Pil Højgaard1, Karen Ellegaard2, Sabrina Mai Nielsen3, Robin Christensen3, Jørgen Guldberg-Møller1, Christine Ballegaard1, Lene Dreyer4, Philip Mease5, Maarten de Wit6, Lone Skov7, Bente Glintborg8, Henning Bliddal2, Else Marie Bartels2, Kirstine Amris2, Lars Erik Kristensen2. 1. The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Rigshospitalet Gentofte, Hellerup, Denmark. 2. The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark. 3. The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, and Odense University Hospital, Odense, Denmark, Aalborg, Denmark. 4. The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Rigshospitalet Gentofte, Hellerup, and Aalborg University Hospital, Aalborg, Denmark. 5. Swedish Medical Center, University of Washington, Seattle. 6. Vrije University, Amsterdam, The Netherlands. 7. Herlev-Gentofte Hospital, Hellerup, Denmark. 8. Rigshospitalet Gentofte, Hellerup, and Rigshospitalet Glostrup, Glostrup, Denmark.
Abstract
OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA). METHODS: An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease-modifying antirheumatic drugs in routine care. Clinical, US, and patient-reported measures were collected at baseline and after 4 months. Widespread nonarthritic pain (WP) was defined as a Widespread Pain Index score of ≥4 with pain in ≥4 of 5 regions. PsA activity by US was defined as color Doppler (yes/no) in selected entheses, joints, or tendons. The main response criteria included the American College of Rheumatology 20% improvement, the Disease Activity in Psoriatic Arthritis 50% improvement, and minimal disease activity. The primary analyses were age- and sex-adjusted logistic regression. RESULTS: WP was present in 24 of 69 included patients (35%) and was associated with worse patient-reported and composite baseline measures, while US and other objective findings were similar to those in patients without WP. The odds of reaching minimal disease activity after 4 months were significantly greater for patients enrolled without WP (odds ratio 18.43 [95% confidence interval 1.51, 224.41]; P = 0.022), while WP did not impair other response measures. Patients with baseline color Doppler activity (n = 42 [61%]) had a worse objective PsA burden, but their chance of treatment response was comparable to those without color Doppler. CONCLUSION: More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort.
OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA). METHODS: An exploratory prospective cohort study enrolled patients with PsA initiating biologic or conventional synthetic disease-modifying antirheumatic drugs in routine care. Clinical, US, and patient-reported measures were collected at baseline and after 4 months. Widespread nonarthritic pain (WP) was defined as a Widespread Pain Index score of ≥4 with pain in ≥4 of 5 regions. PsA activity by US was defined as color Doppler (yes/no) in selected entheses, joints, or tendons. The main response criteria included the American College of Rheumatology 20% improvement, the Disease Activity in Psoriatic Arthritis 50% improvement, and minimal disease activity. The primary analyses were age- and sex-adjusted logistic regression. RESULTS: WP was present in 24 of 69 included patients (35%) and was associated with worse patient-reported and composite baseline measures, while US and other objective findings were similar to those in patients without WP. The odds of reaching minimal disease activity after 4 months were significantly greater for patients enrolled without WP (odds ratio 18.43 [95% confidence interval 1.51, 224.41]; P = 0.022), while WP did not impair other response measures. Patients with baseline color Doppler activity (n = 42 [61%]) had a worse objective PsA burden, but their chance of treatment response was comparable to those without color Doppler. CONCLUSION: More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort.
Authors: Philip J Mease; Dafna D Gladman; Atul Deodhar; Dennis G McGonagle; Peter Nash; Wolf-Henning Boehncke; Alice Gottlieb; Xie L Xu; Stephen Xu; Elizabeth C Hsia; Chetan S Karyekar; Philip S Helliwell Journal: RMD Open Date: 2020-07
Authors: Kurt de Vlam; Alexis Ogdie; Andrew G Bushmakin; Joseph C Cappelleri; Roy Fleischmann; Peter C Taylor; Valderilio Azevedo; Lara Fallon; John Woolcott; Philip J Mease Journal: RMD Open Date: 2021-07
Authors: Kevin L Winthrop; Michael E Weinblatt; Joan Bathon; Gerd R Burmester; Philip J Mease; Leslie Crofford; Vivian Bykerk; Maxime Dougados; James Todd Rosenbaum; Xavier Mariette; Joachim Sieper; Fritz Melchers; Bruce N Cronstein; Ferry C Breedveld; Joachim Kalden; Josef S Smolen; Daniel Furst Journal: Ann Rheum Dis Date: 2019-10-29 Impact factor: 19.103