Drinking episodes during the treatment (relapses or lapses) of alcohol-dependent patients is predicted from clinical ratings of patients and individual background data such as alcohol drinking history and social status. The probability of these relapses (or lapses) is determined up to three days in advance using a logistic regression procedure. The study group consisted of 33 male alcohol-dependent persons, who participated in a treatment program. Clinical ratings were performed three times a week by a trained person during a visit to the clinic. The questionnaire contained 23 different items about irritation, craving for alcohol. sleep disturbances, etc. The relapses were either self-reported or detected by a biochemical marker in a urine sample that was taken daily. The most important factor for a relapse in alcohol drinking was shown to be if the patient already had had one relapse during the treatment. Other important clinical factors were the levels of irritation and autonomic disturbances. None of the variables measuring mood shifts was significant. Family conditions during childhood were the most important background variables. The predictions turned out to have a rather high specificity, but the sensitivity was lower. Half of the relapses were not predicted by an increased probability for relapse. Self-reported relapses were predictable from preceding interviews and were also less frequent compared to those detected objectively by the biochemical markers.

Background: Although the prevalence of Psoriatic Arthritis (PsA) is the same in men and women, women experience a higher burden of disease (pain, disability, fatigue) (1).The persistent belief that women tend to over-report their symptoms compared to men may also contribute to under or delayed diagnosis in women. The clinical pattern of PsA also differs, with men presenting more commonly with peripheral and axial joint damage and women being affected more frequently by polyarthritis (2). Furthermore, most disease activity measures contain pain and quality of life measurement metrics that may perform differently by sex. As a result, this may affect the clinician’s perception of disease severity, influence management decisions and subsequently introduce sex bias in prescribing. Objectives: To assess sex-related differences in baseline demographics, disease characteristics and evolution over 1 year in patients with newly diagnosed PsA. Methods: Our study is embedded in the Dutch south-west Early Psoriatic Arthritis prospective cohort study. We described patient characteristics using simple descriptive analysis techniques. For the comparison across sexes and baseline and 1 year follow up, appropriate tests depending on the distribution were used. Results: 273 men and 294 women with no significant differences in age and ethnicity were included. Women reported significantly longer duration of symptoms before diagnosis and significantly fewer of them were in paid employment at baseline. Oligoarthritis was the most common pattern of arthritis in both sexes. Polyarthritis and enthesitis were more prevalent in women who also presented at baseline a significantly higher tender joint count (Fig.1) than men but no difference in swollen joint count. Figure 1. Longitudinal evolution of TJC68, Pain, VAS global, BRAF for men and women in the first year of PsA. All composite indices (CPDAI, DAPSA, GRACE, MDA, Psoriatic ArthritiS Disease Activity Score) showed significantly worse results in women at baseline. Women also suffered more frequently from comorbid medical conditions, fatigue and anxiety, and reported more severe limitations in function and worse quality of life. At 12 months women, despite the improvement they made, reported significantly higher levels of pain compared to men. Although MDA rates increase over time for both sexes,(Fig.2), it remained significantly more prevalent among men (19.0% vs 11.1% at inclusion, p<0.05 , and 58.1% vs 35.7%, p<0.00 , at T12). DAPSA was significantly higher in women at both timepoints and a significantly higher percentage of men presented remission according to DAPSA score at 12 months. Figure 2. Longitudinal evolution of composite measures for men and women in the first year of PsA. Conclusion: After 1 year of follow-up women didn’t surpass their baseline disadvantages and despite the improvement, they still present higher disease activity, more pain and lower functional capacity than men. The nature of these findings may advocate a need for sex specific adjustment of treatment strategies and evaluation in psoriatic arthritis as sex-related difference in outcome persisted over time. References: [1]Eder L, Thavaneswaran A, Chandran V, Gladman DD. Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. Annals of the rheumatic diseases. 2013;72(4):578-82. [2]Orbai AM, Perin J, Gorlier C, Coates LC, Kiltz U, Leung YY, et al. Determinants of Patient-Reported Psoriatic Arthritis Impact of Disease: An Analysis of the Association with Gender in 458 Patients from 14 Countries. Arthritis care & research. 2019. Disclosure of Interests: Evangelia Passia: None declared, Marijn Vis Grant/research support from: Novartis, Pfizer – grant/research support, Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Novartis, Pfizer – consultant, Laura C Coates: None declared, Anushka Soni Grant/research support from: Oxford-UCB prize fellowship, Speakers bureau: Janssen and Abbvie, Ilja Tchetverikov: None declared, Andreas Gerards: None declared, Lindy-Anne Korswagen: None declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Wiebo van der Graaff: None declared, Josien Veris-van Dieren: None declared, Natasja Denissen: None declared, F. Fodili: None declared, M. Starmans: None declared, Yvonne Goekoop-Ruiterman: None declared, M. van Oosterhout: None declared, Jolanda Luime: None declared

