Search

Psoriatic arthritis (PsA) is a chronic arthritis typically associated with cutaneous psoriasis (PsO). Its pathogenesis is connected to an innate and acquired immune response, as well as genetic risk alleles. The extent of immunopathogenic mechanisms and the heterogenicity of clinical manifestation make the identification of patient-targeted therapies a critical issue, and the treatment decision challenging in patients' management.This review includes a brief overview of biological and small-molecule therapies, focusing on evidence from clinical trials and real-world data that support their use in PsA. We summarize novel and future possible therapeutic strategies, the importance that comorbidities have on selection of therapy and discuss the adverse event of each drug. Relevant papers for up to 1 August 2022 (trials, real-life studies, and reviews) regarding biologics and/or small molecules were summarized.In recent years, the treatment of PsA has been revolutionized by new targeted therapies, which offer the opportunity to perform a tailored-tail management, considering risk factors, comorbidities, and the different PsA phenotypes. Growing experience with these new agents allows novel treatment approaches that may improve clinical outcomes for PsA patients, in terms of remission/low disease activity and quality of life.

Non-infectious uveitis (NIU) can be an early or even the first extra-articular manifestation of systemic rheumatic diseases, or the first one; thus, rheumatologists are often involved in the diagnostic and therapeutic assessment of NIU. We evaluated 130 patients with a diagnosis of NIU who were admitted to two Italian rheumatologic clinics (Tor Vergata University Hospital in Rome, and Federico II University in Naples) from January 2018 to December 2021. Anterior uveitis (AU) occurred in 75.4% of patients, followed by posterior uveitis (PU, 21.5%); acute (54.6%) and recurrent (35.4%) NIU were more documented than chronic NIU (10%), and a bilateral involvement was observed in 38.7% of cases. Half of NIU cases were associated with spondyloarthritis (SpA); the remaining were affected by Behçet disease (BD)-related uveitis (13.9%) and idiopathic NIU (9.2%). HLA-B27+ patients (34.8%) had a higher prevalence of anterior and unilateral NIU (p = 0.005) with acute course (p = 0.04) than HLA-B27– patients. On the contrary, HLA-B51+ patients (19.6%) had mostly PU and bilateral NIU (p < 0.0001) and recurrent course (p = 0.04) than HLA-B51– patients. At the first rheumatologic referral, 117 patients (90%) received systemic treatments. Findings from this study demonstrate that rheumatologic referral has a pivotal role in the diagnostic work-up of NIU and may dramatically influence NIU-treatment strategies.

Purpose This review aims at investigating pathophysiological mechanisms in spondyloarthritis (SpA). Analysis of genetic factors, immunological pathways, and abnormalities of bone metabolism lay the foundations for a better understanding of development of the axial clinical manifestations in patients, allowing physician to choose the most appropriate therapeutic strategy in a more targeted manner. Recent Findings In addition to the contribution of MHC system, findings emerged about the role of non-HLA genes (as ERAP1 and 2, whose inhibition could represent a new therapeutic approach) and of epigenetic mechanisms that regulate the expression of genes involved in SpA pathogenesis. Increasing evidence of bone metabolism abnormalities secondary to the activation of immunological pathways suggests the development of various bone anomalies that are present in axSpA patients. Summary SpA are a group of inflammatory diseases with a multifactorial origin, whose pathogenesis is linked to the genetic predisposition, the action of environmental risk factors, and the activation of immune response. It is now well known how bone metabolism leads to long-term structural damage via increased bone turnover, bone loss and osteoporosis, osteitis, erosions, osteosclerosis, and osteoproliferation. These effects can exist in the same patient over time or even simultaneously. Evidence suggests a cross relationship among innate immunity, autoimmunity, and bone remodeling in SpA, making treatment approach a challenge for rheumatologists. Specifically, treatment targets are consistently increasing as new drugs are upcoming. Both biological and targeted synthetic drugs are promising in terms of their efficacy and safety profile in patients affected by SpA.

