FRI0299 EVALUATION OF ENTHESITIS INDICES AND RESPONSE TO BDMARD THERAPY IN PORTUGUESE PATIENTS WITH SPONDYLOARTHRITIS
Authors: F. Pinheiro, M. Rato, B. M. Fernandes, S. Garcia, S. Ganhão, P. Madureira, M. Bernardes, L. Costa
Journal: Annals of the Rheumatic Diseases (2020)

Background: Enthesitis is a hallmark clinical feature of spondyloarthritis (SpA), but to date, few studies have investigated how the overall response to biological treatment relates to the evolution of enthesitis counts. Objectives: Assess whether the variation in enthesitis indices reflects the overall response to bDMARD therapy in SpA. Methods: This longitudinal, retrospective study included patients who met Assessment of Spondyloarthritis international Society (ASAS) criteria for SpA followed at the Rheumatology Department of a tertiary hospital, under bDMARD therapy. Demographic, laboratorial and clinical data were collected, including Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), Maastrich Ankylosing Spondylitis Enthesitis Score (MASES), Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada (SPARCC) scores. All were evaluated at baseline and at 6, 12, 18 and 24 months after starting the first biological therapy. The variation in each parameter compared with the baseline values was calculated at 6, 12, 18 and 24 months and represented in the form of delta. Correlations between variables were assessed using Spearman test and comparison between groups using Wilcoxon, Mann-Whitney U and Kruskal-Wallis tests. Results: We included 273 patients, 123 (45,1%) females, aged 42,0±12,3 years and with diagnosis of SpA for 15,4±11,2 years at the start of bDMARD therapy. Eighteen (6,6%) had depression. At baseline, mean BASDAI was 6,43 ±1,62, ASDAS-CRP was 4,01 ± 0,86, median MASES was 1 (0-4), LEI 0 (0-1,75) and SPARCC 1 (0-4). Seventy-two patients (26,4%) started golimumab, 71 (26,0%) adalimumab, 66 (24,2%) infliximab, 54 (19,8%) etanercept, 9 (3,3%) certolizumab and 1 (0,4%) secukinumab. Enthesitis indices were significantly higher at baseline in females [median MASES-females 2 (0-5) vs 0 (0-2), p&lt;0,001; LEI-females 0 (0-2) vs 0 (0-1), p=0,03; and SPARCC-females 2 (0-5) vs 0 (0-2), p&lt;0,001], and remained so at 24 months [median MASES-females 1 (0-3,5) vs 0 (0-0), p&lt;0,001; LEI-females 0 (0-0,5) vs 0 (0-0), p&lt;0,001; and SPARCC-females 1 (0-3) vs 0 (0-0), p&lt;0,001]. MASES and SPARCC, but not LEI, at baseline were significantly higher in patients with depression [median MASES-depression 3,5 (2-6) vs 1 (0-4), p=0,01; SPARCC-depression 4 (0-8) vs 1 (0-3), p=0,03], but at 24 months no differences were observed. There was a significant difference between each of the 3 scores of enthesitis when assessed at 6, 12, 18 and 24 months, compared to baseline (p &lt;0.004). No differences were observed regarding the choice of bDMARD. At baseline, MASES had a significant correlation with patient visual analogic scale (VAS) (r=0,18; p=0,01), BASDAI (r=0,36; p&lt;0,001) and BASFI (r=0,21; p=0,003); LEI had a significant correlation with BASDAI (r=0,31; p&lt;0,001) and BASFI (r=0,21; p=0,003); SPARCC had a significant correlation with patient VAS (r=0,19; p=0,01), BASDAI (r=0,37; p&lt;0,001) and BASFI (r=0,26; p&lt;0,001). ΔLEI at 6 months had a significant correlation with ΔBASDAI (r=0,25; p=0,005), ΔASDAS (r=0,190; p=0,03), Δpatient VAS (r=0,23; p=0,01) and Δphysician VAS (r=0,25; p=0,01), but not with ΔESR, ΔCRP and ΔBASMI; no correlation was found at 6 months for ΔMASES or ΔSPARCC. At 12 months, ΔMASES had a significant correlation with ΔBASDAI (r=0,18; p=0,03); ΔLEI with ΔBASDAI (r=0,23; p=0,01) and Δpatient VAS (r=0,19; p=0,03); for ΔSPARCC no significant correlations were found. At 18 months and 24 months, no correlations were found. Conclusion: The initiation of bDMARD led to improved enthesitis indices over a 24-month period. ΔLEI correlates better with SpA activity scores and measurements than the other indices, especially at the first 12 months of initiation of bDMARD therapy. Disclosure of Interests: Filipe Pinheiro: None declared, Maria Rato: None declared, Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Pedro Madureira: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared