Psoriatic Arthritis Impact Of Disease Research Articles

Report of the IDEOM Meeting Adjacent to the GRAPPA 2023 Annual Meeting.

The nonprofit organization International Dermatology Outcome Measures (IDEOM) is committed to improving the implementation of patient-centered outcome measures in dermatologic disease. At a conference adjacent to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting, the IDEOM Psoriatic Disease Workgroup presented updates on recent efforts in outcome measure advancement. Dr. Alice Gottlieb presented the preliminary findings of a study within the Mount Sinai Health System that aims to determine how well the IDEOM musculoskeletal (MSK) symptom framework, which uses the Psoriasis Epidemiology Screening Tool (PEST) and the Psoriatic Arthritis Impact of Disease (PsAID) instruments, functions in clinical settings. Drs. Joseph Merola and Lourdes Perez-Chada updated attendees on the IDEOM MSK-Q, a 9-item patient-reported questionnaire designed to measure the intensity and impact of MSK symptoms on the quality of life in patients with psoriasis (PsO) with or without psoriatic arthritis (PsA). Dr. Vibeke Strand summarized the Outcome Measures in Rheumatology (OMERACT) 2023 conference sessions. Dr. April Armstrong discussed the preliminary findings of a multicentered study designed to validate the 7-item Dermatology Treatment Satisfaction Instrument (DermSat-7) among patients with PsO. She also introduced the Psoriasis and Psoriatic Arthritis Treatment Satisfaction Instrument, a tool that seeks to capture the level of patient satisfaction with current therapy for PsO and PsA. This report summarizes the developments discussed at the IDEOM PsO and PsA research workgroups during the GRAPPA 2023 annual meeting.

Core items to be included in a definition of moderate psoriatic arthritis: literature review and expert opinion.

Evidence-based treatment recommendations for psoriatic arthritis (PsA) suggest that treatment should be individualised but acknowledge the difficulty of correctly defining levels of activity (mild, moderate and severe). The aim of this study was to define the parameters or disease characteristics that should be included in a future definition of moderate PsA. Mixed. methods: (1) literature review to identify previous assessment tools used to classify patients into mild, moderate and severe forms, and (2) survey of rheumatologists, and experts in PsA, to obtain their opinion on the degree of validation and applicability of published definitions and tools, and on the parameters that should be included in a future definition of moderate PsA. We propose eight domains/items to be included in a definition of moderate PsA: number of active joints and inflamed entheses, physician global assessment (by visual analogue scale), dactylitis, body surface area (BSA) affected by psoriasis, psoriasis in special locations, and absence of hip involvement. The Disease Activity Index for Psoriatic Arthritis (DAPSA) score would be supported as part of this definition, as would the Psoriatic Arthritis Impact of Disease (PsAID) index. This study proposes a set of items/domains to be included in a definition of moderate PsA based on literature and expert opinion, which can be the starting point for further development and validation studies of the proposed items.

Analysis of physical activity in psoriatic arthritis: relationship with clinical and analytical parameters and comorbidity-description of the sedentary patient.

This study aimed to relate physical activity and a sedentary lifestyle to clinical, biological, functional, and comorbid parameters in a cohort of patients with psoriatic arthritis (PsA). A cross-sectional study was conducted with 232 PsA patients. Physical activity and sedentary lifestyle were obtained using the International Physical Activity Questionnaire (IPAQ) questionnaire. The demographic, clinical, and biological variables measured were age, time since PsA diagnosis, smoking, type of treatment used, clinical form, presence of enthesitis, dactylitis (present or past), fatigue, tumor necrosis factor (TNF)-alpha, and interleukin 6 (IL-6). Activity and functionality were measured using the Disease Activity Index for Psoriatic Arthritis (DAPSA) and Health Assessment Questionnaire (HAQ) in peripheral forms, while the Ankylosing Spondylitis Disease Activity Score (ASDAS-PCR) and Bath Ankylosing Spondylitis Functional Index (BASFI) were measured in axial forms. Disease impact was assessed using the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire. Alongside comorbidities, obesity, anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], and sleep quality [Insomnia Severity Index (ISI)] were assessed. The mean age was 54.6 (SD: 11.4) years, with 54.3% being male. A total of 25.6% of patients were sedentary. Physical activity and sedentary lifestyle were inversely correlated with fatigue, activity, functionality, and disease impact. Within comorbidities, they correlated with anxiety, depression, and insomnia. In addition, physical activity was inversely correlated with obesity. In linear regression analysis, physical activity was found to be related to body mass index (BMI) with a ß coefficient of -0.1 (p < 0.04; 95%CI: -194.1--4.5), and an R2 value of 0.11. In logistic regression analysis, a sedentary lifestyle was found to be related to pain, with an odds ratio (OR) of 1.5 (p < 0.001; 95%CI:1.1-1.8) and an R2 Nagelkerke value of 0.36. A quarter of the patients were sedentary. Lack of physical activity correlated with worse parameters of clinical activity, functionality, disease impact, and the presence of comorbidities.

