POS1309 THE IMPACT OF PSORIASIS ON PATIENT-REPORTED OUTCOMES IN JUVENILE PSORIATIC ARTHRITIS

Abstract

BackgroundChildren with juvenile psoriatic arthritis (JPsA) are treated similarly to patients in other categories of juvenile idiopathic arthritis (JIA) despite distinctive clinical features, including either a personal or family history of psoriasis. It remains unknown whether the unique features in JPsA lead patients to experience the impact of disease differently from other JIA patients, and how the presence of psoriasis within JPsA affects patient outcomes. These gaps in our knowledge suggest there may be unmet treatment needs in these children and young people.ObjectivesTo compare patient-reported outcomes in patients with JPsA and other JIA categories. Additionally, this study explores whether the presence or absence of psoriasis in patients with JPsA is associated with different outcomes.MethodsChildren and young people with JIA were selected if recruited to the Childhood Arthritis Prospective Study (CAPS), a UK multicentre inception cohort of JIA, between January 2001 and March 2018. Detailed demographic information, clinical data and patient-reported outcomes were collected at initial presentation to paediatric rheumatology. Patient-reported outcomes included well-being as measured on the parental global evaluation (10cm), functional ability (Childhood Health Assessment Questionnaire: CHAQ), pain (10cm), health-related quality of life (Child Health Questionnaire, CHQ psychosocial score), depressive symptoms (Mood and Feelings Questionnaire, MFQ) and parent psychosocial health (General Health Questionnaire: GHQ). The CHQ and MFQ questionnaires were completed in a subset of children recruited until 2015 and aged above 5 and 7 years old, respectively.Patient-reported outcomes in patients with JPsA versus other JIA categories, and in patients with and without psoriasis within JPsA, were tested via multivariable linear regression, adjusted for age at first presentation, gender, disease duration, ethnicity, and number of active joints.ResultsA total of 1653 patients had JIA; the majority (64.7%) were female and median age at onset was 6.5 years (IQR 2.7 - 10.8). A total of 111 (6.7%) were categorised with JPsA, of which 62 (55.9%) were female with median age at onset of 10.2 (IQR 4.3 - 12.5). In those with JPsA, 35% had psoriasis at diagnosis.There were no significant differences between JPsA and non-JPsA in terms of parental global evaluation of wellbeing (p=0.21), CHAQ (p=0.19), pain (p=0.38), CHQ psychosocial (p=0.18), GHQ (p=0.31) or MFQ (p=0.34).Within JPsA, depressive symptom score on the MFQ was higher in patients with psoriasis compared to those without (coefficient=9.8, 95% CI=0.5 to 19.0, p-value=0.04). However, there were no significant differences in parental global evaluation (p=0.4), CHAQ (p=0.3), pain (p=0. 3), CHQ psychosocial score (p=0.5) or GHQ (p=0.7) between those with and without psoriasis in JPsA (Table 1).Table 1.Patient-reported outcomes in children and young people with JPsA with and without psoriasisPatient-reported outcome at JPsA diagnosisOutcomeCoefficient95% confidence intervalp-valueReference – JPsA without psoriasisReferenceReferenceReferenceWellbeing: Parent global (0-10cm)JPsA with psoriasis0.5-0.8, 1.80.45Function: CHAQ (0-3)0.2-0.2, 0.60.28Pain (0-10cm)0.8-0.8, 2.40.34Psychosocial health: CHQ (0-100)-2.4-10.1, 5.30.52Parent psychosocial: GHQ (0-84)-1.3-8.7, 6.10.72Depressive symptoms: MFQ (0-66)9.80.5, 19.00.04ConclusionDespite the differences in clinical features present in JPsA compared to the other JIA subtypes, there were no statistically significant differences in patient-reported outcomes overall at diagnosis. However, within the JPsA group, even when adjusting for age, children with psoriasis at time of arthritis diagnosis reported higher depressive symptom scores compared to those without psoriasis. When treating children with JPsA, attention to diagnosing and treating both arthritis and psoriasis may help mood. If poor mood persists in this subtype, then further allied health care may be required.AcknowledgementsWe thank all the children and young people and their families involved in CAPS, as well as clinical staff and administrators. We also thank the data management team at the University of Manchester (UK). CAPS is funded by Versus Arthritis (UK grant 20542). This report includes independent research funded by the NIHR Biomedical Research Centre Funding Scheme. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. KLH is additionally supported by the Centre for Epidemiology Versus Arthritis (UK grant 21755) at the University of Manchester, UK.Disclosure of InterestsJie Man (Jasmine) Low: None declared, Kimme Hyrich Speakers bureau: AbbVie, Grant/research support from: BMS, UCB, and Pfizer, Nophar Geifman: None declared, Stephanie Shoop-Worrall: None declared