Remission criteria and activity indices in psoriatic arthritis

Remission criteria and activity indices used in rheumatoid arthritis (RA) are often applied in psoriatic arthritis (PsA). Some new indices have been specifically developed for PsA. Our objective was to evaluate the performance of different remission criteria and activity indices in PsA. This is a cross-sectional study that includes consecutive patients with PsA. Information necessary to complete the following indices was captured: Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic Arthritis Screening and Evaluation (PASE), Disease Activity Index for Psoriatic Arthritis (DAPSA), Disease Activity Score in 28 Joints (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) Boolean RA remission criteria. Patients were classified according to activity categories (remission, low, medium, or high disease activity). Correlation between indices was established. Fifty-five patients were included. Mean age was 53 years (SD?=?12), and 35 (63.6 %) were males. Mean PsA disease duration was 5.9 years (SD?=?8.5), and mean psoriasis duration was 15.9 (SD?=?12.6). We found important differences in the percentage of patients classified as in remission by applying different remission criteria: DAS28?=?33 % (95 % confidence interval (CI) 20–45) vs ACR/EULAR?=?4 % (95 % CI 1–17). Particularly, DAS28 and minimal disease activity seemed to be less stringent in PsA than the other indices. Of the specific PsA indices evaluated, CPDAI showed the poorest correlation with all the other activity measurements, although differences were not statistically significant in most cases. Disease activity in PsA is measured by many different indices. In spite they all showed good correlations between them, they classified different patients in different disease status.     

Application of the GRAPPA Psoriatic Arthritis Treatment Recommendations in Clinical Practice

Psoriatic disease presents with a complex array of clinical features, including peripheral synovitis and skin psoriasis, but there is also variable involvement of the nail, dactylitis, enthesitis, and spinal disease. Composite assessment of disease activity and response taking into account the impact of the disease as a whole on an individual’s health and quality of life is of vital importance. Following an extensive literature review, discussions, and consensus, the Group for Research in Psoriasis and Psoriatic Arthritis (GRAPPA) published guidelines to help clinicians make treatment decisions. The utility of these guidelines in routine clinical practice is further enhanced by incorporating them into a Composite Psoriatic Disease Activity Index (CPDAI). The potential application of the CPDAI in typical psoriatic disease patients is presented and discussed. Validation and possible modification of a composite disease activity and responder index is currently being undertaken by GRAPPA.     

Improvements in quality of life and functional status in patients with psoriatic arthritis receiving anti–tumor necrosis factor therapies

Objective

To evaluate the impact of anti–tumor necrosis factor (anti‐TNF) therapies on quality of life (QOL) and functional status in psoriatic arthritis (PsA) patients and study potential predictors for QOL improvements.

Methods

The study was based on a cohort of 596 PsA patients receiving anti‐TNF therapies. Changes in functional status and QOL were assessed using the Health Assessment Questionnaire (HAQ) and Short Form 36 (SF‐36) questionnaire on a 6‐month basis. The Short Form 6D (SF‐6D) was calculated as a utility score. Univariate and multivariate linear regression models were developed to examine potential predictors of QOL improvements at 6 months, using a range of demographic, baseline disease‐specific, and therapeutic variables.

Results

At 6 months, significant improvements in all SF‐36 subscale scores were found, with the greatest percentage improvement from baseline related to physical role (113.8%; 95% confidence interval [95% CI] 102.6, 125.0). The percent improvement for the physical component scale was 53.2% (95% CI 44.5, 61.9) at 6 months, whereas that for the mental component scale was 16.9% (95% CI 14.7, 19.2). The mean ± SD SF‐6D score was 0.58 ± 0.07 at baseline, and this improved to 0.63 ± 0.06 at 6 months. The median HAQ score at baseline was 1.88 (interquartile range [IQR] 1.38–2.25) for the entire cohort, and this improved to 1.25 (IQR 0.63–1.88) at 6 months. Improvements in Disease Activity Score in 28 joints at 6 months were found to be significantly associated with QOL improvements at the same time point.

Conclusion

Anti‐TNF therapy is associated with improvement in both physical and mental status in PsA patients. These improvements were most substantial in patients who also had improvements in their disease activity.     

Health‐related quality of life of patients with psoriatic arthritis: A comparison with patients with rheumatoid arthritis

Objective

To compare health‐related quality of life (QOL) between patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA), using the Medical Outcomes Study Short Form health survey (SF‐36) and the Health Assessment Questionnaire (HAQ).

Methods

Both the SF‐36 and the HAQ were administered to 107 PsA patients attending the University of Toronto Psoriatic Arthritis Clinic between January 1 and December 31, 1994, and to 43 RA patients attending a University of Toronto–affiliated RA clinic during the same period. Standardized assessments of disease activity and severity were also performed at each clinic visit. Logistic regression analysis was used to compare health‐related QOL between PsA and RA.

Results

Both patient populations experienced lower physical health compared with that of a general population sample. The RA patients demonstrated more active inflammatory disease at the time of assessment than the PsA patients. The PsA patients were younger, and more were men. Logistic regression analyses showed that patients with PsA reported higher levels of vitality than patients with RA, even after adjusting for the observed differences in clinical and demographic characteristics. PsA patients, however, reported more role limitations due to emotional problems and more bodily pain after adjusting for the difference in vitality and other covariates.

Conclusions

Although both patient populations experienced reduced QOL, there were some meaningful differences in how the 2 conditions affect health‐related QOL. Further, it appeared that there may be unique disabilities associated with the psoriasis dimension of PsA.

     

Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis

OBJECTIVE: To compare health-related quality of life (QOL) between patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA), using the Medical Outcomes Study Short Form health survey (SF-36) and the Health Assessment Questionnaire (HAQ). METHODS: Both the SF-36 and the HAQ were administered to 107 PsA patients attending the University of Toronto Psoriatic Arthritis Clinic between January 1 and December 31, 1994, and to 43 RA patients attending a University of Toronto-affiliated RA clinic during the same period. Standardized assessments of disease activity and severity were also performed at each clinic visit. Logistic regression analysis was used to compare health-related QOL between PsA and RA. RESULTS: Both patient populations experienced lower physical health compared with that of a general population sample. The RA patients demonstrated more active inflammatory disease at the time of assessment than the PsA patients. The PsA patients were younger, and more were men. Logistic regression analyses showed that patients with PsA reported higher levels of vitality than patients with RA, even after adjusting for the observed differences in clinical and demographic characteristics. PsA patients, however, reported more role limitations due to emotional problems and more bodily pain after adjusting for the difference in vitality and other covariates. CONCLUSIONS: Although both patient populations experienced reduced QOL, there were some meaningful differences in how the 2 conditions affect health-related QOL. Further, it appeared that there may be unique disabilities associated with the psoriasis dimension of PsA.     

Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire and the role of dermatologists: a report from the GRAPPA 2009 annual meeting

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, often with a variable course that ranges from slowly progressive to rapidly destructive. Delay in diagnosis and treatment may lead to an irreversible erosive arthropathy, leading further to physical disability and deformity. The Psoriatic Arthritis Screening and Evaluation (PASE) tool was developed and validated to help dermatologists screen more effectively for PsA; recently, it has been undergoing further validation. An update on the continuing experience with the PASE questionnaire, along with a discussion of why dermatologists have a critical role in screening for PsA, was a major focus of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) annual meeting at Stockholm, Sweden, in June 2009.     

Association of concomitant fibromyalgia with worse disease activity score in 28 joints,health assessment questionnaire,and short form 36 scores in patients with rheumatoid arthritis

Objective

To study the association of the presence of fibromyalgia (FM) with the Disease Activity Score in 28 joints (DAS28), the Health Assessment Questionnaire (HAQ), and the Medical Outcomes Study Short Form 36 (SF‐36) health survey in patients with rheumatoid arthritis (RA).

Methods

A total of 270 outpatients with RA were enrolled in a prospective cross‐sectional study. The patients underwent clinical evaluation and application of the HAQ and SF‐36 questionnaires. Disease activity was evaluated using the DAS28 score. FM and RA diagnoses were made according to American College of Rheumatology criteria.

