Background There are increasingly data about the usefulness of calprotectin levels in chronic inflammatory arthritis and its relationship with prognostic factors. However, few data are available on its role in the diagnosis of acute arthritis. Objectives To evaluate the possible usefulness of testing plasma and synovial fluid (SF) calprotectin levels as a predictor of the final diagnosis behind an acute mono or oligoarthritis. Methods Longitudinal observational study. We included non-consecutive patients referred to the rheumatology emergency department with suspected mono or acute oligoarthritis for a period of 23 months. Patients with a previous diagnosis of inflammatory, infectious or neoplastic disease were excluded. All of them underwent diagnostic arthrocentesis and blood extraction simultaneously. The SF was evaluated under optical microscopy immediately for the study of microcrystals. Samples of SF were also routinely sent to microbiological culture, and calprotectin levels (SFC) and cell count were determined. In blood, the calprotectin level (SC), CRP and ESR were determined. The calprotectin level in plasma was determined by an automated fluoroenzyme-immunoassay technique on an ImmunoCAP250 analyzer (Thermo Fisher). All patients were followed until diagnostic confirmation. The statistical analysis was performed with the SPSS 22.0 program. Results 41 patients were collected, 28 men (68.3%) and 13 women (31.7%) with a mean age of 56.2 years (SD 17.6). The patients presented an average of 6.5 days of symptoms duration (SD 7), manifested as monoarthritis in 80.5% of the cases, with the knee being the most frequently affected joint (92.5%). In all patients, SF culture was negative. The most frequent diagnosis was microcrystalline arthritis in 21 patients (13 gout and 8 pseudogout), followed by the forms of onset of different chronic inflammatory arthropathies (9). Another 8 patients presented a mechanical joint effusion, in 1 patient the final diagnosis was not collected and there were 2 patients who presented other diagnoses (viral oligoarthritis, pigmented villonodular synovitis). Calprotectin values were higher in SF than in serum (mean 73,058 vs 824.75 μg/g). A high positive correlation was found between the SC and the CRP (p Conclusion Our preliminary results suggest that the analysis of SC could complement the information provided by a conventional analysis in the differential diagnosis of acute arthritis in situations in which an arthrocentesis is not possible. Studies with a greater number of patients and that include patients with septic arthritis are necessary. Disclosure of Interests: Marta Aguilar-Zamora: None declared, L Montolio-Chiva: None declared, Isabel de la Morena Speakers bureau: Abbvie, Celgene, Pfzier, UCB, Ghebro, Roche, Sanofi, Janssen., Jose Maria Lopez Ortega: None declared, Carlos Feced Olmos: None declared, Ana V Orenes Vera: None declared, I Vazquez-Gomez: None declared, Elia Valls-Pascual: None declared, D Ybanez-Garcia: None declared, a Martinez-Ferrer: None declared, A Sendra-Garcia: None declared, I Torner-Hernandez: None declared, V Nunez-Monje: None declared, Juanjo J Alegre-Sancho: None declared
Spondyloarthritis (SpA) is a group of related but phenotypically distinct inflammatory disorders that include axial SpA (axSpA) and psoriatic arthritis (PsA). Information on the characteristics and management of these patients in the real world remains scarce.To explore the characteristics and management [disease activity assessment and treatment with secukinumab (SEC) or other biologic disease-modifying antirheumatic drugs (bDMARDs)] of axSpA and PsA patients using natural language processing (NLP) in Electronic Health Records (EHRs).National, multicenter, observational, and retrospective study.We analyzed free-text and structured clinical information from EHR at three hospitals. All adult patients with axSpA, PsA or non-classified SpA from 2018 to 2021 with minimum follow-up of three months were included when starting SEC or other bDMARDs. Clinical variables were extracted using EHRead® technology based on Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) terminology.Out of 887,735 