Characterization of Super-Responder Profile in Patients with Psoriatic Arthritis Treated with b/tsDMARDs: A Retrospective Study of a Longitudinal Cohort

Psoriatic arthritis (PsA) is a complex disease in which remission or low disease activity is now an achievable target. This study aimed to evaluate "super-responders" (SR) among patients with PsA treated with advanced therapies and to explore possible clinical factors associated with the SR phenotype. This is a retrospective analysis of a longitudinal cohort of patients diagnosed with PsA and treated with biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs), with at least 2 years of follow-up. SR were defined as patients achieving very low disease activity (VLDA) within 6 months of therapy initiation and maintaining VLDA for at least 2 years. Data from all clinical visits were reviewed to confirm response patterns. Patients who initiated treatment for PsA were included, regardless of prior biologic use for psoriasis. SR were compared with non-SR patients to identify clinical differences. Logistic regression was performed to evaluate features associated with SR. Among 177 evaluated patients, 29 (16.3%) were classified as SR. SR patients were more often of male sex, had significantly lower baseline pain visual analogue scale scores (p < 0.01), Patient Global Assessment score (p = 0.04), and shorter intervals between psoriasis and PsA diagnosis (p = 0.04). They were more frequently treated with interleukin-17 (IL-17) inhibitors at baseline (37.9% vs. 19.5%, p = 0.04) and had absence of cardiometabolic comorbidities. Logistic regression analysis confirmed associations between SR status and IL-17 treatment, absence of cardiometabolic comorbidities, and lower pain scores. This study may identify a distinct subset of patients with PsA demonstrating rapid and sustained response to treatment. While promising, the clinical utility of the SR concept requires cautious interpretation, especially regarding potential treatment de-escalation. Further validation in multicenter prospective studies may be essential.