scholarly journals The efficacy and safety of apremilast in patients with psoriatic arthritis concurrent with comorbidity in clinical practice

2019 ◽  
Vol 57 (3) ◽  
pp. 299-306
Author(s):  
E. Yu. Loginova ◽  
Yu. L. Korsakova ◽  
A. D. Koltakova ◽  
E. E. Gubar ◽  
P. L. Karpova ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Skin Lesions ◽  
Tender Joint Count ◽  
Psoriatic Skin ◽  
Efficacy And Safety ◽  
Tender Joint ◽  
Number Of Patients ◽  
Conventional Dmards ◽  
Low Activity

Objective: to evaluate the clinical efficacy and safety of the targeted synthetic disease-modifying antirheumatic drug (DMARD) apremilast (AP; Otesla®) in patients with active psoriatic arthritis (PsA) at 14 and 26 weeks after starting the treatment and to identify the place of AP in the combination therapy of patients with PsA, by taking into consideration a comorbidity.Subjects and methods. Examinations were made in 20 patients (11 women and 9 men) with active PsA who had comorbidity, lack of efficiency of or intolerance to previous therapy with synthetic DMARDs or biologic agents, and contraindications to its use. The median baseline Disease Activity in Psoriatic Arthritis (DAPSA) score was 35.6 [24.8; 55.6]; those of DAS and DAS28 were 3.8 [3.2; 5.0] and 4.4 [4.0; 5.2], respectively. AP (Otesla®) was administered in tablets with a starting dose of 10 mg/day with a daily dose escalation of 10 mg to the therapeutic dose of 60 mg/day for 26 weeks. At baseline, 14 and 26 weeks, the disease activity and efficiency of AP were evaluated using DAPSA, DAS, and DAS28, as well as minimal disease activity (MDA) criteria (tender joint count ≤1; swollen joint count ≤1; PASI ≤1 or BSA ≤3%; a patient’s assessment of pain ≤15 mm; patient’s global assessment ≤ 20 mm; Health Assessment Questionnaire (HAQ) ≤ 0.5; enthesitis ≤1). The investigators estimated the number of patients who had achieved remission (DAPSA≤4; DAS<1.6; DAS28<2.6), low activity (5≤DAPSA≤14; 1.6≤DAS<2.4; 2.6≤DAS28<3.2) or MDA (5 of the 7 criteria) during AP therapy at 26-week follow-up. The safety of therapy was evaluated, by analyzing the adverse events (AE): the frequency, severity, and time of their occurrence were studied.Results and discussion. At 26 weeks after AP therapy initiation, there was a significant decrease of all PsA activity scores as compared to the baseline ones to the following median values: DAPSA 25.9 [11.3; 35.2]; DAS 3.3 [1.8; 3.9], and DAS28 3.4 [2.3; 4.8]. The median BASDAI and ASDAS scores also significantly declined from 5.1 [2.5; 7.3] and 3.35 [2.3; 4.2] to 3.45 [2.15; 6.15] and 2.7 [1.8; 3.35], respectively. The median area of psoriatic skin lesions (body surface area (BSA)) significantly reduced from 2 [0.35; 6] to 1 [0.2; 2]. At 26 weeks after starting AP therapy, the low activity/remission according to DAPSA, DAS, and DAS28 was achieved by 20/10%, 20/15%, and 10/35% of patients, respectively. Three (15%) patients achieved MDA. Fifteen (75%) of the 20 patients completed an AP therapy course. In the period of 14 to 26 weeks, four patients dropped out of the study due to ineffective therapy and one because of a severe AE (pneumonia at 14 weeks of treatment); at 26 weeks, another patient was withdrawn due to lack of effect. At 14 weeks, ten patients had a moderate AE that did not required treatment discontinuation. The most common AE were diarrhea in 5 (25%) patients, headache in 4 (20%), nausea in 3 (15%), and insomnia in 3 (15%).Conclusion. AP is a safe and effective drug for the treatment of PsA patients with moderate and high inflammatory activity and various comorbidities that do not allow the use of conventional DMARDs.

