Objectives The AsseSSing Impact in pSoriatic Treatment (ASSIST) study investigated prescribing in routine PsA care and whether the patient-reported outcome—PsA Impact of Disease questionnaire (PsAID-12)—impacted treatment. This study also assessed a range of patient and clinician factors and their relationship to PsAID-12 scoring and treatment modification. Methods Patients with PsA were selected across the UK and Europe between July 2021 and March 2022. Patients completed the PsAID questionnaire and the results were shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded. Results A total of 503 patients were recruited. Some 36.2% had changes made to treatment, and 88.8% of these had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; increase in PSAID-12 score is associated with increased odds of treatment escalation (odds ratio 1.58; P < 0.0001). However, most clinicians reported that PsAID-12 did not impact their decision to escalate treatment, instead supporting treatment reduction decisions. Physician’s assessment of disease activity had the most statistically significant effect on likelihood of treatment escalation (odds ratio 2.68, per 1-point score increase). Escalation was more likely in patients not treated with biologic therapies. Additional factors associated with treatment escalation included: patient characteristics, physician characteristics, disease activity and disease impact. Conclusion This study highlights multiple factors impacting treatment decision-making for individuals with PsA. PsAID-12 scoring correlates with multiple measures of disease severity and odds of treatment escalation. However, most clinicians reported that the PsAID-12 did not influence treatment escalation decisions. Psoriatic Arthritis Impact of Disease (PsAID) scoring could be used to increase confidence in treatment de-escalation.

In children with chronic non-bacterial osteomyelitis, clinical and transcriptional changes in peripheral blood were examined after pamidronate treatment. Clinically effective treatment with pamidronate was associated with reduced expression of two genes (TRDV2 and TRGV9) that encode the subunits of the Vγ9Vδ2 T-cell receptor.

OBJECTIVES:Shared decision-making (SDM) is advocated to improve patient outcomes in PsA. We analysed current prescribing practices and the extent of SDM in PsA across Europe. METHODS:The ASSIST study was a cross-sectional observational study of PsA patients ≥18 years of age attending face-to-face appointments between July 2021 and March 2022. Patient demographics, current treatment and treatment decisions were recorded. SDM was measured by the clinician's effort to collaborate (CollaboRATE questionnaire) and patient communication confidence (PEPPI-5 tool). RESULTS:A total of 503 patients were included from 24 centres across the UK, France, Germany, Italy and Spain. Physician- and patient-reported measures of disease activity were highest in the UK. Conventional synthetic DMARDs constituted a higher percentage of current PsA treatment in the UK than continental Europe (66.4% vs 44.9%), which differed from biologic DMARDs (36.4% vs 64.4%). Implementing treatment escalation was most common in the UK. CollaboRATE and PEPPI-5 scores were high across centres. Of 31 patients with low CollaboRATE scores (<4.5), no patients with low PsAID-12 scores (<5) had treatment escalation. However, of 465 patients with CollaboRATE scores ≥4.5, 59 patients with low PsAID-12 scores received treatment escalation. CONCLUSIONS:Higher rates of treatment escalation seen in the UK may be explained by higher disease activity and a younger cohort. High levels of collaboration in face-to-face PsA consultations suggests effective implementation of the SDM approach. Our data indicate that in patients with mild disease activity, only those with higher perceived collaboration underwent treatment escalation. Prospective studies should examine the impact of SDM on PsA patient outcomes. TRIAL REGISTRATION:clinicaltrials.gov, NCT05171270.

