# Early peripheral psoriatic arthritis: Baseline features of the first 186 patients in the French Nationwide APACHE Cohort

Pascal Claudepierre, Cecile Gaujoux-Viala, Arnaud Constantin, Francis Berenbaum, Bernard Combe, Valerie Devauchelle, Philippe Goupille, Pascal Richette, Daniel Wendling, Gael Mouterde, et al.

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## To cite this version:

Pascal Claudepierre, Cecile Gaujoux-Viala, Arnaud Constantin, Francis Berenbaum, Bernard Combe, et al. Early peripheral psoriatic arthritis: Baseline features of the first 186 patients in the French Nationwide APACHE Cohort. Joint Bone Spine, 2025, 92 (6), pp.105930. 10.1016/j.jbspin.2025.105930. hal-05441142

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Original article

# Early peripheral psoriatic arthritis: Baseline features of the first 186 patients in the French Nationwide APACHE Cohort

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suppl.
Informations

Pascal Claudepierre<sup>a,b,*</sup>, Cecile Gaujoux-Viala<sup>c</sup>, Arnaud Constantin<sup>d</sup>, Francis Berenbaum<sup>e</sup>, Bernard Combe<sup>f</sup>, Valerie Devauchelle<sup>g</sup>, Philippe Goupille<sup>h</sup>, Pascal Richette<sup>i</sup>, Daniel Wendling<sup>j</sup>, Gael Mouterde<sup>k</sup>, Tristan Pascart<sup>l</sup>, Benedicte Razat<sup>m</sup>, Etienne Audureau<sup>n</sup>, Sandrine Jousse-Joulin<sup>g</sup>, Laure Gossec<sup>o,p</sup>

## ARTICLE INFO

**Article history:**
Accepted 21 May 2025
Available online 27 May 2025

**Keywords:**
Psoriatic arthritis
Cohort
Phenotype
Early disease
Sex factors

## ABSTRACT

**Objectives:** To describe the design and methodology of APACHE, a cohort of patients with early peripheral psoriatic arthritis (pPsA), and to assess the main baseline clinical characteristics of the first included patients.

**Methods:** APACHE is an ongoing prospective multicentre national cohort (NCT03768271) with a planned follow-up of 10 years. Included patients have recent-onset (< 12 months) peripheral arthritis, a personal and/or family history of psoriasis, pPsA diagnosed by a rheumatologist, and no history of targeted disease-modifying antirheumatic drug therapy. At inclusion, demographic data, disease activity, comorbidities, and imaging results (not reported here) are collected. A descriptive analysis of these data was performed.

**Results:** The first 186 study patients had a mean age of 44±11 years and mean arthritis duration of 6±4 months; 84 (45%) were women; 169 (91%) had a history of psoriasis (mean duration, 14 years) and 71 (38%) were receiving methotrexate. Disease activity was moderate with a mean DAPSA score of 19±14 and mean swollen and tender joint counts of 2.1±3.2 and 6.0±8.0, respectively. The initially involved joints were mainly the hands (40%) and knees (28%). Entheseal pain (39%) was more prevalent than dactylitis (27%). Comorbidities were common, with obesity in 27% and at least one cardiovascular risk factor or disease in 49% of patients.

**Conclusion:** Patients with early peripheral PsA had moderate disease activity, a predominant oligoarticular profile, and a high prevalence of enthes seal pain.

© 2025 APHP. Published by Elsevier Masson SAS on behalf of Société Française de Rhumatologie. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)).

