitis and dactylitis are associated with greater overall disease burden of PsA, underscoring the importance of identifying, assessing, and effectively managing these periarticular manifestations.
对患有指（趾）炎或附着点炎的银屑病关节炎（PsA）患者进行特征描述，并评估这些表现与疾病活动度及患者报告结局之间的关联。
利用Corrona PsA/脊柱关节炎注册登记库，对年龄≥18岁、患有或未患有指（趾）炎或附着点炎的PsA患者在登记入组时的患者特征、疾病活动度及患者报告结局进行评估。采用回归模型评估指（趾）炎和附着点炎与结局之间的关联，结局包括最小疾病活动度、健康评估问卷评分、患者报告的疼痛和疲劳以及工作效率（工作效率和活动障碍问卷）。对年龄、性别、种族、体重指数、疾病病程以及生物制剂、改善病情抗风湿药和泼尼松使用史进行了校正。
该分析纳入了1567例PsA患者（420例有附着点炎；228例有指（趾）炎）。有指（趾）炎或附着点炎的患者与无指（趾）炎或附着点炎的患者相比，疾病活动度更高，处于最小疾病活动度的可能性更低（P<0.05）。通过健康评估问卷评估，有附着点炎的患者与无附着点炎的患者相比，功能状态更差（校正P=4.15×10）；患者报告的疼痛和疲劳更严重（校正P<0.0001）；工作时出现任何障碍的可能性更高（校正比值比[OR]1.57，P=0.027），总体工作障碍（OR 1.85，P=0.006）以及活动障碍（OR 1.77，P=0.008）。指（趾）炎与类似的数值趋势相关，但与无指（趾）炎的患者相比，差异未达到统计学显著性。
附着点炎和指（趾）炎与PsA总体疾病负担加重相关，凸显了识别、评估和有效管理这些关节周围表现的重要性。
