Psoriatic Arthritis

Key clinical point: Patients with psoriatic arthritis (PsA), particularly women, have higher disease burden from the patient’s perspective than those with rheumatoid arthritis (RA).

Major finding: The mean Visual Analogue Scale scores for pain (34 vs 32; P < .001) and fatigue (35 vs 33; P = .001) were slightly higher in patients with PsA vs RA. Women with PsA vs RA across all age groups had significantly higher scores for pain (<50 years old: 28 vs 18; >70 years old: 48 vs 38) and fatigue (50-59 years old: 41 vs 31; >70 years old: 46 vs 36; all P < .05).

Study details: Findings are from a cross-sectional analysis including patients with PsA (n = 3598) and RA (n = 13,913).

Disclosures: This study was funded by State Research Funding, Kuopio University Hospital Catchment Area, Kuopio, Finland. The authors declared no conflicts of interest.

Source: Weman L et al. Disease burden measured by patient-reported outcomes: Does psoriatic arthritis feel worse than rheumatoid arthritis? A cross-sectional nationwide study. Clin Exp Rheumatol. 2023 (May 15). doi: 10.55563/clinexprheumatol/h9hn90

Key clinical point: Patients with psoriatic arthritis (PsA), particularly women, have higher disease burden from the patient’s perspective than those with rheumatoid arthritis (RA).

Major finding: The mean Visual Analogue Scale scores for pain (34 vs 32; P < .001) and fatigue (35 vs 33; P = .001) were slightly higher in patients with PsA vs RA. Women with PsA vs RA across all age groups had significantly higher scores for pain (<50 years old: 28 vs 18; >70 years old: 48 vs 38) and fatigue (50-59 years old: 41 vs 31; >70 years old: 46 vs 36; all P < .05).

Study details: Findings are from a cross-sectional analysis including patients with PsA (n = 3598) and RA (n = 13,913).

Disclosures: This study was funded by State Research Funding, Kuopio University Hospital Catchment Area, Kuopio, Finland. The authors declared no conflicts of interest.

Source: Weman L et al. Disease burden measured by patient-reported outcomes: Does psoriatic arthritis feel worse than rheumatoid arthritis? A cross-sectional nationwide study. Clin Exp Rheumatol. 2023 (May 15). doi: 10.55563/clinexprheumatol/h9hn90

Key clinical point: Patients with psoriatic arthritis (PsA), particularly women, have higher disease burden from the patient’s perspective than those with rheumatoid arthritis (RA).

Major finding: The mean Visual Analogue Scale scores for pain (34 vs 32; P < .001) and fatigue (35 vs 33; P = .001) were slightly higher in patients with PsA vs RA. Women with PsA vs RA across all age groups had significantly higher scores for pain (<50 years old: 28 vs 18; >70 years old: 48 vs 38) and fatigue (50-59 years old: 41 vs 31; >70 years old: 46 vs 36; all P < .05).

Study details: Findings are from a cross-sectional analysis including patients with PsA (n = 3598) and RA (n = 13,913).

Disclosures: This study was funded by State Research Funding, Kuopio University Hospital Catchment Area, Kuopio, Finland. The authors declared no conflicts of interest.

Source: Weman L et al. Disease burden measured by patient-reported outcomes: Does psoriatic arthritis feel worse than rheumatoid arthritis? A cross-sectional nationwide study. Clin Exp Rheumatol. 2023 (May 15). doi: 10.55563/clinexprheumatol/h9hn90

Key clinical point: Many patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) have impaired sleep despite treatment, with female patients having worse sleep quality than male patients.

Major finding: Overall, 46.6% of patients in the entire cohort had abnormal sleep behavior, with sleep quality being worse in women vs men (P < .001). Depressive symptoms (P < .001), female sex (P = .014), and Disease Activity Score in 28 joints (P = .003) predicted insomnia in PsA.

Study details: The data come from a retrospective medical chart analysis of 330 patients with spondyloarthritis, including 168 patients with PsA and 162 patients with axSpA.

Disclosures: This study was partly funded by an unrestricted grant from Novartis Pharma GmbH, Germany. Several authors, including the lead author, reported receiving speaker honoraria or research or travel grants or serving on advisory boards for several sources, including Novartis.

Source: Frede N et al. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. 2023;9:e002912 (May 19). doi: 10.1136/rmdopen-2022-002912

Key clinical point: Many patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) have impaired sleep despite treatment, with female patients having worse sleep quality than male patients.

Major finding: Overall, 46.6% of patients in the entire cohort had abnormal sleep behavior, with sleep quality being worse in women vs men (P < .001). Depressive symptoms (P < .001), female sex (P = .014), and Disease Activity Score in 28 joints (P = .003) predicted insomnia in PsA.

Study details: The data come from a retrospective medical chart analysis of 330 patients with spondyloarthritis, including 168 patients with PsA and 162 patients with axSpA.

Disclosures: This study was partly funded by an unrestricted grant from Novartis Pharma GmbH, Germany. Several authors, including the lead author, reported receiving speaker honoraria or research or travel grants or serving on advisory boards for several sources, including Novartis.

Source: Frede N et al. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. 2023;9:e002912 (May 19). doi: 10.1136/rmdopen-2022-002912

Key clinical point: Many patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) have impaired sleep despite treatment, with female patients having worse sleep quality than male patients.

Major finding: Overall, 46.6% of patients in the entire cohort had abnormal sleep behavior, with sleep quality being worse in women vs men (P < .001). Depressive symptoms (P < .001), female sex (P = .014), and Disease Activity Score in 28 joints (P = .003) predicted insomnia in PsA.

Study details: The data come from a retrospective medical chart analysis of 330 patients with spondyloarthritis, including 168 patients with PsA and 162 patients with axSpA.

Disclosures: This study was partly funded by an unrestricted grant from Novartis Pharma GmbH, Germany. Several authors, including the lead author, reported receiving speaker honoraria or research or travel grants or serving on advisory boards for several sources, including Novartis.

Source: Frede N et al. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. 2023;9:e002912 (May 19). doi: 10.1136/rmdopen-2022-002912

Key clinical point: Patients with psoriatic arthritis (PsA) and those with Behçet’s syndrome (BS) had significantly elevated levels of serum interleukin-36 alpha (IL-36α), although the extent was lesser in BS, highlighting the potential role of the serum IL-36α level in differential diagnosis between PsA and BS.

Major finding: The median serum IL-36α level in patients with BS (201.7 pg/mL) was significantly higher than that in control individuals (16.9 pg/mL; P < .001) but lower than that in patients with PsA (544 pg/mL; P < .001). An empirical cut-off level of 420.6 pg/mL for IL-36α showed a specificity of 0.93 and sensitivity of 0.70 to distinguish patients with PsA from those with BS.

Study details: The data come from a cross-sectional study including patients with PsA (n = 80) and BS (n = 90) and control individuals without immune-mediated inflammatory disease (n = 80) who were assessed for serum IL-36α levels.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Bettiol A et al. Serum interleukin-36 α as a candidate biomarker to distinguish Behçet’s syndrome and psoriatic arthritis. Int J Mol Sci. 2023;24:8817 (May 16). doi: 10.3390/ijms24108817

Key clinical point: Patients with psoriatic arthritis (PsA) and those with Behçet’s syndrome (BS) had significantly elevated levels of serum interleukin-36 alpha (IL-36α), although the extent was lesser in BS, highlighting the potential role of the serum IL-36α level in differential diagnosis between PsA and BS.

Major finding: The median serum IL-36α level in patients with BS (201.7 pg/mL) was significantly higher than that in control individuals (16.9 pg/mL; P < .001) but lower than that in patients with PsA (544 pg/mL; P < .001). An empirical cut-off level of 420.6 pg/mL for IL-36α showed a specificity of 0.93 and sensitivity of 0.70 to distinguish patients with PsA from those with BS.

Study details: The data come from a cross-sectional study including patients with PsA (n = 80) and BS (n = 90) and control individuals without immune-mediated inflammatory disease (n = 80) who were assessed for serum IL-36α levels.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Bettiol A et al. Serum interleukin-36 α as a candidate biomarker to distinguish Behçet’s syndrome and psoriatic arthritis. Int J Mol Sci. 2023;24:8817 (May 16). doi: 10.3390/ijms24108817

Key clinical point: Patients with psoriatic arthritis (PsA) and those with Behçet’s syndrome (BS) had significantly elevated levels of serum interleukin-36 alpha (IL-36α), although the extent was lesser in BS, highlighting the potential role of the serum IL-36α level in differential diagnosis between PsA and BS.

Major finding: The median serum IL-36α level in patients with BS (201.7 pg/mL) was significantly higher than that in control individuals (16.9 pg/mL; P < .001) but lower than that in patients with PsA (544 pg/mL; P < .001). An empirical cut-off level of 420.6 pg/mL for IL-36α showed a specificity of 0.93 and sensitivity of 0.70 to distinguish patients with PsA from those with BS.

Study details: The data come from a cross-sectional study including patients with PsA (n = 80) and BS (n = 90) and control individuals without immune-mediated inflammatory disease (n = 80) who were assessed for serum IL-36α levels.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Bettiol A et al. Serum interleukin-36 α as a candidate biomarker to distinguish Behçet’s syndrome and psoriatic arthritis. Int J Mol Sci. 2023;24:8817 (May 16). doi: 10.3390/ijms24108817

Key clinical point: No clinically meaningful treatment-related differences were observed in the efficacy, safety, and treatment persistence of ustekinumab over 3 years in younger (<60 years) and older (≥60 years) patients with psoriatic arthritis (PsA).

Major finding: At 6 months, 51.7% and 43.8% of patients aged <60 and ≥60 years achieved clinical Disease Activity Index for Psoriatic Arthritis low disease activity, respectively, with the efficacy being maintained through 36 months. The proportions of patients reporting at least one (32.7% vs 40.9%) and serious (5.3% vs 9.6%) adverse events and treatment persistence were not significantly different among patients age < 60 vs ≥ 60 years.

Study details: This post hoc analysis of the PsABio trial included patients with PsA who received ustekinumab and were subgrouped into those age < 60 years (n = 336) and ≥ 60 years (n = 103).

Disclosures: This study was sponsored by Janssen. Six authors declared being current or former employees of Janssen or shareholders of Johnson & Johnson. Three authors reported ties with various sources, including Janssen.

Source: Gossec L et al. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther. 2023;25:100 (Jun 9). doi: 10.1186/s13075-023-03078-8

Key clinical point: No clinically meaningful treatment-related differences were observed in the efficacy, safety, and treatment persistence of ustekinumab over 3 years in younger (<60 years) and older (≥60 years) patients with psoriatic arthritis (PsA).

Major finding: At 6 months, 51.7% and 43.8% of patients aged <60 and ≥60 years achieved clinical Disease Activity Index for Psoriatic Arthritis low disease activity, respectively, with the efficacy being maintained through 36 months. The proportions of patients reporting at least one (32.7% vs 40.9%) and serious (5.3% vs 9.6%) adverse events and treatment persistence were not significantly different among patients age < 60 vs ≥ 60 years.

Study details: This post hoc analysis of the PsABio trial included patients with PsA who received ustekinumab and were subgrouped into those age < 60 years (n = 336) and ≥ 60 years (n = 103).

Disclosures: This study was sponsored by Janssen. Six authors declared being current or former employees of Janssen or shareholders of Johnson & Johnson. Three authors reported ties with various sources, including Janssen.

Source: Gossec L et al. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther. 2023;25:100 (Jun 9). doi: 10.1186/s13075-023-03078-8

Key clinical point: No clinically meaningful treatment-related differences were observed in the efficacy, safety, and treatment persistence of ustekinumab over 3 years in younger (<60 years) and older (≥60 years) patients with psoriatic arthritis (PsA).

Major finding: At 6 months, 51.7% and 43.8% of patients aged <60 and ≥60 years achieved clinical Disease Activity Index for Psoriatic Arthritis low disease activity, respectively, with the efficacy being maintained through 36 months. The proportions of patients reporting at least one (32.7% vs 40.9%) and serious (5.3% vs 9.6%) adverse events and treatment persistence were not significantly different among patients age < 60 vs ≥ 60 years.

Study details: This post hoc analysis of the PsABio trial included patients with PsA who received ustekinumab and were subgrouped into those age < 60 years (n = 336) and ≥ 60 years (n = 103).

Disclosures: This study was sponsored by Janssen. Six authors declared being current or former employees of Janssen or shareholders of Johnson & Johnson. Three authors reported ties with various sources, including Janssen.

Source: Gossec L et al. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther. 2023;25:100 (Jun 9). doi: 10.1186/s13075-023-03078-8

Key clinical point: Apremilast led to a significant improvement in enthesitis and dactylitis activity among patients with psoriatic arthritis (PsA) presenting with enthesitis and dactylitis phenotypes, with more than one-third of patients achieving remission after 1 year of treatment.

Major finding: After 6 and 12 months of apremilast treatment, remission was achieved by 25% and 34% of patients with enthesitis and 47% and 44% of patients with dactylitis, respectively, with significant improvements in the Leeds Enthesitis and Dactylitis Indexes (P < .001).

Study details: Findings are from a retrospective study including patients with PsA who presented with either enthesitis (n = 118) or dactylitis (n = 96) phenotype and received apremilast.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Lo Gullo A et al. Therapeutic effects of apremilast on enthesitis and dactylitis in real clinical setting: An Italian multicenter study. J Clin Med. 2023;12:3892 (Jun 7). doi: 10.3390/jcm12123892

Key clinical point: Apremilast led to a significant improvement in enthesitis and dactylitis activity among patients with psoriatic arthritis (PsA) presenting with enthesitis and dactylitis phenotypes, with more than one-third of patients achieving remission after 1 year of treatment.

Major finding: After 6 and 12 months of apremilast treatment, remission was achieved by 25% and 34% of patients with enthesitis and 47% and 44% of patients with dactylitis, respectively, with significant improvements in the Leeds Enthesitis and Dactylitis Indexes (P < .001).

Study details: Findings are from a retrospective study including patients with PsA who presented with either enthesitis (n = 118) or dactylitis (n = 96) phenotype and received apremilast.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Lo Gullo A et al. Therapeutic effects of apremilast on enthesitis and dactylitis in real clinical setting: An Italian multicenter study. J Clin Med. 2023;12:3892 (Jun 7). doi: 10.3390/jcm12123892

Key clinical point: Apremilast led to a significant improvement in enthesitis and dactylitis activity among patients with psoriatic arthritis (PsA) presenting with enthesitis and dactylitis phenotypes, with more than one-third of patients achieving remission after 1 year of treatment.

Major finding: After 6 and 12 months of apremilast treatment, remission was achieved by 25% and 34% of patients with enthesitis and 47% and 44% of patients with dactylitis, respectively, with significant improvements in the Leeds Enthesitis and Dactylitis Indexes (P < .001).

Study details: Findings are from a retrospective study including patients with PsA who presented with either enthesitis (n = 118) or dactylitis (n = 96) phenotype and received apremilast.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Lo Gullo A et al. Therapeutic effects of apremilast on enthesitis and dactylitis in real clinical setting: An Italian multicenter study. J Clin Med. 2023;12:3892 (Jun 7). doi: 10.3390/jcm12123892

Key clinical point: Axial spondyloarthritis (axSpA) with or without concomitant psoriasis and axial psoriatic arthritis (PsA) appear distinct entities based on marked demographic, clinical, and genetic differences.

Major finding: Patients with axial PsA vs axSpA with or without psoriasis were older at symptom onset (48.6 vs 44.7 or 41.4 years, respectively; P < .001), had a higher prevalence of dactylitis (43.2% vs 18.3% or 8.4%, respectively; P < .001) and peripheral arthritis (86.7% vs 58.1% or 44.3%, respectively; P < .001), and were less frequently HLA-B27 positive (22.3% vs 55.4% or 65.5%, respectively; P < .001).

Study details: This study included 5208 patients with axSpA (with or without psoriasis) and 2771 with PsA (axial or peripheral arthritis) from the Swiss Clinical Quality Management (SCQM) registry.

Disclosures: This study was funded by Eli Lilly. Two authors declared being employees of SCQM with salary partly financed by Eli Lilly. Several authors declared receiving honoraria, speaking or consulting fees, research grants, or other financial support from various sources, including Lilly and other SCQM supporters. Two authors declared no conflicts of interest.

Source: Ciurea A et al. Characterisation of patients with axial psoriatic arthritis and patients with axial spondyloarthritis and concomitant psoriasis in the SCQM registry. RMD Open. 2023;9:e002956 (Jun 5). doi: 10.1136/rmdopen-2022-002956

Key clinical point: Axial spondyloarthritis (axSpA) with or without concomitant psoriasis and axial psoriatic arthritis (PsA) appear distinct entities based on marked demographic, clinical, and genetic differences.

Major finding: Patients with axial PsA vs axSpA with or without psoriasis were older at symptom onset (48.6 vs 44.7 or 41.4 years, respectively; P < .001), had a higher prevalence of dactylitis (43.2% vs 18.3% or 8.4%, respectively; P < .001) and peripheral arthritis (86.7% vs 58.1% or 44.3%, respectively; P < .001), and were less frequently HLA-B27 positive (22.3% vs 55.4% or 65.5%, respectively; P < .001).

Study details: This study included 5208 patients with axSpA (with or without psoriasis) and 2771 with PsA (axial or peripheral arthritis) from the Swiss Clinical Quality Management (SCQM) registry.

Disclosures: This study was funded by Eli Lilly. Two authors declared being employees of SCQM with salary partly financed by Eli Lilly. Several authors declared receiving honoraria, speaking or consulting fees, research grants, or other financial support from various sources, including Lilly and other SCQM supporters. Two authors declared no conflicts of interest.

Source: Ciurea A et al. Characterisation of patients with axial psoriatic arthritis and patients with axial spondyloarthritis and concomitant psoriasis in the SCQM registry. RMD Open. 2023;9:e002956 (Jun 5). doi: 10.1136/rmdopen-2022-002956

Key clinical point: Axial spondyloarthritis (axSpA) with or without concomitant psoriasis and axial psoriatic arthritis (PsA) appear distinct entities based on marked demographic, clinical, and genetic differences.

Major finding: Patients with axial PsA vs axSpA with or without psoriasis were older at symptom onset (48.6 vs 44.7 or 41.4 years, respectively; P < .001), had a higher prevalence of dactylitis (43.2% vs 18.3% or 8.4%, respectively; P < .001) and peripheral arthritis (86.7% vs 58.1% or 44.3%, respectively; P < .001), and were less frequently HLA-B27 positive (22.3% vs 55.4% or 65.5%, respectively; P < .001).

Study details: This study included 5208 patients with axSpA (with or without psoriasis) and 2771 with PsA (axial or peripheral arthritis) from the Swiss Clinical Quality Management (SCQM) registry.

Disclosures: This study was funded by Eli Lilly. Two authors declared being employees of SCQM with salary partly financed by Eli Lilly. Several authors declared receiving honoraria, speaking or consulting fees, research grants, or other financial support from various sources, including Lilly and other SCQM supporters. Two authors declared no conflicts of interest.

Source: Ciurea A et al. Characterisation of patients with axial psoriatic arthritis and patients with axial spondyloarthritis and concomitant psoriasis in the SCQM registry. RMD Open. 2023;9:e002956 (Jun 5). doi: 10.1136/rmdopen-2022-002956

Key clinical point: Etanercept was safe and effective with low rates of adverse events and led to better clinical outcomes in children with juvenile psoriatic arthritis (JPsA).

Major finding: The overall incidence of adverse events of special interest and serious adverse events were low and included 3 cases of uveitis (incidence rate [IR]/100 person-years 0.55; 95% CI 0.18-1.69), 1 of neuropathy (IR/100 person-years 0.18; 95% CI 0.03-1.29), and 1 of malignancy (IR/100 person-years 0.13; 95% CI 0.02-0.90). The American College of Rheumatology provisional criteria for inactive disease were achieved by 51.9% and 43.8% of patients at 6- and 12-month follow-ups.

Study details: This study included 226 patients with JPsA (aged ≥2 to <18 years) who received etanercept.

