POS0281 THE ASSOCIATION OF CLINICAL PARAMETERS, PATIENT REPORTED OUTCOMES AND SONOGRAPHIC FACTORS WITH DISCREPANCY BETWEEN PATIENTS’ AND EVALUATORS’ GLOBAL ASSESSMENTS IN PSORIATIC ARTHRITIS
Authors: K. Meridor, V. Furer, T. Shochat, O. Elalouf, O. Elkayam, A. Polachek
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The assessment of global disease activity by patients (PGA) and evaluators (EGA) is an essential outcome measure in psoriatic arthritis (PsA). However, a discordance between PGA and EGA poses a challenge in evaluating disease activity in PsA. Several clinical and sonographic factors could influence this discordance. <h3>Objectives:</h3> We aimed to evaluate the magnitude and extent of the discordance between PGA and EGA in PsA patients, and identify clinical, patient reported outcomes (PRO) and ultrasound (US) variables associated with this discordance. <h3>Methods:</h3> Consecutive PsA patients who fulfilled the CASPAR criteria were prospectively recruited. Each patient was evaluated by a comprehensive clinical, PRO questionnaires and sonographic assessment. The clinical evaluation was performed by senior rheumatologists blinded to the PGA and to US measures. PGA and EGA were rated with a 0–10 numerical rating scale, and delta of ≥3 was considered a clinically significant discordance. The US assessment included 52 joints, 40 tendons, and 14 points of entheses (according to the MASEI index plus lateral epicondyles), performed on the same day by an experienced sonographer blinded to the clinical data. The US scores calculation was based on the MAdrid Sonography Enthesitis Index (MASEI) scoring system for enthesitis, EULAR synovitis score for synovitis, and gray scale and Doppler scoring for tenosynovitis. The clinical, PRO and sonographic factors of the concordant and discordant groups were compared using a t-test for normally distributed data, otherwise, a non-parametric test was applied. Fisher's exact test was used to compare categorical variables. Factors associated with discordance were evaluated through univariate and multivariate regression analyses. <h3>Results:</h3> 158 PsA patients (mean age 52.3±13 years, 88 (55.7%) females) were included. The mean difference between PGA and EGA was 3.30 (±2.75) and 88 (55.7%) patients were considered discordant (difference ≥3), while 68 (43.0%) patients were considered concordant (+3 to -3). The discordant group had significantly higher tender joint counts, SPARCC scores, CRP levels, and lower occupation rates compared with the concordant group (p&lt;0.05) (Table 1). Grey scale and Doppler US scores of synovitis, tenosynovitis and enthesitis were similar between the groups. Disease activity scores (including MDA, DAPSA, CPDAI and PASDAS) were significantly higher in the discordant compared to the concordant group. In addition, patients with discordance had higher proportion of fibromyalgia (p&lt;0.001) and significantly worse PRO, including pain, depression, fatigue and different measures of quality of life (SF-36 physical and mental, HAQ and PsAID12, p&lt;0.05) (Figure 1). On multivariate regression, depression, higher tender joint counts and lower swollen joint counts were associated with higher discordance (OR 1.05, p=0.019; OR 1.07, p=0.017 and OR 0.85, p=0.046, respectively). <h3>Conclusion:</h3> The discrepancy between patients' and evaluators' global assessments in PsA is characterized by worse disease activity scores and physical and psychological/mental patient reported outcomes, but not sonographic measures. Depression was associated with higher discordance and, therefore, screening for this comorbidity and appropriate treatment are required. <b>Table 1.</b> Comparison of demographic, clinical and sonographic characteristics between concordant and discordant patient <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>