ABS0774 PUSTULAR PSORIASIS IS LINKED TO A SEVERE DISEASE PHENOTYPE IN PSORIATIC ARTHRITIS

Background: Psoriatic arthritis (PsA) is a chronic inflammatory disease, most commonly associated with chronic plaque psoriasis. Pustular psoriasis, a challenging form of psoriasis, significantly impacts quality of life of patients with psoriasis and may differ in disease course compared to chronic plaque psoriasis. However, data on the impact of pustular psoriasis on the clinical phenotype and outcomes of PsA remain scarce. Objectives: To determine whether pustular psoriasis affects the phenotype, as well as the clinical and radiographic outcomes, in PsA patients compared to chronic plaque psoriasis/sebopsoriasis. Methods: We analyzed data from a prospective observational cohort of PsA patients meeting CASPAR criteria. Patients were categorized into two groups: (1) Pustular psoriasis (generalized pustular, pustular and palmoplantar pustular psoriasis) and (2) Chronic plaque psoriasis and sebopsoriasis. Patients with pustular psoriasis could simultaneously exhibit other psoriasis subtypes but were defined by the pustular phenotype. Baseline demographics, disease-related characteristics, and disease activity measures were compared using descriptive statistics. Generalized estimating equations (GEE) were employed to assess associations between psoriasis subtypes and disease outcomes. Results: Among 1,595 PsA patients, 93 (5.8%) had pustular psoriasis subtypes. Compared with patients with chronic plaque psoriasis/sebopsoriasis, those with pustular psoriasis were older at PsA onset (40.6 vs. 38.5 years) and had a higher BMI (30.6 vs. 28.9). They were also more likely to be ever-smokers (54.8% vs. 42.3%). No differences in body surface area affected by psoriasis (BSA) were observed between the groups; however, patients with pustular psoriasis had higher DLQI scores (median [IQR]: 3.5 [1.0, 10.0] vs. 2.0 [1.0, 6.0]) and DAPSA scores (23.3 [12.3, 41.0] vs. 18.0 [10.0, 31.0]). Nail disease was more prevalent in the pustular group (63.4% vs. 50.7%), as was enthesitis (28.3% vs. 18.4%). However, dactylitis was less frequent (20.7% vs. 27.4%). Lower modified Steinbrocker score was found in the pustular group (median [IQR]: 0.0 [0.0, 5.5] vs. 2.0 [0.0, 10.0]), while the prevalence of axial disease, including radiographic sacroiliitis and syndesmophytes, was similar between groups. Patients with pustular psoriasis reported greater pain (mean [SD]: 4.8 [2.8] vs. 4.3 [2.7]), worse global disease activity assessment (5.1 [2.8] vs. 4.2 [2.7]), and higher HAQ disability scores (0.9 [0.7] vs. 0.7 [0.7]) - Table 1. Subgroup analysis (Table 2) showed that generalized pustular psoriasis patients had the highest BMI and DAPSA scores at clinic entry, while palmoplantar pustular psoriasis was associated with more frequent enthesitis and nail involvement. Other characteristics among the pustular subtypes did not show significant differences (Table 2). GEE models revealed no significant associations between pustular psoriasis and worse outcomes across disease activity measures compared with chronic plaque/sebopsoriasis patients. Conclusion: PsA patients with pustular psoriasis present with a more severe PsA phenotype characterized by higher disease activity, worse quality of life and functional impairment compared with those with chronic plaque psoriasis/sebopsoriasis. REFERENCES: NIL . Table 2Characteristics of PsA patients with different pustular psoriasis subtypes at clinic entry.VariablesGeneralized Pustular Psoriasis(n=13)Pustular Psoriasis(n=15)Palmoplantar Psoriasis(n=65)Age at diagnosis of PsA in years, mean (SD)42.6 (13.9)37.7 (11.5)40.9 (13.8)Age at diagnosis of psoriasis in years, mean (SD)31.8 (17.7)27.5 (14.2)31.7 (14.7)Sex (male), n (%)4 (30.8)11 (73.3)30 (46.2)Ever smoking, n (%)10 (76.9)7 (46.7)34 (52.3)BMI in kg/m2, mean (SD)35.3 (8.7)31.2 (6.2)29.6 (7.5)SJC (0-66), median [IQR]1.0 [0.0, 6.0]1.0 [0.0, 2.0]1.0 [0.0, 4.0]TJC (0-68), median [IQR]6.0 [5.0, 11.0]2.0 [0.0, 5.0]4.0 [2.0, 10.0]Dactylitis, n (%)4 (30.8)4 (26.7)11 (17.2)Enthesitis, n (%)2 (15.4)3 (20.0)21 (32.8)BSA, median [IQR]2.5 [2.0, 22.7]3.0 [1.0, 5.0]2.0 [1.0, 4.0]Nail Disease, n (%)11 (84.6)9 (60.0)39 (60.0)DAPSA, median [IQR]62.5 [34.0, 106.7]12.7 [6.9, 15.2]37.0 [19.9, 47.1]DLQI, median [IQR]4.0 [1.0, 8.0]5.0 [1.5, 8.5]3.0 [1.0, 10.0]Modified Steinbrocker score, median [IQR]0.0 [0.0, 9.0]0.0 [0.0, 10.0]0.0 [0.0, 4.0]Syndesmophytes, n (%)1 (9.1)13 (100.0)7 (13.7)Radiographic Sacroiliitis*, n (%)4 (36.4)1 (7.7)13 (25.5)HLA-C*6 positive, n (%)3 (25.0)2 (16.7)9 (17.0)HAQ disability index, mean (SD)1.2 (0.7)0.8 (0.8)0.9 (0.6)SD, standard deviation; PsA, psoriatic arthritis; BMI, body mass index; SJC, swollen joint count; TJC, tender joint count; BSA, Body Surface Area; DAPSA, Disease Activity Index for Psoriatic Arthritis; DLQI, Dermatology Life Quality Index; HLA, human leukocyte antigen; HAQ, Heath Assessment Questionnaire. * According to the mNY criteria Acknowledgements: NIL . Disclosure of Interests: Virginia Carrizo Abarza: None declared, Pankti Mehta: None declared, Fadi Kharouf: None declared, Shangyi Gao: None declared, Richard Cook: None declared, Maria G Rodriguez-Herrera: None declared, Cheryl F. Rosen Novartis, Abbvie, Astra Zeneca, Incyte, Abbvie, Amgen, Novartis, UCB and Pfizer, Dafna D. Gladman AstraZeneca, Abbvie, Amgen, BMS, Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Pfizzer, UCB, Vinod Chandran AbbVie, BMS, Eli Lilly, Fresenius Kabi, Johnson and Johnson, Novartis, UCB, AbbVie, Eli Lilly, Denis Poddubnyy AbbVie, Canon, DKSH, Eli Lilly, Janssen, MSD, Medscape, Novartis, Peervoice, Pfizer, and UCB, AbbVie, Biocad, Bristol-Myers Squibb, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, and UCB, AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, UCB. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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