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DAPSA, DAS28 and MDA predict long-term treatment regime in psoriatic arthritis. The Swedish Early Psoriatic Arthritis Cohort

1, 2, 3, 4, 5, 6, 7, 8

  1. Department of Medical Sciences, Rheumatology, Uppsala University, Sweden. ulla.lindqvist@medsci.uu.se
  2. Uppsala Clinical Research Centre, Uppsala University, Sweden.
  3. Department of Rheumatology, Falu Hospital, Falu, Sweden.
  4. Department of Rheumatology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
  5. Department of Clinical Sciences, Lund University; and Department of Radiology, University Hospital, Örebro, Sweden.
  6. Spenshult Hospital, Spenshult AB, Oskarström, Sweden.
  7. Department of Rheumatology, Skåne University Hospital Malmö, Lund University, Sweden.
  8. Department of Public Health and Clinical, Medicine/Rheumatology, Umeå University, Sweden.

CER10012 Submission on line
2017 Vol.35, N°6 - PI 0936, PF 0942
Full Papers

Rheumatology Article

 

Abstract

OBJECTIVES:
To describe treatment patterns in the Swedish early psoriatic arthritis cohort (SwePsA) of the mono-/oligo-arthritic (M/O) and polyarthritis (P) and identify early predictive factors for treatment with disease-modifying anti-rheumatic (DMARD), non-steroidal anti-inflammatory drugs (NSAID), and tumour necrosis factor inhibition (TNFi) after 5 years.
METHODS:
Data for 198 M/O and P PsA were obtained within the programme for SwePsA. Multinomial and binary logistic regression analyses were used to assess the association between early predictive factors and treatment after 5 years adjusted for age at inclusion. The analysis of DMARD/NSAID was adjusted for medication at inclusion.
RESULTS:
After inclusion visit, DMARD was prescribed in 30% of M/O and 56% of P PsA; mainly methotrexate. TNFi was not prescribed at inclusion, but 23 patients were treated at 5-year follow-up. The adjusted OR (95% CI) for treatment with both DMARD and NSAID after 5 years was 3.65 (1.34 - 9.89) (p=0.010) for Disease Activity Score 28 (DAS28) >3.2 and 2.90 (1.20–6.99) (p=0.038) for Disease Activity Index in Psoriatic Arthritis (DAPSA) >14 at inclusion. TNFi treatment was, after adjusting for age, associated with high erythrocyte sedimentation rate (p=0.0043), high C-reactive protein (p=0.013), DAPSA (p<0.001), not reaching minimal disease activity (p=0.001) high health assessment questionnaire (p=0.001), patient's overall assessment on the visual analogue scale (VAS) (p=0.009), high pain VAS (p=0.007), and high number of tender and swollen joints (p=0.031) at inclusion.
CONCLUSIONS:
Disease activity in early M/O and P PsA is to be considered in deciding the level of health care assessment and future pharmacological treatment. DAS28 >3.2 and DAPSA>14 early in the disease predict subsequent treatment with DMARD. For prediction of biological treatment, not reaching MDA at onset of disease, would be the composite index of choice.

PMID: 28628468 [PubMed]

Received: 12/10/2016 - Accepted : 20/03/2017 - In Press: 16/06/2017 - Published: 11/12/2017