<footnote><sup>a</sup> AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 94000 Créteil, France</footnote>

<footnote><sup>b</sup> EpiDermE, Université Paris Est Créteil, 94000 Créteil, France</footnote>

<footnote><sup>c</sup> UM1318, Desbrest Institute of Epidemiology and Public Health (IDESP), Montpellier University, Inserm, Department of Rheumatology, CHU de Nîmes, 30900 Nîmes, France</footnote>

<footnote><sup>d</sup> Pierre-Paul-Riquet University Hospital, Toulouse University, Inserm U1291, 31300 Toulouse, France</footnote>

<footnote><sup>e</sup> Sorbonne Université, Inserm CRSA, Department of Rheumatology, AP-HP, Saint-Antoine University Hospital, 75012 Paris, France</footnote>

<footnote><sup>f</sup> CHU de Montpellier, Montpellier University, 34295 Montpellier, France</footnote>

<footnote><sup>g</sup> Department of Rheumatology, Brest University, Inserm 1227, 29200 Brest, France</footnote>

<footnote><sup>h</sup> Tours University, UPR CNRS 4301 CBM, NMNS, Department of Rheumatology, Tours University Hospital, 37044 Tours cedex 9, France</footnote>

<footnote><sup>i</sup> Paris Cité University, Inserm U1132, Department of Rheumatology, AP-HP, Lariboisière University Hospital, 75010 Paris, France</footnote>

<footnote><sup>j</sup> Université de Franche-Comté, Besançon University Hospital, 25000 Besançon, France</footnote>

<footnote><sup>k</sup> Department of Rheumatology, CHU de Montpellier, Desbrest Institute of Epidemiology and Public Health (IDESP), Montpellier University, 34295 Montpellier, France</footnote>

<footnote><sup>l</sup> Department of Rheumatology, Saint-Philibert Hospital, Lille Catholic University, 59160 Lille, France</footnote>

<footnote><sup>m</sup> University Hospital, 31300 Toulouse, France</footnote>

<footnote><sup>n</sup> Clinical Research Unit, AP-HP, Henri-Mondor University Hospital, 94000 Créteil, France</footnote>

<footnote><sup>o</sup> Sorbonne Université, Inserm, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, Team Pepites, 75013 Paris, France</footnote>

<footnote><sup>p</sup> AP-HP, Pitié-Salpêtrière University Hospital, Rheumatology Department, 75013 Paris, France</footnote>

<footnote>* Corresponding author at: Service de Rhumatologie, Hôpital Henri-Mondor, 1, avenue Gustave-Eiffel, 94010 Créteil cedex, France.
E-mail address: pascal.claudepierre@aphp.fr (P. Claudepierre).</footnote>
# 1. Introduction

Psoriatic arthritis (PsA) is a chronic inflammatory rheumatic disease characterised by musculoskeletal inflammation combined with psoriasis or a family history of psoriasis. Although PsA is a form of spondyloarthritis (SpA), the clinical manifestations are distinctive [1]. Disease onset may be acute or gradual. Enthesitis, axial involvement, dactylitis, and/or peripheral arthritis may occur concurrently or sequentially. Peripheral PsA (pPsA) often involves the distal interphalangeal joints, with an asymmetrical distribution, in contrast to rheumatoid arthritis (RA). The condition may progress from mono- or oligoarticular involvement to severe polyarticular disease responsible for substantial joint destruction, deformities, functional impairments, and quality-of-life impairments [1]. The radiographic pattern combining joint destruction and new bone formation (ankylosis, periostitis, osteitis) is very different from that seen in RA.

Identifying prognostic factors remains challenging. Previous research suggests that risk factors for radiographic progression may include delayed diagnosis, age over 50 years, female sex, smoking, obesity, dactylitis, high disease activity, polyarticular involvement, erosive disease, and nail changes [2–11]. Further assessing these factors in large populations is essential to produce strong evidence for assisting early therapeutic decisions, notably regarding the use of targeted therapies.

To assess the patterns of PsA progression over time and to identify reliable prognostic factors, studies must include patients with early-stage disease then monitor them over time. To our knowledge, the Dutch southwest Early Psoriatic Arthritis (DEPAR) study is the only recent cohort of patients with early-stage PsA patients managed under real-life conditions [12]. However, the DEPAR cohort did not focus on patients with peripheral articular involvement. The French Society of Rheumatology consequently developed a national, multicentre, longitudinal, prospective study specifically designed to investigate pPsA diagnosed within the past year. Inclusion in the cohort (A Psoriatic Arthritis CoHort, APACHE) started in January 2020 and is ongoing. For each included patient, clinical, laboratory, imaging, and socioeconomic data, as well as patient-reported outcomes (PROs), are collected at baseline then during standardized visits over ten years.

