Abstract
Psoriatic arthritis (PsA) is an immune-mediated, clinically heterogeneous disease characterized by arthritis, enthesitis, dactylitis, spondylitis, and psoriasis of the skin and nails. Persistent articular inflammation in patients with PsA can lead to structural damage, which can result in reduced physical function and quality of life. Structural damage can occur rapidly, and irreversible joint damage may be observed if patients are not treated promptly and appropriately. Therefore, evaluating therapeutic agents for their ability to inhibit structural progression has become increasingly important, with radiographic progression becoming a key efficacy outcome in clinical trials in PsA. Here, we review how structural damage and progression are assessed in clinical trials and the use of radiographic progression as a study outcome. We also discuss possible limitations in the current assessment of radiographic progression as well as areas of research that may improve the assessment of structural damage in clinical trials of PsA.
Highlights
Psoriatic arthritis (PsA) is an inflammatory disease that develops in approximately 25% of patients with psoriasis [1] and is characterized by arthritis, enthesitis, dactylitis, spondylitis, and psoriasis of the skin and nails [2]
Sharp-van der Heijde scoring method for PsA The Sharp-van der Heijde score modified for PsA (SvdH; total score range, 0–528) assesses joints of the hands, wrists, and feet and includes distal interphalangeal (DIP) joints 2 to 5 of both hands (Table 1) [3, 4]
Findings from this study showed that inhibiting targets other than tumor necrosis factor (i.e., IL-12 and IL-23) could lead to improvements in PsA and inhibition of radiographic progression
Summary
Psoriatic arthritis (PsA) is an inflammatory disease that develops in approximately 25% of patients with psoriasis [1] and is characterized by arthritis, enthesitis, dactylitis, spondylitis, and psoriasis of the skin and nails [2]. PsA was initially considered a mild disease, but evidence has shown that PsA has a substantial impact on patient quality of life and disability [5]. This is largely due to the structural damage associated with the disease, with a higher degree of joint damage correlating with greater disability and limitation of physical function [6]. This article reviews the various scoring systems used to assess radiographic damage in the peripheral joints of patients with PsA, as well as the use of structural damage as an outcome measure in clinical trials
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