title: Differing local and systemic inflammatory burden in polyarticular psoriatic arthritis and rheumatoid arthritis patients on anti-TNF treatment in clinical remission.
abstract: OBJECTIVE
  To analyse clinical, serological and sonographic differences between rheumatoid arthritis (RA) and polyarticular psoriatic arthritis (PsA) patients on anti-TNF therapy in clinical remission.
  
  
  METHODS
  Angiogenic and proinflammatory cytokine serum levels were determined by multiplex ELISA in patients with RA and PsA in clinical remission (DAS28-ESR<2.6), clinically-active RA patients (DAS28>3.2) and healthy controls. Ultrasound (US) scans were made of both wrists and hands.
  
  
  RESULTS
  30 RA and 47 PsA patients in remission, 22 active RA patients and 20 healthy controls were included. PsA patients had significantly lower disease activity according to DAS28-ESR (p=0.006) but not according to DAS28-CRP (p=0.319), and lower serum levels of proinflammatory and angiogenic cytokines than RA patients in remission. PsA patients had cytokine levels similar to healthy controls, while RA patients in remission had similar levels to those of active RA patients. Globally, 31 (40.25%) patients in remission had a PD signal and 12 had SH>2 plus PD [1 PsA vs. 11 RA (p=0.0001)], meeting the criteria for ultrasound-defined active synovitis (UdAS). Patients with UdAS had significantly higher levels of IL-6, IL-20, PIGF and SDF1. More PsA patients were on tapered doses of anti-TNF (63.8%), and more frequently as monotherapy (72.3%), compared with RA patients (26.6% and 20%, respectively).
  
  
  CONCLUSIONS
  Polyarticular PsA patients in remission had lower levels of local (US synovitis) and systemic inflammation than RA patients in remission, even though a significantly higher percentage of PsA patients were on tapered doses of anti-TNF, mainly in monotherapy.
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Ramírez
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Inciarte-Mundo
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cuervo
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Ruiz-Esquide
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: M Victoria
authors.initials: MV
authors.lastname: Hernández
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: Raimón
authors.initials: R
authors.lastname: Sanmartí
authors.affiliation: Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain. jcanete@clinic.ub.es.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D016207:Cytokines / Q000097:blood*; D018450:Disease Progression; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014463:Ultrasonography; D014955:Wrist Joint / Q000000981:diagnostic imaging
chemical_list: D018501:Antirheumatic Agents; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha