Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: A prospective cohort study

Pil Højgaard, Karen Ellegaard, Sabrina Mai Nielsen, Robin Christensen, Jørgen Guldberg-Møller, Christine Ballegaard, Lene Dreyer, Philip Mease, Maarten de Wit, Lone Skov, Bente Glintborg, Henning Bliddal, Else Marie Bartels, Kirstine Amris, Lars Erik Kristensen

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Resumé

OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA).

METHODS: An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease-modifying antirheumatic drugs in routine care. Clinical, US, and patient-reported measures were collected at baseline and after 4 months. Widespread nonarthritic pain (WP) was defined as a Widespread Pain Index score of ≥4 with pain in ≥4 of 5 regions. PsA activity by US was defined as color Doppler (yes/no) in selected entheses, joints, or tendons. The main response criteria included the American College of Rheumatology 20% improvement, the Disease Activity in Psoriatic Arthritis 50% improvement, and minimal disease activity. The primary analyses were age- and sex-adjusted logistic regression.

RESULTS: WP was present in 24 of 69 included patients (35%) and was associated with worse patient-reported and composite baseline measures, while US and other objective findings were similar to those in patients without WP. The odds of reaching minimal disease activity after 4 months were significantly greater for patients enrolled without WP (odds ratio 18.43 [95% confidence interval 1.51, 224.41]; P = 0.022), while WP did not impair other response measures. Patients with baseline color Doppler activity (n = 42 [61%]) had a worse objective PsA burden, but their chance of treatment response was comparable to those without color Doppler.

CONCLUSION: More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort.

OriginalsprogEngelsk
TidsskriftArthritis Care & Research
Vol/bind71
Udgave nummer6
Sider (fra-til)798-810
ISSN2151-464X
DOI
StatusUdgivet - jun. 2019

Fingeraftryk

Psoriatic Arthritis
Ultrasonics
Cohort Studies
Prospective Studies
Color
Antirheumatic Agents
Doppler Ultrasonography
Joints
Logistic Models
Odds Ratio
Confidence Intervals

Bibliografisk note

This article is protected by copyright. All rights reserved.

Citer dette

Højgaard, Pil ; Ellegaard, Karen ; Nielsen, Sabrina Mai ; Christensen, Robin ; Guldberg-Møller, Jørgen ; Ballegaard, Christine ; Dreyer, Lene ; Mease, Philip ; de Wit, Maarten ; Skov, Lone ; Glintborg, Bente ; Bliddal, Henning ; Bartels, Else Marie ; Amris, Kirstine ; Kristensen, Lars Erik. / Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis : A prospective cohort study. I: Arthritis Care & Research. 2019 ; Bind 71, Nr. 6. s. 798-810.
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title = "Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: A prospective cohort study",
abstract = "OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA).METHODS: An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease-modifying antirheumatic drugs in routine care. Clinical, US, and patient-reported measures were collected at baseline and after 4 months. Widespread nonarthritic pain (WP) was defined as a Widespread Pain Index score of ≥4 with pain in ≥4 of 5 regions. PsA activity by US was defined as color Doppler (yes/no) in selected entheses, joints, or tendons. The main response criteria included the American College of Rheumatology 20{\%} improvement, the Disease Activity in Psoriatic Arthritis 50{\%} improvement, and minimal disease activity. The primary analyses were age- and sex-adjusted logistic regression.RESULTS: WP was present in 24 of 69 included patients (35{\%}) and was associated with worse patient-reported and composite baseline measures, while US and other objective findings were similar to those in patients without WP. The odds of reaching minimal disease activity after 4 months were significantly greater for patients enrolled without WP (odds ratio 18.43 [95{\%} confidence interval 1.51, 224.41]; P = 0.022), while WP did not impair other response measures. Patients with baseline color Doppler activity (n = 42 [61{\%}]) had a worse objective PsA burden, but their chance of treatment response was comparable to those without color Doppler.CONCLUSION: More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort.",
author = "Pil H{\o}jgaard and Karen Ellegaard and Nielsen, {Sabrina Mai} and Robin Christensen and J{\o}rgen Guldberg-M{\o}ller and Christine Ballegaard and Lene Dreyer and Philip Mease and {de Wit}, Maarten and Lone Skov and Bente Glintborg and Henning Bliddal and Bartels, {Else Marie} and Kirstine Amris and Kristensen, {Lars Erik}",
note = "This article is protected by copyright. All rights reserved.",
year = "2019",
month = "6",
doi = "10.1002/acr.23693",
language = "English",
volume = "71",
pages = "798--810",
journal = "Arthritis Care & Research",
issn = "2151-464X",
publisher = "JohnWiley & Sons, Inc.",
number = "6",

