Psoriasis Arthritis Patients Research Articles

Risk of developing inflammatory arthritis in patients with psoriasis initiating treatment with biologics: A population-based analysis

BackgroundThe relationship between biologic treatments for psoriasis (PsO) and development of inflammatory arthritis in patients is not fully understood. ObjectiveAnalyze the effects of biologic treatment on development of inflammatory arthritis in PsO patients. MethodsThis retrospective study assessed PsO patients identified in the Optum Clinformatics® Data Mart database from Jan 2007 to Mar 2023 with no baseline diagnosis of inflammatory arthritis. Patients were stratified based on the class of initial biologic treatment (IL-23, IL-12/23, IL-17, or TNF inhibitor) and followed for up to 3 years or development of inflammatory arthritis. Risk of developing inflammatory arthritis was assessed using a multivariate Cox proportional hazard models using IL-23 inhibitors as reference. ResultsIncidence rates of developing inflammatory arthritis expressed as events/100 person-years were 4.99, 7.29, 6.06, and 9.39 for IL-23, IL-17, IL-12/23, and TNF inhibitors respectively. Adjusted hazard ratios were significantly higher for patients receiving IL-17 (1.44; p=.0294) and TNF (1.90; p<.0001) inhibitors when compared to patients receiving IL-23 inhibitors. LimitationsLimitations include those associated with medical coding errors and the potential for protopathic bias. ConclusionPatients receiving IL-23 inhibitors are at lower risk for developing inflammatory arthritis or PsA compared to those receiving IL-17 and TNF inhibitors.

PAPRIKA: A Question Bank for Assessing Psoriatic Arthritis Risk in Individuals of Diverse Ancestries.

We aimed to create a question bank about clinical factors for predicting the diagnoses of psoriatic arthritis in patients with psoriasis of various ancestries and skin tones, which can be completed entirely by patients. Utah Psoriasis Initiative participants without a psoriatic arthritis diagnosis at enrollment were observed for diagnosis during the study period. We inferred ancestry from exome sequencing data and performed Cox proportional hazards regression to identify clinical predictors of psoriatic arthritis in different ancestry groups. Based on results and literature review, we developed a question bank for assessing psoriatic arthritis risk among patients with psoriasis in various ancestries. Patient-reported untreated psoriasis induration and history of fingernail psoriasis were associated with psoriatic arthritis in participants of European and non-European ancestry. We developed the Psoriatic Arthritis Prediction and Identification Question Bank for Diverse Ancestries (PAPRIKA) version 1.0, which included questions regarding psoriasis characteristics, arthritis symptoms, comorbidities, family history, and demographics. PAPRIKA is accessible at http://bjfenglab.org/. The clinical features (untreated psoriasis induration and history of fingernail psoriasis) that can predict psoriatic arthritis in European individuals also work for non-European individuals. PAPRIKA can be used to gather psoriatic arthritis predictive data from patients with psoriasis without provider assistance and is relevant for patients across ancestries.

Predicting Psoriatic Arthritis in Psoriasis Patients - A Swiss Registry Study.

Psoriatic arthritis (PsA) is a prevalent comorbidity among patients with psoriasis, heavily contributing to their burden of disease, usually diagnosed several years after the diagnosis of psoriasis. To investigate the predictability of psoriatic arthritis in patients with psoriasis and to identify important predictors. Data from the Swiss Dermatology Network on Targeted Therapies (SDNTT) involving patients treated for psoriasis were utilized. A combination of gradient-boosted decision trees and mixed models was used to classify patients based on their diagnosis of PsA or its absence. The variables with the highest predictive power were identified. Time to PsA diagnosis was visualized with the Kaplan-Meier method and the relationship between severity of psoriasis and PsA was explored through quantile regression. A diagnosis of psoriatic arthritis was registered at baseline of 407 (29.5%) treatment series. 516 patients had no registration of PsA, 257 patients had PsA at inclusion, and 91 patients were diagnosed with PsA after inclusion. The model's AUROCs was up to 73.7%, and variables with the highest discriminatory power were age, PASI, physical well-being, and severity of nail psoriasis. Among patients who developed PsA after inclusion, significantly more first treatment series were classified in the PsA-group, compared to those with no PsA registration. PASI was significantly correlated with the median burden/severity of PsA (P = .01). Distinguishing between patients with and without PsA based on clinical characteristics is feasible and even predicting future diagnoses of PsA is possible. Patients at higher risk can be identified using important predictors of PsA.

