scholarly journals Prevalence of Depressive Symptoms in Patients With Psoriatic Arthritis: Have Numbers Changed During the COVID-19 Pandemic?

2021 ◽  
Vol 8 ◽  
Author(s):  
Matthias Englbrecht ◽  
Peter Bartz-Bazzanella ◽  
Cay von der Decken ◽  
Georg Gauler ◽  
Patrick Wurth ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Screening Tools ◽  
Prevalence Rates ◽  
Infection Rates ◽  
Patient Health ◽  
National Patient ◽  
Local Healthcare ◽  
Potential Use

This longitudinal analysis compares the prevalence of depressive symptoms in patients with psoriatic arthritis in the context of the COVID-19 pandemic. Data from a national patient register in Germany were analyzed regarding the Patient Health Questionnaire 2 (PHQ-2) to identify cases suspicious for depression at two time points, i.e., before and during the COVID-19 pandemic. Only patients with complete concurrent information on the Disease Activity in Psoriatic Arthritis Score (DAPSA) were included in the analysis. The frequency of depressive symptoms in psoriatic arthritis patients during the COVID-19 pandemic did not differ from the prevalence rates measured before. In addition, prevalence rates for depressive symptoms did not differ when stratifying the patient sample for DAPSA levels of disease activity measured before the pandemic. These results were confirmed further in a sensitivity analysis, limiting the second PHQ-2 assessment to lockdown periods only. However, longitudinal data on the prevalence of depressive symptoms in patients with rheumatic diseases, in general, and psoriatic arthritis, in particular, are scarce in the context of the COVID-19 pandemic. For a sensible comparison of prevalence rates for depressive symptoms in the future, underlying SARS-CoV-2 infection rates and resulting local healthcare disruptions need to be taken into account, besides the potential use of different depression screening tools to evaluate resulting numbers sensibly and draw corresponding conclusions for patient care.

scholarly journals High Prevalence of Poststroke Depression in Ischemic Stroke Patients in Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Fikru Tsehayneh ◽  
Abenet Tafesse
Keyword(s):  
Depressive Symptoms ◽  
Negative Impact ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
Screening Tools ◽  
Limited Information ◽  
Poststroke Depression ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Patient Health

Background. There is limited information and research carried out regarding the prevalence of poststroke depression (PSD) in the study area. Psychiatric disorders complicate a significant proportion of patients suffering from stroke. This of course have a great negative impact on our knowledge about poststroke depression in Ethiopia, and poststroke depression complicates a significant number of stroke patients and their rehabilitation. Methods. A cross-sectional study on all patients aged above 18 years and diagnosed with stroke in the past two years who attended the neurology follow-up clinics of Tikur Anbessa Specialized Hospital (TASH) and Zewditu Memorial Hospital (ZMH) was done by using a structured questionnaire containing Patient Health Questionnaire-9 (PHQ-9) depression screening tool. Result. Of 84 patients who were eligible for the study, 32.2% of patients have depressive symptoms. Women (OR 0.001, 95% CI 0.12–0.87) and aphasic patients (OR 0.034, 95% CI 0.19–1.27) were more likely to have depressive symptoms. Conclusion. Depressive symptoms after stroke are common in Ethiopian patients. Our study demonstrates female and aphasic patients are more likely to screen positive for PSD. Hence, screening all poststroke patients with different screening tools is practical, and further studies are needed to assess the validity of these screening tools and also to assess PSD as a predictor of stroke outcome.

scholarly journals FRI0077 THE PREVALENCE OF DEPRESSION AND ANXIETY IN PATIENTS WITH RHEUMATOID AND PSORIATIC ARTHRITIS AND ITS CONTRIBUTORY FACTORS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 615.2-616
Author(s):  
S. Selvadurai ◽  
L. Mohamed Nor ◽  
N. I. Redzuan ◽  
L. Mohd Isa ◽  
N. S. Shahril
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Associated Factors ◽  
Depression Scale ◽  
Disease Assessment ◽  
Joint Involvement ◽  
Depression And Anxiety ◽  
Prevalence Rates ◽  
The Mean

