title: Hemostatic and fibrinolytic changes are related to inflammatory conditions in patients with psoriatic arthritis--effect of different treatments.
abstract: OBJECTIVE
  To prospectively evaluate the effect of tumor necrosis factor (TNF)-α inhibitors on hemostatic and fibrinolytic variables in subjects with psoriatic arthritis (PsA).
  
  
  METHODS
  Among subjects with PsA who were taking traditional disease-modifying antirheumatic drugs (DMARD), 98 patients with active disease who switched to treatment with TNF-α inhibitors were enrolled in this study (Group 1). In parallel, 98 matched subjects with minimal disease activity (MDA) and treated with DMARD were enrolled (Group 2). In all patients, hemostatic and fibrinolytic variables were evaluated at enrollment and after a 6-month followup. Results were stratified according to treatment and to MDA achievement.
  
  
  RESULTS
  Seventy-six Group 1 and 80 Group 2 subjects completed the 6-month followup. During the followup, significant changes in hemostatic and fibrinolytic variables were found in Group 1, but not in Group 2 subjects. At the end of the followup, patients treated with TNF-α inhibitors showed significantly lower levels of hemostatic and fibrinolytic variables as compared to those treated with traditional DMARD. Among Group 1 subjects, changes in hemostatic and fibrinolytic variable levels were significantly higher in those who achieved MDA versus in those who did not. Multivariate analyses showed that a treatment with TNF-α blockers affected fibrinolytic variables [plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA)] and some acute-phase proteins (D-dimer, coagulation factor VIII, and von Willebrand factor). In contrast, the MDA achievement during treatment with TNF-α blockers maximally affected fibrinolytic variables (PAI-1 and t-PA).
  
  
  CONCLUSIONS
  TNF-α inhibitors brought about a significant improvement of hemostatic and fibrinolytic balance in subjects with PsA. Maximal changes were found in patients achieving MDA.
authors.affiliation: From the Department of Clinical Medicine and Surgery, Reference Centre for Coagulation Disorders, Naples; the Rheumatology and Rehabilitation Research Unit "Salvatore Maugeri" Foundation, Scientific Institute of Telese Terme, Benevento; the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, Psoriatic Arthritis Clinic, Federico II University, Naples, Italy.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.forename: Salvatore
authors.initials: S
authors.lastname: Iervolino
authors.forename: Rosario
authors.initials: R
authors.lastname: Peluso
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Minno
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ambrosino
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scarpa
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000188:drug therapy*; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000187:drug effects / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects*; D005500:Follow-Up Studies; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D010959:Tissue Plasminogen Activator / Q000187:drug effects / Q000378:metabolism; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D014841:von Willebrand Factor / Q000187:drug effects / Q000378:metabolism
chemical_list: D018501:Antirheumatic Agents; D005338:Fibrin Fibrinogen Degradation Products; D014409:Tumor Necrosis Factor-alpha; C036309:fibrin fragment D; D014841:von Willebrand Factor; D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator
keywords: FIBRINOLYSIS; HEMOSTASIS; MINIMAL DISEASE ACTIVITY; PSORIATIC ARTHRITIS