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Bu J, Ding R, Zhou L, Chen X, Shen E. Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review. Front Immunol 2022; 13:880201. [PMID: 35757712 PMCID: PMC9226890 DOI: 10.3389/fimmu.2022.880201] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
Psoriasis is a chronic autoimmune inflammatory disease that remains active for a long period, even for life in most patients. The impact of psoriasis on health is not only limited to the skin, but also influences multiple systems of the body, even mental health. With the increasing of literature on the association between psoriasis and extracutaneous systems, a better understanding of psoriasis as an autoimmune disease with systemic inflammation is created. Except for cardiometabolic diseases, gastrointestinal diseases, chronic kidney diseases, malignancy, and infections that have received much attention, the association between psoriasis and more systemic diseases, including the skin system, reproductive system, and oral and ocular systems has also been revealed, and mental health diseases draw more attention not just because of the negative mental and mood influence caused by skin lesions, but a common immune-inflammatory mechanism identified of the two systemic diseases. This review summarizes the epidemiological evidence supporting the association between psoriasis and important and/or newly reported systemic diseases in the past 5 years, and may help to comprehensively recognize the comorbidity burden related to psoriasis, further to improve the management of people with psoriasis.
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Affiliation(s)
- Jin Bu
- Hospital for Skin Disease (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Ruilian Ding
- Hospital for Skin Disease (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Liangjia Zhou
- Hospital for Skin Disease (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Xiangming Chen
- Sino-French Hoffmann Institute, School of Basic Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Erxia Shen
- Sino-French Hoffmann Institute, School of Basic Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
- The State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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Mathew AJ, Sutton M, Pereira D, Gladman DD, Chandran V. Effectiveness of Disease Modifying Anti-Rheumatic Drugs for Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort. J Rheumatol 2022; 49:1020-1025. [PMID: 35649547 DOI: 10.3899/jrheum.211231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Our objective was to assess the effectiveness of conventional and targeted disease modifying anti-rheumatic drugs (cDMARDs and tDMARDs, respectively) in treating enthesitis in PsA. METHODS Patients with active enthesitis, defined as ≥1 tender entheses (of 29 sites included in the spondyloarthritis research consortium of Canada enthesitis index, the Leeds enthesitis index, and the Maastricht ankylosing spondylitis enthesitis score), enrolled in a large PsA cohort were included. Medications at baseline were classified into 3 mutually exclusive categories: 1.'no treatment/non-steroidal anti-inflammatory drugs (NSAIDs)', 2. 'cDMARDs±NSAIDs' and 3.'tDMARDs±cDMARDs/NSAIDs'. Complete resolution of enthesitis (no tender entheseal site) at 12 months was the primary outcome. Logistic regression models were developed to determine the association between medication category and enthesitis resolution. RESULTS Of the 1270 patients studied, 628(49.44%) had enthesitis; 526 patients (51.71% males; mean age (standard deviation, s.d.) - 49.02(13.12) years; mean enthesitis score (s.d.) 2.13(2.16) with adequate follow-up were analysed. Complete resolution of enthesitis was noted in 453(86%) patients, within a mean period of 8.73 months from baseline. In the regression analysis, though not significant, DMARDs (Categories 2 and 3) had higher odds ratio compared to category 1 for resolution of enthesitis. Enthesitis resolution was associated with lower joint activity (OR 0.97; 95% CI 0.95 - 0.99; p = 0.01) and male sex (OR 1.66; 95% CI 0.97 - 2.84; p = 0.06). CONCLUSION Resolution of enthesitis was observed in 86% of patients in an observational setting regardless of the medication used. Future effectiveness studies may warrant evaluation of enthesitis using advanced imaging.
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Affiliation(s)
- Ashish Jacob Mathew
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Mitchell Sutton
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Daniel Pereira
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Dafna D Gladman
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Vinod Chandran
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
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Gossec L, Siebert S, Bergmans P, de Vlam K, Gremese E, Joven-Ibáñez B, Korotaeva TV, Lavie F, Noël W, Nurmohamed MT, Sfikakis PP, Theander E, Smolen JS. Persistence and effectiveness of the IL-12/23 pathway inhibitor ustekinumab or tumour necrosis factor inhibitor treatment in patients with psoriatic arthritis: 1-year results from the real-world PsABio Study. Ann Rheum Dis 2022; 81:823-830. [PMID: 35210262 PMCID: PMC9120383 DOI: 10.1136/annrheumdis-2021-221640] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We evaluated real-world treatment persistence and effectiveness at 1 year following initiation of IL-12/23 inhibitor ustekinumab or a tumour necrosis factor inhibitor (TNFi) for psoriatic arthritis (PsA). METHODS PsABio (NCT02627768), a prospective, observational study, followed patients with PsA prescribed first-line to third-line ustekinumab or TNFi. Drug persistence, effectiveness (achievement of clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) low disease activity (LDA)/remission and minimal disease activity/very low disease activity (MDA/VLDA)), and safety were assessed every 6 months. In addition to descriptive statistics, propensity score (PS)-adjusted comparisons across cohorts were performed. RESULTS At 1 year, overall persistence was similar in the ustekinumab (n=317/438, 72.4%) and TNFi (n=321/455, 70.5%) groups. PS-adjusted HR (95% CI) for stopping/switching ustekinumab versus TNFi was 0.82 (0.60; 1.13). cDAPSA LDA (including remission)/remission was achieved in 55.9%/22.1% of ustekinumab-treated and 67.1%/31.7% of TNFi-treated patients; PS-adjusted ORs (95% CI) were 0.80 (0.57; 1.10) for cDAPSA LDA and 0.73 (0.49; 1.07) for remission. MDA/VLDA was achieved in 34.2%/11.9% of ustekinumab-treated and 43.1%/12.6% of TNFi-treated patients; PS-adjusted ORs (95% CI) were 0.89 (0.63; 1.26) for MDA and 0.90 (0.54; 1.49) for VLDA. The safety profiles were similar in both groups. CONCLUSION In the real-world PsABio Study, after 1 year of treatment, although unadjusted persistence was numerically slightly higher for ustekinumab versus TNFi and unadjusted effectiveness was numerically slightly higher for TNFi versus ustekinumab, the PS-adjusted comparisons demonstrated comparable overall persistence, effectiveness and safety for both modes of action in PsA.
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Affiliation(s)
- Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, AP-HP, University Hospital Pitié Salpêtrière, Paris, France
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Glasgow, UK
| | - Paul Bergmans
- Biostatistics, Janssen-Cilag BV, Breda, The Netherlands
| | - Kurt de Vlam
- Department of Rheumatology, Universitair Ziekenhuis Leuven, Leuven, Flanders, Belgium
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Tatiana V Korotaeva
- Department of Spondyloarthritis and Psoriatic Arthritis, VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Frederic Lavie
- Medical Affairs, The Janssen Pharmaceutical Companies of Johnson & Johnson, Paris, France
| | - Wim Noël
- Medical Affairs, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Michael T Nurmohamed
- Department of Rheumatology, Reade and VU University Medical Center, Amsterdam, The Netherlands
| | - Petros P Sfikakis
- 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Josef S Smolen
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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De Brandt E, Hillary T. Comorbid Psoriasis and Metabolic Syndrome: Clinical Implications and Optimal Management. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:113-126. [PMID: 35651599 PMCID: PMC9149586 DOI: 10.2147/ptt.s293107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/30/2022] [Indexed: 11/26/2022]
Abstract
Purpose To review the literature on guidance on the follow-up of psoriasis and its comorbidities and to provide practical recommendations. Patients and Methods A PubMed search was conducted using MeSH terms and free text keywords related to "psoriasis", "obesity", "hypertension", "diabetes", "dyslipidemia", "metabolic syndrome" and "Psoriatic arthritis". The search was conducted between September 2021 and January 2022. References of selected articles were scanned to identify additional articles. Results Recommendations on the follow-up of hypertension, obesity, dyslipidemia, type 2 diabetes, metabolic syndrome, psoriatic arthritis, non-alcoholic fatty liver disease and inflammatory bowel disease in psoriasis patients were extracted from the included articles. These data are presented in summary tables for both adults and children. A practical and feasible approach for each comorbidity is discussed. Conclusion Awareness among dermatologists for relevant psoriasis-associated comorbidities is crucial. The dermatologist should function as gatekeeper and screen for comorbidities, in order to make timely referrals when indicated.
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Affiliation(s)
- Eveline De Brandt
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Hillary
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
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Sbidian E, Chaimani A, Garcia-Doval I, Doney L, Dressler C, Hua C, Hughes C, Naldi L, Afach S, Le Cleach L. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2022; 5:CD011535. [PMID: 35603936 PMCID: PMC9125768 DOI: 10.1002/14651858.cd011535.pub5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated disease with either skin or joints manifestations, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. The relative benefit of these treatments remains unclear due to the limited number of trials comparing them directly head-to-head, which is why we chose to conduct a network meta-analysis. OBJECTIVES To compare the efficacy and safety of non-biological systemic agents, small molecules, and biologics for people with moderate-to-severe psoriasis using a network meta-analysis, and to provide a ranking of these treatments according to their efficacy and safety. SEARCH METHODS For this update of the living systematic review, we updated our searches of the following databases monthly to October 2021: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. SELECTION CRITERIA Randomised controlled trials (RCTs) of systemic treatments in adults over 18 years with moderate-to-severe plaque psoriasis, at any stage of treatment, compared to placebo or another active agent. The primary outcomes were: proportion of participants who achieved clear or almost clear skin, that is, at least Psoriasis Area and Severity Index (PASI) 90; proportion of participants with serious adverse events (SAEs) at induction phase (8 to 24 weeks after randomisation). DATA COLLECTION AND ANALYSIS We conducted duplicate study selection, data extraction, risk of bias assessment and analyses. We synthesised data using pairwise and network meta-analysis (NMA) to compare treatments and rank them according to effectiveness (PASI 90 score) and acceptability (inverse of SAEs). We assessed the certainty of NMA evidence for the two primary outcomes and all comparisons using CINeMA, as very low, low, moderate, or high. We contacted study authors when data were unclear or missing. We used the surface under the cumulative ranking curve (SUCRA) to infer treatment hierarchy, from 0% (worst for effectiveness or safety) to 100% (best for effectiveness or safety). MAIN RESULTS This update includes an additional 19 studies, taking the total number of included studies to 167, and randomised participants to 58,912, 67.2% men, mainly recruited from hospitals. Average age was 44.5 years, mean PASI score at baseline was 20.4 (range: 9.5 to 39). Most studies were placebo-controlled (57%). We assessed a total of 20 treatments. Most (140) trials were multicentric (two to 231 centres). One-third of the studies (57/167) had high risk of bias; 23 unclear risk, and most (87) low risk. Most studies (127/167) declared funding by a pharmaceutical company, and 24 studies did not report a funding source. Network meta-analysis at class level showed that all interventions (non-biological systemic agents, small molecules, and biological treatments) showed a higher proportion of patients reaching PASI 90 than placebo. Anti-IL17 treatment showed a higher proportion of patients reaching PASI 90 compared to all the interventions, except anti-IL23. Biologic treatments anti-IL17, anti-IL12/23, anti-IL23 and anti-TNF alpha showed a higher proportion of patients reaching PASI 90 than the non-biological systemic agents. For reaching PASI 90, the most effective drugs when compared to placebo were (SUCRA rank order, all high-certainty evidence): infliximab (risk ratio (RR) 50.19, 95% CI 20.92 to 120.45), bimekizumab (RR 30.27, 95% CI 25.45 to 36.01), ixekizumab (RR 30.19, 95% CI 25.38 to 35.93), risankizumab (RR 28.75, 95% CI 24.03 to 34.39). Clinical effectiveness of these drugs was similar when compared against each other. Bimekizumab, ixekizumab and risankizumab showed a higher proportion of patients reaching PASI 90 than other anti-IL17 drugs (secukinumab and brodalumab) and guselkumab. Infliximab, anti-IL17 drugs (bimekizumab, ixekizumab, secukinumab and brodalumab) and anti-IL23 drugs (risankizumab and guselkumab) except tildrakizumab showed a higher proportion of patients reaching PASI 90 than ustekinumab and three anti-TNF alpha agents (adalimumab, certolizumab and etanercept). Ustekinumab was superior to certolizumab; adalimumab and ustekinumab were superior to etanercept. No significant difference was shown between apremilast and two non-biological drugs: ciclosporin and methotrexate. We found no significant difference between any of the interventions and the placebo for the risk of SAEs. The risk of SAEs was significantly lower for participants on methotrexate compared with most of the interventions. Nevertheless, the SAE analyses were based on a very low number of events with low- to moderate-certainty for all the comparisons (except methotrexate versus placebo, which was high-certainty). The findings therefore have to be viewed with caution. For other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1), the results were similar to the results for PASI 90. Information on quality of life was often poorly reported and was absent for several of the interventions. AUTHORS' CONCLUSIONS Our review shows that, compared to placebo, the biologics infliximab, bimekizumab, ixekizumab, and risankizumab were the most effective treatments for achieving PASI 90 in people with moderate-to-severe psoriasis on the basis of high-certainty evidence. This NMA evidence is limited to induction therapy (outcomes measured from 8 to 24 weeks after randomisation), and is not sufficient for evaluating longer-term outcomes in this chronic disease. Moreover, we found low numbers of studies for some of the interventions, and the young age (mean 44.5 years) and high level of disease severity (PASI 20.4 at baseline) may not be typical of patients seen in daily clinical practice. We found no significant difference in the assessed interventions and placebo in terms of SAEs, and the safety evidence for most interventions was low to moderate quality. More randomised trials directly comparing active agents are needed, and these should include systematic subgroup analyses (sex, age, ethnicity, comorbidities, psoriatic arthritis). To provide long-term information on the safety of treatments included in this review, an evaluation of non-randomised studies and postmarketing reports from regulatory agencies is needed. Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Emilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Anna Chaimani
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, F-75004, Paris, France
- Cochrane France, Paris, France
| | - Ignacio Garcia-Doval
- Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Corinna Dressler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Camille Hua
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Carolyn Hughes
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Luigi Naldi
- Centro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) - FROM (Research Foundation of Ospedale Maggiore Bergamo), Padiglione Mazzoleni - Presidio Ospedaliero Matteo Rota, Bergamo, Italy
| | - Sivem Afach
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Laurence Le Cleach
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
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Lalani A, Conrad C, Shahab S. Acute Psoriatic Exacerbation Secondary to Infected Pacemaker With Staphylococcus aureus and Candida lusitaniae? Cureus 2022; 14:e25078. [PMID: 35719758 PMCID: PMC9202648 DOI: 10.7759/cureus.25078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
Psoriasis is a lifelong chronic hyperproliferative inflammatory immune-mediated disorder. There is a strong association of psoriasis exacerbation with infection of Staphylococcus and Streptococcus species. In the case of our patient, a psoriatic flare manifesting as dactylitis occurred secondary to methicillin sensitive Staphylococcus aureus bacteremia colonization of his pacemaker. If a patient is started on an antibiotic regimen, such as vancomycin, and has symptoms of rash, and swelling in the fingers, it is imperative to ask for a proper rheumatologic history, as vancomycin infusion reaction (previously known as Red Man Syndrome) may not be the cause of the flare-up, such as in the case of our patient. Inversely, patients with psoriasis are more likely to be colonized by S. aureus on the skin and in the nasal cavity, and this can lead to bacteremia and infection of hardware, such as an automatic implantable cardioverter-defibrillator (AICD).
