E. Loginova

SAT0326 Duration of remission and minimal disease activityafter starting and discontinuation of biologic (B) dmards in early psoriatic arthritis patients treated according to treat-to-target strategy (results of an open-label remarca study)

Background The main goal of treat-to-target (T2T) strategy in psoriatic arthritis (PsA) is achievement of remission (REM) or minimal disease activity (MDA). There is limited data concerning the duration of REM/MDA after starting and discontinuation of bDMARDs in early (E) PsA patients (pts). Objectives to investigate the timing and duration of REM/MDA after starting and discontinuation of bDMARDs therapy in EPsA pts treated according to T2T strategy. Methods 34 (M-18/F-16) pts with active EPsA according to the CASPAR criteria non-responder to methotrexate (MTX) subcutaneous treatment, bDMARD-na&x0457;ve were included; mean age 38±11 years, PsA duration 12±10 months (mon.), psoriasis duration 89.8±91.1 mon., median Disease Activity index for Psoriatic Arthritis (DAPSA) 33.55 [28.34–41.77]. All pts started bDMARDs: Adalimumab (21 pts), Certolisumab pegol (3 pts), Etanercept (2 pts), Ustekinumab (8 pts)±MTX. The median duration of bDMARDs treatment was 9 [6.5–15], Min 3 mon. – Max 24 mon. The bDMARDs treatment was stopped due to an individual inefficiency, loss of efficacy or non-medical reasons. At baseline and every 3 mon. all pts underwent assessment of PsA activity by DAPSA and MDA criteria (tender joint count ≤1, swollen joint count ≤1, PASI≤1 or BSA ≤3, patient pain global assessment VAS≤15, patient’s global disease activity VAS≤20, HAQ≤0,5, enthesitis count ≤1). The proportion of pts who achieved REM by DAPSA≤4 and MDA (5 of 7 cutpoints) at least once, as well as timing and duration of REM/MDA after starting and cessation of bDMARDs were performed. Pts reports about a flare coming, close to the scheduled time of assessment, was taken into account. M±SD, Me [Q75; Q50], (%) were calculated. All p<0.05 were considered to indicate statistical significance. Results By the 24 mon. of the study REM by DAPSA and MDA was reached at least once by 27 (79%) and 28 (82%) out of 34 pts, accordingly. Mean timing of REM by DAPSA and MDA after starting of bDMARDs was 5.8±3.2 and 4.0±1.9 mon., accordingly. During the observation 19 out of 27 pts (70.4%) had stopped bDMARDs due to different reasons. 8 out of 27 pts (29.6%) continued the treatment and had REM according to DAPSA by the end of the study. After cessation of bDMARDs flares by DAPSA were seen in 12 out of 19 pts (63.2%) with the mean duration of REM 5.8±2.3 mon. (Fig 1.). The loss of MDA was seen in 12 out of 20 pts (60%) with the mean duration of MDA 6.2±3.0 mon. Pts reports about the time of PsA symptoms flares was 3.5±3.4 mon. 5 out of 34 pts (15%) loss the efficacy after 12.0±4.7 mon. of bDMARDs treatment.Abstract SAT0326 – Figure 1 Dynamics of DAPSA after starting and discontinuation of bDMARDs therapy in EPsA. Conclusions Most EPsA pts treated with bDMARDs according to T2T strategy achieved REM and MDA within 5 mon. Flares after bDMARDs discontinuation within 6 mon were found in more than a half of pts. according to PsA activity indices and within 3 mon. by pts reports. REM and flare timing after bDMARDs therapy discontinuation indicate that further studies concerning optimal management PsA pts by bDMARDs are needed. Disclosure of Interest None declared

THU0307 Qt interval and its correlations with traditional risk factors of development of cardiovascular diseases in patients with active early psoriatic arthritis

