Diagnosis Of Psoriatic Arthritis Research Articles

Psoriatic arthritis : Clinical challenges and pharmaceutical management

Psoriatic arthritis (PsA) is asystemic immune-mediated inflammatory disease of the musculoskeletal system, which is accompanied by achronic and progressive course. It is characterized by different clinical manifestations and can severely impair the quality of life and function of patients due to the existing heterogeneity of the manifestations. The (early) diagnosis of PsA and individualized therapeutic management in routine clinical practice are difficult due to the enormous clinical variability. In addition to the appearance of arthritis of the peripheral joints, there can be involvement of the axial skeleton, skin psoriasis, nail psoriasis, enthesitis and dactylitis. The clinical appearance, course of the disease, risk factors and pathophysiological mechanisms of PsA have been extensively researched in recent decades. With the associated better understanding of the disease, new treatment options and goals for effective treatment have also been established.

The National Prevalence of Clinically Diagnosed Psoriatic Arthritis in Sweden 2017.

Psoriatic arthritis (PsA) prevalence estimates vary across studies; studies based on national data are few. We aimed to estimate the prevalence of clinically diagnosed PsA in Sweden in 2017, overall and stratified by sex/age/education/geography, and to quantify disease-modifying anti-rheumatic drug (DMARD) use among those in contact with specialized rheumatology care 2015-2017. Individuals, 18-79 years (y), alive, residing in Sweden on December 31, 2017, with a prior PsA diagnosis were identified from the National Patient Register (NPR) and/or the Swedish Rheumatology Quality Register (SRQ). The PsA prevalence was estimated according to a base case (BC) definition (≥1 main PsA ICD-code from rheumatology or internal medicine departments in NPR, or a PsA diagnosis in SRQ), four sensitivity analysis definitions, and for those seen in specialized rheumatology care 2015-2017. In the latter group, DMARD use during 2017 was also assessed. Data for stratifications were retrieved from national registers. The crude national prevalence of PsA (18-79y) was estimated at 0.39% (BC), 0.34% after accounting for diagnostic misclassification and 0.32-0.50% across all sensitivity analyses. The prevalence was lower in males and in those with higher level of education. The prevalence for those seen in specialized rheumatology care 2015-2017 was estimated at 0.24%. In this population, 32% received biologic or targeted synthetic DMARDs, and 41% conventional synthetic DMARDs only, during 2017. The prevalence of clinically diagnosed PsA (18-79y) in Sweden in 2017 was around 0.35%. Among PsA cases in recent contact with specialized rheumatology care, almost 3/4 received DMARD therapy in 2017.

Periods till psoriatic arthritis onset and diagnosis in Russian patients with moderate to severe psoriasis (according to psoriasis patient registry)

Background. Early detection of psoriatic arthritis in patients with psoriasis remains an unmet medical need. Early diagnosis and treatment initiation in patients with psoriatic arthritis decreases the risk of adverse patient outcomes and improves patients quality of life.
 Aims. To describe a period between psoriasis and psoriatic arthritis onset and a period between psoriatic arthritis onset and diagnosis in Russian patients with moderate to severe psoriasis.
 Materials and methods. Analysis of data from the psoriasis patient registry. Patients aged 18 years and older with an established diagnosis of psoriasis and psoriatic arthritis were included in the analysis. Noninclusion criteria: no data on psoriasis and/or psoriatic arthritis onset (for the period between psoriasis and psoriatic arthritis onset description); no data on psoriatic arthritis onset and/or diagnosis (for the period between psoriatic arthritis onset and diagnosis description).
 Results. Sample size for the descriptive characteristic of period between psoriasis and psoriatic arthritis onset was 891 patients; sample size for the descriptive characteristic of period between psoriatic arthritis onset and diagnosis was 849 patients.
 Psoriatic arthritis onset preceeded cutaneous manifestation of psoriasis in 2.5% of patients. Concurrent onset of cutaneous psoriasis and psoriatic arthritis (within one year) had 10.7% of patients. In 86.8% of patients, cutaneous manifestation of psoriasis preceded manifestation of psoriatic arthritis.
 Exclusively of patients with psoriatic arthritis developed before or concurrently with cutaneous manifestation of psoriasis, the mean duration of period between psoriasis and psoriatic arthritis onset was 13.7 10.3 years, the median [IQR] 12 [619] years.
 In 24% of patients psoriatic arthritis was diagnosed 1 year and more after its onset. The mean (SD) period from signs and|or symptoms onset till psoriatic arthritis diagnosis was 3.9 5.0 years; median [IQR] was 2 [14.5] years.
 Conclusions. A diagnostic delay in 24% Russian patients with psoriatic arthritis is one year or more. In this subgroup of patients the mean delay in diagnosis of psoriatic arthritis is about 4 years.

The Clinical Characteristics of Psoriatic Arthritis: A Cross-Sectional Study Based on the Psoriatic Arthritis Cohort of West China Hospital.

This study aims to describe the demographic, clinical, laboratory, and ultrasonic characteristics of patients with psoriatic arthritis (PsA) in the Psoriatic Arthritis cohort of West China Hospital. In this cross-sectional study, we included patients diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis, collected their demographic information, medical histories, and treatments, evaluated all domains (skin and nail lesions, tenderness, swelling, enthesitis, dactylitis, and axial arthritis) related to PsA, and then performed descriptive statistical analyses of all data. A total of 275 patients with PsA were included in this study. The ratio of male to female patients was 2.16:1. Skin lesions preceded arthritis in 86.5% of these patients with PsA with a mean interval of 10.1years. The metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints of fingers, and sacroiliac joints are the most commonly involved sites of tenderness, swelling, and the spine, respectively. Among all comorbidities, fatty liver has the highest incidence with 33.1%. Finally, we noted that the mean disease duration of PsA was 4.2years, suggesting a delay in the diagnosis of PsA. Our study proposes that the prevalent population of PsA are male patients with psoriasis over 40years of age who have a long disease course. For patients with PsA, MCP, PIP joints of fingers, and sacroiliac joints are the most frequently affected anatomical sites. With respect to comorbidities, the association between PsA and fatty liver and the underlying molecular mechanisms are worthy of further exploration.

Psoriatic Arthritis Quality of Life Questionnaire: results of translation, cultural adaptation and validation in Russian language

Psoriatic arthritis (PsA) is a chronic progressive disease from the pondyloarthritis group of diseases. In recent years, there has been a significant increase in the incidence of PsA and cases of its severe course, with significant influence on the quality of life (QoL) of patients and early disability. Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) is the first quality of life questionnaire designed specifically for PsA that has not been previously validated in Russia.Objective: to translate the original PsAQoL questionnaire into Russian and evaluate the psychometric properties of the Russian version.Material and methods. The original PsAQoL was translated into Russian using two translational panels. In all, 12 local residents were included in the translation stage of the study. The external and logical validity of the questionnaire was assessed. Further, Russian-speaking patients with an established diagnosis of PsA (n=10) tested the questionnaire. A separate cohort of patients with PsA (n=50) was enrolled in a postal test retest study on 2 occasions, 2 weeks apart. Clinical data and the Medical Outcomes Study-Short Form (SF-36) questionnaire were used to assess convergent validity.Results and discussion. The Russian version of PsAQoL was relevant, clear, and easy to complete (6.1 minutes on average). PsAQoL had high internal consistency (Cronbach's á=0.87) and excellent retest validity (r>0.85). PsAQoL scores correlated most strongly with the SF-36 General Health Scale (r=-0.68, p<0.01). PsAQoL score did not depend on sex and age (p>0.05). The PsAQoL could distinguish between groups of patients defined by self-reported general health status and self-reported severity of PsA.Conclusion. The Russian version of PsAQoL proved to be understandable and easy to complete, as well as a reliable and valid tool for assessing the quality of life of patients with PsA.

The role of the traumatic factor and isomorphic reaction in the early diagnosis of psoriatic arthritis

Rationale: Evaluation of the role of the deep Koebner's phenomenon and traumatization seems to be a promising direction in the search of the solution for the delayed diagnosis of psoriatic arthritis (PsA) in patients with psoriasis. We have put forward the question if joint and ligament abnormalities induced by a trauma or persistent physical activity could be an analogue of the skin isomorphic reaction in psoriasis.
 Aim: To identify joint and ligament abnormalities in patients with psoriasis caused by mechanical stress and their association with the deep Koebner's phenomenon and PsA.
 Materials and methods: This was an open-label, non-randomized, comparative study in parallel groups in 80 in-patients with psoriasis (recruited in the Dermatovenereological clinic № 1, Ufa); the control group included 80 in-patients with PsA. All patients were assessed by a dermatovenereologist, including past history, severity of psoriasis, degree of PsA activity, special questionnaires and the presence of an isomorphic reaction in the skin and periarticular tissues. The joints with maximal physical activity were assessed by X-ray. PsA was diagnosed by a rheumatologist.
 Results: The patients from both groups were matched in terms of age, gender, and duration of psoriasis. Pain, joint stiffness and limitation of mobility were present not only in the PsA group, but also in the patients with psoriasis (35%, 27.5% and 26.2% of the patients, respectively). Despite most of the patients in the psoriasis group had no active complaints (65.0% vs. 0% in the control group, p 0.001), clinical signs of inflammation of the tendons and entheses and relevant history were found in 47.5% (68.7% in the control group, p = 0.007). Hand tendinitis was most prevalent symptom in both groups: 40.0% (32/80) in the psoriasis group and 63.7% (51/80) in the PsA group (p = 0.003). Achilles tendon lesions were found in 17.5% (14/80) and 52.5% (42/80) (p 0.001) and periarticular edema in 27.5% (22/80) and 63.7% (51/80), respectively (p 0.001). The combination of these signs with psoriatic plaques in this area was observed in 32.5% (26/80) and 92.5% (74/80) of the patients, respectively (p 0.001). The comparison of the clinical and X-ray data showed that 38 patients with psoriasis and newly diagnosed PsA had had an increased physical load on the affected joints, as well as signs of a deep isomorphic reaction (tendinitis, periarticular edema, or enthesitis near the involved joints). In both groups, the most common form of PsA was distal one (63.2% [24/38] of the patients with newly diagnosed PsA and 58.7% [47/80] of the patients with previously diagnosed PsA, p = 0.648).
 Conclusion: Involvement of the periarticular tissues, as well as early, including preclinical, X-ray abnormalities in the joints of patients with psoriasis can be associated with increased physical activity and the deep Koebner's phenomenon. Therefore, even if patients with psoriasis do not have any clinical manifestations of PsA and no complaints when seen by a dermatovenereologist, it is recommended to perform a detailed collection of past history data with clarification of the type of physical activity and past trauma, as well as to examine both by inspection and palpation the periarticular tissues (tendons and entheses), for the timely use of X-ray examination, consultation of a rheumatologist aimed at diagnosis of psoriatic arthritis.

Health-related quality of life in gout, psoriatic arthritis, rheumatoid arthritis and ankylosing spondylitis, results from a cross-sectional survey in Western Sweden

Objectives Inflammatory joint diseases (IJDs) substantially affect health-related quality of life (HRQoL). We aimed to compare HRQoL between patients with gout, psoriatic arthritis (PsA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS): (i) overall; (ii) stratified by sex; and (iii) between women and men with the same IJD diagnosis. Method A survey including the RAND36-Item Health Survey for assessing HRQoL was sent to patients with a diagnosis of gout, PsA, RA, or AS, registered at a rheumatology clinic or primary care centre during 2015–2017. HRQoL was compared across IJDs. Because of age differences between diagnoses, age-matched analyses were performed. Results In total, 2896/5130 (56.5%) individuals responded to the questionnaire. Of these, 868 had gout, 699 PsA, 742 RA, and 587 AS. Physical component summary (PCS) scores were more affected than mental component summary (MCS) scores for all diagnoses (PCS range: 39.7–41.2; MCS range: 43.7–48.9). Patients with gout reported better PCS scores than patients with PsA, RA, and AS, who reported similar scores in age-matched analysis. MCS scores were close to normative values for the general population and similar across IJDs. When comparing women and men with respective IJDs, women reported worse PCS (range, all IJDs: 34.5–37.4 vs 37.5–42.5) and MCS (PsA: 44.0 vs 46.8; RA: 46.1 vs 48.7) scores. Conclusion We found that patients with gout reported better PCS scores than patients with other IJDs, for whom the results were similar. Women reported overall worse PCS and MCS scores than men.

Multi-modality data-driven analysis of diagnosis and treatment of psoriatic arthritis

Psoriatic arthritis (PsA) is associated with psoriasis, featured by its irreversible joint symptoms. Despite the significant impact on the healthcare system, it is still challenging to leverage machine learning or statistical models to predict PsA and its progression, or analyze drug efficacy. With 3961 patients’ clinical records, we developed a machine learning model for PsA diagnosis and analysis of PsA progression risk, respectively. Furthermore, general additive models (GAMs) and the Kaplan–Meier (KM) method were applied to analyze the efficacy of various drugs on psoriasis treatment and inhibiting PsA progression. The independent experiment on the PsA prediction model demonstrates outstanding prediction performance with an AUC score of 0.87 and an AUPR score of 0.89, and the Jackknife validation test on the PsA progression prediction model also suggests the superior performance with an AUC score of 0.80 and an AUPR score of 0.83, respectively. We also identified that interleukin-17 inhibitors were the more effective drug for severe psoriasis compared to other drugs, and methotrexate had a lower effect in inhibiting PsA progression. The results demonstrate that machine learning and statistical approaches enable accurate early prediction of PsA and its progression, and analysis of drug efficacy.

Validation of the Toronto Psoriatic Arthritis Screening 2 (TOPAS-2) questionnaire in an Argentinian population

IntroductionToPAS-2 is a questionnaire designed to detect cases of psoriatic arthritis (PsA) in patients with psoriasis (PsO). ObjectiveTo validate the ToPAS-2 questionnaire in patients with psoriasis in Argentina. Materials and methodsPatients ≥18 years old with a diagnosis of PsO. As a control group, patients diagnosed with PsA (CASPAR criteria) and osteoarthritis (OA) (ACR criteria) were included. All patients completed the ToPAS-2 questionnaire and were then evaluated by a rheumatologist. Blood tests were performed to determine Rheumatoid Factor (RF) and erythrocyte sedimentation rate (ERS). Radiographs of the hands, feet, panoramic view of the pelvis, Ferguson, and lumbar and cervical spine were performed. Statistical analysisDescriptive statistics. ROC curves for determination of sensitivity, specificity, and cut-off points of the questionnaire. A p<.05 was considered significant. Results126 patients were evaluated, 54.8% female with a mean age of 54.5 (±14.9) years. The mean schooling was 10.4 (±4.1) years. A total of 45.2% had a diagnosis of PsA, 38.9% of PsO, and 15.9% of OA. The ToPAS-2 result was X 8.4 (±3.6). The mean age according to the groups was 55.5 (±12.5), 48.1 (±15.3), and 67.1 (±11.3) years, with 40.4% female, 57.1%, and 90% respectively. The mean of the ToPAS-2 according to the different groups was 11 (±2.3), 6.8 (±3.0), and 4.6 (±1.9) (p<.01 between all groups) for APs, PsO, and OA, respectively. Of the 49 patients with PsO, 16 patients were diagnosed as PsA, after evaluation by the rheumatologist. The mean ToPAS-2 in these patients was significantly higher than those not diagnosed as PsA [10.1 (±1.8) vs 5.2 (±2)] (p<.001). In the ROC curve analysis, the area under the curve was .97 (95% CI .94–.97). A TOPAS cut-off value of 8.5 had a sensitivity of 88.9% and a specificity of 96% for the diagnosis of PsA. ConclusionThe ToPAS-2 questionnaire proved to be a valid, sensitive, and specific tool for the detection of PsA in patients with psoriasis.

Real-world treatment patterns and use of adjunctive pain and anti-inflammatory medications among patients with psoriatic arthritis treated with IL-17A inhibitors in the United States.

BACKGROUND: Much of the current research on treatment patterns and use of adjunctive pain and anti-inflammatory medications among patients living with psoriatic arthritis (PsA) predates the approval and uptake of IL (interleukin)-17A inhibitors. OBJECTIVE: To compare real-world treatment patterns and use of adjunctive pain and antiinflammatory medications between patients with PsA initiating the IL-17A inhibitors, ixekizumab and secukinumab, in a US-managed care population. METHODS: We conducted a retrospective cohort study using the HealthCore Integrated Research Database. Patients with a PsA diagnosis who initiated ixekizumab or secukinumab treatment between December 1, 2017, and November 30, 2019, were identified. Two cohorts were created based on which of the 2 medications was initiated (index date), and patients with prior use of either drug were excluded, as were patients with ankylosing spondylitis. Patients had to be continuously enrolled in the health plan for 6 months prior to (baseline) and 12 months after the index date (post-index). Inverse probability of treatment weighting was used to minimize confounding from baseline demographic and clinical differences between cohorts. Treatment patterns (dosing, persistence, discontinuation, and switching) and use of adjunctive pain/anti-inflammatory medications were assessed and compared between weighted cohorts using chi-square and t-tests. RESULTS: In total, 407 patients were identified in the ixekizumab cohort (mean age 51.6 years; 54% female) and 1,508 patients were identified in the secukinumab cohort (mean age 50.1 years; 59% female). Prior to weighting, presence of a psoriasis diagnosis code (ixekizumab: 60% vs secukinumab: 45%; standardized difference [std diff] = -0.30), specialty of the index prescriber (std diff = 0.38), and mean number of prior advanced therapies (2.0 vs 1.5; std diff = -0.33) were different between cohorts. Cohorts were well balanced after weighting. The majority of secukinumab patients (71%) received an index dose of 300 mg. Rates of persistence (ixekizumab: 40% vs secukinumab: 43%; P = 0.411) and switching (25% vs 20%; P = 0.072) were not statistically different between cohorts. Use of new adjunctive pain and anti-inflammatory medications was not statistically different between cohorts either (ixekizumab: 63% vs secukinumab: 58%; P = 0.187). CONCLUSIONS: Real-world treatment patterns and use of adjunctive pain and anti-inflammatory medications were similar in patients with PsA initiating ixekizumab and secukinumab in this US-managed care population. Further research examining reasons for discontinuation, switching, and use of adjunctive medications may help inform treatment decisions for patients living with PsA. DISCLOSURES: Ms Pizzicato, Ms Ketkar, and Dr Grabner are employees of HealthCore, Inc, which received funding from Eli Lilly and Company for the conduct of the study on which this manuscript is based. Ms Pepe was an employee of HealthCore, Inc., during the time the study was conducted. Dr Grabner is a shareholder of Elevance Health (legacy Anthem, Inc.). Dr Vadhariya, Dr Birt, and Ms Bolce are employees of Eli Lilly and Company, the manufacturer of ixekizumab (Taltz). Dr Birt and Ms Bolce are shareholders of Eli Lilly and Company. Dr Walsh is a paid consultant to Eli Lilly and Company and Novartis, the manufacturers of ixekizumab (Taltz) and secukinumab (Cosentyx), respectively. Additionally, Dr Walsh is a paid consultant for Pfizer, Janssen, AbbVie, and UCB and has contracts with Pfizer, AbbVie, and Merck.

Current characteristics of a population of psoriatic arthritis and gender disparities

Psoriatic arthritis (PsA) is a polymorphic disease associated with numerous comorbidities. The objective of this study was to describe the main clinicobiological and imaging characteristics of a population of PsA and to extract any disparities between men and women. A total of 132 patients in the rheumatology department of Amiens University Hospital with a confirmed diagnosis of PsA according to the CASPAR criteria were included over a period of 4 months. All data were collected retrospectively in this observational and single-center study. The sex ratio was 1 and the average age at inclusion was 54.9 years. Peripheral PsA was the predominant clinical form. Axial PsA represented 12.1% of cases. Enthesitis was noted in 52.3% of cases while dactylitis was identified in 29.5% of cases. Moreover, 12.1% had a joint symptomatology preceding the appearance of cutaneous signs. HLA-B*27 positivity was found in 33.3% of cases. Chronic hyperuricemia accounted for 10% of our population. Sacroiliitis was observed in 41% of cases. The disparities between men and women are multiple and consistent with the literature: Polyarticular form, enthesitis, obesity, more intensive prescription of s-DMARDs, and b-DMARDs are more associated with the female population. Oligoarticular form, psoriatic nail dystrophy, radiological axial involvement, and chronic hyperuricemia are more encountered in the male population. Our study found a very heterogeneous disease, with marked differences between men and women. Peripheral PsA remains predominant but the search for associated axial involvement, which is probably underestimated, seems essential. This work studied the main characteristics of patients with PsA followed in real life, in a regional university reference center. We have highlighted a very heterogeneous disease as well as some gender disparities, not well described in the literature, which should be taken into account in order to optimize therapeutic management.

