Abstract
Objective The Tight Control of Psoriatic Arthritis (TICOPA) study was the first to undertake treat-to-target approach in PsA. Our aim was to further investigate the radiographic changes in the TICOPA study.
Methods The TICOPA trial recruited patients with early DMARD naïve psoriatic arthritis (PsA). Plain radiographs of the hands and feet were taken at weeks 0 and 48. Clinical outcomes were recorded by a blinded assessor every 12 weeks. In post-hoc analysis, bootstrapped quantile regression, adjusting for baseline values and minimisation factors, was used to compare radiographic scores (modified van der Heijde-Sharp; mvdH-S) defined according to treatment arm or disease activity states.
Results Paired baseline and week 48 radiographs were available for 169/206 (82.0%) at week 48; 84 tight-control, 85 standard therapy. There was no difference in change in total mvdH-S score median (IQR) seen with tight control compared to standard therapy [0.0 (-2.0, 0.5) vs 0.0 (-2.0, 0.0); difference (95% CI) 0.0 (0.0, 0.0)]. Median total mvdH-S score change was lower in those achieving MDA, DAPSA remission and VLDA. The number of people with radiographic progression (a total erosion score of ≥2 at week 48) was numerically lower in the tight control group (5/84 [5.9%] versus 12/85 [14.1%]). Patients with radiographical progression presented with polyarticular disease, high Creactive protein and had poorer clinical outcomes at weeks 12 and 24.
Conclusion These data confirm the benefit of achieving low disease activity states on subsequent radiographic outcome but did not show a significant impact related to a tight-control management approach.