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Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field. orcid-numbers: Machado, Pedro/0000-0002-8411-7972 Inman, Robert/0000-0002-4750-1422 unique-id: ISI:000417778700007 ispartof: Annals Of The Rheumatic Diseases vol:77 issue:1 pages:3-17 ispartof: location:England status: published

Resume Objectif L’evaluation globale par le patient (EVAgb) est une methode d’evaluation essentielle dans le rhumatisme psoriasique. L’objectif etait d’analyser l’interet de l’evaluation globale par le patient dans le rhumatisme psoriasique en etudiant les associations avec les domaines de sante du questionnaire PsAID (Psoriatic Arthritis Impact of Disease). Methodes Analyse post-hoc d’une etude transversale multicentrique de patients atteints de rhumatisme psoriasique. Les donnees collectees comprenaient l’evaluation globale par le patient, les evaluations globales specifiques d’articulation et de peau par le patient, le questionnaire PsAID couvrant l’impact physique (y compris les manifestations articulaires et cutanees) et l’impact psychologique et social ainsi que d’autres elements de comparaison. Une analyse univariee (correlation de Pearson) et une regression lineaire multivariee ont ete menees pour expliquer l’evaluation globale par le patient et les evaluations globales specifiques d’articulation et de peau par le patient. Resultats Parmi les 223 patients (âge moyen 51,0 [ecart type ± 13,3] ans, duree moyenne de la maladie 9,9 [± 10,1] ans, nombre d’articulations gonflees 4,1 [± 5,1], 84,3 % ayant un psoriasis [pour la plupart moins de 5 % de la surface corporelle]), 50,2 % etaient des femmes. Les valeurs moyennes de l’EVAgb etaient de 4,8 (± 2,7), les valeurs moyennes respectives des evaluations d’articulation et de peau etaient de 5,6 (± 2,5) et de 4,1 (± 3,0). La correlation intra-classe entre l’EVAgb et les evaluations d’articulation et de peau etait respectivement de 0,71 (IC a 95 %, 0,64–0,77) et de 0,52 (IC a 95 %, 0,42–0,60). D’apres l’analyse multivariee, l’EVAgb du patient etait bien expliquee (R2 du modele 0,754) par le « coping » ou capacite a faire face (β = 0,287) ; la douleur (β = 0,240) ; les activites de travail et/ou de loisir (β = 0,141) ; et l’anxiete (β = 0,109). Conclusions L’evaluation globale par le patient dans le rhumatisme psoriasique s’expliquait principalement par les composantes physiques mais egalement psychologiques de la maladie.

This review will outline the current pharmacogenomics knowledge about psoriatic arthritis with a special attention to the perspectives and the challenges for its implementation in the clinical practice. To date, different drugs have been developed to contrast the symptoms and the progression of psoriatic arthritis. However, patients have shown high variability of drug response in relation to their genetic makeup. In this context, the advances made in the knowledge and the potentialities of genome-drugs associations paved the path for the development of a precision medicine. In fact, these associations may be successfully combined with the environment information to provide new strategies able to prevent and improve the disease management as well as to enhance the patients quality of life.

