The following is a summary of “Treat-to-target in real-life psoriatic arthritis patients: achieving minimal disease activity with bDMARDs/tsDMARDs and potential barriers,” published in the October 2023 issue of Arthritis and Rheumatism by Ortolan et al.
For a study, researchers determined to study the frequency of minimal disease activity (MDA) in a real-life psoriatic arthritis (PsA) cohort, to investigate predictors of MDA longitudinally, and to evaluate the frequency and predictors of low disease activity (LDA) in patients with axial involvement (axPsA). Enrolled were consecutive PsA patients receiving stable biological or synthetic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs or tDMARDs) at our center. Disease activity indices, such as MDA and ankylosing spondylitis disease activity score-LDA (ASDAS-LDA) for axPsA, were evaluated at baseline and every 6 months, up to 36 months or discontinuation of bDMARDs or tsDMARDs.
Collecting the patients’ medical history, BMI, and comorbidities, such as osteoarthritis (OA) and fibromyalgia. Patients who attained sustained MDA were compared to those who did not regarding certain variables. Using multivariable generalized estimating equation (GEE) models, predictors of MDA and ASDAS-LDA over time were identified. The data were presented as beta coefficient (95% CI) values. There were 104 patients enrolled, 54% males with a mean age of 55,7 years; 52% had axPsA. 52–61% attained MDA across all evaluations, while 17–24% attained ASDAS-LDA. Less frequently were AxPsA, fibromyalgia, OA, and BMI≥35 observed in patients with sustained MDA.
The GEE model confirmed that the following factors were independently and significantly associated with MDA: age (Beta = -0.05), bDMARDs/tsDMARDs duration (Beta = +0.31), axPsA (Beta = -1.07), fibromyalgia (Beta = -3.35), OA (Beta = -1.87), and BMI≥35 (Beta = -2.53). Age (Beta = -0.01), fibromyalgia (Beta = -2.03), and osteoarthritis (Beta = -1.30) were independently associated with ASDAS-LDA. MDA is a realistically attainable objective. AxPsA represents a challenging subset to manage. Sustained MDA depends on disease characteristics (axPsA) and patient characteristics (e.g., age, duration of bDMARDs or tDMARDs, comorbidities).