Construct validity, reliability, and threshold value for treatment goals of the Thai version of the 12-item Psoriatic Arthritis Impact of Disease Questionnaire for patients with psoriatic arthritis.

To determine the construct validity, reliability, and treatment goal threshold of a Thai-language version of the 12-item Psoriatic Arthritis Impact of Disease (Thai-PsAID) questionnaire in patients with psoriatic arthritis (PsA). This cross-sectional study involved administering the proposed Thai-PsAID to 117 Thai patients with PsA. Reliability was assessed by Cronbach's α test and intraclass correlation coefficient (ICC). Construct validity was assessed using Spearman correlation with clinical disease activity index for psoriatic arthritis (cDAPSA), the Health Assessment Questionnaire (HAQ), EQ-5D index, and the patient-acceptable symptom state (PASS). The optimal cutoff score of the Thai-PsAID for minimal disease activity (MDA) was determined by receiver operating characteristic curves. Participants had a mean age of 49.5 years, 61 (52.1%) were female, and the median disease duration was 5 years. The median Thai-PsAID score was 2.1, with a Cronbach's α coefficient of .95 and an ICC of 0.77. The mean time to complete the Thai-PsAID was 2.1 min, with no missing data. The Thai-PsAID score demonstrated a moderate correlation with the cDAPSA, HAQ, and EQ-5D with indices (Spearman's rho of .64, .54, and -.55, respectively). The cutoff of 2.7 has 81%-84% sensitivity and 69%-85% specificity for classifying patients with MDA, satisfied PASS, and indicating no need to escalate medication. The Thai-PsAID is a valid, reliable, and feasible tool for measuring PsA prognosis. A cutoff of 2.7 accurately discriminates MDA and PASS and indicates no need for medication escalation. The Thai-PsAID may be used as a standalone measure.

Early Oligoarticular Psoriatic Arthritis Responds to Treatment With Apremilast: Week 16 Results From FOREMOST - a Phase 4 Randomized Controlled Trial

Early Oligoarticular Psoriatic Arthritis Responds to Treatment With Apremilast: Week 16 Results From FOREMOST – a Phase 4 Randomized Controlled Trial&#x0D; Laure Gossec1, Dafna Gladman2, Laura C. Coates3, Jacob Aelion4, Jitendra Vasandani5, Jyotsna Reddy6, Rebecca Wang6, Michele Brunori6, Stephen Colgan6, Philip Mease7&#x0D; 1Sorbonne Université and Pitié Salpêtrière Hospital, Paris, France; 2Toronto Western Hospital, Toronto, ON, Canada; 3University of Oxford, Oxford, UK; 4West Tennessee Research Institute, Jackson, TN, USA; 5West Texas Clinical Research, Lubbock, TX, USA; 6Amgen Inc., Thousand Oaks, CA, USA; 7Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, WA, USA&#x0D; Introduction &amp; Objectives:&#x0D; Psoriatic arthritis (PsA) is underdiagnosed in dermatology practice, typically presenting 10 years after skin symptoms. Dermatologists may encounter early PsA since up to 30% of patients with psoriasis have PsA. Oligoarticular PsA affects ≤4 joints, is very common, and is underrepresented in clinical trials as most pivotal studies exclude patients with &lt;3 swollen and tender joints. Here, we report the efficacy and safety of apremilast vs. placebo for the treatment of early oligoarticular PsA.&#x0D; Materials &amp; Methods:&#x0D; FOREMOST (NCT03747939) is a phase 4, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Patients with PsA,based on CAPSAR criteria, duration ≤5 years, swollen joint count (SJC) &gt;1 but ≤4, and tender joint count (TJC) &gt;1 but ≤4 were randomized 2:1 to apremilast 30 mg BID (APR) or placebo for 24 weeks. The primary endpoint was the achievement of minimal disease activity (MDA)-Joints1 (mandating SJC ≤1 and TJC ≤1, and 3/5 alternate items) at week 16.&#x0D; Results:&#x0D; Of 308 patients randomized (APR: n=203; placebo: n=105), mean PsA duration was 9.9 months, mean age was 50.9 years, and 39.9% of patients were using csDMARD. MDA-Joints response was achieved in 33.9% vs. 16.0% for patients treated with APR vs. placebo (primary endpoint, P=0.0008). At week 16, a significantly greater proportion, 70.2%, of patients treated with APR achieved cDAPSA REM/LDA vs. 51.8% with placebo (P=0.0017). A greater proportion of patients achieved a good/moderate response in PASDAS score with APR (59.9%) vs. placebo (42.7%). Greater improvements from baseline in PsA Impact of Disease (PsAID)-12 score (LS mean change, −1.5 vs. −0.4; nominal P&lt;0.0001) and nail psoriasis score (visual analog scale [VAS]; LS mean change, −13.9 vs. −6.8; nominal P=0.0094) were observed with APR vs. placebo at week 16. Patients treated with APR also achieved greater improvement in quality of life measures (Patient Pain [VAS ≤15: 59.6 vs. 13.8; nominal P=0.0022], Patient Global Assessment [PtGA; VAS ≤20: 61.7 vs. 20.1; nominal P=0.0286]) when compared to placebo at week 16. No new safety signals were identified.&#x0D; Conclusion:&#x0D; FOREMOST is the first global randomized controlled trial exclusively studying early oligoarticular PsA. We report the first results of FOREMOST, the primary outcome, and show better disease control is achievable with APR, with twice the MDA-Joint response compared with placebo at 16 weeks. These findings show APR treatment of early oligoarticular PsA improves clinical and quality of life outcomes and may inform optimal management of these patients.&#x0D; Reference: 1. Coates LC, et al. J Rheumatol. 2016;43:371–5.