Background Cardiovascular diseases (CVD) are leading cause of morbidity and mortality in patients (pts) with psoriatic arthritis (PsA). An abnormally prolonged and shorted QT interval are associate with an increased risk of ventricular arrhythmias and sudden cardiac death. Objectives to evaluate QT interval during Holter monitoring and cardiovascular (CV) risk assessment using SCORE (Systematic COronary Risk Evaluation) in early PsA (EPsA) pts. Methods We included data of 48 (F.-23) DMARD-naive EPsA pts (according to the CASPAR criteria) with no history of CVD: mean age - 36[28; 47 years, EPsA duration – 6,9[4; 12 months, DAS – 3.97 [3.27; 4.1], C-reactive protein – 19.4 [8.8; 37.6]mg/l. Controls subjects were matched by age, sex (n=48). All pts were assessed for traditional risk factors of CVD, ESC guidelines, 2016 24 hour (24 hour) ECG monitoring were analysed for QT interval corrected for heart rate (QTc). Prolonged QTc was defined as ≥460 ms in women and ≥450 ms in men, short QTc –<330 ms. Ten-year risk of CV death was estimated using SCORE algorithms, ESC guidelines, 2016 categorised as low (<1%), intermediate (1% to <5%), high (≥5% to<10%) or very high (≥10%). Intima-media thickness of the carotid artery (c-IMT) was measured using a high-resolution B-mode ultrasound machine. Results QTc interval during the 24 hours was significantly prolonged in EPsA pts when compared to the control group (table 1). We didn’t find short or prolong QTc interval in EPsA pts and control group.Abstract THU0307 – Table 1 QTc interval in EPsA pts and control group Parameters EPsA pts Controls QTc (ms), day 397[376; 404] 387,5[370,5; 396]* QTc (ms), night 396[377; 408] 390[367; 396,5]* QTc (ms), 24 hour 395[378; 406] 387[370; 396]* Data are present in median values and interquartile range, *p<0,05 (nonparametric paired Mann-Whitney U-test). 62.5% of patients with EPsA were classified as being at low risk 10 year risk of CV death using the SCORE algorithm, 6.25% pts – intermediate risk, 29.2% pts – high risk, 2.1% pts – very high risk. Increased cIMT was found in 11 (22.9%), atherosclerotic plaques - in 15 (31.3%). We found significant correlations between age and QTc duration during the 24 hours (R=0.48), as well as in both day (R=0.46) and night periods (R=0.45), for all p<0.05. We didn’t find correlations between QTc duration and traditional risk factors of CVD, disease activity of EPsA. Significantly correlations were observed between SCORE level and abdominal obesity (R=0.43, p<0.05), BMI (R=0.41, p<0.0001), c-IMT (R=0.41, p<0.05). Conclusions QT interval was significantly prolonged in EPsA pts when compared to the control group. The age of pts was associated with increase of the QTc interval. 29.2% of patients were classified as being at high risk risk 10 year risk of CV death using the SCORE algorithm. The increase level of SCORE associated with a subclinical atherosclerosis. Combination of prolonged QT interval and carotid atherosclerosis confirms presence of high cardiovascular risk in EPsA pts. Disclosure of Interest None declared

SAT0451 The one-year radiographic progression and minimal disease activity in early psoriatic arthritis patients treated according to treat-to-target strategy (results of an ongoing open-label remarca study)

