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Tan WF, Robinson S, Tang MM. A 14-year registry review (2007-2020) on nail involvement among patients with psoriasis in Malaysia. Clin Dermatol 2024:S0738-081X(24)00186-X. [PMID: 39278515 DOI: 10.1016/j.clindermatol.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Nail psoriasis affects 20 to 30% of psoriasis patients and is an early predictor of psoriatic arthropathy (PsA). We have evaluated the prevalence, clinical characteristics, and impact on quality of life of patients with nail psoriasis. We conducted a multicenter retrospective cohort study was of patients registered with The Malaysian Psoriasis Registry (MPR) from 1 January 1, 2007 through 31 December 31, 2020. Of the 24147 patients, 13081 (54.2%) had nail psoriasis. Patients with nail psoriasis had la ater onset of psoriasis (34.0±16.6 vs 32.9±17.6 years, p<0.001) and longer disease duration (11.4±10.5 vs 8.5±9.4 years, p<0.01), with a male to female ratio of 1.2:1. They were more likely to have a family history of psoriasis, cardiometabolic diseases, smoking history, higher body mass index, severe disease, PsA, face and scalp involvement and higher mean Dermatology Life Quality Index scores (9.36±6.84 vs 8.87±6.60). Systemic treatment and biologics were more commonly prescribed in this cohort (25.0% vs 13.2%, p<0.001). Overall, 54.2% of the MPR patients had nail involvement. Nail psoriasis was associated with longer duration of psoriasis, older age of onset, male gender, and a family history of psoriasis. It proved to be an important predictor for PsA, severe psoriasis, face and scalp involvement, increased cardiometabolic risk, and a greater impairment of quality of life.
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Affiliation(s)
- Wen Foong Tan
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, 50586, Kuala Lumpur.
| | - Suganthy Robinson
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, 50586, Kuala Lumpur
| | - Min Moon Tang
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, 50586, Kuala Lumpur
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Queiro R, Alonso S, Pinto-Tasende JA. The nail in psoriatic arthritis: new insights into prognosis and treatment. Expert Opin Biol Ther 2024; 24:715-717. [PMID: 39044719 DOI: 10.1080/14712598.2024.2385020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/23/2024] [Indexed: 07/25/2024]
Affiliation(s)
- Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
- Translational Immunology Division, Biohealth Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Faculty of Medicine, Oviedo University, Oviedo, Spain
| | - Sara Alonso
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Jose A Pinto-Tasende
- Division of Rheumatology, INIBIC, Complexo Hospitalario Universitario de A Coruña, A Coruña Spain
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Orbai AM, Chakravarty SD, You Y, Shawi M, Yang YW, Merola JF. Efficacy of Guselkumab in Treating Nails, Scalp, Hands, and Feet in Patients with Psoriasis and Self-reported Psoriatic Arthritis. Dermatol Ther (Heidelb) 2023; 13:2859-2868. [PMID: 37713133 PMCID: PMC10613182 DOI: 10.1007/s13555-023-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate guselkumab efficacy on regional psoriasis in a subset of psoriasis patients with a self-reported psoriatic arthritis (PsA) diagnosis. METHODS In the phase 3 VOYAGE-1 and -2 studies, at week (W)0, patients with moderate-to-severe psoriasis were randomized to guselkumab 100 mg, placebo → guselkumab 100 mg at W16 through W44, or adalimumab 80 mg then 40 mg at W1 through W48 (VOYAGE-1) or W24 (VOYAGE-2). Pooled efficacy outcomes, including scalp-specific Investigator's Global Assessment (ss-IGA), hands and/or feet Physician's Global Assessment (hf-PGA), fingernail PGA (f-PGA), Nail Psoriasis Area and Severity Index (NAPSI), and Dermatology Life Quality Index (DLQI), were compared (nominal p-values) through W24 in patients with self-reported PsA diagnosis. Response rates/percentage improvement from baseline were determined, employing treatment failure rules and non-response/no improvement data imputation. RESULTS A total of 76, 153, and 106 psoriasis patients with self-reported PsA were randomized to the placebo, guselkumab, or adalimumab groups, respectively; the baseline characteristics of patients in all three arms were comparable. At W16, a greater proportion of guselkumab- versus placebo-treated patients achieved ss-IGA 0/1 (80.6% vs. 22.7%, p < 0.001), hf-PGA 0/1 (68.9% vs. 14.8%, p < 0.001), f-PGA 0/1 (47.6% vs. 17.0%, p < 0.001), and DLQI 0/1 (45.6% vs. 2.7%, p < 0.001) responses; mean percentage NAPSI improvement was also greater with guselkumab (39.5% vs. 6.5%, p < 0.001). At W24, patients receiving guselkumab had higher ss-IGA 0/1 (77.5% vs. 58.5%, p = 0.003) and DLQI 0/1 (47.7% vs. 34.3%, p = 0.024) response rates versus those receiving adalimumab. Response rates/mean percentage improvements at W48 (VOYAGE-1) were numerically greater with guselkumab than adalimumab (e.g., NAPSI improvement: 75.6% vs. 60.9%). CONCLUSIONS Guselkumab-treated patients with psoriasis and self-reported PsA showed meaningful improvements in nail, scalp, and palmoplantar psoriasis. TRIAL REGISTRATION VOYAGE-1 (ClinicalTrials.gov Identifier: NCT02207231) and VOYAGE-2 (ClinicalTrials.gov Identifier: NCT02207244).
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Affiliation(s)
- Ana-Maria Orbai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Yin You
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - May Shawi
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Ya-Wen Yang
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Joseph F Merola
- Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Lu C, Yang F, 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. Chinese Registry of Psoriatic Arthritis (CREPAR): I. Clinical characteristics of Chinese patients with psoriatic arthritis. Int J Rheum Dis 2023; 26:1737-1744. [PMID: 37424174 DOI: 10.1111/1756-185x.14805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/17/2022] [Accepted: 06/17/2023] [Indexed: 07/11/2023]
Abstract
AIM To describe the clinical characteristics of Chinese patients with psoriatic arthritis (PsA) using the data recorded in the Chinese Registry of Psoriatic Arthritis (CREPAR). METHODS This is a cross-sectional study based on the CREPAR registry, which is a prospective registry founded in December 2018. Data regarding clinical characteristics and treatment of patients were collected during every visit. Data recorded at enrollment were extracted, analyzed, and compared with data in other registries or cohorts. RESULTS A total of 1074 patients were registered from December 2018 to June 2021. Of these, 929 (86.5%) patients had a history of peripheral arthritis, and 844 patients (78.6%) had peripheral arthritis at enrollment, of which polyarthritis is the most common subtype. Axial involvement was present in 39.9% of patients, and 50 (4.7%) patients had axial involvement only. More than half of the patients (55.4%) had at least two musculoskeletal presentations at enrollment. The prevalence of low disease activity and remission according to DAPSA were 26.4% and 6.8%, respectively. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological DMARDs were used in 64.9% and 29.1% of patients, respectively. Among patients with different musculoskeletal presentations, patients with dactylitis had the highest proportion of nonsteroidal anti-inflammatory and csDMARD use. The proportion of patients receiving bDMARDs was highest in axial PsA. CONCLUSION The CREPAR registry has provided information on Chinese patients with PsA. Compared with data in other registries or cohorts, the disease activity of patients in CREPAR was higher, and the proportion of bDMARD use was lower.
