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Hen O, Harrison SR, De Marco G, Marzo-Ortega H. Early psoriatic arthritis: when is the right time to start advanced therapy? Ther Adv Musculoskelet Dis 2024; 16:1759720X241266727. [PMID: 39071239 PMCID: PMC11283661 DOI: 10.1177/1759720x241266727] [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: 02/02/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024] Open
Abstract
Despite significant advances in the treatment of psoriatic arthritis (PsA) in the last two decades, remission remains elusive and there is no cure. Evidence from rheumatoid arthritis (RA) confirming enhanced response and outcome from earlier treatment intervention suggests the plausibility of the window of opportunity in the pathogenesis of RA. Yet, data are lacking in PsA. Although treatment response may be enhanced in shorter disease duration, it is unknown how this early intervention may impact long-term outcomes. Furthermore, it remains to be demonstrated whether there is a best treatment strategy and time of intervention. Crucially, the main hurdle when aiming for early treatment intervention is the ability to achieve a timely diagnosis that highlights the need to focus research efforts on characterizing the very early disease stages including the transition to PsA in the at-risk psoriasis population.
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Affiliation(s)
- Or Hen
- NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Medicine ‘C’, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Stephanie R. Harrison
- NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Stephanie R. Harrison is also affiliated to Leeds Institute of Data Analytics, University of Leeds, Leeds
| | - Gabriele De Marco
- NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Stephanie R. Harrison is also affiliated to Leeds Institute of Data Analytics, University of Leeds, Leeds
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Second Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
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Caso F, Costa L, Megna M, Cascone M, Maione F, Giacomelli R, Scarpa R, Ruscitti P. Early psoriatic arthritis: clinical and therapeutic challenges. Expert Opin Investig Drugs 2024. [PMID: 39041193 DOI: 10.1080/13543784.2024.2383421] [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: 04/28/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease of the enthesis and adjacent synovium, skin, and nail, which early diagnosis may be crucial for starting a prompt therapeutic intervention. Theoretically, early treatment offers the advantage of acting on the reduction of the articular damage progression since initial phases of the disease. AREAS COVERED This review explores the challenges of clinical-diagnostic aspects and the underlying pathophysiology of early PsA phases, as well as the evidence evaluating the impact of early intervention on disease outcomes. EXPERT OPINION Main instruments for early PsA diagnosis include recognizing synovial-entheseal inflammatory signs at onset, improving screening PsA high-risk subjects, and increasing disease knowledge of physicians and patients with psoriasis or familial history.PsA continues to significantly impact on the Quality of Life of patients affected by the disease, making necessary to deeply study clinical manifestations, risk factors and underlying immunoinflammatory mechanisms, as well as to identify biomarkers for early identification. Additionally, it remains a need to increase more evidence on understanding how early treatment of PsA and of psoriasis might influence the course of the disease.
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Affiliation(s)
- Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luisa Costa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mario Cascone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Maione
- ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto Giacomelli
- Research and Clinical Unit of immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Mathew AJ, Lund ML, Pedersen MP, Rasmussen SH, Glintborg B, Loft AG, Nissen MJ, Möller B, Rodrigues AM, Santos FP, Rotar Z, Tomšič M, Relas H, Peltomaa R, Gudbjornsson B, Löve TJ, Kocaer SB, Koken Avsar A, Midtbøll Ørnbjerg L, Østergaard M. Enthesitis in a European registry-based cohort of patients with psoriatic arthritis treated with tumour necrosis factor inhibitors: clinical burden, patient-reported outcomes, and treatment response. Scand J Rheumatol 2024; 53:237-247. [PMID: 38771017 DOI: 10.1080/03009742.2024.2336743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/27/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To explore the registration of enthesitis among biologic-naïve patients with psoriatic arthritis (PsA) initiating tumour necrosis factor inhibitor (TNFi) treatment across 12 European registries, compare the disease burden and patient-reported outcomes (PROs) between patients with and without enthesitis, and assess the enthesitis treatment response. METHOD Demographics, clinical characteristics, and PROs at first TNFi (TNFi-1) initiation (baseline) were assessed in patients with PsA, diagnosed by a rheumatologist, with versus without assessment of entheses and between those with versus without enthesitis. Enthesitis scores and resolution frequency were identified at follow-up. RESULTS Of 10 547 patients in the European Spondyloarthritis (EuroSpA) Research Collaboration Network initiating TNFi, 1357 underwent evaluation for enthesitis. Eight registries included a validated scoring system for enthesitis. At baseline, 874 patients underwent entheses assessment [Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) 485 patients, Spondyloarthritis Research Consortium of Canada (SPARCC) 389 patients]. Enthesitis was detected by MASES in 170/485 (35%, mean score ± sd 3.1 ± 2.4) and by SPARCC in 236/389 (61%, 4 ± 3.4). Achilles enthesitis was most frequent, by both MASES (unilateral/bilateral 28%/9%) and SPARCC (48%/18%). MASES/SPARCC baseline and follow-up scores for TNFi-1 were available for 100/105 patients. Of these, 63 patients (63%) (MASES) and 46 (43.8%) (SPARCC) achieved resolution of enthesitis. The site-specific enthesitis resolution was overall lower at SPARCC sites (peripheral; 63-80%) than at MASES sites (mainly axial; 82-100%) following TNFi-1. Disease activity and PROs were worse in patients with versus without enthesitis. CONCLUSION Entheseal assessments are only registered in a minority of patients with PsA in routine care. When assessed, enthesitis was common, and a substantial proportion demonstrated resolution following treatment with TNFi-1.
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Affiliation(s)
- A J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics Rigshospitalet, Glostrup, Denmark
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - M L Lund
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics Rigshospitalet, Glostrup, Denmark
- The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M P Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics Rigshospitalet, Glostrup, Denmark
| | - S H Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics Rigshospitalet, Glostrup, Denmark
| | - B Glintborg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics Rigshospitalet, Glostrup, Denmark
- The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A G Loft
- The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - M J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - B Möller
- Department of Rheumatology and Immunology, Inselspital - University Hospital Bern, University of Bern, Bern, Switzerland
| | - A M Rodrigues
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
- EpiDoC Unit, CEDOC, Nova Medical School, Lisbon, Portugal
- Rheumatology Unit, Hospital dos Lusíadas, Lisbon, Portugal
| | - F P Santos
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
- Rheumatology Unit, Hospital dos Lusíadas, Lisbon, Portugal
- Rheumatic Diseases Lab, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Z Rotar
- biorx.si and Department of Rheumatology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Tomšič
- biorx.si and Department of Rheumatology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - H Relas
- Inflammation Center, Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Peltomaa
- Inflammation Center, Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - B Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - T J Löve
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S B Kocaer
- Faculty of Medicine, and Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - A Koken Avsar
- Department of Rheumatology, Kocaeli Public Hospital, Kocaeli, Turkey
| | - L Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics Rigshospitalet, Glostrup, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics Rigshospitalet, Glostrup, Denmark
- The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Wendling D, Goupille P, Verhoeven F, Prati C. Can we consider a pre-clinical state of axial spondyloarthritis? Joint Bone Spine 2024; 91:105722. [PMID: 38582360 DOI: 10.1016/j.jbspin.2024.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France.
| | - Philippe Goupille
- Service de rhumatologie, UPR CNRS 4301 CBM, NMNS, université de Tours, CHU de Tours, Tours, France
| | - Frank Verhoeven
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Service de rhumatologie, université de Franche-Comté, CHU de Besançon, boulevard Fleming, 25030 Besançon, France
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Thiran A, Petta I, Blancke G, Thorp M, Planckaert G, Jans M, Andries V, Barbry K, Gilis E, Coudenys J, Hochepied T, Vanhove C, Gracey E, Dumas E, Manuelo T, Josipovic I, van Loo G, Elewaut D, Vereecke L. Sterile triggers drive joint inflammation in TNF- and IL-1β-dependent mouse arthritis models. EMBO Mol Med 2023; 15:e17691. [PMID: 37694693 PMCID: PMC10565626 DOI: 10.15252/emmm.202317691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
Arthritis is the most common extra-intestinal complication in inflammatory bowel disease (IBD). Conversely, arthritis patients are at risk for developing IBD and often display subclinical gut inflammation. These observations suggest a shared disease etiology, commonly termed "the gut-joint-axis." The clinical association between gut and joint inflammation is further supported by the success of common therapeutic strategies and microbiota dysbiosis in both conditions. Most data, however, support a correlative relationship between gut and joint inflammation, while causative evidence is lacking. Using two independent transgenic mouse arthritis models, either TNF- or IL-1β dependent, we demonstrate that arthritis develops independently of the microbiota and intestinal inflammation, since both lines develop full-blown articular inflammation under germ-free conditions. In contrast, TNF-driven gut inflammation is fully rescued in germ-free conditions, indicating that the microbiota is driving TNF-induced gut inflammation. Together, our study demonstrates that although common inflammatory pathways may drive both gut and joint inflammation, the molecular triggers initiating such pathways are distinct in these tissues.
