Key clinical point: In the real-world setting, ixekizumab showed improvements in disease activity and treatment persistence in patients with psoriatic arthritis (PsA) with long-standing disease.

Major finding: The mean time of ixekizumab persistence was 86.9 weeks with the persistence rates at 24, 48, and 104 weeks being 95.5%, 84.3%, and 68.5%, respectively. The Disease Activity in Psoriatic Arthritis score reduced significantly from 23.7 at baseline to 14.8 (P  =  .005) and 14.3 (P  =  .004) at 12 and 24 weeks, respectively, of ixekizumab treatment.

Study details: Findings are from an observational, retrospective longitudinal study including 89 adult patients with PsA who initiated ixekizumab.

Disclosures: This study was funded by Eli Lilly & Co. Three authors declared being employees of Lilly and two authors reported employment with a consulting company funded by Lilly. Five authors reported ties with various sources, including Lilly. Other authors declared no conflicts of interest.

Source: Joven B et al. Persistence and use of Ixekizumab in patients with psoriatic arthritis in real-world practice in Spain. The PRO-STIP Study. Rheumatol Ther. 2023 (Jul 23). doi: 10.1007/s40744-023-00584-8

Key clinical point: In the real-world setting, ixekizumab showed improvements in disease activity and treatment persistence in patients with psoriatic arthritis (PsA) with long-standing disease.

Major finding: The mean time of ixekizumab persistence was 86.9 weeks with the persistence rates at 24, 48, and 104 weeks being 95.5%, 84.3%, and 68.5%, respectively. The Disease Activity in Psoriatic Arthritis score reduced significantly from 23.7 at baseline to 14.8 (P  =  .005) and 14.3 (P  =  .004) at 12 and 24 weeks, respectively, of ixekizumab treatment.

Study details: Findings are from an observational, retrospective longitudinal study including 89 adult patients with PsA who initiated ixekizumab.

Disclosures: This study was funded by Eli Lilly & Co. Three authors declared being employees of Lilly and two authors reported employment with a consulting company funded by Lilly. Five authors reported ties with various sources, including Lilly. Other authors declared no conflicts of interest.

Source: Joven B et al. Persistence and use of Ixekizumab in patients with psoriatic arthritis in real-world practice in Spain. The PRO-STIP Study. Rheumatol Ther. 2023 (Jul 23). doi: 10.1007/s40744-023-00584-8

Key clinical point: In the real-world setting, ixekizumab showed improvements in disease activity and treatment persistence in patients with psoriatic arthritis (PsA) with long-standing disease.

Major finding: The mean time of ixekizumab persistence was 86.9 weeks with the persistence rates at 24, 48, and 104 weeks being 95.5%, 84.3%, and 68.5%, respectively. The Disease Activity in Psoriatic Arthritis score reduced significantly from 23.7 at baseline to 14.8 (P  =  .005) and 14.3 (P  =  .004) at 12 and 24 weeks, respectively, of ixekizumab treatment.

Study details: Findings are from an observational, retrospective longitudinal study including 89 adult patients with PsA who initiated ixekizumab.

Disclosures: This study was funded by Eli Lilly & Co. Three authors declared being employees of Lilly and two authors reported employment with a consulting company funded by Lilly. Five authors reported ties with various sources, including Lilly. Other authors declared no conflicts of interest.

Source: Joven B et al. Persistence and use of Ixekizumab in patients with psoriatic arthritis in real-world practice in Spain. The PRO-STIP Study. Rheumatol Ther. 2023 (Jul 23). doi: 10.1007/s40744-023-00584-8

Key clinical point: Synovial and serum B-lymphocyte involvement differ between autoantibody-positive and autoantibody-negative rheumatoid arthritis (RA), with autoantibody-negative RA closely resembling that in polyarticular psoriatic arthritis (PsA).

Major finding: The CD20+ B-cell aggregational score was significantly lower in autoantibody-negative RA than in autoantibody-positive RA (mean 1.8 vs 2.4; P  =  .03) but comparable to that of polyarticular PsA (P  =  .78). The frequency of lympho-myeloid synovitis was lower in autoantibody-negative RA than in autoantibody-positive RA (38.2% vs 62.9%; P  =  .07) but comparable to that of polyarticular PsA (P  =  .8).

Study details: This study included 131 patients who underwent synovial biopsy and were categorized into those having autoantibody-positive RA (n = 43), autoantibody-negative RA (n = 35), symmetric polyarticular PsA (n = 25), and asymmetric oligoarticular PsA (n = 28).

Disclosures: This study was supported by IRCCS Policlinico San Matteo Foundation, Pavia, Italy. C Montecucco and S Bugatti reported receiving grants or research support and personal fees from various sources. The remaining authors declared no conflicts of interest.

Source: De Stefano L et al. Synovial and serum B-cell signature of autoantibody-negative rheumatoid arthritis versus autoantibody-positive rheumatoid arthritis and psoriatic arthritis. Rheumatology (Oxford). 2023 (Jul 22). doi: 10.1093/rheumatology/kead378

Key clinical point: Synovial and serum B-lymphocyte involvement differ between autoantibody-positive and autoantibody-negative rheumatoid arthritis (RA), with autoantibody-negative RA closely resembling that in polyarticular psoriatic arthritis (PsA).

Major finding: The CD20+ B-cell aggregational score was significantly lower in autoantibody-negative RA than in autoantibody-positive RA (mean 1.8 vs 2.4; P  =  .03) but comparable to that of polyarticular PsA (P  =  .78). The frequency of lympho-myeloid synovitis was lower in autoantibody-negative RA than in autoantibody-positive RA (38.2% vs 62.9%; P  =  .07) but comparable to that of polyarticular PsA (P  =  .8).

Study details: This study included 131 patients who underwent synovial biopsy and were categorized into those having autoantibody-positive RA (n = 43), autoantibody-negative RA (n = 35), symmetric polyarticular PsA (n = 25), and asymmetric oligoarticular PsA (n = 28).

Disclosures: This study was supported by IRCCS Policlinico San Matteo Foundation, Pavia, Italy. C Montecucco and S Bugatti reported receiving grants or research support and personal fees from various sources. The remaining authors declared no conflicts of interest.

Source: De Stefano L et al. Synovial and serum B-cell signature of autoantibody-negative rheumatoid arthritis versus autoantibody-positive rheumatoid arthritis and psoriatic arthritis. Rheumatology (Oxford). 2023 (Jul 22). doi: 10.1093/rheumatology/kead378

Key clinical point: Synovial and serum B-lymphocyte involvement differ between autoantibody-positive and autoantibody-negative rheumatoid arthritis (RA), with autoantibody-negative RA closely resembling that in polyarticular psoriatic arthritis (PsA).

Major finding: The CD20+ B-cell aggregational score was significantly lower in autoantibody-negative RA than in autoantibody-positive RA (mean 1.8 vs 2.4; P  =  .03) but comparable to that of polyarticular PsA (P  =  .78). The frequency of lympho-myeloid synovitis was lower in autoantibody-negative RA than in autoantibody-positive RA (38.2% vs 62.9%; P  =  .07) but comparable to that of polyarticular PsA (P  =  .8).

Study details: This study included 131 patients who underwent synovial biopsy and were categorized into those having autoantibody-positive RA (n = 43), autoantibody-negative RA (n = 35), symmetric polyarticular PsA (n = 25), and asymmetric oligoarticular PsA (n = 28).

Disclosures: This study was supported by IRCCS Policlinico San Matteo Foundation, Pavia, Italy. C Montecucco and S Bugatti reported receiving grants or research support and personal fees from various sources. The remaining authors declared no conflicts of interest.

Source: De Stefano L et al. Synovial and serum B-cell signature of autoantibody-negative rheumatoid arthritis versus autoantibody-positive rheumatoid arthritis and psoriatic arthritis. Rheumatology (Oxford). 2023 (Jul 22). doi: 10.1093/rheumatology/kead378

Key clinical point: Patients with psoriasis or psoriatic arthritis (PsA) treated with anti-interleukin-23 (anti-IL-23) antibodies are at a significantly higher risk for ischemic cerebral stroke (ICS) compared with individuals from the general population.

Major finding: The risk for ICS was significantly higher among patients receiving anti-IL-23 treatment compared with individuals from the general population (hazard ratio 1.770; P  =  .03).

Study details: This comparative observational study included patients with psoriasis or PsA who received anti-IL-23 (n = 7051), anti-IL-17 (n = 12,215), anti-IL-12/23 (n = 2819), anti-tumor necrosis factor-α (n = 2133), or apremilast (n = 13,139) therapy, whereas individuals with at least 1 healthcare consumption in a month formed the control group (n = 33,428,380).

Disclosures: This study did not receive any funding. T Passeron declared receiving grants or honoraria from various sources. The other authors declared no conflicts of interest.

Source: Bulsei J et al. Ischemic cerebral stroke risk under psoriasis and psoriatic arthritis treatment: A real-world observational study from the French national healthcare system database. J Eur Acad Dermatol Venereol. 2023 (Jul 17). doi: 10.1111/jdv.19356

Key clinical point: Patients with psoriasis or psoriatic arthritis (PsA) treated with anti-interleukin-23 (anti-IL-23) antibodies are at a significantly higher risk for ischemic cerebral stroke (ICS) compared with individuals from the general population.

Major finding: The risk for ICS was significantly higher among patients receiving anti-IL-23 treatment compared with individuals from the general population (hazard ratio 1.770; P  =  .03).

Study details: This comparative observational study included patients with psoriasis or PsA who received anti-IL-23 (n = 7051), anti-IL-17 (n = 12,215), anti-IL-12/23 (n = 2819), anti-tumor necrosis factor-α (n = 2133), or apremilast (n = 13,139) therapy, whereas individuals with at least 1 healthcare consumption in a month formed the control group (n = 33,428,380).

Disclosures: This study did not receive any funding. T Passeron declared receiving grants or honoraria from various sources. The other authors declared no conflicts of interest.

Source: Bulsei J et al. Ischemic cerebral stroke risk under psoriasis and psoriatic arthritis treatment: A real-world observational study from the French national healthcare system database. J Eur Acad Dermatol Venereol. 2023 (Jul 17). doi: 10.1111/jdv.19356

Key clinical point: Patients with psoriasis or psoriatic arthritis (PsA) treated with anti-interleukin-23 (anti-IL-23) antibodies are at a significantly higher risk for ischemic cerebral stroke (ICS) compared with individuals from the general population.

Major finding: The risk for ICS was significantly higher among patients receiving anti-IL-23 treatment compared with individuals from the general population (hazard ratio 1.770; P  =  .03).

Study details: This comparative observational study included patients with psoriasis or PsA who received anti-IL-23 (n = 7051), anti-IL-17 (n = 12,215), anti-IL-12/23 (n = 2819), anti-tumor necrosis factor-α (n = 2133), or apremilast (n = 13,139) therapy, whereas individuals with at least 1 healthcare consumption in a month formed the control group (n = 33,428,380).

Disclosures: This study did not receive any funding. T Passeron declared receiving grants or honoraria from various sources. The other authors declared no conflicts of interest.

Source: Bulsei J et al. Ischemic cerebral stroke risk under psoriasis and psoriatic arthritis treatment: A real-world observational study from the French national healthcare system database. J Eur Acad Dermatol Venereol. 2023 (Jul 17). doi: 10.1111/jdv.19356

Key clinical point: Musculoskeletal ultrasound along with physical examination can help identify juvenile psoriatic arthritis in pediatric patients with skin psoriasis showing musculoskeletal symptoms.

Major finding: Ultrasound evaluation showed higher number of joint and enthesitis abnormalities in pediatric patients with psoriasis who were symptomatic vs asymptomatic for musculoskeletal pain or swelling (all P ≤ .01). The concordance for detecting synovitis and enthesitis between physical and ultrasound examination was 82%.

Study details: Findings are from a cross-sectional study including 57 pediatric patients with psoriasis and no previous diagnosis of juvenile idiopathic arthritis or any systemic disease-causing articular manifestations who underwent ultrasound evaluation and clinical examination.

Disclosures: This study was supported by the PARTNER Fellowship program created with an unrestricted grant by Celgene-AMGEN, with L Coronel as a PARTNER fellow. Two authors declared ties with various sources, including Amgen. Two authors declared no conflicts of interest.

Source: Coronel L et al. Prevalence of ultrasound and clinical findings suggestive of inflammatory arthritis in children with skin psoriasis. Rheumatology (Oxford). 2023 (Aug 4). doi: 10.1093/rheumatology/kead398

Key clinical point: Musculoskeletal ultrasound along with physical examination can help identify juvenile psoriatic arthritis in pediatric patients with skin psoriasis showing musculoskeletal symptoms.

Major finding: Ultrasound evaluation showed higher number of joint and enthesitis abnormalities in pediatric patients with psoriasis who were symptomatic vs asymptomatic for musculoskeletal pain or swelling (all P ≤ .01). The concordance for detecting synovitis and enthesitis between physical and ultrasound examination was 82%.

Study details: Findings are from a cross-sectional study including 57 pediatric patients with psoriasis and no previous diagnosis of juvenile idiopathic arthritis or any systemic disease-causing articular manifestations who underwent ultrasound evaluation and clinical examination.

Disclosures: This study was supported by the PARTNER Fellowship program created with an unrestricted grant by Celgene-AMGEN, with L Coronel as a PARTNER fellow. Two authors declared ties with various sources, including Amgen. Two authors declared no conflicts of interest.

Source: Coronel L et al. Prevalence of ultrasound and clinical findings suggestive of inflammatory arthritis in children with skin psoriasis. Rheumatology (Oxford). 2023 (Aug 4). doi: 10.1093/rheumatology/kead398

Key clinical point: Musculoskeletal ultrasound along with physical examination can help identify juvenile psoriatic arthritis in pediatric patients with skin psoriasis showing musculoskeletal symptoms.

Major finding: Ultrasound evaluation showed higher number of joint and enthesitis abnormalities in pediatric patients with psoriasis who were symptomatic vs asymptomatic for musculoskeletal pain or swelling (all P ≤ .01). The concordance for detecting synovitis and enthesitis between physical and ultrasound examination was 82%.

Study details: Findings are from a cross-sectional study including 57 pediatric patients with psoriasis and no previous diagnosis of juvenile idiopathic arthritis or any systemic disease-causing articular manifestations who underwent ultrasound evaluation and clinical examination.

Disclosures: This study was supported by the PARTNER Fellowship program created with an unrestricted grant by Celgene-AMGEN, with L Coronel as a PARTNER fellow. Two authors declared ties with various sources, including Amgen. Two authors declared no conflicts of interest.

Source: Coronel L et al. Prevalence of ultrasound and clinical findings suggestive of inflammatory arthritis in children with skin psoriasis. Rheumatology (Oxford). 2023 (Aug 4). doi: 10.1093/rheumatology/kead398

Key clinical point: Depression is prevalent in patients with psoriatic arthritis (PsA), with patients not engaging in sports activities, experiencing fatigue, and having functional impairment being more likely to suffer from depression.

Major finding: Overall, 8.2% and 20.9% of patients with PsA had severe and moderate depressive symptoms, respectively. The odds of having depressive symptoms were higher in patients with functional impairment (odds ratio [OR] 1.08; P < .0001) and those experiencing fatigue (OR 1.56; P < .0001), whereas those engaging in sports for at least 1 hour/week were less likely to be depressed (OR 0.61; P  =  .0017).

Study details: This study included 1225 patients with PsA and 1245 patients with axial spondyloarthritis from the RABBIT-SpA cohort.

Disclosures: This study received open access funding from Projekt Deal, and RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, and various other sources. The authors declared no conflicts of interest.

Source: Reich A et al. Depressive symptoms are associated with fatigue, poorer functional status and less engagement in sports in axSpA and PsA: An analysis from the RABBIT-SpA cohort. Arthritis Res Ther. 2023;25:136 (Aug 2). doi: 10.1186/s13075-023-03127-2.

Key clinical point: Depression is prevalent in patients with psoriatic arthritis (PsA), with patients not engaging in sports activities, experiencing fatigue, and having functional impairment being more likely to suffer from depression.

Major finding: Overall, 8.2% and 20.9% of patients with PsA had severe and moderate depressive symptoms, respectively. The odds of having depressive symptoms were higher in patients with functional impairment (odds ratio [OR] 1.08; P < .0001) and those experiencing fatigue (OR 1.56; P < .0001), whereas those engaging in sports for at least 1 hour/week were less likely to be depressed (OR 0.61; P  =  .0017).

Study details: This study included 1225 patients with PsA and 1245 patients with axial spondyloarthritis from the RABBIT-SpA cohort.

Disclosures: This study received open access funding from Projekt Deal, and RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, and various other sources. The authors declared no conflicts of interest.

Source: Reich A et al. Depressive symptoms are associated with fatigue, poorer functional status and less engagement in sports in axSpA and PsA: An analysis from the RABBIT-SpA cohort. Arthritis Res Ther. 2023;25:136 (Aug 2). doi: 10.1186/s13075-023-03127-2.

Key clinical point: Depression is prevalent in patients with psoriatic arthritis (PsA), with patients not engaging in sports activities, experiencing fatigue, and having functional impairment being more likely to suffer from depression.

Major finding: Overall, 8.2% and 20.9% of patients with PsA had severe and moderate depressive symptoms, respectively. The odds of having depressive symptoms were higher in patients with functional impairment (odds ratio [OR] 1.08; P < .0001) and those experiencing fatigue (OR 1.56; P < .0001), whereas those engaging in sports for at least 1 hour/week were less likely to be depressed (OR 0.61; P  =  .0017).

Study details: This study included 1225 patients with PsA and 1245 patients with axial spondyloarthritis from the RABBIT-SpA cohort.

Disclosures: This study received open access funding from Projekt Deal, and RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, and various other sources. The authors declared no conflicts of interest.

Source: Reich A et al. Depressive symptoms are associated with fatigue, poorer functional status and less engagement in sports in axSpA and PsA: An analysis from the RABBIT-SpA cohort. Arthritis Res Ther. 2023;25:136 (Aug 2). doi: 10.1186/s13075-023-03127-2.

Key clinical point: Patients with psoriatic arthritis (PsA) have dysregulated immune cell profiles that were partially normalized to the levels in control individuals after guselkumab treatment, with this effect being more pronounced among American College of Rheumatology 20 (ACR20) responders.

Major finding: At baseline, 355 and 314 PsA-related genes were upregulated and downregulated, respectively, in patients with PsA vs control individuals, with guselkumab treatment modulating the expression of 82% of upregulated and 77% of downregulated genes at week 24. The ACR20 responders showed a significant decrease in gene set enrichment scores for upregulated PsA-associated genes after 24 weeks of guselkumab treatment (all P ≤ .05).

Study details: This study evaluated whole blood transcriptome profiles of 673 patients with PsA from the DISCOVER-1 and DISCOVER-2 studies. The patients received guselkumab or placebo and there were 21 matched healthy control individuals.

Disclosures: This study was sponsored by Janssen Research & Development (R&D), LLC. Nine authors declared being employees of Janssen R&D and owning stock or stock options in Johnson & Johnson. The other authors reported ties with Janssen or other sources.

Source: Siebert S et al. Guselkumab modulates differentially expressed genes in blood of patients with psoriatic arthritis: Results from two phase 3, randomized, placebo-controlled trials. ACR Open Rheumatol. 2023 (Aug 8). doi: 10.1002/acr2.11589

Key clinical point: Patients with psoriatic arthritis (PsA) have dysregulated immune cell profiles that were partially normalized to the levels in control individuals after guselkumab treatment, with this effect being more pronounced among American College of Rheumatology 20 (ACR20) responders.

Major finding: At baseline, 355 and 314 PsA-related genes were upregulated and downregulated, respectively, in patients with PsA vs control individuals, with guselkumab treatment modulating the expression of 82% of upregulated and 77% of downregulated genes at week 24. The ACR20 responders showed a significant decrease in gene set enrichment scores for upregulated PsA-associated genes after 24 weeks of guselkumab treatment (all P ≤ .05).

Study details: This study evaluated whole blood transcriptome profiles of 673 patients with PsA from the DISCOVER-1 and DISCOVER-2 studies. The patients received guselkumab or placebo and there were 21 matched healthy control individuals.

Disclosures: This study was sponsored by Janssen Research & Development (R&D), LLC. Nine authors declared being employees of Janssen R&D and owning stock or stock options in Johnson & Johnson. The other authors reported ties with Janssen or other sources.

Source: Siebert S et al. Guselkumab modulates differentially expressed genes in blood of patients with psoriatic arthritis: Results from two phase 3, randomized, placebo-controlled trials. ACR Open Rheumatol. 2023 (Aug 8). doi: 10.1002/acr2.11589

Key clinical point: Patients with psoriatic arthritis (PsA) have dysregulated immune cell profiles that were partially normalized to the levels in control individuals after guselkumab treatment, with this effect being more pronounced among American College of Rheumatology 20 (ACR20) responders.

Major finding: At baseline, 355 and 314 PsA-related genes were upregulated and downregulated, respectively, in patients with PsA vs control individuals, with guselkumab treatment modulating the expression of 82% of upregulated and 77% of downregulated genes at week 24. The ACR20 responders showed a significant decrease in gene set enrichment scores for upregulated PsA-associated genes after 24 weeks of guselkumab treatment (all P ≤ .05).

Study details: This study evaluated whole blood transcriptome profiles of 673 patients with PsA from the DISCOVER-1 and DISCOVER-2 studies. The patients received guselkumab or placebo and there were 21 matched healthy control individuals.

Disclosures: This study was sponsored by Janssen Research & Development (R&D), LLC. Nine authors declared being employees of Janssen R&D and owning stock or stock options in Johnson & Johnson. The other authors reported ties with Janssen or other sources.

Source: Siebert S et al. Guselkumab modulates differentially expressed genes in blood of patients with psoriatic arthritis: Results from two phase 3, randomized, placebo-controlled trials. ACR Open Rheumatol. 2023 (Aug 8). doi: 10.1002/acr2.11589

Key clinical point: A structured Very Low Energy Diet intervention was associated with decrease in cytokines and leptins and increase in adipokines along with significant weight loss in patients with psoriatic arthritis (PsA) and obesity, highlighting the anti-inflammatory effect of weight loss in PsA.

Major finding: At month 6, along with significant weight loss, serum levels of interleukin-23 and leptin decreased significantly, whereas that of total adiponectin and high-molecular-weight adiponectin increased significantly in patients with PsA and control individuals (P < .001 for all). The change in body mass index correlated positively with reduction in serum interleukin-23 (P < .001) and improvement in PsA disease activity (P  =  .003).

Study details: Findings are from a prospective interventional weight loss study that included patients with PsA and obesity (n = 41) and matched control individuals without rheumatic disease or psoriasis (n = 39) who were on the Very Low Energy Diet (640 kcal/day) intervention.

Disclosures: This study was financed by grants from Swedish state and other sources, and open access funding was provided by the University of Gothenburg. The authors declared no conflicts of interest.

Source: Landgren AJ et al. Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention. Arthritis Res Ther. 2023;25:131 (Jul 27). doi: 10.1186/s13075-023-03105-8

Key clinical point: A structured Very Low Energy Diet intervention was associated with decrease in cytokines and leptins and increase in adipokines along with significant weight loss in patients with psoriatic arthritis (PsA) and obesity, highlighting the anti-inflammatory effect of weight loss in PsA.

Major finding: At month 6, along with significant weight loss, serum levels of interleukin-23 and leptin decreased significantly, whereas that of total adiponectin and high-molecular-weight adiponectin increased significantly in patients with PsA and control individuals (P < .001 for all). The change in body mass index correlated positively with reduction in serum interleukin-23 (P < .001) and improvement in PsA disease activity (P  =  .003).

Study details: Findings are from a prospective interventional weight loss study that included patients with PsA and obesity (n = 41) and matched control individuals without rheumatic disease or psoriasis (n = 39) who were on the Very Low Energy Diet (640 kcal/day) intervention.

Disclosures: This study was financed by grants from Swedish state and other sources, and open access funding was provided by the University of Gothenburg. The authors declared no conflicts of interest.

Source: Landgren AJ et al. Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention. Arthritis Res Ther. 2023;25:131 (Jul 27). doi: 10.1186/s13075-023-03105-8

Key clinical point: A structured Very Low Energy Diet intervention was associated with decrease in cytokines and leptins and increase in adipokines along with significant weight loss in patients with psoriatic arthritis (PsA) and obesity, highlighting the anti-inflammatory effect of weight loss in PsA.

Major finding: At month 6, along with significant weight loss, serum levels of interleukin-23 and leptin decreased significantly, whereas that of total adiponectin and high-molecular-weight adiponectin increased significantly in patients with PsA and control individuals (P < .001 for all). The change in body mass index correlated positively with reduction in serum interleukin-23 (P < .001) and improvement in PsA disease activity (P  =  .003).

Study details: Findings are from a prospective interventional weight loss study that included patients with PsA and obesity (n = 41) and matched control individuals without rheumatic disease or psoriasis (n = 39) who were on the Very Low Energy Diet (640 kcal/day) intervention.

Disclosures: This study was financed by grants from Swedish state and other sources, and open access funding was provided by the University of Gothenburg. The authors declared no conflicts of interest.

Source: Landgren AJ et al. Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention. Arthritis Res Ther. 2023;25:131 (Jul 27). doi: 10.1186/s13075-023-03105-8

Key clinical point: Children and young people with juvenile psoriatic arthritis (JPsA) have poorer well-being than other subsets of juvenile idiopathic arthritis (JIA), with having psoriasis at JPsA diagnosis linked with more depressive symptoms.

Major finding: Children with JPsA vs other JIA categories had 2.35-times higher odds of having persistently poor well-being scores despite improvements in joint counts and physician global scores (P  =  .013), and children with psoriasis at JPsA diagnosis scored, on average, 10 points higher on the baseline Moods and Feelings Questionnaire (co-efficient 9.77; P  =  .039).

Study details: This study evaluated 1653 children and young people with JIA who were recruited to the Childhood Arthritis Prospective Study, of whom 111 had JPsA at diagnosis.

Disclosures: This study was funded by the Cecil King Memorial Fund and other sources. The authors declared no conflicts of interest.

Source: Low JM et al for the CAPS Principal Investigators. The impact of psoriasis on wellbeing and clinical outcomes in juvenile psoriatic arthritis. Rheumatology (Oxford). 2023 (Jul 19). doi: 10.1093/rheumatology/kead370

Key clinical point: Children and young people with juvenile psoriatic arthritis (JPsA) have poorer well-being than other subsets of juvenile idiopathic arthritis (JIA), with having psoriasis at JPsA diagnosis linked with more depressive symptoms.

Major finding: Children with JPsA vs other JIA categories had 2.35-times higher odds of having persistently poor well-being scores despite improvements in joint counts and physician global scores (P  =  .013), and children with psoriasis at JPsA diagnosis scored, on average, 10 points higher on the baseline Moods and Feelings Questionnaire (co-efficient 9.77; P  =  .039).

Study details: This study evaluated 1653 children and young people with JIA who were recruited to the Childhood Arthritis Prospective Study, of whom 111 had JPsA at diagnosis.

Disclosures: This study was funded by the Cecil King Memorial Fund and other sources. The authors declared no conflicts of interest.

Source: Low JM et al for the CAPS Principal Investigators. The impact of psoriasis on wellbeing and clinical outcomes in juvenile psoriatic arthritis. Rheumatology (Oxford). 2023 (Jul 19). doi: 10.1093/rheumatology/kead370

Key clinical point: Children and young people with juvenile psoriatic arthritis (JPsA) have poorer well-being than other subsets of juvenile idiopathic arthritis (JIA), with having psoriasis at JPsA diagnosis linked with more depressive symptoms.

Major finding: Children with JPsA vs other JIA categories had 2.35-times higher odds of having persistently poor well-being scores despite improvements in joint counts and physician global scores (P  =  .013), and children with psoriasis at JPsA diagnosis scored, on average, 10 points higher on the baseline Moods and Feelings Questionnaire (co-efficient 9.77; P  =  .039).

Study details: This study evaluated 1653 children and young people with JIA who were recruited to the Childhood Arthritis Prospective Study, of whom 111 had JPsA at diagnosis.

Disclosures: This study was funded by the Cecil King Memorial Fund and other sources. The authors declared no conflicts of interest.

Source: Low JM et al for the CAPS Principal Investigators. The impact of psoriasis on wellbeing and clinical outcomes in juvenile psoriatic arthritis. Rheumatology (Oxford). 2023 (Jul 19). doi: 10.1093/rheumatology/kead370

Key clinical point: Whole blood DNA methylation patterns measured before the onset of musculoskeletal symptoms can help distinguish patients with psoriasis who will develop psoriatic arthritis (PsA) from those who will not.

Major finding: The model based on 36 highly relevant methylation markers across 15 genes and intergenic regions (false discovery rate-adjusted P < .05; minimum change in methylation of 0.05) could identify patients with psoriasis who developed PsA from those who did not with an area under the receiver operating characteristic curve of 0.964.

Study details: Findings are from a nested case-control study including patients with psoriasis who later developed PsA (n = 58) matched with patients who did not develop PsA (n = 59).

Disclosures: This study was partly supported by an Early Career Research Grant awarded to RA Pollock from the National Psoriasis Foundation. The authors declared no conflicts of interest.

Source: Cruz-Correa OF et al. Prediction of psoriatic arthritis in patients with psoriasis using DNA methylation profiles. Arthritis Rheumatol. 2023 (Jul 18). doi: 10.1002/art.42654

Key clinical point: Whole blood DNA methylation patterns measured before the onset of musculoskeletal symptoms can help distinguish patients with psoriasis who will develop psoriatic arthritis (PsA) from those who will not.

Major finding: The model based on 36 highly relevant methylation markers across 15 genes and intergenic regions (false discovery rate-adjusted P < .05; minimum change in methylation of 0.05) could identify patients with psoriasis who developed PsA from those who did not with an area under the receiver operating characteristic curve of 0.964.

Study details: Findings are from a nested case-control study including patients with psoriasis who later developed PsA (n = 58) matched with patients who did not develop PsA (n = 59).

Disclosures: This study was partly supported by an Early Career Research Grant awarded to RA Pollock from the National Psoriasis Foundation. The authors declared no conflicts of interest.

Source: Cruz-Correa OF et al. Prediction of psoriatic arthritis in patients with psoriasis using DNA methylation profiles. Arthritis Rheumatol. 2023 (Jul 18). doi: 10.1002/art.42654

Key clinical point: Whole blood DNA methylation patterns measured before the onset of musculoskeletal symptoms can help distinguish patients with psoriasis who will develop psoriatic arthritis (PsA) from those who will not.

Major finding: The model based on 36 highly relevant methylation markers across 15 genes and intergenic regions (false discovery rate-adjusted P < .05; minimum change in methylation of 0.05) could identify patients with psoriasis who developed PsA from those who did not with an area under the receiver operating characteristic curve of 0.964.

Study details: Findings are from a nested case-control study including patients with psoriasis who later developed PsA (n = 58) matched with patients who did not develop PsA (n = 59).

Disclosures: This study was partly supported by an Early Career Research Grant awarded to RA Pollock from the National Psoriasis Foundation. The authors declared no conflicts of interest.

Source: Cruz-Correa OF et al. Prediction of psoriatic arthritis in patients with psoriasis using DNA methylation profiles. Arthritis Rheumatol. 2023 (Jul 18). doi: 10.1002/art.42654

Beleaguered directors of obstetrics/gynecology residency programs may be relieved to know that a new application platform for all ob.gyn. residency applications is poised to come into effect for the 2024-25 cycle.

In a recent joint announcement, the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said the new system, ResidencyCAS, offered by Liaison Centralized Application Service, will replace the Electronic Residency Application Service (ERAS). ERAS was implemented some 25 years ago by the Association of American Medical Colleges.
 

Efficiencies and lower costs

Potential startup glitches aside, the transition will allegedly lower skyrocketing application fees and provide enhanced efficiencies and a better user experience than ERAS. So far, ob.gyn. is first and the only specialty to jump ship from the established platform. But if other specialties follow suit making the new software the norm, that will have a serious impact on ERAS’s revenues, said J. Bryan Carmody, MD, MPH, a pediatric nephrologist at the Children’s Hospital of the King’s Daughters, Norfolk, Va., who closely monitors and writes about residency selection and discussed the coming transition in a recent blog posting.

courtesy Children’s Hospital of the King’s Daughters

“My feeling is that the average program director thinks that ERAS is functional but there are not many, if any, who are in love with ERAS,” Dr. Carmody said in an interview. “I think ERAS will benefit from having a competitor.”

A major drawback for applicants with the removal of ob.gyn. from ERAS, which handles almost all medical specialties, is that those seeking acceptance in more than one specialty will now need to apply twice and incur two sets of costs. “A substantial fraction of applicants do that and now they’ll have to navigate two different systems and collect and format all their documents for both, which will be burdensome,” he said.
 