Results

The overall prevalence of FM was 13.4%. This group of patients had a higher prevalence of female sex, older mean age, higher functional class, and longer morning stiffness than patients with only RA. Mean ± SD DAS28 scores were significantly higher in patients with RA and FM (5.36 ± 0.99) than in patients with RA only (4.03 ± 1.39; P < 0.001). In a multivariable linear regression analysis, FM was an important predictor of the DAS28 score, even after adjusting for the erythrocyte sedimentation rate, number of swollen joints, functional class, number of disease‐modifying antirheumatic drugs currently in use, current dose of steroids, and articular erosions. HAQ and SF‐36 scores were also worse in patients with RA and associated FM.

Conclusion

FM is related to worse scores on the DAS28, HAQ, and SF‐36 in patients with RA. The presence of FM may have major implications in the interpretation of the DAS28 score because it is related to higher scores independently of objective evidence of RA activity.     

The Perspective on Psoriatic Arthritis in Asia

There is a wide variation in the prevalence, incidence, and clinical manifestation of psoriatic arthritis (PsA) across countries due to genetic and environmental factors. Data on PsA in Asia are limited and come from small cross-sectional studies. The burden of PsA in Asia is high, including poor physical functioning, poor quality of life, and high socioeconomic cost. In addition, high rates of subclinical atherosclerosis and traditional cardiovascular risk factors among PsA patients in Asia have been demonstrated. Preliminary data suggest treatment with tumor necrosis factor blockers may reverse atherosclerosis in PsA. Several outcome measure instruments, including the Medical Outcomes Survey Short Form 36 and Health Assessment Questionnaire, have been validated for measuring PsA burden among the Chinese. A coordinated effort in Asia from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and the Asia Pacific League of Associations for Rheumatology (APLAR) will help estimate disease burden and clinical behavior of PsA on that continent.     

The spectrum of psoriatic arthritis in a South African cohort

The aim of this study was to describe the clinical features of patients with psoriatic arthritis (PsA) in a South African cohort. This is a retrospective analysis of patients contributing to development of the international classification criteria for PsA, ClASsification criteria for Psoriatic ARthritis (CASPAR). Patients were all seen at the arthritis clinics at Groote Schuur Hospital, Cape Town. Demographic, clinical, laboratory and radiographic information was collected. This study describes the relevant findings relating to the clinical profile of the patients seen at our centre as well as the effect of family history and/or dactylitis in determining the severity of psoriatic arthritis. There were 45 patients with a male to female ratio of 1:1.25. The mean age of psoriasis onset was 38.34 years (SD 15.54), whilst that of arthritis onset was 43.86 years (SD 13.4). Polyarthritis was the commonest pattern and sacro-iliitis was uncommon. Dactylitis was present in 26%. The presence of family history or of dactylitis did not predict more severe disease. There was a significant correlation between tender and swollen joints. The mean Health Assessment Questionnaire (HAQ) score was 1.05. Eighty-three percent showed evidence of radiological changes, and distal interphalangeal (DIP) erosions were found in 54%. Arthritis mutilans was present in 31%. There were no black subjects in the cohort. The clinical patterns of PsA in our cohort are similar to those reported elsewhere. The paucity of blacks amongst this cohort requires further study. PsA-specific measures of disease activity need to be developed. PsA causes significant joint damage and disability.     

Evaluation of IL-34 in psoriasis and psoriatic arthritis patients: Correlation with disease activity and severity

Introduction

Interleukin-34 (IL-34) is a newly discovered cytokine essential for skin homoeostasis. It is involved in macrophage differentiation, osteoclastogenesis and inflammation. This could suggest a potential role in the pathogenesis of psoriasis and psoriatic arthritis (PsA).

Development of Screening Tools to Identify Psoriatic Arthritis

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that follows an indolent and progressive course. A delay in diagnosis and treatment may lead to irreversible changes such as erosive arthritis, which lead to permanent physical disability and deformity. Administration of a well-designed screening tool can increase detection of PsA and help determine the prevalence of PsA in a given population. Several tools have been developed to help clinicians screen for PsA. Members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis recently led an effort to develop and validate three PsA screening tools: the Psoriatic Arthritis Screening and Evaluation tool, the Psoriasis Epidemiology Screening Tool, and the Toronto Psoriatic Arthritis Screen.     

Drug survival and effectiveness of ustekinumab in patients with psoriatic arthritis. Real-life data from the biologic Apulian registry (BIOPURE)

This study aims to evaluate the drug survival and effectiveness of ustekinumab in psoriatic arthritis (PsA) patients naïve to biologics or inadequate responders to tumor necrosis factor (TNF-IR) inhibitors in real life. PsA patients starting ustekinumab were enrolled from 2014 to 2016. Joint involvement, peripheral or axial, Psoriatic Area Severity Index, Disease Activity Psoriatic Arthritis (DAPSA), Lee Enthesitis Index, Health Assessment Questionnaire, body mass index, comorbidities, co-therapies, mechanism of action, and causes of discontinuation of prior TNFi were collected at baseline, and 6 and 12 months. Twelve-month drug survival was evaluated by Kaplan–Meier curves. Hazard ratios (HRs) of drug discontinuation adjusted for baseline factors were estimated by multiple Cox regression analysis. Percentages of DAPSA-based remission, as crude value and adjusted for drug retention (LUNDEX index), were compared by χ² test. Mean differences of DAPSA from baseline to 6 and 12 months were compared between naïve and TNF-IR patients by ANOVA. Of 160 PsA patients starting ustekinumab, 54 were naïve and 106 were TNF-IR. Twelve-month drug survival was significantly higher in naïve (87%) than in TNF-IR (68%, p?=?0.01). Baseline co-therapy with methotrexate did not increase the persistence on ustekinumab. Naïve patients had the lowest risk of ustekinumab discontinuation (HR 0.27, p?=?0.01), and the highest DAPSA-based remission (34%, LUNDEX 26%). Mean differences from baseline of DAPSA was significantly greater in naïve than in TNF-IR patients at 12 months (??14.4 ± 10 vs. ??4.1 ± 17, p?=?0.01). Our data showed that ustekinumab has a good effectiveness in real life and the best outcomes are achieved in biologic-naïve PsA patients.     

Association of IL1Β (-511 A/C) and IL6 (-174 G &gt; C) polymorphisms with higher disease activity and clinical pattern of psoriatic arthritis

The objective of this study is to analyze whether IL1β (-511G > A) and IL6 (-174 G > C) polymorphisms are associated with inflammatory activity, radiographic damage or clinical pattern of psoriatic arthritis (PsA). One hundred twenty-five patients classified as PsA according to the Classification of Psoriatic Arthritis (CASPAR) criteria were included. Patients were stratified according to their clinical pattern at inclusion as peripheral, axial, or mixed involvement. Disease activity in peripheral or mixed forms was measured using the number of swollen and tender joints, pain analog visual scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and disease activity score 28 (DAS28). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used for axial and mixed forms, as were pain visual analog scale, ESR and CRP. Radiographic damage was evaluated using a modified Sharp score and modified stoke ankylosing spondylitis spinal score (SASSSm). The polymorphisms for the promoter region of IL1β (-511 G/A) and IL-6 (-174 G/C) were analyzed. The G allele of IL1B (-511G/A) polymorphism was associated with higher peripheral joint disease activity (OR 3.13; p?<?0.0004; CI 95 % 1.43–6.82, p (corrected) <0.008), while the G allele of the IL6 (174G > C) polymorphism presented a strong trend to be associated with peripheral forms (70.86 %) (OR 1.89; p?<?0.03; CI 95 % 1.06–3.39, p-corrected 0.05). In addition, this allele showed a lower association with HLA-B27 (15.78 %) compared with C allele (28.57 %) (OR 0.469; p?=?0.02; CI 95 % 0.238–0.923, p-corrected 0.03). This study suggests that the G allele polymorphism of IL1B (-511 A/C) is associated with higher peripheral joint disease activity. On the other hand, the IL6 (-174 G/C) polymorphism showed a strong trend to be associated with the peripheral pattern of PsA.     

