Psoriatic Arthritis Subjects Research Articles

Combined semiquantitative nail-enthesis complex ultrasonography and capillaroscopy in psoriasis and psoriatic arthritis.

This pilot study investigates distinctive features within the nail-enthesis complex among Psoriatic arthritis (PsA), Psoriasis (PSO), Rheumatoid Arthrit is (RA), and Healthy Control (HC) groups, utilizing a combined approach of ultrasound (US) and nailfold videocapillaroscopy (NVC). Clinical assessments and comprehensive US and NVC evaluations of the nail-enthesis complex were conducted on 72 subjects (18 PsA, 16 PSO, 19 RA, 19 HC). Unsupervised clustering models and factor analysis were employed to identify patterns and interrelationships between US and NVC parameters. Significant structural differences were detected, emphasizing the discriminatory power of semiquantitative US scores (GS BUNES, Wortsman type). Trends in vascularization aligned with literature, showcasing dysregulated angiogenesis in PsA and PSO. The clustering model effectively distinguished HC from PsA subjects, revealing a potential continuum between PSO and PsA. RA subjects exhibited subsets with features akin to both HC and PsA/PSO, underscoring the complexity of its manifestations. This study provides insights into nail-enthesis complex alterations, highlighting distinctions among PsA, PSO, RA, and HC subjects. The clustering model emphasizes potential overlap between PSO and PsA. Factor analysis elucidates collinearity in US-detected characteristics, while suggesting limited discriminative power of some quantitative parameters. These findings advocate for further exploration in prospective trials, potentially predicting the evolution of undifferentiated early arthritis and arthritis onset in PSO patients.

Glycosylation Pattern of Serum Clusterin in Psoriatic Arthritis and Rheumatoid Arthritis-The Search for New Diagnostic Glycomarkers.

Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are connective tissue autoimmune diseases. The present study aimed to check whether serum clusterin (CLU) concentration and its glycosylation pattern may be markers differentiating these diseases-blood sera of patients with PsA (n = 37), RA (n = 34), and healthy subjects (control, n = 21) were examined. CLU concentration was measured using the ELISA test. Glycosylation was analyzed using lectin-ELISA with sialo-specific lectins from Maackia amurensis (MAA) and Sambucus nigra (SNA) recognizing sialic acid (SA) α2,3- and α2,6-linked, respectively, and fucose-specific lectins from Lotus tetragonolobus (LTA), Ulex europaeus (UEA), and Lens culinaris (LCA) specific to fucose α1,3-linked, α1,2-linked, and core fucose, respectively. Significantly higher CLU concentrations were observed in the PsA than in the RA patients. The expression of α2,6-linked SA was significantly higher in the PsA and RA patients than in the control. The expression of SNA-reactive SA was visibly higher in the PsA compared to the RA and control group but insignificant. Negative significant correlations between CLU concentrations and its glycans reactivity with LTA and UEA were also observed. Significantly higher serum CLU concentration, accompanied by a high expression of SNA-reactive SA and a reduced degree of Lewisx and Lewisy antennary fucosylation, may constitute a promising panel of parameters differentiating PsA from RA.

Delay in Referral to Specialty Care in Patients with Spondyloarthropathy and Psoriatic Arthritis in India: IRA Database Report

Aim: The present study is intended to evaluate the factors influencing the diagnostic and rheumatology care referral delay in patients with spondyloarthropathy (SpA) and psoriatic arthritis (PsA) in India. Materials and methods: The independent prospective, multicentre, observational study collected data from 8 centres across India through the database created by the Indian Rheumatology Association (IRA). Modified Prasad scale was used for socio-economic classification based on the patient’s income. The data of PsA and SpA were analysed separately, and the causes were compared using t-test for continuous variables and chi-square and Fisher’s exact tests for categorical variables. Results: The mean referral delay noted for PsA and SpA subjects were 16.3±34.35 and 17.48±33.59 (IQR 24 and 34) months, respectively. Majority of the PsA patients and about 65% of SpA subjects reported a lack of awareness of the rheumatology specialty as the major reason for the delay. Another major reason was management by other specialists instead of rheumatologists (65% and 74% respectively). Approximately 8% of patients in both disease groups had no faith in modern care due to perceived elevated risk of adverse effects. SpA patients with improved socio-economic status had a higher proportion of subjects seeking specialty care. A direct association was noted between professional skill and early access to specialty care for both PsA and SpA patients. Conclusion: The lack of awareness of rheumatology as a specialty and patients being managed by other specialties are the two major reasons for delayed referral of SpA and PsA. Additionally, a patient’s economic and skill level can influence their ability to access specialty care.