Background:Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) are both chronic, progressive inflammatory arthritis that can cause significant disability and morbidity. Depression in RA has been associated with higher levels of disease activity, pain, fatigue, work disability, lower treatment compliance and increased suicidal risk and mortality [1]. PsA patients suffer from psoriasis and joint involvement; hence have greater odds of depression by 2.1 times compared with RA [2].Objectives:To compare the prevalence rates of depression and anxiety and its associated factors between RA and PsA patients in Hospital Putrajaya.Methods:A cross sectional survey using the Hospital Anxiety and Depression Scale (HADS) questionnaire were distributed to 300 patients who attended rheumatology outpatient clinic from February – April 2019. The HADS was categorized into 3 groups based on their scores 0-7 (Normal); 8-10 (Borderline); and 11-21 (Abnormal). Data on patient demographics and components of disease assessment scores were recorded. Disease activity was assessed using DAS 28-CRP for all patients. Additional evaluation using Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and body surface area (BSA) were done for PsA patients. P value of < 0.05 was taken as significant.Results:In total, 205 RA and 73 PsA patients were eligible for analysis. Majority of the patients were female, Malay and married for both groups. The mean age group for RA and PsA were 56.2 ± 11.9 years and 51.0 ± 14.6 years. The mean duration of disease for RA were 8 ± 10 years; while for PsA were 6 ± 11 years. The prevalence rates of depression and anxiety for RA were 8.3% and 13.7%; and PsA were 9.6% and 17.8% respectively. Borderline scores for depression occurred in 16.1% of RA patients and 12.3% for PsA. Twenty percent of RA patients (n=41) and twenty-four percent of PsA patients (n=18) scored borderline for anxiety. The significant positive correlations with depression and anxiety in RA include high disease activity scores (r = 0.27; r = 0.31), number of tender joints (r = 0.26; r = 0.24) and pain (r = 0.29; r = 0.27). Higher number of swollen joints significantly correlated with depression (r = 0.16) but not with anxiety. RA patients with Ischaemic Heart Disease (IHD) ± heart failure have higher depression scores (p < 0.05). As for PsA group, high BASDAI score (anxiety: r = 0.34, depression: r = 0.26) and psoriasis involving head and neck region (p < 0.05) were significant associated factors. Age was inversely correlated with anxiety in the PsA group.Conclusion:There is higher prevalence of anxiety in both RA and PsA as compared to depression. Higher disease activity scores were associated with depression and anxiety in both RA and PsA with axial involvement.References:[1]Faith Matcham et al. “Are depression and anxiety associated with disease activity in rheumatoid arthritis? A prospective study” BMC Musculoskeletal Disorders (2016) 17:155.[2]Sinnathurai et al. “Comorbids in psoriatic arthritis and rheumatoid arthritis”. July 2018. Internal Medicine Journal.Available fromhttps://doi.org/10.1111/imj.14046[3]RA Rahim et al. “ Self-reported symptoms of depression, anxiety and stress among patients with Rheumatoid Arthritis in a Malaysian rheumatology centre – prevalence and correlates”. Med J Malaysia Vol 73 No 4 August 2018Disclosure of Interests:None declared

scholarly journals SAT0405 CLINICAL AND PSYCHOLOGICAL PREDICTORS OF GASTROINTESTINAL INTOLERANCE TO METHOTREXATE IN PATIENTS WITH PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1154.2-1155
Author(s):  
G. Natalello ◽  
E. De Lorenzis ◽  
G. Tanti ◽  
P. Rubortone ◽  
M. R. Magurano ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Depressive Symptoms ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Drug Exposure ◽  
Disease Duration ◽  
Anxiety And Depression ◽  
Anticipatory Nausea ◽  
Comorbidity Burden ◽  
Gastrointestinal Intolerance

