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Background: Methotrexate (MTX) is the preferred drug of most rheumatologists for treating psoriatic arthritis (PsA). Despite its widespread use in clinical practice, scientific evidence of methotrexate on the different manifestations of psoriatic disease is limited. Specifically, data of MTX use in usual care and in early PsA patients are lacking. Objectives: To describe the response to MTX for patients with PsA and an oligoarthritis or polyarthritis phenotype in usual care in the first year after diagnosis, and its impact on different aspects of the disease, including patients not achieving minimal disease activity (MDA) despite continuous exposure to MTX Methods: Data collected in the Dutch southwest Early Psoriatic Arthritis cohort (DEPAR) study were used. Patients with a new diagnosis of PsA who have not started disease-modifying antirheumatic drugs (DMARDs) for PsA were eligible to participate. In this analysis, only patients with a phenotype at time of diagnosis of oligoarthritis or polyarthritis (resp. 2-4 joints involved or 5 or more joints, as defined by the rheumatologist), and at least one year follow up were included. Research nurses collected clinical data and data on medication use every three months in the first year after diagnosis. The following outcomes were used to evaluate disease activity: MDA, EULAR active disease (at least one tender and swollen joint), disease activity index for PsA low disease activity (DAPSA-LDA: DAPSA≤14), and disease activity score 28 low disease activity (DAS28-LDA: DAS28≤3.2). Disease activity at six months of patients who started MTX within six months after diagnosis and have continued using MTX until one year after diagnosis was analyzed. Results: In April 2018, 219 patients had a phenotype of oligoarthritis (n=134, 61%) or polyarthritis (n=85, 39%) at time of diagnosis, and at least one year follow up. In 183 (84%) patients, MTX monotherapy was started within six months after diagnosis. Within the first year, 23 of these used MTX intermittently, 25 switched to a different DMARD, and 45 started a different DMARD while remaining on MTX therapy. The remaining 90 patients used MTX monotherapy throughout the first year and of these we assessed disease activity at 6 months after diagnosis. At 6 months, 38 patients out of these 90 were not in MDA despite continuous MTX treatment, while 44 achieved MDA. Major differences amongst the two groups included tender joint count, physical function, evaluation of pain and global disease activity and impact on health-related quality of life scores (Table 1). Conversely, 18% of all patients started MTX monotherapy were in sustained MDA at one year while continuing MTX monotherapy. Conclusion: The majority of patients with a new diagnosis of PsA with a phenotype of oligoarthritis or polyarthritis started MTX within a year after diagnosis. MTX is maintained as monotherapy in half of these patients, with 18% of them achieving sustained MDA using MTX monotherapy at one year. Interestingly, approximately half of the patients who had continued methotrexate monotherapy were not achieving MDA after six months and they report higher impact of disease on clinical and patient reported outcomes, suggesting need to consider improvement of therapy for these patients. Disclosure of Interests: Kim Wervers: None declared, Hannah den Braanker: None declared, Jolanda Luime: None declared, Ilja Tchetverikov: None declared, Andreas Gerards: None declared, Cathelijne Appels: None declared, Wiebo van der Graaff: None declared, Hans van Groenendael: None declared, Lindy-Anne Korswagen: None declared, Josien Veris-van Dieren: None declared, Johanna Hazes: None declared, Marc Kok: None declared, Marijn Vis Grant/research support from: Novartis |
