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

Abstract

To evaluate the effect of achieving minimal disease activity (MDA) within the first year on radiologic damage at 3-year follow-up in patients with newly diagnosed psoriatic arthritis (PsA). Data were used from the Dutch southwest Early PsA cohort, a real-world cohort of newly diagnosed patients with PsA, focusing on those with oligoarthritis or polyarthritis. Patients were stratified into 3 groups: (1) sustained MDA, achieving MDA at least at both 9 and 12 months post diagnosis; (2) nonsustained 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 used by the modified Total Sharp/van der Heijde score for PsA. Group comparisons at 3-year follow-up for radiographic changes were conducted using a linear mixed model. Two hundred eighty-four patients were categorized into 3 groups: 96 patients (34%) in the sustained MDA group, 83 (29%) in the nonsustained MDA group, and 105 (37%) in the no-MDA group. According to baseline characteristics, in the no-MDA group, a notably higher rate of female individuals (70%) and an elevated tender joint count (median 7, IQR 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 0.02-0.08, <i>P</i> < 0.01). 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.