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Objective: 1. identify comorbidities with greatest impact on PsA patients' health status. 2.develop and validate a prospectively applicable comorbidity index for classifying PsA patients according to their comorbid conditions. Methods:This was a retrospective multicenter cohort analysis of PsA patients in a rheumatology clinical registry, assessing the effect of different comorbidities measured at patients' visits over 10-years period. Outcomes of interest included functional ability, quality of life, medications induced complications, hospitalization/ death. A weighted index that was developed in a cohort of 1707 PsA patients. Internal and external validation were carried out.Results: PsA patients who had higher incidence of comorbid condition and were at high risk of hospitalization were men, with older age at disease onset, high BMI (p < 0.05). Multivariate regression analysis identified 29 comorbidities. A comorbidity index weighted according to the regression coefficient of the variables was developed (the score range: 0-37). A cut off point of 8 was associated with a sensitivity of 97.5% and a specificity of 87%. The developed PsACI correlated significantly with the 4 tested comorbidity indices: Charlson comorbidity index, Functional comorbidity index, Rheumatic Diseases comorbidity index, and Multimorbidity index at 1-, 3-, 5-and 10-years. Similar significant correlation was seen on external validation assessment. Conclusion:The PsA-comorbidity index is a valid method for estimating comorbidity risk in PsA patients. It enables the clinicians to include comorbidities assessment and management in their practice. It can be used to predict resource utilization, identify targets for reducing costs, by prospectively identifying PsA patients at high risk.

Objectives 1. to assess the correlation between US findings and clinical parameters, 2. to evaluate the prognostic value of US findings as predictors for clinical outcome and 3. To assess US imaging as an outcome measure in the management of psoriatic arthritis. Methods A cross-sectional study that included 113 patients (58 women/55 men) referred early psoriatic arthritis (ePsA), defined as inflammatory joint symptoms and signs, disease duration <1 year, in association with psoriasis (99/113)/or past psoriasis (14/113). The patients were diagnosed according to the CASPAR criteria. The patients were assessed both clinically and with US at baseline, 3, 6 and 12 month of therapy. Clinical assessment included 68 joints, VAS for disease activity parameters and DAS-44. Total PASI and Maastricht Enthesitis Index scores were assessed. X-ray of the hands, feet, spine and pelvis was also taken for every patient. US examination included: 1. Joints (56 joints) were assessed using Grey-Scale (GS) and Power Doppler (PD). US findings were scored separately on a 0-3 semi-quantitative scale. Erosions were also scored quantitatively (maximum diameter of the erosion: >0- <2 mm: grade 1; ≥2 - <3 mm: grade 2; ≥3 mm: grade 3). Entheses: were scored according to the 0–36 Glasgow Ultrasound Enthesitis Scoring System (GUESS) and with PD signal (calculated with semiquantitative system, score 0–3). Nail: scored quantitatively: grade 1: minimal loss of the hyperechoic definition involving only the ventral nail plate, grade 2: thickening of the nail bed >2.5mm, grade 3: thickening of the nail bed and inhomogeneous thickening of the nail plate. Skin: grade 0: normal, grade 1: thickening of both epidermis and dermis with respect to the surrounding normal skin, and the presence of a hypoechoic band under the psoriatic area Results There was significant correlation between clinically and US detected synovitis (p<0.01). At baseline US joint score showed a significant correlation with TJC68, SJC66, DAS-44, patient global assessment and functional disability. Subclinical US synovitis was found in 51% of all the joints examined whereas subclinical enthesitis was found in 31% of the patients. US joint examination had a sensitivity of 86% (GS)/94% (PD) with a positive predictive value of 88% (GS) and 96% (PD), in comparison to 55% for clinical examination. Arthritis and enthesitis scores were significantly higher (p<0.01) in patients with nail disease. No correlation was found between the PASI and enthesitis scores. Longitudinal data analysis showed a significant correlation (p<0.01) between relative changes in the US scores and changes in clinical parameters at 6 and 12 months of follow-up. Intra-observer agreement was high (interclass correlation coefficient 0.94). Conclusions The results of these studies support the use of US in the early detection of PsA. US findings correlated significantly with clinical disease activity at baseline as well as longitudinally over the treatment course. Entheses are affected early in PsA, and the incidence of inv...

Background With the introduction of Treat-to-Target approach for inflammatory arthritis, adoption of patient reported outcome measures (PROMs) as part of the standard clinical practice has been emphasized by both clinicians and regulatory bodies as changes in these measures reflect changes most important to the patients. Objectives To assess the concurrence and non-concurrence of patient and physician global assessment in Early rheumatoid arthritis (eRA) patients both in disease activity and in remission; 2. To identify the independent related variables for positive (PtGA >PhGA) and negative (PhGA>PtGA) discordance. Methods Retrospective analysis of 480 patients diagnosed according to the 2010 ACR/EULAR criteria for eRA and included in the USACAS study [1]. Before clinical assessment every patient completed a Patient reported outcome measures questionnaire [2]. This includes assessment for functional disability, Quality of life; pain, PtGA and fatigue scores using 0-100 VAS, duration of morning stiffness, self-reported joint tenderness and helplessness as well as systemic affection. The treating physician reviewed the patients answers, before clinical assessment and calculation of disease activity score (DAS-28). Non-concurrence was defined as a difference of 20% (2 or more units) on the VAS between the physician and patient global scores. The patients were stratified into 3 categories: patients with similar (within 20/100 units) scores (PtGA = PhGA); patients with PtGA >20 units or more higher than PhGA (PtGA > PhGA); and those with PhGA >20 or more units higher than PtGA (PhGA > PtGA). Bivariate analysis was carried out as well as multinominal logistic regression analysis. Results In patients with Moderate- highly active disease (DAS-28 >3.2), mean PtGA was 8.6 whereas mean PhGA was 6.7 (P<0.05). Analysis of the scores revealed, PtGA > PhGA in 56% of the patients, PtGA = PhGA in 31% whereas PhGA > PtGA was reported in 13% of the patients. On the other hand, in patients with low disease activity (DAS-28 <3.2) or in remission (DAS-28 <2.6), mean PtGA was 2.3 and mean PhGA was 1.9. Analysis of the scores revealed, PtGA > PhGA 12%, PtGA = PhGA in 79%, PhGA > PtGA in 9%. PtGA > PhGA was associated significantly with scores of DAS-28, pain, fatigue, quality of life, functional disability, duration of morning stiffness, patient self-reported joint tenderness, systemic manifestations, work ability and self-helplessness. PhGA > PtGA was associated with DAS-28, physician reported joint tenderness, swollen joint count, functional disability, ESR and CRP levels. There was no correlation with age, sex, level of education or marital status. Conclusions Global estimates of both patients and physicians vary according to disease activity status. Parameters such as sleep, fatigue, self-helplessness and work ability have a significant impact on the patients with active disease and should be considered by the treating physician. Whilst HAQ assess the patients' functional ability, quality of life assessment should be also ...