Biologics, Targeted Therapies Best for Acute PsA Dactylitis

TOPLINE:

Biologic or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) seemed to be the most effective treatments for patients with acute psoriatic arthritis (PsA) dactylitis.

METHODOLOGY:

• In a prospective observational cohort, the median age of 1735 patients with PsA was 44.9 years, and 55% were men.

• During a median follow-up of 12.1 years, dactylitis occurred in 753 (43.4%) patients and the remaining 982 (56.6%) never had it.

• Among the patients with dactylitis, 295 (39.2%) were treated with nonsteroidal anti-inflammatory drugs (NSAIDs), 273 (36.3%) with conventional synthetic DMARDs, 100 (13.3%) with biologic or targeted synthetic DMARDs, 64 (8.5%) with glucocorticoid injection and a change in DMARD therapy, and 21 (2.8%) with glucocorticoid injection. 

TAKEAWAY:

• Univariable and multivariable analyses showed that the most significant clinical factors associated with acute PsA dactylitis included younger age, male sex, the presence of nail disease, a higher Clinical Disease Activity Index for Psoriatic Arthritis score and a higher modified Steinbrocker score for radiographic damage.

• The median time to resolution of acute symptoms was 0.8 months.

• Treatment with biologic or targeted synthetic DMARDs was associated with faster resolution of acute PsA dactylitis symptoms and longer time to recurrence than other therapies, including conventional synthetic DMARDs and NSAIDs.

• One third of patients experienced recurrence of acute PsA dactylitis following treatment, with a median time to recurrence of 2 years. 

IN PRACTICE:

“Acute dactylitis is common in about 43% of patients with psoriatic arthritis and considered a marker of disease severity, but we saw that treatment with biological or targeted DMARDS was associated with the best outcomes in terms of faster resolution of symptoms and prevention of recurrence,” Fadi Kharouf, MD, clinical research fellow at the University of Toronto/University Health Network, Toronto, Ontario, Canada, said in an interview. 

SOURCE:

Kharouf presented the study at the Spondyloarthritis Research and Treatment Network (SPARTAN) 2025 Annual Meeting in Toronto, Ontario, Canada. 

LIMITATIONS:

No limitations were reported.

DISCLOSURES:

The study was conducted as part of the Gladman Krembil Psoriatic Arthritis Program, which is supported by the Krembil Foundation and the Schroeder Arthritis Institute. Kharouf disclosed being supported by a fellowship from the Krembil Foundation.