ABS1067 WHOLE BODY-MRI IDENTIFIES LOW LEVELS OF INFLAMMATION IN PERIPHERAL JOINTS, BUT HIGHER PREVALENCE OF AXIAL INVOLVEMENT IN EARLY, TREATMENT-NAÏVE PSORIATIC ARTHRITIS: DATA FROM THE GOLMePsA CLINICAL TRIAL

Background: Whole Body magnetic resonance imaging (WB-MRI) provides comprehensive evaluation of peripheral and axial joints and entheses in psoriatic arthritis (PsA) complementing clinical examination by identifying subclinical inflammation and assessing treatment response. Objectives: To describe the prevalence and extent of WB-MRI detected disease features (inflammatory and structural) and their response to treatment in patients with early, treatment naïve PsA. Methods: A multi joint MRI protocol was performed using T1-weighted Spin Echo (SE) before and after IV Gadolinium contrast injection and fluid-sensitive sequences, providing coverage for shoulders, spine (cervical, thoracic, lumbar), pelvis, wrists and hands, knees, ankles and feet. Newly diagnosed PsA patients, fulfilling the CASPAR classification criteria and recruited into a treatment strategy trial, GOLMePsA [1] were invited to undergo WB-MRI at 3 time points: baseline (pre-treatment); week 24 (primary outcome) and week 36 (3 months post trial intervention) using a commercially available 3 Tesla scanner. Briefly, GOLMePsA assessed whether the combination of golimumab and methotrexate (GOLMTX) plus corticosteroids is superior to placebo and MTX (PBOMTX) plus corticosteroids in reducing PASDAS at week 24 [1]. Images were scored by expert readers, blinded to clinical characteristics, treatment allocation and date of scan utilising the MRI-Whole body scoring system for inflammation (WIPE) on Peripheral joints and Entheses; HIMRISS and KIMRISS for inflammatory lesions in hips and knees respectively; HEMRIS for inflammation and damage at the heel entheses (Achilles tendon and plantar fascia insertions); CANDEN and SPARCC-spine for the spine and SPARCC –SIJ for the sacroiliac joints (SIJs) scoring systems. Exploratory estimates of difference or ratios between groups at weeks 24 & 36, and a range of confidence intervals (CI; 75-95%), adjusted for screening values of the outcome and poly/oligoarthritis status, were obtained using multiple binary logistic or quantile (median) regression according to data type and distribution. Results: Between November 2015 and January 2018, 35 persons enrolled in GOLMePsA underwent WB-MRI at baseline, of whom 31/35 (88.6%; 14 GOLMTX, 17 PBOMTX) attended for follow-up scans at weeks 24 & 36. Median joint symptom duration was 10.5 months (IQR 4.2-18.3; absolute range 1.8-197.7); 68% had polyarticular disease, mean PASDAS 5.6 (SD 1.5; range 2.6 to 8.7) (Table 1). Baseline WB-MRI scores (skewed data) showed anatomically widespread, yet fairly low levels of inflammation in peripheral joints and entheses (median MRI-WIPE score 37 - scale range 0-763). A quarter of patients had inflammatory lesions in the SIJ (SPARCC SIJ score ≥2: 25.8 %; n=10/31) and a third in the spine (SPARCC spine score ≥2: 32.3%; n=10/31). The most common spinal lesion was anterior vertebral corners oedema in the lumbar spine. Most participants reported BASDAI>4 (23/30, 1 missing) with no substantial association between BASDAI and MRI spinal findings; 1 participant was classified by clinical assessment as having axial PsA. Median change in MRI-WIPE score between screening and week 24 was -10 (GOLMTX) vs -6 (PBOMTX); adjusted difference (75% CI): -3.4 (-13.5, 6.8). At week 36 median differences were -9 and -7 respectively; adjusted difference -3.0 (-9.9, 4.0). These differences between treatment arms were not significant (although even 75% confidence intervals were wide), and no participants achieved MRI-WIPE remission (total score=0). HEMRIS inflammation and HIMRISS effusion scores improved in a minority, in similar numbers in both groups, at each visit; median changes ranged from -1 to 2 in GOLMTX and from 0 to 0.5 in PBOMTX. The largest difference was for HIMRISS effusion (scale range 0-30) at week 24 in favour of PBOMTX: median change GOLMTX 2, PBOMTX 0; adjusted difference (75% CI): 2.7 (1.0, 4.4). Data on HEMRIS structural, HIMRISS bone marrow lesions (BML), CANDEN and SPARCC were sparse and required dichotomization to improvement achieved/not achieved. CANDEN BMO and SPARCC MRI spine scores improved in 1 GOLMTX participant at weeks 24 & 36 compared to none of the PBOMTX participants. SPARCC MRI SIJ score improved in 1 PBOMTX participant at weeks 24 & 36 compared to none of the GOLMTX participants. CANDEN erosion score improved in 1 participant in each treatment group at weeks 24 & 36. Scores of CANDEN fat lesions and new bone formation remained unchanged. No improvements were observed in HEMRIS structural or HIMRISS BML. Conclusion: This exploratory analysis showed no clinically meaningful differences in change of MRI scores between treatment groups in peripheral or axial joints and entheses in the GOLMePsA clinical trial, possibly reflecting the relatively low inflammatory burden at baseline. However, over one quarter of patients had axial MRI abnormalities at baseline in this newly diagnosed, treatment naïve, early PsA population. REFERENCES: [1] De Marco G, et al. Ann Rheum Dis 2024; Ann Rheum Dis 2024;83:153-4. Acknowledgements: The GOLMePsA trial is an Investigator-Initiated Study funded by Janssen (CNTO148ART2002) and supported by the National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre (BRC) NIHR203331. The views expressed are those of the author(s) and not necessarily those of the NIHR or the University of Leeds or the Department of Health and Social Care. The Sponsor Organisation of the GOLMePsA trial is the Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. Sponsor Number: RR13/10782. Ethical approval was granted by Health Research Authority (HRA) Research Ethics Committee (REC) -NRES Committee East Midlands – Northampton- reference: 14/EM/0124. Disclosure of Interests: Gabriele De Marco Janssen, Novartis, Janssen, Novertis, Walter P Maksymowych Chief Medical Officer for CARE ARTHRITIS, AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB, AbbVie, Galapagos, Pfizer and UCB; educational grants from AbbVie, Janssen, Novartis and Pfizer, Mikkel Østergaard AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, MEDAC, Merck, Novartis, Pfizer, Sandoz and UCB, AbbVie, BMS, Boehinger-Ingelheim, Celgene, Eli-Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Pfizer, Sandoz and UCB, AbbVie, Amgen, BMS, Merck, Celgene, Eli Lilly, Novartis and UCB, Iris Eshed Novartis, Ai Lyn Tan AbbVie, Gilead, Janssen, Lilly, Novartis, Pfizer, Johnson & Johnson and UCB, AbbVie, Gilead, Janssen, Lilly, Novartis, Pfizer, Johnson & Johnson and UCB, Philip S Helliwell Novartis and Janssen, Amgen, Dennis McGonagle AbbVie, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, AbbVie, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, AbbVie, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Elizabeth Hensor: None declared, Helena Marzo-Ortega AbbVie, Amgen, Celgene, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB, AbbVie, Amgen, Celgene, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB, Janssen, Novartis, Pfizer 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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