Incidence of rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica in an inland area of central Italy: results of the CAMPO-RHE study

Increase in axial spondyloarthritis diagnoses after the introduction of the ASAS criteria: a systematic review

To explore the proportion of axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) diagnoses within all newly referred patients visiting rheumatology outpatient clinics. And more specifically, to analyze whether there is an effect of the introduction of the ASAS and CASPAR classification criteria for axSpA and PsA. We systematically searched Embase, Medline Ovid, Cochrane Central and Web of Science from database inception to November 2022. Articles that investigated new onsets of axSpA and PsA in adults from rheumatology clinics were included. In total, 170 out of 7139 studies were found eligible for full-text review, after which 33 unique studies were included. Seventeen studies reported new onsets of axSpA, and 20 studies of PsA. The pooled proportion of axSpA within all newly referred patients was 19% (95% CI 15-23%) and 18% (95% CI 14-22%) for PsA. The proportion of axSpA before 2009 was 3% (95% CI 0-6%) and increased up to 21% (95% CI 14-28%) after 2009. For PsA, limited data were available in order to analyze the proportions of PsA before 2006. Overall, heterogeneity was high (I² > 95%, p < 0.001) that was most likely caused by geographical area, study design, setting and use of different referral strategies. The pooled proportion of axSpA and PsA among patients referred to the rheumatology outpatient clinic was 19 and 18%, respectively. Although the proportion of diagnosed axSpA patients seemed to increase after the introduction of the ASAS criteria, due to the large heterogeneity our findings should be interpreted with caution.

Incidence and Prevalence of Polymyalgia Rheumatica and Giant Cell Arteritis in a Healthcare Management Organization in Buenos Aires, Argentina

OBJECTIVE

To estimate incidence and prevalence of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in a university hospital-based health management organization (Hospital Italiano Medical Care Program) in Argentina.

METHODS

Overall and sex-specific incidence rates (IRs) and prevalence were calculated (age ≥ 50 yrs). Incidence study followed members with continuous affiliation ≥ 1 year from January 2000 to December 2015. Diagnosis as per the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology (ACR) criteria for PMR or the ACR 1990 criteria for GCA. Prevalence was calculated on January 1, 2015.

RESULTS

There were 176,558 persons who contributed a total of 1,046,620 person-years (PY). Of these, 825 developed PMR, with an IR (per 100,000 PY) of 78.8 (95% CI 73.4-84.2) overall, 90.1 (95% CI 82.9-97.2) for women, and 58.9 (95% CI 51.1-66.6) for men. Ninety persons developed GCA; the IR was 8.6 (95% CI 6.8-10.4) overall, 11.1 (95% CI 8.5-10.6) for women, and 4.2 (2.2-6.3) for men. There were 205 prevalent PMR cases and 23 prevalent GCA cases identified from a population of 80,335. Prevalence of PMR was 255 per 100,000 (95% CI 220-290) overall, 280 (95% CI 234-325) for women, and 209 (95% CI 150-262) for men; and the prevalence of GCA was 28.6 per 100,000 (95% CI 16.9-40.3) overall, 36.4 (95% CI 20.1-52.8) for women, and 14.2 (95% CI 0.3-28.1) for men.

CONCLUSION

This is the first study of incidence and prevalence of PMR and GCA in Argentina. There were similarities and differences with cohorts from other parts of the world, but population-based epidemiologic studies in Latin America are needed.

Introduction of a Simplified Psoriatic Arthritis Magnetic Resonance Imaging Score (sPsAMRIS): A Potential Tool for Treatment Monitoring in Peripheral Psoriatic Arthritis

Background: To evaluate whether a simplified (s) version of the psoriatic arthritis magnetic resonance imaging score (PsAMRIS), sPsAMRIS, is a potential tool for therapy monitoring in psoriatic arthritis (PsA). Methods: Seventeen patients with active psoriatic arthritis (PsA) underwent magnetic resonance imaging (MRI) at 3 T of the clinically dominant hand at baseline and after 6 months. Scoring was performed by two musculoskeletal radiologists in terms of the PsAMRIS and sPsAMRIS, which is a simplified version with reduced item numbers based on prior evaluation of responsiveness to change by standardized response means (SRMs). Both scores were compared by calculation of overall and each sub-score’s SRMs and relative efficacy (RE) after bootstrapping. Results: PsAMRIS sub-scores of MCP joints 3 and 4, and proximal interphalangeal (PIP) joint 4 had the highest SRM (−0.07 each), indicating highest responsiveness to change, and were, therefore, included in sPsAMRIS. Compared to PsAMRIS, sPsAMRIS was characterized by higher SRMs (sPsAMRIS: −0.13 vs. PsAMRIS: −0.02) and higher RE (29.46). sPsAMRIS and PsAMRIS were highly correlated at baseline (r = 0.75, p < 0.01 (Pearson’s correlation)) and at 6-month follow-up (r = 0.64, p = 0.01). Mean time burden for completion of scoring per MRI study was significantly reduced when using PsAMRIS (469 ± 87.03 s) as compared to sPsAMRIS (140.1 ± 21.25 s) (p < 0.001). Conclusion: Due to its similar responsiveness to change compared to standard PsAMRIS, and time efficiency, sPsAMRIS might be a potential diagnostic tool to quantitatively assess and monitor therapy in PsA.

Incidence and Prevalence of Polymyalgia Rheumatica (PMR): The Importance of the Epidemiological Context. The Italian Case

OBJECTIVES

to evaluate incidence and prevalence rates of polymyalgia rheumatica (PMR) in Italy, depending on the epidemiological methodology used from time to time.

MATERIALS AND METHODS

A comprehensive literature search in MEDLINE and EMBASE was carried out. The following search terms were used: polymyalgia rheumatica, incidence, prevalence, epidemiology, general practitioner, family medicine, Italy. A search was also carried out in Google scholar using the search phrase: epidemiology of polymyalgia rheumatica in Italy. The period considered was between 1970 and March 2019. All articles containing data on incidence and prevalence of PMR in Italy were read in full. Reviews and non-original manuscripts were excluded as well as all the studies containing incidence and prevalence rates of giant cell arteritis (GCA), unless clearly distinct from data related to patients with PMR alone (isolated and pure PMR).

RESULTS

Five articles corresponded to inclusion and exclusion criteria. Two articles were excluded as they were review articles, and three articles were excluded because there were not clear data on incidence and prevalence rates of isolated PMR. Three articles reported data on the annual incidence of PMR (two of them published by the same group of investigators); two articles reported prevalence data. In one article, both incidence and prevalence were calculated. The annual rate of incidence of PMR was between 0.12 and 2.3 cases/1000 inhabitants aged over 50 years. In the two studies publishing prevalence data, they varied from 0.37% to 0.62%. The differences in incidence and prevalence rates were related to several factors such as the different set of diagnostic criteria used for identifying patients or the diagnostic difficulty for patients with atypical presentations, specifically those without raised erythrocyte sedimentation rate (ESR). In the study with higher annual rate of incidence and higher prevalence of PMR, the collaboration between general practitioner (GP) and the out-of-hospital public rheumatologist resulted in significantly different data than in the other studies. All the five articles presented data from monocentric cohorts.

CONCLUSION

Very few Italian studies addressed the epidemiology of PMR. The contribution of a specific professional figure represented by the out-of-hospital public rheumatologist, present in the Italian National Health System and absent in other countries, can make the Italian experience unique in its kind.

Sustained Very Low Disease Activity and Remission in Psoriatic Arthritis Patients

Introduction

Sustained remission should be considered the main therapeutic target in psoriatic arthritis (PsA). Very low disease activity (VLDA) and a DAPSA score ≤ 4 are the most commonly used criteria. The aim of the present study was to evaluate the rate of sustained remission in a group of PsA patients followed in a real-life setting.

Methods

All PsA patients satisfying CASPAR criteria were followed prospectively every 3–6 months, in a context of clinical practice by January 2013. Sustained remission was defined when patients achieved a DAPSA score ≤ 4 and/or VLDA for at least 12 months. The exclusion criterion was the presence of a condition of VLDA or DAPSA ≤ 4 at the baseline assessment. Kaplan–Meier survival curve was used to evaluate the survival of patients.

Results

A total of 147 PsA patients were evaluated for the study. Of these, 80 performed at least 12 consecutive months of follow-up. The average duration of follow-up was 24 months (range, 12–60 months). At the last follow-up, 22 patients were on csDMARDs treatment while 58 patients were on bDMARDs. Of the 80 patients, 14 (17.5%) achieved a sustained VLDA while 24 (30%) achieved sustained remission according to the DAPSA criteria. The mean duration of remission in patients achieving VLDA and DAPSA ≤ 4 was 17 months for both criteria. High baseline levels of CRP, shorter disease duration, and less pain at baseline were found to be predictors of sustained VLDA and DAPSA remission.

Conclusions

In our study, based on clinical practice, a sustained VLDA was achieved in 17.5% and a sustained remission according to the DAPSA criteria in 30% of patients with PsA.

Update on the epidemiology, risk factors, and disease outcomes of psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects different structures of the musculoskeletal system in addition to the skin and the nail. The complexity of the disease had been a barrier to understand the pathogenesis and define valid outcome tools; however, our understanding about the disease has considerably increased with time mainly because of the advances in imaging, new discoveries in genetics and underlying inflammatory pathways, and better understanding of the epidemiology of the disease and environmental risk factors. The purpose of this review is to summarize developments and changes in epidemiology, risk factors for developing PsA, and outcome measures with a focus on data obtained in the last 10 years.