Background/Purpose: Treat to target recommendations in PsA state that the target of treatment should be remission or low disease activity (LDA). So far, the only validated target available was the minimal disease activity (MDA) criteria. Other potential targets have been developed including very low disease activity (VLDA) and the Disease Activity in PsA (DAPSA) score remission. Potential targets for LDA include DAPSA and clinical (cDAPSA) or the minimal disease activity (MDA) criteria for which modifications have been suggested to mandate individual components.

Using an existing real World cohort, the objectives were to calculate the proportion of patients achieving these criteria, their prognostic value and the overall patient impact of these disease states.

Methods: BioTRAC is an ongoing, prospective registry of inflammatory arthritis patients initiating treatment with infliximab, golimumab (GLM) or ustekinumab. PsA patients treated with GLM were included. Data collected at baseline, 6 and 12 months were used. The definition for MDA, remission and LDA outcomes are described in Table 1.

Results: A total of 188 patients (53% female) were included with a mean (SD) disease duration of 5.5 years. The proportion of patients achieving MDA, remission and LDA at baseline, 6 and 12 months is shown in Figure 1. 75% and 53.3% of patients in DAPSA and cDAPSA remission, respectively, also achieved VLDA (p<0.001). Patients who did not achieve cDAPSA nor DAPSA never achieved VLDA. Higher HAQ scores (p<0.03) were observed in patients achieving remission with remaining dactylitis or active skin disease (BSA≤10%; cDAPSA only). The proportions of patients achieving MDA also achieving MDA Joints, MDA Skin, MDA Joints & Skin and DAPSA LDA were 83.8%, 86.9%, 70.7% and 98.7%, respectively. Patients achieving any MDA target had significantly lower SJC, TJC, PASI, dactylitis and enthesitis scores compared to non-achievers (p<0.006). Patients achieving DAPSA or cDAPSA LDA showed significant reductions in SJC, TJC, PASI, dactylitis and enthesitis scores compared to non-achievers (p<0.05).

Conclusion: VLDA is the most stringent new potential targets for remission in PsA. There was a high level of correlation between scores although residual activity in dactylitis and skin despite DAPSA remission has some impact on patients’ function. MDA Joints, MDA Skin, MDA Joints & Skin, DAPSA LDA and cDAPSA LDA represent new potential targets for LDA in PsA. Patients achieving either DAPSA endpoints, however, did not show a significant reduction in skin disease indicating that those two endpoints are more restricted to joint symptoms.