Combined Single Cell Transcriptome and Surface Epitope Profiling Identifies Potential Biomarkers of Psoriatic Arthritis and Facilitates Diagnosis via Machine Learning.

Early diagnosis of psoriatic arthritis (PSA) is important for successful therapeutic intervention but currently remains challenging due, in part, to the scarcity of non-invasive biomarkers. In this study, we performed single cell profiling of transcriptome and cell surface protein expression to compare the peripheral blood immunocyte populations of individuals with PSA, individuals with cutaneous psoriasis (PSO) alone, and healthy individuals. We identified genes and proteins differentially expressed between PSA, PSO, and healthy subjects across 30 immune cell types and observed that some cell types, as well as specific phenotypic subsets of cells, differed in abundance between these cohorts. Cell type-specific gene and protein expression differences between PSA, PSO, and healthy groups, along with 200 previously published genetic risk factors for PSA, were further used to perform machine learning classification, with the best models achieving AUROC ≥ 0.87 when either classifying subjects among the three groups or specifically distinguishing PSA from PSO. Our findings thus expand the repertoire of gene, protein, and cellular biomarkers relevant to PSA and demonstrate the utility of machine learning-based diagnostics for this disease.

POS1061 THE ITALIAN PROSPECTIVE SIRENA STUDY: FOCUS ON EARLY PSORIATIC ARTHRITIS COHORT AND GENDER DIFFERENCES

Background:Limited data on early Psoriatic Arthritis (PsA) are available1,2.Objectives:To describe baseline data of PsA patients naive to any DMARDs.Methods:SIRENA study is an Italian, prospective Registry of Spondyloarthritis patients diagnosed according to ASAS criteria and naïve to any DMARDs. Data on demographic and clinical characteristics of PsA cohort were collected and analysed, also by gender.Results:203/350 (58%) subjects included in SIRENA Registry had PsA (mean age 51.9 years) and in 190/203 (94%) CASPAR classification criteria were fulfilled. In 70% of patients the diagnosis was performed within 24 months from symptom onset. At baseline, 194/203 (95.6%) had mainly peripheral manifestations, 74.4% of patients had skin psoriasis, 40% nail psoriasis, 39.3% clinical enthesitis and 25.9% dactylitis. Mean SJC66 and TJC68 were, respectively, 3 and 7.2; mean PhGA was 46.3; 14.7% of patients were in MDA.The higher tender joint count in women (mean TJC68 9.3 in women vs 5.3 in men) resulted in a higher disease activity according to DAPSA (high disease activity: 11.5% women vs 4.1% men), a higher joint VAS score (mean score 47.1 women vs 39.8 men) and a lower prevalence of MDA (8.3% women vs 20% men). We observed a higher prevalence of moderate or severe psoriasis in men (BSA≥3%: 37% men vs 27.8% women) while all PROs collected (PtGA, pain VAS score, sleep VAS score, BASFI, BASDAI, HAQ-DI, WPAI) were worse in women.The most common comorbidities were cardiometabolic (35.5%), endocrine (9.4%), and gastrointestinal disorders (7.4%). Cardiometabolic disorders were more frequently reported by men, endocrine and gastrointestinal disorders by women; depression exclusively by women.Conclusion:This analysis provides real-life data in a cohort of early PsA subjects. Relevant gender differences were observed, with women showing a higher disease activity and more joint pain and men having more severe psoriasis. Women also perceived a worse disease burden.

Ultrasound Proven Monosodium Urate Crystal Deposits in the Joints are Associated with Smaller Kidney Size, Decreased Intrarenal Blood Flow and Arteriosclerotic Type Vascular Changes

Abstract Objective: To establish the association between ultrasound (US) burden with articular MSU crystals and renal morphology, blood supply, function and arteriosclerotic carotid arteries alterations in gout patients, individuals with asymptomatic hyperuricemia and no sign of inflammatory arthritis and psoriatic arthritis subjects with asymptomatic hyperuricemia. Methods: 121 consecutive patients were included: 85 patients with gout, 27 subjects with asymptomatic hyperuricemia and 9 psoriatic arthritis patients. Subjects underwent US of both kidneys, common carotid arteries and bilateral US of the joints of the hands, elbows, knees, ankles and feet. For intrarenal blood flow we judged by measuring the renal resistive index (RRI). By US of the carotid arteries were determined intima-media thickness (IMT), common carotid artery resistive index (CCARI) and the presence of atherosclerotic plaques was registered. Results: Individuals with articular US MSU deposits compared to those without had higher RRI (p = 0.035) and smaller kidney size (p = 0.014), but renal parenchymal thickness (p = 0.893), echogenicity (p = 0.291), IMT (p = 0.165), CCARI (p = 0.097), the frequency of nephrolithiasis (p = 0.438) and atherosclerotic plaques (p = 0.830) were similar. Subjects with US evidence of MSU crystals in two or more joint regions had the highest RRI (p = 0.002) and CCARI (p = 0.019). Compared to gout patients the risk of MSU crystal accumulation in the joints of asymptomatic hyperuricemia group was lower by 82.7%, OR = 0.173 (95% CI; 0.060 – 0.498, p = 0.001), while in psoriatic arthritis patients the risk was lower by 82%, OR = 0.180 (95% CI; 0.038-0.861, p = 0.032). Conclusions: This study points out that subjects with larger extent of articular MSU burden have greater vascular stiffness. The accumulation of MSU crystals in the joints may be associated with the accumulation of crystals mainly in the renal interstitium.

P273 Ustekinumab and guselkumab treatment results in differences in serum IL-17A, IL-17F and CRP levels in PsA patients: a comparison from ustekinumab Phase 3 and guselkumab Phase 2 programmes

Abstract Background Ustekinumab (UST) is a monoclonal antibody (mAb) that binds the p40 epitope which is shared by IL-12 and IL-23, whereas guselkumab (GUS) is a mAb that selectively binds the p19 subunit of IL-23. In recent studies, both UST (Phase 3 programs) and GUS (Phase 2 program) have demonstrated a reduction in musculoskeletal clinical signs and symptoms and improvement of psoriatic lesions in patients with active psoriatic arthritis (PsA), implicating the IL-12/23 pathway in disease pathogenesis. This analysis explored the post-treatment pharmacodynamic changes of IL-17A, IL-17F, and CRP with GUS and UST in the context of PsA. Methods Serum protein levels of IL-17A, IL-17F, and CRP were measured in 142 subjects and 38 matched healthy controls from the GUS Phase 2 study at Week (W)0, W4, and W16. In the UST Phase 3 studies, biomarkers were assayed at W0, W4, and W24 as follows: IL-17A (n = 474), IL-17F (n = 237), CRP (n = 927). IL-17A and IL-17F were assayed using Single Molecule CountingTM Human Immunoassay Kits (formerly Singulex). CRP was measured using CardioPhase hsCRP assay (UST studies) or Meso Scale Discovery Platform (GUS study). Results At baseline, the Th17 effector cytokines IL-17A and IL-17F were elevated in the serum of PsA subjects in the GUS Phase 2 cohort compared to healthy controls. IL-17A and IL-17F levels significantly correlated with affected skin body surface area, but not swollen or tender joint scores, in both studies. While none of the baseline levels of evaluated cytokines were associated with American College of Rheumatology (ACR) or Psoriasis Area Severity Index (PASI) clinical responses to UST, baseline IL-17F levels were modestly associated with ACR20 response to GUS at Week 24. Both UST and GUS treatment resulted in pharmacodynamic decreases in IL-17A, IL-17F, and CRP levels, with GUS treatment restoring IL-17A and IL-17F levels to that of healthy controls by W16. Consistent with being a component of ACR scores, CRP changes were significantly associated with ACR20 responses to both UST and GUS treatment. W4 and W16 changes in IL-17F with GUS treatment were significantly associated with ACR20 response at W24. W24 PASI75 response to GUS was significantly associated with W4 changes in IL-17A, with a similar trend observed at W16. Conclusion These results underscore the relevance of the IL-23/Th17 pathway in PsA, with GUS treatment providing a stronger suppression of the pathway than UST treatment. The significant associations of changes in IL-17A and IL-17F levels with GUS treatment with PASI75 and ACR20 response, respectively, support the importance of the IL-23/Th17 pathway for both skin and joint pathologies. The associations of reduction in CRP levels with both UST and GUS treatment also reinforce the role of acute phase inflammation in joint pathology. Disclosures S. Siebert: Other; S.S. has been a study investigator for Janssen. M.J. Loza: Other; M.L. is a Janssen employee. Q. Song: Other; Q.S. is a Janssen employee. P.C. Gorecki: Other; P.G. is a Janssen employee. I.B. McInnes: Other; I.M. has been a study investigator for Janssen. K. Sweet: Other; K.S. is a Janssen employee.

Late-Onset and Elderly Psoriatic Arthritis: Clinical Aspects and Management

Psoriatic arthritis (PsA) can start in subjects aged over 60years, defined as late-onset PsA. In late-onset PsA, the weight of family history and genetic background appears less significant when compared with younger onset PsA, whereas obesity and smoking have been suggested as potential risk factors. In patients with late-onset PsA, erosive polyarticular or oligoarticular patterns are more frequent than other phenotypes. Laboratory findings usually show an increase in levels of acute phase reactants, including erythrocyte sedimentation rate and C-reactive protein. The drugs used for the management of young PsA subjects represent the same therapeutic armamentarium used in patients with late-onset disease. However, in elderly subjects, these anti-inflammatory, immunomodulatory and immunosuppressive therapies, including newer biologic therapies, represent an important challenge due to age aspects, increased frequency of comorbidities and associated polypharmacotherapy. There is a need for more evidence around treatment strategy for these patients in order to identify the best balance between the benefits and risks of pharmacological agents. This is important for establishing how treatment should ideally be tailored to the characteristics of any single patient and to the presence of complex age- and disease-related aspects. The objective of this review is to focus on pathogenetic, clinical and therapeutic aspects of late-onset PsA and the management of elderly PsA patients.

178 Long-term improvements in physical function of disease-modifying anti-rheumatic drug/biologic-experienced and disease-modifying anti-rheumatic drug-naïve psoriatic arthritis subjects treated with apremilast

178 Long-term improvements in physical function of disease-modifying anti-rheumatic drug/biologic-experienced and disease-modifying anti-rheumatic drug-naïve psoriatic arthritis subjects treated with apremilast

Association of variably expressed KIR3dl1 alleles with psoriatic disease.

The purpose of this study is to examine the genetic interaction of variably expressed killer cell immunoglobulin-like receptor (KIR) 3DL1 alleles with their cognate ligand, human leukocyte antigen (HLA)-Bw4, in susceptibility to psoriatic disease (PsD). A novel allelic typing system was developed to differentiate KIR3DL1 alleles (*High, *Low, *Null expression, and 3DS1), in PsD patients, including those with psoriatic arthritis (PsA) and cutaneous psoriasis without arthritis (PsC) and healthy controls. Frequencies of each KIR3DL1 allele, Bw4-80I and Bw4-80T, as well as the genetic interaction between the KIR3DL1 alleles and the Bw4 epitope were analyzed. KIR3DL1 alleles were successfully genotyped in 392 PsA, 260 PsC, and 371 control subjects. Only the KIR3DL1*Null allele was associated with PsD (OR=0.69, p=0.008), both in the PsA (OR=0.69, p=0.02) and PsC patients (OR=0.70, p=0.04) compared to control subjects. No difference in the frequency of KIR3DL1*Null was found between the PsA and PsC patients. The presence of the HLA-Bw4 epitope was significantly associated with PsD, particularly in the PsA patients compared to controls. Bw4-80I was increased in PsD and PsA subjects, but not in PsC patients compared to controls. Bw4-80T was increased in PsA compared to both PsC patients or to controls. No interaction was detected between any of the KIR3DL1 alleles and HLA-Bw4, Bw4-80I, or Bw4-80T. The novel qPCR technique successfully identified the four variably expressed KIR3DL1 alleles. The HLA-Bw4 epitope was associated with psoriatic disease, particularly with PsA, but no genetic interactions with KIR3DL1 alleles were detected.

The impact of concomitant diffuse idiopathic skeletal hyperostosis on the achievement of minimal disease activity in subjects with psoriatic arthritis.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of different entheses. Psoriatic arthritis (PsA) is a seronegative spondyloarthritis associated with psoriasis. Given the possible overlap of the two diseases, we assessed whether DISH presence may affect PsA clinical outcomes. Also, predictors of DISH presence in the cohort were investigated. Consecutive PsA patients from two Italian Rheumatology Research Units were enrolled. Subjects were splitted into two groups, according to the current treatment (TNF-α blockers or traditional DMARDs). All patients underwent a rheumatologic examination, blood sample collections and spine radiographs. Information about traditional vascular risk factors was recorded. In each patient, the presence of minimal disease activity was evaluated and the presence of DISH was established according to the Resnick and Niwayama criteria. Among the 80 enrolled subjects (57.5% men, mean age 56.5±11.1years), the overall prevalence of DISH was 30.0%. Patients with DISH were older, with higher BMI and waist circumference. DISH subjects showed worsen BASMI, HAQ and ESR. In a multivariate regression model, BASMI was a significant predictor of DISH presence (OR 3.027, 95% CI 1.449-6.325, p=0.003). The prevalence of MDA was lower in DISH patients than in no-DISH (16.7 vs 41.1%, p=0.041), and the presence of DISH was a predictor of not achieving MDA (OR 3.485, 95% CI 1.051-11.550, p=0.041). PsA subjects with DISH showed worsen indices of spine mobility and articular function and lower prevalence of minimal disease activity than no-DISH patients.

Cardiovascular risk markers in patients with psoriatic arthritis: A meta-analysis of literature studies

Introduction. Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with psoriatic arthritis (PsA). We performed a meta-analysis on the impact of PsA on major markers of CV risk.Methods. Studies on the relationship between PsA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus, and EMBASE databases.Results. Sixteen case-control studies (898 cases, 1,140 controls) were included. Compared to controls, PsA patients showed a higher CCA-IMT (MD 0.07 mm; 95% CI 0.04, 0.11; P < 0.0001), and a higher frequency of carotid plaques (OR 3.12; 95% CI 1.03, 9.39; P = 0.04). Moreover, a lower FMD was found in PsA subjects than in controls (MD –2.56%; 95% CI –4.17, –0.94; P = 0.002), with no differences in NMD (MD –0.40%; 95% CI –1.19, 0.39; P = 0.32). Because of the low number of studies, no meta- analytical evaluation was performed for PWV, AIx, and ABI. Despite heterogeneity among studies, PsA appears significantly associated with markers of subclinical atherosclerosis and CV risk.Discussion. These findings could help to establish more specific CV prevention strategies in this clinical setting.

Analysis of Trial Data for Infliximab and Golimumab: Baseline C‐Reactive Protein Level and Prediction of Therapeutic Response in Patients With Psoriatic Arthritis

