Axial Psoriatic Arthritis Research Articles

Cartilage collagen type II seromarker patterns in axial spondyloarthritis and psoriatic arthritis: associations with disease activity, smoking and HLA-B27.

The aim of the study was to assess the possible association between type II collagen turnover seromarkers and disease profile in patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA). Outpatients with axial SpA (n=110) or PsA (n=101) underwent clinical examination including disease activity measures and HLA-B27 typing. The procollagen IIA N-terminal peptide (PIIANP) and a matrix metalloproteinase-generated type II collagen fragment (C2M) were quantified in serum by ELISA. C2M was higher in SpA than in controls, 0.41 versus 0.36ng/ml (p=0.004), while PIIANP did not differ between patients and healthy subjects, 2252 versus 2142ng/ml (p=0.13). However, DMARD-naïve SpA patients had higher PIIANP, 2461ng/ml (p=0.01) and C2M, 0.44ng/ml (p=0.0007) levels than controls, and PIIANP correlated with CRP (ρ=0.34). C2M was lower in SpA smokers, 0.36ng/ml versus non-smokers, 0.43ng/ml (p=0.02), while PIIANP was higher in HLA-B27 positive, 2312ng/ml versus negative patients, 2021ng/ml (p=0.03). In PsA, PIIANP and C2M did not differ between patients and controls, but PIIANP was elevated in patients not receiving DMARDs, 2726ng/ml. In PsA, PIIANP and C2M did not differ according to smoking and HLA-B27. Cartilage degradation assessed by C2M is increased in SpA irrespective of treatment but not in PsA. Cartilage synthesis reflected by PIIANP is increased in untreated SpA and PsA. PIIANP correlates with CRP in SpA while not in PsA. In DMARD-naïve SpA but not in PsA, HLA-B27 positivity and smoking are associated with a chondro-proliferative metabolic pattern.

The Definition and Measurement of Axial Psoriatic Arthritis.

This review seeks to update the state of the art of axial psoriatic arthritis (axPsA). The definition and assessment of axPsA can be problematic because no agreement and no definitive data on this topic have been published, resulting in uncertainty as to the best approach to deal with these patients. A few recent scientific reports show new data on the possible coincidence of diffuse idiopathic skeletal hyperostosis and axPsA, as well as on the radiological assessment as measured with the validated instruments for axPsA. Moreover, the role of magnetic resonance imaging has also been evaluated for this intriguing subset. All data confirmed that radiological assessment is a useful tool to detect typical findings of axPsA, while other imaging techniques remain to be validated. Finally, there is no evidence to support treatment of axPsA with traditional disease-modifying antirheumatic drugs, while a "leap" to biologic agents is the only treatment after failure with nonsteroidal antiinflammatory drugs.

Diagnosis of spondyloarthritis: should we need new criteria?