EFFICACY AND SAFETY OF TOFACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS IN REAL CLINICAL PRACTICE

2020 ◽  
Vol 58 (3) ◽  
pp. 268-275
Author(s):  
E. Yu. Loginova ◽  
Yu. L. Korsakova ◽  
E. E. Gubar ◽  
P. L. Karpova ◽  
T. V. Korotaeva
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Clinical Manifestations ◽  
Activity Score ◽  
Tender Joint Count ◽  
Efficacy And Safety ◽  
Low Disease Activity ◽  
Number Of Patients

Objective: to evaluate the clinical efficacy and safety of the targeted synthetic disease-modifying anti-rheumatic drug (DMARD) tofacitinib (TOFA; Yakvinus®) in patients with active psoriatic arthritis (PsA) at 12 and 24 weeks after starting treatment. To define the place of TOFA in the therapy of PsA patients. Subjects and methods. Examinations were made in 41 patients (17 men and 24 women) with active PsA and an insufficient response to previous treatment with synthetic DMARDs and/or biological agents (BA). Before starting therapy, the median disease activity for psoriatic arthritis (DAPSA) and disease activity score (DAS28) were 44.2 [37.8; 55.3] and 5.5 [4.7; 6.1], respectively. TOFA tablets were prescribed at a dose of 5 mg twice daily for 24 weeks with possible dose escalation to 10 mg twice daily after 12 weeks. At the beginning of the investigation, at 12 and 24 weeks, the investigators assessed disease activity and TOFA therapy efficiency of according to DAPSA, DAS28 and minimal disease activity (MDA) criteria: tender joint count ≤1, swollen joint count ≤1, a psoriasis area severity index (PASI) ≤1 or body surface area (BSA) ≤3%, pain intensity ≤15 mm, patient global assessment ≤20 mm, Health Assessment Questionnaire (HAQ) ≤0.5, and enthesitis ≤1. They also determined the number of patients who had achieved remission (DAPSA ≤4, DAS28 score <2.6), low disease activity (DAPSA 5-14, ≤2.6, DAS28 <3.2) or MDA (5 out of the 7 criteria) during TOFA therapy at 24-week follow-up. The safety of therapy was evaluated by analyzing the drug-induced adverse events (AE): the frequency, severity and time of their occurrence were studied. Results and discussion. At 24 weeks after initiation of TOFA therapy, there was a significant decrease of median DAPSA and DAS28 values as compared to baseline, to 11 [4.3; 17.3] and 2.6 [1.7; 3.4] respectively. The median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) also significantly decreased from 6 [4.2; 7] and 3.8 [2.8; 4.4] to 1.4 [0.6; 3.2] and 1.5 [1; 2.1] respectively. The median BSA was significantly reduced from 3 [1; 5] to 0.5 [0.1; 2]. At 24 weeks after initiation of TOFA therapy, DAPSA and DAS28 low disease activity/remission were achieved by 38.5/23.1% and 17.9/53.9% of patients, respectively. Fifteen (38.5%) patients achieved MDA. 38 (92.7%) of the 41 patients completed a full TOFA therapy cycle. Two patients dropped out of the investigation due to ineffective therapy and one due to AE (diarrhea occurring up to 10 times daily, headache, elevated blood pressure, and lacrimation). At 24 weeks, 14 (34.2%) patients reported to have AE. The most common AE noted in 7 (17.1%) patients were infections: acute respiratory viral infection (n=3), fever (n=2), and folliculitis (n=2). In addition, two patients had diarrhea and two had headache. Conclusion. TOFA is an effective drug for the treatment of PsA patients with moderate or high inflammatory activity, has a significant effect on all clinical manifestations of PsA and has a satisfactory safety profile.

