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Background:DISCOVER 1 and 2 are phase-3 trials of guselkumab (GUS, a monoclonal antibody that specifically binds the p19-subunit of IL-23) in patients with psoriatic arthritis (PsA). In both trials, treatment with GUS led to significantly more improvement than placebo (PBO) in the primary endpoint (ACR20) as well as in other measures of arthritis and psoriasis at week (W) 24.1,2Objectives:To evaluate the effect of GUS on fatigue in DISC 1 & 2 using the patient reported outcome (PRO) FACIT-Fatigue, which has demonstrated content validity and strong psychometric properties in clinical trials.3Methods:DISC 1 & 2 enrolled patients with active PsA, despite nonbiologic DMARDS and/or NSAIDS, who were mostly biologic naïve except for ~30% of patients in DISC 1 who had received 1-2 TNFi. Patients were randomized (1:1:1) in a blinded fashion to subcutaneous GUS 100 mg at W0 and W4 then every (q) 8W, to GUS 100 mg q4W, or to matching PBO. Concomitant treatment with select non-biologic DMARDS, oral corticosteroids, and NSAIDs was allowed. The FACIT-Fatigue is a 13-item PRO instrument assessing fatigue and its impact on daily activities and function over the past seven days, with a total score ranging from 0 to 52, higher score denoting less fatigue. A change of ≥4 points is identified as clinically meaningful.3Change from baseline in FACIT-Fatigue was analyzed using MMRM (Figure). Independence of treatment effect on FACIT-Fatigue from effect on ACR20 was assessed using Mediation Analysis4(Table) to estimate the natural direct effect (NDE) and natural indirect effect (NIE) mediated by ACR20 response.Results:At baseline in DISC 1 & 2, the mean FACIT-fatigue scores (SD) were 30.4 (10.4) and 29.7 (9.7), respectively, indicating moderate to severe fatigue. In both DISCOVER 1 & 2 trials, treatment with GUS led to improvements in FACIT-Fatigue scores compared with PBO as early as W8 (Figure). 54%-63% of GUS patients compared with 35%-46% of PBO patients achieved clinically meaningful improvement (≥4 points) in FACIT-Fatigue (P≤0.003). Mediation analysis revealed that the independent treatment effects on fatigue after adjustment for ACR20 response (Natural Direct Effect [NDE], Table) were 12-36% in the q8W GUS dosing group and 69% -70% in the q4W GUS group.Conclusion:In 2 phase-3 trials, treatment with GUS of patients with active PsA led to significant improvements compared to PBO in fatigue, including substantial effects on FACIT-Fatigue that were independent of the effects on ACR 20, especially for the q4W dosing group.References:[1]Deodhar et al. ACR 2019. Abstract #807. Arthr Rheumatol. 2019;71 S10: 1386[2]Mease et al. ACR 2019. Abstract # L13. Arthr Rheumatol. 2019;71 S10:5247[3]Cella et al. Journal of Patient-Reported Outcomes. 2019;3:30[4]Valeri et al. Psychologic Meth. 2013;18:137Table.Mediation Analysis of the Effect of ACR 20 Response on Change from Baseline in FACIT-Fatigue Score at Week 24EffectGUS 100 mg q8W vs. PBOEstimate (95% CI)GUS 100 mg q4W vs. PBOEstimate (95% CI)DISCOVER 1NDE0.36 (-1.7, 2.4)2.60 (0.6, 4.5)*NIE2.75 (1.4, 4.3)*1.20 (0.3, 2.3)*Total Effect3.12 (1.0, 5.2)*3.79 (1.9, 5.4)*Proportion Independent11.7%68.5%Proportion Mediated88.3%31.5%DISCOVER 2NDE1.44 (-0.1, 3.0)2.49 (1.0, 4.1)*NIE2.53 (1.6, 3.6)*1.09 (0.4, 1.9)*Total Effect3.97 (2.4, 5.5)*3.58 (2.1, 5.0)*Proportion Independent36.3%69.7%Proportion Mediated63.7%30.3%*P vs placeboNDE=Natural Direct Effect (effect on FACIT-F beyond effect on ACR20), NIE=Natural Indirect Effect (effect on FACIT-F mediated by ACR20)Mediation analysis4used linear and logistics regression models with Bootstrapping methodAcknowledgments:NoneDisclosure of Interests:Philip Helliwell: None declared, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Bei Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Xiwu Lin Employee of: Janssen Research & Development, LLC, Chenglong Han Employee of: Janssen Research & Development, LLC, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau

Background:With multiple disease domains affected in PsA, clinical and patient-reported outcome (PRO) measures are important to assess disease improvement following treatment. Rapid, meaningful improvements in disease activity are a priority for physicians and patients (pts). Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA. Higher proportions of pts achieved responses in PROs and clinical measures when treated with tofacitinib for 3 months vs placebo (PBO).1-5Proportions of responders were also similar between tofacitinib and adalimumab (ADA) after 3, 6 and 12 months.2,3,5Objectives:To determine the time to initial response using responder definitions for selected PROs and clinical endpoints in pts with active PsA treated with tofacitinib, ADA or PBO switching to tofacitinib.Methods:In this post hoc analysis, data were collected from two Phase 3 studies (OPAL Broaden [12 months;NCT01877668]; OPAL Beyond [6 months;NCT01882439]).3,4Pts receiving tofacitinib 5 or 10 mg twice daily (BID), subcutaneous ADA 40 mg once every two weeks (Q2W; OPAL Broaden only), or PBO switching to tofacitinib 5 or 10 mg BID at Month (M)3, were included. Responder definitions included: HAQ-DI ≥0.35-point improvement from baseline (BL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) total score ≥4-point improvement from BL, minimal disease activity (MDA) yes/no composite response (meeting at least 5 of 7 criteria) and PsA Disease Activity Score (PASDAS) post-BL score of ≤3.2 and >1.6-point improvement from BL. First post-BL data were collected at Week 2 (eg for HAQ-DI) or M1. Time-to-event analyses were performed using the Kaplan-Meier (KM) method, with pts censored at the last observed visit. Log-rank tests compared time to initial response across treatment groups.Results:KM analyses show days to initial response (Figure 1, Figure 2). Time to initial HAQ-DI response was significantly different between treatment groups in OPAL Broaden (pConclusion:Times to initial response in functional ability and disease activity were similar in pts treated with either tofacitinib or ADA. Time to initial response prior to first post-BL observation (Week 2 or M1) was not estimable in this analysis. These results may help physicians better understand the time frame for a meaningful response in pts receiving tofacitinib.References:[1]Strand et al. RMD Open 2019;5:e000808.[2]Strand et al. RMD Open 2019;5:e000806.[3]Mease et al. NEJM 2017;377:1537-50.[4]Gladman et al. NEJM 2017;377:1525-36.[5]Helliwell et al. Arthritis Res Ther 2018;20:242.Acknowledgments:Study sponsored by Pfizer Inc. Medical writing support was provided by Eric Comeau of CMC Connect and funded by Pfizer Inc.Disclosure of Interests:Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Laura C Coates: None declared, Joseph Wu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Lara Fallon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ming-Ann Hsu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Andrew G Bushmakin Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Elizabeth Bacci Employee of: Evidera, Joseph C Cappelleri Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Philip Helliwell: None declared

Background:Inflammatory involvement of the axial skeleton (sacroiliac joints and / or spine) is one of the relatively frequent musculoskeletal manifestations associated with psoriasis / psoriatic arthritis (PsA). There is an urgent need for an evidence-based definition for axial involvement in PsA that would identify a subgroup of patients within the heterogeneous PsA population to conduct observational, interventional and translational studies. ASAS and GRAPPA embarked on a collaborative initiative to develop a definition of axial involvement in PsA.Objectives:To perform a survey to identify variables relevant in the identification of the presence of axial involvement in PsA among members of ASAS and GRAPPA.Methods:The online survey utilized thePAPRIKAmethodology (PotentiallyAllPairwiseRanKings of all possibleAlternatives) that determines decision-makers’ part-worth utilities representing the relative importance of the attributes. Participants were exposed to number of clinical scenarios and were prompted to decide which of the scenarios is more compatible with axial involvement in PsA unless they are equal (Figure). The constant stem of each scenario was “a patient diagnosed with psoriatic arthritis fulfilling the CASPAR criteria”; the variable part included 13 common spondyloarthritis variables (Table). Variables were ranked according to their relative importance.Results:The survey was completed by 186 ASAS/GRAPPA members (63 ASAS only, 80 GRAPPA only, and 43 both societies). The ranking of the variables is presented inTable. The highest ranked parameters indicative of axial involvement in a patient with PsA were presence of typical radiographic or MRI changes in the sacroiliac joints and/or spine followed by the presence of chronic back pain and then inflammatory back pain. A separate analysis of ASAS and GRAPPA members provided the similar results concerning the relevance of the variables.Conclusion:Objective signs of inflammatory involvement of the axial skeleton are the most important indicators of axial disease in PsA in the opinion of the experts. A prospective cohort study is currently being planned to address the value of these and other variables in defining axial involvement in PsA.Table.Ranking of the parameters relevant to deciding on the presence of axial involvement in a PsA patient in the opinion of ASAS and GRAPPA members (n=186).NParametersMedian rankMean rank1Presence of structural damage on an X-ray of SIJ22.82Presence of structural damage on an X-ray of spine3.54.13Presence of subchondral BME / osteitis on MRI of SIJ compatible with SpA44.54Presence of BME / osteitis on MRI of spine compatible with SpA455History or current presence of back pain5.55.86History of or current presence of inflammatory back pain5.567Good response of back pain to non-steroidal anti-inflammatory drugs87.88HLA-B2788.19Family history for SpA9.5910Elevated C-reactive protein109.311Presence of peripheral arthritis and/or enthesitis and/or dactylitis109.412Presence of anterior uveitis109.513Presence of inflammatory bowel disease109.6BME=bone marrow edema, MRI=magnetic resonance imaging, SIJ=sacroiliac joints, SpA=spondyloarthritisDisclosure of Interests:Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Alice Gottlieb Grant/research support from: Boehringer Ingelheim, Incyte, Janssen, Novartis, UCB, Xbiotech, Consultant of: AbbVie, Allergan, Avotres Therapeutics, Beiersdorf, Boehringer Ingelheim, BMS, Celgene, Dermira, Incyte, Eli Lilly, Janssen, LEO Pharma, Novartis, Reddy Labs, Sun Pharmaceutical Industries, UCB, Valeant, Xbiotech, Laura C Coates: None declared, Vinod Chandran Grant/research support from: Abbvie, Celgene, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lily, Janssen, Novartis, Pfizer, UCB, Employee of: Spouse employed by Eli Lily, Philip Helliwell: None declared, Deepak Jadon: None declared, Joachim Sieper Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant

Background:Treatment with the oral selective Janus kinase 1 inhibitor filgotinib was associated with rapid and significant improvements in multiple domains of active psoriatic arthritis versus placebo in the 16-week Phase 2, multicenter, double-blind, randomized EQUATOR trial (NCT03101670).1A significantly greater proportion of patients receiving filgotinib, versus placebo, achieved the primary endpoint of 20% improvement in American College of Rheumatology (ACR) 20 response at Week 16 (80% vs 33%, respectively).1Objectives:The aim of this predefined analysis was to evaluate the consistency of the response to filgotinib across predefined relevant subpopulations participating in the EQUATOR trial.Methods:In EQUATOR, patients with active psoriatic arthritis were treated with filgotinib 200 mg (n=65) or placebo (n=66) once daily for 16 weeks. Key clinical endpoints, including ACR20 and ACR50 (50% improvement) response rates, Psoriatic Arthritis Disease Activity Score (PASDAS), and Disease Activity Index for Psoriatic Arthritis (DAPSA) were evaluated according to the following baseline characteristics: sex, body mass index, disease duration, baseline disease severity, concurrent use of disease-modifying antirheumatic drug(s), and prior exposure to tumor necrosis factor inhibitor(s). For PASDAS and DAPSA scores, statistical analysis of changes from baseline was performed using analysis of covariance with factors for treatment, randomization stratification, subgroup, and an interaction between treatment and subgroup. Least-squares (LS) mean difference between treatment arms and the corresponding 95% confidence intervals (CI) were calculated. For ACR20 and ACR50 response rates, statistical analysis used the point estimate and corresponding 95% CI, based on the Newcombe method.Results:Sixty patients (92%) in the filgotinib group and 64 (97%) in the placebo group completed the study. The total number of patients in each subpopulation ranged from 18 to 104 (Figure 1). Differences in the proportions of patients achieving ACR20 consistently favored filgotinib, compared with placebo, across all subgroups (Figure 1); all differences reached statistical significance. Similarly, differences in the proportions of ACR50 responders and LS mean treatment differences for PASDAS and DAPSA consistently favored filgotinib, reaching statistical significance in most subgroups. No clinically relevant differences in the effect of filgotinib were observed across subgroups. Filgotinib was generally well tolerated and no new safety signals were identified.Conclusion:In the 16-week EQUATOR trial, the effects of filgotinib on key efficacy endpoints were generally consistent across a range of subgroups based on patient, disease, and treatment characteristics.References:[1]Mease P, et al. Lancet 2018;392:2367–77.Acknowledgments:The EQUATOR trial was sponsored by Galapagos NV and co-funded by Galapagos NV and Gilead Sciences. Medical writing support was provided by Hannah Mace MPharmacol, CMPP (Aspire Scientific Ltd, Bollington, UK) and funded by Galapagos NV (Mechelen, Belgium).Disclosure of Interests:Philip Helliwell: None declared, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Laura C Coates: None declared, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Chantal Tasset Shareholder of: Galapagos (share/warrant holder), Employee of: Galapagos, Luc Meuleners Employee of: Galapagos, Leen Gilles Consultant of: Galapagos, Lien Gheyle Employee of: Galapagos, Mona Trivedi Shareholder of: Amgen and Gilead Sciences, Employee of: Gilead Sciences, Muhsen Alani Employee of: Gilead Sciences, Robin Besuyen Shareholder of: Galapagos, Employee of: Galapagos, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau

Background In 2016, members of GRAPPA in collaboration with KPMG LLP (UK) conducted a study to benchmark care in psoriatic arthritis (PsA). Challenges in the care of patients with PsA were identified but a key finding was that centres do not usually have processes in place to measure the impact of improved quality of care.1 Objectives To identify quality of care indicators to enable PsA caregivers to assess and monitor the outcomes of specific initiatives aimed at improving care in four focus areas. The focus areas are aligned to key patient pathway challenges: 1) Shorten time to diagnosis, 2) Improve multi-disciplinary collaboration, 3) Optimise disease management and 4) Improve disease monitoring. Methods 1. Structured review literature to obtain a longlist of 100 potential indicators across 4 focus areas. Search strategy used specific terms related to quality measures in PsA, adjacent and other chronic diseases. 80+publications were reviewed and rated based on relevance to four focus areas. 2. Survey expert rheumatologists and dermatologists representative of different healthcare systems to review the longlist and identify the most meaningful and feasible indicators for use in day to day practice. 3. Consensus discussion among the experts to identify shortlist of indicators based on pre-defined selection criteria. Key criteria for the Indicators were:1 support improvement of patient care2 evidence-based,3 measurable, and4 feasible. 4. Electronic group discussion among the experts to refine definitions of shortlisted indicators and targets. Results The expert group arrived at a consensus with a shortlist of 8 quality indicators across each focus area. Domain (Indicator, Target). 1. Shorten time to diagnosis (a) Average duration from presentation to HCP to confirmed PsA diagnosis. Less than 6 months2 (b)% of patients with Psoriasis who receive a PsA screening test Annually3). 2. Improve multidisciplinary collaboration (a) Multidisciplinary PsA assessment is available (Y/N)4 (b) Does the centre provide suitable training for HCPs, nurses etc. to increase awareness of PsA disease symptoms (Y/N)5 3. Optimise disease management (a) Average number of PsA evaluations done by HCP per patient in a year61–2 annually (b)% PsA patients on whom T2T strategy is applied7 4. Improve disease monitoring (a)% of PsA patients who received full disease assessment for co-morbidities, e.g. co-morbidity index at least once every year8 (b) Availability of short-term unscheduled appointments (Y/N)?9 Max. 2 weeks. Conclusions 8 quality indicators in 4 areas of practice have been defined. The respective targets are evidence based, feasible, measurable and meaningful for patients. References [1] Favier, et al. J Rheumatol2017;44(5):674–678. [2] Haroon, et al. Ann Rheum Dis2015;74(6):1045–50. [3] NICE, Psoriasis: the assessment and management of psoriasis2017. [4] Urruticoechea-Arana, et al. Reumatol Clin2017;24:S1699–258X(17) 30183–3. [5] Betteridge, et al. J Eur Acad Dermatol Venereol2016;30(4):576–585. [6] Combeet al. Ann Rheum Dis2016;0:1–12. [7] Smolen, et al. Ann Rheum Dis2014;73(1):6–16. [8] Miedany, et al. Rheumatol Orthop Med2017;2(2):1–7. [9] Lebwohl, et al. Am J Clin Dermatol2016;17:87–97. Acknowledgements This study was funded by Abbvie Disclosure of Interest None declared

Background In a Phase 2 study, Guselkumab (GUS) was shown to be safe and effective in patients (pts) w/active psoriatic arthritis (PsA). Objectives To evaluate the effect of GUS on dactylitis in a subset of pts w/dactylitis at baseline (BL) in the phase 2 PsA study of GUS. Methods Pts w/active PsA and ≥3% body surface area of plaque psoriasis, despite current or previous treatment, were randomised 2:1 to receive 100 mg subcutaneous GUS at wks 0, 4 then every 8 weeks (wks, q8w) or placebo (PBO) during a 24wk double-blind treatment period. At wk16, pts w/ Results Of 149 pts, 81 presented w/dactylitis at BL (PBO n=23, mean[SD]=3.9 [3.01]; GUS n=58, mean[SD]=6.5 [6.15]) and 66 continued to the active treatment period (PBO→GUS n=16; GUS→GUS n=50). The dactylitis subset was similar to the overall population in BL characteristics except for higher median values for # of swollen joints, # of tender joints, and CRP. At wks 16 and 24, the GUS group had a significantly greater reduction in the dactylitis score (wk24 mean [SD] change from BL, PBO: −0.4 [6.06]; GUS: −3.8 [4.93]; p=0.006) and a greater% of pts w/dactylitis resolution, compared to the PBO group (figure 1). Consistent results were obtained w/the # digits w/dactylitis (wk24 mean [SD] change from BL, PBO: −0.2 [3.04]; GUS: −2.1 [2.21]; p=0.003). Improvement in dactylitis seen at wk24 was maintained in the GUS→GUS group (wk56: mean[SD] change from BL=−5.5 [4.84], 75% of pts w/resolution) and the values for the PBO→GUS group (wk56: mean[SD] change from BL=−4.4 [3.50], 93.7% of pts w/resolution) approached those of the GUS→GUS group. Improvement in dactylitis was greater in ACR20/ACR50 responders vs non-responders in GUS-treated patients (Table 1) and was significantly correlated with improvement in TJC (R=0.38, p=0.004), SJC (R=0.50, p Conclusions GUS is efficacious in resolving symptoms of dactylitis in pts w/active PsA. This effect on dactylitis is correlated with improvement in joint symptoms and physical function. Disclosure of Interest D. Gladman Grant/research support from: Janssen Research and Development, LLC, W.-H. Boehncke Grant/research support from: Janssen Research and Development, LLC, A. Gottlieb Grant/research support from: Janssen Research and Development, LLC, P. Helliwell Grant/research support from: Janssen Research and Development, LLC, P. Nash Grant/research support from: Janssen Research and Development, LLC, X. Xu Employee of: Janssen Research and Development, LLC, S. Xu Employee of: Janssen Research and Development, LLC, Y. Wang Employee of: Janssen Research and Development, LLC, E. Hsia Employee of: Janssen Research and Development, LLC, C. Karyekar Employee of: Janssen Research and Development, LLC, A. Deodhar Grant/research support from: Janssen Research and Development, LLC

