Journal Article

POS0958 CLINICAL AND ULTRASOUND FINDINGS IN DIFFICULT-TO-TREAT PSA: RESULTS FROM THE LEEDS SPECIALIST SPONDYLOARTHRITIS SERVICE

Harrison, S., Di Matteo, A., Marzo-Ortega, H., Weddell, J., Hen, O., Vowden, Z., Barr, A., Naraghi, K., Freeston, J., Vandevelde, C., Mcgonagle, D.

2024

Overview

Background:Up to a third of psoriatic arthritis (PsA) patients fail their first biological/targeted synthetic disease modifying drug (b/tsDMARD) and likelihood of non-response (NR) is greater with each subsequent b/tsDMARD switch. This has substantial cost implications and impacts quality of life. Many factors contribute to NR, e.g. obesity and co-morbidities, making this a difficult-to-treat PsA (D2TPsA) population. Establishing a refractory inflammatory drive underpinning this loss of or lack of response is essential to personalise further treatment strategies for this subgroup.Objectives:To describe the baseline clinical and ultrasound (US) features of patients with D2TPsA, to compare differences in between patients responding to their current b/tsDMARD [disease activity score psoriatic arthritis (DAPSA) low disease activity; DAPSA≤14] vs. moderate-to-high disease activity (DAPSA ≥15) and to explore possible biomarkers associated with b/tsDMARD NR.Methods:A cross-sectional analysis of PsA patients attending the Leeds Specialist Spondyloarthritis Tertiary Service in 2023 who were currently being treated with b/tsDMARDs and had been exposed to ≥2 b/tsDMARDs in total. Demographic, clinical, biochemical and patient outcome data were collected, and US examination performed on the same visit in patients with swollen joint count (SJC) ≥1 (≤3 joints scanned per patient) to objectively measure inflammation. b/tsDMARD NR was defined as DAPSA ≥15 despite adequate trial of drug treatment. Clinical characteristics between those with a DAPSA ≥15 versus DAPSA ≤14 (low disease activity/remission) were compared, and a sub-analysis was performed in those patients with and without joint swelling (DAPSA ≥15/SJC ≥1 vs. DAPSA ≥15/ SJC=0). ANOVA/Wilcoxon-Mann-Whitney-U/Chi-squared tests were used to test for statistical significance between individual variables, and clinically/statistically relevant variables were then included in a logistic regression. For datapoints with <10% missing values the mean was imputed, otherwise the variable was discarded. Analyses were performed in RStudio 2023.06.0 + 421.Results:A total of 594 patients taking b/tsDMARDs for PsA were identified, of which 30.0% (178/594) had received ≥2 b/tsDMARDs of any mode of action (MOA) and 97% (173/178) had received ≥2b/tsDMARD with different MOA. Seventy-four (74.7%; 133/178) were seen face-to-face in clinic, of whom 68.4% (91/133) had a DAPSA ≥15 and 33% (30/91) had at least one swollen joint (Figure 1). DAPSA ≥15 was associated with higher Leeds Enthesitis Index (LEI; 1.0 vs 0.2, p<0.001), Physician Likert disease activity score (PhLDA; 2.8 vs. 1.4, p<0.001), Health Assessment Questionnaire (HAQ; 1.8 vs. 0.6, p<0.001) and extent of impact on ADLs (p<0.001). LEI, PhLDA and HAQ remained significant in the regression. Characteristics that differed between DAPSA ≥15/SJC ≥1 vs. DAPSA≥15/SJC=0 were osteoarthritis (33.3% vs. 55.7%, p=0.044), symptom duration (5.8 vs. 8.1, p=0.066), inflammatory bowel disease (0% vs. 11.5%, p=0.053) and PhLDA (2.1 vs. 3.3, p<0.001). Twenty-seven patients with SJC ≥1 and DAPSA ≥15 underwent joint US, and power doppler (PD) was found in 48.1% (13/27) (Figure 2).Conclusion:In our cohort, LEI, HAQ and PhLDA were significantly higher in patients with DAPSA ≥15 in individual and multivariate logistic regression, and higher PhLDA was associated with joint swelling. However, objective inflammation (PD on US) was only found in ~50% of cases. Findings now require replication in a larger clinical cohort to confirm reproducibility and to explore the utility of clinical characteristics and US as predictors of NR in D2TPsA.REFERENCES:NIL.Figure 1.Flowchart of patients with difficult-to-treat PsA under the care of the Leeds Specialist Spondyloarthritis (SpA) ServiceFigure 2.Summary of clinical characteristics and logistic regression analysesAcknowledgements:The Leeds Spondyloarthritis Specialist Service including all administrative support staff, nursing staff, specialist nurses and junior doctors who help to care for the patients included in this audit. We would also like to thank all our patients for their cooperation without which this work would not be possible.Disclosure of Interests:Stephanie Harrison Received speaker fees for a non-promotional educational meetings sponsored by Janssen and Novartis., Or Hen: None declared, Andrea Di Matteo Janssen., Kamran Naraghi: None declared, Jake Weddell: None declared, Zara Vowden: None declared, Claire Vandevelde Janssen and UCB., Jane Freeston Novartis., Ferring., Andrew Barr: None declared, Dennis McGonagle AbbVie, BMS, Celgene, Eli-Lily, Janssen, Novartis, UCB and Pfizer., AbbVie, BMS, Celgene, Eli-Lily, Janssen, Novartis, UCB and Pfizer., Helena Marzo-Ortega AbbVie, Biogen, Eli-Lily, Janssen, Novartis, Pfizer and UCB., AbbVie, Biogen, Eli-Lily, Janssen, Novartis, Pfizer, Takeda and UCB., Eli-Lilly, Janssen, Moonlake, Novartis, and UCB., Janssen, Novartis, Pfizer and UCB

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited
• Subject: biological DMARD / Descriptive Studies / Health services research / Inflammatory bowel diseases / Inflammatory diseases / Joint diseases / Osteoarthritis / Patients / Psoriatic arthritis / Quality of life / Real-world evidence / Regression analysis / Remission / Rheumatic diseases / Scientific Abstracts / Statistical analysis / Ultrasonic imaging / Ultrasound