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  1. E. Gubar1,
  2. T. Korotaeva1,
  3. Y. Korsakova1,
  4. E. Loginova1,
  5. P. Karpova1
  1. 1Nasonova Research Institute of Rheumatology, Moscow, Russian Federation


Background: Axial involvement in psoriatic arthritis (PsA) is quite common. Tofacitinib (TOFA) is an oral Janus kinase inhibitor. There is no data on the use of TOFA in PsA patients (pts) with axial involvement, nor is there any data on its effect on active MRI sacroiliitis (MRI-SI). There are only preliminary results of a randomized clinical trial on TOFA efficacy on active SI in AS (1).

Objectives: To study the effect of TOFA therapy on active MRI-SI in PsA pts.

Methods: 40 pts (F/M – 23/17) with active PsA fulfilling the CASPAR criteria were examined. No patients with inflammatory back pain (IBP) were specifically selected. Median (Me) age 41.0 [35.0; 50.0] yrs, Me PsA duration 6.0 [3.0; 10.0] yrs. Pts underwent a standard clinical examination of PsA activity: Me tender joint count 19 [12; 24], swollen joint count 11 [8; 16], patient’s global disease activity measured by Visual Analogue Scale (VAS) 70 [50; 80], patient’s pain VAS 65 [50; 75], Me activity indixes: DAPSA 44.2 [37.8; 55.3], BASDAI 6.0 [4.2; 7.0], ASDAS 3.8 [2.8; 4.4]. Me CRP 21.3 [3.2; 72.3] mg/L, ESR 28 [12; 52] mm/h. Enthesitis was observed in 65.9% of pts, dactylitis in 53.7% of pts. Apart from a standard clinical examination, all 40 pts underwent sacroiliac joint (SIJ) MRI on scanner Siemens General Electric 1.5 TESLA. Bone marrow edema/osteitis on MRI (STIR) with one lesion on two consecutive slices or at least two lesions on a single slice, was considered active MRI-SI. MRI results were evaluated by 2 independent readers (radiologist and rheumatologist). TOFA was given in 5 mg tablets bds over a period of 6 months, after which 35 patients underwent SIJ MRI. Me [Q25; Q75], Pierson-χ2 tests were performed. All p<0.05 were considered to indicate statistical significance.

Results: Prior to TOFA therapy, active MRI-SI was detected in 14 of 40 (35%) pts: bilateral in 9 pts, unilateral in 5 pts. At the end of 6 months therapy, active MRI-SI was detected in 4 of 35 (11.4%) pts observed: in 1 pt with baseline bilateral MRI-SI and in 2 pts with unilateral MRI-SI. 1 pt showed negative dynamics, that is, development of active MRI-SI (absent at baseline). The decrease in number of active MRI-SI patients is statistically significant (p = 0.017; Pearson-χ2). At baseline, inflammatory changes were detected in 23 of 80 (28.8%) SIJs, after 6 months of therapy they were found in 5 of 70 (7.1%) SIJs observed. Decrease in number of SIJs with active inflammation is statistically significant (p = 0.001; Pearson-χ2). At baseline, Me BASDAI 6.0 [4.2; 7.0], Me ASDAS 3.8 [2.8; 4.4]. After 6 months of treatment, Me BASDAI 1.4 [0.6; 3.2], Me ASDAS1.5 [1.0; 2.1] (p = 0.001 for both comparisons).

Conclusion: JAK inhibition using TOFA therapy shows high efficacy in reducing active MRI-SI and decreasing activity of axial involvement in PsA. More extensive studies are needed.

References: [1]van der Heijde D. et al. Ann. Rheum. Dis. 2017;76:1340–47

Disclosure of Interests: ELENA GUBAR: None declared, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Yulia Korsakova: None declared, Elena Loginova Speakers bureau: Janssen, Polina Karpova: None declared

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