Background Ixekizumab (IXE) is a high affinity monoclonal antibody that selectively targets interleukin-17A. IXE, every 4 (Q4W) or 2 (Q2W) weeks, was superior to placebo (PBO) in improving the signs and symptoms of psoriatic arthritis (PsA) at Week 24 in biologic-naive patients (pts). Objectives To determine the efficacy and safety of IXE treatment up to 3 years in biologic-naive pts with PsA. Methods In SPIRIT-P1 (NCT01695239), 381 pts entered the extension period (EP; Weeks 24–156). Pts failing to demonstrate ≥20% improvement in both tender and swollen joint counts at Week 32, or any subsequent visit, were discontinued (mandatory discontinuation criteria). Ad-hoc efficacy data are presented for intent-to-treat (ITT) pts initially randomised to IXE at Week 0. Modified non-responder imputation (mNRI; missing data treated as non-response for pts discontinued due to lack of efficacy or adverse events [AEs]; multiple imputation (MI) for all other missing data) was applied to categorical measures. Modified baseline observation carried forward (mBOCF) was applied to continuous efficacy measures. Safety assessments are presented for all pts who entered the EP; baseline was the first IXE dose during the EP. Results Of the 210 pts initially randomised to IXE at Week 0 (ITT), 125 (60%) pts completed 156 weeks of treatment; 27 pts discontinued due to AEs, and 26 pts met the mandatory discontinuation criteria. Efficacy results are summarised (table 1). Improvements in ACR (American College of Rheumatology) and PASI (Psoriasis Area and Severity Index) responses, resolution in enthesitis and dactylitis, and improvements from baseline HAQ-DI (Health Assessment Questionnaire Disability Index), enthesitis, and dactylitis persisted up to Week 156. Safety assessments for all pts who entered the EP are summarised (table 2). Frequencies of treatment-emergent AEs (TEAEs) were similar between IXE Q4W and Q2W. The majority of TEAEs were mild or moderate in severity; serious AEs occurred in 47 pts. Conclusions In pts treated with IXE, improvements in the signs and symptoms of PsA persisted up to 3 years. No unexpected safety signals were observed, and the safety profile was consistent with previous studies of IXE. Disclosure of Interest V. Chandran Grant/research support from: Abbvie, Consultant for: Abbvie, Amgen, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, UCB, R. Fleischmann Consultant for: AbbVie, Acea, Amgen, Bristol-Myers Squibb, Eli Lilly and Company, Novartis, Pfizer, Sanofi-Aventis, and UCB, E. Lespessailles Grant/research support from: Novartis, Eli Lilly and Company, Servier, and Amgen, Speakers bureau: Novartis, Eli Lilly and Company, P. Helliwell Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, Merck, Novartis, and UCB, O. Benichou Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, J. Erickson Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, C. Shuler Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company

Background Up to 50% of patients with psoriatic arthritis (PsA) have associated spinal involvement similar to ankylosing spondylitis (AS). HLA-B27 positivity is lower in PsA compared to other SpA which may affect the disease phenotype. Objectives Our aim was to compare axial phenotype in PsA patients with and without HLA-B27 with AS patients. Methods A large international collaboration collected BASDAI, CRP, HLA-B27 status and sacroiliac joints (SIJ) and spine radiographs. These were read centrally by two blinded readers using consensus on the modified New York criteria, mSASSS and PASRI. AP spine radiographs were examined for symmetry (score difference ≥2 between sides) and morphology of syndesmophytes (typical marginal vs atypical chunky/non-marginal) were compared. Results Eight sites contributed 244 (25% HLA-B27+) PsA patients and 198 (75% HLA-B27+) AS patients. Mean BASDAI, mSASSS and PASRI were higher in AS. When categorised by diagnosis and HLA-B27 there were significant differences for age, sex, disease duration, mSASSS, PASRI and syndesmophyte symmetry. Regression analysis, with mSASSS and PASRI as dependent variables revealed significant associations with age, sex, duration of disease, and group (HLA-B27 and diagnosis). Binary multivariate logistic regression was used to investigate associations of age, sex, HLA-B27 status, diagnosis (PsA v AS) and concomitant diabetes with radiographic features. Sacroiliac symmetry showed no significant associations, whilst syndesmophyte symmetry was associated with increasing age and HLA-B27 positivity. Typical marginal syndesmophytes were associated with age, HLA-B27 status and disease duration: in the cervical spine significant associations with age, sex and HLA-B27 status; in the lumbar spine with age, HLA-B27 and diagnosis. Atypical chunky syndesmophytes were associated only with increasing age and male sex. Conclusions This analysis suggests less difference in radiographic phenotype between AS and axial PsA than previously thought. HLA-B27 negative PsA patients have less severe disease as measured by mSASSS and PASRI with less typical marginal syndesmophytes and symmetry, whilst HLA-B27 positive PsA appears similar to AS. Disclosure of Interest None declared

Background Tofacitinib is an oral Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA). PsA is a heterogeneous disease and composite endpoints allow assessment of multiple clinical outcomes in one instrument. Objectives To examine the effects of tofacitinib treatment on several composite endpoints in patients (pts) with PsA. Methods In 2 placebo (PBO)-controlled, double-blind, multicentre, global Phase 3 studies, pts had active PsA and either had an inadequate response (IR) to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD) and were tumour necrosis factor inhibitor (TNFi)-naive (OPAL Broaden [n=422; 12 months; NCT01877668]), or had an IR to ≥1 TNFi (OPAL Beyond [n=394; 6 months; NCT01882439]). Pts were randomised to receive tofacitinib 5 mg twice daily (BID), tofacitinib 10 mg BID, adalimumab 40 mg subcutaneous injection once every 2 weeks (OPAL Broaden only) or PBO (advancing to tofacitinib 5 or 10 mg BID at Month 3, OPAL Broaden and OPAL Beyond), in addition to continuing on a single, stable csDMARD. Composite endpoints assessed: Psoriatic Arthritis Disease Activity Score (PASDAS), Disease Activity Score using 28 joints with C-reactive protein, Disease Activity Index for Reactive Arthritis/Psoriatic Arthritis (DAREA/DAPSA) and Composite Psoriatic Disease Activity Index (CPDAI). Results Demographics and baseline disease characteristics were generally similar between treatment groups within the 2 studies, except for duration of PsA disease (longer in OPAL Beyond) and geographic distribution (OPAL Broaden having more Eastern EU pts). Baseline values for composite endpoints were generally similar across treatment groups and studies (table 1). Both doses of tofacitinib showed improvements in composite endpoints vs PBO at Month 3 in both studies (table 1). In OPAL Broaden, the effects of adalimumab were similar to both doses of tofacitinib across composite endpoints. Effect size for the composite endpoints (using a subpopulation of pts who had all available data for all endpoints) was highest for PASDAS and typically lowest for DAREA/DAPSA; this rank order of effect size was similar across treatment arms and studies. At Month 3, effect sizes in pts receiving active treatment ranged from 0.90 (DAREA/DAPSA for tofacitinib 5 mg BID) to 2.40 (PASDAS for tofacitinib 10 mg BID) in OPAL Broaden, and 0.81 (DAREA/DAPSA for tofacitinib 5 mg BID) to 1.84 (PASDAS for tofacitinib 10 mg BID) in OPAL Beyond (table 1). Standardised response means generally followed the same pattern as effect size across studies with both doses of tofacitinib (table 1). Conclusions In 2 Phase 3 studies, tofacitinib 5 mg and 10 mg BID improved composite endpoint scores vs PBO over 3 months in pts with PsA. The largest effect size and standardised response means were observed for PASDAS. Effect sizes and standardised response means varied across endpoints but were consistent across studies. Acknowledgements Study sponsored by Pfizer Inc. Medical writing support was provided by C Viegelmann of CMC and funded by Pfizer Inc. Disclosure of Interest P. Helliwell Grant/research support from: AbbVie, Janssen, Pfizer Inc, Consultant for: AbbVie, Janssen, UCB, Speakers bureau: AbbVie, Amgen, Janssen, Pfizer Inc, L. Coates Grant/research support from: AbbVie, Janssen, Consultant for: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer Inc, Sun Pharma, UCB, O. FitzGerald Grant/research support from: AbbVie, BMS, Novartis, Pfizer Inc, Consultant for: Amgen, Celgene, Eli Lilly, Janssen, P. Nash Grant/research support from: AbbVie, BMS, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant for: AbbVie, BMS, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, BMS, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, E. Soriano Grant/research support from: AbbVie, Janssen, Novartis, Pfizer Inc, UCB, Consultant for: AbbVie, Janssen, Novartis, Pfizer Inc, UCB, Speakers bureau: AbbVie, BMS, Janssen, Novartis, Pfizer Inc, Roche, UCB, M. E. Husni Consultant for: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer Inc, Regeneron, UCB, M.-A. Hsu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, K. Kanik Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, T. Hendrikx Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, J. Wu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, E. Kudlacz Shareholder of: Pfizer Inc, Employee of: Pfizer Inc