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International audience; Objectifs: dans le rhumatisme psoriasique (RPso), la fatigue est un aspect important pour les patients. L’objectif était d’évaluer l’ampleur de la fatigue chez les patients souffrant de RPso et les facteurs susceptibles d’expliquer une fatigue intense.Méthodes: il s’agissait d’une analyse ancillaire d’une étude transversale menée dans 13 pays sur des patients non sélectionnés atteints de RPso qui remplissaient les critères CASPAR. L’importance de la fatigue pour les patients a été évaluée par un exercice de hiérarchisation au moyen d’une échelle numérique (EN) (plage 0-10). Les facteurs pouvant être associés à une intensité de fatigue > 5/10, à savoir des variables démographiques (âge, sexe, durée de la maladie, niveau d’éducation) et des caractéristiques de la maladie (nombre d’articulations touchées, protéine réactive C, psoriasis cutané, atteinte axiale, enthésite, dactylite, dommages structuraux) ont été évalués par une analyse logistique univariée et multivariée et une analyse par régression linéaire multiple.Résultats: au total, 246 patients ont été analysés : âge moyen ± écart-type 51,2 ± 13,0 ans ; durée moyenne de la maladie 9,9 ± 10,1 ans ; score DAS 28 moyen 3,5 ± 1,3. La fatigue a été classée en deuxième position d’importance pour les patients après la douleur. Son intensité était élevée : fatigue moyenne 5,0 ± 3,0. L’intensité de fatigue > 5/10 a été bien expliquée (variance expliquée 73 %) par le psoriasis cutané (Odds Ratio 4,67 [intervalle de confiance 95 % 1,05 ; 20,72]), les articulations douloureuses (1,30 [1,01 ; 1,68]) et un faible niveau d’éducation (1,09 [1,02 ; 1,23]). Dans le modèle de régression linéaire multiple, la fatigue a été expliquée par le psoriasis cutané, les articulations douloureuses, l’enthésite, le sexe féminin et le niveau d’éducation.Conclusions: la fatigue est un problème prioritaire chez les patients atteints de RPso. La fatigue mesurée est intense chez ces patients. Les cas d’intensité > 5/10 étaient majoritairement associés à des facteurs liés à la maladie mais aussi à des variables caractéristiques des patients. La fatigue, dans le RPso, indique une étiologie multifactorielle.

Introduction The objective was to develop a questionnaire that can be used to calculate a score reflecting the impact of psoriatic arthritis (PsA) from the patients’ perspective: the PsA Impact of Disease (PsAID) questionnaire. Methods Twelve patient research partners identified important domains (areas of health); 139 patients prioritised them according to importance. Numeric rating scale (NRS) questions were developed, one for each domain. To combine the domains into a single score, relative weights were determined based on the relative importance given by 474 patients with PsA. An international cross-sectional and longitudinal validation study was performed in 13 countries to examine correlations of the PsAID score with other PsA or generic disease measures. Test–retest reliability and responsiveness (3 months after a treatment change) were examined in two subsets of patients. Results Two PsAID questionnaires were developed with both physical and psychological domains: one for clinical practice (12 domains of health) and one for clinical trials (nine domains). Pain, fatigue and skin problems had the highest relative importance. The PsAID scores correlated well with patient global assessment (N=474, Spearman r=0.82–0.84), reliability was high in stable patients (N=88, intraclass correlation coefficient=0.94–0.95), and sensitivity to change was also acceptable (N=71, standardised response mean=0.90–0.91). Conclusions A questionnaire to assess the impact of PsA on patients’ lives has been developed and validated. Two versions of the questionnaire are available, one for clinical practice (PsAID-12) and one for clinical trials (PsAID-9). The PsAID questionnaires should allow better assessment of the patient9s perspective in PsA. Further validation is needed.

Objectives Fatigue is an aspect of psoriatic arthritis (PsA), which is important to patients. The objective was to evaluate magnitude of fatigue in PsA patients and to assess factors that might explain high levels of fatigue. Methods This was an ancillary analysis of a cross-sectional study in 13 countries of unselected PsA patients who fulfilled the CASPAR criteria. Patient-perceived importance of fatigue was assessed through a priority exercise. Levels of fatigue were assessed by a numeric rating scale (range 0–10). Factors potentially associated with fatigue > 5/10: i.e., demographic variables (age, gender, disease duration, education level) and disease related characteristics including joint counts, C-reactive protein, skin psoriasis, axial involvement, enthesitis, dactylitis, structural damage, were assessed by univariate, multivariate logistic and multiple linear regression. Results In all, 246 patients were analysed: mean ± standard deviation age 51.2 ± 13.0 years, mean disease duration 9.9 ± 10.1 years, mean DAS28 3.5 ± 1.3. Fatigue was ranked second in patient-perceived importance, after pain. Magnitude of fatigue was high: mean fatigue 5.0 ± 3.0. Fatigue > 5/10 was well explained (variance explained 73%) by skin psoriasis (odds ratio 4.67 [95% confidence interval 1.05; 20.72]), tender joints (1.30 [1.01; 1.68]) and lower education level (1.09 [1.02; 1.23]). In the multiple linear regression model, fatigue was explained by skin psoriasis, tender joints, enthesitis, female gender, education level. Conclusions Fatigue is a priority for PsA patients. Fatigue levels were high in these patients and fatigue > 5/10 was mainly associated with disease-related factors but also patient-related variables, indicating that the etiology of fatigue in PsA is multifactorial.

