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Kwatra SG, Khattri S, Amin AZ, Ranza R, Kaplan B, Shi L, Padilla B, Soliman AM, McGonagle D. Enthesitis and Dactylitis Resolution with Risankizumab for Active Psoriatic Arthritis: Integrated Analysis of the Randomized KEEPsAKE 1 and 2 Trials. Dermatol Ther (Heidelb) 2024; 14:1517-1530. [PMID: 38739215 PMCID: PMC11169338 DOI: 10.1007/s13555-024-01174-4] [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: 01/31/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION The presence (vs absence) of enthesitis/dactylitis is associated with greater psoriatic arthritis (PsA) activity and reduced health-related quality of life. Risankizumab, an interleukin 23 antagonist, demonstrated superior treatment efficacy over placebo in patients with PsA, including enthesitis/dactylitis. Herein, we report the efficacy of risankizumab on complete resolution of enthesitis and/or dactylitis and improvements in patient-reported outcomes in patients with PsA. METHODS This integrated post hoc analysis of data from KEEPsAKE 1 and KEEPsAKE 2 included patients with baseline enthesitis (Leeds Enthesitis Index > 0) and/or dactylitis (Leeds Dactylitis Index > 0). Efficacy outcomes at weeks 24 and 52 included proportion of patients achieving enthesitis and/or dactylitis resolution and minimal clinically important differences (MCID) in pain, Health Assessment Questionnaire-Disability Index, and Functional Assessment of Chronic Illness Therapy-Fatigue. RESULTS Of 1407 patients, approximately 63%, 28%, and 20% had baseline enthesitis, dactylitis, and both enthesitis/dactylitis, respectively. At week 24, higher response rates were observed for risankizumab vs placebo for resolution of enthesitis, dactylitis, and both enthesitis/dactylitis (differences of 13.9%, 16.9%, and 13.3%, respectively; p < 0.05). By week 52, risankizumab treatment resulted in complete resolution of enthesitis, dactylitis, and both enthesitis and dactylitis in 55.0%, 76.1%, and 52.3% of patients; similar resolution rates occurred among patients who switched from placebo to risankizumab. Among risankizumab-treated patients who achieved resolution of enthesitis and/or dactylitis, MCIDs were also attained in patient-reported pain, disability, and fatigue at week 24 (all p < 0.05; except fatigue in patients with resolution of both enthesitis/dactylitis); responses were sustained through week 52. CONCLUSIONS Higher proportions of risankizumab-treated (vs placebo-treated) patients achieved enthesitis and/or dactylitis resolution and meaningful improvements in patient-reported outcomes at week 24 and generally sustained responses at week 52. Thus, risankizumab may result in sustained alleviation of PsA-related pathognomonic musculoskeletal lesions of enthesitis/dactylitis. CLINICALTRIALS GOV IDENTIFIERS NCT03675308, and NCT03671148.
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Affiliation(s)
- Shawn G Kwatra
- Department of Dermatology, John Hopkins University School of Medicine, 601 N Caroline St, 8th Floor, Baltimore, MD, 21287, USA.
| | - Saakshi Khattri
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ahmad Z Amin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roberto Ranza
- Rheumatology Unit, Hospital das Clínicas, Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | | | | | - Dennis McGonagle
- Division of Rheumatology, University of Washington, Seattle, WA, USA
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
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Bonfiglioli KR, Lopes FODA, de Figueiredo LQ, Ferrari LFF, Guedes L. Ultrasonographic Insights into Peripheral Psoriatic Arthritis: Updates in Diagnosis and Monitoring. J Pers Med 2024; 14:550. [PMID: 38929771 PMCID: PMC11205202 DOI: 10.3390/jpm14060550] [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: 04/22/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians' understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Reumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, Brazil; (F.O.d.A.L.); (L.Q.d.F.); (L.F.F.F.); (L.G.)
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Balulu G, Furer V, Wollman J, Levartovsky D, Aloush V, Elalouf O, Sarbagil-Maman H, Mendel L, Borok S, Paran D, Elkayam O, Polachek A. The association between sonographic enthesitis with sonographic synovitis and tenosynovitis in psoriatic arthritis patients. Rheumatology (Oxford) 2024; 63:190-197. [PMID: 37166435 DOI: 10.1093/rheumatology/kead202] [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: 01/20/2023] [Revised: 03/25/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To examine the association between sonographic enthesitis with sonographic synovitis and tenosynovitis in PsA patients, and the association between sonographic enthesitis and clinical characteristics. METHODS Consecutive PsA patients that fulfilled the ClASsification criteria for Psoriatic ARthritis (CASPAR) were prospectively recruited. Each patient was evaluated by comprehensive clinical and sonographic assessment (greyscale and Doppler), the latter including 52 joints, 40 tendons and 14 entheses [according to MAdrid Sonography Enthesitis Index (MASEI) plus lateral epicondyles] performed by an experienced sonographer blinded to the clinical data. The US enthesitis score was further categorized to inflammatory (hypoechogenicity, thickening, bursitis and Doppler) and structural (enthesophytes/calcifications and erosions) subcategories. Multivariate linear regression models assessed the association between enthesitis and the selected variables. RESULTS A total of 158 PsA patients [mean (s.d.) age 52.3 (13) years, 88 (55.7%) females] were analysed. Multivariate linear regression analyses showed a significant association between sonographic enthesitis and sonographic synovitis (β = 0.18, P = 0.008) and between sonographic enthesitis and sonographic tenosynovitis (β = 0.06, P = 0.02). These associations were derived from the enthesitis inflammatory subcategory of the MASEI (P < 0.05). Associations between enthesitis and synovitis were also demonstrated on the level of the elbow, knee and ankle joints (P < 0.05). In addition, sonographic enthesitis was significantly associated with older age, male sex, swollen joint count, CRP level and physical occupation. CONCLUSIONS Sonographic enthesitis is associated with sonographic synovitis and tenosynovitis. The severity of sonographic enthesitis may represent a marker for inflammatory activity in other musculoskeletal domains.
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Affiliation(s)
- Gavriel Balulu
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Wollman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Levartovsky
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valerie Aloush
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Elalouf
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Sarbagil-Maman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Mendel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Borok
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Paran
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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D'Agostino MA, Carron P, Gaillez C, Conaghan PG, Naredo E, López-Rdz A, Šenolt L, Burgos-Vargas R, Hanova P, Padovano I, Cazenave T, Stoenoiu MS, Backhaus M, Mouterde G, Bao W, Goyanka P, Boers M, Schett G. Effects of secukinumab on synovitis and enthesitis in patients with psoriatic arthritis: 52-week clinical and ultrasound results from the randomised, double-blind ULTIMATE trial with open label extension. Semin Arthritis Rheum 2023; 63:152259. [PMID: 37660536 DOI: 10.1016/j.semarthrit.2023.152259] [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: 12/21/2022] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES In the ULTIMATE study with an open label extension, we assessed the long-term effect of secukinumab at tissue level on synovitis and enthesitis, and across all psoriatic arthritis (PsA) manifestations, using both clinical evaluations and power Doppler ultrasonography (PDUS). METHODS This randomised, placebo-controlled, Phase 3 study (ULTIMATE) included biologic-naïve patients with PsA with active PDUS synovitis and clinical enthesitis, and inadequate response to conventional synthetic disease-modifying antirheumatic drugs. The study consisted of 3 treatment periods; in the first period (baseline to week 12) patients were randomised to receive subcutaneous secukinumab (150 mg or 300 mg according to severity of skin psoriasis) or placebo every week until week 4 and once every 4 weeks up to week 12. In the second period (weeks 12-24) all patients received open-label secukinumab with placebo patients switching to secukinumab (150 mg or 300 mg). The third period (weeks 24-52) was an extended open-label treatment period. The long-term responsiveness of the Global EULAR-OMERACT Synovitis Score (GLOESS), clinical enthesitis and global PDUS-detected enthesitis score (using two candidate definitions of activity) at patient level, together with clinical efficacy across key manifestations of PsA and safety were assessed. RESULTS Of the 166 patients enrolled, 144 completed week 52. A significant reduction in GLOESS was demonstrated in the secukinumab group vs placebo at week 12, followed by a stable reduction of synovitis until week 52 in the secukinumab group while placebo switchers from week 12 reached a similar level of reduction at week 24 with stability thereafter. Likewise, a significant reduction in the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index was shown in the secukinumab group vs placebo at week 12 with sustained improvement to week 52. Global OMERACT PDUS enthesitis scores were numerically lower in secukinumab vs placebo switchers in the first two treatment periods, with some stability in the third period in both groups. Improvements in clinical responses were also observed across all key domains of PsA up to week 52 in both treatment groups with no new or unexpected safety signals. CONCLUSIONS ULTIMATE showed consistent improvements in clinically and ultrasound-assessed synovitis and enthesitis and sustained clinical efficacy through week 52 in patients with PsA treated with secukinumab and placebo switched to secukinumab.
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Affiliation(s)
- Maria Antonietta D'Agostino
- Department of Rheumatology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy.
| | - Philippe Carron
- Department of Internal Medicine and Paediatrics, Ghent University Hospital, VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, United Kingdom
| | - Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
| | - Alejandra López-Rdz
- Dermatológico Country, PSOAPS Psoriasis Clinical and Research Centre, Guadalajara, Mexico
| | - Ladislav Šenolt
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Ruben Burgos-Vargas
- Department of Rheumatology, Hospital General de Mexico, Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico
| | - Petra Hanova
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Ilaria Padovano
- Service de Rhumatologie, Hopital Ambroise Paré, AP-HP. Université Paris Saclay Boulogne-Billancourt, France
| | - Tomas Cazenave
- Instituto de Rehabilitación Psicofisica, Buenos Aires, Argentina
| | - Maria S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium
| | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gaël Mouterde
- Department of Rheumatology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Weibin Bao
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | | | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Germany; Universitätsklinikum Erlangen, Erlangen, Germany
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Elliott A, Wright G, Pendleton A, Rooney M. Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231179524. [PMID: 38024204 PMCID: PMC10655675 DOI: 10.1177/1759720x231179524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/15/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Enthesitis is a hallmark of psoriatic disease, but its clinical assessment is problematic in terms of diagnostic sensitivity and overlap with other comorbid conditions. Ultrasound is a useful tool that can give a more detailed assessment of enthesitis. Research demonstrates that those with persistent ultrasound entheseal disease are at risk of progressive articular damage. With limited data to guide choice between biologic therapy for psoriatic arthritis (PsA) patients, we wanted to assess the response of ultrasound-confirmed enthesitis to different forms of biologic therapies and study its utility in making more informed decisions. Methods This was an open label observational study including patients aged ⩾18 years, who fulfil the classification criteria for PSA (CASPAR) and were due to commence on their first biologic therapy. The primary outcome was the change in MAdrid Sonographic Enthesitis Index (MASEI) score at 16 weeks of treatment. The MASEI score was also modified to assess the active elementary lesions (ActiveMASEI). Results In all, 80 PsA patients were enrolled with 75 patients completing the study [secukinumab n = 23 and tumour necrosis factor inhibitor (TNFi) n = 52]. The mean reduction in MASEI score after 16 weeks of treatment was 3.42 with TNFi versus 1.74 with secukinumab (p = 0.097). There was a significant difference in the change in the MASEIActive score for TNFi versus secukinumab (4.37 versus 2.26; p = 0.030) and this difference was more pronounced when only power Doppler signal within 2 mm of the enthesis insertion was included (4.37 versus 2.00; p = 0.007). Clinical outcomes were similar for both classes of biologic apart from a significant reduction in regards to the Dermatology Life Quality Index and Psoriasis Area and Severity Index score with secukinumab versus TNFi. Conclusions We have for the first time compared the effect of ultrasound-confirmed enthesitis between different forms of biologic therapies for PsA. We have seen an overall improvement in entheseal scores for both classes of medications and demonstrated a larger reduction in active entheseal disease for TNFi versus secukinumab that merits further exploration.