Holistic review

According to the ACOG announcement, the new technology promises to manage the deluge of applications more efficiently and, most important, to allow program directors to evaluate candidates holistically in order to better meet the specific needs of different communities.

courtesy University of Michigan

“The platform makes it much easier to review applicants for important characteristics other than academic, and It will cost applicants about 20% less,” said Maya M. Hammoud, MD, MBA, professor and association chair for education, obstetrics, and gynecology at the University of Michigan, Ann Arbor, and past president of APGO.

So far the announced switch has been positively received. “People are very excited about the change, especially when they see the video,” Dr. Hammoud said.

For Adi Katz, MD, director of gynecology and director of the obstetrics and gynecology residency program at Lenox Hill Hospital, New York, the change signals a step in the right direction, especially when it comes to application reviewing. “The number of applications has been increasing tremendously in the past few years. We have four residency spots and we get almost 900 applications for them, ” she said. “Under the present system it’s hard to give a fair review to all the applicants, and we hope that with change we’ll be able to give each one the attention they deserve.”

An important feature, added Dr. Katz, is that the new software will allow directors to do intuitive, “gut-level” screenings with the help of AI. In this approach, large numbers of candidates can be screened based on intuition in relation to their formal criteria.

Residency program administrators have long sought more holistic ways of screening applicants, and AI has the potential to provide insights into who’s a good fit by finding patterns in very complex data.

“Of course, we won’t know for sure if it’s the right move until we start using the platform,” Dr. Katz said.

courtesy ACOG

“There are many factors beyond academic standing that can help determine which individual applicants would be the best fit for each unique program,” AnnaMarie Connolly, MD, chief of education and academic affairs at ACOG, said in an interview. ”In particular, improved holistic review will allow programs and applicants to better ensure alignment that, for example, considers factors such as applicants’ clinical interests, academic interests, and past life experiences.”

Updated data science is expected better align ob.gyn. programs and applicants, and improve staff efficiency at no cost to programs, Dr. Connolly added. Good alignment of residents with programs is especially important in a patient-interactive specialty such as ob.gyn. Webinars will prepare users to apply the new system.

According to the promotional video, ResidencyCAS integrates all components of application from candidates’ letters and credentials to lists of program directors, applicant reviews, and specialty data analytics. Collecting recommendations and credentials is expected to be streamlined. The software is currently used by 31 U.S. health care professions and across 31,000 programs.

“It’s clear that ob.gyn. residency applicants and ob.gyn. programs have been frustrated by certain aspects of the former application system, one of which being high costs,” Dr. Connolly added. “The feedback we’ve received indicates that programs are excited about a more streamlined process.”
 

AAMC strikes back

Not all groups are so enthusiastic, however, including, understandably, the AAMC, which expressed “surprise and dismay” at the switch.

courtesy AAMC

“While it is too early to fully understand the consequences of this development – intended and unintended – the AAMC remains committed to creating a fair and equitable process for learners, medical schools, and programs,” wrote AAMC spokespersons David J. Skorton, MD, AAMC’s CEO, and Alison J. Whelan, MD, chief academic officer in a statement. “We are concerned that ob.gyn. program data will no longer be part of the numerous and longstanding AAMC data and research efforts.”

Those efforts include the Residency Readiness Survey, multidecade institution-level data and analytics, and future cross-specialty innovations. Lost with the changeover, the AAMC warned, may be the cross-specialty data it has collected, analyzed, and shared since ERAS’s inception, in particular its advocacy, research, and data support for the ob.gyn. community following the 2022 Supreme Court ruling in Dobbs v. Jackson.
 

Evolution of specialty application

In a blog posting, Dr. Carmody outlined the evolution of the specialty residency application process. Pre-ERAS application was slow, cumbersome, and done by mail. With the introduction of ERAS, applicants were able to put their information on floppy discs and submit them to the dean’s office, hopefully triggering interview offers via email. The new approach was originally piloted in partnership with ob.gyn. program directors and now ERAS finds itself in a first-in, first-out situation.

Over the years, program directors suffocating under the weight of applications have periodically asked the AAMC to share data or make changes to ERAS protocols or policies, including those on the sharing of collected information. “Its my perception that frustration about the AAMC’s data sharing was one of the things that led to the change,” Dr. Carmody said. While acknowledging that data sharing must be carefully done, he noted that, when program directors asked to see ERAS data to answer important questions, they were often refused.

While it appears that AAMC’s improvement efforts have not gone far or fast enough, the association pointed to significant efforts to streamline applications. It stressed its ongoing commitment to cooperation “with learners, medical schools, and the ERAS program community to further consider the implications of ACOG’s announcement.” It recently announced a collaboration with Thalamus-connecting the docs, a new interview-management software system the AAMC expects will accelerate innovation across the transition-to-residency process.

“We have many questions and few answers at this time,” Dr. Skorton and Dr. Whelan wrote, “and we will work diligently to fully understand the consequences and keep open communication with all of our constituents.”
 

Financial impact

Ob.gyn., an important but relatively small specialty, represented only 2.8% of the 2022 residency applications on ERAS and $3,362,760 of its $120 million in revenue that year, Dr. Carmody noted. That’s with 2,613 ob.gyn. applicants submitting an average of 63-83 applications depending on their background.

But if the defection of ob.gyn. starts a stampede among program directors in other branches of medicine to ResidencyCAS or some other new platform, that would cost ERAS substantially more.

“The next few years are going to be very telling,” said Dr. Carmody. Although competition may act as a catalyst for needed improvements to ERAS, if momentum grows, the comfortable inertia of staying with a known system may soon be overcome. “And the more specialties that switch, the more that will deprive the AAMC of the revenue it needs to improve the product.”

Dr. Carmody and Dr. Katz disclosed no relevant conflicts of interest with regard to their comments.

Beleaguered directors of obstetrics/gynecology residency programs may be relieved to know that a new application platform for all ob.gyn. residency applications is poised to come into effect for the 2024-25 cycle.

In a recent joint announcement, the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said the new system, ResidencyCAS, offered by Liaison Centralized Application Service, will replace the Electronic Residency Application Service (ERAS). ERAS was implemented some 25 years ago by the Association of American Medical Colleges.
 

Efficiencies and lower costs

Potential startup glitches aside, the transition will allegedly lower skyrocketing application fees and provide enhanced efficiencies and a better user experience than ERAS. So far, ob.gyn. is first and the only specialty to jump ship from the established platform. But if other specialties follow suit making the new software the norm, that will have a serious impact on ERAS’s revenues, said J. Bryan Carmody, MD, MPH, a pediatric nephrologist at the Children’s Hospital of the King’s Daughters, Norfolk, Va., who closely monitors and writes about residency selection and discussed the coming transition in a recent blog posting.

courtesy Children’s Hospital of the King’s Daughters

“My feeling is that the average program director thinks that ERAS is functional but there are not many, if any, who are in love with ERAS,” Dr. Carmody said in an interview. “I think ERAS will benefit from having a competitor.”