The Frequency of Association of Nail Involvement and Psoriatic Arthritis in Psoriasis Patients.

While the relationship between psoriatic arthritis and skin findings is well-known in patients with psoriasis, the relationship between psoriatic arthritis and nail involvement is less known. In this study, it was aimed to examine the frequency of association between nail involvement and psoriatic arthritis in patients with psoriasis. Our study is a retrospective observational study. It was conducted with 250 regis- tered patients who applied to the dermatology polyclinic and clinic of our university hospital. The follow-up forms of the patients were scanned retrospectively and the findings were recorded. The average age of the 250 patients evaluated in this study was 39.62 ± 9.30, and 133 (53.2%) of them were women. The frequency of nail involvement in psoriasis patients was determined to be 36.8% (n=92) and the frequency of arthritis was determined to be 8.8% (n=22). Nail involvement was statisti- cally significantly more common in those with arthritis, and nail involvement was present in all of those with arthritis (P < .001). Nail involvement was significantly more common in those with only arthralgia (P < .001). A significantly higher average of nail psoriasis severity index was found in those with both joint and nail involvement compared to those with only nail involvement (P < .001). There was no statistically significant difference in terms of psoriasis area severity index average (P=.235). Proximal and distal interphalangeal arthralgia and sacroiliac arthralgia were found significantly more frequently in those with nail involvement than in those without nail involvement (respectively P = .007 and P < .001). There was no statistically signifi- cant relationship between nail involvement with the presence of arthritis and the clinical type (respectively P = .288 and P = .955). Joint involvement and nail involvement in patients with psoriasis are closely related, and we think that nail and joint involvement in psoriasis patients should be evaluated together.

Severe Norwegian Scabies Infection in Psoriatic Arthritis Patient with Naïve Hepatitis B and Sepsis: A Case Report

Introduction: Norwegian scabies is an acute form of severe scabies infection seen in immunocompromised patients. Psoriasis arthritis (PsA) is a systemic autoimmune disease involving the synovial tissue and skin. Norwegian scabies with its complication that occurs in PsA patients can be difficult to diagnose and cause mortality if untreated. Case presentation: A 39-year-old woman came to Dr. Soetomo’s hospital with complaints of body aches, peeled white scales all over her body, and immobilization for months. Multiple macular erythemas that were covered by thick scales with indistinct borders and multiple ulcers with slough were found.

Dysregulation of Bile Acids, Lipids, and Nucleotides in Psoriatic Arthritis Revealed by Unbiased Profiling of Serum Metabolites.

The transition from psoriasis to psoriatic arthritis (PsA) occurs in 20-30% of patients; however, the mechanisms underlying the emergence of musculoskeletal disease are not well understood. Metabolic disease is prevalent in psoriasis patients, but whether metabolic factors, other than obesity, increase arthritis risk in psoriasis patients is not known. This study was undertaken to investigate the link between metabolic changes and disease progression in psoriasis patients. To characterize the metabolic alterations during the progression of arthritis in psoriasis patients, we analyzed cross-sectional healthy controls and PsA samples and longitudinal psoriasis serum samples, before and after PsA onset. Nontargeted metabolomic profiling was performed using liquid chromatography mass spectrometry. We identified several serum metabolites that differed between PsA patients, psoriasis patients, and healthy controls. Differentially abundant bile acids, purines, pyrimidines, glutathione, lipids, and amino acid metabolites were noted in these 3 groups. We also noted differences between psoriasis patients who progressed and those who did not progress to PsA. Bile acid and butyrate levels were depressed in those who progressed to PsA compared to those who did not, and the level of inflammatory lipid mediators increased following PsA diagnosis. In particular, the combination of leukotriene B4 and glycoursodeoxycholic acid sulfate were sensitive and specific predictors of PsA progression. We observed notable differences in bile acid, purine, lipid, and amino acid-derived metabolites, among the healthy controls, psoriasis patients, and PsA patients and identified changes during the transition from psoriasis to PsA. The decreased bile acid and butyrate levels and elevated guanine levels in psoriasis patients at risk for PsA were particularly striking and may reflect gut microbial dysbiosis and dysregulated hepatic metabolism, leading to altered proliferation of immune cells and enhanced cytokine expression.