Objective Patient global assessment is a key outcome measure in psoriatic arthritis. To explore the meaning of patient global assessment in psoriatic arthritis by examining associations to domains of health assessed by the Psoriatic arthritis impact of disease score. Methods Post-hoc analysis of a multicentre cross-sectional study of patients with psoriatic arthritis. Data collection included patient global assessment, specific joint and skin global patient assessments, Psoriatic arthritis impact of disease questions covering physical (including joints and skin), psychological and social impact, and other comparator outcomes. Univariate analyses (Pearson correlation) and multivariate linear regression were performed to explain patient global assessment and the specific joint and skin global patient assessments. Results Among 223 patients (mean age: 51.0 [standard deviation, ±13.3] years; mean disease duration: 9.9 [±10.1] years; mean swollen joint count: 4.1 [±5.1]; 84.3% with current psoriasis [mainly of less than 5% body surface area]), 50.2% were females. Mean patient global assessment was 4.8 (±2.7), mean joint and skin patient assessments were respectively 5.6 (±2.5) and 4.1 (±3.0). Intraclass correlation between patient global assessment and joint or skin patient assessment was respectively 0.71 (95% confidence interval, 0.64–0.77) and 0.52 (95% confidence interval, 0.42–0.60). In multivariate analyses, patient global assessment was explained (R2 of model: 0.754) by coping (β = 0.287); pain (β = 0.240); work and/or leisure activities (β = 0.141); and anxiety (β = 0.109). Conclusions Patient global assessment in psoriatic arthritis was explained mainly by physical, but also psychological aspects of the disease.

SummaryA lack of national guidelines in some countries and lack ofconsensus amongst those that do exist in others is problematic.Specifically, poor and inconsistent advice on initiating and opti-mising therapeutic interventions is a barrier to improving out-comes. While European guidelines can help to fill the gap incountries without national guidelines, their role should primar-ily be to strengthen and harmonise existing guidelines, and toprovide a framework for the development of new nationalguidelines. They therefore need to lead the provision of advicethat is not given in existing guidelines. Limited awareness ofguidelines and increasing pressures on patient consultation can Figure 5 The concept of cumulative life course impairment(CLCI) in psoriasis. 22 CLCI results from an interaction betweenthe burden of stigmatisation, physical and psychological co-mor-bidities; and coping strategies and external factors. Significantimpairment may occur in patients with ineffective coping strate-gies and limited social support, even if they have a small burden.This impairment may be less in patients with effective copingstrategies and strong social support networks, even if the bur-den is large. (Figure adapted from Kimball 2010.)

Background Patient adherence is a key element for therapeutic success and represents a major concern for all healthcare professionals. Objective Aim of our study was to assess the frequency of use of treatments currently available for psoriasis and its association with specific socio-demographical and clinical variables. Methods The study population consisted of 1689 patients, aged 12‐85 years. Information concerning sociodemographical variables, clinical features and the type of current treatment was collected. Items on patients’ satisfaction of current treatments and of dermatologist-patient relationship were also included. The chi-squared test was used to estimate the association between the categorical variables, whereas Wilcoxon and Kruskal‐Wallis tests were applied to the interval and ordinal variables. The Cochran‐Mantel‐Haenszel chi-squared trend test was used to evaluate the degree of satisfaction related to dermatologist‐patient relationship. Results Of the 1689 psoriatic patients, 54.1% did not use any treatments and 45.9% used at least one treatment. The use of drugs was significantly associated exclusively to severity of disease and affected body surface area. Systemic therapies, both traditional treatments and biological agents, were mainly used in patients with disease duration >10 years and disease severity. Treatment adherence was significantly associated to the degree of patient’s satisfaction of his⁄her relationship with the dermatologist. Alternative treatment such as over the counter medications and acupuncture were used by 33% of patients. Conclusion The majority of psoriatic patients do not use any treatments. However, treatment adherence significantly increases when dermatologists clarify the treatment schedule, inform patients and meet the patients’ needs.