Objective: This paper describes the baseline demographics, clinical characteristics, and patient-reported outcomes (PROs) according to clinical phenotype of patients with early psoriatic arthritis (PsA) for the purpose of creating a decision support system for daily clinical practice.Method: Patients with newly diagnosed PsA were included in the Dutch south west Early Psoriatic ARthritis (DEPAR) study. No classification criteria were applied, to ensure collection of real-world data on demographics, medication, clinical characteristics, and PROs. An IT infrastructure facilitated data collection.Results: We described 527 patients, categorized according to the clinical phenotype stated by the rheumatologist at the time of diagnosis, namely monoarthritis (15%), oligoarthritis (40%), polyarthritis (23%), enthesitis (10%), axial disease (2%), and dactylitis (10%). Overall psoriasis severity was mild and 83 patients (16%) had no psoriasis. Short-term sick leave (> 1 day per 4 weeks) was 17% and long-term sick leave (> 4 weeks) was 4%. The group with phenotype enthesitis reported the longest duration of complaints, had the highest fatigue scores, and contained the highest percentage of patients with a Hospital Anxiety and Depression Scale (HADS) anxiety score ≥ 8 and depression score ≥ 8.Conclusion: PsA patients presenting at outpatient clinics in the Netherlands had a mild degree of psoriasis, with impairment of quality of life and work productivity. Most patients presented with phenotype oligoarthritis. Those presenting with phenotype enthesitis more often reported scores suggestive of an anxiety or depression disorder and fatigue. It is important for attending rheumatologists to be aware of these differences when assessing patients with PsA.

Objectives: We aimed to describe sonographic structural and inflammatory changes in entheses of patients with recently diagnosed psoriatic arthritis (PsA), patients with established PsA, and young healthy volunteers, and to investigate whether the MAdrid Sonographic Enthesitis Index (MASEI) enables us to distinguish these groups in an extreme comparison. Method: New and established PsA patients and healthy volunteers (aged 20–30 years) were recruited. The triceps, quadriceps, patellar, Achilles and elbow extensor tendon insertion, and plantar fascia entheses were investigated sonographically for structural changes, erosions, calcifications, increased thickness, bursitis, and power Doppler (PD) signal according to the MASEI. Results: The study included 25 new and 25 established PsA patients, and 25 healthy volunteers. Increased thickness and PD signal in knee entheses were common for patients and healthy volunteers, while changes at other locations predominantly occurred in patients only. PD was recoded (1, one spot; 1.5, two or three spots; 2, confluent signal; 3, severe confluent signal) and thickness of knee entheses excluded. This resulted in different modified MASEI scores between PsA patients and young healthy controls: median (interquartile range) modified MASEI of 13 (10–22.5) in new PsA, 13.5 (9.5–18) in established PsA, and 3 (1–8.5) in healthy volunteers (p = 0.002). Conclusions: Structural ultrasound changes and PD in entheses are common in both new and established PsA and healthy controls. MASEI score did not differentiate PsA patients from young healthy volunteers. After recoding of PD severity and excluding thickness of knee entheses, marked differences between PsA patients and healthy controls were observed.

Background Prognostic factors that may guide tapering decisions for DMARDs and TNFi on individual patient level are not available. To improve successful tapering subclinical synovitis may play a role in maintaining the remission state. Studies using ultrasound suggest that the presence of subclinical synovitis may elicit early disease relapse in remission. Objectives Our aim is to determine if ultrasound synovitis precedes disease relapse while tapering synthetic DMARD (sDMARD) or TNFi in patients with RA who achieved clinical remission on sDMARD and TNFi. Methods We included 125 RA patients (aged>17 years) treated with an sDMARD and a TNF-inhibitor who were in remission (DAS44≤2.4 & SJC≤1). Demographic characteristics, swollen and tender joints, laboratory variables and ultrasound synovitis (MCP2-5; PIP2-5; wrists; MTP2-5) were recorded at each visit (every three months) during one year follow-up. Patients were randomised to two tapering strategies: i) tapering sDMARD; ii) tapering TNFi. Disease relapse was defined as DAS44>2.4 or SJC>1. Ultrasound synovitis was defined as GS≤1 and/or PD≤0. To estimate whether ultrasound is able to identify patients who will have a disease relapse within three months follow-up a Cox proportional regression model for time to event data was used. Results: Ultrasound synovitis was found in 58% of RA patients in clinical remission. After one year follow-up 36% of RA patients had a disease relapse of whom 60% had ultrasound synovitis at baseline. table 1 shows the distribution of relapse en ultrasound synovitis for every three months. In the multivariate Cox model increasing number of joints with ultrasound synovitis was not significantly associated with disease relapse within three months follow-up (HR 1.21; 95%CI: 0.97-1.51) [table 2]. Conclusions Monitoring RA patients who started tapering their medication every three months showed limited value for ultrasound to identify patients who will have a disease relapse. Disclosure of Interest: None declared

At present, there are no prognostic parameters unequivocally predicting treatment failure in early rheumatoid arthritis (RA) patients. We investigated whether baseline ultrasonography (US) findings of joints, when added to baseline clinical, laboratory, and radiographical data, could improve prediction of failure to achieve Disease Activity Score assessing 28 joints (DAS28) remission (<2.6) at 1 year in newly diagnosed RA patients.

