The Effect of TNF-α Inhibitors on Nail Psoriasis and Psoriatic Arthritis-Real-World Data from Dermatology Practice.

Georgios Kokolakis,Gerd-Rüdiger Burmester,Kamran Ghoreschi,Robert Sabat,Sarah Ohrndorf,Björn Fritz,Imma Fischer,Susana Gomis-Kleindienst

doi:10.3390/jpm11111083

Abstract

Patients with psoriatic arthritis (PsA) often develop joint symptoms years after their initial diagnosis of psoriasis disease; therefore, dermatologists should test for and detect PsA early. In this study, we focused on patients with psoriasis with both nail and joint disease being treated with tumor necrosis factor-α inhibitors by dermatologists. We performed a noninterventional, prospective, multicenter, and open-label study to evaluate the effectiveness of adalimumab, etanercept, or infliximab over 24 months of continuous therapy in patients with moderate to severe plaque-type psoriasis (Pso) and PsA. Disease assessments with the Psoriasis Area and Severity Index, Nail Psoriasis Severity Index (NAPSI), joint assessment, Dermatology Life Quality Index (DLQI), and Health Assessment Questionnaire (HAQ) instruments were performed every 3 months for the first year and twice annually thereafter. The cohort included 100 patients with Pso, nail psoriasis, and PsA. A significant reduction of NAPSI was observed 3 months after therapy initiation compared with the baseline (mean ± SD, 22.9 ± 17.8 vs. 33.8 ± 21.4; p < 0.001). Similarly, the mean ± SD number of both tender and swollen joints decreased significantly within the first 3 months of treatment, from 10.8 ± 11.5 to 6.4 ± 10.3 (p < 0.001) and from 6.4 ± 9.5 to 3.1 ± 7.2 (p < 0.001), respectively. Additionally, the distal interphalangeal joint involvement improved throughout the observation time, and DLQI and HAQ scores decreased. Improvements in control of skin, nail, and joint symptoms were seen, as well as in patients’ quality of life and functionality. Dermatologists have an important role not only in PsA diagnosis but also in PsA long-term care.

Highlights

Because nail psoriasis significantly affects patients’ quality of life (QoL), it belongs to the criteria for upgrading psoriasis severity, when the affected skin is not considered moderate to severe in disease (PASI < 10) but the patient’s QoL is impaired (DLQI > 10) [6]
Life Quality Index [Dermatology Life Quality Index (DLQI)] > 10), who were candidates for systemic treatment with the TNF-α inhibitors etanercept, adalimumab, and infliximab according to licensure and had psoriasis of the fingernails were included in this observational study
100 patients (63% male; mean ± SD age, 49.6 ± 12.4 years) with Pso and nail psoriasis, as well as psoriatic arthritis (PsA), with a mean ± SD disease duration of Pso of 20.1 ± 13.7 years and a mean ± SD BMI of 28.7 ± 5.5 kg/m2 were included in this cohort study

Summary

Introduction

Psoriasis is a chronic inflammatory disease that affects skin and nails, entheses, and peripheral and axial joints [1]. In most patients with psoriasis, skin disease precedes joint involvement. 67% of patients with psoriatic arthritis (PsA) develop the arthritis nearly 10–20 years after the onset of the cutaneous symptoms of the disease [2]. Nail lesions occur in more than 80% of patients with PsA compared with nearly 40% of patients without PsA [3]. Because nail psoriasis significantly affects patients’ quality of life (QoL), it belongs to the criteria for upgrading psoriasis severity, when the affected skin is not considered moderate to severe in disease (PASI < 10) but the patient’s QoL is impaired (DLQI > 10) [6]

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