scholarly journals Comparison of Different Remission and Low Disease Definitions in Psoriatic Arthritis and Evaluation of Their Prognostic Value

2018 ◽  
Vol 46 (2) ◽  
pp. 160-165 ◽  
Author(s):  
Laura C. Coates ◽  
Alice B. Gottlieb ◽  
Joseph F. Merola ◽  
Caroline Boone ◽  
Annette Szumski ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Residual Disease ◽  
Activity Index ◽  
Skin Lesions ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Clinical Trial Registration ◽  
Low Disease Activity ◽  
Link Type

Objective.There is no agreement on the optimal definitions for assessing disease state in patients with psoriatic arthritis (PsA), and some of the commonly used definitions do not include assessment of skin lesions. We investigated the performance of various definitions in patients with PsA and psoriasis.Methods.This was a posthoc analysis of data from the PRESTA study. The remission definitions analyzed were very low disease activity (VLDA) index, defined as 7/7 of the minimal disease activity (MDA) cutoffs; Disease Activity Index for PsA (DAPSA); and clinical (c-) DAPSA. The low disease activity (LDA) definitions analyzed were as follows: MDA defined as 5/7 cutoffs; MDA joint with both the tender joint count (TJC) and swollen joint count (SJC) cutoffs mandated; MDA skin where skin cutoff was mandated; MDA joint + skin where TJC, SJC, and skin cutoffs were mandated; DAPSA LDA; and cDAPSA LDA.Results.At Week 24, the proportions of patients achieving VLDA, DAPSA, and cDAPSA remission were 10%, 35%, and 37%, respectively. Of the patients achieving DAPSA and cDAPSA remission, 55% and 56%, respectively, had Psoriasis Area and Severity Index > 1. The proportions of patients achieving MDA 5/7, MDA skin, MDA joint, and MDA joint + skin were 44%, 19%, 36%, and 14%, respectively, versus 70% achieving DAPSA and cDAPSA LDA. Notable residual levels of psoriasis were observed in patients achieving the definitions that did not require skin disease control.Conclusion.VLDA and MDA definitions are more stringent than DAPSA and cDAPSA definitions for the assessment of PsA. The relevance of residual disease to patients, however, remains to be determined. [Clinical Trial registration:ClinicalTrials.govNCT00245960]

Significance of Clinical Evaluation of the Metacarpophalangeal Joint in Relation to Synovial/Bone Pathology in Rheumatoid and Psoriatic Arthritis Detected by Magnetic Resonance Imaging

2009 ◽  
Vol 36 (12) ◽  
pp. 2751-2757 ◽  
Author(s):  
MILLICENT A. STONE ◽  
LAWRENCE M. WHITE ◽  
DAFNA D. GLADMAN ◽  
ROBERT D. INMAN ◽  
SAM CHAYA ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Psoriatic Arthritis ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Joint Line ◽  
Tender Joint Count ◽  
Kappa Statistics ◽  
Resonance Imaging ◽  
Tender Joint ◽  
Joint Line Tenderness

Objective.Rheumatologists base many clinical decisions regarding the management of inflammatory joint diseases on joint counts performed at clinic. We investigated the reliability and accuracy of physically examining the metacarpophalangeal (MCP) joints to detect inflammatory synovitis using magnetic resonance imaging (MRI) as the gold standard.Methods.MCP joints 2 to 5 in both hands of 5 patients with rheumatoid arthritis (RA) and 5 with psoriatic arthritis (PsA) were assessed by 5 independent examiners for joint-line swelling (visually and by palpation); joint-line tenderness by palpation (tender joint count, TJC) and stress pain; and by MRI (1.5 Tesla superconducting magnet). Interrater reliability was assessed using kappa statistics, and agreement between examination and corresponding MRI assessment was assessed by Fisher’s exact tests (p < 0.05 considered statistically significant).Results.Interrater agreement was highest for visual assessment of swelling (κ = 0.55–0.63), slight-fair for assessment of swelling by palpation (κ = 0.19–0.41), and moderate (κ = 0.41–0.58) for assessment of joint tenderness. In patients with RA, TJC, stress pain, and visual swelling assessment were strongly associated with MRI evaluation of synovitis. Visual swelling assessment demonstrated high specificity (> 0.8) and positive predictive value (= 0.8). For PsA, significant associations exist between TJC and MRI synovitis scores (p < 0.01) and stress pain and MRI edema scores (p < 0.04). Assessment of swelling by palpation was not significantly associated with synovitis or edema as determined by MRI in RA or PsA (p = 0.54–1.0).Conclusion.In inflammatory arthritis, disease activity in MCP joints can be reliably assessed at the bedside by examining for joint-line tenderness (TJC) and visual inspection for swelling. Clinical assessment may have to be complemented by other methods for evaluating disease activity in the joint, such as MRI, particularly in patients with PsA.