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Affiliation(s)
- Ashley Elliott
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | | | | | - Madeleine Rooney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Ayan G, Ribeiro A, Macit B, Proft F. Pharmacologic Treatment Strategies in Psoriatic Arthritis. Clin Ther 2023; 45:826-840. [PMID: 37455227 DOI: 10.1016/j.clinthera.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The goal of this narrative review was to provide current data on psoriatic arthritis (PsA) therapeutic strategies, supporting treatment decisions with a domain-based approach. METHODS This narrative review of treatment strategies for PsA focused on several disease domains (ie, peripheral arthritis, enthesitis, axial disease, dactylitis, skin and nail disease), as well as the so-called "related conditions" of uveitis, Crohn's disease, and ulcerative colitis. We searched PubMed, EMBASE, international guidelines, and recent congress abstracts. FINDINGS Currently, multiple approved treatment options offer a wide range of options, such as tumor necrosis factor (TNF) inhibitors; inhibitors of interleukin-17 (IL-17), IL-12/23 (IL-12/23), IL-23 (IL-23), and Janus kinase; the phosphodiesterase 4 inhibitor apremilast; and the T-cell modulator abatacept. However, no treatment option shows clear superiority concerning efficacy on peripheral arthritis and dactylitis over the others, whereas limited evidence suggests that the IL-17 inhibitor ixekizumab and the IL-12/23 inhibitor ustekinumab may be superior to TNF inhibitors in treating enthesitis. Recent data on enthesitis have also shown promising results for methotrexate. Treatment of axial PsA is mostly derived from axial spondyloarthritis, and more data are needed focusing on this specific subgroup of PsA patients. Thus far, the most important finding from the only randomized controlled trial in this specific population is that the IL-17 inhibitor secukinumab was superior to placebo in terms of clinical and radiologic end-points in axial PsA. Regarding psoriatic skin involvement, head-to-head trials in PsA as well as skin psoriasis showed the superiority of IL-17, IL-23, and IL-12/23 inhibitors over TNF inhibitors. When treating PsA with concurrent uveitis, according to the existing data, monoclonal TNF inhibitor antibodies should be preferred. In PsA and concomitant inflammatory bowel disease, treatment decisions must include the consideration of which specific type of inflammatory bowel disease (Crohn's disease or ulcerative colitis) is present, as some of the agents either lack data or are ineffective in treating these 2 conditions. In both types, IL-17 inhibitors should be avoided. When determining treatment strategy, comorbidities should be carefully assessed, and the corresponding risk profile of the respective treatment modalities should be taken into consideration. IMPLICATIONS There are many approved therapeutic options for treating patients with PsA, and additional emerging treatment options are in the pipeline. Individualized treatment decisions for each patient, depending on the leading disease phenotype, underlying comorbidities, and patient preferences, should be made based on shared decision-making.
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Affiliation(s)
- G Ayan
- Hacettepe University, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey
| | - A Ribeiro
- Hospital de Clínicas de Porto Alegre, Department of Rheumatology, Porto Alegre, Brazil
| | - Betul Macit
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Mease PJ, Orbai AM, FitzGerald O, Bedaiwi M, Dona L Fleishaker, Mundayat R, Young P, Helliwell PS. Efficacy of tofacitinib on enthesitis in patients with active psoriatic arthritis: analysis of pooled data from two phase 3 studies. Arthritis Res Ther 2023; 25:153. [PMID: 37608391 PMCID: PMC10464128 DOI: 10.1186/s13075-023-03108-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/05/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor for the treatment of psoriatic arthritis (PsA). This post hoc analysis assessed tofacitinib efficacy on enthesitis by baseline location and severity, and impact on disease activity and patient-reported outcomes (PROs), in patients with PsA. METHODS Data were pooled from two phase 3 studies (NCT01877668/NCT01882439) in patients with PsA receiving tofacitinib 5 or 10 mg twice daily to month (M)6 or placebo to M3. Endpoints were: change from baseline in Leeds Enthesitis Index (LEI) or Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC); proportions of patients with enthesitis, relapsed enthesitis after resolution, de novo enthesitis, low disease activity (LDA) or remission (minimal disease activity/very low disease activity; Psoriatic Arthritis Disease Activity Score; Disease Activity Index for Psoriatic Arthritis, and Composite Psoriatic Disease Activity in Psoriatic Arthritis); and PROs (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F] total and arthritis pain Visual Analog Scale scores). Descriptive statistics were generated by visit and treatment. Change from baseline in PROs was evaluated by multivariate linear regression. RESULTS Seven hundred ten patients from two studies were included: 479 had LEI > 0; 545 had SPARCC > 0; and 136 had LEI = 0 and SPARCC = 0 at baseline. At baseline, among patients with LEI > 0 or SPARCC > 0, mean LEI and SPARCC across treatments and enthesitis locations/severities ranged from 1.0-4.4 and 1.3-9.4, respectively. Across several baseline enthesitis locations/severities, changes from baseline in LEI and SPARCC up to M3 were greater with tofacitinib (-2.0-0.4 and -3.5-0.2) vs placebo (-0.9-0.4 and -1.5-1.1). Enthesitis at M6 was more common in patients with greater baseline enthesitis severity. At M6, ≤ 40% of patients with baseline LEI > 0 or SPARCC > 0 whose enthesitis had resolved by M1/M3 experienced a relapse, and < 14% of patients with baseline LEI = 0 and SPARCC = 0 had de novo enthesitis. LDA/remission rates generally increased with tofacitinib over time. Baseline LEI location was significantly associated with change from baseline in arthritis pain score, while baseline SPARCC severity was significantly associated with change from baseline in FACIT-F total and arthritis pain scores. CONCLUSION Tofacitinib treatment resulted in improvements in enthesitis in patients with PsA, regardless of baseline location or severity. TRIAL REGISTRATION NCT01877668;NCT01882439.
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Affiliation(s)
- Philip J Mease
- Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA, 98122, USA.
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Mohamed Bedaiwi
- Division of Rheumatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Yang F, Lu C, Liu H, Dou L, Wang Y, Li H, Duan X, Wu L, Wang Y, Zhang X, Xu J, Su J, Xu D, Zhao J, Wu Q, Li M, Leng X, Zeng X. Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR). Chin Med J (Engl) 2023; 136:951-958. [PMID: 37036901 PMCID: PMC10278716 DOI: 10.1097/cm9.0000000000002646] [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: 12/23/2022] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts. METHODS Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts. RESULTS In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use. CONCLUSIONS Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
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Affiliation(s)
- Fan Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Chaofan Lu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Huilan Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Lei Dou
- Department of Rheumatology and Immunology, The Second People's Hospital of Wuhu, Wuhu, Anhui 241000, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
| | - Hongbin Li
- The Division of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, The People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, China
| | - Yongfu Wang
- Department of Rheumatology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia 014010, China
| | - Xiuying Zhang
- Department of Rheumatology, Zibo Central Hospital, Zibo, Shandong 255036, China
| | - Jian Xu
- Department of Rheumatology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jinmei Su
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Qingjun Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaomei Leng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
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9
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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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10
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Furer V, Wollman J, Levartovsky D, Aloush V, Elalouf O, Sarbagil-Maman H, Mendel L, Borok S, Paran D, Elkayam O, Polachek A. Sex-Based Differences in Sonographic and Clinical Findings Among Patients With Psoriatic Arthritis. J Rheumatol 2023; 50:197-203. [PMID: 36243411 DOI: 10.3899/jrheum.220547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate sex-based sonographic differences in patients with psoriatic arthritis (PsA). METHODS The study population included consecutive prospectively recruited patients with PsA, as determined by the CASPAR (Classification for Psoriatic Arthritis) criteria, who underwent clinical and physical examinations, followed by a detailed ultrasound (US) evaluation (greyscale and Doppler). US evaluation included 52 joints, 40 tendons, and 14 points of entheses (Modified Madrid Sonographic Enthesis Index [MASEI] plus lateral epicondyles) performed by an experienced sonographer blinded to the clinical data. The US score was based on the summation of a semiquantitative score for synovitis, tenosynovitis, and enthesitis. The US enthesitis score was categorized into inflammatory lesions (ie, hypoechogenicity, thickening, bursitis, and Doppler) and structural lesions (ie, enthesophytes/calcifications and erosions). RESULTS The study population of 158 patients included 70 males and 88 females. The males had higher rates of employment (P = 0.01), Psoriasis Area and Severity Index scores (P = 0.04), and mean swollen joint counts (P = 0.04). The total US score and its subcategory scores-the synovitis and tenosynovitis scores-were similar for both sexes, whereas the total enthesitis score and its subcategory score-the inflammatory enthesitis score-were significantly higher for the males compared to the females (P = 0.01 and P = 0.005, respectively). Hypoechogenicity, thickening, and enthesophytes were more prevalent in males compared to females (P < 0.05). Multivariate ordinal logistic regression models showed that male sex was associated with a higher US inflammatory enthesitis score compared to female sex (odds ratio 1.96, P = 0.02). CONCLUSION Sonographic enthesitis was more prevalent in males compared to females with PsA. These differences were not reflected by enthesitis disease activity scores derived from clinical assessment.
