POS0877 A COMPARISON OF PSA AND RA PATIENT PROFILES REQUIRING ADVANCED THERAPIES: PSA PATIENTS ACCESS TO THE ADVANCED THERAPIES EARLIER THAN RA

Abstract

BackgroundInternational guidelines recommend switching to advanced therapy (AT) in patients with Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA), when conventional synthetic disease modifying antirheumatic drugs (csDMARD) fail. There are several factors playing a role in that decision, including patients’ comorbidities and choices as well as the availability of the treatments.ObjectivesHere we present the results of a comparison of PsA and RA patient profiles requiring advanced therapies, from our pilot biologics clinic. Better patient outcomes in one disease may help us to recognize what can be improved in the other.MethodsBiologics clinic is a new initiative at Ottawa Hospital aiming to improve the long-term outcomes. Patients who are about to start or switch advance therapy are evaluated at the biologics clinic. Extensive data regarding disease history, medication exposure and disease activity are collected in a standardized fashion; the comorbidity burden is documented. A protocoled ultrasound (US) is conducted at baseline and three-month intervals, until reaching remission. The data presented here represent a pilot exploratory comparative analysis.ResultsPsA (n=18) and RA(n=42) patients had similar demographic features, other than RA patients being older (table 1). The majority of the comorbidities were similar in both groups, although PsA patients had more frequent liver disease numerically (5 (27.8 %) vs 5 (11.9%), p= 0.149) and less alcohol use (19 (38.9%) vs 7 (45.2%), p= 0.649). PsA patients had more frequent moderate/severe depression using the PHQ (61.1% of PsA vs 26.2% of RA; p=0.01).For disease activity, PsA patients tend to have higher disease activity based on the TJC, HAQ and physician global; in addition to significantly longer morning stiffness then RA (Table 1). Conversely, the disease activity within the joints based on the US scores of RA patients were higher. Disease duration at the time of initiation of the first advanced therapy was significantly shorter in PsA (median (IQR) 1.0 (7.75) years) compared to RA (6 (12.5), p=0.005) and PsA patients were treated with less numbers of csDMARD.ConclusionAccording to our preliminary data, PsA patients access to advanced therapy earlier than the RA. This may be due to the heterogeneity of PsA, such as manifestations other than the joint inflammation (enthesitis and axial disease) determining treatment decisions. PsA patients also had more frequent liver disease, which also may have prevented initiation of csDMARD and led to expediated initiation of the advance therapy- as early as at diagnosis. Whether earlier access leads to better patient outcomes in PsA, will be investigated with long-term follow up. PsA patients having more tender joints despite less severe US scores may be due to the proximity of the enthesis to the joints and difficulties to differentiate entheseal pain from joint involvement by the physical exam. The use of US may improve the assessment of the domains in PsA leading to choosing the right treatments.Table 1.Comparison of PsA and RA patient profilesRA (N:42)N (%)PSA (N:18)N (%)pDemographicsSex: Female30 (71.4 %)12 (66.7 %)0.712Age; Mean±SD59.3±14.950.3±13.60.033Smoking (ever)27 (64.3 %)12 (66.7 %)0.859Disease FeaturesRF positive30 (73.2 %)2 (12.5 %)<0.001anti-CCP positive23 (57.5 %)2 (14.3 %)0.005CRP positive16 (38.1 %)6 (33.3 %)0.726ESR positive16 (38.1 %)7 (38.9 %)0.954Disease duration (years)*14.0 (19.8)5 (13.8)0.036Previous therapies*Previous number of csDMARDs3 (1)2 (2)0.005Previous number of advanced therapies0.5 (2)0.5 (2)0.945Time to first biologics initiation from diagnosis6 (12.5)1 (7.75)0.005Disease activity/Clinical*Duration of morning stiffness (hours)1 (1.4)2 (5.5)<0.001Swollen joint count (44)8 (5)5 (5.5)0.199Tender joint count (44)8.5 (13)14 (17)0.244Patient VAS5.5 (4)6 (3)0.648Physician VAS5 (3)6 (2)0.066HAQ1.125 (1.125)1.625 (1.094)0.087Disease activity/US*Ultrasound: GLOESS score36 (28)22 (28)0.025Ultrasound: Doppler score8 (18)3.5 (7.8)0.058* Median (IQR)REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.