SAT0635 PATIENT-PERCEIVED RESIDUAL BURDEN OF PSORIATIC ARTHRITIS IN PATIENTS IN REMISSION/LOW DISEASE: AN ANALYSIS OF 444 PATIENTS

Abstract

Background The objective of treatment in psoriatic arthritis (PsA) is remission or low disease (ref1). However, there may remain residual patient burden in patients where inflammation is controlled. Objectives To explore patient-perceived burden of disease in PsA patients in remission or low disease, when using different definitions of remission. Methods ReFlap (NCT03119805, ref2) was an observational study in 14 countries of consecutive adult patients with definite PsA and >2 years of disease duration. Remission/low disease status was defined at the baseline visit using composite scores: Minimal Disease Activity (MDA), and Disease Activity in PSoriatic Arthritis (DAPSA) Results Of 466 patients, 444 had disease status and impact available: 220 (50.5%) were male, mean age was 52.2±12.6 years, mean disease duration was 10.1±8.1 years; 261 (62.9%) were taking a conventional DMARD and 255 (61.3%) a biologic. Disease activity was moderate: 154 (36.2%) had no current psoriasis skin lesions, mean tender joint count was 4.7±9.5, mean swollen joint count (SJC) was 2.2±7.0, and mean DAPSA was 16.6±17.2. Remission/low disease was more frequent when defined by DAPSA: 251 (56.5%) patients, than by MDA: 171 (38.5%) patients. As expected, objective measures of disease activity were minimal in the good status categories (e.g., SJC was 0.3±0.8 in MDA and 0.4±0.9 in DAPSA-remission/low disease). In remission/low disease, residual disease impact (assessed with PsAID12) was low: most median levels of symptoms were below 1 on a 0-10 scale; 5 aspects of impact had a median level >=1 (figure); only one had a median level of 2, and this was fatigue. Levels of impact were slightly though significantly higher in patients in DAPSA-defined good status than in patients in both MDA and DAPSA-remission/low disease (all p Conclusion In this unselected population, residual symptoms were of low magnitude using both definitions of good status: DAPSA-based definitions (present in 56%) and MDA (38%), confirming the patient relevance of remission/low disease as a treatment objective. The predominant aspect of impact was fatigue, which is one of the most important domains of impact recognized by patients. Residual burden of disease was lower in the MDA group than in the DAPSA-remission/low disease group, which could indicate that MDA corresponds to a ‘deeper’ form of disease control, though the clinical relevance of the differences observed should be further explored. A holistic approach should be implemented when evaluating people with PsA including when disease control has been obtained.