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Background: The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Objective: The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS. Methods: Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets. Results: All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions. Conclusion: Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.

BackgroundRheumatoid arthritis (RA) guidelines recommend methotrexate (MTX) as anchor therapy in combination with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). However, its tolerability is challenging with a significant proportion of patients not adhering to their prescribed MTX regimen following b/tsDMARD initiation. Rates of MTX tapering and withdrawal have been reported elsewhere but Canadian data are lacking.ObjectivesThis multi-centre, retrospective chart-based cohort study assessed the frequency of MTX withdrawal or tapering following initiation of a b/tsDMARD in Canadian adults with RA.MethodsPatients were eligible if they received MTX for ≥3 months before initiation of a b/tsDMARD that was then prescribed continuously for ≥18 months and was initiated in combination with MTX. Patients taking oral prednisone or equivalent at a dose >10 mg per day, and those whose b/tsDMARD was prescribed prior to 2014, were excluded.ResultsData from 889 patients were included in the analysis. Mean age was 50.6 years and 72.6% were female. Mean time since diagnosis was approximately 8 years. Of the 46.1% of patients with a documented assessment of disease status at baseline, 62.7% of patients had high disease activity. Baseline mean (SD) MTX dose was 18.9 (6.63) mg/week, administered orally (57.4%), subcutaneously (41.3%), or intramuscularly (1.2%). Overall, 270 (30.4%) patients either tapered (123, 13.8%) or discontinued (147, 16.5%) their MTX within 2 years of initiating the b/tsDMARD. Methotrexate dose was unchanged for 582 (65.5%) subjects and increased for 37 (4.2%) subjects. The prescribed b/tsDMARD was most often a tumor necrosis factor inhibitor (TNFi,52.1%), followed by a Janus kinase inhibitor (JAKi, 18.3%), other modes of action (OMA) which included abatacept and rituximab (17.7%) and interleukin-6 inhibitor (IL-6i, 11.9%). The b/tsDMARD type with the highest frequency of MTX Taper or Discontinued was IL-6i (37 patients, 34.9%) followed by TNFi (144 patients, 31.1%), JAKi (47 patients, 28.8%) and OMA (44 patients, 28.0%). In the MTX Discontinued group, the most common reasons for MTX discontinuation were patient decision (27.2%) and adverse events (24.5%). In the MTX Tapered group, the most common reasons for MTX dose change were planned tapering (36.6%) and adverse events (29.3%). In the MTX Increased group, insufficient clinical response (73.0%) was the most common reason provided for MTX dose change. Baseline factors associated with MTX dose discontinuation and tapering by multiple logistic regression were a shorter time since diagnosis (Odds ratio [OR]: 0.981; 95% confidence interval [CI]: 0.964 – 0.999. P=0.0401), use of non-DMARD medications excluding steroids (OR: 0.683; 95%CI: 0.503 – 0.929. P=0.0150) and a greater number of comorbidities (OR: 1.054; 95%CI: 1.001 – 1.110. P=0.0444). The mean (SD) weekly MTX dose at the end of the data extraction period was 14.13 (4.81) mg for the MTX Tapered group, with 109 (88.6%) subjects taking a weekly MTX dose ≥10 mg. In the MTX Increased group the mean (SD) weekly MTX dose was 22.3 (3.74) mg. Interpretation of the effect of MTX dose on disease activity, fatigue, pain and functional status is challenging due to missing data, but most patients in all 4 groups transitioned to low disease activity or remission during the study period.ConclusionMethotrexate withdrawal or tapering occurred in 30.4% of Canadians with RA within two years following b/tsDMARD initiation. There was no evidence of worsening disease activity in these patients. These proportion of Canadian RA patients who reduce or discontinue MTX after the initiation of a ts/bDMARD are generally consistent with those reported in other regions of the world.AcknowledgementsAbbVie Corp. funded the research for this study and provided writing support for this abstract. AbbVie participated in the study design; study research; collection, analysis, and interpretation of data; and writing, reviewing, and approving this abstract for submission. All authors had access to the data; participated in the development, review, and approval of the abstract; and agreed to submit this abstract to EULAR 2022.AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. Medical writing support was provided by John Howell PhD of McDougall Scientific and funded by AbbVie, Inc.Disclosure of InterestsLouis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Lilly, Novartis, Sanofi, Sandoz, Gilead, Fresenius Kabi, Consultant of: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Lilly, Novartis, Sanofi, Sandoz, Gilead, Fresenius Kabi, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Lilly, Novartis, Sanofi, Sandoz, Gilead, Fresenius Kabi, Brandusa Florica Speakers bureau: AbbVie, Amgen, Lilly, Pfizer, Janssen, Novartis, Merck, Consultant of: AbbVie, Amgen, Lilly, Pfizer, Janssen, Novartis, Merck, Grant/research support from: AbbVie, Amgen, Lilly, Pfizer, Janssen, Novartis, Merck, Pierre-André Fournier Shareholder of: AbbVie, Employee of: AbbVie, Tanya Girard Shareholder of: AbbVie, Employee of: AbbVie, Latha Naik Speakers bureau: AbbVie, Consultant of: AbbVie, Grant/research support from: AbbVie, Dalton Sholter Speakers bureau: AbbVie, Amgen, BMS, Celgene, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, UCB, Philip Baer Speakers bureau: Abbvie, Amgen, Lilly, Pfizer, Janssen, Teva, Fresenius Kabi, Viatris, Opticann, Novartis, Organon, Gilead, Celltrion, Astra Zeneca, GSK, Consultant of: Abbvie, Amgen, Lilly, Pfizer, Janssen, Teva, Fresenius Kabi, Viatris, Opticann, Novartis, Organon, Gilead, Celltrion, Astra Zeneca, GSK, Grant/research support from: Abbvie, Amgen, Lilly, Pfizer, Janssen, Teva, Fresenius Kabi, Viatris, Opticann, Novartis, Organon, Gilead, Celltrion, Astra Zeneca, GSK

ObjectivesThe objectives of this study were to describe the demographic profile and baseline disease characteristics of patients with psoriatic arthritis (PsA) treated with either infliximab (IFX), subcutaneous golimumab (GLM) or ustekinumab (UST) treatment in Canadian routine care setting along with assessing long-term effectiveness and safety.MethodsPatients with PsA were enrolled into the Biologic Treatment Registry Across Canada registry (ClinicalTrials.gov Identifier: NCT00741793) from 2005 to 2017. The study visits occurred at study enrolment (baseline) and every 6 months thereafter. Effectiveness was assessed by changes in disease parameters (joint counts, Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire, patient/physician global, minimal disease activity, enthesitis, dactylitis, erythrocyte sedimentation rate, C reactive protein). Improvements from baseline were explored with the paired t-test and the McNemar’s test. Safety was evaluated by assessing the incidence of adverse events (AEs) and drug survival rates.ResultsA total of 111 IFX-treated, 281 GLM-treated and 70 UST-treated patients were enrolled. Most baseline disease parameters remained similar over time in all three cohorts. UST-treated patients had lower mean baseline Disease Activity Score in 28 joints CRP, swollen joint based on 28 joints and higher PASI compared with patients treated with GLM. Treatment with IFX, GLM and UST was associated with significant improvements in all disease parameters over time (pAEs were reported for 74.8%, 69.8% and 52.9% (138, 114 and 115 events/100 patient-years (PYs)) covering 325, 567 and 87 years of exposure for IFX-treated, GLM-treated and UST-treated patients, respectively. Severe AEs were reported in 19.8%, 8.5% and 5.7% (8.8, 7.2 and 8.0 events/100 PYs) in IFX-treated, GLM-treated and UST-treated patients, respectively. The proportion of patients who discontinued treatment were 63.1%, 50.9% and 50.0%, respectively.ConclusionsIFX, GLM and UST treatment significantly reduced disease activity and improved functionality in patients with PsA followed by routine clinical practice and had a safety profile similar to that previously reported in the literature.Trial registration numberNCT00741793.

Background Long-term registries are essential to evaluate new therapies in a patient population that differs from clinical trial and usually varies over time. Objectives To describe the profile of ankylosing spondylitis (AS) patients treated with infliximab (IFX) or golimumab (GLM) treatment in Canadian routine care along with its long-term effectiveness and safety. Methods 810 aS patients treated with IFX or GLM were enrolled into the Biologic Treatment Registry across Canada (BioTRAC) registry between 2005-2015 and 2010-2017, respectively. Study visits occurred at baseline and every 6 months thereafter, as needed per routine care. Effectiveness was assessed with changes in aSDAS, BASDAI, BASFI, MDGA, HAQ-DI, PtGA, back pain and acute phase reactants. Safety was evaluated with the incidence of adverse events (AEs) and drug survival rates. Results Of the 389 IFX- and 421 GLM-treated patients, the proportion of males were 62.7% and 59.1%, the mean age were 45.6 and 45.7 years and the mean disease duration were 8.6 and 6.0 years, respectively. Most patients were bio-naive (>82.7%). Interestingly, we observed a significant decrease in disease duration in the IFX cohort from a median of 8.0 to 3.5 and 1.0 years in 2005-2008, 2009-2012 and 2013-2015, respectively (p Treatment with both IFX and GLM significantly improved all disease parameters over time (P AEs were reported for 67.9% and 70.5% (136 and 131 events/100 PYs) and SAEs for 15.4% and 8.1% (10.5 and 22.7 events/100 PYs) covering 1251.3 and 674.8 years of exposure for IFX- and GLM-treated patients, respectively. The most frequently occurring aEs (>7% of patient in either group) were upper respiratory tract infection, arthralgia and back pain. Two deaths occurred in IFX-treated patients (myocardial infarct, drowning) and two among GLM-treated patients (oropharyngeal cancer; neutropenia, staphylococcal/pseudomonas infections, septic shock). The proportion of patients who discontinued treatment were 65.8% over a mean 3.2 years of exposure in the IFX cohort and 56.8% over 1.6 years in the GLM cohort. Conclusion Both IFX and GLM treatment significantly reduced disease activity and improved functionality in a similar fashion and were well tolerated in patients with aS. Differences in baseline characteristics over time demonstrate improvement in early diagnosis of aS and earlier access to biologic therapies. Disclosure of interests Proton Rahman: None declared, Derek Haaland Grant/research support from: Janssen Sponsored Study, Dalton Sholter Grant/research support from: Janssen Sponsored Study, Michael Starr: None declared, arthur Karasik: None declared, Michelle Teo Grant/research support from: Janssen Sponsored Study, Sanjay Dixit Grant/research support from: Janssen Sponsored Study, Consultant for: Janssen, Speakers bureau: Janssen, ariel Masetto Grant/research support from: amgen, Sanofi, Consultant for: Sanofi, Pfizer, Bristol-Myers Squibb, Novartis, Boehringer ingelheim, Speakers bureau: Novartis, anna Jarosynska Grant/research support from: Janssen Sponsored Study, Pauline Boulos Grant/research support from: Janssen Sponsored Study, Maqbool Sheriff Grant/research support from: Janssen Sponsored Study, Jacqueline Stewart Consultant for: Pfizer, abbvie, amgen, Celgene, Roche, Novartis, Merck, Emmanouil Rampakakis : None declared, Odalis asin MIilan Employee of: Employee of Janssen, allen Lehman Employee of: Employee of Janssen, Meagan Rachich Shareholder of: Janssen, Employee of: Employee of Janssen, Francois Nantel Shareholder of: Janssen, Employee of: Employee of Janssen

Objective.To determine the proportion of patients with rheumatoid arthritis (RA) under rheumatologic care treated with disease-modifying antirheumatic drugs (DMARD) within 6 months from symptom onset and the components of time to treatment and its predictors.Methods.A historical inception cohort of 339 patients with RA randomly selected from 18 rheumatology practices was audited. The proportion that initiated DMARD treatment within 6 months from symptom onset was estimated using Kaplan-Meier analysis. Time to each component of the care pathway was estimated. Multivariable modeling was used to determine predictors of early treatment using 12 preselected variables available in the clinical charts. Bootstrapping was used to validate the model.Results.Within 6 months from symptom onset, 41% (95% CI 36%−46%) of patients were treated with DMARD. The median time to treatment was 8.4 (interquartile range 3.8−24) months. Events preceding rheumatology referral accounted for 78.1% of the time to treatment. The most prominent predictor of increased time to treatment was a concomitant musculoskeletal condition, such as osteoarthritis or fibromyalgia. The significance of other variables was less consistent across the models investigated. Included variables accounted for 0.69 ± 0.03 of the variability in the model.Conclusion.Fewer than 50% of patients with RA are treated with DMARD within 6 months from symptom onset. Time to referral to rheumatology represents the greatest component delay to treatment. Concomitant musculoskeletal condition was the most prominent predictor of delayed initiation of DMARD. Implications of these and other findings warrant further investigation.

Background The Health Assessment Questionnaire (HAQ) remains the gold standard for measuring patient-reported functional status in rheumatoid arthritis (RA) and is included among the measures suggested by the American College of Rheumatology for making treatment decisions in routine care. We have previously shown that significant variability exists in the correlation of individual HAQ questions with patient-reported and clinical outcomes. Objectives The aim of this analysis was to assess, in routine care, the timelines of HAQ improvement as compared to clinical improvement and to examine possible differences in the improvement of individual questions. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis, or psoriatic arthritis with infliximab (IFX) or golimumab (GLM). Eligible people for this analysis included RA patients treated with IFX who were enrolled since 2002 or with GLM enrolled since 2010. Time to achieving minimal important difference (MID; Δ≥0.22) in HAQ, HAQ≤1, minimal disease (MD) in individual HAQ questions (no or some difficulty), CDAI low disease activity (LDA), or CDAI remission was assessed with the Kaplan-Maier estimator of the survival function and cox regression. Results 1205 patients (75.3% female) were included with mean (SD) age of 56.0 (13.6) years and disease duration of 8.4 (8.9) years at baseline. Mean (SD) HAQ and CDAI were 1.55 (0.72) and 33.8 (17.4), respectively. Statistically significant and clinically meaningful improvements in both HAQ and CDAI were observed over time. The cumulative probability of achieving HAQ MID, HAQ≤1, CDAI LDA, and CDAI remission by 12 months was 69.5%, 54.5%, 54.1%, and 18.1%, respectively. Time to achieving HAQ MID [Hazard Ratio (95% CI): 3.6 (3.2–4.2)], HAQ≤1 [2.9 (2.6–3.4)], and CDAI LDA [3.1 (2.7–3.6)] was significantly lower as compared to CDAI remission. With respect to individual HAQ questions, at baseline, the most predominant usual activities that patients were unable to do were taking a tub bath (27.9%), reaching and getting down a 5-pound object from the head (21.8%), and doing chores such as vacuuming or yard work (23.2%). In accordance, time to having no or some difficulty in these activities was significantly higher compared to the remaining HAQ items. Conclusions The results of this analysis show that the timelines for achieving HAQ targets in routine care is comparable to that of achieving CDAI LDA. Significant differences were observed in terms of improvement in individual HAQ items with the inability to take a tub bath, getting heavy overhead objects down, and doing chores being the most persistent. Disclosure of Interest R. Arendse: None declared, B. Haraoui: None declared, D. Choquette: None declared, J. Kelsall: None declared, P. Baer: None declared, D. Sholter: None declared, W. Bensen: None declared, M. Bell: None declared, M. Teo: None declared, E. Rampakakis: None declared, E. Psaradellis: None declared, B. Osborne Employee of: Janssen Inc., C. Tkaczyk Employee of: Janssen Inc., K. Maslova Employee of: Janssen Inc., F. Nantel Employee of: Janssen Inc., A. Lehman Employee of: Janssen Inc.

Background Recent treat-to-target guidelines in PsA recommend that minimal disease activity (MDA) is achieved as early as possible. Patient reported outcomes (PROs) have been criticized for not accurately assessing PsA disease activity as they may reflect aspects not directly related to PsA such as fibromyalgia, depression or other comorbidities. Objectives The aim of this analysis was to assess the proportion of patients failing to achieve MDA based on PROs in a real-world, routine clinical care setting in Canada. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis, ankylosing spondylitis, or PsA with infliximab (IFX) or golimumab (GLM). Eligible participants for this analysis included those with PsA treated with IFX who were enrolled since 2005 or with GLM enrolled since 2010 and with available MDA information at baseline, 6 months, and/or 12 months. MDA was defined as the fulfillment of ≥5 of the following criteria: TJC28≤1, SJC28≤1, PASI≤1, pain (VAS)≤15 mm, PtGA (VAS)≤20 mm, HAQ≤0.5, tender entheseal points ≤1. Near MDA was defined as fulfillment of 4 criteria. Results A total of 196 PsA patients (51.4% male) were included with a mean (SD) age of 49.8 (11.1) years and disease duration since diagnosis of 5.4 (6.3) years. The majority (62.2%) received concomitant DMARD therapy. The proportion of patients with MDA at baseline, 6 months and 12 months was 11.7%, 43.5%, and 44.8%, respectively. Overall, achievement of each individual MDA criterion was: TJC28: 43.0% of cases; SJC28: 51.3%; PASI 68.7%; pain: 27.7%; PtGA: 34.9%; HAQ: 36.8%; entheseal points: 79.4%. Among the 309 instances of non-MDA, 51 (16.5%) were near MDA cases. The most common reason for non-MDA in near MDA cases was patient-reported pain (82.4%) followed by PtGA (68.6%), and HAQ-DI (60.8%). Assuming that these criteria were met (i.e., not included in the MDA formula), the total number of MDA instances would increase from 29.6% to 36.7% (HAQ), 37.6% (PtGA), and to 39.2% (pain). Conclusions The results of the current analysis have shown that, similar to prior analyses in RA, the most common limiting factors in achieving MDA in PsA are PROs, including PtGA, pain, and HAQ-DI, accounting for as many as 82.4% of near MDA cases. Further analyses are required to identify the determinants of the differences in PROs and clinical outcomes. Disclosure of Interest P. Rahman: None declared, A. Avina-Zubieta: None declared, R. Arendse: None declared, W. Bensen: None declared, P. Baer: None declared, J. Kelsall: None declared, M. Starr: None declared, J. Stewart: None declared, D. Sholter: None declared, M. Zummer: None declared, L. Picard: None declared, E. Rampakakis: None declared, E. Psaradellis: None declared, K. Masolova Employee of: Janssen, A. Lehman Employee of: Janssen, F. Nantel Employee of: Janssen, C. Tkaczyk Employee of: Janssen, B. Osborne Employee of: Janssen

Background Early achievement of minimal disease activity (MDA) is recommended as a valid treat-to-target approach in psoriatic arthritis (PsA). Objectives The purpose of the current analysis was to evaluate predictors of MDA achievement in PsA patients treated with anti-TNF agents in Canadian routine clinical care. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis, ankylosing spondylitis, or PsA with Infliximab (IFX) or Golimumab (GLM). Eligible people for this analysis included PsA patients treated with IFX who were enrolled since 2005 or with GLM enrolled since 2010 and with available MDA information at baseline, 6 months, and/or 12 months. MDA was defined as the fulfillment of ≥5 of the following criteria: TJC28≤1, SJC28≤1, PASI≤1, Pain (VAS)≤15mm, PtGA (VAS)≤20mm, HAQ ≤0.5, tender entheseal points ≤1. Independent predictors of MDA achievement were assessed with logistic regression. Results A total of 196 patients (51.4% male and 87.2% bionaive) were included with a mean (SD) age and disease duration of 49.8 (11.1) and 5.4 (6.3) years, respectively. The proportion of patients with MDA was 11.7% at baseline, 43.5% at 6 months, 44.8% at 12 months, and 49.1% at either 6 or 12 months. Among patients with MDA at 6 months, 75.7% had sustained MDA at 12 months. Patients achieving MDA during follow-up had significantly lower disease activity at baseline; mean (SD) disease parameters were: SJC28: 3.24 (3.58) vs. 5.47 (4.31), P Multivariate logistic regression analysis showed that lower baseline HAQ (OR=0.243; P Conclusions The results of the current analysis have shown that 50% of patients treated with IFX or GLM in routine clinical care achieve MDA within the first year of treatment. Lower baseline HAQ, lower TJC28, and lower enthesitis count were identified as significant predictors of MDA achievement. Disclosure of Interest M. Zummer: None declared, P. Rahman: None declared, M. Starr: None declared, J. Kelsall: None declared, A. Avina-Zubieta: None declared, P. Baer: None declared, D. Sholter: None declared, M. Teo: None declared, E. Rampakakis Employee of: JSS Medical Research Inc;, E. Psaradellis Employee of: JSS Medical Research Inc;, B. Osborne Employee of: Janssen, K. Maslova Employee of: Janssen, F. Nantel Employee of: Janssen, A. Lehman Employee of: Janssen, C. Tkaczyk Employee of: Janssen

Objectives To describe the profile of patients with ankylosing spondylitis (AS) treated with infliximab in Canadian routine care and to assess the effectiveness and safety of infliximab in real world. Setting 46 primary care rheumatology practices across Canada. Participants 303 biological-naïve patients with AS or patients previously treated with a biological for

Objective.To describe early rheumatologic management for newly diagnosed rheumatoid arthritis (RA) in Canada.Methods.A retrospective cohort of 339 randomly selected patients with RA diagnosed from 2001–2003 from 18 rheumatology practices was audited between 2005–2007.Results.The most frequent initial disease-modifying antirheumatic drugs (DMARD) included hydroxychloroquine (55.5%) and methotrexate (40.1%). Initial therapy with multiple DMARD (15.6%) or single DMARD and corticosteroid combinations (30.7%) was infrequent. Formal assessment measures were noted infrequently, including the Health Assessment Questionnaire (34.6%) and Disease Activity Score for 28 joints (8.9%).Conclusion.Initial pharmacotherapy is consistent with guidelines from the period. The infrequent reporting of multiple DMARD combinations and formal assessment measures has implications for current clinical management and warrants contemporary reassessment.

Objective Timely access to rheumatology consultation is fundamental to appropriate and effective management of patients with musculoskeletal and autoimmune diseases. Yet, for a variety of reasons, limited and delayed access is commonplace. Moreover, information exchange for referral is often inadequate or poorly communicated. The objective of this work was to improve referral from primary care to rheumatology by formulating and testing a clinically coherent, reliable, and non–diagnosis-dependent Priority Referral Score (PRS). Methods Using a deliberative process, a clinical panel of 10 primary care providers (PCPs) and rheumatology specialists reviewed clinical case scenarios and engaged in a highly iterative process to develop criteria, definitions, and weights for the PRS, a linear 100-point scale to rate the relative urgency of referral. Following tool formulation, clinicians uninvolved with the process tested the PRS against their clinical judgment. Results The PRS comprises 8 criteria, with 2–4 levels for each criterion, and each having a weight generated through conjoint analysis, which forced choices around the comparative urgency of all of the criteria and levels. The PRS showed a strong correlation between clinical rankings of rheumatologists and PCPs in both the deliberative panel, and the physicians subsequently involved in the testing of the PRS. Conclusion No standardized priority-setting criteria are available for the full range of primary care referrals to rheumatologists. The PRS had face value with panelists and provided acceptable interrater and intrarater reliability when tested with other rheumatologists and PCPs. Pilot testing with other clinicians and in other settings is justified and prerequisite to use in clinical practice.

Background Despite the importance of the Health Assessment Questionnaire (HAQ) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in assessing patient-reported functional status and disease activity, they have been critiqued for being time-consuming, not convenient on a daily-basis and thus not contributing to decisions in routine care. Objectives The aim of this analysis was to describe the correlation of individual HAQ and BASDAI questions with patient and physician reported measures used in AS and to examine whether the instruments could be reduced to better reflect routine clinical practice. Methods BioTRAC is an ongoing prospective registry of patients initiating infliximab or golimumab. Data from AS patients treated in 2005-2014 were used. The correlation of individual HAQ and BASDAI questions with patient (pain, BASDAI, HAQ and BASFI) and physician (MDGA) reported measures was described with the Pearson9s correlation coefficient. The impact of each question on the need for help in each HAQ domain was assessed with logistic regression. Factor analysis was used to assess the variability due to each individual question in HAQ and BASDAI. Results A total of 413 AS patients with 1660 BASDAI and 1654 HAQ assessments were included. HAQ and BASDAI questions correlated at different extents with each AS measure. Questions related to “eating” and “gripping” showed the lowest correlation with patient and physician reported measures. All HAQ questions had higher correlations with patient reported measures than with MDGA. The BASDAI question on “fatigue and tiredness” showed the highest correlation with BASFI, while the question on “other joints pain/swelling” showed the lowest correlation with MDGA. None of the HAQ and BASDAI questions were associated with needing help for eating. All other HAQ individual questions were significantly associated with the need for help within their corresponding category, with the exception of Q5C and Q7A. BASDAI question on level of discomfort was significantly associated with the need for help in all HAQ categories, with the exception of “eating” and “walking”. Q2A and Q7C accounted for 59.6% of the HAQ variance. The level of morning stiffness accounted for 73.8% of the BASDAI variance. When combining the HAQ and BASDAI, Q2A and Q3A from HAQ and Q1 from BASDAI accounted for 63.5% of the variance. Conclusions Variability exists in the correlation of HAQ and BASDAI questions with patient and physician reported AS measures. The results suggest that “standing up straight from an armless chair” and “turning faucets on/off” are the main drivers of HAQ, while the level of morning stiffness drives the BASDAI. Three questions were found to drive the combined HAQ and BASDAI which may have implications in the design of self-report instruments. Disclosure of Interest P. Rahman Consultant for: Abbott, AbbVie, Amgen, BMS, Celgene, Janssen, Novartis, Pfizer, Roche, M. Zummer: None declared, W. Olszynski: None declared, M. Khraishi: None declared, D. Sholter: None declared, R. Faraawi Consultant for: Janssen, W. Bensen Consultant for: Janssen, M. Baker: None declared, A. Chow: None declared, J. Vaillancourt Employee of: JSS Medical Research, J. Sampalis Shareholder of: JSS Medical Research, F. Nantel Employee of: Janssen, S. Otawa Employee of: Janssen, A. Lehman Employee of: Janssen, C. Tkaczyk Employee of: Janssen, M. Shawi Employee of: Janssen

Background People with rheumatoid arthritis (RA) and other chronic diseases adjust their lifestyle to accommodate symptoms and limitations. Objectives The aim of the current analysis was to assess the utilization of aids/devices or help over time and to determine whether development of self-management behavior is responsible for HAQ improvement in RA patients on anti-TNF treatment in a real-world clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM. Data were used from RA patients treated with infliximab (IFX) between 2002-2014 or with golimumab (GLM) between 2010-2014. The correlation between the standard HAQ disability index (HAQ-DI) and the alternative disability index (HAQ-ADI), incorporating or not the use of aids/devices/help, respectively, was assessed with the Pearson9s correlation coefficient. Changes in HAQ-DI, HAQ-ADI, the individual HAQ domain scores, or the difference between HAQ-DI and HAQ-ADI over time, were assessed with general linear models. The slope of HAQ-DI and HAQ-ADI improvement in each patient was assessed with the paired-samples t-test. Results 1030 RA patients were included with a mean (SD) age of 56.1 (13.5) years and time since diagnosis of 8.5 (9.1) years. Mean (SD) DAS28, CDAI, HAQ-DI and HAQ-ADI scores at baseline were 5.6 (1.5), 34.3 (16.6), 1.59 (0.71), 1.47 (0.73), respectively. At baseline, highest HAQ domain scores included “Activities”, “Reach”, “Hygiene”, and “Grip”. The use of aids/devices/help was highest for these activities (49.2%, 47.5%, 38.0%, 73.1% of patients, respectively), with females requesting significantly more aids/devices/help than males. Treatment for 60 months resulted in statistically significant and clinically meaningful improvements in HAQ-DI and HAQ-ADI, and in significantly lower utilization of aids/devices/help. A statistically significant difference (P=0.001) was observed in the slope of HAQ-DI (Δ=-0.034/month) and HAQ-ADI (Δ=-0.038/month) improvement over time which could be attributed to the differential rate of use of aids/devices/help over time resulting in the inflation of HAQ-DI. The duration of follow-up was significantly (P Conclusions Our results have shown that problems with “Activities”, “Reaching”, “Hygiene”, and “Gripping” represent primary challenges in RA. Anti-TNF treatment resulted in significant improvements in all HAQ domains. Significant differences were observed over time, however, between HAQ-DI and HAQ-ADI suggesting that RA patients may also adjust their lifestyle to accommodate their symptoms. These findings highlight the importance of educational programs focused on self-management behaviors in RA. Disclosure of Interest D. Sholter Consultant for: Janssen, W. Olszynski Consultant for: Janssen, P. Baer Consultant for: Janssen, M. Sheriff Consultant for: Janssen, S. Dixit Consultant for: Janssen, A. Chow: None declared, B. Haraoui Consultant for: Janssen, D. Choquette Consultant for: Janssen, J. Kelsall Consultant for: Janssen, J. Sampalis: None declared, E. Rampakakis: None declared, F. Nantel Employee of: Janssen, C. Tkaczyk Employee of: Janssen, A. Lehman Employee of: Janssen

Background Several standardized response criteria and disease activity indices are used to assess treatment efficacy in rheumatoid arthritis (RA). These measures comprise different types and number of variables resulting in different weighting of individual variables within each of them. Objectives The aim of this analysis was to compare the performance of ACR, SDAI major and minor, and HAQ response criteria and to determine their level of agreement with the DAS28, SDAI, and CDAI definitions of low disease activity (LDA) and remission in RA patients treated with infliximab (IFX) or golimumab (GLM) in a real-world, Canadian, clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM. The analysis was based on RA patients treated with IFX between 2002-2014 or GLM between 2010-2014. Response was assessed with ACR20, ACR50, ACR70, HAQ improvement of 0.22 and 0.5, SDAI major (≥22) and minor improvement (≥10). Disease state was assessed with DAS28, SDAI, and CDAI definitions of LDA ( Results A total of 830 RA patients with 4,100 available observations were included. The criteria for each definition of response/disease state were met for the following proportion of cases: ACR20 (66.4%), ACR50 (44.5%), ACR70 (26.4%), ΔHAQ≥0.22 (65.5%), ΔHAQ≥0.5 (53.4%), SDAI major improvement (55.8%), SDAI minor improvement (80.8%), DAS28 remission (29.4%), CDAI remission (20.4%), SDAI remission (21.8%), CDAI LDA (57.5%), SDAI LDA (58.1%), and DAS28-ESR LDA (46.0%). Statistically significant (Kappa P Conclusions This analysis showed that significant variation exists in the agreement between the various efficacy outcome measures. Thus, the choice of outcome measure used to make treatment decisions could have a significant impact on patient management. Disclosure of Interest E. Keystone Consultant for: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, Speakers bureau: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, P. Baer Consultant for: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, Speakers bureau: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, A. Avina-Zubieta: None declared, A. Jaroszynska: None declared, J. Rodrigues: None declared, R. Arendse Consultant for: Janssen, D. Sholter: None declared, M. Starr Consultant for: Janssen, A. Masetto: None declared, J. Sampalis Shareholder of: JSS Medical Research, Employee of: JSS Medical Research, E. Rampakakis Employee of: JSS Medical Research, C. Tkaczyk Employee of: Janssen, M. Shawi Employee of: Janssen, A. Lehman Employee of: Janssen, F. Nantel Employee of: Janssen, S. Otawa Employee of: Janssen

Background Recent studies have suggested that early and aggressive treatment of spondyloarthritis, including ankylosing spondylitis (AS) and psoriatic arthritis (PsA), may be associated with favorable patient outcomes, reducing synovial inflammation, delaying joint damage, and maintaining functional status. Objectives The objective of this analysis was to determine the predictive factors of early DAS28 improvement in PsA patients treated with infliximab (IFX) or golimumab (GLM) in a Canadian routine clinical care setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM. The analysis was based on PsA patients treated with IFX or GLM between 2005 and 2014. Variables associated with improved response were examined using general linear models and those showing a statistical trend (P Results A total of 176 patients were included in the analysis with a mean (SD) age of 49.4 (11.4) years and a disease duration of 5.2 (7.2) years. The majority of patients were male (54.1%). Upon 6 months of treatment statistically significant and clinically meaningful improvements were observed in DAS28 (4.1 vs. 2.9; P In univariate analysis, male gender (male vs. female: B=-0.806; P=0.029), not smoking (smokers vs. non-smokers: B=0.984; P=0.131), no previous use of a biologic (naive vs. experienced: B=-1.995; P Conclusions Six-month treatment with IFX or GLM in a real-world setting was associated with significant improvements in all disease parameters studied. Upon adjusting for potential confounders, no prior exposure to a biologic and male gender were identified as independent predictors of greater DAS28 improvement. Disclosure of Interest D. Sholter Consultant for: Janssen, J. Kelsall Consultant for: Janssen, R. Arendse Consultant for: Janssen, A. Avina-Zubieta Consultant for: Janssen, W. Bensen Consultant for: Janssen, M. Zummer Consultant for: Janssen, R. Faraawi Consultant for: Janssen, S. Dixit Consultant for: Janssen, M. Khraishi: None declared, I. Fortin Consultant for: Janssen, J. Sampalis: None declared, E. Psaradellis: None declared, F. Nantel Employee of: Janssen, C. Tkaczyk Employee of: Janssen, A. Lehman Employee of: Janssen

Background The present standard for measuring disease activity in Ankylosing Spondylitis (AS) is the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) which focuses on five major symptoms including fatigue, axial pain, peripheral pain, enthesitis and morning stiffness (severity and duration). Objectives Given that the BASDAI instrument contains two pain questions, the objective was to assess whether pain symptoms are the main drivers of BASDAI scores among AS patients treated with anti-TNFs in routine clinical practice. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab (IFX) or golimumab (GLM). Patients with AS treated with IFX or GLM and enrolled between 2005 and 2014 were included in this analysis. A modified weighted BASDAI score (m-BASDAI) was calculated excluding the axial (Q2) and peripheral (Q3) pain questions of the BASDAI. The correlation of BASDAI, each of its components, and the modified BASDAI (m-BASDAI) was assessed with the Pearson correlation coefficient. BASDAI low disease activity (LDA) and m-BASDAI LDA were defined as a score ≤3. The association between the number of administered analgesics (0, 1, >1) and BASDAI/m-BASDAI was assessed with one-way ANOVA. Results A total of 413 AS patients with 1,709 assessments were included in this analysis. Correlation analysis showed a strong correlation between the full BASDAI and m-BASDAI scores (r=0.98, P Increased use of analgesics (0 vs. 1 vs. >1) over 2 years of follow-up was associated with significantly (P Conclusions Higher levels of AS pain are significantly associated with a higher BASDAI score and increased use of analgesic medications among patients treated with anti-TNFs. In addition to pain, fatigue, tenderness, and morning stiffness are likewise important contributing components in the BASDAI score and the disease burden of AS. Disclosure of Interest P. Rahman Consultant for: Abbott, AbbVie, Amgen, BMS, Celgene, Janssen, Novartis, Pfizer, Roche, A. Jovaisas: None declared, W. Bensen Consultant for: Janssen, W. Olszynski: None declared, A. Jaroszynska: None declared, P. Baer Consultant for: AbbVie, Amgen,BMS, Janssen, Pfizer, Roche, M. Sheriff: None declared, D. Sholter: None declared, E. Psaradellis Employee of: JSS Medical Research, J. Sampalis Shareholder of: JSS Medical Research, F. Nantel Employee of: Janssen, S. Otawa Employee of: Janssen, A. Lehman Employee of: Janssen, C. Tkaczyk Employee of: Janssen, M. Shawi Employee of: Janssen

Background Unlike rheumatoid arthritis (RA), the pattern of joint involvement in psoriatic arthritis (PsA) is usually asymmetric. Furthermore, PsA may demonstrate oligoarthritis or polyarthritis, while RA usually manifests in multiple joints. Objectives To describe the most commonly affected joints in patients with RA and PsA at baseline and after 6 months (mos) of treatment with infliximab (IFX) in a clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis, or PsA with IFX as first biologics or after having been treated with a biologic for

Objectives To assess in a clinical practice the 4-year outcomes in patients with AS treated with infliximab and the performance of ASDAS, a new disease activity measure in AS. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than 6 mos. AS patients treated with infliximab between 2005 and 2012 were included. Descriptive statistics were produced for clinical outcome measures and patient reported outcomes at baseline and follow-up assessments over four years. Within-group changes were assessed for statistical significance with the paired-samples Student9s t-test. The correlation of ASDAS with BASDAI and BASFI was assessed with the Pearson correlation coefficient. The correlation of these measures with MDGA was assessed with the Spearman9s rho. Results A total of 230 AS patients who had at least one follow-up assessment were included in this analysis, with a mean (SD) age of 45.7 (11.5) years and mean (SD) disease duration since diagnosis of 10.0 (10.1) years. At the time of enrollment, mean (SD) patient parameters were: C-reactive protein (CRP) =16.9 (20.2) mg/dL, erythrocyte sedimentation rate (ESR) =25.8 (20.2) mm/hr, morning stiffness =74.6 (40.2), health assessment questionnaire (HAQ-DI) =1.20 (0.61), physician global assessment of disease activity (MDGA) =6.6 (1.9), BASDAI =6.4 (2.1), BASFI =6.1 (2.5), and ASDAS =3.8 (1.0). By 6 mos of treatment significant improvements (P Similar significant changes were observed in ASDAS, BASDAI, and BASFI over time providing evidence of construct validity and sensitivity to change. A strong positive linear correlation between ASDAS and BASDAI (r=0.85; P 3.5) decreased from 62.4% at baseline to 6.9% at 48 months. Conclusions Treatment with infliximab over four years is effective in reducing symptom severity and improving outcomes in patients with AS. Furthermore, the data from this registry confirm the validity and sensitivity to change of the ASDAS score in a real-world AS cohort. Disclosure of Interest P. Rahman: None declared, D. Choquette: None declared, M. Khraishi: None declared, W. Bensen: None declared, S. Shaikh: None declared, D. Sholter: None declared, M. Sheriff: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen, S. Otawa Employee of: Janssen, A. Lehman Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2381

Background Spondyloarthritis, including psoriatic arthritis (PsA), is characterized by inflammatory arthritis affecting axial and peripheral joints. It is commonly associated with extra-articular and peri-articular manifestations (PAMs) including dactylitis and enthesitis. Objectives To evaluate the point prevalence of enthesitis and dactylitis at the time of anti-TNF initiation, their impact on disease severity, and their evolution over time in patients with active PsA treated in a routine clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis (RA), ankylosing spondylitis (AS), or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for

Background Assessment of functional (dis)ability in rheumatoid arthritis (RA) is subject to patient judgment when appraising their ability to do daily activities. Objectives The aim of this analysis was to describe the impact of specific joint involvement on patient reported outcomes (PROs) - functional activity, pain and patient global assessment of disease activity (PtGA) - and to identify joints most resistant to treatment over time. Methods Biologic Treatment Registry Across Canada (BioTRAC) is an ongoing, prospective, registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. In this analysis, data were included from RA patients treated with infliximab between 2002 and 2012 or with golimumab between 2010 and 2012. Based on joint involvement seven groups were created: shoulder(s), elbow(s), metacarpophalangeal (MCP), wrist(s), proximal interphalangeal (PIP), knee(s), and thumb(s). The impact of specific joints on patient outcomes was assessed with the independent-samples t-test. Linear regression was used in order to produce adjusted estimates. Results A total of 935 RA patients with 4,854 assessments were included. Swelling, tenderness, and swelling and/or tenderness in all joint groups were associated with significantly (P Conclusions Significant variability in PROs exists based on the presence of swelling and/or tenderness in specific joint groups. Swelling/tenderness of shoulders, wrists, knees and elbows were the main drivers of HAQ-DI, PtGA and pain. The results have important implications for the achievement of disease remission and suggest that the joint type in addition to the number of affected joints has unique impact on PROs. Disclosure of Interest R. Arendse: None declared, W. Bensen: None declared, A. Chow: None declared, J. Rodrigues: None declared, S. Dixit: None declared, D. Sholter: None declared, P. Baer: None declared, M. Baker: None declared, D. Choquette: None declared, I. Fortin: None declared, A. Jovaisas: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.5185

Background The efficacy of anti-TNF in the management of psoriatic arthritis (PsA) and rheumatoid arthritis (RA) has been demonstrated in numerous controlled clinical trials. Objectives The objective of this analysis was to assess in Canadian routine clinical practice the durability of treatment with infliximab (IFX) in PsA and RA and the determinants associated with sustainability of IFX. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. Patients with PsA or RA treated with IFX who were enrolled between 2002 (2005 for PsA patients) and 2012 were included in this analysis. Dose optimization was defined as an increase in the frequency and/or dosing of IFX. Kaplan Meier (KM) estimates and Cox proportional models were used in the analysis. Results A total of 92 PsA and 830 RA patients were included in the analysis. Mean (SD) age of the PsA and RA patient cohorts was 48.7 (9.9) and 55.8 (13.4) years, respectively, and mean (SD) duration since diagnosis was 6.8 (9.1) and 10.2 (10.1) years, respectively. Twenty seven (29.3%) PsA patients and 407 (49.0%) RA patients had discontinued treatment. Overall KM-based mean (SE) duration of treatment was 41.4 (3.6) months and 61.3 (2.2) months for PsA and RA patients, respectively. Longer treatment duration was associated with significantly greater improvements in pain (parameter estimate PsA: -0.21, P=0.020; RA: -0.27, P Conclusions The results of this observational study have shown a high durability of treatment with IFX for patients with PsA or RA in a real-world setting. Concomitant medication use significantly impacts treatment durability. Furthermore, longer disease duration, higher TJC, less severe skin disease at initiation and previous biologic use in PsA, and absence of IFX dose optimization in RA, may be associated with reduced treatment durability. Disclosure of Interest J. Kelsall: None declared, A. Jovaisas: None declared, P. Rahman: None declared, D. Sholter: None declared, M. Starr: None declared, W. Bensen: None declared, M. Sheriff: None declared, W. Olszynski: None declared, M. Zummer: None declared, R. Faraawi: None declared, A. Chow: None declared, S. Kapur: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.4013

Background Achievement of clinical remission in rheumatoid arthritis (RA) is a process that may take several months. Identification of clinical signs predicting future remission may assist physicians in clinical decision making. Objectives The aim of this analysis was to describe the association between DAS28-ESR scores at 6 months and remission at 12 months in RA patients treated with infliximab (IFX) in a real-world, clinical practice setting. Methods BioTRAC is an ongoing, prospective Canadian registry of patients initiating treatment for RA, ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with IFX or golimumab as first biologics or after having been treated with a biologic for Results A total of 293 patients were included with a mean (SD) age of 56 (13.5) years and disease duration of 10.0 (9.7) years. Mean (SD) DAS28 was 3.8 (1.5) and 3.5 (1.5) at 6 and 12 months, respectively, and the percent with DAS28-ESR remission was 24.6% and 27.0%. Of the patients in remission at 6 months, 65.3% sustained the remission at 12 months, while of those not in remission at 6 months, 14.5% achieved remission at 12 months (P Conclusions The results of this analysis demonstrate that a DAS28-ESR target of ≤3.54 at 6 months maximizes the likelihood of remission at 12 months while a value of ≤2.13 should be targeted for optimal sustainment of remission. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4755

