J Korean Med Sci.  2022 Aug;37(33):e253. 10.3346/jkms.2022.37.e253.

Clinical Characteristics of Patients With Psoriatic Spondylitis Versus Those With Ankylosing Spondylitis: Features at Baseline Before Biologic Therapy

• Kim HA
• Lee E
• Park SY
• Lee SS
• Shin K

• KMID: 2532628
• DOI: http://doi.org/10.3346/jkms.2022.37.e253

Abstract

Background
Clinical characteristics and manifestations of psoriatic arthritis (PsA) have been extensively studied in western countries, yet data of Korean patients with PsA are very limited. We aimed to investigate the clinical traits of patients with PsA and dissect the characteristics of those with axial involvement.
Methods
In this observational study, we analyzed clinical data of 109 patients with PsA who were enrolled in the Korean College of Rheumatology Biologics and Targeted Therapy registry between December 2012 and March 2022 at the time point of initiating or switching to a biologic agent. Data from 2,221 patients with ankylosing spondylitis (AS) registered during the same period were also analyzed. We divided patients with PsA into patients with or without axial involvement and then added AS patients with psoriasis (total three subgroups) for comparative analyses.
Results
Asymmetric oligoarthritis was the most common clinical manifestation in patients with PsA, followed by symmetric polyarthritis and spondylitis. Our analysis indicated that methotrexate and sulfasalazine were the two most prescribed disease-modifying antirheumatic drugs for patients with PsA before starting biologic therapy. The patients with psoriatic spondylitis had more peripheral joint involvement (P = 0.016), less prior uveitis (P < 0.001), and lower human leukocyte antigen B27 (HLA-B27) positivity (P < 0.001) than the AS patients with psoriasis. Furthermore, syndesmophytes and radiographic sacroiliitis were prevalent among patients with PsA and AS patients with psoriasis who had the HLA-B27 gene.
Conclusion
Our study shows that the degree of peripheral arthritis is less severe in Korean patients with PsA who require biologics and reestablishes that psoriatic spondylitis is a common and important clinical pattern in Korean patients with PsA.

Keyword

Psoriatic Arthritis; Clinical Characteristics; Psoriatic Spondylitis; Ankylosing Spondylitis; Human Leukocyte Antigen B27; Disease-modifying Antirheumatic Drug

Reference

1. Gladman DD. Psoriatic arthritis. Dermatol Ther. 2009; 22(1):40–55. PMID: 19222516.

2. Karmacharya P, Chakradhar R, Ogdie A. The epidemiology of psoriatic arthritis: a literature review. Best Pract Res Clin Rheumatol. 2021; 35(2):101692. PMID: 34016528.

3. Veale DJ. Psoriatic arthritis: recent progress in pathophysiology and drug development. Arthritis Res Ther. 2013; 15(6):224. PMID: 24611179.

4. Mohd Affandi A, Khan I, Ngah Saaya N. Epidemiology and clinical features of adult patients with psoriasis in Malaysia: 10-year review from the Malaysian Psoriasis Registry (2007-2016). Dermatol Res Pract. 2018; 2018:4371471. PMID: 29849578.

5. Kishimoto M, Yoshida K, Ichikawa N, Inoue H, Kaneko Y, Kawasaki T, et al. Clinical characteristics of patients with spondyloarthritis in Japan in comparison with other regions of the world. J Rheumatol. 2019; 46(8):896–903. PMID: 30770497.

6. Fan X, Yang S, Sun LD, Liang YH, Gao M, Zhang KY, et al. Comparison of clinical features of HLA-Cw*0602-positive and -negative psoriasis patients in a Han Chinese population. Acta Derm Venereol. 2007; 87(4):335–340. PMID: 17598037.

7. Choi JW, Kim BR, Seo E, Youn SW. Could psoriatic arthritis be easily diagnosed from current suspicious physical findings in the dermatology clinic? Ann Dermatol. 2017; 29(1):48–54. PMID: 28223746.

8. Baek HJ, Yoo CD, Shin KC, Lee YJ, Kang SW, Lee EB, et al. Spondylitis is the most common pattern of psoriatic arthritis in Korea. Rheumatol Int. 2000; 19(3):89–94. PMID: 10776686.

9. Shin D, Kim HJ, Kim DS, Kim SM, Park JS, Park YB, et al. Clinical features of psoriatic arthritis in Korean patients with psoriasis: a cross-sectional observational study of 196 patients with psoriasis using psoriatic arthritis screening questionnaires. Rheumatol Int. 2016; 36(2):207–212. PMID: 26395992.

10. Saad AA, Ashcroft DM, Watson KD, Hyrich KL, Noyce PR, Symmons DP, et al. Persistence with anti-tumour necrosis factor therapies in patients with psoriatic arthritis: observational study from the British Society of Rheumatology Biologics Register. Arthritis Res Ther. 2009; 11(2):R52. PMID: 19356232.

11. Glintborg B, Østergaard M, Dreyer L, Krogh NS, Tarp U, Hansen MS, et al. Treatment response, drug survival, and predictors thereof in 764 patients with psoriatic arthritis treated with anti-tumor necrosis factor α therapy: results from the nationwide Danish DANBIO registry. Arthritis Rheum. 2011; 63(2):382–390. PMID: 21279995.

12. Heiberg MS, Kaufmann C, Rødevand E, Mikkelsen K, Koldingsnes W, Mowinckel P, et al. The comparative effectiveness of anti-TNF therapy and methotrexate in patients with psoriatic arthritis: 6 month results from a longitudinal, observational, multicentre study. Ann Rheum Dis. 2007; 66(8):1038–1042. PMID: 17213251.