The main objective of this article is to describe the design of the APACHE cohort. The secondary objective is to assess the main baseline clinical and laboratory features in the patients included so far.

# 2. Methods

## 2.1. Methods used for the APACHE cohort

### 2.1.1. Study design

APACHE is an ongoing longitudinal prospective cohort study (NCT03768271) in adults. The age range was 18 to 60 years until December 2023, when the upper age limit was changed to 65 years. Patient enrolment started in January 2020. Thirty regional centres in France are participating. Recruitment at each centre occurs in close collaboration with the local community rheumatologists, who refer the patients to the cohort.

The study was approved by the CPP Ouest VI ethics committee (#CPP1134HPS2) on January 2019. Patients are enrolled only after giving their written informed consent. The study is conducted in compliance with Good Clinical Practice Guidelines.

### 2.1.2. Objectives

The main objective is to assess radiographic severity over 5 years in patients with recent-onset pPsA at baseline. The primary end-

point is the presence of at least one erosion, on at least one of the radiographs performed at 5 years. The joints assessed radiographically are the hands, wrists, and feet, as well as any other peripheral joints with arthritis at baseline.

The secondary objectives are to assess radiographic signs of severity other than erosions at 5 years (joint space narrowing and periostitis); to assess all signs of radiographic severity (erosions, joint space narrowing, and periostitis) at 10 years; to identify any genetic, environmental, clinical, and/or therapeutic predictors of radiographic severity at 5 and 10 years; to describe the clinical course of recent-onset pPsA over 5 and 10 years; to evaluate magnetic resonance imaging (MRI) and ultrasound scans changes in distal joints during follow-up; to assess disease burden at 5 and 10 years; to describe treatments used over the first 5 and 10 years; and to develop diagnostic, classification and assessment tools for early pPsA.

### 2.1.3. Patient selection

Females and males aged 18 to 60 years until 2023, then 65 years, were eligible if they had received a diagnosis by a rheumatologist of a first episode of peripheral arthritis, within the last 12 months. Psoriasis diagnosed by a physician and/or psoriasis in one or more first degree-relatives (parents, siblings, children) or second-degree relatives (grandparents, aunts, uncles, nieces, nephews) was also required. Given the absence to date of validated diagnostic criteria for PsA, inclusion requires that the diagnosis of PsA be considered very likely by the rheumatologist; “very likely” is defined as a diagnostic confidence score ≥ 7 on a 0–10 numerical rating scale (NRS) where 0 indicates not likely and 10 virtually certain. Patients had also to be naïve of targeted treatment. Finally, as required by French law, only patients covered by the French statutory health insurance system were included.

The exclusion criteria were as follows: definite diagnosis of an inflammatory rheumatic disease other than peripheral SpA; current or past treatment with a biological or targeted synthetic disease-modifying antirheumatic drug (DMARD), the only exception being apremilast; treatment dating back more than one year with a conventional synthetic DMARD (methotrexate, sulfasalazine, or leflunomide) or with apremilast, until December 2023, after which treatment with methotrexate only for non-rheumatic symptoms dating back more than one year was allowed; oral corticosteroid therapy within the last four weeks in a dosage above 10 mg/d prednisone-equivalent or in a modified dosage; intra-articular or pulse intravenous corticosteroid therapy within the last 4 weeks; contraindications to MRI; cognitive, mental or psychic impairment; difficulty understanding or reading French; guardianship; and known pregnancy.

### 2.1.4. Sample size

The sample size was estimated based on the primary endpoint of the proportion of patients with at least one radiographic joint erosion at 5 years. Few published data on pPsA are available for making assumptions. In one study, erosions on radiographs of the hands and feet were visible in 27% of 117 patients after a mean of 10 months and in 47% of 86 patients after a mean of 2 years; about 20% of patients without erosions at baseline developed erosions within 2 years [13]. In another study, 45% of 71 patients without erosions developed “erosions or deformities” within 10 years [14]. In the Swedish Early Psoriatic Arthritis Registry 5-year Follow-up study, 51% of patients had erosions after a median of 1 year and, at 5 years, an additional 20% had experienced the appearance of radiographic lesions, so that 71% in all had radiographic lesions [15]. Based on these data, we estimated that 25% to 50% of patients with pPsA onset within the past year have at least one erosion and that 20 to 30% develop new erosions within the next 5 years. A reasonable assumption is therefore that 45 to 80% of patients have at least
one erosion at 5 years. To estimate the prevalence of radiographic lesions at 5 years with sufficient accuracy, with a two-sided alpha risk of 5%, the 95% confidence interval for the number of patients needed is 283 to 425. We therefore aim to include 425 patients.

### 2.1.5. Patient follow-up

All patients attend in-person visits at the participating centre at baseline (month 0, M0), M6, M12, M24, M60 (year 5), M90 (year 7.5), and M120 (year 10). Additional online visits are planned at M18, M36, M48, M72, M84, M96, and M108. At each visit, each patient is assessed by a hospital rheumatologist. Patients with a confirmed diagnosis other than pPsA have their follow-up stopped at M24.

Procedures have been set up to avoid loss of follow-up. Newsletters intended for included patients are sent every 6 months to each centre. Patients who miss a scheduled visit are immediately called to arrange a new appointment; if this measure is unsuccessful, the centre sends a letter to the patient and usual rheumatologist. If the planned visit cannot take place, the patient is asked to complete a questionnaire containing the main follow-up items during a telephone interview.

The role of each centre in the study is to collect observational data. Patients are followed and treated by their rheumatologists, most of whom work in private practices in the region served by the relevant participating centre. After each visit, the results of investigations in each patient are communicated to the managing rheumatologist.

### 2.1.6. Data collection for the APACHE cohort

For each patient, clinical, laboratory, and imaging data are collected in an electronic case record form (eCRF).

The clinical data include age and sex; past medical history in the patient and family, general health and comorbidities; weight, height, and blood pressure; assessment by the rheumatologist of confidence in the diagnosis of pPsA assessed on a 0–10 NRS; Assessment of SpondyloArthritis international Society (ASAS) items present [16]; treatments taken in the past year and at baseline; and changes in treatments since the last visit. The results of a rheumatological examination of the axial and peripheral joints are recorded as follows: tender joint count (78 joints), swollen joint count (76 joints), dactylitis score adapted from the Leeds Dactylitis Instrument [17], Leeds Enthesitis score (LEI) with swollen joints and dactylitis collected as separate items for each joint or group of joints [18], Maastricht ankylosing spondylitis enthesitis score (MASES) [19], Spondyloarthritis Research Consortium of Canada (SPARCC) score [20], modified Schober's index, thoracic ampliation, occupip-to-wall distance, tragus-to-wall distance, finger-to-floor distance, lateral flexion of the spine, cervical spine rotation, and inter-malleolar distance. Current and past features of psoriasis (date of onset, sites involved, topical treatment only or also systemic treatment) are collected. Semi-quantitative assessments of the percentage of body surface area (BSA) affected with psoriasis and of lesion activity scored from 1 to 5 with photographs are also recorded, as well as the number of nails affected with psoriasis. The assessing rheumatologist then uses an NRS to score the levels of activity of the rheumatic disease and of the psoriasis.

