Objective: to study the clinical characteristics of PsA and working capacity in patients included in the All-Russian PsA Registry.Patients and methods. The investigation enrolled 614 patients aged 19–84 years with psoriasis from 39 subjects the Russian Federation, who were followed up in the All-Russian PsA Registry. On the basis of the assessment of demographic data, the spectrum of comorbidities, the degree of activity of the underlying disease according to Disease Activity Index for PsA (DAPSA) and Disease Activity in 28 joints (DAS28), clinical, functional, and social indicators were analyzed in the patients. The investigators studied information on the patients employment, working capacity, and disability, by assessing the group of the latter. The health status and the presence and severity of functional impairment in the patients were analyzed using the Health Assessment Questionnaire (HAQ), while their working efficiency was estimated according to the Workers Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI-SHP questionnaire), by calculating the following parameters: absenteeism, presenteeism, an overall decrease in labor productivity, and impairment in daily functional activity.Results and discussion. The analysis of the All-Russian PsA Registry showed that most of them were of working age (30 to 59 years); 48.4% had concomitant diseases. Data on DAPSA changes were obtained in 349 patients, who were recorded to have mainly moderate (34.7%) or high (42.7%) disease activity, multiple dactylitides and enthesitides, and limited joint function. The registry reflects information on the social status of 521 patients: employed (61.2%) and unemployed (22.1%) persons, pensioners (15.2%), and students (1.5%). More than one third (37.1%) of patients with PsA had disability, mainly of Group III. The changes in the HAQ disability index were assessed in 326 patients; mild, moderate, and severe functional impairments were observed in 36, 26.4, and 3.7%, respectively. Absenteeism was detected in less than one third of patients with PsA, presenteeism was found in about half; there was an overall decrease in labor productivity in more than 60% and daily activity impairment in 68.8%. Statistically significant direct moderate correlations were established between the indicators of PsA activity (DAPSA and DAS28) and the level of productivity impairment in the patients; this was mostly related to an overall decline in labor productivity and to a decrease in daily activity.Conclusion. The data obtained from real clinical practice suggest that half of the PsA patients had high disease activity and a third had severe functional impairment, which led to a lower quality of life and to disability. The overall decrease in labor productivity and daily activity, which was detected in more than half of the patients, was associated with high PsA activity. The follow-up in the All-Russian PsA Registry, regular anti-inflammatory therapy with disease-modifying antirheumatic drugs and biological agents can improve the clinical and functional status and, consequently, working capacity in patients with PsA.

Aim – to study 2 years outcomes of the treat-to-target (T2T) strategy in early psoriatic arthritis (ePsA) patients. Material and methods. 68 (33 male/35 female) ePsA patients according to CASPAR criteria (mean age – 37.3±10.8 years; PsA duration – 11.0±9.8 months) were included and were observed till 2 years follow-up. At baseline and every 3 months all patients underwent standard clinical examinations. All patients was given mono-therapy with Methotrexate (MTX) s/c or in combination with biological (b) DMARDs. The number of pts achieved remission (DAPSA≤4), low disease activity (LDA) (5≥DAPSA≤14), minimal disease activity (MDA) (5/7) or very low disease activity (VLDA) (7/7) at least 1 time were calculated. Analysis were performed into three groups depends on type of therapy: 1st group (19 patients) – MTX-monotherapy; 2nd group (11 patients) – combination MTX with bDMARDs; 3rd group – 25 patients who stopped taken bDMARD by the end of the follow-up. Results. By 2 years of follow-up remission by DAPSA/LDA/MDA/VLDA was seen in 51.5%/16.2%/58.8%/42.65% of patients accordingly. In the 1st/2nd groups remission by DAPSA was noted in 68.4%/90% and MDA – in 81.8%/78.9% of patients accordingly. In the 3rd group remission by DAPSA/MDA maintained in 24%/32% of patients accordingly. Conclusion. The T2T strategy is optimal management approach in more than half of the ePsA patients despite of type of treatment within 2 years . The stopped of bDMARD caused a “lost” of remission/MDA in the most of patients.

