SAT0356 DACTYLITIS IN EARLY SPONDYLOARTHRITIS. DATA FROM THE DESIR COHORT
Authors: Daniel Wendling, Clément Prati, Alain Saraux, Anna Moltó, Thao Pham, Maxime Dougados, Xavier Guillot
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Dactylitis is a particular feature shared across the several phenotypical forms of spondyloarthritis (SpA), part of the classification criteria. There are only few data available about impact of dactylitis in early stage of SpA, and factors associated with the presence/history of dactylitis. <h3>Objectives</h3> To study, at baseline and after 5 years in the DESIR cohort, the presence/history of dactylitis in an attempt to evaluate frequency of dactylitis in SpA and to look at the factors associated with presence of dactylitis. <h3>Methods</h3> DESIR is a prospective observational cohort of patients with recent onset (less than 3 years) inflammatory back pain, beginning before 50 years, suggestive of axial SpA, All available factors in the database (clinical, biological, imaging and medico economic) were compared between patients with and without past or present dactylitis at baseline (for categorical variables : odds-ratio +/- 95% CI and chi-square/Fisher tests, for continuous variables : unpaired t-tests/Mann-Whitney), by uni and then multivariate analysis(logistic regression). Significance: p less than 0.05. <h3>Results</h3> At baseline, 708 patients were analyzed. 97 had a past history or a concomitant dactylitis [prevalence 13.7% (CI 95% : 11.6 – 16.2)]. Dactylitis occurred before axial symptoms in 41.3% and before any other symptom in 14.1% of the cases. By univariate analysis, dactylitis was significantly associated with history of arthritis, enthesitis, psoriasis, with elevated CRP and ESR, enthesitic and arthritis scores, BASDAI, ASDAS,BASFI, SF-36, HAQ, ASQoL, shorter disease duration, systemic and local steroids use, and with lower structural damage (sacro iliac, spine). Table shows the result of the multivariate analysis at baseline. After 5 years, 138 cases were recorded in 480 patients with complete follow-up : prevalence 28.75% [CI 95% 24.75-32.75], with estimated incidence of 1.7/100 patient-years. At 5 years, dactylitis was significantly associated (multivariate analysis) with : Achilles enthesitis (OR : 3.3), history of psoriasis (OR: 3.9), cumulative number of ASAS criteria (OR: 7.2), modified New York criteria fulfillment (OR: 0.35), DMARD use (OR: 2.7) and elevated CRP (OR:0.9). <h3>Conclusion</h3> In the DESIR cohort of patients suspected for early SpA, history of dactylitis is present in 13.7% of the cases at baseline and an estimated incidence of 1.7/100 p-y over 5 years. It is an early feature associated with peripheral involvement, and associated with more burden of the disease, more frequent use of DMARDs and steroids, but with less structural damage. <h3>Disclosure of Interests</h3> Daniel Wendling: None declared, Clément Prati: None declared, Alain Saraux Consultant for: Roche SAS, Speakers bureau: Chugai Pharma France, Anna Moltó: None declared, thao pham: 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, xavier guillot: None declared