scholarly journals AB0226 EVALUATION OF RITUXIMAB EFFICACY WITH VARIOUS COMPOSITE MEASURES OF INFLAMMATORY ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1139.1-1139
Author(s):  
Y. Olyunin ◽  
D. Kusevich ◽  
E. Nasonov
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
High Activity ◽  
Inflammatory Activity ◽  
Tender Joint Count ◽  
Control Group ◽  
Tender Joint ◽  
Composite Indices ◽  
Number Of Patients ◽  
Target Activity

Background:Disease modifying anti-rheumatic drugs (DMARD) can provide an unbalanced effect on individual components of the inflammatory process, which in some cases leads to an insufficiently correct assessment of the patient’s status when using composite activity indices [1].Objectives:To compare the results of the rituximab (RTX) efficacy assessment in patients with rheumatoid arthritis (RA) using different composite indices of disease activity.Methods:Patients with active RA observed in 23 medical centers of the Russian Federation were included. They were randomized into 2 groups in a 2:1 ratio. In the main group methotrexate (MTX) was prescribed at 15 mg per week and RTX infusions 600 mg on days 1 and 15. Patients in the control group received MTX 15 mg per week and placebo on days 1 and 15. If after 15 weeks 20% reduction of tender joint count (TJC) and swollen joint count (SJC) was not achieved, another DMARD was prescribed.Results:159 RA patients (131 women and 18 men) were included. The mean age of patients was 51.4±11.8 years, the median duration of RA – 2.8 [0.6; 5.8] years. At baseline DAS28, SDAI and CDAI in all cases assessed disease activity as high. 6 months after RTX administration DAS28 showed remission in 9%, low, moderate and high activity activity in 7%, 47% and 37% of cases, SDAI – in 7%, 12%, 34% and 47%, CDAI – in 7%, 11%, 30% and 52%, respectively. In the control group remission, low, moderate and high activity by DAS28 were revealed in 2%, 2%, 38% and 58%, by SDAI – in 2%, 4%, 35%, 59%, by CDAI – in 2%, 6%, 29%, 63% of patients respectively. After 6 months, in patients achieved the treatment target (remission or low activity) according to DAS28, SJC in 12 cases was 0, in 3 – 1 and in 1 – 2. TJC was 0 in 9 cases and in 7 patients ranged from 1 to 14. The level of C-reactive protein (CRP) in 14 cases was within the normal range and in 2 – increased. Erythrocyte sedimentation rate (ESR) was normal in all cases. SDAI after 6 months showed the target activity in 18 patients treated with RTX. In 12 of them the SJC was 0, in 4 – 1 and in 2 – 2. In 9 cases TJC was 0, in the rest patients it varied from 2 to 5. The level of CRP was normal in 15 patients, ESR – in all patients. CDAI met the target activity in 17 patients. In 12 of them, SJC was 0, in 3 – 1, in 2 – 2. The level of CRP was normal in 14, ESR – in all patients.Conclusion:Assessment of RTX efficacy with DAS28, SDAI, and CDAI in RA provided comparable number of patients who achieved remission or low disease activity 6 months after administration of the drug. The groups of patients who reached this target level of activity by DAS28, SDAI, and CDAI did not have significant differences in the values of main measures characterizing residual inflammatory activity, including SJC, TJC, ESR, and CRP.References:[1]Bastida C, Soy D, Ruiz-Esquide V, Sanmartí R, et al. Br J Clin Pharmacol. 2019 Aug;85(8):1710-1718.Disclosure of Interests:None declared

The Risk of Developing Diabetes Mellitus in Patients with Psoriatic Arthritis: A Cohort Study

2017 ◽  
Vol 44 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Lihi Eder ◽  
Vinod Chandran ◽  
Richard Cook ◽  
Dafna D. Gladman
Keyword(s):  
Diabetes Mellitus ◽  
Psoriatic Arthritis ◽  
General Population ◽  
Disease Activity ◽  
Proportional Hazards ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Tender Joint Count ◽  
Event Analysis ◽  
Tender Joint

Objective.To estimate the prevalence of diabetes mellitus (DM) in patients with psoriatic arthritis (PsA) in comparison with the general population and to assess whether the level of disease activity over time predicts the development of DM in these patients.Methods.A cohort analysis was conducted in patients followed in a large PsA clinic from 1978 to 2014. The prevalence of DM in the patients was compared with the general population of Ontario, Canada, and the age-standardized prevalence ratio (SPR) was calculated. For the assessment of risk factors for DM, time-weighted arithmetic mean (AM) levels of PsA-related disease activity measures were assessed as predictors for the development of DM. Multivariable Cox proportional hazards models were used to compute HR for incident DM after controlling for potential confounders.Results.A total of 1305 patients were included in the analysis. The SPR of DM in PsA compared with the general population in Ontario was 1.43 (p = 0.002). Of the 1065 patients who were included in the time-to-event analysis, 73 patients were observed to develop DM. Based on multivariable analyses, AM tender joint count (HR 1.53, 95% CI 1.08–2.18, p = 0.02) and AM erythrocyte sedimentation rate (HR 1.21, 95% CI 1.03–1.41, p = 0.02) predicted the development of DM.Conclusion.The prevalence of DM is higher in patients with PsA compared with the general population. Patients with elevated levels of disease activity are at higher risk of developing DM.

scholarly journals Sex-Specific Differences and How to Handle Them in Early Psoriatic Arthritis

2021 ◽  
Author(s):  
Evangelia Passia ◽  
Marijn Vis ◽  
Laura Coates ◽  
Anuska Soni ◽  
Ilja Tchetverikov ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Functional Capacity ◽  
Cohort Analysis ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Duration Of Symptoms ◽  
Early Psoriatic Arthritis

Abstract Objectives:The prevalence of Psoriatic Arthritis (PsA) is the same in men and women, however, the latter experience a higher burden of disease and are affected more frequently by polyarthritis. Here, we performed an early PsA cohort analysis to assess sex-related differences in demographics, disease characteristics and evolution over 1 year including applied treatment strategies. Methods:Our study is embedded in the Dutch south-west Early Psoriatic Arthritis cohoRt. We described patient characteristics and treatment decisions. For the comparison across sexes and baseline and 1 year follow up, appropriate tests depending on the distribution were used. Results:273 men and 294 women with no significant differences in age and ethnicity were included. Women reported significantly longer duration of symptoms before diagnosis and significantly higher tender joint count, a higher disease activity, higher levels of pain and lower functional capacity. Although minimal disease activity (MDA) rates increased over time for both sexes, MDA remained significantly more prevalent among men at one year (58.1% vs 35.7%, p<0.00). Initially, treatment strategies were similar in both sexes with Methotrexate being the most frequently used drug during the first year. Women received Methotrexate for a shorter period [196(93-364) vs 306(157-365), p<0.00] and therefore received a lower cumulative dose compared to men. Retention time was shorter for all DMARDs and women had a delayed start on b-DMARDs. Conclusion:After 1 year of standard-of-care treatment women didn’t surpass their baseline disadvantages. Despite the overall improvement, they still presented higher disease activity, higher levels of pain and lower functional capacity score than men. The nature of these findings may advocate a need for sex specific adjustment of treatment strategies and evaluation in early PsA patients.