PsABIOnd Study and eDaily Substudy Design: Long-Term Effectiveness and Safety of Guselkumab and IL-17 Inhibitors in Routine Clinical Practice in Patients with Psoriatic Arthritis.

Randomised clinical studies in psoriatic arthritis (PsA) do not always reflect patients in routine clinical practice. Large-scale data from routine practice are needed to better understand drug persistence, effectiveness and long-term safety of therapeutic agents. PsABIOnd is an international, prospective, observational study designed to collect long-term routine care data in patients with PsA who receive guselkumab (an interleukin-23 [IL-23] inhibitor) or an interleukin-17 (IL-17) inhibitor. Adult patients (≥ 18years) with a confirmed diagnosis of PsA who are starting guselkumab or any approved IL-17 inhibitor as a first, second, third or fourth line of PsA treatment and who provide written informed consent will be eligible to participate. Participants will be followed for a maximum of 36months (+3months) from the start of treatment. Study visits will occur in line with the standard of care, approximately every 6months, plus an additional visit at 3months after the start of treatment. eDaily by PsABIOnd- aneHealth substudy, will document the impact of these treatments on wellbeing and symptoms in a subgroup of participants over a 24-week (+4weeks) observation period on treatment. The primary objective of PsABIOnd is to evaluate treatment persistence with guselkumab and IL-17 inhibitors. Data sources will include validated electronic patient-reported outcomes (ePROs) and physician-completed assessments. Safety data will be collected through reporting adverse events. The eDaily by PsABIOnd substudy will use wearable and digital technologies for continuous activity and sleep monitoring, and frequent patient eDiary and ePRO collection to provide a more detailed and comprehensive picture of PsA. ClinicalTrials.gov identifier: NCT05049798.

Immune and mathematical procedures in early diagnosis of psoriatic and seronegative rheumatoid arthritis

Objectives. Improvement of early diagnosis of psoriatic arthritis based on clinical data, immunological and mathematical research methods. Material and methods. The study was carried out between 2019 and 2022 at the Rheumatology and Nephrology Discipline, in the arthrology and rheumatology departments of the Timofei Moşneaga Republican Clinical Hospital. To accomplish the tasks set out in the study, 110 patients were examined, including 55 patients with psoriatic arthritis (group I) and 55 patients with rheumatoid arthritis (group II). Results. The range with the highest probability of psoriatic arthritis for the instrumental index is between 0.54 and 1.86. Of the 55 patients with psoriatic arthritis in 95% of patients clinical, laboratory, immunological and instrumental indices were within the range of the highest probability of the disease, which indicates a fairly high reliability of the mathematical model. Conclusions. Immune disorders in the early stages of rheumatoid arthritis and psoriatic arthritis are nonspecific and are characterized by an increase in CD16+ (26.2±1.5) and CD29+ (24.8±2.1) in rheumatoid arthritis, which is significantly higher than in psoriatic arthritis CD16+ (22.0±1.3) and CD29+ (17.4±3.2) (p &lt;0.05). A mathematical model of rheumatoid arthritis and psoriatic arthritis has been developed, which serves as an additional way of diagnosing rheumatoid arthritis and early psoriatic arthritis. Keywords: rheumatoid, psoriatic arthritis, mathematical, immune diagnosis.

Importance of quick attainment of minimal disease activity for a positive impact on lives of patients with psoriatic arthritis

ObjectiveTo compare patient-reported outcomes (PROs) from the first year to the third year between patients with psoriatic arthritis (PsA) who achieved minimal disease activity (MDA) in the first year after...

Fluorescence-optical imaging as a promising easy-to-use imaging biomarker to increase early psoriatic arthritis detection in patients with psoriasis: a cross-sectional cohort study with follow-up

ObjectivesTo evaluate the ability of fluorescence-optical imaging (FOI) to detect preclinical musculoskeletal inflammatory signs in patients with skin psoriasis at risk of developing psoriatic arthritis (PsA).MethodsThis investigator-initiated prospective exploratory study...

ADHERENCE TO TREATMENT AND PSYCHO-EMOTIONAL STATUS IN PATIENTS WITH PSORIATIC ARTHRITIS AND COMORBIDITY

At the current stage of medical science, the effectiveness of treatment depends not only on the professionalism of physicians, but also on the responsibility of the patients themselves. Low adherence has been proven to be a significant cause of the reduced therapy effectiveness and quality of life, increased risk of complications and treatment costs, worsening of disease prognosis, and reduced patient life expectancy. According to WHO reports, more than 250 factors can influence the adherence to the treatment. Until now, no "gold standard" has been developed for the assessment of adherence to treatment. Patients with psoriasis typically face social stigmatization and rejection, with subsequent profound effects on self-confidence, self-esteem, and feeling of psycho-emotional discomfort. Comorbidity of arthritis affects the psycho-emotional status of patients even more seriously. The purpose of the study is to analyze the psycho-emotional state, adherence to treatment, medical support and recommendations for lifestyle modification in patients with erosive form of psoriatic arthritis comorbidity. 60 patients with a reliable diagnosis of psoriatic arthritis and comorbid pathology were included in the study. Patients with psoriatic arthritis and comorbidity had mainly an average level of adherence to medication, medical support, and a low level of adherence to recommendations for lifestyle modifications. Taking oral glucocorticosteroids was associated with high adherence to drug therapy, while low adherence to medical care was associated with psychoemotional disorders such as anxiety and depression.

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.

18F-sodium fluoride PET-CT visualizes both axial and peripheral new bone formation in psoriatic arthritis patients

PurposeAs bone formation is associated with psoriatic arthritis (PsA), positron emission tomography (PET) using a 18F-Fluoride tracer may enable sensitive detection of disease activity. Our primary aim was to determine the feasibility of whole-body 18F-sodium fluoride PET-CT in clinically active PsA patients to depict new bone formation (as a reflection of disease activity) at peripheral joints and entheses. Our secondary aim was to describe 18F-sodium fluoride findings in the axial skeleton.MethodsSixteen patients (female 10/16, age 50.6 ± 8.9 years) with PsA fulfilling CASPAR criteria or with a clinical diagnosis of PsA according to the treating rheumatologist and with ≥ 1 clinically active enthesitis site were included. Of each patient, a whole-body 18F-sodium fluoride PET-CT scan was performed. All scans were scored for PET-positive lesions at peripheral joints, enthesis sites and the spine. Clinical disease activity was assessed by swollen/tender joint count 44, enthesitis according to MASES and SPARCC scores.ResultsOut of 1088 evaluated joints, 109 joints showed PET enhancement, mainly in the interphalangeal and metatarsal joints of the feet (14/109, 12.9%) and the distal interphalangeal joints of the hands (14/109, 12.9%). PET positivity was found at 44/464 enthesis sites, mainly at the patella tendon insertion (11/44, 25%) and quadriceps tendon insertion (10/44, 22.7%). Of the PET-positive joints and enthesis sites, respectively 18.2% and 29.5% were clinically positive; 81.8% and 70.5% of the PET-positive joints and entheses respectively were clinically asymptomatic. In 11 patients, ≥ 1 axial PET-positive lesion was observed, mainly in the cervical spine.ConclusionsNew molecular bone formation was observed on 18F-sodium fluoride PET-CT scans, in all domains in which PsA disease activity can be observed, with a substantial part showing no clinical symptoms.Clinical trial registrationEudraCT: 2017-004,850-40, registered on 13 December 2017.

Ultrasound Enthesitis in Psoriasis Patients with or without Psoriatic Arthritis, a Cross-Sectional Analysis

Background and objectives: The main objective of the current study was to describe the prevalence of enthesitis at different sites in a group of patients with psoriasis with or without psoriatic arthritis (PsA). Materials and Methods: The study included adult patients with psoriasis who underwent clinical examination, laboratory tests and ultrasound examination of the entheses. The enthesitis ultrasound scores (BUSES, MASEI, GUESS) were evaluated; the presence of OMERACT-defined enthesitis was also recorded for each scan site. Results: The study included 16 (57.1%) patients with PsA and 12 (42.9%) patients with psoriasis, with an increased average body mass index (29.3 kg/m2). Compared to psoriasis patients, PsA patients had a higher prevalence of nail psoriasis (68.8% compared to 33.3%; p = 0.063). There were no significant differences regarding the clinical examination of entheses between patients with psoriasis and patients with PsA (p = 0.459). Ultrasound scores, BUSES, GUESS and MASEI proved to have statistically significant higher median values in PsA patients compared to psoriasis patients. Compared to psoriasis patients, PsA patients had a significantly higher prevalence of OMERACT-defined enthesitis of the quadriceps tendon and inferior patellar ligament (both 81.3% compared to 25.0%, p = 0.003). Clinical examination of the lateral epicondyle and of the superior patellar ligament was consistent with their ultrasound examination (κ = 0.357, p = 0.043, respectively, κ = 0.404, p = 0.008). Conclusions: Clinical enthesitis scores do not differ between psoriasis and PsA patients. All analyzed ultrasound scores are significantly higher in patients with PsA. OMERACT-defined enthesitis has the ability to discriminate sonographic enthesitis between the two subgroups for bilateral quadriceps and inferior patellar tendon enthesitis. Bilateral ultrasound damage of entheses can suggest a PsA diagnosis.

Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis epidemiology in England from 2004 to 2020: An observational study using primary care electronic health record data.

SummaryBackgroundContemporary data on rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritits (SpA) epidemiology in England are lacking. This knowledge is crucial to planning healthcare services. We updated algorithms defining patients with diagnoses of RA, PsA, and axial SpA in primary care and applied them to describe their incidence and prevalence in the Clinical Practice Research Datalink Aurum, an electronic health record (EHR) database covering ∼20% of England.MethodsAlgorithms for ascertaining patients with RA, axial SpA, and PsA diagnoses validated in primary care EHR databases using Read codes were updated (to account for the English NHS change to SNOMED CT diagnosis coding) and applied. Updated diagnosis and synthetic disease-modifying anti-rheumatic drug code lists were devised by rheumatologists and general practitioners. Annual incidence/point-prevalence of RA, PsA, and axial SpA diagnoses were calculated from 2004 to 2020 and stratified by age/sex.FindingsPoint-prevalence of RA/PsA diagnoses increased annually, peaking in 2019 (RA 0·779% [95% confidence interval (CI) 0·773, 0·784]; PsA 0·287% [95% CI 0·284, 0·291]) then falling slightly. Point-prevalence of axial SpA diagnoses increased annually (except in 2018/2019), peaking in 2020 (0·113% [95% CI 0·111, 0·115]). RA diagnosis annual incidence was higher between 2013-2019 (after inclusion in the Quality and Outcomes Framework, range 49·1 [95% CI 47·7, 50·5] to 52·1 [95% CI 50·6, 53·6]/100,000 person-years) than 2004-2012 (range 34·5 [95% CI 33·2, 35·7] to 40·0 [95% CI 38·6, 41·4]/100,000 person-years). Increases in the annual incidence of PsA/axial SpA diagnosis occurred following new classification criteria publication. Annual incidence of RA, PsA and axial SpA diagnoses fell by 40·1%, 67·4%, and 38·1%, respectively between 2019 and 2020, likely reflecting the COVID-19 pandemic's impact on their diagnosis.InterpretationRecorded RA, PsA, and axial SpA diagnoses are increasingly prevalent in England, underlining the importance of organising healthcare services to provide timely, treat-to-target care to optimise the health of >1% of adults in England.FundingNational Institute for Health and Care Research (NIHR300826).