Ciurea Adrian, Kissling Seraphina, Götschi Andrea, Ørnbjerg Lykke Midtbøll, Rasmussen Simon Horskjær, Tamási Bálint, Möller Burkhard, Nissen Michael J, Glintborg Bente, Loft Anne Gitte, Scherer Almut, Bräm René, Pavelka Karel, Závada Jakub, Dias Joao Madruga, Valente Paula, Gudbjornsson Bjorn, Palsson Olafur, Rantalaiho Vappu, Peltomaa Ritva, Codreanu Catalin, Mogosan Corina, Iannone Florenzo, Sebastiani Marco, Jones Gareth T, Macfarlane Gary J, Castrejon Isabel, Rotar Ziga, Michelsen Brigitte, Wallman Johan K, van der Horst-Bruinsma Irene, Distler Oliver, Østergaard Mikkel, Hetland Merete Lund, Micheroli Raphael, Ospelt Caroline
Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland.
Statistics Group, Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) Foundation, Zurich, Switzerland.
Arthritis Res Ther. 2025 Jan 31;27(1):18. doi: 10.1186/s13075-025-03488-w.
Efficacy of tumour necrosis factor inhibitors (TNFi) for peripheral arthritis in patients with psoriatic arthritis (PsA) has been established in randomized clinical trials that have used improvement in summated joint counts as an outcome. Whether joints at different anatomical locations might respond differentially to TNFi remains unknown. The aim of the study was to investigate potential variations in the responsiveness to a first tumour necrosis factor inhibitor (TNFi) among joints at distinct locations in patients with psoriatic arthritis (PsA) treated in routine clinical care.
Bionaive PsA patients from nine European countries were included in this observational cohort study if ≥ 1 joint was swollen at the initiation of a first TNFi as monotherapy or added to methotrexate. Only the 28-joint count was available without imaging data confirming the presence of synovitis. The primary outcome was time to first resolution of joint swelling at each joint level. Hazard ratios (HR) for resolution comparing different joint locations were estimated using interval-censored mixed-effects Cox proportional hazards models, including a random effect for country and patient, adjusted for age and sex.
A total of 1729 patients with 8397 swollen joints at the start of TNFi were included. Considering the upper extremity, a higher rate of resolution of joint swelling (HR, 95% CI) was observed for the shoulder (1.65, 1.16-2.35) and elbow (1.90, 1.38-2.61), while a lower rate was found for the wrist (0.72, 0.62-0.83) compared to the joints of digit 3. Within fingers, and using the same reference, joint swelling resolved fastest in digit 4 (1.77, 1.49-2.11) and digit 5 (1.88, 1.53-2.31). A lower rate of resolution of joint swelling was found for the knee in comparison to the elbow, the corresponding joint on the upper limb (0.56, 0.40-0.78).
The time to resolution of joint swelling upon treatment with TNFi in patients with PsA seems to depend on the localisation of the affected joints.
肿瘤坏死因子抑制剂（TNFi）治疗银屑病关节炎（PsA）患者外周关节炎的疗效已在随机临床试验中得到证实，这些试验将关节计数总和的改善作为一项指标。不同解剖位置的关节对TNFi的反应是否存在差异仍不清楚。本研究的目的是调查在常规临床治疗中接受治疗的银屑病关节炎（PsA）患者不同部位关节对第一种肿瘤坏死因子抑制剂（TNFi）反应的潜在差异。
来自九个欧洲国家的初治PsA患者被纳入这项观察性队列研究，条件是在开始使用第一种TNFi单药治疗或联合甲氨蝶呤时，至少有1个关节肿胀。仅有28个关节计数可用，且无影像学数据证实滑膜炎的存在。主要结局是每个关节水平首次关节肿胀消退的时间。使用区间删失混合效应Cox比例风险模型估计不同关节部位肿胀消退的风险比（HR），模型包括国家和患者的随机效应，并根据年龄和性别进行调整。
共有1729例患者在开始使用TNFi时出现8397个关节肿胀。考虑上肢，与第3指关节相比，肩部（HR，95%CI）（1.65，1.16 - 2.35）和肘部（1.90，1.38 - 2.61）关节肿胀消退率较高，而腕部（0.72，0.62 - 0.83）较低。在手指中，以同样的关节为参照，第4指（1.77，1.49 - 2.11）和第5指（1.88，1.53 - 2.31）关节肿胀消退最快。与肘部及上肢相应关节相比，膝部关节肿胀消退率较低（0.56，0.40 - 0.78）。
PsA患者使用TNFi治疗后关节肿胀消退时间似乎取决于受累关节的部位。
