Evaluation of Clinical Diagnosis of Axial Psoriatic Arthritis (PsA) or Elevated Patient-reported Spine Pain in CorEvitas’ PsA/Spondyloarthritis Registry

Abstract

Objective. To determine the presence of axial symptoms in patients with psoriatic arthritis (PsA) and examine differences between those with or without a diagnosis of axial PsA (axPsA). Methods. Patients with PsA at their Corevitas’ (formerly Corrona) Psoriatic Arthritis/Spondyloarthritis Registry enrollment visit were stratified into 4 mutually exclusive groups based on axial manifestations: physician-diagnosed axPsA only (Dx+Sx−), patient-reported elevated spine symptoms only (Dx−Sx+; defined as Bath Ankylosing Spondylitis Disease Activity Index ≥ 4 and spine pain visual analog scale ≥ 40), physician-diagnosed and patient-reported manifestations (Dx+Sx+), and no axial manifestations (Dx−Sx−). Patient characteristics, disease activity, and patient-reported outcomes (PROs) at enrollment in each axial manifestation group were compared with the Dx−Sx− group. Associations of patient characteristics with the odds of having axial manifestations were estimated using multinomial logistic regression (reference: Dx−Sx−). Results. Of 3393 patients included, 226 (6.7%) had Dx+Sx−, 698 (20.6%) had Dx−Sx+, 165 (4.9%) had Dx+Sx+, and 2304 (67.9%) had Dx−Sx−. Patients with Dx−Sx+ or Dx+Sx+ were more frequently women and had a history of depression and fibromyalgia (FM) vs patients who had Dx−Sx−. Patients with Dx+Sx− or Dx+Sx+ were more frequently HLA-B27 positive than those with Dx−Sx−. FM was significantly associated with increased odds of Dx+Sx− or Dx+Sx+. Disease activity and PROs were worse in patients with Dx−Sx+ or Dx+Sx+ than in those with Dx−Sx−. Conclusion. Patients who had self-reported elevated spine symptoms, with or without physician-diagnosed axPsA, had worse quality of life and higher disease activity overall than patients without axial manifestations, suggesting an unmet need in this patient population.