Tumor Necrosis Factor Alpha -308G/A Gene Polymorphisms Combined with Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio Predicts the Efficacy and Safety of Anti-TNF-α Therapy in Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis Arthritis.

Background: TNF-α has been reported to be closely associated with autoimmune inflammatory diseases. This study aims to investigate the role of TNF-α -308(rs1800629) G/A gene polymorphisms as well as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the efficacy and safety of TNF inhibitors (TNFi) in patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA), and psoriasis arthritis (PsA). Methods: A total of 515 subjects (181 AS, 144 RA, 48 PsA, 10 hyperbilirubinemia, 10 hyperlipidemia and 122 healthy control) were recruited in this study. The accuracy of RT-PCR methods for identifying individual TNF-α -308 genotypes was assessed using sequencing as the gold standard. Baseline NLR and PLR of patients with AS, RA and PsA and healthy controls (HC) were calculated and compared. Meanwhile, differences between responders and non-responders to TNFi treatment as well as between individuals with and without adverse effects (AE) among responders were compared. Results: The RT-PCR method is stable and reliable for TNF-α -308G/A gene polymorphism analysis, independent of sample status. The GG genotype was overwhelmingly represented, with relatively few GA genotype, whilst the AA genotype was not detected in this study. There was no observed association between TNF-α-308G/A polymorphism and susceptibility in AS, RA or PsA patients. Patients with AS, RA, and PsA had a higher NLR, compared to the HC group. Apart from PsA patients, AS and RA patients had a higher PLR, compared to the HC group. NLR was positively correlated with PLR. Furthermore, a lack of response was more frequently observed in AS and RA patients that carrying the GA genotype than the GG genotype. AS and RA patients with AE had higher NLR and PLR, compared with the non-AE group. Conclusion: Our study preliminarily shown that combining TNF-α -308G/A polymorphisms with NLR and PLR can predict the responsiveness and safety of anti-TNF therapy in patients with AS or RA.

Discovery of Arthritis in Psoriasis Patients for Early Rheumatological Referral (DAPPER): Protocol for a Longitudinal Observational Study.

BackgroundOne in three patients with psoriasis will develop psoriatic arthritis (PsA). If left untreated, this can lead to pain, impaired function, and irreversible joint damage. Timely recognition and referral to a rheumatologist are therefore key. However, current methods used to screen patients with psoriasis for those who might benefit from referral to a rheumatologist are not performing well enough.ObjectiveThe Discovery of Arthritis in Psoriasis Patients for Early Rheumatological Referral (DAPPER) study is designed to determine the prevalence of PsA in a psoriasis population and to find parameters that can be used to develop a new or enhance an existing instrument for a rheumatological referral.MethodsDAPPER is a longitudinal observational study with a 1-year follow-up. Patients with psoriasis (N=300) who are treated at an outpatient dermatological clinic will be screened extensively for signs and symptoms of PsA by a trained rheumatologist. If there is clinical suspicion of PsA and the patient is not yet treated by a rheumatologist, referral to the Department of Rheumatology will follow for confirmation of the diagnosis and further care. After 1 year, data on changes in quality of life and PsA and psoriasis disease activity will be collected from the referred patients. The screening visit will be used to gather demographical and medical data, which can later be used to develop the aforementioned screening instrument.ResultsInclusion started in June 2019 and finished in June 2021. Follow-up with newly discovered patients with PsA is ongoing.ConclusionsThe DAPPER study is specifically designed to improve the detection of existing PsA in a dermatologic outpatient setting. Although internal validity will be tested, external validity will have to be checked using a second validation cohort. To predict the development of PsA in the future, longitudinal/prospective data collection is required and will be performed in a follow-up study (DAPPER-i).Trial RegistrationDutch Trial Register NTR7604; https://www.trialregister.nl/trial/7397International Registered Report Identifier (IRRID)DERR1-10.2196/31647

