Early DMARD Initiation Improves Disease Control in Psoriatic Arthritis, Suggests Study
USA: Researchers have found in a new study that patients with psoriatic arthritis (PsA) were more likely to achieve minimal disease activity (MDA) when disease-modifying anti-rheumatic drugs (DMARDs) were started earlier rather than delayed.
Psoriatic arthritis is a chronic inflammatory condition that can lead to progressive joint damage, functional impairment, and reduced quality of life if not treated promptly. While DMARDs are a cornerstone of PsA management, real-world data on the impact of the timing of treatment initiation remain limited.
To address this gap, investigators analyzed outcomes from the CorEvitas Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry to compare early versus delayed initiation of DMARD therapy.
The study, published in ACR Open Rheumatology, was led by Dr. Philip J. Mease of the Swedish Medical Center/Providence St Joseph Health and the University of Washington, Seattle, along with colleagues. The researchers focused on DMARD-naive patients with PsA enrolled in the registry and categorized them based on the time interval between diagnosis and the start of their first DMARD. Early initiators began treatment within one year of diagnosis, whereas late initiators started DMARDs more than one year after diagnosis.
The cohort had a mean age of 53 years, with women making up more than half of the participants, and most patients were White. Nearly 80% were early DMARD initiators, starting treatment a mean of 0.2 years after diagnosis, whereas late initiators began therapy after an average delay of 8.6 years, indicating a notable treatment gap.
Clinical and patient-reported outcomes were assessed from treatment initiation to six months. Both early and late initiators showed improvements in disease activity and PROs over this period, confirming the overall benefit of DMARD therapy, although key treatment targets favored earlier initiation.
The key findings were as follows:
- After adjustment for relevant confounders, early initiation of DMARD therapy was linked to significantly better clinical outcomes.
- Patients who began DMARD treatment earlier were nearly twice as likely to achieve minimal disease activity compared with those who started therapy later.
- Early initiators also showed greater improvements in the Clinical Disease Activity Index, reflecting a more substantial reduction in overall disease activity.
Minimal disease activity is widely recognized as an important treatment goal in PsA, as its achievement has been linked to better long-term clinical outcomes and improved quality of life. The findings from this registry-based analysis reinforce the concept that earlier therapeutic intervention may enhance the likelihood of reaching this target.
The authors emphasized that while delayed initiation still led to measurable improvements, earlier treatment appeared to confer added benefits. These results highlight the importance of timely diagnosis and prompt initiation of DMARD therapy in patients with PsA. The researchers also noted the need for further studies to confirm these observations and to explore strategies that can reduce delays in treatment initiation in routine clinical practice.
Overall, the study adds real-world evidence supporting early DMARD use as a means to optimize outcomes for patients living with psoriatic arthritis.
Reference:
Mease, P. J., Nowak, M., Choi, J., Lehman, T., Sreih, A., Ho, K., Middaugh, N., & Ogdie, A. (2025). Impact of Delay of Treatment With Disease-Modifying Antirheumatic Drugs in Psoriatic Arthritis: The CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry. ACR Open Rheumatology, 7(6), e70019. https://doi.org/10.1002/acr2.70019
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