Psoriatic Arthritis

The differences between patients who have PsA with axial involvement (AxPsA) and patients who have axial spondyloarthritis with psoriasis (AxSpA+PsO) continue to remain a strong area of interest. Regierer and colleagues recently compared 359 patients with AxPsA vs 181 patients with AxSpA+PsO. These patients were enrolled into the RABBIT-SpA prospective longitudinal cohort study. Given the lack of definition of AxPsA, two definitions were used: 1) clinical judgment by the rheumatologist and 2) imaging (x-ray or MRI) findings. Regardless of clinical or imaging definition used, compared with patients who have AxSpA+PsO those with AxPsA were significantly more often women, were older, were less often HLA-B27 positive, and had more frequent peripheral manifestations but less frequent uveitis. The two diseases thus have significant differences; these should be carefully considered while making treatment decisions.

Another major research focus is on the influence of sex on PsA treatment response. Eder and colleagues conducted a post hoc analysis of pooled data from phase 3 randomized controlled trials that included 816 patients with PsA who received tofacitinib, adalimumab, or placebo. They demonstrate that at 3 months, tofacitinib was more efficacious than placebo, irrespective of sex. However, a higher proportion of men vs women receiving tofacitinib achieved minimal disease activity. This might be due to baseline differences in disease activity. The American College of Rheumatology 20/50/70 response rates were comparable. The incidence of treatment-emergent adverse events was similar in men and women receiving tofacitinib. Thus, sex significantly influences achieving low disease state. Understanding the mechanisms underlying sex differences will help improve treatment response rates in women with PsA.

Atherosclerotic vascular disease (ASVD) is an important comorbidity of PsA. Predicting ASVD remains difficult. The triglyceride-glucose (TyG) index — calculated as ln[fasting triglycerides (in mg/dL) × fasting glucose (in mg/dL)/2] — was recently identified as a marker of insulin resistance and ASVD. Xie and colleagues conducted a cross-sectional study in 165 patients with PsA who underwent carotid ultrasound and had data available for the TyG index. In a model that was adjusted for age, sex, comorbidities, smoking, BMI, low-density lipoprotein cholesterol, psoriasis area and severity index, and disease activity index for PsA, the TyG index was significantly associated with the presence of carotid atherosclerosis (adjusted odds ratio [aOR] 2.69; 95% CI 1.02-7.11) as well as carotid artery plaque (aOR 3.61; 95% CI 1.15-11.38). Thus, this easily calculated marker is associated with ASVD independent of demographic, traditional risk factors, and disease activity and needs further evaluation in prospective studies.

The differences between patients who have PsA with axial involvement (AxPsA) and patients who have axial spondyloarthritis with psoriasis (AxSpA+PsO) continue to remain a strong area of interest. Regierer and colleagues recently compared 359 patients with AxPsA vs 181 patients with AxSpA+PsO. These patients were enrolled into the RABBIT-SpA prospective longitudinal cohort study. Given the lack of definition of AxPsA, two definitions were used: 1) clinical judgment by the rheumatologist and 2) imaging (x-ray or MRI) findings. Regardless of clinical or imaging definition used, compared with patients who have AxSpA+PsO those with AxPsA were significantly more often women, were older, were less often HLA-B27 positive, and had more frequent peripheral manifestations but less frequent uveitis. The two diseases thus have significant differences; these should be carefully considered while making treatment decisions.

Another major research focus is on the influence of sex on PsA treatment response. Eder and colleagues conducted a post hoc analysis of pooled data from phase 3 randomized controlled trials that included 816 patients with PsA who received tofacitinib, adalimumab, or placebo. They demonstrate that at 3 months, tofacitinib was more efficacious than placebo, irrespective of sex. However, a higher proportion of men vs women receiving tofacitinib achieved minimal disease activity. This might be due to baseline differences in disease activity. The American College of Rheumatology 20/50/70 response rates were comparable. The incidence of treatment-emergent adverse events was similar in men and women receiving tofacitinib. Thus, sex significantly influences achieving low disease state. Understanding the mechanisms underlying sex differences will help improve treatment response rates in women with PsA.

