THU0524 FACTORS EXPLAINING PATIENT PERSPECTIVE IN PSORIASIS AND PSORIATIC ARTHRITIS (PSA): THE ROLE OF INFLAMMATION AND STRUCTURAL DAMAGE DETECTED BY ULTRASOUND (THE ECHOPRO STUDY)
Authors: T. Gudu, I. Padovano, E. Mahe, H. Gouze, F. Vidal, I. Bourgault, L. Lara/Gonzalez, A. Guyot, S. Philippe, M. Amy de la Breteque, S. Ruel-Gagné, L. Coronel, F. Costantino, G. Hayem, M. Breban, M. A. D’agostino
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patient reported outcomes (PROs) reflect patients’ opinion on disease activity, impact of disease, quality of life (QoL) and are essential in the assessment of PsA patients. PROs may be influenced by several factors other than disease activity and severity. Ultrasound (US) is an objective tool to evaluate joint inflammation and structural damage in PsA. Objectives: This cross-sectional study aimed at evaluating the role of US-detected inflammation (synovitis, tenosynovitis, enthesitis) and structural damage (erosions, enthesophytes, osteophytes, cortical irregularities), to explain PROs in PsA and to compare that to psoriasis (PsO) patients with and without musculoskeletal (MSK) symptoms. Methods: PsA (CASPAR criteria) [1], PsO with MSK symptoms without fulfilling CASPAR criteria (symptoPsO) and PsO with no MSK symptoms (asymptoPsO) were included. Socio-demographic characteristics, comorbidities, disease duration and treatment were collected. All patients underwent to: a) dermatological and rheumatologic assessment: PsO severity, swollen joint count (SJC), tender JC (TJC), number of dactylitis and enthesitis; b) US evaluation of joints, tendons and entheses according to OMERACT definitions[2], (figure 1); c) PROs assessement: fatigue, disability (HAQ) and QoL (SF36). Variables were compared across groups (chi square or one-way ANOVA test). Correlations were evaluated using Spearman’s test. Results: 208 patients (76 PsA, 64 symptoPsO and 68 asymptoPsO) with similar socio-demographic characteristics and PsO duration were included (table 1). Except for enthesophytes, all US changes were significantly higher in PsA, followed by symptoPsO patients. Table 1. Characteristics of the patients: PsA N= 76 SymptoPsO N=64 AsymptoPsO N=68 p Females, N (%) 33 (43.4) 39 (55.7) 23 (37.1) NS Age 55.58 ± 12.71 52.16 ± 15.61 50.03 ± 14.66 NS Psoriasis duration 18.76 ± 13.37 19.47 ± 15.98 15.03 ± 12.29 NS PASI 0 (0; 36) 3 (0; 16) 5.5 (0; 22.1) &lt;0.001 68 TJC 4 (0; 30) 2 (0; 23) 0 &lt;0.001 66 SJC 0 (0; 23) 0 (0; 3) 0 &lt;0.001 Number of enthesitis 3 (0; 13) 2 (0; 13) 0 &lt;0.001 Number of dactylitis 0 (0; 5) 0 0 NS Fibromyalgia, N (%) 6 (7.9) 4 (5.7) 0 NS N of joints with US synovitis 1 (0; 32) 0 (0; 7) 0 (0; 6) 0.001 N of US enthesitis 0 (0; 11) 0 (0; 2) 0 (0; 2) &lt;0.001 N of US tenosynovitis 0 (0; 7) 0 (0; 1) 0 (0; 1) 0.005 N of joints with US osthephytes/cortical irregularities 2 (0; 22) 1 (0; 25) 1 (0; 21) 0.027 N of joints with US erosions 0 (0; 4) 0 (0; 2) 0 (0; 2) 0.016 N of US entheses with enthesopthytes/calcifications 3 (0; 9) 2 (0; 10) 1 (0; 8) NS N of US enthesis with erosions 0 (0; 5) 0 (0; 1) 0 (0; 2) 0.001 Fatigue (0-10) 4.91 ± 3.08 3.46 ± 3.40 2.57 ± 2.86 &lt;0.001 HAQ (0-3) 1 (0; 2) 0 (0; 2) 0 (0; 1) &lt;0.001 SF36 PF 61.31 ± 30.08 77.46 ± 25.02 89.35 ± 19.25 &lt;0.001 Across all 3 groups, all PROs correlated mainly with demographic variables, comorbidities, TJC, clinical enthesitis, skin severity, depression and fibromyalgia points (r=0.24-0.72). SymptoPsO and PsA reported similar scores of fatigue and impact on most QoL domains, significantly higher than asymptoPsO. HAQ correlated with total number of joints with US irregularities/osteophytes in PsA (r= 0.23; p=0.05), and SF36 physical function with both US inflammatory and damage variables in all three groups (r=0.24-0.34). Conclusion: Quality of life, disability and fatigue were more impaired in PsA and symptoPsO patients than asymptoPsO. In all groups, PROs seem to be mostly associated with socio-demographic characteristics and comorbidities rather than objective measures such as US changes or clinical variables. References: [1]Taylor, Arthritis Rheum 2006 [2]Bruyn, J Rheumatol 2019 Acknowledgments: This work was supported by PARTNER fellowship. Disclosure of Interests: None declared