SAT0395 Scalp Psoriasis as A Surrogate Marker for Psoriatic Arthritis Severity and Treatment Response
Authors: K. de Vlam, A. Szumski, L. Mallbris, H. Jones
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Patients with psoriasis (PsO) are at an increased risk of developing psoriatic arthritis (PsA).<sup>1</sup> It has been observed that scalp PsO is indicative of more severe PsO, and increased PsO severity plus scalp PsO are associated with an increased risk of PsA.<sup>2,3</sup> <h3>Objectives</h3> To determine if baseline scalp PsO is associated with baseline severity of PsA and if it is predictive of treatment response to etanercept (ETN). <h3>Methods</h3> In the PRESTA study (clinicaltrials.gov NCT00245960), patients with PsA plus PsO received either ETN 50 mg twice weekly for 12 wks followed by ETN 50 mg once weekly (QW; n=379) or ETN 50 mg QW for 24 wks (n=373). For this analysis, patients who received ETN 50 mg QW were analyzed by their scalp PsO status (scalp+ versus scalp–). Baseline characteristics investigated in scalp+ vs scalp– patients included age, gender, race, family history of PsO and PsA, and PsA subtype. The following treatment outcomes were compared in scalp+ vs scalp– patients at baseline and in improvements at Wks 12 and 24: C-reactive protein levels and fatigue score; skin involvement measures including body surface area, PsO area severity index, and physician global assessment (PGA) PsO; joint involvement outcomes including the disease activity score in 28-joints, duration of morning stiffness, PGA arthritis, subject global assessment (SGA) of disease activity, subject assessment of joint pain, painful joints (28/68 joint counts), swollen joints (28/66 joint counts), digits with dactylitis, and points with enthesitis; quality of life (QoL) EuroQoL-5D (EQ-5D) and health assessment questionnaire (HAQ) scores. The % of patients achieving dactylitis ≤1, enthesitis ≤1, and HAQ ≤0.5 at Wks 12 and 24 were also calculated. <h3>Results</h3> In the ETN QW cohort, 273/373 (73.2%) patients had scalp PsO. Spondyloarthropathy was the only PsA subtype shown to be significantly higher in scalp+ vs scalp– patients: 43/49 (87.8%) vs. 521/702 (74.2%; P=0.03). At baseline, scalp– patients were older (49.4 years vs 46.0; P=0.010), with more females (52% vs 33%; P=0.001), and a significantly higher number of painful joints (28-joint count; Table). Scalp+ patients had a significantly higher baseline SGA of disease activity. Improvements from baseline at Wks 12 and 24 for both fatigue and subject assessment of joint pain were significantly higher for scalp+ patients with significantly better final Wk 12 and 24 results. However, only improvement in the number of painful joints (28-joint count) was significantly greater for the scalp– group with similar final Wk 12 and 24 results for scalp+ and scalp– patients. Significantly more patients in the scalp– group had dactylitis ≤1 at Wk 24 and enthesitis ≤1 at Wk 12, but significantly more scalp+ patients had HAQ ≤0.5 at Wk 12. No significant differences were observed between the scalp+ and scalp– patients in the other baseline values or in the improvements from baseline for the other treatment outcomes tested. <h3>Conclusions</h3> Significant differences were observed in joint involvement and QoL in patients with scalp+ vs scalp– at baseline and after 12 and 24 wks of ETN treatment, indicating a relationship between joint involvement and scalp PsO status and between QoL and scalp PsO status. <h3>References</h3> Gladman DD et al. Ann Rheum Dis 2005;64 Suppl 2:ii14-7. Haroon M et al. Ann Rheum Dis 2013;72:736-40. Wilson FC et al. Arthritis Rheum 2009;61:233-9. <h3>Acknowledgements</h3> This study was sponsored by Pfizer Inc. Medical writing support was provided by Kim Brown of Engage Scientific and funded by Pfizer Inc. <h3>Disclosure of Interest</h3> K. de Vlam Consultant for: Pfizer Inc., UCB, Abbott, Celgene and Janssen, Speakers bureau: Pfizer Inc., UCB, Abbott, Celgene and Janssen, A. Szumski Employee of: Inventiv Health Inc who were paid contractors to Pfizer Inc., L. Mallbris Employee of: Pfizer Inc., H. Jones Employee of: Pfizer Inc. <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.2949