Prognosis of pharmacotherapy effectiveness in psoriatic arthritis

The aim – to develop a method for predicting the effectiveness of psoriatic arthritis (PsA) therapy.

Methods. 377 PsA patients (pts) were examined: (М/F 185/192). Pts’ age 47.6±12.4 years, psoriasis (PsO) duration 206.8±156.3 months, PsA duration – 84.8±84.6 months. Pts underwent standard clinical examination, the analysis included detection of comorbidities according to ICD-10. Pts were evaluated for achieving minimal disease activity (MDA). Data of visit 2 (6 months of treatment) were analysed.

Results. At 6 months of treatment tender joint count was 3,0 [0.0; 8.0], swollen joint count – 1,0 [0.0; 5.0], C-reactive protein (CRP) – 4,3 (0.0–90.6) mg/l, LEI (Leeds Enthesitis Index) – 0,0 (0.0–6.0), body mass index (BMI) – 27.6±5.2 kg/m². 273 (72%) pts had BMI<30 kg/m², 75 (19.9%) pts – 30≤ BMI<35 kg/m², 29 (7.7%) pts – BMI≥35 kg/m². Mild PsO (BSA≤3%) was found in 264 (70.0%) of 377 pts, moderate (3%<BSA≤10%) – in 96 (25,5%) pts, severe PsO (BSA>10%) – in 17 (4.5%) pts. 82 (21.8%) pts met the MDA criteria. Comorbid diseases were found in 152 (40%) pts.

Multivariate analysis was performed and the following parameters were revealed that negatively correlate with MDA achievement – CRP (p=0.0001), LEI (p=0.001), arterial hypertension (AH) (p=0.08), BSA (p=0.063), BMI (p=0.289). A discriminant rule was obtained that makes it possible to predict the possibility of MDA achievement: 0.046×(CRP, mg/l) + 0.470×LEI + 0.527×(AH) + 0.451×(BSA) + 0.237×(BMI) ≤1.184.

This formula includes the values of CRP, LEI, AH (no AH – 0 points, with AH – 1 point), BSA (BSA≤3% – 1 point, 3%<BSA≤10% – 2 points, BSA>10% – 3 points), BMI (BMI<30 kg/m² – 0, 30≤BMI<35 kg/m² – 1 point, BMI≥35 kg/m² – 2 points). When the expression value is ≤1.184, the achievement of MDA in PsA pts is predicted.

The area under the ROC curve is 0.76, which makes it possible to estimate the predictive accuracy of the model as high (95% CI: 0.71–0.81; p=0.26. For the selected total value of the discriminant function 1.184, sensitivity is 85.4%, specificity – 59.3%.

Conclusion. The developed method for predicting the MDA achievement in PsA pts including the following indicators: CRP, LEI, the presence of hypertension and obesity, severity of PsO – makes it possible to predict the treatment outcome in PsA pts and stimulates both the physician and the patient to modify the factors included in this formula.

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