Pos1076 obesity is associated with less likelihood of remission/ low disease in psoriatic arthritis, a cross-sectional study of 414 patients

BackgroundObesity is a risk factor for psoriatic arthritis (PsA) and is associated with higher disease activity [1].ObjectivesWe aimed to evaluate whether obese patients with PsA were less likely to achieve remission/low disease in a real-life multi-centre cohort.MethodsWe used data from the ReFlap study (NCT03119805)[2], which recruited consecutive adult patient with definite PsA for more than 2 years of disease duration from 14 countries. We collected demographic characteristics, self-reported weight and height, clinical data and patient reported outcomes. Remission/low disease was defined as Disease Activity in PSoriatic Arthritis (DAPSA) ≤ 4, or Minimal disease activity (MDA). Obesity was defined as body mass index (BMI) ≥ 30kg/m2. We compared patient characteristics, disease activity parameters and impact scores between patients with obesity versus non-obese. A multivariable regression model was performed for demographic variables associated with reaching each definition of remission/low disease, adjusted on age, sex, level of education, disease duration, current use of conventional (c-) and biological (b-) disease modifying anti-rheumatic drugs (DMARDs).ResultsAmong 414 patients (49.3% women, mean disease duration 11.0 ±8.2 years), 119 (28.7%) had BMI ≥ 30kg/m2 (obese). Obese patients were more likely to be female, had higher swollen joint and enthesitis counts, higher self-reported pain, poorer physical function, more fatigue and poorer mental health (Table 1). Obese patients were half as likely to achieve MDA or DAPSA remission in multivariable analysis with odd ratios of 0.6 (95% confidence interval, CI: 0.3, 0.8, p=0.049) and 0.4 (95% CI: 0.2, 0.8, p=0.012), respectively for obese compared to non-obese patients (Figure 1).Table 1.Patient characteristics and remission achievement between obese and non-obese patients with psoriatic arthritisNon-obese (n=295)BMI ≥30 (n=119)pFemale, %44.361.50.002Number of comorbidities1.61 (0.93)2.83 (2.01)<0.001Tender joints, 0-683.56 (7.81)5.75 (10.0)0.018Swollen joints, 0-662.19 (7.29)1.46 (2.39)0.285Leeds enthesitis index, 0-60.48 (1.23)0.86 (1.70)0.012PGA disease activity, 0-103.90 (2.73)4.76 (2.67)0.004DAPSA14.9 (15.5)18.3 (16.1)0.045HAQ-DI, 0-30.56 (0.65)0.89 (0.70)<0.001PsAID-12, 0-103.11 (2.36)3.96 (2.50)0.001pain, 0-103.80 (2.81)4.54 (2.83)0.017fatigue, 0-103.93 (3.01)4.68 (3.17)0.025work or leisure activities, 0-103.39 (3.01)4.75 (3.11)<0.001functional capacity, 0-103.36 (2.97)4.40 (3.16)0.002depression, 0-101.88 (2.70)2.75 (3.26)0.006Mean (SD) shown unless specified otherwise. HAQ-DI: Health Assessment Questionnaire – Disability Index; PsA: psoriatic arthritis; PGA: patient global assessment of disease activity; DAPSA: Disease Activity in PSoriatic Arthritis; PsAID: Psoriatic Arthritis Impact of Disease.ConclusionIn this real-life data from 14 countries, obesity was frequent and PsA patients with BMI ≥ 30kg/m2 were more likely to be female, and had higher subjectively reported disease activity and illness impact compared to those with lower BMI. Obese patients had a two-fold lower likelihood of achieving remission/low disease defined by both MDA and DAPSA compared to non-obese patients. PsA patients with comorbid obesity may have different disease profiles from non-obese patients, and require specific management.References[1]Eder, L., et al., Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann Rheum Dis, 2015. 74(5): p. 813-7.[2]Gorlier, C., et al., Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis, 2019. 78(2): p. 201-208.AcknowledgementsThis study was funded by Pfizer.Disclosure of InterestsNone declared