Background Several new drugs, including ustekinumab, apremilast, and secukinumab, became available for the treatment of psoriatic arthritis (PsA) over the last years, broadening our possibilities to treat the disease effectively. The new therapeutic modalities open a new perspective for patients not responding to conventional DMARDs and TNF inhibitors (TNFi). As achieving the lowest possible level of disease activity in all domains of disease is associated with better long-term outcomes, the new therapeutic modalities may potentially also benefit patients with partial but not full disease control with cDMARDs and/or TNFi.1 Therefore, defining an acceptable disease state in routine clinical practice is becoming increasingly important to identify who could potentially benefit from treatment adjustment.
Objectives The aim of the study was to assess how many patients with quiescent disease according to the treating rheumatologist have an acceptable disease state defined as minimal disease activity.
Methods This cross-sectional study was performed in 2 rheumatology outpatient clinics and included a total of 250 PsA patients between Feb 2013 and June 2015. Key inclusion criteria were fulfillment of the CASPAR criteria and quiescent disease in the opinion of the treating rheumatologists, defined by the fact that the rheumatologist did not consider to modify the current treatment. Patients were systematically evaluated by an independent research physician for current disease activity including clinical assessments and patient reported outcomes (PRO). Minimal disease activity (MDA) was defined as the fulfillment of ≥5 of the following: TJC68≤1, SJC68≤1, PASI≤1, VASpain≤15mm, VASptglobal≤20mm, HAQ≤0.5, tender entheseal points≤1.
Results One third (88/250) of the PsA patients with quiescent disease according to the treating rheumatologist did not fulfill MDA criteria (MDA-). A high TJC, VASpain and VASptglobal were the items most frequently contributing to the failure to achieve MDA (not achieved in 83%, 82% and 80%). However, also objective signs of disease activity were higher in MDA- vs MDA+ patients: a SJC>1 occurred in 35% vs 7% (p=0.000), enthesitis>1 in 14% vs 3% (p=0.002), and PASI>1 in 43% vs 26% (p=0.002). There was no difference in treatment use (including cDMARD and TNFi) between MDA- and MDA+. See table 1 for additional patient characteristics.
Conclusions One third of the PsA patients with quiescent disease according to the treating rheumatologist do not achieve the MDA criteria. These patients have higher disease activity both on subjective and objective disease activity measurements. As this is associated with worse PROs, further research should evaluate if treatment adjustments may be beneficial for this patient group with residual disease activity.
L. Coates et.al, GRAPPA Treatment Recs for PsA, Arhtritis & rheumatology 2015
Disclosure of Interest L. Van Mens: None declared, A. van Kuijk Consultant for: Celgene, Janssen, MSD, Novartis, Speakers bureau: BMS, Roche, D. Baeten Grant/research support from: Pfizer, MSD, AbbVie, UCB, Novartis, Janssen, Boehringer Ingelheim, This study was supported by an unrestricted grant from Pfizer to DB, Consultant for: Pfizer, MSD, AbbVie, UCB, Novartis, Janssen, Boehringer Ingelheim, Eli Lilly, Roche, BMS, Glenmark