Clinical Characteristics of Potential “Difficult-to-treat” Patients with Psoriatic Arthritis: A Retrospective Analysis of a Longitudinal Cohort

Abstract

Introduction The EULAR group recently published the definition of difficult-to-treat (D2T) patients for rheumatoid arthritis. However, a similar definition is lacking for patients with psoriatic arthritis (PsA), in which its multi-domain expression may impact the treatment response. The aim of the study was to characterize the potential D2T PsA patients, to assess the risk factors, and to determine the burden of disease. Methods Retrospective analysis of a longitudinal cohort of PsA patients attending a tertiary care center. At each visit, the patients underwent a complete physical examination and the clinical/laboratory data were collected. Data on comorbidities with the assessment of different comorbidity indices were also collected. Disease activity was assessed by using the DAPSA score and the MDA. The PsAID and HAQ-DI were also collected. We use the previous identified definition of D2T patients, applied to our PsA group and modified for this study. Results A total of 106 patients fulfilled the inclusion criteria and were evaluated. Of these, 36 (33.9%) patients fulfilled the criteria for the potential D2T patients. D2T patients showed a significantly higher BMI and higher prevalence of fibromyalgia. Furthermore, D2T patients showed a significantly higher median Functional Comorbidity Index and a significantly higher BSA, LEI, pain level, PsAID score, and HAQ-DI than non-D2T patients. Potential D2T patients also showed a significant delay in the time from diagnosis to first b/ts DMARDs treatment. Conclusions Our study firstly evaluated the presence of clinical characteristics of potential D2T patients and may contribute to future research on this intriguing aspect.

Clinical Characteristics of “Severe” Peripheral Psoriatic Arthritis: A Retrospective Analysis of a Longitudinal Cohort

“…mCPDAI was calculated for each enrolled patient. Similar methods have been presented previously [ 14 ].…”

“…Thus, since the achievement of good control of disease activity is an achievable target, there is now the clinical need to identify patients with severe disease. In fact, the concept of severity may be not totally aligned with the concept of persistent disease activity or with the concept of difficult-to-treat disease, in which patients may be refractory or intolerant to multiple treatment strategies with a difficult management of signs and symptoms [ 14 , 15 ]. In this context, we do believe that disease severity may be defined as the presence of more pronounced inflammatory activity in every disease domain, together with greater functional limitation/reduced quality of life.…”

Influence of comorbidities not associated with fibromyalgia on neuropathic pain in patients with psoriatic arthritis: relationship with clinical parameters

“…However, they did not have a higher BMI (28.4 ± 5.2 vs. 26.9 ± 4.7, p = 0.10, data not shown). The different classification of “non-responders” could be responsible for these results ( 31 ).…”

Effectiveness of sequential lines of biologic and targeted small molecule drugs in psoriasis: A systematic review and meta‐analysis

“…Randomised controlled trials, although best placed to determine efficacy of a novel biologic drug when used first line, often provide limited data on response to later lines of biologic treatment. Eligibility criteria in some cases limit the number and class of previous biologics, and the proportion of participants exposed to >1 prior biologic to avoid enriching the cohort with participants who may be difficult to treat 11 . In those trials that include biologic‐experienced populations, sub‐analyses assessing response stratified by number of previous lines of biologic are limited.…”

“…Eligibility criteria in some cases limit the number and class of previous biologics, and the proportion of participants exposed to >1 prior biologic to avoid enriching the cohort with participants who may be difficult to treat. 11 In those trials that include biologic‐experienced populations, sub‐analyses assessing response stratified by number of previous lines of biologic are limited.…”