Is the patient-perceived impact of psoriatic arthritis a global concept? An international study in 13 Arab countries (TACTIC study).

The Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaire, a recommended measure of patient-reported impact for psoriatic arthritis (PsA), was initially developed in Europe and may lack universal validity. Recognizing the need for a culturally appropriate tool for Arab patients, this study aimed to TranslAte, CulTurally adapt, and validate the PsAID in ArabIC (TACTIC). The PsAID-12 was translated into Arabic using a rigorous process of double translation, back-translation, and cognitive debriefing. The Arabic version was then validated through a study conducted in 13 Arab countries in 2022. Participants were consecutive literate adult patients diagnosed with PsA and fulfilling the CASPAR criteria. Collected data included PsAID-12, disease activity, and legacy patient-reported outcomes. Psychometric properties, such as internal consistency, construct validity, and test-retest reliability, were examined. Factors associated with high PsAID-12 total scores (> 4) were explored using multivariable binary logistic regression. A culturally adapted Arabic PsAID-12 questionnaire was achieved with minor rephrasing. The validation study included 554 patients from 13 countries (mean age 45years, 59% females), with a mean PsAID score of 3.86 (SD 2.33). The Arabic PsAID-12 demonstrated excellent internal consistency (Cronbach's α = 0.95), and correlations with other measures ranged from 0.63 to 0.78. Test-retest reliability (N = 138 patients) was substantial (intraclass correlation coefficient, ICC 0.90 [0.86-0.93]; Cohen's kappa 0.80). Factors associated with a high PsAID score were disability (odds ratio, OR 3.15 [2.03-4.89]), depression (OR 1.56 [1.35-1.81]), widespread pain (OR 1.31 [1.12-1.53]), and disease activity (OR 1.29 [1.13-1.47]). Pain and fatigue were identified as the most impactful PsAID-12 domains for PsA patients. The Arabic PsAID is a valid and reliable measure that reflects the priorities of patients with PsA. PsAID scores correlated with disease activity and legacy outcome measures, as expected, indicating PsAID is a consistent measure of PsA impact across cultures. These findings highlight the potential of the Arabic PsAID in improving the care provided to Arabic-speaking patients worldwide.

Assessment of Patient-Physician Interactions in Psoriatic Arthritis: National Results of the ASSIST Study.

An overarching principle for the management of psoriatic arthritis (PsA) is a shared decision-making process between physicians and patients. The aim of this study is to assess the patient-physician relationship in a group of patients with PsA, by using the Perceived Efficacy in Patient-Physician Interactions (PEPPI) and CollaboRATE instruments. This is a cross-sectional multicenter study where consecutive patients with PsA were enrolled. For each patient, the main demographic, comorbid conditions, and clinical data were collected, including the assessment of disease activity, function, quality of life, and impact of disease. PEPPI and CollaboRATE questionnaires were used, respectively, to evaluate the patient's perception of the patient-physician relationship and the shared decision-making process. A total of 81 patients with PsA were enrolled at four centers in Italy. Overall, our patients showed a high level of confidence in obtaining needed health care, with relatively high median (IQR) values of PEPPI (20; 16-23), and a good shared decision-making process, with high median (IQR) values of CollaboRATE questionnaire (7; 6-9). PEPPI and CollaboRATE scores showed a statistically significant inverse correlation with different clinical variables such as disease duration, Leeds Enthesitis Index, PsA impact of Disease, Health Assessment Questionnaire, pain, patient's global assessment of disease activity and clinical disease activity for PsA. The presence of comorbidities did not appear to be associated with lower values of PEPPI and CollaboRATE. In this study, few patients with PsA were at risk of suboptimal communication with their physician. This phenomenon appeared to be primarily related to higher disease activity and burden.

Validity and score interpretation of the 12-item Psoriatic Arthritis Impact of Disease: an analysis of pooled data from two phase 3 trials of bimekizumab in patients with psoriatic arthritis

ObjectivesTo investigate psychometric performance of the 12-item Psoriatic Arthritis Impact of Disease (PsAID-12) total and individual item scores in patients with psoriatic arthritis (PsA) and to estimate score change thresholds...

