P172 Evaluating the use of patient reported outcome measures to assess intra-pandemic psoriatic arthritis disease activity and comparing them with pre-pandemic clinical assessments
Authors: Song Kaiyang , Kurzeja Dominik , Verdiyeva Ayna , Mirza Maria , Ashraf Madiha , James Lija , Luqmani Raashid 
Published: April 2023

Abstract

Background/Aims
In our department, patient reported outcome measures (PROMs), including RAPID-3 and PSAID12, were employed during the COVID-19 pandemic in asynchronous consultations for patients with psoriatic arthritis (PsA). We compared pre-pandemic DAS28-CRP with intra-pandemic PROMs to assess changes in disease activity since the pandemic. Whilst previous studies have primarily compared PsA PROMs with clinician-assessed scores (e.g. PASDAS), we compare PsA PROMs with clinicians’ overall assessment of disease activity; this judgement considers PROMs, serology studies and individual patient feedback. Finally, we assess whether patients with PROMs indicating active disease were followed up appropriately.

Methods
Clinician-assessed scores were collected between 01/01/2019-01/03/2020 (“pre-pandemic”). Between 01/12/2020-31/03/2022 (“intra-pandemic”), patient data from electronic surveys were analysed in a secure database for calculation of PROMs. These data, alongside blood results and patient comments, informed clinicians’ triage decisions. Clinical outcome data were collected from electronic patient records; ≤3 months follow-up appointment allocation was the target for patients with active disease (moderate/high disease activity). Data analysis was performed using r (version 4.2.2).

Results
In our pre-pandemic cohort (n = 393), 79.8% of patients were in remission (per DAS28-CRP). Conversely, the intra-pandemic cohort (n = 231) showed remission rates of 14.3% (per PSAID12) and 0% (RAPID-3). Indeed, 33.7% (based on PSAID12) vs 75.8% (RAPID-3) had moderate/high disease activity. These results were validated in a paired cohort (n = 38, score recorded in both windows). Disease activity worsened during the pandemic for 63.2% (PSAID12) and 97.4% (RAPID-3) of patients. PSAID-12 correlated positively with RAPID-3 (r = 0.52, p &lt; 0.001), especially when RAPID-3 ≥6.5 (r = 0.75, p &lt; 0.001). When comparing PROMs with clinicians’ assessment of PsA activity in our paired cohort, PSAID12 and RAPID-3 accurately reflected disease status in 70.6% and 58.8% of patients respectively. 3/9 and 9/27 patients with active disease, based on PSAID12 and RAPID-3 respectively, were seen within three months. Conversely, 7/10 patients who clinicians had deemed to have active disease were seen within three months.

Conclusion
Despite approximately 80% of patients being in pre-pandemic remission, the majority reported active intra-pandemic PsA. Whilst RAPID-3 skewed patients towards active disease, PSAID12 skewed patients towards remission/low disease activity. PSAID-12 and RAPID-3 have been previously correlated; however, here we suggest that they could be used interchangeably in patients with high disease activity. PSAID-12 was a better predictor of clinicians’ assessment of disease activity, although neither PROM correlated well with ≤3 months follow-up appointment allocation. Although RAPID-3 and PSAID12 helped inform clinicians’ decisions, neither alone sufficiently reflects patients’ disease states. Remote management is practicable, but future studies should validate these findings across a larger cohort and assess the utility of different PROMs across PsA disease activity categories. Furthermore, multivariate analysis is warranted to ascertain which (combination of) variable(s) (e.g., PROMs, serology results, tender/swollen joint count) best correlates with clinician judgement.
Disclosure
K. Song: None. D. Kurzeja: None. A. Verdiyeva: None. M. Mirza: None. M. Ashraf: None. L. James: None. R. Luqmani: None.