Background: Many patients with psoriasis have undiagnosed psoriatic arthritis. Low specificity is found with many PsA screening tools. A new instrument, the CONTEST questionnaire, was developed utilizing the most discriminative items from existing instruments.Objective: The aim of this study was to compare the CONTEST and PEST screening tools.Methods: People attending secondary care clinics with psoriasis, but not PsA, completed the questionnaires, were assessed for function and quality of life, and had a physical examination. Patients thought to have PsA were compared to those without. The performance of CONTEST and PEST was compared using area under the receiver operating curve (AUC), and sensitivity and specificity at the previously published cut‐offs.Results: A total of 451 dermatology patients were approached, 35% were reviewed and 27 (17%, 95% CI 12.3–21.7) had unidentified psoriatic arthritis. The sensitivity and specificity (95% CI) of PEST were 0.60 (0.42–0.78)/0.76 (0.69–0.83) and for CONTEST 0.53 (0.34–0.72)/0.71 (0.63–0.79). The confidence limits for the AUC overlapped (AUC for PEST 0.72 (0.61–0.84), for CONTEST 0.66 (0.54–0.77).Conclusions: PEST and CONTEST questionnaires performed equally well, with no superiority of the new CONTEST tool.

Background Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease associated with psoriasis, peripheral arthritis, enthesitis, dactylitis, and spondylitis. Ixekizumab (IXE), a monoclonal high affinity antibody that selectively targets interleukin-17A, has improved disease activity and physical function in bDMARD-naive patients with active PsA.1 Herein, results are presented from a phase 3 trial (SPIRIT-P2; NCT02349295) with IXE in patients with active PsA and previous inadequate response to tumour necrosis factor-inhibitors (TNF-i). Objectives To explore the impact of IXE, as assessed by composite endpoints that incorporate multiple disease domains including peripheral arthritis, skin disease, enthesitis, dactylitis, spinal disease, functioning, and global disease assessment, up to 24 weeks (wks). Methods In this phase 3, multicentre, double-blind study, 363 adult patients with active PsA and a history of inadequate response to TNF-i were randomly assigned at a 1:1:1 ratio to subcutaneous administration of 80-mg IXE either every 4 wks (Q4W; N=122) or every 2 wks (Q2W; N=123) following a 160-mg starting dose at Wk 0 or placebo (PBO; N=118). TNF-i inadequate response was defined as lack of efficacy to one or two TNF-i or intolerance to TNF-i. Response to treatment and disease activity were measured at Wks 12 and 24 by the following composite endpoints: minimal disease activity with skin component measured with the Psoriasis Area and Severity Index (MDA) or the static Physician Global Assessment of psoriasis (mMDA) and Composite Psoriatic Disease Activity Index (CPDAI) as well as traditional measures by Psoriatic Arthritis Response Criteria (PsARC). Treatment comparisons were made by a logistic regression model for categorical data with missing values imputed by nonresponder imputation (NRI); a mixed model for repeated measures analysis was used for continuous data. Results At Wks 12 and 24, significantly more patients receiving IXEQ4W or IXEQ2W achieved MDA, mMDA, and PsARC compared with patients receiving PBO (Table). Results for MDA were similar to mMDA results within each treatment group at each time point. CPDAI total scores for patients receiving IXEQ4W or IXEQ2W were significantly improved compared with results for patients receiving PBO. Conclusions Treatment with either IXEQ2W or IXEQ4W provides improvement in disease activity across multiple symptom domains, as measured by various composite endpoints, in patients with active PsA and who had a previous inadequate response to TNF-i. References Mease P et al. 2017 ARD 76(1):79. Disclosure of Interest L. Coates Grant/research support from: Abbvie, Janssen, Consultant for: Abbvie, Celgene, Janssen, Sun Pharma, Pfizer, UCB, MSD, Novartis, Eli Lilly and Company, P. Mease Grant/research support from: Abbvie, Amgen, Bristol Myers Squibb, Celgene, Crescendo, Genentech, Janssen, Eli Lilly and Company, Merck, Novartis, Phizer, UCB Pharma, Sun, Consultant for: Abbvie, Amgen, Bristol Myers Squibb, Celgene, Crescendo, Genentech, Janssen, Eli Lilly and Company, Merck, Novartis, Pfizer, UCB Pharma, Sun, Speakers bureau: Abbvie, Amgen, Bristol Myers Squibb, Celgene, Crescendo, Genentech, Janssen, Pfizer, UCB Pharma, M. Husni Consultant for: Eli Lilly and Company, Novartis, Abbvie, Celgene, Bristol Myers Squibb, Amgen, Janssen, and UCB phrama, E. Lespessailles Grant/research support from: Amgen and Eli Lilly and Company, Speakers bureau: Expancience, Novartis and Servier, D. Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, O. Benichou Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, L. Kerr Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, P. Helliwell Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, Merck, Novartis, and UCB

Background Osteomalacia is caused by a deficiency of vitamin D and can be corrected by changes in diet, lifestyle and supplementation. Consequently, it is a condition where education has a primary role in prevention. Objectives If educational interventions are to be developed and evaluated, then an instrument for measuring knowledge is required. This has led us to develop a novel Osteomalacia Knowledge Questionnaire (OKQ). Methods Based on nominal group technique, a steering group of people who are knowledgeable about osteomalacia, educational theory and questionnaire development was convened. The group decided to use true and false questions. Important areas of knowledge of osteomalacia were first determined by the group and then relevant statements which were true or false were written and grouped into 8 sections of 5 questions, each covering the different areas of knowledge. This resulted in a knowledge instrument with 40 questions in all. The questions were tested for utility and ambiguity in the group and modified and replaced accordingly. The questionnaire was then trialled in 37 people of South Asian origin (an osteomalacia susceptible population), in three groups. Participants were initially administered the OKQ and then received an educational intervention comprising a practitioner led education session on osteomalacia, including a presentation and written or electronic material. Participants were re tested with the OKQ after 6 weeks. Although there is no “gold standard” for measuring knowledge about osteomalacia, if effective, increased knowledge should lead to an increase in vitamin D (Vit D) levels and a decrease in parathormone (Pth) levels. Vitamin D and Parathormone levels were measured alongside the OKQ in 2 of the groups before and after the educational intervention Results Baseline knowledge about osteomalacia was low pre education averaging only 12.7 out of 40 (range 0–29) (n=37). A total of 30 participants (81%) attended for the follow up test. They averaged a score of 13.9 at baseline and 23.4 at follow up. This was statistically significant (p=0.002 Mann Whitney) and demonstrated sensitivity to change of the OKQ. Knowledge at baseline was correlated with vit D and Pth blood levels for two of the groups (n=27). This showed correlation coeficients of 0.128 and -0.407 respectively. For change of knowledge and change of parathormone (n=21) the r value was -0.324 suggesting a relationship between knowledge and Pth that is worthy of confirmation through further studies. Conclusions A novel questionnaire has been developed that has face validity for testing knowledge about osteomalacia. It has proved feasible and shown sensitivity to change. It has also shown promising correlation with biochemical measures of osteomalacia. Acknowledgements This study was funded by Arthritis Research United Kingdom. Disclosure of Interest None declared

For the first time, 8 patients with psoriatic arthritis (PsA) participated as full delegates at the 2013 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Patients were invited to provide their perspective for different sessions of the conference program. Before the conference, the patient delegates had a separate meeting to familiarize themselves with the conference program and to gain a better understanding of the vision and objectives of GRAPPA. During the conference, the patient group discussed options for increased involvement in research projects. Herein we summarize the presentations on patient participation in research, the experiences of the patient group, and plans to enhance the patient perspective in psoriasis and PsA research.

Introduction L’ixekizumab (IXE) est un anticorps monoclonal de haute affinite qui cible de maniere selective l’interleukine-17A. L’IXE, administre toutes les 4 (Q4 W) ou 2 semaines (Q2 W) a ete superieur au placebo sur l’amelioration des signes et des symptomes du rhumatisme psoriasique (RP) a la semaine 24 chez des patients naifs de biotherapie. Notre objectif etait de determiner l’efficacite et la securite de l’IXE jusqu’a 3 ans chez des patients naifs de biotherapie atteints de RP. Materiel et methodes Dans SPIRIT-P1 ( NCT01695239 ), 381 patients ont participe a la phase d’extension (PE, semaines 24 a 156). Les patients sans amelioration d’au moins 20 % du nombre d’articulations gonflees et douloureuses a la semaine 32, ou a toute visite ulterieure, devaient arreter l’etude (criteres d’arret obligatoire). Les donnees d’efficacite ad-hoc sont presentees pour les patients en intention de traiter (ITT), initialement randomises pour recevoir l’IXE a la semaine 0. Une methode d’imputation en non-reponse modifiee (modified non-responder imputation [mNRI] ; donnees manquantes traitees comme une non-reponse pour les patients ayant arrete a cause d’un manque d’efficacite ou d’evenements indesirables [EI] ; imputation multiple [IM] pour toutes les autres donnees manquantes) etait appliquee aux mesures categorielles. Une version modifiee du report de la valeur observee a l’inclusion (modified baseline observation carried forward [mBOCF]) etait appliquee aux mesures d’efficacite continues. L’evaluation de la securite est presentee pour tous les patients qui ont participe a la PE ; le debut de l’evaluation correspondant a la premiere administration d’IXE pendant la PE. Resultats Sur les 210 patients initialement randomises pour recevoir l’IXE a la semaine 0 (ITT), 125 (60 %) ont termine les 156 semaines de traitement ; 27 ont arrete l’etude suite a des EI, et 26 repondaient aux criteres d’arret obligatoire. Les ameliorations des reponses American College of Rheumatology (ACR) et Psoriasis Area and Severity Index (PASI, indice d’etendue et de gravite du psoriasis), la resolution des enthesites et des dactylites, et les ameliorations par rapport a l’inclusion du Health Assessment Questionnaire Disability Index (HAQ-DI, indice d’invalidite selon le questionnaire d’evaluation de l’etat de sante), des enthesites et des dactylites persistaient jusqu’a la semaine 156. Les frequences des EI apparus sous traitement (gravite legere/moderee) etaient similaires entre l’IXE Q4 W et Q2 W ; des EI graves ont ete rapportes pour 47 patients ( Tableaux 1 et 2 ). Conclusion Chez les patients traites par IXE, l’amelioration des signes et des symptomes du RP ont persiste jusqu’a 3 ans. Le profil de securite etait coherent avec celui des precedentes etudes de l’IXE.