A major drawback for applicants with the removal of ob.gyn. from ERAS, which handles almost all medical specialties, is that those seeking acceptance in more than one specialty will now need to apply twice and incur two sets of costs. “A substantial fraction of applicants do that and now they’ll have to navigate two different systems and collect and format all their documents for both, which will be burdensome,” he said.
 

Holistic review

According to the ACOG announcement, the new technology promises to manage the deluge of applications more efficiently and, most important, to allow program directors to evaluate candidates holistically in order to better meet the specific needs of different communities.

courtesy University of Michigan

“The platform makes it much easier to review applicants for important characteristics other than academic, and It will cost applicants about 20% less,” said Maya M. Hammoud, MD, MBA, professor and association chair for education, obstetrics, and gynecology at the University of Michigan, Ann Arbor, and past president of APGO.

So far the announced switch has been positively received. “People are very excited about the change, especially when they see the video,” Dr. Hammoud said.

For Adi Katz, MD, director of gynecology and director of the obstetrics and gynecology residency program at Lenox Hill Hospital, New York, the change signals a step in the right direction, especially when it comes to application reviewing. “The number of applications has been increasing tremendously in the past few years. We have four residency spots and we get almost 900 applications for them, ” she said. “Under the present system it’s hard to give a fair review to all the applicants, and we hope that with change we’ll be able to give each one the attention they deserve.”

An important feature, added Dr. Katz, is that the new software will allow directors to do intuitive, “gut-level” screenings with the help of AI. In this approach, large numbers of candidates can be screened based on intuition in relation to their formal criteria.

Residency program administrators have long sought more holistic ways of screening applicants, and AI has the potential to provide insights into who’s a good fit by finding patterns in very complex data.

“Of course, we won’t know for sure if it’s the right move until we start using the platform,” Dr. Katz said.

courtesy ACOG

“There are many factors beyond academic standing that can help determine which individual applicants would be the best fit for each unique program,” AnnaMarie Connolly, MD, chief of education and academic affairs at ACOG, said in an interview. ”In particular, improved holistic review will allow programs and applicants to better ensure alignment that, for example, considers factors such as applicants’ clinical interests, academic interests, and past life experiences.”

Updated data science is expected better align ob.gyn. programs and applicants, and improve staff efficiency at no cost to programs, Dr. Connolly added. Good alignment of residents with programs is especially important in a patient-interactive specialty such as ob.gyn. Webinars will prepare users to apply the new system.

According to the promotional video, ResidencyCAS integrates all components of application from candidates’ letters and credentials to lists of program directors, applicant reviews, and specialty data analytics. Collecting recommendations and credentials is expected to be streamlined. The software is currently used by 31 U.S. health care professions and across 31,000 programs.

“It’s clear that ob.gyn. residency applicants and ob.gyn. programs have been frustrated by certain aspects of the former application system, one of which being high costs,” Dr. Connolly added. “The feedback we’ve received indicates that programs are excited about a more streamlined process.”
 

AAMC strikes back

Not all groups are so enthusiastic, however, including, understandably, the AAMC, which expressed “surprise and dismay” at the switch.

courtesy AAMC

“While it is too early to fully understand the consequences of this development – intended and unintended – the AAMC remains committed to creating a fair and equitable process for learners, medical schools, and programs,” wrote AAMC spokespersons David J. Skorton, MD, AAMC’s CEO, and Alison J. Whelan, MD, chief academic officer in a statement. “We are concerned that ob.gyn. program data will no longer be part of the numerous and longstanding AAMC data and research efforts.”

Those efforts include the Residency Readiness Survey, multidecade institution-level data and analytics, and future cross-specialty innovations. Lost with the changeover, the AAMC warned, may be the cross-specialty data it has collected, analyzed, and shared since ERAS’s inception, in particular its advocacy, research, and data support for the ob.gyn. community following the 2022 Supreme Court ruling in Dobbs v. Jackson.
 

Evolution of specialty application

In a blog posting, Dr. Carmody outlined the evolution of the specialty residency application process. Pre-ERAS application was slow, cumbersome, and done by mail. With the introduction of ERAS, applicants were able to put their information on floppy discs and submit them to the dean’s office, hopefully triggering interview offers via email. The new approach was originally piloted in partnership with ob.gyn. program directors and now ERAS finds itself in a first-in, first-out situation.

Over the years, program directors suffocating under the weight of applications have periodically asked the AAMC to share data or make changes to ERAS protocols or policies, including those on the sharing of collected information. “Its my perception that frustration about the AAMC’s data sharing was one of the things that led to the change,” Dr. Carmody said. While acknowledging that data sharing must be carefully done, he noted that, when program directors asked to see ERAS data to answer important questions, they were often refused.

While it appears that AAMC’s improvement efforts have not gone far or fast enough, the association pointed to significant efforts to streamline applications. It stressed its ongoing commitment to cooperation “with learners, medical schools, and the ERAS program community to further consider the implications of ACOG’s announcement.” It recently announced a collaboration with Thalamus-connecting the docs, a new interview-management software system the AAMC expects will accelerate innovation across the transition-to-residency process.

“We have many questions and few answers at this time,” Dr. Skorton and Dr. Whelan wrote, “and we will work diligently to fully understand the consequences and keep open communication with all of our constituents.”
 

Financial impact

Ob.gyn., an important but relatively small specialty, represented only 2.8% of the 2022 residency applications on ERAS and $3,362,760 of its $120 million in revenue that year, Dr. Carmody noted. That’s with 2,613 ob.gyn. applicants submitting an average of 63-83 applications depending on their background.

But if the defection of ob.gyn. starts a stampede among program directors in other branches of medicine to ResidencyCAS or some other new platform, that would cost ERAS substantially more.

“The next few years are going to be very telling,” said Dr. Carmody. Although competition may act as a catalyst for needed improvements to ERAS, if momentum grows, the comfortable inertia of staying with a known system may soon be overcome. “And the more specialties that switch, the more that will deprive the AAMC of the revenue it needs to improve the product.”

Dr. Carmody and Dr. Katz disclosed no relevant conflicts of interest with regard to their comments.

Beleaguered directors of obstetrics/gynecology residency programs may be relieved to know that a new application platform for all ob.gyn. residency applications is poised to come into effect for the 2024-25 cycle.

In a recent joint announcement, the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said the new system, ResidencyCAS, offered by Liaison Centralized Application Service, will replace the Electronic Residency Application Service (ERAS). ERAS was implemented some 25 years ago by the Association of American Medical Colleges.
 

