Janta Iustina, Martínez-Estupiñán Lina, Valor Lara, Montoro María, Baniandres Rodriguez Ofelia, Hernández Aragüés Ignacio, Bello Natalia, Hernández-Flórez Diana, Hinojosa Michelle, Martínez-Barrio Julia, Nieto-González Juan Carlos, Ovalles-Bonilla Juan Gabriel, González Carlos Manuel, López-Longo Francisco Javier, Monteagudo Indalecio, Naredo Esperanza, Carreño Luis
Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain,
Clin Rheumatol. 2015 May;34(5):935-42. doi: 10.1007/s10067-015-2880-7. Epub 2015 Jan 31.
The primary objective of this study was to describe and compare clinical and musculoskeletal (MS) ultrasound (US) features between psoriatic arthritis (PsA) patients treated with full and tapered dosage of biologic (b) disease-modified antirheumatic drugs (DMARDs). The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant synthetic (s) DMARDs. We evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or minimal disease activity (MDA) according to their attending rheumatologist and with the patient acceptance. The bDMARD tapering consisted of the following: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of B-mode and Doppler synovitis, tenosynovitis, enthesopathy, and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments, and laboratory results. Seventy-four (72.5 %) patients received full dosage of bDMARDs and 28 (27.5 %) received tapered dosage. The duration with biologic therapy and with current biologic therapy was significantly higher in patients with tapered dosages (p = 0.008 and p = 0.001, respectively). We found no significant differences between clinical, laboratory, and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD. Clinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs.
本研究的主要目的是描述和比较接受全剂量和逐渐减量生物制剂（b）改善病情抗风湿药（DMARDs）治疗的银屑病关节炎（PsA）患者的临床和肌肉骨骼（MS）超声（US）特征。次要目的是比较接受bDMARDs治疗且联合或不联合合成（s）DMARDs的PsA患者的临床和MSUS特征。我们评估了102例接受bDMARDs治疗的PsA患者。根据主治风湿病专家的意见并在患者同意的情况下，对病情维持缓解或疾病活动度最小（MDA）的患者进行了bDMARD剂量逐渐减量。bDMARD逐渐减量包括以下内容：增加皮下注射bDMARDs的给药间隔或减少静脉注射bDMARDs的剂量。临床评估包括对疾病活动度的皮肤科和风湿病学评估。由一位对药物剂量、临床评估和实验室结果不知情的风湿病专家调查B模式和多普勒滑膜炎、腱鞘炎、附着点病和腱周组织炎的存在情况。74例（72.5%）患者接受了全剂量bDMARDs治疗，28例（27.5%）接受了逐渐减量治疗。逐渐减量组患者的生物治疗持续时间和当前生物治疗持续时间显著更长（分别为p = 0.008和p = 0.001）。我们发现，全剂量组与逐渐减量组患者以及联合或不联合sDMARD组患者之间，在临床、实验室和US变量（包括BM和CD）方面均无显著差异。接受全剂量和逐渐减量bDMARDs治疗的患者在临床评估、MSUS变量和MDA状态方面相似。
