Identification and characteristics of patients with potential difficult-to-treat Psoriatic Arthritis: exploratory analyses of the Greek PsA registry

Konstantinos D Vassilakis; Charalampos Papagoras; Nikolaos Fytanidis; Sousana Gazi; Evangelia Mole; Michael Krikelis; Paraskevi V Voulgari; Evripidis Kaltsonoudis; Nikolaos Koletsos; Dimitrios Boumpas; Pelagia Katsimpri; Dimitrios Katsifis-Nezis; Theodoros Dimitroulas; Nikolaos Kougkas; Maria Boutel; Petros P Sfikakis; Maria G Tektonidou; Chrysoula Gialouri; Dimitrios Bogdanos; Theodora Simopoulou; Christos Koutsianas; Evgenia Mavrea; Gkikas Katsifis; Konstantinos Kottas; Maria Konsta; Matthoula Tziafalia; Evangelia Kataxaki; Eleni Kalavri; Kalliopi Klavdianou; Eleftheria P Grika; Charalampos Sfontouris; Dimitrios Daoussis; George Iliopoulos; Ilias Bournazos; Dimitrios Karokis; Konstantinos Georganas; Dimos Patrikos; Dimitrios Vassilopoulos; George E Fragoulis

doi:10.1093/rheumatology/keae263

Identification and characteristics of patients with potential difficult-to-treat Psoriatic Arthritis: exploratory analyses of the Greek PsA registry

Rheumatology (Oxford). 2024 May 17:keae263. doi: 10.1093/rheumatology/keae263. Online ahead of print.

Authors

Konstantinos D Vassilakis¹, Charalampos Papagoras², Nikolaos Fytanidis², Sousana Gazi³, Evangelia Mole³, Michael Krikelis³, Paraskevi V Voulgari⁴, Evripidis Kaltsonoudis⁴, Nikolaos Koletsos⁴, Dimitrios Boumpas⁵, Pelagia Katsimpri⁵, Dimitrios Katsifis-Nezis⁵, Theodoros Dimitroulas⁶, Nikolaos Kougkas⁶, Maria Boutel⁶, Petros P Sfikakis¹, Maria G Tektonidou¹, Chrysoula Gialouri¹, Dimitrios Bogdanos⁷, Theodora Simopoulou⁷, Christos Koutsianas⁸, Evgenia Mavrea⁸, Gkikas Katsifis⁹, Konstantinos Kottas⁹, Maria Konsta¹⁰, Matthoula Tziafalia¹⁰, Evangelia Kataxaki¹¹, Eleni Kalavri¹², Kalliopi Klavdianou¹², Eleftheria P Grika¹³, Charalampos Sfontouris¹³, Dimitrios Daoussis¹⁴, George Iliopoulos¹⁴, Ilias Bournazos¹⁵, Dimitrios Karokis¹⁵, Konstantinos Georganas¹⁵, Dimos Patrikos¹⁵, Dimitrios Vassilopoulos⁸, George E Fragoulis¹

Affiliations

¹ Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
² First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
³ Department of Rheumatology, KAT Hospital, Athens, Greece.
⁴ Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina.
⁵ Joint Academic Rheumatology Program, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
⁶ 4th Department of Medicine, Aristotle University, Thessaloniki, Greece.
⁷ Department of Rheumatology and Clinical Immunology, University of Thessaly, Larissa, Greece.
⁸ Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens "Hippokration", Athens, Greece.
⁹ Rheumatology Clinic, Naval Hospital of Athens, Athens, Greece.
¹⁰ Rheumatology Unit, Sismanoglio Hospital, Athens, Greece.
¹¹ Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece.
¹² Department of Rheumatology, "Asklepieion" General Hospital, Athens, Greece.
¹³ Department of Rheumatology, Evaggelismos Athens General Hospital, Athens, Greece.
¹⁴ Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece.
¹⁵ Private practice, Athens, Greece.

PMID: 38759119
DOI: 10.1093/rheumatology/keae263

Abstract

Objective: To present the characteristics of patients with potential difficult-to-treat (D2T) psoriatic arthritis (PsA).

Methods: We used data from the Greek multicentre registry of PsA patients. D2T-PsA was defined as follows: patients with at least 6-months disease duration, who have failed to at least 1 csDMARD and at least 2 bDMARDs/tsDMARDs with a different mechanism of action and have either at least moderate disease activity (MODA) defined as DAPSA > 14, and/or are not at minimal disease activity (MDA). Demographic and clinical characteristics were compared between D2T and non-D2T PsA patients. In two sensitivity analyses, patients classified as D2T solely according to the MODA or MDA criterion were examined separately.

Results: Among 467 patients included, 77 (16.5%) were considered D2T and 390 non-D2T PsA. Compared with non-D2T, patients with D2T PsA presented more commonly with extensive psoriasis (p< 0.0001) and were more likely to have higher BMI (p= 0.023) and a history of inflammatory bowel disease (p= 0.026). In the MODA and MDA sensitivity analyses, 7.5% and 12.5% of patients were considered D2T, respectively. In both sensitivity analyses, extensive psoriasis was again identified as an independent variable for D2T PsA (p= 0.001 and p= 0.008, respectively). Moreover, female gender (p= 0.034) in the MODA analysis and axial disease (p= 0.040) in the MDA analysis were independent variables for D2T PsA.

Conclusion: Despite the availability of therapies, D2T PsA is common in real-life cohorts of patients with PsA and extensive psoriasis. High BMI, female gender, axial-disease, and history of IBD were also associated with D2T PsA.

Keywords: axial-disease; difficult-to-treat (D2T); psoriasis; psoriatic arthritis; refractory.