In Patients with Early Peripheral Psoriatic Arthritis Baseline C-Reactive Protein, Pain and Ultrasound-Detected Synovitis Predict Subsequent Treatment with ts/bDMARDs. A Retrospective Analysis.

Garifallia Sakellariou,Vittorio Gabba,Francesca Bobbio-Pallavicini,Silvana Quaglini,Carlomaurizio Montecucco,Serena Bugatti

doi:10.3390/jcm10132834

Abstract

With the availability of effective treatment with targeted synthetic and biologic disease-modifying anti-rheumatic drugs (ts/bDMARDs) for psoriatic arthritis (PsA), it is crucial to identify predictors of access to this treatment since disease onset. We retrospectively enrolled patients with peripheral PsA, assessed in an early arthritis clinic from 2005 to 2020. The main baseline demographic, clinical and ultrasonographic (assessment of bilateral wrist and metacarpophalangeal joints) features were evaluated through descriptive statistics and tested as predictors by univariate and multivariate Cox models. The outcome of interest was the indication for ts/bDMARDs within 2 years from diagnosis. We included 238 patients with PsA, with a mean (sd) age of 51.04 (13.98) years; 90 (37.8%) were male, and the median (IQR) symptom duration was 6.12 (3.29–12.25) months. In univariate analyses, C-reactive protein (RR, 95% CI 1.204 (1.065,1.362)), Visual Analogue Scale (VAS) pain (1.027 (1.005,1.048)), the number of tender joints on 28 joints (1.087 (1.025, 1.153)), and a synovial power Doppler (PD) score > 1 (3.63 (1.307, 10.08)) emerged as significant predictors. C-reactive protein, VAS pain and PD confirmed their predictive value also in multivariate models. These results provide preliminary evidence on the features that might characterize patients with early peripheral PsA requiring more intensive monitoring and treatment escalation.

Highlights

Psoriatic arthritis (PsA) is a complex chronic inflammatory disease, in which a variety of clinical manifestations is present in combinations peculiar to each patient [1]
Despite evidence supporting the positive effect of establishing a diagnosis in the early phases of the disease, knowledge of early PsA is far less developed compared to early rheumatoid arthritis (RA), and a clear definition of this condition has not yet been developed
The median values of C-reactive protein (CRP) and ESR were within the range of normality, and the mean (SD) DAS28 was 3.74 (1.23), consistent with moderate disease activity. 155 (67.4%) patients were initially treated with csDMARDs, in particular 80 (34.8) received methotrexate and 58 (25.2%) sulfasalazine; 60 (25.3%) received low-dose glucocorticoids

Summary

Introduction

Psoriatic arthritis (PsA) is a complex chronic inflammatory disease, in which a variety of clinical manifestations is present in combinations peculiar to each patient [1]. Besides heterogeneous patterns of joint involvement and typical extra-articular manifestations, patients with PsA experience an increased burden of comorbidities, cardiovascular events and mortality [2] All of these aspects make PsA a complex and difficult-to-treat condition [3], in which the achievement of a satisfactory disease control still remains an uncovered need for many patients [4]. There is still a limited number of observational studies with a specific focus on early PsA [9], and so far organizational models based on early diagnosis and intensive targeted treatment, widely available in the field of RA [10], have not been implemented for this disease. Despite the presence of many gaps in the full understanding of the optimal management of early PsA, the

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