NEW research analysing data from nine European registries has found that the effectiveness of tumor necrosis factor inhibitors (TNFi) in psoriatic arthritis (PsA) treatment varies by joint location. The study highlights that some joints, such as the shoulder and elbow, respond more rapidly to TNFi therapy than others, like the wrist and knee.
Psoriatic arthritis, a chronic inflammatory condition affecting both the skin and joints, is commonly treated with TNFi, which has been proven to reduce joint inflammation and swelling. However, randomized clinical trials typically measure improvements using overall joint counts rather than assessing individual joint responses. This large-scale observational cohort study aimed to investigate whether certain joints exhibit faster or slower resolution of swelling after TNFi treatment.
The study included 1,729 TNFi-naïve PsA patients across nine European countries, encompassing 8,397 swollen joints at treatment initiation. Researchers examined the time to resolution of swelling in different joints and adjusted their analyses for age, sex, and country-specific variations.
Results showed that TNFi treatment led to faster resolution of swelling in the shoulder and elbow compared to joints in the fingers. Meanwhile, the wrist was less responsive to TNFi than other hand joints. Within the fingers, digit 4 (ring finger) and digit 5 (pinky) showed the most rapid resolution of swelling. Notably, the knee, when compared to the elbow (its upper limb counterpart), exhibited a significantly slower response to TNFi therapy.
These findings suggest that anatomical differences play a role in treatment response, which may have implications for personalised treatment strategies in PsA. Clinicians may need to consider joint-specific responses when evaluating TNFi effectiveness and adjusting treatment plans for patients with persistent joint inflammation.
Further studies incorporating imaging techniques to confirm synovitis could help refine these findings and provide deeper insights into how TNFi impacts different joints in PsA patients. The research underscores the importance of individualised treatment approaches and the need for additional investigation into why certain joints respond more effectively to TNFi than others.
Aleksandra Zurowska, EMJ
Reference
Ciurea A et al. Differences in the response to TNF inhibitors at distinct joint locations in patients with psoriatic arthritis: results from nine European registries. Arthritis Res Ther. 2025;DOI: 10.1186/s13075-025-03488-w.