Psoriatic arthritis quality of life instrument: an assessment of sensitivity and response to change

OBJECTIVE: To assess responsiveness of the Psoriatic Arthritis Quality of Life tool (PsAQoL) and add further data regarding the construct validity of PsAQoL. METHODS: Twenty-eight patients with PsA underwent clinical assessment over a period of 6 months after change of disease modifying therapy, usually to methotrexate. Measures of outcome included PsAQoL, Health Assessment Questionnaire (HAQ), and assessment of disease activity. RESULTS: PsAQoL revealed significant change at 3 and 6 months. Standardized response mean was large at 3 months and small at 6 months. There was strong correlation with other patient-derived measures such as the HAQ and Patient Global at all timepoints. Disease Activity Score-28 and Physician Global showed a relationship with PsAQoL at 3 and 6 months, while a tender joint count relationship was seen only at 6 months. CONCLUSION: The PsAQoL now has responsiveness data and a measure of construct validity to sit alongside previously demonstrated reliability data. Our study has compared the change characteristcs within a group of patients. The next step in the development will require a placebo controlled trial to test discrimination between patients undergoing active treatment or taking placebo.     

The relationship between bristol rheumatoid arthritis fatigue scales and disease activity of patients with rheumatoid arthritis

Fatigue is a symptom that affects the 40–80% of patients with rheumatoid arthritis (RA) and impairs the quality of life. The aim of this study was to assess multidimensional fatigue scales, the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS) and to evaluate their relationship with disease activity in Turkish RA patients. The study included 180 patients with RA. The Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) were used to evaluate disease activity. The participants comprised of 142 females and 38 males. The mean ± standard deviations of DAS28, CDAI, and SDAI were 3?±?1.24, 9.51?±?7.96, and 10.5?±?8.38 respectively. All scales except the emotional subscale were correlated with disease activity. The emotional subscale correlated with CDAI and SDAI but not with DAS28. The results of the study indicated that fatigue and disease activity were correlated. Fatigue is a symptom that impairs the quality of life but it can be easily coped with by controlling disease activity. Thus, it should be assessed in a multidimensional perspective.     

Classification and clinical assessment

There are at least nine classification criteria for psoriatic arthritis (PsA) that have been proposed and used in clinical studies. With the exception of the ESSG and Bennett rules, all of the other criteria sets have a good performance in identifying PsA patients. As the CASPAR criteria are based on a robust study methodology, they are considered the current reference standard. However, if there seems to be no doubt that they are very good to classify PsA patients (very high specificity), they might be not sensitive enough to diagnose patients with unknown early PsA. The vast clinical heterogeneity of PsA makes its assessment very challenging. Peripheral joint involvement is measured by 78/76 joint counts, spine involvement by the instruments used for ankylosing spondylitis (AS), dactylitis by involved digit count or by the Leeds dactylitis index, enthesitis by the number of affected entheses (several indices available) and psoriasis by the Psoriasis Area and Severity Index (PASI). Peripheral joint damage can be assessed by a modified van der Heijde-Sharp scoring system and axial damage by the methods used for AS or by the Psoriatic Arthritis Spondylitis Radiology Index (PASRI). As in other arthritides, global evaluation of disease activity and severity by patient and physician and assessment of disability and quality of life are widely used. Finally, composite indices that capture several clinical manifestations of PsA have been proposed and a new instrument, the Psoriatic ARthritis Disease Activity Score (PASDAS), is currently being developed.     

