OP0028 EARLY ACHIEVEMENT OF MINIMAL DISEASE ACTIVITY IN PSORIATIC ARTHRITIS IS ASSOCIATED WITH LONG-TERM IMPROVEMENTS IN QUALITY OF LIFE

Abstract

BackgroundMinimal disease activity (MDA) is a treatment target in psoriatic arthritis (PsA) that takes both clinical manifestations (joints, skin and enthesis) and the patient perspective into account (1). In a previous study we have shown that achieving MDA in the first year is associated with better quality of life (QoL) regardless whether this was achieved early or late in the first year (2). However, the impact of achieving MDA within the first year on the long-term is lacking.ObjectivesTo compare quality of life at 1, 2 and 3 years between PsA patients who achieve MDA in the first year and those who do not.MethodsNewly diagnosed, DMARD naïve PsA patients with oligo- or polyarthritis and at least 3 years of follow-up, participating in the Dutch southwest Early PsA cohoRt (DEPAR) were included. In short the DEPAR is an observational cohort of newly diagnosed PsA (3). Study visits took place at 3, 6, 9, 12, 18, 24 and 36 months after diagnosis. Patients were categorized in three groups by achievement of MDA in the first year:Sustained MDA, includes patients who were in MDA at both their 9- and 12-month visit;Non-sustained MDA, includes patients who achieved MDA in the first year but did not sustain it at both 9- and 12-months;No MDA, includes patients who did not achieve MDA in the first year.To measure QoL at 1, 2 and 3 years the Short form-36 (SF-36) questionnaire was used. Descriptive statistics were used to compare QoL.ResultsWe included 243 patients (51% male) of whom 113 (47%) were classified as sustained MDA, 64 (26%) as non-sustained MDA and 66 (27%) as no MDA. At baseline, patients had a mean age of 52.7 years and median symptom duration of 9.3 months. Patients in the no MDA group seemed to be older, were more often female and had a longer symptom duration (Table 1). QoL of sustained MDA patients was comparable to the general Dutch population (4) after 1, 2 and 3 years of follow-up. However, patients who did not achieve MDA in the first year had a lower QoL compared to the sustained MDA group and these differences persist in the years thereafter (Figure 1). The physical as well as the mental QoL domains were worse in the no MDA group compared to the other groups.Table 1.Baseline characteristics of patients categorized by MDA groupSustained MDA (n=113)Non-sustained MDA (n=64)No MDA(n=66)Demographics Age (years)51.8 ± 1351.8 ± 1455.3 ± 13 Sex (male)69 (61)33 (52)21 (32) Symptom duration (months)8.5 (4-24)8.1 (3-28)12.9 (5-51)Disease activity Swollen joint count (66)3 (2-5)4 (1-6)4 (2-8) Tender joint count (68)3 (1-6)4 (2-8)8 (4-13) Psoriasis95 (84)58 (91)56 (85) BSA in case of psoriasis (%)3 (2-4)3.3 (1-6.5)3 (1.5-6) Enthesitis29 (26)28 (44)38 (58) LEI in case of enthesitis1 (1-2)2 (1-2)2 (1-4)HAQ0.38 (0.13-0.75)0.75 (0.5-1)1 (0.75-1.38)VAS global31 (15-56)46 (23-65)59 (50-77)VAS pain28 (12-52)50 (26-66)69 (53-80)Results are shown as mean ± standard deviation, n (%) or median (interquartile range). BSA: Body Surface Area; LEI: Leeds Enthesitis Index; HAQ: Health Assessment Questionnaire; VAS: visual analogue scale.Figure 1.(A) 1 year, (B) 2 year and (C) 3 year quality of life scores, measured with the SF-36 domains, for MDA groups and compared with the general Dutch population norms (4), (D) percentage of patients who use biologicals over time per MDA group.Over the years, treatment was intensified in all groups, with biologicals use after three years at 18%, 25% and 31% in the sustained MDA, non-sustained MDA and no MDA group, respectively.ConclusionFailure to achieve MDA in the first year after PsA diagnosis is associated with worse quality of life outcomes that persist over the years despite more intensified treatment.