Amelia Green

Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort.

ObjectivesnTo describe the time interval between the onset of psoriasis and PsA in the UK primary care setting and compare with a large, well-classified secondary care cohort.nnnMethodsnPatients with PsA and/or psoriasis were identified in the UK Clinical Practice Research Datalink (CPRD). The secondary care cohort comprised patients from the Bath PsA longitudinal observational cohort study. For incident PsA patients in the CPRD who also had a record of psoriasis, the time interval between PsA diagnosis and first psoriasis record was calculated. Comparisons were made with the time interval between diagnoses in the Bath cohort.nnnResultsnThere were 5272 eligible PsA patients in the CPRD and 815 in the Bath cohort. In both cohorts, the majority of patients (82.3 and 61.3%, respectively) had psoriasis before their PsA diagnosis or within the same calendar year (10.5 and 23.8%), with only a minority receiving their PsA diagnosis first (7.1 and 14.8%). Excluding those who presented with arthritis before psoriasis, the median time between diagnoses was 8 years [interquartile range (IQR) 2-15] in the CPRD and 7 years (IQR 0-20) in the Bath cohort. In the CPRD, 60.1 and 75.1% received their PsA diagnosis within 10 and 15 years of their psoriasis diagnosis, respectively; this was comparable with 57.2 and 67.7% in the Bath cohort.nnnConclusionnA similar distribution for the time interval between psoriasis and arthritis was observed in the CPRD and secondary care cohort. These data can inform screening strategies and support the validity of data from each cohort.

Serum bone-turnover biomarkers are associated with the occurrence of peripheral and axial arthritis in psoriatic disease:a prospective cross-sectional comparative study

BackgroundA recent systematic review identified four candidate serum-soluble bone-turnover biomarkers (dickkopf-1, Dkk-1; macrophage-colony stimulating factor, M-CSF; matrix metalloproteinase-3, MMP-3; osteoprotegerin, OPG) showing possible association with psoriatic arthritis (PsA). We aimed to: (i) confirm and determine if these four biomarkers are associated with PsA; (ii) differentiate psoriasis cases with and without arthritis; and (iii) differentiate PsA cases with and without axial arthritis.MethodsA prospective cross-sectional comparative two-centre study recruited 200 patients with psoriasis without arthritis (PsC), 127 with PsA without axial arthritis (pPsA), 117 with PsA with axial arthritis (psoriatic spondyloarthritis, PsSpA), 157 with ankylosing spondylitis (AS) without psoriasis, and 50 matched healthy controls (HC). Serum biomarker concentrations were measured using ELISA. Multivariable regression and receiver operating characteristic analyses were performed.ResultsMMP-3 concentrations were significantly higher and M-CSF significantly lower in each arthritis disease group compared with HC (pu2009≤u20090.02). MMP-3 concentrations were significantly higher (adjusted odds ratio, ORadj 1.02 per ng/ml increase in concentration; pu2009=u20090.0004) and M-CSF significantly lower (ORadj 0.44 per ng/ml increase; pu2009=u20090.01) in PsA (pPsA and PsSpA combined) compared with PsC. Dkk-1 concentrations were significantly higher (ORadj 1.22 per ng/mL increase; pu2009=u20090.01), and OPG concentrations significantly lower (ORadj 0.20 per ng/mL increase; pu2009=u20090.02) in patients with axial arthritis (PsSpA and AS combined) than in those without (pPsA). Furthermore, Dkk-1 concentrations were significantly higher along a spectrum of increasing axial arthritis; Dkk-1 concentrations were higher in AS compared with PsSpA (ORadj 1.18 per ng/mL increase; pu2009=u20090.02). Receiver operating characteristic analysis showed MMP-3 to be the best single biomarker for differentiating PsA from PsC (AUC 0.70 for a cut-off of 14.51xa0ng/mL; sensitivity 0.76, specificity 0.60).ConclusionsMMP-3 and M-CSF are biomarkers for the presence of arthritis in psoriatic disease, and could therefore be used to screen for PsA in psoriasis cohorts. Dkk-1 and OPG are biomarkers of axial arthritis; they could therefore be used to screen for the presence of axial disease in PsA cases, and help differentiate PsSpA from AS. High concentrations of Dkk-1 in AS and PsSpA compared with HC, support previous reports that Dkk-1 is dysfunctional in the spondyloarthritides.

Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis: a population-based cohort study

Objectives To determine the risk of uveitis and inflammatory bowel disease (IBD) in patients with psoriatic arthritis (PsA) compared with the general population and patients with psoriasis. Methods A cohort study using data from the UK Clinical Practice Research Datalink between 1998 and 2014. Patients with incident PsA aged 18–89 years were identified and matched to a cohort of patients with psoriasis and a general population cohort. The incidence of uveitis, all IBD, Crohn’s disease and ulcerative colitis was calculated for each study cohort and adjusted relative risks (RRadj) were calculated using conditional Poisson regression. Results 6783 incident cases of PsA were identified with a median age of 49 years. The risk of uveitis was significantly higher in the PsA cohort than in the general population and psoriasis cohorts (RRadj 3.55, 95% CI 2.21 to 5.70 and RRadj 2.13, 95% CI 1.40 to 3.24, respectively). A significant increase was observed for Crohn’s disease (RRadj 2.96,u200995% CI 1.46 to 6.00 and RRadj3.60,u200995% CI 1.83 to 7.10) but not for ulcerative colitis (RRadj1.30,u200995% CI 0.66 to 2.56 and RRadj0.98,u200995% CI 0.50 to 1.92). Conclusions In a primary care-based incidence cohort of patients with PsA, there were substantial risks of developing uveitis and/or Crohn’s disease, but not ulcerative colitis, when compared with the general population and psoriasis controls.

Data Integration for the Assessment of Population Exposure to Ambient Air Pollution for Global Burden of Disease Assessment

Air pollution is a leading global disease risk factor. Tracking progress (e.g., for Sustainable Development Goals) requires accurate, spatially resolved, routinely updated exposure estimates. A Bayesian hierarchical model was developed to estimate annual average fine particle (PM2.5) concentrations at 0.1° × 0.1° spatial resolution globally for 2010-2016. The model incorporated spatially varying relationships between 6003 ground measurements from 117 countries, satellite-based estimates, and other predictors. Model coefficients indicated larger contributions from satellite-based estimates in countries with low monitor density. Within and out-of-sample cross-validation indicated improved predictions of ground measurements compared to previous (Global Burden of Disease 2013) estimates (increased within-sample R2 from 0.64 to 0.91, reduced out-of-sample, global population-weighted root mean squared error from 23 μg/m3 to 12 μg/m3). In 2016, 95% of the worlds population lived in areas where ambient PM2.5 levels exceeded the World Health Organization 10 μg/m3 (annual average) guideline; 58% resided in areas above the 35 μg/m3 Interim Target-1. Global population-weighted PM2.5 concentrations were 18% higher in 2016 (51.1 μg/m3) than in 2010 (43.2 μg/m3), reflecting in particular increases in populous South Asian countries and from Saharan dust transported to West Africa. Concentrations in China were high (2016 population-weighted mean: 56.4 μg/m3) but stable during this period.

Risk of type 2 diabetes and cardiovascular disease in an incident cohort of people with psoriatic arthritis: a population-based cohort study

ObjectivesnTo determine the risk of type 2 diabetes (T2D) and cardiovascular diseases in PsA patients compared with the general population and patients with psoriasis.nnnMethodsnIncident PsA patients aged 18-89 years were identified in the UK Clinical Practice Research Datalink between 1998 and 2014 and were matched (1:4 ratio) to a general population cohort and psoriasis cohort. The incidence of T2D, cerebrovascular disease, ischaemic heart disease and peripheral vascular disease (PVD) was calculated for each study cohort. Conditional Poisson regression was used to calculate adjusted relative risks.nnnResultsnWe identified 6783 incident cases of PsA. The risk of T2D was significantly higher in the PsA cohort than in the general population and the psoriasis cohorts [adjusted relative risk 1.40 (CI95 1.15, 1.70) and adjusted relative risk 1.53 (CI95 1.19, 1.97), respectively]. The incidence of ischaemic heart disease, peripheral vascular disease and the three cardiovascular outcomes combined in the PsA cohort was significantly higher than in the general population. No significant differences in risk were observed between the PsA and psoriasis cohorts for any cardiovascular outcome.nnnConclusionnThe development of T2D in an incident population of PsA is significantly higher than in psoriasis alone or in a general population, whereas the increased risk of cardiovascular disease in PsA and psoriasis is similar.

Costs and Treatment Pathways for Type 2 Diabetes in the UK: A Mastermind Cohort Study.

