Sapienza Arthritis Center, Dipartimento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
Clin Rheumatol. 2019 Nov;38(11):3145-3151. doi: 10.1007/s10067-019-04674-3. Epub 2019 Jul 17.
INTRODUCTION/OBJECTIVE: Apremilast, PDE4 competitive inhibitor, has been recently introduced in the treatment of adult psoriatic arthritis (PsA) patients, but only preliminary data are available on imaging evaluation. Thus, we evaluated the response to apremilast in PsA patients by ultrasonographic (US) assessment.
Thirty-four patients (M/F 7/27; median age 61 years, IQR 15; median disease duration 10 years, IQR 13) treated for polyarticular involvement were longitudinally evaluated. All the patients were assessed at baseline (T0), and after 6 (T1), 12 (T2), and 24 weeks (T3) by DAS28, CDAI, SDAI, and DAPSA. At the same time-points, US assessment was performed in 22 sites (wrists, MCPs, PIPs): synovial effusion/hypertrophy and power Doppler were scored with a semi-quantitative scale (0-3). A total score, corresponding to patient's inflammatory status, was obtained by their sum (0-198). We assessed also the presence of tenosynovitis of flexor of hands' fingers bilaterally, registering the number of involved tendons (US-tenosynovitis score 0-10).
We found a significant reduction in the US inflammatory score values after 6 weeks (T0, median 15 (IQR 11.2); T1, 6 (10.0); P = 0.0002), confirmed at T2 (4.0 (4.0), P = 0.0002) and T3 (4.0 (6.0); P = 0.0003). Finally, US-detected tenosynovitis was observed in 44.1% of patients: a significant improvement in tenosynovitis score was identified at 6 weeks (T0, median 4 (IQR 4); T1, 1 (2); P < 0.0001) and maintained at T2 (0 (IQR 1); P < 0.0001) and T3 ((IQR 1.25); P < 0.0001).
Apremilast is able to induce an early and sustained improvement of ultrasonographic inflammatory status at articular and peri-articular level. Key points •Apremilast induces a significant, early, and sustained improvement of inflammatory joint status in psoriatic arthritis patients. •Ultrasonographic assessment is able to monitor articular and peri-articular response to apremilast.
简介/目的：磷酸二酯酶 4 竞争抑制剂阿普米司特最近被引入治疗成人银屑病关节炎（PsA）患者，但关于影像学评估的初步数据有限。因此，我们通过超声（US）评估来评估阿普米司特治疗 PsA 患者的疗效。
34 例（男/女 7/27；中位年龄 61 岁，IQR 15；中位疾病病程 10 年，IQR 13）多关节受累患者进行纵向评估。所有患者均在基线（T0）时进行评估，并在 6 周（T1）、12 周（T2）和 24 周（T3）时进行 DAS28、CDAI、SDAI 和 DAPSA 评估。同时，在 22 个部位（腕关节、掌指关节、近端指间关节）进行 US 评估：滑膜积液/肥厚和功率多普勒采用半定量评分（0-3）。通过它们的总和（0-198）获得对应患者炎症状态的总评分。我们还评估了双侧手指屈肌腱腱鞘炎的存在，记录受累肌腱的数量（US-腱鞘炎评分 0-10）。
我们发现，在 6 周时，US 炎症评分值显著降低（T0，中位数 15（IQR 11.2）；T1，6（10.0）；P=0.0002），在 T2（4.0（4.0），P=0.0002）和 T3（4.0（6.0）；P=0.0003）时得到确认。最后，44.1%的患者发现 US 检测到腱鞘炎：在 6 周时，腱鞘炎评分显著改善（T0，中位数 4（IQR 4）；T1，1（2）；P<0.0001），并在 T2（0（IQR 1）；P<0.0001）和 T3（IQR 1.25）；P<0.0001）时保持。
阿普米司特能够诱导关节和关节周围水平的超声炎症状态的早期和持续改善。关键点：阿普米司特可显著改善银屑病关节炎患者的关节炎症状态。超声评估能够监测阿普米司特治疗的关节和关节周围反应。
