title: Minimal disease activity and anti-tumor necrosis factor therapy in psoriatic arthritis.
abstract: OBJECTIVE
  A state of minimal disease activity (MDA) was defined and validated as target for treatment in psoriatic arthritis (PsA). We aimed to identify disease characteristics, outcome, and predictors of MDA in patients treated with tumor necrosis factor α (TNFα) blockers.
  
  
  METHODS
  Patients fulfilling the Classification of Psoriatic Arthritis criteria treated with TNFα blockers were followed every 3-6 months. Patients were considered in MDA when they meet at least 5 of the 7 criteria. Sustained MDA was defined as an MDA state lasting ≥12 months. Patients achieving MDA were compared to non-MDA patients. A proportional odds discrete time survival analysis model was applied, adjusting for sex, age, PsA duration, abnormal erythrocyte sedimentation rate (ESR) and clinically damaged joint count at each visit to identify predictors for MDA.
  
  
  RESULTS
  Of the 306 patients treated with TNFα blockers identified from our database, 23 patients were in an MDA state when treatment was commenced; 57 were taking TNFα blockers prior to enrollment. Therefore, 226 subjects were in a non-MDA state and constituted the study population. One hundred forty-five patients of 226 patients (64%) achieved MDA within a mean ± SD duration of 1.30 ± 1.68 years. The mean ± SD duration of MDA was 3.46 ± 2.25 years. At total of 17 patients withdrew from therapy and remained in an MDA state. Male sex (odds ratio [OR] 1.65, 95% confidence interval [95% CI] 1.08-2.53; P = 0.02) and normal ESR (OR 2.27, 95% CI 1.22-4.17; P = 0.009) increased the odds for achieving MDA.
  
  
  CONCLUSIONS
  MDA is achieved in 64% of patients treated with TNFα blockers in a clinical setting. Male sex and normal ESR are predictors for MDA. On withdrawal or reduction in treatment, 11.6% of patients maintained MDA state.
authors.affiliation: University of Toronto Psoriatic Arthritis Program and Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Haddad
authors.affiliation: University of Toronto Psoriatic Arthritis Program and Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Arane
authors.initials: A
authors.lastname: Thavaneswaran
authors.affiliation: University of Toronto Psoriatic Arthritis Program and Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Ioana
authors.initials: I
authors.lastname: Ruiz-Arruza
authors.affiliation: University of Toronto Psoriatic Arthritis Program and Toronto Western Research Institute, Toronto, Ontario, Canada.
authors.forename: Fawnda
authors.initials: F
authors.lastname: Pellett
authors.affiliation: University of Toronto Psoriatic Arthritis Program and Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Vinod
authors.initials: V
authors.lastname: Chandran
authors.affiliation: University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cook
authors.affiliation: University of Toronto Psoriatic Arthritis Program and Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001799:Blood Sedimentation; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012008:Recurrence; D012074:Remission Induction; D015203:Reproducibility of Results; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha