AB0938 Treatment patterns in early psoriatic arthritis according to the age of onset
Authors: M. Gilio, G. Tramontano, U. Bottoni, A. Padula, S. D’Angelo
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The initial treatment of Psoriatic Arthritis (PsA) is largely based on the extent of muscoloskeletal involvement and disease severity according to the stepwise approach of EULAR and GRAPPA recommendations for PsA management, but without reagard to the age of onset. <h3>Objectives</h3> This prospective observational study aimed<sup>1</sup> to describe treatment prescribing patterns in PsA over the first 2 years of follow-up and<sup>2</sup> to determine if the treatment patterns are contidioned by the age of onset. <h3>Methods</h3> Patients with at least 2 years of follow-up within the<b> PsArT</b> (<b>Ps</b>oriatic arthritis<b> A</b>ge-related <b>T</b>reatment patterns) study were included. Patients with a diagnosis of early (symptom duration &lt;52 weeks) PsA, made by rheumatologists with long-standing expertise in PsA, were consecutively recruited and divided into Adult-Onset (AOPsA) (age &lt;60 years) and Late-Onset (LOPsA) (onset age ≥60 years) PsA according to the age at the onset of musculoskeletal manifestations. For the aim of this study, patient's data were collected at the enrollemet (baseline) (T0), at 12 months (T12) and at 24 months (T24). Clinical, laboratory features and treatment patterns, over 2 years were described according to the age stratification. <h3>Results</h3> 46 PsA patients (22 M, 24 F; age 49±16, range 16–90 years) with a disease duration of 20±15 weeks (range 1–52) were enrolled. Compared to the 31 patients with AOPsA, the 15 patients with LOPsA had a signifcant shorter disease duration (17±15 vs. 21±15 weeks, p&lt;0.05) and showed more frequently increased levels of ESR (75% vs. 43%, p&lt;0.05) and CRP (87% vs. 52%, p&lt;0.01). In addition, patients with LOPsA developed more frequently infammatory extremity swelling with pitting oedema (IESPE) over the dorsum of hands and/or of the feet (56% vs. 13%, p&lt;0.01). There were no other significant differences between the 2 groups even though more males were observed in the LOPsA group (56% vs. 42%, p&gt;0.05). The sensitivity of the CASPAR criteria was similar in AOPsA (78%) and LOPsA (75%). Of 46 patients during the first year 80.4% received non steroidal anti-inflammatory drugs, 32.6% received oral corticosteroids, 13.0% received local corticosteroids, 19.5% received synthetic disease-modifying anti-rheumatic drugs (sDMARDs) and 6.5% received biologics (bDMARDs: IFX, ADA, GOL, ETN). During the second year of follow up 73.9% received non steroidal anti-inflammatory drugs, 30.4% received oral corticosteroids, 50% received synthetic disease-modifying anti-rheumatic drugs (sDMARD), 15.2% received biologics (IFX, ADA, GOL, ETN) and received 30.4% local corticosteroids. (see figure) About the drug intake the only statistical significant difference betwen the two groups was the rate of patients using NSAIDs in LoPsA group during the first year (<i>100% vs. 70.9%, p value 0.02</i>). There were no other significant differences in drug intake, therapy changes, discontinuation, add-on therapy according to the age of PsA onset. <h3>Conclusions</h3> During the two years of follow up period a high proportion of patient received NSAIDs in LoPsA group during the first year. The main limit of our study is the low number of patients, therefore a greater number could help to understand whether the age of onset may affect the use of specific type of drugs. <h3>Acknowledgements</h3> The authors would like to express their special appreciation and thanks to Prof. Ignazio Olivieri <h3>Disclosure of Interest</h3> None declared