Cardiovascular effects of Etanercept in patients with psoriatic arthritis: evidence from the cardiovascular risk in rheumatic diseases database

Abstract Background Cardiovascular risk factors and diseases represent the comorbidities with the highest prevalence in rheumatic diseases. Still, actual cardiovascular risk burden is often underestimated in current risk prediction models Methods To assess and compare traditional and nontraditional cardiovascular risk burden in patients with different rheumatic diseases, we analyzed demographical, clinical, laboratory, and non-invasive imaging data on patients with psoriatic arthritis in comparison with a cohort of ANCA-associated vasculitis and systemic lupus erythematosus in a cross-sectional design. Overall, we analyzed 138 patients. Results Data analysis revealed significant differences in traditional and nontraditional markers for cardiovascular disease risk as well as disparities in diastolic (6.67 % in PsA vs. 36% in AAV; OR 0.12 [0.03; 0.42], p < 0.05) and systolic left ventricular function (1.11% in PsA vs. 13.04% in SLE; OR 0.07 [0.005; 0.54], p < 0.05), whereas odds ratios for cardiovascular events did not differ significantly. Conclusion Our findings suggest that cardiovascular risk prediction algorithms should consider disease-specific disparities, which includes non-traditional cardiovascular risk burden, arguing for a patient-oriented risk assessment and consequently accurate risk stratification.

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AB0775 PERIPHERAL JOINT INFLAMMATION IS ASSOCIATED WITH MORE PROATHEROGENIC CARDIOVASCULAR RISK PROFILE IN PATIENTS WITH PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4101 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1685.1-1686

Author(s):

K. Bonek ◽

E. Kuca-Warnawin ◽

E. Kontny ◽

P. Głuszko

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Lipid Profile ◽

Rheumatic Diseases ◽

Risk Profile ◽

Serum Concentrations ◽

Cardiovascular Risk Profile

Background:We have previously found that: (i) patients with spondyloarthritis (SpAs) have higher circulating levels of IL-18 and osteoprotegerin (OPG) than healthy controls (1), (ii) psoriatic arthritis (PsA) patients present with more proatherogenic lipid profile and higher IL-18 levels than ankylosing spondylitis (AS) patients (2)Objectives:To investigate the relationship between disease phenotype, i.e. peripheral arthritis (perPsA n=45), axial PsA (axPsA n=16) and ankylosing spondylitis (AS n=94), cardiovascular risk factors and serum concentrations of IL-18, IL-17.Methods:A group of 155 SpA patients (94 AS/61 PsA), of similar age (44.5 versus 44.9 years), disease duration (4.8 versus 6.8 years), and matched with high disease activity (AS ASDAS-CRP 3.62±0.94; PsA DAPSA 26.75±26.61) were included in the study. The lipid profile comprised triglycerides (TG), total cholesterol (tChol), low- and high-density lipoprotein (LDL and HDL, respectively) measurement. Ischemic Heart Disease (IHD) diagnosis was established from patient’s medical history. Serum concentrations of IL-17AF, IL-18 were measured by specific commercially available enzyme-linked immunosorbent assays (ELISA) and were expressed as medians (pg/ml). The Mann-Whitney test was applied for intergroup comparison, correlation was assessed using Spearman’s Rank tests (r value is shown) with linear regression model.Results:Patients with perPsA had higher rate of IHD than axPsA and AS patients (27% vs 0% vs 7.8%, respectively). perPsA patients had significantly higher diastolic blood pressure than AS patients (perPsA 131±13mmHg vs AS 121±14 mmHg), more severe cardiovascular burden than patients with axial disease, were characterised by higher occurrence of obesity (perPsA 42% vs axPsA o 18% vs 18% AS) and hypertriglyceridemia (perPsA 48% vs axPsA 14% vs 16%AS) as well as higher TG concentration (perPsA 165± 87 mg/dl vs axPsA 111± 63mg/dl vs 110± 57 AS mg/dl). Moreover, patients with perPsA had significantly higher serum concentrations of IL-18 than axPsA and AS groups (132.5pg/ml vs 79.2pg/ml vs 84.9pg/ml), but there were no differences between them in IL-17 concentrations. Interestingly, in patients with perPsA, but no other patients’ groups, statistically significant associations between IL-18 concentrations and proatherogenic risk factors were found, as IL-18 correlated positively with TC (r=0.31), TG (r=0.53) atherogenic index (r=0.6), and uric acid (r=0.3) concentrations, while negatively with HDL levels (r=-0.47). Although patients groups differ in cardiovascular risk profiles, there were no significant differences in CV risk estimation using SCORE scale (perPsA 2.3% vs 1.6% axPsA vs 2.1%AS)Conclusion:We conclude that in PsA peripheral joints inflammation is associated with more proatherogenic cardiovascular risk profile and higher IL-18 serum levels, that seem to be interrelated, while patient’s disease activity is associated with metabolic syndrome. Generally recommended SCORE scale is practically unable to indicate SpA patients with higher CV riskReferences:[1]Kontny E, et al. PAB0733 Associations of serum osteoprotegerin and IL-18 concentrations with cardiovascular risk in ankylosing spondylitis and psoriatic arthritis patientsAnnals of the Rheumatic Diseases2017;76:1310-1311.[2]Bonek K et al. ESAT0310 The associations of serumIL-l18 and osteoprotegerin (OPG) levels with the lipid profile in psoriatic arthritis (PSA) patientsAnnals of the Rheumatic Diseases2018;77:1019-1020.Disclosure of Interests:None declared

