Are There Clinical Demographic or Subclinical Ultrasonographic Data That Can Predict Flare in Psoriatic Arthritis Patients during a Phase of Minimal Disease Activity after Spacing of Anti-TNF Blockers Injections?

Pierluigi Macchioni¹, Giovanni Ciancio², Gilda Sandri³, Alen Zabotti⁴, Luca Montaguti⁵, Gentiana Vukatana⁶, Fabio Mascella⁷, Donatella Chessa⁸, Elisa Verduci⁹, Marcello Govoni¹⁰, Amelia Spinella³, Francesca Zuliani¹¹, Marco Bruschi⁵, Nazzarena Malavolta¹² and Mariacristina Focherini⁷, ¹Rheumatology Unit, Arcispedale S Maria Nuova, IRCCS, Reggio Emilia, Italy, ²Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria Sant’Anna - Ferrara (Italy), ferrara, Italy, ³Rheumatology Unit, University fo Modena & Reggio, Modena, Italy, ⁴Rheumatology Clinic, Department of Medical and Biological Sciences, Santa Maria della Misericordia" University Hospital, Udine, Italy, ⁵Dipartimento Internistico SS di Reumatologia, AUSL Romagna Ospedale Bufalini, Cesena, Italy, ⁶Rheumatology Unit, Department CardioThoracic Vascular, S.Orsola- Malpighi Hospital, Alma Mater Studiorum, Bologna, Bologna, Italy, ⁷Internal Medicine and Rheumatology, Ospedale Infermi Rimini, Rimini, Italy, ⁸Internal Medicine, Ospedale Paolo Dettori, Tempio Pausania, Italy, ⁹Rheumatology Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy, ¹⁰Rheumatology Clinic, Department of Medical and Biological Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria Sant’Anna - Ferrara (Italy), ferrara, Italy, ¹¹Rheumatology Unit, Department of Medical Sciences, Santa Maria della Misericordia" University Hospital, Udine, Italy, ¹²Policlinico S.Orsola-Malpighi, Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: anti-TNF therapy, Psoriatic arthritis and ultrasound

Session Information

Date: Sunday, November 5, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Tumour necrosis factor (TNF)-blocker tapering has been proposed for patients with psoriatic arthritis (PA) in clinical remission. To evaluate if there are clinical, demographic and ultrasound (US) data predictive of disease recurrence after spacing of anti-TNF therapy in PA patient during a phase of minimal disease activity (MDA)

Methods:

Patients treated with anti-TNF for at least 12 months and with at least 6 months duration of MDA were consecutively recruited at 6 Italian centers.

In every center, the local rheumatologists provided PA pts to be examined by US. Personal history, demographic and clinical data were recorded. Each patient underwent the following US examinations : metacarpophalangeal (MCP), knee and tibio-tarsal (TT) joint, flexor and extensor tendon of hand digit, flexor and extensor tendon at carpal area, flexor and extensor tendon of foot, and enthesis of common extensor tendon insertion on the lateral epicondyle of the humerus, quadriceps tendon, patellar tendon, Achilles tendon and plantar fascia insertions on the calcaneus.. Each examination were performed by rheumatologists expert in US, to assess synovitis (joint effusion, synovial proliferation, and power Doppler (PD) signal), and bone erosions, flexor tendon tensynovitis, ext tendon tenonitis, and enthesel involvement using an Esaote MyLabClass with a 5-13 or 6-18 MHz linear probe. US examinators were blind of clinical data of the pts. After the clinical and US examination patients increased the interval between the anti-TNF administration according to a common protocol. The patients were clinically evaluated at three month interval for the maintenance of a state of MDA. Baseline clinical and US data were compared between the group of patients still in MDA at the end of a minimum follow-up period of 6 month vs the group of patient with disease recurrence.

Results:

Sixty-three pts were recruited (mean age 53+13y, mean PA duration 13+8y, mean. MDA duration 21+11m). At the end of follow-up period 5 patient were lost, 47 (81%) maintained a state of MDA and 11 (19%) had recurrence. At baseline US examination 66.7 % of pts had at least one peripheral joint involved (17.5 % had peripheral active synovitis), 47.6% had acute enthesitis and 95.2% chronic enthesopathy. US bursitis was present in 22.2% of pts, 3.7% had hand extensor finger tendon involvement. No significant difference in any US and demographic data were present between the group in persistent MDA vs the recurred group. Patients with baseline Maastricht enthesis index (MEI) > 0 had higher risk of recurrences as compared with the group with MEI = 0 (36% vs 10%, p = 0.034).

Conclusion:

The presence of joint, entheseal and tendon abnormalities at US examination are not predictive of disease recurrence after anti-TNF spacing in PA patients in MDA. Only a value of MEI > 0 is significanly correlated to recurrence.

/span>

Disclosure: P. Macchioni, None; G. Ciancio, None; G. Sandri, None; A. Zabotti, None; L. Montaguti, None; G. Vukatana, None; F. Mascella, None; D. Chessa, None; E. Verduci, None; M. Govoni, None; A. Spinella, None; F. Zuliani, None; M. Bruschi, None; N. Malavolta, None; M. Focherini, None.

To cite this abstract in AMA style:

Macchioni P, Ciancio G, Sandri G, Zabotti A, Montaguti L, Vukatana G, Mascella F, Chessa D, Verduci E, Govoni M, Spinella A, Zuliani F, Bruschi M, Malavolta N, Focherini M. Are There Clinical Demographic or Subclinical Ultrasonographic Data That Can Predict Flare in Psoriatic Arthritis Patients during a Phase of Minimal Disease Activity after Spacing of Anti-TNF Blockers Injections? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/are-there-clinical-demographic-or-subclinical-ultrasonographic-data-that-can-predict-flare-in-psoriatic-arthritis-patients-during-a-phase-of-minimal-disease-activity-after-spacing-of-anti-tnf-blockers/. Accessed .

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-there-clinical-demographic-or-subclinical-ultrasonographic-data-that-can-predict-flare-in-psoriatic-arthritis-patients-during-a-phase-of-minimal-disease-activity-after-spacing-of-anti-tnf-blockers/