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Soomro M, Stadler M, Dand N, Bluett J, Jadon D, Jalali-Najafabadi F, Duckworth M, Ho P, Marzo-Ortega H, Helliwell PS, Ryan AW, Kane D, Korendowych E, Simpson MA, Packham J, McManus R, Gabay C, Lamacchia C, Nissen MJ, Brown MA, Verstappen SMM, Van Staa T, Barker JN, Smith CH, FitzGerald O, McHugh N, Warren RB, Bowes J, Barton A. Comparative genetic analysis of psoriatic arthritis and psoriasis for the discovery of genetic risk factors and risk prediction modelling. Arthritis Rheumatol 2022; 74:1535-1543. [PMID: 35507331 PMCID: PMC9539852 DOI: 10.1002/art.42154] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/16/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022]
Abstract
Objectives Psoriatic arthritis (PsA) has a strong genetic component, and the identification of genetic risk factors could help identify the ~30% of psoriasis patients at high risk of developing PsA. Our objectives were to identify genetic risk factors and pathways that differentiate PsA from cutaneous‐only psoriasis (PsC) and to evaluate the performance of PsA risk prediction models. Methods Genome‐wide meta‐analyses were conducted separately for 5,065 patients with PsA and 21,286 healthy controls and separately for 4,340 patients with PsA and 6,431 patients with PsC. The heritability of PsA was calculated as a single‐nucleotide polymorphism (SNP)–based heritability estimate (h2SNP) and biologic pathways that differentiate PsA from PsC were identified using Priority Index software. The generalizability of previously published PsA risk prediction pipelines was explored, and a risk prediction model was developed with external validation. Results We identified a novel genome‐wide significant susceptibility locus for the development of PsA on chromosome 22q11 (rs5754467; P = 1.61 × 10−9), and key pathways that differentiate PsA from PsC, including NF‐κB signaling (adjusted P = 1.4 × 10−45) and Wnt signaling (adjusted P = 9.5 × 10−58). The heritability of PsA in this cohort was found to be moderate (h2SNP = 0.63), which was similar to the heritability of PsC (h2SNP = 0.61). We observed modest performance of published classification pipelines (maximum area under the curve 0.61), with similar performance of a risk model derived using the current data. Conclusion Key biologic pathways associated with the development of PsA were identified, but the investigation of risk classification revealed modest utility in the available data sets, possibly because many of the PsC patients included in the present study were receiving treatments that are also effective in PsA. Future predictive models of PsA should be tested in PsC patients recruited from primary care.
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Affiliation(s)
- Mehreen Soomro
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK
| | - Michael Stadler
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, UK
| | - James Bluett
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Farideh Jalali-Najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK
| | - Michael Duckworth
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Pauline Ho
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - Philip S Helliwell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - Anthony W Ryan
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland.,Genuity Science, Cherrywood Business Park, Dublin, Ireland
| | - David Kane
- Tallaght University Hospital and Trinity College Dublin, Ireland
| | - Eleanor Korendowych
- Royal National Hospital for Rheumatic Diseases and Dept Pharmacy and Pharmacology, University of Bath, UK
| | - Michael A Simpson
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Jonathan Packham
- Rheumatology Department, Haywood Hospital, Stoke on Trent, Midlands Partnership NHS Foundation Trust, UK.,Academic Unit of Population and Lifespan Sciences, University of Nottingham, University of Nottingham, UK
| | - Ross McManus
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Cem Gabay
- Division of Rheumatology, Department of Medicine, Geneva University Hospitals & Department of Pathology and Immunology, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Céline Lamacchia
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Michael J Nissen
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Matthew A Brown
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Genomics England, Charterhouse Square, London, UK
| | - Suzanne M M Verstappen
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK.,Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tjeerd Van Staa
- Health e-Research Centre, Health Data Research UK North, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Manchester, UK
| | - Jonathan N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guys and St Thomas' Foundation Trust and Kings College London, London, UK
| | | | | | - Oliver FitzGerald
- UCD School of Medicine and Medical Sciences and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases and Dept Pharmacy and Pharmacology, University of Bath, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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158
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Pina Vegas L, Penso L, Claudepierre P, Sbidian E. Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database. JAMA Dermatol 2022; 158:513-522. [PMID: 35319735 PMCID: PMC8943623 DOI: 10.1001/jamadermatol.2022.0364] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
Importance Treatment options for psoriasis (PsO) and psoriatic arthritis (PsA) have evolved significantly throughout the era of biologics. Clinical trials are inadequate to assess the relative long-term efficacy of biologics and are often insufficient regarding safety. Objectives To assess the long-term persistence of different biologic classes to treat PsO and PsA. Design, Setting, and Participants This nationwide cohort study involved the administrative health care database of the French health insurance scheme linked to the hospital discharge database. All adults with PsO and PsA who were new users of biologics (not in the year before the index date) from January 1, 2015, to May 31, 2019, were included and followed up through December 31, 2019. Patients hospitalized for PsA in the PsO cohort and for PsO in the PsA cohort in the year before the index date were excluded. Data were analyzed from June 1 to October 31, 2021. Main Outcomes and Measures Persistence was defined as the time from biologic therapy initiation to discontinuation and was estimated using the Kaplan-Meier method. Comparison of persistence by biologic class involved using propensity score-weighted Cox proportional hazards regression models and adjustment on specific systemic nonbiologics (time-dependent variables). Results A total of 16 892 patients with PsO were included in the analysis (mean [SD] age, 48.5 [13.8] years; 9152 men [54.2%] men). Of these, 10 199 patients (60.4%) started therapy with a tumor necrosis factor (TNF) inhibitor; 3982 (23.6%), with an interleukin 12 and interleukin 23 (IL-12/23) inhibitor; and 2711 (16.0%), with an interleukin 17 (IL-17) inhibitor. An additional 6531 patients with PsA (mean [SD] age, 49.1 [12.8] years; 3565 [54.6%] women) were included; of these, 4974 (76.2%) started therapy with a TNF inhibitor; 803 (12.3%), with an IL-12/23 inhibitor; and 754 (11.5%), with an IL-17 inhibitor. Overall 3-year persistence rates were 40.9% and 36.2% for PsO and PsA, respectively. After inverse probability of treatment weighting and adjustment, the IL-17 inhibitor was associated with higher persistence compared with the TNF inhibitor for PsO (weighted hazard ratio [HR], 0.78 [95% CI, 0.73-0.83]) and PsA (weighted HR, 0.70 [95% CI, 0.58-0.85]) and compared with the IL-12/23 inhibitor for PsA (weighted HR, 0.69 [95% CI, 0.55-0.87]). No difference between the IL-17 inhibitor and IL-12/23 inhibitor for PsO was noted. The IL-12/23 inhibitor was associated with higher persistence than the TNF inhibitor for PsO (weighted HR, 0.76 [95% CI, 0.72-0.80]), with no difference observed for PsA. Conclusions and Relevance The findings of this cohort study suggest that IL-17 inhibitors are associated with higher treatment persistence than the TNF inhibitor for PsO and PsA. Interleukin 17 inhibitors were also associated with higher persistence than the IL-12/23 inhibitor for PsA, with no difference for PsO. However, the persistence rates of all biologics remained globally low at 3 years.
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Affiliation(s)
- Laura Pina Vegas
- EpiDermE, Université Paris Est Créteil, Créteil, France
- Service de Rhumatologie, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil, France
| | - Laetitia Penso
- EpiDermE, Université Paris Est Créteil, Créteil, France
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products and French National Health Insurance, St Denis
| | - Pascal Claudepierre
- EpiDermE, Université Paris Est Créteil, Créteil, France
- Service de Rhumatologie, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil, France
| | - Emilie Sbidian
- EpiDermE, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique 1430, Hôpital Henri Mondor, Créteil, France
- Service de Dermatologie, AP-HP, Hôpital Henri Mondor, Créteil, France
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159
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COVID-19 in Patients with Psoriatic Arthritis. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The COVID-19 pandemic has a negative impact on all aspects of human life and can lead to the exacerbation of chronic diseases. At the same time, it is known that a higher risk of infection and a more severe course of coronavirus infection is found in the elderly, as well as in people with serious comorbidities.
Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is often diagnosed in patients with psoriasis. Specific treatment of patients with chronic inflammatory joint disease include nonsteroidal anti-inflammatory drugs, glucocorticosteroids, disease-modifying antirheumatic drugs, new biological agents, including monoclonal antibodies to IL-6, IL-1, TNF-a, target disease modifying drugs. Medications used for PsA treatment can potentially have both negative and positive effects on the course of COVID-19.
The objective: to analyze the features of COVID-19 in patients with PsA and to study the comorbid pathology after coronavirus infection.
Materials and methods. The study involved 174 people with a verified diagnosis of PsA. Patients were divided into two groups. Group I included 112 (64.4%) persons who had COVID-19, and group II - 62 (35.6%) who had not had coronavirus infection at the time of first examination.
Patients in group I significantly differed from group II in age (p <0.001) and duration of PsA (p <0.001), showed a significantly higher degree of psoriatic skin lesions and activity of the underlying disease (p = 0.001) compared to patients from group II. The participants of the study underwent examination characterize the course of the psoriatic disease and skin lesions and risk of cardiovascular disease.
Results. To date, there are no clear scientific data that reveal the specific features of COVID-19 infection and the effect of antirheumatic therapy on the development of dangerous complications associated with coronavirus infection in patients with PsA.
The analysis of comorbid pathology has found cardiovascular pathology in 67 (59.8%) of patients, including arterial hypertension – in 58 (51.8%) people, metabolic syndrome – in 34 (30.4%), diseases of the digestive system – in 32 (28.6%) and respiratory system – in 24 (21.4%) of persons.
Conclusions. Patients with higher activity and duration of the PsA were significantly more likely to get COVID-19 and demonstrated higher total cardiovascular risk for the next 10 years.
Further research is needed to study the impact of specific basic rheumatological drugs on the outcomes of COVID-19 and to analyze the broader effects of the pandemic on the course of psoriatic arthritis.
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160
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Nguyen T, Churchill M, Levin R, Valenzuela G, Merola JF, Ogdie A, Orbai AM, Scher JU, Kavanaugh A, Kianifard F, Rollins C, Calheiros R, Chambenoit O. Secukinumab in US Biologic-Naive Patients With Psoriatic Arthritis: Results From the Randomized, Placebo-Controlled CHOICE Study. J Rheumatol 2022; 49:894-902. [DOI: 10.3899/jrheum.210912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/22/2022]
Abstract
Objective To evaluate secukinumab 300 mg and 150 mg vs placebo in a US-only population of biologic-naive patients with psoriatic arthritis (PsA). Methods CHOICE was a randomized, double-blind, controlled trial conducted in the United States. Biologic-naive patients with PsA and psoriasis were randomized 2:2:1 to secukinumab 300 mg (n = 103), secukinumab 150 mg (n = 103), or placebo (n = 52). The primary objective was to show superiority of secukinumab 300 mg vs placebo in ACR20 response at week 16. Additional objectives included the effect of secukinumab on dactylitis, enthesitis, psoriasis, and safety. Results ACR20 response rates at week 16 were higher with secukinumab 300 mg than with placebo (51.5% vs 23.1%; odds ratio, 3.51 [95% CI: 1.65, 7.45]; P = .0011). Secukinumab 300 mg also led to greater ACR50/70 responses and improvements in other variables vs placebo. Responses were generally sustained over time. Patients with inadequate response to secukinumab 150 mg at weeks 16, 28, or 40 who received dose escalation to 300 mg experienced improved clinical response after uptitration. The most common adverse events were upper respiratory tract infections and diarrhea. No inflammatory bowel disease was reported or new safety signals observed. Conclusion Secukinumab 300 mg led to rapid and significant improvements over placebo in symptoms of PsA in this heavier population of US-only biologic-naive patients. Findings were consistent with previous studies and suggest that secukinumab 300 mg is a safe and efficacious first-line biologic treatment for patients with PsA.
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161
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Yuksel Bozdemir N, Inan Yuksel E, Toraman ZA, Cicek D, Demir B, Gunbey F. Factors Affecting Onychomycosis in Patients with Psoriasis. Dermatol Ther 2022; 35:e15513. [DOI: 10.1111/dth.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Esma Inan Yuksel
- Basaksehir Cam and Sakura City Hospital, Clinics of Dermatology Istanbul Turkey
| | | | - Demet Cicek
- Firat University Hospital, Department of Dermatologye Elazig Turkey
| | - Betul Demir
- Firat University Hospital, Department of Dermatologye Elazig Turkey
| | - Fatma Gunbey
- Firat University Hospital, Department of Microbiology Elazig Turkey
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162
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Hioki T, Komine M, Ohtsuki M. Diagnosis and Intervention in Early Psoriatic Arthritis. J Clin Med 2022; 11:jcm11072051. [PMID: 35407659 PMCID: PMC8999837 DOI: 10.3390/jcm11072051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/19/2022] [Accepted: 03/29/2022] [Indexed: 02/05/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disorder that affects approximately 20–30% of patients with psoriasis. PsA causes deformities and joint damage, impairing quality of life and causing long-term functional disability. Several recent studies demonstrated that early diagnosis and intervention for PsA prevents permanent invalidity. However, the clinical features of PsA vary and are shared with other differential diseases, such as reactive arthritis, osteoarthritis, and ankylosing spondylitis. The common and overlapping features among these diseases complicate the accurate early diagnosis and intervention of PsA. Therefore, this review focuses on the current knowledge of the diagnosis of early PsA and discusses the meaning of early intervention for early PsA.
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Affiliation(s)
- Tomoyuki Hioki
- Department of Dermatology, Central Japan International Medical Center, Minokamo 505-8510, Japan
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan;
- Correspondence: (T.H.); (M.K.)
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan;
- Correspondence: (T.H.); (M.K.)
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Japan;
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163
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Nielsen ML, Nymand LK, Thomsen SF, Thyssen JP, Egeberg A. Delay in diagnosis and treatment of patients with psoriasis - a population-based cross-sectional study. Br J Dermatol 2022; 187:590-591. [PMID: 35383889 DOI: 10.1111/bjd.21594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mia-Louise Nielsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lea K Nymand
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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164
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Incidence and prevalence of psoriatic arthritis in patients with psoriasis stratified by psoriasis disease severity: Retrospective analysis of an electronic health records database in the United States. J Am Acad Dermatol 2022; 86:748-757. [PMID: 34547358 DOI: 10.1016/j.jaad.2021.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/09/2021] [Accepted: 09/10/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Among patients in the United States with psoriasis (PsO), limited data exist on the incidence and prevalence of psoriatic arthritis (PsA) based on disease severity. OBJECTIVE To assess the incidence, prevalence, and predictors of PsA among patients with PsO stratified by PsO severity using treatment type. METHODS Incidence of PsA per 100 PsO patient-years (PY) and prevalence were assessed using the Optum electronic health records database. Incidence was assessed from PsO diagnosis and 1 year after PsO diagnosis overall and stratified by mutually exclusive treatment classes as a severity surrogate. RESULTS The overall incidence of PsA was 2.9 (95% CI, 2.9-3.0) events per 100 PY. The incidence (95% CI) by severity surrogate was 2.1 (2.1-2.1), 9.9 (9.5-10.4), and 17.6 (16.9-18.3) events per 100 PY for patients with mild, moderate, and severe PsO as determined by receiving nonsystemics, nonbiologic systemic therapy, and biologics, respectively. When excluding patients diagnosed with PsA 1 year after PsO diagnosis, overall incidence was lower (1.7 [95% CI, 1.6-1.7] events per 100 PY), with similar trends for treatment-severity surrogates. LIMITATIONS Results may not be generalizable to a wider population. CONCLUSION The risk of developing PsA increased with disease severity and was highest in patients with the most severe PsO.
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165
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Sachdeva M, Abduelmula A, Mufti A, Georgakopoulos JR, Lytvyn Y, Yeung J. A Systematic Review Characterizing Psoriatic Arthritis Onset and Exacerbation in Patients Receiving Biologic Therapy. J Cutan Med Surg 2022; 26:414-419. [PMID: 35317662 PMCID: PMC9361424 DOI: 10.1177/12034754221088556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background While biologic therapies revolutionized treatment of
immune-mediated inflammatory diseases (IMIDs), some adverse
effects have been noted. This includes the development and
exacerbation of PsA in patients on biologic agents, however the
outcomes were not extensively explored. Objective To perform a systematic review to characterize the outcomes of PsA
onset or exacerbation secondary to biologic use. Methods MEDLINE and EMBASE search conducted on March 23, 2021 resulted in
18 studies comprised of 64 patients. Results Of the 64 patients, 57 (89.1%) experienced new-onset PsA and 7
(10.9%) experienced exacerbation of preexisting PsA following
exposure to a biologic; most commonly a TNF-α inhibitor (42.2%,
n = 27/64) and IL-12/23 inhibitors
(39.1%, n = 25/64). The mean durations of
biologic use before PsA onset and exacerbation were 14.8 months
and 5.2 months, respectively. Twenty-four patients (44.4%)
subsequently switched to an alternate biologic without further
reports of PsA-related adverse events. All 64 patients reported
a specific treatment for PsA; most commonly discontinuation of
the associated biologic agent (32.8%, n =
21/64). Complete resolution of PsA was reported in 35.9%
(n = 23/64) of cases, of which 91.3%
(n = 21/23) resulted after
discontinuation of biologic. Conclusion Although we characterized outcomes of PsA induction and
exacerbation secondary to biologic use, large-scale studies are
required.
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Affiliation(s)
- Muskaan Sachdeva
- 7938 Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | | | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | | | - Yuliya Lytvyn
- 7938 Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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166
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Cui R, Chen M, Li X, Wang Q, Tong Q, Zhang H, Chen Z, Tao YL, Bi XL, Deng H, Yuan DF, He DY, Ding YF, Dai SM. Assessment of four screening tools and retrieval of key questions to detect undiagnosed psoriatic arthritis in Chinese patients with psoriasis: A multicenter study. J Dermatol 2022; 49:615-623. [PMID: 35318711 DOI: 10.1111/1346-8138.16355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 12/01/2022]
Abstract
Several screening tools have been developed to facilitate early diagnosis of psoriatic arthritis (PsA); however, their performance varied greatly across different studies. In this study, we validated and compared the performance of four screening tools in detecting undiagnosed PsA Chinese patients with psoriasis, and determined the key questions and their weights. The four screening tools were the Early Arthritis for Psoriatic Patients (EARP) questionnaire, Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire, Psoriasis and Arthritis Screening Questionnaire (PASQ), and Psoriasis Epidemiology Screening Tool (PEST). The receiver-operator curve (ROC) with area under curve (AUC) was used to determine sensitivity, specificity, and accuracy. Least absolute shrinkage and selection operator and logistic regression were utilized to retrieve key questions, and a nomogram was utilized to visualize their weights. Of 482 psoriasis patients from dermatology clinics, 77 were newly diagnosed with PsA. Another 68 patients with newly diagnosed PsA from rheumatology clinics were incorporated in the analysis. ROC analysis indicated that the optimal cut-off values for EARP, PASE, PASQ, and PEST were 3, 40, 7, and 3, with corresponding sensitivities of 91.4%, 88.6%, 86.2%, and 88.5%, and specificities of 88.6%, 75.2%, 80.2%, and 83.6%, respectively. The AUC of EARP (0.925) was higher than those of PASE (0.885), PASQ (0.905), and PEST (0.827). However, none of them were sufficiently sensitive to identify pure axial PsA (sensitivities of EARP, PASQ, and PASE were 25.0%, 36.8%, and 42.1%, respectively). Twelve key questions were retrieved from these four tools to establish a nomogram with a high discrimination (C-index = 0.993) and a good calibration (mean absolute error = 0.014). In conclusion, to screen undiagnosed PsA, EARP has slightly better balanced sensitivity and specificity, and higher accuracy. The retrieval of key questions and nomogram signify the necessity of attributing different scores to differently weighted questions when developing a new screening tool to make it function more efficiently.
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Affiliation(s)
- Ran Cui
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Miao Chen
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xia Li
- Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Wang
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiang Tong
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hua Zhang
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhiyong Chen
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi-Li Tao
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xin-Ling Bi
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hui Deng
- Department of Dermatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ding-Fen Yuan
- Department of Dermatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dong-Yi He
- Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional and Western Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional and Western Medicine, Shanghai Chinese Medicine Research Institute, Shanghai, China
| | - Yang-Feng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, China.,Institute of Psoriasis of Tongji University, Shanghai, China
| | - Sheng-Ming Dai
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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167
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Chaiyabutr C, Jiamton S, Silpa-Archa N, Wongpraparut C, Wongdama S, Chularojanamontri L. Retrospective study of psoriasis in people living with HIV: Thailand's experience. J Dermatol 2022; 49:607-614. [PMID: 35293003 DOI: 10.1111/1346-8138.16352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (<100 cells/μl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.
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Affiliation(s)
- Chayada Chaiyabutr
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sukhum Jiamton
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Silpa-Archa
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanisada Wongpraparut
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supisara Wongdama
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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168
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Ogdie A, Myers K, Mansfield C, Tillett W, Nash P, Leach C, Nowell WB, Gavigan K, Zueger P, McDearmon-Blondell E, Walsh J. Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry. Rheumatol Ther 2022; 9:735-751. [PMID: 35279798 PMCID: PMC8964868 DOI: 10.1007/s40744-022-00436-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Despite recent advances in treatment for psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. To further characterize these unmet needs, we evaluated patients’ experiences regarding the burden of PsA symptoms and disease impacts, and patients’ preferences for treatment. Methods Patients from ArthritisPower, a rheumatology research registry, completed a web-based survey. Object case best–worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in nine PsA-related disease impacts. BWS data were analyzed using a random-parameters logit model. Patient demographics, preferences for mode and frequency of therapy, and preferences for methotrexate were analyzed descriptively. Results Among the 332 participants, most were White (94%), female (80%), with mean age of 54 years (SD 11.4). In the BWS, joint pain was the most bothersome symptom, followed by other musculoskeletal pain and fatigue. The BWS for disease impacts found that improvements in the ability to perform physical activities were most important, followed by improvements in the ability to function independently, sleep quality, and the ability to perform daily activities. The most burdensome symptoms and desired disease impact improvements were similar in patients regardless of their experience with biologic disease-modifying antirheumatic drugs. The most preferred mode and frequency of treatment administration was oral, once-daily medication (preferred by 38% of respondents), and 74% prioritized therapies that significantly improved joint-related symptoms versus psoriasis-related symptoms. The majority of respondents (65%) preferred PsA treatment regimens that did not include methotrexate. Conclusions Patients with PsA from a rheumatology registry found musculoskeletal pain symptoms to be the most bothersome and prioritized improvements to functional impacts of their disease. These findings can better inform development of new therapies and guide shared patient-provider treatment decision-making. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00436-x.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelley Myers
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Carol Mansfield
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Colton Leach
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | - Jessica Walsh
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
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169
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Ciaffi J, Mele G, Mancarella L, Brusi V, Lisi L, Faranda Cordella J, Lubrano E, D'Angelo S, Meliconi R, Ursini F. Prevalence of Type 2 and Type 1 Diabetes in Psoriatic Arthritis: An Italian Study. J Clin Rheumatol 2022; 28:e324-e329. [PMID: 35192591 DOI: 10.1097/rhu.0000000000001706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) is burdened by an increased susceptibility to cardiovascular diseases. Comorbid diabetes may represent one of the key factors contributing to this risk. The aim of our medical records review study was to investigate the prevalence of type 2 diabetes (T2D) and type 1 diabetes (T1D) in an Italian PsA cohort. METHODS The clinical records of all patients consecutively seen at our clinic with a diagnosis of PsA during a 12-month period were reviewed to identify comorbid T2D or T1D. For comparison, a 1:1 age- and sex-matched group of individuals with noninflammatory diseases was recruited. RESULTS The final study cohort comprised 408 patients. The prevalence of T2D was 7.8% (95% confidence interval, 5.6-10.8) in PsA and 4.4% in controls (95% confidence interval, 2.8-6.9; p = 0.04). Two cases (0.49%) of T1D were identified in the PsA cohort, whereas no cases were observed in controls. In a multivariate logistic regression model including age, disease duration, and body mass index (BMI) as covariates, increasing age (odds ratio [OR], 1.079; p = 0.006) and BMI (OR, 1.188; p = 0.011) but not PsA duration predicted being classified as having T2D. In a similar model accounting for age and BMI, average disease activity score including 28 joints and C-reactive protein showed a trend toward significance (OR, 1.639; p = 0.066). CONCLUSIONS In conclusion, our data provide further support to the emerging evidence of an increased risk of T2D in PsA patients. Cardiometabolic comorbidity represents a significant aspect of integrated arthritis management to improve long-term cardiovascular outcomes and to provide a comprehensive treatment.
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Affiliation(s)
- Jacopo Ciaffi
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Giulio Mele
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Luana Mancarella
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Veronica Brusi
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Lucia Lisi
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | | | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso
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Anastasiou C, Yazdany J. Review of publications evaluating opioid use in patients with inflammatory rheumatic disease. Curr Opin Rheumatol 2022; 34:95-102. [PMID: 35044328 PMCID: PMC8974237 DOI: 10.1097/bor.0000000000000868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW This article discusses publications assessing the prevalence, efficacy, and safety of opioid analgesics in patients with rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, and systemic sclerosis. RECENT FINDINGS Recent studies show long-term opioid use is common in patients with inflammatory rheumatic disease. We did not find any studies demonstrating improved function or pain control with long-term opioid use in people with rheumatic diseases. Some data shows potential adverse effects including increased risk for fractures and opioid poisoning hospitalizations. There is evidence demonstrating an association of opioid use with mental health disorders, fibromyalgia, obesity, and disability, although causative links have not been established. Only minimal reductions in opioid use were observed after initiation of biologic disease modifying antirheumatic drugs (DMARDs). Studies have shown delayed DMARD initiation and reduced DMARD use in patients on opioids, raising concerns that these analgesics may delay care or initially mask symptoms of active disease. SUMMARY Available literature highlights high levels of opioid use in people with rheumatic disease, without scientific evidence to support efficacy for chronic pain control and increasing evidence of adverse events. These findings strongly suggest that opioids do not have a routine role in the chronic management of inflammatory rheumatic diseases.
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Affiliation(s)
- Christine Anastasiou
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
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171
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Purzycka-Bohdan D, Kisielnicka A, Zabłotna M, Nedoszytko B, Nowicki RJ, Reich A, Samotij D, Szczęch J, Krasowska D, Bartosińska J, Narbutt J, Lesiak A, Barasińska P, Owczarczyk-Saczonek A, Czerwińska J, Szepietowski JC, Batycka-Baran A, Czajkowski R, Górecka-Sokołowska M, Rudnicka L, Czuwara J, Sobalska-Kwapis M, Strapagiel D, Szczerkowska-Dobosz A. Chronic Plaque Psoriasis in Poland: Disease Severity, Prevalence of Comorbidities, and Quality of Life. J Clin Med 2022; 11:jcm11051254. [PMID: 35268344 PMCID: PMC8911198 DOI: 10.3390/jcm11051254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
The epidemiology of psoriasis has not been widely assessed in Polish population so far. This study aimed to investigate psoriasis epidemiological situation by evaluating disease course and severity, management, comorbidities, environmental factors, and knowledge about this disorder among psoriatic patients in Poland. A cross-sectional cohort population-based study enrolled 1080 psoriatic patients and 1200 controls. The mean age of psoriasis onset was 27.6 years; 78.24% had type I psoriasis. Positive family history of psoriasis was reported in 44.81% of patients, whereas itch was reported in vast majority of patients (83.33%). Based on PASI score moderate psoriasis was the most common in studied group (mean 12.63 ± 9.33, range 0−67.2). The DLQI score (12.01 ± 7.41, range 0−30.0) indicated a very large effect of psoriasis on the quality of life. Hypertension was the most prevalent comorbidity (33.80%), followed by obesity (16.85%) and dyslipidemia (11.85%). Stress was the foremost cause of disease exacerbation (66.20%); however, infections (44.07%) and seasonal changes (45.09%) had also an impact on the course of psoriasis. Psoriatic patients were more often smokers (37.59%) vs. general population (27.50%; p < 0.0001). In conclusion, epidemiological studies help clinicians in better disease and patient understanding, which may translate into better management and patient compliance.
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Affiliation(s)
- Dorota Purzycka-Bohdan
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
- Correspondence:
| | - Anna Kisielnicka
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Monika Zabłotna
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Bogusław Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
- Invicta Fertility and Reproductive Centre, Molecular Laboratory, 80-850 Gdansk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Dominik Samotij
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Justyna Szczęch
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Dorota Krasowska
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (D.K.); (J.B.)
| | - Joanna Bartosińska
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (D.K.); (J.B.)
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Paulina Barasińska
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, 10-229 Olsztyn, Poland; (A.O.-S.); (J.C.)
| | - Joanna Czerwińska
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, 10-229 Olsztyn, Poland; (A.O.-S.); (J.C.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (J.C.S.); (A.B.-B.)
| | - Aleksandra Batycka-Baran
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (J.C.S.); (A.B.-B.)
| | - Rafał Czajkowski
- Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland; (R.C.); (M.G.-S.)
| | - Magdalena Górecka-Sokołowska
- Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland; (R.C.); (M.G.-S.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (L.R.); (J.C.)
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (L.R.); (J.C.)
| | - Marta Sobalska-Kwapis
- Biobank Laboratory, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-237 Lodz, Poland; (M.S.-K.); (D.S.)
| | - Dominik Strapagiel
- Biobank Laboratory, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-237 Lodz, Poland; (M.S.-K.); (D.S.)
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
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Tofacitinib combined with leflunomide for treatment of psoriatic arthritis with IgA nephropathy: a case report with literature review. Clin Rheumatol 2022; 41:2225-2231. [PMID: 35192086 DOI: 10.1007/s10067-022-06113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/03/2022]
Abstract
Psoriasis is a systemic inflammatory disease that is associated with increased risk of several diseases, such as psoriatic arthritis (PsA), inflammatory bowel disease, and cardiovascular diseases. About 20 to 30% patients with psoriasis subsequently develop PsA. IgA nephropathy is the most common primary glomerular disease world-wide. Psoriasis and IgA nephropathy appear to be associated, but the mechanism underlying this connection is unclear. Tofacitinib and leflunomide are common treatments for psoriatic arthritis. We administered tofacitinib combined with leflunomide to a 38-year-old female patient who presented with PsA and IgA nephropathy. After treatment, she experienced significant reductions in the psoriatic lesions, pain in the right knee joint, and proteinuria. Administration of tofacitinib combined with leflunomide for treatment of a patient who had PsA complicated with IgA nephropathy led to significant resolution of the symptoms of both conditions. These results suggest similarities in the pathogenesis of PsA and IgA nephropathy and a possible new treatment for IgA nephropathy.
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173
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Evaluation of the prevalence of musculoskeletal conditions in consecutive patients with skin psoriasis: a descriptive cross-sectional study. Rheumatol Int 2022; 42:651-657. [DOI: 10.1007/s00296-022-05099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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174
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Gottlieb AB, Wells AF, Merola JF. Telemedicine and psoriatic arthritis: best practices and considerations for dermatologists and rheumatologists. Clin Rheumatol 2022; 41:1271-1283. [PMID: 35083564 PMCID: PMC8791553 DOI: 10.1007/s10067-022-06077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
Telemedicine encompasses a variety of modalities that allow for the remote assessment and treatment of patients. The technologies, services, and tools available for telemedicine in the USA are increasingly becoming an integral part of the healthcare system to bridge the gaps in care that can arise from geographic and/or socioeconomic obstacles and provider shortages. Telemedicine can be applied to a spectrum of clinical areas, including rheumatic diseases. Psoriatic arthritis (PsA) is a chronic, inflammatory, multisystem disease with predominately skin and joint manifestations. PsA is often misdiagnosed and/or undiagnosed, which can lead to worse patient outcomes, including irreversible joint erosion and damage. The difficulties in diagnosing and managing PsA are confounded by the emergence and increased use of telemedicine because of the COVID-19 pandemic. Telemedicine presents the opportunity to increase access to healthcare by rheumatologists and dermatologists to improve training and education regarding PsA and to decrease time attributed to office visits associated with PsA. However, challenges in diagnosing PsA without a thorough in-person physical examination by a trained rheumatologist or dermatologist exist. We provide an overview of the ways telemedicine can be incorporated into clinical care and optimized for patients with PsA; characteristic clinical features of PsA, with a focus on skin and joint signs and symptoms; screening tools to be used in routine clinical care; assessments that can be used to evaluate quality of life, functional ability, and disease activity in PsA; and resources and recommendations for the development of future telemedicine use in rheumatology and dermatology.Key Points • Patients with psoriatic arthritis (PsA) are often misdiagnosed and/or undiagnosed. • Telemedicine can improve access to healthcare by rheumatologists and dermatologists. • Telemedicine can be incorporated into clinical care and optimized for managing PsA. |
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Affiliation(s)
- Alice B. Gottlieb
- Icahn School of Medicine at Mount Sinai, 10 Union Square East, New York, NY USA
| | - Alvin F. Wells
- Aurora Rheumatology and Immunotherapy Center, Franklin, WI USA
| | - Joseph F. Merola
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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175
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Koussiouris J, Chandran V. Autoantibodies in Psoriatic Disease. J Appl Lab Med 2022; 7:281-293. [PMID: 34996072 DOI: 10.1093/jalm/jfab120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/13/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Psoriasis (Ps) is an inflammatory skin disease affecting over 8 million people in the USA and Canada. Approximately a quarter of patients with Ps have an inflammatory arthritis termed psoriatic arthritis (PsA). Psoriatic disease encompassing both Ps and PsA is regarded as an immune-mediated inflammatory disease, exhibiting both autoimmune and autoinflammatory features. Innate immune cell activation promotes inflammation and the cellular infiltrate in inflamed tissue is predominantly lymphocytic. CONTENT A narrative review of the current literature on the presence and clinical significance of autoantibodies found in psoriatic disease are presented. The frequency of several autoantibodies in Ps and PsA patients as well as their association with disease diagnosis, disease activity, and treatment response are reviewed. SUMMARY Despite historically described as a rheumatoid factor negative (seronegative) disease, an array of autoantibodies has been identified in patients with psoriatic disease. Many of the autoantibodies reviewed are elevated in Ps and PsA patients and are associated with disease activity, treatment response, and cardiovascular disease risk. The identification of autoantibodies in Ps and PsA patients points to an autoimmune component potentially playing a role in psoriatic disease; however, additional evidence is needed to determine the clinical utility of these autoantibodies and their contribution to disease pathogenesis.
