Registro Español de Artritis Psoriásica de Reciente Comienzo (estudio REAPSER). Objetivos y metodología / Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): aims and methodology

OBJETIVOS: Describir la metodología del Registro Español de Artritis Psoriásica de reciente comienzo de la Sociedad Española de Reumatología (REAPSER), así como sus fortalezas y limitaciones. El objetivo principal del proyecto es identificar factores pronósticos de la evolución clínica y radiográfica en una cohorte de pacientes que padecen artritis psoriásica (APs) diagnosticada con menos de 2 años de evolución. MATERIAL Y MÉTODO: Estudio observacional, prospectivo (2 años de seguimiento; periodicidad anual de las visitas), multicéntrico. La intención en la visita basal fue reflejar la situación del paciente antes de que la evolución de la enfermedad se viese modificada por los tratamientos pautados en los servicios de reumatología. Los pacientes fueron invitados a participar consecutivamente en una de sus visitas habituales al reumatólogo. El tamaño muestral finalmente alcanzado fue de 211 pacientes. Se recogen datos sociodemográficos; de situación laboral; historia familiar; antecedentes personales y comorbilidad; antropométricos; estilo de vida; uso de los servicios de salud; situación clínica al diagnóstico de APs; afectación articular y dolor espinal; dolor y valoración global de la enfermedad; entesitis, dactilitis y uveítis; afectación cutánea y ungueal; situación funcional y calidad de vida; evaluación radiográfica; determinaciones analíticas; tratamiento; brotes en esqueleto axial y periférico. CONCLUSIONES: El estudio REAPSER incluye una cohorte de pacientes con APs de inicio reciente reclutados antes de que la evolución de la enfermedad se viese modificada por la prescripción de FAME en los servicios de reumatología. Se espera que la información exhaustiva recogida en las visitas suponga una amplia fuente de datos para futuros análisis

AIMS: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2 years of symptom evolution. METHODS: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis

Obesity in psoriatic arthritis: Comparative prevalence and associated factors.

Obesity is a common cardiovascular risk factor in psoriatic disease. Although the prevalence of obesity is high, the factors associated with it in patients with psoriatic arthritis (PsA) are poorly understood. We aimed to analyze the frequency and obesity-associated factors in a cohort of PsA.This retrospective cross-sectional study included 290 consecutive patients with PsA according to CASPAR criteria. Three-hundred ten psoriatic patients without arthritis and 600 outpatients without inflammatory conditions were used as comparison populations. The factors associated with obesity were analyzed first using conditional logistic regression. The significant factors in this first model were introduced in a multivariate model using a backward step approach.This series included 159 men (54.8%) and 131 women (45.2%), with an average age of 54 ±â€Š12 years. Obesity was more common both in psoriasis (36.5% vs 22%, OR 2.1 [95%CI: 1.5-2.8), P < .01]) and PsA (27.6% vs 22%, OR 1.4 [95%CI: 1.0-1.9], P < .05) than in the non-inflammatory population. Obesity was more frequent in psoriasis (36.5%) than in PsA (27.6%), OR 1.5 95% CI: 1.1 to 2.1, P < .05. After correcting for age, sex, disease duration, and other confounders, independent associations with obesity (P < .05) were: PsA family history (OR 3.6, 95%CI: 1.1-12.4), evolution as axial disease (OR 4.4, 95%CI: 1.0-15.4), and dyslipidemia (OR 3.5, 95%CI: 1.5-8.6).Obesity is common in psoriatic disease, but much more frequent among patients with cutaneous than joint disease. Patients who present with spondylitis during evolution are more prone to this comorbidity, and therefore, should be closely monitored to correct this eventuality in a timely manner.

Hypertension is associated with increased age at the onset of psoriasis and a higher body mass index in psoriatic disease.