Association between small dense LDL and sub-clinical atherosclerosis in patients with psoriatic arthritis

Psoriatic arthritis (PsA) is an inflammatory rheumatic disorder occurring in patients with psoriasis. Several studies have shown an association between Psa and traditional atherosclerotic risk factors. We evaluated the relationship between small dense low-density lipoproteins particles (sd-LDL) a risk marker for atherosclerosis, sub-clinical atherosclerosis and PsA in a group of 50 patients with PsA and in 100 controls. Cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides, insulin, homeostasis model assessment (HOMA), Apo B, and sd-LDL have been measured. LDL particle separation was performed and seven LDL subfractions were obtained, LDL score (percentage of sd-LDL) and mean LDL particle size were calculated. PsA patients and control group differ significantly (p?<?0.001) in triglycerides values (119.3?±?52.0 vs 90.7?±?40.7 mg/dL), Apo B (1.1?±?0.2 vs 0.9?±?0.1 g/L), insulin (8.9?±?4.9 vs 5.8?±?3.2 mU/L), HOMA (2.2?±?1.7 vs 1.3?±?0.8), BMI (27.7?±?3.3 vs 25.8?±?3.8). LDL score is significantly higher in PsA as compared to control (9.0?±?10.7 vs 2.9?±?4.7 mg/dL); and mean LDL size is significantly lower in PsA than control (268.1?±?4.6 vs 271.2?±?2.7 Å). These differences were confirmed when stratifying PsA patients for treatment and for disease activity. LDL score and LDL diameter significantly were correlated with the carotid IMT in patients with PsA. These findings show a novel relationship between LDL score and mean LDL size with PsA diagnosis and with sub-clinical atherosclerosis. Sd-LDL gives potentially useful information in the risk assessment for atherosclerotic disease in PsA patients.     

Radiographic Progression in Psoriatic Arthritis Achieving a Good Response to Treatment: Data Using Newer Composite Indices of Disease Activity

Objective

To compare radiographic outcomes according to the magnitude of the response utilizing 3 new psoriatic composite disease activity measures (the Psoriatic Arthritis Disease Activity Score [PASDAS], the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis Composite Exercise [GRACE], and the Disease Activity in PsA [DAPSA]).

Methods

The data were taken from the GO‐REVEAL data set, a large randomized, double‐blind study that evaluated the safety and efficacy of 2 doses of the tumor necrosis factor inhibitor golimumab in subjects with active psoriatic arthritis (PsA). Response criteria at 24 weeks were applied across the whole data set, irrespective of treatment group. Radiographic scores at baseline and 24 weeks were assessed using the modified Sharp/van der Heijde method for PsA.

Results

Overall, for each measure, radiographic progression was significantly greater in subjects with a moderate or poor outcome, and absent in those with a good outcome. The proportion of subjects without radiographic progression in the good outcome group was 83% using the PASDAS (χ² = 7.9; P = 0.02), 80% using the GRACE (χ² = 5.8; P = 0.05), and 76% using the DAPSA (χ² = 3.4; P = 0.19).

Conclusion

Response criteria for disease‐specific composite measures enable separation between groups in terms of radiographic progression and may therefore be used as suitable targets for interventional studies, as well as in the clinic.

     

Effects of adalimumab therapy on musculoskeletal manifestations and health-related quality of life in patients with active psoriatic arthritis

Objectives

Adalimumab, a fully human anti-tumor necrosis factor monoclonal antibody, was retrospectively evaluated for its effect on musculoskeletal manifestations and health-related quality of life in patients with psoriatic arthritis (PsA) during daily clinical practice.

Methods

Patients who initiated adalimumab therapy after March 2010 were followed for at least 24 weeks with the clinical outcome measures. Eleven patients, all men with a mean age of 45.4 years, had mean psoriasis durations of 16.2 and 8.4 years at baseline.

Results

After 24 weeks, 72.7, 63.6, and 45.5 % of the patients met the ACR 20, 50, and 70 response criteria, respectively, while 81.8 % achieved the PsA response criteria. Disease Activity Score using the 28-joint count and CRP declined from 3.2 ± 1.2 at baseline to 1.3 ± 0.4 at week 24 (P < 0.01). The Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores also decreased significantly (both P values were <0.01). After 24 weeks, three out of eight dimensions of the Medical Outcomes Study 36-Item Short Form Health Survey and Physical Component Summary were significantly improved (all P values were <0.05).

Conclusions

Adalimumab exerted its effect as early as week 4, and it was sustained until the end of the 24-week observation period in the PsA patients.