Background:Methotrexate (MTX) is a first-line treatment for psoriatic arthritis (PsA). Gastrointestinal intolerance (GI) to the drug is a common adverse event that limits its use and can be mediated by autonomic dysfunction or classical conditioning phenomena to repeated drug exposure. Anxiety and depression could promote these processes.Objectives:To assess the prevalence of GI to MTX and its association with anxiety and depression in PsA patients.Methods:One hundred unselected PsA patients in stable MTX treatment were characterized by disease characteristics, adherence to treatment by Morisky Medication Adherence Scale (MMAS-8) and comorbidity by Rheumatic Disease Comorbidity Index (RDCI). Depressive and anxious symptoms were assessed by Hospital Anxiety and Depression Scale (HADS). The presence and the severity of nausea, vomiting, abdominal pain and diarrhoea after administration (associative symptoms) and just before or even at the thought of taking MTX (anticipatory symptoms) were recorded.Results:Patients had a mean age of 56.9±12.0 years and a disease duration of 9.5 years (0.1-58.0 years). They were male, smokers and overweight in 40.0%, 20.0% and 65.0% of cases, respectively. The prevalence of both significant anxious and depressive symptoms was 42.0%. DAPSA showed remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in 24.0%, 41.0%, 32.0% and 3.0% of patients, respectively. MTX was taken orally by 15.0% of patients and associated with another conventional or biological DMARD in 14.0% and 35.0% of cases, respectively. Symptoms of GI to MTX were complained by 69.3% of patients. Specifically, the prevalence of nausea, diarrhea, vomiting and abdominal pain was 59.0%, 23.0%, 21.0% and 30.0% with associative pattern and 43.0%, 12.0%, 10.0% and 16.0% with anticipatory pattern, respectively. Patients with anxious symptoms experienced more frequently moderate to severe associative nausea (71.4% vs 50.0%, p=0.032) and abdominal pain (42.9% vs 20.7%, p=0.017), and anticipatory nausea (42.9% vs 19.0%, p=0.009), vomiting (14.3% vs 6.9%,p=0.046), and abdominal pain (26.2% vs 8.6%, p=0.018) than non-anxious patients. Patients with depressive symptoms more commonly had associative diarrhea (33.0% vs 15.5%, p=0.037), with no difference in the prevalence of anticipatory symptoms. The presence of associative and anticipatory nausea was associated with higher anxiety scores (p=0.006 and p=0.02 respectively) without differences in the depression score. Associative nausea characterized younger patients (p=0.001), female (p=0.02), with lower BMI (p=0.02) and treated with higher MTX doses (p=0.05). Anticipatory nausea was associated with a lower age (p=0.02), a lower BMI (p=0.005), a longer disease duration (p=0.028), a lower DAPSA (p=0.02), an higher MTX doses (p=0.02) and a lower comorbidity burden (p=0.03). The anticipatory and associative nausea determined lower compliance according to MMAS-8 (p=0.007 and p=0.001, respectively). An anxious profile characterized patients with moderate to severe associative nausea also in the logistic regression model corrected for age (≥65 years), gender, BMI (≥25 kg/m2) and MTX dose (≥0.2mg/kg/week) (OR 3.0, IC 1.1-8.4, p=0.036), and patients with anticipatory nausea also in the model corrected for age (≥65 years), gender, BMI (≥25 kg/m2) and MTX dose (≥0.2mg/kg/week) and disease duration (≥6 years) (OR 3.0, IC 1.1-8.0,p=0.027).Conclusion:Up to two-thirds of patients with PsA who have been treated with MTX experienced symptoms of GI, leading to reduced therapeutic adherence. Associative and anticipatory symptoms characterize patients with a specific clinical and psychological profile.Disclosure of Interests:Gerlando Natalello: None declared, Enrico De Lorenzis: None declared, Giacomo Tanti: None declared, Pietro Rubortone: None declared, Maria Rosaria Magurano: None declared, Giusy Peluso: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer

scholarly journals Criterion-related validity and reliability of the Urdu version of the patient health questionnaire in a sample of community-based pregnant women in Pakistan

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5185 ◽  
Author(s):  
John A. Gallis ◽  
Joanna Maselko ◽  
Karen O’Donnell ◽  
Ke Song ◽  
Kiran Saqib ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorder ◽  
Pregnant Women ◽  
Low Income ◽  
Screening Tools ◽  
Validity And Reliability ◽  
Community Based ◽  
Major Depressive ◽  
Internal Reliability ◽  
Patient Health

Background Depression is one of the most prevalent, yet unrecognized but treatable mental disorders in low and middle income countries (LMICs). In such locations, screening tools that are easy-to-administer, valid, and reliable are needed to assist in detecting symptoms of depression. The Patient Health Questionnaire (PHQ-9) is one of the most widely used depression screeners. However, its applicability to community-based settings of Pakistan is limited by the lack of studies examining its validity and reliability in such settings. The current study aimed to demonstrate the criterion-related validity and internal reliability of the Urdu version of the PHQ-9 in a sample of community-based pregnant women in Pakistan compared to a diagnostic clinical interview, the Structured Clinical Interview for DSM disorders (SCID), using data from a depression treatment cluster randomized trial in rural Pakistan. Methods Pregnant women in a rural, low income sub-district in Pakistan were approached between October 2014 and February 2016 and, after providing informed consent, screened for depression using the Urdu version of the PHQ-9, with a cutoff of ≥10 used to indicate significant depressive symptoms. Following the PHQ-9, the diagnostic module for current major depressive episode of the SCID was administered. We examined the psychometric properties of PHQ-9 compared to SCID as a gold standard, using sensitivity, specificity, and negative and positive predictive value to measure the criterion-related validity of the PHQ-9 as an indicator of symptoms of depression. We computed area under the receiver operating characteristic curve to determine diagnostic accuracy, and used Cronbach’s alpha to assess internal reliability. Results A total of 1,731 women in their third trimester of pregnancy were assessed for major depressive disorder. Of these women, 572 (33%) met the cutoff for significant depressive symptoms on PHQ-9, and 454 (26%) were assessed positive for depression using the SCID. The sensitivity and specificity of PHQ-9 at a cutoff of ≥10 was 94.7% and 88.9%, respectively. The positive and negative predictive values were 75.2% and 97.9%, respectively; and the area under the curve was 0.959. Internal reliability, as measured by Cronbach’s alpha, was 0.844. Discussion Valid and reliable screening tools to assist in detecting symptoms of depressive disorder are needed in low income settings where depressive disorders are highly prevalent. The Urdu version of the PHQ-9 has not been previously validated against a well-known assessment of depression in a community setting among pregnant women in Pakistan. This study demonstrates that the Urdu version of the PHQ-9 has acceptable criterion-related validity and reliability for screening for depressive symptoms in Pakistan among community-based pregnant women; and when the recommended cut-off score of ≥10 is used it can also serve as an accurate screening tool for major depressive disorder.

