Phenotype-treatment dissociation in psoriatic and nonpsoriatic peripheral spondyloarthritis: a propensity score-matched analysis with novel treatment intensity metrics
CLINICAL RHEUMATOLOGY, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s10067-026-08366-7
- Dergi Adı: CLINICAL RHEUMATOLOGY
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
Objective To compare the clinical phenotype, treatment intensity, and outcomes of psoriatic arthritis (PsA) and nonpsoriatic peripheral spondyloarthritis (pSpA) using propensity score-matched real-world data and reproducible quantitative metrics of therapeutic escalation.Methods We analyzed a single-center cohort of 204 patients with peripheral SpA. Treatment trajectories were reconstructed line-by-line to derive three metrics: the composite intensity score (maximal escalation), the cumulative treatment burden (total pharmacologic exposure), and the biologic line index (timing of biologic initiation). PsA and pSpA were compared using 1:1 PSM with 12 covariates.Results At baseline, PsA exhibited a more inflammatory phenotype, with higher frequencies of dactylitis, small-joint involvement, inflammatory back pain, and erosive damage, whereas pSpA displayed a large-joint, lower-limb-predominant pattern. Unmatched biologic exposure was higher in PsA (32.1% vs. 6.1%). After matching, PsA received significantly more intensive therapy: higher cumulative treatment burden (p = 0.002), greater maximal treatment intensity (p = 0.003), and earlier biologic initiation (HR 0.28, log-rank p = 0.003). DAS28-CRP-defined peripheral inflammatory outcomes did not differ between PsA and pSpA (remission 79% vs. 84%, p = 0.773; last-visit DAS28-CRP values were similar). Findings persisted across doubly robust regression and overlap weighting. Among pSpA patients (60% ASAS-positive and 40% ASAS-negative), ASAS subgroups showed similar DAS28-CRP-defined peripheral inflammatory outcomes and treatment patterns.Conclusion Psoriasis shaped phenotype and treatment behavior in peripheral SpA but was not associated with different DAS28-CRP-defined peripheral inflammatory outcomes. Nonpsoriatic pSpA received less intensive treatment escalation despite similar clinical outcomes, highlighting the need to evaluate tailored therapeutic approaches.