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Affiliation(s)
- John Koussiouris
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Vinod Chandran
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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176
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Laborde CM, Larzabal L, González-Cantero Á, Castro-Santos P, Díaz-Peña R. Advances of Genomic Medicine in Psoriatic Arthritis. J Pers Med 2022; 12:jpm12010035. [PMID: 35055350 PMCID: PMC8780979 DOI: 10.3390/jpm12010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/16/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Although early diagnosis is important for reducing the risk of irreversible structural damage, there are no adequate screening tools for this purpose, and there are no clear markers of predisposition to the disease. Much evidence indicates that PsA disorder is complex and heterogeneous, where genetic and environmental factors converge to trigger inflammatory events and the development of the disease. Nevertheless, the etiologic events that underlie PsA are complex and not completely understood. In this review, we describe the existing data in PsA in order to highlight the need for further research in this disease to progress in the knowledge of its pathobiology and to obtain early diagnosis tools for these patients.
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Affiliation(s)
| | | | - Álvaro González-Cantero
- Department of Dermatology, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain;
- Faculty of Medicine, Universidad Francisco de Vitoria, Ctra. Pozuelo-Majadahonda, 28223 Pozuelo de Alarcón, 28034 Madrid, Spain
| | - Patricia Castro-Santos
- Immunology, Centro de Investigaciones Biomédicas (CINBIO), Universidad de Vigo, 36310 Vigo, Spain;
| | - Roberto Díaz-Peña
- Faculty of Health Sciences, Universidad Autónoma de Chile, Talca 3460000, Chile
- Correspondence: or ; Tel.: +34-981-955-073
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177
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Tillett W, Coates LC, Kiri S, Taieb V, Willems D, Mease PJ. Achievement of more stringent disease control is associated with reduced burden on workplace and household productivity: results from long-term certolizumab pegol treatment in patients with psoriatic arthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221140846. [DOI: 10.1177/1759720x221140846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Psoriatic arthritis (PsA) impacts the physical health and functional ability of patients, leading to reduced productivity. High unemployment rates and absence due to sickness have been reported in patients with PsA. Objectives: This post hoc study investigated certolizumab pegol treatment impact on workplace and household productivity in patients with PsA, and assessed whether achievement of more stringent disease control was associated with greater improvements in productivity. Design: RAPID-PsA was a 216-week phase III trial. Methods: This post hoc study used a generalised estimating equations (GEE) model to examine the disease activity association, measured using American College of Rheumatology (ACR) and Disease Activity in PSoriatic Arthritis (DAPSA), and workplace and household productivity, assessed using an arthritis-specific Work Productivity Survey (WPS). The GEE model estimated the mean cumulative number of days patients meeting different disease control criteria were affected by absenteeism or presenteeism in the workplace and household. Results: In all, 273 patients were randomised to certolizumab pegol and 183 (67.0%) completed Week 216. At baseline, 60.8% of patients were employed outside the home. Improved disease control, measured using ACR and DAPSA criteria, was associated with fewer cumulative days affected by workplace absenteeism through Week 216: ACR70: 4.1 days, ACR50 to <70: 7.7, ACR20 to <50: 20.9, <ACR20: 35.7; DAPSA remission (REM): 3.3, low disease activity (LDA): 9.8, moderate disease activity (MoDA): 22.4, high disease activity (HDA): 54.0. Improved disease control was also associated with fewer days affected by workplace presenteeism: ACR70: 5.6, ACR50 to <70: 19.3, ACR20 to <50: 71.2, < ACR20: 141.2; DAPSA REM: 5.7, LDA: 25.8, MoDA: 77.2, HDA: 223.6. Similar associations between greater disease control and improved productivity were observed for household absenteeism and presenteeism. Conclusion: This post hoc study demonstrates the cumulative workplace and household work productivity benefits for patients with PsA when achieving more stringent thresholds of disease control with certolizumab pegol treatment.
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Affiliation(s)
- William Tillett
- Department of Pharmacy & Pharmacology, Centre for Therapeutic Innovation, University of Bath, Bath, BA13NG, UK
- Royal National Hospital for Rheumatic Diseases, Bath, BA13NG, UK
| | - Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases, University of Oxford and Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | | | - Philip J. Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
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178
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Shobha V, Kodishala C, Chandrashekara S, Kumar S, Haridas V, R Rao V, Jois R, Daware M, Singh Y, Singhai S, Dharmanand BG, Chebbi P, Subramanian R, Kamath A, Karjiigi U, K Jain V, Dharmapalaiah C, Prasad S, Srinivasa C, Janardana R, Pinto B, Nazir B, Harshini AS, Mahendranath KM. Clinical profiling of psoriatic arthritis: an observational cross-sectional study from Karnataka Psoriatic Arthritis Cohort. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_213_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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179
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Song A, Lee SE, Kim JH. Immunopathology and Immunotherapy of Inflammatory Skin Diseases. Immune Netw 2022; 22:e7. [PMID: 35291649 PMCID: PMC8901701 DOI: 10.4110/in.2022.22.e7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 12/01/2022] Open
Abstract
Recently, there have been impressive advancements in understanding of the immune mechanisms underlying cutaneous inflammatory diseases. To understand these diseases on a deeper level and clarify the therapeutic targets more precisely, numerous studies including in vitro experiments, animal models, and clinical trials have been conducted. This has resulted in a paradigm shift from non-specific suppression of the immune system to selective, targeted immunotherapies. These approaches target the molecular pathways and cytokines responsible for generating inflammatory conditions and reinforcing feedback mechanisms to aggravate inflammation. Among the numerous types of skin inflammation, psoriasis and atopic dermatitis (AD) are common chronic cutaneous inflammatory diseases. Psoriasis is a IL-17–mediated disease driven by IL-23, while AD is predominantly mediated by Th2 immunity. Autoimmune bullous diseases are autoantibody-mediated blistering disorders, including pemphigus and bullous pemphigoid. Alopecia areata is an organ-specific autoimmune disease mediated by CD8+ T-cells that targets hair follicles. This review will give an updated, comprehensive summary of the pathophysiology and immune mechanisms of inflammatory skin diseases. Moreover, the therapeutic potential of current and upcoming immunotherapies will be discussed.
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Affiliation(s)
- Ahreum Song
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hoon Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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180
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Findeisen KE, Östör AJK. The Role of Interleukin-23 Inhibition in the Treatment of Psoriatic Arthritis. Rheumatology (Oxford) 2022. [DOI: 10.17925/rmd.2022.1.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Psoriatic arthritis is a chronic inflammatory autoimmune disease with varied manifestations, including functional limitation and reduced quality of life. Improved understanding of the immunopathogenesis of psoriatic arthritis, particularly the role of the interleukin-23 and interleukin-17 axis, has led to the development of therapeutic targets to alter the natural history of the condition. In this article, we review the role of monoclonal antibodies targeting the p19 subunit of interleukin-23 in the treatment of psoriatic arthritis.
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181
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Chen M, Zhang H, Chen Z, Dai SM. Perceptions of Rheumatologists on Diagnosis of Psoriatic Arthritis in China. Front Immunol 2021; 12:733708. [PMID: 34925316 PMCID: PMC8677709 DOI: 10.3389/fimmu.2021.733708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective High prevalence of undiagnosed psoriatic arthritis (PsA) and prolonged diagnostic delay are key troubles in the appropriate management of PsA. To analyze the possible causes for this phenomenon, a web-based nationwide survey was conducted to investigate rheumatologists’ perceptions on PsA diagnosis in China. Methods The electronic questionnaire consisting of 38 questions were designed by an expert panel and distributed with the online survey tool Sojump, which is a professional online survey platform. The completed questionnaires by real-name rheumatologists were collected. Results A total of 1594 valid questionnaires were included. More than half of Chinese rheumatologists reported it was challenging to make a diagnosis of PsA. The four major challenges were “Difficulties in identification of atypical or hidden psoriasis”, “Absence of diagnostic biomarkers”, “No active self-report of history or family history of psoriasis” and “Various musculoskeletal manifestations”. In diagnosing PsA, minor participants had incorrect knowledge of inflammatory arthropathy (13.7%), acute phase reactant (23.8%), and rheumatoid factor (28.7%). There were no significant differences in the knowledge of PsA and practice habits in diagnosing PsA between modern western medicine (WM)- and traditional Chinese medicine (TCM)-rheumatologists. The part-time rheumatologists were not as good as full-time rheumatologists in diagnosing PsA. Conclusions About three quarters of Chinese rheumatologists are familiar with the elements in PsA diagnosis and have good practice habits in diagnosing PsA. Four main challenges in making PsA diagnosis are revealed. There was no significant difference in the knowledge of PsA between WM- and TCM-rheumatologists.
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Affiliation(s)
- Miao Chen
- Department of Rheumatology & Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hua Zhang
- Department of Rheumatology & Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhiyong Chen
- Department of Rheumatology & Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Sheng-Ming Dai
- Department of Rheumatology & Immunology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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182
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Poddubnyy D, Baraliakos X, Van den Bosch F, Braun J, Coates LC, Chandran V, Diekhoff T, van Gaalen FA, Gensler LS, Goel N, Gottlieb AB, van der Heijde D, Helliwell PS, Hermann KGA, Jadon D, Lambert RG, Maksymowych WP, Mease P, Nash P, Proft F, Protopopov M, Sieper J, Torgutalp M, Gladman DD. Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Ther Adv Musculoskelet Dis 2021; 13:1759720X211057975. [PMID: 34987619 PMCID: PMC8721378 DOI: 10.1177/1759720x211057975] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Involvement of the axial skeleton (sacroiliac joints and spine) is a relatively frequent manifestation associated with psoriatic skin disease, mostly along with involvement of peripheral musculoskeletal structures (peripheral arthritis, enthesitis, dactylitis), which are referred to as psoriatic arthritis (PsA). Data suggest that up to 30% of patients with psoriasis have PsA. Depending on the definition used, the prevalence of axial involvement varies from 25% to 70% of patients with PsA. However, there are currently no widely accepted criteria for axial involvement in PsA.Objective: The overarching aim of the Axial Involvement in Psoriatic Arthritis (AXIS) study is to systematically evaluate clinical and imaging manifestations indicative of axial involvement in patients with PsA and to develop classification criteria and a unified nomenclature for axial involvement in PsA that would allow defining a homogeneous subgroup of patients for research. DESIGN Prospective, multicenter, multinational, cross-sectional study. METHODS AND ANALYSES In this multicenter, multinational, cross-sectional study, eligible patients [adult patients diagnosed with PsA and fulfilling Classification Criteria for Psoriatic Arthritis (CASPAR) with musculoskeletal symptom duration of ⩽10 years not treated with biological or targeted synthetic disease-modifying anti-rheumatic drugs] will be recruited prospectively. They will undergo study-related clinical and imaging examinations. Imaging will include radiography and magnetic resonance imaging examinations of sacroiliac joints and spine. Local investigators will evaluate for the presence of axial involvement based on clinical and imaging information which will represent the primary outcome of the study. In addition, imaging will undergo evaluation by central review. Finally, the central clinical committee will determine the presence of axial involvement based on all available information. ETHICS The study will be performed according to the ethical principles of the Declaration of Helsinki and International Council for Harmonisation Good Clinical Practice guidelines. The study protocol will be approved by the individual Independent Ethics Committee / Institutional Review Board of participating centers. Written informed consent will be obtained from all included patients.Registration: ClinicalTrials.gov ID: NCT04434885.
