POS1068 DISCOVERY OF ARTHRITIS IN PSORIATIC PATIENTS FOR EARLY RHEUMATOLOGICAL REFERRAL (DAPPER): DEVELOPMENT OF A SCREENING TOOL FOR ACTIVE PSORIATIC ARTHRITIS IN PSORIASIS PATIENTS

Abstract

BackgroundOne in three patients with psoriasis (Pso) will develop psoriatic arthritis (PsA). Active PsA can lead to disability and joint damage. Current screening methods are targeted at finding all PsA patients in a Pso population. However, PsA patients with inactive disease are unlikely to benefit from rheumatological referral.ObjectivesTo develop a screening tool for dermatologists to identify patients with a high risk for active PsA in their Pso population, who would benefit from rheumatological referral.MethodsThis observational study consisted of Pso patients, stratified 1:1:1 for current therapy (topical, conventional systemic, biologic). Patients were screened by a rheumatologist for PsA, adjacent to a regular scheduled dermatologist visit. Active PsA was defined as a diagnosis of PsA, with at least 1 inflamed joint or entheses, or evidence of active spondyloarthritis. Inactive PsA was defined as a diagnosis of PsA, with no active (spondylo)arthritis at moment of screening. Univariable logistic regression was used to determine variables indicative of the presence of active PsA versus Pso only. Parameters with a P < 0.1 were entered into a multivariable model. A P-value of < 0.05 was considered significant. Sensitivity, specificity, positive and negative likelihood of the model were calculated using a 2x2-grid.ResultsThe DAPPER cohort consisted of 304 patients: 225 (74%) Pso only, 48 (16%) Pso and inactive PsA, 30 (10%) Pso and active PsA. One patient could not be classified. Mean age was 54 ± 16.1 years (Pso 53 ± 16.6; inactive PsA 55 ± 15.7; active PsA 52 ± 13.5). Thirty six percent of patients were female (Pso 30/225 – 36%; inactive PsA 19/48 – 40%, active PsA 10/30 – 33%).Univariable logistic regression showed significant differences between Pso only and Pso with active PsA for: treatment history with methotrexate (OR 3.03; 95% CI 1.12, 8.23), treatment history with biologics (OR 4.96, 95% CI 2.17, 11.37), current use of biologics (OR 3.37; 95% CI 1.55, 7.33), patient-reported history of nail Pso (OR 3.01; 95% CI 1.28, 7.04), patient-reported history of swollen joints (OR 7.95; 95% CI 3.12, 20.28), patient-reported history of swollen digits (OR 4.82, 95% CI 2.19, 10.62), previous diagnosis of arthritis by physician (OR 15.09; 95% CI 6.32, 36.03), current joint pain (OR 5.81; 95% CI 1.35, 25.098); current back pain (OR 2.74; 1.23, 6.12); prolonged morning stiffness (OR 4.43; 95% CI 1.90, 10.34), and a higher VAS joint pain (OR 1.02; 95% CI 1.00, 1.03).Two backward selection models were made: model 1 using 4 variables with the highest significance, model 2 using 4 variables with the highest effect size. Both methods resulted in 2 predictors: patient-reported history of swollen joints (OR 3.95; 95% CI 1.43, 10.95), and previous diagnosis of arthritis by physician (OR 9.53; 95% CI 3.80, 28.88). A forward selection model using all parameters with a P-value <0.1 resulted in a model with 3 variables: age at start Pso (OR 0.96; 95% CI 0.93-0.99), patient-reported history of swollen joints (OR 3.68; 95% CI 1.30, 10.12), and previous diagnosis of arthritis by physician (OR 11.22; 95% CI 4.21, 29.92).Based on these models, we developed a screening tool using two questions: 1. Did you ever have a swollen joint? 2. Did a doctor ever tell you that you had arthritis? A positive answer to either question would indicate a positive test. This screening method results in a sensitivity for active PsA of 84%, a specificity of 52%, with a positive likelihood ratio of 1.74 and a negative likelihood ratio of 0.31.ConclusionThis dermatology-based Pso cohort showed that ten percent of Pso patients had active PsA. We showed that the best predictors for the presence of active PsA were a patient-reported history of swollen joints, and a previous diagnosis of arthritis by physician. With these predictors, we could detect 84% of patients with active PsA.Figure 1.Disclosure of InterestsTamara van Hal Speakers bureau: T.v.H. received personal fees from Eli Lily and Novartis, non-financial support from UCB, outside the submitted work., Michelle Mulder Speakers bureau: M.M. received non-financial support from UCB, outside the submitted work., Mark Wenink: None declared, Juul Van den Reek Speakers bureau: JMPA van den Reek has received speaking fees/attended advisory boards from AbbVie, Janssen, BMS, Almirall, LEO Pharma and Eli Lilly and reimbursement for attending a symposium from Janssen, Pfizer, Celgene and AbbVie. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboud University Medical Center Nijmegen, the Netherlands., E.M.G.J. de Jong Speakers bureau: EMGJ de Jong has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including AbbVie, Janssen Pharmaceuticals, Novartis, Lily, Celgene, Leo Pharma, UCB and Almirall., Consultant of: EMGJ de Jong has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including AbbVie, Janssen Pharmaceuticals, Novartis, Lily, Celgene, Leo Pharma, UCB and Almirall., Grant/research support from: EMGJ de Jong has received research grants for the independent research fund of the department of dermatology of the Radboud University Medical Center Nijmegen, the Netherlands from AbbVie, Pfizer, Novartis, Janssen Pharmaceuticals and Leo Pharma