Management Of Psoriatic Arthritis Research Articles

Psoriatic arthritis: new evidence for old concepts.

The review gives an updated overview of some of the new concepts in the management of psoriatic arthritis (PsA): early diagnosis, remission as an objective, treat-to-target, and treatment guidelines. Early diagnosis, targeting remission as part of a treatment strategy, and new guidelines providing evidence-based support to these concepts are main topics in recent publications. Dermatologists and rheumatologists should work together to reduce the number of patients remaining undiagnosed, and the time to do so.Remission definition in PsA is still controversial. There is good evidence and convincing arguments for both multidimensional measures, such as minimal disease activity, or unidimensional ones, as disease activity index for PsA. New data on the analysis of tight control of inflammation in early PsA trial showed that the strategy might not be cost-effective on the short term, and that oligoarthritis is less benefited.The new European League Against Rheumatism and Group for Research and Assessment of Psoriasis and PsA recommendations exhibit differences. Methotrexate and tumor necrosis factor inhibitors are favored in European League Against Rheumatism guidelines, whereas other conventional synthetic disease-modifying antirheumatic drugs and biologics are equally positioned in Group for Research and Assessment of Psoriasis and PsA recommendations.

Treatment strategies for psoriatic arthritis

The therapeutic management of psoriatic arthritis has seen major changes over the last few years, as illustrated by the recent updates of the GRAPPA and EULAR recommendations. These changes were driven by new studies establishing important benefits from early management and tight control of disease activity. The concepts underlying the treatment of psoriatic arthritis must be reappraised in the light of these new data. The objectives of this review are to discuss new concepts, to describe and assess the new drug classes introduced for psoriatic arthritis and, whenever possible, to define the specific indications of each class based on the rheumatic disease phenotype and presence of extraarticular manifestations.

Effectiveness and Persistence of The First Tumor Necrosis Factor Inhibitor In Portuguese Psoriatic Arthritis Patients

Tumor necrosis factor inhibitors (TNFi) dramaticaly improved the management of psoriatic arthritis (PsA). Nevertheless, a significant proportion of patients do not respond and/or are intolerant to TNFis. The objective of this work was to assess the effectiveness, measured by response rates and drug survival, and the main reasons for TNFi discontinuation, in PsA patients. This was a retrospective non-interventional study of PsA patients registered at the Rheumatic Diseases Portuguese Registry, with at least 1 TNFi prescription. Data was analyzed at 0, 3, 6, 12, 24, 36 and 48 months after starting a first TNFi. Response was measured by composite disease activity (DAS, ACR, PsARC, BASDAI, ASDAS, MDA) and functional (HAQ) indices. Drug survival was assessed by Kaplan-Meier survival analysis. In all analyses significance level was set at 0.05. 705 PsA patients were included, with a mean age of 52.5 years (±13.3); 50.8% (n=358) female. 185 patients (26.24%) treated with adalimumab, 322 (45.67%) etanercept, 100 (14.18%) golimumab and 98 (13.90%) with infliximab. The average response rates, measured by composite disease activity and functional indices, are shown in Table 1. The average drug persistence was of 31.79±17.03 months for TNFi as a group, with 205 (29.08%) of discontinuations during a period of 4 years of follow-up. The main reasons for discontinuation of the first TNFi were: non-response/loss of response 111 (54.15%), adverse event 48 (23.41%), surgery 6 (2.93%), refusal to continue treatment, 4 (1.95%), loss to follow-up 3 (1.46%), pregnancy 4 (1.95%), death 2 (0.98%), remission 2 (0.98%), and others 10 (4.88%). PsA patients receiving a first TNFi will persist on treatment for an average of 2.6 years with treatment discontinuations rates of 29.08%. Non-response/loss of response constitutes the major reason for treatment discontinuation in this population.

Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients.

Psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) are both chronic, inflammatory conditions that result in a substantial burden of disease and reduced quality of life for patients. Patient involvement in developing optimal disease management strategies, including defining appropriate goals, therapies, and treatment options, as well as in setting policy priorities and agendas, is key. A working group of patient organization representatives and rheumatologists explored what patients consider to be unmet needs, important treatment gaps, and future priorities in PsA and AxSpA management. Reducing pain and fatigue, and improving physical and social functioning and work productivity were identified as important treatment goals for patients. Although the major treatment target for both PsA and AxSpA is remission, with low/minimal disease activity an alternative target for patients with established or long-standing disease, the meaning of remission from the patient’s perspective needs to be explored further as it may differ considerably from the physician’s perspective. Key recommendations from the working group to tackle unmet needs included reducing time to diagnosis, increasing patient and physician disease awareness, focusing on patients’ priorities for treatment goals, and improving patient–physician communication. By addressing these key action points moving forward, the hope is that outcomes will continue to improve for patients with PsA and AxSpA.

The current status and unmet needs in the management of psoriatic arthritis: Viewpoint from physicians in Taiwan.

To analyze the real-world clinical practice for the treatment of psoriatic arthritis (PsA) and to assess physicians' prescription, difficulties in diagnosis, therapeutic strategy, rationales for biologic therapies and unmet needs in Taiwan. We conducted a nationwide cross-sectional observational study by face-to-face in depth interviews with 50 rheumatologists and 30 dermatologists who took care of patients with PsA. The major procedures for recognizing PsA included joint, skin and nail examinations, radiographic imaging, and medical history. More dermatologists established the diagnosis when psoriatic patients with arthritis didn't present with rheumatoid factors (p<0.05). For milder arthritis, physicians tended to prescribe etanercept in combination with conventional disease-modifying antirheumatic drugs (DMARDs). The efficacy, safety, retention rate, and non-parenteral administration are the major concerns of physicians which are also the primary unmet needs in the current management of PsA. This survey showed the status quo in Taiwan of the clinical management for PsA including diagnostic difficulties, therapeutic consideration, rationales for biologic DMARDs selection and unmet needs in treatment. It has indicated that interdisciplinary collaboration may further improve the quality for PsA care. These results may help establish new strategy to develop next generation biologics.

Management of psoriatic arthritis among cutaneous psoriasis patients: from pathogenesis to therapy.

Psoriatic arthritis (PsA) is an inflammatory rheumatism belonging to spondyloarthritis family and which occurs in about 30% of patients with psoriasis. The pathogenesis entails a genetic predisposition, environmental and immunologic factors. Most of the time, cutaneous lesions precede apparition of articular manifestations and dermatologists who treat psoriatic patients have to regularly screen for early PsA, especially in patients with risk factors (notably nail psoriasis). Early detection greatly increases the chances for successful treatment and can prevent slow joint destruction. EULAR and GRAPPA have recently published PsA treatment recommendations. Pharmacological therapies for PsA begin with non-steroidal anti-inflammatory drugs, then conventional synthetic as methotrexate, and lastly biological disease-modifying anti-rheumatic drugs. There are significant metabolic comorbidities and increased cardiovascular morbidity in patients with PsA. This aspect must be taken into account in PsA management by pharmaceutical and non-pharmaceutical approach (including educational programs). Close collaboration between dermatologists, rheumatologists and primary care clinicians is recommended to provide optimum care and to prevent the occurrence of structural damages or quality of life alteration.

PMS24 - Secukinumab In The Management of Psoriatic Arthritis In Greece: A Budget Impact Analysis

PMS24 - Secukinumab In The Management of Psoriatic Arthritis In Greece: A Budget Impact Analysis

Long-term treatment with adalimumab in psoriatic arthritis: serum adalimumab concentration, immunogenicity and the link with clinical response.

ObjectivesAn observational study to evaluate the relationship between serum concentrations of adalimumab and disease activity in patients receiving long-term adalimumab treatment for psoriatic arthritis.MethodsSerum adalimumab and adalimumab antidrug antibodies were quantified by enzyme linked immunosorbent assay. Disease activity was assessed using Disease Activity Score (44 joint measures). Serum C-reactive protein was quantified using standard methods.ResultsA total of 30 patients were recruited. There were significant inverse correlations between serum adalimumab concentration and serum C-reactive protein (CRP) concentration [r = −0.43], the number of tender joints (r = −0.4), and Disease Activity Score (DAS44)-CRP (r = −0.36). Mean serum adalimumab levels were significantly higher in patients with DAS44-CRP <1.6 than in patients with DAS44-CRP ≥1.6.ConclusionsSerum adalimumab could be an important tool that may improve the management of psoriatic arthritis in patients responding to long-term treatment.

201 Retrospective Study of the Management of Psoriatic Arthritis with Tumour Necrosis Factor Inhibitors in the UK: Capture Study Preliminary Analysis

201 Retrospective Study of the Management of Psoriatic Arthritis with Tumour Necrosis Factor Inhibitors in the UK: Capture Study Preliminary Analysis

E76 Management of Psoriatic Arthritis in East of England

E76 Management of Psoriatic Arthritis in East of England

Psoriatic arthritis in 2015: Advancement continues in imaging, tight control and new drugs.

In 2015, a EULAR task force released evidence-based recommendations on the use of imaging in the clinical management of spondyloarthritis, including psoriatic arthritis. These recommendations, together with articles dealing with tight control strategies and use of the IL-17A inhibitor secukinumab, have consolidated progress in the management of psoriatic arthritis.

A comparative study on the efficacy of Intra articular Methylprednisolone with oral Etoricoxib in the pain management of Psoriatic arthritis

Background: Psoriatic arthritis is the major complication of psoriasis and the most common medication used for pain management is NSAID’s, followed by intra-articular steroids. Aim: To compare the efficacy of intra articular Methylprednisolone with oral Etoricoxib in the pain management of Psoriatic arthritis. Materials and Methods: A prospective comparative study was conducted in the pain clinic of department of Anaesthesiology for a period of one year. A total of 120 patients with psoriatic arthritis were included for the study. The patients were divided into 2 groups of 60 in each group. Group A patients received oral etoricoxib 120 mg OD for 6 weeks and the Group B patients received only one dose of intra-articular methyl prednisolone in the dosage of 20 mg (1 ml). All the patients were followed for a period of 6 weeks with 2 follow-up visits. The outcome measures adopted were visual analogue pain scale and psoriatic arthritis quality of life score. Results: The baseline score of both visual analogue pain score and PsAQAL was found to be high and the score decreases during the 1st (1st week) and 2nd (6th week) follow-up (P

Pharmacological treatment of psoriatic arthritis: a systematic literature review for the 2015 update of the EULAR recommendations for the management of psoriatic arthritis

ObjectiveTo update the evidence on the efficacy and safety of pharmacological agents in psoriatic arthritis (PsA).MethodsSystematic literature review of randomised controlled trials comparing pharmacological interventions in PsA: non-steroidal anti-inflammatory drugs,...

European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update

BackgroundSince the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective...

Early psoriatic arthritis: should we treat it in the same way as we treat rheumatoid arthritis?

Joint damage predicts functional limitation and mortality in psoriatic arthritis patients, but evidence from cohort studies supports the idea that early diagnosis and treatment are beneficial. Given the revolution in the treatment of rheumatoid arthritis, treating to targets and close control have become attractive concepts in the clinical management of psoriatic arthritis. The evidence in favor of the use of conventional disease modifying antirheumatic drugs is weak, but observational study results suggest that the early use of anti-TNF drugs should be encouraged. Ustekinumab and apremilast are useful alternatives for patients failing on previous anti-TNF therapy, and ampremilast can also be used for the first-line treatment of selected cases (i.e., patients who cannot tolerate other first-line treatments).

Management of Psoriatic Arthritis

Traditional disease-modifying antirheumatic drugs (DMARD) remain the first-line treatment of psoriatic arthritis (PsA), despite lack of randomized controlled trials, and with evidence based on observational studies. Anti-tumor necrosis factor agents remain a top choice for biologic treatment, complemented with new biologics with different targets (IL12-23 and IL17). Unmet needs have been identified for patients who do not respond to treatment. Among targeted small molecules Apremilast is approved for the treatment of PsA and Tofactitinib is under investigation. The drugs discussed herein have the potential to address unmet needs; however, additional research is required to identify more effective therapies for PsA.

Ultrasound in psoriatic arthritis. Can it facilitate a best routine practice in the diagnosis and management of psoriatic arthritis?

Important advances from both therapeutic and clinical assessment have recently been reported in psoriatic arthritis (PsA). Moreover, the constant challenge to provide a more comprehensive assessment of this heterogeneous disease results in a variety of clinical instruments that help the clinician for a global evaluation of both disease activity and responsiveness. The current European League Against Rheumatism (EULAR) recommendations on the use of imaging suggest the use of ultrasound (US) in chronic arthritis to increase the diagnostic accuracy and improvement of its management as compared to clinical examination alone. Although US findings are not firmly established in daily clinical practice, it demonstrated several positive aspects such as good sensitivity and specificity, acceptable reliability, and adequate sensitivity to change, especially in the peripheral PsA. Additionally, recent works introduced the role of US in the assessment of skin and nails opening interesting area of research. The aim of this paper is to describe the potential role of US in the assessment of PsA and to discuss the current evidence supporting its application in daily clinical practice.

Making the next steps in psoriatic arthritis management: current status and future directions.

Psoriatic arthritis (PsA) is a chronic inflammatory condition with articular and extra-articular manifestations: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail disease. It is associated with cardiovascular comorbidities. It is now recognized as a new entity, different from rheumatoid arthritis and other spondyloarthritis in terms of clinical manifestations, pathogenesis, and response to therapies. Anti-tumor necrosis factors (anti-TNFs) have demonstrated clinical efficacies exceeding that of conventional disease modifying antirheumatic drugs (DMARDs). The current treatment paradigms recommend early diagnosis and treatment, and a strategic and target orientated approach, aiming at a low disease activity status. New understanding in the immunopathogenesis of PsA has led to new treatment targets. This review addresses the evidence of current treatment for each of the domains as an aid to the clinician managing these patients in the clinic. Some new therapeutic targets are presented. We highlight the importance of development and validation in outcome measures, including that of composite scores that capture various disease domains that will facilitate future clinical trials to inform the best treatment.

Nail psoriasis as a predictor of the development of psoriatic arthritis

Psoriatic arthritis is a psoriasis-related spondyloarthropathy that occurs in 20–30% of patients with psoriasis. Various imaging studies have demonstrated that there is a considerable proportion of undiagnosed psoriatic arthritis among patients with psoriasis. Since early detection and treatment of psoriatic arthritis could, ultimately, allow the prevention of clinical and radiologic progression of the disease, there is the need to establish clinical indicators to detect this risk.Nail psoriasis has been proposed as a predictor for the development of psoriatic arthritis. The inflammation involving the entheses, called enthesitis, is an early inflammatory change seen in psoriatic arthritis, and nail changes appear to result from the close relationship between the nail and the enthesis of the distal interphalangeal extensor tendon, one of the main entheseal compartments affected in psoriatic arthritis.As skin lesions precede articular symptoms in more than 75–80% of patients with psoriatic arthritis, dermatologists may play a key role in the early detection and management of psoriatic arthritis.

Prologue: 2014 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)

The 2014 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in New York, New York, USA, and attended by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups. Summaries of presentations at that meeting are introduced, including the GRAPPA-organized Fellows Symposium adjacent to the 2014 Swiss Psoriasis Day in Geneva. At the GRAPPA meeting itself, a Trainees Symposium was organized for rheumatology fellows and dermatology residents to present their research work; several patient research partners (PRP) organized Building Bridges, a session of interactive dialogue regarding the roles and responsibilities of PRP and researchers participating in working groups at GRAPPA and elsewhere; and 5 dermatology sessions were held to report on the international dermatology outcome measures group. Among the meeting topics were dermatologists’ management of psoriatic arthritis (PsA); the unmet need for a comprehensive assessment tool for psoriasis; the Psoriasis Symptom Inventory; and the importance of treat-to-target strategies for managing psoriasis. Other presentations included an update of GRAPPA’s research initiative to develop evidence-based criteria to identify inflammatory arthritis, enthesitis, dactylitis, and spondylitis; the utility of magnetic resonance imaging in PsA; a review of the PsA working group at OMERACT (Outcome Measures in Rheumatology); and updates on several GRAPPA educational projects. Considerable time was allotted to discussions of GRAPPA’s efforts to update its treatment guidelines for PsA.