High Incidence Of Disease Recurrence After Discontinuation Of Disease Modifying Anti-Rheumatic Drug Treatment In Patients With Psoriatic Arthritis In Remission

Elizabeth Araujo¹, Stephanie Finzel¹, Dominik A. Schreiber², Matthias Englbrecht¹, Axel J. Hueber³, Francesca Faustini³, Juergen Rech³ and Georg Schett¹, ¹Dept of Medicine 3, Rheumatology and Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, ²University of Erlangen-Nuremberg, Erlangen, Germany, ³Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: psoriatic arthritis and remission

Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment III

Session Type: Abstract Submissions (ACR)

Background/Purpose:

In the era of modern anti-rheumatic therapy, it is now possible to contemplate the idea of clinical remission in patients with psoriatic arthritis (PsA). It is however unknown whether patients in clinical remission can stop methotrexate (MTX) or tumor necrosis factor inhibitor (TNFi) treatment. The objective of this study was to investigate drug-free remission in patients with PsA and potential predictors for flare

Methods:

Patients with PsA in remission (no musculoskeletal symptoms, no or minimal skin/nail disease) for at least 6 months were included. At baseline the following parameters were assessed: age, sex, BMI, disease duration, duration of remission, swollen joint count, tender joint count, VAS-pain, VAS-global, NAPSI, PASI, MASES, LDI, HAQ-DI, SF-36, FACIT-F, anti-rheumatic therapy (MTX, TNFi), ESR and CRP. In addition, ultrasound of 30 joints and 20 enthesis was performed. After discontinuation of therapy at day 1, patients were followed for 6 months for the occurrence of flares.

Results:

26 patients (methotrexate monotherapy: N =14, tumor necrosis factor inhibitors: N = 12) with a mean age of 55.2 years, absence of musculoskeletal symptoms and minimal skin disease (mean PASI: 0.21) were enrolled. Incidence of recurrence of disease was high (N=20, 76.9%,) and occurred rapidly (74.50 ± 51.72 days) after treatment discontinuation. Male PsA patients were significantly more likely to lose remission. Long disease duration, more severe skin involvement, and the presence of synovial hypertrophy by ultrasonographic examination at baseline decreased the likelihood for drug-free remission. Re-initiation of DMARDs promptly restored remission in all PsA patients with recurrence of disease.

Conclusion:

This study shows that the chance to reach drug-free remission in PsA patients is low. Discontinuation of DMARD therapy cannot be recommended in patients with PsA.

Disclosure:

E. Araujo,
None;

S. Finzel,
None;

D. A. Schreiber,
None;

M. Englbrecht,
None;

A. J. Hueber,
None;

F. Faustini,
None;

J. Rech,
None;

G. Schett,
None.

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