Minimal Disease Activity and Remission in Psoriatic Arthritis Patients Treated with Anti-TNF-α Drugs

Objective. A state of remission is the target of therapy in chronic arthritis. The aim of the present study was to assess the rate of minimal disease activity (MDA) and remission in patients with psoriatic arthritis (PsA) treated with tumor necrosis factor (TNF-alpha) blockers. Disease characteristics and predictors of MDA were also evaluated. Methods. Patients fulfilling the ClASsification for Psoriatic ARthritis (CASPAR) criteria and treated with TNF-alpha blockers adalimumab, etanercept, or golimumab were enrolled and prospectively followed every 4 months for 1 year in a clinical practice setting. Patients were considered in MDA when they met at least 5/7 of the criteria previously defined. Other remission criteria evaluated were 28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6 and Disease Activity in Psoriatic Arthritis (DAPSA) score <= 3.3. Patients achieving MDA were compared to non-MDA to identify outcome predictor factors. Results. Of the 75 patients treated with TNF-alpha blockers, at baseline no patients were in MDA or had a DAPSA score <= 3.3, while 25 (21.3%) had a DAS28-CRP score < 2.6. Five patients (6%) discontinued treatment because of side effects or inefficacy during followup. After 12 months, MDA was achieved in 46 patients (61.3%). No difference was found among the 3 anti-TNF-alpha drugs. Predictors for MDA were found to be male sex, high CRP, high erythrocyte sedimentation rate, and low Health Assessment Questionnaire. Conclusion. In our prospective observational study, based on a clinical practice setting, MDA was achieved in 61.3% of patients treated with TNF-alpha blockers, identifying this as an achievable target for patients with PsA. Predictors of remission were also identified.