Treatment with medication often used for attention-deficit/hyperactivity disorder (ADHD) was associated with lower risk of psychiatric hospitalization, all-cause hospitalization, or death in adults with borderline personality disorder, based on data from more than 17,000 individuals.

Although most patients with borderline personality disorder (BPD) receive psychopharmacological treatment, clinical guidance and outcomes data for specific medication use in these patients are lacking, wrote Johannes Lieslehto, MD, PhD, of the University of Eastern Finland, Niuvankuja, and colleagues.

Dr. Lieslehto

In a study published in Acta Psychiatrica Scandinavica , the researchers – using national databases in Sweden – identified 17,532 adults with BPD who were treated with medications between 2006 and 2018.

Medications included benzodiazepines, antipsychotics, and antidepressants, as well as medications often used for ADHD: clozapine, lisdexamphetamine, bupropion, and methylphenidate. The mean age of the study population was 29.8 years and 2,649 were men.

The primary outcomes were psychiatric hospitalization (which served as an indication of treatment failure), all-cause hospitalization, or death.

Overall, treatment with benzodiazepines, antipsychotics, and antidepressants was associated with increased risk of psychiatric rehospitalization, with hazard ratios of 1.38, 1.19, and 1.18, respectively, and with increased risk of all-cause hospitalization or death (HR 1.37, HR 1.21, HR 1.17, respectively).

By contrast, treatment with ADHD medication was associated with decreased risk of psychiatric hospitalization (HR = 0.88), as well as a decreased risk of all-cause hospitalization or death (HR = 0.86).

Specifically, clozapine, lisdexamphetamine, bupropion, and methylphenidate were associated with decreased risk of psychiatric rehospitalization, with hazard ratios of 0.54, 0.79, 0.84, and 0.90, respectively.

Treatment with mood stabilizers had no significant impact on outcomes.

BPD patients treated with ADHD medications also may exhibit ADHD symptoms, the researchers wrote in their discussion. However, “Although BPD and ADHD partially overlap in symptoms such as impulsivity and emotion dysregulation, previous efforts to investigate the efficacy of ADHD medication treatment in BPD are scarce,” and randomized, controlled trials are needed to determine whether these medications should be given to BPD patients without comorbid ADHD symptoms, they said.

The findings were limited by several factors including the lack of clinical parameters on symptom severity, quality of life, and level of function, and premature prescribing of medication (protopathic bias) may have affected the results, the researchers noted.

The results were strengthened by the large sample size and long follow-up, which increases the generalizability to real-world patients, and suggest that many pharmacological treatments for BPD may not improve outcomes, the researchers said. However, “even in the presence of possible protopathic bias, treatment with lisdexamphetamine, bupropion, methylphenidate, and clozapine was associated with improved outcomes, encouraging further research on these treatments,” they said.

The study was supported by the Finnish Ministry of Social Affairs and Health and the Academy of Finland. Dr. Lieslehto had no financial conflicts to disclose.

Treatment with medication often used for attention-deficit/hyperactivity disorder (ADHD) was associated with lower risk of psychiatric hospitalization, all-cause hospitalization, or death in adults with borderline personality disorder, based on data from more than 17,000 individuals.

Although most patients with borderline personality disorder (BPD) receive psychopharmacological treatment, clinical guidance and outcomes data for specific medication use in these patients are lacking, wrote Johannes Lieslehto, MD, PhD, of the University of Eastern Finland, Niuvankuja, and colleagues.

Dr. Lieslehto

In a study published in Acta Psychiatrica Scandinavica , the researchers – using national databases in Sweden – identified 17,532 adults with BPD who were treated with medications between 2006 and 2018.

Medications included benzodiazepines, antipsychotics, and antidepressants, as well as medications often used for ADHD: clozapine, lisdexamphetamine, bupropion, and methylphenidate. The mean age of the study population was 29.8 years and 2,649 were men.

The primary outcomes were psychiatric hospitalization (which served as an indication of treatment failure), all-cause hospitalization, or death.