Background Treat-to-target (T2T) strategy has benefit in early psoriatic arthritis (EPsA) treatment. Its influence on radiographic progression has limited data. Objectives to investigate radiographic outcomes and minimal disease activity (MDA) after 1-year of T2T strategy in patients with EPsA. Methods 40 (M-18/F-22) DMARD-naïve pts with active EPsA, according to the CASPAR criteria, mean age 38.4±11.1 yrs., PsA duration 11.9±10.6 months, psoriasis duration 73.8±84.6 months, median DAS 3.8 [3.2; 4.7] from the open-label REMARCA study were included. At baseline all pts were treated by Methotrexate (MTX) subcutaneous (s/c) 20–25 mg/week. Pts that still had medium or high activity after 3–6 months were treated by combination therapy MTX+ biologic therapy (BT) - anti-TNF or Ustekinumab (n=21). By the end of the study, 19 pts were treated by MTX-monotherapy. At baseline and after 1-yr. of treatment PsA activity index and digital radiographs of hands and feet were performed. All images were scored according to Sharp/van der Heijde (Sh.-v.d. H) method by a blinded musculoskeletal radiologist. Median total score (TS Sh.-v.d. H) = total erosion score (TES) + total narrowing score (TNS), the proportion of pts who reached MDA, M±SD, Me [Q75; Q50], W-test, U-test, (%) were calculated. All p<0.05 were considered to indicate statistical significance. Results At baseline, 23 out of 40 pts (57%) had erosion. By 1 yr., the number of pts with erosion increased up to 26 pts (65%). The median TS Sh.-v.d. H significantly increased from 91.5 [72–108.5] to 91.5 [73.5–111.5] (W-test, p<0.01), TES from 2 [0–4.5] to 2.5 [0–5] (W-test, p<0.05) and TNS from 85 [69–105] to 87 [71.5–107] (W-test, p<0.01). At 1 yr. of therapy there was no significant difference between the treatment groups in the value of TS Sh.-v.d. H (W-test p>0.05). 25 of pts (62.5%) had reached MDA by 1 yr. In pts who did not reach MDA (n=15) by 1 yr. TES was significantly higher at baseline compare to those who reached MDA: 3 [2–9] and 0 [0–3] accordingly (U-test, p<0.05). In the group of pts who did not reach MDA 1 yr. progression was significantly higher (table).Table 1 Sh.-v. d.H score MDA (n=25) No MDA (n=15) Baseline After 1 yr. Baseline After 1 yr. TES 0 [0–3] 1* [0–3] 3# [2–9] 5# [2–11] TNS 88 [70–108] 88 [71–108] 84 [68–98] 84 [74–103] TS Sh.-v.d. H. 89 [72–109] 89* [72–110] 93 [81–106] 93* [83–115] #significant differences between groups (U-test, p<0.05). *- significant differences into group (W-test, p<0.05). In 29 out of 40 pts (72.5%) there was no X-ray progression considering both erosion and joint space narrowing. 13 of them (45%) were treated by MTX and 16 pts (55%) by MTX+BT. Negative X-ray progression was found in 11 out of 40 pts (27.5%): 6 of them (54.5%) were treated by MTX and 5 pts (45.5%) by MTX+BT. Conclusions In the Russian cohort of active EPsA pts erosion was found in more than half of cases. Active EPsA pts treated according to T2T strategy during 1 year in 72.5% did not show any radiographic progression, only a quarter of pts (27.5%) had negative X-ray progression by the end of the study, regardless of the type of therapy. The pts who achieved MDA had less erosive progression. Disclosure of Interest None declared

SAT0478 Rapid3 questionnaire has high discriminating ability in minimal disease activity attainment in patients with early psoriatic arthritis treated according to tight control strategy in daily clinical practice (results of one-year open-label remarca study)