At the in-person visit, the patients complete the following PRO questionnaires: Bath Ankylosing Spondylitis Functional Index (BASFI) [21]; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) [22]; Fibromyalgia Rapid Screening Tool (FIRST) [23]; EQ-5D-3L [24]; SF36 questionnaire [25]; Psoriatic Arthritis Impact of Disease-12 (PsAID-12) [26]; Dermatology Life Quality Index (DLQI) [27]; Health Assessment Questionnaire – Disability Index (HAQ-DI) [28]; Work Productivity and Activity Impairment Questionnaire: Psoriatic Arthritis (WPAI:PsA) [29]; Hospital Anxiety and Depression Scale (HADS) [30]; Patient Acceptable Symptom State (PASS);

and visual analogue scales (VAS) assessing psoriasis symptoms (overall pain, disease activity, overall health, severity of scalp psoriasis, and severity of nail psoriasis).

At baseline, tests for HLA B27 and anti-nuclear antibodies are performed. The following blood tests are done at each in-person visit: full blood-cell count; erythrocyte sedimentation rate; and levels of C-reactive protein (CRP), haemoglobin, creatinine, and transaminases. At baseline and selected subsequent visits, fasting blood glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides are measured. The titres of rheumatoid factor and anti-cyclic citrullinated peptide (CCP) antibodies are determined at M24, M60, and M120. Finally, the following samples are collected for storage at -80°C: serum and plasma at M0, M12, M24, M60, and M120; urine at M0, M12, M60, and M120; DNA at M6; and RNA at M0 and M12.

The imaging studies performed in the cohort include radiographs, MRIs, and ultrasound scans. Radiographs obtained at M0, M12, M24, M60, and M120 are as follows: antero-posterior views of the hands and wrists; antero-posterior, oblique, and lateral views of the feet; and antero-posterior and lateral views of any joint with evidence of arthritis. An antero-posterior radiograph of the pelvis is performed at M0, M60, and M120. Each participating centre evaluates the radiographs for presence of one or more erosions and for joint space narrowing. Subsequently, the radiographs will be reviewed centrally. At baseline, MRI is performed according to the following hierarchy of sites: hand and wrist if painful (on the right side if the pain is bilateral); foot when hands-wrists are not painful but foot is painful (on the right side if the pain is bilateral); in the absence of pain in the 4 extremities, the MRI site is the possible site of arthritis in the past year, hand and wrist (right side if bilateral), and otherwise foot (right side if bilateral), and finally right hand and wrist when there is no hand, wrist, or foot pain or arthritis. MRIs of the site imaged at baseline are repeated at M24, M60, and M120. The MRIs are not read locally and will be subjected to a centralised review. Finally, ultrasound scans of 46 joints, 26 tendons, and 12 entheses are performed at M0, M24, M60, and M120. Evidence of synovitis and tenosynovitis by B-mode scanning and power Doppler is evaluated using a semi-quantitative 0–3 scale according to the EULAR-OMERACT scoring system. Enthesitis meeting the OMERACT definition is recorded as present or absent. The fingers and toes are assessed for dactylitis [31–33]. The sonographers underwent a centralized training and reproducibility assessment before inclusion of the first patient.

The Supplemental File 1 provides details on the databases, study organisation, and oversight committees.

### 2.2. Methods for the current study

The current study is a preliminary analysis of the main baseline features in the patients included up to 29 February 2024. Imaging study findings and PROs were not considered. Given reports of increased cardiovascular-disease risk in patients with PsA, cardiovascular risk factors and diseases were described [34–39].

Descriptive statistics were computed for the overall population. No imputation for missing data was performed.

## 3. Results

The first patient was included in January 2020. The recruitment rate was initially very slow due to the COVID-19 pandemic. By 29 February 2024, 193 patients had been included. Seven patients had major protocol deviations and were therefore excluded, leaving 186 patients for the study.