Atherosclerotic vascular disease (ASVD) is an important comorbidity of PsA. Predicting ASVD remains difficult. The triglyceride-glucose (TyG) index — calculated as ln[fasting triglycerides (in mg/dL) × fasting glucose (in mg/dL)/2] — was recently identified as a marker of insulin resistance and ASVD. Xie and colleagues conducted a cross-sectional study in 165 patients with PsA who underwent carotid ultrasound and had data available for the TyG index. In a model that was adjusted for age, sex, comorbidities, smoking, BMI, low-density lipoprotein cholesterol, psoriasis area and severity index, and disease activity index for PsA, the TyG index was significantly associated with the presence of carotid atherosclerosis (adjusted odds ratio [aOR] 2.69; 95% CI 1.02-7.11) as well as carotid artery plaque (aOR 3.61; 95% CI 1.15-11.38). Thus, this easily calculated marker is associated with ASVD independent of demographic, traditional risk factors, and disease activity and needs further evaluation in prospective studies.

The differences between patients who have PsA with axial involvement (AxPsA) and patients who have axial spondyloarthritis with psoriasis (AxSpA+PsO) continue to remain a strong area of interest. Regierer and colleagues recently compared 359 patients with AxPsA vs 181 patients with AxSpA+PsO. These patients were enrolled into the RABBIT-SpA prospective longitudinal cohort study. Given the lack of definition of AxPsA, two definitions were used: 1) clinical judgment by the rheumatologist and 2) imaging (x-ray or MRI) findings. Regardless of clinical or imaging definition used, compared with patients who have AxSpA+PsO those with AxPsA were significantly more often women, were older, were less often HLA-B27 positive, and had more frequent peripheral manifestations but less frequent uveitis. The two diseases thus have significant differences; these should be carefully considered while making treatment decisions.

Another major research focus is on the influence of sex on PsA treatment response. Eder and colleagues conducted a post hoc analysis of pooled data from phase 3 randomized controlled trials that included 816 patients with PsA who received tofacitinib, adalimumab, or placebo. They demonstrate that at 3 months, tofacitinib was more efficacious than placebo, irrespective of sex. However, a higher proportion of men vs women receiving tofacitinib achieved minimal disease activity. This might be due to baseline differences in disease activity. The American College of Rheumatology 20/50/70 response rates were comparable. The incidence of treatment-emergent adverse events was similar in men and women receiving tofacitinib. Thus, sex significantly influences achieving low disease state. Understanding the mechanisms underlying sex differences will help improve treatment response rates in women with PsA.

Atherosclerotic vascular disease (ASVD) is an important comorbidity of PsA. Predicting ASVD remains difficult. The triglyceride-glucose (TyG) index — calculated as ln[fasting triglycerides (in mg/dL) × fasting glucose (in mg/dL)/2] — was recently identified as a marker of insulin resistance and ASVD. Xie and colleagues conducted a cross-sectional study in 165 patients with PsA who underwent carotid ultrasound and had data available for the TyG index. In a model that was adjusted for age, sex, comorbidities, smoking, BMI, low-density lipoprotein cholesterol, psoriasis area and severity index, and disease activity index for PsA, the TyG index was significantly associated with the presence of carotid atherosclerosis (adjusted odds ratio [aOR] 2.69; 95% CI 1.02-7.11) as well as carotid artery plaque (aOR 3.61; 95% CI 1.15-11.38). Thus, this easily calculated marker is associated with ASVD independent of demographic, traditional risk factors, and disease activity and needs further evaluation in prospective studies.

MANCHESTER, ENGLAND – Janus kinase (JAK) inhibitors may be associated with a higher risk for cancer relative to tumor necrosis factor (TNF) inhibitors, according to a meta-analysis reported at the annual meeting of the British Society for Rheumatology.

Looking at all phase 2, 3, and 4 trials and long-term extension studies across the indications of rheumatoid arthritis, psoriatic arthritis, psoriasis, axial spondyloarthritis, inflammatory bowel disease, and atopic dermatitis, the risk ratio for any cancer developing was 1.63 when compared with anti-TNF therapy (95% confidence interval, 1.27-2.09).

Sara Freeman/MDedge News

By comparison, JAK inhibitor use was not significantly associated with any greater risk for cancer than methotrexate (RR, 1.06; 95% confidence interval, 0.58-1.94) or placebo (RR, 1.16; 95% CI, 0.75-1.80).