Summary Background Multiple questionnaires to screen for psoriatic arthritis (PsA) have been developed but the optimal screening questionnaire is unknown. Objectives To compare three PsA screening questionnaires in a head-to-head study using CASPAR (the Classification Criteria for Psoriatic Arthritis) as the gold standard. Methods This study recruited from 10 U.K. secondary care dermatology clinics. Patients with a diagnosis of psoriasis, not previously diagnosed with PsA, were given all three questionnaires. All patients who were positive on any questionnaire were invited for a rheumatological assessment. Receiver operating characteristic (ROC) curves were used to compare the sensitivity, specificity and area under the curve of the three questionnaires according to CASPAR criteria. Results In total, 938 patients with psoriasis were invited to participate and 657 (70%) patients returned the questionnaires. One or more questionnaires were positive in 314 patients (48%) and 195 (62%) of these patients attended for assessment. Of these, 47 patients (24%) were diagnosed with PsA according to the CASPAR criteria. The proportion of patients with PsA increased with the number of positive questionnaires (one questionnaire, 19·1%; two, 34·0%; three, 46·8%). Sensitivities and specificities for the three questionnaires, and areas under the ROC curve were, respectively: Psoriatic Arthritis Screening Evaluation (PASE), 74·5%, 38·5%, 0·594; Psoriasis Epidemiology Screening Tool (PEST), 76·6%, 37·2%, 0·610; Toronto Psoriatic Arthritis Screen (ToPAS), 76·6%, 29·7%, 0·554. The majority of patients with a false positive response had degenerative or osteoarthritis. Conclusion Although the PEST and ToPAS questionnaires performed slightly better than the PASE questionnaire at identifying PsA, there is little difference between these instruments. These screening tools identify many cases of musculoskeletal disease other than PsA.

OBJECTIVES: Tendon involvement is common in spondyloarthritis. The MRI signal from the Achilles tendon has been used to quantify mechanical tendinopathy; however, conventional MRI is limited by the short T(2) of normal tendon. Short and ultrashort echo time (UTE) MRI have the potential to better measure signal intensity reflecting changes in T(2) or gadolinium enhancement. Furthermore, UTE images could be used for normalisation to reduce variability. The aim of this work was to investigate such techniques in patients with spondyloarthritis (SpA). METHODS: The Achilles tendons of 14 healthy volunteers and 24 patients with symptomatic spondyloarthritis were studied. Combined UTE (TE=0.07 ms) and gradient echo (TE=4.9 ms) images were acquired before and after intravenous gadolinium together with pre-contrast gradient echo images (TE=2 ms). The signal intensity from a region of interest in the Achilles tendon above the calcaneus was measured. The relative enhancement at echo times of 0.07 ms (RE(0.1)) and 4.9 ms (RE(5)) were calculated. The ratios of the signal intensities from both 4.9 ms and 2 ms gradient echo images to the signal intensity from the UTE image were calculated (RTE(5) and RTE(2) respectively). RESULTS: Interobserver intraclass correlation coefficients were excellent (≥0.97). The contrast-to-noise ratio was higher for enhancement on UTE images than on gradient echo images. RE(0.1), RTE(5) and RTE(2) were significantly higher in SpA patients than controls. CONCLUSION: Signal intensity ratios using UTE images allow quantitative measurements to be made which are sensitive to tendon T(2) or contrast enhancement and which are increased in spondyloarthritis. They therefore have the potential for use as measures of tendon disease in spondyloarthritis.

Objective To determine the prevalence of psoriatic arthritis (PsA) using the ClASsification criteria for Psoriatic ARthritis (CASPAR) for classification. Methods People with psoriasis were identified from the computerized morbidity indices of 2 large UK general practices, total population 22,500. Questionnaires were mailed to all 633 patients thus identified. Of the respondents, a 50% sample was assessed clinically and a proportion had blood samples and radiographs taken. Patients labeled as having psoriasis were also cross-referenced with a local secondary care morbidity index for PsA and rheumatoid arthritis. Figures for the prevalence of PsA were estimated from these data. Results One hundred sixty-eight questionnaires were returned (response rate 27%) and 93 people (55% of questionnaire respondents) were examined. Of these 93 people, 12 (4 of whom were cross-referenced to the hospital database) were thought to have PsA clinically, all fulfilling the CASPAR criteria for PsA. Six of the 93 examined patients did not have psoriasis or a family history of psoriasis and had no historical features or clinical signs of psoriasis on interview and examination. Extrapolating from the data of those people actually examined, the estimated (corrected) prevalence was 13.8% (95% confidence interval 7.1–24.1%). Conclusion The estimated prevalence of PsA in this population, using the CASPAR criteria, was 13.8%. Misclassification of psoriasis and arthritis, and response bias, indicate that this is probably an overestimate.

Aims To investigate the relationship between limited joint mobility (LJM; measured both passively and during gait) and plantar pressure measurements. Methods A cross-sectional study involving 28 diabetic patients with peripheral neuropathy but no plantar ulceration (DN), 25 diabetic patients with ulceration (DU), 25 diabetic control patients with no ulceration or peripheral neuropathy (DC), and 25 non-diabetic reference subjects (NDR). Movements of the ankle joint complex (AJC) and 1st metatarsophalangeal (MTP) joint were recorded, together with plantar pressures. Results The passive range of motion at the AJC was significantly reduced in all the diabetes groups, but the gait range of motion was comparable with non-diabetic subjects. At the AJC, no correlation was found between the passive and gait range of motion (ROM) and these were not correlated with plantar pressure variables. At the 1st MTP, a correlation was found between the passive and gait dorsiflexion ROM and a significant correlation existed between gait dorsiflexion ROM at the 1st MTP joint and peak forefoot pressures in the DU group. Conclusions Despite a significant reduction in the passive ROM at the AJC in the diabetic groups, the gait ROM was indistinguishable from reference subjects and was not correlated with plantar pressure variables. At the 1st MTP joint, a correlation was found between the passive and gait ROM and furthermore the gait ROM was correlated with peak forefoot pressures, suggesting ROM measures at the 1st MTP joint may be preferable to ROM measures at the AJC.

The objective of these guidelines is to provide healthcare professionals, including primary care dental practitioners, with clear guidance on the management of patients on oral anticoagulants requiring dental surgery. The guidance may not be appropriate in all cases and individual patient circumstances may dictate an alternative approach.

Background and objective: Since the original description of psoriatic arthritis (PsA) subgroups by Moll and Wright, there has been some discrepancy in the precise prevalence of the different subgroups and in particular the proportion of patients with polyarthritis. The higher prevalence of the polyarthritis subgroup may be due to the inclusion of patients with seronegative rheumatoid arthritis with coincidental psoriasis. The classification of psoriatic arthritis (CASPAR) study database provided an opportunity to examine this question. Methods: The CASPAR study collected clinical, radiological and laboratory data on 588 patients with physician-diagnosed PsA and 525 controls with other inflammatory arthritis, 70% of whom had rheumatoid arthritis. Patients with PsA were divided into two groups: polyarthritis and non-polyarthritis (which included the Moll and Wright subgroups of spinal disease, distal interphalangeal predominant and arthritis mutilans) and were compared with patients with rheumatoid arthritis. Comparisons were made between all three groups and, if a significant difference occurred, between the two groups with PsA. Results: The three groups differed significantly with regard to all clinical and laboratory variables except duration of disease. Significant differences were also found between the two groups of PsA in terms of age, sex, total number of involved joints, disability score and symmetry. However, no differences were found between the groups of patients with PsA in terms of seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptide, enthesitis, and spinal pain and stiffness. Further, dactylitis was commonly seen in patients with PsA (57% in the polyarticular group and 45% in non-polyarticular group), and uncommonly found in patients with rheumatoid arthritis (5%). With the exception of entheseal changes, syndesmophytes and osteolysis, typical radiological features of PsA could not be used to distinguish between the PsA subgroups. Conclusions: The evidence suggests that the changing prevalence of the polyarticular subgroup of PsA is not because doctors include patients with seronegative rheumatoid arthritis with coincidental psoriasis.