patients, 758 were included, of which 328 had axSpA [58.5% male; mean (SD) age of 50.7 (12.7) years], 365 PsA [54.8% female, 53.9 (12.4) years], and 65 non-classified SpA. Mean (SD) time since diagnosis was 36.8 (61.0) and 24.1 (35.2) months for axSpA and PsA, respectively. Only 116 axSpA patients (35.3%) had available Ankylosing Spondylitis Disease Activity Score (ASDAS) or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at bDMARD onset, of which 61 presented active disease. Disease Activity in PSoriatic Arthritis (DAPSA) or Disease Assessment Score - 28 joints (DAS-28) values at bDMARD onset were available for only 61 PsA (16.7%) patients, with 23 of them having active disease. The number of patients with available tender joint count or swollen joint count assessment was 68 (20.7%) and 59 (18%) for axSpA, and 115 (31.5%) and 119 (32.6%) for PsA, respectively. SEC was used in 63 (19.2%) axSpA patients and in 63 (17.3%) PsA patients.Using NLP, the study showed that around one-third of axSpA and one-sixth of PsA patients have disease activity assessments with ASDAS/BASDAI or DAPSA/DAS-28, respectively, highlighting an area of improvement in these patients' management.Investigating axial spondyloarthritis and psoriatic arthritis patients using natural language processing We conducted a study in Spain to better understand patients with specific rheumatic conditions known as axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). To analyze their characteristics, we used a computer technology called EHRead, which uses Natural Language Processing (NLP) to analyze free text from electronic health records. Out of a large group of patients, we focused on 758 individuals who had axSpA or PsA. Most of the axSpA patients were men, and they were around 51 years old on average. For the PsA patients, most were women, and their average age was about 54 years. We analyzed outcomes and treatments of these patients. Our findings showed that we can describe and assess a cohort of patients from real world using NLP. Besides, only about one-third of axSpA patients and one-sixth of PsA patients had their respective outcomes completely assessed, which indicates that there is potential room for improvement in the management of axSpA and PsA. The most promising feature in our study is the use of NLP, an artificial intelligence technology that helps us understand information in medical records written in free text. This can help us explore the characteristics of patients and their management in the real world, bringing an opportunity to enhance the care of patients with axSpA and PsA.
Background Tocilizumab (TCZ) has shown to be effective for large vessel vasculitis including giant cell arteritis (GCA) and Takayasu arteritis (TAK) (1-5 ). However, LVV-GCA and TAK show different demographic and clinical features that may influence on TCZ therapeutic response. Objectives To compare the effectiveness of TCZ in patients with LVV-GCA and patients with TAK. Methods Observational multicenter study of patients with LVV-GCA and TAK who received TCZ. Outcome variables were: a ) proportion of patients who achieved complete clinical improvement along with normalization of laboratory markers (CRP ≤0.5mg/dL and/or ESR ≤ 20 mm/1st hour) at 12 months b ) complete improvement in imaging techniques. A comparative study between patients with LVV-GCA and TAK was performed. Results We evaluated 70 LVV-GCA and 57 TAK patients who received TCZ. Main clinical and demographic characteristic are described in Table 1. Patients with TAK were younger, had longer disease duration, had received more commonly previous biologic therapy and were receiving higher doses of prednisone at baseline. TCZ intravenous administration was more common in TAK patients (80.7% vs 48.6%; p<0.01). Follow-up time after TCZ onset was similar in both groups. At 12 months, about 75% of patients achieved complete clinical improvement and ESR/CRP normalization in both groups. A follow-up imaging technique was performed in 37 LVV-GCA patients after a mean time of 12.9±6.0 months and 38 TAK patients after 9.5±5.0 months. Complete improvement in imaging techniques was only observed in 18.9% and 21.1% of