CASPAR Classification Criteria Research Articles

Minimal disease activity and associated factors in patients with psoriatic arthritis: cross-sectional study from a single center.

Psoriatic arthritis (PsA) is a heterogeneous disease with various manifestations such as dactylitis, enthesitis, spondylitis, and skin involvement. Minimal disease activity (MDA) has been successfully used in daily clinical practice and is considered a reasonable treatment target in patients with PsA. In this study, we aimed to evaluate the MDA status and associated factors in patients with PsA in our tertiary referral clinic. This cross-sectional study included patients who met the CASPAR classification criteria and had at least 6 months of follow-up data between 2001 and 2021. Patients who met at least 5 of 7 criteria (tender joint count ≤ 1/68, swollen joint count ≤ 1/66, Psoriasis Area Severity Index [PASI] ≤ 1, Visual Analogue Scale [VAS] ≤ 15, patient global VAS ≤ 20, Health Assessment Questionnaire-Disability Index [HAQ-DI] ≤ 0.5, and enthesitis number ≤ 1) were considered to achieve MDA. Data from 172 patients (61% female) were analyzed and included in the study. While most patients had polyarticular involvement (33.7%), mono-oligoarthritis was present in 30.2%, mixed type in 26.2%, isolated distal interphalangeal arthritis in 5.8%, isolated spondylitis in 2.9%, and arthritis mutilans in 1.2%. Overall, 95 (55.2%) of the patients were observed at MDA, which was lower in tumor necrosis factor inhibitor (TNFi) users compared to only conventional synthetic disease-modifying antirheumatic drug users. In univariate analysis, MDA was associated with higher patient age, longer psoriasis duration, late-onset PsA, and continued use of first TNFi. In multivariate analysis, higher patient age, late-onset PsA, and higher continuation rate of first TNFi were associated with MDA. In the study, more than half of our patients achieved MDA status. A higher MDA rate was associated with a higher continuation rate at first-line TNFi treatment. The relatively large population who could not reach MDA status in our study indicates an unmet need for monitoring and treatment of PsA.

Risk factors and assessment of subclinical atherosclerosis in patients with psoriatic arthritis

ObjectiveTo understand the prevalence of subclinical atherosclerosis (SCA) in psoriatic arthritis (PsA) patients; to explore the correlation between PsA combined with SCA and traditional cardiovascular risk factors and disease activity; to compare the role of Framingham Risk Score (FRS) and atherosclerotic cardiovascular disease (ASCVD) scores. MethodsWe included 50 PsA patients who met the CASPAR classification criteria, 50 diabetes patients and 50 healthy people. Clinical data were collected from all patients, minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA), ASCVD, FRS were assessed in patients with PsA, and carotid artery intima–media thickness was measured. ResultsThe prevalence of SCA in PsA patients was significantly higher than that in healthy controls (44% vs 24%, P<0.05). Smoking, drinking, ASCVD, FRS were the risk factors of PsA with SCA (P<0.05). Psoriasis (PsO) duration, PtGA, VAS and DAPSA were the risk factors for PsA with SCA (P<0.05). FRS and ASCVD scores underestimated SCA risk in PsA patients. ConclusionCompared with healthy controls, patients with PsA have higher prevalence of SCA. High DAPSA is a risk factor for PsA with SCA. Carotid ultrasound can monitor SCA in patients with PsA, improve stratification of cardiovascular risk.

Performance of Low-dose Computed Tomography, Magnetic Resonance Imaging and Conventional Radiography in Differentiating Axial Involvement in Patients with Psoriatic Arthritis