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Affiliation(s)
- Victoria Furer
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Wollman
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Levartovsky
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valerie Aloush
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Elalouf
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Sarbagil-Maman
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Mendel
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Borok
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Paran
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Polachek
- V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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11
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Macía-Villa C, De Miguel E. New Advances in the Knowledge of Elemental Enthesis Lesions: Doppler, Erosion, and Thickness. J Rheumatol 2023; 50:6-8. [PMID: 36455941 DOI: 10.3899/jrheum.221116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Cristina Macía-Villa
- C. Macía-Villa, MD, PhD, Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid;
| | - Eugenio De Miguel
- E. De Miguel, MD, PhD, Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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12
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Smerilli G, Cipolletta E, Destro Castaniti GM, Di Matteo A, Di Carlo M, Moscioni E, Francioso F, Mirza RM, Grassi W, Filippucci E. Doppler Signal and Bone Erosions at the Enthesis Are Independently Associated With Ultrasound Joint Erosive Damage in Psoriatic Arthritis. J Rheumatol Suppl 2023; 50:70-75. [PMID: 35105703 DOI: 10.3899/jrheum.210974] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To explore the association of the Outcome Measures in Rheumatology ultrasound (US) entheseal abnormalities with the presence of US joint bone erosions in psoriatic arthritis (PsA). METHODS Consecutive patients with PsA were included in this cross-sectional study. Demographic and clinical variables were collected. A bilateral US assessment was carried out at the following entheses: plantar fascia, and the quadriceps, patellar (proximal and distal), and Achilles tendons. The following US entheseal abnormalities were registered: hypoechogenicity, thickening, Doppler signal < 2 mm from the bony cortex, calcification/enthesophyte, and bone erosion. The presence of US joint bone erosions was investigated at the second and fifth metacarpophalangeal joints, ulnar head, and fifth metatarsophalangeal (MTP) joint, bilaterally, as well as at the level of the most inflamed joint on physical examination. Multiple linear regression analysis was performed to identify clinical and/or US variables associated with US-detected joint bone erosions. RESULTS A total of 104 patients with PsA were enrolled. At least 1 joint bone erosion was found in 47 of 104 patients (45.2%). Bone erosions were most frequently detected at the fifth MTP joint level (42/208 joints [20.2 %] in 32/104 patients [30.8%]). In the multivariate model, only a power Doppler (PD) signal at the enthesis (P < 0.001, standardized β = 0.51), bone erosions at the enthesis (P = 0.02, standardized β = 0.20), PsA disease duration (P = 0.04, standardized β = 0.17), and greyscale joint synovitis (P = 0.03, standardized β = 0.42) were associated with US-detected joint bone erosions. CONCLUSION PD signal and bone erosions at the enthesis represent sonographic biomarkers of a more severe subset of PsA in terms of US-detected joint erosive damage.
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Affiliation(s)
- Gianluca Smerilli
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona;
| | - Edoardo Cipolletta
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Giulia Maria Destro Castaniti
- G.M. Destro Castaniti, MD, University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, "P. Giaccone" Hospital, Palermo
| | - Andrea Di Matteo
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Marco Di Carlo
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Erica Moscioni
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Francesca Francioso
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Riccardo Mashadi Mirza
- R. Mashadi Mirza, MD, Radiology Department, A.O. Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Walter Grassi
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
| | - Emilio Filippucci
- G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona
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13
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Fahmi DS, Makarm WK, Zaghlol RS. Burden of enthesitis on the quality of life and work productivity in psoriatic arthritis patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
Psoriatic arthritis (PsA) which affects 6–42% of psoriasis patients is the most common extra-cutaneous manifestation of the psoriasis disease. Enthesitis may be considered as a sign of increased disease burden due to its association with several clinical aspects. Therefore, the aim of the study was to investigate the effect of clinical enthesitis on quality of life and work productivity in PsA patients.
Results
Enthesitis was detected in 50% of patients. There was statistically significant difference between the studied groups as regard disease activity index for psoriatic arthritis (DAPSA) score, psoriatic arthritis impact of the disease 12 (PsAID-12), Health Assessment Questionnaire disability index (HAQ-DI), and Spondyloarthritis Research Consortium of Canada index (SPARCC) with higher mean score in patients with enthesitis. The majority of patients with enthesitis had a higher percentage of impairment in daily activities (95.5%) than those without enthesitis (38.6%), as well as a statistically significant positive correlation between SPARCC index and both work absenteeism and work productivity loss. Furthermore, enthesitis in both the upper and lower sites was related with worse quality of life (36.4%) and higher work impairment (45.5%) compared to patients with enthesitis in either the upper or lower sites alone.
Conclusion
Enthesitis was a frequent complaint among PsA patients. PsA patients with enthesitis had a significant disease burden regardless of enthesitis location, and patients with enthesitis in both the upper and lower sites have a worse quality of life and a higher work impairment.
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14
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Agache M, Popescu CC, Popa L, Codreanu C. Ultrasound Enthesitis in Psoriasis Patients with or without Psoriatic Arthritis, a Cross-Sectional Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1557. [PMID: 36363514 PMCID: PMC9696198 DOI: 10.3390/medicina58111557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 09/23/2023]
Abstract
Background and objectives: The main objective of the current study was to describe the prevalence of enthesitis at different sites in a group of patients with psoriasis with or without psoriatic arthritis (PsA). Materials and Methods: The study included adult patients with psoriasis who underwent clinical examination, laboratory tests and ultrasound examination of the entheses. The enthesitis ultrasound scores (BUSES, MASEI, GUESS) were evaluated; the presence of OMERACT-defined enthesitis was also recorded for each scan site. Results: The study included 16 (57.1%) patients with PsA and 12 (42.9%) patients with psoriasis, with an increased average body mass index (29.3 kg/m2). Compared to psoriasis patients, PsA patients had a higher prevalence of nail psoriasis (68.8% compared to 33.3%; p = 0.063). There were no significant differences regarding the clinical examination of entheses between patients with psoriasis and patients with PsA (p = 0.459). Ultrasound scores, BUSES, GUESS and MASEI proved to have statistically significant higher median values in PsA patients compared to psoriasis patients. Compared to psoriasis patients, PsA patients had a significantly higher prevalence of OMERACT-defined enthesitis of the quadriceps tendon and inferior patellar ligament (both 81.3% compared to 25.0%, p = 0.003). Clinical examination of the lateral epicondyle and of the superior patellar ligament was consistent with their ultrasound examination (κ = 0.357, p = 0.043, respectively, κ = 0.404, p = 0.008). Conclusions: Clinical enthesitis scores do not differ between psoriasis and PsA patients. All analyzed ultrasound scores are significantly higher in patients with PsA. OMERACT-defined enthesitis has the ability to discriminate sonographic enthesitis between the two subgroups for bilateral quadriceps and inferior patellar tendon enthesitis. Bilateral ultrasound damage of entheses can suggest a PsA diagnosis.
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Affiliation(s)
- Mihaela Agache
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Claudiu C. Popescu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Liliana Popa
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology and Allergology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Cătălin Codreanu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
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15
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Mathew AJ, Sutton M, Pereira D, Gladman DD, Chandran V. Effectiveness of Disease Modifying Anti-Rheumatic Drugs for Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort. J Rheumatol 2022; 49:1020-1025. [PMID: 35649547 DOI: 10.3899/jrheum.211231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Our objective was to assess the effectiveness of conventional and targeted disease modifying anti-rheumatic drugs (cDMARDs and tDMARDs, respectively) in treating enthesitis in PsA. METHODS Patients with active enthesitis, defined as ≥1 tender entheses (of 29 sites included in the spondyloarthritis research consortium of Canada enthesitis index, the Leeds enthesitis index, and the Maastricht ankylosing spondylitis enthesitis score), enrolled in a large PsA cohort were included. Medications at baseline were classified into 3 mutually exclusive categories: 1.'no treatment/non-steroidal anti-inflammatory drugs (NSAIDs)', 2. 'cDMARDs±NSAIDs' and 3.'tDMARDs±cDMARDs/NSAIDs'. Complete resolution of enthesitis (no tender entheseal site) at 12 months was the primary outcome. Logistic regression models were developed to determine the association between medication category and enthesitis resolution. RESULTS Of the 1270 patients studied, 628(49.44%) had enthesitis; 526 patients (51.71% males; mean age (standard deviation, s.d.) - 49.02(13.12) years; mean enthesitis score (s.d.) 2.13(2.16) with adequate follow-up were analysed. Complete resolution of enthesitis was noted in 453(86%) patients, within a mean period of 8.73 months from baseline. In the regression analysis, though not significant, DMARDs (Categories 2 and 3) had higher odds ratio compared to category 1 for resolution of enthesitis. Enthesitis resolution was associated with lower joint activity (OR 0.97; 95% CI 0.95 - 0.99; p = 0.01) and male sex (OR 1.66; 95% CI 0.97 - 2.84; p = 0.06). CONCLUSION Resolution of enthesitis was observed in 86% of patients in an observational setting regardless of the medication used. Future effectiveness studies may warrant evaluation of enthesitis using advanced imaging.
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Affiliation(s)
- Ashish Jacob Mathew
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Mitchell Sutton
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Daniel Pereira
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Dafna D Gladman
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
| | - Vinod Chandran
- AJ Mathew DNB, DM Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India. M Sutton MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. D Pereira MSc Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. DD Gladman MD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. V Chandran DM, PhD, FRCPC Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Ontario, Canada. Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Potential conflicts of interest: None. Address for correspondence: Dr. Vinod Chandran, 1E416, Toronto Western Hospital, 399 Bathurst Street, Toronto Ontario, Canada, M5T2S8.
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Elliott A, McGonagle D, Rooney M. Integrating imaging and biomarker assessment to better define psoriatic arthritis and predict response to biologic therapy. Rheumatology (Oxford) 2021; 60:vi38-vi52. [PMID: 34951926 PMCID: PMC8709569 DOI: 10.1093/rheumatology/keab504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
The treatment options for PsA have substantially expanded over the last decade. Approximately 40% of patients will not respond to first-line anti-TNF-α therapies. There is limited data to help clinicians select the most appropriate biologic therapy for PsA patients, including guidance for decisions on biologic therapy switching. In this review we will examine the current understanding of predictors of response to treatment. Imaging technology has evolved to allow us to better study psoriatic disease and define disease activity, including synovitis and enthesitis. Enthesitis is implicated in the pathogenesis, diagnosis and prognosis of PsA. It appears to be a common thread among all of the various PsA clinical presentations. Enthesitis mainly manifests as tenderness, which is difficult to distinguish from FM, chronic pain and mechanically associated enthesopathy, and it might be relevant for understanding the apparent 40% failure of existing therapy. Excess adipose tissue makes if more difficult to detect joint swelling clinically, as many PsA patients have very high BMIs. Integrating imaging and clinical assessment with biomarker analysis could help to deliver stratified medicine in PsA and allow better treatment decision making. This could include which patients require ongoing biologic therapy, which class of biologic therapy that should be, and who alternatively requires management of non-inflammatory disease.