Table 1 reports the main patient features at baseline. Mean patient age was 44 ± 11 years and 84/186 (45%) patients were
<table><caption>**Table 1**
Main baseline features of the first 186 patients included in the APACHE cohort.</caption><thead><tr><th></th><th>n = 186</th></tr></thead><tbody><tr><td>Age, y mean ± SD</td><td>44 ± 11</td></tr><tr><td>Psoriasis in the patient, n (%)</td><td>169 (91)</td></tr><tr><td>Psoriasis duration at baseline, y, mean ± SD</td><td>14 ± 12</td></tr><tr><td>Past or current psoriasis distribution, n (%)</td><td></td></tr><tr><td>Scalp</td><td>115 (68)</td></tr><tr><td>Skin</td><td>135 (80)</td></tr><tr><td>Genital area</td><td>37 (26)</td></tr><tr><td>Palms and soles</td><td>33 (23)</td></tr><tr><td>Nails</td><td>56 (39)</td></tr><tr><td>Familial psoriasis, n (%)</td><td>105 (57)</td></tr><tr><td>Familial psoriasis but no psoriasis in the patient, n (%)</td><td>17 (9)</td></tr><tr><td>Body mass index, kg/m², mean ± SD</td><td>27.1 ± 5.4</td></tr><tr><td>Time from first arthritis to baseline, months, mean ± SD</td><td>6 ± 3.5</td></tr><tr><td>First peripheral site involved with arthritis, n (%)</td><td></td></tr><tr><td>Hands</td><td>74 (40)</td></tr><tr><td>Knees</td><td>53 (28)</td></tr><tr><td>Feet</td><td>34 (18)</td></tr><tr><td>Wrists</td><td>31 (17)</td></tr><tr><td>Number of painful joints/78, mean ± SD</td><td>6 ± 8</td></tr><tr><td>Number of swollen joints/76, mean ± SD</td><td>2.1 ± 3.2</td></tr><tr><td>C-reactive protein</td><td></td></tr><tr><td>Mean ± SD (mg/L)</td><td>15 ± 20</td></tr><tr><td>Above 5 mg/L, n (%)</td><td>89 (49)</td></tr><tr><td>DAPSA Score, mean ± SD</td><td>19 ± 14</td></tr><tr><td>Past or current dactylitis, n (%)</td><td>50 (27)</td></tr><tr><td>Past or current inflammatory back pain, n (%)</td><td>107 (58)</td></tr><tr><td>Meeting Calin criteria</td><td>48 (27)</td></tr><tr><td>Meeting Berlin criteria</td><td>55 (31)</td></tr><tr><td>Past or current enthesitis, n (%)</td><td>73 (39)</td></tr><tr><td>Past or current anterior chest wall pain, n (%)</td><td>47 (25)</td></tr><tr><td>Crohn's disease or ulcerative colitis, n (%)</td><td>1 (0.5)</td></tr><tr><td>Past or current anterior uveitis, n (%)</td><td>1 (1)</td></tr></tbody></table>

DAPSA: Disease Activity in Psoriatic Arthritis Score.

<table><caption>**Table 2**
Baseline cardiovascular risk factors and diseases in the first 186 patients included in the APACHE cohort.</caption><thead><tr><th>Cardiovascular risk factors or diseases</th><th>n = 186</th></tr></thead><tbody><tr><td>Patients with cardiovascular risk factors and/or diseases, n (%)</td><td></td></tr><tr><td>0</td><td>113 (61)</td></tr><tr><td>1 or 2</td><td>66 (35)</td></tr><tr><td>3 or more</td><td>7 (3.8)</td></tr><tr><td>Normal or low weight (BMI < 25 kg/m²), n (%)</td><td>75 (40)</td></tr><tr><td>Overweight (25 ≤ BMI < 30 kg/m²), n (%)</td><td>61 (33)</td></tr><tr><td>Obesity (BMI ≥ 30 kg/m²), n (%)</td><td>50 (27)</td></tr><tr><td>Hypertension, n (%)</td><td>35 (19)</td></tr><tr><td>Coronary artery disease, n (%)</td><td>2 (1.1)</td></tr><tr><td>Myocardial infarction, n (%)</td><td>4 (2.2)</td></tr><tr><td>Stroke, n (%)</td><td>1 (0.5)</td></tr><tr><td>Type 1 diabetes, n (%)</td><td>1 (0.5)</td></tr><tr><td>Type 2 diabetes, n (%)</td><td>13 (7.0)</td></tr><tr><td>Gout, n (%)</td><td>5 (2.7)</td></tr></tbody></table>