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As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project.

Background Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Objective To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. Methods Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. Results Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient9s status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9–10 (10: maximum agreement) for all recommendations. A research agenda was formulated. Conclusions The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA.

Individuals with psoriatic arthritis (PsA) are often undiagnosed or misdiagnosed (1,2), potentially leading to delays in receiving appropriate treatment. Many individuals with PsA consider their disease to be severe but view available treatment options as equally or more burdensome (3). Consequently, the long-term outcomes for patients with PsA tend to be poor, marked by disease progression (4), poor health-related quality of life (HRQOL) (5), increasing disability (5–7), comorbidities (8–10), and high direct and indirect costs (11,12). To explore the possible solutions to these issues, the Psoriatic Arthritis Forum was convened on October 29, 2012, in London. Its members included experts in rheumatology and dermatology as well as patient representatives from Europe and North America. The primary goals of the Psoriatic Arthritis Forum were to define unmet needs and gaps in PsA diagnosis and treatment and discuss potential ways in which to address these gaps, focusing on defining and implementing consistent standards of detection and care. This consensus statement summarizes the findings of this working group.

BackgroundPsoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD).MethodsThe recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement.ResultsTen recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined.ConclusionThese recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

Contains fulltext : 80789.pdf (Publisher’s version ) (Closed access) Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.

We evaluated risk factors such as socio-demographic characteristics, smoking habits and alcohol consumption, associated with hypertension, diabetes and obesity in psoriasis patients, in order to plan health education programs that could prevent the onset or progression of co-morbidities. The study population consisted of 1376 patients with psoriasis who were consecutively recruited at 21 Italian Departments of Dermatology. Information concerning socio-demographic variables, smoking and alcohol consumption, and the presence of chronic disorders such as hypertension, type 2 diabetes and obesity was collected. The risk of co-morbidities according to the various exposure variables was calculated using logistic regression models. Psoriasis patients living in extremely urban areas showed the highest risk of diabetes (OR = 1.99, 95% CI 1.06-5.23) and obesity (OR = 2.60, 95% CI 1.10-16.12), as compared to patients living in rural areas. The OR for hypertension was higher for smokers (> 15 cigarettes per day, OR = 1.37, 95% CI 1.01-2.03) and drinkers (> 2 glasses/day of wine, OR = 2.11, 95% CI 1.31-3.40). The OR for diabetes or obesity was higher for drinkers: 1 drink/day (OR = 1.93, 95% CI 1.01-3.67) and > 1 drink/day of spirits (OR = 2.90, 95% CI 1.43-5.82), respectively. The results of our survey highlight the need to detect psoriasis patients with different susceptibilities to co-morbidities in order to plan specific health campaigns aimed at changing people's lifestyles with respect to smoking, drinking and diet.

Objective: Our aim was to assess the role of the body mass index (BMI) in the clinical response to systemic treatment for psoriasis. Methods: A nationwide cohort study of patients receiving a new systemic treatment for plaque psoriasis at reference centres in Italy was conducted. Information was gathered through a web-based electronic form. Patients being maintained on the same medication and with data available at 8 and 16 weeks by March 31, 2007, were eligible. The outcome was a reduction in the Psoriasis Area Severity Index (PASI) of at least 75% at follow-up compared to baseline (PASI-75). Results: Out of 8,072 patients enrolled, 2,368 were eligible and analysable at 8 weeks and 2,042 at 16 weeks. PASI-75 was achieved by 819 patients (34.5%) at 8 weeks and 1,034 (50.6%) at 16 weeks. The proportion steadily decreased with increased values of BMI. Compared to normal weight (BMI = 20–24) the adjusted odds ratio for achieving PASI-75 in obese patients was 0.73 (95% CI = 0.58–0.93) at 8 weeks and 0.62 (95% CI = 0.49–0.79) at 16 weeks. The impact of the BMI did not show remarkable variations according to the drug prescribed at entry. Conclusion: The BMI affects the early clinical response to systemic treatment for psoriasis.

