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Pelechas E, Memi T, Voulgari PV, Drosos AA. A Case of Recalcitrant Psoriatic Arthritis to TNF Inhibitors Improved After Administration of Secukinumab, an IL-17A Inhibitor. Rheumatol Ther 2017; 4:509-513. [PMID: 29022197 PMCID: PMC5696296 DOI: 10.1007/s40744-017-0084-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Indexed: 01/20/2023] Open
Abstract
Psoriatic arthritis (PsA) is a unique inflammatory arthritis due to the fact that patients have to deal not only with pain but also with their skin appearance, which may have a detrimental effect on their everyday lives and psychology. Treating a patient with PsA, improving both the musculoskeletal and skin symptoms is a challenge for the clinical rheumatologist. In this case, we present a patient of recalcitrant PsA to tumor necrosis factor inhibitors (TNFi) who had an exceptional improvement after administration of the interleukin-17A inhibitor (IL-17Ai) secukinumab.
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Affiliation(s)
- Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Tereza Memi
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
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Graceffa D, Maiani E, Sperduti I, Ceralli F, Bonifati C. Clinical remission of psoriatic arthritis in patients receiving continuous biological therapies for 1 year: the experience of an outpatient dermatological clinic for psoriasis. Clin Exp Dermatol 2014; 40:136-41. [DOI: 10.1111/ced.12504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2014] [Indexed: 01/14/2023]
Affiliation(s)
- D. Graceffa
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
| | - E. Maiani
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
| | - I. Sperduti
- Biostatistic Division; Scientific Direction; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
| | - F. Ceralli
- Department of Rheumatology; San Camillo-Forlanini Hospital; Rome Italy
| | - C. Bonifati
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
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de Vlam K, Lories RJ. Update in treatment options for psoriatic arthritis. Expert Rev Clin Immunol 2014; 5:779-88. [DOI: 10.1586/eci.09.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chimenti M, Esposito M, Giunta A, Graceffa D, Babino G, Teoli M, Mazzotta A, Perricone R, Chimenti S. Remission of Psoriatic Arthritis after Etanercept Discontinuation: Analysis of Patients' Clinical Characteristics Leading to Disease Relapse. Int J Immunopathol Pharmacol 2013; 26:833-8. [DOI: 10.1177/039463201302600333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Psoriatic arthritis is a chronic, inflammatory, disabling arthritis affecting up to 30% of psoriatic patients. Recently, it has been demonstrated that tumor necrosis factor alpha (TNF-α) plays a pivotal role in inducing and maintaining joint damage and that molecules that block this cytokine are effective in the treatment of psoriatic arthritis. Etanercept is a recombinant fusion protein acting as a competitive inhibitor of TNF-α, and numerous clinical trials have demonstrated its efficacy in determining psoriatic arthritis remission. However, specific criteria defining psoriatic arthritis remission have not been delineated and few data describing the length of the remission after etanercept discontinuation are available. The aim of this observational, retrospective study was to assess post-remission efficacy maintenance and relapse characteristics after etanercept interruption in patients with moderate-to-severe peripheral psoriatic arthritis (PsA) and cutaneous involvement.