Gender-Related Differences in Disease Activity and Clinical Features in Patients with Peripheral Psoriatic Arthritis: A Multi-Center Study

2021 ◽  
pp. 105177
Author(s):  
Mehmet Tuncay Duruöz ◽  
Halise Hande Gezer ◽  
Kemal Nas ◽  
Erkan Kılıç ◽  
Betül Sargın ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Clinical Features ◽  
Multi Center Study ◽  
Center Study

scholarly journals Toll-like receptor 4-mediated cytokine synthesis and post-stroke depressive symptoms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michal Korostynski ◽  
Dzesika Hoinkis ◽  
Marcin Piechota ◽  
Slawomir Golda ◽  
Joanna Pera ◽  
...  
Keyword(s):  
Gene Expression ◽  
Depressive Symptoms ◽  
Ex Vivo ◽  
Toll Like Receptor ◽  
Toll Like Receptor 4 ◽  
Post Stroke ◽  
Cytokines And Chemokines ◽  
Patient Health ◽  
Post Stroke Depression ◽  
Cytokine Synthesis

AbstractAltered cytokine synthesis thought to contribute to the pathophysiology of post-stroke depression (PSD). Toll-like receptor 4 (TLR4) is a master regulator of innate immunity. The aim of this study was to explore the putative association between TLR4-mediated cytokine synthesis and subsequent symptoms of PSD. In total, 262 patients with ischemic stroke and without a history of PSD were included. Depressive symptoms were assessed using the Patient Health Questionnaire-9 in 170 patients on Day 8 and in 146 at 3 months after stroke. Blood samples taken on Day 3 after stroke were stimulated ex vivo with lipopolysaccharide (LPS). Ex vivo synthesized cytokines (TNFα, IP-10, IL-1β, IL-6, IL-8, IL-10, and IL-12p70) and circulating cytokines (TNFα, IL-6, sIL-6R, and IL-1ra) were measured using the enzyme-linked immunoassay or cytometric method. RNA sequencing was used to determine the gene expression profile of LPS-induced cytokines and chemokines. LPS-induced cytokine synthesis and the gene expression of TLR4-dependent cytokines and chemokines did not differ between patients with and without greater depressive symptoms. The plasma level of IL-6, but not TNFα, sIL-6R, and IL-1ra, was higher in patients who developed depressive symptoms at 3 months after stroke (median: 4.7 vs 3.4 pg/mL, P = 0.06). Plasma IL-6 predicted the severity of depressive symptoms at 3 months after stroke (β = 0.42, P = 0.03). In conclusion, TLR4-dependent cytokine synthesis was not associated with greater post-stroke depressive symptoms in this study. Circulating IL-6 might be associated with depressive symptoms occurring at 3 months after stroke.

scholarly journals SAT0415 AGE RELATIONSHIP WITH ULTRASOUND ARTICULAR AND ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS: CROSS-SECTIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1160.2-1161
Author(s):  
I. Fairushina ◽  
D. Abdulganieva ◽  
E. Kirillova ◽  
R. Abdrakipov
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Power Doppler ◽  
Severity Index ◽  
Cross Sectional Study ◽  
Blood Biomarkers ◽  
Cross Sectional ◽  
Age Related ◽  
Hs Crp ◽  
Axial Involvement

