ABS0010 CLINICAL AND EPIDEMIOLOGICAL FEATURES OF DIFFICULT-TO-TREAT PSORIATIC ARTHRITIS: A CROSS-SECTIONAL STUDY

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Background: Psoriatic Arthritis (PsA) is a multifaceted disease affecting skin, peripheral joints, axial skeleton, and nails, often accompanied by challenging comorbidities, complicating its management. While the concept of difficult-to-treat rheumatoid arthritis (RA) has been delineated by the EULAR task force, a standardized definition for difficult-to-treat PsA (D2T PsA) is yet to be established. Objectives: This study aimed to characterize the clinical and epidemiological features of patients classified as D2T PsA compared to non-D2T PsA patients. Additionally, analysis of sexes and biologic/targeted synthetic disease-modifying antirheumatic drug (bDMARDs/tsDMARDs) treatment were evaluated. Methods: A prospective study was conducted at a tertiary center involving patients diagnosed with Psoriatic Arthritis (PsA) according to the Classification Criteria for Psoriatic Arthritis (CASPAR 2006). Patients were prospectively evaluated from March 1, 2023, to December 1, 2023. D2T PsA was defined as patients who failed at least one conventional DMARDs and at least two bDMARDs/tsDMARDs, and who also have at least moderate disease activity (MODA), defined as Disease Activity for Psoriatic Arthritis (DAPSA) score >14. Comparison between male and female patients and between patients treated with immunobiological agents and those not receiving such treatment were performed. Results: A total of 169 patients with psoriatic arthritis (PsA) were included in the study. Of these, 27 (16%) were classified as belonging to the difficult-to-treat PsA (D2T PsA) group, while 142 (84%) were classified in the non-D2T PsA group. The D2T PsA group was younger (55 ± 14.2 years, p=0.044), had higher cutaneous activity as assessed by PASI (1.2 ± 9, p=0.016), and a higher incidence of systemic glucocorticoid use (40.7% vs. 9.1%, p=0.002) compared to the non-D2T PsA group. No significant differences were observed regarding disease duration, axial or peripheral involvement, or comorbidities. Current use of non-anti-TNF bDMARDs was more common in the D2T PsA group (74%). When comparing male and female patients, a higher proportion of axial disease was observed in the male group (36.9% vs. 18.1%, p=0.009). Additionally, men had a higher prevalence of alcoholism (19.5% vs. 2.5%, p=0.006). In contrast, women had higher rates of fibromyalgia (18.1% vs. 4.3%, p=0.005) and depression (22% vs. 4.3%, p=0.005). No significant differences were found in terms of age at diagnosis, disease duration, use of immunobiological agents, or disease activity (DAPSA and PASI). In the analysis of patients on bDMARD therapy versus those not on bDMARDs, we observed that the bDMARD group had a younger age at disease diagnosis (40 ± 12.9 years vs. 45 ± 11.2, p=0.004) and a higher proportion of axial disease (35.2% vs. 17.1%, p=0.013). Additionally, patients on bDMARDs had more active disease, both in terms of joint involvement and skin manifestations, as indicated by higher DAPSA (13.7 ± 15.2, p=0.037) and PASI (2.6 ± 5.8, p=0.016) scores, respectively. This was further supported by a greater proportion of patients with moderate disease activity (DAPSA > 14) in the bDMARD group (37.1% vs. 20.3%, p=0.025). Regarding comorbidities, patients on bDMARDs had a higher mean BMI (29.1 ± 5.7, p=0.018), and interestingly, these patients had a lower incidence of smoking (18% vs. 34.3%, p=0.025). No significant differences were observed in other comorbidities. Conclusion: Despite advancements in understanding PsA and the availability of new therapies, a subset of patients presents with D2T PsA, posing considerable clinical challenges. This study contributes to analyzing the clinical and epidemiological differences in patients with D2T PsA, as well as exploring the reasons why treating PsA can be so challenging, with the aim of helping to design new treatment strategies in the future. REFERENCES: [1] Fagni F, Motta F, Schett G, Selmi C. Difficult-to-Treat Psoriatic Arthritis: A Conceptual Approach. Arthritis Rheumatol. 2024 May;76(5):670-674. doi: 10.1002/art.42780. Epub 2024 Jan 24. PMID: 38108094. Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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