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Excess Cardiovascular Risk in Inflammatory Rheumatic Diseases: Pathophysiology and Targeted Therapy

Current Pharmaceutical Design ◽

10.2174/138161212799504740 ◽

2012 ◽

Vol 18 (11) ◽

pp. 1465-1477 ◽

Cited By ~ 19

Author(s):

Haner Direskeneli

Keyword(s):

Cardiovascular Risk ◽

Targeted Therapy ◽

Rheumatic Diseases ◽

Inflammatory Rheumatic Diseases

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AB1280-HPR REQUIRED FORCE TO OBTAIN A POSITIVE SQUEEZE TEST AUTOMATIZED IN PATIENTS WITH HAND ARTHRALGIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4515 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1931.3-1931

Author(s):

M. M. Castañeda-Martínez ◽

G. Figueroa-Parra ◽

D. Vega-Morales ◽

B. R. Vázquez Fuentes ◽

Y. G. Ordoñez Azuara ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Rheumatic Diseases ◽

Primary Care Physicians ◽

Clinical Aspects ◽

Inflammatory Rheumatic Diseases ◽

Undifferentiated Arthritis ◽

Left Hand ◽

Hand Force ◽

The Uk

Background:Primary care physicians (PCP) are usually the first contact of people with inflammatory rheumatic diseases, and find the early symptoms of Rheumatoid Arthritis (RA) difficult to distinguish from those of other rheumatic diseases. A time-delay in the reference to Rheumatology is a health issue in several countries. The clinical aspects that general practitioner took into account in hand arthralgia patients are important to make the reference. In particular the Squeeze Test (ST) - which is simple to perform and rapidly done, ST is useful for identifying progression to RA in patients with undifferentiated arthritis. The ST has been described as not reliable because is clinician-dependent.Objectives:To identify the required force that needs to be applied in order to obtain a positive Automatized Squeeze Test (AST) in a cohort of patients with hand arthralgia.Methods:Ninety-seven patients were recruited in Family Medicine Consultation and in Rheumatology Consultation of the Hospital Universitario “Dr. José Eleuterio González” in Monterrey, Nuevo León, México. Eligible patients were adults (aged≥18 years) with hand arthralgia (that wasn’t caused by trauma) as their chief complaint. After obtaining informed consent and after a questionnaire application, patients were submitted to AST maneuver, using an automated compressor with different forces already predetermined in the interface of the software used for compression.Results:In this cohort of 98 patients, 79 (80.6%) were women. The mean age was 51.14 years (SD 14.66). Ninety-six (97.9%) patients were right handed. The diagnoses were Osteoarthritis (OA) (16.3%), RA (5.1%), Undifferentiated arthritis (1.2%), Psoriatic arthritis (1.2%) and Fibromyalgia (2%). Force measures according to diagnoses are reported in Table 1.Table 1.Diagnoses and mean forcesDiagnosisn (%)Right hand force mean (kg/s2) (SD)Left hand force mean (kg/s2) (SD)OA16 (16.3)3.53 (2.74)3.18(2.73)RA5 (5.1)3.60 (2.53)3.16(1.36)UA1 (1.2)7.60(0)8.70(0)PsA1 (1.2)7.60(0)7.80(0)FM2 (2.0)4.11(4.40)1.75(1.06)OA, Osteoarthritis;RA, Rheumatoid Arthritis;UA, Undifferentiated Arthritis;PsA, Psoriatic Arthritis;FM, Fibromyalgia;SD, Standard DeviationConclusion:In the cases of RA and OA, the means of force to obtain a positive AST was lower than in the rest of the diagnoses.References:[1]Stack R, Nightingale P, Jinks C, Shaw K, Herron-Marx S, Horne R et al. Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open. 2019;9(3):e024361.Disclosure of Interests:None declared

