BackgroundDepression is one of the precursors of psoriasis and psoriatic arthritis (PsA) development. It was found that depression and anxiety negatively affect the achievement of remission in PsA. B. Michelsen 2017] Interrelation of anxiety, depression and fatigue (according to patient-reported outcomes) with disease activity, erosive arthritis and skin lesion severity in early PsA hadn’t been sufficiently studied.ObjectivesTo study anxiety, depression and fatigue disorders (according to patient-reported outcomes) and their correlation with disease activity, erosive arthritis and severity of psoriasis in early PsA patients (pts).Methods78 pts (M/F–39/39) with early PsA according to CASPAR criteria were included; all pts had peripheral arthritis for ≤2 years; mean age 36.5±10.7 years, disease duration 12.2±10.3 mo. It was a treatment naïve cohort. All pts underwent standard clinical examination of PsA activity. Mean disease activity indexes (DAS)=4. 0±1.4, DAS28=4.2±1.1. 78 patients were studied for fatigue (according to FACIT), patient global disease activity (PGA), patients pain measured by VAS, and Health Assessment Questionnaire (HAQ); 66 patients (M/F–33/33) were studied for anxiety and depression (according to HADS). At HADS score ≥8 patients had anxiety and depression disorders. Higher scores for FACIT scales indicate better quality of life (less fatigue). Skin lesion severity was evaluated in terms of body surface area (BSA) affected and Psoriasis Area Severity Index (PASI). When BSA was ≥3%, PASI was calculated. PASI≥11 indicates moderate and severe psoriasis. Descriptive statistics was used, M±SD, Me [Q25;Q75], U-test were performed; p<0.05 was considered to indicate statistical significance.ResultsMean FACIT score was low amounting to 35.3±9.6, testifying increased fatigue; mean anxiety index was 5.7±3.1, depression index was 3.8±3.0. Anxiety disorders were detected in 16 out of 66 (24.2%) pts, depression disorders in 9 out of 66 (13.0%) pts. Negative correlation was found between FACIT score and DAS (r=-0.26), DAS28 (r=-0.26), CRP (r=-0.27), PGA (r=-0.35); and pain VAS (r=-0.25). Depression was more pronounced in pts with erosive arthritis in hands and/or feet (r=0.31). Negative correlation of FACIT score (r=-0.54), correlation of anxiety (r=0.26) and depression (r=0.33) indexes was found with health-related functional indexes according to HAQ. HADS indexes (anxiety and depression) are cross-correlating (r=0.51) and are negatively correlating with FACIT scores (r=-0.49 and r=-0.48, accordingly). An association was found of anxiety and depression indexes with the severity of psoriasis PASI index (r=0.38 and r=0.31, accordingly).ConclusionsIn early treatment-naïve PsA patients, increased fatigue and in a quarter of cases anxiety disorders, in 13% of patients depression disorders had been found. Psychological disorders are associated with PsA activity, the severity of psoriasis and joints erosion. Fatigue, anxiety and depression in early PsA patients result in the reduction of their functional capacity.Di...

Spondyloarthritis (SpA) comprises a number of inflammatory rheumatic diseases with overlapping clinical manifestations. Strong association with several HLA-I alleles and T cell infiltration into an inflamed joint suggest involvement of T cells in SpA pathogenesis. In this study, we performed high-throughput T cell repertoire profiling of synovial fluid (SF) and peripheral blood (PB) samples collected from a large cohort of SpA patients. We showed that synovial fluid is enriched with expanded T cell clones that are shared between patients with similar HLA genotypes and persist during recurrent synovitis. Using an algorithm for identification of TCRs involved in immune response we discovered several antigen-driven CD8+ clonal groups associated with risk HLA-B*27 or HLA-B*38 alleles. We further show that these clonal groups were enriched in SF and had higher frequency in PB of SpA patients vs healthy donors, implying their relevance to SpA pathogenesis. Several of the groups were shared among patients with different SpAs that suggests a common immunopathological mechanism of the diseases. In summary, our results provide evidence for the role of specific CD8+ T cell clones in pathogenesis of SpA.

