Background Treatment-to-target (T2T) strategy for early psoriatic arthritis (EPsA) has limited data.
Objectives To determine proportion of EPsA patients (pts) who achieves remission and minimal disease activity (MDA) after one year of T2T strategy
Methods 25 (M/F – 9/16) DMARD-naïve patients (pts) with active EPsA, according to the CASPAR criteria, mean age 38.6±10.3 years, PsA duration 12 [5; 24] months, psoriasis (PsO) duration 36 [12; 84] months, disease activity index (DAS) 3.9 [3.1; 4.7], DAS28 4.3 [3.7; 4.7], modified composite psoriatic disease index (joint-enthesis-dactylitis-skin domains) (mCPDAI) 8 [7; 8], after signing a consent form for the participant in the REMARCA [Russian invEstigation of MethotrexAte and biologics in eaRly aCtive inflammatory Arthritis] study were included. At the baseline and every other 3 months of therapy all pts underwent standard clinical examination, dactylitis, enthesitis by Leeds Enthesial Index (LEI)+Plantar Fascia (PF), Body Surface Psoriasis Area (BSA), Health Assessment Questionnaire (HAQ), Dermatology Quality Life Index (DQLI), DAS, DAS28-C-RP, C-RP (mg/l). The dose of MTX s/c was escalated by 5 mg every 2 weeks from 10 mg/wk to appropriate dose 20-25 mg/wk according to the drug intolerance. If pts do not achieve the MDA or remission after 3 months of MTX-mono therapy, then combination therapy of MTX+ADA by standard regime was continued. At 6 and 12 months of therapy the proportion of pts who attained DAS<1.6/DAS28-C-RP<2.6/mCPDAI=0 remission or MDA, ACR20/50/70 were calculated. Mean ± SD, Me [Q25; Q75], %, Friedman (Fr.) ANOVA were performed. All p<0.05 were considered to indicate statistical significance.
Results Significant improvements in disease activity and physical health function related to quality of life from baseline up to 6 and 12 months are shown on table 1.
At baseline enthesitis ≥1 by LEI+PF were found in 68% of pts. By 6 and 12 months of therapy the proportion of those with enthesitis significantly decreased to 20% and 16% of pts accordingly (Fr. ANOVA, p<0.001). At baseline dactylitis were found in 56% of pts. By 6 and 12 months of therapy dactylitis significantly decreased to 24% and 16% of pts accordingly (Fr. ANOVA, p<0.001). By 6 months of therapy 40%/40%/32% of pts reached DAS/DAS28-C-RP/mCPDAI remission accordingly. MDA was seen in 14 (56%) of pts. By 12 months of therapy DAS/DAS28-C-RP/mCPDAI remission significantly increased to 56%/52%/60% of pts respectively (Fr. ANOVA, p<0.001). At 12 months of therapy MDA significantly increased to 17 (68%) of pts (Fr. ANOVA, p<0.001). By 12 months of therapy ACR20/50/70 was seen in 68%/68%/68% of pts respectively.
Conclusions One year of T2T strategy with MTX-mono therapy or also in combination with ADA significantly improves all clinical domains and quality of life in active EPsA. Prolonged T2T up to one year is helpful to achieve MDA and remission in more than half of active EPsA pts.
Disclosure of Interest None declared