Background The Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID12) has been developed to measure impact of Psoriatic Arthritis (PsA) for purposes of monitoring and clinical management. Although validated in patients with longstanding disease, data on validity and sensitivity to change in early PsA is lacking. Objectives We aim to relate change in disease activity to change in PsAID12 score in early PsA and evaluate which PsAID domains are more likely to change. Methods Patients with a new diagnosis of PsA were included in the Dutch southwest Early Psoriatic Arthritis cohoRt (DEPAR). For this analysis, patients that have PsAID12 (range 0–10) and Composite Psoriatic Disease Activity Index (CPDAI, range 0–15) data at two consecutive visits (i.e. 3 months apart) within the first year were included. In case multiple periods per patients were available, the first time period was chosen. The change in PsAID is compared to the change in disease activity over this period, measured with the CPDAI using Spearman9s correlation coefficient. Change in score on individual domains of the PsAID was analysed in subgroups of patients that perceived improvement in health and those that perceived worsening. The SF-36 question on self-perceived change in health was used to determine these subgroups. Results 143 unique patients had at least one period with two PsAID and CPDAI measurements (67 from baseline-3 months, 26 3–6 months, 25 6- 9 months and 25 9–12 months). Mean age was 51 (SD 13.7) and 70 (49%) were male. The initial median PsAID was 3.35 (IQR 1.4–5.1) and the subsequent score was 2.25 (0.95–4.8 with a mean delta of 0.52 (P<0.01). Median first CDPAI score was 4 (2–7) and 3 (1–5) for the second with a mean delta of 0.45 (P<0.05). The difference in PsAID score was significantly but moderately correlated with the difference in CPDAI (Spearman9s rho 0.267, P=0.0013). 58 patients (41%) report a better health status compared to 3 months ago. Figure 1 shows that patients with self-perceived improvement of health have the highest improvement in pain and only domains of skin problems and embarrassment/shame did not improve significantly. Patients reporting worsening of health (n=29) only have significantly lower scores in fatigue, discomfort and social domains. Conclusions Improvement in CPDAI disease activity is significantly but moderately associated with improvement in PsAID score, with the biggest improvement in the pain domain in patients with a self-reported improvement of health. Disclosure of Interest None declared

. Methotrexatee (MTX) is frequently used for the treatment of rheumatoid arthritis (RA). However,, not all RA patients respond to MTX. The aim of this study was to asses whether thee effect of MTX on T-cell activation could predict the clinical response on MTX. Whole bloodd cultures (WBC) of 34 RA patients were analysed for T-cell cytokine production beforee and 2h after the first MTX dose. In vitro sensitivity to MTX was also determined. Severall clinical parameters were followed in all patients during 12 weeks of MTX treatment.. In vitro and ex vivo analysis of T-cell cytokine production can not be used to predictt the clinical response.

