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Clinical Rheumatology

, Volume 38, Issue 11, pp 3145–3151 | Cite as

Musculoskeletal ultrasound in monitoring response to apremilast in psoriatic arthritis patients: results from a longitudinal study

  • Fulvia CeccarelliEmail author
  • Ramona Lucchetti
  • Carlo Perricone
  • Francesca Romana Spinelli
  • Enrica Cipriano
  • Simona Truglia
  • Francesca Miranda
  • Valeria Riccieri
  • Manuela Di Franco
  • Rossana Scrivo
  • Cristiano Alessandri
  • Guido Valesini
  • Fabrizio Conti
Original Article
  • 96 Downloads

Abstract

Introduction/objective

Apremilast, PDE4 competitive inhibitor, has been recently introduced in the treatment of adult psoriatic arthritis (PsA) patients, but only preliminary data are available on imaging evaluation. Thus, we evaluated the response to apremilast in PsA patients by ultrasonographic (US) assessment.

Methods

Thirty-four patients (M/F 7/27; median age 61 years, IQR 15; median disease duration 10 years, IQR 13) treated for polyarticular involvement were longitudinally evaluated. All the patients were assessed at baseline (T0), and after 6 (T1), 12 (T2), and 24 weeks (T3) by DAS28, CDAI, SDAI, and DAPSA. At the same time-points, US assessment was performed in 22 sites (wrists, MCPs, PIPs): synovial effusion/hypertrophy and power Doppler were scored with a semi-quantitative scale (0–3). A total score, corresponding to patient’s inflammatory status, was obtained by their sum (0–198). We assessed also the presence of tenosynovitis of flexor tendons of hands’ fingers bilaterally, registering the number of involved tendons (US-tenosynovitis score 0–10).

Results

We found a significant reduction in the US inflammatory score values after 6 weeks (T0, median 15 (IQR 11.2); T1, 6 (10.0); P = 0.0002), confirmed at T2 (4.0 (4.0), P = 0.0002) and T3 (4.0 (6.0); P = 0.0003). Finally, US-detected tenosynovitis was observed in 44.1% of patients: a significant improvement in tenosynovitis score was identified at 6 weeks (T0, median 4 (IQR 4); T1, 1 (2); P < 0.0001) and maintained at T2 (0 (IQR 1); P < 0.0001) and T3 ((IQR 1.25); P < 0.0001).

Conclusions

Apremilast is able to induce an early and sustained improvement of ultrasonographic inflammatory status at articular and peri-articular level.

Key points

Apremilast induces a significant, early, and sustained improvement of inflammatory joint status in psoriatic arthritis patients.

•Ultrasonographic assessment is able to monitor articular and peri-articular response to apremilast.

Keywords

Apremilast Joint inflammation Psoriatic arthritis Treatment response Ultrasonographic assessment 

Notes

Compliance with ethical standards

Patients provided written informed consent at the time of the visit. The local ethical committee of “Policlinico Umberto I” of Rome approved the study.

Disclosures

None.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Fulvia Ceccarelli
    • 1
    Email author
  • Ramona Lucchetti
    • 1
  • Carlo Perricone
    • 1
  • Francesca Romana Spinelli
    • 1
  • Enrica Cipriano
    • 1
  • Simona Truglia
    • 1
  • Francesca Miranda
    • 1
  • Valeria Riccieri
    • 1
  • Manuela Di Franco
    • 1
  • Rossana Scrivo
    • 1
  • Cristiano Alessandri
    • 1
  • Guido Valesini
    • 1
  • Fabrizio Conti
    • 1
  1. 1.Sapienza Arthritis Center, Dipartimento Medicina Interna e Specialità MedicheSapienza Università di RomaRomeItaly

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