Hepatic steatosis, carotid plaques and achieving MDA in psoriatic arthritis patients starting TNF-α blockers treatment: a prospective studyReport as inadecuate

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Arthritis Research and Therapy

, 14:R211

First Online: 04 October 2012Received: 19 April 2012Revised: 12 July 2012Accepted: 04 October 2012


IntroductionWe prospectively evaluated whether hepatic steatosis HS and the presence of carotid plaques CPs impacts on achieving minimal disease activity MDA in psoriatic arthritis PsA patients starting tumor necrosis factor TNF-α blockers treatment.

MethodsBefore starting treatment with TNF-α blockers, consecutive PsA subjects with an active disease were evaluated for the presence of the metabolic syndrome MetS, HS and CPs. The incidence of MDA was evaluated 12 and 24 months later.

ResultsAmong 270 PsA subjects, 91 33.7% exhibited the MetS, 58 21.5% CPs and 76 28.1% HS. At the 12-month follow-up, 98 36.3% individuals achieved MDA. Compared with those who did, a higher prevalence of the MetS, HS and CPs was found in subjects who did not achieve the MDA P always < 0.001. After adjusting for the MetS and for all the other demographic-clinical characteristics analyzed, the presence of HS and CPs at baseline independently predicted the risk of not achieving MDA Hazard Ratio: 1.91, 95% confidence interval CI: 1.04 to 3.38, P = 0.035 and Hazard Ratio: 3.21, 95%CI: 1.64 to 6.29, P = 0.001, respectively. Separate Kaplan-Meier survival models confirmed this Log-Rank: 12.894, P < 0.001 and Log-Rank: 12.849, P < 0.001, respectively. Compared with those without, progressively increasing Hazard Ratios of not achieving MDA were found in those with HS, CPs or HS + CPs at baseline. Moreover, the presence of HS and-or CPs predicted the risk of relapse during the additional 12-month follow-up Hazard Ratio: 2.85, 95%CI: 1.27 to 6.37, P = 0.011 and Hazard Ratio: 3.17, 95%CI: 1.57 to 6.41, P = 0.001 respectively.

ConclusionsHS and-or CPs at baseline are negative predictors of achieving and maintaining MDA.

AbbreviationsCCAcommon carotid artery

CPscarotid plaques

CRPC-reactive protein


DMARDsdisease modifying anti-rheumatic drugs

ESRerythrocyte sedimentation rate

HAQhealth assessment questionnaire

HRhazard ratio

HShepatic steatosis

IFGimpaired fasting glucose


IMTintima-media thickness

MDAminimal disease activity

MetSmetabolic syndrome


NCEPNational Cholesterol Education Program

Non-MDAsubjects not achieving MDA

PASIpsoriasis area severity index

PsApsoriatic arthritis

SJCswollen joint count

s-MDAsustained MDA

TJCtender joint count

SDstandard deviation

TNF-αtumor necrosis factor-α


VASvisual analog scale for pain

VRFsvascular risk factors.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4049 contains supplementary material, which is available to authorized users.

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Author: Matteo Nicola Dario Di Minno - Rosario Peluso - Salvatore Iervolino - Roberta Lupoli - Anna Russolillo - Giovanni Tarantin

Source: https://link.springer.com/

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