A large number of classification criteria for spondyloarthritis (SpA) are simultaneously used in modern rheumatology in the almost complete absence of diagnostic criteria. This poses a number of problems, among which there are two most important ones: 1) the frequent use of classification criteria to make a diagnosis in real clinical practice; 2) the possibility of stating different nosological entities of SpA in one patient in the presence of the same clinical picture. Objective : to investigate the specific features of the diagnosis of SpA and the use of its classification criteria in clinical practice. Subjects and methods . The investigation enrolled 119 patients with the established diagnosis of ankylosing spondylitis (AS), psoriatic arthritis (PsA), undifferentiated axial or peripheral SpA. Whether their clinical picture complied with the modified New York criteria, the European Spondyloarthropathy Study Group (ESSG) criteria, the Amor criteria, and the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial and peripheral SpA and whether the Russian version of the modified New York criteria complied with the Classification criteria of Psoriatic ARthritis (CASPAR) were determined in the patients. Results . Sixty-three patients diagnosed with AS (M45), 44 with PsA (M07.0-07.3), 8 with undifferentiated SpA (M46.9), and 4 with nonradiographic axial SpA (M46.8) were followed up by attending physicians. The latter diagnosed AS in 10 patients who met the ASAS criteria for axial PsA but not the modified New York criteria. Twenty-one patients diagnosed as having PsA simultaneously met both the CASPAR criteria and the modified New York criteria, which could establish the diagnosis of AS in these cases. Eighty-one (68.0%) out of the 119 patients met the Amor criteria; 98 (82.3%) patients, the ESSG criteria; 91 (76.5%), the ASAS criteria for axial SpA; 18 (15.1%), the ASAS criteria for peripheral SpA; 76 (63.8%), the modified New York criteria; 88 (73.9%), the Russian version of the modified New York criteria; 42 (32.3%), the CASPAR criteria. No intersection of criteria was observed in only 5 patients; 113 (94.9%) patients met ≥2 criteria; 96 (80.7%), ≥3 criteria; 81 (68.1%), ≥4 criteria; 66 (55.5%), simultaneously ≥5 criteria; and 18 (15.1%), simultaneously 6 criteria. Conclusion . Most patients with SpA meet ≥2 classification criteria, which gives the chance to state ≥2 nosological entities in the same patient. This demonstrates the elaboration of diagnostic criteria that can make a clear distinction between different forms of SpA in clinical practice.

Serum soluble bone turnover biomarkers in psoriatic arthritis and psoriatic spondyloarthropathy.

Because psoriatic arthritis (PsA) is an inflammatory disease of joints, serum soluble biomarkers specific for chronic joint and bone inflammation may predict future disease severity and response to therapy, thereby informing stratified medicine approaches. The objectives of our systematic review were to determine whether serum soluble bone and cartilage turnover biomarkers are (1) associated with PsA or psoriatic spondyloarthropathy; and (2) associated with disease activity, disease severity, or clinical phenotype. Ten studies met eligibility criteria. Matrix metalloproteinase (MMP)-3, Dickkopf (DKK)-1, macrophage colony-stimulating factor (M-CSF), crosslinked telopeptide of collagen-1, and tumor necrosis factor-related apoptosis-inducing ligand were associated with PsA, with equivocal results for osteoprotegerin (OPG) and bone alkaline phosphatase (ALP). MMP-3, DKK-1, M-CSF, CPII:C2C (ratio of cartilage degradation vs byproduct formation), and possibly OPG were associated with PsA independently of psoriasis. C1-2C (a neoepitope released when type 2 cartilage is degraded by collagenases) was associated with both tender and swollen joint counts, and bone morphogenetic protein-4 with patient global assessment of disease, pain score, and the Bath Ankylosing Spondylitis Disease Activity Index. Bone ALP was associated with disease activity. M-CSF and receptor activator of nuclear factor-κB ligand were associated with several plain radiographic features. No studies have investigated biomarker associations specifically with axial PsA.

Updated guidelines for the management of axial disease in psoriatic arthritis.

Axial involvement in patients with psoriatic arthritis (PsA) remains common and can be defined in terms of spinal disease alone or in combination with peripheral manifestations. Diagnosis is based upon inflammatory spinal symptoms or the presence of radiological sacroiliitis and other radiographic signs of spondylitis, or by criteria for axial spondyloarthritis (SpA) defined by ASAS (Assessment of SpondyloArthritis International Society). Although recent data are scarce for efficacy of traditional therapies for axial disease (e.g., nonsteroidal antiinflammatory drugs, methotrexate, etc.), limited data are available for targeted biologics and novel agents. We identify and evaluate the efficacy of therapeutic interventions for treatment of axial disease in PsA. This review is an update of the axial PsA section of the treatment recommendations project by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

Disease activity measurements and monitoring in psoriatic arthritis and axial spondyloarthritis.