BACKGROUND AND AIMS: High blood pressure (HBP) is a common comorbidity in psoriatic disease. Some studies indicate a higher prevalence of HBP among arthritis patients, in relation to psoriasis alone, within the psoriatic spectrum. Our objective was to study the prevalence of HBP in both types of patients as well as to analyse the factors associated with it. METHODS: A cross-sectional observational study of 600 patients with psoriatic disease attended in a multidisciplinary clinic of a reference centre. We first analysed the frequency of this comorbidity and then the factors associated with it using conditional logistic regression. The significant factors in this first model were introduced in a multivariate model using a backward step approach. RESULTS: A total of 144 patients were hypertensive (24%). Of patients with arthritis, 86/290 (29.7%) had HBP, compared with 58/310 (18.7%) with psoriasis (OR 1.7 95%, CI 1.25-2.50, p = 0.003). Hypertension was independently associated with higher age at onset of psoriasis (OR 1.04, 95%CI 1.03-1.06, p < 0.001) and a higher body mass index (OR 1.13, 95%CI, 1.06-1.22, p < 0.001). CONCLUSIONS: HBP is more prevalent in patients with arthritis within the spectrum of psoriatic disease. Patients with a higher body mass index and those with later-onset psoriasis are more prone to this comorbidity. KEY POINTS: • The factors of psoriatic disease associated with HBP are little known. • HBP is more prevalent in patients with arthritis within the spectrum of psoriatic disease. • In patients with psoriatic disease, for each point of increase in the body mass index, the risk of HBP increases by 13%. • For each year of onset of psoriasis above 40 years, the risk of HBP increases by 4%.

Polyarticular evolution and late-onset psoriasis may be associated with cardiovascular disease in psoriatic arthritis.

BACKGROUND AND AIMS: Patients with psoriatic arthritis (PsA) have high prevalence of cardiovascular risk factors (CVRF), and they also show higher rates of cardiovascular disease (CVD). We aimed to corroborate these findings and identify factors associated with these events in our clinical setting. METHODS: This cross-sectional study included 340 consecutive patients seen in a tertiary care hospital. The prevalence of CVRF was compared to that of 600 outpatients without inflammatory conditions. To analyze CVD-associated factors, odds ratio (OR) values were calculated by conditional logistic regression analysis. Significant variables in the univariate analysis were then introduced in a multivariate analysis with a backward stepwise approach. RESULTS: Patients with psoriatic arthritis had higher frequencies of hypertension (36% vs 23%, OR 2.4, 95%CI: 1.6-2.7, P < 0.0001), diabetes (13.8% vs 5%, OR 2.8, 95%CI: 1.7-4.3, P < 0.0001), obesity (35% vs 22%, OR 2.1, 95%CI: 1.5-2.8, P < 0.0001) and tobacco use (26% vs 21%, OR 1.4, 95%CI: 1.0-1.8, P < 0.05). More PsA patients had CVD compared to non-inflammatory patients (9.4% vs 5.8%, OR 1.68, 95%CI: 1.02-2.76, P < 0.05). Independent CVD-associated factors were: an age of onset of psoriasis >40 years (OR 3.4, 95%CI: 1.1-10.0, P < 0.05), a high number of swollen joints during evolution (OR 2.9, 95%CI: 1.1-8.0, P < 0.05), hypertension (OR 5.3, 95%CI: 1.6-17.6, P < 0.01) and dyslipidemia (OR 2.6, 95%CI: 1.0-7.2, P < 0.05). CONCLUSIONS: Cardiovascular risk should be carefully evaluated in patients with PsA whose disease presents a high inflammatory burden and in those with late-onset psoriasis.

Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology. / Registro Español de Artritis Psoriásica de Reciente Comienzo (estudio REAPSER). Objetivos y metodología.

AIMS: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution. METHODS: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.

Coccigodinia relacionada con uso de anillo vaginal anticonceptivo / Coccydynia related to the use of a contraceptive vaginal ring

La coccigodinia es un síndrome que se presenta con frecuencia en las consultas de Reumatología en forma de dolor en punta terminal del coxis, empeorando habitualmente al sentarse. Aunque la causa más frecuente es la postraumática local, existen diversas causas de dolor en el coxis. Presentamos un caso inhabitual en el que la coccigodinia comenzó poco después de instaurar un sistema de anticoncepción por anillo vaginal y remitió completamente al retirar este sistema (AU)

Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system (AU)

Coccydynia related to the use of a contraceptive vaginal ring. / Coccigodinia relacionada con uso de anillo vaginal anticonceptivo.

Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system.

A polyarticular onset and diabetes could be the main predictors of cardiovascular events in psoriatic arthritis.

OBJECTIVES: We aimed to determine which disease features could be associated to the risk of cardiovascular (CV) events in a PsA cohort from a tertiary care institution. METHODS: We conducted an age- and sex-matched case-control study in which the cases were all PsA patients who developed cardiovascular (CV) events during the study period (2010-14). The control group was free of CV events during the same period. Univariate analysis was performed to examine unadjusted associations of potential risk factors. Significant variables in the univariate analysis were then introduced in a multivariate analysis with a backward stepwise approach. RESULTS: Of the 206 patients enrolled, 17 (8.3%) patients developed a total of 25 CV events (10 stroke, 9 acute coronary events and 6 ischaemic peripheral vascular events). In univariate analysis these patients showed more pustular psoriasis (OR 5.5, p=0.02), polyarticular onset (OR 3.2, p=0.03), polyarthritis during follow-up (OR 2.9, p=0.04), arthritis onset after 40 yr (OR 3.7, p=0.02), high lipid levels (OR 2.8, p=0.04), hypertension (OR 6.4, p=0.0008), diabetes (OR 12.1, p<0.0001) and lower educational level (OR 3.2, p=0.05). After controlling for age and other confounders, a polyarticular onset of PsA (OR 3.7, p=0.043) and diabetes (OR 8.1, p=0.001) remained as independently related to the risk of CV events. CONCLUSIONS: Traditional CV risk factors as well as factors related to the inflammatory nature of the disease were the main predictors of CV complications in this PsA population.

Age at disease onset may help to further characterize the disease phenotype in psoriatic arthritis.

OBJECTIVE: To evaluate whether the age of disease presentation helps to better characterize the disease phenotype in PsA. METHODS: Retrospective cohort study that included 205 consecutive patients fulfilling the CASPAR criteria for PsA. Study outcomes were assessed using univariate and multivariate analyses according to the age of onset of both skin and joint disease (cut off at 40years). RESULTS: Early onset psoriasis (EOP) showed more extensive skin involvement (OR 2.3, P=0.011), axial pattern as disease onset (OR 4.6, P=0.009) and mixed pattern during evolution (OR 2.4, P=0.019), family history of both psoriasis (OR 3.1, P=0.003) and PsA (OR 4.0, P=0.021), higher prevalence of HLA-C*06 (OR 2.03, P=0.03) and HLA-B*27 (OR 2.7, P=0.02). Early onset arthritis (EOA) had more family history of PsA (OR 2.9, P=0.007), and HLA-B*27 positivity (OR 5.9, P<0.0001). Patients with late onset arthritis (LOA) were more likely to have DM (OR 4.0, P=0.009), hypertension (OR 2.5, P=0.004), dyslipidemia (OR 2.3, P=0.011), and obesity (OR 1.7, P=0.012). Late onset psoriasis (LOP) tended to have more obesity (OR 1.9, P=0.035), DM (OR 9.4, P<0.0001), hypertension (OR 4.1, P<0.0001), and ischemic heart disease during follow-up (OR 5.9, P=0.021). In multivariate analysis, LOP predicted DM development (OR 12.1, P=0.006). LOA was shown to be an independent risk factor for hypertension (OR 5.2, P=0.039). CONCLUSION: Age at disease onset exerts a strong influence on several domains of disease phenotype in PsA. Therefore, this descriptor should be considered a good stratification option for epidemiological and genetic studies in PsA.

The Region Centromeric to HLA-C Is a Key Region for Understanding the Phenotypic Variability of Psoriatic Arthritis.

