rheumatology-congress-physiology-2019-posters-abstracts

Page 41

December 9-10, 2019 | Barcelona, Spain

Volume 14

ARTHRITIS AND RHEUMATOLOGY

ANATOMY AND PHYSIOLOGY

International Conference on

Journal of Orthopaedics Trauma Surgery

and Related Research

Rheumatology Congress 2019 & Anatomy and Physiology 2019

December 09-10, 2019

J Orthop Trauma Surg Rel Res, ISSN: 1897-2276

Inflammatory back pain in psoriatic arthritis is significantly more responsive to

corticosteroids compared to back pain in ankylosing spondylitis: A prospective, open-

labelled, controlled pilot study

Muhammad Baig

Galway University Hospital, Ireland

Background

: The efficacy of corticosteroids in patients with psoriatic

arthritis (PsA) and inflammatory back pain has not been studied to date. In

this controlled trial, we aimed to investigate the comparative performance

of corticosteroids in patients with active axial-PsA (AxPsA) versus those

with active ankylosing spondylitis (AS).

Methods

: Patients with AxPsA and AS (naïve to biologic therapies), who

not only had clinically active disease, but also had bone marrow oedema

on magnetic resonance imaging of the sacroiliac joints, were recruited.

Clinically active disease was defined as inflammatory back pain (fulfilling

Assessment of Spondyloarthritis International Society (ASAS) expert

criteria), with spinal pain score (numerical rating scale 0-10) ≥4 and Bath

AS Disease Activity Index (BASDAI) score ≥4 despite taking nonsteroidal

anti-inflammatory drugs. Moreover, we recruited a control group of patients with non-inflammatory lower back pain. All patients

received a single, intra-muscular dose of depot corticosteroid injection (triamcinolone acetonide 80 mg) at baseline. The intra-

muscular corticosteroid option was used to overcome any drug compliance issues. Clinical outcome assessments were made

at the following time points: baseline, week 2, and week 4. The primary efficacy end point was mean change in Ankylosing

Spondylitis Disease Activity Score (ASDAS) at week 2. Key secondary outcomes were mean change in the BASDAI, Bath

Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) at weeks 2 and 4.

Results

: In total, 40 patients were recruited (15 with AxPsA, 15 with AS, and 10 controls). At week 2 following corticosteroid

treatment, patients with AxPsA had significantly greater improvement in the mean ASDAS compared to patients with AS (1.43

± 0.39 vs. 1.03 ± 0.30, p = 0.004), and also when compared to controls (p <0.001). At week-4, similar significant trend of

ASDAS improvement was seen among AxPsA patients compared to AS patients (1.09 ± 0.32 vs. 0.77 ± 0.27, p = 0.007) and

controls (p < 0.001). Similarly, the mean BASDAI, visual analogue scale spinal pain score, ASQoL and BASFI improved

significantly among patients with AxPsA compared to patients with AS and controls at week 2 (p <0.05), with this trend also

largely maintained at week 4.

Conclusions

: Axial inflammation in patients with PsA responds significantly better to corticosteroids than in patients with AS.

This furthers the argument and adds to the growing evidence that AxPsA and AS are distinct entities.