Hepatic steatosis, carotid plaques and achieving MDA in psoriatic arthritis patients starting TNF-α blockers treatment: a prospective study

Abstract

IntroductionWe prospectively evaluated whether hepatic steatosis (HS) and the presence of carotid plaques (CPs) impacts on achieving minimal disease activity (MDA) in psoriatic arthritis (PsA) patients starting tumor necrosis factor (TNF)-α blockers treatment.MethodsBefore starting treatment with TNF-α blockers, consecutive PsA subjects with an active disease were evaluated for the presence of the metabolic syndrome (MetS), HS and CPs. The incidence of MDA was evaluated 12 and 24 months later.ResultsAmong 270 PsA subjects, 91 (33.7%) exhibited the MetS, 58 (21.5%) CPs and 76 (28.1%) HS. At the 12-month follow-up, 98 (36.3%) individuals achieved MDA. Compared with those who did, a higher prevalence of the MetS, HS and CPs was found in subjects who did not achieve the MDA (P always < 0.001). After adjusting for the MetS and for all the other demographic/clinical characteristics analyzed, the presence of HS and CPs at baseline independently predicted the risk of not achieving MDA (Hazard Ratio: 1.91, 95% confidence interval (CI): 1.04 to 3.38, P = 0.035 and Hazard Ratio: 3.21, 95%CI: 1.64 to 6.29, P = 0.001, respectively). Separate Kaplan-Meier survival models confirmed this (Log-Rank: 12.894, P < 0.001 and Log-Rank: 12.849, P < 0.001, respectively). Compared with those without, progressively increasing Hazard Ratios of not achieving MDA were found in those with HS, CPs or HS + CPs at baseline. Moreover, the presence of HS and/or CPs predicted the risk of relapse during the additional 12-month follow-up (Hazard Ratio: 2.85, 95%CI: 1.27 to 6.37, P = 0.011 and Hazard Ratio: 3.17, 95%CI: 1.57 to 6.41, P = 0.001 respectively).ConclusionsHS and/or CPs at baseline are negative predictors of achieving and maintaining MDA.

Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers

“…The European League Against Rheumatism (EULAR) suggests a periodic CV risk assessment in rheumatological settings, including disease activity as an independent risk factor 34. In turn, major markers of atherosclerosis (carotid plaques; hepatic steatosis), besides globally assessing the damage due to cardiometabolic and/or inflammatory determinants,35 36 seem to help to identify patients at high risk of not achieving MDA 22…”

Minimal Disease Activity as a Treatment Target in Psoriatic Arthritis: A Review of the Literature

“…A range of common comorbidities in PsA have also been identified as negative predictive factors for achieving MDA, including metabolic syndrome, increased weight, hepatic steatosis, carotid plaques, and coexistence of fibromyalgia 35,36,37,38 . There is also some evidence that successful weight loss may improve the attainment of MDA with anti-TNF therapies 39 .…”

The impact of concomitant diffuse idiopathic skeletal hyperostosis on the achievement of minimal disease activity in subjects with psoriatic arthritis

“…From February 2012 to January 2013, consecutive patients diagnosed with PsA according to the classification of psoriatic arthritis (Study Group) criteria [6], referring to the rheumatology outpatients clinic of the "Salvatore Maugeri" Foundation in Telese Terme and from the Psoriatic Arthritis Research Unit, Federico II University Naples, were screened for inclusion in this study.…”

“…According to validated criteria [6], patients were classified as having achieved minimal disease activity (MDA) when fulfilling five of the following seven outcome measures: TJC ≤ 1; SJC ≤ 1; PASI ≤ 1 or body surface area ≤3; VAS-p ≤ 15; VAS-g score ≤20; HAQ ≤ 0.5 and TEC ≤ 1. Otherwise, they were considered as not having achieved MDA.…”