ACHIEVEMENT OF MINIMAL DISEASE ACTIVITY AND PROGRESSION OF RADIOGRAPHIC CHANGES IN EARLY PSORIATIC ARTHRITIS ONE YEAR AFTER INITIATION OF TREATMENT IN «TREAT TO TARGET» STRATEGY (PRELIMINARY RESULTS OF THE REMARKA STUDY)

Abstract

Achievement of minimal disease activity (MDA) is the main goal of the Treat-to-target (T2T) strategy in early psoriatic arthritis (ePsA). Radiographic progression in patients with ePsA treated according to the T2T strategy has been studied insufficiently. Objective: To study the frequency of achievement of MDA and X-ray progression in patients with early PsA treated according to the T2T strategy 1 year after initiation of treatment. Subjects and methods. Forty patients (22 women) with active ePsA, who met the CASPAR criteria (mean age was 38,4±11,1 years, the median duration of PsA – 7,0 [4,0; 18,0] months, the duration of psoriasis – 38,0 [9,5; 114,0] months, DAS – 3,8 [3,2; 4,7]), were included in the REMARKA study. At the start of the study all patients received subcutaneous methotrexate (MTX) in a dose of 20–25 mg/week. If high or moderate disease activity persisted after 3–6 months, patients (n=21) were transferred to combined therapy with MTX and a biological agent (BA). The remaining 19 patients continued MTX monotherapy. Initially and one year later, the MDA criteria were evaluated (tender joint count ≤1, swollen joint count ≤1, PASI ≤1 or BSA ≤3, pain on visual analog scale (VAS) ≤15 mm, patient global assessment of activity on VAS ≤20 mm, HAQ ≤0,5, tender enthesis count ≤1) and digital radiography of hands and feet was performed. Radiographic progression was assessed by an independent radiologist using the modified method of Sharp/van der Heijde: total score (TS) = erosion score (ES) + joint space narrowing score (JSNS). Results and discussion. At the time of enrollment, 23 patients (57%) with ePsA had erosions. One year later the number of patients with erosions increased to 26 (65%). The TS has significantly increased, although its median has not changed (before treatment – 91.5 [72; 108,5], after one year – 91.5 [73,5; 111,5], p 0,05). In 29 out of 40 patients (72,5%), no radiographic progression was detected neither in the ES nor in the JSN; 13 out of 29 (45%) received MTX and 16 (55%) – MTX + BA. In 11 out of 40 (27,5%) patients, negative radiographic changes according to ES (n=10) and JSNS (n=4) were detected, with three patients having progression in both scores. In this group, 6 patients (54,5%) received MTX monotherapy and 5 (45,5%) – MTX + BA. After 1 year, 25 (62,5%) patients achieved MDA. Among patients who did not achieve MDA (n=15) after 1 year, the ES was significantly higher at the beginning of the study compared to those who achieved MDA: median 3 [2; 9] and 0 [0; 3], respectively (p < 0,05). In the group of patients who did not achieve MDA in a year, radiographic progression was more significant. Conclusion. In russian cohort more than half of patients with ePsA had erosions. After one year of follow up 72,5% of patients with ePsA treated according to the T2T strategy showed no radiographic progression, and a quarter of patients (27,5%) had negative radiographic changes, regardless of the type of the therapy. Patients with ePsA, who achieved MDA, had less prominent radiographic progression in a year.