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Affiliation(s)
- Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, VIB Center for Inflammation Research, Ghent, Belgium
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany
| | - Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Vinod Chandran
- Division of Rheumatology, Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Torsten Diekhoff
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Floris A. van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lianne S. Gensler
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Niti Goel
- Patient Research Partner; Abcuro, Inc., Newton, MA, USA; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alice B. Gottlieb
- Department of Dermatology, Mount Sinai-Beth Israel Hospital, Icahn School of Medicine, New York, NY, USA
| | | | - Philip S. Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | | | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Robert G. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; Medical Imaging Consultants, Edmonton, AB, Canada
| | - Walter P. Maksymowych
- Department of Medicine, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada
| | - Philip Mease
- Division of Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, WA, USA
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Fabian Proft
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dafna D. Gladman
- Division of Rheumatology, Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
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183
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Gao J, Shen X, Ko R, Huang C, Shen C. Cognitive Process of Psoriasis and Its Comorbidities: From Epidemiology to Genetics. Front Genet 2021; 12:735124. [PMID: 34899832 PMCID: PMC8662384 DOI: 10.3389/fgene.2021.735124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022] Open
Abstract
Psoriasis (PsO) is a chronic inflammatory skin disease that affects approximately 2% of the population all over the world. Comorbidities of PsO have increasingly garnered more interest in the past decades. Compared with the normal population, the incidences of comorbidities are higher among patients with PsO. In the last 20 years, researchers have focused on studying the genetic components of PsO, and genetic associations between PsO and its comorbidities were elucidated. This review provides an in-depth understanding and summarization of the connection between PsO and its comorbidities from the perspectives of epidemiology and genetics. Further understanding of PsO and its comorbidities will promote research on the pathogenesis, drug development, novel therapy methods, and personalized and precision treatment of PsO and its comorbidities.
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Affiliation(s)
- Jing Gao
- Department of Dermatology, the Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Xue Shen
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, China
| | - Randy Ko
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Cong Huang
- Department of Dermatology, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory for Translational Medicine of Dermatology, Shenzhen Peking University-the Hong Kong University of Science and Technology Medical Center, Shenzhen, China
| | - Changbing Shen
- Department of Dermatology, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory for Translational Medicine of Dermatology, Shenzhen Peking University-the Hong Kong University of Science and Technology Medical Center, Shenzhen, China
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184
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Giovannini I, Bosch P, Dejaco C, De Marco G, McGonagle D, Quartuccio L, De Vita S, Errichetti E, Zabotti A. The Digital Way to Intercept Psoriatic Arthritis. Front Med (Lausanne) 2021; 8:792972. [PMID: 34888334 PMCID: PMC8650082 DOI: 10.3389/fmed.2021.792972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022] Open
Abstract
Psoriasis (PsO) and Psoriatic Arthritis (PsA) are chronic, immune-mediated diseases that share common etiopathogenetic pathways. Up to 30% of PsO patient may later develop PsA. In nearly 75% of cases, skin psoriatic lesions precede arthritic symptoms, typically 10 years prior to the onset of joint symptoms, while PsO diagnosis occurring after the onset of arthritis is described only in 15% of cases. Therefore, skin involvement offers to the rheumatologist a unique opportunity to study PsA in a very early phase, having a cohort of psoriatic “risk patients” that may develop the disease and may benefit from preventive treatment. Progression from PsO to PsA is often characterized by non-specific musculoskeletal symptoms, subclinical synovio-entheseal inflammation, and occasionally asymptomatic digital swelling such as painless toe dactylitis, that frequently go unnoticed, leading to diagnostic delay. The early diagnosis of PsA is crucial for initiating a treatment prior the development of significant and permanent joint damage. With the ongoing development of pharmacological treatments, early interception of PsA has become a priority, but many obstacles have been reported in daily routine. The introduction of digital technology in rheumatology may fill the gap in the physician-patient relationship, allowing more targeted monitoring of PsO patients. Digital technology includes telemedicine, virtual visits, electronic health record, wearable technology, mobile health, artificial intelligence, and machine learning. Overall, this digital revolution could lead to earlier PsA diagnosis, improved follow-up and disease control as well as maximizing the referral capacity of rheumatic centers.
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Affiliation(s)
- Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Philipp Bosch
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | | | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Enzo Errichetti
- Department of Medical and Biological Sciences, Institute of Dermatology, University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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185
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Luengas-Martinez A, Paus R, Young HS. A novel personalised treatment approach for psoriasis: anti-VEGF-A therapy. Br J Dermatol 2021; 186:782-791. [PMID: 34878645 PMCID: PMC9313866 DOI: 10.1111/bjd.20940] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 12/25/2022]
Abstract
Chronic plaque psoriasis is an inflammatory skin disease in which genetic predisposition along with environmental factors lead to the development of the disease, which affects 2% of the UK’s population and is associated with extracutaneous morbidities and a reduced quality of life. A complex crosstalk between innate and adaptive immunity, the epithelia and the vasculature maintain the inflammatory milieu in psoriasis. Despite the development of promising treatment strategies, mostly targeting the immune system, treatments fail to fulfil every patient’s goals. Vascular endothelial growth factor‐A (VEGF‐A) mediates angiogenesis and is upregulated in the plaques and plasma of patients with psoriasis. Transgenic expression of VEGF‐A in experimental models led to the development of skin lesions that share many psoriasis features. Targeting VEGF‐A in in vivo models of psoriasis‐like inflammation resulted in disease clearance. Anti‐angiogenesis treatments are widely used for cancer and eye disease and there are clinical reports of patients treated with VEGF‐A inhibitors who have experienced Psoriasis Area and Severity Index improvement. Existing psoriasis treatments downregulate VEGF‐A and angiogenesis as part of their therapeutic effect. Pharmacogenetics studies suggest the existence of different genetic signatures within patients with psoriasis that correspond with different treatment responsiveness and disease severity. There is a subset of patients with psoriasis with an increased predisposition to produce high levels of VEGF‐A, who may be most likely to benefit from anti‐VEGF‐A therapy, offering an opportunity to personalize treatment in psoriasis. Anti‐VEGF‐A therapies may offer an alternative to existing anticytokine strategies or be complementary to standard treatments for the management of psoriasis.
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Affiliation(s)
- A Luengas-Martinez
- Centre for Dermatology Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - R Paus
- Centre for Dermatology Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H S Young
- Centre for Dermatology Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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186
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Qi F, Tan Y, Yao A, Yang X, He Y. Psoriasis to Psoriatic Arthritis: The Application of Proteomics Technologies. Front Med (Lausanne) 2021; 8:681172. [PMID: 34869404 PMCID: PMC8635007 DOI: 10.3389/fmed.2021.681172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Psoriatic disease (PsD) is a spectrum of diseases that affect both skin [cutaneous psoriasis (PsC)] and musculoskeletal features [psoriatic arthritis (PsA)]. A considerable number of patients with PsC have asymptomatic synovio-entheseal inflammations, and approximately one-third of those eventually progress to PsA with an enigmatic mechanism. Published studies have shown that early interventions to the very early-stage PsA would effectively prevent substantial bone destructions or deformities, suggesting an unmet goal for exploring early PsA biomarkers. The emergence of proteomics technologies brings a complete view of all involved proteins in PsA transitions, offers a unique chance to map all potential peptides, and allows a direct head-to-head comparison of interaction pathways in PsC and PsA. This review summarized the latest development of proteomics technologies, highlighted its application in PsA biomarker discovery, and discussed the possible clinical detectable PsA risk factors in patients with PsC.
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Affiliation(s)
- Fei Qi
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Yaqi Tan
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Amin Yao
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Xutong Yang
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Yanling He
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
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187
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Erazo Luna EV, Echavarría Sierra CJ, Cornejo-Sánchez DM, Sanclemente G, Pineda Trujillo NG. Protective association exhibited by a single nucleotide polymorphism of the IFIH1 gene in patients with psoriasis: A case-control study. Medwave 2021; 21:e8492. [PMID: 34882124 DOI: 10.5867/medwave.2021.11.002099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Psoriasis is a chronic inflammatory dermatosis, a with variable clinical presentation and whose multifactorial etiology carries an essential genetic component. Multiple genetic variations associated with psoriasis have been described around the world. However, these variants are unknown among the Colombian population. This study aimed to evaluate the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene and its ssociation with the development of psoriasis in a Colombian population. Methods An observational, unmatched, case-control study was performed, including 51 patients with psoriasis and 151 population controls, all with self-reported Paisa ancestry (from the Antioquia region). All individuals were genotyped for the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene, and its association with psoriasis was pursued. Both groups were demographically characterized, and cases were also assessed for clinical variables. Results Through the allelic association analysis, cases were found to have a lower frequency of the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene than controls; 5% versus 22.67%, respectively. There were no significant differences in age or sex. We also found that psoriasis vulgaris was the most common variant (78%), that about half of the cases had nail psoriasis (56%), 19.6% had psoriatic arthritis, and that 45% had some comorbidity. Conclusions The results obtained from this study confirm that carriers of the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene have a decreased risk of developing psoriasis.
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Affiliation(s)
- Evelyn Vanesa Erazo Luna
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia; Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. ORCID: 0000-0002-6116-3191
| | - Claudia Janeth Echavarría Sierra
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia; Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. ORCID: 0000-0003-0373-2031
| | - Diana M Cornejo-Sánchez
- Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. ORCID: 0000-0002-2667-7592
| | - Gloria Sanclemente
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. Address: Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia. EMail: ; . ORCID: 0000-0002-1555-2751
| | - Nicolás Guillermo Pineda Trujillo
- Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia: ORCID: 0000-0002-8342-2510
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Jalali-Najafabadi F, Stadler M, Dand N, Jadon D, Soomro M, Ho P, Marzo-Ortega H, Helliwell P, Korendowych E, Simpson MA, Packham J, Smith CH, Barker JN, McHugh N, Warren RB, Barton A, Bowes J. Application of information theoretic feature selection and machine learning methods for the development of genetic risk prediction models. Sci Rep 2021; 11:23335. [PMID: 34857774 PMCID: PMC8640070 DOI: 10.1038/s41598-021-00854-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/27/2021] [Indexed: 01/20/2023] Open
Abstract
In view of the growth of clinical risk prediction models using genetic data, there is an increasing need for studies that use appropriate methods to select the optimum number of features from a large number of genetic variants with a high degree of redundancy between features due to linkage disequilibrium (LD). Filter feature selection methods based on information theoretic criteria, are well suited to this challenge and will identify a subset of the original variables that should result in more accurate prediction. However, data collected from cohort studies are often high-dimensional genetic data with potential confounders presenting challenges to feature selection and risk prediction machine learning models. Patients with psoriasis are at high risk of developing a chronic arthritis known as psoriatic arthritis (PsA). The prevalence of PsA in this patient group can be up to 30% and the identification of high risk patients represents an important clinical research which would allow early intervention and a reduction of disability. This also provides us with an ideal scenario for the development of clinical risk prediction models and an opportunity to explore the application of information theoretic criteria methods. In this study, we developed the feature selection and psoriatic arthritis (PsA) risk prediction models that were applied to a cross-sectional genetic dataset of 1462 PsA cases and 1132 cutaneous-only psoriasis (PsC) cases using 2-digit HLA alleles imputed using the SNP2HLA algorithm. We also developed stratification method to mitigate the impact of potential confounder features and illustrate that confounding features impact the feature selection. The mitigated dataset was used in training of seven supervised algorithms. 80% of data was randomly used for training of seven supervised machine learning methods using stratified nested cross validation and 20% was selected randomly as a holdout set for internal validation. The risk prediction models were then further validated in UK Biobank dataset containing data on 1187 participants and a set of features overlapping with the training dataset.Performance of these methods has been evaluated using the area under the curve (AUC), accuracy, precision, recall, F1 score and decision curve analysis(net benefit). The best model is selected based on three criteria: the ‘lowest number of feature subset’ with the ‘maximal average AUC over the nested cross validation’ and good generalisability to the UK Biobank dataset. In the original dataset, with over 100 different bootstraps and seven feature selection (FS) methods, HLA_C_*06 was selected as the most informative genetic variant. When the dataset is mitigated the single most important genetic features based on rank was identified as HLA_B_*27 by the seven different feature selection methods, consistent with previous analyses of this data using regression based methods. However, the predictive accuracy of these single features in post mitigation was found to be moderate (AUC= 0.54 (internal cross validation), AUC=0.53 (internal hold out set), AUC=0.55(external data set)). Sequentially adding additional HLA features based on rank improved the performance of the Random Forest classification model where 20 2-digit features selected by Interaction Capping (ICAP) demonstrated (AUC= 0.61 (internal cross validation), AUC=0.57 (internal hold out set), AUC=0.58 (external dataset)). The stratification method for mitigation of confounding features and filter information theoretic feature selection can be applied to a high dimensional dataset with the potential confounders.
