SAT0351 Very low disease activity, dapsa remission, and patient-acceptable symptom state in psoriatic arthritis
Authors: R. Queiro, J.D. Cañete, C. Montilla, M.A. Abad, S. Gómez, A. Cabez
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The goal of treatment in psoriatic arthritis (PsA) according to the T2T strategy is remission, or at least, a low disease activity state<sup>1</sup>. Currently there is no clear agreement on how to measure these treatment goals. <h3>Objectives</h3> To explore the relationship between very low disease activity (VLDA) state, according to the MDA 7/7 criteria<sup>2</sup>, and DAPSA remission<sup>3</sup>, as well as its association with the impact of the disease evaluated by the PsAID questionnaire<sup>4</sup>, in patients with PsA in routine clinical practice. <h3>Methods</h3> Post-hoc analysis of the MAAPs study<sup>5</sup>. We included patients who met CASPAR criteria, with at least one year of disease evolution, and treated with biological and/or synthetic DMARDs according to the usual clinical practice in Spain. Patients were considered in VLDA if they met 7/7 of the MDA criteria, and in DAPSA/cDAPSA remission (this last without CRP) if they had a value ≤4. A PsAID &lt;4 represented a patient-acceptable symptom state (PASS). The frequency of these states and kappa (κ) agreement between them were analysed. <h3>Results</h3> Of the 227 patients included in the original study, 26 (11.5%), 52 (30.6%), 65 (36.9%) and 125 (55%) were in VLDA, DAPSA remission, cDAPSA remission, and PASS, respectively. There was a moderate agreement between VLDA and DAPSA remission (κ=0.52) or the cDAPSA remission (κ=0.42). Patients in VLDA had a lower impact of the disease measured by PsAID [mean total score (SD): VLDA 1.1 (1.2); DAPSA remission 1.3 (1.5); cDAPSA remission 1.7 (1.6)]. There was a moderate agreement between DAPSA remission or cDAPSA remission and PASS (κ=0.55 and κ=0.58 respectively), while fair agreement was found between VLDA and PASS (κ=0.18). <h3>Conclusions</h3> About one third of this series reached DAPSA remission, while only 11.5% reached VLDA state. On the other hand, more than half were in PASS situation. Agreement between VLDA and DAPSA was moderate. Although the MDA 7/7 criteria seem to be more stringent criteria for assessing remission, DAPSA remission shows better agreement with PASS. DAPSA and VLDA would be adequate treatment targets in daily practice. <h3>References</h3> [1] Smolen JS, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis2018;77:3–17. [2] Coates LC, et al. Defining Low Disease Activity States in Psoriatic Arthritis using Novel Composite Disease Instruments. J Rheumatol2016;43:371–375. [3] Schoels MM, et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis2016;75:811–818. [4] Gossec L, et al. A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis2014;73:1012–1019. [5] Queiro R, et al. Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study. Arthritis Res Ther2017;19:72. <h3>Disclosure of Interest</h3> None declared