patients with LVV-GCA and TAK, respectively (Figure 1). Table 1. LVV-GCA (n=70) TAK (n=57) p General features Age (years), mean ± SD 67.2 ± 10.5 40.5 ± 16.3 < 0.01 Sex (female), n (%) 51 (72.9) 49 (86) 0.07 Disease evolution before TCZ onset (months), median [IQR] 5 [2-15] 12 [3-37] <0.01 Baseline laboratory parameters ESR (mm/1st hour), median [IQR] 32 [12.5-54.7] 31 [10-52] 0.82 CRP (mg/dL), median [IQR] 1.4 [0.5-2.4] 1.4 [0.5-3.5] 0.41 Baseline prednisone dose (mg/day), median [IQR] 15 [10-20] 30 [15-50] < 0.01 Previous therapy Conventional DMARDs, n(%) 45 (64.3) 44(77.2) 0.51 Biologic therapy, n (%) 0(0) 12 (21.1) <0.01 TCZ therapy Intravenous, n (%) 34 (48.6) 46 (80.7) < 0.01 Combined with MTX, n(%) 24 (34.3) 24 (42.1) 0.37 Follow-up time after TCZ onset, median [IQR] 20 [10-36] 18 [7-41] 0.73 Complete clinical improvement and ESR/CRP normalization at 12 months, n/N (% ) 35/47 (74.4) 30/39 (76.9) 0.79 Complete improvement in imaging techniques, n/N(% ) 7/37 (18.9) 8/38 (21.1) 0.85 CRP: C-reactive protein; DMARDs: Disease-modifying anti-rheumatic drugs ESR: erythrocyte sedimentation rate; GCA: giant cell arteritis; IQR: interquartile range; LVV: large vessel; MTX: methotrexate; n: Number of patients; N: total number of patients: TCZ: tocilizumab; TAK:takayasu Figure 1. Conclusion The effectiveness of TCZ was similar in patients with LVV-GCA and TAK, despite a more refractory disease in TAK patients. A discordance between clinical and imaging activity improvement was observed in both LVV-GCA and TAK, as reported in previous studies (3 ). References [ 1 ] Calderón-Goercke M, et al. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003 [2]Prieto-Peña D et al. Ther Adv Musculoskelet Dis. 2021;13:175. PMID: 34211589. [3]Prieto Peña D et al. Clin Exp Rheumatol. 2021;39 Suppl 129:69-75. PMID: 33253103. [4]González-Gay MA, et al. Expert Opin Biol Ther. 2019;19:65-72. doi: 10.1080/14712598.2019.1556256. [5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019;48(4):720-727. doi: 10.1016/j.semarthrit.2018.05.007 Disclosure of Interests None declared
SUMMARY Nitrogen is an important factor determining grain yield of barley ( Hordeum vulgare L.). Optimal rates and application timing can vary according to the environmental conditions under which the crop is grown. For 8 years (1979–86) barley yield, tillering, and leaf-area response to N application rates and timing were studied in southern Spain. The results showed that, under our experimental conditions, the most advantageous N rate for grain yield was 60 kg/ha, either split equally between sowing and tillering, or else with the greater proportion applied at tillering. Nitrogen applied at sowing increased number of tillers per plant, and N applied at tillering favoured tiller survival for later spike formation. In addition, N applied at tillering increased the number of leaves per plant, leaf area per plant, and the leaf area index, the maximum value of which occurred at anthesis.
Background: Apremilast (APR) has demonstrated efficacy in orogenital ulcers of Behçet´s disease (BD). Response of other clinical manifestations remains unknown. Objectives: To assess the efficacy and safety of APR in monotherapy or combined with disease-modifying anti-rheumatic drugs (DMARDs) in non-aphthous ulcers of BD. Methods: National multicenter open-label study on 34 BD patients treated with APR at maintained standard dose of 30 mg twice daily. Results: From a cohort of 51 patients with APR by refractory orogenital ulcers of BD, we selected 34 (24 women/10 men, mean age 43.8±14.3 years), cases with another clinical manifestation/s. Excluding CTs, colchicine or NSAIDs, APR was given in monotherapy (n=21) or combined with conventional and/or biologic DMARDs in 13 cases (5 methotrexate, 3 azathioprine, 3 hydroxychloroquine, 1 sulfasalazine, 1 dapsone, 2 tocilizumab, 1 IFX). Other active manifestations present at APR onset were: arthralgia/arthritis (16, true arthritis in 5), folliculitis/pseudofolliculitis (14), erythema nodosum (3), furunculosis (2), paradoxical psoriasis by TNFi (2), intestinal ileitis (2), deep venous thrombosis (2), leg ulcers (1), erythematosus and scaly skin lesions (1), fever (1), unilateral anterior uveitis (1) and neurobehçet (1). After a median follow-up of 6 [3-12] months, folliculitis and ileitis improved, neurobehçet remained stable and musculoskeletal manifestations evolved in a variable way. (TABLE) TABLE. Conclusion: In addition of orogenital ulcers, APR in monotherapy or combined, seems to be useful in skin manifestations of BD Disclosure of Interests: Alba Herrero Morant: None declared, Belen Atienza Mateo: None declared, J. Loricera: None declared, Vanesa Calvo del Rio Grant/research support from: MSD and Roche, Speakers bureau: Abbott, Lilly, Celgene, Grünenthal, UCB Pharma, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Gerard Espinosa: None declared, Jenaro Graña: None declared, Clara Moriano: None declared, Trinidad Pérez Sandoval: None declared, Manuel Martín Martínez: None declared, Elvira Diez: None declared, María Dolores García-Armario: None declared, Esperanza Martínez: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Patricia Moya Alvarado: None declared, Francisca Sivera: None declared, Jaime Calvo Grant/research support from: Lilly, UCB, Consultant of: Abbvie, Jansen, Celgene, Isabel de la Morena: None declared, Francisco Ortiz Sanjuán: None declared, José Andrés Román Ivorra: None declared, Ana Pérez Gómez: None declared, Alejandro Olive: None declared, Carolina Díez: None declared, Juan José Alegre: None declared, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, Ángels Martínez-Ferrer: None declared, Javier Narvaez: None declared, Ignasi Figueras: None declared, Ana Isabel Turrión: None declared, Susana Romero-Yuste: None declared, Pilar Trénor: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD
Background Interstitial lung disease (ILD) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA) and leads to a significantly increased risk for morbidity and mortality compared with RA alone [1]. The analysis of Electronic Health Records (ERHs) using machine learning (ML) and Natural Language Processing (NLP) holds great promise to better characterize the disease in real-world settings. Objectives This study aims to a) estimate the prevalence of RA in Spain, b) determine the frequency of RA-ILD among RA patients, and c) describe the demographic and clinical characteristics in RA/RA-ILD patients. Methods Observational, retrospective, and multicenter study based on the secondary use of unstructured clinical data in EHRs from 6 Spanish hospitals between January 1, 2014 and December 31, 2019. The free-text information from patients’ records was captured with SAVANA’s EHRead , a validated NLP technology which extracts clinical information from EHRs and standardizes it into a SNOMED-CT-based clinical terminology [2]. The study population comprised all adult patients ≥18 years with RA in the selected period and sites. Descriptive statistics were presented in summary tables. Prevalence was calculated dividing the total number of patients with RA over the total number of attended patients. This analysis was performed by age and sex. Results Among all attended patients in the participating hospitals within the study period, 11,163 patients with RA were identified; of these, 8.6% (n = 959) had RA-associated ILD (RA-ILD). The age-adjusted prevalence of RA is shown in Figure 1. The estimated prevalence (95% CI) in the overall population was 0.49 (0.37-0.60), being 0.26 (0.19-0.32) in males and 0.71 (0.54-0.87) in females. Most patients in the RA (73.9%; n = 8,250) and RA-ILD populations (63.3%, n = 607) were female (Table 1). The median age (Q1, Q3) was 60.8 (49, 74) and 67 (56, 77) years in the RA and RA-ILD groups, respectively. Regarding disease course, the time from RA to ILD diagnosis was 27.6 (3.7, 73.2) months. Most comorbidities presented higher rates in the RA-ILD population, as shown in Table 1. Among patients with available ILD subtype information (n = 618), the most common was usual interstitial pneumonia (29.8%; n = 184). Table 1. Demographics and comorbidities in the RA and RA-ILD patient populations RA* N=11,163 RA-ILD N=959 Gender, n (%) Female 8,250 (73.9) 607 (63.3) Male 2,913 (26.1) 352 (36.7) Age at first mention of disease (years) 1 Median (Q1, Q3) 61 (49, 74) 67 (56, 77) Comorbidities, n (%) Dyslipidaemia 4369 (39.1) 316 (33) Hypertension 3851 (34.5) 320 (33.4) Diabetes mellitus 2970 (26.6) 248 (25.9) Infections 2129 (19.1) 328 (34.2) Bone fracture 1875 (16.8) 210 (21.9) Osteoporosis 1275 (11.4) 150 (15.6) Malignancies 1004 (9) 169 (17.6) Kidney failure 1006 (9) 156 (16.3) Heart failure 993 (8.9) 184 (19.2) Depression 825 (7.4) 99 (10.3) Psoriasis 773 (6.9) 39 (4.1) Obesity 732 (6.6) 90 (9.4) Asthma 740 (6.6) 82 (8.6) Atrial Fibrillation 729 (6.5) 102 (10.6) *RA includes patients in the RA-ILD population. 