Abstract
IntroductionSince remission is now possible in psoriatic arthritis (PsA) we wished to examine remission rates in PsA patients following anti tumour necrosis factor alpha (TNFα) therapy and to examine possible predictors of response.MethodsAnalysis of a prospective patient cohort attending a biologic clinic, between November 2004 and March 2008, was performed prior to commencing therapy and at regular intervals. Baseline clinical characteristics including demographics, previous disease-modifying antirheumatic drug (DMARD) response, tender and swollen joint counts, early morning stiffness, pain visual analogue score, patient global assessment, C reactive protein (CRP) and health assessment questionnaire (HAQ) were collected.ResultsA total of 473 patients (152 PsA; 321 rheumatoid arthritis (RA)) were analyzed. At 12 months remission, defined according to the disease activity score using 28 joint count and CRP (DAS28-CRP), was achieved in 58% of PsA patients compared to 44% of RA patients, significant improvement in outcome measures were noted in both groups (P < 0.05). Analysis of a subgroup of PsA and RA patients matched for DAS28-CRP at baseline also showed higher numbers of PsA patients achieving remission. Linear regression analysis identified the HAQ at baseline as the best predictor of remission in PsA patients (P < 0.001).ConclusionsDAS28 remission is possible in PsA patients at one year following anti-TNF therapy, at higher rates than in RA patients and is predicted by baseline HAQ.
Highlights
Since remission is possible in psoriatic arthritis (PsA) we wished to examine remission rates in PsA patients following anti tumour necrosis factor alpha (TNFα) therapy and to examine possible predictors of response
Patients commencing Infliximab, Adalimumab and Etanercept were assessed at baseline, 3, 6 and 12 months with clinical examination, swollen joint count (SJC) and tender joint count (TJC), visual analogue scores (VAS) for pain and for patient global, Health Assessment Questionnaire (HAQ)
The results of this study suggest that, using a single measure of disease activity with an agreed level defined as remission, biologic therapies result in high remission rates in PsA patients, greater than a comparator group of rheumatoid arthritis (RA) patients even when matched for baseline disease activity
Summary
Since remission is possible in psoriatic arthritis (PsA) we wished to examine remission rates in PsA patients following anti tumour necrosis factor alpha (TNFα) therapy and to examine possible predictors of response. Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, usually seronegative for rheumatoid factor associated with psoriasis [1,2]. PsA was considered a benign disease, one study suggesting only 11% of patients developed erosions over seven years [3]. In the same journal it was highlighted that a number of reports suggested a high occurrence of erosions in between 46 to 62% of patients [4]. In a Finnish population based study 46% developed erosions [5] and in another study 62% of patients worsened and the pattern of disease changed over time [6].
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