IL TREAT-TO-TARGET NELLA REAL-LIFE IN PAZIENTI AFFETTI DA ARTRITE PSORIASICA

Objective: our study aimed at describing, in a real-life cohort of psoriatic arthritis (PsA) patients, the rates of minimal disease activity (MDA) achievement, and to longitudinally explore predictors of MDA. In patients with axial involvement (axPsA), we also examined the rates and predictors of low axial disease activity achievement. Methods: consecutive PsA patients in stable biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) were enrolled. Disease activity indices, including MDA and Ankylosing spondylitis Disease Activity Score-Low Disease Activity (ASDAS-LDA) for axPsA, were evaluated at baseline and every 6 months, up to 36 months or bDMARDs permanent discontinuation. Patient history, BMI, comorbidities (including osteoarthritis (OA) and fibromyalgia) were collected. Characteristics of patients were compared between patients reaching sustained MDA and those who did not. Multivariable Generalized Estimating Equation (GEE) models were built to identify predictors of MDA and ASDAS-LDA over time. Data were expressed as coefficient  (95%CI). Results: 104 patients were enrolled, 54% males, mean age 55.7 5.0 years; 52% had axPsA. Across all evaluations, 52%-61% reached MDA, and 17%-24% reached ASDAS-LDA. AxPsA, fibromyalgia, OA and BMI35 were less frequently observed in patients with sustained MDA. The GEE model confirmed these factors were negatively and independently associated to MDA (axPsA =–1.07, 95%CI –1.82/–0.33; fibromyalgia: =–3.35, 95%CI–5.09/ –1.61; OA: =–1.87, –3.07/0.66; BMI35: =–2.53; 95% –4.27/–0.79). Older age (=–0.05; 95% CI –0.09/–0.02) and longer bDMARDs duration (=0.31, 95%CI 0.00- 0.02) had a negative and positive association, respectively, with MDA. Older age (=–0.01, 95%CI: –0.04- 0.01), fibromyalgia (=–2.03, 95%CI –3.50/–0.56) and OA (=–1.30; 95% –2.29/–0.31) were independently associated also to ASDAS-LDA. Conclusion MDA is an attainable target in real-life patients. AxPsA represents a difficult-to-treat subset. Sustained MDA depends both on disease features (axSpA) and patients’ characteristics (age, bDMARDs duration, comorbidities: OA, fibromyalgia).