Background Psoriatic arthritis (PsA) is characterized by a variety of radiographic changes which include both signs of joint destruction (joint space narrowing reflecting cartilage loss and bone erosions) and joint remodeling (new bone formation possible leading to joint ankylosis). These changes are considered irreversible. Actual radiographic scoring methods focus largely on joint space narrowing and joint erosions. The use of TNF blockade has dramatically changed the clinical and radiographic outcome of PsA,showing to be effective in retarding or halting the progression of destructive joint disease. The effects on new bone formation and ankylosis in particular have not been extensively studied. The latter aspect may occur over a longer time frame than that usually evaluated for joint destruction (2 years).
Objectives to evaluate radiographic changes in PsA patients treated with etanercept over an extended time interval.
Methods 20 patients with DMARD resistant polyarticular PsA were previously included in a open observational study of etanercept treatment1. X-rays of hand & feet were read using the Ratingen scoring system, evaluating both erosions and new bone formation. X-rays were scored at baseline and year 1 and 6 (or longer) by one observer blinded for the order. Joint remodeling specifically leading to joint repair for the individual joints of hands and feet was recorded. Joint repair was defined as the reappearance of a joint space combined with clearly delineated joint margins.
Results Results of the Ratingen score are given in table 1. Erosion scores in the patients did not deteriorate over time. Five out of 20 patients showed striking joint repair in six joints, all but one in the feet: three patients in MTP joints (MTP 1 & 5) and two patients in PIP joints. One patient showed repair in a DIP joint of the dominant hand.
Conclusions Treatment with etanercept stops in a sustainable manner radiographic signs of joint destruction in patients with severe PsA. In the feet, true repair of destructed joints occurs.
de Vlam K, Lories RJ.1Efficacy, effectiveness and safety of etanercept in monotherapy for refractory psoriatic arthritis: a 26-week observational study. Rheumatology. 2006 Mar;45(3):321-4.
Disclosure of Interest None Declared
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