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Affiliation(s)
- Farideh Jalali-Najafabadi
- Centre for Genetics and Genomics Versus Arthritis,Centre for Musculoskeletal Research,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.
| | - Michael Stadler
- Centre for Genetics and Genomics Versus Arthritis,Centre for Musculoskeletal Research,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK
| | - Nick Dand
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London , UK
| | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mehreen Soomro
- Centre for Genetics and Genomics Versus Arthritis,Centre for Musculoskeletal Research,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK
| | - Pauline Ho
- Centre for Genetics and Genomics Versus Arthritis,Centre for Musculoskeletal Research,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit,Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Helen Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Manchester, UK
| | - Philip Helliwell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Manchester, UK
| | - Eleanor Korendowych
- Royal National Hospital for Rheumatic Diseases and Dept Pharmacy and Pharmacology, University of Bath, Bath , UK
| | - Michael A Simpson
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London , UK
| | - Jonathan Packham
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham , UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guys and St Thomas' Foundation Trust, London, UK
| | - Jonathan N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases and Dept Pharmacy and Pharmacology, University of Bath, Bath , UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis,Centre for Musculoskeletal Research,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit,Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis,Centre for Musculoskeletal Research,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit,Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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189
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Casasola-Vargas J, Flores-Alvarado D, Silveira LH, Sicsik-Ayala S, Reyes-Cordero G, Villanueva Quintero G, Amaya Guerra M, Reyes Orozco SG, Zazueta Montiel BE, Hernández-Paz R, Mendoza-Fuentes A, Bernard-Medina AG, López Rodriguez A, Barbosa Cobos RE, Burgos-Vargas R, Pacheco-Tena C. Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis. REUMATOLOGIA CLINICA 2021; 17:611-621. [PMID: 34305032 DOI: 10.1016/j.reumae.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022]
Abstract
Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. METHODS The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. RESULTS 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. CONCLUSIONS With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.
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Affiliation(s)
- Julio Casasola-Vargas
- Servicio de Reumatología, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Diana Flores-Alvarado
- Facultad de Medicina y Hospital Universitario de la Universidad Autónoma de Monterrey, Nuevo León, Nuevo León, Mexico
| | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Sandra Sicsik-Ayala
- Hospital De Especialidades 71, Unidad Médica De Alta Especialidad, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | | | - Mario Amaya Guerra
- Centro de Salud y Desarrollo, Universidad de Monterrey, Monterrey, Nuevo León, Mexico
| | - Sara G Reyes Orozco
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Beatriz E Zazueta Montiel
- Centro Médico del Ángel S.C. Centro de Investigación de Enfermedades Reumáticas, Mexicali, Baja California, Mexico
| | | | | | | | | | | | - Rubén Burgos-Vargas
- Servicio de Reumatología, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico.
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190
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Ogdie A, Matthias W, Thielen RJ, Chin D, Saffore CD. Racial Differences in Prevalence and Treatment for Psoriatic Arthritis and Ankylosing Spondylitis by Insurance Coverage in the USA. Rheumatol Ther 2021; 8:1725-1739. [PMID: 34564835 PMCID: PMC8475338 DOI: 10.1007/s40744-021-00370-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) may receive suboptimal care, and differences in care by race/ethnicity, sex, and insurance coverage are not well studied. METHODS This was a descriptive, retrospective cross-sectional US claims database analysis utilizing the Medicaid multi-state segment of the IBM® MarketScan® Commercial Claims and Encounters Supplemental Database and Optum Insight Clinformatics® Data Mart database for 2019. Patients aged ≥ 18 years with PsA or AS and continuous medical and pharmacy coverage were included. Outcomes evaluated were prevalence and percentage of patients receiving biologic disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic DMARDs (tsDMARDs) or visiting a rheumatologist. Outcomes were stratified by race/ethnicity, sex, and insurance coverage, with outcomes determined for commercial insurance, Medicare, and Medicaid enrollees. Differences observed in outcomes were numerical in nature. RESULTS Prevalences of PsA and AS were highest for Medicare enrollees (320 and 156 per 100,000 persons [0.32 and 0.16%], respectively) and lowest for Medicaid enrollees (132 and 71 per 100,000 persons [0.13 and 0.07%], respectively). White patients had the greatest prevalence versus patients of other races/ethnicities. Females had a higher prevalence of PsA than males, while AS prevalence was generally lower for females versus males for each insurance category. The percentage of patients prescribed bDMARDs/tsDMARDs was highest for commercial insurance enrollees (PsA 63%, AS 43%) and lowest for Medicare enrollees (PsA 21%, AS 11%). The proportion of patients who saw a rheumatologist was lower for Medicaid enrollees (PsA 12%, AS 10%) than for commercial insurance or Medicare enrollees (PsA 68%, 55%; AS 67%, 42%). For commercial insurance and Medicare enrollees, the percentage of patients visiting a rheumatologist was similar by race/ethnicity but higher for females versus males. CONCLUSIONS The prevalence and treatment of PsA and AS differs by race/ethnicity, insurance coverage, and sex in the USA. Efforts for improving access to care are needed to improve outcomes among all patients.
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Affiliation(s)
- Alexis Ogdie
- University of Pennsylvania, Philadelphia, PA, USA
| | - Wesley Matthias
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. GMH1, ABV1 4NW-102-04, North Chicago, IL, 60064-6078, USA
- AbbVie Inc., North Chicago, IL, USA
| | - Richard J Thielen
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. GMH1, ABV1 4NW-102-04, North Chicago, IL, 60064-6078, USA
- AbbVie Inc., North Chicago, IL, USA
| | - Daniel Chin
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. GMH1, ABV1 4NW-102-04, North Chicago, IL, 60064-6078, USA
- AbbVie Inc., North Chicago, IL, USA
| | - Christopher D Saffore
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. GMH1, ABV1 4NW-102-04, North Chicago, IL, 60064-6078, USA.
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191
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Gupta S, Garbarini S, Nazareth T, Khilfeh I, Costantino H, Kaplan D. Characterizing Outcomes and Unmet Needs Among Patients in the United States with Mild-to-Moderate Plaque Psoriasis Using Prescription Topicals. Dermatol Ther (Heidelb) 2021; 11:2057-2075. [PMID: 34648148 PMCID: PMC8514608 DOI: 10.1007/s13555-021-00620-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/25/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Topical therapies are considered first-line treatment in the management of plaque psoriasis (PSO). However, data on patient-reported outcomes for topicals are scarce. We designed a survey to record the treatment experience of patients with mild-to-moderate PSO using prescription topicals. METHODS An online cross-sectional survey was conducted among adult patients on prescription topicals for mild-to-moderate PSO (body surface area [BSA] ≤ 10%) in the US. Data on treatment goals, changes in PSO after current treatment, satisfaction with current treatment (assessed with the Treatment Satisfaction Questionnaire for Medication [TSQM]), and treatment adherence (how often current treatment was taken as instructed) were collected. Descriptive analysis was used to evaluate outcomes. RESULTS Of the 175 patients with mild-to-moderate PSO who completed the survey, 67.4% were female, with a median age of 55.0 years and 10.8 years since PSO diagnosis. Patients reported (medians) the use of three topicals since diagnosis, with 5 years on the current prescription topical. The top three treatment goals for current topical treatment were improvements in visible skin, 97.1%; non-skin related symptoms, 62.9%; and social/emotional well-being, 60.0%. Overall, 43.4% of patients reported 0% BSA change and 5.7% reported ≥ 75% BSA reduction. Approximately 75.0% each reported improvement in itch and pain symptoms. Embarrassment/self-consciousness because of skin symptoms persisted in 72.6% of patients. Median TSQM scores for global satisfaction, convenience, and effectiveness ranged between 58 and 72, indicating partial treatment satisfaction, except for side effects, which was high (median: 100). Approximately half of patients (49.7%) reported not being highly adherent to treatment. CONCLUSION Contrary to their treatment goals, patients with mild-to-moderate PSO using prescription topicals reported partial effectiveness, incomplete symptom resolution, impacted emotional and social well-being, and suboptimal global satisfaction, effectiveness, adherence, and convenience. Our findings highlight several unmet needs among topical-experienced, systemic-naïve patients with mild-to-moderate PSO using prescription topicals.
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Affiliation(s)
| | | | | | | | | | - David Kaplan
- Adult and Pediatric Dermatology, Overland Park, KS, USA
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192
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Singh R, Koppu S, Perche PO, Feldman SR. The Cytokine Mediated Molecular Pathophysiology of Psoriasis and Its Clinical Implications. Int J Mol Sci 2021; 22:ijms222312793. [PMID: 34884596 PMCID: PMC8657643 DOI: 10.3390/ijms222312793] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022] Open
Abstract
Psoriasis is the result of uncontrolled keratinocyte proliferation, and its pathogenesis involves the dysregulation of the immune system. The interplay among cytokines released by dendritic, Th1, Th2, and Th17 cells leads to the phenotypical manifestations seen in psoriasis. Biological therapies target the cytokine-mediated pathogenesis of psoriasis and have improved patient quality of life. This review will describe the underlying molecular pathophysiology and biologics used to treat psoriasis. A review of the literature was conducted using the PubMed and Google Scholar repositories to investigate the molecular pathogenesis, clinical presentation, and current therapeutics in psoriasis. Plaque psoriasis', the most prevalent subtype of psoriasis, pathogenesis primarily involves cytokines TNF-α, IL-17, and IL-23. Pustular psoriasis', an uncommon variant, pathogenesis involves a mutation in IL-36RN. Currently, biological therapeutics targeted at TNF-α, IL-12/IL-23, IL-17, and IL-23/IL-39 are approved for the treatment of moderate to severe psoriasis. More studies need to be performed to elucidate the precise molecular pathology and assess efficacy between biological therapies for psoriasis. Psoriasis is a heterogenous, chronic, systemic inflammatory disease that presents in the skin with multiple types. Recognizing and understanding the underlying molecular pathways and biological therapeutics to treat psoriasis is important in treating this common disease.
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Affiliation(s)
- Rohan Singh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
| | - Sindhuja Koppu
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
| | - Patrick O. Perche
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (R.S.); (S.K.); (P.O.P.)
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Correspondence:
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Carneiro S, Palominos PE, Anti SMA, Assad RL, Gonçalves RSG, Chiereghin A, Lyrio AM, Ximenes AC, Saad CG, Gonçalves CR, Kohem CL, Marques CDL, Schainberg CG, de Souza Meirelles E, Resende GG, Pieruccetti LB, Keiserman MW, Yazbek MA, Sampaio-Barros PD, da Cruz Lage R, Bonfiglioli R, Oliveira TL, Azevedo VF, Bianchi WA, Bernardo WM, Dos Santos Simões R, de Medeiros Pinheiro M, Campanholo CB. Brazilian Society of Rheumatology 2020 guidelines for psoriatic arthritis. Adv Rheumatol 2021; 61:69. [PMID: 34819174 DOI: 10.1186/s42358-021-00219-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.
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Affiliation(s)
- Sueli Carneiro
- Universidade Federal do Rio de Janeiro (UFRJ), Rua Farme de Amoedo, 140/601. Ipanema, Rio de Janeiro, RJ, CEP 22420-020, Brazil.
| | | | | | | | | | | | - Andre Marun Lyrio
- Pontifícia Universidade Católica de Campinas (PUC), Campinas, Brazil
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Felbo SK, Terslev L, Juul Sørensen I, Hendricks O, Kuettel D, Lederballe Pedersen R, Chrysidis S, Duer A, Zachariae C, Skov L, Østergaard M. Musculoskeletal pain in psoriasis - relation to inflammation and additional value of ultrasound in psoriatic arthritis classification. Rheumatology (Oxford) 2021; 61:2835-2847. [PMID: 34849603 DOI: 10.1093/rheumatology/keab865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate and compare clinical features and ultrasound signs of inflammation in joints and entheses in patients with psoriasis (PsO) with and without musculoskeletal pain, and the additional value of ultrasound in classification of psoriatic arthritis (PsA). Furthermore, to explore the association between such findings and patient-reported outcomes (PROs) and the performance of screening-questionnaires for identifying patients with PsA. METHODS Patients with PsO (n = 126) recruited from a nationwide survey were evaluated at one of four rheumatology departments. The evaluation included clinical examination, laboratory tests, radiography, greyscale (GS) and colour Doppler (CD) ultrasound of 48 joints and 12 entheses, PROs, and four screening-questionnaires for PsA. Patients were classified with Classification for PsA (CASPAR), ultrasound-modified CASPAR, and ultrasound-only criteria. RESULTS When subgroups of self-reported pain (63%), no pain (29%) and diagnosed PsA (9%) were compared, patients with pain had higher tenderness-related clinical scores (tender joints, entheses and fibromyalgia points) and ultrasound GS sum-scores, compared with 'no pain' patients. PROs were negligibly-moderately correlated with pain-related clinical scores (Spearman's rho = 0.11-0.59, all patients), and negligibly-weakly with ultrasound sum-scores (rho = 0.01-0.34). More patients could be classified as PsA when ultrasound synovitis/enthesitis was included as entry criterion (ultrasound-modified CASPAR, 66% of all patients) compared with conventional CASPAR (35%) or ultrasound-only criteria (52%). Sensitivities of screening-questionnaires were low for fulfilment of CASPAR (0.23-0.66), ultrasound-modified CASPAR (0.17-0.57), and ultrasound-only (0.20-0.57) criteria. CONCLUSION Self-reported pain in PsO is related to ultrasound inflammation. Ultrasound-modified CASPAR criteria identified almost twice as many patients as conventional CASPAR criteria. Screening-questionnaires showed limited value.
