Background Psoriatic arthritis (PsA) has various clinical manifestations. The therapeutic response of patients may be affected by epidemiological parameters such as body mass index (BMI), disease duration, sex and the choice of therapy.
Objectives To illustrate the clinical manifestations of psoriatic arthritis and to assess the impact of epidemiological features and treatment choice on therapeutic response.
Methods We retrospectively studied 411 patients diagnosed with PsA and we recorded the clinical manifestations of the disease. Data of 254 out of 411 patients were analyzed to examine the possible effect of BMI, disease activity, sex and treatment choice on therapeutic response. Patients were followed up at predefined time points [baseline, 12 weeks (wks), 24 wks, 48 and 240 wks after initiation of therapy]. The treatment response was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), disease activity score-28 (DAS) -C-Reactive Protein (CRP), DAS28-erythrocyte sedimentation rate (ESR) and Health Assessment Questionnaire (HAQ). Patients were categorized in three groups: patients treated with biological synthetic disease modifying anti-rheumatic drugs (DMARDs) (anti-tumor necrosis factor alpha (TNFa) agents), patients treated with synthetic DMARDs and combined therapy (biological and synthetic DMARDs).
Results The interval between psoriasis and PsA in women is shorter (p=0,041). PsA presented predominantly as asymmetric oligoarthritis (41,60%), followed by symmetric polyarthritis (24,57%). Arthritis of distal phalangeal joints was established in 3,16%, while 4,37% showed only enthesitis or dactylitis. Axial involvement was recorded in 26,27%7.Twenty-eight patients had only axial disease and 80 had axial and peripheral joint involvement. 23/411 patients (5,60%),had eye involvement, 8/411 (1,95%) and 6/411 (1,46%) had involvement of the urogenital and gastrointestinal system, respectively. Eleven patients had pulmonary fibrosis. In the subgroup analysis of 254 patients, disease duration was positively correlated in all time points (p<0,005) with all disease activity scores. Statistical significant differences with respect to gender was observed for DAS28-CRP (3,93–2,96, 3,54–2,64 p<0,001) and DAS28-ESR (3,37 – 2,82 p=0,001, 3,06–2,62 p=0,023) at 12 and 24 wks respectively. More specifically women showed higher disease activity than males the first 6 months after treatment. BMI was not significantly correlated with the disease activity. Treatment with biological DMARD showed a statistically significant difference in all disease activity scores early in the disease course (p<0,05) in comparison with those receiving conventional DMARD. After the first 12 wks all disease activity scores were rather stable with no differences between the treatment groups.
Conclusions PsA manifests predominantly as asymmetric oligoarthritis. Extraarticular manifestations are less frequent. Higher disease duration was associated with higher disease activity. Women early on disease course had higher DAS-28 scores. Treatment with biological DMARD showed better response in PsA patients compared with synthetic early in the disease course. However, after the first 12 wks there were no significant differences in treatment response with respect to treatment choice.
Disclosure of Interest None declared
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