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Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Predicting the course: Real-world trajectories toward minimal disease activity in psoriatic arthritis
Mauro Fatica1, Fabio Massimo Perrotta2, Paola Conigliaro3
1Academic Rheumatology Unit, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy.; Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
Objectives:
To investigate real-world trajectories toward minimal disease activity (MDA) in psoriatic arthritis (PsA) patients starting their first biologic or targeted synthetic DMARD (bDMARD/tsDMARD) and identify baseline predictors of each trajectory.
Methods:
This is a retrospective observational study of 289 patients with PsA (CASPAR criteria) from two Italian tertiary centers (2020-2023), all not in MDA at baseline and with ≥24 months follow-up. MDA status was assessed every 6 months. Patients were categorized into four trajectories based on MDA achievement and maintenance: Super Responders, Delayed Responders, Fluctuating Responders, and Non-Responders. Clinical features and treatment patterns were compared, and multivariable logistic regression identified predictors of trajectory membership.
Results:
Mean age was 52.4 ± 12.3 years, disease duration 7.3 ± 5.1 years, and baseline DAPSA 23.4 ± 11.6. Most patients started TNF-α inhibitors (70.9%), and 60.9% achieved MDA at 24 months. Trajectory distribution was: Super Responders (23.2%), Delayed Responders (21.8%), Fluctuating Responders (37.0%), and Non-Responders (18.0%). Super Responders were predominantly male, with lower baseline disease activity and fewer metabolic comorbidities. Non-Responders were more often female, overweight/obese, and had higher fibromyalgia rates. Predictors of Super Responder status included male sex (OR 2.26) and absence of metabolic comorbidities (OR 2.29); higher baseline DAPSA decreased odds (OR 0.92). Predictors of Non-Responder status were female sex (OR 2.56), fibromyalgia (OR 5.30), and overweight/obesity (OR 2.04). No significant predictors of the other trajectory groups were found.
Conclusions:
Patients with PsA initiating bDMARD/tsDMARDs exhibit diverse disease trajectories. Identified predictors may inform trajectory-based risk stratification and optimize treat-to-target approaches.
Insights
Psoriatic arthritis patients show varied responses to first-line biologic or targeted synthetic DMARDs. Baseline factors like sex, weight, and comorbidities predict achieving minimal disease activity, aiding personalized treatment.
Area of Science:
- Rheumatology
- Clinical Immunology
- Pharmacology
Background:
- Psoriatic arthritis (PsA) management aims for minimal disease activity (MDA).
- Real-world data on treatment trajectories for PsA patients initiating their first biologic or targeted synthetic DMARD (bDMARD/tsDMARD) is crucial.
- Understanding predictors of different treatment responses can optimize patient care.
Purpose of the Study:
- To analyze real-world trajectories toward MDA in PsA patients starting their first bDMARD/tsDMARD.
- To identify baseline predictors associated with distinct MDA achievement and maintenance trajectories.
Main Methods:
- Retrospective observational study of 289 PsA patients from two Italian centers (2020-2023).
- Patients had no MDA at baseline and ≥24 months follow-up, with MDA assessed every 6 months.
- Four trajectories defined: Super, Delayed, Fluctuating, and Non-Responders; multivariable logistic regression used for predictor identification.
Main Results:
- 60.9% of patients achieved MDA by 24 months; trajectory distribution: Super (23.2%), Delayed (21.8%), Fluctuating (37.0%), Non-Responders (18.0%).
- Super Responders were predominantly male with lower baseline disease activity and fewer metabolic comorbidities.
- Non-Responders were more often female, overweight/obese, and had higher rates of fibromyalgia.
Conclusions:
- PsA patients exhibit diverse disease trajectories when initiating bDMARD/tsDMARD therapy.
- Baseline predictors like sex, metabolic comorbidities, fibromyalgia, and disease activity influence these trajectories.
- These findings can inform risk stratification and enhance treat-to-target strategies in PsA management.
