Extensive psoriasis, IBD history predict difficult-to-treat psoriatic arthritis
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Key takeaways:
- Up to one in six patients in a large, real-life cohort had difficult-to-treat PsA.
- Predictors of difficult-to-treat disease included extensive psoriasis, higher BMI, IBD history and female gender.
Difficult-to-treat psoriatic arthritis was common in a large, real-life cohort, with key risk factors including extensive psoriasis, higher BMI and a history of inflammatory bowel disease, according to data published in Rheumatology.
“Despite the availability of numerous therapeutic options, many patients with PsA display residual disease activity and fail to achieve remission or at least low disease activity,” Konstantinos D. Vassilakis, PhD, MSc, of the National and Kapodistrian University of Athens, in Greece, and colleagues wrote. “In analogy to rheumatoid arthritis, therefore, the concept of difficult-to-treat PsA has arisen in the literature.”
To assess the characteristics of patients with potentially difficult-to-treat PsA, Vassilakis and colleagues conducted a cross-sectional study using data from a large, multicenter Greek registry. The study included 467 patients with PsA, 16.5% (n = 77) of whom demonstrated what was considered to be difficult-to-treat PsA, seen between January 2022 through December 2022.
Difficult-to-treat PsA was defined as having failed at least one conventional synthetic disease-modifying antirheumatic drug (DMARD) — unless contraindicated — or two biologic/traditional synthetic DMARDs with different mechanisms of action — except apremilast (Otezla, Amgen). Patients also must have had a disease duration of at least 6 months and, at the time of assessment, have at least moderate disease activity and/or not be classified as demonstrating minimal disease activity.
According to the researchers, multivariable regression revealed that patients with difficult-to-treat PsA were more likely to have extensive psoriasis, defined as a body surface area index of 3% of more (OR = 5.05; 95% CI, 2.22-11.47). Those patients also more commonly had greater BMI (OR = 1.07; 95% CI, 1.01-1.13) and had ever demonstrated inflammatory bowel disease (OR = 1.22; 95% CI, 1.25-31.06).
Vassilakis and colleagues also conducted two sensitivity analyses. One analysis was based on patients fitting definitions for moderate disease activity — defined as a score greater than 14 on Disease Activity Index for Psoriatic Arthritis (DAPSA) — while the other was based on those not in minimal disease activity, regardless of DAPSA score. Respectively, those analyses indicated female gender (P = .034) and axial disease (P = .04) as independent variables predicting difficult-to-treat PsA.
“Our exploratory analysis using a large database of patients with PsA, and three different definitions of difficult-to-treat PsA, demonstrated that up to one [in] every six patients has difficult-to-treat PsA in rea-life settings,” Vassilakis and colleagues wrote.
“Certain patient (female gender, obesity) and disease (extensive skin disease, axial involvement, history of IBD) characteristics were associated with its occurrence,” they added. “These findings are of help in the ongoing effort for better defining difficult-to-treat PsA and, more importantly, for designing management strategies to decrease its incidence.”
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