Trajectory of radiographic change over a decade: the effect of transition from conventional synthetic disease-modifying antirheumatic drugs to anti-tumour necrosis factor in patients with psoriatic arthritis

Andrew Allard, Anna Antony, Gavin Shaddick, Deepak R Jadon, Charlotte Cavill, Graham Robinson, Eleanor Korendowych, Neil McHugh, William Tillett

Research output: Contribution to journalArticle

2 Citations (Scopus)
24 Downloads (Pure)

Abstract

Objectives: To describe the trajectory of radiographic progression among patients with PsA who transitioned from conventional synthetic DMARDs to anti-TNF-α inhibitors in routine care.

Methods: A retrospective sample of patients with PsA (ClASsification criteria for Psoriatic ARthritis) was taken from the Bath longitudinal cohort. All patients had radiographs of the hands and feet taken: 5 years before (T0), at the time of (T1) and 5 years after (T2) commencing anti-TNF treatment. Radiographs were scored blinded using the PsA-modified Sharp-van der Heijde score (mSvdHS) and for osteoproliferation (Psoriatic Arthritis Ratingen Score) by A.Allard, A.Antony and W.T. This sample size was calculated to ensure 90% power to determine the smallest detectable difference of the mSvdHS to a 5% significance level. Cumulative probability plots were used to determine the probability of radiographic progression pre- (T0-T1) and post- (T1-T2) anti-TNF treatment.

Results: Eighty-four radiographs from 28 patients were selected for inclusion. The median [interquartile range (IQR)] disease duration at baseline (T0) was 8.5 (0-19.5) years. The interval between T0-T1 and T1-T2 was 4.2 years (3.34-6.65) and 4.9 years (4.25-5.87), respectively. The median mSvdHS at baseline (T0) was 8.5 (IQR 1.75-27.5). The median (IQR) rate of change in mSvdHS per year reduced after commencing anti-TNF, from 2.1 (0.88-3.92) between T0-T1 to 1.0 (IQR 0.05-2.35) between T1-T2 (P = 0.012).

Conclusion: The trajectory of damage accumulation over a 10-year period in this observational clinical cohort is low overall. The rate of radiographic damage as measured by the mSvdHS slows following commencement of anti-TNF.

Original languageEnglish
Pages (from-to)269-273
Number of pages5
JournalRheumatology
Volume58
Issue number2
Early online date20 Sep 2018
DOIs
Publication statusPublished - 1 Feb 2019

Keywords

  • Anti-tumour necrosis factor (anti-TNF)
  • Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD)
  • Psoriatic arthritis
  • Radiographic progression

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

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  • Projects

    The Assessment of Structural Damage in Psoriatic Arthritis

    Tillett, W.

    1/05/14 → …

    Project: Central government, health and local authorities

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