Background In Psoriatic arthritis (PsA) the pattern of joint involvement seems to be more heterogenic than Rheumatoid Arthritis (RA). Therefor the 66/68 joint count is frequently used in PsA scores. In this study we would like to investigate whether using less extensive joint counts influences PsA disease activity measures Objectives To evaluate the effect of using a 28, 44 or 66/68 joint count on Minimal Disease Activity (MDA). Methods Newly diagnosed PsA patients were included in the Dutch Early south-west Psoriatic Arthritis Registry (DEPAR) study between August 2013 and January 2017. Joint scores at baseline and 6 months were calculated using a 28, 44 and 66/68 joint count. Consecutively MDA was calculated using each of these joint counts. MDA is defined as minimal disease activity in 5 out of 7 domains (swollen joints, tender joints, PASI, patient vas pain, patient vas global, HAQ, enthesitis) Results In total, 413 patients were included into the study, of which 320 had reached 6 months follow-up at the time of this abstract. Half of the patients were male (49%), and mean age was 50 years (SD 13.8). The percentage of patients with at least one involved joint (swollen or tender) at baseline decreased from 91% using the 66/68 score to 88% with 44 joints and then to 80% with a 28 joint count (Table 1). At 6 month these scores were 66% 63% and finally 56% respectively for the 66/68, 44 and 28 joint count. After 6 months, 96 patients (30%) had achieved MDA using the original 66/68 joint count. Using a 28 joint count, 10 more patients (10% of the MDA population) were classified as having achieved MDA. Conclusions Using reduced joint count joints in PsA misclassifies around 10% of patients as having no joint involvement. It also misclassifies about 10% of the MDA population of having achieved MDA while they have not. Full 66/68 joint counts remain recommended for measuring disease activity in PsA. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is a multifaceted disease. Objectives We aimed to evaluate change in medication over time guided by joints, skin, enthesis, low back pain and dactylitis in newly diagnosed PsA patients Methods Newly diagnosed PsA patients were included in the Dutch Early south-west Psoriatic Arthritis cohoRt (DEPAR) study between August 2013 and March 2016. Initial drug treatment and escalation of therapy were described for all patients. Drivers of treatment changes in the first year were evaluated by mixed ordered ordinal regression with outcome treatment change and variables joints (66/68 count), skin (PASI), entheses (LEI and MASES), dactylitis (LDI) and axial disease (BASDAI) Results 323 patients had had baseline assessment in March 2016. Their average age was 50.0 years (SD 13.8) and 49% were male. 80% patients had arthritis (19% monoarthritis, 39% oligoarthritis and 23%polyarthritis), 9% had an enthesitis subtype, 2% axial disease and 9% dactylitis. Initial treatment consisted of methotrexate (MTX) (52%), in 7% of other synthetic disease modifying antirheumatic drugs (sDMARDs) and due to treatment of psoriasis 3% biologicals. Within the different phenotypes MTX was most frequently started in polyarthritis (84%) followed by oligoarthritis (63%), monoarthritis (33%) and other phenotypes (5%). At 12 months 70% (n=148) stayed on the initial drug. Of those switched, 9 started MTX, within the initial MTX users (n=74) almost equal percentages stopped, switched to metoject or biological (4%). A smaller percentage (2%) switch to leflunomide. Changes in medication were driven by swollen joint count and the presence of dactylitis (Table 1) Conclusions MTX was initiated in about half of the early PsA patients. The majority of patients were kept on the initial treatment strategy in first year. Failure on initial drug led to variation in subsequent drugs with additional start of other sdmards, switch subcutaneuous MTX, to other sdmards or to biological dmards. Treatment change was driven by Swollen Joint Count and presence of Dactylitis. Skin, Enthesis and Axial disease did not play a role in escalating treatment. Disclosure of Interest None declared

Background Previous research in our group showed that sonographic signs of enthesitis are present in early and established PsA, but in young healthy volunteers as well. The Madrid Sonographic Enthesitis Index (MASEI) was only able to differentiate between patients and healthy volunteers after excluding knee enthesis thickness from the score and semi-quantitative scoring of Power Doppler (PD) signal (1). Objectives We aim to validate the modified MASEI in a larger cohort of established PsA patients and healthy volunteers. Methods Established PsA patients and healthy volunteers aged 35–55 were asked to participate in this cross-sectional study, irrespective of presence of enthesitis complaints. The triceps, quadriceps, proximal and distal patellar and Achilles tendon and plantar fascia (i.e. the locations of the MASEI) and the common extensor insertion at the lateral epicondyle of the elbow were evaluated sonographically for structural changes (i.e. erosions, calcifications and structure) and active inflammation (thickness, bursitis and PD). Results 84 established PsA patients and 25 healthy volunteers participated. Sonographic structural changes and one or two spots of PD signal were common in both groups. The modified MASEI was significantly higher in PsA patients (median 12 (IQR 7.25–17) vs. 7.5 (5–9), P<0.001), while the original MASEI did not differ significantly (Table 1). Confluent PD over a larger area was only seen in 8% of the established PsA patients. Structural damage on ultrasound was more pronounced in the patients compared to the healthy volunteers. Number of PD locations and PD score did not distinguish the two groups. Conclusions Inflammatory and structural changes of the enthesis measured with ultrasound are common in both unselected PsA patients and healthy volunteers, but more pronounced in established PsA patients. References Wervers K, Rasappu N, Vis M, Tchetverikov I, Kok MR, Gerards AH, et al. AB0733 Masei Shows Substantial Changes in The Entheses of Young Healthy Volunteers – Amending Its PD Score and Excluding Knee Entheses Thickness Provides Better Discrimination of Enthesitis in Psoriatic Arthritis Patients. Ann Rheum Dis 2016;75:1155. Disclosure of Interest None declared

To decrease the burden of disease of rheumatoid arthritis (RA), patients at risk for RA need to be identified as early as possible, preferably when no clinically apparent synovitis can be detected. Up to now, it has been fairly difficult to identify those patients with arthralgia who develop inflammatory arthritis (IA), but recent studies using ultrasound (US) suggest that earlier detection is possible. We aimed to identify patients with arthralgia developing IA within 1 year using US to detect subclinical synovitis at first consultation.

