The Impact of Early Attainment of Minimal Disease Activity on Radiographic Outcomes: A Real-World Longitudinal Cohort Study in Psoriatic Arthritis.

Abstract

OBJECTIVE To evaluate the effect of achieving Minimal Disease Activity (MDA) within the first year on radiologic damage at follow-up 3 years in patients with newly diagnosed Psoriatic Arthritis (PsA). METHODS Data were used from the Dutch southwest Early PsA cohort, a real-world cohort of newly diagnosed PsA patients, focusing for this manuscript on those with oligoarthritis or polyarthritis. Patients were stratified into three groups: [1] Sustained-MDA- achieving MDA at least at both 9 and 12 months post-diagnosis; [2] Non-sustained-MDA- achieving MDA in the first year but not sustaining it at 9 and 12 months; [3] No-MDA- not achieving MDA in the first year. Radiographic assessment was utilized by the PsA-modified Total Sharp/van de Heijde Score. Group comparisons at follow-up 3 years for radiographic changes were conducted using a Linear Mixed Model. RESULTS 284 patients were categorized into three groups: 96 patients (34%) in the sustained- MDA group, 83 (29%) in the non-sustained-MDA group, and 105 (37%) in the no-MDA group. According to baseline characteristics, in the no-MDA group, a notably higher rate of females (70%) and an elevated tender joint count (median (IQR): 7(4-12)) were observed. Patients who did not achieve MDA in the first year experienced remarkably higher radiographic changes during follow-up than the sustained-MDA group (β = 0.05 (95% CI 0.02 to 0.08), p < 0.01). CONCLUSION Radiographic changes during the 3-year follow-up were markedly higher in those unable to achieve MDA within the first year of follow-up, emphasizing the long-term structural benefits of reaching stringent disease activity targets early in the disease course.