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

Research output: Contribution to journalJournal articleResearchpeer-review

52 Downloads (Pure)

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.

Original languageEnglish
JournalArthritis Care & Research
Volume71
Issue number6
Pages (from-to)798-810
ISSN2151-464X
DOIs
Publication statusPublished - Jun 2019

Fingerprint

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

Cite this

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. In: Arthritis Care & Research. 2019 ; Vol. 71, No. 6. pp. 798-810.
@article{30b6b0874e4048a0a2cf5c2a9a86a565,
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",

}

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, vol. 71, no. 6, pp. 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.

In: Arthritis Care & Research, Vol. 71, No. 6, 06.2019, p. 798-810.

Research output: Contribution to journalJournal articleResearchpeer-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 -