Efficiencies and lower costs

Potential startup glitches aside, the transition will allegedly lower skyrocketing application fees and provide enhanced efficiencies and a better user experience than ERAS. So far, ob.gyn. is first and the only specialty to jump ship from the established platform. But if other specialties follow suit making the new software the norm, that will have a serious impact on ERAS’s revenues, said J. Bryan Carmody, MD, MPH, a pediatric nephrologist at the Children’s Hospital of the King’s Daughters, Norfolk, Va., who closely monitors and writes about residency selection and discussed the coming transition in a recent blog posting.

courtesy Children’s Hospital of the King’s Daughters

“My feeling is that the average program director thinks that ERAS is functional but there are not many, if any, who are in love with ERAS,” Dr. Carmody said in an interview. “I think ERAS will benefit from having a competitor.”

A major drawback for applicants with the removal of ob.gyn. from ERAS, which handles almost all medical specialties, is that those seeking acceptance in more than one specialty will now need to apply twice and incur two sets of costs. “A substantial fraction of applicants do that and now they’ll have to navigate two different systems and collect and format all their documents for both, which will be burdensome,” he said.
 

Holistic review

According to the ACOG announcement, the new technology promises to manage the deluge of applications more efficiently and, most important, to allow program directors to evaluate candidates holistically in order to better meet the specific needs of different communities.

courtesy University of Michigan

“The platform makes it much easier to review applicants for important characteristics other than academic, and It will cost applicants about 20% less,” said Maya M. Hammoud, MD, MBA, professor and association chair for education, obstetrics, and gynecology at the University of Michigan, Ann Arbor, and past president of APGO.

So far the announced switch has been positively received. “People are very excited about the change, especially when they see the video,” Dr. Hammoud said.

For Adi Katz, MD, director of gynecology and director of the obstetrics and gynecology residency program at Lenox Hill Hospital, New York, the change signals a step in the right direction, especially when it comes to application reviewing. “The number of applications has been increasing tremendously in the past few years. We have four residency spots and we get almost 900 applications for them, ” she said. “Under the present system it’s hard to give a fair review to all the applicants, and we hope that with change we’ll be able to give each one the attention they deserve.”

An important feature, added Dr. Katz, is that the new software will allow directors to do intuitive, “gut-level” screenings with the help of AI. In this approach, large numbers of candidates can be screened based on intuition in relation to their formal criteria.

Residency program administrators have long sought more holistic ways of screening applicants, and AI has the potential to provide insights into who’s a good fit by finding patterns in very complex data.

“Of course, we won’t know for sure if it’s the right move until we start using the platform,” Dr. Katz said.

courtesy ACOG

“There are many factors beyond academic standing that can help determine which individual applicants would be the best fit for each unique program,” AnnaMarie Connolly, MD, chief of education and academic affairs at ACOG, said in an interview. ”In particular, improved holistic review will allow programs and applicants to better ensure alignment that, for example, considers factors such as applicants’ clinical interests, academic interests, and past life experiences.”

Updated data science is expected better align ob.gyn. programs and applicants, and improve staff efficiency at no cost to programs, Dr. Connolly added. Good alignment of residents with programs is especially important in a patient-interactive specialty such as ob.gyn. Webinars will prepare users to apply the new system.

According to the promotional video, ResidencyCAS integrates all components of application from candidates’ letters and credentials to lists of program directors, applicant reviews, and specialty data analytics. Collecting recommendations and credentials is expected to be streamlined. The software is currently used by 31 U.S. health care professions and across 31,000 programs.

“It’s clear that ob.gyn. residency applicants and ob.gyn. programs have been frustrated by certain aspects of the former application system, one of which being high costs,” Dr. Connolly added. “The feedback we’ve received indicates that programs are excited about a more streamlined process.”
 

AAMC strikes back

Not all groups are so enthusiastic, however, including, understandably, the AAMC, which expressed “surprise and dismay” at the switch.

courtesy AAMC

“While it is too early to fully understand the consequences of this development – intended and unintended – the AAMC remains committed to creating a fair and equitable process for learners, medical schools, and programs,” wrote AAMC spokespersons David J. Skorton, MD, AAMC’s CEO, and Alison J. Whelan, MD, chief academic officer in a statement. “We are concerned that ob.gyn. program data will no longer be part of the numerous and longstanding AAMC data and research efforts.”

Those efforts include the Residency Readiness Survey, multidecade institution-level data and analytics, and future cross-specialty innovations. Lost with the changeover, the AAMC warned, may be the cross-specialty data it has collected, analyzed, and shared since ERAS’s inception, in particular its advocacy, research, and data support for the ob.gyn. community following the 2022 Supreme Court ruling in Dobbs v. Jackson.
 

Evolution of specialty application

In a blog posting, Dr. Carmody outlined the evolution of the specialty residency application process. Pre-ERAS application was slow, cumbersome, and done by mail. With the introduction of ERAS, applicants were able to put their information on floppy discs and submit them to the dean’s office, hopefully triggering interview offers via email. The new approach was originally piloted in partnership with ob.gyn. program directors and now ERAS finds itself in a first-in, first-out situation.

Over the years, program directors suffocating under the weight of applications have periodically asked the AAMC to share data or make changes to ERAS protocols or policies, including those on the sharing of collected information. “Its my perception that frustration about the AAMC’s data sharing was one of the things that led to the change,” Dr. Carmody said. While acknowledging that data sharing must be carefully done, he noted that, when program directors asked to see ERAS data to answer important questions, they were often refused.

While it appears that AAMC’s improvement efforts have not gone far or fast enough, the association pointed to significant efforts to streamline applications. It stressed its ongoing commitment to cooperation “with learners, medical schools, and the ERAS program community to further consider the implications of ACOG’s announcement.” It recently announced a collaboration with Thalamus-connecting the docs, a new interview-management software system the AAMC expects will accelerate innovation across the transition-to-residency process.

“We have many questions and few answers at this time,” Dr. Skorton and Dr. Whelan wrote, “and we will work diligently to fully understand the consequences and keep open communication with all of our constituents.”
 

Financial impact

Ob.gyn., an important but relatively small specialty, represented only 2.8% of the 2022 residency applications on ERAS and $3,362,760 of its $120 million in revenue that year, Dr. Carmody noted. That’s with 2,613 ob.gyn. applicants submitting an average of 63-83 applications depending on their background.

But if the defection of ob.gyn. starts a stampede among program directors in other branches of medicine to ResidencyCAS or some other new platform, that would cost ERAS substantially more.

“The next few years are going to be very telling,” said Dr. Carmody. Although competition may act as a catalyst for needed improvements to ERAS, if momentum grows, the comfortable inertia of staying with a known system may soon be overcome. “And the more specialties that switch, the more that will deprive the AAMC of the revenue it needs to improve the product.”

Dr. Carmody and Dr. Katz disclosed no relevant conflicts of interest with regard to their comments.