scholarly journals Influence of IL-6 and TNF-α on clinical manifestations, activity and comorbidity in a group of patients with psoriatic arthritis

2020 ◽  
Author(s):  
Carlos Montilla ◽  
Gómez-Lechón Luis ◽  
Esther Toledano ◽  
Elisa Acosta ◽  
Olga Compán ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Clinical Manifestations ◽  
Tender Joint Count ◽  
Hla B27 ◽  
Tender Joint ◽  
Cross Sectional ◽  
Tnf Α ◽  
Biologic Dmard ◽  
Clinical Variants

Abstract Objectives To relate the levels of IL-6 and TNF-α in patients with psoriatic arthritis (PsA) with the clinical variants, the disease activity and the presence of comorbidities. Methods Cross-sectional observational study that included 184 patients with PsA according to CASPAR criteria. IL-6 and TNF-α levels were determined. As clinical variables, the clinical form (peripheral, axial or mixed), the presence of dactylitis, the severity of psoriasis measured by PASI and HLA-B27 were determined. Disease activity was measured by the tender joint count, swollen joint count, entheses affected, the severity of psoriasis measured by PASI, ESR, and CRP. The minimum disease activity (MDA) was also measured. Cardiovascular risk markers such as waist /hip ratio (w/ h) and analytical variables: apolipoprotein A, apolipoprotein B, lipoprotein a, insulin, insulin resistance (HOMA-R) and microalbuminuria in urine 24 hours (MA) were included in comorbidity. The presence of fatty liver was measured by ultrasound and fatigue by the FACIT-F questionnaire. Results The mean age of the patients was 55.12 years (SD: 11.29). One hundred and one were men (54.89%). 14.67% of the patients were on treatment with biologic DMARD (bDMARD). One hundred and two patients had peripheral involvement (55.43%), 69 mixed (37.5%) and 13 (7.07%) exclusively axial. 17.93% of the patients had a positive HLA-B27. 53.26% of the patients achieved a MDA. In the analysis of IL-6, we found a correlation with CRP (R: 0.32; P = 0.001), in addition, in patients with positive HLA-B27 we found lower concentrations of IL-6 (3.25 + 2, 26 Vs 5.81 + 7.23) -p < 0.001). We found no association with other variables related to inflammatory activity and / or comorbidity. TNF-α concentrations were higher in patients receiving TNF-α inhibitors ((178.89 SD: 181.31 vs 10.42 SD: 11.15; P < 0.001). Excluding these patients, we only found a correlation with the MA (R: 0.39; p < 0.001). Conclusions In our patients, the presence of HLA-B27 influenced IL-6 concentrations. TNF-α could be considered as a marker of subclinical renal damage.

scholarly journals Application and Modifications of Minimal Disease Activity Measures for Patients with Psoriatic Arthritis Treated with Adalimumab: Subanalyses of ADEPT

2013 ◽  
Vol 40 (5) ◽  
pp. 647-652 ◽  
Author(s):  
Philip J. Mease ◽  
Michele Heckaman ◽  
Sonja Kary ◽  
Hartmut Kupper
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Global Assessment ◽  
Health Assessment ◽  
Severity Index ◽  
Tender Joint Count ◽  
Physician Global Assessment ◽  
Minimal Disease Activity ◽  
Tender Joint ◽  
Minimal Disease