In disease modifying antirheumatic drug (DMARD)-naive early rheumatoid arthritis (RA), to compare the efficacy of methotrexate (MTX) and infliximab (IFX) with MTX and intravenous corticosteroid for remission induction.In a 78-week multicentre randomised controlled trial, double-blinded to week 26, 112 treatment-naive RA patients (1987 American College of Rheumatology classification criteria) with disease activity score 44 (DAS44)2.4 were randomised to MTX + IFX or MTX + single dose intravenous methylprednisolone 250 mg. A treat-to-target approach was used with treatment escalation if DAS442.4. In the IFX group, IFX was discontinued for sustained remission (DAS441.6 for 6 months). The primary outcome was change in modified total Sharp-van der Heijde score (mTSS) at week 50.The mean changes in mTSS score at week 50 in the IFX and intravenous steroid groups were 1.20 units and 2.81 units, respectively (adjusted difference (95% CI) -1.45 (-3.35 to 0.45); p=0.132). Radiographic non-progression (mTSS2.0) occurred in 81% vs 71% (OR 1.77 (0.56 to 5.61); p=0.328). DAS44 remission was achieved at week 50 in 49% and 36% (OR 2.13 (0.91 to 5.00); p=0.082), and at week 78 in 48% and 50% (OR 1.12 (0.47 to 2.68); p=0.792). Exploratory analyses suggested higher DAS28 remission at week 6 and less ultrasound synovitis at week 50 in the IFX group. Of the IFX group, 25% (14/55) achieved sustained remission and stopped IFX. No substantive differences in adverse events were seen.In DMARD-naive early RA patients, initial therapy with MTX+high-dose intravenous steroid resulted in good disease control with little structural damage. MTX+IFX was not statistically superior to MTX+intravenous steroid when combined with a treat-to-target approach.

Objective.There are several new composite indices for assessing disease activity in psoriatic arthritis (PsA). Each may function as a disease state variable and a responder index. The aim of our study was to determine cutoffs for disease activity and response.Methods.Data from the Group for GRAPPA Composite Exercise (GRACE) study were used to develop cutoffs using a number of different approaches. Voting on choice of cutoff was undertaken at the 2013 GRAPPA Annual Meeting in Toronto, Ontario, Canada.Results.After voting, results for cutoffs for low/high disease activity for the Psoriatic ArthritiS Disease Activity Score (PASDAS), GRAppa Composite scorE (GRACE index), and Composite Psoriatic Disease Activity Index (CPDAI), respectively, were 3.2/5.4, 2.3/4.7, and 4/8. The measurement error for each composite score was estimated at 0.8, 1, and 2 for PASDAS, GRACE, and CPDAI, respectively.Conclusion.Response criteria for the new composite indices have been developed. These now require further validation and testing in other datasets.

Two main groups of soft-tissue disorders are identified: specific soft tissue syndromes and a non-specific disorder as yet not fully characterized. Specific soft tissue syndromes occur in joint, muscle or nerve and are associated with characteristic symptoms and physical signs. These include epicondylitis at the elbow, tendon disorders at the wrist and nerve entrapments such as carpal tunnel syndrome. The non-specific soft tissue syndrome is primarily described by symptoms of pain but may include muscular symptoms (such as weakness and cramp) or nerve symptoms (such as numbness, pins and needles, and burning). Agreed, validated diagnostic criteria for use in surveillance are urgently required. Biological markers are still sought; both muscle and nerve seem promising for future studies. The multifactorial aetiology of these disorders will be discussed, and guidelines to management will embrace the principles of this model. Treatments aimed at the pain in isolation are most often studied. Psychosocial and environmental influences on the presentation and persistence of pain need further evaluation.

To understand better a complex disease such as psoriatic arthritis (PsA), collection of a large amount of information on clinical, laboratory, and radiological features is required over an extended period of time. Longitudinal data can be effectively collected and stored in clinical registries and databases. This article reviews current databases in PsA and proposes a structure for an international PsA registry. Careful collection and analysis of patient data through collaborative efforts will likely advance our knowledge of pathogenesis and provide new and much needed insights about the course and prognosis of the disease.

Multiple questionnaires to screen for psoriatic arthritis (PsA) have been developed but the optimal screening questionnaire is unknown.To compare three PsA screening questionnaires in a head-to-head study using CASPAR (the Classification Criteria for Psoriatic Arthritis) as the gold standard.This study recruited from 10 U.K. secondary care dermatology clinics. Patients with a diagnosis of psoriasis, not previously diagnosed with PsA, were given all three questionnaires. All patients who were positive on any questionnaire were invited for a rheumatological assessment. Receiver operating characteristic (ROC) curves were used to compare the sensitivity, specificity and area under the curve of the three questionnaires according to CASPAR criteria.In total, 938 patients with psoriasis were invited to participate and 657 (70%) patients returned the questionnaires. One or more questionnaires were positive in 314 patients (48%) and 195 (62%) of these patients attended for assessment. Of these, 47 patients (24%) were diagnosed with PsA according to the CASPAR criteria. The proportion of patients with PsA increased with the number of positive questionnaires (one questionnaire, 19·1%; two, 34·0%; three, 46·8%). Sensitivities and specificities for the three questionnaires, and areas under the ROC curve were, respectively: Psoriatic Arthritis Screening Evaluation (PASE), 74·5%, 38·5%, 0·594; Psoriasis Epidemiology Screening Tool (PEST), 76·6%, 37·2%, 0·610; Toronto Psoriatic Arthritis Screen (ToPAS), 76·6%, 29·7%, 0·554. The majority of patients with a false positive response had degenerative or osteoarthritis.Although the PEST and ToPAS questionnaires performed slightly better than the PASE questionnaire at identifying PsA, there is little difference between these instruments. These screening tools identify many cases of musculoskeletal disease other than PsA.

Background Psoriatic arthritis (PsA) is an inflammatory arthritis that is associated with psoriasis. Although the majority of PsA genetic risk loci identified also confer risk for psoriasis, we have recently reported evidence of loci that are associated with PsA and not psoriasis, including an association at the IL23R locus which is also independent of a psoriasis variant at the same locus. Methods The PsA-specific SNP rs12044149, and the psoriasis SNP rs9988642 at the IL23R locus were genotyped in a cohort of 914 PsA cases and 6,945 controls from Spain, Crete, Germany and the UK, with the Life Technologies QuantStudio genotyping platform. Association testing was carried out using PLINK, and a meta-analysis was performed with PsA Immunochip data (1,962 cases, 8,923 controls). Genotype data was also available from the psoriasis WTCCC2 study (excluding known PsA, n=1,784) to compare effect sizes between PsA and psoriasis using multinomial logistic regression in Stata, and to directly compare PsA and psoriasis genotypes. Credible SNP sets were calculated for the PsA and psoriasis IL23R associations using the Bayesian refinement method, and functionally annotated. Results We replicated the association rs12044149 with PsA ( P =4.03x10 –6 ), which remained significant when conditioning upon the psoriasis variant, rs9988642 ( P cond =4.86x10 –6 ), and reached genome-wide significance during meta-analysis of the combined PsA dataset ( P meta =4.76x10 –20 ). Only a modest association was found for rs9988642 ( P =0.04), with no genome-wide significance found during meta-analysis ( P =4.61x10 –4 ). Within the psoriasis dataset, this association remained significant when conditioning upon rs12044149 ( P =1.0x10 –07 vs. P cond =1.63x10 –5 ). Effect estimates for rs12044149 were significantly different between PsA and psoriasis ( P =2.0x10 –3 ), and direct comparison of genotypes for PsA and psoriasis found the risk allele to be significantly increased in PsA ( P =4.52x10 –4 , OR=1.3). Credible SNPs for rs12044149 mapped to promoter and enhancer regions within memory CD8 + T cells, which we have previously reported to be critical for PsA. Conclusions We have successfully replicated a PsA-specific (associated with PsA but not psoriasis) risk variant at the IL23R locus in an independent cohort, confirming rs12044149 to be distinct from rs9988642 (r 2 =0.02). This gives five PsA-specific associations that have now been identified. Disclosure of Interest None declared

Background RAPID3 is a patient completed outcome measure assessing disease activity in inflammatory arthritis consisting of the health assessment questionnaire (HAQ) and two VAS scales. It is feasible for use in clinical practice and has been well validated in rheumatoid arthritis (RA) and other conditions, but there is little data on its use in psoriatic arthritis (PsA). Objectives To investigate the responsiveness and discrimination of RAPID3 and a modified version with skin VAS in the Tight Control of Psoriatic Arthritis (TICOPA) trial. Methods Data from the TICOPA trial were used to assess the performance of the RAPID3 index. RAPID3 was calculated using the HAQ-DI, patient completed pain VAS and global disease activity VAS. Due to concerns about skin involvement in PsA, we also calculated a novel RAPID3Ps score which also included a skin activity VAS to see if performance was superior. Results from the RAPID3 measures were correlated with the PsA disease activity score (PASDAS) a composite disease activity score already validated by GRAPPA. Change in the RAPID3 measures and other outcome measures were compared between the tight control arm and the standard care arm of the TICOPA study using t-test for continuous variables and chi-squared for categorical measures of disease state. Results RAPID3 scores strongly correlated with PASDAS (Pearson correlation 0.794, p When looking at differentiation between treatment groups, change in RAPID3 score at 48 weeks was highly discriminant (t value -3.43, p Looking at specific cutpoints, RAPID3 “near remission” was also highly discriminant between treatment groups (chi squared 7.48, p=0.006) although with a lower value than the minimal disease activity criteria for PsA (chi squared 10.11, p=0.001). Conclusions RAPID3 shows good correlation with other validated measures of disease activity in PsA and addition of a psoriasis measure does not seem necessary in this population. The RAPID3 score and “near remission” definition are able to effectively discriminate between two active treatment groups in an interventional trial. Acknowledgement We acknowledge all collaborators and participants in the TICOPA trial. Disclosure of Interest None declared

To assess the correspondence between ideal and actual monitoring for disease-modifying anti-rheumatic drugs and the reasons for protocol failure, and the sharing of this task between primary and secondary care, we studied 249 patients with rheumatoid arthritis in a single district general hospital. Ideal monitoring protocols were derived from data sheets and from the rheumatological literature. Overall the ideal protocol was followed in 65% of cases: this ranged from 93% for methotrexate to 26% for sodium aurothiromalate. Most of the monitoring was done in general practice (e.g. 67% of all blood tests) and, with some exceptions, general practitioners (GPs) were willing to perform this task. However, many GPs reported logistic differences with specimen transfer and expressed the need for more information and support. Poor communication between hospital, patient and GP was also found to be a cause of protocol failure.

BackgroundPsoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD).MethodsThe recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement.ResultsTen recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined.ConclusionThese recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

Passive articular stiffness is not only a function of articular tissues, but also tissues associated with movement, such as muscles and tendons. Allowance has been made for the relative contribution of these extra-articular tissues in comparing the resting stiffness of normal subjects and patients with rheumatoid arthritis. In addition, the stiffness of the muscle-joint complex with agonist/antagonist muscles co-contracting has been measured. Significant muscle wasting was found in rheumatoid arthritis (forearm muscle cross-sectional area for normals: 30.9 cm2, for rheumatoid arthritis: 22.7 cm2, p = 0.002). Allowing for this, there was a significant difference in resting stiffness between normals and rheumatoid arthritis subjects (adjusted resting stiffness normals: 90.8 × 10-3Nm/deg, rheumatoid arthritis: 120.3 × 10-3Nm/deg, p = 0.015). There was no difference between the groups in terms of the relationship between stiffness and grip at different levels of muscle co-contraction, suggesting the muscles are qualitatively normal in rheumatoid arthritis.

Five hundred and three patients with RA were questioned about the symptom of back pain. Chronic back pain, lasting more than 3 months, occurred in 33 per cent of the group. A group of 100 back pain patients were studied in more detail using a structured questionnaire, clinical examination and radiology. Ninety-four of these patients had low back pain. Particular clinical patterns (such as that of the facet syndrome) were sought but no clear characteristics were found. Fifty-two lumbar spine X-rays were available from the RA population and these were compared to 52 age and sex matched X-rays from outpatients with chronic mechanical low back pain. Significant differences between these groups radiologically were a higher frequency of osteoporosis and a higher frequency of disc narrowing without associated osteophytes in the RA population. This study differs from previous reports which found other characteristic radiological features of RA of the lumbar spine (spondylolisthesis, facet erosions, and vertebral fracture), a discrepancy possibly resulting from the use of a control group having low back pain.

Repetitive strain injury, or work related upper limb disorder, provides an interesting paradigm for the study of the relative contribution of physical and psychological factors to the resulting pain and disability. Sixty three subjects were studied, comprising the work-force of a subsection of a large local industrial company, in whom pain in the arm related to work was known to be common. Ergonomic data were obtained by estimating the cumulative daily load on the wrist joint for each of four identified tasks. Data on the occurrence of pain, treatment sought, and disability were obtained by a structured self administered questionnaire. Psychological data were obtained by administering the Hospital Anxiety and Depression (HAD) scale, a self reported measure of anxiety and depression, and the Bradford Somatic Inventory (BSI), an inventory of somatic symptoms associated with anxiety and depression. The employment specific period prevalence of work related upper limb disorder was 81%, with 30% of the subjects having pain at the time of the study. Domestic disability was minimal in all but two subjects, though the use of devices such as jar openers at home was common (12 of 51 subjects). Medical advice was seldom sought. Twenty per cent of subjects had received anti-inflammatory drugs, 10% had received physiotherapy, and 47% had wrist splints. Pain was related to the tasks with the highest estimated daily loads, but a history of pain and current pain were associated with higher scores on the HAD and BSI scales, suggesting an interaction between physical and psychological factors.

To evaluate an existing tool (the Swedish modification of the Psoriasis Assessment Questionnaire) and to develop a new instrument to screen for psoriatic arthritis in people with psoriasis.The starting point was a community-based survey of people with psoriasis using questionnaires developed from the literature. Selected respondents were examined and additional known cases of psoriatic arthritis were included in the analysis. The new instrument was developed using univariate statistics and a logistic regression model, comparing people with and without psoriatic arthritis. The instruments were compared using receiver operating curve (ROC) curve analysis.168 questionnaires were returned (response rate 27%) and 93 people attended for examination (55% of questionnaire respondents). Of these 93, twelve were newly diagnosed with psoriatic arthritis during this study. These 12 were supplemented by 21 people with known psoriatic arthritis. Just 5 questions were found to be significant predictors of psoriatic arthritis in this population. Figures for sensitivity and specificity were 0.92 and 0.78 respectively, an improvement on the Alenius tool (sensitivity and specificity, 0.63 and 0.72 respectively).A new screening tool for identifying people with psoriatic arthritis has been developed. Five simple questions demonstrated good sensitivity and specificity in this population but further validation is required.

Atlas of psoriatic arthritis / , Atlas of psoriatic arthritis / , کتابخانه دیجیتال جندی شاپور اهواز

For over 30 years investigators have used the simple but non-validated classification criteria suggested by Moll and Wright. Several authors have suggested modifications but most remain invalid or require HLA analysis. Now, a world wide initiative has developed new criteria (the CASPAR criteria) which include both clinical, laboratory and radiological features. These will require further study before they are fully adopted for future studies but their improved performance should result in less variation between study cohorts.

To investigate the relationship between limited joint mobility (LJM; measured both passively and during gait) and plantar pressure measurements.A cross-sectional study involving 28 diabetic patients with peripheral neuropathy but no plantar ulceration (DN), 25 diabetic patients with ulceration (DU), 25 diabetic control patients with no ulceration or peripheral neuropathy (DC), and 25 non-diabetic reference subjects (NDR). Movements of the ankle joint complex (AJC) and 1st metatarsophalangeal (MTP) joint were recorded, together with plantar pressures.The passive range of motion at the AJC was significantly reduced in all the diabetes groups, but the gait range of motion was comparable with non-diabetic subjects. At the AJC, no correlation was found between the passive and gait range of motion (ROM) and these were not correlated with plantar pressure variables. At the 1st MTP, a correlation was found between the passive and gait dorsiflexion ROM and a significant correlation existed between gait dorsiflexion ROM at the 1st MTP joint and peak forefoot pressures in the DU group.Despite a significant reduction in the passive ROM at the AJC in the diabetic groups, the gait ROM was indistinguishable from reference subjects and was not correlated with plantar pressure variables. At the 1st MTP joint, a correlation was found between the passive and gait ROM and furthermore the gait ROM was correlated with peak forefoot pressures, suggesting ROM measures at the 1st MTP joint may be preferable to ROM measures at the AJC.

Background Previous studies have shown that around 25% of patients with psoriatic arthritis (PsA) have radiographic erosions at presentation but the level of erosive disease is usually very low. Previous data in established PsA has suggested a higher sensitivity for bone erosions with US compared to plain radiography. Objectives The aim of this analysis was to investigate how many early PsA patients had erosions only visible using US at presentation. Methods Within the Tight Control of Psoriatic Arthritis (TICOPA study), all patients had radiographs of the hands and feet at baseline and week 48. Patients seen in Leeds also underwent an US assessment of their most symptomatic or dominant hand assessing MCPs and PIPs at the same timepoints. The presence of erosions seen on radiographs and US were compared at an individual joint level and at a patient level. Joints with erosive changes seen only on US at baseline were checked at 48 weeks for presence of radiographic and/or ultrasound erosions. Results There were 89 patients who had US scans of the MCP and PIP joints with corresponding radiographs at baseline, the majority of whom had repeat scans at 48 weeks (n=74) contributing a total of 163 scans for analysis. In the majority of cases (81/89 91.0% of patients) there was no evidence of erosive disease on radiographs at baseline, however an additional 19 patients had erosions visible on US alone. 25 (3.5%) joints at baseline and 32 (5.6%) at 48 weeks showed erosive disease spread across the MCPs and PIPs (see table). At follow up, none of these erosions were visible on radiographs, with 13 of 23 joints re-scanned still showing erosions on US. Conclusions There was a low frequency of erosive disease seen in the TICOPA study with little progression over the 48 week study period. Of those with normal radiographs, 23% of patients had additional erosions in the fingers visualised on US, with less erosions identified in the middle MCP joints where US access can be limited. Disclosure of Interest L. Coates Grant/research support from: Pfizer, Consultant for: Pfizer, J. Freeston Grant/research support from: Pfizer, J. Nam Grant/research support from: Pfizer, P. Conaghan Grant/research support from: Pfizer, Consultant for: Pfizer, P. Helliwell Grant/research support from: Pfizer, Consultant for: Pfizer