13. Kim J, Koh JH, Choi SJ, Jeon CH, Kwok SK, Kim SK, et al. KOBIO, the first web-based Korean Biologics Registry operated with a unified platform among distinct disease entities. J Rheum Dis. 2021; 28(4):176–182.

14. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006; 54(8):2665–2673. PMID: 16871531.

15. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984; 27(4):361–368. PMID: 6231933.

16. Yamamoto T, Ohtsuki M, Sano S, Igarashi A, Morita A, Okuyama R, et al. Epidemiological analysis of psoriatic arthritis patients in Japan. J Dermatol. 2016; 43(10):1193–1196. PMID: 26992450.

17. Song Z, Deng X, Xie W, Li B, Zhang Z. Clinical characteristics of psoriatic arthritis in Chinese patients: a cross-sectional study. Rheumatol Ther. 2021; 8(4):1845–1857. PMID: 34665456.

18. Dönmez S, Pamuk ON, Akker M, Ak R. Clinical features and types of articular involvement in patients with psoriatic arthritis. Clin Rheumatol. 2015; 34(6):1091–1096. PMID: 25066919.

19. Gunal EK, Kamali S, Gul A, Ocal L, Konice M, Aral O, et al. Clinical evaluation and comparison of different criteria for classification in Turkish patients with psoriatic arthritis. Rheumatol Int. 2009; 29(4):365–370. PMID: 18766345.

20. Nossent JC, Gran JT. Epidemiological and clinical characteristics of psoriatic arthritis in northern Norway. Scand J Rheumatol. 2009; 38(4):251–255. PMID: 19247847.

21. Salvarani C, Lo Scocco G, Macchioni P, Cremonesi T, Rossi F, Mantovani W, et al. Prevalence of psoriatic arthritis in Italian psoriatic patients. J Rheumatol. 1995; 22(8):1499–1503. PMID: 7473473.

22. Azevedo S, Santos-Faria D, Leite Silva J, Ramos Rodrigues J, Sousa Neves J, Peixoto D, et al. Obesity, metabolic syndrome and other comorbidities in rheumatoid arthritis and psoriatic arthritis: influence on disease activity and quality of life. Acta Reumatol Port. 2019; 44(4):322–324. PMID: 32281967.

23. Hackett S, Ogdie A, Coates LC. Psoriatic arthritis: prospects for the future. Ther Adv Musculoskelet Dis. 2022; 14:1759720X221086710.

24. Jamnitski A, Symmons D, Peters MJ, Sattar N, McInnes I, Nurmohamed MT. Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review. Ann Rheum Dis. 2013; 72(2):211–216. PMID: 22532629.

25. Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol. 2013; 27(Suppl 3):12–29. PMID: 23845149.

26. Oh EH, Ro YS, Kim JE. Epidemiology and cardiovascular comorbidities in patients with psoriasis: a Korean nationwide population-based cohort study. J Dermatol. 2017; 44(6):621–629. PMID: 28191654.

27. Zisman D, Eder L, Elias M, Laor A, Bitterman H, Rozenbaum M, et al. Clinical and demographic characteristics of patients with psoriatic arthritis in northern Israel. Rheumatol Int. 2012; 32(3):595–600. PMID: 21120489.

28. Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, et al. Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res (Hoboken). 2011; 63(12):1729–1735. PMID: 21905258.

29. Soriano ER, Acosta-Felquer ML, Luong P, Caplan L. Pharmacologic treatment of psoriatic arthritis and axial spondyloarthritis with traditional biologic and non-biologic DMARDs. Best Pract Res Clin Rheumatol. 2014; 28(5):793–806. PMID: 25488785.

30. Vivekanantham A, McGagh D, Coates LC. Current treatments and recommendations for psoriatic arthritis. Best Pract Res Clin Rheumatol. 2021; 35(2):101680. PMID: 33824068.

31. Rudwaleit M, Landewé R, van der Heijde D, Listing J, Brandt J, Braun J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009; 68(6):770–776. PMID: 19297345.

32. Baraliakos X, Coates LC, Braun J. The involvement of the spine in psoriatic arthritis. Clin Exp Rheumatol. 2015; 33(5):Suppl 93. S31–S35.

33. Mease PJ, Palmer JB, Liu M, Kavanaugh A, Pandurengan R, Ritchlin CT, et al. Influence of axial involvement on clinical characteristics of psoriatic arthritis: analysis from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol. 2018; 45(10):1389–1396. PMID: 29961691.

34. Queiro R, Sarasqueta C, Belzunegui J, Gonzalez C, Figueroa M, Torre-Alonso JC. Psoriatic spondyloarthropathy: a comparative study between HLA-B27 positive and HLA-B27 negative disease. Semin Arthritis Rheum. 2002; 31(6):413–418. PMID: 12077714.

35. Feld J, Ye JY, Chandran V, Inman RD, Haroon N, Cook R, et al. Is axial psoriatic arthritis distinct from ankylosing spondylitis with and without concomitant psoriasis? Rheumatology (Oxford). 2020; 59(6):1340–1346. PMID: 31593590.

36. Hanly JG, Russell ML, Gladman DD. Psoriatic spondyloarthropathy: a long term prospective study. Ann Rheum Dis. 1988; 47(5):386–393. PMID: 3260473.

37. Chandran V, Barrett J, Schentag CT, Farewell VT, Gladman DD. Axial psoriatic arthritis: update on a longterm prospective study. J Rheumatol. 2009; 36(12):2744–2750. PMID: 19884276.