TOPLINE

A 24-week course of apremilast in patients with psoriasis at high risk for psoriatic arthritis (PsA) did not significantly change entheseal lesions or entheseal bone density on high-resolution peripheral quantitative CT (HR-pQCT), while skin symptoms and joint tenderness improved.

METHODOLOGY

• Researchers conducted a prospective, open-label study to assess whether apremilast could modify early entheseal bone and inflammatory changes in patients with psoriasis at increased risk for PsA.
• They included 20 patients with moderate-to-severe psoriasis (mean age, 50 years; 45% women) at a German center who reported arthralgia, had subclinical inflammatory or structural changes on hand MRI and/or HR-pQCT, and had no prior exposure to biologics.
• Patients received 30 mg apremilast twice daily for 24 weeks, with imaging and clinical assessments conducted at baseline, week 12, and week 24.
• The primary endpoint was change in structural entheseal lesions on HR-pQCT at week 24. Secondary endpoints included MRI-detected inflammatory changes, bone structure and biomechanics, and clinical response.

TAKEAWAY

• Measures of structural entheseal lesions, entheseal bone density, cortical thickness, and biomechanical parameters at the distal radius did not change significantly over 24 weeks.
• MRI detected new erosions in 4 patients at week 24 who had no erosions at baseline, while total MRI inflammation scores remained unchanged.
• Tender joint count decreased from 3.2 at baseline to 0.9 at week 24 (P = .01), and psoriasis area and severity index decreased from 10.9 to 4.7 (P = .015). No patient developed clinically overt PsA during the study.
• Most adverse events were mild or moderate, and no new safety signals were reported.

IN PRACTICE

"[The] trial underscores the potential that targeted interventions at the earliest phases of PsA not only improve psoriatic skin disease and early nociceptive manifestions but may be accompanied by no significant longitudinal change in selected HR-pQCT-derived structural changes associated with psoriatic disease, including structural entheseal lesions and measures of bone volume and bone quality," the authors of the study wrote.

SOURCE

The study was led by David Simon, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Germany. It was published online on August 8 in Arthritis Research & Therapy.

LIMITATIONS

The study had a small sample size and a single-arm open-label design, which may have limited the generalizability of findings. The study lacked a control group. Imaging used a dominant-hand protocol instead of symptom-directed imaging.

DISCLOSURES

The study was supported by Amgen, which provided funding and trial medication. Other sources of funding included Deutsche Gesellschaft für Rheumatologie und klinische Immunologie Forschungsinitiative 2025, Else Kröner-Fresenius Stiftung, and the European Union. Multiple authors reported receiving consulting fees, speaker honoraria, research support, or advisory board roles with pharmaceutical companies including Amgen. One author reported having leadership roles and being a shareholder of Boston Imaging Core Lab. Detailed author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.