Analysis Of The Clinical Efficacy And Safety Of Infliximab For Psoriati Arthritis

Objectives:The pathogenesis of psoriatic arthritis(PsA)has not been fully elucidated,and it still faces great challenges in the therapy.Recently,it has been found that tumor necrosis factor-α(TNF-α)has a destructive effect on the joint structure through the study of the immune system in the pathogenesis of PsA.Therefore,more and more attention has been paid to the therapeutic strategies targeting TNF-α,which has prompted the research and development if TNF-αinhibitors(TNFi).The application of TNFi provides a new choice for the treatment of PsA.Infliximab(IFX)is a human-mouse chimeric TNF-α monoclonal antibody,which is widely used in many autoimmune diseases.The efficacy and safety of IFX the treatment of PsA still need to be further evaluated.In this study,the clinical data of IFX in the treatment of PsA were analyzed to evaluate its clinical efficacy and safety.Methods:Thirty-six patients with active PsA who were treated with IFX 3mg/kg regularly in the Department of Rheumatology,Qilu Hospital of Shandong University from October 2018 to July 2020 were collected.All the patients met the criteria of active PsA with exclusion of contraindications.The patients were divided into peripheral psoriatic arthritis(pePsA)(24 patients)and axial psoriatic arthritis(axPsA)(12 patients).The clinical data of the patients were collected at 2 w,6 w,14 w,22 w,and 30 w before infusion of IFX.The tender and swollen joints count,pain visual analogue scale(VAS)score,physician’s VAS score for the disease activity,patient’s VAS score for the disease activity,patient’s Health Assessment Questionnaire(HAQ)score,erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP)were recorded for peripheral PsA patients.The tender and swollen joints count,ESR,CRP,morning stiffness,patient’s VAS score for the disease activity,the patient’s assessment of night back pain and overall back pain VAS score,Bath ankylosing spondylitis functional index(BASFI),and inflammatory response were recorded for axial PsA patients.Then the disease activity index of psoriatic arthritis(DAPSA)and the proportion of patients who achieved ACR20,ACR50,ACR70 or ASAS 20,ASAS40,ASAS70 remission could be calculated and recorded.Simultaneously,routine blood test,liver and kidney function,and infection of various parts of the body during the follow-up period were also recorded.The data at 0 w before medication were used as the baseline data to compare the data after medication and the improvement of DAPSA,the proportion of ACR and ASAS remissions.The therapeutic effects and safety of IFX on PsA could be evaluated from these data.Results:1.In peripheral PsA patients,the number of painful and swollen joints,pain VAS score,CRP,and ESR were improved significantly(P<0.01)at 6 w.The proportion of patients with ACR20,ACR50,and ACR70 remission increased gradually along with the prolongation of IFX treatment time.At the end of follow-up(30 w),23 cases(95.8%),21 cases(87.5%),and 17 cases(70.8%)achieved ACR20,ACR50,and ACR70 remissions,respectively.According to DAPSA,3 cases(12.5%)of patients achieved disease remission and 15 cases(62.5%)achieved low disease activity at the end of follow-up.2.In patients with axial PSA,the patients’ night time back pain and overall pain VAS,CRP,ESR,and BASFI were improved significantly(P<0.05)at 6 w.The proportion of patients with ASAS20,ASAS40,and ASAS70 increased gradually along with the prolongation of IFX treatment time.At the end of follow-up(30 w),12 cases(100%),12 cases(100%),and 9 cases(75%)achieved remissions of ASAS20,ASAS40,and ASAS70,respectively.According to DAPSA,3 cases(25%)of patients achieved disease remission and 8 cases(66.7%)achieved low disease activity at the end of follow-up.3.For all the PsA patients,the number of pain and swelling joints,CRP,and ESR were improved significantly(P<0.01)at 6 w.According to DAPSA,6 cases(16.7%)of patients achieved disease remission and 23 cases(63.89%)achieved low disease activity at the end of follow-up.These results indicated that IFX has a rapid onset of effect in the treatment of PsA and has a sustained effect.4.Two cases(5.56%)experienced skin itching and other discomfort during the infusion process,and the symptoms were relieved after symptomatic treatment.The above-mentioned patients did not stop the treatment or adjust the drug dose,and no symptoms of discomfort recurred afterwards.No serious adverse reactions were recorded in the remaining patients.Conclusions:IFX has a significant effect on the treatment of active PsA,which can relieve the clinical symptoms of patients significantly,control inflammation indicators quickly,and reach a state of low disease activity.The serious adverse reactions were not occurred during the IFX treatment.IFX is helpful to improve the quality of life and prognosis of PsA patients.IFX is a reliable new choice for the treatment of PsA.It can be concluded that IFX will become an important biological agent for the treatment of PsA.