OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA).
METHODS: An exploratory prospective cohort study enrolled PsA patients initiating biologic/conventional synthetic disease modifying anti-rheumatic drugs in routine care. Clinical-, US- and patient-reported measures were retrieved at baseline and after 4 months. Widespread non-arthritic pain (WP) was defined as Widespread Pain Index ≥4 with pain in ≥4/5 regions. PsA activity by US was defined as colour Doppler (CD) (yes/no) in selected entheses, joints or tendons. Main response criteria included American College of Rheumatology 20% (ACR20), Disease Activity in Psoriatic Arthritis 50% (DAPSA50), and Minimal Disease Activity (MDA). The primary analyses were age-and gender adjusted logistic regression.
RESULTS: WP was present in 24 (35%) of 69 included patients, and associated with worse patient-reported and composite baseline measures while US and other objective findings were similar to patients without WP. The odds of 4-months MDA were significantly greater for patients enrolled without WP (OR=18.43 [95% CI: 1.51-224.41], p=0.022), while WP did not impair other response measures. Patients with baseline CD activity (n=42 [61%]) had worse objective PsA burden but their chance of treatment response was comparable to those without CD.
CONCLUSIONS: More than one-third of PsA patients presented with widespread non-arthritic pain, which was associated with worse patient-reported scores and failure to achieve MDA following cs/bDMARD therapy. PsA activity by colour Doppler ultrasound had no influence on subsequent treatment response in this PsA cohort. This article is protected by copyright. All rights reserved.
Available at: http://works.bepress.com/philip-mease/391/