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Affiliation(s)
- 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, China
| | - 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, 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, China
| | - Lei Dou
- Department of Rheumatology and Immunology, The Second People's Hospital of Wuhu, Wuhu, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongbin Li
- The Division of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, The People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yongfu Wang
- Department of Rheumatology, First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Xiuying Zhang
- Department of Rheumatology, ZiBo Central Hospital, Zibo, China
| | - Jian Xu
- Department of Rheumatology, The First Affiliated Hospital of Kunming Medical University, Kunming, 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, 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, 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, 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, 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, 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, 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, China
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Peng YT, Yu RT, Chen AJ, Wen ZY, Xu J, Huang K, Wang P. Predicting the Risk of Nail Involvement in Psoriasis Patients: Development and Assessment of a Predictive Nomogram. Diagnostics (Basel) 2023; 13:diagnostics13040633. [PMID: 36832121 PMCID: PMC9955142 DOI: 10.3390/diagnostics13040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Nail involvement has a tremendous impact on psoriasis patients. Early detection and prompt intervention of psoriatic nail damage are necessary. METHODS A total of 4290 patients confirmed to have psoriasis between June 2020 and September 2021 were recruited from the Follow-up Study of Psoriasis database. Among them, 3920 patients were selected and divided into the nail involvement group (n = 929) and the non-nail involvement group (n = 2991) by inclusion and exclusion criteria. Univariate and multivariable logistic regression analyses were performed to identify the predictors of nail involvement for the nomogram. Calibration plots, the receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the discriminative and calibrating ability and clinical utility of the nomogram. RESULTS Sex, age at onset, duration, smoking, drug allergy history, comorbidity, sub-type of psoriasis, scalp involvement, palmoplantar involvement, genital involvement, and PASI score were selected to establish the nomogram for nail involvement. AUROC (0.745; 95% CI: 0.725-0.765) indicated the satisfactory discriminative ability of the nomogram. The calibration curve showed favorable consistency, and the DCA showed the good clinical utility of the nomogram. CONCLUSION A predictive nomogram with good clinical utility was developed to assist clinicians in evaluating the risk of nail involvement in psoriasis patients.
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Affiliation(s)
| | | | | | | | | | | | - Ping Wang
- Correspondence: ; Tel.: +86-13271982269
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Walsh JA, Ogdie A, Michaud K, Peterson S, Holdsworth EA, Karyekar CS, Booth N, Middleton-Dalby C, Chakravarty SD, Dennis N, Gossec L. Impact of key manifestations of psoriatic arthritis on patient quality of life, functional status, and work productivity: Findings from a real-world study in the United States and Europe. Joint Bone Spine 2023; 90:105534. [PMID: 36706947 DOI: 10.1016/j.jbspin.2023.105534] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To determine the individual impact of key manifestations of psoriatic arthritis (PsA) on quality of life (QoL), physical function, and work disability. METHODS Data from the Adelphi 2018 PsA Disease-Specific Programme, a multinational, cross-sectional study of PsA patients, were used. PsA manifestations included peripheral arthritis (number of joints affected), psoriasis (body surface area [BSA]), axial involvement (inflammatory back pain [IBP] and sacroiliitis) enthesitis, and dactylitis. General, and disease-specific QoL, physical function, and work disability were measured with EQ-5D-5L, PsAID-12, HAQ-DI, and WPAI, respectively. Multivariate regression adjusting for potential confounders evaluated the independent effect of PsA manifestations on each outcome. RESULTS Among the 2222 PsA patients analysed, 77.0% had active psoriasis and 64.4% had peripheral arthritis; 5.9%, 6.8%, 10.2%, and 3.6% had enthesitis, dactylitis, IBP, or sacroiliitis, respectively. Mean EQ VAS scores were significantly poorer in patients with vs. without enthesitis (59.9 vs. 75.6), dactylitis (63.6 vs. 75.4), and with greater peripheral joint involvement (none: 82.5; 1-2 affected joints: 74.1; 3-6 joints: 74.2; >6 joints: 65.0). Significantly worse mean PsAID-12 scores were associated with vs. without enthesitis (4.39 vs. 2.34) or dactylitis (4.30 vs. 2.32), and with greater peripheral joint involvement (none: 1.21; 1-2 joints: 2.36; 3-6 joints: 2.74; >6 joints: 3.92), and BSA (none: 1.49; >3-10%: 2.96; >10%: 3.43). Similar patterns were observed with HAQ-DI and WPAI scores. CONCLUSION Most PsA manifestations were independently associated with worse general, and PsA-specific QoL, physical function, and work disability, highlighting the need for treatments targeting the full spectrum of PsA symptoms to lower the burden of disease.
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Affiliation(s)
- Jessica A Walsh
- University of Utah and Salt Lake City Veterans Affairs, Utah, USA.
| | - Alexis Ogdie
- Perelman School of Medicine, Penn Medicine, Philadelphia, USA
| | - Kaleb Michaud
- University of Nebraska Medical Center, Nebraska & Forward Databank, Kansas, USA
| | | | | | | | | | | | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, USA; Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Natalie Dennis
- Amaris, Health Economics and Market Access, Paris, France
| | - Laure Gossec
- Sorbonne université, Inserm, Institut Pierre Louis d'épidémiologie et de santé publique, Paris, France; Pitié-Salpêtrière hospital, AP-HP, Sorbonne université, rheumatology department, Paris, France
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Cengiz G, Nas K, Keskin Y, Kılıç E, Sargin B, Acer Kasman S, Alkan H, Sahin N, Cüzdan Balta N, Gezer İA, Keskin D, Mülkoğlu C, Reşorlu H, Ataman Ş, Bal A, Baykul M, Duruöz MT, Küçükakkaş O, Yurdakul OV, Alkan Melikoğlu M, Ayhan FF, Bodur H, Çaliş M, Çapkin E, Devrimsel G, Gök K, Hizmetli S, Kamanlı A, Ecesoy H, Kutluk Ö, Şen N, Şendur ÖF, Tekeoğlu İ, Toprak M, Tolu S, Tuncer T. The impact of nail psoriasis on disease activity, quality of life, and clinical variables in patients with psoriatic arthritis: A cross-sectional multicenter study. Int J Rheum Dis 2023; 26:43-50. [PMID: 36165674 DOI: 10.1111/1756-185x.14442] [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: 03/02/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
AIM Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). METHOD This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the χ2 test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. RESULTS In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). CONCLUSION We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.
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Affiliation(s)
- Gizem Cengiz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Kemal Nas
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Yaşar Keskin
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Kılıç
- Rheumatology Clinic, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Betül Sargin
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Sevtap Acer Kasman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Marmara University, İstanbul, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Nilay Sahin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Balikesir University, Balikesir, Turkey
| | - Nihan Cüzdan Balta
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, School of Medicine, Selcuk University, Konya, Turkey
| | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hatice Reşorlu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Şebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Merve Baykul
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Marmara University, İstanbul, Turkey
| | - Okan Küçükakkaş
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Meltem Alkan Melikoğlu
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Fikriye Figen Ayhan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Atılım University, Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mustafa Çaliş
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erhan Çapkin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Kevser Gök
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Sami Hizmetli
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation. School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ayhan Kamanlı
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Hilal Ecesoy
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Öznur Kutluk
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Nesrin Şen
- Department of Rheumatology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Ömer Faruk Şendur
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - İbrahim Tekeoğlu
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Murat Toprak
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Medipol University, Istanbul, Turkey
| | - Tiraje Tuncer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Akdeniz University, Antalya, Turkey
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Helliwell PS, Mease PJ, Kavanaugh A, Coates LC, Ogdie A, Deodhar A, Strand V, Kricorian G, Liu LXH, Collier D, Gladman DD. Impact of clinical domains other than arthritis on composite outcomes in psoriatic arthritis: comparison of treatment effects in the SEAM-PsA trial. RMD Open 2022; 8:rmdopen-2022-002366. [PMID: 35863864 PMCID: PMC9310247 DOI: 10.1136/rmdopen-2022-002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We used the Study of Etanercept And Methotrexate in Combination or as Monotherapy in Subjects with Psoriatic Arthritis (SEAM-PsA) data set to examine the impact of presence of enthesitis, dactylitis, nail disease and/or psoriasis on treatment response in patients with early psoriatic arthritis (PsA). METHODS This post hoc analysis evaluated the effect of baseline Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index (EI), Leeds Enthesitis Index (LEI), Leeds Dactylitis Index (LDI), modified Nail Psoriasis Severity Index (mNAPSI) scores and body surface area (BSA) on composite outcomes of minimal disease activity (MDA) responses, Psoriatic Arthritis Disease Activity Score (PASDAS) low disease activity (LDA), PASDAS changes and Good Responses and Disease Activity Index for Psoriatic Arthritis (DAPSA) scores at Week 24. RESULTS Overall, 851 patients completed the SEAM-PsA trial and were included in the analysis. Baseline enthesitis (SPARCC EI>0 vs SPARCC EI=0 or LEI>0 vs LEI=0) was not associated with improved outcomes. Baseline dactylitis (LDI>0 vs LDI=0) was positively associated with improved MDA (OR: 1.4, p=0.0457), PASDAS LDA (OR: 1.8, p=0.0014) and Good Responses (OR: 1.6, p=0.0101) and greater reductions in PASDAS (estimate: -0.9, p<0.0001) and DAPSA scores (estimate: -3.8, p=0.0155) at Week 24. Similarly, baseline nail disease (mNAPSI >1 vs mNAPSI≤1) was positively associated with improved MDA (OR: 1.8, p=0.0233) and PASDAS LDA (OR: 1.8, p=0.0168) responses and greater reduction in PASDAS (estimate: -0.7, p=0.0005) at Week 24. CONCLUSIONS Results from our analysis suggest that presence of dactylitis and nail disease, but not enthesitis, are associated with improved outcomes in patients with early PsA who were treated with methotrexate and/or etanercept.
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Affiliation(s)
- Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Phillip J Mease
- Rheumatology Research, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA
| | - Laura C Coates
- Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexis Ogdie
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | | | | | - David Collier
- Clinical Development, Amgen Inc, Thousand Oaks, California, USA
| | - Dafna D Gladman
- Centre for Prognosis Studies in The Rheumatic Diseases, University of Toronto, Toronto, Ontario, Canada
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Abstract
Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is included within the spondyloarthritis, a group of rheumatological diseases characterized by different clinical manifestations and associated comorbidities, that can compromise the quality of life of patients. The diagnosis of PsA is sometimes difficult due to an enormous clinical and radiological variability, including six different domains of involvement: peripheral joint, axial skeleton, skin psoriasis, nail psoriasis, enthesitis and dactylitis. Currently, there are no biomarkers that allow the detection of PsA in patients with psoriasis, so a high level of suspicion is important, mainly by dermatologists, but also by other specialists, such as family doctors. Advances in the knowledge of new immunological mechanisms and joint management by rheumatologists and dermatologists have made it possible to improve the therapeutic approach in patients with PsA.
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Gialouri CG, Fragoulis GE. Disease activity indices in psoriatic arthritis: current and evolving concepts. Clin Rheumatol 2021; 40:4427-4435. [PMID: 34003419 DOI: 10.1007/s10067-021-05774-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/18/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Psoriatic arthritis (PsA) is a highly heterogenous disease, with many different clinical manifestations inside or outside of the musculoskeletal system and the skin. It is often accompanied by comorbidities like cardiovascular diseases and mental health disorders. Acute phase reactants are not always elevated and specific markers for diagnosis and/or monitor the disease are lacking thus far. These characteristics possibly reflect the difficulty in agreement about a disease activity index for PsA. Many indices have been proposed over the last years, each of them considering different combinations of disease characteristics. We performed a literature search for relevant articles using PubMed and Embase. No data limits were applied. The keywords "Psoriatic arthritis" OR "PsA" AND "disease activity" AND "index" OR "indices" were used. Reference lists of relevant articles were also reviewed. Articles were also identified through searches of the authors' own files. In this review, we comparatively present the available indices (simple or composite) used for measuring activity in PsA, highlighting their weaknesses, strengths, and disparities. We comment also on the caveats and pitfalls that are encountered in assessment of disease activity, in relation to clinical practice and research. A widely accepted index for measuring disease activity in PsA is lacking. Other parameters, mostly related to patient-reported outcomes and to novel biomarkers might be included in the future, in such indices. Key points • Disease activity in PsA is multiparametric and its assessment is challenging due to many different phenotypes. • Many different indices are currently in use of PsA disease activity assessment. • Each PsA disease activity index has specific pros and cons.
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Affiliation(s)
- Chrysoula G Gialouri
- Department of Propaedeutic Internal Medicine, Medical School, Rheumatology Unit, "Laiko" General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 str, 11527, FirstGoudi, Athens, Greece
| | - George E Fragoulis
- Department of Propaedeutic Internal Medicine, Medical School, Rheumatology Unit, "Laiko" General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 str, 11527, FirstGoudi, Athens, Greece.
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland.
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