Abstract
BackgroundAlthough the effects of interleukin-17A (IL-17A) inhibition on the signs and symptoms of psoriatic arthritis (PsA) are well defined, little is known about its impact of local inflammatory and structural changes in the joints. The PSARTROS study was designed to elucidate the effects of IL-17A inhibition on inflammation and bone changes in joints affected by PsA.MethodsThis was a prospective open-label study in 20 patients with active PsA receiving 24 weeks of treatment with the IL-17A inhibitor secukinumab. Magnetic resonance imaging (MRI), power Doppler ultrasound (PDUS), and high-resolution peripheral quantitative computer tomography (HR-pQCT) of the hands were performed at baseline and after 24 weeks to assess synovitis, periarticular inflammation, bone erosion, enthesiophyte formation, and bone structure. Demographic and clinical measures of joint disease (DAPSA and DAS28-ESR), skin disease (PASI and BSA), and composite measures (minimal disease activity, or MDA) were also recorded.ResultsTreatment with secukinumab led to significant improvement of signs and symptoms of PsA; 46% reached MDA and 52% DAPSA low disease activity. MRI synovitis (P = 0.034) and signal in PDUS (P = 0.030) significantly decreased after 24 weeks of treatment. Bone erosions in MRI and HR-pQCT and enthesiophytes in the HR-pQCT did not show any progression, and structural integrity and functional bone strength remained stable.ConclusionsIL-17 inhibition by secukinumab over 24 weeks led to a significant decrease of synovial inflammation and no progression of catabolic and anabolic bone changes in the joints of patients with PsA.Trial registrationClinicalTrials.gov Identifier: NCT02483234, June 26, 2015; retrospectively registered.
Highlights
The effects of interleukin-17A (IL-17A) inhibition on the signs and symptoms of psoriatic arthritis (PsA) are well defined, little is known about its impact of local inflammatory and structural changes in the joints
Patients had moderate-to-high PsA activity according to Disease Activity Score 28-joint count–erythrocyte sedimentation rate (DAS28-Erythrocyte sedimentation rate (ESR)) and Disease Activity in PSA (DAPSA) with a median Tender joint count (TJC) of 10 (6.25–20) and Swollen joint count (SJC) of 4 (3–5.75)
Effects of secukinumab on bone erosions We examined whether secukinumab therapy arrests the progression of bone erosions in patients with PsA
Summary
The effects of interleukin-17A (IL-17A) inhibition on the signs and symptoms of psoriatic arthritis (PsA) are well defined, little is known about its impact of local inflammatory and structural changes in the joints. Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the joints and the entheses and leads to bone damage [1]. The inflammatory process in PsA afflicts the synovium and the periosteal insertions of tendons and ligaments. Chronic inflammation at these synovial and entheseal sites leads to bone erosions and enthesiophytes, respectively, and a link to the intestinal microbiome has been suggested [1, 2]. Inhibition of IL-17A by neutralizing antibodies has been shown to improve the signs and symptoms of joint disease in patients with PsA [6,7,8]
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