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Luchetti Gentiloni MM, Paci V, Cimaroli I, Agostinelli A, Giannoni M, Campanati A, Diotallevi F, Carotti M, Sessa F, Sordillo R, Macchini C, Fiorini F, Massaccesi L, Ciferri M, Gigli M, Marconi V, Perini L, Marani A, Giovagnoni A, Polonara G, Offidani AM, Benfaremo D, Proft F, Poddubnyy D, Moroncini G. The ATTRACT study: screening for the early identification of axial psoriatic arthritis in a cohort of Italian psoriatic patients. Rheumatology (Oxford) 2024; 63:2152-2161. [PMID: 37878802 PMCID: PMC11292137 DOI: 10.1093/rheumatology/kead566] [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: 08/11/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE There is growing interest in the early identification of patients with axial PsA (axPsA). We aimed to evaluate whether a dermatology-based screening strategy could help to identify axPsA patients. METHODS The dermatologist-centred screening (DCS) questionnaire was administrated by dermatologists to consecutive patients fulfilling the inclusion criteria [(i) age ≥18 years and (ii) clinical diagnosis of psoriasis made by a dermatologist] to identify patients eligible (affirmative answers 1-3c of the DCS) for rheumatological evaluation. Clinical, laboratory, genetic and imaging data were collected from all referred patients. RESULTS Among the 365 patients screened, 265 fulfilled the inclusion criteria and 124/265 (46.8%) were eligible for rheumatological referral. Diagnosis of axPsA, with or without peripheral PsA (pPsA), was made in 36/124 (29.0%) patients; pPsA without axial involvement was found in 21/124 (16.9%) patients. Back pain at screening was recorded in 174 (66%) patients, with 158 (60%) reporting a back pain duration longer than 3 months and 140 (53%) reporting back pain onset before the age of 45 years. Active inflammatory and/or structural post-inflammatory changes in the sacroiliac joints and/or spine were observed in all axPsA patients. Patients with PsA showed a numerically longer duration of back pain and higher CRP levels in comparison with patients with psoriasis without PsA. CONCLUSION The DCS tool proved to be a valuable screening strategy for detecting and characterizing patients with axPsA in a real-life cohort of psoriasis patients in a dermatological setting and helped to identify a substantial number of patients affected by undiagnosed pPsA.
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Affiliation(s)
| | - Valentino Paci
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Ilaria Cimaroli
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Alice Agostinelli
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Melania Giannoni
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Anna Campanati
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Federico Diotallevi
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Marina Carotti
- Radiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Sessa
- Neuroradiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Raffaella Sordillo
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Cristina Macchini
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Federico Fiorini
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Leonardo Massaccesi
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Monia Ciferri
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Marco Gigli
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Valentina Marconi
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Lucia Perini
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Internal Medicine Residency Programme, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Andrea Marani
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Andrea Giovagnoni
- Radiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Gabriele Polonara
- Neuroradiology Clinic, Department of Radiological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Anna Maria Offidani
- Dermatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Devis Benfaremo
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin, Berlin, Germany
| | - Gianluca Moroncini
- Medical Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
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Baraliakos X, Pournara E, Coates LC, Navarro-Compán V, Blanco R, O’Brien E, Schulz B, Landewe R. Magnetic resonance imaging characteristics in patients with psoriatic arthritis and axial manifestations from the MAXIMISE cohort. Rheumatology (Oxford) 2024; 63:85-92. [PMID: 37094184 PMCID: PMC10765145 DOI: 10.1093/rheumatology/kead162] [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: 11/23/2022] [Revised: 02/23/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE The current analysis of the MAXIMISE trial was conducted to investigate the presence of post-inflammatory and degenerative spinal changes and inflammatory changes in spinal processes identified in baseline MRIs and their potential for predicting differential treatment effects in a cohort of PsA patients with axial manifestations. METHODS Baseline spinal MRIs from the MAXIMISE trial were re-read to identify additional inflammatory (spinal process), post-inflammatory, and degenerative changes, and investigate the differential treatment effect of these imaging features using logistic regression modelling. RESULTS In addition to bone marrow oedema assessed at primary analysis, spinal process inflammation and post-inflammatory changes evaluated by FAt Spondyloarthritis Spine Score were documented in 11.1% and 20.2% patients, respectively. At least one type of degenerative change was noted in 64% patients, with Pfirrmann grade ≥3 (51.1%) being the most common. Combining primary and re-read MRI findings, 67.1% of patients presented with inflammatory or post-inflammatory changes while 21.2% had degenerative changes alone. Although not statistically significant, post-inflammatory changes were associated with a trend for better efficacy outcomes in terms of ASAS20, ASAS40 and BASDAI50 responses; a trend for worse outcomes was observed in the presence of degenerative changes. CONCLUSION The current analysis revealed the occurrence of additional inflammatory and post-inflammatory changes suggestive of axial PsA (axPsA) and a trend for better clinical outcomes for patients treated with secukinumab. These results elucidate the imaging characteristics and improve our current understanding of axPsA thereby supporting the interpretation of future trials. TRIAL REGISTRATION ClinicalTrials.gov, NCT02721966.
