Background/Purpose: We consider multidisciplinary management necessary, especially in a subgroup of patients with Psoriatic Arthritis (PsA) for complexity, cutaneous and / or joint involvement. Despite the limited evidence of efficacy of methotrexate (MTX) and other classical synthetic DMARDs (csDMARDs) in these patients, they are commonly prescribed in our multidisciplinary unit (following the recommendations of experts, in peripheral PsA). Objective: To assess joint and cutaneous involvement in patients with peripheral psoriatic arthritis not receiving biologics in our multidisciplinary unit (visited for at least 6 months)

Methods: We review clinical the records of 199 PsA patients visited in our multidisciplinary unit and select 74 patients with the above mentioned criteria; we collect epidemiological and clinical data, and joint and skin activity evaluation by DAPSA, PASI, BSA and PGA (in plaque psoriasis) and proportion of patients that achieve MDA (minimum disease activity) as a therapeutic goal. Data were analyzed using SPSSv23.

Results: 74 patients, 63.5% males, aged mean(SD) 54.8(14.0) years. 56 peripheral PsA and 18 mixed (peripheral predominance); with mean 94.9(92.4) months of disease; 35.1% with previous clinical enthesitis and 37.8% previous dactylitis. Cutaneous disease consisted mainly (82.4%) in plaque psoriasis, 9.5% affecting folds, 4.1% onychopathy. 52,7% have received a previous DMARD of (31.1% MTX, 9.5% leflunomide) and 23.0% PUVA; 4.1% have received previous biological treatment. Current treatment: 83.8% DMARDs (68.9% MTX and 5.4% leflunomide) with a mean follow-up of 60.6(55.0) months. Disease activity: Skin plaque psoriasis was mainly controlled: 73.4% low PASI level (23.4% moderate) median PASI 3.0 [1.5-5.0]; 50.0% mild BSA, median BSA 3.0[1.0-6.0]. 73.1% PGA of very mild or mild-moderate disease. 87.0% of patients met DAPSA criteria of remission-low disease activity (DAPSA median 3.15[1.34-6.71]; 55.9% achieved DAPSA <4); 75.7% were in low activity / remission according to medical judgement. Overall 63.9% of patients achieved MDA; 15.3% (10 patients) had relative” contraindications” to biological therapy (6 cases of recent cancer, 2 HBV infection).

Conclusion: Over half of PsA patients from our multidisciplinary unit achieve low cutaneous and articular disease activity under csDMARDs, mainly Methotrexate. The use of targeted DMARDs such as apremilast in this scenario before biological therapies may improve disease outcomes in a subgroup of patients, corresponding with the efficacy shown in different domains of the psoriatic disease. Further research is needed to compare clinical results between csDMARDs and Apremilast.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-results-of-patients-with-peripheral-psoriatic-arthritis-not-receiving-biological-therapy-in-a-multidisciplinary-unit/