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Affiliation(s)
- Ashley Elliott
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Madeleine Rooney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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17
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[Benefit of ultrasound in the phenotype recognition of psoriatic arthritis]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53. [PMID: 34916682 PMCID: PMC8695159 DOI: 10.19723/j.issn.1671-167x.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To explore the difference in phenotype recognition of PsA patients in two clinical scenarios, physical examination with and without ultrasound assessment. METHODS PsA patients who visited the rheumatology and clinical immunology department of Peking University First Hospital between January 2010 and October 2020, with complete data of clinical and ultrasound assessment were enrolled. The phenotypes were first identified based on physical examination only, and then combined with enthesitis and dactylitis shown on power doppler and gray-scale ultrasound. The phenotype groupings without and with ultrasound assessment were presented with Wayne diagram. The distributions of different clinical phenotypes were compared by using χ2 test or Fisher's exact test. The differences of clinical phenotypes with and without ultrasound assessment were compared by using Wilcoxon signed rank test. RESULTS A total of 227 patients with PsA were enrolled with one or more clinical domains. Physical examination revealed that psoriasis was in 209 (92.1%, 209/227) patients, nail involvement in 98 (43.2%, 98/227) patients, peripheral arthritis in 219 (96.5%, 219/227) patients, axial involvement in 25 (11.0%, 25/227) patients, dactylitis in 80 (35.2%, 80/227) patients, and enthesitis in 18 (7.9%, 18/227) patients. Besides 18 patients with clinical enthesitis, ultrasound scan revealed acute enthesitis in 80 patients, with hypoechogenicity (55 cases), tendon thickening (62 cases), and presence of Doppler signals (48 cases). Similarly, dactylitis on ultrasound was found in 18 patients besides those patients with clinical dactylitis. Compared with the phenotypes recognized based on physical examination only, the additional ultrasound assessment revealed that the most common phenotypes, peripheral arthritis was significantly less frequently recognized (49.8% vs. 27.8%, P < 0.001), however on the other hand, the proportion of the patients with peripheral arthritis and enthesitis was significantly increased (4.4% vs. 18.1%, P < 0.001). The phenotype of peripheral arthritis combined with enthesitis, and dactylitis was also dramatically increased (1.8% vs. 17.6%, P < 0.001). CONCLUSION Ultrasound is a useful tool to identify enthesitis and dactylitis. With the aid of ultrasound assessment, rheumatologists can better identify the lesions of PsA, accurately identify the phenotypes, and further guide the subsequent treatment.
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Smerilli G, Di Matteo A, Cipolletta E, Grassi W, Filippucci E. Enthesitis in Psoriatic Arthritis, the Sonographic Perspective. Curr Rheumatol Rep 2021; 23:75. [PMID: 34427783 PMCID: PMC8384799 DOI: 10.1007/s11926-021-01039-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To provide an overview of the ultrasound (US) studies focusing on enthesitis in psoriatic arthritis (PsA). Recent Findings Last-generation US equipment has demonstrated the ability to detect subtle morphostructural and vascular abnormalities at entheseal level. US is able to identify pathologic changes in both “classical” (i.e., the site of attachment of tendons, ligaments, and joint capsules into the bone) and “functional” entheses (i.e., anatomical regions where tendons or ligaments wrap around bony pulleys). Summary US has the potential to be the first-line method in the assessment of enthesitis. In the present review we critically discussed the current definitions of US enthesitis, the scoring systems, and the main fields of application (i.e., the detection of enthesitis in PsA and psoriasis, the identification of different disease subsets, and the assessment of response to treatment).
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
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Factors Associated with Health-Related Quality of Life in Psoriatic Arthritis Patients: A Longitudinal Analysis. Rheumatol Ther 2021; 8:1341-1354. [PMID: 34287811 PMCID: PMC8380589 DOI: 10.1007/s40744-021-00349-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is considered a multifaceted disease, with patients reporting low health-related quality of life (HRQoL). Data on disease burden are substantial and there exists a need for properly designed studies to learn more about the evolution of HRQoL in this condition. This study aims to identify factors associated to HRQoL evolution in PsA patients followed-up in a real-world setting in Spain. METHODS We conducted a retrospective longitudinal observational study including incident patients from the rheumatology outpatient clinic of Hospital Clínico San Carlos (Madrid, Spain), diagnosed for the first time of PsA, defined as having received any ICD9/ICD10 diagnosis code of PsA, from 2007 to 2016, and followed-up until loss of follow-up, death, or November 2017. The influence of demographic and clinical variables in baseline HRQoL [assessed with the Rosser Classification Index (RCI)] was analyzed using bivariable and multivariable generalized linear models. The influence of those variables and of treatment-related factors in repeated measures of HRQoL was analyzed using bivariable and multivariable generalized estimating equations (GEE) models nested by patient. RESULTS Two hundred and thirty patients were included in the analysis, with 3384 registered visits. At baseline, older age, a previous diagnosis of obesity, and the presence of enthesitis were significantly associated with worse HRQoL. During follow-up, using an exchangeable working correlation structure, the presence of enthesitis was also associated with worse HRQoL, coefficient (95% CI) - 0.006 (- 0.01 to - 0.002), p = 1.00E-03; conversely, treatment with methotrexate or antimalarials was associated with better HRQoL with 0.007 (0.001-0.014), p = 0.020 and 0.003 (0.001-0.005), p = 3.00E-03, respectively. CONCLUSIONS Musculoskeletal manifestations and comorbidities exert a deleterious effect in HRQoL of PsA patients. Therefore, the optimal management of this condition needs to also address these manifestations in order to try to restore the QoL of these patients.
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McGonagle D, Aydin SZ, Marzo-Ortega H, Eder L, Ciurtin C. Hidden in plain sight: Is there a crucial role for enthesitis assessment in the treatment and monitoring of axial spondyloarthritis? Semin Arthritis Rheum 2021; 51:1147-1161. [PMID: 34537464 DOI: 10.1016/j.semarthrit.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To review the evidence surrounding the pathophysiology of enthesitis in axial spondyloarthritis (axSpA), its prevalence and contribution to the overall disease burden, and response to treatment at axial and peripheral sites. METHODS Literature searches of the Cochrane Library, PubMed, and Embase / Medline using the terms "enthesitis", "enthesopathy", "spondyloarthritis", "axial spondyloarthritis", and "ankylosing spondylitis" were conducted. Publications mentioning enthesitis or enthesopathy in the context of pathophysiology, diagnosis, or treatment were included. RESULTS Enthesitis is a common symptom of axSpA, occurring with high prevalence at axial and several peripheral sites. Inflammation at the site of enthesis is an early key manifestation of axSpA. Clinically evaluable enthesitis contributes significantly to the burden of disease, correlating with worse symptomatology and downstream structural damage. Despite its importance in driving axSpA disease processes, enthesitis is somewhat neglected in current approaches to disease assessment and management. Enthesitis is excluded from some commonly used disease activity measures, is not routinely assessed in clinical practice, and many methods of clinical assessment omit key accessible axial sites, such as the spinous processes. CONCLUSION Enthesitis plays a central role in driving the pathophysiology of axSpA. There is a need for a renewed focus on the early detection, measurement and treatment of enthesitis.
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Affiliation(s)
- Dennis McGonagle
- The Leeds Institute of the Rheumatic and Musculoskeletal Disease, University of Leeds, Chapeltown Road, Leeds LS7 4SA, United Kingdom; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.
| | - Sibel Z Aydin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Helena Marzo-Ortega
- The Leeds Institute of the Rheumatic and Musculoskeletal Disease, University of Leeds, Chapeltown Road, Leeds LS7 4SA, United Kingdom; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Lihi Eder
- Division of Rheumatology, Department of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto, Canada
| | - Coziana Ciurtin
- Department of Rheumatology, Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London, United Kingdom
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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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Mease PJ, Gladman DD, Deodhar A, McGonagle DG, Nash P, Boehncke WH, Gottlieb A, Xu XL, Xu S, Hsia EC, Karyekar CS, Helliwell PS. Impact of guselkumab, an interleukin-23 p19 subunit inhibitor, on enthesitis and dactylitis in patients with moderate to severe psoriatic arthritis: results from a randomised, placebo-controlled, phase II study. RMD Open 2021; 6:rmdopen-2020-001217. [PMID: 32665433 PMCID: PMC7425189 DOI: 10.1136/rmdopen-2020-001217] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 01/11/2023] Open
Abstract
Objective To evaluate the effect of guselkumab on enthesitis and dactylitis in a phase II trial of patients with active psoriatic arthritis (PsA). Methods This was a phase II, randomised, placebo-controlled, double-blind trial of adults with active PsA (≥3 swollen and ≥3 tender joints and C reactive protein ≥0.3 mg/dL) despite conventional synthetic disease-modifying anti-rheumatic drug, non-steroidal anti-inflammatory drug, and/or oral corticosteroid therapy. Patients were randomised to subcutaneous injections of guselkumab 100 mg or placebo at weeks 0, 4 and every 8 weeks, with placebo crossover to guselkumab at week 24. Dactylitis was scored on a scale of 0–3 on each digit; enthesitis was assessed using the Leeds Enthesitis Index (0–6). Other assessments included American College of Rheumatology (ACR) and Psoriasis Area and Severity Index responses. Results Of 149 randomised patients, 107 patients had enthesitis (mean score=2.7) and 81 patients had dactylitis (mean dactylitis score=5.7) at baseline. Mean improvements in enthesitis and dactylitis at week 24 were greater in the guselkumab group versus placebo and sustained through week 56. Similar results were observed for the proportions of patients with resolution of enthesitis and dactylitis. At week 56, mean improvements in enthesitis and dactylitis among patients who switched from placebo to guselkumab treatment were similar to those in the guselkumab group. In the guselkumab group, ACR20 responders had greater improvements in enthesitis and dactylitis versus non-responders (week 24). Conclusions At week 24, the guselkumab group had greater mean improvements in enthesitis and dactylitis and greater proportions of patients with resolution of enthesitis and dactylitis versus placebo. ACR20 response was associated with improvements in enthesitis and dactylitis. Trial registration number ClinicalTrials.gov: NCT02319759. URL: https://clinicaltrials.gov/ct2/show/NCT02319759; Registered 18 December 2014.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, Washington, USA .,University of Washington, Seattle, Washington, USA
| | | | - Atul Deodhar
- Oregon Health & Science University, Portland, Oregon, USA
| | - Dennis G McGonagle
- Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Peter Nash
- Griffith University School of Medicine, Brisbane, Australia
| | | | - Alice Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, NewYork, NewYork, USA
| | - Xie L Xu
- Janssen Research & Development LLC, La Jolla, California, USA
| | - Stephen Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Elizabeth C Hsia
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA.,University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Philip S Helliwell
- Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Macía-Villa C, Cruz Valenciano A, De Miguel E. Enthesis lesions are associated with X-ray progression in psoriatic arthritis. Int J Rheum Dis 2021; 24:828-833. [PMID: 33905167 DOI: 10.1111/1756-185x.14122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze the relationship among enthesis ultrasound (US) lesions and radiological structural damage in psoriatic arthritis (PsA) patients. METHODS Consecutive PsA patients with swelling of at least 1 of the 2nd to 5th metacarpophalangeal joints were included. Clinical and demographic data were collected. The Madrid Sonographic Enthesitis Index (MASEI) was selected to evaluate the enthesis, with its total score and MASEI-activity and MASEI-structural damage subscores. The modified Sharp van der Heijde method for PsA and the New York criteria for sacroiliitis were selected to evaluate cumulative bone damage on X-rays. RESULTS Twenty-seven patients were included. Male gender, older age, longer PsA duration and acute reactant factors were associated with greater bone cumulative damage. Enthesis tendon thickening, enthesophytes, total MASEI and the MASEI-structural damage subscore showed significant correlations with radiographic peripheral and sacroiliac damage scores. Tendon thickening and enthesophytes were the enthesis lesions more frequently associated with radiographic damage in PsA. CONCLUSION The enthesis MASEI score was associated with axial and articular radiographic structural damage in PsA patients. The MASEI-structural damage subscore correlated better with cumulative bone damage in PsA than the MASEI-activity subscore.
