Usefulness of ultrasound in the assessment of the efficacy of apremilast in psoriatic arthritis: Articular, enthesitic and nail index.

BACKGROUND

Psoriatic arthritis (PsA) affects joints and entheses. The objective is to use ultrasound (US) to see inflammatory changes in joints and entheses in patients with active PsA starting Apremilast.

PRIMARY

OBJECTIVE

20% reduction in the US index (UIC) at 12 months.

METHODOLOGY: Multicenter, prospective, open-label study. Patients with PsA (≥2 swollen joints) and ≥2 US synovitis in joints and ≥1 US enthesitis at screening were recruited. Follow-up was 52 weeks (baseline and 1, 6, 9, 12 months). US (joint, tendon, and entheses), clinical (SJC, TJC, LEI, PGA, PtGA), and biological (ESR and CRP) parameters were recorded.

RESULTS

48 patients were evaluated, 46 were included in the follow-up and 26 completed the 52-week study. The primary endpoint was achieved, with reductions of up to 40%. All clinical and ultrasound variables decreased significantly after 12 months. 75 adverse events (AEs) were recorded in 33 patients, and only one serious event (SAE). Reasons for withdrawal included AEs (6 patients), lack of efficacy (8 patients), and other reasons (loss to follow-up, withdrawal of consent) for 6 patients.

CONCLUSIONS

Changes in different domains of PsA in patients treated with Apremilast can be best identified by ultrasound. Ultrasound is an excellent tool to study joints, tendons, and entheses in PsA. Apremilast is a safe, well-tolerated, and effective treatment for several patterns of PsA (joints, entheses) as demonstrated by ultrasound. Ultrasound can also identify nail diseases in patients with PsA.