SAT0337 MORE THAN 30% PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS PRESENT WITH PERIPHERAL ARTHRITIS: INCIDENCE AND FACTORS ASSOCIATED DURING 5 YEARS OF FOLLOW-UP OF THE DESIR COHORT
Authors: Clementina López-Medina, Adeline Ruyssen-Witrand, Maxime Dougados, Anna Moltó
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Peripheral arthritis is the most frequent peripheral manifestation in Spondyloarthritis (SpA). However, there is a lack of knowledge about its prevalence and incidence over time in recent axial SpA (axSpA). Objectives: a) To describe the prevalence and incidence of peripheral arthritis during 5 years of follow-up on the DESIR cohort; b) to describe the time of onset regarding axial symptoms; c) to evaluate factors associated with their appearance; d) to evaluate the impact of this symptom on treatment, Patient Reported Outcomes (PROs) and sick leave during 5 years of follow-up. <h3>Methods</h3> Data from the early axSpA patients from the DESIR cohort (first 5 years of follow-up) were analysed. The prevalence and the incidence of peripheral arthritis at each study visit were calculated. A Kaplan-Meier curve was performed to evaluate the time of onset of this manifestation regarding the axial symptoms onset. Univariate and multivariate logistic regressions were performed to evaluate baseline factors associated to the development of the arthritis. We compared the use of drugs between patients with and without arthritis by Chi-square test, and finally we evaluate the impact of this symptom on PROs (BASDAI, BASFI and SF36-questionnaire) and on days of sick leave after 5 years of follow-up through the use of a mixed model with random effects (patients). <h3>Results</h3> Out of the 708 patients included in the analysis, 255 (36.0%) showed at least one episode of arthritis (151 before the inclusion visit, and 104 during the follow-up), with a time-person rate of 3.7 cases per 100 person-year. Regarding axial symptoms, 20.4%, 13.70% and 65.9% patients suffered the first episode of arthritis before, concomitantly and after axial symptoms onset, respectively. Multivariate analysis showed that baseline factors associated to the development of arthritis are age ≥33 years (OR 1.60, 95%CI 1.12-2.27), non-smokers (OR 1.58, 95%CI 1.10-2.27), HLAB27 negative (OR 1.47, 95%CI 1.04-2.08), CRP &gt;6mg/dl (OR 1.99, 95%CI 1.35-2.92), no history of uveitis (OR 2.03, 95%CI 1.07-3.84), dactylitis (OR 8.50, 95%CI 4.96-14.60) and enthesitis (OR 2.00, 95%CI 1.41-2.84). Concerning the use of drugs, patients with arthritis showed a significant greater use of TNF blockers (49.4% vs. 29.1%, p&lt;0.001), csDMARDs (40.4% vs. 13.9%, p&lt;0.001), oral corticosteroids (37.6% vs. 22.1%, p&lt;0.001) and ≥1 intraarticular corticosteroids (31.0% vs. 6.8%, p&lt;0.001), in comparison with patients without history of arthritis. We did not found differences concerning NSAIDs, intramuscular and intravenous corticosteroids. Finally, the mixed model showed that, after 5 years of follow-up, patients with arthritis had higher levels on BASDAI (40.5±22.6 vs. 34.3±20.7, p&lt;0.001) and BASFI (27.9±23.2 vs. 22.5±21.0, p=0.001), poorer quality of life (SF36-mental component 42.7±11.7 vs. 44.0±11.0, p=0.003; SF-36 physical component 40.9±9.7 vs. 43.1±0.2, p&lt;0.001) and higher number of days of sick leave (18.0±57.5 vs. 12.8±47.2, p=0.024). <h3>Conclusion</h3> In recent axSpA, 36% of patients reported peripheral arthritis at any time of the disease, and this appeared more frequently after axial symptoms onset. This symptom is more prevalent among patients with HLAB27 negative, non-smokers, with high CRP and with other peripheral manifestations. Arthritis were associated with a greater use of bDMARDs, csDMARDs and corticosteroids, and had an impact on function, quality of life and days of sick leave. <h3>Disclosure of Interests</h3> Clementina López-Medina: None declared, Adeline Ruyssen-Witrand: None declared, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Anna Moltó: None declared