Prognostic factors of good response to DMARDs in psoriatic arthritis: a narrative review

ABSTRACT

Introduction

The management of Psoriatic arthritis (PsA) has evolved in the last decade with a significant increase in treatment options making the choice for clinicians difficult. Thus, the different factors of good prognosis for each treatment are presented in this review.

Areas covered

Current available treatment and assessment tools for the response of treatment are presented. A systematic review of the literature, on Pubmed, Medline and Cochrane databases and abstracts from the last three EULAR and ACR annual conferences was performed. Factors associated with a good response to csDMARDs, tsDMARDs and bDMARDs are presented.

Expert opinion

Dactylitis and axial involvement are associated with a poor response to methotrexate. Leflunomide has shown better efficacy in the presence of established polyarticular involvement. TNF inhibitors are to be preferred in young men with an elevated CRP while obesity, high disease activity and long disease duration are factors associated with poor response. Apremilast and ustekinumab are more effective in mono and oligo articular disease. Abatacept is more effective in patients with high CRP, high disease activity and polyarticular involvement. Finally, there are no available data with the anti IL17 These factors are some arguments to help clinicians, but comparative study are needed to conclude.

KEYWORDS:

• Prognostic factors
• psoriatic Arthritis
• treatment
• DMARDs

Article Highlights

• The management of psoriatic arthritis is complex because of the multiple domains of the phenotype and the multiple available treatments.

• There are no prognostic factors of good response with methotrexate

• TNF inhibitors are more effective in young men with a short disease duration

• Apremilast and ustekinumab are more effective in mono and oligoarticular arthritis.

• Abatacept is more effective in patients with active disease and with biological inflammation.

Declaration of interest

C. Prati has received has acted as a consultant or served as an advisory board member for, and received speaker fees from: Novartis, Lilly and Pfizer; companies that may be affected by the research reported in the enclosed paper.

D. Wendling has received has acted as a consultant or served as an advisory board member for, and received speaker fees from: AbbVie, Bristol-Myers Squib, Merck Sharp Dohme, Pfizer, Roche Chugai, Amgen, Nordic Pharma, UCB, Novartis, Janssen, Celgene, Hospira, Lilly, Sandoz, Grunenthal; companies that may be affected by the research reported in the enclosed paper.

F. Verhoeven has received has acted as a consultant or served as an advisory board member for, and received speaker fees from: Novartis, Merck Sharp Dohme, Celgen, Amgen, Roche Chugai and Bristol-Myers Squib; companies that may be affected by the research reported in the enclosed paper.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.