Background:Detection of subclinical enthesitis and synovitis in psoriatic arthritis (PsA) is prevalent and ultrasound (US) examination is informative tool for it diagnosing. Aging positively affects degenerative changes.Objectives:To study relationship between US articular and entheseal findings with age in patients with PsA.Methods:57 patients were enrolled to study with fulfilled PsA criteria (CASPAR, 2009). Data collection: demographical, clinical (current psoriasis, axial involvement, enthesitis, dactylitis), US (synovitis count (by Grey Scale), Power Doppler(PD)+ synovitis), thickening and hypoechogenicity at enthesis, PD+ enthesitis, entheses with structural components); biological (high sensitive C-reactive protein (hsCRP), Erythrocyte Sedimentation Rate (ESR).US examination included 798 joints and 3078 entheses (bilateral shoulders, acromioclavicular joints, elbows, wrists, hips, knees, ankles; entheses at the projection of these joints (total number - 54). US entheseal findings were fixed according to consensus-based US definition and scoring for enthesitis in spondyloarthritis and PsA (OMERACT US)1.Results:In all 57 patients: male - 25 (43.9%), mean age 43.4±10.3(SD) years (y), PsA duration was 7 (3;10) y, Ps duration 10 (8; 22) y; 53 (41.1%) had axial involvement, 42 (73.7%) dactylitis, 8 (14%) clinical enthesitis, and 56 (98.2 %) skin psoriasis, Psoriasis Activity and Severity Index score 6.4 (2;14.4), Disease Activity in PsA score 18.1 (10.2;26.1), hsCRP 10.1(2.4;21.4), ESR 20 (11.3;31.5).Synovitis count increased with age noticeably (r=0.508, p<0.01), and weak correlation of PD+ synovitis (r=0.262, p=0.049) and age was found. The entheseal thickening and hypoechogenicity and structural findings increased with age respectively (r=0.345, p=0.009; r=0.337, p=0.01). There was no correlation between PD+ enthesitis and age. The assosiation between PD+ enthesitis and blood biomarkers of inflammation (hs-CRP (r=0.364, p=0.008); ESR (p=0.358, p=0.008) was found.Conclusion:Our study found significant relationship between age and US synovitis. Association between age and US entheseal involvement was noted. Only PD+ enthesitis was not related with age in comparison with other US entheseal findings. The presence of PD US signal at enthesitis in association with increased inflammatory blood biomarkers can be evaluated as the sign of disease activity regardless of age and not as age-related lesion in PsA patients.References:[1]Balint PV, Terslev L, Aegerter P et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis.;2018;77(12):1730-1735.Disclosure of Interests:None declared

scholarly journals THU0538 IN PSORIATIC ARTHRITIS PATIENTS CONSIDERED IN REMISSION BY THEIR RHEUMATOLOGIST, CAN DISCORDANCE IN DISEASE ACTIVITY ASSESSMENT BETWEEN PATIENT AND RHEUMATOLOGIST BE EXPLAINED BY RESIDUAL INFLAMMATION AS MEASURED BY ULTRASONOGRAPHIC EXAMINATION?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 508-508
Author(s):  
M. Moly ◽  
C. Lukas ◽  
J. Morel ◽  
B. Combe ◽  
G. Mouterde
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Power Doppler ◽  
Minimal Disease Activity ◽  
Activity Assessment ◽  
Grey Scale ◽  
Minimal Disease ◽  
Disease Activity Assessment

Background:Psoriatic arthritis (PsA) is a heterogeneous disease and its assessment is sometimes difficult. Perception of disease activity by patient and physician is frequently discordant in patients in clinical remission. Ultrasound (US) is an imaging technique, which can detect inflammation in PsA.Objectives:The aim of our study was to assess whether persistence of disease activity evaluated by the patient, considered in remission by his rheumatologist, was associated with inflammation measured by US.Methods:We performed a transversal monocentric study. PsA patients were included if they met the CASPAR criteria and were considered in remission by their rheumatologist. Demographic data, characteristics of the disease and treatments were collected. Discordance was defined by a difference between patient’s and rheumatologist’s global assessment ≥30/100 on a Visual Analogic Scale. An US examination was performed on 50 joints, 28 tendons and 14 entheses by an independent investigator. Synovial or tendon sheath hypertrophy and PD signal were evaluated on a semi-quantitative scale, B Mode and PD signal abnormalities on entheses were searched, according to the EULAR-OMERACT scoring system. US remission was defined by no power Doppler (PD) signal on joints, tendons and entheses and minimal US activity by maximum one PD signal on the same sites. Univariate and multivariate analyses were performed to evaluate factors associated with US abnormalities.Results:Sixty-two PsA patients were included. 40.3% were women, the mean (SD) age was 55 (14) years, 42% were in US remission and 71% in minimal US activity (Table 1), 19.4% had ≥1 PD synovitis and 88.7% had a B mode synovitis, 95.2% had a B mode abnormality on entheses and 51.6% had ≥1 PD signal on entheses. Thirty nine percent had a discordant disease activity assessment with their rheumatologist. In univariate analysis, discordance was not associated with US remission (OR=1.71 (95%CI 0.61-4.83), p=0.224) or US minimal disease activity (OR=0.99 (95%CI 0.32-3.05), p=0.602). In multivariate analysis, US remission was independently associated with female gender (OR=3.94 (95%CI 1.20-12.9), p=0.024) and younger age (OR=0.95 (95%CI 0.91-0.99), p=0.027). Minimal US activity was associated with history of enthesis lesion (OR=11.26 (95%CI 1.34-94.93), p=0.026) and age (OR=0.95 (95%CI 0.90-1), p=0.044).Table 1.Ultrasound characteristics of the 62 PsA patients.N (%)Ultrasound remission26 (41.9)Ultrasound minimal disease activity44 (71)Patients with ≥1 grey scale synovitis55 (88.7)Patients with ≥1 Power Doppler synovitis12 (19.4)Patients with ≥1 grey scale tenosynovitis15 (24.2)Patients with ≥1 Power Doppler tenosynovitis1 (1.6)Patients with ≥1 grey scale enthesitis lesion (thickness, hypo echogenicity, calcification, enthesophyte, erosion, bursitis)59 (95.2)Patients with ≥1 Power Doppler enthesitis32 (51.6)Conclusion:Our study showed persistent inflammation evaluated by US in PsA patients considered in remission by their rheumatologist. However, prevalence of residual inflammation evaluated by US was not higher in patients with self-assessment of their disease discordant from their rheumatologist.Disclosure of Interests:Marie Moly: None declared, Cédric Lukas: None declared, Jacques Morel: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Gael Mouterde: None declared

scholarly journals AB0542 EVALUATION OF APREMILAST USE IN THE ROUTINE CLINICAL PRACTICE IN PATIENTS WITH PSORIATIC ARTHRITIS NAÏVE TO BIOLOGICAL TREATMENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1303.2-1304
Author(s):  
J. Gratacos-Masmitja ◽  
J. L. Álvarez Vega ◽  
E. Beltrán ◽  
A. Urruticoechea-Arana ◽  
C. Fito-Manteca ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Routine Clinical Practice ◽  
Wilcoxon Test ◽  
Psychiatric Disease ◽  
Biological Therapies ◽  
Research Support ◽  
Disease Evolution ◽  
Biological Treatments

Background:Apremilast is a non-biologic systemic agent approved for the treatment of plaque psoriasis, oral ulcers of Behcet’s disease and PsA with proven efficacy in clinical trials [1,2]. However, more real-world evidence of apremilast use and effectiveness is needed to identify the patient profile most likely to benefit from this treatment [3].Objectives:To evaluate the persistence of apremilast treatment in patients with PsA naïve to biological treatments in routine clinical practice and assess its effectiveness. Baseline clinical characteristics on patients who started apremilast were also evaluated.Methods:Observational, prospective, multicenter (20 centers) study including consecutive adult patients with PsA naïve to biological therapies who had started treatment with apremilast during the previous 5 to 7 months and were followed-up during 12 months. Variables recorded were persistence of treatment with apremilast at 6 months (6mo) and number of swelling joints, presence of enthesitis and dactylitis, and disease activity, measured by the Disease Activity in Psoriatic Arthritis (DAPSA) score and Physician Global Assessment (PGA) of psoriasis, collected at baseline (BL) (i.e., apremilast treatment start) and 6mo; comorbidities were retrospectively collected at BL. Categorical and quantitative variables were compared using McNemar’s and Wilcoxon test, respectively. Data sets analyzed included all assessable patients.Results:Of the 60 patients recruited at the time of this interim analysis, 54 (90.0%) [mean (SD) age 53.4 (13.9) years] were assessable; 41 (75.9%) of these continued treatment with apremilast at 6mo. At BL, 34 (63.0%) patients had at least one comorbidity, the most frequent being cardiovascular disease (n=15, 27.8%), including hypertension (n=8, 14.8%), metabolic/endocrine disease (n=18, 33.3%), including obesity (n=8, 14.8%) and dyslipidemia (n=10, 18.5%). Psychiatric disease (i.e., depression) (n=5, 9.3%) and neoplasia (n=8, 14.8%) were also observed. The number of swelling joints decreased from median (Q1, Q3) 4.0 (2.0, 7.0) at BL to 1.5 (0.0, 4.0) at 6mo (p=0.0012). Patients with dactylitis and enthesitis decreased from 19 (35.2%) and 16 (29.6%) at BL to 10 (18.5%) and 9 (16.7%) at 6mo (p=0.0225 and p=0.0391), respectively. The distribution of patients in the different disease activity categories according to DAPSA scale changed between BL and 6mo, indicating a favorable disease evolution (Figure 1 next page). According to PGA, at BL (n=53), disease activity was categorized as mild in 18.0%, as moderate in 72.0%, and as severe in 10% of patients and, at 6mo (n=54), as mild in 70.6%, as moderate in 25.5%, and as severe in 3.9% of patients. Fifteen (27.8%) patients interrupted treatment permanently (n=13, 24.1%) or temporarily (n=2, 