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6
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Lukasik Z, Carron P, Webers C. To taper or not to taper biological disease-modifying antirheumatic drugs in axial spondyloarthritis anno 2023: That is the question. Best Pract Res Clin Rheumatol 2023; 37:101869. [PMID: 37658017 DOI: 10.1016/j.berh.2023.101869] [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: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
The 2022 ASAS-EULAR recommendations for the management of axial spondyloarthritis (axSpA) propose to consider dose reduction of biological disease-modifying antirheumatic drugs (bDMARDs) for patients in sustained remission. However, this recommendation does not offer clear guidance for daily clinical practice. In this review, we analyze randomized clinical trials and real-world data on tapering and discontinuation of bDMARDs in patients with axSpA. We discuss the scientific rationale and benefits of tapering, identify advice to apply tapering in current practice, and delineate aspects to be investigated in future research.
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Affiliation(s)
- Zuzanna Lukasik
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, Ghent, Belgium; VIB Center for Inflammation Research, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, Ghent, Belgium; VIB Center for Inflammation Research, Ghent, Belgium.
| | - Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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7
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Puche-Larrubia MÁ, López-Medina C, Ziadé N. Peripheral spondyloarthritis: What have we learned? Best Pract Res Clin Rheumatol 2023; 37:101862. [PMID: 37599204 DOI: 10.1016/j.berh.2023.101862] [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: 06/16/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
The peripheral spondyloarthritis (pSpA) entity remains poorly defined in comparison with axial SpA and psoriatic arthritis, as the clinical symptoms have low specificity, the biological markers are virtually lacking, and dedicated randomized controlled trials in this specific indication remain scarce. In addition, clinical similarities between pSpA and psoriatic arthritis (PsA) have been described, partly explained by a resemblance in the pathophysiology of both entities. Thus, diagnosing pSpA can be challenging because of the overlap with other entities and the absence of a specific test or imaging study that can definitively diagnose the condition. The aim of this review is to summarize the current understanding of pSpA, its epidemiology, physiopathology, clinical diagnosis, and classification criteria. In addition, we present patient-reported outcomes used in pSpA clinical studies, available evidence on therapies, and future directions.
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Affiliation(s)
| | - Clementina López-Medina
- Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Cordoba, Cordoba, Spain.
| | - Nelly Ziadé
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
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8
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Cozzi G, Scagnellato L, Lorenzin M, Savarino E, Zingone F, Ometto F, Favero M, Doria A, Vavricka SR, Ramonda R. Spondyloarthritis with inflammatory bowel disease: the latest on biologic and targeted therapies. Nat Rev Rheumatol 2023:10.1038/s41584-023-00984-8. [PMID: 37386288 DOI: 10.1038/s41584-023-00984-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
Spondyloarthritis (SpA) encompasses a heterogeneous group of chronic inflammatory diseases that can affect both axial and peripheral joints, tendons and entheses. Among the extra-articular manifestations, inflammatory bowel disease (IBD) is associated with considerable morbidity and effects on quality of life. In everyday clinical practice, treatment of these conditions requires a close collaboration between gastroenterologists and rheumatologists to enable early detection of joint and intestinal manifestations during follow-up and to choose the most effective therapeutic regimen, implementing precision medicine for each patient's subtype of SpA and IBD. The biggest issue in this field is the dearth of drugs that are approved for both diseases, as only TNF inhibitors are currently approved for the treatment of full-spectrum SpA-IBD. Janus tyrosine kinase inhibitors are among the most promising drugs for the treatment of peripheral and axial SpA, as well as for intestinal manifestations. Other therapies such as inhibitors of IL-23 and IL-17, phosphodiesterase 4 inhibitor, α4β7 integrin blockers and faecal microbiota transplantation seem to only be able to control some disease domains, or require further studies. Given the growing interest in the development of novel drugs to treat both conditions, it is important to understand the current state of the art and the unmet needs in the management of SpA-IBD.
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Affiliation(s)
- Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Francesca Ometto
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zürich and Center for Gastroenterology and Hepatology, Zürich, Switzerland
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy.
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Proft F, Käding H. Same, same or different? Commonalities and differences between spondyloarthritis and its subsets of axial and peripheral spondyloarthritis with psoriatic arthritis and its diverse phenotypes. RMD Open 2023; 9:rmdopen-2022-002872. [PMID: 37028815 PMCID: PMC10083843 DOI: 10.1136/rmdopen-2022-002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023] Open
Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Henriette Käding
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
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10
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Predicting the onset of rheumatoid arthritis. Joint Bone Spine 2023; 90:105556. [PMID: 36842761 DOI: 10.1016/j.jbspin.2023.105556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 02/28/2023]
Abstract
Various scores have attempted to predict the onset of rheumatoid arthritis (RA). In particular, EULAR proposed a simple rule to identify new-onset arthralgia suspicious for progression to RA. However, its specificity would likely be higher if serological tests were included. In patients with clinical arthritis, reliable predictive criteria for progression to RA have also been identified. Overall, the validity of the available scores is still being debated. Such scores do not fully account for the interactions between risk factors in specific subpopulations. New technologies could help to overcome these limitations, but we need databases containing a sufficient number of RA and pre-RA patients, including pre-diagnostic monitoring. Today, the existing predictive rules cannot compete with expert opinions.
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Palominos PE, Fernández-Ávila DG, Coates LC, Adebajo A, Toukap AN, Abogamal A, Polachek A, van Kuijk AWR, Caso F, de Marco G, Kaeley GS, Steinkoenig I, Chau J, Feletar M, Vis M, Elkayam O, Sewerin P, d'Angelo S, Aydin SZ, AlShehhi W, Helliwell PS. Management of Dactylitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2023; 50:265-278. [PMID: 36319013 DOI: 10.3899/jrheum.220311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This literature review aimed to identify the most efficacious current interventions for dactylitis and provide up-to-date scientific evidence to support the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommendations on the management of psoriatic arthritis. METHODS Original articles published from 2013 to 2020, registered in MEDLINE, Embase, and Cochrane Library, describing interventional trials and reporting dactylitis-related outcomes were included. The 20 members of the GRAPPA dactylitis group were divided into 9 subgroups according to treatment, and members of each group independently extracted data from articles/abstracts corresponding to their group by using a standardized data extraction form. RESULTS Forty-nine publications were analyzed, representing 40 randomized clinical trials (RCTs) and including 16,752 patients. Dactylitis was assessed as a secondary outcome in 97.5% of these trials and more than 40% of RCTs did not employ a specific dactylitis measure or instrument. CONCLUSION The emergence of agents with novel mechanisms of action in recent years, such as interleukin 17 (IL-17), IL-12/23, IL-23, and Janus kinase inhibitors, has significantly expanded the available treatment options for dactylitis. This article points out the lack of consensus regarding dactylitis assessment and the paucity of data concerning the effect of local steroid injections, nonsteroidal antiinflammatory drugs, and conventional disease-modifying antirheumatic drugs. Clinical trials evaluating the effect of these traditional and low-cost medications used to treat dactylitis should be encouraged.
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Affiliation(s)
- Penélope Esther Palominos
- P.E. Palominos, MD, PhD, Rheumatology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil;
| | - Daniel G Fernández-Ávila
- D.G. Fernández-Ávila, MD, PhD, Rheumatology Unit, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Laura C Coates
- L.C. Coates, MD, PhD, Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Adewale Adebajo
- A. Adebajo, MD, MBE, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Adrien Nzeusseu Toukap
- A. Nzeusseu Toukap, MD, Rheumatology Department, Saint-Luc University Hospitals, and Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Ahmed Abogamal
- A. Abogamal, MD, PhD, Al-Azhar Faculty of Medicine, Cairo, Egypt
| | - Ari Polachek
- A. Polachek, MD, Department of Rheumatology, Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arno W R van Kuijk
- A.W.R. van Kuijk, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, the Netherlands
| | - Francesco Caso
- F. Caso, MD, PhD, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriele de Marco
- G. de Marco, MD, Leeds Biomedical Research Center at Leeds Teaching Hospitals NHS Trust, and University of Leeds, Leeds, UK
| | - Gurjit S Kaeley
- G.S. Kaeley, MD, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ingrid Steinkoenig
- I. Steinkoenig, BA, GRAPPA Patient Research Partner, Cleveland, Ohio, USA
| | - Jeffrey Chau
- J. Chau, MCS, GRAPPA Patient Research Partner, Hong Kong SAR, China
| | - Marie Feletar
- M. Feletar, MD, Dandenong Rheumatology, Melbourne, Australia
| | - Marijn Vis
- M. Vis, MD, PhD, Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
| | - Ori Elkayam
- O. Elkayam, MD, Department of Rheumatology, Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Philipp Sewerin
- P. Sewerin, MD, PhD, Heinrich-Heine-Universität Duesseldorf, University Hospital Duesseldorf, Department and Hiller Research-Unit for Rheumatology, Duesseldorf, Germany
| | - Salvatore d'Angelo
- S. d'Angelo, MD, PhD, Rheumatology Institute of Lucania, and Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Sibel Zehra Aydin
- S.Z. Aydin, MD, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Eder L, Mathew AJ, Carron P, Bertheussen H, Cañete JD, Azem M, Delle Sedie A, Salvarani C, Ranza R, Elliott A, Turkiewicz A, de Toledo RA, Bukulmez H, Stoenoiu MS, Mandelin AM, Koehm M, Lindsay CA, Siegel E, Mease PJ. Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2023; 50:258-264. [PMID: 36319005 DOI: 10.3899/jrheum.220312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Enthesitis is a key pathological and clinical feature of psoriatic arthritis (PsA) in children and adults. Enthesitis is typically assessed clinically using several validated enthesitis scoring systems that have been used in clinical trials. Enthesitis treatment response has been reported as change in the total enthesitis score or the proportion of patients who achieved complete resolution. The majority of trials in PsA did not require patients to have enthesitis at study entry since enthesitis was evaluated only as a secondary outcome. Despite the inherent limitations of the clinical assessment of enthesitis, imaging of the entheses using ultrasound or magnetic resonance imaging has rarely been used in clinical trials to assess response to treatment of enthesitis. This systematic review summarizes existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA to facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA. METHODS We performed a systematic literature review to identify 41 randomized clinical trials that reported enthesitis treatment response in patients with PsA. For each intervention, the response effect size was summarized and the quality of evidence was graded. Recommendations were then formulated for the various pharmacological and nonpharmacological therapies. RESULTS We included 41 randomized clinical trials in our review and graded each intervention. CONCLUSION Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA.
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Affiliation(s)
- Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada;
| | - Ashish J Mathew
- A.J. Mathew, MBBS, DNB, DM, The Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Philippe Carron
- P. Carron, MD, PhD, Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, and VIB Center for Inflammation Research, Ghent, Belgium
| | | | - Juan D Cañete
- J.D. Cañete, DMD, PhD, Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - May Azem
- M. Azem, MD, Solo Private Practice, and Department of Internal Medicine, Lake Hospital, University Hospital Systems, Cleveland, Ohio, USA
| | - Andrea Delle Sedie
- A. Delle Sedie, MD, Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carlo Salvarani
- C. Salvarani, MD, Dipartimento Specialità Mediche, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia and Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Ranza
- R. Ranza, MD, PhD, Rheumatology Unit, Hospital de Clinicas, EBSERH, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Ashley Elliott
- A. Elliott, MB Bch BAO, MSc, MRCP, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Ricardo Acayaba de Toledo
- R.A. de Toledo, MD, MSc, Regional School of Medicine Foundation of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Hulya Bukulmez
- H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria S Stoenoiu
- M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Arthur M Mandelin
- A.M. Mandelin II, MD, PhD, Northwestern University, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michaela Koehm
- M. Koehm, MD, Rheumatology Division, University Hospital Frankfurt and Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
| | - Chris A Lindsay
- C.A. Lindsay, PharmD, GRAPPA Patient Research Partner, Aurinia Pharmaceuticals Inc., Rockville, Maryland, USA
| | - Evan Siegel
- E. Siegel, MD, Arthritis and Rheumatism Associates, Rockville, Maryland, and Georgetown University School of Medicine, Washington, DC, USA
| | - Philip J Mease
- P.J. Mease MD, MACR, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA
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13
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Izci Duran T, Torgutalp M, Rios Rodriguez V, Proft F, López-Medina C, Dougados M, Poddubnyy D. The impact of psoriasis on the clinical characteristics, disease burden and treatment patterns of peripheral spondyloarthritis. Rheumatology (Oxford) 2022; 62:135-146. [PMID: 35451472 DOI: 10.1093/rheumatology/keac235] [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: 01/19/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, disease burden, and treatment patterns of peripheral spondyloarthritis (pSpA) patients with and without psoriasis using data from the ASAS-perSpA study. METHODS We included 433 patients who had a diagnosis of pSpA according to the rheumatologist's diagnosis from the ASAS-PerSpA study. The presence of a personal history of psoriasis was defined as the presence of signs of psoriasis at physical examination or the presence of psoriatic nail dystrophy, including onycholysis, pitting and hyperkeratosis, or a history of psoriasis diagnosed by a physician. Clinical characteristics, patient-reported outcomes and treatment pattern were compared between subgroups with and without psoriasis. RESULTS A total of 83 patients (19.2%) had a personal history of psoriasis. Patients with psoriasis were older (48.4 vs 43.2 years) and had a longer diagnostic delay (7.4 vs 3.5 years), a higher frequency of dactylitis (36.1 vs 20.0%) and enthesitis (65.1 vs 55.4%) than patients without psoriasis. A longer diagnostic delay (odds ratio [OR] = 1.06 [95% CI 1.01, 1.11]), lower odds for HLA-B27 positivity (OR = 0.31 [95% CI 0.15, 0.65]) and higher odds for enthesitis (OR = 2.39 [95% CI 1.16, 4.93]) were associated with the presence of psoriasis in a multivariable regression analysis. While patient-reported outcomes were comparable between groups, a higher use of biologic DMARDs was observed in patients with vs without psoriasis. CONCLUSION The presence of psoriasis has an impact on clinical characteristics of pSpA. pSpA patients without psoriasis were less frequently treated with biologic DMARDs despite similar disease burden as compared with patients with psoriasis.
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Affiliation(s)
- Tugba Izci Duran
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clementina López-Medina
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,Department of Rheumatology, Reina Sofia Hospital, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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14
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Ziade N, Bou Absi M, Baraliakos X. Peripheral spondyloarthritis and psoriatic arthritis sine psoriase: are we dealing with semantics or clinically meaningful differences? RMD Open 2022; 8:rmdopen-2022-002592. [DOI: 10.1136/rmdopen-2022-002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Diagnosing peripheral spondyloarthritis (pSpA) remains a significant challenge due to the lack of specific disease biomarkers and the overlap with other SpA subtypes, mainly psoriatic arthritis (PsA), which represents a diagnostic challenge particularly in the absence of skin psoriasis (PsAsine psoriase). This narrative review aimed to compare the epidemiology, genetic susceptibility, pathophysiology, classification criteria, disease phenotype and burden, and therapeutic guidelines between patients diagnosed with pSpA and those with PsAsine psoriase,to determine if the two entities should be considered jointly or distinctly. Globally, pSpA appears to be more inclusive compared with PsAsine psoriase. Areas of similarities include age of onset, number of joints involved and prevalence of axial involvement. However, patients with pSpA have a male gender predominance, a higher prevalence of HLA-B27, enthesitis and involvement of large joints of the lower limbs, whereas patients with PsAsine psoriasehave a higher prevalence HLA-Cw6, dactylitis and involvement of hand distal interphalangeal joints. Therefore, the difference between pSpA and PsAsine psoriasegoes beyond semantics. The few dissimilarities should drive scientific efforts to reach a better characterisation of pSpA as an individual disease. Accordingly, randomised clinical trials should target patients with well-defined pSpA to identify effective therapies in this population.
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Navarro-Compán V, Ermann J, Poddubnyy D. A glance into the future of diagnosis and treatment of spondyloarthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111611. [PMID: 35898564 PMCID: PMC9310200 DOI: 10.1177/1759720x221111611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
The last two decades have seen major developments in the field of
spondyloarthritis (SpA), but there are still important unmet needs to address.
In the future, we envisage important advances in the diagnosis and treatment of
SpA. In the diagnosis of SpA, the use of online and social media tools will
increase awareness of the disease and facilitate the referral of patients to
rheumatology clinics. In addition, more specific diagnostic tests will be
available, especially advanced imaging methods and new biomarkers. This will
allow most patients to be diagnosed at an early stage of the disease. In the
treatment of SpA, an increasing number of novel treatment targets can be
expected, most of which will be directed against intracellular enzymes. We hope
to see more strategy trials shaping treatment pathways in SpA and accommodating
principals of precision medicine. Approved treatment options will be available
for both axial and peripheral SpA. We also hope to intervene not only at the
inflammation level but also at the level of underlying immunological processes
that might be associated with a higher probability of long-standing remission if
not a cure. Finally, artificial intelligence techniques will allow for the
analysis of large-scale data to answer relevant research questions for the
diagnosis and management of patients with SpA.
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Affiliation(s)
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin 12203, Germany
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16
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How is early spondyloarthritis defined in the literature? Results from a systematic review. Semin Arthritis Rheum 2022; 55:152032. [DOI: 10.1016/j.semarthrit.2022.152032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 05/24/2022] [Indexed: 01/20/2023]
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17
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Ziade N, Rassi J, Elzorkany B, Lopez-Medina C, Gamal SM, Hlais S, Dougados M, Baraliakos X. What is peripheral spondyloarthritis? Identifying proportion, phenotype and burden in post hoc analysis of the ASAS-PerSpA study. Semin Arthritis Rheum 2022; 55:152012. [PMID: 35489171 DOI: 10.1016/j.semarthrit.2022.152012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Little is known about the prevalence, phenotype, and burden of peripheral spondyloarthritis (pSpA). The objective of the study is to compare the phenotype and burden of disease of pure pSpA to that of pure psoriatic arthritis (PsA), pure axial SpA (axSpA), and combined forms of SpA. METHODS This is a post hoc analysis of 4,185 patients from the cross-sectional ASAS-Peripheral involvement in SpA (PerSpA) study. Patients were approached in 2 ways: the first approach was based on the rheumatologist's diagnosis (diagnostic approach) and the second one was based on the fulfillment of ASAS or CASPAR classification criteria (classification criteria approach). Demographics, disease phenotype, and burden were compared among pure pSpA, PsA, axSpA, and the combined forms. FINDINGS The proportion of pSpA was 31.5% of SpA using the classification criteria approach and 10.3% using the diagnostic approach. pSpA was pure (i.e. without axSpA or PsA) in 16.8% of pSpA using the criteria, and in 62.3% using the diagnostic approach. Using classification criteria and diagnostic approach, respectively, pure pSpA patients had a high prevalence of peripheral joint disease (86 and 96%), synovitis (76 and 91%), and enthesitis (57 and 55%), a positive HLA-B27 in 65 and 59%, a high C-Reactive Protein level in 51% and inflammatory back pain in 52 and 42%. However, compared to pure PsA and pure axSpA, they had a significantly higher disease burden, but lower use of biologics using both approaches. INTERPRETATION The proportion of pSpA varies when using the classification criteria or the diagnostic approach. pSpA occurred in a pure form less frequently than PsA and axSpA and had intermediate features but a higher disease burden. FUNDING The PerSpA main study has been conducted under the umbrella of ASAS thanks to unrestricted grants from PFIZER, LILLY, ABBVIE, NOVARTIS, UCB, JANSSEN, MERCK.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Joe Rassi
- Surgery Department, Saint-Joseph University, Beirut, Lebanon; Orthopedic Surgery Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Bassel Elzorkany
- Rheumatology Department, Kasr Alaini Hospitals, Cairo University, Egypt.
| | - Clementina Lopez-Medina
- Rheumatology Department, Cochin Hospital, Paris, France; Rheumatology Department, Reina Sofia University Hospital / IMIBIC/ University of Cordoba, Cordoba, Spain.
| | - Sherif M Gamal
- Rheumatology Department, Kasr Alaini Hospitals, Cairo University, Egypt.
| | - Sani Hlais
- Family Medicine Department, Saint-Joseph University, Beirut, Lebanon; Family Medicine Department, American University of Beirut, Lebanon.
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18
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2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. Joint Bone Spine 2022; 89:105344. [PMID: 35038574 DOI: 10.1016/j.jbspin.2022.105344] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Update the French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. METHODS Following standardized procedures, a systematic literature review was done by four supervised rheumatology residents based on questions defined by a task force of 16 attending rheumatologists. The findings were reviewed during three working meetings that culminated in each recommendation receiving a grade and the level of agreement among experts being determined. RESULTS Five general principles and 15 recommendations were developed. They take into account pharmacological and non-pharmacological measures along with treatment methods based on the dominant phenotype present (axial, articular, enthesitis/dactylitis) and the extra-articular manifestations (psoriasis, inflammatory bowel disease, uveitis). NSAIDs are the first-line pharmacological treatment in the various presentations. Conventional synthetic disease modifying antirheumatic drugs (csDMARDs) are not indicated in the axial and isolated entheseal forms. If the response to conventional treatment is not adequate, targeted therapies (biologics, synthetics) should be considered; the indications depend on the clinical phenotype and presence of extra-articular manifestations. CONCLUSION This update incorporates recent data (published since the prior update in 2018) and the predominant clinical phenotype concept. It aims to help physicians with the everyday management of patients affected by spondyloarthritis, including psoriatic arthritis.
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Hegde A, Mangal V, Vasdev V, Singh K, Bhanu K. Pure peripheral spondyloarthritis, is it exceedingly rare? A real-world experience from an Indian tertiary care hospital. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_117_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Carron P, De Craemer AS, Renson T, Colman R, Elewaut D, Van den Bosch F. TNFi-induced sustained clinical remission in peripheral spondyloarthritis patients cannot be maintained with a step-down strategy based on methotrexate. Rheumatology (Oxford) 2021; 60:4880-4883. [PMID: 33471112 DOI: 10.1093/rheumatology/keab056] [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: 10/10/2020] [Accepted: 11/14/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Treatment with golimumab monotherapy in early peripheral SpA (pSpA) results in higher rates of clinical remission compared with treatment in more longstanding disease. When reaching remission, treat-to-target recommendations suggest tapering of treatment. We therefore explored whether addition of MTX would permit discontinuation of golimumab in patients with pSpA in sustained clinical remission. METHODS After a 2-year extension phase with golimumab treatment, patients with pSpA reaching clinical remission in the CRESPA trial were offered a tapering strategy leading to discontinuation of golimumab and replacement by MTX monotherapy. Patients were prospectively followed to assess the rate of sustained biologic-free clinical remission. In case of relapse of arthritis, enthesitis or dactylitis under MTX monotherapy, golimumab was restarted. RESULTS Of the original 60 pSpA patients, 25 entered the step-down strategy. Currently, only 4 patients (16%) are still in sustained remission under MTX monotherapy. In 21 patients (84%), golimumab was reinstalled because of relapse of disease activity (n = 19) or development of adverse events related to MTX (n = 2). Restarting golimumab treatment promptly restored clinical remission in all patients within 12 weeks. CONCLUSION In patients with early pSpA achieving clinical remission after 2 years of golimumab treatment, step-down therapy to monotherapy with MTX led to high rates of clinical relapse. This underscores the overall weak efficacy of MTX in maintaining clinical remission in pSpA. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT01426815.
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Affiliation(s)
- Philippe Carron
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Thomas Renson
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Roos Colman
- Biostatistics Unit of the Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
| | - Filip Van den Bosch
- Department of Internal Medicine and Paediatrics, Ghent University Hospital.,VIB Center for Inflammation Research
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21
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Beckers E, Been M, Webers C, Boonen A, Ten Klooster PM, Vonkeman HE, van Tubergen A. Performance of three composite measures for disease activity in peripheral spondyloarthritis. J Rheumatol 2021; 49:256-264. [PMID: 34470791 DOI: 10.3899/jrheum.210075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate concurrent validity and discrimination of the Disease Activity Psoriatic Arthritis score (DAPSA), Psoriatic Arthritis Disease Activity Score (PASDAS) and Ankylosing Spondylitis Disease Activity Score (ASDAS) in peripheral spondyloarthritis (pSpA) in clinical practice. METHODS Data from a Dutch registry for SpA (SpA-Net) were used. Predefined hypotheses on concurrent validity of the composite measures with 15 other outcome measures of disease activity, physical function and health-related quality of life were tested. Concurrent validity was considered acceptable if ≥75% of the hypotheses were confirmed. Discrimination was assessed by stratifying patients in DAPSA, PASDAS and ASDAS predefined disease activity states and studying mean differences in health outcomes by one-way ANOVA. Furthermore, the concordance in disease activity states was determined. All analyses were repeated in subgroups with and without psoriasis. RESULTS DAPSA, PASDAS and ASDAS scores were available for 191, 139 and 279 patients with pSpA, respectively. The concurrent validity and discrimination of all composite measures were acceptable as the strength of correlations were as hypothesized in ≥75% of the studied correlations. With increasing disease activity states, scores in nearly all outcome measures worsened significantly. The DAPSA, PASDAS and ASDAS classified 22%, 56% and 48% of the patients, respectively, in the two highest disease activity states. Stratified analyses for concomitant psoriasis revealed no relevant subgroup differences. CONCLUSION The performance of DAPSA, PASDAS and ASDAS in pSpA was acceptable, and independent of concomitant psoriasis. Due to discrepancy in classification, the validity of existing thresholds for disease activity states warrants further study in pSpA.
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Affiliation(s)
- Esther Beckers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Marin Been
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Casper Webers
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Annelies Boonen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Peter M Ten Klooster
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Harald E Vonkeman
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands; Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. The authors declare that they have no conflict of interest. Funding declaration: SpA-Net was financially supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw; project number 836042001) and Dutch Arthritis Society, and was additionally sponsored by Abbvie, Biogen, Celgene, Janssen-Cilag, MSD, Novartis, Pfizer and UCB. Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author. Address correspondence to Esther Beckers, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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22
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Truong SL, Chin J, Liew DFL, Zahir SF, Ryan EG, Rubel D, Radford-Smith G, Robinson PC. Systematic Review and Meta-Analysis of Inflammatory Bowel Disease Adverse Events with Anti-Interleukin 17A Agents and Tumor Necrosis Factor Inhibitors in Rheumatic Disease and Skin Psoriasis. Rheumatol Ther 2021; 8:1603-1616. [PMID: 34449067 PMCID: PMC8572260 DOI: 10.1007/s40744-021-00360-6] [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: 07/17/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The aim of this work is to perform a systematic review and meta-analysis of anti-tumor necrosis factor (anti-TNF) and anti-interleukin-17 (anti-IL-17) trials for spondyloarthritis, psoriatic arthritis, and psoriasis comparing rates of inflammatory bowel disease (IBD) events compared to placebo. Methods MEDLINE, EMBASE, and The Cochrane Library were searched for double-blind, randomized placebo-controlled anti-TNF and anti-IL-17 trials of included diseases. Inflammatory bowel disease events from the RCT period were pooled and meta-analyzed using statistical methods suitable for low-event-rate meta-analysis (Peto’s, Mantel–Haenszel, hypergeometric-normal model, and Shuster-Guo-Skyler). When observed data were insufficient, we performed an exploratory sensitivity analysis to compare methods. Results We identified 9551 original papers, and included 96 publications: 65 anti-TNF and 31 anti-IL-17 trials, containing 21 new and 12 flare IBD events in 28,209 participants. New IBD on anti-IL-17 occurred 0.23/100 patient-years (PY) in psoriasis, 0.61/100 PY in PsA and 1.63/100 PY in spondyloarthritis, rates similar to observational cohorts, and less commonly on anti-TNF (0/100 PY, 0/100 PY, 0.32/100 PY, respectively). No evidence of difference between groups was found, with wide CI from many pooled counts of zero, especially in placebo arms. Conclusions IBD events were rare, occurring at rates similar to biologic-naive groups. We could not find statistically significant differences in risk of new or recurrent IBD between treatment and control groups using selected meta-analytical methods for low event rate scenarios. Meta-analyses of this topic require more IBD events, ideally without pooling heterogeneous groups. Larger, thoroughly reported trials with systematic and detailed safety reporting are required to improve risk estimation and to make accurate inferences. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00360-6.
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Affiliation(s)
- Steven L Truong
- Department of Medicine, Griffith University, Brisbane, QLD, Australia.,Coast Joint Care, Maroochydore, QLD, Australia
| | - Jasmine Chin
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - David F L Liew
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, Australia.,Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
| | - Syeda Farah Zahir
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth G Ryan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Diana Rubel
- Australian National University and Woden Dermatology, Canberra, Australia
| | | | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia. .,School of Clinical Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Bowen Bridge Road, Herston, QLD, 4006, Australia.
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23
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Kaeley GS, Kaler JK. Peripheral Enthesitis in Spondyloarthritis: Lessons from Targeted Treatments. Drugs 2021; 80:1419-1441. [PMID: 32720292 DOI: 10.1007/s40265-020-01352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A significant proportion of patients with spondyloarthritis (SpA) have peripheral enthesitis. Data suggest that psoriatic arthritis (PsA) patients with enthesitis have a higher disease burden than those without enthesitis. Over the past decade, there has been a proliferation of treatment options for spondyloarthropathy. These medications target multiple signaling pathways, including tumor necrosis factor (TNF), interleukin (IL)-17A, IL-12/23, IL-23, thymus (T)-cell co-stimulation, intracellular Janus kinases, and phosphodiesterase enzymes. As a key domain in SpA, enthesitis outcomes are included in pivotal trials of these agents and are reported as secondary outcome measures. One significant limitation is that the clinical evaluation of enthesitis relies on eliciting tenderness on palpation and is insensitive when compared with imaging. Furthermore, direct comparisons between studies are not available due to the use of different outcome measures, lack of consistent and comprehensive reporting outcomes, and subgroup analyses with a lower number of patients with enthesitis. This systematic review describes the epidemiology, pathophysiology, and available targeted therapies against enthesitis, as well as a detailed report of their efficacy. One major trend identified during this review is incomplete reporting of outcome measures, as many studies reported proportions of enthesitis prevalence. Factors that affected responsiveness in clinical trials included the entheseal instrument used, the number of subjects available for comparison, as well as the therapeutic agent. In general, anti-TNF and anti-IL-17 agents, as well as Janus kinase inhibitors, show moderate responsiveness for enthesitis. The data for IL-23 targeting is contradictory.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine Jacksonville, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA.
| | - Jaspreet K Kaler
- Division of Rheumatology, University of Florida College of Medicine Jacksonville, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA
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24
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Renson T, Carron P, De Craemer AS, Deroo L, de Hooge M, Krabbe S, Jans L, Østergaard M, Elewaut D, Van den Bosch F. The value of magnetic resonance imaging for assessing disease extent and prediction of relapse in early peripheral spondyloarthritis. Arthritis Rheumatol 2021; 73:2044-2051. [PMID: 33982902 DOI: 10.1002/art.41783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to assess the inflammatory burden in pSpA by lower-extremity MRI in an early remission-induction strategy study with TNF blockade. Furthermore, we sought to determine the value of MRI to predict disease relapse versus sustained remission after treatment discontinuation. METHODS Thirty-two early pSpA patients with lower limb involvement on clinical examination and confirmed by ultrasonography, participated in a remission-induction trial with a TNF-inhibitor (TNFi). Patients underwent MRI of joints and entheses of the lower extremities at baseline and at clinical remission, after which TNFi treatment was withdrawn. Images were evaluated for joint effusion, joint osteitis, entheseal soft tissue inflammation (STI), and entheseal osteitis. RESULTS Joint effusion and enthesitis on clinical examination and ultrasonography correlated well with MRI abnormalities. In addition, a substantial amount of subclinical involvement was seen on MRI, mainly in ankle joints and heel entheses. Inflammation scores were markedly lower in the subclinical joints and entheses versus those clinically involved. Inflammatory load on MRI decreased significantly upon TNFi treatment. Whereas 80% of the clinically involved joints at baseline showed no effusion on remission MRI, two out of three involved entheses at baseline showed residual inflammation. In addition, patients relapsing after treatment discontinuation displayed more entheseal STI on remission MRI compared to those maintaining drug-free remission. CONCLUSION Our findings delineate a differential response of synovitis and enthesitis, with enthesitis on MRI responding less upon TNFi treatment. Furthermore, residual entheseal inflammation might be indicative for the need for continuous therapy.
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Affiliation(s)
- Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Manouk de Hooge
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1017, Copenhagen, Denmark
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1017, Copenhagen, Denmark
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Center for Inflammation Research, Ghent University, Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium
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25
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Management of particular clinical situations in psoriatic arthritis: an expert's recommendation document based on systematic literature review and extended Delphi process. Rheumatol Int 2021; 41:1549-1565. [PMID: 33934175 PMCID: PMC8316175 DOI: 10.1007/s00296-021-04877-5] [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: 03/09/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
To establish practical recommendations for the management of patients with psoriatic arthritis (PsA) with particular clinical situations that might lead to doubts in the pharmacological decision-making. A group of six expert rheumatologists on PsA identified particular clinical situations in PsA. Then, a systematic literature review (SLR) was performed to analyse the efficacy and safety of csDMARDs, b/tsDMARDs in PsA. In a nominal group meeting, the results of the SLR were discussed and a set of recommendations were proposed for a Delphi process. A total of 65 rheumatologists were invited to participate in the Delphi. Agreement was defined if ≥ 70% of the participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grade of recommendation was established based on the Oxford Evidence-Based Medicine categorisation. Particular clinical situations included monoarthritis, axial disease, or non-musculoskeletal manifestations. The SLR finally comprised 131 articles. A total of 16 recommendations were generated, all but 1 reached consensus. According to them, it is crucial to carefully analyse the impact of individual manifestations on patients (disability, quality of life, etc.), but also to recognise the impact of each drug singularities on selected clinical phenotypes to adopt the most appropriate treatment strategy. Early diagnosis and treatment to target approach, along with a close risk management, is also necessary. These recommendations are intended to complement gaps in national and international guidelines by helping health professionals address and manage particular clinical situations in PsA.
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26
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van Dijk BT, van Steenbergen HW, Niemantsverdriet E, Brouwer E, van der Helm-van Mil AHM. The value of inquiring about functional impairments for early identification of inflammatory arthritis: a large cross-sectional derivation and validation study from the Netherlands. BMJ Open 2020; 10:e040148. [PMID: 33318115 PMCID: PMC7737110 DOI: 10.1136/bmjopen-2020-040148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Healthcare professionals other than rheumatologists experience difficulties in detecting early inflammatory arthritis (IA) by joint examination. Self-reported symptoms are increasingly considered as helpful and could be incorporated in online tools to assist healthcare professionals, but first their discriminative ability must be assessed. As part of this effort, we evaluated whether inquiring about functional impairments could aid early IA identification. DESIGN Cross-sectional derivation and validation study. SETTING Data from two Early Arthritis Recognition Clinics (EARC) in the Netherlands were studied, which are easy access outpatient rheumatology clinics intermediary between primary and secondary care for patients in whom general practitioners suspect but are unsure about IA presence. PARTICIPANTS Between 2010 and 2014, 997 patients consecutively visited the Leiden-EARC (derivation cohort). Patients consecutively visiting the Groningen EARC (2010-2014, n=506) and Leiden-EARC (2015-2018, n=557) served as validation cohorts. PRIMARY AND SECONDARY OUTCOME MEASURES Physical functioning was assessed with the Health Assessment Questionnaire Disability-Index (HAQ); IA presence by physical joint examination by rheumatologists. HAQ questions were studied individually regarding discriminative ability for IA presence. For the best discriminating question, ORs and positive predictive values (PPVs) for IA presence were determined. RESULTS IA was ascertained in 43% (derivation cohort), 53% and 35% (validation cohorts). In the derivation cohort, IA presence associated with higher mean HAQ scores (0.84 vs 0.73, p=0.003). One question on difficulties with dressing equalled discriminative ability of the total HAQ score. 'Difficulties with dressing' yielded ORs for IA presence of 1.8 (95% CI 1.4 to 2.4) in the derivation cohort; 2.0 (1.4 to 2.9) and 2.1 (1.5 to 3.1) in the validation cohorts. After adjustments for clinical characteristics these were 1.7 (1.3 to 2.3), 1.6 (1.1 to 2.5) and 1.9 (1.2 to 2.9). PPVs (probabilities of IA for positive answers) ranged 42%-60% and negative predictive values (probabilities of no IA for negative answers) ranged 57%-74%. CONCLUSIONS Patient-reported difficulties with dressing in patients with suspected IA associated with actual IA presence. Although further validation is required, for example, in primary care, this simple question could be of help in future early IA detection tools for healthcare professionals with limited experience in joint examination.
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Affiliation(s)
| | | | | | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annette H M van der Helm-van Mil
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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27
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Weiss PF, Fuhlbrigge RC, von Scheven E, Lovell DJ, Colbert RA, Brunner HI. Children with enthesitis-related arthritis could benefit from treatments targeted for adults with spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 74:1058-1064. [PMID: 33278336 DOI: 10.1002/acr.24529] [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: 09/21/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022]
Abstract
This review will summarize clinical, genetic and pathophysiologic characteristics that are shared between children with enthesitis related arthritis (ERA) with axial involvement and adults with non-radiographic, and in some cases radiographic, axial spondyloarthritis (SpA); and between children with ERA and primarily peripheral disease manifestations and adults with peripheral SpA. Due to the differences in classification criteria for children with ERA and adults with axial and peripheral SpA, the FDA granted automatic full waivers of studies in children for new medications for "axial spondyloarthropathies including ankylosing spondylitis" up until July 2020. Thus, although current juvenile idiopathic arthritis (JIA) treatment guidelines recommend the use of biologic disease modifying anti-rheumatic drugs (DMARDs) as part of the early treatment for patients with ERA, none of the FDA-approved therapies for peripheral SpA or non-radiographic axial SpA (certolizumab pegol, ixekizumab, and secukinumab) have been studied or are labelled for use in children with ERA. Considering the similarities between adult spondyloarthritis and ERA in terms of etiology, genetics, pathogenesis and clinical manifestations summarized in this review, medications approved for axial SpA or peripheral SpA should also be studied in children with active ERA involving axial or peripheral joints, respectively, with the intent to achieve labeling for use in children. Considering the current lack of effective FDA-approved therapies for ERA, the FDA should also consider requiring pediatric studies for medications that have already been approved for the treatment of adults with SpA.
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Affiliation(s)
- Pamela F Weiss
- Children's Hospital of Philadelphia, Perlman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Robert C Fuhlbrigge
- Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, USA, Cincinnati
| | - Emily von Scheven
- University of California, San Francisco. California, USA, Cincinnati
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Robert A Colbert
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
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28
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Renson T, Carron P, De Craemer AS, Deroo L, de Hooge M, Krabbe S, Jans L, Chen M, Østergaard M, Van den Bosch FE, Elewaut D. Axial involvement in patients with early peripheral spondyloarthritis: a prospective MRI study of sacroiliac joints and spine. Ann Rheum Dis 2020; 80:103-108. [PMID: 33115761 DOI: 10.1136/annrheumdis-2020-218480] [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: 07/01/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess axial involvement on MRI in early peripheral spondyloarthritis (pSpA) and to evaluate whether axial inflammation predicts relapse on treatment withdrawal. METHODS Fifty-six patients with early, active, newly diagnosed pSpA underwent MRI of the sacroiliac joints (SIJs) and spine prior to golimumab initiation. At sustained clinical remission of pSpA, treatment was withdrawn and a second MRI was performed. Bone marrow oedema (BME) was scored by three readers according to the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Scores were compared with an axial spondyloarthritis cohort (Belgian Arthritis and Spondylitis cohort). Structural lesions were assessed using a similar method. Furthermore, fulfilment of the Assessment of Spondyloarthritis International Society (ASAS) definition of a positive MRI for sacroiliitis was assessed. Spinal images were evaluated for BME and structural lesions using the Canada-Denmark MRI spine scoring system by two readers. RESULTS Thirty-six per cent showed SIJ BME at baseline, all fulfilling the ASAS definition of sacroiliitis. No association with back pain was found. Twenty-one per cent displayed SIJ structural lesions. Spinal BME was limited: the median inflammation scores were low and no patients had ≥5 inflammatory corner lesions. On clinical remission, a significant decrease in SIJ SPARCC scores was detected. On clinical remission, no significant differences in SIJ SPARCC scores were noted between patients relapsing and those maintaining remission after treatment discontinuation. CONCLUSION In patients with early pSpA, a surprisingly high prevalence of sacroiliitis on MRI was observed; SPARCC scores decreased significantly on tumour necrosis factor inhibition. Residual inflammation on MRI was not predictive of relapse of peripheral manifestations. No relevant inflammatory spinal involvement was detected. Collectively, our findings suggest a higher inflammatory burden in patients with early pSpA than anticipated.
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Affiliation(s)
- Thomas Renson
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium .,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Philippe Carron
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Liselotte Deroo
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Manouk de Hooge
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lennart Jans
- Radiology, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Min Chen
- Radiology, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Dirk Elewaut
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
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29
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Coates LC, Abraham S, Tillett W, Mease PJ, Ramiro S, Wu T, Wang X, Pangan AL, Song IH. Performance and Predictors of Minimal Disease Activity Response in Peripheral Spondyloarthritis Patients Treated With Adalimumab. Arthritis Care Res (Hoboken) 2020; 74:259-267. [PMID: 32937016 DOI: 10.1002/acr.24442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine concurrent validity and discrimination of modified minimal disease activity (mMDA) criteria in peripheral spondyloarthritis (pSpA) following OMERACT filter principles and determine predictors of mMDA response. METHODS Four mMDA versions were derived in the ABILITY-2 study using the SPondyloArthritis Research Consortium of Canada (SPARCC) or Leeds Enthesitis Index (LEI) but excluding psoriasis. To assess concurrent validity, mMDA versions were correlated with Peripheral SpondyloArthritis Response Criteria (PSpARC) remission, Ankylosing Spondylitis Disease Activity Score for inactive disease (ASDAS ID), and physician global. Treatment discrimination was assessed between adalimumab and placebo at week 12. Multiple logistic regression was used to determine baseline predictors of long-term mMDA responses and sustained mMDA. RESULTS The four mMDA versions showed a stronger positive correlation with PSpARC remission (rtet >0.95) versus ASDAS ID (rtet >0.75) at week 12 and years 1-3 and were able to show discrimination (p<0.001). Responsiveness was shown at week 12; significantly more patients receiving adalimumab versus placebo achieved all four versions of mMDA. Approximately 40-60% of adalimumab-treated patients achieved mMDA-LEI or SPARCC at years 1-3. Achieving mMDA response after 12 weeks of adalimumab treatment was a robust positive predictor of attaining long-term mMDA through 3 years (odds ratios: 11.38-27.13 for mMDA-LEI; 17.98-37.85 for mMDA-SPARCC). CONCLUSIONS All four versions of mMDA showed concurrent validity and discriminated well between adalimumab and placebo treatment groups. Early mMDA response is a more consistent predictor of long-term mMDA achievement than baseline characteristics. The 5 of 6 versions of mMDA could be an appropriate treatment target in pSpA patients.
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Affiliation(s)
| | - Sonya Abraham
- National Institute for Health Research/Wellcome CRF, Imperial College Healthcare NHS Trust, London, UK
| | - William Tillett
- Royal National Hospital for Rheumatic Diseases, Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
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30
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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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Carron P, De Craemer AS, Van den Bosch F. Peripheral spondyloarthritis: a neglected entity-state of the art. RMD Open 2020; 6:e001136. [PMID: 32385142 PMCID: PMC7299516 DOI: 10.1136/rmdopen-2019-001136] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
Peripheral spondyloarthritis (pSpA) refers to a number of seemingly different spondyloarthritis subsets in which psoriatic arthritis (PsA) is the most common, and symptoms of arthritis, enthesitis or dactylitis predominate the clinical presentation. Although formal classification criteria for pSpA have been introduced in 2011, only a minority of epidemiological and clinical studies addressed this clinical entity as a separate disease. Moreover, research on outcome measures and treatment modalities in pSpA has been mainly focused on PsA. Subsequently, all biological treatments are off-label in patients with non-psoriatic pSpA. Its neglected status has important implications for clinical practice since the emerging group of early-diagnosed non-psoriatic pSpA patients remains poorly characterised and lacks specific treatment recommendations. This review summarises what is currently known regarding pSpA in terms of epidemiology, clinical presentation, diagnosis and therapeutic approach.
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Affiliation(s)
- Philippe Carron
- Rheumatology, University Hospital Ghent, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Rheumatology, University Hospital Ghent, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
| | - Filip Van den Bosch
- Rheumatology, University Hospital Ghent, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent, Belgium
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Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis? Rheum Dis Clin North Am 2020; 46:311-325. [DOI: 10.1016/j.rdc.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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33
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Fujikawa K, Kawashiri SY, Endo Y, Mizokami A, Tsukada T, Mine M, Uetani M, Kawakami A. Diagnostic efficacy of ultrasound detection of enthesitis in peripheral spondyloarthritis. Mod Rheumatol 2019; 30:1060-1066. [PMID: 31663417 DOI: 10.1080/14397595.2019.1687113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: We investigated the diagnostic efficacy of power Doppler ultrasound (PDUS) to detect enthesitis in Japanese patients with peripheral spondyloarthritis (SpA).Methods: This was a single-center cohort study of patients with peripheral symptoms suggestive of SpA. Articular synovia, tendons, and entheses were assessed by PDUS at baseline. Clinical, laboratory, and radiologic findings and classification criteria for SpA were also evaluated.Results: 136 patients were consecutively evaluated. A definite diagnosis was obtained in 111 patients, including 72 with SpA and 39 non-SpA. Among the patients with SpA, PDUS demonstrated articular synovitis in 40 of the 72 patients (56%), tenosynovitis or peritendinitis in 48 (67%), and enthesitis in 63 (88%). Considering PDUS alone, enthesitis in at least one site was the most useful means of differentiating SpA from non-SpA (sensitivity 87.5%; specificity 82.1%; accuracy 85.6%; positive likelihood ratio 4.88). Combining that finding along with fulfillment of Amor, European Spondyloarthropathy Study Group, or Assessment of SpondyloArthritis international Society criteria for peripheral SpA increased the specificity of the diagnosis (92.5%, 92.3%, and 97.4%, respectively).Conclusion: PDUS enthesitis is useful for the diagnosis of SpA with peripheral symptoms. Combining PDUS enthesitis with established SpA classification criteria is beneficial in diagnosing peripheral SpA.
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Affiliation(s)
- Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yushiro Endo
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan.,Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Toshiaki Tsukada
- Department of Rheumatology, Aino Memorial Hospital, Unzen, Japan
| | - Masanobu Mine
- Department of Rheumatology, Suga Orthopedic Hospital, Isahaya, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Abstract
This article discusses treat-to-target strategies in axial spondyloarthritis and current status. Treatment ranging from nonsteroidal anti-inflammatory drugs to biologic and other disease-modifying drugs is discussed in the context of treat-to-target. The article explores evidence from landmark randomized, controlled trials and observational studies focusing on both radiographic and nonradiographic axial spondyloarthritis. The feasibility of treat-to-target, as well as predictors of remission are addressed in line with existing evidence. Finally, issues around management principles and challenges, as well as unmet need in the field, are highlighted.
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Affiliation(s)
- Elena Nikiphorou
- Department of Inflammation Biology, King's College London, Weston Education Centre, Cutcombe Road, Room 3.53, 3rd Floor, London SE5 9RJ, UK; Department of Rheumatology, King's College Hospital, London, UK
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Claudiusstr. 45, Herne 44649, Germany.
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35
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Abstract
PURPOSE OF REVIEW There was a substantial progress in the field of spondyloarthritis (SpA) in terms of understanding disease mechanisms, early diagnosis, and improved treatment. Nonetheless, several unresolved questions and unmet needs do remain. RECENT FINDINGS Although the diagnostic delay in axial SpA is decreasing, it remains one of the longest in rheumatology. Application of referral strategies, as well as correct application and interpretation of imaging finding in the clinical context, is the main key to early diagnosis of axial SpA. Tumor necrosis factor (TNF) alpha and interleukin (IL)-17 represent currently two major treatment targets in SpA, while other promising targets such as IL-23 or IL-6 failed in clinical trials. There is an unmet need for strategy trials to optimize and to individualize treatment in SpA. The role of Janus kinases and their blockade in SpA is still to be explored. TNF blockade showed efficacy in peripheral SpA, and other targets (IL-17 and IL-23) should be investigated in clinical trials. Early, effective, and long-term suppression of inflammation is currently the best method to prevent structural damage progression in the spine in axial SpA, while specific effects of IL-17 blockade and of nonsteroidal anti-inflammatory drugs on new bone formation are still being investigated. This review summarizes the recent advances in diagnosis and treatment of SpA and discusses the current unmet needs in the field.
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36
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Abstract
Peripheral spondyloarthritis refers to spondyloarthritis with predominant peripheral (arthritis, enthesitis or dactylitis) involvement. Diagnosis can be challenging, particularly in the absence of SpA extra-articular manifestations such as uveitis, psoriasis or inflammatory bowel disease. Evaluation of disease activity should always include assessment of objective signs of inflammation, particularly in the presence of enthesitis as the sole peripheral manifestation, mainly due to the potential misdiagnosis with fibromyalgia tender points. Several recommendations for management/treatment of psoriatic arthritis have been published by EULAR and GRAPPA but none for peripheral SpA in general. NSAIDs and glucocorticoids are recommended as the first step of treatment in all peripheral manifestations, while conventional synthetic (cs) DMARDs seem only efficacious in arthritis. Several biologics and targeted synthetic (ts) DMARDs (TNFi, anti-IL17 and JAK-inhibitors) have been proven to be efficacious in peripheral involvement in PsA (arthritis and enthesitis), but studies on peripheral SpA are lacking.
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Affiliation(s)
- Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM (U-1153), CRESS, Paris, France.
| | - Joachim Sieper
- Rheumatology, Charité, Campus Benjamin Franklin, Berlin, 12200, Germany
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37
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van Mens LJJ, de Jong HM, Fluri I, Nurmohamed MT, van de Sande MGH, Kok M, van Kuijk AWR, Baeten D. Achieving remission in psoriatic arthritis by early initiation of TNF inhibition: a double-blind, randomised, placebo-controlled trial of golimumab plus methotrexate versus placebo plus methotrexate. Ann Rheum Dis 2019; 78:610-616. [PMID: 30808625 DOI: 10.1136/annrheumdis-2018-214746] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Early initiation of effective treatment favours remission in rheumatoid arthritis, but it remains unknown if the same concept applies to psoriatic arthritis (PsA). Therefore, this study investigated whether the combination of golimumab plus methotrexate (MTX) as a first-line treatment is superior to MTX alone in inducing remission in PsA. METHODS This investigator-initiated, multicentre, double-blind, randomised, placebo-controlled trial included 51 MTX and bDMARD-naive patients with PsA fulfilling the CASPAR criteria and with active disease at baseline (≥3 swollen joint count/tender joint count). Patients were randomised to golimumab (50 mg SC monthly)+MTX (n=26) (TNFi arm) or matched placebo+MTX (n=25) (MTX arm). MTX was started 15 mg/week and increased to 25 mg/week over 8 weeks. The primary endpoint was percentage of patients achieving Disease Activity Score (DAS) remission (<1.6) at week 22. Safety was assessed throughout the study. RESULTS The primary efficacy endpoint was achieved by 81% in the TNFi arm versus 42 % in the MTX arm (p=0.004). This difference in DAS remission was already observed at week 8. A significant difference in favour of the golimumab+MTX arm at week 22 was also observed for other response criteria such as MDA, ACR20/50/70, disease measures and patient-reported outcomes. The occurrence rates of adverse event and treatment-emergent adverse event were similar in both arms. CONCLUSIONS In patients with early PsA, DAS remission at week 22 was almost doubled with golimumab+MTX versus MTX alone. This double-blind, randomised, placebo-controlled study supports the concept that early initiation of TNFi in patients with PsA favours remission. TRIAL REGISTRATION NUMBER NCT01871649.
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Affiliation(s)
- Leonieke J J van Mens
- Clinical Immunology and Rheumatology, Amsterdam UMC, AMC/University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Amsterdam, The Netherlands
| | - Henriëtte M de Jong
- Clinical Immunology and Rheumatology, Amsterdam UMC, AMC/University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Amsterdam, The Netherlands
| | - Inka Fluri
- Clinical Immunology and Rheumatology, Amsterdam UMC, AMC/University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and immunology Center, Amsterdam, The Netherlands.,Clinical Immunology and Rheumatology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Marleen G H van de Sande
- Clinical Immunology and Rheumatology, Amsterdam UMC, AMC/University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and immunology Center, Amsterdam, The Netherlands
| | - Marc Kok
- Rheumatology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Arno W R van Kuijk
- Amsterdam Rheumatology and immunology Center, Amsterdam, The Netherlands.,Rheumatology, Jan van Breemen Research Institute
- Reade, Amsterdam, The Netherlands
| | - Dominique Baeten
- Clinical Immunology and Rheumatology, Amsterdam UMC, AMC/University of Amsterdam, Amsterdam, The Netherlands .,Amsterdam Rheumatology and immunology Center, Amsterdam, The Netherlands
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Lories RJ. Advances in understanding the pathophysiology of spondyloarthritis. Best Pract Res Clin Rheumatol 2019; 32:331-341. [PMID: 31171306 DOI: 10.1016/j.berh.2018.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/10/2018] [Indexed: 01/02/2023]
Abstract
Progressive understanding of the underlying pathophysiology of axial spondyloarthritis has successfully translated into innovative therapeutic strategies and successful management of patients in the clinic. This review summarizes the key roles of the pro-inflammatory cytokines tumor necrosis factor and interleukin-17 in the onset and progression of disease and how these cytokines are instrumental in shaping the concept that enthesitis is a key feature of axial spondyloarthritis. Advances in immunological technologies have led to the important insight that different cell populations, part of both the innate and adaptive immune system, play a key role in axial spondyloarthritis. In addition to inflammation, structural damage to the axial skeleton, in particular progressive ankylosis of the sacroiliac joints and the spine, is key to the outcome of patients. Novel data integrate the role of pro-inflammatory cytokines and enthesitis in this context.
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Affiliation(s)
- Rik J Lories
- KU Leuven, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, Leuven, Belgium; University Hospitals Leuven, Division of Rheumatology, Leuven, Belgium.
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39
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Carron P, Varkas G, Renson T, Colman R, Elewaut D, Van den Bosch F. High Rate of Drug-Free Remission After Induction Therapy With Golimumab in Early Peripheral Spondyloarthritis. Arthritis Rheumatol 2018; 70:1769-1777. [DOI: 10.1002/art.40573] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/22/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Philippe Carron
- Ghent University Hospital and VIB Inflammation Research Center; Ghent University; Ghent Belgium
| | - Gaëlle Varkas
- Ghent University Hospital and VIB Inflammation Research Center; Ghent University; Ghent Belgium
| | - Thomas Renson
- Ghent University Hospital and VIB Inflammation Research Center; Ghent University; Ghent Belgium
| | - Roos Colman
- Biostatistics Unit of the Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Dirk Elewaut
- Ghent University Hospital and VIB Inflammation Research Center; Ghent University; Ghent Belgium
| | - Filip Van den Bosch
- Ghent University Hospital and VIB Inflammation Research Center; Ghent University; Ghent Belgium
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40
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Efficacy of new treatments for dactylitis of psoriatic arthritis: update of literature review. Clin Rheumatol 2018; 38:591-596. [PMID: 30328022 DOI: 10.1007/s10067-018-4328-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/14/2018] [Accepted: 10/08/2018] [Indexed: 01/05/2023]
Abstract
Dactylitis is a frequent disabling feature of psoriatic arthritis (PsA). Therapeutic strategy on dactylitis is not really codified. We performed a complementary literature review (since a previous one in 2014) of efficacy of new treatments recently used in PsA on this specific clinical manifestation. Eleven publications were retained (4697 patients). In the randomized double-blind placebo-controlled trials analyzed, authors declared ustekinumab, ixekizumab, adalimumab, and apremilast efficient. Secukinumab, clazakizumab, abatacept, and tofacitinib were promising. Brodalumab was ineffective. Calculations of odds ratios for residual dactylitis were significant for clazakizumab 100 mg and secukinumab in anti-TNF-naïve population. Homogenization of dactylitis assessment and use of this criterion as primary outcome are necessary to have better data on treatment efficacy in the future.
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41
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Evolution of clinical trials for rheumatoid arthritis and spondyloarthritis. Curr Opin Rheumatol 2018; 30:340-346. [DOI: 10.1097/bor.0000000000000516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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42
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Van den Bosch F, Coates L. Clinical management of psoriatic arthritis. Lancet 2018; 391:2285-2294. [PMID: 29893227 DOI: 10.1016/s0140-6736(18)30949-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 01/01/2023]
Abstract
Psoriatic arthritis, or the broader term psoriatic disease, refers to an inflammatory disorder that affects multiple organs, including the skin and joints, and that also has related extra-articular manifestations and can have comorbidities. Patients with psoriatic disease have a substantial clinical burden. Early identification leading to timely diagnosis and treatment is crucial to prevent long-term structural damage and disability and the associated socioeconomic consequences. The increase in therapeutic options, such as disease-modifying anti-rheumatic drugs, both biological and targeted synthetic, has revolutionised the treatment of skin and joint disease, and has prompted clinicians to use the full clinical picture of an individual patient to make rational treatment decisions. Current research is also focused on treatment strategies, including treat to target, early remission-induction, and tapering.
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Affiliation(s)
- Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Department of Internal Medicine, Ghent University, Ghent, Belgium.
| | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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43
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Actualisation 2018 des recommandations de la Société française de rhumatologie (SFR) pour la prise en charge en pratique courante des malades atteints de spondyloarthrite. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rhum.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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44
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Wendling D, Lukas C, Prati C, Claudepierre P, Gossec L, Goupille P, Hudry C, Miceli-Richard C, Molto A, Pham T, Saraux A, Dougados M. 2018 update of French Society for Rheumatology (SFR) recommendations about the everyday management of patients with spondyloarthritis. Joint Bone Spine 2018; 85:275-284. [PMID: 29407043 DOI: 10.1016/j.jbspin.2018.01.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update French Society for Rheumatology recommendations about the management in clinical practice of patients with spondyloarthritis (SpA). SpA is considered across the range of clinical phenotypes (axial, peripheral, and entheseal) and concomitant manifestations. Psoriatic arthritis is included among the SpA phenotypes. METHODS According to the standard procedure advocated by the EULAR for developing recommendations, we first reviewed the literature published since the previous version of the recommendations issued in June 2013. A task force used the results to develop practice guidelines, which were then revised and graded using AGREE II. RESULTS Four general principles and 15 recommendations were developed. The first four recommendations deal with treatment goals and general considerations (assessment tools and comorbidities). Recommendations 5 and 6 are on non-pharmacological treatments. Recommendation 7 is about nonsteroidal anti-inflammatory drugs, which are the cornerstone of the treatment, and recommendations 8 to 10 are on analgesics, glucocorticoid therapy, and conventional disease-modifying antirheumatic drugs. Biologics are the focus of recommendations 11 through 14, which deal with newly introduced drug classes, including their indications (active disease despite conventional therapy and, for nonradiographic axial SpA, objective evidence of inflammation) and monitoring, and with patient management in the event of treatment failure or disease remission. Finally, recommendation 15 is about surgical treatments. CONCLUSION This update incorporates recent data into a smaller number of more simply formulated recommendations, with the goal of facilitating their use for guiding the management of patients with SpA.
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Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4266, université Bourgogne Franche-Comté, place Goudimel, 25030 Besançon, France.
| | - Cédric Lukas
- EA2415, département de rhumatologie, institut universitaire de recherche clinique, université de Montpellier, CHU de Lapeyronie, 34000 Montpellier, France
| | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4267, FHU Increase, université Bourgogne Franche-Comté, 25030 Besançon, France
| | - Pascal Claudepierre
- Service de rhumatologie, groupe hospitalier Henri-Mondor, AP-HP, Créteil, 94000, France; EA 7379-épiderme, université Paris Est Créteil, Créteil, 94000, France
| | - Laure Gossec
- UPMC universié Paris 06, Sorbonne universités, institut Pierre-Louis d'épidémiologie et de santé publique (UMRS 1136), 75252 Paris, France; Rheumatology department, hôpital Pitié Salpêtrière, AP-HP, 75013 Paris, France
| | - Philippe Goupille
- Service de rhumatologie, CHRU de Tours, 37000 Tours, France; UMR CNRS 7292, université François-Rabelais, 37000 Tours, France
| | - Christophe Hudry
- Cabinet de rhumatologie, 75008 Paris, France; Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France
| | - Corinne Miceli-Richard
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France
| | - Anna Molto
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France; INSERM (UU1153), clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75014 Paris 14, France
| | - Thao Pham
- Service de rhumatologie, hôpital Sainte-Marguerite, Aix-Marseille université, AP-HM, 13000 Marseille, France
| | - Alain Saraux
- Service de rhumatologie, CHU de Brest, 29609 Brest cedex, France; UMR1227, université de Bretagne Occidentale, labex IGO, Brest, 29000 France
| | - Maxime Dougados
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France; INSERM (UU1153), clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75014 Paris 14, France
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