Background Methotrexate (MTX) is a common first line DMARD in psoriatic arthritis (PsA) but until recently no RCTs evaluating its efficacy in PsA were available. The MIPA trial found no significant difference in arthritis outcomes at 6 months but was criticised as the target dose was only 15mg. Objectives The aim of this analysis was to investigate clinical outcomes in patients with early PsA treated with MTX in the TICOPA study. Methods Within the Tight Control of Psoriatic Arthritis, patients (in either arm) could be treated with methotrexate. All patients in the tight control arm received MTX as first line monotherapy for the first 12 weeks while patients in the standard care arm the majority of the patients in the standard care arm also received MTX. Clinical outcomes were recorded at the 12 week visit including joint counts, PASI, NAPSI, enthesitis and dactylitis measures. Results Of the 206 patients enrolled in TICOPA, 188 received oral methotrexate in the first 12 weeks of the trial. Of these, 175 patients reached a dose of at least 15mg by 12 weeks, with 122 reaching a dose of at least 20mg and 86 reaching the top dose of 25mg. The proportions of patients achieving the ACR outcomes at 12 weeks were ACR20 40.8%, ACR50 18.8% and ACR70 8.6% with 22.4% achieving minimal disease activity (MDA). Improvements were also seen in PASI scores with 27.2% reaching a PASI75. For those with enthesitis at baseline (n=148) the median change in enthesitis score was 0 (IQ range -1, 0 for LEI and IMPACT, -2, 1 for MASES). For those with baseline dactylitis (n=59), there was a median change in LDI scores of -59.7 (-157.4, -26.4). 117 patients had nail involvement and these patients showed a median change in mNAPSI score of -2 (IQ range -8, 0) with changes more commonly in the nail bed due to the short follow up time. Slightly higher proportions of patients receiving 180mg MTX or more over the 12 week period (equivalent to an average of 15mg per week) achieved ACR20, 50 and PASI 75 but the numbers were small so this did not reach significance. Conclusions Despite this data being open-label, it does show improvements in multiple clinical outcomes associated with MTX use in PsA. The proportion reaching ACR20 is slightly higher than that in MIPA (41 vs 34%) but no comparative data are available for the other outcomes. There is a suggestion of better responses with doses above 15mg per week but the dose-response is harder to assess in such a study where confounding exists as patients doing well may be left on lower doses. Disclosure of Interest L. Coates: None declared, P. Helliwell Grant/research support from: Pfizer, Consultant for: Pfizer

Hypovitaminosis D continues to be a problem for South Asian people living in the UK. This study investigates the association between widespread unexplained pain and biochemical osteomalacia in this group of people.All South Asian patients attending with unexplained widespread pain (CWP) over a two-year period had biochemical tests for osteomalacia: calcium, phosphate, alkaline phosphatase, vitamin D (25OHD), and parathyroid hormone (PtH). For comparison, a control group consisted of patients in whom a specific rheumatic diagnosis (SRD) had been made. A follow up questionnaire was sent enquiring about pain, disability and dietary habits. A small proportion of the responders attended for a further set of biochemical tests for osteomalacia.The majority of patients in both groups had a raised PtH (124/220, 57%) and a low 25OHD (117/160, 73%). Where data on both PtH and 25OHD were available, 47% (64/137) had a combination of reduced 25OHD and raised PtH. Few of these patients had abnormal calcium, phosphate or alkaline phosphates. From the postal questionnaire the prevalence of disability and continuing pain was high in both groups, with the majority of respondents complaining of difficulty with activities and nearly half needing help. Pain was widespread, the same or worse and graded above 7/10 for 69% and 78% of respondents in the CWP and SRD groups respectively. Overall, sixty one percent of respondents thought their gait pattern had changed in the last year. No significant differences were seen between respondents based on diagnosis (CWP or SRD), initial or subsequent PtH levels, or current calcium and vitamin D consumption. At the time of the second blood test, 52% of those with an elevated PtH on the first test now had a normal PtH value but 31% of those with a normal PtH first time had an elevated PtH.This observational study conducted in a rheumatology clinic in the north of England has shown high levels of biochemical osteomalacia in people of South Asian origin and high levels of persistent pain and disability, unrelated to diagnosis, biochemical status or treatment with calcium and vitamin D.

Many of the following questions reflect items on the research agenda of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) for Outcome Measures in Rheumatology (OMERACT) 8 (May 2006) and will have task forces addressing them in the form of research projects, questionnaires, and consensus exercises. ### Which joints should be included in psoriatic arthritis (PsA) assessment: carpometacarpal joints, distal interphalangeal (DIP) joints, feet DIPs? Should we perform 76, 68, 44, or 28 joint counts? Can feet DIPs be distinguished from proximal interphalangeal (PIP) joints clinically and/or radiologically? Can they be distinguished from osteoarthritis radiologically? Should we count or score? Mease : When we set about to assess joints in the original etanercept trial, our assumption was that we needed to capture a larger number of joints than in typical rheumatoid arthritis (RA) trials, including the DIP joints of both hands and feet, as well as the carpometacarpal (CMC) joints which can be commonly affected, thus using a 76/74 joint count. Some have countered that it is difficult in many patients to assess the DIP joints of the feet, especially the smaller ones, and that assessment of the CMC joint may not be valid. Further, radiologists have grumbled that it is often difficult to distinguish the DIP joints, especially in the feet. Thus the perennial question is: Is it sufficient to count the joints, or does it add more information to score relative degree of tenderness and swelling in each joint? The Erlangen analysis of raw data from the etanercept and infliximab phase II trials suggests that counts are as distinguishing as scores, and that 76, 68, 44, and 28 joint counts are all adequate to detect differences between treatment and placebo. The only caveat is that it is worthwhile to assess at least 68 joints at study entry in order to qualify a patient, especially oligoarticular patients. FitzGerald would omit the second through fifth proximal interphalangeal (PIP) joints of the toes as difficult to assess. Gladman : However, this may be important not only at study entry. If a patient happens to have a number of feet or distal …

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy with a prevalence between 0.1 and 1% and an equal sex distribution [1]. Psoriasis affects 1–3% of the population, with approximately a third of patients developing PsA [2]. The course of PsA is variable and unpredictable ranging from a mild nondestructive disease to a severe debilitating erosive arthropathy. Erosive and deforming arthritis occurs in 40–60% of PsA patients (followed at hospital clinics), and is progressive from within the first year of diagnosis [3, 4]. The classification of PsA is an area of ongoing international discussion. The five subgroups proposed by Moll and Wright [5] are still frequently used, although considerable overlap between these groups is now recognized. For the purpose of these guidelines we have differentiated between peripheral joint disease in PsA and axial disease alone. Psoriatic spondylitis is similar to ankylosing spondylitis (AS), although it is often less symptomatic, less limiting and radiologically tends to be asymmetrical and less severe [6]. However, despite these differences, until such time as there is evidence that psoriatic spondylitis responds in a different manner from AS to TNFblockade, we recommend that AS guidelines for anti-TNFtreatment are used for the management of psoriatic spondylitis [7]. Much like rheumatoid arthritis (RA), PsA can lead to chronic joint damage, increased disability [8, 9] and increased mortality [10, 11]. Social and financial implications are also important, both in terms of personal loss and the impact of direct (e.g. medical care) and indirect (e.g. inability to work) costs to the state. It is recognized that psoriasis is associated with an increased risk of non-melanoma skin cancers [12], most probably a result of excessive exposure to sunlight and enhanced by use of psoralen and ultraviolet A (PUVA) therapy [13]. The guidelines recognize that these risks that may be potentiated by anti-TNFtreatment and specific recommendations have been made accordingly (see sections headed Exclusion criteria and Monitoring and Toxicity). Need for guideline

OBJECTIVE--To relate weakness of grip to loss of forearm muscle bulk, hand joint deformity, and hand joint tenderness in patients with rheumatoid arthritis (RA). METHODS--Using anthropometric data we have estimated the anatomical cross-sectional area (CSA) of forearm muscles in 100 subjects with RA compared with 100 aged and sex-matched normal subjects. We also recorded hand joint tenderness using a modification of the Ritchie articular index, and a simple index of hand joint deformity. RESULTS--We found a significant reduction in anatomical CSA in RA (forearm CSA in normal subjects 29.7 cm2 and in RA 25.9 cm2; p = 0.002). In simple linear regression we found that 46.3% of the variation in grip strength in normal subjects was explained by variation in muscle CSA; in RA this figure decreased to 33.4%. Adding terms for joint deformity and pain in a multiple regression model improved the amount of variation explained to 37.9%. CONCLUSIONS--Although there is significant muscle wasting in RA, it is likely that reduction in strength is also attributable to joint deformity and pain leading to inhibition of grip directly and, indirectly, by arthrogenous muscle inhibition. Doubts remain about the quality of muscle in RA.

Objectives The purpose of this study was to compare radiographic outcomes according to the magnitude of the response utilizing 2 new psoriatic composite disease activity measures (the Psoriatic Arthritis Disease Activity Score (PASDAS),and the GRAPPA Composite Exercise (GRACE)) [1] with DAS28 as a comparator. The data were taken from the GO-REVEAL dataset, a large (N=324) randomised, double-blind, study which evaluated the safety and efficacy of 2 doses of golimumab in subjects with active PsA. Methods Data collected in the GO-REVEAL study was not sufficient to calculate all the components of the GRACE index, soimputation was used to obtain values for the PsA quality of life measure (PsAQoL). Response criteria at 24 weeks were applied across the whole dataset, irrespective of treatment group. Radiographic scores at baseline and 24 weeks were assessed. Results Radiographic progression was greater in subjects with a poor outcome with treatment, and less in those with a good outcome. Radiographic scores were intermediate for those with a moderate outcome (Table). Analysis of variance statistics were significant for all three measures but were more significant for the psoriatic arthritis specific indices. Data were also generated for the proportion of subjects in whom no radiographic progression was seen, and these data were compared across the outcome measures using chi-squared statistics: PASDAS, 82% in good outcome group did not have radiographic progression χ2 =8.5, GRACE 80%, χ2 =6.6, DAS28, 76% χ2 =4.6. View this table: Conclusions Response criteria for disease specific composite measures enable better separation between groups in terms of radiographic progression and may therefore be used as suitable targets for interventional studies and in the clinic. References 1. Helliwell PS, Fitzgerald O, Fransen J: Composite Disease Activity and Responder Indices for Psoriatic Arthritis: Development of Cut-offs for Both Disease Activity States and Response. J Rheum, in press (2014). Disclosure of Interest P. Helliwell Consultant for: Janssen, A. Kavanaugh Grant/research support: Janssen DOI 10.1136/annrheumdis-2014-eular.4692