Our aim was to assess the role of the body mass index (BMI) in the clinical response to systemic treatment for psoriasis.A nationwide cohort study of patients receiving a new systemic treatment for plaque psoriasis at reference centres in Italy was conducted. Information was gathered through a web-based electronic form. Patients being maintained on the same medication and with data available at 8 and 16 weeks by March 31, 2007, were eligible. The outcome was a reduction in the Psoriasis Area Severity Index (PASI) of at least 75% at follow-up compared to baseline (PASI-75).Out of 8,072 patients enrolled, 2,368 were eligible and analysable at 8 weeks and 2,042 at 16 weeks. PASI-75 was achieved by 819 patients (34.5%) at 8 weeks and 1,034 (50.6%) at 16 weeks. The proportion steadily decreased with increased values of BMI. Compared to normal weight (BMI = 20-24) the adjusted odds ratio for achieving PASI-75 in obese patients was 0.73 (95% CI = 0.58-0.93) at 8 weeks and 0.62 (95% CI = 0.49-0.79) at 16 weeks. The impact of the BMI did not show remarkable variations according to the drug prescribed at entry.The BMI affects the early clinical response to systemic treatment for psoriasis.

Background Over recent years the public health system has shown increasing interest in patients' views for use as guideline criteria in evaluating the quality of assistance above all for those patients with chronic diseases. Hence the interest in psoriasis, which is a chronic disease frequently associated with diabetes mellitus, hypertension, obesity, and cardiovascular diseases. The aims of our study were to describe clinic characteristics of patients with psoriasis, the quality of the assistance perceived by patients arrived at outpatients clinics and the information received, in order to identify areas in Italy requiring improvement. Methods 1954 patients, aged between 18 and 85 years, were consecutively enrolled at outpatients clinics across 21 Italian provinces over the period December 2004 – January 2006. A standardized questionnaire was developed in collaboration with an Italian Association of Psoriatic Patients (A.DI.PSO) and tested in a pilot study. The questionnaire was divided into three sections: the first section included social, demographic and individual variables; the second concerned the quality of the assistance perceived by the patients at public dermatologic clinics and the third focused on the need of information requirements of patients with psoriasis. The χ2 test was used to estimate the association between the categorical variables under study. Kruskal-Wallis test was applied to the interval and ordinal variables. Results The presence of psoriatic arthritis was reported in 26.0% of patients. Associated chronic diseases included depression (15.4%), hypertension (13.3%), obesity (8.9%) and type 2 diabetes mellitus (7.3%). The study highlighted the need of improvements of health care services at public dermatologic clinics especially in overcoming architectonic barriers and reducing appointment wait-times, particularly in South Italy. However, patients reported a positive relationship with Health System employers due to the confidentiality. This positive impression was confirmed by the observation that dermatologists were considered the best source of information about therapies on psoriasis. Conclusion Our study allowed to identify critical aspects which could be tackled through initiatives with the aim of improving these emerged needs.

Background: Psoriasis is often associated with the risk of physical disability, social discomfort and psychological disorders. Objectives: The aim of this study was to investigate the prevalence of depressive symptomatology among Italian patients with psoriasis vulgaris, in order to better evaluate the disease severity in this patient population. Methods: Five thousand Italian patients with psoriasis were mailed the Center for Epidemiological Studies-Depression Scale (CES-D) questionnaire, a 20-item instrument developed to perform epidemiological studies of depressive symptomatology in the general population. Questionnaires with responses to 16 or more items were considered evaluable. Results: We received evaluable questionnaires from 2,391 patients, including 1,528 men (63.9%) and 863 women (36.1%). Depressive symptomatology was observed in 1,482/2,391 patients (62% overall; females, 63%; males, 61%). Men Conclusion: Our results are consistent with previous studies showing that psoriasis is associated with profound psychological morbidity, in particular with depression in a large number of patients. It is important to consider this association in the overall management of psoriasis.

