Farina Antonella, Medico Patrizia Del, Parisi Simone, Becciolini Andrea, Visalli Elisa, Molica-Colella Aldo Biagio, Lumetti Federica, Caccavale Rosalba, Scolieri Palma, Andracco Romina, Girelli Francesco, Bravi Elena, Colina Matteo, Volpe Alessandro, Ianniello Aurora, Franchina Veronica, Platè Ilaria, Di Donato Eleonora, Amato Giorgio, Salvarani Carlo, Lucchini Gianluca, De Lucia Francesco, Bosco Ylenia Dal, Colella Francesco Molica, Santilli Daniele, Ferrero Giulio, Marchetta Antonio, Arrigoni Eugenio, Riva Michele, Foti Rosario, Sandri Gilda, Bruzzese Vincenzo, Paroli Marino, Fusaro Enrico, Ariani Alarico
Rheumatology Outpatient Clinic, Internal Medicine Unit, Ospedale "A. Murri", Fermo, Italy.
Rheumatology Outpatient Clinic, Internal Medicine Unit, Civitanova Marche Hospital, Civitanova Marche, Italy.
Mediterr J Rheumatol. 2024 Dec 31;35(4):639-644. doi: 10.31138/mjr.271223.bua. eCollection 2024 Dec.
Psoriatic arthritis (PsA) phenotypes show different responses to the many available drugs. For a tailored medicine, it is important to choose the most effective treatment according to patients' characteristics. Apremilast is recommended in PsA with moderate activity. In clinical practice, the most suitable PsA patients for apremilast are those affected by the peripheral oligo-articular arthritis. However, it is not so straightforward to definitely identify this phenotype. Musculoskeletal ultrasound (MUS) is a good tool for detecting the joints actually involved by PsA. The aim of this study is to verify if MUS assessment is useful in selecting the best PsA responders to apremilast.
The following data of all consecutive PsA patients from 15 centres were recorded: anamnestic data, disease activity, PsA phenotype, apremilast treatment duration and reason of suspension. MUS assessment before apremilast treatment was the criteria which clustered patients in two groups. Apremilast retention rate estimate the drug's effectiveness. The Cox analysis revealed the risk factors associated with treatment persistence. Mann-Whitney U and Chi-squared tests assessed the intergroup differences.
Only 40% of 356 patients (M:F: 152/204; median age 60 yrs) received MUS examination. In MUS group the moderate disease (median DAPSA 22.9 vs 26.9; p=0.0006) and the oligo-articular phenotype (63.6% vs 36.1%, p<0.0001) were more common. The retention rate was higher in MUS group (HR 0.55 IC95% 0.32-0.94; p=0.03).
In apremilast treated PsA patients, baseline MUS assessment is related to an increased retention rate. MUS may identify patients' characteristics favourable to apremilast response.
银屑病关节炎（PsA）的不同表型对多种现有药物呈现出不同反应。对于个性化医疗而言，根据患者特征选择最有效的治疗方法至关重要。阿普司特被推荐用于治疗中度活动性PsA。在临床实践中，最适合使用阿普司特的PsA患者是那些患有外周寡关节炎的患者。然而，明确识别这种表型并非易事。肌肉骨骼超声（MUS）是检测PsA实际累及关节的良好工具。本研究的目的是验证MUS评估是否有助于选择对阿普司特反应最佳的PsA患者。
记录了来自15个中心的所有连续PsA患者的以下数据：既往史数据、疾病活动度、PsA表型、阿普司特治疗持续时间和停药原因。阿普司特治疗前的MUS评估是将患者分为两组的标准。阿普司特保留率用于评估药物疗效。Cox分析揭示了与治疗持续性相关的危险因素。Mann-Whitney U检验和卡方检验评估组间差异。
356例患者中仅有40%（男：女=152/204；中位年龄60岁）接受了MUS检查。在MUS组中中度疾病（中位DAPSA 22.9对26.9；p=0.0006）和寡关节炎表型（63.6%对36.1%，p<0.0001）更为常见。MUS组的保留率更高（HR 0.55，IC95% 0.32 - 0.94；p=0.03）。
在接受阿普司特治疗的PsA患者中，基线MUS评估与保留率增加相关。MUS可能识别出有利于阿普司特反应的患者特征。
