Ogdie Alexis, Blachley Taylor, Lakin Paul R, Dube Blessing, McLean Robert R, Hur Peter, Mease Philip J
A. Ogdie, MD, MSCE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
T. Blachley, MS, P.R. Lakin, MS, B. Dube, MPH, R.R. McLean, DSc, MPH, CorEvitas, LLC, Waltham, Massachusetts.
J Rheumatol. 2022 Mar;49(3):281-290. doi: 10.3899/jrheum.210662. Epub 2021 Dec 1.
To determine the presence of axial symptoms in patients with psoriatic arthritis (PsA) and examine differences between those with or without a diagnosis of axial PsA (axPsA).
Patients with PsA at their Corevitas' (formerly Corrona) Psoriatic Arthritis/Spondyloarthritis Registry enrollment visit were stratified into 4 mutually exclusive groups based on axial manifestations: physician-diagnosed axPsA only (DxSx), patient-reported elevated spine symptoms only (DxSx; defined as Bath Ankylosing Spondylitis Disease Activity Index ≥ 4 and spine pain visual analog scale ≥ 40), physician-diagnosed and patient-reported manifestations (DxSx), and no axial manifestations (DxSx). Patient characteristics, disease activity, and patient-reported outcomes (PROs) at enrollment in each axial manifestation group were compared with the DxSx group. Associations of patient characteristics with the odds of having axial manifestations were estimated using multinomial logistic regression (reference: DxSx).
Of 3393 patients included, 226 (6.7%) had DxSx, 698 (20.6%) had DxSx, 165 (4.9%) had DxSx, and 2304 (67.9%) had DxSx. Patients with DxSx or DxSx were more frequently women and had a history of depression and fibromyalgia (FM) vs patients who had DxSx. Patients with DxSx or DxSx were more frequently HLA-B27 positive than those with DxSx. FM was significantly associated with increased odds of DxSx or DxSx. Disease activity and PROs were worse in patients with DxSx or DxSx than in those with DxSx.
Patients who had self-reported elevated spine symptoms, with or without physician-diagnosed axPsA, had worse quality of life and higher disease activity overall than patients without axial manifestations, suggesting an unmet need in this patient population.
确定银屑病关节炎（PsA）患者中轴向症状的存在情况，并检查诊断为轴向型银屑病关节炎（axPsA）和未诊断为轴向型银屑病关节炎的患者之间的差异。
在Corevitas（原Corrona）银屑病关节炎/脊柱关节炎登记处登记就诊的PsA患者，根据轴向表现分为4个相互排斥的组：仅医生诊断为axPsA（DxSx）、仅患者报告脊柱症状升高（DxSx；定义为巴斯强直性脊柱炎疾病活动指数≥4且脊柱疼痛视觉模拟量表≥40）、医生诊断和患者报告的表现（DxSx）以及无轴向表现（DxSx）。将每个轴向表现组入组时的患者特征、疾病活动度和患者报告结局（PROs）与DxSx组进行比较。使用多项逻辑回归估计患者特征与有轴向表现几率的关联（参考：DxSx）。
在纳入的3393例患者中，226例（6.7%）有DxSx，698例（20.6%）有DxSx，165例（4.9%）有DxSx，2304例（67.9%）有DxSx。与有DxSx的患者相比，有DxSx或DxSx的患者女性更常见，且有抑郁症和纤维肌痛（FM）病史。有DxSx或DxSx的患者比有DxSx的患者HLA-B27阳性更常见。FM与DxSx或DxSx几率增加显著相关。有DxSx或DxSx的患者的疾病活动度和PROs比有DxSx的患者更差。
自我报告脊柱症状升高的患者，无论是否有医生诊断的axPsA，总体生活质量都比无轴向表现的患者更差，疾病活动度更高，这表明该患者群体存在未满足的需求。