254 COVID-19 related outcomes in psoriasis and psoriasis arthritis patients

Psoriasis is a systemic chronic inflammatory disorder that affects the skin and is associated with other disorders. There is scan literature on outcomes of COVID19 patients with Psoriasis (Pso) and Psoriasis Arthritis (PsoA), especially from multicenter data. Therefore, the aim was to examine investigate the risk of COVID complications in these two groups. A retrospective cohort study was done using TriNetX, a federated real time database of 63 million records. COVID patient cohorts were identified by validated ICD-10/serology codes per CDC guidelines.

16742 Depression as a risk factor for the development of psoriasis

Background: Depression has been linked to increased levels of inflammatory cytokines including TNF-α and IL-6, sharing some inflammatory cytokines associated with psoriasis. Moreover, depression is an independent risk factor for developing psoriatic arthritis in psoriasis patients, suggesting that depression may influence the disease course of psoriasis. Our study investigated whether depression increases the risk of developing psoriasis in the first place.

The Relationship Between C-Reactive Protein Level, Disease Severity and Psoriatic Arthritis In Psoriasis Patients

Amaç: Bu çalışmada “Immune Mediated Inflammatory Disease (İmmün Aracılı İltihabi Hastalık)” grubuna dâhil olan psoriasis ve psoriatik artritte, C-reaktif proteinin psoriasis şiddeti ve psoriatik artrit ile ilişkisini tespit etmek amaçlandı. Gereç ve Yöntem: Çalışmaya 18-70 yaş arası psoriatik artriti olan veya olmayan toplam 201 psoriasis hastası ve kontrol grubu olarak 18-70 yaş arası 98 sağlıklı birey alındı. Psoriasis şiddeti psoriasis alan şiddet indeksi ile hesaplandı ve eşzamanlı serum C-Reaktif Protein düzeyi (immunoturbidimetric latex yöntemi ile) bakılıp hastalar fizik tedavi ve rehabilitasyon kliniğinde psoriatik artrit yönünden değerlendirildi. Gruplar arası C-Reaktif Protein düzeyleri karşılaştırıldı. Psoriasis hastalarında C-Reaktif Protein düzeyi ve psoriasis alan şiddet indeksi korelasyonuna bakıldı. Bulgular: C-Reaktif Protein düzeyinin, psoriasis hastalarında normal popülasyona göre yüksek olduğu (p&amp;lt;0,001) ancak psoriasis şiddeti arasında korelasyon olmadığı saptandı (p=0,093) . C-Reaktif Protein değerleri, aktif psoriatik artrit hastalarında kontrol grubuna (p&amp;lt;0,001) ve psoriasis hastalarına (p&amp;lt;0,001) göre yüksek bulundu. C-Reaktif Protein değerleri açısından aktif psoriatik artrit hastaları ile inaktif psoriatik artrit hastaları arasında istatistiksel olarak anlamlı fark bulunmadı (p=0,449). Sonuç: C-Reaktif Protein’in psoriasis hastalarında normal insanlara göre yüksek olmasına rağmen, hastalık şiddetiyle korele olmadığından, psoriasis şiddeti takibinde kullanımının yararlı olmayacağı; ancak psoriasis hastalarında psoriatik artrit gelişimi açısından takipte kullanılanılabileceğini düşünmekteyiz. Aktif ve inaktif psoriatik artrit hastalarında C-Reaktif Protein düzeyi açısından anlamlı fark saptanmaması, psoriatik artritin aktif veya inaktif dönemde olduğunu değerlendirmede tek başına yeterli bir belirteç olmadığı sonucunu doğurmaktadır.

