Remission in psoriatic arthritis: is it possible and how can it be predicted?

Tajvur P Saber, C T Ng, Guillaume Renard, Bernadette M Lynch, Eliza Pontifex, Ceara A E Walsh, Alexia Grier, Marian Molloy, Barry Bresnihan, Oliver Fitzgerald, Ursula Fearon, Douglas J Veale, Tajvur P Saber, C T Ng, Guillaume Renard, Bernadette M Lynch, Eliza Pontifex, Ceara A E Walsh, Alexia Grier, Marian Molloy, Barry Bresnihan, Oliver Fitzgerald, Ursula Fearon, Douglas J Veale

Abstract

Introduction: Since remission is now possible in psoriatic arthritis (PsA) we wished to examine remission rates in PsA patients following anti tumour necrosis factor alpha (TNFalpha) therapy and to examine possible predictors of response.

Methods: Analysis 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.

Results: A 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).

Conclusions: DAS28 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.

Figures

Figure 1
Figure 1
Individual clinical outcome measures in Psoriatic arthritis over time. The top left graph depicts the rapid response of Tender Joint Count (TJC) to commencement of treatment with a biologic agent. The top right shows similar response of Swollen Joint Count (SJC). The bottom left graph shows CRP mg/L decline with biologic therapy. The bottom right graph shows HAQ and its dramatic improvement. Time is shown as O for baseline and then 3, 6 and 12 months.
Figure 2
Figure 2
Comparison of DAS28-CRP response in PsA versus RA patients over time. 2a DAS28-CRP in PsA (dotted line) is compared to RA (solid black line). Remission represented by the line at DAS28 value of 2.6. There is a highly significant response of PsA compared to RA at all time points. 2b shows a subgroup of patients matched for disease activity at baseline (n = 41 in each group) and similar dramatic response.
Figure 3
Figure 3
Percentage of patients in DAS28-CRP remission over time. PsA represented by the dotted line shows a dramatic immediate response to Biologic therapy compared to RA, represented by solid black line. A total of 58% PsA patients are in remission at 12 months compared to 44% of RA patients.