Disclosures: This study was sponsored by Immunex, a wholly owned subsidiary of Amgen Inc. S Stryker and D Collier declared being employees of and owning stocks in Amgen. SJ Balevic and T Beukelman declared receiving grants or research support, honoraria, or consulting fees or participating in data safety monitoring boards for various sources. The other authors declared no conflicts of interest.

Source: Correll CK et al. Occurrence of adverse events and change in disease activity after initiation of etanercept in paediatric patients with juvenile psoriatic arthritis in the CARRA Registry. RMD Open. 2023;9:e002943 (May 25). doi: 10.1136/rmdopen-2022-002943

Key clinical point: Etanercept was safe and effective with low rates of adverse events and led to better clinical outcomes in children with juvenile psoriatic arthritis (JPsA).

Major finding: The overall incidence of adverse events of special interest and serious adverse events were low and included 3 cases of uveitis (incidence rate [IR]/100 person-years 0.55; 95% CI 0.18-1.69), 1 of neuropathy (IR/100 person-years 0.18; 95% CI 0.03-1.29), and 1 of malignancy (IR/100 person-years 0.13; 95% CI 0.02-0.90). The American College of Rheumatology provisional criteria for inactive disease were achieved by 51.9% and 43.8% of patients at 6- and 12-month follow-ups.

Study details: This study included 226 patients with JPsA (aged ≥2 to <18 years) who received etanercept.

Disclosures: This study was sponsored by Immunex, a wholly owned subsidiary of Amgen Inc. S Stryker and D Collier declared being employees of and owning stocks in Amgen. SJ Balevic and T Beukelman declared receiving grants or research support, honoraria, or consulting fees or participating in data safety monitoring boards for various sources. The other authors declared no conflicts of interest.

Source: Correll CK et al. Occurrence of adverse events and change in disease activity after initiation of etanercept in paediatric patients with juvenile psoriatic arthritis in the CARRA Registry. RMD Open. 2023;9:e002943 (May 25). doi: 10.1136/rmdopen-2022-002943

Key clinical point: Etanercept was safe and effective with low rates of adverse events and led to better clinical outcomes in children with juvenile psoriatic arthritis (JPsA).

Major finding: The overall incidence of adverse events of special interest and serious adverse events were low and included 3 cases of uveitis (incidence rate [IR]/100 person-years 0.55; 95% CI 0.18-1.69), 1 of neuropathy (IR/100 person-years 0.18; 95% CI 0.03-1.29), and 1 of malignancy (IR/100 person-years 0.13; 95% CI 0.02-0.90). The American College of Rheumatology provisional criteria for inactive disease were achieved by 51.9% and 43.8% of patients at 6- and 12-month follow-ups.

Study details: This study included 226 patients with JPsA (aged ≥2 to <18 years) who received etanercept.

Disclosures: This study was sponsored by Immunex, a wholly owned subsidiary of Amgen Inc. S Stryker and D Collier declared being employees of and owning stocks in Amgen. SJ Balevic and T Beukelman declared receiving grants or research support, honoraria, or consulting fees or participating in data safety monitoring boards for various sources. The other authors declared no conflicts of interest.

Source: Correll CK et al. Occurrence of adverse events and change in disease activity after initiation of etanercept in paediatric patients with juvenile psoriatic arthritis in the CARRA Registry. RMD Open. 2023;9:e002943 (May 25). doi: 10.1136/rmdopen-2022-002943

Key clinical point: Patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) who initiated methotrexate showed similar rates of methotrexate retention; however, the addition of any other disease-modifying antirheumatic drugs (DMARD) to the treatment regimen was more rapid in RA vs PsA.

Major finding: Overall, 71% of patients with PsA and 76% of patients with RA remained on methotrexate at 2 years after initiating methotrexate. The risk for adding any other DMARD to the treatment regimen was greater in the RA vs PsA group (adjusted hazard ratio 0.86; 95% CI 0.77-0.96), with methotrexate monotherapy improving disease activity in both the groups.

Study details: This observational study included DMARD-naive patients with newly diagnosed PsA (n = 3642) who initiated methotrexate and matched comparator patients with RA (n = 3642).

Disclosures: This study was funded by grants from the Swedish Rheumatism Association and others. Some authors declared serving as consultants or receiving lecture fees, speakers’ bureau fees, or research support from various sources.

Source: Lindström U et al. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: An observational nationwide study. RMD Open. 2023;9:e002883 (May 12). doi: 10.1136/rmdopen-2022-002883

Key clinical point: Patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) who initiated methotrexate showed similar rates of methotrexate retention; however, the addition of any other disease-modifying antirheumatic drugs (DMARD) to the treatment regimen was more rapid in RA vs PsA.

Major finding: Overall, 71% of patients with PsA and 76% of patients with RA remained on methotrexate at 2 years after initiating methotrexate. The risk for adding any other DMARD to the treatment regimen was greater in the RA vs PsA group (adjusted hazard ratio 0.86; 95% CI 0.77-0.96), with methotrexate monotherapy improving disease activity in both the groups.

Study details: This observational study included DMARD-naive patients with newly diagnosed PsA (n = 3642) who initiated methotrexate and matched comparator patients with RA (n = 3642).

