Resistant to therapy psoriatic arthritis. Data from Russian Registry of psoriatic arthritis patients

The aim – to identify clinical characteristics of resistant to therapy psoriatic arthritis (PsA) patients. Material and methods . 459 patients (M/F=213/246), mean age 46.1±12.5 years (yrs) with PsA treated by biologic or target synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) within 2 yrs were included. Difficultto-treat (D2T) PsA was defined as failure of ≥2 b/tsDMARDs with different mechanism of action among tumor necrosis factor (TNF) inhibitors, anti-interleukin (IL) 17, anti-IL12/23, anti-IL13 and Janus kinase (JAK) inhibitors within 2 yrs of follow-up. Complex-to-manage (C2M) PsA was defined as failure of ≥2 b/tsDMARDs and includes additional factors such as lack of access to treatment or contraindication or intolerance. D2T and C2M patient’s characteristics were compared with each other and with responders to therapy (non-D2T) patients using statistical tests. Results. 352 (76.7%) patients (M/F=163/189) responded to the first b/tsDMARDs. 107 (23.3%) patients were resistant to treatment. Of these, 53 (11.5% of all those included in the study) (M/F=26/27) were identified as D2T and 54 (11.8%) (M/F=24/30) as C2M. A comparative analysis performed of 107 resistant and 352 responding patients with PsA showed that PsA-resistant patients had a significantly more often enthesitis 31% vs 17% (p=0.002), dactylitis 34% vs 20% (p=0.004), depression 30% vs 19% (p=0.002), cardiovascular diseases 28% vs 40% (р=0.031) and ≥2 comorbidities 39% vs 51% (р=0.045), than those who responded to treatment. A comparative analysis performed of 54 C2M PsA and 53 D2T PsA showed that C2M patients had a significantly more often pain/discomfort 43% vs 19% (p=0.024) and depression 41% vs 19% (p=0.04), significantly less often enthesitis 15% vs 47% (p=0.001) and dactylitis 24% vs 43% (р=0.04) than D2T PsA. Conclusions. In real clinical practice treatment-resistant PsA patients occur in quarter (23.3%) cases, of them D2T PsA patients – in 11.5% and C2M – in 11.8% cases. Treatment-resistant PsA patients compared with responders to therapy are characterized by presence of enthesitis, dactylitis and various comorbidities mainly depression and cardiovascular disease. C2M PsA patients compared with D2T PsA are characterized by presence of pain/discomfort and depression.