Risk factors for axial inflammatory arthritis in patients with psoriatic arthritis
The Journal of Rheumatology,  Clinical Article

Chandran V et al. – Axial involvement is an important manifestation of psoriatic arthritis (PsA). This study aimed to identify risk factors associated with the presence of axial PsA (AxPsA) in patients with PsA. The results of this study suggest that severe peripheral arthritis and HLA-B*27 are risk factors for AxPsA.

Methods

  • Patients with AxPsA (bilateral sacroiliitis ≥ grade 2/unilateral sacroiliitis ≥ 3 and inflammatory neck/back pain or limited spinal mobility) at first clinic visit were identified from the University of Toronto PsA clinic database
  • Risk factors associated with presence of AxPsA were determined
  • Patients without AxPsA at first clinic visit were identified
  • Under a multistate framework, proportion of patients with PsA who subsequently developed AxPsA was estimated robustly using marginal methods and Markov model
  • Risk factors at baseline that were associated with future development of AxPsA were identified through multiplicative time-homogeneous Markov models

Results
  • Included 206 patients
  • 50 patients had AxPsA at first clinic visit. HLA-B*27, radiographic damage to peripheral joints, and elevated ESR increased odds of having AxPsA, while family history of PsA decreased the odds
  • 156 patients did not have AxPsA at first clinic visit
  • On followup, 28 developed AxPsA, and 11 died
  • Estimated that after 10 years of followup, 15% would develop AxPsA
  • Nail dystrophy, number of radiographically damaged joints, periostitis, and elevated ESR increased the risk of developing AxPsA, while swollen joints decreased risk

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