Background Rheumatoid Arthritis (RA) is a chronic inflammatory disease with a heterogeneous treatments’ clinical response. Goals of treatment are remission and low disease activity, which are not achieved in all patients despite the introduction of early treatment and the treat to target strategy. Objective To investigate the causes of disease-modifying antirheumatic drugs (DMARDs) discontinuation and treatment failure and multiple failure for inefficacy, and to identify possible failure predictors’ according to RA patient characteristics in a real-world setting. Methods 718 RA patients were retrospectively evaluated. Conventional synthetic (cs) and biologic (b)DMARDs treatments line/s, effectiveness, and reasons of discontinuations were evaluated. Patients failing to at least two csDMARDs or bDMARDs’ drug for inefficacy were defined “csDMARDs multifailure” and “bDMARDs multifailure”, respectively. Discontinuation of at least two cs- and bDMARDs was termed “global multifailure”. Results In total, 1422 csDMARDs and 714 bDMARDs treatment were analysed. Causes of csDMARDs discontinuation were intolerance (21.8%), inefficacy (20.2%), acute adverse reactions (5.3%) and severe infections (0.6%) while csDMARDs multifailure for inefficacy was observed in 5.7% of cases. Reasons of bDMARDs withdrawal were inefficacy (29%), intolerance (10.0%), acute adverse reaction (6.3%) and severe infections (1.5%). Altogether, 8.4% of patients were bDMARDs multifailure for inefficacy while 16.6% were global multifailure. Longstanding disease (≥ 12 months) and smoke habit, resulted as positive predictor of csDMARDs failure (OR 2.6 and OR 2.7, respectively). Thyreopathy was associated with both csDMARDs failure and global multifailure (OR 2.4 and OR 1.8, respectively). Higher prevalence of failure to at least one bDMARDs and global multifailure was detected in female than male (OR 2.3 and OR 2, respectively). Conclusions Different causes of drug discontinuation were observed on DMARDs treatments. Demographic and clinical features were identified as possible predictors of both cs- and bDMARDs treatment failure and multiple failure, underlining the need of a more personalized therapeutic approach to achieve treatment targets.

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy typically associated with psoriasis (PsO). The pathogenesis is strictly related to the association among the presence of genetic risk alleles and innate and acquired immune response with dramatic consequences on bone remodeling. Clinically, PsA patients may present heterogenicity of articular and periarticular manifestations that may be associated with the presence of comorbidities making treatment decision challenging in patients management. The identification of patient-targeted therapies is still a critical issue. Actually, several biological and synthetic drugs are promising in terms of efficacy and safety profile. National and international treatment recommendations support clinicians in the decision of the best treatment, although they may have limits basically related to updates and different outcomes included in the clinical studies evaluated. The aim of this narrative review is therefore to give guidance for clinicians for PsA patients treatment. For this purpose, we evaluated evidence on biological therapies efficacy used for PsA treatment. Specifically, we reviewed data on biological therapies, Janus kinases (JAK) inhibitors, and drugs with a new mechanism of action that are part of the treatment pipeline. The concept of "switching" and "swapping" is also described, as well as data concerning special populations such as pregnant women and elderly patients.

Long-term quality of life (QoL) is significantly compromised in patients with psoriatic arthritis (PsA) and only partially improves achieving remission or low disease activity. The main aim of this study is to evaluate the QoL in PsA patients and to investigate their possible relationship with clinical remission and low disease activity, and with its duration over time.A multicentre cross-sectional observational study has been performed. QoL domains considered were analysed through PROs. Chi2 test was used for analysis of contingency tables, while Mann-Whitney test and Kruskal-Wallis test with Holm's pairwise comparison corrections were used to compare ranks. To evaluate variables associated to the different QoL domains, univariate and multiple linear regressions were used.143 participants were included in this study. The physical component of the Short Form-36 or Functional Assessment of Chronic Illness Therapy-Fatigue tends to improve with short duration of low or minimal disease activity. However, this is not confirmed for the mental component of SF-36 (MCS), which improved only with longer duration of low/minimal disease activity.This study proves the existence of an inverse relation between disease activity and QoL domains. Apart from low or minimal disease activity, also its persistence over time has a great influence on the patient's perception of their clinical condition; therefore, persistence over time of clinical remission/low disease activity should be added to the latest definition of treat-to-target in PsA.