Background Acute anterior uveitis (AAU) is common in ankylosing spondylitis (AS) (1). Golimumab, a tumor necrosis factor alpha (TNF-α) blocker, has proven to be effective in the treatment of AS (2). We have shown earlier that treatment with adalimumab, another TNF-α blocker, leads to a significant decrease in the recurrence rate of AAU (3) in AS. At present, the effect of golimumab on the recurrence rate of AAU in AS is unknown. Objectives To investigate the effect of golimumab treatment on the recurrence rate of AAU attacks in AS patients. Methods Consecutive AS patients were enrolled who all fulfilled the 1984 Modified New York criteria, and fulfilled the criteria for initiating treatment with a TNF-α blocker in the Netherlands. All patients were treated with golimumab 50mg once a month for 12 months. During treatment, all occurring AAU attacks were assessed. The historic presence of AAU attacks was assessed from the year before baseline for non-biological treated patients, or the year before the first treatment with a TNF-α blocker in case of a switch from another TNF-α blocker to golimumab. Disease activity was measured with the Ankylosing Spondylitis Disease Activity Score – C-reactive protein (ASDAS). Response to treatment was assessed with the ASAS-20. Results In total, 93 patients (65% male) were evaluable as per protocol, with a mean age of 44±13 years and a median disease duration of 7 (0–53) years. Fifty-one patients (55%) were TNF-α blocker naive. Median ASDAS score at baseline was 3.1 (0.7–5.5), which decreased to 1.9 (0.1–5.1) at 12 months. ASAS-20 response was achieved by 36% of patients at month three (p<0.001), and by 49% of patients at month twelve (p<0.001). Six patients (7%) had a prior history of AAU with a total of nine attacks in the year prior to the first TNF-α blocker use (9.8/100 patient years). During golimumab treatment, the rate of recurring AAU attacks was reduced to two new attacks (2.2/100 patient years), a significant reduction of 78% (p<0.001). These two AAU attacks occurred in two separate patients, of whom one had no history of AAU. Conclusions Treatment of AS patients with golimumab leads to a significant decrease in disease activity. Simultaneously, the rate of recurring AAU attacks decreased significantly during golimumab treatment. References Stolwijk C, van TA, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis 2015 Jan;74(1):65–73. Inman RD, Davis JC, Jr., Heijde D, Diekman L, Sieper J, Kim SI, et al. Efficacy and safety of golimumab in patients with ankylosing spondylitis: results of a randomized, double-blind, placebo-controlled, phase III trial. Arthritis Rheum 2008 Nov;58(11):3402–12. Van Denderen JC, Visman IM, Nurmohamed MT, Suttorp-Schulten MS, van der Horst-Bruinsma IE. Adalimumab significantly reduces the recurrence rate of anterior uveitis in patients with ankylosing spondylitis. J Rheumatol 2014 Sep;41(9):1843–8. Disclosure of Interest S. Heslinga: None declared, M. Nurmohamed: None declared, A. Gerards: None declared, E. Griep: None declared, C. Koehorst: None declared, M. Kok: None declared, A. Schilder: None declared, M. Verhoef Employee of: Merck Sharp & Dohme the Netherlands, a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA., I. Van der Horst-Bruinsma Grant/research support from: This study was funded by Merck Sharp & Dohme the Netherlands, a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Background To decrease burden of disease of rheumatoid arthritis (RA) we need to identify patients at risk for RA as early as possible, preferably as no clinical apparent synovitis could be detected yet. Previous studies suggest that this should be in the arthralgia phase or even before that. Up to now it has been fairly difficult to identify those arthralgia patients who develop inflammatory arthritis (IA), but recent studies in ultrasound (US) suggest that earlier detection is possible [1]. Objectives We aim to identify which arthralgia patients will develop clinical apparent IA within a year using US to detect subclinical synovitis at first consultation. Methods In a multi-centre prospective cohort study we followed arthralgia patients with ≥2 painful joints of hands, feet or shoulders without clinical apparent synovitis. Patients had a symptom duration of <1 year which could not be explained by other conditions (e.g. fibromyalgia). We collected data at baseline, 6 months and 12 months follow-up, which included physical examination, laboratory variables (ESR, CRP, auto-antibodies), diagnosis and medication used (including DMARDs at 6 and 12 months). At baseline we examined patients by US, which included 26 joints (MCP2–5, PIP2–5, wrists, MTP2–5) graded on greyscale (GS; 0–3) and power Doppler (PD; 0–3) according to a semi-quantitatively scoring system of Naredo et al. US synovitis was defined as GS grade 2 or 3 and/or PD grade 1, 2 or 3. After one year follow-up we determined the incidence of IA (clinical soft tissue swelling or start of DMARD treatment). We performed a complete-case analysis. For univariate logistic regression we tested demographic characteristics, clinical characteristics, and ultrasound findings and their association for development of IA. For multivariate logistic regression we selected the strongest variables (p<0.2). Results In total, 196 patients were included of whom 154 completed the 12 months follow-up. At baseline 72 (38%) arthralgia patients had US synovitis and in 29 (15%) patients a positive PD signal was detected. At 12 months follow-up 36 (23%) patients had developed IA of whom 22 patients initiated DMARD treatment. Table 1 shows baseline characteristics of cases and non-cases and the results of the univariate analysis. Strongest variables were ACPA, RF, morning stiffness >30 minutes and PD signal. In the multivariate logistic regression positive ACPA (OR 4.56: 95% CI 1.26–16.46) and the presence of PD signal (OR 5.79: 95% CI 1.75–19.19) at baseline were associated with the development of IA during one year follow-up. Conclusions In this early arthralgia cohort 38% of patients showed US synovitis at baseline. At 12 months 23% of the patients developed IA. In a multivariate analysis positive PD signal and positive ACPA were significantly associated with the development of IA after one year. References Colebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint PV, D9Agostino MA, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013 Jun;72(6):804–14. Disclosure of Interest None declared