Background Fatigue is an important aspect of disease for people suffering from psoriatic arthritis (PsA) (ref 1). However, little is known about the factors explaining fatigue in PsA. The causes of fatigue in inflammatory rheumatic diseases such as PsA, spondyloarthritis or rheumatoid arthritis are unclear; fatigue is diversely reported as being related either to patient characteristics, e.g., demographic, psychological and social factors, or to disease characteristics, e.g. disease activity. Objectives To evaluate the magnitude of fatigue in PsA and to assess if fatigue appears more strongly associated with patient- or with disease-related characteristics. Methods Patients: international cross-sectional study of unselected patients with a definite diagnosis of PsA according to the CASPAR criteria, in 13 countries [1]. Magnitude of fatigue was assessed by a numeric rating scale (range 0-10). Factors associated with high fatigue (>5/10) were assessed by multivariate logistic regression. The factors tested for association were patient related characteristics including demographic variables (age, gender, disease duration and country, education level); disease-related characteristics including articular activity (number of tender joints and number of swollen joints), skin activity (current psoriasis of more than 5% body surface); other activity (axial involvement, enthesitis, dactylitis, extra-articular involvement) and structural damage. Other patient reported outcomes including quality of life were not analysed since usually highly associated to fatigue. Results Data from 246 patients were analysed: mean age 51.2±13.0 yrs; N=119 (48.8%) males. Most had long-standing disease. Mean (±SD) fatigue was 5.0 (±3.0); 44.7% of patients had a fatigue level above 5 out of 10. High fatigue was well explained (AUC of the model, 0.73) by the following elements in multivariate analysis: higher skin activity (odds ratio, OR=4.7 [1.1; 20.7]), higher tender joint count (OR=1.1 [1.0; 1.1]) and lower education level (OR=0.9 [0.8; 1.0]). Conclusions Fatigue levels were high in this population of patients with PsA. High fatigue was explained mainly by disease activity rather than patient-related variables, indicating fatigue may be closely related to the disease process in PsA. Further studies are needed. References Gossec et al. PsAID study, EULAR 2013. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2309

Objectives The PsA impact of disease (PsAID) project is a EULAR initiative to elaborate a questionnaire reflecting the impact of PsA based on the patients’ perception, with the involvement of patient research partners. Methods (1) Selection of domains: Patient research partners from 11 European countries, members of the Task Force, identified 16 important domains (areas of health). In a subsequent survey, 139 patients from 13 countries prioritised the 16 domains of health according to importance. The 12 top-ranking domains were kept for the next step; 9 domains had the highest individualised priority. (2) Phrasing of questions: discussions within the group allowed the formulation of 12 numeric rating scale (NRS) questions, one for each domain. These questions were translated into 11 languages. (3) Relative importance of each domain: Relative weight of the domains was determined by asking the patients in the validation study to “spend 100 points” across the domains. This process was performed twice, once for 9 domains and once for 12 domains. The ‘points’ were analysed by their ranks and linearly transformed to a 0-10 scale. (4) Validation study : An international cross-sectional and longitudinal study was performed in 13 countries to examine the psychometric properties of the PsAID. Results (a) The 12 domains of health relate both to physical and to psychological domains (e.g. pain, skin problems, fatigue but also embarrassment and/or shame with appearance, social participation and depression). The decision was taken to have 2 PsAID scores: one with 9 domains for use in clinical trials (for feasibility reasons), and one with 12 domains for use in clinical practice (to assess all the aspects important for patients). (b) Each domain is assessed by a single NRS question with a time-frame of one week. (c) A relative importance was calculated for each domain in order to combine data into a single result. The PsAID12 (clinical practice score) uses simplified weights. Pain, fatigue and skin problems are the domains with highest relative importance. (d) In all, 474 patients participated in the validation study: the population had long disease duration and moderately active disease. Correlations were, as expected, high with other patient-reported outcomes, particularly patient global (R=0.82-0.84). Test-retest reliability assessed in 71 stable patients was high (ICC, 0.94-0.95). Sensitivity to change assessed in 71 other patients 3 months after a DMARD/biologic change, was also acceptable and comparable to other outcomes (standardised response means, 0.90-0.91). Conclusions A questionnaire to assess the impact of PsA on patients’ lives has been developed and validated. Two versions of the questionnaire are available, one for clinical practice and one for clinical trials. They should allow a better assessment of the patient’s perspective in PsA, but further validation is needed in other cohorts of patients and in clinical trials. Disclosure of Interest None Declared