In addition to the critical need of measuring tools for drug development of spondyloarthritis (SpA), these tools are also valuable for patient management. An early diagnosis, determination of early therapeutic response, and monitoring therapeutic response have now become increasingly important because effective therapies are available, and therapies such as anti-tumor necrosis factor (TNF) drugs are even more effective if used in early disease stages. In this review, we focus on disease activity measurements and monitoring in axial SpA and psoriatic arthritis (PsA). Both axial SpA and PsA have heterogeneous clinical manifestations. Therefore, in addition to the measurement of each clinical domain, composite measures inclusive of all clinical domains can be very helpful and are more likely to give complete and reliable information about the disease activity. A major focus of this review is to describe the recently developed composite measures for axial SpA and PsA.

Reliability of Radiographic Scoring Methods in Axial Psoriatic Arthritis

Important differences exist between axial psoriatic arthritis (AxPsA) and ankylosing spondylitis (AS). The Bath Ankylosing Spondylitis Radiology Index (BASRI), the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS), and the Radiographic Ankylosing Spondylitis Spinal Score (RASSS) were developed to score AS, and the Psoriatic Arthritis Spondylitis Radiology Index (PASRI) to score AxPsA. We aimed to develop a computerized scoring application and compare the intra- and interrater reliability of these scoring systems in AS and AxPsA. A computerized scoring application was developed to facilitate the scoring of radiographic features and calculate total scores for established scoring methods for AS and AxPsA. Digital spinal radiographs of 18 patients with AS and 40 patients with AxPsA were read in random order individually by 4 rheumatologists, data were entered into the application, and scores were obtained. The intraclass correlation coefficients (ICC) of the intra- and interrater reliability of scores for each method were then computed. In AS, the intra- and interrater ICC was 0.91 and 0.80 for sacroiliitis grade, 0.96 and 0.86 for BASRI-spine, 0.98 and 0.86 for mSASSS, 0.96 and 0.75 for RASSS, and 0.99 and 0.93 for PASRI, respectively. In AxPsA, the intra- and interrater ICC was 0.81 and 0.67 for sacroiliitis grade, 0.77 and 0.52 for BASRI-spine, 0.91 and 0.65 for mSASSS, 0.90 and 0.68 for RASSS, and 0.92 and 0.88 for PASRI, respectively. Available radiographic scoring systems perform well in AS and have moderate intra- and interrater reliability when applied to AxPsA. However, PASRI may be superior for assessing structural damage in AxPsA.

AB0740 Comparative Study of Patients with Peripheral Psoriatic Arthritis, Axial Psoriatic Arthritis and Axial Spondyloarthritis without Psoriasis

BackgroundAxial involvement in Psoriatic Arthritis (PsA) is reported to be between 40 -70%1. We aimed to compare the disease characteristics and quality of life (QoL) in patients with PsA with...

AB0927 Long-Term Tnfα Antagonists Treatment Efficacy in Autoimmune Uveitis

BackgroundUveitis is an inflammatory disease which causes approximately 10% of blindness cases. Although it has several etiologies, the most frequent is autoimmune. The treatment in autoimmune uveitis is based on...

AB0748 Intermalleolar Distance in Axial Spondyloarthritis: Patients with Psoriatic Spondylitis Have Worse Measurements Compared to Ankylosing Spondylitis

BackgroundAnkylosing Spondylitis (AS) disease status is assessed using BASMI [1] which is derived from 5 measures, including intermalleolar distance (IMD), each scored as 0, 1 or 2. Originally, IMD was...

THU0512 Surfactant Protein-D, A Component of the Innate Immune Defence, in Patients with Axial Spondyloarthritis or Psoriatic Arthritis

BackgroundSurfactant protein-D (SP-D) belongs to the collectin family of the innate immune system. It has pro- and anti-inflammatory activities according to its oligomerization. Microbial opsonization and scavenging of nuclear debris...

Certolizumab pegol: a review of its use in patients with axial spondyloarthritis or psoriatic arthritis.