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Affiliation(s)
| | - Effie Pournara
- Novartis Pharma AG, Immunology, Hepatology and Dermatology, Basel, Switzerland
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Ricardo Blanco
- Divisions of Immunology, Endocrinology, and Rheumatology, Hospital University Marqués de Valdecilla, Santander, Spain
| | | | - Barbara Schulz
- Novartis Pharma AG, Immunology, Hepatology and Dermatology, Basel, Switzerland
| | - Robert Landewe
- Department of Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Pascu LS, Sârbu N, Brădeanu AV, Jicman (Stan) D, Matei MN, Sârbu MI, Voinescu DC, Nechita A, Tatu AL. MRI Findings in Axial Psoriatic Spondylarthritis. Diagnostics (Basel) 2023; 13:diagnostics13071342. [PMID: 37046559 PMCID: PMC10093281 DOI: 10.3390/diagnostics13071342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
Psoriatic arthritis is a significant medical condition with a high prevalence, a wide variety of non-specific symptoms, and a high degree of overlap with other spondylarthritis disorders, particularly ankylosing spondylitis. Hence, knowledge of the magnetic resonance imaging (MRI) manifestations and a multidisciplinary strategy are required for the better management of these patients. We searched publications from the last 10 years and focused on the most relevant ones which discussed the classification criteria, the MRI characteristics of axial psoriatic arthritis, the importance of MRI for follow up, and the reliability of skin and synovial biopsy. Axial spondylarthritis can be diagnosed and followed up on using the well-established MRI technique and, additionally, a biopsy. The analysis and concordance between them can provide new directions for future studies.
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Affiliation(s)
| | - Nicolae Sârbu
- “Sf. Ioan” Clinical Emergency Children Hospital, 800487 Galati, Romania
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Andrei Vlad Brădeanu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
- “Sf. Andrei” Emergency County Clinical Hospital, 177 Brailei st, 800578 Galati, Romania
| | - Daniela Jicman (Stan)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Madalina Nicoleta Matei
- “Sf. Ioan” Clinical Emergency Children Hospital, 800487 Galati, Romania
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Mihaela Ionela Sârbu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Doina Carina Voinescu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
- “Sf. Andrei” Emergency County Clinical Hospital, 177 Brailei st, 800578 Galati, Romania
| | - Aurel Nechita
- “Sf. Ioan” Clinical Emergency Children Hospital, 800487 Galati, Romania
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Alin Laurențiu Tatu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
- Infectious Diseases Dermatology Department, “Sf. Parascheva” Infectious Diseases Clinical Hospital, 800179 Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR, 800008 Galati, Romania
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Sen R, Kim E, Napier RJ, Cheng E, Fernandez A, Manning ES, Anderson ER, Maier KD, Hashim M, Kerr GS, Fang MA, Hou JK, Chang E, Walsh JA, Raychadhuri SP, Reimold A, Caplan L. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Biomarkers in Axial Spondyloarthritis: Observational Studies From the Program to Understand the Longterm Outcomes in Spondyloarthritis Registry. Arthritis Rheumatol 2023; 75:232-241. [PMID: 36053919 PMCID: PMC9892177 DOI: 10.1002/art.42333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/30/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study was conducted to assess the utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting radiographic sacroiliitis and active disease in axial spondyloarthritis (SpA) and to explore the association between use of a tumor necrosis factor inhibitor (TNFi) and these laboratory values compared with traditional inflammatory markers. METHODS Observational data from the Program to Understand the Longterm Outcomes in Spondyloarthritis (PULSAR) registry were analyzed. We generated receiver operating characteristic curves to calculate laboratory cutoff values; we used these values in multivariable logistic regression models to identify associations with radiographically confirmed sacroiliitis and active disease. We also used logistic regression to determine the likelihood of elevated laboratory values after initiation of TNFi. RESULTS Most study participants (n = 354) were White, male, and HLA-B27 positive. NLR (odds ratio [OR] 1.459, P = 0.034), PLR (OR 4.842, P < 0.001), erythrocyte sedimentation rate (OR 4.397, P < 0.001), and C-reactive protein (CRP) level (OR 2.911, P = 0.001) were independent predictors of radiographic sacroiliitis. Models that included PLR with traditional biomarkers performed better than those with traditional biomarkers alone. NLR (OR 6.931, P = 0.002) and CRP (OR 2.678, P = 0.004) were predictors of active disease, but the model that included both NLR and CRP performed better than CRP alone. TNFi use reduced the odds of elevated NLR (OR 0.172, P < 0.001), PLR (OR 0.073, P < 0.001), erythrocyte sedimentation rate (OR 0.319, P < 0.001), and CRP (OR 0.407, P < 0.001), but models that included NLR or PLR and traditional biomarkers performed best. CONCLUSIONS These findings demonstrate an association between NLR and PLR and sacroiliitis and disease activity, with NLR and PLR showing response after TNFi treatment and adding useful clinical information to established biomarkers, thus perhaps assisting in management of axial SpA.