Real-world apremilast use in biologic-naïve psoriatic arthritis patients. Data from Spanish clinical practice

IntroductionApremilast is approved for treatment of psoriasis and psoriatic arthritis (PsA). Real-world evidence on apremilast effectiveness in clinical practice is limited. MethodsObservational study enrolling adult patients, across 21 Spanish centres, who had initiated apremilast in the prior 6 (±1) months and were biologic naive. Data were collected at routine follow-up visits 6 and 12 months after apremilast initiation. Primary outcome was 6 and 12-month persistence to apremilast. Secondary outcomes included Disease Activity for PsA (DAPSA), joint erosions, enthesitis, dactylitis, and patient-reported quality of life (QoL, measured using the PsA impact of disease [PsAID] questionnaire). ResultsWe included 59 patients. Most had oligoarticular PsA, moderate disease activity, and high comorbidity burden. Three-quarters were continuing apremilast at 6 months and two-thirds at 12 months; mean (SD) apremilast treatment duration was 9.43 (1.75) months. DAPSA scores showed improved disease activity: one-third of patients in remission or low activity at apremilast initiation versus 62% and 78% at 6 and 12 months, respectively. Eleven of 46 patients with radiographic assessments had joint erosions at apremilast initiation and none at month 12. Median (Q1, Q3) number of swollen joints was 4.0 (2.0, 6.0) at apremilast initiation versus 0.0 (0.0, 2.0) at 12 months. Incidence of dactylitis and enthesitis decreased between apremilast initiation (35.6% and 28.8%, respectively) and month 12 (11.6% and 2.4%, respectively). Over two-thirds of patients had a PSAID-9 score <4 (cut-off for patient-acceptable symptom state) at month 12. ConclusionsIn Spanish clinical practice, two-thirds of PsA patients continued apremilast at 12 months, with clinical benefits at the joint level, no radiographic progression of erosions, and a positive impact on patient-reported QoL.Trial registration number Clinicaltrials.gov: NCT03828045.

Factors associated with achieving an acceptable health-related quality of life in the treatment of patients with psoriatic arthritis

Objective: to analyze factors associated with the achievement of acceptable health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA) 7 years after the start of observation.Material and methods. The study included 53 patients (28 women, 25 men) with PsA who met the 2006 CASPAR criteria. The mean age of patients was 45.7±12.0 years, the median duration of PsA was 90 [72; 99] months, and the observation period was 81 [61; 91] months. The study included patients in early stage of PsA (duration up to 2 years), who were treated according to the “treat-to-target” strategy (T2T) for 24 months. Subsequently, all patients continued therapy according to the standards of medical care under the supervision of the treating physician. Over time, a standard rheumatological examination was performed. Activity of PsA was assessed by DAPSA, psoriasis by BSA, HRQoL by Psoriatic Arthritis Impact of Disease (PsAID-12); body mass index (BMI, kg/m2 ) and functional status by HAQ were also assessed. PsAID-12 ≤4 corresponded to achieving a Patient Acceptable State Status (PASS). The results were analyzed in two groups of patients: PsAID-12 ≤4 and PsAID-12 &gt;4. The number of patients (%) who achieved minimal disease activity (MDA) after 1–2 years of active treatment and after 7 years was assessed. X-rays of the hands and feet (n=42) were performed using standard methods, changes were assessed using the Sharp/van der Heijde method modified for PsA (m-Sharp/van der Heijde).Results and discussion. After 7 years, 38 (71.7%) of 53 patients were found to have PASS. Patients who achieved PASS had significantly lower PsA and psoriasis activity, lower CRP levels, lower m-Sharp/van der Heijde scores, better functional status and HRQoL, and lower BMI at baseline. Factors associated with achieving PASS were identified: absence of nail psoriasis, BSA ≤3%, CRP ≤5 mg/l, number of swollen joints ≤3, number of painful joints ≤5, HAQ ≤0.5 at baseline and after 24 months, and achievement of MDA during the first 12 months of treatment.Conclusion. The majority of PsA patients treated at an early stage according to T2T principles had PASS, which is associated with low disease activity, fewer joint erosions, better functional status and achievement of MDA during the first 12 months of therapy. These factors should be considered when predicting disease progression.

Real-world apremilast use in biologic-naïve psoriatic arthritis patients. Data from Spanish clinical practice

IntroductionApremilast is approved for treatment of psoriasis and psoriatic arthritis (PsA). Real-world evidence on apremilast effectiveness in clinical practice is limited. MethodsObservational study enrolling adult patients, across 21 Spanish centres, who had initiated apremilast in the prior 6 (±1) months and were biologic naive. Data were collected at routine follow-up visits 6 and 12 months after apremilast initiation. Primary outcome was 6 and 12-month persistence to apremilast. Secondary outcomes included Disease Activity for PsA (DAPSA), joint erosions, enthesitis, dactylitis, and patient-reported quality of life (QoL, measured using the PsA impact of disease [PsAID] questionnaire). ResultsWe included 59 patients. Most had oligoarticular PsA, moderate disease activity, and high comorbidity burden. Three-quarters were continuing apremilast at 6 months and two-thirds at 12 months; mean (SD) apremilast treatment duration was 9.43 (1.75) months. DAPSA scores showed improved disease activity: one-third of patients in remission or low activity at apremilast initiation versus 62% and 78% at 6 and 12 months, respectively. Eleven of 46 patients with radiographic assessments had joint erosions at apremilast initiation and none at month 12. Median (Q1, Q3) number of swollen joints was 4.0 (2.0, 6.0) at apremilast initiation versus 0.0 (0.0, 2.0) at 12 months. Incidence of dactylitis and enthesitis decreased between apremilast initiation (35.6% and 28.8%, respectively) and month 12 (11.6% and 2.4%, respectively). Over two-thirds of patients had a PSAID-9 score <4 (cut-off for patient-acceptable symptom state) at month 12. ConclusionsIn Spanish clinical practice, two-thirds of PsA patients continued apremilast at 12 months, with clinical benefits at the joint level, no radiographic progression of erosions, and a positive impact on patient-reported QoL.Trial registration number Clinicaltrials.gov: NCT03828045.