Background Psoriatic Arthritis (PsA) is a multi-features disease requiring disease activity measures that capture not only joint disease, such as the Composite Psoriatic Disease Activity Index (CPDAI) and the Psoriatic Arthritis Disease Activity Score (PASDAS). Although both are well validated in clinical trials, little data exists on their evolvement in daily clinical care. Objectives to describe the longitudinal evolvement of CPDAI and PASDAS and its associations with demography, disease, and DMARDs. Methods Newly diagnosed consecutive PsA patients were recruited in 8 hospitals in the Netherlands from August 2013 to November 2015. Demographic and disease characteristics were registered. Data was analysed in the first 3 months by linear regression and over 12 months using linear mixed model with random intercept for CPDAI (0–15) and PASDAS (0–10) Results In November 2015 281 patients had had a baseline assessment, of which 234, 198, 157 and 129 had had resp. a 3, 6, 9 and 12 month assessment. The mean age was 50.6 (SD 13.6) and 50.5% were male. In terms of arthritis subtypes, 56 (20%) had monoarthritis, 108 (39%) oligoarthritis, 80 (29%) polyarthritis and 35 (12%) were diagnosed with axial disease, dactylitis or enthesitis only. PASDAS evolved from a mean of 4.0 points (SD 1.2, n=174) at baseline, to 3.3 (SD 1.1, n=160) at 3 months, and 2.6 (SD 1.1, n=94) at 12 months. CPDAI evolved from 5.5 (SD 2.1, n=229), to 4.4 (SD 2.0, n=213) to 2.97 (SD 1.8, n=113) resp. Associations and their course over time are described in table 1. In summary: MTX had a lowering effect on both the CPDAI and PASDAS in the multivariate analysis, while baseline scores and disease duration had a raising effect. Higher baseline PASDAS and CPDAI values in the multivariate analysis were associated with being female, the presence of oligo- or polyarthritis and tender enthesis, for CPDAI also with the presence of morning stiffness. Similar results were observed in the 3-months linear regression. Conclusions PASDAS and CPDAI decrease over time associated with the use of Methotrexate, while higher baseline values and longer disease duration affected this negatively. Disclosure of Interest None declared

Background Early and intensive treatment with DMARDs are essential for remission induction in newly diagnosed RA patients. However, demographic, psychosocial and disease related factors may play a role as well. Objectives To investigate which demographic, psychosocial and disease related factors are associated with attaining remission at two consecutive visits in early RA patients treated in a treat-to-target manner Methods We used 12 months follow-up data from patients participating in the tREACH trial1,2 in which induction therapy strategies were compared: (A) combination high dose conventional therapy ((MTX + sulfasalazine + hydroxychloroquine or (B) MTX. Both groups had glucocorticoid (GCs) bridging. Disease activity (DAS) was assessed every 3 months. Remission was defined as DAS<1.6 at 2 consecutive visits (3 months). Univariate and multivariate logistic and Cox regression analyses were performed including demographic, disease related and psychosocial factors evaluated at baseline as predictors for attaining remission during 12 months of follow-up. Results 281 patients (68% female; mean DAS 3.4, median HAQ 1.00) were included. During 1 year of follow-up, 129 of 281 (46%) patients (group A: 90 (49%), group B: 39 (40%)) attained remission at 2 consecutive visits. 76/281 (27)% achieved remission within 6 months. Univariate analyses revealed that female sex was associated with a lower chance of attaining remission (demographic factors). Similar relations were observed for higher DAS, HAQ and worse physical functioning (disease factors) and higher levels of anxiety, depression, fatigue and passive coping with pain and lower levels of mental functioning and internal locus of control (psychosocial factors). In multivariate analyses, female sex, treatment and higher levels of fatigue were associated with a lower chance to attain remission within 6 months, whereas older age, female sex and higher levels of depression were associated with increased time to remission within 12 months. Conclusions In the tREACH trial, 46% of early RA patients attained remission within 1 year of follow-up. Female sex, higher baseline DAS, HAQ, and several psychosocial factors were predictors for attaining remission, but in the final models age, sex, baseline DAS, fatigue and depression remained. Results suggest that high levels of fatigue and depressive symptoms may prevent patients from attaining remission despite treatment according to a tight control and treat-to-target strategy. References Claessen et al. BMC Musculoskelet Disord 2009:71. De Jong et al. Ann Rheum Dis. 2013 Jan;72. Disclosure of Interest None declared