Abstract Background/Aims Psoriatic arthritis (PsA) is a heterogeneous, multi-dimensional disease. Treatment pathways are not well defined and have to be tailored to the individual; however, little is known about the factors underpinning a decision to intensify treatment. By comparing treatment data between countries, we can understand more about factors influencing patient outcomes and establish international benchmarks in practice. Methods ASSIST was a cross sectional study of patients (18 years and older) diagnosed with PsA. Participants were selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain). Patients were selected from face to face (F2F) appointments using systematic sampling with random starting numbers generated for each site. Participants were treated as usual in their routine clinical practice. The Health Assessment Questionnaire (HAQ) and the EQ-5D-5L QoL survey were provided to all participants as patient-reported outcome tools. The perceived confidence on patient-physician interaction score (PEPPI) and the CollaboRATE measure were used to assess patient satisfaction with a consultation. Results 503 patients from 24 centres across five countries in Europe (49.1% F, 50.9% M) (mean age 53) participated in the survey between 12/07/2021-22/03/2022. Despite similar rates of treatment escalation and similar satisfaction with consultations, QoL was poorer in the UK. Comparing EQ-5D-5L scores, participants in the UK (107) reported worse outcomes across all domains except pain/discomfort versus participants in mainland Europe (396). 52.3% in the UK reported some problems with self-care versus 33.9% in mainland Europe. 72.9% of patients in the UK reported issues with mobility (mainland Europe: 61.6%). The UK had the highest percentage of participants reporting issues with anxiety (66.4%). The UK had the most severe HAQ scores, (mean= 0.936) compared to means of 0.62 or below in other countries. Physician-reported severity of disease was higher in the UK; however, patients in the UK reported the second highest PEPPI scores, the second highest collaboRATE scores and comparable methods of treatment escalation (dose adjustment or addition of another medication) to mainland Europe. Moreover, data on co-morbidities (including FCI categorical breakdown) does not demonstrate obvious variation between the UK and Europe. Conclusion Overall, patients with PsA in the UK reported lower quality of life (QoL) compared to patients in mainland Europe. It is not clear from our data why the UK performs less well on the majority of EQ-5D-5L domains and HAQ scoring compared to Europe. This may relate to variation in disease activity; however, there is potential selection bias in the higher disease activity reported by physicians in the UK as patients with more severe disease could have been selected for F2F appointments compared to mainland Europe. There may also be additional factors outside of the consultation impacting these scores, which could be identified with future research. Disclosure C. Coyle: None. L. Watson: None. M. Brooke: None. U. Kiltz: None. E. Lubrano: None. R. Queiro: None. D. Trigos: None. J. Brandt-Jürgens: None. S. D'Angelo: None. A. Delle Sedie: None. E. Dernis: None. P. Helliwell: None. P. Ho: None. A. Hueber: None. B. Joven Ibáñez: None. M. Köhm: None. C. Montilla Morales: None. J. Packham: None. J. Antonio Pinto Tasende: None. F. Ramíez García: None. A. Ruyssen-witrand: None. R. Scrivo: None. S. Twigg: None. M. Welcker: None. M. Soubrier: None. T. Wirth: None. L. Gossec: None. L. Coates: None.

