Background Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, and The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has defined clinical core domains for assessment of PsA.
Objectives In an investigator-initiated trial to evaluate the clinical efficacy of adalimumab in patients with PsA assessed by the Psoriatic Arthritis Response Criteria (PsARC), the American College of Rheumatology (ACR) response rates, and clinical core domains defined by GRAPPA.
Methods Anti-TNF-naïve PsA patients were included in a follow-up cohort study, with the following main inclusion criteria: PsA according to Moll and Wright criteria, ≥3 (of 76) swollen joints, ≥3 (of 78) tender joints, hand involvement (clinical swelling of ≥1 finger joint and/or ≥1 sausage finger), and clinical indication for anti-TNF therapy according to treating physician. Modified PsARC and ACR response rates were calculated. Last observation carried forward (LOCF) imputation was used for missing values at completed visits.
Results Baseline characteristics of the 42 PsA patients were: 18 males/24 females, median (interquartile range) age 52 (41-64) years, joint disease duration 8.5 (5-15) years, and skin disease duration 23 (10-35) years.
Disease activity parameters at baseline and week 24 were: high-sensitive CRP 4.62 (1.81-9.53) [week 24: 0.85 (0.66-2.88)*] mg/L, swollen joint count (SJC, 76) 8.5 (6-16) [w24: 0 (0-2)*], tender joint count (TJC, 78) 21.5 (11-41) [w24: 2(0-6)*], VAS pain 63 (49-74) [w24: 4 (17-34)] mm, VAS global 66 (49-78) [w24: 24 (6-44)*] mm, VAS physician 51 (41-65) [w24: 5 (2-12)] mm, HAQ-score 1.0 (0.4-1.5) [w24: 0.38 (0-0.88)], MASES 13-enthesis count 3 (0-6) [w24: 0 (0-6) NS], dactylitis count 0 (0-2) [w24: 0 (0-1) NS], sum NAPSI nail score 4 (0-31) [w24: 0 (0-6)*], physician’s global assessment for psoriasis (PGA)-score 2 (1-3) [w24: 1 (0-1)*], body surface area affected by psoriasis (BSA) 1 (0.9-2) [w24 0.9 (0-1)*] %, quality of life EQ-5D score 0.655 (0.559-0.708) [w24: 0.776 (0.660-1.00)*], *all P
The table shows the Intention-To-Treat (ITT), and Completer Analysis (CA) for PsARC and ACR-response rates.
Conclusions Adalimumab therapy had a high clinical efficacy as assessed by PsARC and ACR response rates, and caused improvement in all clinical core domains. More than 2/3 had a significant PsARC-response already after 2 weeks, whereas high treatment responses (ACR50/70) were primarily seen later.
Disclosure of Interest None Declared
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