Background Little data is available on quality of life in newly diagnosed psoriatic arthritis (PsA) patients and its relation to the extent of the disease. Objectives To describe quality of life in newly diagnosed PsA related to the extent of the disease as defined by the number of swollen joints and the presence or absence of tender enthesis. Methods Baseline data of consecutively recruited incident PsA patients was used from the Dutch south west Psoriatic Arthritis Registry (DEPAR) study between August 2013 to November 2015. Health-related quality-of-life (HRQoL) was assessed by the 8 subscales of the Short-Form 36 (SF-36) questionnaire (0–100, higher score represents a better HRQL) and the PsA-specific quality-of-life (PsAQoL) questionnaire (0–20, lower score represents a better HRQL). Patients were classified in the three arthritis subtypes (i.e. mono-, oligo- or polyarthritis) based on evaluation of the rheumatologist. A tender enthesis was defined as having at least one tender enthesis using the Leeds Enthesitis Index (LEI) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). Results 209 patients with arthritis at time of inclusion completed the SF-36 questionnaire. Average age was 51.4 years (SD 13.7) and 55% were male. Of these patients 49 had monoarthritis, 92 oligoarthritis and 68 polyarthritis. At least one tender enthesis was present in 45%, 38% and 53% of the patients. Mean scores of the subdomains in the SF-36 were similar across the different arthritis-groups, with better scores for monoarthritis compared to oligo and polyarthritis. However, when separating the groups based on the presence of a tender enthesis HRQoL decreased substantially for all groups across all subdomains of the SF-36, with a mean difference of 15 points (Figure 1). Mean scores of all subdomains were significantly lower in the tender enthesis group (n=106) compared to the non-tender enthesis group (n=131). Comparable results were observed for the PsAQoL scores (mono: 7.09 (SD 6.24) vs. 2.15 (SD 2.85); oligo: 7.11 (5.21) vs 4.18 (5.65) and 8.52 (6.04) vs 2.16 (2.90) Conclusions Stratifying the HRQoL for the presence of tender enthesis, present in about half of newly diagnosed PsA patients, showed lower levels of health-related quality-of-life across both physical and mental scales, independent of arthritis classification, emphasizing the importance of the enthesis in PsA. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is a disease with musculoskeletal and skin inflammation (psoriasis). Attempts are being made to develop comprehensive disease measures to capture global disease activity. However very little is known on how much psoriasis actually affects quality of life (QOL) in patients with PsA. Objectives In this study we aim to determine to what extent psoriasis affects quality of life in incident Psoriatic Arthritis patients. Methods Data collected at baseline in the Dutch south west Psoriatic Arthritis Registry (DEPAR) study were used. The DEPAR includes newly diagnosed PsA patients from 8 hospitals in the South-West of the Netherlands. PsA core measurements were collected: Swollen and Tender join count (66/68), enthesitis (LEI and MASES), dactylitis (LDI) and psoriasis (PASI). In addition 3 patient reported measures of quality of life were administered. Short Form-36 (SF-36) is a self-administered 36-item health survey questionnaire. The items are assigned to eight scales grouped in two factors: physical component summary (PCS) and mental component summary (MCS, score 0–100). Skindex-17 is a self-administered 17-item dermatology questionnaire that explores functioning, emotions and symptoms in a Symptoms Subscale (SS; range 0–10) and a Psychosocial Subscale (PS; range 0–24).The DLQI is a self-administered 10-item questionnaire, score 0–30 with higher scores resulting in poorer quality of life. It covers Symptoms and feelings, Daily activities, Leisure, Work and school, Personal relationships and Treatment Results In total 281 patients were included: mean age was 50.6 (SD 13.6) and 50.5% were male. In terms of arthritis subtypes, 56 (20%) had mono-arthritis, 108 (39%) oligo-arthritis, 80 (29%) poly-arthritis and 35 (12%) were diagnosed with axial disease, dactylitis or enthesitis only. The Median PASI score was 2.3, ranging from 0 to 22.5. Divided in PASI categories (1) this resulted for 12% in no skin disease, 72% mild (>0–7), 11% moderate (7–12) and 5% had severe (>12) psoriasis. Median PASI scores were different for mono, oligo to polyarthritis group: 2.7 (0–12.3), 3.4 (0–22.5) and 4.4 (0–21). Skin related quality of life measured by DLQI showed a median 1 (QR 0–5) and the two subscales of the skindex resulted in a median SS 4 (IQR 2–6) and a PS of 2 (IQR 0–8), and a SF-36 PCS of 40.3 (8.3) and SF-36 MCS of 47.7 (10.4).(table 1) Comparing none and mild psoriasis to moderate and sever psoriasis resulted in median scores for DLQI: 1 vs 5 (p<0.01) and Skindex-17 SS: 4 vs 7 and skindex-17 PS: 2 vs 7 (p<0.01)while significant difference was observed for the bodily pain an emotional role subscales of the SF-36. (P<0.05) Conclusions Skin involvement in incident Psoriatic Arthritis is in the majority of patients mild with median PASI score of 2.3. About 15% suffered from moderate to severe psoriasis. Skin quality of life measures showed poorer health states for these patients, which was also reflected in the emotional role and bodily pain subscale of more generic QOL questionnaire: SF-36. Disclosure of Interest None declared