Background Patient (PtGA) and physician (MDGA) global assessment of disease activity are standard outcome measures used in clinical practice and research to ascertain patient and physician subjective perception of disease activity in psoriatic arthritis (PsA). Given that the PtGA and MDGA measure the same construct from two different perspectives, assessing their concordance may provide valuable insight on patient and physician differences with respect to the relative importance placed on specific disease parameters. Objectives The aim of this analysis was to assess the agreement between PtGA and MDGA, and to compare the correlation of PtGA or MDGA with the Psoriasis Area and Severity Index (PASI) in PsA patients treated with infliximab (IFX) in a Canadian real-world, routine clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis, ankylosing spondylitis, or PsA with IFX or golimumab as first biologics or after having been treated with a biologic for Results A total of 92 patients (52.2% male) were included with a mean (SD) age of 48.7 (9.9) years and disease duration of 6.8 (9.1) years. At baseline, mean (SD) disease parameters were: PASI =3.3 (5.6); swollen joint count (SJC28) =4.0 (3.8); tender joint count (TJC28) =5.9 (5.3); PtGA =5.0 (2.8); MDGA =5.8 (2.2) cm. Prior to IFX initiation, 78 (84.8%) patients had been treated with a traditional DMARD (71.7% with methotrexate). Overall, a strong agreement was observed between PtGA and MDGA (r=0.632). The correlation of PASI with PtGA was low (r=0.213), whereas it was moderate with MDGA (r=0.343) (Figure 1). Overall, internal consistency was poor between PASI and both PtGA (CA =0.373, ICC =0.229) and MDGA (CA =0.445, ICC =0.286) although it was higher with the latter. Multivariate linear regression resulted in the exclusion of PtGA from the model, also supporting the stronger association of MDGA with PASI. When considering other disease parameters, PtGA showed a very strong correlation with pain (r=0.885) and strong with HAQ-DI (r=0.596), whereas a strong correlation was observed between MDGA and both pain and HAQ-DI (r=0.652 and r=0.520, respectively). Conclusions The results of this analysis shows that the association of PASI is stronger with MDGA when compared to PtGA. However, patient-reported pain and HAQ-DI were better correlated with PtGA and MDGA when compared to PASI, suggesting that both patients and rheumatologists place more emphasis on pain and functional activity than on skin symptoms when evaluating the global status of PsA. Disclosure of Interest : D. Sholter: None declared, P. Rahman: None declared, J. A. Avina-Zubieta: None declared, J. Kelsall: None declared, R. Arendse: None declared, M. Khraishi: None declared, S. Shaikh: None declared, W. Bensen: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.5316

Objectives Efficacy of TNFi agents in the management of rheumatoid arthritis (RA) has been demonstrated in clinical trials. Variations with respect to patient (pt) profile, extent of physician familiarization with TNFi agents, and pt management may affect real-world outcomes. The aim of this analysis is to compare the pt profile and outcomes of RA pts treated with infliximab under routine clinical practice in biologic treatment registry sites of different sizes. Methods BioTRAC is an ongoing, prospective registry of pts initiating treatment for RA with infliximab as first biologics or treated with a biologic for 35pts. Total pts enrolled in each type of practice site was; Group A:n=324, Group B:n=239, Group C:n=269. Results Mean age was 55.8 yrs with 76% of pts being female and 74.2% RF+. No significant differences in demographic characteristics and RF status were observed between the subgroups. Pts seen at larger sites had significantly shorter disease duration (Group A: 11.9 years, Group B: 10.9 years, Group C: 7.5 years; P Upon adjusting for baseline disease activity, DAS28-CRP remission (P=0.013) and clinically meaningful improvement in HAQ-DI (Δ≥0.25; P=0.025) over 24mons of treatment was significantly greater among pts seen in larger sites. Conclusions Consistent with findings from a Canadian early RA registry 1 , results of this real-world observational study demonstrate that significant variation in disease characteristics, pt management and outcomes exist within the BioTRAC registry based on the size of the site. A trend towards earlier infliximab initiation and improved outcomes was observed with larger enrolment sites. References Harris J, et al. Improving outcomes in early RA by determining best practices: Does site size matter or is best treatment early? An analysis of the Canadian ERA cohort. CRA 2013 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3740

Background The prevalence of rheumatoid arthritis (RA) is 2-4 times higher in women compared to men. Furthermore, RA incidence in women increases from the age of menarche peaking around menopause, while it is rare in men younger than 45 years (1). Several studies have shown that treatment outcomes are worse in women (2). Objectives This analysis examined gender-specific differences with respect to disease parameters at initiation of the first anti-TNF agent for RA treatment in a Canadian routine clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. In this analysis, data were assessed from RA patients treated with golimumab subcutaneous as a first biologic who were enrolled between 2010 and 2012. Results 121 RA patients were included with mean (SD) disease duration of 9.3 (9.6) years. Eighty-nine patients (73.6%) were female. In the overall population, rheumatoid factor positivity was observed in 67% of patients and 17.5% were smokers, without any significant differences between genders. Patient reported disease parameters differed significantly between genders. Despite the younger age (56.6 vs. 62.0 years; P=0.051), female patients reported significantly higher pain (56.6 vs. 44.5 mm; P=0.045), patient global assessment (PtGA: 6.0 vs. 4.7 cm; P=0.034), tender joint count (10.2 vs. 6.8; P=0.022), and functional disability (HAQ-DI: 1.43 vs. 1.06; P=0.024). In addition, a statistical trend towards higher morning stiffness in female patients was observed (55.7 vs. 38.9; P=0.063). However, physician assessment of global disease activity (MDGA: 5.7 vs. 5.5; P=0.581), SJC (7.9 vs. 8.5; P=0.641), DAS28-ESR (5.3 vs. 4.7; P=0.086), CDAI (29.7 vs. 24.5; P=0.120) and SDAI (32.1 vs. 30.2; P=0.675) were statistically comparable between genders. Conclusions Objective measures (SJC, CRP/ESR), MDGA and composite outcomes were similar for male and female patients at golimumab initiation, with the exception of TJC being higher in women. Patient reported outcomes (PROs: pain, PtGA, HAQ-DI), however, were worse at baseline for female patients at biologic treatment initiation. These findings are similar to our previous research on patients initiating anti-TNF IV therapy (3). Overall, the results may suggest gender bias in the interpretation and use of PROs during the treatment decision making process in Canadian RA patients. References Wilder RL. J Rheumatol Suppl. 1996 Mar;44:10-2. Forslind K. et al. Ann Rheum Dis. 2007 Jan;66(1):46-52. Bensen W. et al. J Rheumatol Suppl. 2013 Jun:40:1020-1. Disclosure of Interest D. Sholter: None declared, W. Bensen: None declared, D. Choquette: None declared, I. Fortin: None declared, R. Arendse: None declared, J. Kelsall: None declared, M. Sheriff: None declared, R. Faraawi: None declared, J. Rodrigues: None declared, M. Zummer: None declared, S. Dixit: None declared, M. Starr: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.3979

Objectives The objective of this study was to describe and compare over time the demographics and disease parameters at infliximab treatment initiation and to assess the effectiveness of treatment at 6 and 12 months in real life cohort AS patients. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. People with AS treated with infliximab who were enrolled between 2002 and 2013 were included in this analysis (N=303) and stratified to two groups (2005-2007: n=135; 2008-2013: n=168) based on the year of enrolment in the registry. Results Patient demographics were comparable in the two cohorts with a mean (SD) age of 45.72 (11.74) years and the majority being males (62.4%). A significant change in the geographic distribution of patients enrolled in the BioTRAC registry was observed (P=0.001) and more patients with provincial coverage were enrolled in 2008-2013 compared to 2005-2007 (P=0.012). A trend towards earlier initiation of infliximab was observed in more recent years as indicated by the shorter disease duration (11.12 vs. 8.24 years; P=0.013) and the lower number of prior traditional DMARDs used (0.83 vs. 0.59; P=0.078). Furthermore, overall, patients recruited in 2008-2013 had lower disease activity compared to those enrolled in 2005-2007. ESR (29.96 vs. 19.91 mm/hr; P Treatment for 6 months resulted in a greater proportion of patients in the 2008-2013 cohort achieving inactive disease (ASDAS Conclusions The results of this analysis show that the profile of the AS patient population in the BioTRAC registry has changed over time towards lower disease activity and earlier initiation in the patient management process. These results may reflect differences in patient management over time or may be related to earlier access to care. Irrespective of enrolment period, 6-month treatment with infliximab was effective in reducing disease activity in AS patients. Disclosure of Interest D. Choquette: None declared, M. Starr: None declared, M. Khraishi: None declared, W. Bensen: None declared, S. Shaikh: None declared, J. Rodrigues: None declared, D. Sholter: None declared, M. Sheriff: None declared, J. Vaillancourt: None declared, J. Sampalis: None declared, A. Lehman Employee of: Janssen, S. Otawa Employee of: Janssen, F. Nantel Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2375

To assess the reliability and construct validity of the 6 minute walk (6MW) in persons with fibromyalgia (FM) and to determine an equation for predicting peak oxygen consumption (pVO2) from the distance covered in 6 minutes.Ninety-six women who met the American College of Rheumatology (ACR) criteria for FM were tested on the 6MW and the Fibromyalgia Impact Questionnaire (FIQ). A subset (n = 23) were tested on a separate day for pVO2 during a symptom-limited, incremental treadmill test. Twelve subjects repeated the 6MW five times over 10 days. Heart rate and rating of perceived exertion (RPE) were recorded for each walk. Intraclass correlations were used to determine the reliability of the 6MW. Validity was examined by correlating the 6MW with pVO2 and the FIQ. Body mass index (BMI) and 6MW were independent variables in a stepwise regression to predict pVO2.A significant increase in distance occurred from Walk 1 to Walk 2 (p = 0.000) with the distance maintained on the remaining walks (p = 0.148) The correlations of the 6MW with the FIQ and pVO2 were -0.325 and 0.657, respectively. The regression equation to predict pVO2 from 6MW distance and BMI was: pVO2 (ml/kg/min) = 21.48 + (-0.4316 x BMI) + [0.0304 x distance(m)] (R = 0.76, R2 = 0.66).When using the 6MW it is necessary to conduct a practice walk, with the second walk taken as the baseline measure. It was determined from the correlations that the 6MW cannot replace the FIQ as a measure of function. The 6MW may be used as an indicator of aerobic fitness, although obtaining VO2 by means of a graded exercise test is preferable.

To determine treatment success rates and factors predicting successful outcome using yttrium-90 intraarticular injections for chronic knee synovitis refractory to other treatments.A retrospective one year review of 133 treatment interventions with yttrium-90 (Y-90) with response recorded at 3, 6, 9, and 12 mo after injection.An excellent, good, or fair response (a treatment benefit) as evaluated by objective (degree of joint effusion, joint tenderness, range of motion) and subjective (visual analog scale, degree of pain) assessments occurred in 81, 82, 80, and 75% of joints at 3, 6, 9, and 12 mo, respectively. When only excellent and good responses were considered successful treatment then 49, 48, 57, and 46% had successful treatment at 3, 6, 9, and 12 mo, respectively. 8 of 15 joints (53%) reinjected after primary treatment failure or relapse showed a beneficial response. Patients treated successfully were more likely to have a normal radiographic appearance rather than one showing destructive changes (78 vs 54% treatment success; p0.05); to have localized disease or systemic disease in remission, rather than active systemic disease (66 vs 30% treatment success; p0.001); and shorter duration of joint disease (6.9 vs 10.2 years; p0.05).Y-90 synovectomy successfully treats patients with chronic knee synovitis refractory to other therapies. Primary treatment failures or relapses may be successfully treated by reinjection. Patients with less destructive radiographic changes, shorter duration of joint disease, and localized disease tend to respond more favorably.

In this paper the rheumatic features of a selection of inherited diseases are reviewed. Further evidence has been reported strengthening the association between hypercholesterolemia and Achilles tendinous xanthomatosis, although the clinical manifestations of hyperlipidemic arthropathy remain poorly understood. Osteonecrosis of the femoral head is demonstrated to have a good functional prognosis in children and adolescents with Gaucher's disease. Magnetic resonance imaging of the liver may prove to be useful in monitoring enzyme replacement in Gaucher's disease because it correlates with the presence of avascular necrosis. A case of cervical myelopathy in Hunter's disease is also presented.

Background Despite the importance of HAQ in assessing patient-reported functional status, it was originally developed primarily for research studies. As a result, HAQ has been critiqued for being time-consuming, not easily scored, and, thus, not contributing to decisions in routine care, and being influenced by comorbidities[ref][1]. Objectives To describe the correlation of individual HAQ questions with outcome measures used in Rheumatoid Arthritis (RA). To examine whether the instrument could be reduced to better reflect routine clinical practice. Methods BioTRAC is an ongoing, prospective registry of RA, AS, or PsA patients initiating infliximab or golimumab as first biologics or after

Background In recent years, disease remission in rheumatoid arthritis (RA) has been assessed using various disease activity indices such as the DAS28, SDAI, CDAI, ACR/EULAR-recommended Boolean definition and the Patient Activity Scale (PAS). Objectives The aim of this analysis is to describe the agreement between these five indices in classifying remission as well as to assess their correlation in a routine clinical care setting. Methods BioTRAC is an ongoing, prospective Canadian registry of rheumatology patients initiating treatment with infliximab or golimumab. In this analysis, data from RA patients who were treated with infliximab between January 2002 and June 2011 and had available information in all indices were used. The definitions for remission were as follows: DAS28-ESR Results Seven hundred twenty five RA patients who had 2,897 complete assessments were included in the analysis. Non-remission was classified by all indices in 68.8% of the cases, while 31.2% achieved remission in one (12.4%), two (3.5%), three (3.4%), four (4.2%) and all five types (7.7%) of indices. Factor analysis showed that PAS accounted for 71.5% of the matrix variance, followed by DAS28-ESR (12.4%), SDAI (9.2%), CDAI (5.2%), and Boolean remission (1.6%), suggesting that PAS may reflect different aspects than the clinical indices. PAS remission revealed the lowest correlation with remission classified by the remaining indices (Table 1) and removal of any index, except PAS, would result in a lower overall Cronbach’s alpha. Conclusions The results of this analysis show that variability exists in the classification of remission by various disease activity indices. This variability was found to be predominantly due to the Patient Activity Scale, a patient-driven composite tool, suggesting that the patient perception of disease activity may differ from that captured by clinical outcome measures. Disclosure of Interest W. Bensen: None Declared, A. Jovaisas: None Declared, C. Thorne: None Declared, P. Baer: None Declared, M. Khraishi: None Declared, S. Dixit: None Declared, D. Choquette: None Declared, M. Starr: None Declared, I. Fortin: None Declared, D. Sholter: None Declared, E. Rampakakis Employee of: JSS Medical Research, J. Sampalis Employee of: JSS Medical Research, A. Lehman Employee of: Janssen, F. Nantel Employee of: Janssen, M. Shawi: None Declared, S. Otawa Employee of: Janssen

To the Editor: We read with interest the recent letter1 and editorial2 discussing anti-tumor necrosis factor (anti-TNF)-induced lupus requiring cessation of therapy for disease resolution. A lack of published experience of successful TNF inhibitor switching (8 total cases in the literature) causes concern for rheumatologists faced with this clinical scenario. We describe 2 more patients who successfully switched to different TNF inhibitor after developing anti-TNF-induced lupus. A 43-year-old woman with a 15-year history of seropositive rheumatoid arthritis (RA) achieved remission when treated with adalimumab 50 mg biweekly 8 years ago. Adalimumab was increased to 50 mg weekly when she developed an arthritis flare. Her arthritis worsened and she developed severe pleuritis but no other lupus features. Laboratory investigations revealed anti-dsDNA antibodies that were not present in her preadalimumab antibody profile and persistence of anti-SSA antibodies that were present prior to adalimumab. A diagnosis of adalimumab-induced lupus was made and adalimumab was discontinued. Her symptoms resolved while taking prednisone … Address correspondence to Dr. Keeling; E-mail: stephanie.keeling{at}ualberta.ca