Remission Induction Treatment Strategies in Early Psoriatic Arthritis: A Clinical and Imaging Study

Effective remission-induction strategies are not established in early Psoriatic Arthritis (PsA) and a comprehensive definition of remission is lacking. This thesis explored the effects of combined Methotrexate (MTX), Golimumab (GOL) and steroids in inducing remission in early, treatment naïve PsA; the role of imaging in the assessment of remission; and the potential of newly proposed sets of remission.
Methods
This work firstly presents a systematic review of the literature that identified relevant knowledge gaps: the definition of remission in early PsA; the interventions likely to induce remission across musculoskeletal and cutaneous domains of disease; and the limited scope of current outcome measures, as these fail to assess disease activity across disease domains.
Then new remission criteria for early PsA (three sets) were designed, aimed at assessing disease activity in the musculoskeletal domains (set A). Set B added the skin/nails domain to set A items. Set C added imaging (whole-body ultrasound and magnetic resonance scans) remission items to those of set B (“deep remission”).
The GOLMePsA study (a randomized, double-blind placebo-controlled trial of treatment-naïve early PsA) dataset was used as a platform to: 1) formally confirm the test-retest reliability of the Psoriatic ArthritiS Disease Activity Score (PASDAS), the recommended outcome measure for PsA trials; 2) test the prevalence of remission (as defined by sets A, B and C) in GOLMePsA participants following intervention; 3) correlate remission data with PASDAS levels, intended at identifying novel remission subgroups by PASDAS values.
Results and Conclusions
GOLMePsA participants achieved low disease activity following intensive interventions, recording responses across musculoskeletal and cutaneous domains. However, treatment allocation was not associated to remission prevalence (achieved by 8.3%). Remission sets A and B related to novel subgroupings by PASDAS levels (≤1.2 value). Notably, achievement of remission reduced the need for resuming biologic drugs by the end of trial.