1 Patients’ age when either RA or ILD was first detected in the EHRs. RA = rheumatoid arthritis; ILD = interstitial lung disease Conclusion This pioneering study is the first to characterize RA-ILD using NLP methodology in a multicenter setting. By analyzing readily available real-world data in patients EHRs, we were able to estimate the prevalence of RA in the Spanish population and describe the demographic and clinical characteristics of patients with RA/RA-ILD. References [1]Bongartz T, Nannini C, Medina-Velasquez YF et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis and rheumatism 2010; 62: 1583-1591. [2]Canales L, Menke S, Marchesseau S et al. Assessing the Performance of Clinical Natural Language Processing Systems: Development of an Evaluation Methodology. JMIR Med Inform 2021; 9: e20492. Acknowledgements RA-W-ILD Study Group Disclosure of Interests Jose Andrés Román Ivorra Speakers bureau: AbbVie, Bristol Myers Squibb, FER, Galápagos, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Consultant of: AbbVie, Bristol Myers Squibb, FER, Galápagos, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Grant/research support from: AbbVie, Bristol Myers Squibb, FER, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Isabel de la Morena Speakers bureau: Pfizer, Novartis, Janssen, AbbVie, MSD, UCB, Sanofi, Roche, Nordic, Lilly, NEREA COSTAS TORRIJO Speakers bureau: UCB, Novartis, Pfizer, Belen Safont Speakers bureau: AstraZeneca, Roche, Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, J. Fernández-Melón Speakers bureau: Bristol Myers Squibb, UCB, Galapagos, Belen Nuñez Speakers bureau: Boehringer Ingelheim, Roche, Bristol Myers Squibb, Grant/research support from: Boehringer Ingelheim, Roche, Lucía Silva Fernández Speakers bureau: Bristol Myers Squibb, Consultant of: Novartis, MSD, Laura Cebrián Méndez Speakers bureau: Pfizer, Lilly, Gebro, Novartis, Consultant of: Pfizer, Leticia Lojo Consultant of: UCB, Belén López-Muñiz Speakers bureau: Boehringer Ingelheim, Roche, AstraZeneca, Novartis, Mundipharma, Gebro, GlaxoSmithKline, Ernesto Trallero Speakers bureau: Amgen, MSD, Maria Lopez Lasanta: None declared, Raul Maria Veiga Cabello: None declared, Maria Del Pilar Ahijado Guzman: None declared, Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Employee of: Savana, David Vilanova Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Celgene, Raul Castellanos Moreira Speakers bureau: Lilly, Pfizer, Roche, Sanofi, UCB, Bristol Myers Squibb, Consultant of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Sara Lujan Valdés Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
Background Since 2011, the use of Belimumab for the treatment of Systemic Lupus Erythematosus (SLE) has demonstrated efficacy and safety in several randomised clinical trials. However, strict inclusion criteria may restrict those results limiting the interpretation of these results to routine clinical practice populations. Objectives The aim of this study was to analyse the profile of patients using Belimumab as well as the clinical, serological and corticosteroid-sparing outcomes that may result from it use. Methods Retrospective cohort study including patients diagnosed with SLE and treated with Belimumab. Epidemiological, clinical and analytical data were collected at 6, 12 and 24 months before and after starting treatment with Belimumab. To assess effectiveness, the SELENA-SLEDAI, SLICC, clinical changes, concomitant treatments, corticosteroid dose and ds-DNA and C3-C4 levels were used. Safety was evaluated by assessing the need and cause for discontinuation of Belimumab. Results Thirty-one