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Affiliation(s)
| | - Ana Cruz Valenciano
- Department of Rheumatology, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
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Mascarenhas S, Couette N. A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices. Diagnostics (Basel) 2021; 11:diagnostics11040669. [PMID: 33917826 PMCID: PMC8068272 DOI: 10.3390/diagnostics11040669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.
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Psoriatic arthritis: the role of the nonphysician clinician in the diagnosis and treatment of patients with psoriasis. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00814-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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26
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Bollow M. [Typical arthritis of the hands : Psoriatic arthritis]. Radiologe 2021; 61:448-457. [PMID: 33783565 DOI: 10.1007/s00117-021-00841-3] [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: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is considered the prototype of peripheral spondyloarthritides (SpA) and is associated as skin-bone disease (SkiBo) with typical skin changes and with typical arthritides of the joints, especially of the hands and feet. OBJECTIVE Systematic review of imaging manual findings patterns in PsA with its typical enthesitic arthritides in context with clinical findings. MATERIALS AND METHODS A review based on the current literature on the subject from a radiological and rheumatological point of view is provided. RESULTS In PsA, inflammatory manifestations in the hands and feet are the most frequently affected regions of the body. Image morphological variability between early and late stages is evident. The projection radiographic characteristic of PsA is the simultaneous coexistence of osteodestructive-rarefactive changes with typical osteoproliferative-proliferative changes, which are part of the Classification of Psoriatic Arthritis (CASPAR) criteria. With the help of magnetic resonance imaging (MRI), the image-morphological spondyloarthritis inflammatory patterns of enthesitis, dactylitis and osteitis can be detected in the hands even in the early stages. CONCLUSIONS The basic knowledge of the image morphological changes of this complex autoimmunological skin-bone disease will be imparted in order to gain the necessary confidence in the systematic diagnostic evaluation of hand arthritis patterns typical for PsA in images both at the initial diagnosis and over the course of the disease and in the classification of early and late stages, which serve as a guide for rheumatologists regarding "step-up" treatments.
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Affiliation(s)
- Matthias Bollow
- Ruhr-Universität Bochum, Bochum, Deutschland. .,Klinik für diagnostische und interventionelle Radiologie, Augusta-Kranken-Anstalt Bochum, Bergstraße 26, 44791, Bochum, Deutschland.
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Mease P. Enthesitis in psoriatic arthritis (Part 3): clinical assessment and management. Rheumatology (Oxford) 2021; 59:i21-i28. [PMID: 32159795 PMCID: PMC7065458 DOI: 10.1093/rheumatology/keaa042] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/05/2019] [Indexed: 01/07/2023] Open
Abstract
Enthesitis is a common clinical feature of PsA, which is characterized by inflammation at the site of insertion of tendons, ligaments and joint capsule fibres into bone. Enthesitis is relatively unique to the spondyloarthritides, setting this group of diseases apart from other rheumatological conditions. The pathophysiological underpinnings of this clinical domain, and the imaging assessment of it, are described in accompanying articles in this supplement. The focus of this article is on the assessment of enthesitis by physical examination, the impact of enthesitis on function and quality of life, the impact of concomitant FM on clinical assessment, and the evidence for therapy of enthesitis garnered in trials of biologic and targeted synthetic DMARDs. Several physical examination measures of enthesitis have been developed and have proved reliable in assessment of enthesitis. Enthesitis has a significant deleterious impact on function and quality of life. The presence of concomitant FM in ≤20% of patients may result in artefactual worsening of assessment of disease severity and hinder achievement of the goal of low disease activity or remission. Several targeted therapies, which, for example, target the TNF, IL-17, IL-23, phosphodiesterase 4 or Janus kinase pathways, have shown significant efficacy in the treatment of enthesitis, resulting in improvement of function and quality of life for patients with PsA.
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Affiliation(s)
- Philip Mease
- Rheumatology Division, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
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Galante CM. Supporting young adults with psoriatic arthritis. Nursing 2020; 50:24-31. [PMID: 33009283 DOI: 10.1097/01.nurse.0000718032.41238.db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psoriatic arthritis (PsA) is associated with psoriasis, a chronic inflammatory skin disease. About 30% of patients with psoriasis develop PsA, and some of these patients are children and young adults. Because onset can be gradual, PsA signs and symptoms are easily attributed to other causes, especially in younger patients. This article discusses the assessment, pathophysiology, and diagnosis of PsA and informs nurses how best to support patients with PsA.
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Affiliation(s)
- Christine M Galante
- Christine M. Galante is an assistant professor of nursing at New York Institute of Technology in Old Westbury, N.Y
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Mease PJ, Liu M, Rebello S, McLean RR, Dube B, Glynn M, Hur P, Ogdie A. Association of Nail Psoriasis With Disease Activity Measures and Impact in Psoriatic Arthritis: Data From the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol 2020; 48:520-526. [PMID: 33060307 DOI: 10.3899/jrheum.190923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the association of nail psoriasis with disease activity, quality of life, and work productivity in patients with psoriatic arthritis (PsA). METHODS All patients with PsA who enrolled in the Corrona PsA/Spondyloarthritis Registry between March 2013 and October 2018 and had data on physician-reported nail psoriasis were included and stratified by presence vs absence of nail psoriasis at enrollment. Patient demographics, disease activity, quality of life (QOL), and work productivity at enrollment were compared between patients with vs without nail psoriasis using t-tests or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables. RESULTS Of the 2841 patients with PsA included, 1152 (40.5%) had nail psoriasis and 1689 (59.5%) did not. Higher proportions of patients with nail psoriasis were male (51.9% vs 44.1%) and disabled from working (12.3% vs 7.8%) compared with patients without nail psoriasis (all P < 0.05). Patients with nail psoriasis had higher disease activity than those without nail psoriasis, including higher tender and swollen joint counts, worse Disease Activity Index for Psoriatic Arthritis and Psoriatic Arthritis Disease Activity Score values, and increased likelihood of having enthesitis and dactylitis (all P < 0.05). Patients with nail psoriasis had worse pain, fatigue, and work and activity impairment than those without nail psoriasis (all P < 0.05). CONCLUSION Patients with PsA who have nail psoriasis had worse disease activity, QOL, and work productivity than those without nail involvement, emphasizing the importance of identification and management of nail disease in patients with PsA.
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Affiliation(s)
- Philip J Mease
- P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington;
| | - Mei Liu
- M. Liu, PhD, S. Rebello, MPH, R.R. McLean, DSc, MPH, B. Dube, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts
| | - Sabrina Rebello
- M. Liu, PhD, S. Rebello, MPH, R.R. McLean, DSc, MPH, B. Dube, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts
| | - Robert R McLean
- M. Liu, PhD, S. Rebello, MPH, R.R. McLean, DSc, MPH, B. Dube, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts
| | - Blessing Dube
- M. Liu, PhD, S. Rebello, MPH, R.R. McLean, DSc, MPH, B. Dube, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts
| | - Meghan Glynn
- M. Liu, PhD, S. Rebello, MPH, R.R. McLean, DSc, MPH, B. Dube, MPH, M. Glynn, MS, CPH, Corrona, LLC, Waltham, Massachusetts
| | - Peter Hur
- P. Hur, PharmD, MBA, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Alexis Ogdie
- A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Orbai AM, Birt JA, Holdsworth EA, Booth N, Malatestinic WN, Sprabery AT, Reginato AM. Impact of Enthesitis on Psoriatic Arthritis Patient-Reported Outcomes and Physician Satisfaction with Treatment: Data from a Multinational Patient and Physician Survey. Rheumatol Ther 2020; 7:937-948. [PMID: 33052584 PMCID: PMC7695789 DOI: 10.1007/s40744-020-00242-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Enthesitis is a core outcome domain assessed in psoriatic arthritis (PsA) clinical trials. Limited evidence describes the impact of enthesitis on patient-reported outcomes (PROs) and physician satisfaction with current treatment options. The objective of this analysis is to characterize the impact of enthesitis on PROs and physician satisfaction with currently available treatment in clinical practice settings. Methods Cross-sectional survey of rheumatologists, dermatologists, and their consulting patients with PsA in Australia, Canada, European Union (EU5), and the USA conducted in 2018. Physicians assessed current presence and severity of enthesitis, overall disease severity, other symptoms experienced, and their satisfaction with the current treatment. PsA participant self-reported data included current pain level, EQ5D, Psoriatic Arthritis Impact of Disease (PsAID12), Health Assessment Questionnaire Disability Index (HAQ-DI), and Work Productivity and Activity Impairment Index (WPAI-SHP). Bivariate descriptive analyses were conducted to describe features and outcomes in participants with and without enthesitis. Results Rheumatologists (454) and dermatologists (238) provided information for 3157 participants with PsA. Mean participant age was 49.2 years, and 45.9% were female. Enthesitis was present currently in 6.5% (205) of participants with PsA. Those with enthesitis had worse overall disease severity compared to those without enthesitis (12.2% vs 2.2% severe) and had more extraarticular manifestations, including nail psoriasis, dactylitis, and sacroiliitis. Enthesitis was associated with more pain, worse quality of life (QoL), increased disability, and a negative impact on work. Participants with enthesitis had higher NSAIDs and opioid pain medication use but similar biologic use. Physicians were significantly less satisfied with current PsA treatment in participants with enthesitis versus without enthesitis. Conclusions Participants with psoriatic arthritis with enthesitis experienced significantly higher disease burden than those without enthesitis but were not more likely to receive advanced therapies. Physicians were significantly more dissatisfied with treatment in patients with enthesitis than in those without it. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00242-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie A Birt
- Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA.
