Backround:

Differences in Comorbidities Related to Rheumatoid Arthritis and Psoriatic-Arthritis: Data From Large Prospectiv Observational Studies Sunday 534

Frank Behrens1, Diamant Thaci2, Hanns-Martin Lorenz3, Brigitte Krummel-Lorenz4, Lothar Meier5, Holger Gnann6, Gerd Greger7, Bianca Wittig7 and Harald Burkhardt1 1CIRI/Rheumatology, J.W. Goethe University, Frankfurt/Main, 2Klinik für Dermatologie, Venerologie und Allergologie, J.W. Goethe University, Frankfurt/Main, 3Medizinische Klinik und Poliklinik, Universität, Heidelberg, 4CIRI/ Endokrinologikum, Frankfurt/Main, 5CIRI/Rheumatologische Schwerpunktpraxis, Hofheim, 6Abteilung Biostatistik, GKM Gesellschaft für Therapieforschung mbH, München, 7Abbott GmbH & Co KG, Wiesbaden, Germany

To examine the impact of Rheumatoid Arthritis and Psoriatic Arthritis on the prevalence of type II diabetes, obesity, and osteoporosis.

 

Background:

Cross-sectional comparative analyses of baseline character- istics of two cohorts of patients with long-lasting rheumatoid arthritis (RA), and psoriatic arthritis (PsA) enrolled in prospective observational multi-centre studies. Patients with active RA (n= 4640) or PsA (n=1467) and either an inadequate response or intolerance to conventional or biologic disease modifying therapy who had enrolled in observational studies of adalimumab were analysed. Baseline prevalence rates of type II diabetes, obesity, and osteoporosis and the odds ratios with 95% confidence intervals (CI) for identified risk factors were calculated.  

 

Methods:

Conclusion: Patients with PsA have a higher rate of type II diabetes and an elevated BMI, but reduced levels of systemic inflammation and a lower prevalence of osteoporosis than patients with RA. The observed differences between RA and PsA patients do not support the concept of systemically released proinflammatory mediators as a dominant contributor to comorbidities in distinct inflammatory disorders. Our data thus suggest that disease-specific factors beyond inflammation impact the development of comorbidities in patients with inflammatory disorders.    

 

Table 1: Demographic data

Figure 2: Comparison of BMI

Table 2: Observed comorbidities Condition

RA patients (N=4583)

PsA patients (N=1467)

P value

n % n % Any 2979 65.0 903 61.1 .0174 Idiopathic hypertension 1437 31.4 439 29.9 .3148 Osteoporosis 1001 21.8 88 6.0 <.0001 Degenerative spine disease 689 15.0 170 11.6 .0009 Degenerative joint disease 513 11.2 116 7.9 .0003 Type II diabetes < 60 years ≥ 60 years

317 127 190

6.9 4.5

10.9

124 74 50

8.5 6.1

19.1

.0500

.0324

.0003 Hyperlipoproteinemia 241 5.3 100 6.8 .0269 Obesity (BMI ≥ 30 kg/m2) 805 17.8 432 30.3 <.0001 Psychiatric disorder/depression

225 4.9 78 5.3 .5362

Mean number of comorbidities (SD)

1.5 (1.7) 1.7 (1.4)

Parameter RA Patients (N=4640)

PsA Patients (N=1467)

Demographic characteristics Age, yrs (SD) 54.5 (12.7) 49.5 (11.4) BMI, kg/m2 (SD) 25.9 (4.8) 28.0 (5.4) Females, % 77.3% 47.6% Disease duration, yrs (SD) 11.9 (9.4) 9.9 (8.7) Disease characteristics Tender joint count (SD) 12.2 (7.4) 7.4 (7.2) Swollen joint count (SD) 9.6 (6.4) 5.8 (6.4) DAS 28 (SD) 5.8 (1.3) 4.7 (1.4) CRP, mg/L (SD) % of patients above ULN (8.2 mg/L)

32.9 (61.6) 70.4

15.6 (31.9) 42.9

ESR, mm/h (SD)* Female % of female patients above ULN Male % of male patients above ULN

