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Background Patients with psoriasis arthritis (PsA) have heterogeneous clinical presentations, with diverse articular and dermatological features and varied disease courses and outcomes, so the assessment of disease activity implies important difficulties. Although the goal of treatment of PsA is to achieve remission, there is no a universally accepted definition. Objectives The purpose of this study was to assess agreement by experts on recommended disease activity assessment in PsA patients and to develop a consensus definition of clinical remission. Methods A modified Delphi approach was used as a consensus method. A scientific committee of experts provided 86 statements that were submitted in 2 rounds to a panel of 130 Spanish experts in PsA (in September and October 2018, respectively), addressing issues regarding the current assessment of remission, variables that should be included in the minimal assessment of PsA patients and the definition of remission, and the use of disease activity scores. Results The expert panel reached agreement for 53 proposed statements (61.6%). There was consensus that the definition of remission in PsA should include: the absence of signs and symptoms, physical well-being, the absence of impact of the disease, the absence of inflammation and progression in imaging tests (radiography and magnetic resonance) and the absence of inflammation measured by biomarkers (ESR, CRP). It is recommended to use some index designed specifically for the assessment of disease activity and the variables that should include the minimal assessment of PsA patients are: painful/swollen joints, enthesitis, dactylitis, axial involvement, skin and nail involvement, physical function, quality of life, structural damage assessed by imaging techniques, CRP, both patient and physician global assessment, both patient and physician skin assessment and extra-articular manifestations. The use of a treat-to-target (T2T) strategy should be considered in PsA patients, especially in those with a high risk of progression of structural damage. Although the ideal therapeutic goal is remission, there is consensus that low disease activity (LDA) is an acceptable goal. The most recommended tool to assess the disease activity in the clinic is DAPSA, with cut-off values of ≤ 4 for remission and > 4 to 14 for LDA. In patients who have reached the minimum activity of the disease, there was agreement in which the most suitable index was the MDA (Minimal Disease activity), with cut-off values of 5 to 7. ASDAS (or alternatively BASDAI) may be used in cases with axial involvement. There was also consensus to include the Psoriatic arthritis Impact of Disease questionnaire (PsAID) for the assessment of patients’ quality of life in follow-up consultations. The proposed definition of clinical remission in PsA is the absence of disease activity assessed using DAPSA or MDA (and/or aSDAS in patients with axial involvement), and the absence of later radiological progression. Conclusion On the basis of the available evidence and expert consensus, recommendations have been made for disease activity assessment in PsA and a proposal for definition of clinical remission was made that may be useful in the management of PsA patients Disclosure of interests None declared

Background: Patients with psoriatic arthritis (PsA) experience significant disability and reduced quality of life, resulting from the emotional distress and functional impairment associated with psoriatic skin lesions, as well as joint disease. Patient reported outcomes are important to evaluate healthcare interventions and to reflect the impact of PsA on patients’ lives. Objectives: The aims of the present study were to describe disease characteristics of PsA patients with an acceptable symptoms state (PsAID score Methods: Post-hoc analysis of data from a cross-sectional observational, multicenter study, aimed at evaluating the prevalence of MDA in a Spanish population with PsA, to describe their characteristics and to evaluate the association between MDA and the impact of the disease as assessed by the PsAID questionnaire. The original study included 227 adult patients of both genders diagnosed with PsA according to CASPAR criteria with at least one year of disease evolution and on treatment with biological and/or conventional synthetic disease modifying anti-rheumatic drugs (cDMARD). The PsAID questionnaire reflects the effect of PsA from the patient’s perspective. It is composed of 12 physical and psychological domains. PsAID score Results: 122 patients with a PsAID score A moderate relationship between HAQ Conclusion: There are discrepancies between the treatment goals (MDA) and the impact of disease as assessed by PsAID. Clinical characteristics such as DIP involvement, inflammatory load (PCR) and genetic factors (familial history) seem to be associated with a lower probability of being in an acceptable symptoms state in PsA patients. Disclosure of interests: Ruben Queiro Silva: None declared, Juan D. Canete: None declared, Susana Gomez Employee of: I am a current employee of Pfizer., ana Cabez Employee of: Pfizer