References

    1. Reece RJ, Canete JD, Parsons WJ, Emery P, Veale DJ. Distinct vascular patterns of early synovitis in psoriatic, reactive, and rheumatoid arthritis. Arthritis Rheum. 1999;42:1481–1484. doi: 10.1002/1529-0131(199907)42:7<1481::AID-ANR23>;2-E.
    1. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665–2673. doi: 10.1002/art.21972.
    1. Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol. 2000;27:1247–1250.
    1. Veale DJ. The epidemiology of psoriatic arthritis: fact or fiction? J Rheumatol. 2000;27:1105–1106.
    1. Kaipiainen-Seppanen O. Incidence of psoriatic arthritis in Finland. Br J Rheumatol. 1996;35:1289–1291. doi: 10.1093/rheumatology/35.12.1289.
    1. Jones SM, Armas JB, Cohen MG, Lovell CR, Evison G, McHugh NJ. Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol. 1994;33:834–839. doi: 10.1093/rheumatology/33.9.834.
    1. Gladman DD. Mortality in psoriatic arthritis. Clin Exp Rheumatol. 2008;26:S62–65.
    1. Kane D, Pathare S. Early psoriatic arthritis. Rheum Dis Clin North Am. 2005;31:641–657. doi: 10.1016/j.rdc.2005.07.009.
    1. van der Horst-Bruinsma IE, Clegg DO, Dijkmans BA. Treatment of ankylosing spondylitis with disease modifying antirheumatic drugs. Clin Exp Rheumatol. 2002;20:S67–70.
    1. Emery P, Gabay C, Kraan M, Gomez-Reino J. Evidence-based review of biologic markers as indicators of disease progression and remission in rheumatoid arthritis. Rheumatol Int. 2007;27:793–806. doi: 10.1007/s00296-007-0357-y.
    1. Breedveld FC, Emery P, Keystone E, Patel K, Furst DE, Kalden JR, St Clair EW, Weisman M, Smolen J, Lipsky PE, Maini RN. Infliximab in active early rheumatoid arthritis. Ann Rheum Dis. 2004;63:149–155. doi: 10.1136/ard.2003.013961.
    1. Saleem B, Nizam S, Emery P. Can remission be maintained with or without further drug therapy in rheumatoid arthritis? Clin Exp Rheumatol. 2006;24:S-33–S-36.
    1. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–324. doi: 10.1002/art.1780310302.
    1. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, Zwinderman AH, Ronday HK, Han KH, Westedt ML, Gerards AH, van Groenendael JH, Lems WF, van Krugten MV, Breedveld FC, Dijkmans BA. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52:3381–3390. doi: 10.1002/art.21405.
    1. de Vlam K, Lories RJ. Remission in psoriatic arthritis. Curr Rheumatol Rep. 2008;10:297–302. doi: 10.1007/s11926-008-0048-z.
    1. Symmons DP, Lunt M, Watkins G, Helliwell P, Jones S, McHugh N, Veale D. Developing classification criteria for peripheral joint psoriatic arthritis. Step I. Establishing whether the rheumatologist's opinion on the diagnosis can be used as the "gold standard". J Rheumatol. 2006;33:552–557.
    1. Vander Cruyssen B, De Keyser F, Kruithof E, Mielants H, Van den Bosch F. Comparison of different outcome measures for psoriatic arthritis in patients treated with infliximab or placebo. Ann Rheum Dis. 2007;66:138–140. doi: 10.1136/ard.2006.055541.
    1. Ziebland S, Fitzpatrick R, Jenkinson C, Mowat A. Comparison of two approaches to measuring change in health status in rheumatoid arthritis: the Health Assessment Questionnaire (HAQ) and modified HAQ. Ann Rheum Dis. 1992;51:1202–1205. doi: 10.1136/ard.51.11.1202.
    1. Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol. 2005;23:S93–99.
    1. Coates LC, Cawkwell LS, Ng NW, Bennett AN, Bryer DJ, Fraser AD, Emery P, Marzo-Ortega H. Sustained response to long-term biologics and switching in psoriatic arthritis: results from real life experience. Ann Rheum Dis. 2008;67:717–719. doi: 10.1136/ard.2007.082925.
    1. Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, Singh A, Pedersen RD, Koenig AS, Freundlich B. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet. 2008;372:375–382. doi: 10.1016/S0140-6736(08)61000-4.
    1. Combe B, Landewe R, Lukas C, Bolosiu HD, Breedveld F, Dougados M, Emery P, Ferraccioli G, Hazes JM, Klareskog L, Machold K, Martin-Mola E, Nielsen H, Silman A, Smolen J, Yazici H. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) Ann Rheum Dis. 2007;66:34–45. doi: 10.1136/ard.2005.044354.
    1. Gladman DD, Mease PJ, Healy P, Helliwell PS, Fitzgerald O, Cauli A, Lubrano E, Krueger GG, van der Heijde D, Veale DJ, Kavanaugh A, Nash P, Ritchlin C, Taylor W, Strand V. Outcome measures in psoriatic arthritis. J Rheumatol. 2007;34:1159–1166.
    1. Saad AA, Ashcroft DM, Watson KD, Symmons DP, Noyce PR, Hyrich KL. Efficacy and safety of anti-TNF therapies in psoriatic arthritis: an observational study from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2010;49:697–705. doi: 10.1093/rheumatology/kep423.
    1. Kvien TK, Heiberg, Lie E, Kaufmann C, Mikkelsen K, Nordvag BY, Rodevand E. A Norwegian DMARD register: prescriptions of DMARDs and biological agents to patients with inflammatory rheumatic diseases. Clin Exp Rheumatol. 2005;23:S188–194.
    1. Sokka T, Toloza S, Cutolo M, Kautiainen H, Makinen H, Gogus F, Skakic V, Badsha H, Peets T, Baranauskaite A, Geher P, Ujfalussy I, Skopouli FN, Mavrommati M, Alten R, Pohl C, Sibilia J, Stancati A, Salaffi F, Romanowski W, Zarowny-Wierzbinska D, Henrohn D, Bresnihan B, Minnock P, Knudsen LS, Jacobs JW, Calvo-Alen J, Lazovskis J, Pinheiro Gda R, Karateev D. Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study. Arthritis Res Ther. 2009;11:R7.
    1. James WH. Sex ratios and hormones in HLA related rheumatic diseases. Ann Rheum Dis. 1991;50:401–404. doi: 10.1136/ard.50.6.401.
    1. Melillo N, Corrado A, Quarta L, D'Onofrio F, Cantatore FP. Psoriatic arthritis and Klinefelter syndrome: case report. Clin Rheumatol. 2007;26:443–444. doi: 10.1007/s10067-005-0153-6.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa