Background:Clinical patterns and disease burden of PsA varies in different parts of the world. Demographic studies from Indian subcontinent are sparseObjectives:To study the cutaneous, articular profile of PsA and describe their disease activity, disability and co-morbidities (CMs)Methods:This is a multicenter, cross-sectional, non-interventional study from Karnataka, India. All consecutive PsA patients defined by CASPAR or expert diagnosis were evaluated over 8 months from 17 Rheumatology centers across Karnataka using standard parameters such as PASI, DAPSA, Indian version of HAQ-DI1, psoriatic co-morbidity index2(Cidx) and MDA 5. Patient consent and EC obtainedResults:549 PsA patients were evaluated and their disease characteristics are shown in Table 1 & 2. PsA preceded psoriasis in in 81 (14.7%).Table 1.Patient characteristics (n=549)DEMOGRAPHICSPsACommonest age group of PsA (yrs)31-40PsA SubclassificationM:F6:5Symmetric polyarthritis216(40.7%)Type 1 PsoriasisType 2 Psoriasis279(55.8%)221(44.2%)Mean duration (yrs)Asymmetric oligoarthritis202(38.1%)Psoriasis8.8(±7.8)DIP predominant88(16.6%)PsA5.2(±6.3)Arthritis mutilans16(4.2%)PsA preceded psoriasis81(14.7%)Dactylitis182(33.9%)Family h/oPsoriasis107(19.7%)Enthesitis109(20.3%)PsA33(6%)Mean TJC686.3(±8.9)AS11(2%)Mean SJC683.5(±5.2)Uveitis5(0.9%)Type of PsoriasisPlaque253(59.9%)IBD3(0.5%)Erythrodermic 31(7.3%)Type I & II psoriasis did not differ in PASI, DAPSA, HAQ-DI or having a family h/o psoriasis. Type II psoriasis had higher Cidx than type I (p=0.0001). Pt pain VAS, DAPSA, PhyGA, PtGA & SJC significantly correlated with higher HAQ-DI (p<0.0001). TJC, ESR, CRP & PASI had minor correlation with HAQ-DI. Females had higher HAQ-DI compared to males (p=0.02). Knee joint involvement caused disability most frequently. Cidx was higher in males (p=0.008). Minor correlation was found between Cidx with age, HAQ-DI & DAPSA. Mean BMI of our cohort was 26.8(±14.8) kg/m2. 56.5% were overweight. Higher BMI was not associated with age, duration of arthritis, DAPSA, PASI, HAQ-DI & Cidx.Infections (any time) were recorded in 10.8%, of which skin was the commonest site in 38.9%; 30.5% of these needed hospitalizations.Conclusion:Despite mild skin disease in majority, more than half of the patients have moderate to severe joint activity. Mild to moderate functional disability in nearly half of our cohort indicate high burden of damage. High incidence of co-morbidities in PsA compared with general population is in line with published literature. In addition to aggressive control of articular activity, detection and control of co-morbidities must be an integral part of PsA management.References:[1]https://doi.org/10.1093/rheumatology/41.12.1457[2]http://dx.doi.org/10.1136/annrheumdis-2016-eular.4598Table 2.Disease characteristicsDISEASE ACTIVITYDISABILITYCO-MORBIDITIESMean PASI: 3.8(7.4)Mean HAQ-DI: 0.3(0.45)Mean Cidx: 0.98(1.6)Mild (PASI 0-5)480(80%)Mild-mod disability260(48.2%)N with 1 or more CMs232(42.3%)Severe (>10)57(10.6%)ADL with most frequent disabilityClimbing a flight of stairs 189(35%)HTNT2DMSmokingPsA severity19.8%16.6%5.4%3.2%Mean DAPSA: 18.8(16.6)ADL with highest disability scoreSitting cross-legged/squattingAnxietyIHDDyslipidemiaOthers3.1%2.3%2%<2% eachRemission100(19.9%)Low DA145(28.8%)Moderate DA137(27.2%)High DA123(24.5%)Family h/o CV dis/stroke72(15.2%)Disclosure of Interests:None declared

