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ORIGINAL RESEARCH article

Front. Med.
Sec. Rheumatology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1509082

Difficult-to-treat psoriatic arthritis: towards a better definition through the application of a statistical model in a real-life cohort

Provisionally accepted
Ennio Giulio Favalli Ennio Giulio Favalli 1,2Giacomo Biganzoli Giacomo Biganzoli 3Gilberto Cincinelli Gilberto Cincinelli 1,2*Matteo Ferrito Matteo Ferrito 1,2Ester Luconi Ester Luconi 3Maria Manara Maria Manara 1Martina Biggioggero Martina Biggioggero 1Patrizia Boracchi Patrizia Boracchi 3,4Roberto Caporali Roberto Caporali 1,2
  • 1 Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, Italy
  • 2 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
  • 3 Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
  • 4 Data Science and Research Center (DSRC), University of Milan, Milan, Italy

The final, formatted version of the article will be published soon.

    The study aims to test the D2T PsA definition translated from rheumatoid arthritis within a singlecenter observational cohort of PsA patients treated with b/tsDMARDs. In addition, we aimed to identify a numerical index defining D2T-PsA based on a ratio between observed and expected failed b/tsDMARDs, and to exploit a predictive model to identify features associated with the D2T condition.The study enrolled 267 consecutive adult PsA patients receiving b/tsDMARDs and collected demographic, clinical, and clinimetric data. The prevalence of D2T PsA patients was first determined using a proposed definition., and We then developed aa predictive model to assessed the difficulty of treatment of PsA patients based on failed b/tsDMARDs normalized by expected failures. A generalized linear model explored clinical and demographical features associated with difficult-to-treat patients, with a bagging procedure for robust variable selection to include in a univariate analysis and a multivariable model.Of the 267 patients, only 8 (2.9%) met the D2T PsA criteria. Applying the predictive model to 177 patients, 17.2% exhibited higher difficultness-to-treat. Univariate analysis identified associations between difficultness-to-treat and female sex, psoriasis pattern, fibromyalgia presence, and steroid therapy. Multivariate analysis confirmed associations with fibromyalgia, nail and pustular psoriasis, and steroid use.The proposed D2T PsA definition captured only a small proportion of patients with increased treatment difficulty according to the predictive model. These findings suggest potential criteria refinement for defining D2T PsA patients, providing insights for better managing treatment complexities in PsA.

    Keywords: "Psoriatic arthritis", "Difficult-to-treat", "b/tsDMARDs", "Predictive model", "Drug resistance"

    Received: 10 Oct 2024; Accepted: 22 Nov 2024.

    Copyright: © 2024 Favalli, Biganzoli, Cincinelli, Ferrito, Luconi, Manara, Biggioggero, Boracchi and Caporali. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Gilberto Cincinelli, Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, Italy

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