Background/Purpose: There had been a lot of new therapeutic agents for the treatment of Psoriatic Arthritis (PsA) in the last decade. In this study we aimed to assess the treatment choices of rheumatologists in real life in the era of new options, focusing on new diagnosis of PsA.

Methods: The Psoriatic Arthritis Registry of Turkey (PsART) is a multicenter web-based PsA registry (1). At the time of the analysis, 283 out of 1353 patients for the registry had new diagnosis and were given treatment for PsA for the 1^st time. Within these 283 patients, 174 also had at least one follow up visit where the changes in the medications and response rates were documented. Fourteen of 174 patients who had used synthetic DMARDs because of psoriasis, were not assessed for treatment strategies. Psoriatic arthritis minimal disease activity (MDA) parameters were collected at baseline and during follow-up period.

Results: Overall, 160 patients (56.9% female), with a mean (SD) age of 44.9±12.6 were assessed. Polyarticular, mono-oligoarticular, and axial disease were 27.6%, 48.2%, and 34.5%, respectively. Baseline minimal disease activity parameters were followed; tender and swollen joint counts 4.8 (4.7) and 2.3 (3.5), body surface area 13.0 (16.6), Leeds enthesis index 0.08 (0.36), patients global assessment of disease activity-VAS 60 (21), pain-VAS 58 (25) and HAQ-DI 0.89 (0.60). Baseline and last control visit treatments were given at table 1. Mean (SD) and median (range) follow-up duration was 16 (13) months and 14 (min-max 3-43) months. The retention rates of methotrexate, sulphasalazine, leflunomide were 90.3%, 91.5%, and 100%, respectively. Twenty-one (13.1%) patients were switched synthetic DMARDs to anti-TNF treatments during follow up period. The baseline characteristics of patients who remained on synthetic DMARDs versus who were switched to biologics did not differ. Only 40% of patients achieved to minimal disease activity in the last visit.

Table 1. Baseline and follow-up treatment choices in psoriatic arthritis

Conclusion: Methotrexate is the most commonly used drug for newly diagnosed PsA patients in real life. Sulphasalazine was chosen either in combination or as monotherapy for a subgroup of patients although not being a part of the EULAR or GRAPPA recommendations. Leflunomide seems to be a second line treatment option. The cross-sectional assessment of PsART cohort, almost 31% of patients used biological DMARDs (1). Moreover within 16 months, 13% of new diagnosed PsA patients were switched from synthetic DMARDs to anti-TNF treatments. Glucocorticoid usage decreased during follow-up period.

Reference

1. Kalyoncu U et al. The Psoriatic Arthritis Registry of Turkey: results of a multicenter registry on 1081 patients. Rheumatology. 2017;56:279-286.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-treatment-choices-and-response-for-a-psoriatic-arthritis-inception-cohort/