“Our data suggests that rather than JAK inhibitors necessarily being harmful, it could be more a case of TNF inhibitors being protective,” said Christopher Stovin, MBChB, a specialist registrar in rheumatology at the Princess Royal University Hospital, King’s College Hospital NHS Trust, London.

“We should stress that these are rare events in our study, roughly around 1 in every 100 patient-years of exposure,” Dr. Stovin said.

“Despite having over 80,000 years of patient exposure, the median follow-up duration for JAK inhibitors was still only 118 weeks, which for cancers [that] obviously have long latency periods is still a relatively small duration of time,” the researcher added.

“People worry about the drugs. But there is a possibility that [a] disturbed immune system plays a role per se in development of cancers,” consultant rheumatologist Anurag Bharadwaj, MD, DM, said in an interview.

“Although there are studies which attribute increased risk of cancer to different DMARDs [disease-modifying antirheumatic drugs] and biologics like TNF, but on other hand, it’s maybe that we are giving these drugs to patients who have got more serious immunological disease,” suggested Bharadwaj, who serves as the clinical lead for rheumatology at Basildon (England) Hospital, Mid & South Essex Foundation Trust.

“So, a possibility may be that the more severe or the more active the immunological inflammatory disease, the higher the chance of cancer, and these are the patients who go for the stronger medications,” Dr. Bharadwaj said.

There is an “immunological window of opportunity” when treating these inflammatory diseases, said Dr. Bharadwaj, noting that the first few months of treatment are vital. “For all immunological diseases, the more quickly you bring the immunological abnormality down, the chances of long-term complications go down, including [possibly that the] chances of cancer go down, chances of cardiovascular disease go down, and chances of lung disease go down. Hit it early, hit it hard.”

Concern over a possible higher risk for cancer with JAK inhibitors than with TNF inhibitors was raised following the release of data from the ORAL Surveillance trial, a postmarketing trial of tofacitinib (Xeljanz) that had been mandated by the Food and Drug Administration.

“This was a study looking at the coprimary endpoints of malignancy and major adverse cardiovascular events, and it was enriched with patients over the age of 50, with one additional cardiac risk factor, designed to amplify the detection of these rare events,” Dr. Stovin said.

“There was a signal of an increased risk of malignancy in the tofacitinib group, and this led to the FDA issuing a [boxed warning for all licensed JAK inhibitors] at that time,” he added.

Dr. Stovin and colleagues aimed to determine what, if any, cancer risk was associated with all available JAK inhibitors relative to placebo, TNF inhibitors, and methotrexate.

In all, data from 62 randomized controlled trials and 14 long-term extension studies were included in the meta-analysis, accounting for 82,366 patient years of follow-up. The JAK inhibitors analyzed included tofacitinib, baricitinib (Olumiant), upadacitinib (Rinvoq), filgotinib (Jyseleca), and peficitinib (Smyraf). (Filgotinib and peficitinib have not been approved by the FDA.)

The researchers performed sensitivity analyses that excluded cancers detected within the first 6 months of treatment, the use of higher than licensed JAK inhibitor doses, and patients with non-rheumatoid arthritis diagnoses, but the results remained largely unchanged, Dr. Stovin reported.  

“Perhaps not surprisingly, when we removed ORAL Surveillance” from the analysis comparing JAK inhibitors and TNF inhibitors, “we lost statistical significance,” he said.

“Longitudinal observational data is needed but currently remains limited,” Dr. Stovin concluded.

Dr. Stovin and Dr. Bharadwaj reported no relevant financial relationships. The meta-analysis was independently supported. Dr. Bharadwaj was not involved in the study and provided comment ahead of the presentation.

A version of this article first appeared on Medscape.com.

MANCHESTER, ENGLAND – Janus kinase (JAK) inhibitors may be associated with a higher risk for cancer relative to tumor necrosis factor (TNF) inhibitors, according to a meta-analysis reported at the annual meeting of the British Society for Rheumatology.