IntroductionMedication therapy for type 2 diabetes has become increasingly complex, and there are few reliable data on the current state of clinical practice. We report treatment pathways and associated costs of medication therapy for people with type 2 diabetes in the UK, their variability and changes over time.MethodsPrescription and biomarker data for 7159 people with type 2 diabetes were extracted from the GoDARTS cohort study, covering the period 1989–2013. Average follow-up was 10xa0years. Individuals were prescribed on average 2.4 (SD: 1.2) drugs with average annual costs of £241. We calculated summary statistics for first- and second-line therapies. Linear regression models were used to estimate associations between therapy characteristics and baseline patient characteristics.ResultsAverage time from diagnosis to first prescription was 3xa0years (SD: 4.0xa0years). Almost all first-line therapy (98%) was monotherapy, with average annual cost of £83 (SD: £204) for 3.8xa0(SD: 3.5)xa0years. Second-line therapy was initiated in 73% of all individuals, at an average annual cost of £219 (SD: £305). Therapies involving insulin were markedly more expensive than other common therapies. Baseline HbA1c was unrelated to future therapy costs, but higher average HbA1c levels over time were associated with higher costs.ConclusionsMedication therapy has undergone substantial changes during the period covered in this study. For example, therapy is initiated earlier and is less expensive than in the past. The data provided in this study will prove useful for future modelling studies, e.g. of stratified treatment approaches.

FRI0514 Psoriatic arthritis is associated with diagnostic delay and worse outcome at three months when compared to rheumatoid arthritis: results from the uk national audit for inflammatory arthritis

Background Psoriatic arthritis (PsA) is underdiagnosed in primary care, and can be difficult to distinguish from osteoarthritis. Accumulating evidence suggests that diagnostic delay is associated with poorer functional outcome despite treatment. Objectives To develop a better understanding of the diagnostic delay and burden of disease in patients with PsA, and to investigate management within the first three months of diagnosis. Methods Data were analysed on all participants with a final diagnosis of PsA from The National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis, undertaken by the British Society for Rheumatology and commissioned by the Healthcare Quality Improvement Programme, recruited between 1/2/2014 and 30/10/2015. Data were collected from patients and clinicians at baseline and three months. 1016 participants with PsA (mean age 49.4±14.5 years; 54% female) were matched 1:1 by age and sex with participants with Rheumatoid Arthritis (RA). Results Patients with PsA had a significantly longer delay to presentation and diagnosis than those with RA (p<0.02, Table 1), and this remained significant when adjusted for age, sex, ethnicity and social status. PsA patients had lower median tender (4.0 vs 7.0) and swollen (3.0 vs 5.0) joint counts and lower mean baseline ESR (21.9 vs 27.8 mm/hr) and CRP (16.2 vs 24.2 mg/L) values than patients with RA (p<0.01 for all comparisons), and this remained significant when adjusted for potential confounders. Mean baseline scores for the Inflammatory Arthritis Impact of Disease (IAID) questionnaire were lower in patients with PsA (5.34±2.25 vs 5.94±2.35 in RA, lower scores indicating less impact), although this was not statistically significant when adjusted for demographics and disease activity (p=0.36). There was no significant difference between physical function at baseline between the groups (median HAQ 0.88 PsA vs 1.13 RA, p=0.70). At follow-up, patients with PsA had significantly higher mean IAID scores (4.32±2.60 vs 3.78±2.56, P<0.05). In those with paired results, the mean improvement in IAID score was 1.32 (95% CI 0.99–1.65) in PsA vs 2.37 (95% CI 2.07–2.67) in RA. In patients with high disease activity at baseline (DAS28 >5.1) a good EULAR response was seen in only 21.4% in PsA vs 30.3% in RA. There was a marked difference in the DMARDs initially prescribed, and the differences remained significant when only those with a DAS28 score indicating moderate or high disease activity at presentation were analysed, as shown in Figure 1.Table 1. Median delay in weeks PsA RA Unadjusted Adjusted* Unadjusted Adjusted* Symptoms to GP Presentation 8.9 8.9 7.1 6.6 GP Presentation to Referral 5.3 5.4 4.3 4 GP Presentation to Diagnosis 12.4 12.1 9.9 9.7 Symptoms to Diagnosis 29.0 28.6 21.4 21.6 *Adjusted for age, sex, ethnicity and deprivation Index; p<0.02 for all between group comparisons. Conclusions This study demonstrates that patients with PsA have a longer delay to diagnosis between both symptom onset and presentation to primary care, and referral to secondary care and diagnosis than those with RA. Despite similar disease impact and physical function at diagnosis, patients with PsA are less likely to receive combination DMARD treatment, and have increased disease burden at three months. Disclosure of Interest None declared