Background Introduction of biological disease modifying antirheumatic drugs (DMARDs) in the treatment of Psoriatic arthritis (PsA) have altered the therapeutic approach of these patients showing a good outcome.
Objectives The main purpose of the present observational study was to estimate treatment response in PsA patients receiving conventional DMARDs, biological DMARDs or combined therapy.
Methods We studied 254 patients diagnosed with PsA. Patients with axial involvement fulfilled the Assessment of SpondyloArthritis international Society (ASAS) criteria and additionally the ClASsification criteria for Psoratic ARthritis (CASPAR) for patients with peripheral joint involvement. We compared the therapeutic response in patients receiving conventional DMARDs, biological DMARDs and combined therapy. Data were collected at predefined time points, baseline, 12 weeks (wks), 24 wks, 48 and 240 wks after initiation of therapy. The treatment response was assessed by using Bath Ankylosing Spondylitis Activity Index (BASDAI), Bath Ankylosing Spondylitis Functionality Index (BASFI), Disease Activity Score in 28 joints-CRP (DAS28-CRP), Disease Activity Score in 28 joints -TKE (DAS28-TKE) and Health Assessment Questionnaire (HAQ). Patients were categorized in three groups according to their treatment: patients mainly with axial disease who were treated with biological DMARDs (anti-TNFa agents) (group A), patients with peripheral arthritis with or without axial involvement treated with conventional DMARDs: methotrexate, leflunomide, cyclosporine (group B) and combined therapy: biological and conventional DMARDs (group C) according to their therapeutic response.
Results Treatment with biological DMARDs showed a statistically significant difference in all disease activity scores early in the disease course (p<0,05) in comparison with those receiving conventional DMARDs. More specifically 12 wks after the initiation of the treatment patients receiving biological DMARDs had significant lower values for DAS28-TKE (2,04±0,69 – 3,35±0,94 p=0,0446), DAS28-CRP (2,44±0,83 – 3,73±1,22 p=0,015), BASDAI (0,85±0,59 – 2,73±1,60 p=0,0426), BASFI (1,2±1,08 – 3,29±2,07 p=0,0366) and HAQ (0,32±0,38 – 0,80±0,48 p=0,001). The patients receiving combined therapy showed better response rates at week 12 in comparison with the patients receiving conventional DMARDs but the differences were not statistically significant (p>0,05 in all cases). At the time points 24, 48 and 240 wks all disease activity scores were stable with no statistically significant differences within or between the three groups (p>0,05).
Conclusions In the current study, treatment with biological DMARDs showed better response in PsA patients than those treated with conventional DMARDs early in the disease course. After the first 12 wks there were no significant differences in treatment response with respect to treatment choice.
Disclosure of Interest None declared