Background RAPID3 is an instrument based on patients report outcomes (PROs) for the assessment of remission and disease activity in rheumatoid arthritis. The advantages of this questionnaire in treat-to-target (T2T) strategy in early psoriatic arthritis (EPsA) have not been studied properly. Objectives to study discriminating ability of RAPID3 in minimal disease activity (MDA) attainment in patients with EPsA treated during one year according to tight control strategy. Methods 61 (M/F–29/32) patients (pts) with active EPsA, according to CASPAR criteria, mean age 37±10.6 years, PsA duration 11.3±10.2 months, psoriasis duration 75.4±80.9 months were included. All pts signed a consent form for participation in the open-label REMARCA study. At baseline and after 1year (yr.) of therapy all pts underwent evaluation of PsA activity by Tender Joint count (TJC78), Swollen Joint Count (SJC76), physicians global disease activity (PhGA) VAS, DAS, CRP (mg/l) and by PROs - patient pain global assessment VAS, Patient global disease activity (PGA) VAS, Health Assessment Questionnaire (HAQ) and RAPID3. The dose of Methotrexate (MTX) subcutaneous (s/c) was escalated by 5 mg every 2 weeks from 10 mg/wk up to 20–25 mg/wk. If pts did not achieve MDA after 3–6 months of MTX mono-therapy, combination therapy (CoT) of MTX+Adalimumab (ADA) was started in a standard regime; CoT was continued up to 1 yr. The proportion of pts who achieved MDA was calculated. M±SD, Me [Q25;Q75], %, Spearman rank correlation R, W-test, U-test, ROC-curve analysis were performed. All p<0.05 were considered to indicate statistical significance. Results By 1 yr. of therapy 36 out of 61 pts (59%) and 25 out of 61 pts (41%) were treated with MTX and with MTX+ADA accordingly. Significant improvements in PsA activity and PROs from baseline up to 1 yr. were observed: DAS 3.93 [3.20–4.58]/1.36 [0.82–2.25], SJC 7 [5–11]/1 [0–3], TJC 8 [6–1]/1 [0–3], PhGA 56 [48–69]/10 [5–20] and VAS pain 54 [48–68]/11 [1–20], PGA 55 [49–68]/14 [7–24], HAQ 0.75 [0.50–1]/0 [0–0.63] accordingly (for all W-test p<0.001). Significant positive correlations between RAPID3 and PsA activity, PROs and CRP are shown in table 1 (for all R p<0.001). Parameters R DAS 0.74 TJC78 0.68 SJC76 0.63 PGA VAS 0.82 Pain VAS 0.83 PtGA VAS 0.81 CRP 0.69 MDA was seen in 43 out of 61% pts (70.5%). At the same time RAPID3 and CRP significantly decreased from 12.7 [9.2–16.8] to 4.3 [2.0–7.8] and from 16.6 [8.6–34.6] to 2.1 [0.9–6.7] mg/l accordingly (for all W-test, p<0.001). Among those who have achieved MDA RAPID3 was in “near remission” status and significantly less compared to pts that did not achieve MDA-2.5 [1.3–5.3] and 8.1 [6.0–15.1] accordingly (U-test, p<0.001). According to the results of ROC-curve analysis RAPID3 score had a high discriminating ability for the presence of MDA - AUC 0.888 [0.808–0.969] (Fig. 1). Conclusions RAPID3 based on PROs is a simple instrument for evaluating PsA activity. RAPID3 has shown high discriminating ability in MDA attainment in EPsA pts treated according to tight-control strategy, and could be useful in daily clinical practice. Disclosure of Interest None declared

AB0800 Comparison of One Year Response to Treatment-to-Target Strategy by Methotrexate Subcutaneous Monotherapy and Its Combination with Adalimumab in Active Early Peripheral Psoriatic Arthritis (Results of an Ongoing Open-Label Remarca Study)

