What Remains of Psoriatic Arthritis After Treatment

January 23, 2018

Moderate to high disease activity may persist.

Key points
• Residual disease activity was found in nearly two-thirds of 142 patients with psoriatic arthritis (PsA) who were receiving treatment in a rheumatology outpatient clinic.

• Forty-six percent of these patients had moderate to high disease activity, according to the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA).

• Treatment was adjusted in only 21 (23%) of the 90 patients with residual disease.

The study
Dutch researchers conducted an observational cross-sectional study at 2 rheumatology outpatient clinics in Amsterdam. Included in the study were 142 adults with PsA who were treated with conventional disease-modifying anti-rheumatic drugs (csDMARDs), such as methotrexate and leflunomide, and tumor necrosis factor (TNF) inhibitors. The express goal of the study was to "assess current clinical practice on defining residual disease and subsequent treatment decisions."1

Results
Among the 90 patients considered to have remaining disease activity, 31% had at least 1 swollen joint (including 16% with 3 or more swollen joints), 60% had 1 or more tender joints, 18% had enthesitis, 9% had dactylitis, and 30% had a skin involvement score higher than 2 on a 10-point scale. Based on the cDAPSA composite score, 46% of these patients had moderate to high disease activity.

Residual disease activity was more common in patients treated with a csDMARD only (66%) or a second TNF inhibitor (69%) than in those who were still taking their first TNF inhibitor (44%) (P  =  .019).

Treatment was modified in only 21 (23%) of the 90 patients with residual disease.

The most common reasons not to adjust treatment were:
• The rheumatologist considered the complaints "minor" (39/69 [57%])
• Patient's preference not to modify treatment (10/69 [14%])
• Absence of additional treatment options (5/69 [7%])
• Lack of compliance and/or adverse events (5/69 [7%])

"Overall, judgment by the rheumatologist and/or patient rather than objective hurdles to intensify treatment (absence of additional treatment options, lack of compliance, intolerance) drove the decision not to modify treatment," noted the researchers.

Disclosures:

The authors report that their work was supported by an unrestricted grant from UCB.

References:

1. van Mens LJJ, van de Sande MGH, Fluri IA, et al. Residual disease activity and treatment adjustments in psoriatic arthritis in current clinical practice.Arthritis Res Ther. 2017;19:226. doi:10.1186/s13075-017-1424-8.