Certolizumab pegol (Cimzia(®)) is a polyethylene glycolylated antigen-binding fragment of a recombinant human monoclonal antibody that binds to and selectively neutralizes tumour necrosis factor (TNF) α. In the EU, subcutaneous certolizumab pegol is indicated for the treatment of adults with severe active axial spondyloarthritis (axSpA), comprising ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA), and for adults with active psoriatic arthritis (PsA). In the USA it is indicated for the treatment of adults with active AS or active PsA. This article reviews the efficacy and tolerability of certolizumab pegol in these patients and briefly summarizes its pharmacology. In two ongoing, well-designed studies, data at 12 and 24 weeks showed that treatment with certolizumab pegol (200 mg every 2 weeks or 400 mg every 4 weeks) was effective in improving the clinical signs and symptoms of disease, health-related quality of life and productivity in patients with axSpA (the RAPID-axSpA study) or PsA (the RAPID-PsA study), with the improvements maintained during longer-term (48 weeks) treatment. Within the axSpA population, clinical benefits with certolizumab pegol were seen both in patients with AS and in those with nr-axSpA. In addition, 12 weeks' treatment with certolizumab pegol reduced inflammation in the sacroiliac joints and spine in patients with axSpA and 24 weeks' treatment with the agent slowed radiographic disease progression in patients with PsA. Certolizumab pegol was generally well tolerated in these studies, with a tolerability profile consistent with that seen in previous clinical trials in other indications. Although additional long-term and comparative data are needed to position certolizumab pegol with respect to other TNFα antagonists, current evidence indicates that certolizumab pegol is an effective option for the treatment of axSpA (including AS and nr-axSpA) and PsA.

SAT0367 Frequency of Radiological Hip Involvement and Total Hip Replacement in A Large Single Center Spondyloarthritis Cohort with Biological Treatments: HÜR-BİO REAL Life Results

BackgroundTotal hip replacement (THR) is a favorable treatment option for severe ankylosing spondylitis (AS). However, THR may be an option for another spondyloarthritis (SpA) such as psoriatic arthritis (PsA) and...

Calculation skills for nurses: psoriatic arthritis

Nurse PrescribingVol. 11, No. 9 Calculation SkillsCalculation skills for nurses: psoriatic arthritisDilyse NuttallDilyse NuttallSearch for more papers by this authorDilyse NuttallPublished Online:30 Sep 2013https://doi.org/10.12968/npre.2013.11.9.430AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Joint Formulary Committee (2012) British National Formulary 63. British Medical Association and Royal Pharmaceutical Society of Great Britain, London Google Scholar National Institute for Health and Clinical Excellence (2010) NICE technology appraisal guidance 199. Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis. http://www.niceorg.uk/nicemedia/live/13110/50422/50422.pdf. (accessed 18 September 2012) Google Scholar FiguresReferencesRelatedDetailsCited byBenefit of health education by a training nurse in patients with axial and/or peripheral psoriatic arthritis: A systematic literature review20 August 2016 | Rheumatology International, Vol. 36, No. 11 1 September 2013Volume 11Issue 9ISSN (print): 1479-9189ISSN (online): 2052-2924 Metrics History Published online 30 September 2013 Published in print 1 September 2013 Information© MA Healthcare LimitedPDF download

Brief Report: Magnetic Resonance Imaging Assessment of Axial Psoriatic Arthritis: Extent of Disease Relates to HLA–B27

ObjectiveTo determine the prevalence, on magnetic resonance imaging (MRI), of bone marrow edema lesions in symptomatic axial psoriatic arthritis (PsA), and to compare this prevalence with that in nonradiographic axial spondyloarthritis (SpA) and ankylosing spondylitis (AS) and its relationship to HLA–B27 status.MethodsWe performed a cross‐sectional audit of MRI scans of lumbar spine (L‐spine) and sacroiliac (SI) joints. Using the semiquantitative Leeds Scoring System in which bone marrow edema is graded from 0 to 3 according to severity of the lesions, MRI scans were scored independently by 2 expert readers who were blinded to the clinical characteristics of the patients. Concordant data from the 2 readers were used to report on definite lesions.ResultsMRIs from 76 patients with comparable age ranges were categorized into 3 groups: those from PsA patients, those from patients with nonradiographic axial SpA, and those from AS patients. HLA–B27 positivity was similar in PsA patients (10 of 33) and patients with nonradiographic axial SpA (10 of 24) and higher in AS patients (18 of 19). Total MRI scores (L‐spine plus SI joints) were higher in AS patients than in PsA patients (P = 0.025) or in patients with nonradiographic axial SpA (P = 0.007). A relationship was seen between the severity and extent of disease and HLA–B27 positivity in PsA patients, which was comparable to that in AS patients. HLA–B27–negative PsA patients had lower MRI scores than HLA–B27–positive PsA patients (P = 0.03) and AS patients (P = 0.006), whereas scores were similar in HLA–B27–positive PsA patients and AS patients. Similarly, MRI scores of HLA–B27–negative patients with nonradiographic axial SpA were lower than those of AS patients (P = 0.01).ConclusionHLA–B27 positivity defines a group of patients with more severe axial bone marrow edema that is likely related to the classic AS phenotype. Clinically, HLA–B27–negative PsA is more likely to be reported as a “negative” MRI examination result.

Diffuse Idiopathic Skeletal Hyperostosis in Psoriatic Arthritis

To determine the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with psoriatic arthritis (PsA) and to identify the features associated with its occurrence. Patients were recruited from the University of Toronto PsA observational cohort initiated in 1978. All patients fulfilled the CASPAR criteria. Radiographs of peripheral joints and spine were obtained every 2 years. DISH was defined as flowing bony bridges in at least 4 contiguous thoracic vertebrae. Each PsA patient with DISH was matched by sex to 3 PsA patients without DISH. Demographics, disease characteristics, and radiographic features were compared using McNemar test, Fisher's exact test, chi-square test, and paired t test as appropriate. Logistic regression analyses models with stepwise regression were conducted. DISH was observed in 78 (8.3%) of 938 patients with PsA. Patients with DISH were older and had longer disease duration, higher body mass index (BMI), and higher uric acid levels. Diabetes and hypertension were more prevalent in patients with DISH than in those without. The severity of radiographic damage to peripheral joints was also greater in patients with DISH. The presence of inflammatory back pain, HLA-B*27 allele, and sacroiliitis was similar in both groups. Patients with DISH had more syndesmophytes and calcaneal spurs. Older age, higher BMI, and the presence of radiographic damage to peripheral joints were associated with DISH in multivariate analysis. The diagnosis of DISH is possible in the presence of axial PsA. DISH was associated with known DISH-related factors including older age and high BMI, as well as the presence of radiographic damage to peripheral joints.

Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force

BackgroundTherapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA).ObjectiveTo define the...

Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis

BackgroundCurrent recommendations for the management of axial spondyloarthritis (SpA) and psoriatic arthritis are to monitor disease activity and adjust therapy accordingly. However, treatment targets and timeframes of change have not...

SP0049 MRI in psoriatic arthritis - update on the current state

The clinical appearance of psoriatic arthritis (PsA) is very diverse, involving the spine, sacroiliac joints, peripheral joints and/or entheses, and accordingly MRI findings vary. PsA shares clinical manifestations with rheumatoid...

SAT0302 Spinal involvement in axial psoriatic artritis is not determined by the presence of HLA-B27. Is the HLA-B27 arm of the axial SPA criteria reliable for classifying axial psoriatic arthritis?

BackgroundThere is a debate whether axial psoriatic arthritis (axPsA) is an ankylosing spondylitis with psoriasis, however due to the fact that PsA has characteristic clinical features, this concept is debatable....