Background: Sacroiliac joints (SIJ) radiography has lower sensitivity and specificity compared to magnetic resonance imaging (MRI) and low-dose CT (ldCT) of the SIJ for detecting axial spondyloarthritis. Whether this is also true for axial psoriatic arthritis (axPsA) remains uncertain. This study aimed to evaluate the performance of ldCT, MRI, and conventional radiography of SIJ and spine in distinguishing axial involvement in PsA patients. Methods: Fifty-one consecutive PsA patients (70.6% male, age 41 ± 13 years) meeting the CASPAR classification criteria, regardless of back pain, were included. All patients underwent SIJ and whole-spine radiography, SIJ MRI as well as SIJ ldCT, while 25 (49%) of 51 patients also underwent whole-spine MRI and ldCT. One rheumatologist with expertise in imaging and one trained reader evaluated images. The final diagnosis of axPsA was ascertained by two experienced rheumatologists. The sensitivity, specificity, and diagnostic accuracy of the three modalities for discriminating axPsA were compared. Results: AxPsA was diagnosed in 33.3% (17) of 51 patients. In discerning axial involvement in PsA patients, MRI exhibited superior sensitivity (92.9%) compared with ldCT (83.3%) and radiography (67.9%), while ldCT demonstrated higher specificity (97.1%) than MRI (86.4%) and radiography (72.7%). LdCT achieved the highest diagnostic accuracy (92%) among the three modalities, surpassing radiography (71%) and being comparable to MRI (89%). In the subgroup of patients with whole spine imaging, the combination of MRI and ldCT SIJ had the best diagnostic accuracy, reaching 93%. Including SIJ ldCT in addition to SIJ MRI further improved specificity (86.7% vs. 73.3%) with unchanged sensitivity (100%), while incorporating SIJ MRI alongside SIJ ldCT further improved sensitivity from 83% to 100%, with a modest decrease in specificity (86.7% vs. 93.3%). However, incorporating spine MRI/ldCT alongside SIJ MRI/ldCT did not further improve sensitivity or specificity in discriminating axial involvement in PsA patients. Conclusion: LdCT demonstrated superior diagnostic performance in distinguishing axial involvement in PsA patients compared to MRI or radiography, although MRI was more sensitive for detecting active sacroiliitis. The highest diagnostic performance was achieved with both MRI and ldCT of the SIJ. Additional spine imaging did not further increase diagnostic performance.

Performance of the ASAS-proposed Cut-offs for Positive MRI Typical of Axial Spondyloarthritis for Discriminating Axial Involvement in Patients with Psoriatic Arthritis

Background: Unlike axial spondyloarthritis (axSpA), no classification criteria are currently available for axial psoriatic arthritis (axPsA). This study aimed to evaluate the performance of the proposed cut-offs from the Assessment of Spondyloarthritis International Society (ASAS) data-driven definitions for active and structural magnetic resonance imaging (MRI) lesions typical of axSpA in distinguishing axial involvement in patients with psoriatic arthritis (PsA). Methods: Seventy-two consecutive PsA patients (67% male, aged 45± 14 years) meeting the CASPAR classification criteria, regardless of the presence of back pain, were included. All patients underwent radiography of the pelvis and spine, as well as sacroiliac joint (SIJ) MRI, while 52 (72%) of 72 patients also underwent whole-spine MRI. The final diagnosis of axPsA was ascertained by two experienced rheumatologists. One rheumatologist with expertise in imaging and one trained reader evaluated the radiography and MRI images. Results: AxPsA was diagnosed in 27/72 (38%) patients. The proposed cut-offs for active sacroiliitis demonstrated high specificity (95.6%) but relatively low sensitivity (51.9%) in distinguishing patients with and without axPsA. When structural lesions of the SIJ were included in addition to active lesions, the sensitivity significantly improved (96.3% vs. 51.9%) with a modest decrease in specificity (86.7% vs. 95.6%). Incorporating MRI spine lesions (using the proposed cut-offs for positive spine MRI from the SPACE cohort) alongside SIJ lesions did not further change sensitivity or specificity compared with assessing SIJ alone. Conclusion: The ASAS-proposed cut-offs for identifying active and structural lesions of SIJ demonstrated satisfactory performance in discriminating axial involvement in PsA patients.

Beyond expectations: disease duration and psychological burden in psoriatic arthritis.

This study aims to investigate the relationship between disease duration and psychological burden in PsA and to identify the risk factors associated with psychological distress. Patients with PsA who met CASPAR classification criteria enrolled by Turkish League Against Rheumatism (TLAR)-Network. Patients were categorized into three groups based on disease duration: early stage (< 5years), middle stage (≥ 5, < 10years), and late stage (≥ 10years). All patients underwent clinical and laboratory assessment using standardized protocol and case report forms. The associations between psychological variables and clinical parameters were assessed by a multivariate analysis. Of the 1113 patients with PsA (63.9% female), 564 (%50.7) had high risk for depression and 263 (%23.6) for anxiety. The risk of psychological burden was similar across all PsA groups, and patients with a higher risk of depression and anxiety also experienced greater disease activity, poorer quality of life, and physical disability. Multivariate logistic regression revealed that female gender (OR = 1.52), PsAQoL (OR = 1.13), HAQ (OR = 1.99), FiRST score (OR = 1.14), unemployment/retired (OR = 1.48) and PASI head score (OR = 1.41) were factors that influenced the risk of depression, whereas the current or past enthesitis (OR = 1.45), PsAQoL (OR = 1.19), and FiRST score (OR = 1.26) were factors that influenced the risk of anxiety. PsA patients can experience a comparable level of psychological burden throughout the course of their disease. Several socio-demographic and disease-related factors may contribute to mental disorders in PsA. In the present era of personalized treatment for PsA, evaluating psychiatric distress can guide tailored interventions that improve overall well-being and reduce disease burden.

Assessment of Liver Function among Patients with Rheumatoid Arthritis Versus Patients with Psoriatic Arthritis Treated by Methotrexate

Background:Hepatotoxicity is a well-known adverse effect of methotrexate therapy.&#x0D; Objective: To assess liver functions such as ALT and AST in patients with rheumatoid arthritis and psoriatic arthritis receiving methotrexate and compare the liver functions in those patients cured by using methotrexate.&#x0D; Patients and Methods: This observational, cross-sectional analysis involved 50 patients with RA who satisfied EULAR-ACR-2010 standards for RA and 50 PSA cases who fulfilled CASPAR classification criteria for PSA, receiving constant weekly MTX therapy (oral or parenteral) up to 25mg, together with folic acid, liver function parameters such as ALT and AST in patients with rheumatoid and psoriatic arthritis were estimated and compared.&#x0D; Results: 78% of the 100 participants who were enrolled in this study were females. 10% of the participants were smokers, but there was no significant difference between the two groups (p = 0.410). None of the patients were alcoholics. There was a significant difference between the groups regarding the type of medications. 42% of the RA group were on other medications compared with 2% of the PSA cases (p &lt; 0.001). The mean ALT of the PSA group (26.0 IU/L) was considerably (p = 0.005) greater than the mean of the RA group (19.6 IU/L) which shows an insignificant (p = 0.055) change between the two groups regarding the means of AST (26.3 IU/L in the PSA participants matched with 20.6 IU/L in the RA participants).&#x0D; Conclusion: Our research data shows that patients with PSA treated by methotrexate had a higher mean ALT level when compared with RA patients.

Assessment of Liver Function among Patients with Rheumatoid Arthritis Versus Patients with Psoriatic Arthritis Treated by Methotrexate

Background:Hepatotoxicity is a well-known adverse effect of methotrexate therapy. Objective: To assess liver functions such as ALT and AST in patients with rheumatoid arthritis and psoriatic arthritis receiving methotrexate and compare the liver functions in those patients cured by using methotrexate. Patients and Methods: This observational, cross-sectional analysis involved 50 patients with RA who satisfied EULAR-ACR-2010 standards for RA and 50 PSA cases who fulfilled CASPAR classification criteria for PSA, receiving constant weekly MTX therapy (oral or parenteral) up to 25mg, together with folic acid, liver function parameters such as ALT and AST in patients with rheumatoid and psoriatic arthritis were estimated and compared. Results: 78% of the 100 participants who were enrolled in this study were females. 10% of the participants were smokers, but there was no significant difference between the two groups (p = 0.410). None of the patients were alcoholics. There was a significant difference between the groups regarding the type of medications. 42% of the RA group were on other medications compared with 2% of the PSA cases (p &lt; 0.001). The mean ALT of the PSA group (26.0 IU/L) was considerably (p = 0.005) greater than the mean of the RA group (19.6 IU/L) which shows an insignificant (p = 0.055) change between the two groups regarding the means of AST (26.3 IU/L in the PSA participants matched with 20.6 IU/L in the RA participants). Conclusion: Our research data shows that patients with PSA treated by methotrexate had a higher mean ALT level when compared with RA patients. Keywords: Methotrexate, Rheumatoid arthritis, psoriatic arthritis, liver transaminases, Hepatotoxicity

What is peripheral spondyloarthritis? Identifying proportion, phenotype and burden in post hoc analysis of the ASAS-PerSpA study

BackgroundLittle is known about the prevalence, phenotype, and burden of peripheral spondyloarthritis (pSpA). The objective of the study is to compare the phenotype and burden of disease of pure pSpA to that of pure psoriatic arthritis (PsA), pure axial SpA (axSpA), and combined forms of SpA. MethodsThis is a post hoc analysis of 4,185 patients from the cross-sectional ASAS-Peripheral involvement in SpA (PerSpA) study. Patients were approached in 2 ways: the first approach was based on the rheumatologist's diagnosis (diagnostic approach) and the second one was based on the fulfillment of ASAS or CASPAR classification criteria (classification criteria approach). Demographics, disease phenotype, and burden were compared among pure pSpA, PsA, axSpA, and the combined forms. FindingsThe proportion of pSpA was 31.5% of SpA using the classification criteria approach and 10.3% using the diagnostic approach. pSpA was pure (i.e. without axSpA or PsA) in 16.8% of pSpA using the criteria, and in 62.3% using the diagnostic approach. Using classification criteria and diagnostic approach, respectively, pure pSpA patients had a high prevalence of peripheral joint disease (86 and 96%), synovitis (76 and 91%), and enthesitis (57 and 55%), a positive HLA-B27 in 65 and 59%, a high C-Reactive Protein level in 51% and inflammatory back pain in 52 and 42%. However, compared to pure PsA and pure axSpA, they had a significantly higher disease burden, but lower use of biologics using both approaches. InterpretationThe proportion of pSpA varies when using the classification criteria or the diagnostic approach. pSpA occurred in a pure form less frequently than PsA and axSpA and had intermediate features but a higher disease burden. FundingThe PerSpA main study has been conducted under the umbrella of ASAS thanks to unrestricted grants from PFIZER, LILLY, ABBVIE, NOVARTIS, UCB, JANSSEN, MERCK.

Course and Prognosis of AA Amyloidosis in Patients with Psoriatic Arthritis: Report of Three Cases from a Single Center Cohort and Review of the Literature.

Objective:Herein, we aimed to evaluate the frequency and clinical features of AA amyloidosis in patients with PsA followed up in our tertiary referral clinic.Methods:We retrospectively evaluated PsA patients classified according to CASPAR classification criteria followed-up in our tertiary referral clinic for AA amyloidosis. The literature search was also done by three independent researchers using the keywords “psoriatic arthritis AND amyloidosis”, “spondyloarthritis AND amyloidosis”, “AA amyloidosis”, “secondary amyloidosis”.Results and conclusions:A total of 253 patients were included into the analysis. Two thirds of (n=162; 64%) the patients were women, and the mean age of the patients was 50.6 ± 13.4 (range, 20–90). We identified three patients with AA amyloidosis in 253 patients with PsA (1.2 %). The frequency of PsA-related amyloidosis in our AA amyloidosis cohort (n=165) was 1.8 %. Literature search revealed only a retrospective cohort study and 17 case reports, and we analysed these 31 cases. Nearly half of the cases were male, mean age of the patients was 50.7±15.3 and mean age of amyloidosis diagnosis was 47.2±16.7 years. Most of these patients had both polyarticular and axial involvement (81.3%). AA amyloidosis is a rare in patients with PsA. It should be kept in mind that patients with PsA who have not received appropriate treatment for a long time and/or have refractory disease may develop AA amyloidosis.

Differences in oxylipin profile in psoriasis versus psoriatic arthritis

BackgroundOxylipins are biological lipids that have been implicated in inflammation. We previously found that certain oxylipins correlated with clinical manifestations in psoriatic arthritis (PsA) patients. Here, we compare oxylipin profiles in PsA patients and those with psoriasis (PsO) without inflammatory arthritis to identify oxylipins that associate with specific disease manifestations to better understand disease pathogenesis and identify new biomarkers.MethodsConsecutive patients with PsA (who met the CASPAR classification criteria for PsA) and PsO were recruited from the Rheumatology Outpatient Clinic. A thorough clinical examination was performed, including entheseal (Leeds enthesitis index (LEI)) and joint involvement (SJC/TJC 66/68). Patients were evaluated for pain and global disease activity on a visual analog scale (VAS) ranging from 0 to 100. This was followed by disease activity scores calculation: cDAPSA (Disease Activity Index for Psoriatic Arthritis) and Psoriasis Area and Severity Index (PASI). Serum oxylipins were determined by mass spectrometry and their association with clinical characteristics (PASI/LEI and cDAPSA) was analyzed using Metaboanalyst 4.0 and R version 3.6.1.ResultsTwenty PsO (average age 52 [10.8], 55% males) and 19 PsA patients (average age 60.5 [11.4], 63.1% males) were included. PsO patients had an average body mass index (BMI) of 33.7 (6.84) and an average PASI of 3.8 (4.2). PsA patients had an average BMI of 31.9 (5.6), TJC of 9.3 (10.41), SJC of 3.7 (4.23), with an average cDAPSA of 23.3 (11.4). 63.1% of PsA patients had enthesitis (average LEI 2.2 [3]) and the same percentage had psoriasis (average PASI 3(5]). Sera were analyzed for oxylipin levels. PsO and PsA patients with higher PASI score (> 2.5) had significantly lower serum concentrations of pro-inflammatory oxylipins, most of them arachidonic acid derived (AA). Oxylipin profiling did not associate with cDAPSA. Interestingly, several AA-derived oxylipins (5,15 di-HETE (5S,15S-dihydroxy-6E,8Z,10Z,13E-eicosatetraenoic acid), 5-oxoETE (5-Oxo-eicosatetraenoic acid), PGE2 (prostaglandin E2), 11bPGE2 (11 beta prostaglandin D2), and LTB4 (leukotriene B4)) were significantly increased in PsA patients with enthesitis compared to those without.ConclusionsThe AA-derived proinflammatory oxylipins were lower in both PsO and PsA patients with higher skin scores. Joint disease activity was not associated with the concentrations of oxylipins. Yet, enthesitis was associated with an increase of AA-derived pro-inflammatory oxylipins in PsA patients. Further studies are needed to determine whether oxylipin profiling can be a good biomarker of enthesitis in PsA patients.

POS1061 THE ITALIAN PROSPECTIVE SIRENA STUDY: FOCUS ON EARLY PSORIATIC ARTHRITIS COHORT AND GENDER DIFFERENCES

Background:Limited data on early Psoriatic Arthritis (PsA) are available1,2.Objectives:To describe baseline data of PsA patients naive to any DMARDs.Methods:SIRENA study is an Italian, prospective Registry of Spondyloarthritis patients diagnosed according to ASAS criteria and naïve to any DMARDs. Data on demographic and clinical characteristics of PsA cohort were collected and analysed, also by gender.Results:203/350 (58%) subjects included in SIRENA Registry had PsA (mean age 51.9 years) and in 190/203 (94%) CASPAR classification criteria were fulfilled. In 70% of patients the diagnosis was performed within 24 months from symptom onset. At baseline, 194/203 (95.6%) had mainly peripheral manifestations, 74.4% of patients had skin psoriasis, 40% nail psoriasis, 39.3% clinical enthesitis and 25.9% dactylitis. Mean SJC66 and TJC68 were, respectively, 3 and 7.2; mean PhGA was 46.3; 14.7% of patients were in MDA.The higher tender joint count in women (mean TJC68 9.3 in women vs 5.3 in men) resulted in a higher disease activity according to DAPSA (high disease activity: 11.5% women vs 4.1% men), a higher joint VAS score (mean score 47.1 women vs 39.8 men) and a lower prevalence of MDA (8.3% women vs 20% men). We observed a higher prevalence of moderate or severe psoriasis in men (BSA≥3%: 37% men vs 27.8% women) while all PROs collected (PtGA, pain VAS score, sleep VAS score, BASFI, BASDAI, HAQ-DI, WPAI) were worse in women.The most common comorbidities were cardiometabolic (35.5%), endocrine (9.4%), and gastrointestinal disorders (7.4%). Cardiometabolic disorders were more frequently reported by men, endocrine and gastrointestinal disorders by women; depression exclusively by women.Conclusion:This analysis provides real-life data in a cohort of early PsA subjects. Relevant gender differences were observed, with women showing a higher disease activity and more joint pain and men having more severe psoriasis. Women also perceived a worse disease burden.

Validation of the Toronto Psoriatic Arthritis Screen II (ToPAS II) questionnaire in a Brazilian population.