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SAT0372 PATIENTS WITH PSORIATIC ARTHRITIS SHOW HIGHER BONE DENSITY COMPARED TO AGE AND GENDER MATCHED PATIENTS WITH ANKYLOSING SPONDYLITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3566 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1133.2-1134

Author(s):

D. Freier ◽

E. Wiebe ◽

R. Biesen ◽

T. Buttgereit ◽

S. Hermann ◽

...

Keyword(s):

Back Pain ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Bone Density ◽

Rheumatic Diseases ◽

Inflammatory Rheumatic Diseases ◽

Age And Gender ◽

Gender Distribution ◽

Density Data ◽

And Gender

Background:The prevalence of osteoporosis in inflammatory rheumatic diseases such as psoriatic arthritis (PsA) has not been sufficiently clarified yet, and the data in the literature are heterogeneous. In addition, it is still unclear to what extent patients with PsA differ in terms of bone density from patients with other forms of spondyloarthritis such as ankylosing spondylitis (AS).Objectives:In an interim analysis of the Rh-GIOP Study (ClinicalTrials.gov IdentifierNCT02719314), we observed that PsA patients demonstrated more frequently normal bone density than any other patient group analyzed (suffering from e.g. rheumatoid arthritis or systemic sclerosis). The main objective of this investigation was to compare bone density data from patients with PsA and AS, as both diseases belong to the spondyloarthritis group. 1100 patients with inflammatory rheumatic diseases provided the basis of Rh-GIOP, a prospective study monitoring glucocorticoid (GC)-induced osteoporosis in patients with rheumatic diseases. Rh-GIOP was established in 2015 at the Charité University Hospital. Bone mineral density data were measured by dual x-ray absorptiometry (DXA).Methods:92 patients with PsA (65% female) were compared with 51 patients suffering from AS (35% female). Potential risk and protective factors (e.g. data on GC treatment, anti-rheumatic therapy), laboratory parameters (e.g. Vitamin D, alkaline phosphatase, calcium and inflammatory markers) and functional status (e.g. Health Assessment Questionnaire, sporting activities, back pain) were compared between these groups. Statistical analysis was performed descriptively using mean and standard deviation, t-tests for metric variables, and chi-square tests for nominal variables. Due to the heterogeneous gender distribution, an additional statistical matching was performed to compare patients matched by age and gender.Results:Patients with PsA displayed significantly higher minimal T-scores than patients with AS (p=0.003) even though patients with AS were younger and more often male (p<0.001). AS patients showed a higher frequency of osteopenic bone densities (p<0.05), however, no differences in the frequency of osteoporotic bone densities were found. Body-mass-index (BMI) was significantly higher (p<0.001) in PsA patients. PsA patients demonstrated a higher frequency of csDMARD use (p<0.001). Additional analyses among PsA patients with and without csDMARDs revealed also significantly higher minimal T-scores in PsA patients taking csDMARDs (90% Methotrexate), and both groups showed the same average of age and gender distribution. Furthermore, AS patients complained significantly more often of back pain (96 % vs. 74%, p=0.001) than PsA patients. No differences in GC use or cumulative GC dose were found. All results could be confirmed when groups were matched by age and gender.Conclusion:Our results demonstrate that patients with PsA display higher bone density compared to age and gender matched patients with ankylosing spondylitis. Possible influencing factors could be the higher frequency of csDMARD use, higher BMI or the lower frequency of back pain in PsA patients. Multivariate tests and additional biomarker investigations in larger cohorts are necessary to corroborate these findings and to identify underlying pathogenic differences which could serve for an explanation.Disclosure of Interests:Desiree Freier: None declared, Edgar Wiebe: None declared, Robert Biesen: None declared, Thomas Buttgereit: None declared, Sandra Hermann: None declared, Timo Gaber: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

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POS1065 CIRCULATING ENDOTHELIAL CELLS AS A MARKER OF CARDIOVASCULAR DISEASES IN PATIENTS WITH PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1000 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 811.1-811

Author(s):

S. Smiyan ◽

A. Bilukha ◽

B. Koshak

Keyword(s):

Endothelial Cells ◽

Cardiovascular Risk ◽

Psoriatic Arthritis ◽

Cardiovascular Diseases ◽

Endothelial Damage ◽

Diagnostic Methods ◽

Circulating Endothelial Cells ◽

Control Group ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk

Background:Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. Mortality among patients with PsA is 1.28 times higher than population levels and in most cases it is caused by cardio-vascular diseases (CVD). Those patients have increased risk of clinical and subclinical CVD, mostly due to endothelial dysfunction (ED) and accelerated atherosclerosis. Elevated levels of circulating endothelial cells (CEC) have been described in different cardiovascular pathologies, suggesting their potential use as diagnostic biomarkers for dysfunction of endothelium.Objectives:To identify the potential role of circulating endothelial cells as a marker of cardiovascular diseases in patients with psoriatic arthritis.Methods:In total, ninety-four patients with PsA, who fulfilled the disease criteria (CASPAR) were examined using standard diagnostic methods (including C-reactive protein (CRP), lipid profile) and evaluation endothelium-dependent vasodilation in response to reactive hyperemia (EDVD). Circulating endothelial cells were determined in the peripheral venous blood samples by flow cytometry and counted according to a standardized protocol using a fluorescence microscope after acridine orange labeling. The control group, which were consisted from thirty healthy adults were also examined.Results:CEC were quantified in patients with PsA (7,15 ± 0,19 cells mL−1) and in the control group (4,05 ± 0,11 cells mL−1). Comparing two groups of patients, endothelial circulating cell level was significantly different (p = 0.0001). Finally, we analyzed the relationship between CEC count, comorbidities, cardiovascular risk factors and EDVD in patients with PsA. Increased CEC levels were associated with obesity (r=0,62), duration of disease (r=0,65), age (r=0,67), increased CRP (r=0,76), high blood pressure (r=0,87) and decreased EDVD (r=–0,91).Conclusion:CEC counts were significantly higher in patients with PsA, positively correlated with the main factors of CVD, and another specific marker of ED - EDVD. Elevated CEC levels were also associated with high concentrations of CRP, which plays a direct role in promoting vascular inflammation, vessel damage and clinical CVD events. In conclusion, increased CEC counts provide a direct proof of endothelial damage in patient with PsA and a clinically informative diagnostic tool for endothelial damage in pre-symptomatic CVD. As CEC are one of the most sensitive biomarker for ED, further efforts should concentrate on improving the sensitivity of its detection in order to increase diagnostic sensitivity.References:[1]Maura Farinacci, Thomas Krahn, Wilfried Dinh, et al. Circulating endothelial cells as biomarker for cardiovascular diseases. Res Pract Thromb Haemost, Vol. 3, Issue, 2019, P.49-58;[2]C. Horreau, C. Pouplard, E. Brenautet, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol, Vol. 27, Issue 3, 2013, P.12-19;[3]Frank Verhoeven, Clément Prati, Céline Demougeot, Daniel Wendling. Cardiovascular risk in psoriatic arthritis, a narrative review. Joint Bone Spine, Vol. 87, Issue 5, 2020, P.413-418;Disclosure of Interests:None declared.

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Personal NO2 and Volatile Organic Compounds Exposure Levels are Associated with Markers of Cardiovascular Risk in Women in the Cape Town Region of South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16132284 ◽

2019 ◽

Vol 16 (13) ◽

pp. 2284 ◽

Cited By ~ 4

Author(s):

Frans Everson ◽

Patrick De Boever ◽

Tim S. Nawrot ◽

Nandu Goswami ◽

Mashudu Mthethwa ◽

...

Keyword(s):

Cardiovascular Risk ◽

Cape Town ◽

Cardiovascular Effects ◽

Intima Media Thickness ◽

Air Pollutant ◽

International Standards ◽

Ethyl Benzene ◽

Limited Information ◽

Brachial Artery Diameter ◽

Exposure Levels

Exposure to ambient NO2 and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO2 was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region.

