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Axial psoriatic arthritis: the impact of underdiagnosed disease on outcomes in real life

  • Sibel Zehra Aydin
  • Orhan Kucuksahin
  • Levent Kilic
  • Atalay Dogru
  • Ozun Bayindir
  • Cem Ozisler
  • Ahmet Omma
  • Emine Figen Tarhan
  • Abdulsamet Erden
  • Gezmis Kimyon
  • Meryem Can
  • Ediz Dalkilic
  • Sule Yavuz
  • Sibel Bakirci Ureyen
  • Esen Kasapoglu Gunal
  • Fatıma Arslan Alhussain
  • Lutfi Akyol
  • Ayse Balkarli
  • Sema Yilmaz
  • Muhammet Cinar
  • Muge Tufan Aydin
  • Dilek Solmaz
  • Ridvan Mercan
  • Sukran Erten
  • Umut Kalyoncu
Brief Report
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Abstract

Psoriatic arthritis (PsA) may affect different joints, including the spine. The prevalence of spinal involvement is variable depending on the definition and a subset of patients have been identified in cohorts that do not have clinical features of axial disease and yet have imaging findings. Still, there is not a consensus on how and when to screen axial disease. In this study, we aimed to investigate factors associated with being underdiagnosed for axial psoriatic arthritis (axPsA) and its impacts on outcomes. Disease features and outcomes of axPsA according to the physician (n = 415) were compared with patients with imaging findings only (sacroiliitis fulfilling the modified New York criteria, n = 112), using data from a real-life PsA registry. Patients with imaging findings only were more frequently women (83/220 (37.7%) vs 29/122 (23.8%); p = 0.008). This group also had higher peripheral disease activity (imaging only vs clinical AxPsA: mean (SD) tender joint count 5.3 (6.1) vs 3.3 (4.7), swollen joint count 1.9 (2.9) vs 1.2 (2.4); p < 0.001 for both comparisons) and was less often treated using TNF inhibitors (16.1 vs 38.2%; p < 0.001) than patients who were classified as axPsA. Patient-reported outcomes were similar in both groups. PsA patients, especially women with more severe peripheral disease, have a higher risk of being underdiagnosed for axPsA. The severity of peripheral symptoms may be a risk factor to mask the spinal features of PsA.

Keywords

Axial disease Psoriatic arthritis Radiography 

Notes

Acknowledgments

We would like to thank the following collaborators for their participation: Adem Kucuk, Emel Gonullu, Emine Duygu Ersozlu Bozkir, Funda Erbasan, Gozde Yildirim Cetin, Senol Kobak, Serpil Ergullu Esmen, Servet Akar, Seval Pehlevan, Soner Senel, Tuncay Duruoz, Kenan Aksu, Yasemin Kabasakal, Timucin Kasifoglu.

We would also like to thank Drs Laure Gossec and Helena Marzo-Ortega for criticizing and helping to improve our dataset and analyzing for this manuscript.

Compliance with ethical standards

Conflict of interest

Sibel Aydin has received honoraria from Abbvie, Novartis, Pfizer, UCB, and Sanofi.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Sibel Zehra Aydin
    • 1
  • Orhan Kucuksahin
    • 2
  • Levent Kilic
    • 3
  • Atalay Dogru
    • 4
  • Ozun Bayindir
    • 5
  • Cem Ozisler
    • 6
  • Ahmet Omma
    • 7
  • Emine Figen Tarhan
    • 8
  • Abdulsamet Erden
    • 9
  • Gezmis Kimyon
    • 10
  • Meryem Can
    • 11
  • Ediz Dalkilic
    • 12
  • Sule Yavuz
    • 11
  • Sibel Bakirci Ureyen
    • 13
  • Esen Kasapoglu Gunal
    • 14
  • Fatıma Arslan Alhussain
    • 15
  • Lutfi Akyol
    • 16
  • Ayse Balkarli
    • 17
  • Sema Yilmaz
    • 18
  • Muhammet Cinar
    • 19
  • Muge Tufan Aydin
    • 20
  • Dilek Solmaz
    • 21
  • Ridvan Mercan
    • 22
  • Sukran Erten
    • 2
  • Umut Kalyoncu
    • 23
  1. 1.Ottawa Hospital Research InstituteUniversity of Ottawa Faculty of MedicineOttawaCanada
  2. 2.Department of Internal Medicine, Division of RheumatologyAnkara Yildirim Beyazit UniversityAnkaraTurkey
  3. 3.Department of Internal Medicine, Division of Rheumatology Hacettepe University HospitalHacettepe UniversityAnkaraTurkey
  4. 4.Department of Internal Medicine, Division of RheumatologySuleyman Demirel UniversityIspartaTurkey
  5. 5.Department of Internal Medicine, Division of RheumatologyEge UniversityIzmirTurkey
  6. 6.Department of Internal Medicine, Division of RheumatologyDiskapi Yildirim Beyazit Education and Research HospitalAnkaraTurkey
  7. 7.Department of Internal Medicine, Division of RheumatologyAnkara Numune Education and Research HospitalAnkaraTurkey
  8. 8.Department of Internal Medicine, Division of RheumatologyMugla Sitki Kocman UniversityMuğlaTurkey
  9. 9.Department of Internal Medicine, Division of RheumatologyHacettepe UniversityAnkaraTurkey
  10. 10.Department of Internal Medicine, Division of RheumatologyGaziantep UniversityGaziantepTurkey
  11. 11.Department of Internal Medicine, Division of RheumatologyMarmara UniversityIstanbulTurkey
  12. 12.Department of Internal Medicine, Division of RheumatologyUludag UniversityBursaTurkey
  13. 13.Faculty of Medicine, RheumatologyUniversity of OttawaOttawaCanada
  14. 14.Department of Internal Medicine, Division of RheumatologyMedeniyet University Goztepe Education and Research HospitalIstanbulTurkey
  15. 15.Department of Internal MedicineMedeniyet University Goztepe Training and Research HospitalIstanbulTurkey
  16. 16.Department of Internal Medicine, Division of RheumatologySamsun Ondokuz Mayis UniversitySamsunTurkey
  17. 17.Antalya Training and Research Hospital, RheumatologyAntalyaTurkey
  18. 18.Department of Internal Medicine, Division of RheumatologySelçuk ÜniversityKonyaTurkey
  19. 19.Department of Internal Medicine, Division of RheumatologyGulhane Education and Research HospitalAnkaraTurkey
  20. 20.Department of Internal Medicine, Division of RheumatologyBaskent UniversityAdanaTurkey
  21. 21.Department of Internal Medicine, Division of RheumatologyIzmir Katip Celebi UniversityIzmirTurkey
  22. 22.Hatay Hospital, RheumatologyAntakyaTurkey
  23. 23.Faculty of Medicine, Department of Internal Medicine, Division of RheumatologyHacettepe UniversityAnkaraTurkey

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