Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohort
ObjectivesThe study aims to evaluate the applicability of the D2T psoriatic arthritis (PsA) definition, adapted from rheumatoid arthritis, within a single-center observational cohort of PsA patients treated with b/tsDMARDs. In addition, we aimed to establish a numerical index defining D2T-PsA based...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2024.1509082/full |
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| author | Ennio Giulio Favalli Ennio Giulio Favalli Giacomo Biganzoli Gilberto Cincinelli Gilberto Cincinelli Matteo Ferrito Matteo Ferrito Ester Luconi Maria Manara Martina Biggioggero Patrizia Boracchi Patrizia Boracchi Roberto Caporali Roberto Caporali |
| author_facet | Ennio Giulio Favalli Ennio Giulio Favalli Giacomo Biganzoli Gilberto Cincinelli Gilberto Cincinelli Matteo Ferrito Matteo Ferrito Ester Luconi Maria Manara Martina Biggioggero Patrizia Boracchi Patrizia Boracchi Roberto Caporali Roberto Caporali |
| author_sort | Ennio Giulio Favalli |
| collection | DOAJ |
| description | ObjectivesThe study aims to evaluate the applicability of the D2T psoriatic arthritis (PsA) definition, adapted from rheumatoid arthritis, within a single-center observational cohort of PsA patients treated with b/tsDMARDs. In addition, we aimed to establish a numerical index defining D2T-PsA based on the ratio of observed to expected failed b/tsDMARDs and to develop a predictive model identifying features associated with the D2T condition.MethodsThe study included 267 consecutive adult PsA patients receiving b/tsDMARDs, collecting demographic, clinical, and clinimetric data. The prevalence of D2T PsA patients was assessed using a proposed definition. We then developed a predictive model to assess treatment difficulty, utilizing PsA-normalized failed b/tsDMARDs. A generalized linear model was applied to identify clinical and demographic features associated with D2T PsA, employing a bagging procedure for robust variable selection, followed by univariate and multivariable analyses.ResultsAmong the 267 patients, only 8 of them (2.9%) met the proposed D2T PsA criteria. In a subset of 177 patients analyzed using the predictive model, 17.2% of them demonstrated higher treatment difficulty. Univariate analysis revealed associations between treatment difficulty and female sex, psoriasis pattern, fibromyalgia, and steroid therapy. Multivariate analysis confirmed significant associations between fibromyalgia, nail and pustular psoriasis, and steroid use.ConclusionAccording to the predictive model, the proposed D2T PsA definition identified a small subset of patients with increased treatment difficulty. These findings highlight the need for refining the criteria to better define D2T PsA patients, providing valuable insights into managing complex treatment challenges in PsA. |
| format | Article |
| id | doaj-art-72c3a494eaad437eb0e1f655d2d3a119 |
| institution | Kabale University |
| issn | 2296-858X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-72c3a494eaad437eb0e1f655d2d3a1192024-12-16T04:19:01ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-12-011110.3389/fmed.2024.15090821509082Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohortEnnio Giulio Favalli0Ennio Giulio Favalli1Giacomo Biganzoli2Gilberto Cincinelli3Gilberto Cincinelli4Matteo Ferrito5Matteo Ferrito6Ester Luconi7Maria Manara8Martina Biggioggero9Patrizia Boracchi10Patrizia Boracchi11Roberto Caporali12Roberto Caporali13Department of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyDepartment of Biomedical and Clinical Sciences, University of Milan, Milan, ItalyDepartment of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyDepartment of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyDepartment of Biomedical and Clinical Sciences, University of Milan, Milan, ItalyDepartment of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, ItalyDepartment of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, ItalyDepartment of Biomedical and Clinical Sciences, University of Milan, Milan, ItalyData Science and Research Center (DSRC), University of Milan, Milan, ItalyDepartment of Rheumatology and Medical Sciences, ASST Gaetano Pini-CTO Institute, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyObjectivesThe study aims to evaluate the applicability of the D2T psoriatic arthritis (PsA) definition, adapted from rheumatoid arthritis, within a single-center observational cohort of PsA patients treated with b/tsDMARDs. In addition, we aimed to establish a numerical index defining D2T-PsA based on the ratio of observed to expected failed b/tsDMARDs and to develop a predictive model identifying features associated with the D2T condition.MethodsThe study included 267 consecutive adult PsA patients receiving b/tsDMARDs, collecting demographic, clinical, and clinimetric data. The prevalence of D2T PsA patients was assessed using a proposed definition. We then developed a predictive model to assess treatment difficulty, utilizing PsA-normalized failed b/tsDMARDs. A generalized linear model was applied to identify clinical and demographic features associated with D2T PsA, employing a bagging procedure for robust variable selection, followed by univariate and multivariable analyses.ResultsAmong the 267 patients, only 8 of them (2.9%) met the proposed D2T PsA criteria. In a subset of 177 patients analyzed using the predictive model, 17.2% of them demonstrated higher treatment difficulty. Univariate analysis revealed associations between treatment difficulty and female sex, psoriasis pattern, fibromyalgia, and steroid therapy. Multivariate analysis confirmed significant associations between fibromyalgia, nail and pustular psoriasis, and steroid use.ConclusionAccording to the predictive model, the proposed D2T PsA definition identified a small subset of patients with increased treatment difficulty. These findings highlight the need for refining the criteria to better define D2T PsA patients, providing valuable insights into managing complex treatment challenges in PsA.https://www.frontiersin.org/articles/10.3389/fmed.2024.1509082/fullpsoriatic arthritisdifficult-to-treatb/tsDMARDspredictive modeldrug resistance |
| spellingShingle | Ennio Giulio Favalli Ennio Giulio Favalli Giacomo Biganzoli Gilberto Cincinelli Gilberto Cincinelli Matteo Ferrito Matteo Ferrito Ester Luconi Maria Manara Martina Biggioggero Patrizia Boracchi Patrizia Boracchi Roberto Caporali Roberto Caporali Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohort Frontiers in Medicine psoriatic arthritis difficult-to-treat b/tsDMARDs predictive model drug resistance |
| title | Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohort |
| title_full | Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohort |
| title_fullStr | Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohort |
| title_full_unstemmed | Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohort |
| title_short | Difficult-to-treat psoriatic arthritis: refining the definition using a statistical model in a real-life cohort |
| title_sort | difficult to treat psoriatic arthritis refining the definition using a statistical model in a real life cohort |
| topic | psoriatic arthritis difficult-to-treat b/tsDMARDs predictive model drug resistance |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1509082/full |
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