Rheumatology Research, Swedish Medical Center; Clinical Professor University of Washington School of Medicine, Seattle, USA.
Clin Exp Rheumatol. 2013 Jul-Aug;31(4 Suppl 78):S59-62. Epub 2013 Oct 4.
Remission in psoriatic arthritis (PsA), albeit variably defined, is a desirable and achievable state, especially in the era of biologic therapy. Historically, studies have used remission criteria derived from rheumatoid arthritis (RA), which indicate that remission is seen in a greater percentage of patients than in RA, including the possibility of drug-free remission in some patients. The Minimal Disease Activity (MDA) measure developed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is a currently acceptable goal of therapy, taking into account PsA-specific elements such as skin disease and enthesitis. Newer PsA composite measures which include thresholds for remission are under development and are now included in prospective clinical trials. Once remission is achieved and sustained on therapy, a natural question is whether treatment can be reduced or discontinued to avoid treatment toxicities and costs. Exploratory data are being analysed from observational cohorts regarding the capacity to reduce treatment dose, dose frequency, or discontinue use of a medication whilst maintaining remission. A controlled dose-reduction and discontinuation study design is outlined, which may provide controlled evidence for such a paradigm of treatment.
银屑病关节炎（PsA）的缓解，尽管定义各不相同，但却是一种理想且可实现的状态，尤其是在生物治疗时代。从历史上看，研究使用了源自类风湿关节炎（RA）的缓解标准，这些标准表明缓解在患者中的比例高于 RA，包括一些患者可能无需药物即可缓解。由银屑病和银屑病关节炎研究与评估小组（GRAPPA）制定的最小疾病活动度（MDA）测量是目前可接受的治疗目标，考虑到了关节炎特异性的元素，如皮肤疾病和附着点炎。正在开发新的包含缓解阈值的关节炎复合指标，并已纳入前瞻性临床试验。一旦达到缓解并持续治疗，一个自然的问题是是否可以减少或停止治疗以避免治疗毒性和成本。正在对观察性队列中的探索性数据进行分析，以评估在维持缓解的同时减少治疗剂量、剂量频率或停止使用药物的能力。概述了一种控制剂量减少和停药的研究设计，该设计可能为这种治疗模式提供对照证据。
