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Downloaded from http://ard.bmj.com/ on October 25, 2017 - Published by group.bmj.com
Scientific Abstracts
SAT0292
FACILITATING A MODULAR APPROACH TO THE
ASSESSMENT OF PSORIATIC ARTHRITIS
J. Wajed 1 , K. Gadsby 2 , P. Helliwell 3 , E. Korendowych 4 , S. Oliver 5 ,
L. Parrish 6 , B. Kirkham 1 . 1 Rheumatology, Guy?s & St Thomas? NHS Trust,
London; 2 Royal Derby Hospital, Derby; 3 Leeds University Hospital, Leeds;
4
Royal National Hospital for Rheumatic Diseases, Bath; 5 Minerva Health
Centre, Preston; 6 East Kent University Hospital, Kent, United Kingdom
Background: Psoriatic Arthritis (PsA) is a complex condition involving both
axial and peripheral joints, together with enthesitis, dactylitis and skin. A
complete assessment of PsA is challenging within the short time available
in routine clinics. Assessment of these components is important as they all
contribute significantly to disease burden, and may require specific treatments
for optimal outcome.
Objectives: As part of an initiative programme promoting the ?Treat-to-Target?
concept, a group of rheumatologists, dermatologists and nurse specialists
considered ways of assessing all components of psoriatic disease in routine
clinics. A modular approach for assessing psoriatic disease was proposed, with
skin and axial disease initially assessed by questionnaire. Patients identified
with significant symptoms could then be further clinically assessed. This study
reports patient acceptability and utility of this proposal in a routine clinic setting.
Methods: A trained receptionist handed two questionnaires to sequential
patients with psoriatic arthritis attending routine clinics at Guy?s Hospital,
asking two questions:Questionnaire 1: Have you been suffering from any neck
or back pain recently? Questionnaire 2: Do you have psoriasis at the moment?
If patients answered yes to question 1, the questionnaire invited them to
complete the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI),
on the reverse side. If they answered yes to question 2, they completed
the Dermatology Life Quality Index (DLQI). Questionnaires had a tick-box
format, and were completed in the waiting area prior to their appointment,
then reviewed at their consultation with the doctor. Patients who had BASDAI
scores >4 were seen again in a follow-up consultation at 3 months.
Results: 70 pairs of questionnaires were distributed and completed. All
patients found them easy to understand and to answer. 47 patients (67.1%)
identified co-existing neck or back pain, with 28 (59.6%) scoring BASDAI >4.
On further review, 19 had axial pain due to degenerative spinal disease, and
9 cases had active spondylitis. 45 patients (62.6%) identified themselves as
having co-existing psoriasis, with 24 patients (51%) scoring DLQI >5 and 8
patients (17%) a DLQI >10.
Conclusions: This preliminary use of screening questionnaires to facilitate a
modular approach to the assessment of PsA showed high patient acceptability,
and clinicians found the scores useful to indicate the extent of skin and
axial involvement. We closely monitored our cohort with active spondylitis,
and initially optimized NSAID therapy if possible. At three month follow up,
2 patients had repeat BASDAI >4, making them eligible for tumour necrosis
factor inhibitor therapy. This was started in these 2 patients with good effect.
DLQI >5 indicates significant skin involvement. 62.6% of our patient group
reported skin involvement, of whom over a third had a DLQI >5, but only 8 of
70 patients had a score >10 suggesting more severe psoriasis activity.
We propose the use of these questionnaires in routine practice. This patient
acceptable approach helps identify skin and axial skeleton involvement early,
so that treatment can be optimized quickly. In the future this approach will assist
new composite disease activity measures for the assessment and treatment of
psoriatic arthritis.
Acknowledgements: Abbott Immunology supported the Psoriatic Arthritis
Assessment Academy programme.
Disclosure of Interest: None Declared
SAT0293
COMPARISON OF EUROPEAN SCORE AND TWO
NATIONAL GUIDELINES CALIBRATED FOR
CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS
WITH PSORIATIC ARTHRITIS
C. Magro-Checa, J.L. Rosales-Alexander, J. Salvatierra, J. Cantero-Hinojosa,
J. Gonz醠ez-Dom韓guez, E. Raya-羖varez. Rheumatology, San Cecilio
University Hospital, Granada, Spain
Background: Stratifying cardiovascular risk using risk charts is central to
decision-making on treatment to prevent cardiovascular disease. EULAR
task force on cardiovascular (CV) risk management in patients (pts) with
inflammatory arthritis recommends the use of the SCORE chart when no
local guidelines are available. In our country, two charts have been calibrated
and are widely used to calculate CV mortality at 10 years, the SCORE table
(cSCORE) and the Framingham-Wilson (REGICOR).
Objectives: To assess the CV risk in Psoriatic Arthritis (PsA) pts using the
SCORE for low risk European countries (eSCORE) and compare it with the
cSCORE and the REGICOR. Furthermore, we analyzed the correlation of
several clinical and serological variables with these indexes and the percentage
of pts that received adequate therapy for the management of CV risk.
Methods: This cross-sectional study included 147 consecutive pts who fulfilled
the CASPAR criteria followed in our outpatient clinics. Patients with a previous
CV event and diabetics were excluded. The following data were recorded
for analysis: sex, age, body mass index, classic CV risk factors, lipid profile,
duration in years since diagnosis, clinical patterns of the PsA, treatment, and
Saturday, 9 June 2012
571
inflammatory markers. The eSCORE function model, the cSCORE and the
REGICOR were compared and the concordance (Kappa Index) between the
three guides calculated. According to our national guidelines, a high CV risk
has been defined by a SCORE ?5% and REGICOR ?10%, the cutoff point
recommended to start treatment.