Objective: to analyze preliminary data on 5-year clinical and radiographic outcomes in patients with early psoriatic arthritis (PsA) observed as part of the Treat to target (T2T) strategy.Patients and methods. We examined 37 patients (18 men and 19 women) with early PsA who met the CASPAR criteria (2006), who received treatment according to the principles of the T2T strategy for 24 months. The mean age of the patients was 43.3±11.7 years, the median (Me) of PsA duration was 72 [60; 90] months, psoriasis – 120 [88; 180] months, follow up – 62 [51; 81] months. After completion of participation in the T2T strategy, patients were followed up in a real clinical setting. Most of the patients used methotrexate, biologic disease modifying antirheumatic drugs and non-steroidal anti-inflammatory drugs. In the dynamics after 5 years, PsA activity was determined by the DAPSA index and the achievement of the minimum disease activity (MiDA). In 16 (43%) patients, a dynamic assessment of radiographic changes in the joints of the hands and feet was performed using the Sharp quantitative method modified for PsA (m-Sharp/vanderHeijde).Results and discussion. By 24 months of therapy (the end of the T2T study), DAPSA remission was registered in 19 (52%) patients, in the same number of cases (16%) low (LDA), moderate (MDA) and high (HDA) disease activity was noted. Me DAPSA was 3.85 [0.67; 21.76], MiDA was detected in 22 (59.5%) patients. After 5 years of observation, Me DAPSA was 7.67 [2.2; 14.5]. Remissions according to DAPSA were achieved in 13 (35%) patients, LDA – also in 13 (35%), MDA – in 5 (14%), HDA remained in 6 (16%), MiDA – in 20 (54%). No significant differences were found when comparing disease activity at 24 months (at the end of the T2T study) and after 5 years of follow-up (p=0.41). In 11 (69%) out of 16 patients after 5 years, a negative trend was recorded in the assessment of radiological progression.Conclusion. After 5 years of follow-up, 70% of patients with PsA treated at an early stage of the disease as part of the T2T strategy achieved remission or LDA, and 54% of patients remained in MiDA. In 69% of patients, despite the achievement of remission and MiDA, there was a negative radiological dynamic in the hands and feet.

BackgroundPsoriatic arthritis (PsA) is a chronic, musculoskeletal inflammatory disease that develops in up to 30% of patients (pts) with psoriasis (PsO). There are conflicting data about correlations between skin and joint severity from the observational cohort [1, 2]. But it’s very important for clinical phenotyping and treatment PsA pts.Objectivesto evaluate association between PsO severity and PsA activity.Methods778 (M/F=357/421) PsA pts fulfilling the CASPAR criteria were included into Russian rheumatological observational cohort. Mean age 46.7±13 years (yrs), DAPSA 29.05±19.7, CRP - 15.3±23 mg/l, SJC/66 - 6.6±7.5, TJC/68 – 10.6±10.2, LEI – 1.06±1.4. All pts underwent standard clinical examination: tender joins count (TJC)/68, swelling joints count (SJC)/66, CRP (mg/l), DAPSA, dactylitis, enthesitis by LEI, nail/skin PsO was evaluated. All pts were divided in two groups based on BSA≤3% (mild PsO) and BSA>3% (moderate/severe). M±SD, Me [Q25; Q75], Min-Max, %, t-test, Pierson-χ2, Manna-Whitney tests, ORs with 95% CI were performed. All p<0.05 were considered to indicate statistical significance.ResultsBSA≤3% was found in 427 out of 778 pts (54.9%), BSA>3% in 352 pts out of 778 (45.2%). Nail PsO were seen in 258 out of 778 (33.2%). Among these pts with BSA>3% nail PsO were seen in significantly more cases - 135 out of 258 pts (52.3%) (p=0.03). In pts with BSA>3% all parameters of PsA activity (DAPSA, SJC, TJC, CRP) was significantly higher compare to pts with BSA≤3% (for all p<0.0001).The one-factor model of logistic regression shown that PsO severity significantly associated with nail PsO, higher PsA activity by DAPSA, CRP, SJC, TJC and smoking (OR analysis with CI 95% for all parametres are shown on Figure 1).Figure 1.Forest plot of factors associated with psoriasis severity in PsA pts.ConclusionIn our observational cohort about half of PsA pts had severe PsO. Skin severity associated with higher PsA activity. It should be taken into account for choice of properly treatment both for skin and joint in clinical practice.References[1]Mease PJ, etzel cJ, Huster WJ, et al. Understanding the association between skin involvement and joint activity in patients with psoriatic arthritis: experience from the corrona registry. RMD Open 2019;5:e000867. doi:10.1136/ rmdopen-2018-000867.