Objectives: To compare the clinical manifestations of spinal disease, peripheral arthritis and enthesitis, and to evaluate the effectiveness of adalimumab in a large cohort of patients with AS in relation to the presence or absence of psoriasis.
Methods: Patients aged > or = 18 years with active AS were enrolled in an open-label study of adalimumab 40 mg every other week. Clinical symptoms were measured at baseline and Week 12 using standard assessment criteria. Differences between patients with and those without psoriasis were assessed. The relationship between changes in skin and AS symptoms was also analysed.
Results: Of 1250 patients with AS who were enrolled in the study, 148 (11.8%) had a history of psoriasis, including 108 patients with current (active) psoriasis at entry. Baseline disease characteristics, including spinal structural damage, peripheral arthritis (> or = 1 swollen joints) and enthesitis (> or = 1 inflamed entheses), were similar in both groups. At Week 12, Assessment of SpondyloArthritis international Society 40% response was achieved by 46.7 and 54.7% and Bath AS Disease Activity Index 50% response by 58.6 and 57.0% of patients with and without psoriasis, respectively. Median changes in swollen joint scores and Maastricht AS Enthesitis Scores were similar in both groups. Skin changes during adalimumab treatment in AS patients with a history of psoriasis did not correlate with changes in AS symptoms.
Conclusions: The presence of psoriasis had no influence on the other clinical manifestations of patients with AS. Treatment with adalimumab markedly improved axial disease, peripheral arthritis and enthesitis, regardless of history of psoriasis.