Activated antimicrobial peptides due to periodontal bacteria in synovial fluid – The link between psoriatic arthritis and periodontitis?

BackgroundThe impact of periodontal disease on systemic conditions has not been fully identified yet. Literature shows that the incidence of psoriatic arthritis in psoriasis-patients is higher in presence of periodontitis. To this day, it is not fully clear which pathophysiological mechanism lies behind this correlation. The missing link between these diseases might be the activation of antimicrobial peptides (AMPs) due to DNAs of periodontal bacteria in synovial fluid. HypothesisPeriodontitis is not only a local inflammation but effects systemic conditions as well. We assume that periodontitis is an important risk factor for the development of psoriatic arthritis in patients with psoriasis due to the increase of AMPs triggered by elevated periodontal bacteria DNAs in synovial fluid. ConclusionSystemic inflammation caused by periodontitis, the circulation of inflammatory proteins and the increase of potential pathogenic bacteria in the blood stream as well as in synovial fluid might trigger the over-expression of several immunological factors as AMPs and activate immune cells in all parts of the body.

Differences in the serum metabolome and lipidome identify potential biomarkers for seronegative rheumatoid arthritis versus psoriatic arthritis

ObjectivesThe differential diagnosis of seronegative rheumatoid arthritis (negRA) and psoriasis arthritis (PsA) is often difficult due to the similarity of symptoms and the unavailability of reliable clinical markers. Since chronic...

Circulating microRNAs in extracellular vesicles as potential biomarkers for psoriatic arthritis in patients with psoriasis.

Psoriatic arthritis (PsA) develops in ~30% of patients with psoriasis. The diagnosis of PsA is challenging, and there are no reliable molecular markers in clinical use. MicroRNAs are short non-coding regulatory RNAs, which can be actively packaged into extracellular vesicles (EVs) and secreted to the circulation. To explore whether plasma-derived EV microRNAs may serve as biomarkers for PsA in patients with psoriasis. Plasma samples were obtained from patients with cutaneous-only psoriasis (PsC) and patients with psoriasis and PsA. Plasma EVs were isolated using miRCURY™ Exosome Isolation Kit. RNA sequencing was used to identify differentially expressed EV miRNAs in the discovery phase (PsC, n=15; PsA, n=14). In the validation phase (PsC, n=29; PsA, n=28), 41 selected miRNAs were analysed in plasma EVs by qPCR. The association of the identified miRNAs with PsA was assessed by logistic regression analysis. RNA sequencing identified 19 plasma EV miRNAs with significantly different levels between PsA and PsC in the discovery cohort. Significantly lower levels of plasma EV let-7b-5p and miR-30e-5p in PsA vs. PsC were confirmed in the validation cohort, and their decreased levels were found to be associated with the presence of PsA. ROC analysis revealed an AUC of 0.68 (95% CI 0.53-0.83) for let-7b-5p and 0.69 (95% CI 0.55-0.84) for miR-30e-5p. Circulating EV microRNA levels are altered in patients with PsA as compared with PsC. Findings of this exploratory study suggest that circulating EV microRNAs may serve as biomarkers for arthritis in psoriasis patients.