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AB0830 LIPID PROFILE IN PSORIATIC ARTHRITIS. FREQUENCY AND ASSOCIATION WITH DISEASE ACTIVITY.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2185 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1719.1-1720

Author(s):

V. Savio ◽

Y. Tissera ◽

M. I. Quaglia ◽

J. A. Albiero ◽

C. G. Alonso ◽

...

Keyword(s):

Cardiovascular Risk ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Lipid Profile ◽

Activity Index ◽

Laboratory Data ◽

Disease Index ◽

Interleukin 12 ◽

Joint Involvement ◽

Apo B

Background:Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with higher risk of cardiovascular events and metabolic syndrome. The inflammation not only accelerates atherosclerosis, but also may influence cardiovascular (CV) risk factors such as lipid profile, blood pressure and insulin resistance. Lipid profile has previously been studied in PsA, however this association is still controversial.Objectives:To study the frequency of altered lipid profile in patients with PsA and its association with disease activity.Methods:We studied all the patients with diagnosis of PsA who consecutively attended to Rheumatology Unit at Cordoba Hospital from July 2018 to December 2019. PsA was diagnosed according CASPAR criteria. Clinical and laboratory data were collected. The activity of the disease was evaluated by PASI, MDA and DAPSA. Quantitative variables will be expressed in median and 1st and 3rd interquartile; qualitative variables expressed in frequency and percentage. Correlation analysis was calculated using Spearman’s rank correlation coefficient. P<0.05 was considered statistically significant.Results:42 PsA patients were included. Mean age was 56 years old (47.25-62.75) and 54.76% were female (n=23). 92.86% (n=39) of the patients had plaque Psoriasis and 87.8% (n=36) had peripheral joint involvement.Frequency of comorbidities in PsA are shown in Graphic 1. 31 (73.8%) of the patients were treated with topical therapy, 3 (7.14%) with phototherapy, 31 (73.8%) with Methotrexate and 17 (41.46%) with biologics and JAK inhibitor. Activity Disease Index and Lipid profile are shown in Table 1 and 2.There was not association between Apo B/Apo A coefficient with DAPSA (rho=0.013; p=0.940) and MDA (rho=-0.029; p=0.867).Conclusion:In spite of the presence of cardiovascular factors in the majority of PsA patients, lipid profile is not correlated with disease activity in this population.References:[1]Ahlehoff O, Gislason GH, Charlot M, et al. Psoriasis is associated with clinically significant cardiovascular risk: A Danish nationwide cohort study. J Intern Med 2011;270:147-57.[2]Mallbris, L., Ritchlin, C.T., Ståhle, M. “Metabolic disorders in patients with psoriasis and psoriatic arthritis.” Curr RheumatolRep.8(5): 355–363. 2006[3]Ng CY, Tzeng I-S, Liu S-H, Chang Y-C, Huang Y-H. Metabolic parameters in psoriatic patients treated with interleukin-12/23 blockade (Ustekinumab). J Dermatol 2018; 45:309–313[4]Kaur S, Kingo K, Zilmer M. Psoriasis and cardiovascular risk – do promising new biomarkers have clinical impact? Mediators Inflamm 2017; 2017: 7279818[5]Gentile M, Peluso R, Di Minno MN, et al. Association between small dense LDL and sub-clinical atherosclerosis in patients with psoriatic arthritis. ClinRheumatol 2016; 35: 2023-9.Graphic 1.Comorbidities in PsATable. 1.Activity Disease Index in PsAACTIVITY INDEXn=42DAPSA14.45 (9.72-23.92)DAPSA≤4 REMISSION3>4 y ≤14 low disease activity16>14 y ≤28 moderate disease activity17>28 high disease activity3cDAPSA14.00 (8.00-23.00)/41*MDA9 (25)/36PASI2.20 (0.20-6.80)/41**Expressed in median and interquartiles.Qualitative variables expressed in frequency and percentage.Table. 2.Lipid Profile in PsA patients.Cholesterol (mg/dl)194.5 (164.8-218.2)HDL (mg/dl)48.00 (37.00-57.00)LDL (mg/dl)114.5 (78.5-140.8)TG (mg/dl)139.50 (89.25-191.20)Expressed in median and interquartiles.Disclosure of Interests:None declared

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POS1067 BASELINE VITAMIN D LEVELS AND DISEASE ACTIVITY AND RESPONSE IN PORTUGUESE PATIENTS WITH PSORIATIC ARTHRITIS UNDER bMDARD: DOES IT MAKE A DIFFERENCE?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1255 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 812.1-812

Author(s):

F. Oliveira Pinheiro ◽

B. M. Fernandes ◽

S. Garcia ◽

M. Rato ◽

D. Fonseca ◽

...

