OBJECTIVE: To evaluate patient-reported outcomes (PROs) after initiation of tumor necrosis factor inhibitor (TNFi) treatment in European real-world patients with psoriatic arthritis (PsA). Further, to investigate PRO remission rates across treatment courses, registries, disease duration, sex, and age at disease onset. METHODS: Visual analog scale or numerical rating scale scores for pain, fatigue, patient global assessment (PtGA), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) from 12,262 patients with PsA initiating a TNFi in 13 registries were pooled. PRO remission rates (pain ≤ 1, fatigue ≤ 2, PtGA ≤ 2, and HAQ-DI ≤ 0.5) were calculated for patients still on the treatment. RESULTS: For the first TNFi, median pain score was reduced by approximately 50%, from 6 to 3, 3, and 2; as were fatigue scores, from 6 to 4, 4, and 3; PtGA scores, from 6 to 3, 3, and 2; and HAQ-DI scores, from 0.9 to 0.5, 0.5, and 0.4 at baseline, 6, 12, and 24 months, respectively. Six-month Lund Efficacy Index (LUNDEX)-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 24%, 31%, 36%, and 43% (first TNFi); 14%, 19%, 23%, and 29% (second TNFi); and 9%, 14%, 17%, and 20% (third TNFi), respectively. For biologic-naïve patients with disease duration < 5 years, 6-month LUNDEX-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 22%, 28%, 33%, and 42%, respectively. Corresponding rates for patients with disease duration > 10 years were 27%, 32%, 41%, and 43%, respectively. Remission rates were 33%, 40%, 45%, and 56% for men and 17%, 23%, 24%, and 32% for women, respectively. For patients aged < 45 years at diagnosis, 6-month LUNDEX-adjusted remission rate for pain was 29% vs 18% for patients ≥ 45 years. CONCLUSION: In 12,262 biologic-naïve patients with PsA, 6 months of treatment with a TNFi reduced pain by approximately 50%. Marked differences in PRO remission rates across treatment courses, registries, disease duration, sex, and age at onset of disease were observed, emphasizing the potential influence of factors other than disease activity on PROs.

A Cefle MD TURKBIO Registry and Division of Rheumatology School of Medicine Kocaeli University Kocaeli Turkey

A G Loft MD PhD The DANBIO registry and Department of Rheumatology Aarhus University Hospital Aarhus Denmark

B Gudbjornsson MD PhD Centre for Rheumatology Research Landspitali University Hospital and the Faculty of Medicine University of Iceland Reykjavík Iceland

B Michelsen MD PhD Center for Treatment of Rheumatic and Musculoskeletal Diseases Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

B Möller MD Department for Rheumatology and Immunology Inselspital University Hospital Bern University of Bern Bern Switzerland

C Codreanu MD PhD RRBR C Mogosan MD PhD RRBR Center for Rheumatic Diseases University of Medicine Bucharest Bucharest Romania

C Sanchez Piedra MD PhD Spanish Agency of Health Technology Assessment Instituto de Salud Carlos 3 Madrid Spain

F Iannone MD PhD DETO Rheumatology Unit University of Bari Bari Italy

G Jones PhD BSRBR AS and Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen UK

J K Wallman MD PhD Department of Clinical Sciences Lund Rheumatology Lund University Skåne University Hospital Lund Sweden

J Vencovsky MD DSc J Závada MD PhD Institute of Rheumatology Prague and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

K Eklund MD PhD H Relas MD PhD ROB FIN Division of Rheumatology Inflammation Center Helsinki University Hospital and University of Helsinki Helsinki Finland

K M Fagerli MD PhD Center for Treatment of Rheumatic and Musculoskeletal Diseases Diakonhjemmet Hospital Oslo Norway

L Jacobsson MD PhD Department of Rheumatology and Inflammation Research Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

L M Ørnbjerg MD PhD K Rugbjerg MSc PhD S Georgiadis MSc PhD S H Rasmussen MSc PhD Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

L M Ørnbjerg MD PhD K Rugbjerg MSc PhD S Georgiadis MSc PhD S H Rasmussen MSc PhD Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark;

M J Nissen MD PhD Department of Rheumatology Geneva University Hospital Geneva Switzerland

M J Santos MD PhD Rheumatology Department Hospital Garcia de Orta Rheumatology Research Unit Faculdade de Medicina Lisboa and Reuma pt Portugal

M L Hetland MD PhD DMSc M Østergaard MD PhD DMSc Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark and Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

M Pombo Suarez MD PhD Rheumatology Department Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Spain

M Sebastiani MD PhD Rheumatology Unit University of Modena and Reggio Emilia Modena Italy

M van der Sande MD PhD Amsterdam UMC University of Amsterdam Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology Amsterdam Institute for Infection and Immunity Amsterdam the Netherlands

T J Love MD PhD Faculty of Medicine University of Iceland and Department of Science Landspitali University Hospital Reykjavík Iceland

Z Rotar MD PhD M Tomšič MD PhD Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

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