Anti-tumor necrosis factor medications have demonstrated good efficacy in treating psoriatic arthritis (PsA). Clinical responses at the primary end point in recent clinical trials of golimumab in PsA subjects yielded lower American College of Rheumatology 20% criteria for improvement (ACR20) responses than those seen in the Infliximab Multinational Psoriatic Arthritis Controlled Trial 2 infliximab study. However, baseline C-reactive protein (CRP) levels of PsA subjects enrolled in these trials differed significantly. We hypothesized that baseline CRP levels predict the observed differing clinical response rates at the primary end point. Combining the data from the infliximab and golimumab trials, we stratified the data by baseline CRP levels and then correlated these cohorts with response to treatment, specifically the Psoriasis Area and Severity Index and the ACR20, ACR50, and ACR70 responses. The mean baseline CRP level in the infliximab trial was 1.9 mg/dl versus 1.4 mg/dl in the golimumab trial. Only 23% of golimumab subjects had a CRP level ≥1.7 mg/dl versus 35% of infliximab subjects (P = 0.0023). All subjects with a CRP level ≥1.7 mg/dl at baseline achieved higher ACR20, ACR50, ACR70 response rates (56%, 36%, and 18%, respectively) at the primary end point of 14 weeks in the infliximab and golimumab clinical trials than any subjects with a CRP level <1.7 mg/dl (48%, 28%, and 13%, respectively [P = 0.045, P = 0.027, and P = 0.089, respectively]). These results demonstrate that an increased baseline CRP level predicted improved therapeutic response at the primary end point for subjects treated with both golimumab and infliximab. To allow for comparison between future drug development studies and meta-analyses, baseline CRP levels should be factored into the multivariate analysis

Impact Of The Neutrophil-to-Lymphocyte Ratio On Coronary Flow Reserve And Incipient Myocardial Dysfunction In Patients With Psoriatic Arthritis

Aim: The aim of the present study was to investigate the impact of Neutrophil-Lymphocyte Ratio (NLR) on Coronary Flow Reserve (CFR) and incipient myocardial dysfunction in patients with Psoriatic Arthritis (PsA) without risk for coronary artery disease. Methods and results: We analyzed clinical, hematologic, echocardiographic and CFR data of 68 patients (mean age 41.5 ± 8.2years), who had no risk factor for coronary artery disease. Sixty-two healthy subjects were served as control group. NLR was significantly higher in patients with PsA versus control subjects (7.86 ± 0.6 vs. 1.39 ± 0.6, P<0 .0001). CFR was significantly lower in patients with PsA than in control subjects (1.9 ± 0.3 vs. 3.6 ± 0.2; P <0.002). The myocardial function was significantly impaired in patients than control subjects (E/E’ was 12.3 + 0.7 vs. 5.3 ± 0.8; P<0.01 and Sm was 3.9 ± 0.3 vs. 8.9 ± 0.5; P<0.01). NLR was significantly negatively correlated with CFR (r=- 0.73, P<0.0001); Sm (r=0.43; P<0.03), and positively correlated with E/E’ (r=0.57; P<0.001). Using multiple logistic regression analysis, NLR, and C-reactive protein levels emerged as independent predictors of impaired CFR, elevated E/E’ and decreased Sm. In receiver operating characteristics curve analysis, NLR ≥ 3.2 and ≥ 3.6 were the cut-offs in predicting impaired CFR and increased E/E’ in patients with PsA. Conclusion: High NLR is a powerful and independent predictor of impaired CFR and incipient myocardial dysfunction in patients with psoriasis arthritis.

Impact of hypertension on vascular remodeling in patients with psoriatic arthritis

We studied the impact of hypertension along with traditional and new cardiovascular risk factors on the structural and functional properties of arteries in psoriatic arthritis (PsA) patients. We examined 42 PsA subjects (aged 51±9 years) stratified according to hypertensive status (19 normotensive, PsA-NT and 23 hypertensives, PsA-HT). Thirty-eight normotensive subjects (C-NT) and 23 hypertensives (C-HT) comparable by age and sex served as controls. Mean carotid intima-media thickness (mean-IMT) and mean of the maximum IMT (M-Max) were evaluated by ultrasound in carotid artery segment bilaterally. Post-occlusion flow-mediated dilation (FMD) of the brachial artery was evaluated by ultrasonography. These parameters were correlated with risk factors, markers of inflammation and disease activity. Values of mean-IMT were higher in both groups of PsA patients compared with C-NT (0.68 mm in PsA-NT and 0.75 mm in PsA-HT versus 0.61 mm in C-NT). PsA-HT displayed higher M-Max (0.95 mm) versus both C-HT (0.71 mm) and PsA-NT (0.79 mm). FMD was impaired in PsA subjects compared with C-NT (5.7% in PsA-NT and 6.0% PsA-HT versus 9.3% in C-NT), whereas there was no difference among PsA-HT, PsA-NT, and C-HT groups. Values of carotid IMT were directly related to tumor necrosis factor (TNF)-α, osteoprotegerin (OPG), blood pressure and lipid profile levels. FMD showed an inverse relationship with TNF-α and blood pressure, but no correlation with lipids. In conclusion, PsA per se implies a pro-atherogenic remodeling, which is enhanced by the hypertensive status. TNF-α and OPG may have an independent role in the development of such vascular damage.

AB0588 Prevalence of conventional cardiovascular risk factors in patients with psoriasis alone and in patients with psoriatic arthritis

BackgroundPatients with psoriasis and psoriatic arthritis (PsA) are at increased risk of cardiovascular disease. It has been suggested that this elevated risk reflects an increased prevalence of conventional cardiovascular risk...

Obesity and the prediction of minimal disease activity: A prospective study in psoriatic arthritis

We prospectively evaluated whether obesity impacts achievement of minimal disease activity (MDA) in subjects with psoriatic arthritis (PsA). Among PsA subjects with an active disease and who were starting a treatment with tumor necrosis factor α blockers, 135 obese (body mass index [BMI] >30 kg/m(2) ) patients and 135 patients of normal weight (controls) were followed up for 24 months. At baseline and at the 12- and 24-month followup, all subjects underwent a clinical, rheumatologic, and laboratory assessment. With the exception of the prevalence of hypercholesterolemia and hypertriglyceridemia, case and control subjects were similar for all the clinical and demographic characteristics analyzed. At the 12-month followup, in both cases and controls, no significant changes in body weight were found (P > 0.05 for all). MDA was achieved by 98 (36.3%) of the 270 PsA individuals. The prevalence of obesity was higher in those that did not achieve MDA than in those that did (64.0% versus 25.5%; P < 0.001). After adjusting for all the other variables, obesity was associated with a higher risk of not achieving MDA (hazard ratio [HR] 4.90, 95% confidence interval [95% CI] 3.04-7.87; P < 0.001). The HR of not achieving MDA was 3.98 (95% CI 1.96-8.06, P < 0.001) and 5.40 (95% CI 3.09-9.43, P < 0.001) in subjects with first-degree (BMI <30 kg/m(2) ) and second-degree (BMI 30-35 kg/m(2) ) obesity, respectively. Among the 98 subjects who had achieved MDA at the 12-month followup, the presence of obesity was associated with a poor probability of sustained MDA at the 24-month followup (HR 2.04, 95% CI 1.015-3.61; P = 0.014). Obesity is a negative predictor of achieving and maintaining MDA.

Decreased prevalence of atopic features in patients with psoriatic arthritis, but not in psoriasis vulgaris

The prevalence of atopic disorders is reduced in patients with various autoinflammatory diseases but, to our knowledge, this association has not been studied in psoriasis vulgaris or psoriatic arthritis (PSA). Prevalence of hay fever, asthma, and sensitization to common aeroallergens was compared in patients with psoriasis vulgaris to patients with PSA and control subjects; we also investigated whether atopy influences the arthritis activity and severity scores in patients with PSA. In a cross-sectional cohort study design, the differences in patient-reported lifetime prevalence of atopic disorders and serum IgE directed against common aeroallergens were compared. The effect of atopy on arthritis severity was assessed using the 28-joint Disease Activity Score and Health Assessment Questionnaire. Logistic regression models were used to calculate crude and adjusted odds ratios with 95% confidence intervals (CI) for presence of atopy. A total of 168 patients with PSA, 133 patients with psoriasis vulgaris, and 147 control subjects were included. The lifetime prevalence of hay fever did not differ across groups. Patients with PSA were less likely to have had asthma than control subjects (adjusted odds ratio 0.20; 95% CI 0.04-0.92) and they were less likely to be sensitized (adjusted odds ratio 0.50; 95% CI 0.25-0.99). Health Assessment Questionnaire-visual analog scales for pain and for patient global score were significantly reduced by sensitization to common aeroallergens (beta-coefficients -0.54 [95% CI -0.84 to -0.25] and -18.4 [95% CI -28.5 to -8.25], respectively.) This was a cross-sectional, small-numbered study. Atopy may protect against development of PSA and diminish its severity.

