Session Information
Session Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment: Clinical Features of Spondylarthritis
Session Type: Abstract Submissions (ACR)
Background/Purpose:
A state of Minimal Disease Activity (MDA) has been defined and validated as a target for treatment in PsA. The purpose of the study is to identify disease characteristics and predictors of MDA in PsA patients treated with TNF blockers.
Methods:
Patients fulfilled the CASPAR criteria and were followed regularly every 3-6 months and completed radiographic evaluation at 2-year intervals. TNFα blockers were prescribed when patients failed standard of care. Patients were considered in MDA when met at least 5/7 of the criteria defined by Coates et al[i].Sustained MDA was defined as MDA lasting for ≥ 12 months. Patients achieving MDA were compared to patients who did not achieve MDA. A proportional odds discrete time survival analysis model was applied adjusting for gender, age at visit, duration of PsA, presence of abnormal ESR and damaged joint count at each visit to identify predictors for MDA.
Results:
Of the 306 patients treated with anti-TNF agents 23 were in MDA at baseline and 57 were prescribed anti-TNF agents prior to enrolment. 226 were in non-MDA state and constituted the study population. 145/226 patients achieved MDA after an average of 1.30 (1.68) years and for a mean duration of 3.46 (2.25) years. Patients who achieved MDA were more likely males (71.9% vs. 55.2%), younger at diagnosis (34.4 vs. 39.0 years), had a lower actively inflamed joint count (7.3 vs. 15.1), dactylitis (9.1% vs 13.9%), enthesitis (10.8% vs. 17.4% and tenosynovitis (9.2% vs. 21.7%), but more likely to have clinical damage (72.7% vs. 52.2%) and higher modified Steinbrocker score (25.5 vs. 11.5) as well as axial involvement (46.2% vs. 25%) at baseline compared to patients that didn’t achieve MDA. Non-MDA patients had higher BMI (31.3 vs. 28.8), more were classified with functional class III/IV (33.3% vs. 10.1%) and had a lower SF-36 physical (28.1 vs. 43.9) and mental (41.9 vs. 49.9) component summary scores at baseline compared to the MDA group. HLA B*27 was found in 24.8% patients with MDA compared to 9.2% patients who didn’t achieve MDA (P=0.007). The majority of patients in both groups were also treated with DMARDs and NSAIDs. No significant difference was found in disease duration, alcohol use, smoking, ESR, CRP or PASI score between the two groups. Patients who achieved MDA had less radiographic progression over time compared to patients without MDA. The survival analysis showed that after adjusting for characteristics at each visit male gender increased the odds of achieving MDA (OR=1.68 CI 1.11, 2.53, P=0.01), whereas an abnormal ESR lowered the odds of achieving MDA (OR=0.46 CI 0.27, 0.80, P=0.06). As for sustained MDA, only normal ESR was found to a predictor (OR 0.06 CI 0.03-0.15, P<0.0001).
Conclusion:
63% of the study group achieved MDA after an average duration of 1.3 years and those patients had less active disease at baseline but more damage with less radiographic progression over time. A normal ESR at each visit and male gender were predictors of MDA in patients treated with TNF blockers, the presence of HLA B*27 has a prognostic value also in identifying patients who achieve MDA.
[i] Ann Rheum Dis. 2010 Jan;69(1):48-53)
Disclosure:
A. Haddad,
None;
A. Thavaneswaran,
None;
I. Ruiz Arruza,
None;
V. Chandran,
None;
R. J. Cook,
None;
D. D. Gladman,
Abbott, Bristol-Myers Squibb, Celgene, Johnson & Johnson, MSD, Novartis, Pfizer, UCB Pharma,
2,
Abbott, Bristol-Myers Squibb, Celgene, Johnson & Johnson, MSD, Novartis, Pfizer, UCB Pharma,
5.
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-disease-characteristics-and-predictors-of-minimal-disease-activity-on-tnf-blockers-results-from-a-longitudainal-observational-cohort/