SAT0351 Very low disease activity, dapsa remission, and patient-acceptable symptom state in psoriatic arthritis

Background The goal of treatment in psoriatic arthritis (PsA) according to the T2T strategy is remission, or at least, a low disease activity state1. Currently there is no clear agreement on how to measure these treatment goals. Objectives To explore the relationship between very low disease activity (VLDA) state, according to the MDA 7/7 criteria2, and DAPSA remission3, as well as its association with the impact of the disease evaluated by the PsAID questionnaire4, in patients with PsA in routine clinical practice. Methods Post-hoc analysis of the MAAPs study5. We included patients who met CASPAR criteria, with at least one year of disease evolution, and treated with biological and/or synthetic DMARDs according to the usual clinical practice in Spain. Patients were considered in VLDA if they met 7/7 of the MDA criteria, and in DAPSA/cDAPSA remission (this last without CRP) if they had a value ≤4. A PsAID Results Of the 227 patients included in the original study, 26 (11.5%), 52 (30.6%), 65 (36.9%) and 125 (55%) were in VLDA, DAPSA remission, cDAPSA remission, and PASS, respectively. There was a moderate agreement between VLDA and DAPSA remission (κ=0.52) or the cDAPSA remission (κ=0.42). Patients in VLDA had a lower impact of the disease measured by PsAID [mean total score (SD): VLDA 1.1 (1.2); DAPSA remission 1.3 (1.5); cDAPSA remission 1.7 (1.6)]. There was a moderate agreement between DAPSA remission or cDAPSA remission and PASS (κ=0.55 and κ=0.58 respectively), while fair agreement was found between VLDA and PASS (κ=0.18). Conclusions About one third of this series reached DAPSA remission, while only 11.5% reached VLDA state. On the other hand, more than half were in PASS situation. Agreement between VLDA and DAPSA was moderate. Although the MDA 7/7 criteria seem to be more stringent criteria for assessing remission, DAPSA remission shows better agreement with PASS. DAPSA and VLDA would be adequate treatment targets in daily practice. References [1] Smolen JS, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis2018;77:3–17. [2] Coates LC, et al. Defining Low Disease Activity States in Psoriatic Arthritis using Novel Composite Disease Instruments. J Rheumatol2016;43:371–375. [3] Schoels MM, et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis2016;75:811–818. [4] Gossec L, et al. A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis2014;73:1012–1019. [5] Queiro R, et al. Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study. Arthritis Res Ther2017;19:72. Disclosure of Interest None declared