Hepatic Steatosis and Disease Activity in Subjects with Psoriatic Arthritis Receiving Tumor Necrosis Factor-α Blockers

Little is known about tumor necrosis factor-α (TNF-α) blockers, disease activity, and liver steatosis (hepatic steatosis; HS) in subjects with psoriatic arthritis (PsA). We prospectively evaluated changes in HS during treatment with TNF-α blockers. In 48 patients with PsA who had evidence of HS before the beginning of TNF-α blocker treatment, an ultrasound followup examination was performed after a 12-month treatment period with TNF-α blockers. All subjects were stratified according to minimal disease activity (MDA) or not (n-MDA), during treatment with TNF-α blockers. Changes in grade of HS were evaluated in parallel in 42 controls with HS and without PsA. At baseline, no significant difference in HS score was found between PsA subjects and controls (HS scores 1.46 ± 0.65 vs 1.62 ± 0.66, respectively; p = 0.249). At 12-month followup, a worsening HS score was found in 20 (41.7%) patients with PsA and in 6 (14.3%) controls (p = 0.005). Overall, the grade of HS worsening was higher in patients with PsA (0.37 ± 0.70) than in controls (0.09 ± 0.43; p = 0.028). A significantly lower prevalence of worsening HS was found among patients with PsA with MDA, compared with n-MDA subjects (16.7% vs 66.7%, respectively; p = 0.001). Laboratory measures of liver function behaved similarly. The risk of worsening HS in patients with PsA who had MDA was similar to that in controls (HR 1.20, 95% CI 0.34-4.33, p = 0.77), and higher in patients who did not have MDA (HR 4.46, 95% CI 1.73-11.47, p = 0.001, regression analysis). Compared with patients with MDA, those with active disease after 12-month treatment with TNF-α blockers exhibited significantly higher incidence of worsening liver steatosis.

Predictors of Early Minimal Disease Activity in Patients with Psoriatic Arthritis Treated with Tumor Necrosis Factor-α Blockers

To identify predictors of early minimal disease activity in patients with psoriatic arthritis (PsA) receiving tumor necrosis factor-α (TNF-α) antagonists. In total 146 consecutive patients with PsA eligible for anti-TNF-α therapy were enrolled. At baseline (T0) information about age, sex, PsA subset, disease duration, comorbidities, and treatments was collected. All subjects were tested for metabolic syndrome (MetS) and/or liver steatosis. A clinical and laboratory evaluation was performed at T0 and at 3 months (T3). Changes in all these variables were compared in subjects achieving minimal disease activity (MDA) and those who did not. Among 146 PsA subjects, 10 discontinued therapy before 3-month followup because of adverse events; thus 136 concluded the study. All clinical outcome measures changed significantly from T0 to T3. Erythrocyte sedimentation rate showed a significant reduction (p < 0.001). C-reactive protein (CRP), serum cholesterol, and triglycerides showed no significant variation (p > 0.05). The prevalence of MetS and liver steatosis showed no significant differences between subjects achieving MDA and those who did not (p = 0.347 and 0.053, respectively). Patients achieving MDA at T3 were younger than those not achieving MDA (p = 0.001). A lower baseline tender joint count (p = 0.001), swollen joint count (p = 0.013), Bath Ankylosing Spondylitis Disease Activity Index (p = 0.021), and Ritchie index (p = 0.006) were found in subjects achieving MDA. Age (OR 0.896, p = 0.003) and Bath Ankylosing Spondylitis Functional Index (BASFI) (OR 0.479, p = 0.007) inversely predicted, whereas CRP (OR 1.78, p = 0.018) directly predicted, achievement of MDA at T3. In patients with PsA, age, CRP, and BASFI at the beginning of treatment were found to be reliable predictors of MDA after 3 months of TNF-α blocker therapy.