Overall, treatment with benzodiazepines, antipsychotics, and antidepressants was associated with increased risk of psychiatric rehospitalization, with hazard ratios of 1.38, 1.19, and 1.18, respectively, and with increased risk of all-cause hospitalization or death (HR 1.37, HR 1.21, HR 1.17, respectively).

By contrast, treatment with ADHD medication was associated with decreased risk of psychiatric hospitalization (HR = 0.88), as well as a decreased risk of all-cause hospitalization or death (HR = 0.86).

Specifically, clozapine, lisdexamphetamine, bupropion, and methylphenidate were associated with decreased risk of psychiatric rehospitalization, with hazard ratios of 0.54, 0.79, 0.84, and 0.90, respectively.

Treatment with mood stabilizers had no significant impact on outcomes.

BPD patients treated with ADHD medications also may exhibit ADHD symptoms, the researchers wrote in their discussion. However, “Although BPD and ADHD partially overlap in symptoms such as impulsivity and emotion dysregulation, previous efforts to investigate the efficacy of ADHD medication treatment in BPD are scarce,” and randomized, controlled trials are needed to determine whether these medications should be given to BPD patients without comorbid ADHD symptoms, they said.

The findings were limited by several factors including the lack of clinical parameters on symptom severity, quality of life, and level of function, and premature prescribing of medication (protopathic bias) may have affected the results, the researchers noted.

The results were strengthened by the large sample size and long follow-up, which increases the generalizability to real-world patients, and suggest that many pharmacological treatments for BPD may not improve outcomes, the researchers said. However, “even in the presence of possible protopathic bias, treatment with lisdexamphetamine, bupropion, methylphenidate, and clozapine was associated with improved outcomes, encouraging further research on these treatments,” they said.

The study was supported by the Finnish Ministry of Social Affairs and Health and the Academy of Finland. Dr. Lieslehto had no financial conflicts to disclose.

Treatment with medication often used for attention-deficit/hyperactivity disorder (ADHD) was associated with lower risk of psychiatric hospitalization, all-cause hospitalization, or death in adults with borderline personality disorder, based on data from more than 17,000 individuals.

Although most patients with borderline personality disorder (BPD) receive psychopharmacological treatment, clinical guidance and outcomes data for specific medication use in these patients are lacking, wrote Johannes Lieslehto, MD, PhD, of the University of Eastern Finland, Niuvankuja, and colleagues.

Dr. Lieslehto

In a study published in Acta Psychiatrica Scandinavica , the researchers – using national databases in Sweden – identified 17,532 adults with BPD who were treated with medications between 2006 and 2018.

Medications included benzodiazepines, antipsychotics, and antidepressants, as well as medications often used for ADHD: clozapine, lisdexamphetamine, bupropion, and methylphenidate. The mean age of the study population was 29.8 years and 2,649 were men.

The primary outcomes were psychiatric hospitalization (which served as an indication of treatment failure), all-cause hospitalization, or death.

Overall, treatment with benzodiazepines, antipsychotics, and antidepressants was associated with increased risk of psychiatric rehospitalization, with hazard ratios of 1.38, 1.19, and 1.18, respectively, and with increased risk of all-cause hospitalization or death (HR 1.37, HR 1.21, HR 1.17, respectively).

By contrast, treatment with ADHD medication was associated with decreased risk of psychiatric hospitalization (HR = 0.88), as well as a decreased risk of all-cause hospitalization or death (HR = 0.86).

Specifically, clozapine, lisdexamphetamine, bupropion, and methylphenidate were associated with decreased risk of psychiatric rehospitalization, with hazard ratios of 0.54, 0.79, 0.84, and 0.90, respectively.

Treatment with mood stabilizers had no significant impact on outcomes.

BPD patients treated with ADHD medications also may exhibit ADHD symptoms, the researchers wrote in their discussion. However, “Although BPD and ADHD partially overlap in symptoms such as impulsivity and emotion dysregulation, previous efforts to investigate the efficacy of ADHD medication treatment in BPD are scarce,” and randomized, controlled trials are needed to determine whether these medications should be given to BPD patients without comorbid ADHD symptoms, they said.

