Effectiveness of Disease-Modifying Antirheumatic Drugs for Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort

Abstract

Objective Our objective was to assess the effectiveness of conventional and targeted disease modifying anti-rheumatic drugs (cDMARDs and tDMARDs, respectively) in treating enthesitis in PsA. Methods Patients with active enthesitis, defined as ≥1 tender entheses (of 29 sites included in the spondyloarthritis research consortium of Canada enthesitis index, the Leeds enthesitis index, and the Maastricht ankylosing spondylitis enthesitis score), enrolled in a large PsA cohort were included. Medications at baseline were classified into 3 mutually exclusive categories: 1.'no treatment/non-steroidal anti-inflammatory drugs (NSAIDs)', 2. 'cDMARDs±NSAIDs' and 3.'tDMARDs±cDMARDs/NSAIDs'. Complete resolution of enthesitis (no tender entheseal site) at 12 months was the primary outcome. Logistic regression models were developed to determine the association between medication category and enthesitis resolution. Results Of the 1270 patients studied, 628(49.44%) had enthesitis; 526 patients (51.71% males; mean age (standard deviation, s.d.) – 49.02(13.12) years; mean enthesitis score (s.d.) 2.13(2.16) with adequate follow-up were analysed. Complete resolution of enthesitis was noted in 453(86%) patients, within a mean period of 8.73 months from baseline. In the regression analysis, though not significant, DMARDs (Categories 2 and 3) had higher odds ratio compared to category 1 for resolution of enthesitis. Enthesitis resolution was associated with lower joint activity (OR 0.97; 95% CI 0.95 – 0.99; p = 0.01) and male sex (OR 1.66; 95% CI 0.97 – 2.84; p = 0.06). Conclusion Resolution of enthesitis was observed in 86% of patients in an observational setting regardless of the medication used. Future effectiveness studies may warrant evaluation of enthesitis using advanced imaging.

Therapeutic Effects of Apremilast on Enthesitis and Dactylitis in Real Clinical Setting: An Italian Multicenter Study

“…The inverse association between remission and baseline activity score was also observed for peripheral arthritis (i.e., DAPSA) [ 30 ]. Data from the University of Toronto PsA clinic reported that the resolution of enthesitis was associated with lower joint activity and male sex [ 31 ]. Similar to our study, they reported that a high CRP level at baseline was associated with a better response to therapy.…”