Looking at all phase 2, 3, and 4 trials and long-term extension studies across the indications of rheumatoid arthritis, psoriatic arthritis, psoriasis, axial spondyloarthritis, inflammatory bowel disease, and atopic dermatitis, the risk ratio for any cancer developing was 1.63 when compared with anti-TNF therapy (95% confidence interval, 1.27-2.09).

Sara Freeman/MDedge News

By comparison, JAK inhibitor use was not significantly associated with any greater risk for cancer than methotrexate (RR, 1.06; 95% confidence interval, 0.58-1.94) or placebo (RR, 1.16; 95% CI, 0.75-1.80).

“Our data suggests that rather than JAK inhibitors necessarily being harmful, it could be more a case of TNF inhibitors being protective,” said Christopher Stovin, MBChB, a specialist registrar in rheumatology at the Princess Royal University Hospital, King’s College Hospital NHS Trust, London.

“We should stress that these are rare events in our study, roughly around 1 in every 100 patient-years of exposure,” Dr. Stovin said.

“Despite having over 80,000 years of patient exposure, the median follow-up duration for JAK inhibitors was still only 118 weeks, which for cancers [that] obviously have long latency periods is still a relatively small duration of time,” the researcher added.

“People worry about the drugs. But there is a possibility that [a] disturbed immune system plays a role per se in development of cancers,” consultant rheumatologist Anurag Bharadwaj, MD, DM, said in an interview.

“Although there are studies which attribute increased risk of cancer to different DMARDs [disease-modifying antirheumatic drugs] and biologics like TNF, but on other hand, it’s maybe that we are giving these drugs to patients who have got more serious immunological disease,” suggested Bharadwaj, who serves as the clinical lead for rheumatology at Basildon (England) Hospital, Mid & South Essex Foundation Trust.

“So, a possibility may be that the more severe or the more active the immunological inflammatory disease, the higher the chance of cancer, and these are the patients who go for the stronger medications,” Dr. Bharadwaj said.

There is an “immunological window of opportunity” when treating these inflammatory diseases, said Dr. Bharadwaj, noting that the first few months of treatment are vital. “For all immunological diseases, the more quickly you bring the immunological abnormality down, the chances of long-term complications go down, including [possibly that the] chances of cancer go down, chances of cardiovascular disease go down, and chances of lung disease go down. Hit it early, hit it hard.”

Concern over a possible higher risk for cancer with JAK inhibitors than with TNF inhibitors was raised following the release of data from the ORAL Surveillance trial, a postmarketing trial of tofacitinib (Xeljanz) that had been mandated by the Food and Drug Administration.

“This was a study looking at the coprimary endpoints of malignancy and major adverse cardiovascular events, and it was enriched with patients over the age of 50, with one additional cardiac risk factor, designed to amplify the detection of these rare events,” Dr. Stovin said.

“There was a signal of an increased risk of malignancy in the tofacitinib group, and this led to the FDA issuing a [boxed warning for all licensed JAK inhibitors] at that time,” he added.

Dr. Stovin and colleagues aimed to determine what, if any, cancer risk was associated with all available JAK inhibitors relative to placebo, TNF inhibitors, and methotrexate.

In all, data from 62 randomized controlled trials and 14 long-term extension studies were included in the meta-analysis, accounting for 82,366 patient years of follow-up. The JAK inhibitors analyzed included tofacitinib, baricitinib (Olumiant), upadacitinib (Rinvoq), filgotinib (Jyseleca), and peficitinib (Smyraf). (Filgotinib and peficitinib have not been approved by the FDA.)

The researchers performed sensitivity analyses that excluded cancers detected within the first 6 months of treatment, the use of higher than licensed JAK inhibitor doses, and patients with non-rheumatoid arthritis diagnoses, but the results remained largely unchanged, Dr. Stovin reported.  

“Perhaps not surprisingly, when we removed ORAL Surveillance” from the analysis comparing JAK inhibitors and TNF inhibitors, “we lost statistical significance,” he said.

“Longitudinal observational data is needed but currently remains limited,” Dr. Stovin concluded.

Dr. Stovin and Dr. Bharadwaj reported no relevant financial relationships. The meta-analysis was independently supported. Dr. Bharadwaj was not involved in the study and provided comment ahead of the presentation.

A version of this article first appeared on Medscape.com.

