Biologic Saves Joints in Psoriatic Arthritis
Patients with psoriatic arthritis had minimal structural changes in their joints with golimumab through 2 years of treatment, a researcher reported here.
The mean changes in total radiographic joint score, which reflected both bone erosions and joint space narrowing, were −0.39 among patients receiving 50 mg of subcutaneous golimumab once monthly and −0.32 for patients receiving 100 mg each month, reported Chandrabhusan Chattopadhyay, MD, of Wrightington Hospital in Wigan, England, and colleagues.
“That actually represented healing of erosions,” he said at the annual meeting of the British Society for Rheumatology.
The study included 405 adults, all of whom had three or more swollen and tender joints.
Initially they were randomized to one of the two golimumab doses or placebo. Golimumab (Simponi) is a human monoclonal anti-tumor necrosis factor-alpha (TNF) antibody, administered as subcutaneous injections.
At week 16, patients with a response of less than 10% in swollen and tender joint counts were randomized to one of the two active treatment groups, and at week 24 all remaining placebo patients were assigned to the 50 mg group.
Psoriatic arthritis facts
- About one in 10 people with psoriasis also develop inflammation of joints (psoriatic arthritis).
- The first appearance of the skin disease (psoriasis) can be separated from the onset of joint disease (arthritis) by years.
- Psoriatic arthritis belongs to a group of arthritis conditions that cause inflammation of the spine (spondyloarthropathies).
- Patients with psoriatic arthritis can develop inflammation of tendons, cartilage, eyes, lung lining, and, rarely, the aorta.
- The arthritis of psoriatic arthritis is treated independently of the psoriasis, with exercise, ice applications, medications, and surgery.
After one year of treatment, blinding was discontinued and patients in the 50 mg group could have their dose escalated to 100 mg if needed.
Participants’ mean age was 45, and almost two-thirds were male.
The median number of swollen joints at baseline was 13, and the median number of tender joints was 23.
What Is Psoriatic Arthritis?
Psoriatic arthritis (PsA) is a type of chronic inflammatory arthritis associated with the chronic skin condition psoriasis, which is believed to be an inherited condition. Psoriasis, which affects about 2 percent of the U.S. population, most often causes patches of thick, reddened, irritated skin with flaky, silver-white patches called scales.
Psoriatic arthritis typically appears about 10 years after the onset of psoriasis, which can manifest at any age, though most people are diagnosed between the ages of 15 and 35. The main symptoms of psoriatic arthritis are:
- painful, swollen joints
- tenderness where muscles or ligaments attach to bones, particularly the heel and bottom of the foot
- back pain
- nail changes such as separating from the nail bed, or becoming pitted or infected-looking
- morning stiffness
- general fatigue
- reduced range of motion
- redness and pain in tissues surrounding the eyes (conjunctivitis)
Median level of C-reactive protein was 0.6 mg/dL, and mean scores on the Health Assessment Questionnaire (HAQ) were 1 to 1.1.
Mean total van der Heijde-Sharp total joint scores ranged from 16.34 to 22.99.
After 1 year of treatment with this golimumab, the changes in total joint scores were:
Placebo group: 0.10
50 mg group: −0.30
100 mg group: −0.35
At 2 years, when all patients had been receiving the active treatment, those who had originally been randomized to placebo were showing less progression in their total joint scores, which had decreased from 0.10 to 0.08, Chattopadhyay said.