Background Evaluation for efficacy of PsA therapy was difficult by methods of Rheumatoid arthritis assessment because PsA patient had skin and nail psoriasis, joint involvement, axial involvement and enthesitis. Nowadays, a state of Minimal Disease Activity (MDA) was defined and validated as target for treatment in PsA.
Objectives The study aim was to identify disease characteristics, clinical outcome and predictors of MDA in patients treated with ADA in clinical practice.
Methods Patients were considered in MDA when they meet at least 5/7 of the criteria defined by Coates et.al.1) We compared patients achieving MDA to non-MDA at baseline characteristics. Group comparisons were made non-parametrically with the Wilcoxon rank-sum tests.From the Receiver operating characteristic (ROC) curves, the optimal cut-off point corresponding to the maximum sum of sensitivity and specificity was computed. Predictors of achieved MDA after ADA therapy were analyzed by means of stepwise logistic regression using the variables selected. For all models, a P value of <0.05 as significant has been considered. The last observation carried forward (LOCF) technique was used to make up for missing values.
Thirty-one patients (24men, 7 women) with diagnosis of PsA, according CASPAR criteria, were enrolled in this study from March 2010 to December 2012.Patients characteristic were age (46.2±9.3 years), disease duration (psoriasis 15.1±9.8 years, psoriatic arthritis 5.6±5.6years),Body Mass Index (BMI: 24.6±3.8), Tender Joint Count 68/28 (4.4±5.0/2.3±3.1), Swollen Joint Count 66/28 (4.4±5.5/2.4±3.2), Physician VAS (4.7±2.0cm), Patient Global VAS (4.9±2.7cm), Patient Pain VAS (4.6±3.1cm), DAS28CRP4/ESR4 (3.4±1.0/3.6±1.1), CDAI (14.4±8.3), SDAI (15.6±8.4), modified HAQ (1.087±1.113), BASDAI (4.3±2.4), BASFI (2.0±2.1), BASMI (2.7±1.9), Psoriasis Area Severity Index (PASI: 9.0±8.8), SF36-PCS/ MCS (37.4±12.5/45.3±13.3), Total amount of (Right and left)grip power (30.5±10.2 kg), back muscle power (73.0±31.9 kg), ACPA (all negative), Rheumatoid factor (all negative), ANA (14 positive, 16 negative, 1 unclear), MMP-3 (119.3±86.8 ng/ml), CRP (1.19±1.13 mg/dl), ESR (24.8±19.3 mm/h).
Results MDA is achieved in 83.9% (26/31cases) of patients treated with ADA for 52 weeks in clinical practice. Five cases could not achieve MDA at 52weeks after ADA therapy.One of five cases could not continue ADA therapy for worsening skin lesion at 24weeks. Baseline Patient Global VAS (4.4±2.6, 7.6±1.9 p=0.0240), Patient Pain VAS (4.1±3.0, 7.2±2.2 p=0.0338),BASDAI (3.9±2.3, 6.3±2.0 p=0.0135) were different from MDA group and non-MDA group respectively. The cut-off points for Patient Global VAS (cut-off 5.1, AUC=0.823, p=0.0434), Patient Pain VAS (cut-off 5.0, AUC=0.804, p=0.0118), BASDAI (cut-off 4.6, AUC=0.854, p=0.0076).Finally in multivariate analysis, Only Patient Global VAS (OR=0.594, CI=0.363-0.971, p=0.0379) increased the odds for achieving MDA.
Conclusions MDA is achieved in 83.9% (26/31cases) of patients treated with ADA for 52 weeks in clinical practice. Only Patient Global VAS are predictors for MDA.
Coates et.al. Ann Rheum Dis 2010;69:48-53
Disclosure of Interest None declared