BackgroundMDA is a valid instrument for evaluating PsA treatment results. There is limited data about MDA attainment after starting bDMARDs and non-bDMARDs in routine care. RU-PsART collected data from 25 rheumatology clinics in the Russian Federation.Objectivesevaluate MDA attainment after starting bDMARDs and non-bDMARDs treatment in PsA pts in routine care.Methods294 (M/F–133/161) pts with PsA, diagnosed according to CASPAR criteria, mean age 41.2±1.9 (Min 21 – Max 72) years (yrs.), PsA duration 6.1±5.3 (Min 0 – Max 31) yrs., psoriasis duration 13.6±10.7 (Min 0.2 – Max 54.8) yrs. were included in the RU-PsART after signing consent participation forms. The present analysis included 274 pts who have data concerning PsA activity, treatment and MDA. The number of pts who reached MDA at least once were calculated. At the time of evaluation 81 out of 274 pts (29.6%) were taking bDMARDs±sDMARDs Infliximab (25 pts), Etanercept (16 pts), Adalimumab (14pts), Ustekinumab (8pts), Golimumab (5pts), Sekukinumab (2pts). 193 out of 274 pts (70.4%) were taking other types of treatment - sDMARDs±NSAID, mostly methotrexate (74.2%), sulfasalazine (12%), leflunomide (3.6%), hydroxichlorochine (0.4%); steroids (9.8%). All pts underwent evaluation of PsA activity by DAS28, CRP, Pt/Physician GA, Pain GA by VAS (0–100 mm), swollen/tender joints count (SJC/TJC), DAPSA and considered REM≤4/LDA≤14. M±SD, Me [Q25; Q75], Min-Max,%, U-test, ORs with 95% CI were performed. All CI >1, p≤0.05 were considered to indicate statistical significance.ResultsAt time of evaluation 60 out of 274 pts (21%) reached MDA at least once. Mean duration of sDMARDs and bDMARDs±sDMARDs was 116;17/Min 3 - Max 204 months and 97;15/Min 2 - Max 82 months accordingly. 28 out of 193 pts (10.4%) taking sDMARDs achieved MDA. Among 81 pts taking bDMARDs±sDMARDs MDA was seen in significantly more cases - 32 pts (30.8%), OR=3.85 [CI 95% 2.11–7.01]. REM/LDA by DAPSA was found in significantly more cases compared to pts taking other therapies – in 50 out of 81 pts (61.7%) and in 56 out of 193 pts (29%) accordingly (p≤0.05, U-test). Pts who had ever taken bDMARDs±sDMARDs had significantly less PsA activity compared to those who had taken other types of treatment (table 1).Abstract THU0305 – Table 1ConclusionsMDA was seen in 21% of PsA pts in routine care but starting bDMARDs has a significantly higher probability of reaching MDA in most cases despite duration of treatment.Disclosure of InterestNone declared

BackgroundMDA is a treatment target of PsA. There is limited data about the frequency and the time of MDA achievement by the use of bDMARD therapy in early and long-term PsA in clinical practice. RU-PsART collected data from 25 rheumatology clinics in the Russian Federation.Objectives: to investigate the cumulative frequency and timing of MDA attainment in early and long-term PsA after starting bDMARDs in clinical practice.Methods140 (M/F–77/63) bDMARD-naive PsA pts according to CASPAR criteria were included in the RU-PsART, after signing consent participation forms; median (Me) age 42 [Min 19-Max 73] years (yrs). All patients were divided into two groups based on PsA duration at the time of bDMARDs initiation: early PsA≤2 yrs (67pts) and long-term PsA>2 yrs (73pts). All pts underwent standard clinical examinations of PsA and psoriasis activity and were treated with the following bDMARDs: Infliximab (26pts), Etanercept (20pts), Adalimumab (37pts), Ustekinumab (33pts), Golimumab (19pts), Sekukinumab (4pts), Certolizumab pegol (1pts). MDA was defined as ≥ 5 of the following criteria: tender joint count ≤1, swollen joint count ≤1, PASI≤1 or BSA≤3, patient pain global assessment VAS≤15, patient’s global disease activity VAS≤20, HAQ≤0,5, enthesitis count ≤1. The cumulative frequency and the time of MDA attainment were calculated in both groups. Kaplan-Meier cumulative analysis, Me (CI95%), Min-Max,%, Breslow, Tarone-Ware, Log Rank tests were performed. All CI>1, p<0.05, were considered to indicate statistical significance.ResultsMDA has been achieved after bDMARDs initiation in 33 out of 67 (49%) pts with early PsA and in 23 out of 73 (32%) pts with long-term PsA. The Me time of MDA achievement was significantly shorter in early PsA in comparison to long-term PsA pts: 21 (CI 95%:13.1-28.9) months and 58 (CI95%:0-118.1) months of bDMARD therapy accordingly (p<0.05 for all tests) (Fig.1).Figure 1Cumulative frequency and time of MDA achievement after starting bDMARDs in early and long-term PsA.ConclusionComparative analysis has shown that cumulative frequency of MDA achievement after bDMARDs initiation was significantly higher (49% vs 32%) and faster (21 vs 58 months) in early PsA than in long-term PsA. That confirms the benefit of bDMARD therapy initiation at the early stage of PsA.Disclosure of InterestsElena Loginova Speakers bureau: Novartis, Celgene Corporation, Biocad, Janssen, AbbVie Inc, Tatiana Korotaeva Speakers bureau: Novartis, Celgene Corporation, AbbVie Inc, Biocad, Janssen, Pfizer, UCB, Lilly, Anastasia Koltakova: None declared, ELENA GUBAR: None declared, Yulia Korsakova Speakers bureau: Celgene Corporation, Janssen, Maria Sedunova: None declared, Igor Pristavsky: None declared, Irina Umnova: None declared, Irina Bondareva: None declared, Snezana Kudishina: None declared, Evgeny Nasonov Speakers bureau: Pfizer, Inc., MSD, Novartis, AbbVie Inc., Celgen Corporation, Biocad, Janssen, UCB, Inc.

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