Background Influence of the different types of treatment on treatment-to-target (T2T) strategy results for early psoriatic arthritis (EPsA) has not been studied yet. Objectives To compare attainment of remission and minimal disease activity (MDA) using Methotrexate (MTX) subcutaneous (s/c) monotherapy or also in combination with Adalimumab (ADA) after one year of T2T strategy. Methods 25 (M/F – 9/16) DMARD-naïve patients (pts) with active EPsA, according to the CASPAR criteria, mean age 38.6±10.3 years, PsA duration 12 [5; 24] months, psoriasis (PsO) duration 36 [12; 84] months, disease activity index (DAS) 3.9 [3.1; 4.7], modified composite psoriatic disease index (joint-enthesis-dactylitis-skin domains) (mCPDAI) 8 [7; 8] after signing a consent form for the participant in the REMARCA [Russian invEstigation of MethotrexAte and biologics in eaRly aCtive inflammatory Arthritis] study were included. At baseline and every other 3 months for total 12 months of therapy all pts underwent standard clinical examination, including Tender Joint count (TJC78), Swollen Joint Count (SJC76), dactylitis, enthesitis, patient pain VAS, patient global disease activity VAS, physicians global disease activity VAS, DAS, Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire (HAQ), Dermatology Quality Life Index (DQLI). The dose of MTX s/c was escalated by 5 mg every 2 weeks from 10 mg/wk to appropriate dose 20-25 mg/wk according to the drug intolerance. If pts did not achieve the MDA or remission after 3 months of MTX mono-therapy, then combination therapy of MTX+ADA 40 mg every two weeks was continued up to one year. At 12 months of therapy the proportion of pts who attained DAS<1.6/mCPDAI=0 remission or MDA, ACR20/50/70 were calculated. Mean ± SD, Me [Q25; Q75], %, Fishers exact test, Friedman (Fr.) ANOVA, U-test were performed. All p<0.05 were considered to indicate statistical significance.2 Results By 12 months of therapy 12 out of 25 and 13 out of 25 pts were treated by MTX-mono therapy and combination therapy with MTX+ADA accordingly. At baseline pts following to MTX-mono therapy had significantly lower PsA activity by DAS/mCPDAI compare to these following to combination therapy MTX+ADA: 3.3 [2.6; 3.9]/7.5 [6; 8] and 4.7 [3.7; 5.0]/8 [8; 9] respectively (U-test, p<0.03 for all). At 12 months of therapy DAS remission achieved 7 (58.3%)/7 (53.8%) of pts, mCPDAI remission achieved 9 (75%)/16 (46.2%) of pts, MDA was seen in 9 (75%)/8 (61.5%) of pts with MTX-mono/MTX+ADA combination therapy accordingly (Fishers exact test p=0.25-0.52-0.67 respectively). ACR 20/50/70 were observed in 12 (100%)/11 (84.6%) of pts and in 10 (83.3%)/10 (76.9%) of pts and in 7 (58.3%)/8 (61.5%) of pts with MT-mono/MTX+ADA combination therapy accordingly (Fr. ANOVA, p=0.48 for all). By 12 months of therapy no significant differences were found in PsA activity by DAS/mCPDAI between pts with MTX-mono and MTX+ADA combination therapy: 1.3 [0.9; 2.1]/2.5 [1.5; 3.5] and 1.6 [1.3; 2.2]/4 [2; 7], U-test, p=0.568 and p=0.174, accordingly. Conclusions One year of T2T strategy with tight control over reached remission and MDA provides similar response rates regardless of the type of therapy in active EPsA. Disclosure of Interest None declared

AB0765 Treat to Target Strategy in Active Early Psoriatic Arthritis (Preliminary Results Of An Ongoing Remarca Study): Table 1