With the aim of clarifying the role of several polymorphisms around the HLA-C locus in the clinical expression of PsA, the distribution of several polymorphic markers and genes located around the HLA-C locus was analyzed in a well-established cohort of 110 patients with PsA, 50 patients with psoriasis alone, and 110 healthy controls. The frequency of these genes was also analyzed by PsA articular models, based on three main subgroups: oligoarthritis, polyarthritis, and spondylitis. Distal interphalangeal joint (DIP) involvement was associated with the presence of MICB-CA20 (OR 6.0, 95% CI: 1.58-22.69, P = 0.005). HLA-DRB∗07 was associated with oligoarticular forms of PsA (OR 4.1, 95% CI: 1.8-9.3, P = 0.0007). The spondylitic forms overexpressed the antigen HLA-B∗27 (OR 5.7, 95% CI: 2.4-13.6, P = 0.0001). MICA-A5.1 showed association with polyarthritis (OR 3.7, 95% CI: 1.5-8.8, P = 0.006). Genes telomeric to HLA-C were overexpressed in psoriasis but not in PsA subphenotypes. This study shows that the region centromeric to HLA-C is a key region that expresses not only disease risk genes but also genes that help explain the phenotypic variability of PsA.

Age at disease onset: a key factor for understanding psoriatic disease.

Psoriasis and PsA are immune-mediated diseases with a strong genetic component. More than 20 new loci have been recently linked to these diseases. However, interactions between these genes and the phenotypic traits of both diseases are poorly understood at present. Stratification of psoriatic disease according to the sex of the patients, genetic factors or age at onset has allowed in the last few years a better understanding of the principles governing the onset and progression of these processes. The age of onset of psoriasis has been used for decades as an appropriate descriptor to define two subpopulations of psoriatic patients (types I and II) whose clinical and immunogenetic characteristics have been very well differentiated. Moreover, in patients with PsA this distinction between type I and II psoriasis also seems equally operative. In patients with PsA expressing the HLA-C*06 antigen, the latency between the onset of psoriasis and onset of joint symptoms is longer than in those without this marker. It is also known that PsA tends to appear earlier in patients with HLA-B*27 positivity, and that these patients also show a shorter interval of time between the onset of cutaneous lesions and the onset of joint disease. This review highlights the growing importance of age at disease onset as a key stratification factor in worldwide clinical and genetic studies of psoriatic disease.

Clinical differences between men and women with psoriatic arthritis: relevance of the analysis of genes and polymorphisms in the major histocompatibility complex region and of the age at onset of psoriasis.

It has been shown that males with spondyloarthritis tend to suffer from more severe spinal disease while females are more likely to have peripheral joint involvement. Nevertheless, gender-related differences have not been thoroughly explored in psoriatic arthritis (PsA). In PsA, males accumulate more peripheral and axial joint damage compared to women. However, it is not clear whether these findings are secondary to differences in occupational physical activity, hormonal changes, or other factors. The present study analyzed the differences in clinical expression of PsA between men and women. We have also evaluated the possible existence of gender-linked differences in the distribution of genes and polymorphisms within the major histocompatibility complex and whether patients' age at the onset of psoriasis established any differences in these aspects. Women suffered more polyarthritis, greater functional impairment, and a larger number of swollen joints during followup. We appreciated a differential expression of certain MHC genes according to gender and age at onset of psoriasis. Our results point to the need to include patient's age at the onset of psoriasis and gender as key stratification elements in future studies of genetic associations in PsA.

Entheseal ultrasound abnormalities in patients with SAPHO syndrome.

This study was conducted to investigate the presence and characteristics of the ultrasound lesions that may be found in the entheses of patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. This cross-sectional study included 15 patients with SAPHO syndrome and 30 healthy controls matched for age, sex and body mass index. Subjects with regular sport activities as well as those with other rheumatic conditions were excluded from the study. Ultrasonography was used in both groups to study 14 entheses of the upper and lower extremities. Different elementary lesions representative of enthesis damage were defined. A total of 210 entheses in the study group and 420 in the control group were evaluated. Only one patient presented clinical enthesitis. In the study group, seven of the 15 patients (47%) showed morpho-structural entheseal alterations, versus only four of the 30 controls (13.3%; p < 0.001). The subjects with SAPHO showed ultrasound alterations in 32/210 entheses (15%), while the controls showed alterations in 20/420 entheses (4.8%), p < 0.001. The entheses with the largest number of morpho-structural alterations were those of the patellar and Achilles tendon. None of the controls showed power Doppler signal at enthesis or perienthesis level. Ultrasound evidence of enthesopathy seems to be a common feature in this series of patients with SAPHO syndrome.