Background Tendon complaints are common in both healthy adults and patients with psoriatic arthritis (PsA). Ultrasound (US) could be used to investigate whether these are located at the enthesis and of inflammatory origin, as it is able to detect structural changes and inflammatory changes using Power Doppler. Objectives We aim to describe the difference in ultrasound abnormalities in the entheses of patients with recently diagnosed PsA, patients with established PsA and young healthy volunteers (20–30 years). using the MASEI US score Methods Consecutively newly diagnosed PsA patients participating in the Dutch south west Psoriatic Arthritis Registry (DEPAR), patients with >2 years PsA and healthy volunteers (aged 20–30 years) were asked to participate. An ultrasound was performed by one examiner unaware of clinical findings using an Esoate Mylab 60 (probe LA-435 and LA-523). The triceps, quadriceps, proximal and distal patellar and Achilles tendon insertion, plantar fascia (i.e. the locations of the Madrid Sonographic Enthesis Index; MASEI) and the tendon insertion at the lateral epicondyle of the elbow were investigated (1). In each location structural changes, erosions, calcifications, increased thickness and Power Doppler signal and is some locations bursitis were evaluated, resulting in a total score (range 0–158). Results In total, 25 newly diagnosed PsA patients (A), 25 established PsA patients (B) and 25 healthy volunteers (C) participated. The median of the MASEI+ score was for A 18 (IQR 15–30), for B 22 (IQR 15–27) and for C 10 (IQR 5–15) (Table 1). Of note, the reference values for thickness of the Quadriceps tendon at the superior pole (6.1 mm), the inferior pole (4.0 mm) and the insertion at the tuberosity of the tibia (4.0 mm) were exceeded by 50%, 58% and 70% of the entheses of healthy volunteers (50 tendons). Also the degree of Power Doppler signal varied from one spot of signal to a confluent signal in large section of the enthesis, suggesting different levels of inflammation or possibly even false-positive findings. The images were re-evaluated for PD signal (assigning 1 point for one spot of signal, 1.5 for 2 or 3 spots, 2 for confluent small area or 3 points for confluent large area). When excluding increased thickness of knee entheses and using the re-evaluated PD scores the median MASEI was resp. 13 (IQR 10–22.5), 13.5 (IQR 9.5–18) and 3 (IQR 1.5–8) (Table 1). Conclusions US structural changes and inflammation in the entheses are common in both early and established PsA patients using the MASEI. In healthy young adults US enthesitis was only observed around the knee. MASEI ultrasound score differentiated PsA patients from healthy volunteers when dropping the knee tendon enthesis thickness and applying a refined Power Doppler score. Our findings need to be confirmed in a larger cohort of healthy controls and patients. References de Miguel E, Cobo T, Munoz-Fernandez S, Naredo E, Uson J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2009;68(2):169–74. Disclosure of Interest None declared

Objectives With early and intensive treatment many patients with early RA attain remission. Aims were to investigate (1) the frequency and time to sustained remission and subsequent tapering in patients initially treated with conventional synthetic disease modifying anti-rheumatic drug ((cs)DMARD) strategies and (2) the frequency and time to flare and regained remission in patients tapering csDMARDs and biological (b)DMARDs during 2 years of follow-up. Methods Two-year follow-up data from the treatment in the Rotterdam Early Arthritis Cohort (tREACH) cohort were used. Patients were randomised to initial treatment with triple DMARD therapy (iTDT) with glucocorticoid (GC) bridging or methotrexate monotherapy (iMM) with GC bridging. Patients were evaluated every 3 months. In case Disease Activity Score (DAS) was >2.4 treatment was switched to a TNF-blocker. In case DAS<1.6 at 2 consecutive time points, tapering was initiated according to protocol. Outcomes were rates of sustained remission (DAS<1.6 at 2 consecutive time points), flare (medication increase after tapering) and remission after flare (DAS<1.6). Data were analysed using Kaplan-Meier analyses. Results During 2 years of follow-up, sustained remission was achieved at least once by 159 (57%) of patients, of whom 118 and 23 patients initiated tapering of csDMARDs and bDMARDs, respectively. Thirty-four patients achieved drug-free remission. Flare rates were 41% and 37% and within 1 year, respectively. After flare, 65% of patients tapering csDMARDs re-achieved remission within 6 months after treatment intensification. Conclusions Regardless of initial treatment strategy, 57% of patients achieved sustained remission during 2 years of follow-up. Flare rates were 41% and 37% within 12 months in patients tapering csDMARDs and bDMARDs, respectively. Trial registration number ISRCTN26791028; Post-results.