POS1170 DECIPHERING DIFFICULT-TO-TREAT PSORIATIC ARTHRITIS (D2T-PsA): INSIGHTS FROM AN INTERNATIONAL GRAPPA PATIENT SURVEY

Background: Psoriatic arthritis (PsA) is a chronic inflammatory disease with diverse manifestations, making its management challenging. Despite therapeutic advancements, some patients remain refractory to therapy, with sustained remission elusive. Recognizing the need for precise classifications, GRAPPA has differentiated "complex-to-manage" PsA (C2M-PsA) from "difficult-to-treat" PsA (D2T-PsA). While C2M-PsA encompasses broader clinical and psychosocial complexities, D2T-PsA refers to persistent inflammation despite multiple therapeutic interventions [1]. A healthcare professional survey has provided key clinical insights [2], and incorporating patient-reported experiences is essential for refining these definitions and addressing unmet needs. Objectives: This study aimed to capture patient perspectives on factors contributing for D2T- and C2M-PsA classifications, emphasizing disease burden, quality of life (QoL), and treatment challenges across diverse linguistic and cultural backgrounds. Methods: An electronic survey, developed in collaboration with GRAPPA members and patient research partners (PRPs), included demographic questions, structured items, and open-ended responses. Translated into 9 languages, the survey ensured cultural relevance through native speakers and PRP review. Quantitative data were analyzed descriptively, and qualitative responses underwent thematic coding using Dedoose. Triangulation with demographic data enhanced insights. Results: The survey included 570 patients across 10 languages, with most being female (68.8%), White (72.6%), and aged ≥ 40 years (81.8%). When asked which manifestations should define D2T- or C2M-PsA, persistent joint pain (65.7%) and skin psoriasis (65.7%) were most frequently endorsed, followed by restrictions on daily activities (54.9%) and persistent fatigue (52.8%). Similarly, arthritis (47.3%) and fatigue (41.4%) were the most cited factors when reflecting on personal experiences (Figure 1A). Symptom ranking, where lower values represent greater impact, identified arthritis as the most impactful (mean ranking: 2.25), followed by axial disease (3.01) and comorbidities (3.04) (Figure 1B). Language-specific differences revealed variations in symptom priorities. For example, Dutch-speaking respondents emphasized fatigue (78.7%) and its impact on QoL and work, compared to English- (45.6%) and Portuguese-speakers (39.2%). Italian-speakers prioritized restrictions on daily activities (59.4%) and social life, linking these to emotional distress and frustration. In contrast, English- (87.5%) and Portuguese-speakers (85.1%) highlighted joint pain as the primary challenge. When discussing which symptoms should be included in these definitions, many participants emphasized the emotional burden of PsA, with 43.7% reporting depression, anxiety, and social stigma as significant contributors. Over half (66.4%) emphasized QoL issues, such as impaired sleep and reduced life enjoyment, while 50.6% cited work impairment as critical. Financial costs and time commitments further compounded challenges for 48.6% of respondents. Thematic analysis of 293 comments linked treatment failure to diminished QoL, pain, and treatment uncertainty (Figure 2). Language-specific differences emerged. For instance, Dutch-speakers associating fatigue with reduced QoL and work impairment, while Italians-speakers prioritized daily activities and social life restrictions. Conversely, English- and Portuguese-speakers focused on pain, linking it to decreased mobility and reliance on others. Conclusion: This study highlights patient-reported challenges regarding D2T- and C2M-PsA, underscoring the impact of persistent symptoms, fatigue, and psychosocial burden. There was consensus across language groups on the importance of QoL issues and work impairment in assessing PsA complexity. Language-specific differences further reinforce the need for culturally tailored interventions. These insights will inform the development of GRAPPA-endorsed definitions and guide more inclusive treatment strategies for PsA. REFERENCES: [1] Singla S*, Ribeiro A*, Torgutalp M, et al. Difficult-to-treat psoriatic arthritis (D2T PsA): a scoping literature review informing a GRAPPA research project. RMD Open. 2024;10(1):e003809. [2] Ribeiro AL*, Singla S*, Chandran V, et al. Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals. Rheumatol Adv Pract. 2024;8(3):rkae074. Acknowledgements: NIL . Disclosure of Interests: Andre Lucas Ribeiro AbbVie and Johnson & Johnson, Shikha Singla: None declared, Vinod Chandran AbbVie/Abbot, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, UCB, AbbVie/Abbot, Nicholas Chronis: None declared, Wilson Liao: None declared, Christine Lindsay: None declared, Enrique R. Soriano AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, AbbVie, Janssen, Novartis, and Roche, AbbVie, Janssen, Novartis, Pfizer, Roche, and UCB, M. Cameron Hay: None declared, Ennio Lubrano: None declared, Jean-Guillaume Letarouilly: None declared, Satoshi Kawaai: None declared, Sebastián Herrera: None declared, Mitsumasa Kishimoto AbbVie, Amgen, Asahi-Kasei Pharma, Astellas, Azumi, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Novartis, Tanabe-Mitsubishi, and UCB, AbbVie, Amgen, Asahi-Kasei Pharma, Astellas, Azumi, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Novartis, Tanabe-Mitsubishi, and UCB, Philip J. Mease AbbVie, Acelyrin, Aclaris, Amgen, Boehringer-Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Moonlake, Novartis, Pfizer, SUN Pharma, Takeda, UCB, Ventyx and Xinthera, AbbVie, Acelyrin, Aclaris, Amgen, Boehringer-Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Moonlake, Novartis, Pfizer, SUN Pharma, Takeda, UCB, Ventyx and Xinthera, AbbVie, Acelyrin, Aclaris, Amgen, Boehringer-Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Moonlake, Novartis, Pfizer, SUN Pharma, Takeda, UCB, Ventyx and Xinthera, Fabian Proft Novartis, Eli Lilly, UCB, AbbVie, AMGEN, BMS, Celgene, Galapagos, Hexal, Janssen, Medscape, MSD, Pfizer and Roche, Novartis, Eli Lilly and 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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