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Affiliation(s)
- Sara Kamp Felbo
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Inge Juul Sørensen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dorota Kuettel
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, South West Jutland Hospital, Esbjerg, Denmark
| | - Anne Duer
- Department of Diagnostic Radiology, Rigshospitalet, Glostrup, Denmark
| | - Claus Zachariae
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Lone Skov
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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195
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Psoriatic Arthritis: The Influence of Co-morbidities on Drug Choice. Rheumatol Ther 2021; 9:49-71. [PMID: 34797530 PMCID: PMC8814223 DOI: 10.1007/s40744-021-00397-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022] Open
Abstract
Psoriatic arthritis (PsA) is associated with a higher burden of co-morbidities such as obesity, cardiovascular disease, non-alcoholic fatty liver disease, inflammatory eye disease, inflammatory bowel disease, skin cancer and depression compared to the general population. In the last 20 years, the therapeutic options for PsA have increased exponentially with the availability of tumor necrosis factor-alpha (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-12/23 inhibitors and Janus kinases/signal transducer and activator of transcription proteins (JAK/STAT) inhibitors. The articular and extra-articular manifestations of PsA usually dictate the treatment choice but important consideration must be given to the corresponding co-morbidities while deciding the drug therapy due to associated safety profile, effect on disease activity, etc. This review provides a comprehensive review of common co-morbidities in PsA and how they can influence treatment choices.
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196
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Skougaard M, Jørgensen TS, Jensen MJ, Ballegaard C, Guldberg-Møller J, Egeberg A, Christensen R, Benzin P, Stisen ZR, Merola JF, Coates LC, Strand V, Mease P, Kristensen LE. Change in psoriatic arthritis outcome measures impacts SF-36 physical and mental component scores differently: an observational cohort study. Rheumatol Adv Pract 2021; 5:rkab076. [PMID: 34778701 PMCID: PMC8578691 DOI: 10.1093/rap/rkab076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/28/2021] [Indexed: 01/22/2023] Open
Abstract
Objective The objective was to investigate interplay and physical and mental component scores between change (Δ) in health-related quality of life (HRQoL) quantified by the physical component score (PCS) and mental component score (MCS) retrieved from short-form health survey (SF-36), change in disease activity (ΔDAS28CRP) and manifestations of PsA. Methods PsA patients initiating new medical therapy were enrolled. Independent disease measures evaluating disease activity, enthesitis, psoriasis, pain and fatigue were collected at treatment initiation and after 4 months. Interplay between independent disease measures and dependent outcome measures, ΔPCS and ΔMCS, was described with univariate regression analyses. Multivariate regression analyses were applied to assess the impact of independent variables, such as individual disease outcome measures vs ΔDAS28CRP on ΔPCS and ΔMCS. Results One hundred and eight PsA patients were included. In the univariate regression analyses, improvement in fatigue, pain and disability were associated with improvement in ΔPCS (β; -2.08, -0.18 and -13.00, respectively; all P < 0.001) and ΔMCS (β; -1.59, -0.12 and -6.07, respectively; P < 0.001, P < 0.001 and P = 0.003, respectively). When patient-reported outcomes were included in the final multivariate models, improvements in ΔPCS and ΔMCS were associated with improvements in pain, fatigue and disability (P < 0.001). Improvement in enthesitis impacted ΔPCS positively (β -0.31, P < 0.001). No association was found between change in skin psoriasis, ΔPCS and ΔMCS (β 0.15, P = 0.056 and β 0.05, P = 0.561, respectively). Conclusion In this PsA patient cohort, diminishing pain, disability and fatigue improved PCS and MCS significantly. Changes in enthesitis and psoriasis did not grossly impact HRQoL compared with DAS28CRP. Individual PsA manifestations influence HRQoL differently, which is important clinically when targeting treatment. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT02572700.
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Affiliation(s)
- Marie Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tanja S Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mia J Jensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christine Ballegaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Guldberg-Møller
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Peter Benzin
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zara R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Phillip Mease
- Swedish Medical Centre/Providence St. Joseph Health and the University of Washington, Seattle, WA, USA
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Proft F, Torgutalp M, Muche B, Rios Rodriguez V, Verba M, Poddubnyy D. Efficacy of tofacitinib in reduction of inflammation detected on MRI in patients with Psoriatic ArthritiS presenTing with axial involvement (PASTOR): protocol of a randomised, double-blind, placebo-controlled, multicentre trial. BMJ Open 2021; 11:e048647. [PMID: 34785545 PMCID: PMC8596027 DOI: 10.1136/bmjopen-2021-048647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is an inflammatory disease characterised by synovitis, enthesitis, dactylitis and axial involvement. The prevalence of axial involvement ranges from 25% to 70% in this patient group. Treatment recommendations for axial PsA were mainly extrapolated from guidelines for axial spondyloarthritis, and the main treatment options are non-steroidal anti-inflammatory drugs and biological disease-modifying antirheumatic drugs (tumour necrosis factor, IL-17 and IL-23 inhibitors). Tofacitinib was approved for the treatment of PsA and its efficacy on axial inflammation has been demonstrated in a phase II study of ankylosing spondylitis (AS). This prospective study aims to evaluate the efficacy of tofacitinib in reducing inflammation in the sacroiliac joints (SIJs) and spine on MRI in patients with axial disease of their PsA presenting with active axial involvement compatible with axial PsA. METHODS AND ANALYSES This is a randomised, double-blind, placebo-controlled, multicentre clinical trial in patients with axial PsA who have evidence of axial involvement, active disease as defined by a Bath AS Disease Activity Index score of ≥4 and active inflammation on MRI of the SIJs and/or spine as assessed by and independent central reader. The study includes a 6-week screening period, a 24-week treatment period, which consist of a 12-week placebo-controlled double-blind treatment period followed by a 12-week active treatment period with tofacitinib for all participants, and a safety follow-up period of 4 weeks. At baseline, 80 subjects shall be randomised (1:1) to receive either tofacitinib or matching placebo for a 12-week double-blind treatment period. At week 12, an MRI of the whole spine and SIJs will be performed to evaluate the primary study endpoint. ETHICS AND DISSEMINATION The study will be performed according to the ethical principles of the Declaration of Helsinki and the German drug law. The independent ethics committees of each centre approved the ethical, scientific and medical appropriateness of the study before it was conducted. TRIAL REGISTRATION NUMBER NCT04062695; ClinicalTrials.gov and EudraCT No: 2018-004254-22; European Union Clinical Trials Register.
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Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Burkhard Muche
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Maryna Verba
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitätsmedizin Berlin, Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, German Rheumatism Research Center Berlin, Berlin, Berlin, Germany
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Sepehri NZ, Raeisi T, Razi B, Janmohammadi P, Darand M, Alizadeh S. The association between psoriasis and psoriatic arthritis with the risk of osteoporosis, osteopenia and bone fractures: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14630. [PMID: 34260133 DOI: 10.1111/ijcp.14630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS The possible association between psoriatic/psoriatic arthritis (PsA) and bone loss has been observed; however, studies have yielded inconclusive results. This meta-analysis aimed to assess whether there is an increase in the risk of osteoporosis, osteopenia and fractures in patients with psoriasis/PsA, compared with healthy individuals. METHODS PubMed and Scopus were systematically searched from their inception to September 2020 to identify relevant studies. Relative risk, hazard ratio or odds ratio (OR), with their corresponding 95% confidence intervals (95% CI) were calculated and pooled using a random-effects model. RESULTS A total of 12 different studies, with a total of 199 389 296 participants, were included. Overall, no significant relationship was observed between psoriasis/PsA and the risk of osteoporosis (psoriasis: OR = 1.28, 95%CI = 0.86-1.90; PsA: OR = 1.32, 95%CI = 0.79-2.19) and osteopenia (psoriasis: OR = 1.50, 95%CI = 0.75-3.02; PsA: OR = 1.61, 95%CI = 0.67-3.85). However, in the subgroup analysis, psoriasis was significantly associated with an increased risk of osteoporosis in men (OR = 1.27, 95%CI = 1.02-1.59) and studies with cohort design (OR = 1.04, 95%CI = 1.003-1.09). Psoriasis was also related to the risk of osteopenia in studies on a combination of both genders (OR = 2.86, 95%CI = 2.70-3.02). The pooled analysis demonstrated a significantly higher risk of fractures among patients with psoriasis (OR = 1.29, 95%CI = 1.02-1.63) and PsA (OR = 2.88, 95%CI = 1.51-5.48), compared with participants without psoriasis/PsA. CONCLUSIONS Patients with psoriasis/PsA have an increased risk of fractures. There is little evidence supporting the relation of psoriasis to osteoporosis/osteopenia.
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Affiliation(s)
| | - Tahereh Raeisi
- Department of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Bahman Razi
- Department of Hematology and Blood Banking, School of Medicine, Tarbiat Modares University (TMU), Tehran, Iran
| | - Parisa Janmohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mina Darand
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Kubanov AA, Karamova AE, Chikin VV, Verbenko DA, Znamenskaya LF, Artamonova OG. Genetic markers for psoriatic arthritis in patients with psoriasis. Part I: non-HLA genes. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Psoriatic arthritis often develops in patients with psoriasis and can lead to joint deformity, stiffness, dysfunction, and disability. Psoriatic arthritis is a polygenic disease. and the issue of personalizing the prognosis of its development can only be resolved taking into account the variability of plenty genomic loci associated with the development of the disease. The personification of the prognosis of the disease can be solved taking into account the variability of the set of genomic loci with which its development is associated. The review examines genomic polymorphisms associated with the development of psoriatic arthritis not psoriasis, except of HLA polymorphisms. Genome regions containing polymorphisms, allelic variants of which are associated both with the development of psoriatic arthritis and reducing the likelihood of its occurrence, are described. It has been reported that the predisposition to the development of psoriatic arthritis in patients with psoriasis is determined by genes encoding proteins involved in inflammation and bone metabolism.
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Al Rayes H, Alazmi M, Attar S, Alderaan K, Alghamdi M, Alghanim N, Alhazmi A, Alkhadhrawi N, Almohideb M, Alzahrani Z, Bedaiwi M, Halabi H. Consensus-based recommendations on the diagnosis, referral and clinical management of patients with psoriatic arthritis. Rheumatol Int 2021; 42:391-401. [PMID: 34716785 DOI: 10.1007/s00296-021-05029-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Psoriatic arthritis (PsA) is a highly heterogeneous disease with complex manifestations. Limited understanding of the disease and non-availability of local guidelines pose challenges in the management of PsA in Saudi Arabia. Therefore, this expert consensus is aimed to provide recommendations on the management of patients with PsA, including referral pathway, definition of remission and treat-to-target (T2T) approach. A Delphi technique of consensus development was used involving an expert panel comprised of 10 rheumatologists, one dermatologist and one family physician. Based on the review of available published evidence and the opinions of clinical experts, key recommendations were developed. A consensus was achieved in defining the following: management guideline adaptable for Saudi Arabia, most useful screening tool, laboratory investigations, imaging tests and criteria for referring suspected PsA patients to a rheumatologist. In addition, an agreement was achieved in defining the T2T strategy and remission for the clinical management of PsA. Overall, these recommendations provide an evidence-based framework for the management of PsA patients in Saudi Arabia.
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Affiliation(s)
- Hanan Al Rayes
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, 21577, Saudi Arabia.
| | - Mansour Alazmi
- Department of Rheumatology, Prince Mohammed Medical City, Al Jouf, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khaled Alderaan
- Department of Rheumatology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mushabab Alghamdi
- Department of Rheumatology, University of Bisha, Bisha, Saudi Arabia
| | - Nayef Alghanim
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nadeer Alkhadhrawi
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammad Almohideb
- Department of Dermatology, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohamed Bedaiwi
- Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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