Oligoarticular Psoriatic Arthritis: Addressing Clinical Challenges in an Intriguing Phenotype

High-frequency ultrasonography for the detection of subclinical arthritis in chronic plaque psoriasis patients - A cross-sectional study

Background Psoriatic arthritis (PsA) is seen in almost 30-40% cases of psoriasis. Psoriasis precedes the onset of PsA in 85% of cases. Delay in the diagnosis of PsA may lead to poor functional outcomes and morbidity. Screening psoriasis patients with high-frequency ultrasound helps to diagnose arthritis at an early stage leading to prompt intervention and possible reduction in the morbidity associated with the disease. Objectives To determine the role of high frequency ultrasonography (USG) in the detection of subclinical PsA. Methods A cross-sectional study was conducted in a dermatology and radiology department of Armed Forces Medical College, Pune between July 2021 and December 2022. Patients of chronic plaque psoriasis with no clinical evidence of arthritis were assessed using high-frequency USG. Various parameters such as bony erosions, synovial thickening, tendon thickening, tendon hypo-echogenicity, calcifications and power doppler signals were assessed. Results A total of 117 patients were included in the study. The distal interphalangeal joint (DIP) and Achilles tendon were the most commonly affected sites. Synovial thickening in DIP was observed in 67 (57%) patients and Achilles tendon thickening was observed in 39 (33%) patients. Limitations of the study The cross-sectional nature of the study is the major limitation. A longitudinal study will be required to understand the clinical relevance of ultrasonographic changes in these patients. Another limitation of the study is the lack of age and gender-matched controls. Future research should include such controls to ensure more accurate results. Conclusion Subclinical arthritis is common in patients with chronic plaque psoriasis. High-frequency ultrasound is a useful tool for detecting subclinical synovitis and enthesitis in asymptomatic patients. The DIP joint and Achilles tendon ultrasound can be used for screening for early detection of PsA.

Inhibition of Interleukin-17 in Patients with Oligoarticular Psoriatic Arthritis

INTRODUCTION

This study evaluated the efficacy of the interleukin-17A inhibitor secukinumab in patients with oligoarticular psoriatic arthritis (PsA).

METHODS

A total of 84 patients with oligoarticular PsA, defined as 1-4 tender joints and 1-4 swollen joints, were pooled from the FUTURE 2-5 and MAXIMISE trials (NCT01752634, NCT01989468, NCT02294227, NCT02404350, and NCT02721966). Patients were grouped by treatment received at week 12 (secukinumab 300 mg, secukinumab 150 mg, or placebo) and week 52 (any secukinumab 300 mg or any secukinumab 150 mg). Efficacy was assessed by the proportion of patients achieving selected clinical outcomes. The predictors of Disease Activity index for Psoriatic Arthritis (DAPSA) responses at weeks 12 and 52 were identified by logistic regression analysis.

RESULTS

Secukinumab treatment resulted in greater achievement of DAPSA-based low disease activity (LDA), DAPSA-based remission (REM), DAPSA50, and DAPSA75 than placebo at week 12, with improvements sustained or further increased through week 52. LDA or REM was achieved at week 52 by more than 90% of patients who received either secukinumab dose, although secukinumab 300 mg resulted in the highest achievement of the stringent DAPSA75 and DAPSA REM outcomes. At week 12, younger age was associated with DAPSA LDA or REM and DAPSA50, while lower baseline swollen joint count was associated with DAPSA REM. No predictors were identified at week 52. The safety profile was consistent with the full study populations.

CONCLUSION

Secukinumab demonstrated efficacy vs placebo across several outcome measures in patients with oligoarticular PsA at week 12, with sustained or improved responses through week 52.

Oligoarticular vs Polyarticular Psoriatic Arthritis: A Longitudinal Study Showing Similar Characteristics

OBJECTIVE

The objectives of this study were to determine whether patients with oligoarticular presentation differ from those with polyarticular presentation and to identify potential predictors for evolution of oligoarthritis to polyarthritis in patients with psoriatic arthritis (PsA).

METHODS

Patients who entered the University of Toronto PsA clinic between 1978 and 2018 within 12 months of diagnosis were identified. Only patients with ≥ 2 clinic visits were included. Patients were followed at 6- to 12-month intervals according to standard protocol, which included demographics, clinical history, detailed clinical examination, laboratory information, and patient questionnaires. Radiographs were done at 2-year intervals. Oligoarthritis was defined by the presence of ≤ 4 inflamed joints and progression as an increase to ≥ 5 joints. Statistical analyses included logistic regression models as well as Weibull regression models, adjusted for age, disease duration, and sex.

RESULTS

Of 407 patients, 192 (47%) presented with oligoarthritis. Whereas demographic features were similar to those with polyarthritis, more patients with polyarthritis presented with dactylitis and enthesitis. Similar joint distribution was observed, with small joints of the hands and feet being most commonly affected. Patients with polyarthritis had higher Health Assessment Questionnaire and lower 36-item Short Form Health Survey (SF-36) scores. Of the 192 oligoarticular patients, 117 (61%) remained oligoarticular and 75 (39%) progressed to polyarthritis. A lower SF-36 mental component summary (MCS) score was the predictor for progressing to polyarthritis.

CONCLUSION

Oligoarticular PsA occurs in 47% of patients with PsA and is similar to polyarticular disease, with most patients having small joint involvement. The only predictor for progression to polyarthritis was lower SF-36 MCS.

Canadian Rheumatologists' Perspectives on Moderate Psoriatic Arthritis and Oligoarticular Psoriatic Arthritis

OBJECTIVE

Psoriatic arthritis (PsA) substantially impairs quality of life. Clinical trials generally focus on polyarticular PsA, but less is known about the assessment and management of oligoarticular and moderate PsA. An online survey was conducted to determine Canadian rheumatologists' perspectives on the definition and treatment of oligoarticular and moderate PsA.

METHODS

Regional and national experts treating patients with PsA were asked to complete an online survey to assess their approach to identifying and managing patients with PsA. Survey questions were developed based on guidance from a committee of Canadian rheumatologists.

RESULTS

Sixty-four of 78 rheumatologists responded, representing 6 major Canadian provinces. Nearly half of respondents were in practice > 20 years. The majority of rheumatologists reported using swollen joint count (SJC) to describe moderate PsA (86.4%) and oligoarticular PsA (96.7%), and considered location of inflammation in PsA assessments. SJC cutoff scores for reporting moderate PsA varied among rheumatologists, suggesting lack of an agreed-upon definition for moderate PsA. Sixty-eight percent of rheumatologists identified access to treatment as the greatest challenge with oligoarticular PsA.

CONCLUSION

According to the surveyed rheumatologists, SJC remains a key assessment variable when defining oligoarticular and moderate PsA. Although the number of joints is considered when determining the effect of PsA on patients, joint location and functional impairment are also considered when describing the disease as moderate. Access to treatment for patients with < 5 affected joints is challenging.

Descriptive Comparisons of the Effect of Apremilast and Methotrexate Monotherapy in Oligoarticular Psoriatic Arthritis: The Corrona Psoriatic Arthritis/Spondyloarthritis Registry Results

OBJECTIVE

Therapeutic response was evaluated among new apremilast, methotrexate (MTX), or biologic disease-modifying antirheumatic drug (bDMARD) initiators with oligoarticular psoriatic arthritis (PsA).

METHODS

Patients with oligoarticular PsA in the Corrona PsA/Spondyloarthritis Registry initiating treatment with apremilast, MTX, or bDMARD, and completing 6-month follow-up were included.

RESULTS

In total, 150 patients initiated monotherapy (apremilast: n = 34; MTX: n = 15; bDMARD: n = 101). Apremilast initiators had higher baseline disease activity than MTX initiators. At follow-up, apremilast initiators experienced numerically greater disease activity improvements than MTX initiators and similar improvements to bDMARD initiators.

CONCLUSION

Findings suggest apremilast monotherapy is an effective option for patients with oligoarticular PsA.