Report of the Skin Research Workgroups From the IDEOM Breakout at the GRAPPA 2022 Annual Meeting.

The International Dermatology Outcome Measures (IDEOM) organization presented an update on its progress related to patient-centered outcome measures for psoriasis (PsO) and psoriatic arthritis (PsA) at the 2022 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The Musculoskeletal (MSK) Symptoms working group presented an update on the development of the IDEOM Musculoskeletal Questionnaire (IDEOM MSK-Q). The IDEOM MSK-Q is a patient-reported outcome measure intended to capture MSK symptoms and describe their intensity and impact on health-related quality of life in patients with psoriatic disease. IDEOM also presented the progress of the integration of the Psoriasis Epidemiology Screening Tool (PEST) and Psoriatic Arthritis Impact of Disease (PsAID) questionnaires into the Epic electronic health record system. This will allow for automated PsA screening and symptom measurement in the hopes of improving disease detection and treat-to-target strategies. The Treatment Satisfaction working group discussed the development of the DermSat-7, a 7-item treatment satisfaction questionnaire specific for dermatological conditions. The DermSat-7 is currently being validated in a multicenter study of patients with PsO.

Women With Psoriatic Arthritis Experience Higher Disease Burden Than Men: Findings From a Real-World Survey in the United States and Europe.

Although psoriatic arthritis (PsA) is equally present in men and women, sex may influence clinical manifestations and the impact of disease on patients' lives. This study assessed differences in clinical characteristics, disability, quality of life (QOL), and work productivity by sex in real-world practice. A cross-sectional survey of rheumatologists/dermatologists and their patients with PsA was conducted in France, Germany, Italy, Spain, the United Kingdom, and the United States between June and August 2018. Data collected included demographics, treatment use, clinical characteristics (tender joint count, swollen joint count, body surface area affected by psoriasis), QOL (EuroQoL 5-Dimension questionnaire [EQ-5D], Psoriatic Arthritis Impact of Disease [PsAID12]), disability (Health Assessment Questionnaire-Disability Index [HAQ-DI]), and work productivity (Work Productivity and Impairment Index [WPAI]). Outcomes were compared between men and women using parametric and nonparametric tests, as appropriate. Of 2270 patients (mean age 48.6 [SD 13.3] yrs, mean disease duration 4.9 [SD 6.0] yrs), 1047 (46.1%) were women. Disease duration, disease presentation, and biologic use (mean 54.2%) were comparable between women and men. Women reported worse QOL (EQ-5D: 0.80 [SD 0.2] vs 0.82 [SD 0.2]; P = 0.02), greater disability (HAQ-DI: 0.56 [SD 0.6] vs 0.41 [SD 0.5]; P < 0.01) and work activity impairment (WPAI: 27.9% [SD 22.0] vs 24.6% [SD 22.4]; P < 0.01) than men. However, women had a lower burden of comorbidities (Charlson Comorbidity Index: 1.10 [SD 0.5] vs 1.15 [SD 0.6]; P < 0.01). In patients with similar PsA disease activity and treatment, women experienced greater disease impact than men. This represents a significant consideration for the therapeutic management of PsA.

Demographic and Clinical Factors Associated with Patient-Reported Remission in Psoriatic Arthritis.