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Affiliation(s)
- Rouhin Sen
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Emmeline Kim
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Ruth J Napier
- Portland VAMC and Oregon Health Sciences University, Portland
| | - Elizabeth Cheng
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Andrea Fernandez
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Evan S Manning
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | | | - Kyle D Maier
- San Antonio Military Medical Center, San Antonio, Texas
| | - Mena Hashim
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
| | - Gail S Kerr
- Georgetown University Hospital, Howard University Hospital, and Washington DC VAMC, Washington, DC
| | - Meika A Fang
- West Los Angeles VAMC, and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason K Hou
- Houston VAMC and Baylor College of Medicine, Houston, Texas
| | | | - Jessica A Walsh
- Salt Lake City VAMC and University of Utah Hospital, Salt Lake City
| | | | - Andreas Reimold
- Dallas VAMC and University of Texas Southwestern Medical Center, Dallas
| | - Liron Caplan
- Rocky Mountain Regional VAMC, and University of Colorado School of Medicine, Denver, Colorado
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5
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Gubar EE, Korotaeva TV. Axial involvement in psoriatic arthritis. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-546-560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Among the variety of clinical manifestations of psoriatic arthritis (PsA) – including peripheral arthritis, dactylitis, enthesitis, and axial disease – spondylitis is the least studied. There is no generally accepted definition of axial PsA (axPsA), nor is there any common terminology or diagnostic criteria for it. In the rheumatology community, there is also no consensus regarding radiological and MRI assessment of axial involvement in PsA patients, while disease activity indexes and the therapeutic tactics are borrowed from those used in treating axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS). However, despite a range of similarities in immunopathogenetic mechanisms of axPsA and axSpA, there are also certain differences that may affect the treatment response in these patients. The aim of this review is the analysis of data on axial disease in PsA. The article discusses the genetic features, clinical presentations, imaging techniques, differential diagnostics and treatment options of axPsA.
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Affiliation(s)
- E. E. Gubar
- V.A. Nasonova Research Institute of Rheumatology
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Diaz P, Feld J, Eshed I, Eder L. Characterising axial psoriatic arthritis: correlation between whole spine MRI abnormalities and clinical, laboratory and radiographic findings. RMD Open 2022; 8:rmdopen-2021-002011. [PMID: 35074901 PMCID: PMC8788330 DOI: 10.1136/rmdopen-2021-002011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the prevalence of inflammatory and structural lesions using whole spine MRI in patients with psoriatic disease, and to assess their correlation with clinical features and with axial spondyloarthritis (axSpA) classification criteria. METHODS This retrospective analysis included patients with whole spine and sacroiliac joints (SIJ) MRI, selected from 2 populations: (1) active psoriatic arthritis (PsA), irrespective of axial symptoms; (2) psoriasis with confirmed or suspected PsA and axSpA symptoms. MRI spondylitis and/or sacroiliitis (MRI-SpA) was defined according to Assessment of Spondyloarthritis International Society (ASAS) consensus and by radiologist impression. Agreement between MRI-SpA and different inflammatory back pain (IBP) definitions (Berlin/ASAS/rheumatologist criteria) and the axSpA classification criteria were calculated considering MRI as gold standard. Logistic regression determined MRI-SpA-associated factors. RESULTS 93 patients were analysed (69.9% PsA; 30.1% psoriasis). Back pain was present in 81.7%, defined as IBP in 36.6%-57%. MRI-SpA was found in 9.7% of patients by ASAS definition and in 12.9% by radiologist impression, of which 25% had isolated spondylitis.Low agreement was found between the three IBP definitions and MRI-SpA. Rheumatologist criteria was the most sensitive (50%-55.6%) while ASAS and Berlin criteria were the most specific (61.9%-63%). axSpA criteria had poor sensitivity for MRI-SpA (22.2%-25%). Late onset of back pain or asymptomatic patients accounted for most cases with MRI-SpA not meeting axSpA or IBP criteria. Male sex was associated with MRI-SpA (OR 6.91; 95% CI 1.42 to 33.59) in multivariable regression analysis. CONCLUSION Prevalence of MRI-defined axSpA was low and showed poor agreement with IBP and axSpA criteria.
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Affiliation(s)
- Pamela Diaz
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Departamento de Inmunología Clínica y Reumatología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joy Feld
- Rheumatology Unit, Carmel Hospital, Haifa, Israel
| | - Iris Eshed
- Radiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Lihi Eder
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada .,Women's College Research Institute, Toronto, Ontario, Canada
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Gezer HH, Duruöz MT. The value of SPARCC sacroiliac MRI scoring in axial psoriatic arthritis and its association with other disease parameters. Int J Rheum Dis 2022; 25:433-439. [PMID: 35080124 DOI: 10.1111/1756-185x.14285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to assess patients with axial psoriatic arthritis (AxPsA) using the Canadian Spondyloarthritis Research Consortium (SPARCC) sacroiliac joint (SIJ) scores and to seek correlations between magnetic resonance imaging (MRI) scores and disease characteristics. METHODS Forty PsA patients (32 females, mean age 46.4 years) who had been documented to have active or structural lesions on SIJ MRI were retrospectively evaluated. Disease duration, medications, and disease activity, including Disease Activity in Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), minimal disease activity (MDA), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were recorded. On sacroiliac MRI scans, the SPARCC scores of sacroiliac joint inflammation (SIS) and sacroiliac joint structural damage (SSS) were evaluated. RESULTS The mean disease duration was 51.4 ± 70.4 months. MRI showed active inflammation in 30 patients (75%) and at least 1 structural lesion in 32 patients (92.5%). The most prevalent structural lesion was erosion (82.5%), followed by fat metaplasia (65%), backfill (12.5%), and ankylosis (2.5%). Only fat metaplasia scores were significantly higher in men than in women (P = .007). Of clinical and laboratory parameters, only C-reactive protein (CRP) was significantly higher in the presence of active inflammation (P = .01). The SIS score was significantly correlated with disease duration (r = -.35) and CRP levels (r = .42,). The SSS score was inversely correlated with BASDAI (r = -.37), ASDAS-CRP (r = -.39), and ASDAS - erythrocyte sedimentation rate (r = -.32). The overall SPARCC scores did not differ between patients in DAPSA remission and non-remission and between those in MDA and non-MDA. CONCLUSION Although radiologic involvement is generally not severe in AxPsA, MRI still provides additional information about inflammatory activity and structural lesions. CRP may be helpful in monitoring the radiologic disease activity in AxPsA.
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Affiliation(s)
- Halise Hande Gezer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
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Zeidler HK. Psoriatic Spondylitis: A Disease Manifestation in Debate: Evidences to Know for the Clinical Rheumatologist. J Clin Rheumatol 2022; 28:38-43. [PMID: 34941618 DOI: 10.1097/rhu.0000000000001815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT With the advent of classification criteria for psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), patients with axial manifestations associated with psoriasis, initially described in the l950s as a specific entity termed psoriatic spondylitis (PS), are now categorized within PsA, ankylosing spondylitis (AS), and axSpA. Thus, different terms are used to describe axial disease in patients with PsA including PS, axial psoriatic arthritis (axPsA), and psoriatic spondyloarthritis. Patients with PS may present with inflammatory and/or mechanical back pain, but also may display axial disease on imaging despite not complaining of back pain. Cervical spondylitis has been reported in 35% to 75% of patients with PsA. Axial disease is silent in 20% and 25% of patients with axial PsA and PsA, respectively. The majority of axPsA patients have peripheral arthritis alongside the axial involvement, whereas only 2% to 5% of PsA patients have solely axial arthritis with no peripheral arthritis.A debate is currently underway as to whether inflammatory axial disease and psoriasis represent axSpA with psoriasis or a subset of PsA named axPsA. Studies have recognized that axial disease in PsA patients seems to be different demographically, genetically, clinically, and radiographically when compared with AS with or without psoriasis. This narrative review summarizes current knowledge regarding axial involvement of PsA in terms of history, terminology, classification, epidemiology, clinical presentation, imaging, diagnosis, and treatment, with the aim of providing advice for management of PS in clinical evidence-based practice. Data-driven studies are needed to develop clear, nonoverlapping classification criteria for spinal involvement in PsA.
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9
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Diekhoff T, Lambert R, Hermann KG. MRI in axial spondyloarthritis: understanding an 'ASAS-positive MRI' and the ASAS classification criteria. Skeletal Radiol 2022; 51:1721-1730. [PMID: 35199195 PMCID: PMC9283193 DOI: 10.1007/s00256-022-04018-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
In 2009, the Assessment of SpondyloArthritis international Society (ASAS) published a definition of 'active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis'. This new definition of an 'ASAS-positive MRI' was integral to new classification criteria for axial spondyloarthritis that were published in the same year. The ASAS MRI definition had the considerable advantage of simplicity and the definition gained popularity as guidance for interpreting MRI of the sacroiliac joints in clinical practice. However, classification criteria are not designed for use in clinical practice with the consequence that overreliance on the presence of bone marrow edema, which is the principal determinant of an 'ASAS-positive MRI', may result in a tendency to overcall inflammatory sacroiliitis in the clinical setting. This article aims to inform the reader about the rationale behind the ASAS definition of a positive MRI and ASAS classification criteria, their proper use in research and why they should not be used in clinical practice. The article also contains guidance for an updated imaging protocol and interpretation of images including typical imaging findings, differential diagnosis, and common pitfalls.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Lambert
- Department of Radiology & Diagnostic Imaging, University of Alberta, 2A2.41MC, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Medical Imaging Consultants, 202-11010 - 101 Street, Edmonton, AB, T5H 4B9, Canada
| | - Kay Geert Hermann
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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10
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Trohman RG. My Double Trouble: An Autobiographical Case Report of Psoriasis and Psoriatic Arthritis. Cureus 2021; 13:e20617. [PMID: 34956807 PMCID: PMC8694657 DOI: 10.7759/cureus.20617] [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: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Psoriasis and psoriatic arthritis are overlapping, related, but distinct entities. Each occurs as a result of a complex combination of precipitants, genetic predispositions, and variable expression of a self-sustaining proinflammatory state. My case history and clinical course are outlined below. In addition, the epidemiology, pathogenesis, and the expanding armamentarium of treatment options, including their strengths and weaknesses, are discussed in detail.
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Affiliation(s)
- Richard G Trohman
- Cardiac Electrophysiology, Rush University Medical Center, Chicago, USA
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Ogdie A, Blachley T, Lakin PR, Dube B, McLean RR, Hur P, Mease P. Evaluation of Clinical Diagnosis of Axial Psoriatic Arthritis or Elevated Patient-Reported Spine Pain in CorEvitas' Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol 2021; 49:281-290. [PMID: 34853090 DOI: 10.3899/jrheum.210662] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the presence of axial symptoms in patients with psoriatic arthritis (PsA) and examine differences between those with or without a diagnosis of axial PsA (axPsA). METHODS Patients with PsA at their CorEvitas' (formerly Corrona) Psoriatic Arthritis/Spondyloarthritis Registry enrollment visit were stratified into 4 mutually exclusive groups based on axial manifestations: physician-diagnosed axPsA only (Dx+Sx-), patient-reported elevated spine symptoms only (Dx-Sx+; defined as Bath Ankylosing Spondylitis Disease Activity Index ≥4 and spine pain visual analog scale ≥40), physician-diagnosed and patient-reported (Dx+Sx+), and no axial manifestations (Dx-Sx-). Patient characteristics, disease activity, and patient-reported outcomes (PROs) at enrollment in each axial manifestation group were compared with the Dx-Sx- group. Associations of patient characteristics with the odds of having axial manifestations were estimated using multinomial logistic regression (reference: Dx-Sx-). RESULTS Of 3393 patients included, 226 (6.7%) had Dx+Sx-, 698 (20.6%) had Dx-Sx+, 165 (4.9%) had Dx+Sx+, and 2304 (67.9%) had Dx-Sx-. Patients with Dx-Sx+ or Dx+Sx+ were more frequently women and had a history of depression and fibromyalgia vs patients who had Dx-Sx-. Patients with Dx+Sx- or Dx+Sx+ were more frequently HLA-B27 positive than those with Dx-Sx-. Fibromyalgia was significantly associated with increased odds of Dx+Sx- or Dx+Sx+. Disease activity and PROs were worse in patients with Dx-Sx+ or Dx+Sx+ than in those with Dx-Sx-. CONCLUSION Patients who had self-reported elevated spine symptoms, with or without physician-diagnosed axPsA, had worse quality of life and higher disease activity overall than patients without axial manifestations, suggesting an unmet need in this patient population.
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Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; CorEvitas, LLC, Waltham, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA. Funding: This study was sponsored by CorEvitas, LLC. CorEvitas has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Genentech, Gilead, Janssen, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Sun, and UCB. The design and conduct of the study was a collaborative effort between CorEvitas, LLC, and Novartis Pharmaceuticals Corporation, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data and review and approval of the manuscript. Conflicts of interest: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (Forward), and Novartis (University of Pennsylvania). T. Blachley, P.R. Lakin, B. Dube, and R.R. McLean are employees of CorEvitas, LLC. P. Hur is an employee of Novartis Pharmaceuticals Corporation. P.J. Mease has received research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to: Alexis Ogdie, MD, MSCE, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104;
| | - Taylor Blachley
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; CorEvitas, LLC, Waltham, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA. Funding: This study was sponsored by CorEvitas, LLC. CorEvitas has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Genentech, Gilead, Janssen, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Sun, and UCB. The design and conduct of the study was a collaborative effort between CorEvitas, LLC, and Novartis Pharmaceuticals Corporation, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data and review and approval of the manuscript. Conflicts of interest: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (Forward), and Novartis (University of Pennsylvania). T. Blachley, P.R. Lakin, B. Dube, and R.R. McLean are employees of CorEvitas, LLC. P. Hur is an employee of Novartis Pharmaceuticals Corporation. P.J. Mease has received research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to: Alexis Ogdie, MD, MSCE, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104;
| | - Paul R Lakin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; CorEvitas, LLC, Waltham, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA. Funding: This study was sponsored by CorEvitas, LLC. CorEvitas has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Genentech, Gilead, Janssen, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Sun, and UCB. The design and conduct of the study was a collaborative effort between CorEvitas, LLC, and Novartis Pharmaceuticals Corporation, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data and review and approval of the manuscript. Conflicts of interest: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (Forward), and Novartis (University of Pennsylvania). T. Blachley, P.R. Lakin, B. Dube, and R.R. McLean are employees of CorEvitas, LLC. P. Hur is an employee of Novartis Pharmaceuticals Corporation. P.J. Mease has received research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to: Alexis Ogdie, MD, MSCE, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104;
| | - Blessing Dube
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; CorEvitas, LLC, Waltham, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA. Funding: This study was sponsored by CorEvitas, LLC. CorEvitas has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Genentech, Gilead, Janssen, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Sun, and UCB. The design and conduct of the study was a collaborative effort between CorEvitas, LLC, and Novartis Pharmaceuticals Corporation, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data and review and approval of the manuscript. Conflicts of interest: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (Forward), and Novartis (University of Pennsylvania). T. Blachley, P.R. Lakin, B. Dube, and R.R. McLean are employees of CorEvitas, LLC. P. Hur is an employee of Novartis Pharmaceuticals Corporation. P.J. Mease has received research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to: Alexis Ogdie, MD, MSCE, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104;
| | - Robert R McLean
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; CorEvitas, LLC, Waltham, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA. Funding: This study was sponsored by CorEvitas, LLC. CorEvitas has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Genentech, Gilead, Janssen, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Sun, and UCB. The design and conduct of the study was a collaborative effort between CorEvitas, LLC, and Novartis Pharmaceuticals Corporation, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data and review and approval of the manuscript. Conflicts of interest: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (Forward), and Novartis (University of Pennsylvania). T. Blachley, P.R. Lakin, B. Dube, and R.R. McLean are employees of CorEvitas, LLC. P. Hur is an employee of Novartis Pharmaceuticals Corporation. P.J. Mease has received research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to: Alexis Ogdie, MD, MSCE, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104;
| | - Peter Hur
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; CorEvitas, LLC, Waltham, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA. Funding: This study was sponsored by CorEvitas, LLC. CorEvitas has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Genentech, Gilead, Janssen, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Sun, and UCB. The design and conduct of the study was a collaborative effort between CorEvitas, LLC, and Novartis Pharmaceuticals Corporation, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data and review and approval of the manuscript. Conflicts of interest: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (Forward), and Novartis (University of Pennsylvania). T. Blachley, P.R. Lakin, B. Dube, and R.R. McLean are employees of CorEvitas, LLC. P. Hur is an employee of Novartis Pharmaceuticals Corporation. P.J. Mease has received research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to: Alexis Ogdie, MD, MSCE, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104;
| | - Philip Mease
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; CorEvitas, LLC, Waltham, MA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA. Funding: This study was sponsored by CorEvitas, LLC. CorEvitas has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly, Genentech, Gilead, Janssen, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Sun, and UCB. The design and conduct of the study was a collaborative effort between CorEvitas, LLC, and Novartis Pharmaceuticals Corporation, and financial support for the study was provided by Novartis. Novartis participated in the interpretation of data and review and approval of the manuscript. Conflicts of interest: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas, Janssen, Lilly, Novartis, and Pfizer, and has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Psoriasis Foundation, Rheumatology Research Foundation, Pfizer (University of Pennsylvania), Amgen (Forward), and Novartis (University of Pennsylvania). T. Blachley, P.R. Lakin, B. Dube, and R.R. McLean are employees of CorEvitas, LLC. P. Hur is an employee of Novartis Pharmaceuticals Corporation. P.J. Mease has received research grants from AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun Pharma, and UCB; and speakers bureau fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB. Address correspondence to: Alexis Ogdie, MD, MSCE, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104;
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12
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Saalfeld W, Mixon AM, Zelie J, Lydon EJ. Differentiating Psoriatic Arthritis from Osteoarthritis and Rheumatoid Arthritis: A Narrative Review and Guide for Advanced Practice Providers. Rheumatol Ther 2021; 8:1493-1517. [PMID: 34519965 PMCID: PMC8572231 DOI: 10.1007/s40744-021-00365-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple organ systems and is characterized by skin and joint manifestations. PsA is frequently undiagnosed and/or misdiagnosed, especially because of the similarities in clinical presentation shared with other arthritic diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). An accurate and timely diagnosis of PsA is crucial to prevent delays in optimal treatment, which can lead to irreversible joint damage and increased functional disability. Patients are usually seen by a number of different healthcare providers on their path to a diagnosis of PsA, including advanced practice providers (APPs). This review provides a comprehensive overview of the characteristic features that can be used to facilitate the differentiation of PsA from RA and OA. Detailed information on clinical manifestations, biomarkers, radiologic features, and therapeutic recommendations for PsA included here can be applied in routine clinical settings to provide APPs with the confidence and knowledge to recognize and refer patients more accurately to rheumatologists for management of patients with PsA.
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Affiliation(s)
- William Saalfeld
- Arthritis Center of Nebraska, 3901 Pine Lake Road, Suite 120, Lincoln, NE, 68516, USA.
| | - Amanda M Mixon
- Arthritis and Rheumatology Clinic of Northern Colorado, Fort Collins, CO, USA
| | - Jonna Zelie
- URMC Division of Rheumatology, Rochester, NY, USA
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Cooksey R, Rahman MA, Kennedy J, Brophy S, Choy E. Biologic use in psoriatic arthritis and ankylosing spondylitis patients: a descriptive epidemiological study using linked, routine data in Wales, UK. Rheumatol Adv Pract 2021; 5:rkab042. [PMID: 34632260 PMCID: PMC8496109 DOI: 10.1093/rap/rkab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES PsA and AS are chronic diseases associated with significant morbidities. National and international management guidelines include treatment with biologic therapies to improve outcomes and quality of life. There are limited real-world data on the patients' journey from symptom onset to diagnosis and treatment in the UK. We use real-life, linked health data to explore patient pathways and the impact of biologics on patient outcomes. METHODS Data from the Secure Anonymised Information Linkage databank in Wales were used to assess diagnosis and treatment of patients ≥18 years of age with at least one International Classification of Diseases, Tenth Revision code present for PsA/AS in rheumatology clinic data and at least one Read code present in primary care records. We investigated the use of biologics while exploring demographics, comorbidities and surgical procedures of 641 AS patients and 1312 PsA patients. RESULTS AS patients were significantly younger at diagnosis and were predominantly male. The average time from presenting symptoms to diagnosis of AS and PsA was 7.9 (s.d. 5.5) and 9.3 (s.d. 5.5) years, respectively. The proportion of patients receiving biologic treatment was significantly higher in AS (46%) compared with PsA patients (28.8%); of these, 23.1% of AS and 22.2% of PsA patients stopped/switched a biologic. There was a significant reduction in primary care involvement, sick notes and disability living allowance for both AS and PsA patients following biologic initiation. CONCLUSION This real-world descriptive study confirms that patients treated with biologics have reduced disability and time off work despite being initiated ∼13 years after the first symptoms and 6 years after diagnosis.
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Affiliation(s)
- Roxanne Cooksey
- Division of Infection and Immunity, CREATE Centre, Section of
Rheumatology, School of Medicine, Cardiff University,
Cardiff
- Health Data Research UK, Swansea University Medical
School, Swansea
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
| | | | - Jonathan Kennedy
- Health Data Research UK, Swansea University Medical
School, Swansea
| | - Sinead Brophy
- Health Data Research UK, Swansea University Medical
School, Swansea
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
| | - Ernest Choy
- Division of Infection and Immunity, CREATE Centre, Section of
Rheumatology, School of Medicine, Cardiff University,
Cardiff
- National Centre for Population Health and Wellbeing
Research, Swansea, UK
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Gottlieb AB, Bakewell C, Merola JF. Musculoskeletal Imaging for Dermatologists: Techniques in the Diagnosis and Management of Psoriatic Arthritis. Dermatol Ther (Heidelb) 2021; 11:1199-1216. [PMID: 34145558 PMCID: PMC8322349 DOI: 10.1007/s13555-021-00565-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Indexed: 01/18/2023] Open
Abstract
Psoriatic arthritis is an inflammatory condition affecting up to 30% of patients with psoriasis. Patients may experience irreversible joint damage if not treated early, and diagnostic delays of even 6 months are associated with radiographic progression and impaired function. Therefore, early detection and intervention are of critical importance in patients with psoriatic arthritis. Given that psoriasis often precedes symptoms of psoriatic arthritis, dermatologists are uniquely positioned to identify patients with psoriatic arthritis early in their disease course, before permanent damage has occurred. Several screening tools have been developed to help dermatologists identify patients who may have psoriatic arthritis, but these tools may not capture patients with subclinical disease or quantify the type and severity of the underlying tissue insult, which is often the presenting sign of psoriatic arthritis. In these cases, a combination of clinical assessment and musculoskeletal imaging (e.g., ultrasound) is required. This review summarizes three common musculoskeletal imaging techniques used in the diagnosis and management of patients with psoriatic arthritis: conventional radiography, ultrasound, and magnetic resonance imaging. Further understanding of musculoskeletal imaging will assist dermatologists in making treatment decisions and allow them to have a more active role in the detection of psoriatic arthritis.
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Affiliation(s)
| | | | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Mathew AJ, Østergaard M, Eder L. Imaging in psoriatic arthritis: Status and recent advances. Best Pract Res Clin Rheumatol 2021; 35:101690. [PMID: 34016527 DOI: 10.1016/j.berh.2021.101690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The heterogeneous nature of psoriatic arthritis (PsA), encompassing several domains, with varied presentations brings about considerable challenges in disease evaluation. Prompt diagnosis and targeted therapy have resulted in disease remission being accepted as an attainable goal in PsA. Imaging has played a pivotal role in early diagnosis, better understanding of pathogenesis, monitoring of disease, and as an outcome measurement tool in clinical trials in PsA. Conventional radiography has been the cornerstone of assessing structural damage. With the advent of ultrasound and magnetic resonance imaging, better delineation of the various structures involved in the disease process is possible, thus enabling sensitive assessment of inflammatory and structural pathologies together. In this review, imaging modalities used in routine assessment and clinical trials in PsA will be discussed in detail, focusing on advances over the past 5 years.
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Affiliation(s)
- Ashish J Mathew
- Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Furer V, Levartovsky D, Wollman J, Wigler I, Paran D, Kaufman I, Elalouf O, Borok S, Anouk M, Sarbagil-Maman H, Berman M, Polachek A, Matz H, Flusser G, Druckmann I, Eshed I, Elkayam O. Prevalence of Nonradiographic Sacroiliitis in Patients With Psoriatic Arthritis: A Real-life Observational Study. J Rheumatol 2021; 48:1014-1021. [PMID: 33452174 DOI: 10.3899/jrheum.200961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To establish the prevalence of nonradiographic sacroiliitis within a real-life sample of patients with psoriatic arthritis (PsA), using pelvic radiographs and magnetic resonance imaging (MRI) of sacroiliac joints (SIJs). METHODS This cross-sectional study included 107 consecutive adults with PsA (Classification Criteria for Psoriatic Arthritis criteria). Participants completed clinical and laboratory evaluation, pelvic radiographs scored for radiographic sacroiliitis according to the modified New York (mNY) criteria, and noncontrast MRI of SIJs, scored by the Berlin score and categorized into active sacroiliitis using the 2016 Assessment of Spondyloarthritis international Society (ASAS) criteria and the presence of structural sacroiliitis. RESULTS Radiographic sacroiliitis/mNY criteria were detected in 28.7% (n = 29), confirmed by MRI-detected structural lesions in 72.4% (n = 21). Active sacroiliitis was detected by MRI in 26% (n = 28) of patients, with 11% (n = 11) qualifying for nonradiographic sacroiliitis. Patients with radiographic and nonradiographic sacroiliitis had similar clinical characteristics, except for a longer duration of psoriasis (PsO) and PsA in the radiographic subgroup (PsO: 23.8 ± 12.5 vs 14.1 ± 11.7 yrs, P = 0.03; PsA: 12.3 ± 9.8 vs 4.7 ± 4.5 yrs, P = 0.02, respectively). Inflammatory back pain (IBP) was reported in 46.4% (n = 13) with active sacroiliitis and 27% (n = 3) with nonradiographic sacroiliitis. The sensitivity of IBP for detection of nonradiographic sacroiliitis was low (27%) and moderate for radiographic sacroiliitis (52%), whereas specificity ranged from 72% to 79% for radiographic and nonradiographic sacroiliitis, respectively. CONCLUSION The prevalence of active sacroiliitis among a real-life population of patients with PsA was 26%. However, the prevalence of nonradiographic sacroiliitis was low (11%) compared to the radiographic sacroiliitis (28.7%) seen in patients with longer disease duration. IBP was not a sensitive indicator for the presence of early-stage sacroiliitis that was commonly asymptomatic.
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Affiliation(s)
- Victoria Furer
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv;
| | - David Levartovsky
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Jonathan Wollman
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Irena Wigler
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Daphna Paran
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ilana Kaufman
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ofir Elalouf
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Sara Borok
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Marina Anouk
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Hagit Sarbagil-Maman
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Mark Berman
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ari Polachek
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Hagit Matz
- H. Matz, MD, Department of Dermatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Gideon Flusser
- G. Flusser, MD, I. Druckmann, MD, Department of Radiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ido Druckmann
- G. Flusser, MD, I. Druckmann, MD, Department of Radiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Iris Eshed
- I. Eshed, MD, Department of Radiology, Sheba Medical Center, Ramat Gan, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- V. Furer, MD, D. Levartovsky, MD, J. Wollman, MD, I. Wigler, MD, D. Paran, MD, I. Kaufman, MD, O. Elalouf, MD, S. Borok, MD, M. Anouk, MD, H. Sarbagil-Maman, MD, M. Berman, MD, A. Polachek, MD, O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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