Background Treat to target (T2T) strategy for spondyloarthritis, including psoriatic arthritis (PsA) has been recently proposed. The main goal of this strategy is to reach remission or low/minimal disease activity (MDA). Objectives to investigate T2T strategy with methotrexate (MTX) subcutaneous (s/c) and anti-TNF-therapy (adalimumab) in active early peripheral psoriatic arthritis (EPsA). Methods 23 (M/F – 8/15) treatment-naïve patients (pts) with active peripheral EPsA, according to the CASPAR criteria, mean age 39.1±10.6 yrs., PsA duration 7 [4; 24] mo., disease activity index (DAS) 3.97 [3.07; 4.67], DAS28 4.33 [3.68; 4.73], Psoriasis duration 36 [12; 84] mo., PASI 6 [3.1;9.7], BSA (%) 1 [0.5; 3.65], HAQ 0.75 [0.63; 1.25], C-reactive protein (C-RP, mg/l) 15 [8.6;25.1], ESR (mm/h) 15 [8.6;25.1] were included. At the baseline and every other 3 mo. of therapy all pts underwent standard clinical examination: Tender Joint count (TJC78/28), Swollen Joint Count (SJC76/28), patient pain VAS, patient/physicians global disease activity VAS, PASI, BSA, HAQ, DAS, DAS28, C-RP (mg/l), ESR (mm/h). Response to the treatment was defined as percentage of pts who met remission (DAS<1.6 or DAS28<2.6), low disease activity (LDA) (1.6≤DAS<2.4 or 2.6≤DAS28<3.2), MDA, ACR20/50/70. The dose of MTX (s/c) was escalated by 5 mg eow from 10 mg/wk to 20 mg/wk. If pts do not achieve the MDA/LDA or remission after 3 mo. MTX mono-therapy (MoT) combination therapy (CoT) MT+Adalimumab (ADA) 40 mg s/c eow will start. Mean ± SD, Me [Q25; Q75], χ2-test, Friedman ANOVA were performed. All p<0.05 were considered to indicate statistical significance. Results Significant changes in baseline data up to 6 mo. of therapy are now avalible. Table 1 Baseline (n=23) 3 mo. (n=23) 6 mo. (n=23) Friedman ANOVA DAS 28 4.33 [3,68; 4,73] 3.56 [2,91; 4,35] 2.94 [1.3; 3.55] 0.001 DAS 3.97 [3,07; 4,67] 2.76 [2,17; 3,65] 2.06 [1.22; 3.3] <0.001 C-RP 15 [8.6; 25.1] 5.7 [2.3; 10.7] 4.9 [0.9; 38] <0.001 SJC/76 8 [7; 11] 4 [2; 8] 2 [0; 6] <0.001 TJC/78 9 [6; 15] 5 [3; 10] 3 [1; 7] <0.001 HAQ 0.75 [0.63; 1.25] 0.38 [0; 0.87] 0.13 [0; 0.63] <0.001 PASI 6 [3.1; 9.7] 7.1 [0; 32.5] 0 [0; 3.6] 0.148 BSA 1 [0.5; 3.65] 1 [0.3; 2.3] 0.35 [0; 1.6] <0.001 After 3 mo. of therapy MoT MTX remission by DAS/DAS28 was seen in 13%/22.7%, LDA by DAS/DAS28 in 21.7%/27.3% and MDA in 26.1% of pts. ACR 20/50/70 was achieved 65.2%/26.15/8.7% of pts accordingly. After 3 mo. 4 pts had high disease activity and were treated by CoT MT+ADA 40 mg s/c eow, 19 pts were continued MTX MoT. After 6 mo. remission by DAS/DAS28 was seen in 34.8%/39.1%, LDA by DAS/DAS28 in 26.1%/39.1% and MDA in 47.8% of pts. ACR 20/50/70 was achieved 73.9%/60.9%/47.8% of pts accordingly. After 6 mo. of MTX MoT (n=19) remission by DAS/DAS28 was seen in 36.8%/36.8%, LDA in 15.8%/36.8%, MDA in 47.4% of pts. ACR 20/50/70 was achieved 68.4%/52.6/42.1% of pts. MTX+ADA CoT (n=4) ACR 20/50/70 and MDA was achieved 100%/100%/75% and 50% of pts accordingly. Conclusions T2T strategy - active treatment of EpsA pts with predominantly MoT MTX s/c for 6 mo. show MDA in a half of pts (47.8%), remission by DAS in a third (34.8%) and ACR20/50/70 achieved 73.9%/60.9%/47.8% of pts accordingly. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3151

AB0948 Disease duration is a factor of the joint damage in DMARDs naÏve early perypheral psoriatic arthritis patients

Background In psoriatic arthritis (PsA) radiographic joint damage is a risk factor of the a poor outcome of the disease and mortality. Objectives the aim of this study was to determine whether the duration of PsA has an influence on the progression joint erosion in early peripheral DMARD naïve PsA patients (pts). Methods 60 pts (M/F – 23/37) with new onset PsA, according to the CASPAR criteria, the mean age 41.25±13.6 yrs, (Min 18-Max 72 yrs.), the average duration of the PsA being 0.87 yr. [0.5;1.5] (Min 0.16 - Max 2 yrs.), the average duration of the PsO being 7.5 yr. [2;20] (Min 0.3 - Max 47 yrs.), the mean DAS 3.45 (2.76; 4.41),DMARD naïvewere recruited.All pts underwent standard radiographic (Rg) examination and MRI of the hands and the feet via “Artoscan C” (0.2 T) (“Esaote” Italy). In both Rg and MRI slides were being calculated the number of the joint’s region (NJ’sR) with erosions and cysts depends on PsA duration – until 0.5 yr. (n=22), 0.5 - 1 yrs. (n=18), >1 yr. (n=20) by the two radiologist. Results are expressed as Mean ± SD, Me[Q25; Q75],(Min-Max); Pearson’s correlation coefficient, Kruskal-Wallis (K-W)H -test for comparison were performed. All p<0.05 were considered to indicate statistical significance. Results In the MRI slides for PsA duration until 0.5 yr.; 0.5 -1yrs.; >1yr. the mean NJ’sR with erosions and cysts was 0.95±1.4, [Min 0 - Max 4]; 0.67±1.53, [Min 0- Max 6]; 2.70±3.84, [Min 0 – Max 12] accordingly. By the Rg for PsA duration until 0.5 yr.; 0.5 -1yrs.; >1yr. the mean NJ’sR with erosions and cysts was 1.73±2.09, [Min 0 - Max 7]; 2.33±2.95, [Min 0- Max 8]; 3.30±3.89, [Min 0 – Max12] accordingly. We were found significant correlation between PsA but not PsO duration and NJ’sR with erosions and cysts both MRI (r=0.38) and Rg (r=0.27). Significant differences were found in NJ’sR with erosions and cysts for PsA duration until and after 1.5 yr. (KW-H (1.60) =6.48, p=0.0109). Conclusions The course of the PsA is more severe than thought previously. PsA pts should be treated at an early stage of the PsA in order to try and prevent joint damage and for an overall better outcome of the disease. Disclosure of Interest None Declared

