RESEARCH - Frequency and duration of clinical remission in patients with peripheral psoriatic arthritis requiring second-line drugs

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Rheumatology Advance Access published online on April 9, 2008

Rheumatology, doi:10.1093/rheumatology/ken059

Frequency and duration of clinical remission in patients with

peripheral psoriatic arthritis requiring second-line drugs

F. Cantini1, L. Niccoli1, C. Nannini1, E. Cassarà1, P. Pasquetti1, I.

Olivieri2 and C. Salvarani3

12nd Division of Medicine, Rheumatology Unit, Hospital of Prato,

2Rheumatology Department of Lucania, S. Carlo Hospital of Potenza and

Madonna delle Grazie Hospital of Matera and 3Division of Rheumatology,

Arcispedale S. Nuova, Reggio Emilia, Italy.

Abstract

Objective. To evaluate the frequency and duration of clinical

remission in patients with PsA.

Methods. All consecutive new outpatients with peripheral PsA requiring

second-line drugs and RA observed between January 2000 and December

2005 were included in a prospective, case-control study. Primary end

point was to assess the frequency of remission in peripheral PsA

compared with RA. Secondary end points were to compare the duration of

clinical remission during treatment and after therapy interruption,

ACR 20, 50, 70 response rates and to detect any remission predictor at

diagnosis. Treatment regimen was standardized in both groups. From

January 2003 to December 2005, therapy was suspended in PsA patients

and controls if achieving remission.

Results. One or more episodes of remission occurred in 57/236 (24.1%)

PsA patients and in 20/268 (7.5%) controls (P < 0.001). The mean

duration of remission was of 13 ± 9.4 months in PsA patients and 4 ±

3.7 in controls (P > 0.001). Remission episodes were more frequent in

PsA patients treated with anti-TNF compared with those receiving

traditional DMARDs (P > 0.001), with no differences regarding the

duration. After therapy interruption, the remission duration was 12 ±

2.4 months in PsA and 3 ± 1.5 in RA (P < 0.001). No remission

predictor at diagnosis resulted by multivariate analysis.

Conclusion. Remission is possible in up to 24% of patients with

peripheral PsA. It is significantly more frequent, but not longer, in

patients receiving anti-TNF drugs compared with those treated with

traditional DMARDs. Patients remain in remission for a long period

after therapy interruption, thus suggesting an intermittent

therapeutic strategy.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken059v1?papetoc

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