| | | | | | | | | | - Anthony M Reginato
- Division of Rheumatology and Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Mease PJ, Liu M, Rebello S, Hua W, McLean RR, Yi E, Park Y, Ogdie A. Characterization of Patients With Axial Spondyloarthritis by Enthesitis Presence: Data from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. ACR Open Rheumatol 2020; 2:449-456. [PMID: 32627974 PMCID: PMC7368134 DOI: 10.1002/acr2.11154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To compare the characteristics of patients with axial spondyloarthritis (axSpA) who had enthesitis versus those without enthesitis. METHODS This study included adult patients with axSpA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013 to August 2018). Enthesitis was assessed at enrollment via the Spondyloarthritis Research Consortium of Canada Enthesitis Index. Characteristics were compared between patients with and without enthesitis using t tests or Wilcoxon rank-sum tests for continuous variables and χ2 or Fisher exact tests for categorical variables. RESULTS Of 477 patients with axSpA, 121 (25.4%) had enthesitis (mean, 3.9 sites) at enrollment. Higher proportions of patients with enthesitis were female and had nonradiographic axSpA than those without enthesitis (both P < 0.05). Additionally, higher proportions of patients with enthesitis had prior biologic (38.8% vs 27.2%) and conventional synthetic disease-modifying antirheumatic drug (csDMARD; 24.8% vs 13.3%) use and were currently receiving a combination of biologics and csDMARDs (28.6% vs 18.1%) than those without enthesitis. Patients with enthesitis had worse disease activity (tender and swollen joint counts, physician global assessment, Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondylitis Functional Index), spinal mobility, and quality of life (pain, fatigue, Health Assessment Questionnaire, and EuroQol visual analog scale scores); greater work impairment; and had a history of depression and fibromyalgia than those without enthesitis (all P < 0.05). CONCLUSION In this US-based real-world study, enthesitis in patients with axSpA was associated with worse disease activity and quality of life than those with no enthesitis.
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Affiliation(s)
- Philip J. Mease
- Swedish Medical Center/Providence St. Joseph Health and University of WashingtonSeattleWashington
| | - Mei Liu
- Corrona, LLCWalthamMassachusetts
| | | | | | | | - Esther Yi
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | - Yujin Park
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | - Alexis Ogdie
- University of PennsylvaniaPhiladelphiaPennsylvania
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Mease PJ, Liu M, Rebello S, Hua W, McLean RR, Hur P, Ogdie A. Disease Characteristics, Quality of Life, and Work Productivity by Enthesitis Site: Real-world Data From the US Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol 2020; 48:367-375. [PMID: 32482647 DOI: 10.3899/jrheum.191117] [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] [Accepted: 05/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effect of clinical enthesitis by body site in patients with psoriatic arthritis (PsA). METHODS Adults with PsA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013-March 2018) were included. Enthesitis at enrollment was assessed by the Spondyloarthritis Research Consortium of Canada Enthesitis Index and classified by affected sites (upper, lower, or both). Disease activity (e.g., Clinical Disease Activity Index, Clinical Disease Activity Index for PsA), patient-reported outcomes (PRO; e.g., patient-reported pain and fatigue), and work productivity were compared between those with and without enthesitis using t- or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables. The association of enthesitis with disease activity and PRO measures versus no enthesitis was modeled using multivariable-adjusted linear or logistic regression. RESULTS Of 2003 patients with PsA, 391 (19.5%) had enthesitis: 80 (20.5%) in upper sites only; 137 (35.0%) in lower sites only; and 174 (44.5%) in both. Regardless of location, disease activity and PRO were worse in patients with versus without enthesitis. In adjusted models, the presence of enthesitis at any site was significantly associated with worse disease activity versus no enthesitis. Enthesitis in lower or both upper and lower sites was associated with higher pain and fatigue scores and greater work impairment versus no enthesitis. CONCLUSION Patients with clinical enthesitis had worse disease activity regardless of enthesitis location versus those without enthesitis, and patients with enthesitis in lower or both upper and lower sites had worse pain, fatigue, and work impairment.
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Affiliation(s)
- Philip J Mease
- P.J. Mease, MD, MACR, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington;
| | - Mei Liu
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Sabrina Rebello
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Winnie Hua
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Robert R McLean
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Peter Hur
- P. Hur, PharmD, MBA, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Alexis Ogdie
- A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, Primdahl J, McGonagle DG, Aletaha D, Balanescu A, Balint PV, Bertheussen H, Boehncke WH, Burmester GR, Canete JD, Damjanov NS, Kragstrup TW, Kvien TK, Landewé RBM, Lories RJU, Marzo-Ortega H, Poddubnyy D, Rodrigues Manica SA, Schett G, Veale DJ, Van den Bosch FE, van der Heijde D, Smolen JS. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis 2020; 79:700-712. [PMID: 32434812 PMCID: PMC7286048 DOI: 10.1136/annrheumdis-2020-217159] [Citation(s) in RCA: 527] [Impact Index Per Article: 131.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA). METHODS According to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined. RESULTS The updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed. CONCLUSION These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.
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Affiliation(s)
- Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP.Sorbonne Universite, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3; 2nd Department of Medicine, Hietzing Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dennis G McGonagle
- LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Andra Balanescu
- Research Center of Rheumatic Diseases, Sf Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Juan D Canete
- Arthritis Unit, Department of Rheumatology and IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Nemanja S Damjanov
- Institute of Rheumatology, Belgrade University School of Medicine, Belgrade, Serbia
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
- Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Tore K Kvien
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
- Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Rik Jozef Urbain Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Flanders, Belgium
- Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Helena Marzo-Ortega
- LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Denis Poddubnyy
- Department of Rheumatology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Epidemiology, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Santiago Andres Rodrigues Manica
- Rheumatology, Hospital de Egas Moniz, Lisboa, Portugal
- Universidade Nova de Lisboa Centro de Estudos de Doencas Cronicas, Lisboa, Portugal
| | - Georg Schett
- Internal Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Douglas J Veale
- Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium
| | - Désirée van der Heijde
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Wien, Austria
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Wien, Austria
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Psoriasis is an independent risk factor for entheseal damage in axial spondyloarthritis. Semin Arthritis Rheum 2020; 50:42-47. [DOI: 10.1016/j.semarthrit.2019.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/24/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022]
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Kaeley GS, Bakewell C, Deodhar A. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther 2020; 22:1. [PMID: 31898524 PMCID: PMC6939339 DOI: 10.1186/s13075-019-2050-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/05/2019] [Indexed: 11/13/2022] Open
Abstract
Early differentiation between different types of inflammatory arthritis and subsequent initiation of modern treatments can improve patient outcomes by reducing disease activity and preventing joint damage. Routine clinical evaluation, laboratory testing, and radiographs are typically sufficient for differentiating between inflammatory and predominantly degenerative arthritis (e.g., osteoarthritis). However, in some patients with inflammatory arthritis, these techniques fail to accurately identify the type of early-stage disease. Further evaluation by ultrasound imaging can delineate the inflammatory arthritis phenotype present. Ultrasound is a noninvasive, cost-effective method that enables the evaluation of several joints at the same time, including functional assessments. Further, ultrasound can visualize pathophysiological changes such as synovitis, tenosynovitis, enthesitis, bone erosions, and crystal deposits at a subclinical level, which makes it an effective technique to identify and differentiate most common types of inflammatory arthritis. Limitations associated with ultrasound imaging should be considered for its use in the differentiation and diagnosis of inflammatory arthritides.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, 653-1 West 8th St., LRC 2nd Floor L-14, Jacksonville, FL, 32209, USA.
| | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Almodóvar R, Cañete JD, de Miguel E, Pinto JA, Queiro R. Definition of Remission and Disease Activity Assessment in Psoriatic Arthritis: Evidence and Expert-Based Recommendations. ACTA ACUST UNITED AC 2019; 17:343-350. [PMID: 31859154 DOI: 10.1016/j.reuma.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/10/2019] [Accepted: 10/10/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to reach a consensus on the best instruments to monitor disease activity in patients with psoriatic arthritis (PsA) and to develop a consensus definition of remission. METHODS A modified Delphi approach was used. A scientific committee provided statements addressing the definition of remission and the monitoring of PsA in clinical practice. The questionnaire was evaluated in 2 rounds by rheumatologists with experience in managing PsA patients. RESULTS A panel of 77 rheumatologists reached agreement on 62 out of the 86 proposed items (72.0%). The most recommended index for monitoring disease activity was DAPSA (cut-off values: ≤4 for remission and >4-14 for low disease activity ([LDA]), MDA (at least 5/7 criteria). In cases with axial involvement, ASDAS was the preferred index (cut-off values: <1.3 for remission and <2.1 for LDA). BASDAI (cut-off values: ≤2 for remission and ≤4 for LDA) may be used as an alternative. PsAID was the preferred tool to assess disease impact. CONCLUSION We propose a definition of remission in PsA as the absence of disease activity evaluated by DAPSA or MDA (ASDAS and/or BASDAI in patients with axial involvement), which would imply absence of signs or symptoms of inflammation, physical well-being, lack of disease impact, and absence of inflammation as measured by biological markers.
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Affiliation(s)
- Raquel Almodóvar
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Juan D Cañete
- Department of Rheumatology, Hospital Clínic e IDIBAPS, Barcelona, Spain
| | - Eugenio de Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - José Antonio Pinto
- Department of Rheumatology, Complexo Hospitalario Universitario de A Coruña, Spain
| | - Rubén Queiro
- Department of Rheumatology, Hospital Universitario Central de Asturias, Spain.
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Aydin SZ, Bakirci S, Kasapoglu E, Castillo-Gallego C, Alhussain FA, Ash ZR, Kurum E, McGonagle D, Marzo-Ortega H, Gladman D, Eder L. The Relationship Between Physical Examination and Ultrasonography of Large Entheses of the Achilles Tendon and Patellar Tendon Origin. J Rheumatol 2019; 47:1026-1030. [DOI: 10.3899/jrheum.190169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the relationship between physical examination (PE) and sonographic features of enthesitis, based on anatomical sites.Methods.The analysis was done using merged raw data of 3 studies on 2298 entheses.Results.Patients with clinical Achilles enthesitis had more abnormalities on ultrasound (US): hypoechogenicity, p < 0.001; thickening, p = 0.001; Doppler signals, p = 0.002; and erosions, p = 0.02. The patellar tendon origin also correlated with PE but distal patellar tendon insertion and plantar aponeurosis were uncoupled from the US.Conclusion.The relationship between clinical and sonographic findings for large entheses is dependent on the anatomical site. For the patellar tendon origin and Achilles entheses, PE is significantly linked to US findings.