Background Enteropathic Spondyloarthritis (ESpA) belongs to the group of Spondyloarthritis (SpA) tipically associated with inflammatory bowel disease (IBD) as Crohn9s Disease (CD) and Ulcerative Colitis (UC). Joint pain is the most common (22–33%) and significant extra-intestinal manifestation in patients with IBD and its management requires reumatological and gastroenterological competence in collaboration. No data concerning the Health-related quality of life (HRQoL) have been evaluated in patients affected by ESpA. Objectives Prospective study was performed in a combined GastroIntestinal and RHEumatologic “GI-Rhe” clinic, in order to evaluate: 1) prevalence and characteristics of articular manifestations in a group of IBD patients; 2) quality of life, state of health and well-being in ESpA patients. Methods Patients affected by IBD who presented muscolo-skeletal pain between February 2013 and September 2016 (CD 264 and UC 142) were enrolled. New diagnosis, disease management, adverse events as well as laboratory evaluations were assessed every 3 months during the follow-up. Disease activity, function and quality of life in ESpA patients were assessed by ASDAS-CRP, HAQ-S and EuroQol questionnaire. Results A total of 427 patients were evaluated for joint involvement (Table 1). The prevalence of SpA in IBD patients was 49.6% (n=212: UC 71 (43.3%), CD 141 (53.4%)), suggesting that the majority of patients with IBD who complain arthralgia may have a concomitant SpA. Other rheumatologic diseases were detected in the study population in 215 patients defined as IBD non-SpA. There was a significantly higher prevalence of active intestinal disease in patients with SpA with respect to IBD-non SpA (CD: CDAI>150 in 18.4% vs 8.2% p=0.004; UC: Mayo score >3 in 15.5% vs 0%, p=0.0004). The evaluation of the EuroQoL demonstrated a mean value of 0.59 in IBD-SpA patients and of 0.55 in IBD non-SpA (Figure 1A). In IBD-SpA, the health related status was: decent 69.8%, good 17.9% and bad 9.4%. In IBD-non SpA, the health related status was: decent in 74.8%, good in 17.7% and bad in 7% of patients. In both groups, none of the patients had a neither exceptional nor great perception of QoL. No significant differences were observed between the two groups (Figure 1B-C). Conclusions The joint clinic facilitates diagnosis and management of SpA and IBD. Although IBD-SpA patients showed higher IBD disease activity than IBD-non SpA one, both groups of patients have a good health related QL. Disclosure of Interest None declared

Golimumab is a fully human monoclonal antibody against tumor necrosis factor (TNF) approved for the treatment of ulcerative colitis and not for Crohn disease (CD). Many CD patients experience primary, secondary failure, or intolerance to other TNF inhibitors (TNFi) approved in Italy for CD (adalimumab and infliximab). Spondyloarthritis (SpA) may be associated with CD (enteropathic, ESpA) in up to 50% of patients requiring a multidisciplinary and tailored approach. However, only few data from literature and no formal trials determined the efficacy and safety of golimumab in ESpA patients. We performed a case series on 12 patients affected by active CD and active ESpA were failure or intolerant to previous TNFi approved in Italy for both SpA and CD, infliximab and adalimumab. Golimumab was administered following rheumatologic dosage (subcutaneous 50 mg monthly; 100 mg monthly for patients ≥100 kg). Gastrointestinal and rheumatologic disease activity was evaluated with a follow-up of 2 years. A total of 9 patients were followed for 2 years of golimumab treatment. CD clinical activity ameliorated as shown by the reduction of Harvey-Bradshaw index and Crohn disease activity index (CDAI) at 12 and 24 months of treatment (P = .03 and P = .04, respectively) associated with reduction of C-reactive protein at 12 and 24 months (P = .04 for both comparisons) of treatment. SpA assessment revealed a significant reduction in tender joint count at 6 (P = .03), 12 (P = .03), and 24 months (P = .007) of treatment. Swollen joint count, pain, SpA disease activity, and disability reduced in several patients during the follow-up. No adverse events were registered in the follow-up. We demonstrate good clinical efficacy and safety profile of both gastrointestinal and rheumatologic involvement. This may indicate promising therapeutic option for ESpA patients affected by CD, and non-responsive to other TNFi.

