P174 Psoriatic arthritis patients in the UK have a lower quality of life than patients in mainland Europe - an analysis from the ASSIST study
Authors: Coyle Conor , Watson Lily , Brooke Melanie , Kiltz Uta , Lubrano Ennio , Queiro Ruben , Trigos David , Brandt-Jürgens Jan , D'Angelo Salvatore , Sedie Andrea Delle , Dernis Emmanuelle , Helliwell Philip , Ho Pauline , Hueber Axel , Ibáñez Beatriz Joven , Köhm Michaela , Morales Carlos Montilla , Packham Jon , Tasende José Antonio Pinto , García Felipe Julio Ramíez , Ruyssen-witrand Adeline , Scrivo Rossana , Twigg Sarah , Welcker Martin , Soubrier Martin , Wirth Theo , Gossec Laure , Coates Laura 
Published: April 2023

Abstract

Background/Aims
Psoriatic arthritis (PsA) is a heterogeneous, multi-dimensional disease. Treatment pathways are not well defined and have to be tailored to the individual; however, little is known about the factors underpinning a decision to intensify treatment. By comparing treatment data between countries, we can understand more about factors influencing patient outcomes and establish international benchmarks in practice.

Methods
ASSIST was a cross sectional study of patients (18 years and older) diagnosed with PsA. Participants were selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain). Patients were selected from face to face (F2F) appointments using systematic sampling with random starting numbers generated for each site. Participants were treated as usual in their routine clinical practice. The Health Assessment Questionnaire (HAQ) and the EQ-5D-5L QoL survey were provided to all participants as patient-reported outcome tools. The perceived confidence on patient-physician interaction score (PEPPI) and the CollaboRATE measure were used to assess patient satisfaction with a consultation.

Results
503 patients from 24 centres across five countries in Europe (49.1% F, 50.9% M) (mean age 53) participated in the survey between 12/07/2021-22/03/2022. Despite similar rates of treatment escalation and similar satisfaction with consultations, QoL was poorer in the UK. Comparing EQ-5D-5L scores, participants in the UK (107) reported worse outcomes across all domains except pain/discomfort versus participants in mainland Europe (396). 52.3% in the UK reported some problems with self-care versus 33.9% in mainland Europe. 72.9% of patients in the UK reported issues with mobility (mainland Europe: 61.6%). The UK had the highest percentage of participants reporting issues with anxiety (66.4%). The UK had the most severe HAQ scores, (mean= 0.936) compared to means of 0.62 or below in other countries. Physician-reported severity of disease was higher in the UK; however, patients in the UK reported the second highest PEPPI scores, the second highest collaboRATE scores and comparable methods of treatment escalation (dose adjustment or addition of another medication) to mainland Europe. Moreover, data on co-morbidities (including FCI categorical breakdown) does not demonstrate obvious variation between the UK and Europe.

Conclusion
Overall, patients with PsA in the UK reported lower quality of life (QoL) compared to patients in mainland Europe. It is not clear from our data why the UK performs less well on the majority of EQ-5D-5L domains and HAQ scoring compared to Europe. This may relate to variation in disease activity; however, there is potential selection bias in the higher disease activity reported by physicians in the UK as patients with more severe disease could have been selected for F2F appointments compared to mainland Europe. There may also be additional factors outside of the consultation impacting these scores, which could be identified with future research.
Disclosure
C. Coyle: None. L. Watson: None. M. Brooke: None. U. Kiltz: None. E. Lubrano: None. R. Queiro: None. D. Trigos: None. J. Brandt-Jürgens: None. S. D'Angelo: None. A. Delle Sedie: None. E. Dernis: None. P. Helliwell: None. P. Ho: None. A. Hueber: None. B. Joven Ibáñez: None. M. Köhm: None. C. Montilla Morales: None. J. Packham: None. J. Antonio Pinto Tasende: None. F. Ramíez García: None. A. Ruyssen-witrand: None. R. Scrivo: None. S. Twigg: None. M. Welcker: None. M. Soubrier: None. T. Wirth: None. L. Gossec: None. L. Coates: None.