ACR/ARHP 2013 Report – Early and aggressive DMARD treatment improves outcomes in psoriatic arthritis

Treatment of psoriatic arthritis with early, aggressive pharmacologic intervention with disease-modifying antirheumatic drugs (DMARDs) while utilizing a a treat-to-target approach achieves  better outcomes than  standard care,  researchers reported  at the American College of Rheumatology 2013 Annual Meeting.

The goal of the study was, “to replicate similar findings in other inflammatory arthropathies, notably rheumatoid arthritis, where a treat-to-target approach is known to favorably influence long-term outcomes for these patients,” said investigator Philip Helliwell, MD, PhD, senior lecturer in rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds University  in Leeds, UK.

The investigators evaluated and compared data showing differences in outcome measurements among two groups of psoriatic arthritis patients. The first group was treated according to a tight control approach, following guidelines on DMARD use to reach set targets in disease-related measurements.

The second group was treated with a standard care protocol.

Using data from eight medical treatment centers in the UK from 2008 to 2012, the researchers identified

206 people with psoriatic arthritis. They followed their progress for 48 weeks according to their treatment protocol.

Subjects in the tight control group were treated with escalating therapy if they did not meet minimal disease activity criteria at set time intervals. They began on the DMARD methotrexate with rapid escalation to a dose of 25mg after six weeks if they tolerated the drug.  If their disease was not controlled according to disease activity criteria at 12 weeks, they received a more powerful DMARD combination.

After another 12 weeks, if these patients had three or more tender or swollen joints, they received anti-tumor necrosis factor (Anti-TNF) therapy. If they had less than three tender or swollen joints and did not meet the minimal disease activity criteria, they switched to methotrexate and alternative DMARD combination.

The standard treatment group was treated with DMARDS, and there were no set time limits for drug therapy escalation or disease measurements.

The researchers used ACR20, ACR50 and ACR70 criteria to measure disease activity (representing 20, 50, and 70 percent improvement, respectively).

In the tight control group, 55 percent achieved ACR20, 44 percent achieved ACR50 and 33 percent achieved ACR70. In the standard care group, 37 percent achieved ACR20, 21 percent achieved ACR50 and 15 percent achieved ACR70.

The researchers concluded that the significant differences in outcomes indicate that an aggressive, targeted approach to treating psoriatic arthritis greatly improves disease-activity outcomes .

“For the first time, it has been shown that aggressive treatment of inflammation in psoriatic arthritis gives better outcomes,” said Dr. Helliwell. “Further, the target used in the study – minimal disease activity – assesses a wide spectrum of disease features, including skin and enthesitis, and not just the articular aspects of this complex disease. Patients with this disorder have to endure several different disease manifestations. This study has shown that appropriate targeted therapy can be effective across all these aspects, an important finding for the person with this disorder.”