Results: The mean eSCORE was 1,36�25% and 18 pts (11,4%) were above
the threshold of high or very high CV risk (?5%). After applying the cSCORE
the values were 2,23�48% and with REGICOR were 4�4%. Therefore,
34 pts (21,5%) and 20 pts (12,7%) were reclassified as high o very high
CV risk (SCORE ?5%, REGICOR ?10%) respectively. Multivariate regression
analysis showed that the most important prognostic factor for predicting the
cSCORE was the age (Total R-square 64%; p=0,000) followed by systolic
blood pressure. Of notice, the ESR was also a prognostic factor of the SCORE
(p<0,05). Both eSCORE and REGICOR showed a bad concordance (Kappa
Index 0,63 and 0,55 respectively) with cSCORE. Based on the eSCORE, the
percentage of high and very high CV risk pts treated with antihypertensive
and lipid-lowering treatment was 75% and 85% of pts respectively, but when
pts were reclassified with cSCORE, this percentage decreases to 65,21% and
35,29%, and with REGICOR to 55,55% and 22,22% respectively.
Conclusions: Assessment of the CV risk in PsA pts applying the eSCORE
or REGICOR leads to an underestimation of the risk in comparison with the
application of the cSCORE, which have an impact on the correct management
of these pts. Variable analysis showed that ESR, but not CRP, was a prognostic
factor of the SCORE what suggests that sustained inflammation could play a
role in the increase of CV risk.
References:
[1] Peters MJL et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms
of inflammatory arthritis. Ann Rheum Dis. 2010;69:325?331.
Disclosure of Interest: None Declared
SAT0294
MONITORING DISEASE ACTIVITY IN EARLY PSORIATIC
ARTHRITIS WITH ULTRASOUND - COMPARISON OF
CLINICAL RESPONDERS AND NONRESPONDERS
A.P. Nigg 1 , A.M. Malchus 1 , M. Gr黱ke 1 , M. Witt 1 , J.C. Prinz 2 ,
H. Schulze-Koops 1 . 1 Div. of Rheumatology, Medizinische Klinik IV, University
of Munich; 2 Dept. of Dermatology, University of Munich, Munich, Germany
Background: Assessment of disease activity in early psoriatic arthritis (PsA)
is a challenge because of the potential underestimation of the extent of
inflammation by clinical examination and the absence of disease-specific
biochemical markers. Sensitive and reliable diagnostic modalities enabling
visualization of early inflammatory changes may be useful tools for monitoring
the response to therapy.
Objectives: Prospective study to analyze the correlation between semiquantitative ultrasound (US) scores and clinical parameters during the course of the
disease and to determine the prognostic value of US findings for the overall
clinical outcome, defined by EULAR response criteria and minimal disease
activity (MDA).
Methods: Patients with psoriasis with a recent onset of joint pain (<5
years, visual analogue scale (VAS) pain ?30/100) who were naive to
immunosuppressive treatment were eligible for study inclusion (n=42). To date,
23 patients have completed a minimum of 1 follow-up visit, Patients were
evaluated by US and clinically at baseline and after 3, 6 and 12 months. In each
patient, a total of 56 joints were examined by US Grey-Scale (GSUS) and power
doppler (PDUS). US findings were scored separately on a 0-3 semi-quantitative
scale as previously described. US synovitis score was calculated by adding
the scores in the GSUS and PDUS modes for all joints examined. Clinical
assessment included a joint count of 68 tender and 66 swollen joints, VAS
for disease activity (patient and physician), VAS for pain, DAS28-CRP, Leeds
dactylitis instrument, HAQ and CRP. Treatment was initiated and modified
at the discretion of the primary rheumatologist and dermatologistfollowing
international recommendations. EULAR response criteria and criteria for MDA
(Coates L. et al.) in PsA were defined for each follow-up period.
Results: At baseline, US synovitis score showed a highly significant correlation
with TJC68 (r=0,57), SJC66 (r=0,63), physician global activity (r=0,54) and
DAS28-CRP (r=0,42). In contrast, the US synovitis score did not correlate
with disease duration, PASI, HAQ and patient global activity. Longitudinal data
showed a significant correlation between relative changes in the US score
and changes in several clinical parameters within 3 month treatment periods:
TJC68 (r=0,62), SJC66 (r=0,49) and physician global activity (r=0,42). Clinical
responders were more likely to have higher US scores at baseline and showed
a significantly higher reduction of the mean US synovitis score between the
follow-up-visits compared to non-responders: 25,2 vs. 11,4 (p=0,05) (good
EULAR response)/15,3 vs. 12,9 (n.s.) (moderate EULAR response)/12,3 vs.
13,4 (n.s.) (no EULAR response)/13,3 pt. vs. 6,8 pt. (n.s.) (MDA)/16,1 pt. vs.
14,5 pt. (n.s.) (no MDA).
Conclusions: US is a useful diagnostic and monitoring tool in early psoriatic
arthritis. US findings correlate significantly with parameters of clinical disease
activity during the course of treatment. Clinical responders (defined by EULAR
response criteria and MDA) showed a higher relative reduction of the US
score. Therefore, reduction of inflammatory changes detected by US within a
3-month follow-up period may be predictive for a favourable long term clinical,
Downloaded from http://ard.bmj.com/ on October 25, 2017 - Published by group.bmj.com
SAT0294 Monitoring disease activity in early
psoriatic arthritis with ultrasound comparison of clinical responders and
nonresponders
A.P. Nigg, A.M. Malchus, M. Gr黱ke, M. Witt, J.C. Prinz and H.
Schulze-Koops
Ann Rheum Dis 2013 71: 571
doi: 10.1136/annrheumdis-2012-eular.3241
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