Rheumatoid arthritis (RA) and autoimmune thyroid disease (AITD) can occur in the same patient in the autoimmune polyglandular syndrome 2. The association of the two conditions has been recognized long-time ago and the prevalence of AITD in patients with RA and vice versa is well assessed. Geographical variation of AITD and related autoantibodies in RA patients is partly due to ethnic and environmental differences of the studied populations. The impacts of thyroid disorders on RA outcome and vice versa are still controversy. In both AITD and RA genetic susceptibility and environmental factors play a synergic role in the development of the diseases. In this review we aimed at investigating the association of AITD and thyroid autoantibodies with RA, the common pathogenic pathways, the correlation with RA disease activity, and influence of the treatment.

Background:Enteropathic Spondyloarthritis (ESpA) belongs to the group of Spondyloarthritis (SpA) typically associated with inflammatory bowel disease (IBD). SpA are divided into axial (ax) or peripheral disease. Ax-SpA are classified as ankylosing spondylitis (AS) and non-radiographic (nr-) axSpA based on the presence or absence of definite structural changes in conventional radiographs (CR).Objectives:Aim of this study was to determine whether comorbidities and gender could lead to a different response rate to TNF-inhibitors (TNFi) in ESpA patients.Methods:ESpA patients treated with TNFi [adalimumab (ADA) or infliximab (IFX)] were retrospectively evaluated between November 2018 and October 2020 and divided in two cohort according to gender. In addition, TNFi treatments line/s, effectiveness and reasons of discontinuations, as inefficacy, intolerance, acute adverse reaction, development of infections and other causes, were evaluated at baseline (T0), at 6 (T6), 12 (T12), and 24 (T24) months of therapy. Patients who were failure to at least two TNFi were considered as “multifailure”. Statistical analyses were performed using chi square/Fisher tests and variance analysis (SPSS software).Results:120 ESpA patients (M 40.52%; F 40.18%) treated with TNFi were evaluated. Clinical and laboratory baseline (T0) characteristics are summarized in Table 1. AS subtype was more common in men (39.5%) than in woman (14.3%) (p=0.03). Concerning comorbidities, hypertension and anemia were more prevalent in men than women (25% vs 9%, p=0.01; 11.6% vs 1.3%, p=0.02, respectively), while thyreopathy and psychiatric disorders were more common in female than male (11.7% vs 0%, p=0.02; 16.9% vs 4.6%, p=0.04, respectively). No difference was observed between genders in distribution of BMI, smokers, disease duration, HLAB27 positivity and presence of extra-articular manifestations. 202 TNFi treatments (50.9% ADA and 24.3% IFX) were evaluated in 120 patients [74 treatments (36.6%) in 43 men; 128 treatments (63.4%) in 77 women]. Considering treatment effectiveness, higher prevalence of failure was observed in woman that in men (67.2% vs 39.2%, p=0.0005). Moreover, women with psychiatric disorders undergone more lines treatment that men (16.8% vs 4.6%, p=0.01, OR=4). On the other hand, men with hypertension, were more multifailure compared with women (25.6% vs 16.3%, p=0.001, OR=3). No other differences according to gender were found.At T6, 7.5% of patients (n=9) had acute adverse reaction (n=1 with ADA; n=8 with IFX); at T12, 14.2% of patients (n=17) had IBD inefficacy. At T24, secondary inefficacy on IBD and/or SpA was the main cause of TNFi discontinuation compared with other causes (58.4% vs 41.6%; p=0.04), mostly in female cohort (40% vs 20% in woman; p=0.04). Analyzing TNFi effectiveness, CRP and HAQ improvement was noted at T6 (p=0.024 and 0.036, respectively), as ASDAS-CRP and BASDAI (p=0.02 and p=0.013, respectively) and maintained in the following evaluations at T12 and T24. At T24, men shown higher PCR and BASDAI improvement compared with women (p=0.036 and p=0.04, respectively).Conclusion:Data suggest that gender and comorbidities could influenced TNFi response in ESpA patients, advising differences among woman and men. Knowledge of these variable represents a major challenge for a personalized treatment management.Disclosure of Interests:None declared.

Background:Micronutrient deficiencies (MNDs) are common among patients with chronic inflammatory diseases. These are associated with a pro-inflammatory status and co-morbidities, and influenced by several factors, such as age and gender.Objectives:No any study has investigated MNDs and their correlation with gender in Spondyloarthritis (SpA). With this purpose, this study analyzed the occurrence of anemia and the status of ferritin (Fe), vitamin D [25(OH)D], vitamin B12 (B12), and folic acid (FA) in a cohort of patients with SpA.Methods:Levels of Hb, Fe, 25(OH)D, B12, FA, were evaluated in 220 SpA outpatients (137 females and 83 age-matched males) with Psoriatic arthritis (PsA, n=110) and SpA (n=110). Disease activity was assessed by DAPSA or ASDAS-CRP as appropriate and functional status was evaluated with HAQ score. Body Mass Index (BMI) was selected as a metabolic clinic parameter.Results:Male and female patients were similar for disease duration and severity as well as the distribution of diagnosis and treatments (Table 1). In males, BMI was higher than in females (P=0.03) and positively correlated with the age (P=0.01). In female patients, BMI directly correlated with HAQ (P=0.03). The prevalence of anemia (HbTable 1.Data from the study population.Females (n=137)Males (n=83)PAge (yrs; §)51.65 ± 1352.9 ± 12.8NSBMI (*)24 [17.2 - 50.2]25.8 [19.6 - 43.6]< 0.05CRP (mg/l; *)2.9 [0 - 53]2 [0 - 61]NSHb (g/dl; §)13 ± 1.214.4 ± 1.4NSFe (mg/l; *)37 [2 - 148]64 [4 - 452]< 0.0525(OH)D (ng/ml; *)28.2 [5 - 67]25 [5 - 50]< 0.05Vitamin B12 (pmol/l; *)350 [60 - 990]313 [47 - 797]NSFolic Acid (ng/ml; *)7 [1.7 - 40]6.9 [1.8 - 39]NSPsA (N/%)73/68.2334/31.77NSSpA (N/%)64/4149/59NSConcomitant IBD (n/%)56/65.929/34.1NSDisease duration (months; *)69 [6 - 540]76.5 [3 - 768]NSLow D.A. (N/%)62/45.2547/56.6NSModerate-high D.A. (N/%)75/54.7536/43.4NSCOXIB-inhibitors (N/%)21/15.48/9.6NScDMARDs monotherapy (N/%)35/25.510/12NSbDMARDs (N/%)81/59.1265/78.4NSBMI, body mass index; CRP, C-reactive protein; Hb, haemoglobin; Fe, ferritin; 25(OH)D, vitamin D; PsA, psoriatic arthritis; SpA, spondyloarthritis; IBD, inflammatory bowel disease; D.A., disease activity; cDMARDs, conventional Disease Modifying Antirheumatic Drugs; bDMARDs, biological DMARDs; § mean ± SD; * median [min-max].Conclusion:Our study describes for the first time the possibility of a relevant prevalence of MNDs in SpA patients. Furthermore, we show that MNDs could be also influenced by gender difference and age. Of note, our findings highlight the importance of a screening focused on MNDs in SpA patients. This could be key in optimizing management of SpA patients, in which inflammatory-dependent dysmetabolism is frequent.References:[1]Yamamoto EA, Jørgensen TN. Relationships Between Vitamin D, Gut Microbiome, and Systemic Autoimmunity. Front Immunol. 2020;10:3141.[2]Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12:2097.[3]Bañuls-Mirete M, Ogdie A, Guma M. Micronutrients: Essential Treatment for Inflammatory Arthritis? Curr Rheumatol Rep. 2020;22:87.Disclosure of Interests:None declared.