Disclosures: This study was funded by grants from the Swedish Rheumatism Association and others. Some authors declared serving as consultants or receiving lecture fees, speakers’ bureau fees, or research support from various sources.

Source: Lindström U et al. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: An observational nationwide study. RMD Open. 2023;9:e002883 (May 12). doi: 10.1136/rmdopen-2022-002883

Key clinical point: Patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) who initiated methotrexate showed similar rates of methotrexate retention; however, the addition of any other disease-modifying antirheumatic drugs (DMARD) to the treatment regimen was more rapid in RA vs PsA.

Major finding: Overall, 71% of patients with PsA and 76% of patients with RA remained on methotrexate at 2 years after initiating methotrexate. The risk for adding any other DMARD to the treatment regimen was greater in the RA vs PsA group (adjusted hazard ratio 0.86; 95% CI 0.77-0.96), with methotrexate monotherapy improving disease activity in both the groups.

Study details: This observational study included DMARD-naive patients with newly diagnosed PsA (n = 3642) who initiated methotrexate and matched comparator patients with RA (n = 3642).

Disclosures: This study was funded by grants from the Swedish Rheumatism Association and others. Some authors declared serving as consultants or receiving lecture fees, speakers’ bureau fees, or research support from various sources.

Source: Lindström U et al. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: An observational nationwide study. RMD Open. 2023;9:e002883 (May 12). doi: 10.1136/rmdopen-2022-002883

Key clinical point: Brepocitinib, the tyrosine kinase 2/Janus kinase 1 inhibitor, was superior to placebo in reducing signs and symptoms of psoriatic arthritis (PsA) and was well-tolerated throughout the 52-week study period.

Major finding: At week 16, American College of Rheumatology 20 response was achieved by a significantly higher proportion of patients receiving brepocitinib at doses of 30 mg (66.7%; P = .0197) and 60 mg (74.6%; P = .0006) compared with placebo (43.3%), with the response being maintained through week 52. Overall, 12 serious adverse events were reported in the brepocitinib arms (30 and 60 mg) by week 52. No deaths were reported.

Study details: Findings are from a phase 2b, dose-ranging, parallel treatment group trial including 218 patients with active PsA who were randomly assigned to receive either brepocitinib (60, 30, or 10 mg once daily) or placebo.

Disclosures: This study was sponsored by Pfizer Inc. Several authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Mease P et al. Efficacy and safety of tyrosine kinase 2/Janus kinase 1 Inhibitor brepocitinib for active psoriatic arthritis: A phase IIb randomized controlled trial. Arthritis Rheumatol. 2023 (May 17). doi: 10.1002/art.42519

Key clinical point: Brepocitinib, the tyrosine kinase 2/Janus kinase 1 inhibitor, was superior to placebo in reducing signs and symptoms of psoriatic arthritis (PsA) and was well-tolerated throughout the 52-week study period.

Major finding: At week 16, American College of Rheumatology 20 response was achieved by a significantly higher proportion of patients receiving brepocitinib at doses of 30 mg (66.7%; P = .0197) and 60 mg (74.6%; P = .0006) compared with placebo (43.3%), with the response being maintained through week 52. Overall, 12 serious adverse events were reported in the brepocitinib arms (30 and 60 mg) by week 52. No deaths were reported.

Study details: Findings are from a phase 2b, dose-ranging, parallel treatment group trial including 218 patients with active PsA who were randomly assigned to receive either brepocitinib (60, 30, or 10 mg once daily) or placebo.

Disclosures: This study was sponsored by Pfizer Inc. Several authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Mease P et al. Efficacy and safety of tyrosine kinase 2/Janus kinase 1 Inhibitor brepocitinib for active psoriatic arthritis: A phase IIb randomized controlled trial. Arthritis Rheumatol. 2023 (May 17). doi: 10.1002/art.42519

Key clinical point: Brepocitinib, the tyrosine kinase 2/Janus kinase 1 inhibitor, was superior to placebo in reducing signs and symptoms of psoriatic arthritis (PsA) and was well-tolerated throughout the 52-week study period.

Major finding: At week 16, American College of Rheumatology 20 response was achieved by a significantly higher proportion of patients receiving brepocitinib at doses of 30 mg (66.7%; P = .0197) and 60 mg (74.6%; P = .0006) compared with placebo (43.3%), with the response being maintained through week 52. Overall, 12 serious adverse events were reported in the brepocitinib arms (30 and 60 mg) by week 52. No deaths were reported.

Study details: Findings are from a phase 2b, dose-ranging, parallel treatment group trial including 218 patients with active PsA who were randomly assigned to receive either brepocitinib (60, 30, or 10 mg once daily) or placebo.

Disclosures: This study was sponsored by Pfizer Inc. Several authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Mease P et al. Efficacy and safety of tyrosine kinase 2/Janus kinase 1 Inhibitor brepocitinib for active psoriatic arthritis: A phase IIb randomized controlled trial. Arthritis Rheumatol. 2023 (May 17). doi: 10.1002/art.42519

The history and findings in this case are consistent with a diagnosis of psoriatic spondylitis.

Psoriatic spondylitis is a form of psoriatic arthritis (PsA) that affects the spine and the joints in the pelvis (axial involvement). PsA is a chronic, heterogeneous condition that affects approximately 25%-30% of patients with psoriasis, particularly those with severe psoriasis or nail or scalp involvement. It is characterized by musculoskeletal inflammation (arthritis, enthesitis, spondylitis, and dactylitis). PsA is a spondyloarthritis that can be found either in the peripheral or axial skeleton. If not treated, it may result in permanent joint damage and loss of function. 

Patients with PsA may present with nail and skin changes, peripheral arthritis, enthesitis, dactylitis, and axial spondyloarthritis (SpA), either alone or in combination. Common symptoms of axial involvement in PsA include morning back/neck stiffness that lasts longer than 30 minutes, neck or back pain that improves with activity and worsens after prolonged inactivity, and diminished mobility. PsA affects men and women equally, and typically develops when patients are between 30 and 50 years of age. As with psoriasis, PsA is associated with numerous comorbidities, such as cardiovascular disease, metabolic syndrome, obesity, diabetes, depression, uveitis, and anxiety.

The diagnosis of psoriatic spondylitis is confirmed by physical examination and imaging. Axial PsA characteristics, including sacroiliitis and spondylitis, are distinguished by the development of syndesmophytes (ie, ossification of the annulus fibrosus). Useful imaging tools for evaluating patients with PsA include plain radiography, CT, ultrasound, and MRI. Although MRI and ultrasound may be more sensitive than plain radiography for detecting early joint inflammation and damage and axial changes, including sacroiliitis, they are not mandatory for a diagnosis of PsA to be made.

International guidelines have been developed by the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), the European Alliance of Associations for Rheumatology (EULAR), and the Assessment of Spondyloarthritis International Society to guide the treatment of axial PsA. The goals of treatment include minimizing pain, stiffness, and fatigue; improving and preserving spinal flexibility and posture; improving functional capacity; and maintaining the ability to work, with a target of remission or minimal/low disease activity.

Treatment options for symptomatic relief include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and sacroiliac joint injections with glucocorticoids for mild disease; long-term treatment with systemic glucocorticoids is not recommended. If patients remain symptomatic or have erosive disease or other indications of high disease activity, guidelines recommend initiation of a tumor necrosis factor (TNF) inhibitor (eg, adalimumab, etanercept, infliximab, golimumab, certolizumab pegol). Disease-modifying antirheumatic drugs (eg, methotrexate) are not routinely prescribed for patients with axial disease because they have not been shown to be effective. In patients with significant skin involvement, treatment with interleukin-17A inhibitors may be preferred to TNF inhibitors. 

If patients have an inadequate response to a first trial of a TNF inhibitor, guidelines recommend trying a second TNF inhibitor before switching to a different class of biologic. For patients who do not respond to TNF inhibitors, a Janus kinase inhibitor (tofacitinib) may be considered. Additionally, nonpharmacologic therapies (eg, exercise, physical therapy, massage therapy, occupational therapy, acupuncture) are recommended for all patients with active PsA.

Herbert S. Diamond, MD, Professor of Medicine (retired), Temple University School of Medicine, University of Pittsburgh; Chairman, Department of Medicine Emeritus, Western Pennsylvania Hospital, Pittsburgh, PA.

Herbert S. Diamond, MD, has disclosed no relevant financial relationships.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

The history and findings in this case are consistent with a diagnosis of psoriatic spondylitis.

Psoriatic spondylitis is a form of psoriatic arthritis (PsA) that affects the spine and the joints in the pelvis (axial involvement). PsA is a chronic, heterogeneous condition that affects approximately 25%-30% of patients with psoriasis, particularly those with severe psoriasis or nail or scalp involvement. It is characterized by musculoskeletal inflammation (arthritis, enthesitis, spondylitis, and dactylitis). PsA is a spondyloarthritis that can be found either in the peripheral or axial skeleton. If not treated, it may result in permanent joint damage and loss of function. 

Patients with PsA may present with nail and skin changes, peripheral arthritis, enthesitis, dactylitis, and axial spondyloarthritis (SpA), either alone or in combination. Common symptoms of axial involvement in PsA include morning back/neck stiffness that lasts longer than 30 minutes, neck or back pain that improves with activity and worsens after prolonged inactivity, and diminished mobility. PsA affects men and women equally, and typically develops when patients are between 30 and 50 years of age. As with psoriasis, PsA is associated with numerous comorbidities, such as cardiovascular disease, metabolic syndrome, obesity, diabetes, depression, uveitis, and anxiety.

The diagnosis of psoriatic spondylitis is confirmed by physical examination and imaging. Axial PsA characteristics, including sacroiliitis and spondylitis, are distinguished by the development of syndesmophytes (ie, ossification of the annulus fibrosus). Useful imaging tools for evaluating patients with PsA include plain radiography, CT, ultrasound, and MRI. Although MRI and ultrasound may be more sensitive than plain radiography for detecting early joint inflammation and damage and axial changes, including sacroiliitis, they are not mandatory for a diagnosis of PsA to be made.