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Højgaard, P, Ellegaard, K, Nielsen, SM, Christensen, R, Guldberg-Møller, J, Ballegaard, C, Dreyer, L, Mease, P, de Wit, M, Skov, L, Glintborg, B, Bliddal, H, Bartels, EM, Amris, K & Kristensen, LE 2019, 'Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: A prospective cohort study', Arthritis Care & Research, bind 71, nr. 6, s. 798-810. https://doi.org/10.1002/acr.23693

Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis : A prospective cohort study. / Højgaard, Pil; Ellegaard, Karen; Nielsen, Sabrina Mai; Christensen, Robin; Guldberg-Møller, Jørgen; Ballegaard, Christine; Dreyer, Lene; Mease, Philip; de Wit, Maarten; Skov, Lone; Glintborg, Bente; Bliddal, Henning; Bartels, Else Marie; Amris, Kirstine; Kristensen, Lars Erik.

I: Arthritis Care & Research, Bind 71, Nr. 6, 06.2019, s. 798-810.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis

T2 - A prospective cohort study

AU - Højgaard, Pil

AU - Ellegaard, Karen

AU - Nielsen, Sabrina Mai

AU - Christensen, Robin

AU - Guldberg-Møller, Jørgen

AU - Ballegaard, Christine

AU - Dreyer, Lene

AU - Mease, Philip

AU - de Wit, Maarten

AU - Skov, Lone

AU - Glintborg, Bente

AU - Bliddal, Henning

AU - Bartels, Else Marie

AU - Amris, Kirstine

AU - Kristensen, Lars Erik

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/6

Y1 - 2019/6

N2 - OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA).METHODS: An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease-modifying antirheumatic drugs in routine care. Clinical, US, and patient-reported measures were collected at baseline and after 4 months. Widespread nonarthritic pain (WP) was defined as a Widespread Pain Index score of ≥4 with pain in ≥4 of 5 regions. PsA activity by US was defined as color Doppler (yes/no) in selected entheses, joints, or tendons. The main response criteria included the American College of Rheumatology 20% improvement, the Disease Activity in Psoriatic Arthritis 50% improvement, and minimal disease activity. The primary analyses were age- and sex-adjusted logistic regression.RESULTS: WP was present in 24 of 69 included patients (35%) and was associated with worse patient-reported and composite baseline measures, while US and other objective findings were similar to those in patients without WP. The odds of reaching minimal disease activity after 4 months were significantly greater for patients enrolled without WP (odds ratio 18.43 [95% confidence interval 1.51, 224.41]; P = 0.022), while WP did not impair other response measures. Patients with baseline color Doppler activity (n = 42 [61%]) had a worse objective PsA burden, but their chance of treatment response was comparable to those without color Doppler.CONCLUSION: More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort.

AB - OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA).METHODS: An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease-modifying antirheumatic drugs in routine care. Clinical, US, and patient-reported measures were collected at baseline and after 4 months. Widespread nonarthritic pain (WP) was defined as a Widespread Pain Index score of ≥4 with pain in ≥4 of 5 regions. PsA activity by US was defined as color Doppler (yes/no) in selected entheses, joints, or tendons. The main response criteria included the American College of Rheumatology 20% improvement, the Disease Activity in Psoriatic Arthritis 50% improvement, and minimal disease activity. The primary analyses were age- and sex-adjusted logistic regression.RESULTS: WP was present in 24 of 69 included patients (35%) and was associated with worse patient-reported and composite baseline measures, while US and other objective findings were similar to those in patients without WP. The odds of reaching minimal disease activity after 4 months were significantly greater for patients enrolled without WP (odds ratio 18.43 [95% confidence interval 1.51, 224.41]; P = 0.022), while WP did not impair other response measures. Patients with baseline color Doppler activity (n = 42 [61%]) had a worse objective PsA burden, but their chance of treatment response was comparable to those without color Doppler.CONCLUSION: More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort.

U2 - 10.1002/acr.23693

DO - 10.1002/acr.23693

M3 - Journal article

C2 - 29975012

VL - 71

SP - 798

EP - 810

JO - Arthritis Care & Research

JF - Arthritis Care & Research

SN - 2151-464X

IS - 6

ER -