Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


The Swedish Early Psoriatic Arthritis (SwePsA) Registry. 5-Year Follow-up: Higher Disease Activity, Greater Functional Impairment and Worse Outcome for Women Compared to Men.

Theander1,  Elke, Husmark2,  Tomas, Alenius3,  Gerd-Marie, Larsson4,  Per, Teleman5,  Annika, Geijer6,  Mats, Lindqvist7,  Ulla R. C.

Department of Rheumatology, Skåne University Hospital, Lund University, Malmö, Sweden
Department of Rheumatology, Falu Hospital, Falun, Sweden
Department of Public Health and Clinical Medicine, Rheumatology, Umeå University Hospital, Umeå, Sweden
Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
Spenshult Rheumatological Hospital, Oskarstrom, Sweden
Department of Radiology, Skåne University Hospital, Lund University, Lund, Sweden
Department of Medical Sciences, Rheumatology, University Hospital, Uppsala university, Uppsala, Sweden

Background/Purpose:

SwePsA intends to describe the course of disease during early psoriatic arthritis (PsA) in a real life clinical setting in Sweden. Here we present results from a 5-year follow-up of 206 patients and analyse predictors of unfavourable outcome.

Methods:

In 6 Swedish centres patients with signs suggestive of PsA were included in the registry within 2 years from symptom onset. Two-hundred and six patients fulfilling CASPAR (1) or ASAS (2) criteria who had passed the 5-year follow-up visit were included. DAS-28 and DAPSA (3) were used as disease activity measures. Clinical remission (defined as no tender or swollen joints and normal ESR and CRP) and Minimal Disease Activity (MDA) (4) were used as outcome measures. Patterns of joint involvement and medication were assessed.

Results:

Mean age at baseline:46 years, younger in male (n=88) than female (n=118) patients (48 vs 43 years).

DAS-28 was 3.4 at baseline and 2.6 at 5-year follow-up, significantly higher in women (3.7 and 2.9) than in men (2.9 and 2.1) at both visits. Likewise DAPSA scores were significantly higher in women (22.9 and 14.0) than in men (14.9 and 9.9) at both visits. The degree of improvement (delta DAS-28 and delta DAPSA) was similar in women and men. A larger proportion of men were in MDA state or remission at 5-year follow-up (50% vs 30% and 36% vs 23%). While women had significantly more often polyarticular disease at baseline (52% vs 33%) and also kept that pattern over the 5 years (21%), men had more often axial or mono/oligoarticular disease at baseline or converted to it during follow-up.

Despite higher disease activity in women there was a trend towards less DMARD treatment (40% of women vs 34% of men had never been treated with DMARDs). The use of biologics did not differ (7% vs 6%).

Predictors of MDA or remission at 5-year follow-up were male gender, low HAQ and short delay between symptom onset and inclusion, mono/oligoarticular or axial disease pattern at baseline, for MDA also low DAS-28, DAPSA, TJC, PGA and pain VAS. In multivariate analysis male gender, axial disease, shorter delay between symptom onset and inclusion and preserved physical functioning at inclusion independently predicted better outcome. Exclusion of patients with axial disease only did not change the results.

Conclusion:

In early PsA male gender, axial disease, short delay between symptom onset and diagnosis, as well as preserved function at diagnosis are predictors of favourable outcome at 5-year follow-up. Early recognition of PsA and active treatment may be important particularly in women with polyarticular disease.

References:

1.Taylor, Wet al.. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54:2665–73.

1.Rudwaleit, Met al.. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70:25–31.

1.Schoels, Met al.. Application of the DAREA/DAPSA score for assessment of disease activity in psoriatic arthritis. Ann Rheum Dis 2010;69:1441–7.

1.Coates, LCet al.. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010;69:48–53.

To cite this abstract, please use the following information:
Theander, Elke, Husmark, Tomas, Alenius, Gerd-Marie, Larsson, Per, Teleman, Annika, Geijer, Mats, et al; The Swedish Early Psoriatic Arthritis (SwePsA) Registry. 5-Year Follow-up: Higher Disease Activity, Greater Functional Impairment and Worse Outcome for Women Compared to Men. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :504
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