Highlights from

European League Against Rheumatism

meeting 2018

Amsterdam 13-16 June 2018

NSAIDs widely used in first years in patients with late-onset psoriatic arthritis

Gili et al. initiated a prospective observational study which aimed to describe treatment prescribing patterns in PsA over the first 2 years of follow-up. They also evaluated if the treatment patterns in PsA are in any way conditioned by the age of onset of the disease.

A total of 46 patients with at least 2 years of follow-up within the PsArT (Psoriatic arthritis Age-related Treatment patterns) study were included in the study. These were patients who were diagnosed with early (symptom duration <52 weeks) PsA. Twenty-four of them were female, mean age was 49 with range 16-90 years, and mean disease duration was 20 weeks (range 1-52). This group was divided into Adult-Onset (AOPsA) (age <60 years) and Late-Onset (LOPsA) (onset age ≥60 years) PsA according to the age at the onset of musculoskeletal manifestations. Data were collected at the time of enrollment (baseline), at 12 months, and at 24 months.

It was found that those patients who had LOPsA (n=15) when compared to AOPsA patients (n=31), had a significant shorter disease duration (17 vs 21 weeks, p<0.05) as well as showing more frequently increased levels of erythrocyte sedimentation rate (ESR; 75% vs 43%, p<0.05) and CRP (87% vs 52%, p <0.01). Moreover, LOPsA patients developed more frequently inflammatory extremity swelling with pitting oedema over the dorsum of hands and/or of feet (56% vs 13%, p<0.01). No other significant differences between both groups were seen.

For instance, sensitivity of the CASPAR criteria was similar in AOPsA (78%) and LOPsA (75%) patients. With regard to medication used during the first year, 80.4% of patients received NSAIDs, 32.6% received oral corticosteroids, 13.0% received local corticosteroids, 19.5% received sDMARDs, and 6.5% received bDMARDs (infliximab, adalimumab, golimumab, and etanercept). For the second year, these percentages were 73.9%, 30.4%, 30.4%, 50%, and 15.2%, respectively. The only statistical significant difference between both groups was the rate of patients using NSAIDs in the LOPsA group during the first year (100% vs 70.9%, p=0.02). No other significant differences in drug intake, therapy changes, discontinuation, or add-on therapy according to the age of PsA onset were observed.

It was concluded that during the two years of follow up period, NSAIDs were used in a large number of LOPsA patients during the first year. However, the researchers pointed out that this study had only a low number of patients, thus no robust conclusion could be drawn. New studies into this matter with larger numbers of patients would be very helpful to elucidate these findings further and to clarify if and what the influence is of the age of onset with regard to treatment patterns.[9]

  1. Gilio M, et al. Abstract AB0938. EULAR 2018.

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