DMARDS May Be Effective Treatment Option for Enthesitis

A recent observational study found that use of conventional and targeted disease modifying anti-rheumatic drugs (cMARDS, tDMARDs) may be successful in treating enthesitis among patients with psoriatic arthritis (PsA). Enthesitis is thought to play a role in the pathogenesis of PsA, and is observed in 27%-35% of patients with PsA. This figure may be underestimated, though, as the entheses are often overlooked in clinical examination.

There were 526 patients with active enthesitis, as defined as ≥1 tender entheses, and PsA, and with adequate follow-up were included in the study. Patients were classified based on their medications at baseline: no treatment/non-steroidal anti-inflammatory drugs (NSAIDs); cDMARDS±NSAIDs; and tDMARDS±cMARDS/NSAIDs. The primary outcome was complete resolution of enthesitis (defined as 0 tender entheseal sites) at 12 months.

The patients included had a mean enthesitis score of 2.13. Of the 526 total patients, 453 (86%) experienced complete resolution of enthesitis, regardless of the medication used, within a mean period of 8.73 months. Although not significant, the groups that included DMARDs (both t and c) had a higher odds ratio for resolution of enthesitis than the no treatment/NSAIDs group. Enthesitis resolution was also associated with lower joint activity and male sex.

The study authors added that “future effectiveness studies may warrant evaluation of enthesitis using advanced imaging.”

—Allison Casey

Reference:
Mathew AJ, Sutton M, Pereira D, Gladman DD, Chandran V. Effectiveness of disease modifying anti-rheumatic drugs for enthesitis in a prospective longitudinal psoriatic arthritis cohort. J Rheumatol. Published online: June 2022. DOI:10.3899/jrheum.211231