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Published on: March 1, 2024
Prevalence and Predictors of Achieving Sustained Remission in Psoriatic Arthritis: A Swedish Nationwide Registry
Olafur Palsson1, Jon T Einarsson2, Johan K Wallman2
1O. Palsson, MD, Lund University, Department of Clinical Sciences, Section for Rheumatology, Lund and Skåne University Hospital, Lund, Sweden, and Department of Science, Landspitali University Hospital, and Faculty of Medicine, University of Iceland, and Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland.
Objective:
To estimate the prevalence and predictors of sustained remission (SR) in patients with psoriatic arthritis (PsA) receiving biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in Sweden.
Methods:
All patients with PsA initiating b/tsDMARDs and who were registered in the national Swedish Rheumatology Quality Register (SRQ) from April 1999 to December 2019 were included. Data on disease/treatment characteristics at first b/tsDMARD (baseline) initiation and all subsequent visits were extracted from the SRQ. Remission was defined as Disease Activity Score in 28 joints based on C-reactive protein (DAS28-CRP) ≤ 2.6, Disease Activity Index for Psoriatic Arthritis in 28 joints (DAPSA28) ≤ 4 or the physician global assessment of disease activity (PGA) on a scale of 0 to 4 (remission = 0), and SR when these criteria persisted during ≥ 2 consecutive visits for ≥ 6 months. Baseline predictors of SR were explored using logistic regression analysis.
Results:
Data on 4669 patients with PsA with 48,773 visits were available. Eighty-one percent of patients achieved DAS28-CRP remission ever, and 54% achieved SR at least once. The corresponding percentages for DAPSA28 were 46% and 24% and for PGA were 69% and 38% for ever reaching remission and SR, respectively. Male sex was a positive predictor of reaching SR when measured by DAPSA28 and PGA but not by DAS28-CRP. Fewer swollen joints at baseline predicted SR according to all 3 remission criteria.
Conclusion:
A considerable proportion of patients with PsA receiving various b/tsDMARDs never achieved remission, and approximately half never achieved SR in this Swedish nationwide registry study. Fewer swollen joints at first b/tsDMARD initiation increases the likelihood of SR, regardless of remission criteria used. There was still a sex difference when measured with DAPSA28 and PGA, with men being more likely to reach SR.