Background:Psoriatic arthritis (PsA) treatment paradigm has dramatically change during the last 15 years, improving patients clinical outcomes and quality of life. We have now the possibility of a wide option among bDMARDs with different targets: TNF-inhibitors (TNFi), anti-IL17A inhibitors and anti-p40IL12/23. However, the choice of the “best” treatment in PsA patients is still a challenge in our daily clinical practice, making treatment decision a tricking issue.Objectives:Aim of the study was to retrospectively evaluate the distribution of clinical PsA subtypes and comorbidities among bDMARDs treated patients in the last 15 years in a monocentric cohort of the Rheumatology Unit, University of Rome Tor Vergata.Methods:Patients affected by PsA diagnosed by the CASPAR criteria and treated with a bDMARDs, in the last 15 years were enrolled. Clinical assessment included the presence of: oligo and/or polyarthritis and axial involvement (yes/no), enthesitis (yes/no), dactylitis (yes/no), PsO and onychopathy (yes/no). Comorbidities, as cardiovascular, metabolic syndrome and kidney diseases, were registered. The overall timeframe was halved in: 1st period (2004-2011) and 2nd period (2012-2019). Chi-square test was used to analyze the distribution of clinical PsA subtypes and comorbidities.Results:Data from 314 consecutive PsA patients treated with bDMARDs were obtained (Table 1). A total of 259 (82,48%) patients were treated with TNFi, while 55 (17,52%) with non-TNFi (i.e. Secukinumab, Ustekinumab or Apremilast). In the 1st period, 143 (86,14%) patients were treated with TNFi and 23 (13,85%) with non-TNFi; in the 2nd period, 116 (78,4%) patients were treated with TNFi and 32 (21,2%) with non-TNFi. PsA patients with polyarticular involvement were on TNFi in a higher prevalence in the first period than in the second (pConclusion:Here, we demonstrated that clinicians treatment choice in patients with moderate-severe PsA may be influenced by the clinical subtype and/or the occurrence of comorbidities. In particular, during the last years, the use of non-TNFi can be chosen more adequately as a therapeutical challenge in patients with different clinical manifestations and with comorbidities, improving PsA treatment paradigm.Table 1.Clinical characteristics of patients enrolled.TNFiNon-TNFi2004-20112012-20192004-20112012-2019F (N)104681622M (N)533498Total, divided for period1571022530Total, divided for drugs25955F/M (%)66/3467/3364/3673/27Age, years55,4±13,0956,28±11,3454,80±12,5657,44±11,15Disease duration, months156±106,03162,69±101,65172,87±108,53167,2±108,89Age of onset, years42,57±13,0041,73±12,1342,065±15,3345,8±13,6Age of diagnosis, years44,74±12,9843,35±11,2543,4±14,3346,8±15,98Diagnostic delay, months72±34,6812±8,526,73±10,6427±15,12Disclosure of Interests:None declared

Background:Diagnostic delay of spondyloarthritis (SpA) has been established even in combination with inflammatory bowel disease and may contribute to radiographic progression and disability.Objectives:We aimed to evaluate diagnostic delay in enteropathic SpA (eSpA) and explore associated demographic, clinical, and radiographic characteristics.Methods:We analysed consecutive eSpA patients referred to the combined gastro-rheumatologic clinic of the University of Rome Tor Vergata. Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac (SI) joints and spine were performed in axial (ax)SpA patient and examined by two independent radiologists. MRI were assessed for the presence of active/chronic inflammatory lesions, disease activity by ASDAS and inflammatory markers. Statistical analyses were performed using Mann-Whitney, chi square/Fisher tests and covariance analysis (SPSS software).Results:190 eSpA patients (124 female, mean age 47.5±12.8 years, disease duration 72±67.4 months, 73 UC/117 CD; 118 peripheral SpA, 72 axSpA including 44 non radiographic (nr)-axSpA) were evaluated. Axial eSpA patients had a higher prevalence of men sex (pMedian diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Rad-ax-SpA patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 vs 31/10-57 months, p=0.03). Patients with rad-axSpA were older and with longer disease duration than patients with nr-axSpA (p=0.005 and p=0.019). Low education status and high rate of employment were found in rad-axSpA compared with nr-axSpA (p=0.003 and p=0.03, respectively).Rad-axSpA patients with sclerosis, syndesmophytes and bridge at CR had a higher diagnostic delay than those without lesions (p=0.03, p=0.043, pFigure 1.Conclusion:Demographic and clinical factors differentiate axSpA from nr-axSpA patients. Diagnostic delay was higher in rad-axSpA compared with nr-axSpA despite the same treatment. Some lesions of spine/SI at CR and MRI, and psoriasis, were mostly associated with diagnostic delay and sex.Disclosure of Interests:None declared