Vitamin d deficiency in psoriatic patients -A case control study

Abstract Introduction: Many studies have shown that vitamin D deficiency have been associated with multiple autoimmune conditions like psoriasis, rheumatoid arthritis, diabetes mellitus. Objective: The main purpose of this study was to analyze vitamin D status of psoriasis patients in comparison to healthy controls. Materials and Methods: The study comprised of 50 (30 male & 20 female) clinically confirmed cases of chronic plaque psoriasis of age group (20-60 years) attending outpatient department of Dermatology, venereology, leprosy, Vinayaka Mission’s Medical College & Hospital, Karaikal from 2012 to 2014.At the same time 50 healthy individuals without psoriasis were also investigated (age & sex matched). Results: The mean serum 25-OHD levels in psoriatic patients and controls were 22.308+_2.974 and 33.726 +_2.688 ng/ml respectively. The difference was statistically significant (P= Limitations: Additional studies with bigger numbers of patients are essential to evaluate the pathogenic mechanisms associated with psoriasis and vitamin D. Keywords: Psoriasis, Autoimmunity, Psoriasis Area and severity index, 25-hydroxy vitamin D. Introduction Psoriasis is a chronic, non-contagious skin disease characterized by red, inflamed cutaneous lesions covered with silvery-white scale. It involves the innate immunologic system (keratinocytes, dendritic cells, histiocytes, mastocytes and endothelial cells) and acquired immunologic system (T lymphocytes).[1]Psoriatic plaques are defined histologically by epidermal hyperplasia, epidermal and dermal infiltration by leukocytes and changes in dermal microvasculature.[2] Psoriasis affects both genders equally and can occur at any age, although it most commonly appears for the first time between the ages of 15 and 25. The disease affects the skin and potentially the joints. The prevalence of psoriatic arthritis in psoriasis patients is estimated to be between 25-31%. Vitami

Value of combining biologics with methotrexate for treatment of psoriatic arthritis-questions remain

Concomitant methotrexate (MTX) improves the therapeutic effect of biologic therapies in rheumatoid arthritis treatment. However, the influence of MTX on biologic therapy in psoriasis arthritis (PsA) has not yet been fully clarified, as data from randomized clinical studies are lacking. So far, it is only known, that PsA patients with inadequate response to MTX or non-steroidal anti-inflammatory drugs alone respond equally well to asubsequent biologic therapy. The aim of this study is to investigate whether MTX-naive patients achieve greater disease improvement with the combination of MTX and abiologic than with biologic monotherapy alone, and whether patients on MTX in whom abiologic therapy is additionally started would worsen if MTX is discontinued. The current data situation and its limitations are presented. Furthermore, an investigator-initiated multicenter randomized clinical study in patients with active PsA is introduced (MUST study), which investigates the influence of placebo-controlled MTX combination therapy with the interleukin12/23 inhibitor ustekinumab (UST) in order to close the existing evidence gap. The primary objective of the study is to demonstrate the non-inferiority of UST monotherapy compared to MTX/UST combination therapy as measured by mean DAS28 values at week24. Of 196 planned patients, 77have been included so far. Recruitment is still open. The MUST study offers the ideal opportunity to investigate the influence of concomitant MTX in acontrolled study design and to assess whether the addition of MTX to UST therapy or its continuation is beneficial for PsA patients.

Evaluation of IL-34 in psoriasis and psoriatic arthritis patients: Correlation with disease activity and severity

IntroductionInterleukin-34 (IL-34) is a newly discovered cytokine essential for skin homoeostasis. It is involved in macrophage differentiation, osteoclastogenesis and inflammation. This could suggest a potential role in the pathogenesis of psoriasis and psoriatic arthritis (PsA). Aim of the workTo assess serum IL-34 level in psoriatic patients with and without arthritis and to correlate it with disease activity and severity. Patients and methodsSerum IL-34 level was measured in 45 psoriasis patients (21 had PsA) and 20 healthy controls. Patients were clinically assessed using psoriasis skin area severity index (PASI), composite psoriasis disease activity index (CPDAI) and peripheral joint score (PJS). Radiological assessment of hands and feet was done using modified Sharp-van der Heijde (mSvH) scoring method for PsA. ResultsThe mean age of the PsA patients (47.4±10.2years) was comparable with the psoriasis only patients (42.5±7.5years) and control (43.4±7years). Serum IL-34 was significantly higher among PsA patients compared to those without arthritis and controls (median=2500ng/L, 512ng/L and 325ng/L, respectively). CPDAI was significantly higher in PsA compared to patients without arthritis. PASI scores were comparable between patients. Serum IL-34 level correlated significantly with each of PASI, CPDAI and PJS but not with the mSvH score. Receiver operator characteristic curve analysis revealed that serum IL-34 testing showed excellent diagnostic performance for PsA in psoriasis patients. ConclusionThe markedly elevated IL-34 serum level in PsA patients compared to non-arthritic ones and its remarkable correlation with PsA disease activity, suggest its importance as a marker for arthritis in psoriasis patients.

