Background/Purpose: Psoriatic arthritis (PsA) is a complex rheumatic disease with severity that ranges from mild to severe. The mild form of PsA can be referred to as oligoarticular (OLIGO), whereas more severe cases are considered polyarticular (POLY) form. Furthermore, peripheral joint and axial involvement are also recognized in PsA. This analysis examined OLIGO vs. POLY differences and presence of axial involvement at initiation of golimumab (GLM) for the treatment of PsA in a Canadian routine clinical practice setting.

Methods: Biologic Treatment Registry Across Canada (BioTRAC) is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis, ankylosing spondylitis, or PsA with Infliximab, GLM, or ustekinumab for PsA. PsA patients treated with GLM who were enrolled since 2010 were eligible for the analysis. OLIGO involvement was defined as (≤2 SJC) and POLY (>2 SJC), while axial involvement included spinal symptoms or spondylitis with peripheral arthritis. Minimal disease activity (MDA) was defined as the fulfillment of ≥5 of the following criteria: TJC28≤1, SJC28≤1, PASI≤1 or BSA≤3, Pain (VAS)≤15mm, PtGA (VAS)≤20mm, HAQ ≤0.5, tender entheseal points ≤1.

Results: A total of 201 PsA patients were included in this analysis; 30.8% had oligoarthritis, 68.0% had polyarthritis, while 26.0% had axial involvement at baseline. Baseline parameters are described by axial involvement and articular involvement (Table 1). Increased baseline disease activity was observed among patients with axial involvement for MDGA, PtGA, pain, and presence of enthesitis (p<0.05). Patients with polyarthritis were older, less likely to have been previously treated with a biologic, and had significantly (p<0.05) higher SJC28, TJC28, morning stiffness, MDGA, PtGA, pain, DAS28, HAQ, and enthesitis at GLM initiation. At 6 months, statistically significant between group differences were observed for MDA achievement. There were significantly lower proportions of patients achieving MDA among patients with axial involvement (26.7% vs. 61.8%, p=0.020) and polyarthritis (35.9% vs. 80.0%, p<0.001). Multivariate logistic regression analysis showed that patients with oligoarticular involvement (OR=3.92; p=0.035), younger age (OR=0.96; p=0.051), and lower baseline HAQ (OR=0.32; p=0.007) were associated with higher odds of MDA achievement at 6 months of treatment while axial involvement did not have a significant impact.

Conclusion:  The results of the current analysis highlight that differences exist in the baseline patient profile based on the presence or absence of axial involvement and POLY involvement among PsA patients treated with GLM. Furthermore, OLIGO disease was identified as a significant independent predictor of MDA achievement with almost a four-fold higher likelihood of achieving target relative to patients with polyarthritis.

Table 1: Patient Characteristics and Disease Parameters at Baseline by Axial and Articular Involvement Axial Involvement Articular Involvement Parameter Mean (SD) / % Yes No p-Value Olgioarthritis Polyarthritis p-value Age: Years 47.8 (13.8) 52.1 (13.3) 0.096 47.4 (11.9) 53.8 (12.7) 0.001 Disease Duration: years 7.0 (8.2) 5.6 (7.4) 0.592 5.2 (7.3) 5.7 (6.9) 0.668 Prior Biologic 5.1% 2.7% 0.605 12.9% 3.0% 0.020 Concomitant DMARDs 76.9% 79.0% 0.821 77.6% 80.8% 0.695 Concomitant MTX 71.8% 57.1% 0.126 63.8% 64.6% >0.999 Concomitant NSAIDS 38.5% 49.5% 0.266 43.5% 48.5% 0.541 ESR: mm/hr 13.7 (10.6) 19.3 (19.0) 0.372 15.1 (15.3) 18.9 (17.5) 0.153 SJC28 6.2(4.4) 5.0(4.5) 0.102 0.9(0.8) 7.3(3.5) <0.001 TJC28 9.1(7.6) 6.9(6.6) 0.142 2.4(2.7) 9.5(6.8) <0.001 Morning stiffness:min 47.9(45.1) 32.3(38.8) 0.064 27.0 (35.4) 42.3(43.2) 0.009 Physician Global (MDGA): NRS 0-10 5.8 (2.0) 4.9(2.0) 0.035 3.9 (1.9) 5.8 (1.8) <0.001 Patient Global (PtGA): VAS mm 61.3(25.7) 51.3(25.1) 0.022 39.6(26.7) 59.4(22.7) <0.001 Pain 59.5(23.5) 48.9(24.4) 0.016 35.3(25.6) 59.6(21.1) <0.001 DAS28 4.5(1.3) 4.3(1.5) 0.490 2.9(1.1) 4.9(1.2) <0.001 PASI 2.3(3.6) 2.5(5.1) 0.424 1.7(2.4) 2.5(5.1) 0.227 HAQ 1.2(0.6) 1.0(0.7) 0.110 0.7 (0.7) 1.2(0.6) <0.001 Dactylitis 41.0% 35.6% 0.565 31.3% 38.3% 0.462 Enthesitis 56.4% 29.7% 0.004 22.6% 37.9% 0.049 Nail Pitting 38.5% 23.8% 0.096 27.1% 25.8% >0.999

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/articular-and-axial-involvement-differences-in-psoriatic-arthritis-patients-treated-with-golimumab-in-canadian-real-world-practice/