AB0779 TOWARDS A GLOBAL MANAGEMENT OF PSORIATIC ARTHRITIS: ESTIMATION OF THE CARDIOVASCULAR RISK AND THE ACTIVITY OF THE DISEASE IN CLINICAL PRACTICE
Authors: José andrés Lorenzo Martín, Estefania Pardo Campo, Marina Pino Martínez, Lilian Consuelo Charca Benavente, Luis Marcelino Arboleya Rodríguez, Sara alonso Castro, Mercedes Alperi-López, Francisco Javier Ballina-García, Rubén Queiró Silva
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Psoriatic arthritis (PsA) patients usually have a high prevalence of cardiovascular risk factors (CVRF) and cardiovascular events, which makes the routine estimation of cardiovascular risk (CVR) highly advisable. Currently, this risk is estimated through classic risk scores (SCORE, Framinghan), however, the values of these scores may underestimate the real CVR of these patients. On the other hand, in clinical decision making and when evaluating the therapeutic response, it is advisable the use of some composite activity index. The heterogeneity of PsA makes it difficult to estimate the real activity and the remission state, so it is important to assess which of these composite index is more suitable for these purposes in clinical practice. <h3>Objectives:</h3> We aimed to analyze whether carotid ultrasound is a useful tool for estimating CVR in patients with PsA, and if it is capable of correcting the estimated risk using classical tables. We also analyzed the usefulness of the MDA criteria and the DAPSA categories for clinical decision making in real practice. <h3>Methods:</h3> A cross-sectional study was conducted with 136 consecutive patients with PsA (CASPAR criteria). Sociodemographic and anthropometric data, CVRF, disease activity according to DAPSA categories, HAQ, MDA, and CVR measured by SCORE chart, was collected. An IMT&gt; 800 μm and/or the presence of carotid plaque (Mannheim consensus), defined a high CVR by ultrasound. We analyzed the concordance (kappa) between the MDA response and the low activity and remission categories according to the DAPSA. Clinical variables of PsA associated with a high CVR were evaluated by multivariateanalyses. <h3>Results:</h3> Intima-media thickness values correlated well with CVR categories according to SCORE (p&lt; 0.0001). 40% of patients included in the low and moderate risk categories according to the SCORE risk chart were reclassified as high CVR after the ultrasound examination. In the multivariate analysis, some characteristics of the disease were independently associated with a high CVR. This reveals that patients with enthesitis and/or structural damage are those who tend to have a high CVR. When comparing DAPSA and MDA criteria, we found a moderate correlation between the MDA response and the DAPSA low activity (κ = 0.52, p &lt;0.0001) and between MDA and DAPSA remission (κ = 0.47; p &lt;0.0001). <h3>Conclusion:</h3> A high percentage of patients with low-moderate risk according to the SCORE risk chart are reclassified as patients with high CVR after the ultrasound examination. The high CVR in our population is related not only to classical CVRF, but also to the inflammatory load (enthesitis) and structural damage (erosions) of PsA. DAPSA is an appropriate instrument for clinical decision making in routine practice because it correlates reasonably well with stringent therapeutic goals such as MDA. <h3>Disclosure of interests:</h3> None declared