Psoriatic Arthritis in Psoriasis Patients: Evaluation of Clinical and Radiological Features

Psoriatic Arthritis in Psoriasis Patients: Evaluation of Clinical and Radiological Features

Diagnosis and management of psoriatic arthropathy in primary care.

Psoriasis arthritis (PsA) is a chronic, inflammatory disease, affecting predominantly skin and joints (Figure 1). Skin psoriasis develops before arthritis in the majority of cases, with a typical time lag of 5 to 10 years. However, around 20% of PsA patients never develop psoriasis.1 The prevalence of psoriasis in the UK is approximately 2% of the adult population.2 Figure 1. Typical clinical presentation of psoriasis arthritis. The white arrow denotes dactylitis and the black arrows denote psoriasis. Epidemiological studies indicate that between 10% and 30% of people with psoriasis will go on to develop PsA, giving a population prevalence for PsA of 0.4%. Out of 40 million adults in England, around 160 000 would be expected to have PsA. According to the National Institute for Health and Care Excellence (NICE), only 6200 people in England are currently registered to receive biological therapies for PsA, representing 4% of this population. Of the 350 000 people in the UK who have rheumatoid arthritis (RA), 35 000 (10%) are on biological therapies. PsA appears to be underdiagnosed not only in the UK but also abroad. According to the American Psoriasis Foundation, there are over 7 million adults in the US who have psoriasis but only 520 000 (7.4%) of these patients have …

Safety and efficacy of etanercept in children with the JIA categories extended oligoarthritis, enthesitis-related arthritis and psoriasis arthritis.

The approval of etanercept for the treatment of the juvenile idiopathic arthritis (JIA) categories extended oligoarthritis (ExtOA), enthesitis-related arthritis (ERA) and psoriasis arthritis (PsA) was recently added to the approval for the treatment of polyarticular-course JIA (PA). This study aims to evaluate the efficacy and safety of etanercept in a large number of patients with the additional JIA categories. The Biologika in der Kinderrheumatologie (BIKER) registry documents baseline demographics, clinical characteristics and disease activity parameters. Efficacy was determined using the PedACR 30/50/70 response criteria and the Juvenile Arthritis Disease Activity Score (JADAS)-10. Safety assessments were based on adverse events' reports. Until December 2012, a total of 1,678 JIA patients, incorporating 238 ERA, 315 ExtOA and 127 PsA patients were included. JADAS-10 demonstrated marked improvement compared to baseline after 3 to 24months in ExtOA [16.1 ± 7.6 (baseline), 5.1 ± 5.2 (3months), 3.0 ± 3.5 (24months)]; ERA (15.3 ± 7.2, 4.4 ± 4.7, 4.0 ± 4.9) and PsA (14.7 ± 6.4, 5.0 ± 4.6, 5.3 ± 6.4). Compared to patients with PA, the rate of serious adverse events [relative risk (RR) 1.39 (0.95-2.03, p = 0.08)] and nonserious [1.18 (1.02-1.35; p = 0.03)] adverse events were elevated. The rate of uveitis flares was significantly higher in PsA (3.3/100patient-years), ExtOA (2.8/100patient-years) and ERA (2.7/100patient-years) than in rheumatoid factor (RF)-negative polyarticular JIA (1.3/100 pat.yrs) or RF-positive polyarticular JIA (0.27/100patient-years). Reports on chronic inflammatory bowel disease were numerically more frequent in ExtOA, ERA and PsA. Administration of etanercept in patients with the JIA categories ExtOA, ERA and PsA is safe and very efficacious in children. Attention should be paid to the occurrence of extraarticular autoimmunopathies.