3.7%), due to no/partial response (n=8, 14.8%), tolerability issues leading to adverse events (n=3, 5.6%), patient decision (n=2, 3.7%), and other reasons (n=2, 3.7%) after a mean (SD) treatment of 3.05 (2.20) months.Conclusion:Forty-one (75.9%) patients with PsA naïve to biological therapies were treated with apremilast during ≥6 months. After treatment, the number of swelling joints, and dactylitis and enthesitis decreased and changes in disease activity according to DAPSA and PGA pointed to a favorable disease evolution. Apremilast treatment provides a clinical benefit to patients with PsA treated in clinical practice.References:[1]Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016 Feb 10;75(3):499 LP-510[2]Torres T and Puig L. Apremilast: A novel oral treatment for psoriasis and psoriatic arthritis. Am J clin Dermatol. 2018 Feb;19(1):23-32[3]Coates LC, Kavanaugh A, Mease PJ et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015. Treatment Recommendations for Psoriatic Arthritis. Arthritis Rheumatol. 2016;68(5):1060– 71.Disclosure of Interests:Jordi Gratacos-Masmitja Speakers bureau: MSD, Pfizer, AbbVie, Janssen Cilag, Novartis, Celgene y Lilly., Consultant of: MSD, Pfizer, AbbVie, Janssen Cilag, Novartis, Celgene y Lilly., José Luis Álvarez Vega Speakers bureau: Abbvie, Amgen, MSD, Lilly, Roche, Esteve, UCB, Menarini, Pfizer, GSK, BMS, Janssen, Novartis, Gebro., Consultant of: Abbvie, Amgen, MSD, Lilly, Roche, Esteve, UCB, Menarini, Pfizer, GSK, BMS, Janssen, Novartis, Gebro., Grant/research support from: Abbvie, Amgen, MSD, Lilly, Roche, Esteve, UCB, Menarini, Pfizer, GSK, BMS, Janssen, Novartis, Gebro., Emma Beltrán Speakers bureau: Abbvie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: Abbvie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, ANA URRUTICOECHEA-ARANA: None declared., C. Fito-Manteca: None declared., Francisco Maceiras: None declared., Joaquin Maria Belzunegui Otano Speakers bureau: Lilly, Amgen, Novartis, Abbvie, Janssen., J. Fernández-Melón Speakers bureau: Amgen SL, Eugenio Chamizo Carmona: None declared., Abad Hernández Speakers bureau: MSD, Abbvie, Pfizer, Kern, Novartis, Biogen, Sandoz, Amgen, Sanofi, Lilly, Roche and Janssen-Cilag, Consultant of: MSD, Abbvie, Pfizer, Kern, Novartis, Biogen, Sandoz, Amgen, Sanofi, Lilly, Roche and Janssen-Cilag, Grant/research support from: MSD, Abbvie, Pfizer, Kern, Novartis, Biogen, Sandoz, Amgen, Sanofi, Lilly, Roche and Janssen-Cilag, Inmaculada Ros Consultant of: Amgen, Grant/research support from: MSD, Roche, Novartis, lilly, Pfizer, Amgen, Eva Pascual Shareholder of: Amgen, Employee of: Amgen, Juan Carlos Torre Speakers bureau: Amgen, Lilly, Novartis, Janssen, Pfizer, Consultant of: Amgen, Lilly, Novartis, Janssen, Pfizer, Grant/research support from: Amgen, Lilly, Novartis, Janssen, Pfizer.

scholarly journals POS0208 GENDER DIFFERENCES IN RESPONSE TO BIOLOGICALS. WOMEN FARE WORSE ACROSS INFLAMMATORY ARTHRITIS DISEASES - DATA FROM THE BIOREG

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 320.1-321
Author(s):  
E. Loibner ◽  
V. Ritschl ◽  
B. Leeb ◽  
P. Spellitz ◽  
G. Eichbauer-Sturm ◽  
...  
Keyword(s):  
Gender Differences ◽  
Psoriatic Arthritis ◽  
Gender Difference ◽  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Tnf Inhibitors ◽  
Significant Difference ◽  
The Difference ◽  
All Diseases