34.6 (23.3) 34.1 (23.0) 53.1% 36.5 (24.4) 70.1%

23.5 (20.1) 23.7 (19.5) 34.7% 23.4 (20.8) 46.4%

FFbH, % remaining functional capacity (SD)

58.0 (24.0) 68.4 (21.4)

Prior therapies DMARDs, % Mean number (SD) Mean years of treatment

94.8 2.8 (1.40) 8.9 (10.4)

93.9 1.8 (1.0) 4.1 (5.0)

Biologic agents, % Mean number (SD) Mean months of treatment

34.2 0.44 (0.68) 13.6 (13.5)

27.5 0.33 (0.58) 4.6 (11.6)

Current therapies Systemic glucocorticoids, % Mean equivalent prednisolone dose, mg/day (SD)

84.2 9.2 (7.0)

42.5 3.6 (7.4)

Analgesics, % 27.2 19.6 NSAIDs, % 43.2 37.0 COX-2 inhibitors, % 20.4 12.4 DMARDs MTX, % Leflunomide, % Sulphasalazine, %

52.6 20.0 5.9

43.9 10.2 3.1

Figure 1: Prevalence of comorbidities

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RA RA RA PsA PsA PsA < 40 years 40 - < 50 years 50 - < 60 years 60 - < 70 years

RA PsA RA PsA > 70 years

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RA PsA RA PsA > 70 years 50 - < 60 years 40 - < 50 years < 40 years

19,5%

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29,5%

31,5%

RA RA RA PsA PsA PsA < 40 years 40 - < 50 years 50 - < 60 years 60 - < 70 years

RA PsA RA PsA > 70 years

75% Percentile

25% Percentile

Median

PsA RA

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male

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MI (

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31,5%

RA RA RA PsA PsA PsA < 40 years 40 - < 50 years 50 - < 60 years 60 - < 70 years

RA PsA RA PsA > 70 years

female

Comparison of baseline characteristics rheumatoid arthritis vs. Psoriatic arthritis prior to initiation of adalimumab therapy

ATD PsV PsA RA 0"

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ATD PsV PsA RA

Comparison of body mass indices (BMI) rheumatoid arthritis (RA) vs. psoriatic arthritis (PsA) for each decade

Percentages of patients in different BMI classes: rheumatoid arthritis (RA) vs. psoriatic arthritis (PsA) in comparison to psoriasis (PsV) and a non-psoritic inflammatory skin disease (atopic dermatitis ATD)

Comparison of prevalence of osteoporosis in rheumatoid arthritis (RA) vs. psoriatic arthritis (PsA) per decade

Comparison of prevalence of diabetes type II in rheumatoid arthritis (RA) vs. psoriatic arthritis (PsA) per decade

Dia

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(%)

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RA RA RA PsA PsA PsA < 40 years 40 - < 50 years 50 - < 60 years 60 - < 70 years

RA PsA RA PsA > 70 years

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RA RA RA PsA PsA PsA < 40 years 40 - < 50 years 50 - < 60 years 60 - < 70 years

RA PsA RA PsA > 70 years

female

Prevalence rates revealed a discordant relationship between type II diabetes and osteoporosis in RA compared with PsA. Whereas the PsA cohort exhibited a higher rate of type II diabetes than the RA cohort, particularly in patients over 60 years of age (19.1% vs 10.9%; P=.0003), the frequency of osteoporosis was reduced (6.0% vs 21.8%; P<.0001) in PsA independent of age and gender. The PsA and psoriasis cohorts had similar proportions of overweight and obese patients; both of these conditions were associated with much higher BMIs than RA or atopic dermatitis. Although atopic dermatitis is also an inflammatory cutaneous condition, this patient population had a very low proportion of overweight or obese patients. Logistic regression uncovered rheumatoid factor seropositivity as a previously unidentified serological marker for increased risk of osteoporosis in PsA patients (odds ratio = 3.319 [95% CI, 1.822 to 6.045]).

Results: