Time to lift the moratorium on IL-23 inhibitors for axial psoriatic arthritis.

<p>Spondyloarthritis (SpA) describes a group of related inflammatory conditions, including ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis, SpA associated with inflammatory bowel disease and undifferentiated SpA.1 Classification criteria have been developed and validated by the Assessment of SpondyloArthritis international Society (ASAS) to distinguish axial‐predominant SpA from peripherally predominant SpA. These criteria contribute to diagnosis, but are not ideal diagnostic criteria as they possess only moderate sensitivity. Diagnosis of axial SpA should be established by a rheumatologist, after careful consideration of these criteria and individual patient factors.</p><p>Recent research into axial SpA has improved diagnostic assessment, using MRI and has established MRI and radiography as the main tools for assessing disease activity, response to treatment and prognosis. Diagnosis of axial SpA is often dependent on the choice and interpretation of imaging in individuals with axial symptoms. These consensus statements were developed to provide an evidence‐based approach to imaging in axial SpA.</p>

AB0840 INFLUENCE OF PSORIATIC ARTHRITIS (PsA) ON BONE LOSS AND ANALYSIS BETWEEN AXIAL AND PERIPHERAL PsA IN JAPANESE PATIENTS

Background:Axial Spondyloarthritis (AxSpA) and axial Psoriatic Arthritis (AxPsA) have overlapping features but also meaningful differences in genetics, clinical presentation and immunophenotype. Active sacroiliitis may be evident in both entities through...

Spondyloarthritis is a group of chronic inflammatory diseases that includes axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). AxSpA primarily affects the axial skeleton, manifesting with hallmark features such as inflammatory back pain and a strong association with human leukocyte antigen-B27. On the other hand, axial involvement in PsA (axial PsA) poses unique challenges in the diagnosis, classification, and management. These challenges stem from a limited understanding of this condition and an absence of a specific definition for its diagnosis. Although shared genetic and environmental contributors are observed, the presence of differences suggests the possibility that axial PsA may, in fact, represent a distinct clinical entity rather than axSpA. The prevailing classification criteria, such as ClASsification criteria for Psoriatic ARthritis for PsA and the Assessment of SpondyloArthritis International Society criteria for axSpA, are insufficient in capturing the full scope of axial PsA. Moreover, treatment paradigms for axial PsA are primarily extrapolated from axSpA due to the lack of targeted trials in this specific population. Biologic disease-modifying anti-rheumatic drugs, encompassing tumor necrosis factor inhibitors, interleukin (IL)-17 inhibitors, and Janus kinase inhibitors, have demonstrated efficacy in axSpA and PsA. However, IL-23 inhibitors have not shown efficacy in axSpA, and currently, no results from randomized controlled trials in axial PsA are available. While axial PsA exhibits features that overlap with axSpA, emerging evidence underscores its distinct pathophysiology and clinical characteristics, highlighting the need for standardized definitions and tailored therapeutic approaches to optimize outcomes. Ongoing studies evaluating therapeutic efficacy and molecular characterization hold promises to enhance understanding and management of axial PsA, thus paving the way for personalized treatment strategies. This review aims to provide an overview of the similarities and differences between axial PsA and axSpA and seeks to disentangle the intersections between these two diseases.

Background:Although pts with axial PsA and axial SpA share some common clinical characteristics, there are also potential differences that may influence disease assessment and treatment response. Identifying differences between the...