Keyword(s):

Vitamin D ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Rheumatic Diseases ◽

Response To Therapy ◽

Response Criteria ◽

National Database ◽

Vitamin D Levels ◽

Activity Measures ◽

Disease Activity Measures

Background:There is growing evidence that vitamin D [25(OH)D]) plays an important role in maintaining skeletal health and modulating the immune system. Epidemiological data indicate that vitamin D deficiency is common in immune-mediated rheumatic diseases, especially in rheumatoid arthritis, but there is little data regarding its association with disease activity and response to therapy in patients with psoriatic arthritis (PsA) under bDMARD therapy.Objectives:We aimed to assess whether 25(OH)D basal levels correlate with disease activity and clinical response to the first bDMARD, at 6 and 12 months of therapy, in a monocentric cohort of patients with PsA.Methods:This retrospective study was carried out on PsA patients from a Rheumatology department of a tertiary hospital, fulfilling CASPAR criteria and registered in our national database (Reuma.pt), who started the first bDMARD since 2008. Demographic, clinical and laboratory criteria were evaluated at 0, 6 and 12 months of biologic therapy. Disease activity was assessed using CDAI, SDAI, DAS28(4V), BASDAI, ASDAS, DAPSA and the response was measured using the EULAR, BASDAI50, ASDAS, ASAS, ACR and PsARC responses. Correlations were made between absolute serum levels of 25(OH)D and continuous variables, as well as associations between different vitamin D cutoffs and disease activity measures and response criteria. Multiple linear and logistic regression analyses were performed to determine whether vitamin D is a predictor of disease activity and therapeutic response.Results:We included 81 patients, 41 (50.6%) females; with a mean age of 48.0±11.7 years, a mean disease duration of 9.5±7.4 years and a mean body mass index of 28.4±5.2 kg/m2. Thirteen (16.0%) were smokers. The mean 25(OH)D basal level was 25.5±13.2 ng/ml, 21 (25.9%) had 25(OH)D basal levels ≥30 ng/mL and 31 (38.3%) ≤20 ng/mL. Sixty-two patients (76.5%) were under csDMARD therapy. Golimumab (29, 35,8%), etanercept (28, 34.6%) and adalimumab (10, 12.3%) were the most frequently prescribed bDMARDs. There were only very weak, albeit positive, correlations between 25(OH)D levels and measures of disease activity. The BASDAI50 response at 6 months was associated with higher basal 25(OH)D levels (29.5±14.5 vs 21.5±10.2 ng/mL, p = 0.013); the ASAS20 (33.9±15.9 vs 24.2±12.8 ng/mL; p = 0.023), ASAS40 (31.9±14.6 vs 25.0±13.8 ng/mL; p = 0.023) and ASAS70 (47.0±4.2 vs 26.6±14.2; p = 0.027) responses at 12 months were associated with higher basal levels of 25(OH)D; basal 25(OH)D levels were ≥ 30ng/mL in a significantly higher proportion of patients who achieved CDAI (38.9% vs 10.5%; p = 0.027) and SDAI (38.9% vs 7.7%; p = 0.008) remission and ASDAS disease inactive (29.4% vs 7.3%; p = 0.040) at 1 year. In the regression models, basal levels of 25(OH)D were found to be predictors of good EULAR responders (OR 1.315, 1.017-1.213 95% CI; p = 0.037) at 6 months. Basal levels of 25(OH)D were not significantly different in patients who discontinued bDMARD and no significant correlations or associations were identified regarding more specific PsA activity measures, such as DAPSA and PsARC, nor were they predictive of these responses.Conclusion:We can conclude that there is a global trend for an association between higher levels of vitamin D and lower measures of disease activity and better therapeutic responses to the first biologic. It was possible to find statistically significant associations with some disease activity measures and response criteria that, although primarily designed for other rheumatic diseases, are often used in PsA.Disclosure of Interests:None declared.

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