Risk factors for axial inflammatory arthritis in patients with psoriatic arthritis.
OBJECTIVE
Axial involvement is an important manifestation of psoriatic arthritis (PsA). We aimed to identify risk factors associated with the presence of axial PsA (AxPsA) in patients with PsA.


METHODS
Patients with AxPsA (bilateral sacroiliitis >or= grade 2/unilateral sacroiliitis >or= 3 and inflammatory neck/back pain or limited spinal mobility) at first clinic visit were identified from the University of Toronto PsA clinic database. Risk factors associated with the presence of AxPsA were determined. Subsequently, patients without AxPsA at first clinic visit were identified. Under a multistate framework, the proportion of patients with PsA who subsequently developed AxPsA was estimated robustly using marginal methods and a Markov model. Risk factors at baseline that were associated with future development of AxPsA were identified through multiplicative time-homogeneous Markov models.


RESULTS
Our study included 206 patients. Fifty patients had AxPsA at first clinic visit. HLA-B*27, radiographic damage to peripheral joints, and elevated erythrocyte sedimentation rate (ESR) increased odds of having AxPsA, while family history of PsA decreased the odds. One hundred fifty-six patients did not have AxPsA at first clinic visit. On followup, 28 developed AxPsA, and 11 died. We estimated that after 10 years of followup, 15% would develop AxPsA. Nail dystrophy, number of radiographically damaged joints, periostitis, and elevated ESR increased the risk of developing AxPsA, while swollen joints decreased the risk.


CONCLUSIONS
These results suggest that severe peripheral arthritis and HLA-B*27 are risk factors for AxPsA.
Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Ontario, Canada.
Vinod
V
Chandran
David C
DC
Tolusso
Richard J
RJ
Cook
Dafna D
DD
Gladman
D000328:Adult; D015535:Arthritis, Psoriatic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D001175:Arthrography; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D007596:Joints / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index