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.