BMC rheumatology · 2026
Predictors at diagnosis for initiation of biologic or targeted synthetic disease-modifying anti-rheumatic drugs in patients with spondyloarthritis and psoriatic arthritis.
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Hameed Mohaned A, Exarchou Sofia, Sharma Ankita, Bergström Ulf, Einarsson Jon T, Turesson Carl
Аннотация
BACKGROUND: There is limited data on factors predicting the initiation of biologic and targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) in Spondyloarthritis (SpA) and Psoriatic arthritis (PsA). The relative importance of objective inflammation and other patient factors in this context is unclear.
METHODS: A retrospective cohort study included consecutive patients diagnosed with SpA and PsA in 2012-2016 at a single rheumatology center. Data at diagnosis were obtained from medical records and from linkage to national and regional registers. Baseline predictors of b/tsDMARD initiation were assessed by Cox regression.
RESULTS: Among 119 PsA patients (mean age 49 years, 49% male), 41.7% initiated b/tsDMARDs (median 15 months after diagnosis). In patients with PsA, older age was negatively associated with b/tsDMARD initiation (hazard ratio (HR) per standard deviation 0.74; 95% confidence interval (CI) 0.55-1.00), but no other significant predictors were identified. Among 120 SpA patients (mean age 38 years, 64% male), 41.5% initiated bDMARDs (median 7 months after diagnosis). Predictors included elevated CRP levels (HR 2.68; 95% CI 1.44-5.01) and bone marrow edema (BME) on magnetic resonance imaging of sacroiliac joints (SIJ) (HR 1.94; 95% CI 1.02-3.70). There was no significant association with age at SpA diagnosis, or with sex, education, family background, country of birth, or comorbidities.
CONCLUSIONS: Elevated CRP and SIJ BME at diagnosis were associated with bDMARD initiation in patients with SpA, while older patients with PsA may be less likely to start b/tsDMARDs. Education and ethnicity did not seem to influence b/tsDMARD initiation, suggesting equitable treatment access.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: A retrospective cohort study included consecutive patients diagnosed with SpA and PsA in 2012-2016 at a single rheumatology center. Data at diagnosis were obtained from medical records and from linkage to national and regional registers. Baseline predictors of b/tsDMARD initiation were assessed by Cox regression.
RESULTS: Among 119 PsA patients (mean age 49 years, 49% male), 41.7% initiated b/tsDMARDs (median 15 months after diagnosis). In patients with PsA, older age was negatively associated with b/tsDMARD initiation (hazard ratio (HR) per standard deviation 0.74; 95% confidence interval (CI) 0.55-1.00), but no other significant predictors were identified. Among 120 SpA patients (mean age 38 years, 64% male), 41.5% initiated bDMARDs (median 7 months after diagnosis). Predictors included elevated CRP levels (HR 2.68; 95% CI 1.44-5.01) and bone marrow edema (BME) on magnetic resonance imaging of sacroiliac joints (SIJ) (HR 1.94; 95% CI 1.02-3.70). There was no significant association with age at SpA diagnosis, or with sex, education, family background, country of birth, or comorbidities.
CONCLUSIONS: Elevated CRP and SIJ BME at diagnosis were associated with bDMARD initiation in patients with SpA, while older patients with PsA may be less likely to start b/tsDMARDs. Education and ethnicity did not seem to influence b/tsDMARD initiation, suggesting equitable treatment access.
CLINICAL TRIAL NUMBER: Not applicable.