women. The mean NRS score for confidence in the diagnosis of PsA by the referring rheumatologist was 9 ± 1. Mean arthritis duration was 6 ± 4 months. The HLA B27 antigen was found in 34/161 patients (21%). The mean numbers of swollen and tender joints were 2.1 ± 3.2 and 6.0 ± 8.0, respectively. The first joints involved were the hands in 40% and the knees in 28% of patients. The CRP level was normal in 51% patients. Past or current enthesal pain was reported in 39% of patients, whereas 27% of patients had past or current dactylitis. The Disease Activity in Psoriatic Arthritis Score (DAPSA) was 19 ± 14, indicating moderate activity. Treatment consisted in non-steroidal anti-inflammatory drugs in 41% of patients, methotrexate in 38% and glucocorticoids in 5%. Two patients had inflammatory bowel disease and one had uveitis.

Table 2 shows that cardiovascular risk factors and diseases were common, being present in 49% of patients. Moreover, 27% of patients had obesity and 26% were current smokers.

## 4. Discussion

In this article, the methodology used for enrolment and follow-up in the APACHE cohort is described and the baseline features of the first 186 included patients are reported. A key characteristic of the cohort is that it includes only patients with pPsA and with disease onset within the past year. The objective is to recruit 425 patients then monitor them for at least 10 years. A vast array of data will be collected for each patient, including clinical findings; laboratory test results; radiographic, MRI, and ultrasound abnormalities; PROs; and economic information. These data will serve for developing multiple research projects focusing on the diagnosis, prognosis, epidemiology, pathogenesis, management, and medical economics of pPsA. The inclusion confined to patients with peripheral arthritis, very recent disease onset at baseline, and comprehensive 10-year follow-up will provide information that differs from that provided by available studies of PsA [2–15]. Despite this considerable strength of the APACHE cohort, the absence of data collection on potential axial involvement with PsA is a limitation.

To our knowledge, this study provides the first information on features in patients with pPsA with onset within the past year. Males predominated slightly, typical age at onset was about 45 years, and oligoarticular disease with a mean of 2.1 affected joints was the most common presentation. The hands and/or wrists were involved initially in 57% of cases. A history of psoriasis was found in 91% of patients, with a mean duration of 14 years, whereas only 9% had a family history of psoriasis but no psoriasis themselves. The CRP level was normal in half the patients.

## 5. Conclusion

In conclusion, this study details the methodology used for the APACHE cohort confined to patients with recent-onset pPsA and describes the baseline features in the patients enrolled so far. The numerous studies being planned to assess the clinical, laboratory, imaging, and PRO data from the APACHE cohort are expected to provide new insights into the many facets of pPsA.

## Contributors

All authors contributed to the work and read and approved the final version of the manuscript for submission. PC accepts full responsibility for the work and conduct of the study and acts as guarantor.

## Funding

The APACHE cohort is supported by the French Society of Rheumatology and unrestricted grants from the following sources, in order of decreasing support: UCB, Abbvie, Lilly, Novartis, Janssen, Amgen, Galapagos, Viatris, and Biogen.

## Patient and public involvement

Neither the patients nor the public were involved in the design, conduct, reporting, or dissemination plans of this research.

## Patient consent for publication

Each patient provided informed written consent before enrolment in the APACHE cohort.
## Ethics approval

This study was conducted according to Good Clinical Practice guidelines and was approved in January 2019 by the Comité de Protection des Personnes Ouest VI, Brest ethics committee.

## Provenance and peer review

Not commissioned; externally peer reviewed.

## Disclosure of interest

PC has received consultant fees from AbbVie, Amgen, Biogen, BMS, Celltrion HealthCare, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB.