ObjectiveEarly identification of patients unlikely to achieve good long‐term disease control with anti–tumor necrosis factor therapy in axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) is important for physicians following treat‐to‐target recommendations. Here we assess associations between disease activity or clinical response during the first 12 weeks of treatment and attainment of treatment targets at week 48 in axial SpA and PsA patients receiving certolizumab pegol.MethodsThe relationship between disease activity or clinical response during the first 12 weeks of treatment and achievement of week‐48 targets (for axial SpA: inactive disease based on Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C‐reactive protein [CRP] level, or Bath Ankylosing Spondylitis Disease Activity Index <2 with normal CRP level; and for PsA: minimal disease activity) was assessed post hoc using RAPID‐axSpA and RAPID‐PsA trial data.ResultsA clear relationship between disease activity from week 2 to 12 and achievement of week‐48 treatment targets was observed in both axial SpA and PsA populations. In axial SpA, week‐48 ASDAS inactive disease was achieved by 0% of patients (0 of 21) with ASDAS very high disease activity at week 12, compared to 68% of patients (34 of 50) with week‐12 ASDAS inactive disease. For PsA, week‐48 minimal disease activity was achieved by 0% of patients (0 of 26) with Disease Activity Score in 28 joints (DAS28) using the CRP level >5.1 at week 12, compared to 73% of patients (57 of 78) with DAS28‐CRP <2.6. Similar results were observed regardless of the disease activity measure used. Clinical response at week 12 also predicted week‐48 outcomes, though to a lesser extent than disease activity.ConclusionUsing disease activity and the clinical response state during the first 12 weeks of certolizumab pegol treatment, it was possible to identify a subset of axial SpA and PsA patients unlikely to achieve long‐term treatment goals.

AB0727 MAGNETIC RESONANCE IMAGING IN SYMPTOMATIC BACK PAIN IN INFLAMMATORY BOWEL DISEASE: STRUCTURAL LESIONS AND HLA-B27 IMPROVE THE DIAGNOSTIC ACCURACY IN AXIAL SPONDYLOARTHRITIS

The aim of the current study was to compare the clinical and treatment characteristics and dimensions of health-related quality of life between female and male patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA). The present study is cross-sectional and comprises 119 patients with axial SpA and 198 patients with PsA. Clinical data were collected by standardized and self-reported instruments. Disease activity was evaluated by the Ankylosing Spondylitis Disease Activity Score with C-reactive protein and the Disease Activity in PSoriatic Arthritis (for SpA and PsA, respectively). Health-related quality of life was assessed with the Medical Outcomes Study 36-item Short Form Survey. Patients were stratified by gender, and the socio-demographic, clinical, and quality-of-life data were compared. Women with axial SpA and PsA had significantly lower education (p<0.001, p=0.004, respectively) and higher disease activity (p<0.001, p=0.003, respectively). Female patients with axial SpA were more frequently under second-line therapy (p=0.026) and glucocorticoid treatment (p=0.005), while women with PsA had more radiographic progression (p=0.006). Female patients with axial SpA and PsA had worse scores in the dimensions of quality of life regarding physical role, bodily pain, vitality, and mental health. Women with axial SpA had lower scores in general health, while women with PsA had lower scores in physical and social functioning. Women with axial SpA and PsA had worse scores than men in most clinical and treatment characteristics and health-related quality of life dimensions.

To evaluate the 8-year survival of the first tumor necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (SpA) or psoriatic arthritis (PsA), identify the predictive factors for withdrawal, and compare the discontinuation rates for infliximab, etanercept, and adalimumab. We evaluated PsA and axial SpA patients treated with a first-line TNFi between 2005 and 2015 at 4 Italian tertiary centers. Eight-year drug survival was calculated by the Kaplan-Meier method, and risk for discontinuation among treatment groups compared by stratified log-rank test. Univariate and multivariate Cox proportional hazard models were developed to examine predictors of withdrawal. Of 614 patients (316 axial with SpA, 298 with PsA), 203 received adalimumab, 131 etanercept, and 280 infliximab, with similar frequencies in axial SpA and PsA subgroups. The cumulative 8-year retention rate in the whole population was 55.1% (57.2% and 51.9% for axial SpA and PsA, respectively; P = not significant). No significant differences were observed in drug persistence among individual TNFi in either group. Male sex (hazard ratio [HR] 0.595 [95% confidence interval (95% CI) 0.405-0.875]; P = 0.008) and concomitant methotrexate use (HR 0.648 [95% CI 0.426-0.985]; P = 0.042) were associated with a lower risk of withdrawal in PsA. High baseline Bath Ankylosing Spondylitis Disease Activity Index (HR 0.9842 [95% CI 0.9708-0.9980]; P = 0.028) was associated with a lower risk of withdrawal in axial SpA. No difference was found in the comparative analysis of reasons for discontinuation between PsA and axial SpA. We reported that the real-life 8-year retention rate of the first TNFi in axial SpA and PsA is greater than 50%, with no significant differences between axial SpA and PsA, irrespective of the individual TNFi.

Objective: To analyze clinical and imaging characteristics of patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) with spinal involvement (axial PsA, axPsA) and to develop principles for the differential diagnosis between axPsA and axSpA.Material and methods. A total of 222 patients were examined: 108 with axSpA (Group 1) and 114 with axPsA (Group 2). Group 1 included patients meeting the criteria for axSpA/ankylosing spondylitis (AS); Group 2 included patients meeting the CASPAR criteria for PsA with axial involvement. Axial involvement was defined as radiographically confirmed (rc) sacroiliitis (SI; bilateral SI ≥ grade II or unilateral SI ≥ grade III), active SI on MRI, or ≥1 syndesmophyte in the cervical (CS) and/or lumbar (LS) spine. Inflammatory back pain (IBP) was assessed using ASAS criteria.Results and discussion. Patients in Group 1 were younger (p&lt;0.001), more frequently HLA-B27 positive (p&lt;0.001), and more often had IBP (p=0.001). In Group 2, later onset of back pain (&gt;40 years) was more common (p&lt;0.001), along with peripheral arthritis (p&lt;0.001), dactylitis (p=0.004), and skin psoriasis (p&lt;0.001). Nail psoriasis was observed exclusively in Group 2 (p&lt;0.001). Heel enthesitis was more frequent in Group 1 (p&lt;0.001). Patients in Group 2 had higher BASDAI scores (p&lt;0.001) and more often had high ASDAS-CRP disease activity (p&lt;0.001). They also had higher BASFI scores (p=0.008), pain scores (p=0.002), and patient global assessment (p=0.021).rcSI and sacroiliac joint ankylosis were more common in Group 1 (p=0.03 and p=0.006, respectevly). Group 2 more frequently exhibited syndesmophytes in the LS (p&lt;0.001) and CS (p=0.004), as well as bulky (p&lt;0.001), asymmetric (p=0.006), and non-bridging (p&lt;0.001) syndesmophytes. Vertebral changes in the absence of SI (p&lt;0.001), higher mSASSS scores (p&lt;0.001), and more frequent erosions of hand and foot joints, multiple erosions, osteolysis, juxta-articular new bone formation (p&lt;0.001 for all), and joint ankylosis (p=0.008) were also observed in Group 2, along with elevated CRP levels (p=0.002).Conclusion: This study revealed several genetic, demographic, clinical, and imaging differences that collectively enable the differential diagnosis between axSpA/AS and axPsA.

BackgroundThe problem of axial spondyloarthritis’ (axSpA) differential diagnostics is not solved, especially in the early stages of the axSpA. Therefore, new diagnostic markers for axSpA are needed.Objectivesof the study were...

BackgroundInvestigating gender-specific differences in rheumatology is crucial for improving personalized treatment. The present study aimed to explore gender differences in psychological characteristics and features associated with impaired physical and mental quality of life in male and female patients affected by axial spondyloarthritis or psoriatic arthritis.MethodsThe present study is cross-sectional. Quality of life was evaluated using a Medical Outcome Study 36-item Short Form health survey (SF-36), and physical and mental component scores were presented. Data about disease activity, anxiety and depression, fatigue, perceived stress, and coping strategies were collected. The patients were stratified by gender, and clinical and psychological data were compared.ResultsA total of 119 patients with axial spondyloarthritis [age 49.0 (SD 11.7); 45.4% F] and 198 patients with psoriatic arthritis [age 56.9 (SD 11.6); 62.6% F] were included. Female patients with axial spondyloarthritis and psoriatic arthritis had worse scores on fatigue, pain, perceived stress, physical quality of life, dysfunctional coping strategies, mental quality of life (only in axial spondyloarthritis), and anxiety (only in psoriatic arthritis) than men. In multivariable analysis, physical quality of life is mainly explained by fatigue and pain, and mental quality of life by fatigue, anxiety and stress in women with axial spondyloarthritis and psoriatic arthritis. Fatigue, pain and anxiety were significant variables across the models with male patients.ConclusionsThe study indicates that female patients with axial spondyloarthritis and psoriatic arthritis experience worse scores in psychological variables compared to men. Additionally, women’s quality of life is significantly lower when compared to men’s one, primarily due to factors such as fatigue, stress, pain, and anxiety. To enhance patient well-being, therapeutic strategies should be tailored to address the unique clinical and psychological needs that arise from gender differences.

Background:Heterogeneity in psoriatic arthritis (PsA) is a current matter of discussion, especially concerning axial involvement.Objectives:To determine the profile of axial PsA (axPsA) in a worldwide setting. Secondly, to identify predictive...

Background. Axial spondyloarthritis (axSpA) and axial psoriatic arthritis (axPsA) are known to differ in imaging features (radiography and magnetic resonance imaging) and treatment response. These conditions may also present differences in bone mass quality and bone mineral density (BMD). Radiofrequency Echographic Multi Spectrometry (REMS) is an emerging technique for bone assessment that analyzes raw, unfiltered ultrasound signals acquired during scanning of the lumbar spine and proximal femur. Unlike conventional DXA, REMS minimizes artifacts from ectopic calcifications such as syndesmophytes and osteophytes, commonly observed in these diseases. This study aimed to compare T-scores obtained with REMS and DXA to evaluate REMS reliability in assessing BMD in axSpA and axPsA, and to explore qualitative and quantitative differences in bone mass between these patient cohorts. Materials and methods. Adult patients admitted to the Rheumatology Unit of AOU Senese and Florence Careggi were included. Participants had a confirmed diagnosis of axSpA or axPsA and were receiving treatment with biological disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase inhibitors (JAKi). Patients with a prior diagnosis of osteoporosis, ongoing osteoporosis treatment or previous vertebral fractures were excluded. All patients underwent lumbar spine and femoral DXA as well as REMS scans in the same anatomical sites. BMD and Fragility Score were compared between groups. A variable (Δ) was defined as the difference between REMS and DXA T-scores at the lumbar spine and femur. Results. Twenty-five patients were enrolled (13 axSpA; 12 axPsA) with comparable age and sex distribution. No significant differences in Δ T-scores at the lumbar spine and femur were observed compared to the general population. Concordance between REMS and DXA T-scores was assessed in relation to diagnosis (axSpA vs PsA), BMI and age. For the lumbar spine, T-score concordance was not statistically significant (p = 0.606); whereas femoral measurements showed significant concordance (p = 0.003), although the intraclass correlation coefficient (ICC) was below an acceptable range. No significant Δ differences were observed according to diagnosis or BMI at either site. A negative correlation between age and femoral Δ was noted (p = 0.02). Conclusions. Consistent with limited existing literature, REMS demonstrates potential reliability for qualitative and quantitative assessment of bone mass in patients with axSpA and axPsA at the lumbar spine. Regarding the femur, REMS-DXA concordance did not show significant differences, highlighting the need for further validation in larger cohorts.

Background: Although secukinumab has become available in India since mid-2016, there is no published data on its usage in axial spondyloarthritis (axial SpA) and psoriatic arthritis (PsA). In this study, we analyzed the real-world usage of this drug to assess the effectiveness and safety in axial SpA and PsA. Methods: All patients with active axial SpA or PsA who had received secukinumab as a biological disease-modifying antirheumatic therapy either as a primary or as a secondary biological therapy covering the period between August 2017 and February 2020 from five Indian centers were included in the study. Whereas Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 and Ankylosing Spondylitis Disease Activity Score (ASDAS) C-reactive protein (CRP) improvement were used to assess the treatment response in axial SpA, DAS 28ESR was used for PsA. The data were retrospectively analyzed. Results: Out of 45 patients included in the study, 27 had axial SpA and 18 had PsA. Disease duration (median [interquartile range]) was 60 (96) months in axial SpA and 54 (108) in PsA. In axial SpA, out of 21 patients who had completed at least 6 months of therapy, 19 demonstrated a BASDAI 50 response and 20 reported good response as per ASDAS CRP (15, low disease activity and 5, inactive disease). In PsA, 14 patients had completed at least 6 months of therapy and 8 of them went in remission and another 4 achieved low disease activity. Adverse events were few (2, upper respiratory tract infection; 1 pneumonia; 3, uveitis; and leukocytoclastic vasculitis in 1) with no tuberculosis reported. Conclusion: In its real-life usage to treat both active axial SpA and PsA, secukinumab was found to be effective and safe.