The findings were limited by several factors including the lack of clinical parameters on symptom severity, quality of life, and level of function, and premature prescribing of medication (protopathic bias) may have affected the results, the researchers noted.

The results were strengthened by the large sample size and long follow-up, which increases the generalizability to real-world patients, and suggest that many pharmacological treatments for BPD may not improve outcomes, the researchers said. However, “even in the presence of possible protopathic bias, treatment with lisdexamphetamine, bupropion, methylphenidate, and clozapine was associated with improved outcomes, encouraging further research on these treatments,” they said.

The study was supported by the Finnish Ministry of Social Affairs and Health and the Academy of Finland. Dr. Lieslehto had no financial conflicts to disclose.

The AGA Government Affairs Committee is pleased to announce the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment. If passed, the bill would expand Medicare coverage to include screening and treatment of obesity by health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options for all Americans since many private insurance companies model their covered health benefits to reflect Medicare.

The AGA Government Affairs Committee is pleased to announce the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment. If passed, the bill would expand Medicare coverage to include screening and treatment of obesity by health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options for all Americans since many private insurance companies model their covered health benefits to reflect Medicare.

The AGA Government Affairs Committee is pleased to announce the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment. If passed, the bill would expand Medicare coverage to include screening and treatment of obesity by health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options for all Americans since many private insurance companies model their covered health benefits to reflect Medicare.

Key clinical point: The presence of cardiometabolic multimorbidity may be associated with an improved treatment persistence with secukinumab in patients with psoriatic arthritis (PsA).

Major finding: The cumulative 60-month drug retention rate for secukinumab was 57.0% in patients with cardiometabolic multimorbidity (P  =  .042). Those with type 2 diabetes had a significantly better drug retention rate than those without (P  =  .044).

Study details: Findings are from a retrospective study of prospectively followed-up patients with PsA (n = 207) who received secukinumab for at least 3 months.

Disclosures: The study did not disclose the source of funding. The authors declared no conflicts of interest.

Source: Ruscitti P et al. The assessment of the drug retention rate of secukinumab in patients with psoriatic arthritis in a real-life multicentre cohort. Clin Exp Rheumatol. 2023 (Jul 24). doi: 10.55563/clinexprheumatol/tpp63h

Key clinical point: The presence of cardiometabolic multimorbidity may be associated with an improved treatment persistence with secukinumab in patients with psoriatic arthritis (PsA).

Major finding: The cumulative 60-month drug retention rate for secukinumab was 57.0% in patients with cardiometabolic multimorbidity (P  =  .042). Those with type 2 diabetes had a significantly better drug retention rate than those without (P  =  .044).

Study details: Findings are from a retrospective study of prospectively followed-up patients with PsA (n = 207) who received secukinumab for at least 3 months.

Disclosures: The study did not disclose the source of funding. The authors declared no conflicts of interest.

Source: Ruscitti P et al. The assessment of the drug retention rate of secukinumab in patients with psoriatic arthritis in a real-life multicentre cohort. Clin Exp Rheumatol. 2023 (Jul 24). doi: 10.55563/clinexprheumatol/tpp63h

Key clinical point: The presence of cardiometabolic multimorbidity may be associated with an improved treatment persistence with secukinumab in patients with psoriatic arthritis (PsA).

Major finding: The cumulative 60-month drug retention rate for secukinumab was 57.0% in patients with cardiometabolic multimorbidity (P  =  .042). Those with type 2 diabetes had a significantly better drug retention rate than those without (P  =  .044).

Study details: Findings are from a retrospective study of prospectively followed-up patients with PsA (n = 207) who received secukinumab for at least 3 months.

Disclosures: The study did not disclose the source of funding. The authors declared no conflicts of interest.

Source: Ruscitti P et al. The assessment of the drug retention rate of secukinumab in patients with psoriatic arthritis in a real-life multicentre cohort. Clin Exp Rheumatol. 2023 (Jul 24). doi: 10.55563/clinexprheumatol/tpp63h

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