CGV has received consultant or speaker fees from AbbVie, Alfasigma, Amgen, Biogen, Biocon, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion HealthCare, Chugai, Eli Lilly, Fresenius Kabi, Galapagos, Gilead Sciences Inc., Janssen, Medac, Merck-Serono, Mylan, Nordic Pharma, Novartis, Pfizer, Sandoz, Sanofi, UCB, and Viatrix.

AC has received consultant or speaker fees from AbbVie, Amgen, Boehringer, Celltrion, Galapagos, Johnson & Johnson, Lilly, Novartis, Sanofi, and UCB.

FB, BC, VD, TP, BR, EA, S J-J declare that they have no competing interest.

PG: is a consultant for AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and UCB Pharma.

PR: has received consultant fees from AbbVie, Amgen, Biogen, BMS, Janssen, Lilly, Novartis, Pfizer, and UCB.

DW has received consultant or speaker fees from AbbVie, BMS, MSD, Pfizer, Nordic Pharma, UCB, Novartis, Lilly, Janssen, Alfasigma, and Celltrion; and accommodation expenses from Fresenius Kabi and Sandoz.

GM has received consultant or speaker fees from AbbVie, Alfasigma, Biogen, Biocon, Bristol-Myers Squibb, Chugai, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sandoz, UCB, and Viatrix.

LG has the following disclosures unrelated to the present submitted work: research grants from AbbVie, Biogen, Lilly, Novartis, and UCB; consultant fees from AbbVie, AlfaSigma, Amgen, BMS, Celltrion, Janssen, Lilly, MSD, Novartis, Pfizer, Stada, and UCB; and non-financial support from AbbVie, Amgen, Biogen, Celltrion, Janssen, Pfizer, and UCB.

## Acknowledgements

The APACHE cohort study is conducted under the control of the Assistance publique-Hôpitaux de Paris via the GHU Mondor Chenevier Créteil Clinical Research Unit and under the umbrella of the French Society of Rheumatology. Database management is done by the Department of Public Health (Prof. Etienne Audureau, Hôpital Henri-Mondor, Créteil). We thank the investigators participating in the cohort.

The principal investigators are listed below.

Prof. Athan Baillet (Grenoble), Prof. Francis Berenbaum (Paris - Saint-Antoine), Prof. Maxime Breban (Paris - Boulogne-Billancourt), Prof. Veronique Breuil (Nice), Prof. Pascal Claude-pierre (Paris - Créteil), Prof. Arnaud Constantin (Toulouse), Prof. Emmanuelle Dernis (Le Mans), Prof. Philippe Dieude (Paris - Bichat), Prof. Rene-Marc Flipo (Lille), Prof. Cecile Gaujoux-Viala (Nîmes), Prof. Elisabeth Gervais (Poitiers), Prof. Laure Gossec (Paris - La Pitié-Salpêtrière), Prof. Jacques-Eric Gottenberg (Strasbourg), Prof. Philippe Goupille (Tours), Prof. Pascal Guggenbuhl (Rennes), Prof. Sandrine Guis (Marseille), Dr. Slim Lassoued (Cahors), Prof. Benoit Le Goff, (Nantes) Dr. Eric Lespessailles

(Orléans), Prof. Damien Loeuille (Nancy), Prof. Hubert Marotte (Saint-Étienne), Dr. Anna Molto (Paris - Cochin), Dr. Gael Mouterde (Montpellier), Dr. Tristan Pascart (Lille2), Prof. Pascal Richette (Paris - Lariboisière), Dr. Fabienne Roux (Paris - Saint-Joseph), Prof. Alain Saraux (Brest), Prof. Anne Tournadre (Clermont-Ferrand), Prof. Olivier Vittecoq (Rouen), Prof. Daniel Wendling (Besançon).

## Appendix A. Supplementary data

Supplementary data associated with this article can be found in the online version, at https://doi.org/10.1016/j.jbspin.2025.105930.

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