Background: Psoriatic arthritis (PsA) patients usually have a high prevalence of cardiovascular risk factors (CVRF) and cardiovascular events, which makes the routine estimation of cardiovascular risk (CVR) highly advisable. Currently, this risk is estimated through classic risk scores (SCORE, Framinghan), however, the values of these scores may underestimate the real CVR of these patients. On the other hand, in clinical decision making and when evaluating the therapeutic response, it is advisable the use of some composite activity index. The heterogeneity of PsA makes it difficult to estimate the real activity and the remission state, so it is important to assess which of these composite index is more suitable for these purposes in clinical practice. Objectives: We aimed to analyze whether carotid ultrasound is a useful tool for estimating CVR in patients with PsA, and if it is capable of correcting the estimated risk using classical tables. We also analyzed the usefulness of the MDA criteria and the DAPSA categories for clinical decision making in real practice. Methods: A cross-sectional study was conducted with 136 consecutive patients with PsA (CASPAR criteria). Sociodemographic and anthropometric data, CVRF, disease activity according to DAPSA categories, HAQ, MDA, and CVR measured by SCORE chart, was collected. An IMT> 800 μm and/or the presence of carotid plaque (Mannheim consensus), defined a high CVR by ultrasound. We analyzed the concordance (kappa) between the MDA response and the low activity and remission categories according to the DAPSA. Clinical variables of PsA associated with a high CVR were evaluated by multivariateanalyses. Results: Intima-media thickness values correlated well with CVR categories according to SCORE (p In the multivariate analysis, some characteristics of the disease were independently associated with a high CVR. This reveals that patients with enthesitis and/or structural damage are those who tend to have a high CVR. When comparing DAPSA and MDA criteria, we found a moderate correlation between the MDA response and the DAPSA low activity (κ = 0.52, p Conclusion: A high percentage of patients with low-moderate risk according to the SCORE risk chart are reclassified as patients with high CVR after the ultrasound examination. The high CVR in our population is related not only to classical CVRF, but also to the inflammatory load (enthesitis) and structural damage (erosions) of PsA. DAPSA is an appropriate instrument for clinical decision making in routine practice because it correlates reasonably well with stringent therapeutic goals such as MDA. Disclosure of interests: None declared

Background: Ustekinumab (UST) is a drug with proven efficacy in two randomized clinical trials in psoriatic arthritis -PsA- (PSUMMIT I and II). The data from these trials suggest that the 90 mg dose may be better than the 45 mg dose. Studies real world evidence (RWE) show that UST is effective and safe, nevertheless most of the evidence is base on the 45mg dose.1 Objectives: Our objective has been to check the effectiveness and safety of UST 90 mg in patients with PsA in RWE conditions. Methods: An observational study in RWE conditions was driven. We included 58 patients (37 women, 21 men, age 55 ± 8.7 years) with PsA from a single university hospital. All patients met CASPAR criteria. The observation period was from July 2017 to the present. All patients received the 90 mg dose from the beginning. The average BMI was 29.9 ± 4.41. 50% of patients were obese. To measure the disease activity, the DAPSA index was used. A descriptive statistic was performed and the McNemar test was used to analyse the mean change of the DAPSA (final-basal). A bivariate analysis was performed to identify associated factors with a DAPSA remission/low activity. Results: The duration of psoriasis was 14.8 ± 12.8 years, and 6.3 ± 6.5 years for the arthritis. 34.5% were oligoarticular forms, 13.8% polyarticular forms, and the remaining 51.7% were mixed forms. The distal interphalangeal joints synovitis was present in 38% of the patients and dactylitis in 24%. 17 patients were naive to biologic drugs (29.3%), UST was second line in 25.9%, third in 32.8%, fourth in 10.3% and fifth in 1.7% of patients. Half of the patients were treated with MTX. In the baseline situation, 9.4% had low activity, 75% had moderate activity, and 15.6% had high activity by DAPSA index. At the end of the analysis, 12.5% were in remission, 59.4% in low activity, and 28.1% in moderate activity, according to the DAPSA index. There were no patients in high activity. That is, 72% were in DAPSA remission/low activity. The average reduction of DAPSA was 9.53 ± 5.52 (McNemar’s p Conclusion: In this RWE series, UST 90 mg was effective and safe in 75% of our patients probability of achieving a remission/low activity state by DAPSA. References [1] Ustekinumab in psoriatic arthritis: need for studies from real-world evidence. Queiro R, Coto-Segura P. Expert Opin Biol ther. 2018 Sep;18(9):931-935. Disclosure of interests: None declared