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Affiliation(s)
- M.S. Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Unit of Rheumatology, University of Rome Tor Vergata, Rome Italy
| | - M. Esposito
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - A. Giunta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - D. Graceffa
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Unit of Rheumatology, University of Rome Tor Vergata, Rome Italy
| | - G. Babino
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - M. Teoli
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - A. Mazzotta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - R. Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Unit of Rheumatology, University of Rome Tor Vergata, Rome Italy
| | - S. Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
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Chimenti MS, Ballanti E, Perricone C, Cipriani P, Giacomelli R, Perricone R. Immunomodulation in psoriatic arthritis: focus on cellular and molecular pathways. Autoimmun Rev 2012. [PMID: 23183378 DOI: 10.1016/j.autrev.2012.10.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis. Pathogenesis is incompletely understood and pathophysiological role of synovium is just beginning to be elucidated. PsA could be considered an enthesal disease and this hypothesis is the link between mechanical stress (entheses) and immunologically active tissue (synovium). Histologically, PsA is characterized by lining layer hyperplasia, diffuse infiltrate of B, T, macrophages and dendritic cells associated with neutrophils' proliferation and angiogenesis. T cells are present, and oligoclonal T-cell expansions have been demonstrated in both skin and synovium. Histological findings are associated with monocyte-derived cytokines expression, as Myeloid-related protein (S100A8/A9). They play an important role in intracellular functions and cytoskeleton-membrane interactions. S100A8/A9 has a role in the propagation and perpetuation of the inflammatory process in patients with psoriasis and PsA, because of an activated monocyte/macrophage system that involve, distal to the skin, the "enthesal-complex." Complement system can be considered part of the acute phase response as demonstrated by higher plasma levels of C3 and C4 complement components in PsA patients compared with healthy subjects. These abnormal levels are then reverted by anti-TNF drugs. Evidences of efficacy of anti-TNF are expressed by reduction of vascularity and immune cells in synovial tissue. Therefore, innate response generates high concentrations of inflammatory cytokines which promote effector functions of a variety of tissue cells and sustain the characteristic chronicity of synovitis. The challenge will be the development of molecules affecting the balance between innate and adaptive immunity without affecting beneficial functions of the perfect concert of immunological process.
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Affiliation(s)
- Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
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Saber TP, Fearon U, Veale DJ. Is remission a more realistic goal in psoriatic arthritis? Ther Adv Musculoskelet Dis 2012; 3:3-7. [PMID: 22870461 DOI: 10.1177/1759720x10389847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tajvur P Saber
- Dublin Academic Medical Centre, Department of Rheumatology, Bone and Joint Unit, St Vincent's University Hospital and the Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
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IERVOLINO SALVATORE, DI MINNO MATTEONICOLADARIO, PELUSO ROSARIO, LOFRANO MARIANA, RUSSOLILLO ANNA, DI MINNO GIOVANNI, SCARPA RAFFAELE. Predictors of Early Minimal Disease Activity in Patients with Psoriatic Arthritis Treated with Tumor Necrosis Factor-α Blockers. J Rheumatol 2012; 39:568-73. [DOI: 10.3899/jrheum.110763] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective.To identify predictors of early minimal disease activity in patients with psoriatic arthritis (PsA) receiving tumor necrosis factor-α (TNF-α) antagonists.Methods.In total 146 consecutive patients with PsA eligible for anti-TNF-α therapy were enrolled. At baseline (T0) information about age, sex, PsA subset, disease duration, comorbidities, and treatments was collected. All subjects were tested for metabolic syndrome (MetS) and/or liver steatosis. A clinical and laboratory evaluation was performed at T0 and at 3 months (T3). Changes in all these variables were compared in subjects achieving minimal disease activity (MDA) and those who did not.Results.Among 146 PsA subjects, 10 discontinued therapy before 3-month followup because of adverse events; thus 136 concluded the study. All clinical outcome measures changed significantly from T0 to T3. Erythrocyte sedimentation rate showed a significant reduction (p < 0.001). C-reactive protein (CRP), serum cholesterol, and triglycerides showed no significant variation (p > 0.05). The prevalence of MetS and liver steatosis showed no significant differences between subjects achieving MDA and those who did not (p = 0.347 and 0.053, respectively). Patients achieving MDA at T3 were younger than those not achieving MDA (p = 0.001). A lower baseline tender joint count (p = 0.001), swollen joint count (p = 0.013), Bath Ankylosing Spondylitis Disease Activity Index (p = 0.021), and Ritchie index (p = 0.006) were found in subjects achieving MDA. Age (OR 0.896, p = 0.003) and Bath Ankylosing Spondylitis Functional Index (BASFI) (OR 0.479, p = 0.007) inversely predicted, whereas CRP (OR 1.78, p = 0.018) directly predicted, achievement of MDA at T3.Conclusion.In patients with PsA, age, CRP, and BASFI at the beginning of treatment were found to be reliable predictors of MDA after 3 months of TNF-α blocker therapy.
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[Psoriatric arthritis - a permanent challenge for rheumatologists and patients: part 2: imaging diagnostics, classification and therapy]. Z Rheumatol 2011; 70:775-89. [PMID: 21979255 DOI: 10.1007/s00393-011-0870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In recent years a considerable number of imaging techniques have been used to demonstrate the onset and progression of arthritis-related changes in psoriatric arthritis (PsA). Moreover the identification of new immunological pathways has resulted in a substantial improvement of available therapies for PsA increasing the chance for the individual to receive effective treatment. Although an all-embracing disease activity score is still lacking, there is a variety of symptom-related tools to adequately reflect the course of disease and to evaluate the corresponding treatment success. This manuscript aims to give an overview of the latest corresponding knowledge with respect to PsA.
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Anti-TNFα discontinuation in rheumatoid and psoriatic arthritis: Is it possible after disease remission? Autoimmun Rev 2011; 10:636-40. [DOI: 10.1016/j.autrev.2011.04.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Coates LC, Jonckheere CL, Molin S, Mease PJ, Ritchlin CT. Summary of the International Federation of Psoriasis Associations (IFPA) meeting: a report from the GRAPPA 2009 annual meeting. J Rheumatol 2011; 38:530-9. [PMID: 21362781 DOI: 10.3899/jrheum.101115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The International Federation of Psoriasis Associations (IFPA) organized the second World Psoriasis and Psoriatic Arthritis Conference in Stockholm, Sweden, in June 2009. The 2009 collaborative multidisciplinary meeting attracted nearly 1000 clinicians and investigators from dermatology, rheumatology, basic science, and industry, as well as patients and leaders of patient organizations, from 68 countries. The major theme of the meeting was "Psoriasis - Skin and Beyond," and the primary aim was to highlight the significant effects of psoriasis and related comorbidities on patient function and quality of life. The annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) was held concurrently, and several GRAPPA members attended both meetings. Key presentations at IFPA that GRAPPA members believed were highlights of that meeting are summarized here.
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Affiliation(s)
- Laura C Coates
- University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
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Saber TP, Ng CT, Renard G, Lynch BM, Pontifex E, Walsh CAE, Grier A, Molloy M, Bresnihan B, Fitzgerald O, Fearon U, Veale DJ. Remission in psoriatic arthritis: is it possible and how can it be predicted? Arthritis Res Ther 2010; 12:R94. [PMID: 20482783 PMCID: PMC2911878 DOI: 10.1186/ar3021] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 05/04/2010] [Accepted: 05/18/2010] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Since remission is now possible in psoriatic arthritis (PsA) we wished to examine remission rates in PsA patients following anti tumour necrosis factor alpha (TNFalpha) therapy and to examine possible predictors of response. METHODS Analysis of a prospective patient cohort attending a biologic clinic, between November 2004 and March 2008, was performed prior to commencing therapy and at regular intervals. Baseline clinical characteristics including demographics, previous disease-modifying antirheumatic drug (DMARD) response, tender and swollen joint counts, early morning stiffness, pain visual analogue score, patient global assessment, C reactive protein (CRP) and health assessment questionnaire (HAQ) were collected. RESULTS A total of 473 patients (152 PsA; 321 rheumatoid arthritis (RA)) were analyzed. At 12 months remission, defined according to the disease activity score using 28 joint count and CRP (DAS28-CRP), was achieved in 58% of PsA patients compared to 44% of RA patients, significant improvement in outcome measures were noted in both groups (P<0.05). Analysis of a subgroup of PsA and RA patients matched for DAS28-CRP at baseline also showed higher numbers of PsA patients achieving remission. Linear regression analysis identified the HAQ at baseline as the best predictor of remission in PsA patients (P<0.001). CONCLUSIONS DAS28 remission is possible in PsA patients at one year following anti-TNF therapy, at higher rates than in RA patients and is predicted by baseline HAQ.
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Affiliation(s)
- Tajvur P Saber
- Department of Rheumatology, Dublin Academic Medical Centre, St Vincent's University Hospital, and The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Elm Park, Dublin 4, Ireland
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Comparison of effectiveness and safety of infliximab, etanercept, and adalimumab in psoriatic arthritis patients who experienced an inadequate response to previous disease-modifying antirheumatic drugs. Clin Rheumatol 2010; 29:399-403. [DOI: 10.1007/s10067-009-1340-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 11/30/2009] [Accepted: 12/08/2009] [Indexed: 10/20/2022]
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