Objective.This posthoc analysis evaluated the percentage of patients with psoriatic arthritis (PsA) who achieved minimal disease activity (MDA) and compared the results with a modified MDA substituting the physician global assessment (PGA) for the Psoriasis Activity and Severity Index (PASI) using data from the ADalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT; NCT00646386).Methods.Patients with active PsA were randomized to receive adalimumab 40 mg or placebo every other week for 24 weeks. MDA was defined as achieving ≥ 5 of the following criteria: tender joint count ≤ 1; swollen joint count ≤ 1; PASI ≤ 1 or body surface area ≤ 3%; patient pain score ≤ 15 [1–100 mm visual analog scale (VAS)]; patient global assessment (PGA) of disease activity ≤ 20 (1–100 mm VAS); Health Assessment Questionnaire ≤ 0.5; and tender entheseal points ≤ 1 (only heels assessed). For modification of the MDA, PASI ≤ 1 was substituted with PGA “Clear” as MDAPGA1 and PGA “Clear” or “Almost clear” as MDAPGA2.Results.Sixty-seven patients were treated with adalimumab and 69 with placebo. At Week 24, MDA, MDAPGA1, and MDAPGA2 were achieved by 39%, 37%, and 39%, respectively, of patients treated with adalimumab versus 7%, 5%, and 8% of patients on placebo (p < 0.001). Kappa coefficients indicated good agreement between PASI and PGA at Week 24.Conclusion.ADEPT results indicated that significantly more patients treated with adalimumab achieved MDA by Week 24 compared with placebo. Modification of the MDA by replacing PASI ≤ 1 with PGA assessments did not alter the results, which may improve feasibility of practical use of the index.

Measuring disease activity in psoriatic arthritis: PASDAS implementation in a tightly monitored cohort reveals residual disease burden

Rheumatology ◽  
2020 ◽  
Author(s):  
Michelle L M Mulder ◽  
Tamara W van Hal ◽  
Frank H J van den Hoogen ◽  
Elke M  G  J   de Jong ◽  
Johanna E Vriezekolk ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Disease Burden ◽  
Residual Disease ◽  
Clinical Care ◽  
Cross Sectional Study ◽  
Inflammatory Back Pain ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Cross Sectional

Abstract Objectives We aimed to investigate the disease activity and overall disease burden of (subgroups of) patients with PsA using the Psoriatic Arthritis Disease Activity Score (PASDAS) in an already tightly monitored cohort. Methods This is a cross-sectional study evaluating data from the first visit of 855 PsA patients after implementation of the PASDAS in our tightly monitored cohort [e.g. DAS 28 (DAS28) was provided as an anchor]. Differences in clinical outcomes between subgroups of patients using established cut-offs for disease activity status [i.e. very low (VLDA), low (LDA), moderate (MDA), and high disease activity (HDA)] were examined. Results Based on the PASDAS, 53.1% of patients were in VLDA/LDA. 29.5% of patients had ≥1 swollen joint, 20.6% had ≥1 enthesitis index point and 3.0% had active dactylitis. Based on DAS28, 77.5% of the patients were in VLDA/LDA. Patients reaching both DAS28 VLDA/LDA status and PASDAS VLDA/LDA status [N = 445 (52.0%)] were compared with patients reaching only DAS28 VLDA/LDA status [N = 218 (25.5%)]. For these latter patients, significantly worse scores on separate parameters were found in measures used for PASDAS/DAS28 calculation (e.g. swollen and tender joint count and patient’s visual analogue scale global disease activity) as well as other disease measures (e.g. function and inflammatory back pain). This result remained, even when the stricter VLDA cut-off was used for the DAS28. Conclusion PASDAS implementation uncovered relevant residual disease activity in a quarter of patients previously assessed as being in DAS28 VLDA/LDA, underscoring the potential value of PASDAS measurements in PsA clinical care.

scholarly journals Use of a multidimensional RAPID3 questionnaire to assess the achievement of remission and minimal disease activity in patients with early psoriatic arthritis treated according to Treat-to-target strategy