IntroductionAchievement of remission in psoriatic arthritis is a key goal for patients and clinicians, yet definitions of remission may vary. Previous efforts have utilized multidomain measures such as minimal disease activity that assess the status of joints, skin, and function to determine current level of psoriatic arthritis (PsA) disease activity. The goal of this study is to identify factors associated with patient-reported psoriatic arthritis remission.MethodsThe National Psoriasis Foundation conducted a cross-sectional study using an online survey of a random stratified sample of 1570 individuals with psoriatic disease in the USA. Participants were asked about a provider diagnosis of psoriasis and/or psoriatic arthritis, comorbid conditions, and psoriatic arthritis impact and disease activity, and demographic questions. All participants reporting a physician-given diagnosis of psoriatic arthritis were asked if they felt their psoriatic arthritis was in remission (“Do you feel your psoriatic arthritis is in remission?” Yes/No/Unsure) and, if so, length of remission. Individuals with psoriasis and psoriatic arthritis reporting a body surface area impacted by psoriasis 3% or less were asked if they felt their psoriasis was in remission. Psoriatic arthritis disease activity and impact was assessed using the nine-question Psoriatic Arthritis Impact of Disease (PsAID-9) instrument and a global PsA-related quality of life question. PsAID-9 scores ≤ 4 were used to indicate acceptable disease state. Multivariate logistic regression was used to identify factors associated with patient-perceived PsA remission.ResultsOf 834 participants with PsA, including 76 (4.8%) with PsA without skin involvement ever, 144 (17.3%) felt their psoriatic arthritis was in remission, with an average remission duration of 43 months. Of those in remission, 116 (78.4%) reported currently using a treatment for their PsA, with most (75.7%) reporting using a biologic therapy for their PsA in the past 12 months. Multivariate logistic regression revealed that patient-perceived psoriatic arthritis remission was independently associated with experiencing acceptable disease state (PsAID-9 ≤ 4), perception of psoriasis remission, lower impact of PsA on global quality of life, and non-white race. Age, sex, body mass index, or biologic use in the last 12 months were not associated with patient-reported PsA remission.ConclusionOverall, patient perception of PsA remission was most strongly associated with patient-reported psoriasis remission.

257 Understanding health disparities among patients with psoriasis: Results from National Psoriasis Foundation annual surveys 2019 – 2021

The National Psoriasis Foundation conducts a cross-sectional study of the psoriatic patient community using an online survey conducted annually. Using survey data from 2019 – 2021, this study sought to understanding of health disparities among patients with psoriasis. Survey participants provided demographic information and provider diagnosis of psoriasis (PsO), psoriatic arthritis (PsA) or both. Severity was assessed using the Patient Reported Extent of Psoriasis Involvement (PREPI) for patients with PsO and established cut points for the Psoriatic Arthritis Impact of Disease (PsAID-9) for those with PsA.

P273 Factors related to insomnia in patients with psoriatic arthritis: a cross-sectional study

Abstract Background/Aims Several studies have demonstrated an increased prevalence of sleep disorders in patients with psoriatic arthritis (PsA). However, there are few data on the relationship between sleep disturbance and disease activity in PsA. We conducted a cross-sectional study to investigate the prevalence of insomnia symptoms and poor sleep quality in PsA and examine correlation with demographic, clinical and patient-reported outcome measures. Methods Patients were recruited from rheumatology clinics at a single centre. Patients had a diagnosis of PsA, met the CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria and were aged ≥ 18 and ≤ 80 years. They had no other confirmed sleep disorder diagnoses. Disease activity was calculated using the cDAPSA (Clinical Disease Activity in PSoriatic Arthritis) score. Disease impact was measured using a pain visual analogue scale (VAS) and the Psoriatic Arthritis Impact of Disease (PsAID)-12 questionnaire and functional impairment was assessed using the health assessment questionnaire (HAQ). We used the Sleep Condition Indicator (SCI) to assess symptoms of Diagnostic and Statistical Manual of Mental Disorders (DSM)-V insomnia disorder (ID). The SCI is a score from 0-30 with lower scores indicating worse subjective sleep. We used the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality. Relationships between clinical characteristics and sleep disturbance were examined using Pearson’s correlation coefficients and multivariable logistic regression. Results Thirty participants were enrolled in the study, of which 13 were female. Mean (SD) age of participants was 49 (13.5) years. Overall, the prevalence of probable DSM-V ID (SCI score ≤ 16) was 43.33% (13/30) with a mean (SD) SCI score of 6.80 (4.79). Mean (SD) PSQI score was 6.77 (3.22) with 60% (18/30) classified as subjective poor sleepers. Mean (SD) pain VAS, PsAID-12 and HAQ were 33.89 (28.67), 2.97 (2.05) and 46.12 (38.83), respectively. Mean (SD) cDAPSA score was 12.3 (15). A significant correlation was observed between the SCI score and cDAPSA (r=-0.3809, p = 0.038), and SCI and PsAID-12 scores (r=-0.3809, p = 0.033). No correlation was found between SCI score and HAQ, age, pain VAS, or disease duration. Multivariable logistic regression controlling for age found an association between cDAPSA and probable ID (OR:1.098 95%CI:1.014-1.253). This association did not persist once pain level, gender, PsAID-12 and HAQ scores were controlled for. Conclusion This cross-sectional analysis of patients with PsA demonstrates that sleep disturbance is highly prevalent. Symptoms of insomnia in this small cohort were related to higher baseline disease activity and self-reported disease impact. This study is the first to demonstrate these findings and warrants further exploration in a larger sample size with longitudinal data. It would be of interest to understand the relationship between insomnia and disease activity and whether insomnia is responsive to treating PsA to low disease activity levels. Disclosure D. McGagh: None. N.M. McGowan: None. S. Elahi: None. J. MacDonald: None. K.E.A. Saunders: None. L.C. Coates: None.

