AB0436 STRUCTURAL AND INFLAMMATORY IMAGING PARAMETERS IN PSORIATIC ARTHRITIS: A COMPARISON OF DMARD-NAIVE AND DMARD-FAILURE PATIENTS (2024)

Abstract

Background: Psoriatic Arthritis (PsA) is a heterogeneous musculoskeletal disease with no cure, but several treatments including disease-modifying antirheumatic drugs (DMARDs) are available. The use of imaging techniques may facilitate diagnosis and determine appropriate treatment options. However, comparison of patients with diverse disease aspects is limited in the literature, specifically for DMARD-naive (those who have never used DMARD) and DMARD-failure (non-responders to previous DMARD treatment) PsA patients. Analyzing differences between these PsA patient groups can lead to appropriate patient identification and may facilitate adequate treatment selection.

Objectives: The objective was to compare DMARD-naive and DMARD-failure patient groups with active PsA disease, assessing inflammatory and structural damage differences by employing diverse imaging approaches. Also, the influence of patient demographics on these differences were analyzed.

Methods: This study utilized a diverse imaging strategy by integrating imaging scores to evaluate DMARD-naive and DMARD-failure PsA patients with active disease at baseline. All patients were included from the discovery cohort of the TOFA-PREDICT study, a multicenter trial investigating prediction of therapy response in PsA¹. Of the 80 patients included, 40 were DMARD-naive and 40 were DMARD-failures. All of the participants met the Classification Criteria for Psoriatic Arthritis (CASPAR) and had disease duration of at least eight weeks. MRI, ¹⁸F-FDG PET/CT and conventional radiographs at baseline were utilized to capture various imaging parameters (Table 2). Multiple linear regression analysis was conducted to identify differences between the two groups based on these imaging parameters. Subsequently, the same analysis was used to investigate the influence of patient demographics on the observed differences.

Results: There were limited differences between the two groups. None of the inflammatory imaging parameters showed statistical significance for between group difference (p>0.1). For structural imaging parameters, only Heel Enthesitis Magnetic Resonance Imaging Scoring System (HEMRIS) structure Achilles tendon (p=0.043) and Sharp-van der Heijde (SHS) joint space narrowing (p=0.052) was significantly different between groups (p<0.1) with higher values in DMARD-failure for both parameters. However, after correction of patient demographics (i.e., age, BMI, current smoking status, time since diagnosis of PsA, time since diagnosis of Psoriasis), the observed difference disappeared for both imaging scores (p>0.1). Among these demographics only current smoking status and age significantly contributed to the models for HEMRIS structure Achilles tendon and SHS joint space narrowing, respectively.

Conclusion: Overall, DMARD-naive and DMARD-failure active PsA patients showed similar inflammation and structural damage with respect to imaging parameters, especially after correction of patient demographics. Thus, combining DMARD-naive and DMARD-failure (after correction of patient demographics) may be a valid approach to offer a more comprehensive understanding of PsA progression for future analyses.

Acknowledgements: This study was conducted as a collaboration between University Medical Center Utrecht and Pfizer. Pfizer is the study sponsor and the project is co-funded by the PPP Allowance made available by Health~Holland Top Sector Life Sciences & Health, to stimulate public–private partnerships (grant number: LSHM17074).

Disclosure of Interests: Nağme Ö. Renkli: None declared, Nienke J. Kleinrensink: None declared, Julia Spierings J.S. received research grants from Boehringer Ingelheim and Miltenyi Biotec., Simon C. Mastbergen: None declared, Harald E. Vonkeman AbbVie, Novartis, Pfizer, UCB, Johnson and Johnson, Galapagos and Boehringer Ingelheim, Shasti C. Mooij: None declared, Lydia G. Schipper: None declared, Amin Herman: None declared, Iris ten Katen: None declared, Frank Nap: None declared, Marjolein Hol: None declared, Pim de Jong Research support from Philips Healthcare, Mylène Jansen: None declared, Wouter Foppen W.F. received research grants from Novo Nordisk and Pfizer, which were paid to the institution and has performed consultancy for Pfizer. PdJ, the department of Radiology of the UMC Utrecht receives research support from Philips Healthcare.