Radiographic Changes in PsA: Conventional Synthetic DMARDs vs Anti-TNF Therapy

hand psoriatic arthritis
hand psoriatic arthritis
Investigators assessed radiographic progression in patients with psoriatic arthritis following transition from conventional synthetic disease-modifying rheumatic drugs to anti-tumor necrosis factor-α therapy.

In patients with psoriatic arthritis (PsA), the rate of radiographic damage was found to decrease following the initiation of anti-tumor necrosis factor (TNF) therapy, according to the results of a retrospective, observational study of a cohort of patients from Bath, United Kingdom. Findings from the analysis were published in Rheumatology (Oxford).

A team of investigators sought to describe the trajectory of radiographic progression in patients with PsA who transitioned from conventional synthetic disease-modifying antirheumatic drugs to anti-TNF-α agents in routine care. Radiographs were assessed for erosions and joint space narrowing using the modified Sharp-van der Heijde score (mSvdHS), the method demonstrated to be most sensitive to change among individuals with PsA.

A total of 28 patients with PsA were included in the study; mean age was 61 ± 13.4 years, and 15 of the patients were men. All participants underwent radiographic examination of the hands and feet 5 years before (baseline; T0), at the time of (T1), and 5 years after (T2) initiating anti-TNF therapy. Median disease duration at T0 was 8.5 years (interquartile range [IQR], 0-19.5 years); median study follow-up period was 9.5 years.

A total of 84 radiographs from the 28 participants were selected for inclusion. The interval between T0– T1 and T1– T2 was 4.2 years (IQR, 3.34-6.65 years) and 4.9 years (IQR,

4.25-5.87 years). Median mSvdHS at T0 was 8.5 (IQR, 1.75-27.5).

Median scores for erosions and joint space narrowing were 1.5 (IQR, 0.00-11.50) and 4.5 (IQR, 1.00-15.00), respectively. Median rate of progression in mSvdHS, erosion score, and joint space narrowing score per year was 2.1 (IQR, 0.88-3.93), 0.4 (IQR, 0.00-1.91), and 1.4 (IQR, 0.68-2.30), respectively.

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After the commencement of anti-TNF therapy, 64% of patients continued to experience radiographic progression, with 32% developing progressive erosive disease and 61% developing progressive joint space narrowing. Median rate of change in mSvdHS per year improved significantly to 1.0 (IQR, 0.05-2.35) units per year on anti-TNF treatment (P= .01). Furthermore, median rate of change in erosions improved to 0.0 units per year (IQR, 0.00-0.81), and median rate of joint space narrowing improved to 0.7 (IQR, 0.05-1.81); however, these values did not achieve statistical significance.

The investigators concluded that in the patients with PsA who were evaluated in this study, the trajectory of damage accumulation is low overall, with the rate of disease progression in mSvdHS slowing among those in this clinical practice cohort in whom anti-TNF therapy had been initiated.

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Allard A, Antony A, Shaddick G, et al. Trajectory of radiographic change over a decade: the effect of transition from conventional synthetic disease-modifying antirheumatic drugs to anti-tumour necrosis factor in patients with psoriatic arthritis [published online September 20, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key297