The Toronto Psoriatic Arthritis Screen II (ToPAS II) was developed as a tool to screen patients with probable psoriatic arthritis. We aimed to evaluate the validation of the ToPAS II questionnaire in a Brazilian population. The Portuguese translation of the ToPAS II was sent to us by the developer authors of the original index, and adapted to Brazilian Portuguese. Subjects were recruited from dermatology, general, and rheumatology outpatient clinics. After patients completed the questionnaire, they were assessed by a rheumatologist, according to standard protocol. Receiver operating characteristics (ROC) was used to obtain the sensitivity and specificity of the Brazilian Portuguese version of the ToPAS II questionnaire. One hundred and eighty-four subjects were recruited in the study. There were 70 subjects from the psoriasis group, 44 subjects from the psoriatic arthritis (PsA) group, 40 subjects from the rheumatology (non-PsA) group, and 45 healthy controls. Twenty-four patients (34.3%) in the psoriasis group had inflammatory pain and met the CASPAR classification criteria. The area under the ROC curve was 0.96, which indicates that an excellent predictor and optimum cutoff threshold to discriminate patients diagnosed with PsA used was eight as originally chosen. The overall sensitivity and specificity based on the cutoff threshold of eight were 91.3 and 90.9%, respectively. The Portuguese Brazilian version of the ToPAS II has good sensitivity and specificity and is a useful tool to screen for PsA. Key Points • Among these psoriasis patients, almost 35% in fact had psoriatic arthritis without correct diagnosis. Keeping alert of the need to disclose screening tool's use. • The TOPAS II can facilitate the screening of patients suggestive of inflammatory joint disease (with high probability of rheumatologic diagnosis) decreasing morbidity of these patients.

Imagerie du rhumatisme psoriasique

Imaging is one of the keys to diagnosing psoriatic arthritis. The different modalities will make it possible to highlight the key elements of the disease and its specificity in relation to other spondyloarthritis. This distinction concerns both axial and peripheral lesions, particularly dactylitis. First of all, the standard radiograph which visualizes periostitis present on the epiphyses or phalanges, a diagnostic element in the CASPAR classification criteria, but also juxta-articular erosions which make psoriatic arthritis one of the two chronic inflammatory erosive joint diseases with rheumatoid arthritis. The other anomalies such as acro-osteolysis, joint ankylosis, which are close to osteoarticular destruction on the same anatomical structure, hand or foot, are perfectly identified on the standard images. Ultrasound and MRI have made it possible to describe enthesitis and its capsulo-ligamentary and bony relationships, describing a true anatomical complex. These extra-articular inflammatory attacks are occurring often early in the disease course. Bone damage in the form of bone oedema is the prerogative of MRI to the sacroiliac joints and the spine, in the entheses areas, as in axial ankylosing spondylitis. Spinal damage includes C1-C2 damage like that of rheumatoid arthritis, multi-stage syndesmophytes, which are often larger and coarser, para-syndesmophytes, and radiological or MRI sacroiliitis, which is often less extensive and unilateral. The progression of peripheral joint lesions, erosions and joint space narrowing, is the hallmark of symmetrical or asymmetrical psoriatic polyarthritis.

Pro- and anti-inflammatory eicosanoids in psoriatic arthritis.

Eicosanoids are biological lipids that serve as both activators and suppressors of inflammation. Eicosanoid pathways are implicated in synovitis and joint destruction in inflammatory arthritis, yet they might also have a protective function, underscoring the need for a comprehensive understanding of how eicosanoid pathways might be imbalanced. Until recently, sensitive and scalable methods for detecting and quantifying a high number of eicosanoids have not been available. Here, we intend to describe a detailed eicosanoid profiling in patients with psoriatic arthritis (PsA) and evaluate correlations with parameters of disease activity. Forty-one patients with PsA, all of whom satisfied the CASPAR classification criteria for PsA, were studied. Outcomes reflecting the activity of peripheral arthritis as well as skin psoriasis, Disease Activity Score (DAS)28, Clinical Disease Index (CDAI) and Body Surface Area (BSA) were assessed. Serum eicosanoids were determined by LC-MS, and the correlation between metabolite levels and disease scores was evaluated. Sixty-six eicosanoids were identified by reverse-phase LC/MS. Certain eicosanoids species including several pro-inflammatory eicosanoids such as PGE2, HXB3 or 6,15-dk,dh,PGF1a correlated with joint disease score. Several eicosapentaenoic acid (EPA)-derived eicosanoids, which associate with anti-inflammatory properties, such as 11-HEPE, 12-HEPE and 15-HEPE, correlated with DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index) as well. Of interest, resolvin D1, a DHA-derived anti-inflammatory eicosanoid, was down-regulated in patients with high disease activity. Both pro- and anti-inflammatory eicosanoids were associated with joint disease score, potentially representing pathways of harm as well as benefit. Further studies are needed to determine whether these eicosanoid species might also play a role in the pathogenesis of joint inflammation in PsA.

