P265 Burden of psoriatic nail disease and response to biologic therapy in a PsA cohort

Abstract

Abstract Background Psoriatic nail disease is one of the six disease manifestations of psoriatic arthritis (PsA) in addition to peripheral arthritis, psoriasis, enthesitis, dactylitis and axial disease. Nail pitting is associated with an increased risk of developing PsA and onycholysis is associated with radiographic damage at the distal interphalangeal joints. Quantitative assessment of psoriatic nail disease is rarely performed in clinical practice therefore little is known about the burden of nail disease and effect of treatment in observational cohorts. We set out to quantify the burden of nail disease and response to b/tsDMARD treatment in a secondary care cohort. Methods Data were taken from the Bath PsA cohort. Patients fulfil CASPAR criteria and have clinical and patient reported outcomes at routine clinic follow-up visits. Patients commencing a b/tsDMARD with at least one follow up visit were included for analysis. Nail involvement was assessed using the Bath Nail score; pitting (0-10), onycholysis (0-10), hyperkeratosis (0-10) and severe deformity (0-10). Results 157 of 485 (32%) of the cohort commencing b/tsDMARDS had nail disease at baseline and were included in the analysis. At baseline nail pitting (65%) and onycholysis (57%) were the most frequent nail manifestations followed by hyperkeratosis (14%) and severe nail deformity (7%) (Table 1). At the first follow-up visit (mean duration 20 weeks), 39% of patients achieved clear nails. At the final follow-up visit (mean duration 59 weeks) 56% had clear nails and 44% of patients had residual nail disease with a median (IQR) nail score of 0 (0.0-2.0). Earliest improvements were seen in nail bed manifestations (onycholysis/ hyperkeratosis) whilst improvement in nail matrix features (pitting) occurred later (Table 1) (p < 0.001). Conclusion Psoriatic nail disease affects one third of those commencing b/tsDMARDs in this cohort. Earliest treatment responses are seen in features of psoriatic nail dystrophy that affect the nail distally. At 20 weeks 39% of those with nail disease at baseline achieve clear nails. At one year, 44% of patients have ongoing nail manifestations, but few patients have persistently high nail scores. Disclosures P. Nair None. A. Anthony None. C. Lovell None. E. Korendowych None. C. Cavill None. N. McHugh None. W. Tillett None.