2019 ◽  
Vol 56 (6) ◽  
pp. 739-745
Author(s):  
E. Yu. Loginova ◽  
T. V. Korotaeva ◽  
A. D. Koltakova
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Combined Therapy ◽  
Treat To Target ◽  
Tender Joint Count ◽  
Minimal Disease Activity ◽  
Open Label ◽  
Number Of Patients ◽  
Minimal Disease ◽  
Target Strategy

The current Treat-to-target (T2T) strategy in the management of patients with psoriatic arthritis (PsA) is based on strict control over the dynamics of a patient's status and timely correction of therapy according to the presence or absence of remission or minimal disease activity (MDA) within 6 months after treatment initiation. The multidimensional RAPID3 questionnaire based on the patient's own opinion of his/her health status, has demonstrated its high effectiveness in assessing remission in patients with rheumatoid arthritis (RA). The possibilities of using the RAPID3 questionnaire in patients with early PsA (ePsA) with T2T strategy have not yet been studied.Objective: to investigate whether the multi-dimensional RAPID3 questionnaire may be used to assess the achievement of remission and MDA in ePsA patients with a T2T (Treat-to-target) strategySubjects and methods. The investigation enrolled 61 patients (29 men and 32 women) with ePsA meeting the 2006 CASPAR criteria; the mean age of the patients was 37±10.6 years; the duration of PsA and psoriasis was 11.3±10.2 and 75.4±80.9 months, respectively. The patients were followed up for 12 months during the open-label REMARCA study performed by the T2T principles. At baseline, all the patients were given methotrexate (MTX; Methoject) subcutaneously at a dose of 10 mg/week, with escalation by 5 mg every 2 weeks up to 20–25 mg/week. If there was no low disease activity (LDA), DAS28/DAS remission, or MDA after 3 months, the patients received combined therapy with MTX 20–25 mg/week and adalimumab (ADA) or ustekinumab (UST) at standard doses. All the patients underwent standard rheumatologic examination before therapy and every 3 months. The investigators calculated tender joint count (TJC) among 78 joints; swollen joint count (SJC) among 76 joints, the Ritchie articular index, and the number of entheses by the Leeds Enthesitis index (LEI). Joint pain measurement, patient (PGA) and physician (PhGA) global assessment on visual analog scale (VAS) was performed, the serum level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were evaluated. DAS and DAS28, HAQ and RAPID3 functional index were estimated. The number of patients achieving LDA, DAS/DAS28 remission, and MDA were determined. Results and discussion. At 1 year of therapy, 36 (59%) out of the 61 patients and 25 (41%) out of the 61 patients were treated with MTX and this drug in combination with ADA or UST, respectively. After 1 year of treatment, the whole group displayed a significant improvement of all PsA activity parameters as compared with baseline values: DAS, 3.93 [3.20; 4.58] / 1.36 [0.82; 2.25], SJC, 7 [5; 11] / 1 [0; 3], TJC, 8 [6; 1] / 1 [0; 3], PhGA, 56 [48; 69] / 10 [5; 20] and VAS pain, 54 [48; 68] / 11 [1; 20], PGA, 55 [49; 68] / 14 [7; 24], HAQ, 0.75 [0.50; 1] / 0 [0; 0.63], respectively. There was a significant correlation of RAPID3 with PsA activity and CRP. MDA was seen in 43 (70.5%) out of the 61 patients. Among the patients who had achieved MDA, the RAPID3 values corresponded to remission, but were significantly higher in the patients who had not attained MDA: 2.5 [1.3; 5.3] and 8.1 [6.0; 15.1], respectively. RAPID3 demonstrated high sensitivity in assessing the achievement of remission, LDA, and MDA in patients with ePsA.Conclusion. RAPID3 based on a patient's personal opinion of his/her disease is a simple and reliable tool to assess the disease activity in patients with ePsA and to monitor the efficiency of therapy with a T2T strategy and may be really useful in practice.

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