Background:Biologics have been the focus of recent treatment guidelines and ‘Treat to Target’ strategies for both psoriasis (PsO) & psoriatic Arthritis (PsA). However, in day-today practice, combination DMARDs anchored around methotrexate are mainstay in majority of patients.Objectives:To describe experience and effectiveness of Methotrexate in combination with conventional DMARDs in Karnataka Psoriatic Arthritis Cohort.Methods:Treatment information was extracted from KPsAC (n=549) which is a cross sectional, non-interventional study conducted across 17 rheumatology practicing centres in Karnataka, India using a structured proforma. This study was approved by respective Ethical committee. Information on efficacy was extracted for various csDMARDs in combination with methotrexate. Standard disease activity outcome measures were used for assessing the response to therapy (DAPSA, PASI, HAQ, MDA5). All participating rheumatologists underwent training to calculate PASI and other outcome scores.Results:Nearly half of the patients in our cohort were on methotrexate (44%) monotherapy. Proportion of patients who received combination csDMARD anchored on methotrexate were 29%. The choice of add on csDMARD was as per clinician discretion or subject preference. Patients were divided in to three groups based on treatments they were receiving at the time of study: Methotrexate (Mtx)+Leflunomide (Lef), Mtx+Sulfasalazine (SSz) and Mtx+Apremilast(Apr). Their characteristics along with outcome measures are depicted in table 1. In Mtx+Apr group: remission or low disease activity was present in 42%, HAQ score of <0.5 was seen in 82%, and only one patient had a PASI of > 10. PASI was significantly lower in the Mtx+Apr group compared to Mtx+Lef group (p<0.009) and Mtx +Ssz group (p < 0.020)Conclusion:Apremilast is an orally administered, small molecule inhibitor of phosphodiesterase 4 (PDE4)**. In this observational study, 3 groups of methotrexate plus csDMARD- leflunomide, sulphasalazine and apremilast fared similarly for articular domain of PsA. However, in cutaneous domain, PASI was significantly lower in apremilast + methotrexate group. To our knowledge, this is the first real life report of the use of combination DMARDs in unselected PsA patients demonstrating effectiveness of apremilast in cutaneous domain. Methotrexate remains anchor DMARD for treatment of PsA in 2/3rdof PsA patients. Addition of apremilast to methotrexate inadequate responders appears to be beneficial in PsA with persistent cutaneous disease. However, being an observational study, this needs to be confirmed in controlled clinical trials.References:**Apremilast: A Review in Psoriasis and Psoriatic Arthritis, Drugs March 2017, Volume 77, Issue 4.Table.Characteristics and comparison of combination csDMARDsMTX+SSZ(N=39)MTX+LEF (n=77)MTX+APR(N=45)Median Age (years)373935Median disease duration (months)96101112Enthesitis (Ever)6(15%)21(27%)4(8%)Dactylitis (Ever)9((23%)28(36%)12 (26%)DAPSA < 46(15%)9(11%)10(22%) 4-1414(36%)25(32%)13(29%) 14-287(18%)24(31%)11(24%)PASI >107(18%) #14(18%) *1(2%) *#HAQ < 0.530(77%)60(78%)37(82%)MDA 5 achieved16(41%)25(32%)19(42%)*P value < 0.009 #P value <0.02Disclosure of Interests:None declared

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Mashabaladi Kwath is a multi-herb decoction which contains seven important herbs in equal quantity and two drugs as Prakshep dravya. The present study provides updated information on its phytochemical analysis, pharmacological properties and probable mode of action of Mashabaladi Kwath. The phytochemical analysis of the decoction revealed the presence of Alkaloid, Tannin, Saponin, flavonoid and phenol. The decoction has Tridoshaghana action mainly Vata-Kaphashamaka along with Nadibalya (nervine), Dhatuvardhak-Pushtikar (nourishes and strengthening the body tissue, fluids etc.), Shophahar (anti-inflammatory), Shoolahar (subsides pain), Raktapittahara (haemostatic), Amapachan (digestive), Rasayan (rejuvenating), Vrushya (aphrodisiac) etc. All these properties of Mashabaldi Kwath are considered to combat vitiation of Vata in Pakshaghata (hemiplegia), Manyasthamba (cervical spondylitis), Karnanada (tinnitus) and Ardita (facial paralysis). The physiochemical properties of Kshaya showed Loss on Drying at 105 0 C -11.16%, Total solid -15.18%, Acid insoluble Ash -0.01%, Water Soluble Extractive -16.4%, Alcohol Soluble Extractives -8.3%, pH -6.67 and specific gravity -1.20.

Lumbar spinal stenosis is abnormal narrowing of spinal canal at lumbar region, may occur as a result of progression of spondylotic changes. In this observational clinical study Madhu tailik basti was administered as Yoga basti for a period of 8 days. The Madhu tailik basti provided a highly significant effect on pain, stiffness, pricking sensation, twitching and significant effect on heaviness. SLR test, tenderness and Oswestry disability index showed highly significant effect of treatment. The overall assessment showed; most of the patients, that is 07 patients (70%) were showed marked relieved, followed by 03 patients (30%) were moderately improved after completion of the treatment. The drugs used in Madhu tailik basti are considered as Laghu, Ruksha, Ushna, Teekshna having Vata-kapha shamaka action. Owing to this property, antagonism to Kapha and Vata & the Teekshna Guna of basti help in overcoming the Srotodushti causes potent anti-inflammatory, pain relieving effect. There was improvement in overall functional status after eight days treatment with Madhu tailik basti. The patients can make significant gains in symptoms, SLR angle and Oswestry disability index score in relatively short periods of time. Despite the limitations of this clinical study, conclude that the Madhu tailik basti is a simple and effective treatment modality for Lumbar spinal stenosis without any adverse effects.