AB0721 Magnetic resonance imaging of sacroiliac joints in early polyarthicular peripheral psoriatic and rheumatoid arthritis (remarca investigation)

Background Active sacroiliitis (SI) by magnetic resonance imaging (MRI) has been proposed as an important symptom of early spondyloarthritis (SpA) and would be helpful for the distinction between perhypheral polyarthicular psoriatic arthritis (PsA) and rheumatoid arthritis (RA) at an early stage. Objectives To compare involvement of sacroiliac joints by MRI, frequency of inflammatory back pain (IBP) and HLA-B27 in early perypheral polyarthicular PsA and RA. Methods 54 patients (pts) with early inflammatory polyarthritis were included, 29 (M/F – 13/16) with PsA, according to the CASPAR criteria, the mean age 36.5±11.27 yrs, the mean duration of disease 13.0±9.77 mo. and 25(M/F – 7/18) with RA, according to the ACR/EULAR 2010 criteria, the mean age 52.6±14.7 yrs, the mean duration of disease 4.0±1.72 mo. All pts underwent clinical examination (CE) to determine short-term IBP and IBP by ASAS criteria, HLA-B27 antigen test (in 27 PsA pts and in 20 RA pts) MRI of the SI joints by the apparatus “Signa Ovation” (0,35T “GE Medical Systems”) according to REMARCA (Russian InvEstigation of MethotrexAte and Biologics in EaRly ACtive Inflammatory Arthritis) protocol. Bone marrow oedema (BMO)/osteitis on STIR-images by MRI are believed to be a sign of active sacroiliitis (MRI-ASI). All MRI-scans were checked by blinded readers. Mean±SD, median and quartiles [Me (Q25; Q75)], t-test, χ2-test, Fisher’s exact, Yule’s coefficient of association (Q-level from -1 to 1) and Phi were performed. All p<0.05 were considered to indicate statistical significance. Results Those pts with PsA and RA had an equal level of activity by DAS28 - 4.09±1.26/4.62±0.86 (t-test p>0.24). In comparison a greater number of MRI-ASI was found in PsA than in RA – 12 pts (41.4%)/3pts (12%) accordingly (Fisher’s exact, p<0.016). No correlations were found between MRI-ASI and DAS28 in PsA and RA pts. In PsA pts IBP was found in 11 pts (37.9%), 6 out of 11 pts (54.5%) had IBP by ASAS criteria and 5 out of 11 pts (45.5%) had short-term IBP. In RA group 3 pts had only mechanical back pain. In PsA HLA-B27 was found in 9 out of 27 pts (33.3%) and in 3 out of 20 RA pts (15%) (t-test p<0.014). A high level of association was found between IBP and ASI in PsA pts (Q=0.91, Phi=0.56, Fisher’s exact p<0,003) (see table 1). A modest association was found between HLA-B27 and ASI in PsA pts (Q=0.75, Phi=0.56, Fisher’s exact p<0.039) (see table 2). Conclusions MRI-ASI is quite common in early PsA but also can be found in early RA. In PsA pts MRI-ASI is strongly associated with IBP and moderately with HLA-B27 in most cases, so all three tests can be helpful in distinguishing polyarthicular PsA and RA at an early stage. Disclosure of Interest None Declared