Abstract Background/Aims Psoriatic arthritis (PsA) is a multi-system disease with a range of management options. Treatment may vary by geographic location. We compared disease characteristics and prescribing practices in the UK and Europe in the post-Covid era. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patient and disease characteristics, current treatment and treatment decisions (medications unchanged, switched, added or reduced) were recorded. The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with arthritis subtype, patient age, disease activity and duration shown (Table 1). Physician- and patient-reported disease severity was highest in the UK, where median patient age was lowest. Conventional synthetic (cs) DMARDS constituted a higher percentage of current PsA treatment in UK than continental Europe (66.4% vs 44.9%), whereas biologic use was more frequent in Europe (68.1% vs 36.4%). Adalimumab was the most commonly used biologic in the UK and Spain. Adalimumab and secukinumab were equally used in Germany, and ixekizumab and adalimumab were joint-first in Italy. Implementing change to the current PsA treatment was most common in the UK, predominantly being a treatment increase. This may reflect the higher level of disease activity or younger patient age in the UK than other countries, as treatment escalation is more likely earlier in the disease course. In the UK, treatment escalation was more commonly achieved by medication addition (26.2%) than medication switch (14%) or dose increase (7.5%). In Europe, medication addition and switch were of more similar frequency (10.9% vs 9.85%). Conclusion Disease characteristics and treatment strategies varied between countries, but particularly between UK and the rest of Europe. In contrast to mainland Europe, csDMARDs predominated in the UK, perhaps reflecting current NICE guidelines. Treatment escalation was most common in the UK, in keeping with higher disease activity. Disclosure L. Watson: None. C. Coyle: None. M. Brooke: None. U. Kiltz: None. E. Lubrano: None. R. Queiro: None. D. Trigos: None. J. Brandt-Juergens: None. S. D'Angelo: None. A. Delle Sedie : None. E. Dernis: None. P. Helliwell: None. P. Ho: None. A. Hueber: None. B. Joven: None. M. Koehm: None. C. Montilla: None. J. Packham: None. J.P. Tasende: None. F.J.R. Garcia: None. A. Ruyssen-Witrand: None. R. Scrivo: None. S. Twigg: None. M. Welcker: None. M. Soubrier: None. T. Wirth: None. L. Gossec: Consultancies; AbbVie, Amgen, BMS, Celltrion, Galapagos, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB. Grants/research support; Amgen, Galapagos, Lilly, Pfizer, Sandoz, UCB. L.C. Coates: None.

Abstract Background/Aims A personalised approach is required to optimise management of psoriatic arthritis (PsA). Shared decision-making between physician and patient is key, resulting in greater patient satisfaction and outcomes. We assessed the degree of perceived collaboration following clinic visits in the UK and Europe and whether this was associated with treatment escalation. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patients completed the collaboRATE questionnaire (scored 0-9), where high scores indicate greater perceived collaboration. The perceived efficacy in patient-physician interactions (PEPPI) tool (scored 5-25) assessed the patients’ view on their confidence in the consultation. Patient, physician, and disease characteristics were recorded, alongside treatment decisions (medications unchanged, switched, added or reduced). The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with key characteristics shown (Table 1). Generally, the level of disease severity was low (mean total PsAID score 3.6/10) and PEPPI scores were high, indicating patient confidence in the consultation. A subgroup (n = 10) perceived difficulty in sharing their concerns (PEPPI <12/25). However, collaboRATE scores remained high (mean score 7.96), suggesting satisfaction in the physician’s effort to understand patient concerns. Consultation satisfaction was not associated with treatment decisions: mean collaboRATE and PEPPI scores in those with and without treatment escalation were similar. Mean collaboRATE and PsAID scores were not associated. In patients with low collaboRATE scores (<5), only patients with higher PsAID scores (>5) had treatment escalation. However, in patients with high collaboRATE scores, even patients with low PsAID scores had treatment escalation. Conclusion Patients report high levels of shared decision-making in face-to-face PsA consultations, unrelated to treatment escalation. In patients with low PsAID scores, those with higher perceived collaboration are more likely to have treatment escalation than those without, perhaps reflecting the identification of otherwise undetected symptoms/concerns. Disclosure L.L. Watson: None. C. Coyle: None. M. Brooke: None. U. Kiltz: None. E. Lubrano: None. R. Queiro: None. D. Trigos: None. J. Brandt-Juergens: None. S. D'Angelo: None. A. Delle Sedie : None. E. Dernis: None. P. Helliwell: None. P. Ho: None. A. Hueber: None. B. Joven: None. M. Koehm: None. C. Montilla: None. J. Packham: None. J.P. Tasende: None. F.J.R. Garcia: None. A. Ruyssen-Witrand: None. R. Scrivo: None. S. Twigg: None. M. Welcker: None. M. Soubrier: None. T. Wirth: None. L. Gossec: Consultancies; AbbVie, Amgen, BMS, Celltrion, Galapagos, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB. Grants/research support; Amgen, Galapagos, Lilly, Pfizer, Sandoz, UCB. L.C. Coates: None.