[2]Gottlieb AB, Mease PJ, Mark Jackson J, et al. Clinical characteristics of psoriatic arthritis and psoriasis in dermatologists’ offices. Journal of Dermatological Treatment 2006;17:279–87.AcknowledgementsThe RU-PsART study groupDisclosure of InterestsNone declared

BackgroundIn Psoriatic arthritis (PsA) patients (pts) persistence inflammation in the peripheral joins leading bone erosions, joint space narrowing and new bone formation. Tight control of PsA disease improved joint and skin outcomes, but the number of pts with erosions increased [1]. Despite of clinical improvement no long-term treat to target (T2T) strategy data on radiographs progression yet [2].ObjectivesTo study X-ray progression in PsA pts treated according to T2Tstrategy at the early stage of disease at 6 years (yrs) follow-up.Methods30 (M/F–17/13) PsA pts fulfilling CASPAR criteria, mean age 44.7±11.4 yrs, median (Me) PsA duration 78.5 [66;95] month (mos), Me follow-up 71 [60;86] mos, Me DAPSA 24 [7;45]. All pts was treated according to T2T strategy at the early stage with MTX alone or in combination with iTNF within 2 yrs. When T2T study was ended all pts were treated according to standard care. All pts underwent standard clinical examination of PsA activity, DAPSA was calculated. Radiographs of the hands and feet were available for 30 pts at baseline and 26 (86.6%) at 6-yrs follow-up. Radiographs of the hands and feet were scored using the modified van der Heijde-Sharp (m-v-d-HS) scoring method for PsA assessing both erosion, joint space narrowing (JSN) and total score (TS) m-v-d-HS. Scoring was done by two readers. The number of pts with erosions was calculated at baseline and 6 yrs later. M±SD, Me [Q25; Q75], Me (Min-Max), Mann-Whitney test were performed. All p<0.05 were considered to indicate statistical significance.ResultsAt 6 yrs follow-up Me TS m-v-d-HS and JSN significantly increased from 34 (0-104) to 50 (6-253) and from 34 (0-97) to 50 (6-127) accordingly (p=0.006 and p=0.011); count of erosion from 0 (0-13) to 4 (0-128), p=0.002. In 19 out of 26 pts significantly negative X-Ray progression in the feet and hands by TS m-v-d-HS, count erosion, joint space narrowing was seen (for all p<0.05). In 7 out of 26 pts no X-Ray progression was found. PsA activity by DAPSA was significantly higher in pts with X-ray progression compare to those without progression 14.1 [5.19;33.67] and 2.22 [0.55;13.54] accordingly (p=0.04). 6 yrs later the number of pts with erosions significantly increased from 12 out of 26 (46%) at baseline to 22 out of 26 (85%) pts accordingly (p=0.002).ConclusionAt 6 yrs follow-up negative radiographic progressions in the hand and feet found in mostly early PsA pts despite of tight control treatment strategy within 2 yrs.References[1]Coates LC, Moverley AR, McParland L, Brown S, Navarro-Coy N, O’Dwyer JL, Meads DM, Emery P, Conaghan PG, Helliwell PS. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015 Dec 19;386(10012):2489-98[2]Coates LC, Mahmood F, Freeston J, Emery P, Conaghan PG, Helliwell PS. Long-term follow-up of patients in the TIght COntrol of inflammation in early Psoriatic Arthritis (TICOPA) trial. Rheumatology (Oxford). 2020 Apr 1;59(4):807-810Disclosure of InterestsPolina Tremaskina: None declared, Elena Loginova Speakers bureau: Janssen, Tatiana Korotaeva Speakers bureau: Pfizer, MSD,AbbVie, Novartis-Sandoz, JSC Biocad, Janssen, UCB, Lilly, Anastasiia Sukhinina: None declared, Svetlana Glukhova: None declared, Alexander Smirnov: None declared, Alexander Lila: None declared