Background:Gender differences in prevalence and disease course are known in various rheumatic diseases; however, investigations of gender difference concerning therapeutical response have yielded variable results.Objectives:The aim of this retrospective study was to investigate, whether a gender difference in response rate to biological disease-modifying antirheumatic drugs (bDMARDs) and apremilast in bDMARD-naïve patients could be observed across the three most prevalent inflammatory arthritis diseases: rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriatic arthritis (PsA). Additionally, a response to individual TNF blockers was investigated in this respect.Methods:Data from bDMARD-naïve RA-, SpA- and PsA-patients from Bioreg, the Austrian registry for biological DMARDs in rheumatic diseases, were used. Patients with a baseline (Visit 1=V1) and follow-up visits at 6 months (Visit 2=V2) and 12 months (Visit 3=V3) were included and response to therapy with TNF-inhibitors (TNFi), furthermore to therapy with rituximab, tocilizumab and apremilast was analyzed according to gender. The remaining bDMARDs were not analyzed due to small numbers. Key response-parameter for RA was disease activity score (DAS28), whereas for PsoA the Stockerau Activity Score for Psoriatic Arthritis (SASPA) and for SpA the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were employed; in addition, the Health assessment Questionnaire (HAQ) was used. Data were analyzed in R Statistic stratified by gender using Kruskal-Wallis and Wilcoxon tests.Results:354 women and 123 men with RA (n=477), 81 women and 69 men with PsA (n=150), 121 women and 191 men with SpA (n=312) were included. No significant differences in biometrics was seen between female and male patients at baseline in all diseases.In RA patients overall DAS28 decreased from baseline (V1) to V2 and V3 (DAS28: V1: male: 4.38 [3.66, 5.11], female: 4.30 [3.68, 5.03], p(m/f) = 0.905; V2: male: 2.66 [1.73, 3.63], female: 3.10 [2.17, 3.98], p(m/f) = 0.015; V3: male: 2.25 [1.39, 3.36], female: 3.01 [1.87, 3.87], p(m/f) = 0.002). For TNF inhibitors (n=311), there was a significant difference between genders at V2 (Fig.1a). Patients receiving Rituximab (n=41) displayed a significantly higher DAS28 at baseline in females, which diminished in the follow up: V1: (p(m/f) p=0.002; V2: p=0.019; V3: p=0.13); response to tocilizumab (n=63) did not show any gender differences.In PsA patients overall SASPA decreased from baseline (V1) to V2 and V3 (SASPA: V1: male: 4.00 [2.80, 5.20], female: 4.40 [2.80, 5.80], p(m/f) = 0.399; V2: male: 2.20 [1.20, 3.50], female: 3.40 [2.00, 5.00], p(m/f) = 0.071; V3: male: 1.80 [0.80, 2.70], female: 3.01 [2.35, 4.80], p(m/f) = 0.001). For TNF inhibitors (n=79), there was a significant difference between genders at V3 (Fig 1a). For Apremilast (n=39), there was a significant difference between genders at V2 (Fig.1c).In SpA patients overall BASDAI decreased from baseline (V1) to V2 and V3 (BASDAI: V1: male: 4.70 [2.88, 6.18], female: 4.80 [3.30, 6.20], p(m/f) = 0.463; V2: male: 3.05 [2.00, 4.60], female: 3.64 [2.62, 5.41], p(m/f) = 0.039; V3: male: 3.02 [1.67, 4.20], female: 3.65 [2.18, 5.47], p(m/f) = 0.016). In V3 a differential BASDAI in response to TNFi (n=299) was observed (Fig.1a).Possible differences of response to individual TNFi (etanercept, infliximab, other TNFi) measured by HAQ were investigated in all diseases together. The difference between male and females was significant at baseline for all 3 TNFi; whereas with the use of ETA the significant difference was carried through to V2 and V3, it was lost with the use of IFX and was variable with the other TNFi (Fig.1b)Figure 1.Conclusion:Female patients showed a statistically lower response to TNFi in all three disease entities (RA, SpA and PsoA) to a variable degree in our homogenous central european population. Interestingly, the difference was not uniform across individual TNFi when measured by HAQ. Gender differences were also seen in response to Apremilast.Disclosure of Interests:Elisabeth Loibner: None declared, Valentin Ritschl: None declared, Burkhard Leeb Speakers bureau: AbbVie, Roche, MSD, Pfizer, Actiopharm, Boehringer-Ingelheim, Kwizda, Celgene, Sandoz, Grünenthal, Eli-Lilly, Grant/research support from: TRB, Roche, Consultancies: AbbVie, Amgen, Roche, MSD, Pfizer, Celgene, Grünenthal, Kwizda, Eli-Lilly, Novartis, Sandoz;, Peter Spellitz: None declared, Gabriela Eichbauer-Sturm: None declared, Jochen Zwerina: None declared, Manfred Herold: None declared, Miriam Stetter: None declared, Rudolf Puchner Speakers bureau: AbbVie, BMS, Janssen, Kwizda, MSD, Pfizer, Celgene, Grünenthal, Eli-Lilly, Consultant of: AbbVie, Amgen, Pfizer, Celgene, Grünenthal, Eli-Lilly, Franz Singer: None declared, Ruth Fritsch-Stork: None declared

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