P.J. Mease, MD, MACR, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington;
M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts.
J Rheumatol. 2021 Mar;48(3):367-375. doi: 10.3899/jrheum.191117. Epub 2020 Jun 1.
To assess the effect of clinical enthesitis by body site in patients with psoriatic arthritis (PsA).
Adults with PsA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013-March 2018) were included. Enthesitis at enrollment was assessed by the Spondyloarthritis Research Consortium of Canada Enthesitis Index and classified by affected sites (upper, lower, or both). Disease activity (e.g., Clinical Disease Activity Index, Clinical Disease Activity Index for PsA), patient-reported outcomes (PRO; e.g., patient-reported pain and fatigue), and work productivity were compared between those with and without enthesitis using - or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables. The association of enthesitis with disease activity and PRO measures versus no enthesitis was modeled using multivariable-adjusted linear or logistic regression.
Of 2003 patients with PsA, 391 (19.5%) had enthesitis: 80 (20.5%) in upper sites only; 137 (35.0%) in lower sites only; and 174 (44.5%) in both. Regardless of location, disease activity and PRO were worse in patients with versus without enthesitis. In adjusted models, the presence of enthesitis at any site was significantly associated with worse disease activity versus no enthesitis. Enthesitis in lower or both upper and lower sites was associated with higher pain and fatigue scores and greater work impairment versus no enthesitis.
Patients with clinical enthesitis had worse disease activity regardless of enthesitis location versus those without enthesitis, and patients with enthesitis in lower or both upper and lower sites had worse pain, fatigue, and work impairment.
评估银屑病关节炎（PsA）患者不同部位的临床附着点炎的影响。
纳入 2013 年 3 月至 2018 年 3 月期间入组 Corrona Psoriatic Arthritis/Spondyloarthritis 注册研究的成人 PsA 患者。入组时附着点炎通过加拿大脊柱关节炎研究协会附着点炎指数进行评估，并按受累部位（上、下或两者）进行分类。采用 -检验或 Wilcoxon 秩和检验比较附着点炎与无附着点炎患者的疾病活动度（如临床疾病活动指数、银屑病关节炎临床疾病活动指数）、患者报告结局（PRO；如患者报告的疼痛和疲劳）和工作效率，采用卡方检验或 Fisher 确切概率法比较分类变量。采用多变量调整线性或逻辑回归模型，分析附着点炎与疾病活动度和 PRO 指标的相关性。
在 2003 例 PsA 患者中，391 例（19.5%）存在附着点炎：仅上部位 80 例（20.5%）；仅下部位 137 例（35.0%）；上、下部位均有 174 例（44.5%）。无论部位如何，有附着点炎的患者与无附着点炎的患者相比，疾病活动度和 PRO 更差。在调整模型中，任何部位存在附着点炎与无附着点炎相比，疾病活动度显著更差。下部位或上、下部位均有附着点炎与无附着点炎相比，疼痛和疲劳评分更高，工作受损更严重。
无论附着点炎的部位如何，有临床附着点炎的患者的疾病活动度均较无附着点炎的患者更差，而下部位或上、下部位均有附着点炎的患者疼痛、疲劳和工作受损更严重。