Background:Psoriatic arthritis (PsA) is a chronic immune-mediated disease associated with psoriasis (PsO). Overexpression of inflammatory cytokines such as tumor necrosis factor (TNF)-α plays a key role in the pathogenic mechanisms. Golimumab (GLM) is a fully human monoclonal antibody IgG1k neutralizing TNF-α approved for PsA and PsO, but effectiveness evaluation in real life remains a crucial issue.Objectives:In a real-life setting, to determine the survival rate of GLM (drug survival) at 48 months in the global population, in different clinical settings, and the effectiveness of GLM in improving joint symptoms and cutaneous manifestations in patients affected by moderate to severe PsA with cutaneous involvement.Methods:We collected retrospectively from 1 January 2014 to 31 December 2019 data from 105 patients affected by PsA, according to the Classification for Psoriatic Arthritis (CASPAR) criteria, who started treatment with GLM. Inclusion criteria were age > 18 years and had a diagnosis of PsA > 6 months, the presence of peripheral arthritis (at least one active joint) and active PsO. Relevant anamnestic, clinical, biochemical data and biological treatment line were collected at baseline (T0) and after 6 (T6), 12 (T12), 24 (T24) and 48 (T48) months of GLM treatment. Comparisons between baseline and 48 months continuous variables were performed using a paired t-test or a Wilcoxon signed-rank test for paired samples. The drug survival rates were analyzed using Kaplan-Meier estimates. Drug survival rates were read from the Kaplan-Meier survival curves. Differences in drug survival between groups were analyzed using a log-rank (Mantel-Cox) test, by stratifying for sex, BMI, smoking habit and line of treatment. A p-value Results:Peripheral arthritis was present in 67 (63.8%) cases, axial disease in 37 (35.3%), enthesitis and PsO as prominent manifestations in 82 (78%) and 84 (80%) patients respectively. Erosive disease was present in 38 (36.2%) of patients at baseline. The most frequent comorbidities were MetS described in 20 (19%) patients and cardiovascular disease described in 33 (31.4%) patients, probably due to the high incidence of smokers (33 (31.4%) of patients) and to the elevate BMI score (27.1±6.0). At 48 months, the 42% (44 of 105) (figure 1A) of the patients have discontinued therapy; the most frequent reason was insufficient response/loss of efficacy (30 patients (28.6%) out of 105). Unexpectedly, no statistical significant difference emerged according to gender (p=0.652), BMI (p=0.655), smoking habit (p=0.466) and line of treatment (p=0.208) (figure 1B-E). Finally, the effectiveness of GLM in improving joint symptoms and cutaneous manifestations was confirmed once again, with a statistical significant improvement at 48 months in clinical (BASDAI pConclusion:This multicentric study revealed a high drug persistence of GLM in real-life patients, although the presence of comorbidities. Unlike what is known in literature, our study population presented no differences in terms of clinical response and efficacy between male and female, smokers and no-smokers, obese and health-weight patients, different line of treatment. On the other hand, efficacy and safety of GLM has been demonstrated once again also in real-life treatments.References:No references.Disclosure of Interests:giulia lavinia fonti: None declared, Maria Sole Chimenti: None declared, Arianna D’Antonio: None declared, miriam teoli: None declared, Francesco Caso: None declared, Luisa Costa: None declared, marco tasso: None declared, Augusta Ortolan: None declared, Mariagrazia Lorenzin: None declared, Paola Conigliaro: None declared, paola triggianese: None declared, Raffaele Scarpa: None declared, Roberto Perricone: None declared, Roberta Ramonda Speakers bureau: Novartis, Celgene, Janssen, Pfizer, Abbvie, Lilly