International guidelines have been developed by the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), the European Alliance of Associations for Rheumatology (EULAR), and the Assessment of Spondyloarthritis International Society to guide the treatment of axial PsA. The goals of treatment include minimizing pain, stiffness, and fatigue; improving and preserving spinal flexibility and posture; improving functional capacity; and maintaining the ability to work, with a target of remission or minimal/low disease activity.

Treatment options for symptomatic relief include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and sacroiliac joint injections with glucocorticoids for mild disease; long-term treatment with systemic glucocorticoids is not recommended. If patients remain symptomatic or have erosive disease or other indications of high disease activity, guidelines recommend initiation of a tumor necrosis factor (TNF) inhibitor (eg, adalimumab, etanercept, infliximab, golimumab, certolizumab pegol). Disease-modifying antirheumatic drugs (eg, methotrexate) are not routinely prescribed for patients with axial disease because they have not been shown to be effective. In patients with significant skin involvement, treatment with interleukin-17A inhibitors may be preferred to TNF inhibitors. 

If patients have an inadequate response to a first trial of a TNF inhibitor, guidelines recommend trying a second TNF inhibitor before switching to a different class of biologic. For patients who do not respond to TNF inhibitors, a Janus kinase inhibitor (tofacitinib) may be considered. Additionally, nonpharmacologic therapies (eg, exercise, physical therapy, massage therapy, occupational therapy, acupuncture) are recommended for all patients with active PsA.

Herbert S. Diamond, MD, Professor of Medicine (retired), Temple University School of Medicine, University of Pittsburgh; Chairman, Department of Medicine Emeritus, Western Pennsylvania Hospital, Pittsburgh, PA.

Herbert S. Diamond, MD, has disclosed no relevant financial relationships.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

The history and findings in this case are consistent with a diagnosis of psoriatic spondylitis.

Psoriatic spondylitis is a form of psoriatic arthritis (PsA) that affects the spine and the joints in the pelvis (axial involvement). PsA is a chronic, heterogeneous condition that affects approximately 25%-30% of patients with psoriasis, particularly those with severe psoriasis or nail or scalp involvement. It is characterized by musculoskeletal inflammation (arthritis, enthesitis, spondylitis, and dactylitis). PsA is a spondyloarthritis that can be found either in the peripheral or axial skeleton. If not treated, it may result in permanent joint damage and loss of function. 

Patients with PsA may present with nail and skin changes, peripheral arthritis, enthesitis, dactylitis, and axial spondyloarthritis (SpA), either alone or in combination. Common symptoms of axial involvement in PsA include morning back/neck stiffness that lasts longer than 30 minutes, neck or back pain that improves with activity and worsens after prolonged inactivity, and diminished mobility. PsA affects men and women equally, and typically develops when patients are between 30 and 50 years of age. As with psoriasis, PsA is associated with numerous comorbidities, such as cardiovascular disease, metabolic syndrome, obesity, diabetes, depression, uveitis, and anxiety.

The diagnosis of psoriatic spondylitis is confirmed by physical examination and imaging. Axial PsA characteristics, including sacroiliitis and spondylitis, are distinguished by the development of syndesmophytes (ie, ossification of the annulus fibrosus). Useful imaging tools for evaluating patients with PsA include plain radiography, CT, ultrasound, and MRI. Although MRI and ultrasound may be more sensitive than plain radiography for detecting early joint inflammation and damage and axial changes, including sacroiliitis, they are not mandatory for a diagnosis of PsA to be made.

International guidelines have been developed by the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), the European Alliance of Associations for Rheumatology (EULAR), and the Assessment of Spondyloarthritis International Society to guide the treatment of axial PsA. The goals of treatment include minimizing pain, stiffness, and fatigue; improving and preserving spinal flexibility and posture; improving functional capacity; and maintaining the ability to work, with a target of remission or minimal/low disease activity.

Treatment options for symptomatic relief include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and sacroiliac joint injections with glucocorticoids for mild disease; long-term treatment with systemic glucocorticoids is not recommended. If patients remain symptomatic or have erosive disease or other indications of high disease activity, guidelines recommend initiation of a tumor necrosis factor (TNF) inhibitor (eg, adalimumab, etanercept, infliximab, golimumab, certolizumab pegol). Disease-modifying antirheumatic drugs (eg, methotrexate) are not routinely prescribed for patients with axial disease because they have not been shown to be effective. In patients with significant skin involvement, treatment with interleukin-17A inhibitors may be preferred to TNF inhibitors. 

If patients have an inadequate response to a first trial of a TNF inhibitor, guidelines recommend trying a second TNF inhibitor before switching to a different class of biologic. For patients who do not respond to TNF inhibitors, a Janus kinase inhibitor (tofacitinib) may be considered. Additionally, nonpharmacologic therapies (eg, exercise, physical therapy, massage therapy, occupational therapy, acupuncture) are recommended for all patients with active PsA.

Herbert S. Diamond, MD, Professor of Medicine (retired), Temple University School of Medicine, University of Pittsburgh; Chairman, Department of Medicine Emeritus, Western Pennsylvania Hospital, Pittsburgh, PA.

Herbert S. Diamond, MD, has disclosed no relevant financial relationships.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.