BACKGROUND: Efficacy of tumour necrosis factor inhibitors (TNFi) for peripheral arthritis in patients with psoriatic arthritis (PsA) has been established in randomized clinical trials that have used improvement in summated joint counts as an outcome. Whether joints at different anatomical locations might respond differentially to TNFi remains unknown. The aim of the study was to investigate potential variations in the responsiveness to a first tumour necrosis factor inhibitor (TNFi) among joints at distinct locations in patients with psoriatic arthritis (PsA) treated in routine clinical care. METHODS: Bionaive PsA patients from nine European countries were included in this observational cohort study if ≥ 1 joint was swollen at the initiation of a first TNFi as monotherapy or added to methotrexate. Only the 28-joint count was available without imaging data confirming the presence of synovitis. The primary outcome was time to first resolution of joint swelling at each joint level. Hazard ratios (HR) for resolution comparing different joint locations were estimated using interval-censored mixed-effects Cox proportional hazards models, including a random effect for country and patient, adjusted for age and sex. RESULTS: A total of 1729 patients with 8397 swollen joints at the start of TNFi were included. Considering the upper extremity, a higher rate of resolution of joint swelling (HR, 95% CI) was observed for the shoulder (1.65, 1.16-2.35) and elbow (1.90, 1.38-2.61), while a lower rate was found for the wrist (0.72, 0.62-0.83) compared to the joints of digit 3. Within fingers, and using the same reference, joint swelling resolved fastest in digit 4 (1.77, 1.49-2.11) and digit 5 (1.88, 1.53-2.31). A lower rate of resolution of joint swelling was found for the knee in comparison to the elbow, the corresponding joint on the upper limb (0.56, 0.40-0.78). CONCLUSION: The time to resolution of joint swelling upon treatment with TNFi in patients with PsA seems to depend on the localisation of the affected joints.

Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen UK

Center for Rheumatic Diseases University of Medicine and Pharmacy Bucharest Romania

Center for Treatment of Rheumatic and Musculoskeletal Diseases Diakonhjemmet Hospital Oslo Norway

Centre for Rheumatology Research Landspitali University Hospital Reykjavik Iceland

Centro de Estudos de Doenças Cronicas NOVA Medical School Lisbon Portugal

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopedics Rigshospitalet Glostrup Denmark

DANBIO Registry Rigshospitalet Glostrup Denmark

Department of Clinical Medicine Aarhus University Aarhus Denmark

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Sciences Lund Rheumatology Skåne University Hospital Lund University Lund Sweden

Department of Clinical Sciences Rheumatology Lund University and Skane University Hospital Lund Sweden

Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Rheumatology Aarhus University Hospital Aarhus Denmark

Department of Rheumatology and Immunology Inselspital University Hospital Bern Switzerland

Department of Rheumatology Centro Hospitalar Do Médio Tejo Torres Novas Portugal

Department of Rheumatology Geneva University Hospital Geneva Switzerland

Department of Rheumatology Hospital de Sao Sebastio Centro Hospitalar de Entre O Douro E Vouga Santa Maria da Feira Portugal

Department of Rheumatology Hospital General Universitario Gregorio Marañón Madrid Spain

Department of Rheumatology Inflammation Center Helsinki University Hospital and University of Helsinki Helsinki Finland

Department of Rheumatology Radboud University Medical Center Nijmegen the Netherlands

Department of Rheumatology University Hospital Zurich University of Zurich Rämistrasse 100 Zurich CH 8091 Switzerland

Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia

Faculty of Medicine and Health Technology Tampere University Tampere Finland

Faculty of Medicine Complutense University of Madrid Madrid Spain

Faculty of Medicine University of Iceland Reykjavik Iceland

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Research Unit Sørlandet Hospital Kristiansand Norway

Rheumatology Unit University of Modena and Reggio Emilia Modena Italy

Statistics Group Swiss Clinical Quality Management in Rheumatic Diseases Foundation Zurich Switzerland

Swiss Ankylosing Spondylitis Association Zurich Switzerland

Swiss Tropical and Public Health Institute Allschwil Switzerland

Tampere University Hospital Centre for Rheumatic Diseases Tampere Finland

University of Basel Basel Switzerland

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