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McInnes IB, Puig L, Gottlieb AB, Ritchlin CT, Song M, You Y, Kafka S, Morgan GJ, Rahman P, Kavanaugh A. Association Between Enthesitis and Health-related Quality of Life in Psoriatic Arthritis in Biologic-naive Patients from 2 Phase III Ustekinumab Trials. J Rheumatol 2019; 46:1458-1461. [PMID: 30936281 DOI: 10.3899/jrheum.180792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Evaluate enthesitis, physical function, and health-related quality of life (HRQOL) among patients with psoriatic arthritis (PsA) who are naive to anti-tumor necrosis factor agents. METHODS In PSUMMIT 1 and 2, patients with PsA were randomized to placebo or ustekinumab 45 mg or 90 mg. Enthesitis was assessed at weeks 0 and 24 (Maastricht Ankylosing Spondylitis Enthesitis Score). Assessments included Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study Short Form-36 (SF-36) physical component summary/mental component summary (PCS/MCS), and American College of Rheumatology 20 (ACR20). RESULTS At Week 24, 21 had worsened enthesitis, 158 had improved enthesitis, and 412 had unchanged enthesitis. Improved enthesitis was associated with improvements in HAQ-DI and SF-36 MCS. Results were similar for ACR20 responders and nonresponders. CONCLUSION Improvement in enthesitis at Week 24 was associated with improvements in physical function/HRQOL regardless of ACR20 response.
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Affiliation(s)
- Iain B McInnes
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA. .,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego.
| | - Lluís Puig
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
| | - Alice B Gottlieb
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
| | - Christopher T Ritchlin
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
| | - Michael Song
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
| | - Yin You
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
| | - Shelly Kafka
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
| | - G James Morgan
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
| | - Proton Rahman
- From the University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre, Glasgow, Scotland; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; University of Rochester, Medical Center, Rochester, New York; Janssen Research & Development LLC, Spring House, Pennsylvania; Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA; Memorial University, St. John's, Newfoundland and Labrador, Canada; University of California-San Diego, San Diego, California, USA.,I.B. McInnes, MD, PhD, University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow Biomedical Research Centre; L. Puig, MD, PhD, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona; A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai; C.T. Ritchlin, MD, MPH, University of Rochester, Medical Center; M. Song, MD, Janssen Research & Development LLC; Y. You, MS, Janssen Research & Development LLC; S. Kafka, MD, Janssen Scientific Affairs LLC; G.J. Morgan, MD, Janssen Scientific Affairs LLC; P. Rahman, MD, Memorial University; A. Kavanaugh, MD, University of California-San Diego
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Krajewska-Włodarczyk M, Owczarczyk-Saczonek A, Placek W, Wojtkiewicz M, Wiktorowicz A, Wojtkiewicz J. Distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis. Sci Rep 2019; 9:3628. [PMID: 30842536 PMCID: PMC6403314 DOI: 10.1038/s41598-019-39985-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/07/2019] [Indexed: 12/20/2022] Open
Abstract
The aim of the study was an ultrasound assessment of distal interphalangeal (DIP) joint enthesopathy in patients with nail psoriasis. Altogether, 72 patients with nail psoriasis (41 with psoriasis and 31 with psoriatic arthritis) and 30 people in the control group participated in the study. In total, 1014 nails were examined. The thickness of DIP digital extensor tendons in the groups of patients with psoriasis (Ps) and psoriatic arthritis (PsA) was correlated with the nail bed thickness (r = 0.316, p = 0.027 vs. r = 0.402, p = 0.031, respectively) and with the thickness of the nail matrix in patients with psoriasis (r = 0.421, p = 0.012). The linear regression model showed the tendon thickness in Ps patients to be affected by the nail bed thickness, duration of psoriasis and the thickness of the nail matrix, whereas in PsA patients it was found to be significantly affected by duration of psoriasis and of arthritis, the nail bed thickness, CRP concentration and the swollen joint count. Our findings may indicate the role of the nail-tendon apparatus changes in the PsA development and they emphasise the justifiability of US examinations in patients with psoriasis direct assessment of morphological changes in nails as potential predictors of PsA development.
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Affiliation(s)
- Magdalena Krajewska-Włodarczyk
- Department of Rheumatology, Municipal Hospital in Olsztyn, 10-900, Olsztyn, Poland. .,Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland. .,Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland.
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
| | - Waldemar Placek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
| | - Maja Wojtkiewicz
- Faculty of Earth Sciences, Department of Geomatics and Cartography Nicolaus Copernicus University, Torun, Poland.,DRAMIŃSKI S.A. Ultrasound Scanners, Olsztyn, Poland
| | | | - Joanna Wojtkiewicz
- Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland.,Laboratory for Regenerative Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
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40
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Zhou W, Chandran V, Cook R, Gladman DD, Eder L. The association between occupational-related mechanical stress and radiographic damage in psoriatic arthritis. Semin Arthritis Rheum 2019; 48:638-643. [DOI: 10.1016/j.semarthrit.2018.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/22/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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Polachek A, Cook R, Chandran V, Gladman DD, Eder L. Correction to: The association between sonographic enthesitis and radiographic damage in psoriatic arthritis. Arthritis Res Ther 2019; 21:20. [PMID: 30642391 PMCID: PMC6330750 DOI: 10.1186/s13075-019-1814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ari Polachek
- Centre for Prognostic Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, 1-412, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Vinod Chandran
- Department of Medicine and Laboratory Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Pathobiology, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Dafna D Gladman
- Center for Prognostic Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Lihi Eder
- Department of Medicine, University of Toronto, Women's College Research Institute, Women's College Hospital, Room 6326, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Abstract
Psoriatic arthritis (PsA) is an inflammatory arthritis that is estimated to affect approximately 30% of patients with psoriasis. Enthesitis and dactylitis, two hallmarks of PsA, are associated with radiographic peripheral/axial joint damage and severe disease. Clinical symptoms of enthesitis include tenderness, soreness, and pain at entheses on palpation, whereas dactylitis is recognized by swelling of an entire digit that is different from adjacent digits. Both ultrasound and magnetic resonance imaging can be used to diagnose enthesitis and dactylitis, especially in patients in whom symptoms may be difficult to discern. Delayed treatment of PsA can result in irreversible joint damage and reduced quality of life. Thus, it is recommended that dermatologists monitor patients with psoriasis for these two early and important manifestations of PsA.
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Affiliation(s)
- Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, 59 One Mile Road Ext. Suite G, East Windsor, NJ, 08520, USA.
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Eder L, Aydin SZ. Imaging in Psoriatic Arthritis-Insights About Pathogenesis of the Disease. Curr Rheumatol Rep 2018; 20:77. [PMID: 30370449 DOI: 10.1007/s11926-018-0793-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Heterogeneity is a hallmark of PsA as musculoskeletal inflammation can affect different tissues including the synovial joint, tendons, entheses, bursa, and bone. RECENT FINDINGS Relying on clinical examination for investigating underlying mechanisms in PsA is limited by the inherent inaccuracies of examination of the joints, enthesis, and spine. In addition, unlike synovial-centered diseases, histology is hard to obtain for the entheses and spine, limiting the knowledge for different manifestations of PsA. These limitations prompted the use of imaging modalities to improve our understanding of the underlying mechanisms in PsA. Imaging modalities can identify and quantify the extent of inflammation and damage in the synovial joints, entheses, and tendons which all contribute to the heterogeneity of PsA. This review summarizes the contribution of imaging to the understanding of the underlying mechanisms of different clinical manifestations of PsA.
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Affiliation(s)
- Lihi Eder
- Women's College Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Sibel Zehra Aydin
- Division of Rheumatology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Tom S, Zhong Y, Cook R, Aydin SZ, Kaeley G, Eder L. Development of a Preliminary Ultrasonographic Enthesitis Score in Psoriatic Arthritis - GRAPPA Ultrasound Working Group. J Rheumatol 2018; 46:384-390. [PMID: 30323008 DOI: 10.3899/jrheum.171465] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the performance of various sonographic elemental entheseal lesions in distinguishing between psoriatic arthritis (PsA) and controls to inform the development of a novel sonographic enthesitis score for PsA. METHODS A total of 100 age- and sex-matched individuals (50 PsA and 50 controls) were evaluated. Eleven entheseal sites were scanned bilaterally according to a standardized protocol by 2 sonographers. Based on the Outcome Measures in Rheumatology (OMERACT) definition of sonographic enthesitis, the following lesions were assessed: structural entheseal changes (hypoechogenicity), thickening, bone erosion, enthesophytes, calcification, and Doppler signal, in addition to bursitis and bone irregularities. The images were read by 2 readers blinded to the clinical information. A series of logistic regression models were used to find the optimal combination of entheseal sites and elementary lesions that distinguished PsA from controls. RESULTS Mean age was 55 ± 10 years (59% males). The optimal model that distinguished PsA from controls included 5 elementary lesions (enthesophytes, Doppler signal, erosions, thickening, and hypoechogenicity) and 6 entheseal sites (patellar ligament insertions into the distal patella and tibial tuberosity, Achilles tendon and plantar fascia insertions into the calcaneus, common extensor tendon insertion into lateral epicondyle, and supraspinatus insertion into the superior facet of the humerus). The area under the receiver-operating characteristic curve for this model was 0.93 (95% CI 0.88-0.98). CONCLUSION We identified potential elemental ultrasonographic abnormalities and entheseal sites that could distinguish PsA and controls. This information will contribute to the development of a new sonographic score for assessment of enthesitis in patients with PsA.
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Affiliation(s)
- Stephanie Tom
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Yujie Zhong
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Richard Cook
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Sibel Zehra Aydin
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Gurjit Kaeley
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Lihi Eder
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA. .,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
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Abstract
PURPOSE OF REVIEW Psoriatic arthritis (PsA) is a chronic inflammatory spondyloarthritis that can cause progressive joint damage and irreversible disability. Advances in modern therapies, now mean a target of remission is an achievable goal in PsA. There is strong and consistent evidence that a treat-to-target (T2T) approach to PsA management results in better patient outcomes; however, the practicalities of incorporating this strategy into routine clinical practice remain a challenge. The heterogeneous nature of this condition and the need for validated outcome measures have to-date hampered consensus on a definition of remission. This review aims to summarise the current T2T research landscape in PsA and highlight potential roles for biomarkers and imaging advances in revolutionising the T2T concept. RECENT FINDINGS There is a growing body of evidence to support the implementation of a T2T strategy, using a pre-defined target in PsA management, with significant benefits in disease outcome, physical function and quality of life. Whilst remission is the ultimately goal for PsA patients and their clinicians, further comparative studies of different treatment targets are needed to establish a widely acceptable definition of remission.
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Affiliation(s)
- Laura J Tucker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Weiyu Ye
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
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Bakirci Ureyen S, Karacaer C, Toka B, Erturk Z, Eminler AT, Kaya M, Tascilar K, Tamer A, Uslan I, Kurum E, McGonagle D, Aydin SZ. Similar subclinical enthesitis in celiac and inflammatory bowel diseases by ultrasound suggests a gut enthesis axis independent of spondyloarthropathy spectrum. Rheumatology (Oxford) 2018; 57:1417-1422. [PMID: 29741671 DOI: 10.1093/rheumatology/key102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Higher subclinical enthesitis on US has been reported in IBD and celiac disease, separately. The objective of this study was to compare IBD and celiac disease for enthesitis on US. Higher enthesitis scores in IBD compared with celiac disease would support a shared pathogenic mechanism between IBD and spondyloarthritis, whereas similar scores may suggest a general impact of gut inflammation on the enthesis. Methods Patients with IBD, celiac disease and healthy controls (HCs) were recruited and 12 entheses were scanned by US, blind to the diagnosis and clinical assessment. Elementary lesions for enthesitis were scored on a scale between 0 and 3, for inflammation, damage and total US scores. Results A total of 1260 entheses were scanned in 44 patients with celiac disease, 43 patients with IBD and 18 HCs. The three groups were matched for age and BMI. Patients with celiac disease and IBD had higher inflammation scores than HCs [10.4 (6.5), 9.6 (5.4) and 5.6 (5.2), respectively, P = 0.007) whereas damage scores were similar. Both age and BMI had significant effects on the entheseal scores, mostly for inflammation scores but when controlling for these the US enthesopathy scores were still higher in celiac disease and IBD. Conclusion The magnitude of subclinical enthesopathy scores is similar between celiac disease and IBD in comparison with HCs. These findings suggest that the common factor between both diseases and enthesopathy is abnormal gut permeability, which may be modified by the genetic architecture of IBD leading to clinical arthropathy.
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Affiliation(s)
- Sibel Bakirci Ureyen
- Department of Internal Medicine, Division of Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Cengiz Karacaer
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Bilal Toka
- Department of Internal Medicine, Division of Gastroenterology, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Zeynep Erturk
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Ahmet Tarik Eminler
- Department of Internal Medicine, Division of Gastroenterology, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Muhammed Kaya
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Koray Tascilar
- Department of Internal Medicine, Division of Rheumatology, Istanbul Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Ali Tamer
- Department of Internal Medicine, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Ihsan Uslan
- Department of Internal Medicine, Division of Gastroenterology, Sakarya Education and Research Hospital, Sakarya, Turkey
| | - Esra Kurum
- Department of Statistics, University of California, Riverside, Riverside, CA, USA
| | - Dennis McGonagle
- Depertment of Internal Medicine, Division of Rheumatology, Leeds Institute of the Rheumatic and Musculoskeletal Disease, Leeds, UK.,University of Leeds, Faculty of Medicine, Rheumatology, Leeds, UK
| | - Sibel Zehra Aydin
- Department of Internal Medicine, Division of Rheumatology, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
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Yang L, Fanok MH, Mediero-Munoz A, Fogli LK, Corciulo C, Abdollahi S, Cronstein BN, Scher JU, Koralov SB. Augmented Th17 Differentiation Leads to Cutaneous and Synovio-Entheseal Inflammation in a Novel Model of Psoriatic Arthritis. Arthritis Rheumatol 2018; 70:855-867. [PMID: 29439292 PMCID: PMC5984671 DOI: 10.1002/art.40447] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 02/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To introduce a novel preclinical animal model of psoriatic arthritis (PsA) in R26Stat3Cstopfl/fl CD4Cre mice, and to investigate the role of Th17 cytokines in the disease pathogenesis. METHODS We characterized a novel murine model of Th17-driven cutaneous and synovio-entheseal disease directed by T cell-specific expression of a hyperactive Stat3 allele. By crossing R26Stat3Cstopfl/fl CD4Cre mice onto an interleukin-22 (IL-22)-knockout background or treating the mice with a neutralizing antibody against IL-17, we interrogated how these Th17 cytokines could contribute to the pathogenesis of PsA. RESULTS R26Stat3Cstopfl/fl CD4Cre mice developed acanthosis, hyperkeratosis, and parakeratosis of the skin, as well as enthesitis/tendinitis and periarticular bone erosion in different joints, accompanied by osteopenia. T cell-specific expression of a hyperactive Stat3C allele was found to drive the augmented Th17 response in these animals. Careful characterization of the mouse bone marrow revealed an increase in osteoclast progenitor (OCP) and RANKL-producing cells, which contributed to the osteopenia phenotype observed in the mutant animals. Abrogation of the Th17 cytokines IL-17 or IL-22 improved both the skin and bone phenotype in R26Stat3Cstopfl/fl CD4Cre mice, revealing a central role of Th17 cells in the regulation of OCP and RANKL expression on stromal cells. CONCLUSION Perturbation of the IL-23/Th17 axis instigates Th17-mediated inflammation in R26Stat3Cstopfl/fl CD4Cre mice, leading to cutaneous and synovio-entheseal inflammation and bone pathologic features highly reminiscent of human PsA. Both IL-17A and IL-22 produced by Th17 cells appear to play critical roles in promoting the cutaneous and musculoskeletal inflammation that characterizes PsA.
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Affiliation(s)
- Lu Yang
- Department of Pathology, NYU School of Medicine, New York, NY 10016
| | - Melania H. Fanok
- Department of Pathology, NYU School of Medicine, New York, NY 10016
| | - Aranzazu Mediero-Munoz
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY 10016
| | - Laura K Fogli
- Department of Pathology, NYU School of Medicine, New York, NY 10016
| | - Carmen Corciulo
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY 10016
- Divisions of Rheumatology and Translational Medicine, Department of Medicine, NYU School of Medicine, New York, NY 10016
| | - Shahla Abdollahi
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY 10016
| | - Bruce N. Cronstein
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY 10016
- Divisions of Rheumatology and Translational Medicine, Department of Medicine, NYU School of Medicine, New York, NY 10016
| | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY 10016
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Yue J, Wu D, Tam LS. The role of imaging in early diagnosis and prevention of joint damage in inflammatory arthritis. Expert Rev Clin Immunol 2018; 14:499-511. [PMID: 29754519 DOI: 10.1080/1744666x.2018.1476849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Inflammatory arthritis is characterized by chronic inflammation in the synovium, associated with degradation of cartilage and erosion of juxta-articular bone. The bone loss and joint destruction mediated by aberrant immunological responses resulting in proinflammatory cytokine release and various immune cell activation are known as osteoimmunology. Areas covered: A structured literature search including Medline and PubMed, Cochrane meta-analyses and abstracts of international congresses was performed to review joint damage in inflammatory arthritis in terms of pathogenesis, novel imaging assessment, and prevention. Expert commentary: Deeper understanding of the integration of the skeletal and immune as well as inflammatory system is paving the way to prevent bone loss and bone destruction in inflammatory arthritis. With the availability of various imaging modalities such as ultrasound, magnetic resonance imaging (MRI) and high-resolution peripheral quantitative computed tomography (HR-pQCT), we are now able to detect early joint damage, early diagnosis of inflammatory arthritis, monitor the progression or even ascertain whether the inflammatory process is effectively suppressed to allow repair of joint damage by novel therapeutic agents.
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Affiliation(s)
- Jiang Yue
- a Department of Medicine & Therapeutics , The Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Dongze Wu
- a Department of Medicine & Therapeutics , The Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Lai-Shan Tam
- a Department of Medicine & Therapeutics , The Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin , Hong Kong
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Polachek A, Cook R, Chandran V, Abji F, Gladman D, Eder L. The Association Between HLA Genetic Susceptibility Markers and Sonographic Enthesitis in Psoriatic Arthritis. Arthritis Rheumatol 2018; 70:756-762. [DOI: 10.1002/art.40423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/17/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Ari Polachek
- Toronto Western Hospital; Toronto Ontario Canada
- Tel Aviv Sourasky Medical Center and Sackler Faculty Medical Center; Tel Aviv University; Tel Aviv Israel
| | | | - Vinod Chandran
- University of Toronto; Toronto Western Hospital; Toronto Ontario Canada
| | - Fatima Abji
- Toronto Western Hospital; Toronto Ontario Canada
| | - Dafna Gladman
- University of Toronto; Toronto Western Hospital; Toronto Ontario Canada
| | - Lihi Eder
- University of Toronto; Women's College Hospital; Toronto Ontario Canada
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Kaeley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C. Enthesitis: A hallmark of psoriatic arthritis. Semin Arthritis Rheum 2018; 48:35-43. [PMID: 29429762 DOI: 10.1016/j.semarthrit.2017.12.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe the growing importance of enthesitis in patients with psoriatic arthritis (PsA) and discuss the advantages and disadvantages of clinical and imaging methods currently used to assess enthesitis. METHODS PubMed literature searches were conducted using the terms psoriatic arthritis, entheses, enthesitis, pathology, imaging, ultrasound, magnetic resonance imaging, clinical, and indices. Articles were deemed relevant if they provided insight into the pathology, monitoring, and/or diagnosis of enthesitis in PsA, or if they discussed clinical or imaging indices used to assess enthesitis. RESULTS Enthesitis is an early manifestation of PsA that is associated with increased disease activity and reduced quality of life. A variety of clinical indices exist to assess enthesitis in PsA; however, the Leeds Enthesitis Index and Maastricht Ankylosing Spondylitis Enthesitis Score index have been the most frequently used indices in recent clinical trials. Limitations of these indices include an inability to discern structural involvement, risk of missing subclinical enthesitis, and lack of sensitivity in detecting enthesitis, especially in patients with central sensitization and/or pain amplification. Such limitations have led to the emergent importance of imaging techniques in the assessment of enthesitis. Although there have been recent advances in magnetic resonance imaging, ultrasound (US) appears to be the preferred method for detecting enthesitis because it allows for accurate assessment of the soft-tissue components of entheses and also for new bone formation. Hypoechogenicity, increased thickness of tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity have been identified as important US characteristics of enthesitis. CONCLUSION Enthesitis is thought to be integrally involved in the pathogenesis of PsA and is associated with worse prognostic outcomes in patients with PsA. A validated US index with entheses that are less confounded by mechanical factors and obesity would be the most effective measure of enthesitis in PsA. As imaging techniques continue to advance, our understanding of enthesitis and its involvement in PsA will also improve.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, 653-1 West 8th St., LRC 2nd Floor L-14, Jacksonville, FL, 32209.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Sibel Z Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
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