patients were included, mostly 28 (90.32%) women, with a mean age of 48.55 ± 1.95 years and a mean time of disease progression since diagnosis of 16.13 ± 1.77 years. The most prevalent affection before initiation of Belimumab were joint (83.87%), systemic (58.06%), skin (29.03%) and nephropathy (22.58%). The mean SELENA-SLEDAI score before Belimumab was 5.32 ± 0.46; 64.5% had elevated anti-dsDNA, 48.39% and 54.84% had low C3 and C4 levels, respectively. Before starting Belimumab, the most used treatments were both antimalarials (72.4%) and corticosteroids (80.6%). The main reason for starting Belimumab was the ineffectiveness of previous treatments (67.7%). The vast majority of patients were treated subcutaneously (90.3%) and there were no major adverse events leading to drug withdrawal, with a median duration of use of 19.3 months (IQR: 9.75-35.55). Conclusion After starting Belimumab, a decrease in the SELENA-SLEDAI activity scale, an increase in C3 and C4 levels, and a significant decrease in anti-dsDNA levels at 6 months were observed. At 12 and 24 months, continuity of this trend was observed, although statistical significance was not reached. As concerns corticosteroids, we observed a decrease in steroid use below 7.5mg/day and even 5mg/day after the introduction of Belimumab avoiding the undesirable effects of prolonged steroid use. Table 1. BEFORE BELIMUMAB (n=31) 6 MONTHS (n=28) 12 MONTHS (n=22) 24 MONTHS (n=9) ESLEDAI x̄ (SD) 5,32 (0,46) 2,28 (0,44) 2,90 (0,72) 3,44 (1,39) P<0,001 P<0,005 p>0,05 High dsDNA - n (%) 18 (58,06) 14 (61,29) 14 (45,16) 4 (12,9) P<0,001 P=0,036 P=0,7 Low C3 (<90mg/dl) - n (%) 15 (48,39) 11 (35,48) 9 (29,03) 3 (9,68) P=0,006 P=0,193 P=0,06 Low C4 (<16mg/dl) - n (%) 17 (54,84) 14 (45,16) 11 (35,48) 5 (16,13) P<0,001 P=0,003 P=0,217) Figure 1. Disclosure of Interests None declared
Psoriatic arthritis (PsA) is a complex and heterogeneous inflammatory disease. Secukinumab, a biologic disease-modifying antirheumatic drug (bDMARD), has extensive clinical evidence of efficacy and safety in the treatment of PsA but data in clinical practice are still limited. This study aims to provide real-world evidence on secukinumab use, effectiveness, and persistence in PsA.A retrospective, multicenter study was conducted on patients diagnosed with PsA and treated with secukinumab up to June 2021 at 12 centers in the Valencian Community (Spain). Data on DAS28-CRP, DAPSA, Tender and Swollen Joint Counts (TJC, SJC), enthesitis, dactylitis, skin and nail involvement, pain, patient and physician global assessment (ptGA, phGA) using 100-mm visual analog scale (VAS), and persistence for up to 24 months were collected.A total of 178 patients were included (49% men; mean [standard deviation, SD] age: 51.4 [10.5] years; 39% obese). Secukinumab was used as a first-, second-, or ≥ third-line bDMARD in 37, 21, and 42% of patients, respectively. The percentage of patients achieving at least low disease activity (DAS28-CRP ≤ 3.2) increased from 25% at baseline to 66% at month 6 (M6) and was maintained (75%) up to M24. Mean (SD) DAS28-CRP baseline values (3.9 [1.2]) decreased to 2.9 (1.1) (p < 0.001) at M6 and remained low through M24 (2.6 [1.1]) (p < 0.001). Secukinumab also improved peripheral arthritis increasing the percentage of patients with TJC = 0 (20% baseline; 57% M24) and SJC = 0 (37% baseline; 80% M24). Treatment reduced the percentage of patients with enthesitis (25% baseline; 6% M24), dactylitis (20% baseline; 4% M24), and skin (70% baseline; 17% M24), and nail (32% baseline; 2% M24) involvement. Additionally, we observed improvements in the mean pain VAS (-26.4 mm M24), ptGA (-26.2 mm M24), and phGA (-24.8 mm M24). Secukinumab showed an overall 24-month persistence rate of 67% (95% confidence interval [CI]: 60-74%). Patients receiving first-line secukinumab showed the highest 24-month persistence rate (83, 95% CI: 73-92; p = 0.024).Secukinumab showed long-term effectiveness across the six key PsA domains thus reducing disease activity and pain, which are major treatment goals. This was accompanied by high persistence rates, especially in bDMARD naive patients.
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