Prevalence, clinical features and treatment pattern of patients with concurrent diagnoses of rheumatoid arthritis and psoriatic disease: results of a 14-year retrospective study in a tertiary referral center.

Background:Multiple comorbidities, including rheumatoid arthritis (RA), have been reported to be associated with psoriasis.Objective:This study aimed to determine the prevalence and the clinical features of RA among patients with psoriasis in a tertiary referral center.Methods:Between January 2000 and December 2013, all patients coded with psoriatic disease (ICD-9 CM 696.0 OR ICD-9 CM696.1) and RA (ICD-9 CM 714.0) in a tertiary medical center were enrolled.Results:There were 10,844 patients and 9073 patients with psoriatic disease and RA identified by diagnostic codes, respectively. Among patients with psoriasis, 111 patients had claim-based diagnosis of RA (1.02%). By reviewing medical records and telephone interview or clinic visits, 25 of the 111 patients (0.23%) was identified unequivocally as having concurrent RA. Among them, 17 (68%) were female and 16 (64%) patients developed arthritis prior to the onset of psoriasis with a mean lag of 6.3 years (1–19 years); 8 (32%) had psoriasis skin lesions prior to the onset of arthritis with a mean lag of 6.9 years (3–20 years); 1 (4%) had skin lesions and arthritis in the same time; 17 (68%) patients also fulfilled the CASPAR classification criteria for psoriatic arthritis. The mean age of onset for arthritis was 49.6 years old.Conclusions:The prevalence of RA in psoriasis might be overestimated in some previous studies using claimed database. Patients with concurrent RA and psoriasis showed a comparable age of onset and male to female ratio, but had more axial involvements compared to patients without psoriasis.

ASSOCIATION OF ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODY IN A SAMPLE OF ADULT PATIENTS WITH PSORIASIS AND PSORIATIC ARTHROPATHY

Objective: Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy commonly associated with psoriasis, a large number of patients with PsA that has persistent inflammation may develop progressive joint damage and disability and have reduced life expectancy. This study aims to determine the associations of anti-cyclic citrullinated peptide (CCP) antibodies in adult patients with psoriasis and PsA.Methods: A case–control study was conducted at Baghdad teaching hospital, Units of Rheumatology and Dermatology, during the period from December 2016 to April 2017 including three groups; 40 patients with psoriasis, 40 patients with PsA fulfilling the CASPAR classification criteria, and 40 healthy control persons.Results: Two patients with psoriasis (5%) and 10 patients with PsA (25%) were seropositive for anti-CCP antibodies (ACPA). Healthy controls were negative for anti-CCPA. Regarding ACPA positivity, a significant difference was found between those three studied groups (p&lt;0.001) and there was a significant difference between positive and negative ACPA in PsA patients regarding disease activity score (p=0.044).Conclusion: Positive ACPA were found more significant with PsA than in patients with psoriasis as well as associated with higher disease activity.

SAT0191 Can Spectral Doppler Identify Nail Enthesitis in Psoriatic Arthritis?

BackgroundInflammatory activity may be quantified using Spectral Doppler (sD), which detects power Doppler (PD) signal through the internal resistance index (RI) in microcirculation1,2.ObjectivesAssess the RI in the nail bed in...

AB0688 Carotid Intima-Media Thickness in Spondyloarthritis: Prevalence of Subclinical Atherosclerosis in Patients without Clinically Evident Cardiovascular Disease

BackgroundAS and PsA patients without clinically evident cardiovascular disease have a high prevalence of subclinical cardiovascular disease in form of increased carotid intima-media thickness (IMT) and carotid plaques compared to...

SAT0312 Psoriasis and psoriatic arthritis among natives and mestizos from the andean mountains region of peru

BackgroundPrevious epidemiological studies described that both Psoriasis (Ps) and Psoriatic Arthritis (PsA) are diseases with negligible prevalence among Natives from the Andean mountains of Peru. We herein first report the...

AB0944 Baseline serum 14-3-3 ETA levels predict ACR50 response to adalimumab therapy in psoriatic arthritis

BackgroundTNFα blockers have had a significant impact on the management of psoriatic arthritis (PsA). Despite their effectiveness, patient response is heterogeneous, underscoring the need for markers to assist in therapy...