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Filippou G, Pellegrino ME, Sorce A, Sirotti S, Ferrito M, Gitto S, Messina C, Albano D, Sconfienza LM. Updates in Ultrasound in Rheumatology. Radiol Clin North Am 2024; 62:809-820. [PMID: 39059973 DOI: 10.1016/j.rcl.2024.02.012] [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] [Indexed: 07/28/2024]
Abstract
BACKGROUND The purpose of the authors' narrative review was to outline the current literature regarding the use of ultrasound in main rheumatic disorders and summarize the updates, specifically about rheumatoid arthritis, psoriatic arthritis, and crystal-induced arthropathies. METHODS The authors searched on PubMed for articles discussing the major updates regarding the role of ultrasound in the previously mentioned rheumatic conditions. RESULTS The authors have provided the updated definitions, new criteria, and diagnostic scores. CONCLUSIONS In rheumatology's dynamic landscape, this review provides valuable insights for researchers and clinicians on ultrasound's role in improving patient care and outcomes in rheumatic diseases.
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Affiliation(s)
- Georgios Filippou
- Rheumatology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Adriana Sorce
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Silvia Sirotti
- Rheumatology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Matteo Ferrito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Salvatore Gitto
- Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Carmelo Messina
- Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Domenico Albano
- Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Luca Maria Sconfienza
- Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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Ricci V, Tamborrini G, Zunica F, Chang KV, Kara M, Farì G, Naňka O, Özçakar L. High-resolution ultrasound imaging of elementary lesions in dactylitis. J Ultrasound 2024; 27:281-290. [PMID: 38006512 PMCID: PMC11178685 DOI: 10.1007/s40477-023-00834-z] [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: 07/22/2023] [Accepted: 10/02/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE The aim of the present study was to illustrate the (potential) diagnostic role of high resolution US images in assessing the elementary lesions of dactylitis. METHODS Using high-frequency US machines/probes, we matched the micro-anatomical cadaveric architecture of the digit with multiple sonographic findings of dactylitis. High-sensitive color/power Doppler assessments have also been performed to evaluate the digital microvasculature. DISCUSSION Modern US equipment/features guarantee prompt and in-depth B-mode and color/power Doppler imaging of tiny anatomical structures of the digit which are usually not properly visible with standard US machines. More specifically, hypervascularization of the digital subcutaneous tissue, fibrous pulleys of flexor tendons, dorsal synovial pads as well as pathological changes of the distal entheseal anchorage network can be accurately detected. CONCLUSION In clinical practice, high-end US equipment can be used to accurately assess the digits in patients with dactylitis. This way, simple and convenient sonographic diagnosis of different elementary lesions can be timely established.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland
- Rheumatology Clinic, University Hospital of Basel, Basel, Switzerland
| | - Fiammetta Zunica
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, 20154, Milan, Italy
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Huy Branch, Taipei, Taiwan
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine Ankara, Hacettepe University Medical School, Ankara, Turkey
| | - Giacomo Farì
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, Lecce, Italy
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine Ankara, Hacettepe University Medical School, Ankara, Turkey
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Rahman P, McInnes IB, Deodhar A, Schett G, Mease PJ, Shawi M, Cua DJ, Sherlock JP, Kollmeier AP, Xu XL, Sheng S, Ritchlin CT, McGonagle D. Association between enthesitis/dactylitis resolution and patient-reported outcomes in guselkumab-treated patients with psoriatic arthritis. Clin Rheumatol 2024; 43:1591-1604. [PMID: 38472528 PMCID: PMC11018666 DOI: 10.1007/s10067-024-06921-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES To evaluate the association between enthesitis resolution (ER) and dactylitis resolution (DR) and meaningful improvements in patient-reported outcomes (PROs) among biologic-naïve patients with PsA receiving guselkumab in the DISCOVER-2 study. METHODS Enthesitis and dactylitis, characteristic lesions of PsA, were evaluated by independent assessors using the Leeds Enthesitis Index (range, 0-6) and Dactylitis Severity Score (range, 0-60). Proportions of patients with ER or DR (score = 0) among those with score > 0 at baseline were determined at weeks 24, 52, and 100. PROs included: fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue]), pain (0-100 visual analog scale), physical function (Health Assessment Questionnaire-Disability Index [HAQ-DI]), and health-related quality of life (36-item Short-Form Health Survey physical/mental component summary [SF-36 PCS/MCS]). Meaningful responses were defined as: improvements of ≥ 4 for FACIT-Fatigue, ≥ 0.35 for HAQ-DI, and ≥ 5 for SF-36 PCS/MCS and absolute scores of ≤ 15 for minimal pain and ≤ 0.5 for normalized HAQ-DI. Associations between ER/DR status and PRO response status were tested using a Chi-square test. RESULTS Guselkumab-treated patients with ER were more likely than those without ER to achieve minimal pain (p < 0.001), normalized HAQ-DI (p < 0.001), and PCS response (p < 0.05) at weeks 24, 52, and 100. Patients with DR were more likely than those without DR to achieve FACIT-Fatigue response at week 24 and week 52 (both p ≤ 0.01) and minimal pain at week 24 and normalized HAQ-DI at week 52 (both p ≤ 0.03). CONCLUSION In biologic-naïve patients with active PsA treated with guselkumab, achieving ER or DR was associated with durable improvements in selected PROs, including those of high importance to patients. TRIAL REGISTRATION ClinicalTrials.gov ( https://clinicaltrials.gov ) NCT03158285; Registered: May 16, 2017. Key Points • At week 100, 65% and 76% of guselkumab-treated patients achieved enthesitis and dactylitis resolution (ER/DR). • Achieving ER was associated with achieving DR and vice versa through the end of study. • Achieving ER or DR was associated with durable and meaningful improvements in selected patient-reported outcomes.
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Affiliation(s)
- Proton Rahman
- Memorial University of Newfoundland, St. Johns, NF, Canada
| | | | - Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
| | - Georg Schett
- FAU Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Phillip J Mease
- Rheumatology Research, Providence Swedish Medical Center, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - May Shawi
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Daniel J Cua
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Jonathan P Sherlock
- Janssen Research & Development, LLC, Spring House, PA, USA
- University of Oxford, Oxford, UK
| | | | - Xie L Xu
- Janssen Research & Development, LLC, San Diego, CA, USA
| | - Shihong Sheng
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | - Dennis McGonagle
- Leeds Biomedical Research Centre, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
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Rischke S, Poor SM, Gurke R, Hahnefeld L, Köhm M, Ultsch A, Geisslinger G, Behrens F, Lötsch J. Machine learning identifies right index finger tenderness as key signal of DAS28-CRP based psoriatic arthritis activity. Sci Rep 2023; 13:22710. [PMID: 38123604 PMCID: PMC10733369 DOI: 10.1038/s41598-023-49574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory systemic disease whose activity is often assessed using the Disease Activity Score 28 (DAS28-CRP). The present study was designed to investigate the significance of individual components within the score for PsA activity. A cohort of 80 PsA patients (44 women and 36 men, aged 56.3 ± 12 years) with a range of disease activity from remission to moderate was analyzed using unsupervised and supervised methods applied to the DAS28-CRP components. Machine learning-based permutation importance identified tenderness in the metacarpophalangeal joint of the right index finger as the most informative item of the DAS28-CRP for PsA activity staging. This symptom alone allowed a machine learned (random forests) classifier to identify PsA remission with 67% balanced accuracy in new cases. Projection of the DAS28-CRP data onto an emergent self-organizing map of artificial neurons identified outliers, which following augmentation of group sizes by emergent self-organizing maps based generative artificial intelligence (AI) could be defined as subgroups particularly characterized by either tenderness or swelling of specific joints. AI-assisted re-evaluation of the DAS28-CRP for PsA has narrowed the score items to a most relevant symptom, and generative AI has been useful for identifying and characterizing small subgroups of patients whose symptom patterns differ from the majority. These findings represent an important step toward precision medicine that can address outliers.
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Affiliation(s)
- Samuel Rischke
- Institute of Clinical Pharmacology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
| | - Sorwe Mojtahed Poor
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Department of Rheumatology, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
| | - Robert Gurke
- Institute of Clinical Pharmacology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
| | - Lisa Hahnefeld
- Institute of Clinical Pharmacology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
| | - Michaela Köhm
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Department of Rheumatology, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
| | - Alfred Ultsch
- DataBionics Research Group, University of Marburg, Hans-Meerwein-Straße, 35032, Marburg, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
| | - Frank Behrens
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany
- Department of Rheumatology, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
| | - Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt Am Main, Germany.
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Abstract
PURPOSE OF REVIEW Imaging is used in the diagnosis of peripheral and axial disease in juvenile spondyloarthritis (JSpA). Imaging of the joints and entheses in children and adolescents can be challenging for those unfamiliar with the appearance of the maturing skeleton. These differences are key for rheumatologists and radiologists to be aware of. RECENT FINDINGS In youth, skeletal variation during maturation makes the identification of arthritis, enthesitis, and sacroiliitis difficult. A great effort has been put forward to define imaging characteristics seen in healthy children in order to more accurately identify disease. Additionally, there are novel imaging modalities on the horizon that are promising to further differentiate normal physiologic changes versus disease. SUMMARY This review describes the current state of imaging, limitations, and future imaging modalities in youth, with key attention to differences in imaging interpretation of the peripheral joints, entheses, and sacroiliac joint in youth and adults.
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Affiliation(s)
- Hallie A Carol
- Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Pamela F Weiss
- Division of Rheumatology, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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McGonagle D, McInnes IB, Deodhar A, Schett G, Shawi M, Chakravarty SD, Kollmeier AP, Xu XL, Sheng S, Xu S, Ritchlin CT, Rahman P, Mease PJ. Guselkumab, a Selective Interleukin-23 p19 Subunit Inhibitor, Resolves Dactylitis in Patients With Active Psoriatic Arthritis: Pooled Results Through Week 52 From Two Phase 3 Studies. ACR Open Rheumatol 2023; 5:227-240. [PMID: 36880890 PMCID: PMC10100698 DOI: 10.1002/acr2.11537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/29/2022] [Accepted: 02/06/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE Previous analyses of pooled DISCOVER-1 and DISCOVER-2 data through Week 24 showed significantly higher rates of dactylitis resolution in patients treated with guselkumab compared with placebo. Here, we investigate associations between dactylitis resolution and other outcomes through 1 year. METHODS Patients were randomized 1:1:1 to receive subcutaneous injections of guselkumab 100 mg at Week 0, Week 4, and then every 4 or 8 weeks, or placebo with crossover to guselkumab at Week 24. Independent assessors determined dactylitis severity score (DSS; 0-3/digit; total = 0-60). Dactylitis resolution (DSS = 0) (prespecified) and at least 20%, at least 50%, and at least 70% DSS improvement from baseline (post hoc) were determined through Week 52 (nonresponder imputation for treatment failure through Week 24 and for missing data through Week 52). ACR50, tender/swollen joints, low disease activity (LDA) as assessed by composite indices, and radiographic progression (DISCOVER-2 only) were assessed in patients with dactylitis versus without dactylitis resolution at Week 24 and Week 52. RESULTS Patients with dactylitis at baseline (473 of 1118) had more severe joint and skin disease than those without dactylitis (645 of 1118). At Week 52, approximately 75% of guselkumab-randomized patients with dactylitis at baseline had complete resolution; approximately 80% had at least 70% DSS improvement. Through Week 52, new-onset dactylitis (DSS ≥1) was uncommon among patients with a DSS of 0 at baseline. Guselkumab-randomized patients with dactylitis resolution were more likely to achieve ACR50, at least 50% reduction in tender and swollen joints, and LDA at Week 24 and Week 52 than those without resolution. At Week 52, patients with dactylitis resolution had numerically less radiographic progression from baseline (DISCOVER-2). CONCLUSION Through 1 year, approximately 75% of guselkumab-randomized patients had complete resolution of dactylitis; patients exhibiting resolution were more likely to achieve other important clinical outcomes. Given the high burden of dactylitis, resolution may be associated with better long-term patient outcomes.
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Affiliation(s)
- Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds; National Institute for Health Research (NIHR) Biomedical Research Centre, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Georg Schett
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - May Shawi
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania
| | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, and Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Xie L Xu
- Janssen Research & Development, LLC, San Diego, California
| | - Shihong Sheng
- Immunology Biostatistics, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Stephen Xu
- Immunology Biostatistics, Janssen Research & Development, LLC, Spring House, Pennsylvania
| | | | - Proton Rahman
- Craig L. Dobbin Genetics Research Centre, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Phillip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington
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Richette P, Vis M, Ohrndorf S, Tillett W, Ramírez J, Neuhold M, van Speybroeck M, Theander E, Noel W, Zimmermann M, Shawi M, Kollmeier A, Zabotti A. Identification of PsA phenotypes with machine learning analytics using data from two phase III clinical trials of guselkumab in a bio-naïve population of patients with PsA. RMD Open 2023; 9:rmdopen-2022-002934. [PMID: 37001920 PMCID: PMC10069583 DOI: 10.1136/rmdopen-2022-002934] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesPsoriatic arthritis (PsA) phenotypes are typically defined by their clinical components, which may not reflect patients’ overlapping symptoms. This post hoc analysis aimed to identify hypothesis-free PsA phenotype clusters using machine learning to analyse data from the phase III DISCOVER-1/DISCOVER-2 clinical trials.MethodsPooled data from bio-naïve patients with active PsA receiving guselkumab 100 mg every 8/4 weeks were retrospectively analysed. Non-negative matrix factorisation was applied as an unsupervised machine learning technique to identify PsA phenotype clusters; baseline patient characteristics and clinical observations were input features. Minimal disease activity (MDA), disease activity index for psoriatic arthritis (DAPSA) low disease activity (LDA) and DAPSA remission at weeks 24 and 52 were evaluated.ResultsEight clusters (n=661) were identified: cluster 1 (feet dominant), cluster 2 (male, overweight, psoriasis dominant), cluster 3 (hand dominant), cluster 4 (dactylitis dominant), cluster 5 (enthesitis, large joints), cluster 6 (enthesitis, small joints), cluster 7 (axial dominant) and cluster 8 (female, obese, large joints). At week 24, MDA response was highest in cluster 2 and lowest in clusters 3, 5 and 6; at week 52, it was highest in cluster 2 and lowest in cluster 5. At weeks 24 and 52, DAPSA LDA and remission were highest in cluster 2 and lowest in clusters 4 and 6, respectively. All clusters improved with guselkumab treatment over 52 weeks.ConclusionsUnsupervised machine learning identified eight PsA phenotype clusters with significant differences in demographics, clinical features and treatment responses. In the future, such data could help support individualised treatment decisions.
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Affiliation(s)
- Pascal Richette
- Rheumatology Department, AP-HP, Lariboisière Hospital, INSERM U1132, Paris, France
- Université Paris Cité, Paris, France
| | - Marijn Vis
- Rheumatology, Erasmus MC Universitair Medisch Centrum, Rotterdam, The Netherlands
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Julio Ramírez
- Rheumatology Department, Hospital Universitari Clínic and IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marlies Neuhold
- EMEA Medical Affairs Immunology, Janssen-Cilag, Zug, Switzerland
| | | | - Elke Theander
- EMEA Medical Affairs Immunology, Janssen-Cilag, Solna, Sweden
| | - Wim Noel
- EMEA Medical Affairs Immunology, Janssen-Cilag BV, Breda, The Netherlands
| | | | - May Shawi
- Medical Affairs, Janssen Global Services LLC, Horsham, Pennsylvania, USA
| | - Alexa Kollmeier
- Research and Development, Immunology, Janssen Research and Development LLC, San Diego, California, USA
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Institute, University of Udine, Udine, Italy
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Phenotypic heterogeneity in psoriatic arthritis: towards tissue pathology-based therapy. Nat Rev Rheumatol 2023; 19:153-165. [PMID: 36596924 DOI: 10.1038/s41584-022-00874-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 01/04/2023]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous disease involving multiple potential tissue domains. Most outcome measures used so far in randomized clinical trials do not sufficiently reflect this domain heterogeneity. The concept that pathogenetic mechanisms might vary across tissues within a single disease, underpinning such phenotype diversity, could explain tissue-distinct levels of response to different therapies. In this Review, we discuss the tissue, cellular and molecular mechanisms that drive clinical heterogeneity in PsA phenotypes, and detail existing tissue-based research, including data generated using sophisticated interrogative technologies with single-cell precision. Finally, we discuss how these elements support the need for tissue-based therapy in PsA in the context of existing and new therapeutic modes of action, and the implications for future PsA trial outcomes and design.
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Koreshkova KM, Khismatullina ZR. The role of trauma and isomorphic reaction in the pathogenesis of psoriatic arthritis. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1323] [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
The role of biomechanical stress and trauma in the initiation of inflammation of the joints and periarticular structures in psoriatic arthritis (PA) is currently not fully understood. Soft tissues and joints are the target for constant biomechanical stress and microtrauma, leading to inflammation. There is an opinion that this inflammation in PA is due to an analogue of the skin isomorphic reaction that develops in the skin of psoriatic patients in response to trauma. Some authors have called this reaction the deep Koebner phenomenon. It is assumed that the early, preclinical phase of psoriatic arthritis may be based on inflammation of the enthesis as a response to microtrauma, and explained by the proximity of the entheses and the articular membranes. Detection of early changes in entheses in psoriatic patients, including those who do not have complaints from the musculoskeletal system, is of great importance for the early diagnosis of psoriatic arthritis. In the literature review, the sources for the period 20102021 were studied, devoted to the role of the isomorphic reaction and microtraumatization in the pathogenesis of PA, as well as the role of various imaging methods for the early diagnosis of enthesitis in psoriatic patients.
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10
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Gisondi P, Bellinato F, Maurelli M, Geat D, Zabotti A, McGonagle D, Girolomoni G. Reducing the Risk of Developing Psoriatic Arthritis in Patients with Psoriasis. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:213-220. [PMID: 35975124 PMCID: PMC9375973 DOI: 10.2147/ptt.s323300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/04/2022] [Indexed: 01/22/2023]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory arthritis associated with psoriasis, which may manifest with different domains such as dactylitis, enthesitis, synovitis and spondylitis. The estimated prevalence of PsA in patients with psoriasis ranges widely between 6% and 42%. In most cases, PsA is preceded by skin involvement by an average time of 7-8 years. In the complex patho-mechanisms involved in the transition from psoriasis to PsA, the gut and skin have been proposed as the sites of immune activation triggering or contributing to the development of PsA. In such a transition, a subclinical phase has been identified, characterized by enthesopathy where soluble biomarkers and imaging findings but no clinical symptoms are detectable. Recent studies have provided some evidence that timely treated psoriasis may reduce the risk of developing PsA.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Geat
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital ‘Santa Maria della Misericordia’ c/o University of Udine, Udine, Italy
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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11
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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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12
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Li SS, Du N, He SH, Liang X, Li TF. Dactylitis is associated with more severe axial joint damage and higher disease activity in axial psoriatic arthritis. J Rheumatol 2022; 49:1012-1019. [DOI: 10.3899/jrheum.220098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
Objective To investigate the association of dactylitis with disease activity and the severity of radiological damage in patients with axial psoriatic arthritis (AxPsA). Methods Patients with AxPsA met the classification criteria (CASPAR) were recruited. Clinical data, radiographic changes and disease activity in AxPsA patients with or without dactylitis were compared using t-tests, Mann-Whitney U test or Kruskal-Wallis test for continuous variables, Ⲭ2 or Fisher exact tests for categorical variables and logistic regression analysis for the association between dactylitis and radiographic damage. Results A total of 186 AxPsA patients were analysed and dichotomized by the presence or absence of dactylitis. Patients with dactylitis had higher levels of CRP, ESR, NLR and PLR than those who did not have (PCRP=0.004; PESR=0.006; PNLR=0.035; PPLR=0.020). In addition, dactylitic AxPsA patients also had higher TJC, SJC, DAPSA and HAQ (P<0.001), and higher score of DAS28, ASDAS, BASFI and BASDAI (P<0.05), while less patients met MDA and DAPSA-LDA criteria (P<0.05). Consistently, they had more severe radiological damage (P< 0.05), higher sacroiliac scores (OR 2.076, 95%CI 1.137 to 3.791, P=0.017) and more significant reduction in BMD (OR 2.422, 95%CI 1.342 to 4.372, P=0.003). No statistical differences were observed for HLA-B27 and LEI between these two group patients. Notably, only half of dactylitic AxPsA patients had inflammatory back pain. Conclusion Our study demonstrated that dactylitic AxPsA patients had higher disease activity and more severe joint damage compared those without dactylitis. Careful examination of axial involvements and proper management are recommended.
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13
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Gialouri CG, Evangelatos G, Fragoulis GE. Choosing the Appropriate Target for the Treatment of Psoriatic Arthritis: TNFα, IL-17, IL-23 or JAK Inhibitors? Mediterr J Rheumatol 2022; 33:150-161. [PMID: 36127928 PMCID: PMC9450184 DOI: 10.31138/mjr.33.1.150] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
Psoriatic arthritis (PsA) is a highly heterogenous disease. Apart from arthritis and psoriasis, other manifestations can also occur, including enthesitis, dactylitis, axial-, nail-, eye- and bowel- involvement. Comorbidities are also frequent in the setting of PsA, with cardiovascular disease and mental-health disorders being the most frequent. The Rheumatologist's arsenal has many different treatment options for treating PsA. Despite their effectiveness, there are some differences in terms of efficacy and safety that might affect clinician's decision for one or the other drug. Comparing biologic DMARDs and JAK-inhibitors, one could say that they have similar effectiveness in terms of musculoskeletal manifestations. However, anti-IL-17 and anti-IL-23 drugs seem to be more effective for skin manifestations. In contrast, JAK-inhibitors and etanercept might be less effective for these manifestations. Inflammatory bowel disease and uveitis are non-responsive to etanercept and anti-IL-17 drugs. As regards to comorbidities, data are scarce, but future studies will shed light on possible differential effect of bDMARDs or JAK-inhibitors. Safety is always an important drive for choosing the appropriate treatment. Infections are the most common adverse event of these drugs. Etanercept and anti-IL-17 drugs are safer for patients having latent tuberculosis, while herpes zoster is more common in individuals receiving JAK-inhibitors. Finally, venous thromboembolism risk, should be taken into account when JAK-inhibitors are used. In this review, we comparatively present, as outlined above, the various aspects that could affect the choice of the appropriate bDMARD or JAK-inhibitor for the treatment of a PsA patient.
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Affiliation(s)
- Chrysoula G. Gialouri
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
| | - George E. Fragoulis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
- Corresponding Author: George E. Fragoulis, MD, PhD Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens Laiko General Hospital, Mikras Asias 75 Str, 11527 Athens, Greece, Tel.: +30 210 746 2636, E-mail:
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14
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Tanaka Y, Luo Y, O'Shea JJ, Nakayamada S. Janus kinase-targeting therapies in rheumatology: a mechanisms-based approach. Nat Rev Rheumatol 2022; 18:133-145. [PMID: 34987201 PMCID: PMC8730299 DOI: 10.1038/s41584-021-00726-8] [Citation(s) in RCA: 192] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 02/06/2023]
Abstract
The four Janus kinase (JAK) proteins and seven signal transducer and activator of transcription (STAT) transcription factors mediate intracellular signal transduction downstream of cytokine receptors, which are implicated in the pathology of autoimmune, allergic and inflammatory diseases. Development of targeted small-molecule therapies such as JAK inhibitors, which have varied selective inhibitory profiles, has enabled a paradigm shift in the treatment of diverse disorders. JAK inhibitors suppress intracellular signalling mediated by multiple cytokines involved in the pathological processes of rheumatoid arthritis and many other immune and inflammatory diseases, and therefore have the capacity to target multiple aspects of those diseases. In addition to rheumatoid arthritis, JAK inhibition has potential for treatment of autoimmune diseases including systemic lupus erythematosus, spondyloarthritis, inflammatory bowel disease and alopecia areata, in which stimulation of innate immunity activates adaptive immunity, leading to generation of autoreactive T cells and activation and differentiation of B cells. JAK inhibitors are also effective in the treatment of allergic disorders, such as atopic dermatitis, and can even be used for the COVID-19-related cytokine storm. Mechanism-based treatments targeting JAK-STAT pathways have the potential to provide positive outcomes by minimizing the use of glucocorticoids and/or non-specific immunosuppressants in the treatment of systemic immune-mediated inflammatory diseases.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
| | - Yiming Luo
- Vasculitis Translational Research Program Systemic Autoimmunity Branch, National Institute of Arthritis, Musculoskeletal, and Skin Diseases NIH, Bethesda, MD, USA
| | - John J O'Shea
- Molecular Immunology & Inflammation Branch, and Translational Immunology Section, National Institute of Arthritis & Musculoskeletal and Skin Diseases, NIH, Bethesda, MD, USA
| | - Shingo Nakayamada
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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15
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Damiani G, Bragazzi NL, Karimkhani Aksut C, Wu D, Alicandro G, McGonagle D, Guo C, Dellavalle R, Grada A, Wong P, La Vecchia C, Tam LS, Cooper KD, Naghavi M. The Global, Regional, and National Burden of Psoriasis: Results and Insights From the Global Burden of Disease 2019 Study. Front Med (Lausanne) 2022; 8:743180. [PMID: 34977058 PMCID: PMC8716585 DOI: 10.3389/fmed.2021.743180] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Psoriasis is a common, chronic, inflammatory, debilitating, systemic disease with a great impact on healthcare systems worldwide. As targeted therapies have transformed the therapeutic landscape, updated estimates of the Global Burden of Disease (GBD) imposed by psoriasis are necessary in order to evaluate the effects of past health care policies and to orient and inform new national and international healthcare strategies. Methods: Data were extracted from the GBD 2019 study, which collates a systematic review of relevant scientific literature, national surveys, claims data, and primary care sources on the prevalence of psoriasis. Prevalence data were combined with disability weight (DW) to yield years lived with disability (YLDs). Measures of burden at global, regional, and national levels were generated for incidence, prevalence, and YLDs, due to psoriatic disease. All measures were reported as absolute numbers, percentages, and crude and age-adjusted rates per 100,000 persons. In addition, psoriasis burden was assessed by socio-demographic index (SDI). Findings: According to the GBD 2019 methodology, there were 4,622,594 (95% uncertainty interval or UI 4,458,904-4,780,771) incident cases of psoriasis worldwide in 2019. The age-standardized incidence rate in 2019 was 57.8 (95% UI 55.8-59.7) per 100,000 people. With respect to 1990, this corresponded to a decrease of 20.0% (95% UI -20.2 to -19.8). By sex, the age-standardized incidence rate was similar between men [57.8 (95% UI 55.8-59.8) per 100,000 people] and women [(57.8 (95% UI 55.8-59.7) per 100,000 people]. With respect to 1990, this corresponded to a decrease by 19.5% (95% UI -19.8 to -19.2) and by 20.4% (95% UI -20.7 to -20.2) for men and women, respectively. The age-standardized incidence rate per 100,000 persons was found to vary widely across geographic locations. Regionally, high-income countries and territories had the highest age-standardized incidence rate of psoriasis [112.6 (95% UI 108.9-116.1)], followed by high-middle SDI countries [69.4 (95% UI 67.1-71.9)], while low SDI countries reported the lowest rate [38.1 (95% UI 36.8-39.5)]. Similar trends were detected for prevalence and YLDs. Conclusion: In general, psoriasis burden is greatest in the age group of 60-69 years, with a relatively similar burden among men and women. The burden is disproportionately greater in high-income and high SDI index countries of North America and Europe. With advances in psoriasis therapeutics, objective evaluation of psoriasis disease burden is critical to track the progress at the population level.
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Affiliation(s)
- Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States.,Clinical Dermatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | | | - Dongze Wu
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Dennis McGonagle
- National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom
| | - Cui Guo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Robert Dellavalle
- Department of Dermatology, University of Anschutz Medical Campus, Aurora, CO, United States
| | - Ayman Grada
- Department of Dermatology, Boston University School of Medicine, Boston, MA, United States
| | - Priscilla Wong
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kevin D Cooper
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
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16
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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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17
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[Benefit of ultrasound in the phenotype recognition of psoriatic arthritis]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53. [PMID: 34916682 PMCID: PMC8695159 DOI: 10.19723/j.issn.1671-167x.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To explore the difference in phenotype recognition of PsA patients in two clinical scenarios, physical examination with and without ultrasound assessment. METHODS PsA patients who visited the rheumatology and clinical immunology department of Peking University First Hospital between January 2010 and October 2020, with complete data of clinical and ultrasound assessment were enrolled. The phenotypes were first identified based on physical examination only, and then combined with enthesitis and dactylitis shown on power doppler and gray-scale ultrasound. The phenotype groupings without and with ultrasound assessment were presented with Wayne diagram. The distributions of different clinical phenotypes were compared by using χ2 test or Fisher's exact test. The differences of clinical phenotypes with and without ultrasound assessment were compared by using Wilcoxon signed rank test. RESULTS A total of 227 patients with PsA were enrolled with one or more clinical domains. Physical examination revealed that psoriasis was in 209 (92.1%, 209/227) patients, nail involvement in 98 (43.2%, 98/227) patients, peripheral arthritis in 219 (96.5%, 219/227) patients, axial involvement in 25 (11.0%, 25/227) patients, dactylitis in 80 (35.2%, 80/227) patients, and enthesitis in 18 (7.9%, 18/227) patients. Besides 18 patients with clinical enthesitis, ultrasound scan revealed acute enthesitis in 80 patients, with hypoechogenicity (55 cases), tendon thickening (62 cases), and presence of Doppler signals (48 cases). Similarly, dactylitis on ultrasound was found in 18 patients besides those patients with clinical dactylitis. Compared with the phenotypes recognized based on physical examination only, the additional ultrasound assessment revealed that the most common phenotypes, peripheral arthritis was significantly less frequently recognized (49.8% vs. 27.8%, P < 0.001), however on the other hand, the proportion of the patients with peripheral arthritis and enthesitis was significantly increased (4.4% vs. 18.1%, P < 0.001). The phenotype of peripheral arthritis combined with enthesitis, and dactylitis was also dramatically increased (1.8% vs. 17.6%, P < 0.001). CONCLUSION Ultrasound is a useful tool to identify enthesitis and dactylitis. With the aid of ultrasound assessment, rheumatologists can better identify the lesions of PsA, accurately identify the phenotypes, and further guide the subsequent treatment.
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18
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Dubash S, Alabas OA, Michelena X, Garcia-Montoya L, Wakefield RJ, Helliwell PS, Emery P, McGonagle DG, Tan AL, Marzo-Ortega H. Dactylitis is an indicator of a more severe phenotype independently associated with greater SJC, CRP, ultrasound synovitis and erosive damage in DMARD-naive early psoriatic arthritis. Ann Rheum Dis 2021; 81:490-495. [PMID: 34893470 PMCID: PMC8921567 DOI: 10.1136/annrheumdis-2021-220964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022]
Abstract
Objective To characterise the impact of dactylitis in disease-modifying antirheumatic drug (DMARD)-naive early psoriatic arthritis (PsA). Methods Patients with early PsA meeting the classification criteria for PsA (CASPAR) were recruited. Clinical outcomes were recorded, and ultrasonography was conducted to assess grey scale (GS) and power Doppler (PD) synovitis, periarticular cortical bone erosions and enthesitis. The cohort was dichotomised by the presence or absence of dactylitis. Results Of 177 patients with PsA, those with dactylitis (dactylitic PsA (81/177, 46%)) had higher tender joint count (p<0.01), swollen joint count (SJC) (p<0.001) and C reactive protein (CRP) (p<0.01) than non-dactylitic PsA. Dactylitis was more prevalent in toes (146/214 (68.2%)) than fingers (68/214 (31.8%)); ‘hot’ dactylitis was more prevalent than ‘cold’ (83.6% vs 16.4%). Ultrasound (US) synovitis and erosions were significantly more prevalent in dactylitic PsA (p<0.001 and p<0.001, respectively). Exclusion of dactylitis in dactylitic PsA confirmed significantly greater SJC (3 vs 1, p=0.002), US synovitis (GS ≥2: 20.6% vs 16.1%, p<0.001, or PD ≥1: 5.1% vs 3.3%, p<0.001) and erosions (1.1% vs 0.5% joints, p=0.008; 26.1% vs 12.8% patients, p=0.035%) than non-dactylitic PsA. Synovitis (GS ≥2 and/or PD ≥1) occurred in 53.7% of dactylitis. No substantial differences were observed for US enthesitis. Conclusion Dactylitis signifies a more severe disease phenotype independently associated with an increased disease burden with greater SJC, CRP, US-detected synovitis and bone erosions in DMARD-naive early PsA and may be a useful discriminator for early risk stratification.
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Affiliation(s)
- Sayam Dubash
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Oras A Alabas
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Xabier Michelena
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Rheumatology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Leticia Garcia-Montoya
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Richard J Wakefield
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Paul Emery
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Dennis G McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Ai Lyn Tan
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Ultrasound Effectiveness of Steroid Injection for hand Psoriatic Dactylitis: Results from a Longitudinal Observational Study. Rheumatol Ther 2021; 8:1809-1826. [PMID: 34652687 PMCID: PMC8572270 DOI: 10.1007/s40744-021-00383-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction To assess clinical and ultrasound effectiveness of steroid injection (local treatment, LT) into the digital flexor tendon sheath for the treatment of psoriatic dactylitis compared to systemic treatment (ST) alone. Methods In this observational, multicentre, prospective study, 88 cases of symptomatic hand dactylitis were evaluated clinically and sonographically by high-frequency ultrasound (US) probe in both greyscale (GS) and power Doppler (PD). The presence of flexor tenosynovitis (FT), soft tissue oedema (STO), peritendon extensor inflammation and synovitis was assessed (including DACtylitis glObal Sonographic—DACTOS—score) before treatment, at 1-month (T1) and 3-months (T3) follow-up. LT was proposed to all patients. Patients refusing LT were treated with oral NSAIDs. Patients continued the same baseline csDMARDs and/or corticosteroid therapy during the whole follow-up period. US response was defined for DACTOS score < 3 and US remission for DACTOS score = 0. Results At T3 evaluation the ST group showed a significantly higher persistence (grade > 1) of FT and STO (p < 0.001 for all) and MCP synovitis (p = 0.001). US remission was achieved only in the LT group (at T3 31% vs. 0, p < 0.001). The percentage of patients with DACTOS < 3 was significantly greater in the LT group compared with ST group, at both T1 (49% vs. 5%, p < 0.001) and T3 evaluation (76% vs. 7%, p < 0.001). In multiple conditional logistic regression analysis, the only factor associated with US remission was LT (T3 odds ratio = 41.21, p < 0.001). Conclusions US confirmed the effectiveness of steroid injection for dactylitis by demonstrating that it involves the resolution of extra-articular inflammation, in particular FT and STO.
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20
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Pustake M, Vidhale T, Nadgire S. Psoriatic Arthritis With Dactylitis: A Case Report and Concise Review of Treatment Options. Cureus 2021; 13:e16966. [PMID: 34527455 PMCID: PMC8419559 DOI: 10.7759/cureus.16966] [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] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
Dactylitis is characterized by generalized swelling of a finger or toe. Though it is commonly seen, the literature on psoriatic dactylitis is scant, with the majority consisting of solitary case reports. The literature on the treatment of dactylitis is considerably more limited. Dactylitis usually responds to non-steroidal anti-inflammatory drugs (NSAIDs) or traditional disease-modifying antirheumatic drugs (DMARDs). Numerous randomized studies have lately shown the effectiveness of different biological agents in the treatment and maintenance of psoriatic arthritis (PsA) and associated dactylitis. In primary care practice, a patient may present with dactylitis without a history of psoriasis. In such cases, an attempt should be made to detect the underlying psoriasis by looking for a psoriatic patch in hidden areas viz. skin folds, groin or scalp. Here, we describe a case of PsA with dactylitis in this case report, with an emphasis on treatment and outcome. We also attempted to focus on the various treatment options for dactylitis.
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Affiliation(s)
- Manas Pustake
- Department of Internal Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Tushar Vidhale
- Department of Internal Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Swastik Nadgire
- Department of Internal Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
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21
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Carriero A, Lubrano E, Picerno V, Padula AA, D'Angelo S. Corticosteroid injection treatment for dactylitis in psoriatic arthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211041864. [PMID: 34471429 PMCID: PMC8404638 DOI: 10.1177/1759720x211041864] [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: 03/30/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Dactylitis – a hallmark clinical feature of psoriatic arthritis (PsA) – that occurs in 30–50% of PsA patients, is a marker of disease severity for PsA progression, an independent predictor of cardiovascular morbidity and impairs the motor functions of PsA patients. There is a paucity of evidence for the treatment due to the absence of randomized controlled trials assessing dactylitis as a primary endpoint and current practice arises from the analysis of dactylitis as a secondary outcome. Corticosteroid (CS) injections for dactylitis in PsA patients are a therapeutic treatment option for patients with isolated dactylitis or for patients with flares in tendon sheaths, despite stable and effective systemic treatment. The aim of this narrative review is to briefly illustrate the clinical aspects of dactylitis in PsA, the imaging and clinimetric tools used to diagnose and monitor dactylitis, the current treatment strategies and principally to provide a comprehensive picture of the clinical efficacy and safety with ultrasound-guide and blind techniques of CS injections for dactylitis in PsA patients.
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Affiliation(s)
- Antonio Carriero
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Via Petrone snc, 85100 Potenza (PZ), Italy
| | - Ennio Lubrano
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Valentina Picerno
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Angela Anna Padula
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Salvatore D'Angelo
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
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22
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Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging. J Clin Med 2021; 10:jcm10122604. [PMID: 34204773 PMCID: PMC8231617 DOI: 10.3390/jcm10122604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023] Open
Abstract
Dactylitis, one of the most typical features of psoriatic arthritis (PsA), is the diffuse swelling of the digits and is determined by the involvement of different anatomic structures, including: the subcutaneous fibrous tissue “accessory pulley” system; flexor tendons, with their related structures; the articular synovium; the small enthesis of the hands. Dactylitis is currently considered both a marker of disease activity and severe prognosis and its importance in PsA is emphasized by the inclusion in the classification criteria of PsA. This review focuses on the role of imaging in the management of PsA patients with dactylitis in clinical practice and in a research setting. Furthermore, imaging could be a valuable tool to assist in unravelling some of the underlying mechanisms of the onset and chronicization of dactylitis in PsA patients.
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23
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Mease PJ, Gladman DD, Deodhar A, McGonagle DG, Nash P, Boehncke WH, Gottlieb A, Xu XL, Xu S, Hsia EC, Karyekar CS, Helliwell PS. Impact of guselkumab, an interleukin-23 p19 subunit inhibitor, on enthesitis and dactylitis in patients with moderate to severe psoriatic arthritis: results from a randomised, placebo-controlled, phase II study. RMD Open 2021; 6:rmdopen-2020-001217. [PMID: 32665433 PMCID: PMC7425189 DOI: 10.1136/rmdopen-2020-001217] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 01/11/2023] Open
Abstract
Objective To evaluate the effect of guselkumab on enthesitis and dactylitis in a phase II trial of patients with active psoriatic arthritis (PsA). Methods This was a phase II, randomised, placebo-controlled, double-blind trial of adults with active PsA (≥3 swollen and ≥3 tender joints and C reactive protein ≥0.3 mg/dL) despite conventional synthetic disease-modifying anti-rheumatic drug, non-steroidal anti-inflammatory drug, and/or oral corticosteroid therapy. Patients were randomised to subcutaneous injections of guselkumab 100 mg or placebo at weeks 0, 4 and every 8 weeks, with placebo crossover to guselkumab at week 24. Dactylitis was scored on a scale of 0–3 on each digit; enthesitis was assessed using the Leeds Enthesitis Index (0–6). Other assessments included American College of Rheumatology (ACR) and Psoriasis Area and Severity Index responses. Results Of 149 randomised patients, 107 patients had enthesitis (mean score=2.7) and 81 patients had dactylitis (mean dactylitis score=5.7) at baseline. Mean improvements in enthesitis and dactylitis at week 24 were greater in the guselkumab group versus placebo and sustained through week 56. Similar results were observed for the proportions of patients with resolution of enthesitis and dactylitis. At week 56, mean improvements in enthesitis and dactylitis among patients who switched from placebo to guselkumab treatment were similar to those in the guselkumab group. In the guselkumab group, ACR20 responders had greater improvements in enthesitis and dactylitis versus non-responders (week 24). Conclusions At week 24, the guselkumab group had greater mean improvements in enthesitis and dactylitis and greater proportions of patients with resolution of enthesitis and dactylitis versus placebo. ACR20 response was associated with improvements in enthesitis and dactylitis. Trial registration number ClinicalTrials.gov: NCT02319759. URL: https://clinicaltrials.gov/ct2/show/NCT02319759; Registered 18 December 2014.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, Washington, USA .,University of Washington, Seattle, Washington, USA
| | | | - Atul Deodhar
- Oregon Health & Science University, Portland, Oregon, USA
| | - Dennis G McGonagle
- Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Peter Nash
- Griffith University School of Medicine, Brisbane, Australia
| | | | - Alice Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, NewYork, NewYork, USA
| | - Xie L Xu
- Janssen Research & Development LLC, La Jolla, California, USA
| | - Stephen Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Elizabeth C Hsia
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA.,University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Philip S Helliwell
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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24
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Kato M, Ikeda K, Sugiyama T, Tanaka S, Iida K, Suga K, Nishimura N, Mimura N, Kasuya T, Kumagai T, Furuya H, Iwamoto T, Iwata A, Furuta S, Suto A, Suzuki K, Kawakami E, Nakajima H. Associations of ultrasound-based inflammation patterns with peripheral innate lymphoid cell populations, serum cytokines/chemokines, and treatment response to methotrexate in rheumatoid arthritis and spondyloarthritis. PLoS One 2021; 16:e0252116. [PMID: 34019595 PMCID: PMC8139502 DOI: 10.1371/journal.pone.0252116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/10/2021] [Indexed: 01/22/2023] Open
Abstract
Objectives We aimed to explore the associations of musculoskeletal inflammation patterns with peripheral blood innate lymphoid cell (ILC) populations, serum cytokines/chemokines, and treatment response to methotrexate in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Methods We enrolled 100 patients with either RA or SpA and performed ultrasound to evaluate power Doppler signals for synovitis (52 joint regions), tenosynovitis (20 tendons), and enthesitis (44 sites). We performed clustering analysis using unsupervised random forest based on the multi-axis ultrasound information and classified the patients into groups. We identified and counted ILC1-3 populations in the peripheral blood by flow cytometry and also measured the serum levels of 20 cytokines/chemokines. We also determined ACR20 response at 3 months in 38 patients who began treatment with methotrexate after study assessment. Results Synovitis was more prevalent and severe in RA than in SpA, whereas tenosynovitis and enthesitis were comparable between RA and SpA. Patients were classified into two groups which represented synovitis-dominant and synovitis-nondominant inflammation patterns. While peripheral ILC counts were not significantly different between RA and SpA, they were significantly higher in the synovitis-nondominant group than in the synovitis-dominant group (ILC1-3: p = 0.0007, p = 0.0061, and p = 0.0002, respectively). On the other hand, clustering of patients based on serum cytokines/chemokines did not clearly correspond either to clinical diagnoses or to synovitis-dominant/nondominant patterns. The synovitis-dominant pattern was the most significant factor that predicted clinical response to methotrexate (p = 0.0065). Conclusions Musculoskeletal inflammation patterns determined by ultrasound are associated with peripheral ILC counts and could predict treatment response to methotrexate.
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Affiliation(s)
- Manami Kato
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
- * E-mail:
| | - Takahiro Sugiyama
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Shigeru Tanaka
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuma Iida
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kensuke Suga
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Nozomi Nishimura
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Norihiro Mimura
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Tadamichi Kasuya
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Takashi Kumagai
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Hiroki Furuya
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Taro Iwamoto
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Arifumi Iwata
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Akira Suto
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kotaro Suzuki
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Eiryo Kawakami
- Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
- Medical Sciences Innovation Hub Program, RIKEN, Wako, Saitama, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
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25
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Tinazzi I, McGonagle D, Macchioni P, Aydin SZ. Power Doppler enhancement of accessory pulleys confirming disease localization in psoriatic dactylitis. Rheumatology (Oxford) 2021; 59:2030-2034. [PMID: 31794000 DOI: 10.1093/rheumatology/kez549] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/09/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The digital accessory pulleys are highly mechanically stressed mini-entheses that are thickened in patients with a history of PsA-related dactylits. This study explored whether these pulleys are involved in PsA dactylitis as assessed by intra-pulley US power Doppler changes. METHODS Fifty-eight PsA patients with dactylitis had US of the second to fourth digits for pulleys of the dactylitic and contralateral digits. The Leeds Dactylometer was used for thickness measurement. The presence of digital pain, tenderness, and swelling in the dactylitis finger and in the contralateral side was evaluated. RESULTS We recruited 34 patients with acute and 24 patients with chronic dactylitis, 45/58 (77%) of which had tenderness on clinical assessment. Intra-pulley power Doppler was more frequently found in the dactylitic digits compared with contralateral sides and linked to A1, A2 and A4 pulleys thickening [power Doppler signals in A1 pulley (51%), A2 (22%) and A4 (12%) in dactylitic digit; compared with 1 A1, A2 and A4 pulleys each in the contralateral side (1.7%)]. Almost all cases had peri-tendinous oedema, and 82.6% of dactylitic digits had flexor tenosynovitis with power Doppler signals in 65.2% of flexor tendons. CONCLUSION Despite their small size and relatively avascular, the accessory pulleys exhibit power Doppler change in active Psoriatic dactylitis, supporting a pivotal role in dactylitis-related tenosynovitis and extra-tendinous disease.
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Affiliation(s)
- Ilaria Tinazzi
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and The University of Leeds, Leeds, UK
| | | | - Sibel Zehra Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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26
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Li KJ, Tsai TF, Lo Y, Wang TS. Correlation of clinical diagnosis of dactylitis by the dermatologist and ultrasonographic diagnosis by the rheumatologist in patients with psoriasis arthritis: Experience of a single clinic. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_53_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Musculoskeletal Ultrasound in Monitoring Clinical Response to Treatment in Acute Symptomatic Psoriatic Dactylitis: Results from a Multicentre Prospective Observational Study. J Clin Med 2020; 9:jcm9103127. [PMID: 32992634 PMCID: PMC7601129 DOI: 10.3390/jcm9103127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023] Open
Abstract
This observational and prospective study evaluated the clinical correlations of sonographic lesions in consecutive psoriatic arthritis (PsA) dactylitis cases. Eighty-three dactylitic digits were evaluated clinically and sonographically before treatment and at one-month (T1) and three-month (T3) follow-up. Clinical evaluation included the Leeds Dactylitis Index-basic (LDI-b) score and the visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). High-frequency ultrasound with grey scale (GS) and power Doppler (PD) assessed flexor tenosynovitis (FT), soft tissue oedema (STO), extensor tendon paratenonitis, and joint synovitis. There was a statistically significant correlation between the clinical parameters (VAS-p, VAS-FI, and LDI-b) and FT and STO at T1 and T3. We found statistically significant improvement in FT and STO for the cases with clinically meaningful treatment responses (p < 0.001). After a multiple conditional logistic regression analysis, the only variables that correlated with a T1 clinical response were the resolutions of PD FT (OR 15.66) and PD STO (OR 6.23), while the resolution of PD FT (OR 27.77) and of GS STO (OR 7.29) correlated with a T3 clinical response. The clinical improvements of active dactylitis are linked to the regression of sonographic evidence of extracapsular inflammation (particularly FT and STO).
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28
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Marzo-Ortega H, Tan AL, McGonagle D, Pickles D, Dubash S, Vandevelde CY, Coates LC, Siebert S, Helliwell PS. BSR Spondyloarthritis Course, 27 February 2020. Spondyloarthritis: pathogenesis, diagnosis and management. Rheumatol Adv Pract 2020; 4:rkaa043. [PMID: 33005861 PMCID: PMC7519775 DOI: 10.1093/rap/rkaa043] [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: 06/18/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
High-quality continuous medical education is essential to maintain excellence in health-care delivery, upskilling professionals and improving patient outcomes. This is particularly relevant when addressing rare disease groups, such as the spondyloarthritides, a group of heterogeneous inflammatory conditions that affect joints and other organs, such as the skin, bowel and eye. Professional bodies, such as the British Society for Rheumatology (BSR), are well placed to deliver this type of education. In 2020, the BSR ran a dedicated SpA course aimed at rheumatology health-care professionals wishing to update their basic knowledge of SpA with a review of the latest advances in the field. Here, we summarize the proceedings of the meeting and discuss the value of such an initiative.
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Affiliation(s)
- Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - David Pickles
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
| | - Sayam Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Claire Y Vandevelde
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Philip S Helliwell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
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29
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Dubash SR, De Marco G, Wakefield RJ, Tan AL, McGonagle D, Marzo-Ortega H. Ultrasound Imaging in Psoriatic Arthritis: What Have We Learnt in the Last Five Years? Front Med (Lausanne) 2020; 7:487. [PMID: 32984374 PMCID: PMC7477070 DOI: 10.3389/fmed.2020.00487] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a complex heterogeneous disease with multiple inter-related pathologies such as synovitis, enthesitis, tendinopathy, and dactylitis. Clinical assessment is limited in its detail to assess pathology, thus in recent years, ultrasound (US) has become more popular, given its high sensitivity to detect inflammatory arthritis and ability to inform clinical decisions. Although a qualitative technique, US findings can be graded semi-quantitatively for grayscale (GS) and power Doppler (PD). Synovitis is frequently present in inflammatory arthritis pathologies, and in PsA, recent evidence shows a propensity for tendon and entheseal lesions. The presence of flexor tenosynovitis and flexor tendon insertional enthesopathy at accessory pulleys is supportive of the “Deep Koebner” concept. Peri-tendinous inflammation—mutual to PsA or rheumatoid arthritis (RA), is associated with soft tissue oedema with PD signal frequently at the flexor tendon compartments in PsA. Research on enthesitis in PsA/PsO has improved understanding in subclinical and clinical PsA, explored associations with progression to PsA, and investigated links to prognosis assessment. Dactylitis is a pathognomonic PsA lesion where US has enhanced knowledge of the disease course and pathology of lesions such as: flexor tenosynovitis; synovitis; and soft tissue oedema. Increased US sensitivity has also brought innovation including promising automated ultrasound scanning techniques. So, what have we learnt in recent years and what are the unmet needs to focus future research initiatives in this disabling disease? This narrative review article assesses the neoteric evidence, bringing into context the knowledge gained and highlighting potential areas of research.
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Affiliation(s)
- Sayam R Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Gabriele De Marco
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Richard J Wakefield
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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30
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Prinz I, Sandrock I, Mrowietz U. Interleukin-17 cytokines: Effectors and targets in psoriasis-A breakthrough in understanding and treatment. J Exp Med 2020; 217:jem.20191397. [PMID: 31727784 PMCID: PMC7037256 DOI: 10.1084/jem.20191397] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
This review summarizes the steps from basic research on IL-17 family cytokines to understanding their role in psoriasis pathogenesis to the approval of a number of monoclonal antibodies targeting IL-17 pathways as first line treatment of psoriasis and psoriatic arthritis. The IL-17 cytokine family comprising IL-17A to IL-17F and receptor subunits IL-17RA to IL-17RE represents a genetically ancient intercellular network regulating local tissue homeostasis. Its pivotal role in antifungal defense and its central position in the pathogenesis of inflammatory diseases including psoriasis were discovered only relatively late in the early 2000s. Since the connection of dysregulated IL-17 and psoriasis pathogenesis turned out to be particularly evident, a number of monoclonal antibodies targeting IL-17 pathways have been approved and are used as first line treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis, and further agents are currently in clinical development.
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Affiliation(s)
- Immo Prinz
- Institute of Immunology, Hannover Medical School, Hannover, Germany.,Centre for Individualized Infection Medicine, Hannover, Germany.,Cluster of Excellence RESIST - Resolving Infection Susceptibility (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Inga Sandrock
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | - Ulrich Mrowietz
- Psoriasis Center at the Department of Dermatology and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
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31
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Zabotti A, Sakellariou G, Tinazzi I, Idolazzi L, Batticciotto A, Canzoni M, Carrara G, De Lucia O, Figus F, Girolimetto N, Macchioni P, McConnell R, Possemato N, Iagnocco A. Novel and reliable DACTylitis glObal Sonographic (DACTOS) score in psoriatic arthritis. Ann Rheum Dis 2020; 79:1037-1043. [PMID: 32430315 DOI: 10.1136/annrheumdis-2020-217191] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Dactylitis is one of the most typical features of psoriatic arthritis (PsA), with a high lifetime prevalence and inclusion in PsA clinical indices. Musculoskeletal ultrasonography (Msk-US) can readily detect inflammatory involvement of finger anatomical structures particular to dactylitis and monitor therapeutic effects. In this study, we aim to identify the characteristic lesions in PsA dactylitis of the hands, assess the reliability of Msk-US in scoring those lesions and develop a DACTylitis glObal Sonographic (DACTOS) score. METHODS After a systematic literature review on the use of Msk-US in PsA dactylitis, 12 rheumatologists participated in a three-round Delphi procedure and consensus meeting to agree on the sonographic elementary lesions characterising dactylitis and on the composition of a global sonographic score. Then, a web-based and a patient-based intra-rater and inter-rater reliability exercise was performed to assess those lesions included in the score. RESULTS DACTOS score was obtained by summing the scores of each lesion selected in the Delphi survey: subcutaneous soft tissue oedema, flexor tenosynovitis, peritendon extensor inflammation and synovitis. The DACTOS score ranges from 0 to 25. In the reliability exercises, we obtained moderate-to-excellent agreement for the sonographic lesions included in the score. CONCLUSIONS The novel DACTOS score is a reliable measure to interpret the multiple characteristic sonographic features of dactylitis. The DACTOS score provides a useful global analysis of dactylitis of the hand and can represent a support to clinical diagnosis as well as a useful tool for the management and research in patients with PsA with dactylitis.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Garifallia Sakellariou
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Luca Idolazzi
- Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Alberto Batticciotto
- Department of Internal Medicine, Rheumatology Unit, ASST-Settelaghi. "Ospedale di Circolo - Fondazione Macchi", Varese, Italy
| | - Marco Canzoni
- Primary Care Department, Local Health Unit (ASL), Rome -1, Rome-4 and Viterbo, Rome, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Orazio De Lucia
- Rheumatology and Orthopedic Department, ASST-Gaetano Pini/CTO Orthopedic and Traumatology Specialist Center, Milan, Italy
| | - Fabiana Figus
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, MFRU, Turin, Italy
| | - Nicolò Girolimetto
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Macchioni
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rebecca McConnell
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Niccolò Possemato
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, MFRU, Turin, Italy
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32
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Girolimetto N, Macchioni P, Citriniti G, Tinazzi I, Bascherini V, Martinis F, Marchetta A, Possemato N, Tasso M, Peluso R, Punzi L, Salvarani C, Scarpa R, McGonagle D, Costa L, Caso F. Effectiveness of steroid injection for hand psoriatic dactylitis: results from a multicentre prospective observational study. Clin Rheumatol 2020; 39:3383-3392. [PMID: 32418040 DOI: 10.1007/s10067-020-05142-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the effectiveness of steroid injection (local treatment, LT) into the digital flexor tendon sheath of dactylitis in psoriatic arthritis (PsA) patients as compared with systemic treatment (ST). METHODS Forty-six PsA patients with a total of 73 dactylitic fingers were assessed in an observational, multicentre, prospective study by the Leeds Dactylitis Index basic (LDI-b) score and evaluated for local pain (visual analogue scale-VAS pain) and functional impairment (VAS-FI). Steroid injection was proposed to all patients. Patients refusing LT were treated with oral NSAIDs. Both the groups continued baseline csDMARDs and/or corticosteroids therapy. The clinical outcomes were measured at baseline, 1 month (T1) and 3 months (T3). RESULTS The reduction of VAS-pain, VAS-FI and LDI-b values was statistically significant higher in the LT group (24 patients, 38 dactylitic fingers) as compared with the ST group (22 patients, 35 dactylitic fingers), both at T1 (p < 0.001, p < 0.001 and p = 0.008, respectively) and at T3 (p < 0.001, p < 0.001 and p < 0.001, respectively). A clinically meaningful treatment response (defined as a contemporary reduction of at least 5 points in VAS-pain and VAS-FI or as values of VAS-pain and VAS-FI were both ≤ 2) was observed at T1 in 33 (87%) digits in LT group and in 6 (17%) digits in ST group (p < 0.001). At T3, clinical response improved significantly in both the groups, with significant difference (94% vs 31%, p < 0.001). CONCLUSIONS For the first time, we show the effectiveness of steroid injection into the digital flexor tendon sheath in improving clinical aspects of hand psoriatic dactylitis. Key Points • Therapy with steroid injection (local treatment, LT), into the digital flexor tendon sheath for the treatment of active dactylitis in psoriatic arthritis patients, is more effective when compared with systemic treatment (ST) alone. • The reduction of VAS-pain, VAS-functional impairment (VAS-FI) and Leeds Dactylitis Index basic values was statistically significant higher in the LT group as compared with the ST group, both at T1and at T3. • A clinically meaningful response was observed at T1 in 87% of digits of patients treated with steroid injection and in 17% of digits of the systemic treatment group (p < 0.001). At T3, clinical response improved significantly in both the groups, with significant difference. • For the first time, findings from this study show that the use of steroid injections into the digital flexor tendon sheath for psoriatic dactylitis could be an effective and safe first-line therapy for psoriatic dactylitis.
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Affiliation(s)
- Nicolò Girolimetto
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy.,Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Macchioni
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Citriniti
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Vittoria Bascherini
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy
| | - Federica Martinis
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Antonio Marchetta
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Niccolò Possemato
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy
| | - Leonardo Punzi
- Centre for Gout and Metabolic Bone and Joint Diseases, Rheumatology, SS Giovanni and Paolo, Venice, Italy
| | - Carlo Salvarani
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy.
| | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, Leeds, UK
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy
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Vieira-Sousa E, Alves P, Rodrigues AM, Teixeira F, Tavares-Costa J, Bernardo A, Pimenta S, Pimentel-Santos FM, Gomes JL, Aguiar R, Pinto P, Videira T, Catita C, Santos H, Borges J, Sequeira G, Ribeiro C, Teixeira L, Ávila-Ribeiro P, Martins FM, Canhão H, McInnes IB, Ribeiro RM, Fonseca JE. GO-DACT: a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis. Ann Rheum Dis 2020; 79:490-498. [PMID: 32193187 PMCID: PMC7147178 DOI: 10.1136/annrheumdis-2019-216500] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 11/16/2022]
Abstract
Objectives To assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis. Methods Multicentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint. Results Twenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy. Conclusions The combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis. Trial registration number NCT02065713
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Affiliation(s)
- Elsa Vieira-Sousa
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal .,Rheumatology Department, Hospital de Santa Maria, Lisboa, Portugal
| | - Pedro Alves
- Radiology Department, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
| | - Ana M Rodrigues
- Rheumatology Unit, Hospital de Santo Espirito da Ilha Terceira EPER, Angra do Heroismo, Ilha Terceira, Portugal.,Comprehensive Health Research Center (CHRC), Lisbon, Portugal.,EpiDoc Unit, CEDOC, Nova Medical School, Lisbon, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho EPE, Ponte de Lima, Portugal
| | - Jose Tavares-Costa
- Rheumatology Department, Unidade Local de Saúde do Alto Minho EPE, Ponte de Lima, Portugal
| | - Alexandra Bernardo
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sofia Pimenta
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando M Pimentel-Santos
- Rheumatology Department, Hospital de Egas Moniz, Lisboa, Portugal.,Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | - Renata Aguiar
- Rheumatology Department, Hospital Infante Dom Pedro, Aveiro, Portugal
| | - Patrícia Pinto
- Rheumatology Department, Hospital Centre of Vila Nova de Gaia Espinho, Vila Nova de Gaia, Porto, Portugal
| | - Taciana Videira
- Rheumatology Department, Hospital Centre of Vila Nova de Gaia Espinho, Vila Nova de Gaia, Porto, Portugal
| | - Cristina Catita
- Rheumatology Clinic, Hospital Particular do Algarve, Faro, Portugal
| | - Helena Santos
- Rheumatology Department, Instituto Português de Reumatologia, Lisboa, Portugal
| | - Joana Borges
- Rheumatology Department, Instituto Português de Reumatologia, Lisboa, Portugal
| | - Graça Sequeira
- Rheumatology Department, Centro Hospitalar Universitário do Algarve EPE, Faro, Portugal
| | - Célia Ribeiro
- Rheumatology Department, Centro Hospitalar Universitário do Algarve EPE, Faro, Portugal
| | - Lídia Teixeira
- Rheumatology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Pedro Ávila-Ribeiro
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.,Rheumatology Department, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Helena Canhão
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal.,EpiDoc Unit, CEDOC, Nova Medical School, Lisbon, Portugal
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Ruy M Ribeiro
- Laboratório de Biomatemática, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.,Rheumatology Department, Hospital de Santa Maria, Lisboa, Portugal
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34
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Stoll ML, Mellins ED. Psoriatic arthritis in childhood: A commentary on the controversy. Clin Immunol 2020; 214:108396. [PMID: 32229291 DOI: 10.1016/j.clim.2020.108396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/28/2022]
Abstract
Approximately 5% of children with juvenile idiopathic arthritis (JIA) are diagnosed with the psoriatic form of the disease. In recent years, there has been substantial scholarship demonstrating both heterogeneity within the disease as well as similarities with other forms of JIA, culminating in a recent proposal for the categorization of JIA that excluded the psoriatic form altogether. The purpose of the review is to summarize the clinical, epidemiologic, and genetic features of psoriatic JIA (PsJIA), comparing it with other categories of JIA including spondyloarthritis. We conclude that there are sufficient unique clinical and genetic features within PsJIA as well as similarities with its adult counterpart that warrant including it within the JIA paradigm.
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Affiliation(s)
- Matthew L Stoll
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7(th) Avenue South, Children's Park Place North Suite G10, Birmingham, AL 35233, USA.
| | - Elizabeth D Mellins
- Department of Pediatrics, Program in Immunology, Stanford University, 269 Campus Drive, CCSR Rm 2105c, Stanford, CA 94305-5164, USA.
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35
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Baraliakos X, Kleyer A, Simon D, Köhm M, Ohrndorf S, Sewerin P. [Imaging of psoriatic arthritis and aspects of radiographic progression]. Z Rheumatol 2020; 79:40-52. [PMID: 31822993 DOI: 10.1007/s00393-019-00735-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous multifactorial disease with musculoskeletal involvement, which can be manifested as monoarthritis, oligoarthritis or polyarthritis and in some patients can also affect the axial skeleton. The most frequent indications of inflammation are bone marrow edema and enthesitis. The early and differential diagnosis of PsA is a clinical challenge, particularly as a differential diagnosis from other inflammatory or degenerative diseases of joints. Inflammatory joint and tendon alterations in the region of the extremities and the spine can be visualized with high sensitivity by the use of magnetic resonance imaging (MRI), musculoskeletal sonography (US) and fluorescence optical imaging (FOI). The use of MRI has a prognostic value with respect to the further radiographic course of the disease, particularly in the initial stages of the disease. Structural damage can be specifically and also partially demonstrated 3‑dimensionally in peripheral joints and the spine by the use of computed tomography (CT) and conventional X‑ray imaging. High-resolution peripheral quantitative CT (HR-pQCT) in particular, can visualize pathophysiological processes and the morphological consequences even in early stages of the disease. The values of conventional X‑ray diagnostics, CT, MRI, musculoskeletal US and alternative imaging procedures are presented with respect to the diagnostics and prognosis of the progression of patients with PsA.
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Affiliation(s)
- X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - A Kleyer
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - D Simon
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - M Köhm
- Rheumatologie und Fraunhofer IME Institutsteil TMP, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - S Ohrndorf
- Med. Klinik mit SP Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - P Sewerin
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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36
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Hamard A, Burns R, Miquel A, Sverzut JM, Chicheportiche V, Wybier M, Bousson V. Dactylitis: A pictorial review of key symptoms. Diagn Interv Imaging 2020; 101:193-207. [PMID: 32001209 DOI: 10.1016/j.diii.2020.01.005] [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: 09/13/2019] [Revised: 12/21/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Dactylitis refers to a global swelling of a finger or a toe giving it a clinical sausage-shape presentation. It is an extremely suggestive symptom as it guides the rheumatologist towards a shortlist of diagnoses. However, radiologists are less familiar with dactylitis. The aim of this review is to detail and illustrate the main causes of dactylitis using standard X-ray imaging, ultrasound, computed tomography and magnetic resonance imaging in order to make radiologists more familiar with this symptom by illustrating the various conditions that are associated with dactylitis including infection, peripheral spondyloarthritis, sarcoidosis, microcrystalline deposition, osteoid osteoma, and sickle cell disease.
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Affiliation(s)
- A Hamard
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France; Department of Radiology, EA 2415, Medical Imaging Group, Nimes University Hospital, 30029 Nîmes, France.
| | - R Burns
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - A Miquel
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - J M Sverzut
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - V Chicheportiche
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - M Wybier
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France
| | - V Bousson
- Department of Radiology, Lariboisiere Hospital, AP-HP, 75010 Paris, France; Université de Paris, Diderot Paris 7, B30A CNRS UMR 7052, 75010 Paris, France
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37
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Zabotti A, McGonagle DG, Giovannini I, Errichetti E, Zuliani F, Zanetti A, Tinazzi I, De Lucia O, Batticciotto A, Idolazzi L, Sakellariou G, Zandonella Callegher S, Sacco S, Quartuccio L, Iagnocco A, De Vita S. Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia. RMD Open 2019; 5:e001067. [PMID: 31749987 PMCID: PMC6827749 DOI: 10.1136/rmdopen-2019-001067] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 01/21/2023] Open
Abstract
Objective Non-specific musculoskeletal pain is common in subjects destined to develop psoriatic arthritis (PsA). We evaluated psoriatic patients with arthralgia (PsOAr) compared with psoriasis alone (PsO) and healthy controls (HCs) using ultrasonography (US) to investigate the anatomical basis for joint symptoms in PsOAr and the link between these imaging findings and subsequent PsA transition. Methods A cross-sectional prevalence analysis of clinical and US abnormalities (including inflammatory and structural lesions) in PsOAr (n=61), PsO (n=57) and HCs (n=57) was performed, with subsequent prospective follow-up for PsA development. Results Tenosynovitis was the only significant sonographic feature that differed between PsOAr and PsO (29.5% vs 5.3%, p<0.001), although synovitis and enthesitis were numerically more frequent in PsOAr. Five patients in PsOAr and one in PsO group developed PsA, with an incidence rate of 109.2/1000 person-years in PsOAr vs 13.4/1000 person-years in PsO (p=0.03). Visual Analogue Scale pain, Health Assessment Questionnaire, joint tenderness and US active enthesitis were baseline variables associated with PsA development. Conclusion Tenosynovitis was associated with arthralgia in subjects with psoriasis. Baseline US evidence of enthesitis was associated with clinical PsA development in the longitudinal analysis. These findings are relevant for enriching for subjects at risk of imminent PsA development.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Dennis G McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Enzo Errichetti
- Institute of Dermatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Francesca Zuliani
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Orazio De Lucia
- Rheumatology and Orthopedic Department, ASST-Gaetano Pini/CTO Orthopedic and Traumatology Specialist Center, Milan, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi. "Ospedale di Circolo - Fondazione Macchi", Varese, Italy
| | - Luca Idolazzi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Garifallia Sakellariou
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Stefania Sacco
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
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38
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Murakami S, Nagano T, Nakata K, Onishi A, Umezawa K, Katsurada N, Yamamoto M, Tachihara M, Kobayashi K, Nishimura Y. Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review. Intern Med 2019; 58:2839-2843. [PMID: 31243239 PMCID: PMC6815895 DOI: 10.2169/internalmedicine.2556-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A 51-year-old man underwent second-line treatment for non-small-cell lung cancer (NSCLC) with the immune checkpoint inhibitor (ICI) pembrolizumab. On day 2 after two cycles of pembrolizumab, he presented with edema limited to the left third, fourth, and fifth fingers. Based on symptoms, laboratory results, and contrast-enhanced magnetic resonance imaging (MRI) findings, we diagnosed him with tenosynovitis. We prescribed oral prednisolone (0.5 mg/kg/day), and pembrolizumab was continued. Prednisolone immediately relieved the symptoms, and the tumor was still shrinking on day 21 after eight cycles of pembrolizumab. ICI-induced tenosynovitis was managed while continuing ICI usage, suggesting that 0.5 mg/kg/day prednisone might be effective for tenosynovitis without ICI cessation.
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Affiliation(s)
- Shoko Murakami
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Kyosuke Nakata
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Akira Onishi
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan
| | - Kanoko Umezawa
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Naoko Katsurada
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Masatsugu Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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39
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Girolimetto N, Macchioni P, Tinazzi I, Costa L, Peluso R, Tasso M, Bascherini V, Addimanda O, Marchetta A, Possemato N, Salvarani C, McGonagle D, Scarpa R, Caso F. Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis: results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis. Clin Rheumatol 2019; 39:1157-1165. [PMID: 31302859 DOI: 10.1007/s10067-019-04683-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/19/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite diffuse digital swelling, dactylitis may sometimes be asymptomatic. The objective of this study was to compare the clinical and ultrasonographic features of symptomatic with asymptomatic psoriatic arthritis (PsA) dactylitis. METHODS One hundred and twenty-five hand dactylitis were evaluated in a multicenter cross-sectional study for the presence of pain, subjective functional limitation, and tenderness (4-points scale) with the calculation of a Leeds Dactylitis Index (LDI) score. Fingers were subsequently investigated using high-frequency ultrasound (US) both in gray-scale (GS) and power Doppler (PD), for the presence and grading of flexor tenosynovitis, soft tissue edema, subcutaneous PD signal (PDUS), extensor tendon involvement, and joints synovitis. Clinical and US characteristics of symptomatic dactylitic fingers were compared with the asymptomatic dactylitic ones. RESULTS Symptomatic fingers (n = 80) had a significantly lower dactylitis duration compared to asymptomatic fingers (n = 36) (p < 0.001). Values of LDI, patient VAS-pain, and VAS-functional score were significantly higher in fingers with symptomatic dactylitis (p < 0.001 and p = 0.010, respectively). Symptomatic dactylitis had a higher prevalence of flexor tenosynovitis of grade > 2, soft tissue edema and subcutaneous PDUS signal (p < 0.001). Asymptomatic dactylitis showed a greater prevalence of joint synovitis (both in GS and in PD) than symptomatic dactylitis (p < 0.001). CONCLUSIONS Digital tenderness and pain are linked to US tenosynovitis of grade > 2 and extra synovial abnormalities and conversely asymptomatic dactylitis is associated with joint-based synovitis.Key Points• Digital tenderness and local pain in psoriatic arthritis dactylitis are strongly associated with flexor tenosynovitis of grade> 2, soft tissue edema, and subcutaneous PD signal.• In psoriatic arthritis, asymptomatic dactylitis showed a greater prevalence of joint synovitis than symptomatic dactylitis.• In psoriatic arthritis, ultrasound inflammatory abnormalities are present in about 70% of cold dactylitis which is linked for disease chronicity.• In psoriatic arthritis, the flexor tendon and adjacent soft tissues play a significant role in symptomatic dactylitis.
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Affiliation(s)
- Nicolò Girolimetto
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Pierluigi Macchioni
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Tinazzi
- Rheumatology Unit, Ospedale Sacro Cuore, Negrar, Verona, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Vittoria Bascherini
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Olga Addimanda
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Niccolò Possemato
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, Leeds, UK
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy.
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
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Chimenti MS, Triggianese P, De Martino E, Conigliaro P, Fonti GL, Sunzini F, Caso F, Perricone C, Costa L, Perricone R. An update on pathogenesis of psoriatic arthritis and potential therapeutic targets. Expert Rev Clin Immunol 2019; 15:823-836. [PMID: 31177868 DOI: 10.1080/1744666x.2019.1627876] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Innate immune response and bone remodeling are key factors contributing to the pathogenesis of psoriatic arthritis (PsA). Moreover, the evidence of autoantibodies in patients' sera suggests an autoimmune side in PsA. Besides the immune pathways, studies strongly support the role of genetic risk alleles in affecting the clinical heterogeneity of PsA as well as the response to therapy. A good clinical response to treatment, indeed, represents a challenge in PsA patients and the identification of patient-targeted therapies is still a critical issue. Areas covered: We performed a systematic review aiming at describing new evidence on PsA pathogenesis and treatments. Reported items for systematic reviews (PRISMA checklist) were analyzed. Studies included from the PubMed database addressed the following items: innate immunity, autoimmunity, bone remodeling, and therapeutic targets in PsA; time frame of research 1970-2019. Specifically, we reviewed data on IL-17 inhibitors, abatacept, JAK inhibitors, ABT 122, and A (3) adenosine receptors agonist, CF101. Expert opinion: In PsA an intriguing pathogenetic network has been documented. Several biological and synthetic drugs are promising in terms of efficacy and safety profile.
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Affiliation(s)
- Maria Sole Chimenti
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Paola Triggianese
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Erica De Martino
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Paola Conigliaro
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Giulia Lavinia Fonti
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Flavia Sunzini
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Francesco Caso
- b Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University Federico II , Naples , Italy
| | - Carlo Perricone
- c Arthritis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome , Rome , Italy
| | - Luisa Costa
- b Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University Federico II , Naples , Italy
| | - Roberto Perricone
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
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The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study. Nutrients 2019; 11:nu11030601. [PMID: 30871045 PMCID: PMC6471071 DOI: 10.3390/nu11030601] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 12/31/2022] Open
Abstract
Intermittent circadian fasting, namely Ramadan, is a common worldwide practice. Such fasting has a positive impact on psoriasis, but no data exist on its role in psoriatic arthritis (PsA)—a disease that is clearly linked to body mass index. We enrolled 37 patients (23 females and 14 males) with a mean age 43.32 ± 7.81 and they fasted for 17 h for one month in 2016. The baseline PsA characteristics were collected and 12 (32.4%) patients had peripheral arthritis, 13 (35.1%) had axial involvement, 24 (64.9%) had enthesitis, and 13 (35.1%) had dactylitis. Three patients (8.1%) were treated with methotrexate, 28 (75.7%) with TNF-α blockers, and 6 (16.2%) with IL-17 blockers. After a month of intermittent fasting, C-reactive protein (CRP) levels decreased from 14.08 ± 4.65 to 12.16 ± 4.46 (p < 0.0001), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) decreased from 2.83 ± 1.03 to 2.08 ± 0.67 (p = 0.0078), Psoriasis Area Severity Index (PASI) decreased from 7.46 ± 2.43 to 5.86 ± 2.37 (p < 0.0001), and Disease Activity index for PSoriatic Arthritis (DAPSA) decreased from 28.11 ± 4.51 to 25.76 ± 4.48 (p < 0.0001). Similarly, enthesitis improved after fasting, with Leeds Enthesitis Index (LEI) decreasing from 2.25 ± 1.11 to 1.71 ± 0.86 (p < 0.0001) and dactylitis severity score (DSS) decreasing from 9.92 ± 2.93 to 8.54 ± 2.79 (p = 0.0001). Fasting was found to be a predictor of a decrease in PsA disease activity scores (DAPSA, BASDAI, LEI, DSS) even after adjustment for weight loss. IL-17 therapy was found to be an independent predictor of decreases in LEI after fasting. These preliminary data may support the use of chronomedicine in the context of rheumatic diseases, namely PsA. Further studies are needed to support our findings.
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