THU0309 Ten years follow-up study of clinical disease status and treatment in psoriatic arthritis patients from an outpatient clinic in southern norway

Abstract

Background In the new millennium remission has become an obtainable treatment goal for chronic inflammatory joint disorders, shown in particular for rheumatoid arthritis (RA). This has been attributed to new treatment strategies (early intervention and treat-to-target) and new drugs e.g. biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs).1 For psoriatic arthritis (PsA) there is a lack of longitudinal long term clinical data illuminating potential changes that may have occurred over the years. Objectives To explore long term changes in clinical disease status and treatment in PsA patients monitored in an ordinary Norwegian outpatient clinic in the period 2008–2017. Methods For each year we collected data from last patient visit recorded in the hospital clinical computer system GoTreatIT Rheuma. Included patients had to fulfil the CASPAR criteria and have peripheral arthritis. Standard clinical data collection included demographic data, clinical measures of disease activity (Disease Activity Score with 28 joint counts [DAS28], Clinical Disease Activity Index [CDAI] and Assessors Global Assessments (AGA) on Visual Analogue Scale 0–100 mm (VAS)) laboratory measures of disease activity (Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and Patient-Reported Outcomes Measures (PROMs) of physical function (MHAQ), morning stiffness and VAS scores for joint pain, fatigue and Patient Global Assessment (PGA). Treatment with prednisolone, synthetic DMARDs (sDMARDs) or bDMARDs, was recorded. Results Over the 10 years mean annual number of PsA patients monitored was 331, mean age 58.4 years, disease duration 9.6 years, BMI 27.6 kg/m2, females 49% and current smokers 17.6%. A statistically significant decrease for measures of disease activity for the period 2008–2017 was seen (all p<0.01): ESR 15.8–10.9 mm/hr, CRP 7.6–4.1 mg/dl, 28 swollen joints 1.5–0.6, 28 tender joints 3.3–1.6, DAS28 3.32–2.46, CDAI 10.1–6.8 and AGA 14.5–8.6 mm. No statistically significant changes in PROMs was seen. Mean values for the period was: MHAQ 0.46, joint pain 36.3 mm, fatigue 44.2 mm, PGA 38.8 mm and morning stiffness 0.95 hour. From 2008 to 2017 the percentage of patients treated with bDMARDs and/or sDMARDs and/or prednisolone increased from 72.6% to 80.9%. For the 10 year period the annual proportion of patients did not significantly change neither for treatment with prednisolone (14.9%), synthetic DMARDs (53.0%, Methotrexate 38.5%) or biologics (29.9%), this both for TNF (28.1%) and non-TNF inhibitors (1.8%). Conclusions Despite obvious limitations using disease activity measures (28 joint count, DAS28 and CDAI) designed for use in RA, our study indicate that disease activity decreased in our PsA outpatients over the 10 year period. This despite no significant change in proportions of patients treated with sDMARDs and bDMARDs. For PROMs no significant changes was seen. With new available outcome measures designed for use in PsA and more treatment options available e.g. secukinumab (IL17 inhibition) and ustekinumab (IL12/23) and tofacitinib (JAK inhibitor) further improvements in clinical outcomes both for disease activity and patient perception can be expected. Reference [1] Smolen, et al. ARD2017;76:960–77 Disclosure of Interest G. Haugeberg Shareholder of: Diagraphit AS, Grant/research support from: Unrestricted Grant from Pfizer Norway, S. Tengesdal: None declared, I. J. Hansen: None declared, B. Michelsen: None declared, A. Diamantopoulos: None declared, A. Kavanaugh: None declared