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Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study

  • Observational Research
  • Published:
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Abstract

Psoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of ‘active enthesitis’, ‘history of enthesitis’ or ‘none’ in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by − 9.740 and − 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis.

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Acknowledgements

We acknowledge dr Nazmiye Kurşun for statistical consulting and Scribendi Editing Services for external editing.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Hacettepe, Talatpaşa Blv No:82, Altındağ, 06230, Ankara, Turkey

    Ismihan Sunar & Sebnem Ataman

  2. Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey

    Kemal Nas, Yıldıray Aydın, Ayhan Kamanlı & Ibrahim Tekeoğlu

  3. Rheumatology Clinic, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey

    Erkan Kilic

  4. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey

    Betul Sargin

  5. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey

    Sevtap Acer Kasman & Mehmet Tuncay Duruöz

  6. Department of Physical Medicine and Rehabilitation, Pamukkale University School of Medicine, Denizli, Turkey

    Hakan Alkan

  7. Department of Physical Medicine and Rehabilitation, Balıkesir University School of Medicine, Balıkesir, Turkey

    Nilay Sahin

  8. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University School of Medicine, Kayseri, Turkey

    Gizem Cengiz & Mustafa Calis

  9. Rheumatology Clinic, Van Training and Research Hospital, Van, Turkey

    Gizem Cengiz

  10. Rheumatology Clinic, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey

    Nihan Cuzdan

  11. Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey

    Ilknur Albayrak Gezer

  12. Department of Physical Medicine and Rehabilitation, Kırıkkale University School of Medicine, Kirikkale, Turkey

    Dilek Keskin

  13. Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey

    Cevriye Mülkoğlu & F. Figen Ayhan

  14. Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey

    Hatice Resorlu

  15. Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

    Ajda Bal

  16. Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, Istanbul, Turkey

    Okan Küçükakkaş, Ozan Volkan Yurdakul & Yaşar Keskin

  17. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey

    Meltem Alkan Melikoglu

  18. Department of Physical Theraphy and Rehabilitation, Uşak University, High School of Health Sciences, Uşak, Turkey

    F. Figen Ayhan

  19. Department of Physical Medicine and Rehabilitation, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey

    Hatice Bodur

  20. Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey

    Erhan Capkın

  21. Department of Physical Medicine and Rehabilitation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey

    Gul Devrimsel

  22. Rheumatology Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey

    Kevser Gok

  23. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey

    Sami Hizmetli

  24. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey

    Hilal Kocabas

  25. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey

    Oznur Kutluk & Tiraje Tuncer

  26. Rheumatology Clinic, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

    Nesrin Şen

  27. Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey

    Omer Faruk Şendur

  28. Department of Physical Medicine and Rehabilitation, Yuzuncu Yıl University School of Medicine, Van, Turkey

    Murat Toprak

  29. Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, Istanbul, Turkey

    Sena Tolu

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  1. Ismihan Sunar
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  2. Sebnem Ataman
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  3. Kemal Nas
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Contributions

All authors have substantial contributions to the conception or design of the work, drafting or revising it critically for important intellectual content, have approved the final version to be published, and in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All co-authors are fully responsible for all aspects of the study and the final manuscript in line with the IJME 4 criteria.

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Correspondence to Ismihan Sunar.

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Authors declare no conflicts of interest or financial support.

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Ethics committee approval was obtained from the Sakarya University Ethics Committee on 25.01.2018 and with the number of 42 and conducted in accordance with the Helsinki Declaration.

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This paper exhibits the data of a wide group of Turkish patients with PsA from almost all regions of the country. A total of 1130 patients were divided into two groups as ones with and without enthesitis and compared in terms of some clinical characteristics. This cross-sectional study suggests that enthesitis has relations to disease activity, functional status, and quality of life.

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Sunar, I., Ataman, S., Nas, K. et al. Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study. Rheumatol Int 40, 283–294 (2020). https://doi.org/10.1007/s00296-019-04480-9

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  • DOI: https://doi.org/10.1007/s00296-019-04480-9

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