Relationship between disease impact scores and C-reactive protein/albumin ratio in patients with psoriatic arthritis

AimTo evaluate the relationships between the C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and Disease Activity in Psoriatic Arthritis (DAPSA) and Psoriatic Arthritis Impact of Disease 12-item-questionnaire (PsAID-12) scores in patients with psoriatic arthritis (PsA).MethodsThis cross-sectional study involved 160 (121 female) patients with PsA who were >18 years old and treated in the rheumatology clinic of Dışkapı Yıldırım Beyazıt Education and Research Hospital between January 2020 and January 2021. Demographic and clinical data, PsAID-12 and DAPSA scores, CRP, erythrocyte sedimentation rate (ESR), albumin level, neutrophil, lymphocyte, and platelet counts were recorded.ResultsThe mean age was 46.49 ± 11.12 years; median (min-max) disease duration was 2 years (0.5-34). The PsAID score was ≥4 (high disease impact) in 74.4% of patients. Patients with high disease impact had significantly higher CRP, ESR, CAR, NLR, PLR, neutrophil counts, and DAPSA scores (P < 0.001). PsAID scores significantly highly correlated with CRP (rho 0.864, P < 0.001), DAPSA significantly highly correlated with the CAR (rho 0.890, P < 0.001). Receiver operating characteristic curve analysis showed that the CAR (area under the curve [AUC] 0.901, P < 0.05, 95% confidence interval [CI] 0.855-0.947, NLR (AUC 0.759, P < 0.05, 95% CI 0.680-0.838), and PLR (AUC 0.686, P < 0.05, 95% CI 0.591-0.782) predicted high disease impact. The cut-off value for the CAR was 0.98.ConclusionThe CAR can be useful in daily practice as a simple and quick assessment method to evaluate disease impact in PsA.

AB0560 EFFECT OF DEUCRAVACITINIB ON THE PSORIATIC ARTHRITIS IMPACT OF DISEASE (PsAID) QUESTIONNAIRES 12 AND 9: ANALYSIS OF A PHASE 2 STUDY OF ACTIVE PSORIATIC ARTHRITIS

Background:Tyrosine kinase 2 (TYK2) is an intracellular kinase that mediates IL-23, IL-12, and IFNα/β signaling. Deucravacitinib is a novel, oral selective inhibitor of TYK2 via the TYK2 regulatory domain. Phase 2 results showed deucravacitinib was efficacious and well tolerated versus placebo (PBO) in patients (pts) with active psoriatic arthritis (PsA). The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire is a EULAR-developed, validated instrument designed to specifically assess the impact of PsA on health-related quality of life (HRQoL) from the pt’s perspective and is available as separate versions for clinical practice (PsAID-12) and clinical trials (PsAID-9).1Objectives:To compare the effect of deucravacitinib vs PBO on PsAID-12 and PsAID-9 responses and to assess relationships between PsAID scores and clinical and pt-reported outcome (PRO) measures.Methods:This is an ongoing, 1-year, double-blind, Phase 2 trial (NCT03881059). Pts with active PsA were randomized 1:1:1 to deucravacitinib 6 mg or 12 mg once daily, or PBO for 16 weeks (wk). PsAID-12 and PsAID-9, other PROs, and clinical response outcomes were assessed at baseline (BL) and Wk 16. Mean changes from BL in PsAID-12 and PsAID-9 total scores at Wk 16 were determined for each treatment group as well as by response outcomes (ie, achievement of response at Wk 16 for PROs and select clinical response outcomes; Table 1). Spearman correlations between PsAID-12 and PsAID-9 scores and clinical and PRO measures were also assessed.Results:203 pts were randomized and BL characteristics were similar across groups. Adjusted mean changes from BL in PsAID-12 and PsAID-9 scores at Wk 16 were significantly greater in the deucravacitinib groups vs PBO (Figure 1). Adjusted mean changes from BL in PsAID-12 and PsAID-9 scores at Wk 16 were significantly improved with deucravacitinib vs PBO in pts who achieved response for PROs, as well as PASDAS low disease activity and PASI 75 response (Table 1). Adjusted mean changes from BL were generally similar with deucravacitinib vs PBO in nonresponders. Spearman correlation analysis revealed significant correlations at BL and Wk 16 between PsAID-12 and PsAID-9 scores and clinical and PRO measures (P&lt;0.0001).Conclusion:With deucravacitinib vs PBO, PsAID-12 and PsAID-9 scores were significantly improved vs BL at Wk 16. PsAID detected additional improvements among pts achieving response for multiple other PROs and select clinical outcome measures.

P088 Multidisciplinary working in the management of axial and peripheral spondyloarthritis

Abstract Background/Aims Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA), but evidence supporting its effectiveness and benefits in SpA is scarce.The objectives of this review were to describe the characteristics, effectiveness and feasibility of MD working compared to uni-disciplinary approach in studies of patients with SpA. Methods A literature review was conducted according to the PICO framework. We included studies on patients with axial and/or peripheral SpA, and we assessed several outcomes such as diagnosis, treatment, feasibility, disease and patient-related outcomes (Table 1). Results Fifteen articles met the review’s eligibility criteria, including 13 observational studies and two randomised controlled trials. In total 4,312 patients were analysed, including patients with psoriatic arthritis, enteropathic SpA, ankylosing spondylitis, and SpA with anterior uveitis. Most of the studies included a combined clinic encompassing a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, working in tandem according to predefined referral criteria and treatment algorithms. The main outcomes assessed in studies on MD working in SpA, matched with their outcome measures are depicted in Table 1. MD working was reported to lead to better outcomes in all studies, including: better identification and diagnosis of the disease; earlier and more comprehensive treatment approach; and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. However, these results are mostly derived from studies with design issues and without a uni-disciplinary care comparator arm. Conclusion Despite the lack of strong and reliable evidence to support its benefits compared to standard care, MD working is an essential part of the care of patients with SpA. Further studies and initiatives should be developed so that the challenges and limits of MD care can be improved upon. P088 Table 1:Outcomes and outcome measures evaluated in studies of multidisciplinary working in spondyloarthritisOutcomesOutcome measuresDiagnosisEarly diagnosisAssessment of SpondyloArthritis Society (ASAS) criteria; New York criteria The Classification Criteria for Psoriatic Arthritis (CASPAR); Moll and Wright criteria Rheumatologist’s / dermatologist’s (clinical) judgment Not defined ("standard diagnostic criteria for inflammatory bowel diseases and rheumatic diseases")Diagnosis delayThe total lag time from joint symptom onset to the first rheumatologic assessment Diagnostic delay: the time interval between the onset of the symptoms and the correct diagnosis being made Physician-related diagnostic delay: the time interval between the initial visit to a physician and the time of diagnosisReclassification of diagnosisNumber of patients, N (%)Disease relatedDisease activityMusculoskeletal: - The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) - The Ankylosing Spondylitis Disease Activity Score- C-reactive protein (ASDAS-CRP) - Disease Activity in PSoriatic Arthritis (DAPSA) Gastroenterology: - Crohn''s disease activity index (CDAI) - the partial Mayo (pMAYO) Psoriasis: - Psoriasis Area Severity Index (PASI)Physical functionBath AS Metrology Index (BASMI) Bath AS Functional Index (BASFI) Bath Ankylosing Spondylitis Patient Global Score (BAS-G) Health Assessment Questionnaire (HAQ)ComorbiditiesPrevalence of diabetes, hypertension, hyperlipidaemia, and current/past smoking statusComplications during FU/ adverse eventsPrevalence of infection and adverse medication effects (i.e., elevated liver function test, headache).TreatmentTherapeutic adjustmentNumber of patients, N (%) having had their treatment changedPatient reported outcomesQuality of lifeInflammatory Bowel Disease Questionnaire (IBDQ) Short Form (SF36) Dermatology Life Quality Index (DLQI) Psoriatic Arthritis Impact of Disease (PsAID-12)Global wellness• HAQ • SF36 • Patient Global Assessment (PGA)Patient global assessmentPGAActivity limitations and participation restrictionsThe Canadian Occupational Performance Measure (COPM)Patient satisfactionSatisfaction questionnaire (developed by the multidisciplinary team)Feasibility/ costsHealth service utilisationquestionnaire developed by the Stanford University School of Medicine with four indicators (outpatient visits, emergency visits, hospitalizations, and hospitalization days) Disclosure T. Gudu: None. D.R. Jadon: None.

What influences patients' opinion of remission and low disease activity in psoriatic arthritis? Principal component analysis of an international study.

In PsA, the treatment objective is remission or low disease activity (LDA), but patients' perception of remission is poorly studied. This analysis aimed to identify factors associated with patient-defined remission. This analysis uses ReFlaP data, an international PsA study, with remission defined as 'At this time, is your psoriatic arthritis in remission, if this means: you feel your disease is as good as gone?'. Variables associated with, first, patient-defined remission and, second, LDA were identified using multivariable logistic regression and principal component analysis (PCA) to explore correlated variables. Of 424 patients (50.2% male, mean age 52 years) with established disease, 94 (22.2%) reported themselves as being in remission and 191 (45.0%) as LDA alone. In multivariable analysis pain, psoriasis, impact of disease, physician opinion of symptoms from joint damage and Groll comorbidity index were independent predictors of remission. For LDA, results were similar. Using PCA, variance explained was 74% by five components for men and 80% by six components for women. The key component from PCA for remission was, for both sex, disease impact (Psoriatic Arthritis Impact of Disease, pain and HAQ) explaining 22.2-27.5% of variance. Other factors included musculoskeletal disease activity, chronicity/joint damage, psoriasis, enthesitis and CRP. For LDA, similar factors were identified but the variance explained was lower (64-68%). Many factors impact on patients' opinion of remission, dominated by disease impact. Disease activity in multiple domains, chronicity/age, comorbidities and symptoms due to other conditions contribute to a robust model highlighting that patient-defined remission is multifaceted. Clinicaltrials.gov, http://clinicaltrials.gov, NCT03119805.