MANCHESTER, ENGLAND – Janus kinase (JAK) inhibitors may be associated with a higher risk for cancer relative to tumor necrosis factor (TNF) inhibitors, according to a meta-analysis reported at the annual meeting of the British Society for Rheumatology.

Looking at all phase 2, 3, and 4 trials and long-term extension studies across the indications of rheumatoid arthritis, psoriatic arthritis, psoriasis, axial spondyloarthritis, inflammatory bowel disease, and atopic dermatitis, the risk ratio for any cancer developing was 1.63 when compared with anti-TNF therapy (95% confidence interval, 1.27-2.09).

Sara Freeman/MDedge News

By comparison, JAK inhibitor use was not significantly associated with any greater risk for cancer than methotrexate (RR, 1.06; 95% confidence interval, 0.58-1.94) or placebo (RR, 1.16; 95% CI, 0.75-1.80).

“Our data suggests that rather than JAK inhibitors necessarily being harmful, it could be more a case of TNF inhibitors being protective,” said Christopher Stovin, MBChB, a specialist registrar in rheumatology at the Princess Royal University Hospital, King’s College Hospital NHS Trust, London.

“We should stress that these are rare events in our study, roughly around 1 in every 100 patient-years of exposure,” Dr. Stovin said.

“Despite having over 80,000 years of patient exposure, the median follow-up duration for JAK inhibitors was still only 118 weeks, which for cancers [that] obviously have long latency periods is still a relatively small duration of time,” the researcher added.

“People worry about the drugs. But there is a possibility that [a] disturbed immune system plays a role per se in development of cancers,” consultant rheumatologist Anurag Bharadwaj, MD, DM, said in an interview.

“Although there are studies which attribute increased risk of cancer to different DMARDs [disease-modifying antirheumatic drugs] and biologics like TNF, but on other hand, it’s maybe that we are giving these drugs to patients who have got more serious immunological disease,” suggested Bharadwaj, who serves as the clinical lead for rheumatology at Basildon (England) Hospital, Mid & South Essex Foundation Trust.

“So, a possibility may be that the more severe or the more active the immunological inflammatory disease, the higher the chance of cancer, and these are the patients who go for the stronger medications,” Dr. Bharadwaj said.

There is an “immunological window of opportunity” when treating these inflammatory diseases, said Dr. Bharadwaj, noting that the first few months of treatment are vital. “For all immunological diseases, the more quickly you bring the immunological abnormality down, the chances of long-term complications go down, including [possibly that the] chances of cancer go down, chances of cardiovascular disease go down, and chances of lung disease go down. Hit it early, hit it hard.”

Concern over a possible higher risk for cancer with JAK inhibitors than with TNF inhibitors was raised following the release of data from the ORAL Surveillance trial, a postmarketing trial of tofacitinib (Xeljanz) that had been mandated by the Food and Drug Administration.

“This was a study looking at the coprimary endpoints of malignancy and major adverse cardiovascular events, and it was enriched with patients over the age of 50, with one additional cardiac risk factor, designed to amplify the detection of these rare events,” Dr. Stovin said.

“There was a signal of an increased risk of malignancy in the tofacitinib group, and this led to the FDA issuing a [boxed warning for all licensed JAK inhibitors] at that time,” he added.

Dr. Stovin and colleagues aimed to determine what, if any, cancer risk was associated with all available JAK inhibitors relative to placebo, TNF inhibitors, and methotrexate.

In all, data from 62 randomized controlled trials and 14 long-term extension studies were included in the meta-analysis, accounting for 82,366 patient years of follow-up. The JAK inhibitors analyzed included tofacitinib, baricitinib (Olumiant), upadacitinib (Rinvoq), filgotinib (Jyseleca), and peficitinib (Smyraf). (Filgotinib and peficitinib have not been approved by the FDA.)

The researchers performed sensitivity analyses that excluded cancers detected within the first 6 months of treatment, the use of higher than licensed JAK inhibitor doses, and patients with non-rheumatoid arthritis diagnoses, but the results remained largely unchanged, Dr. Stovin reported.  

“Perhaps not surprisingly, when we removed ORAL Surveillance” from the analysis comparing JAK inhibitors and TNF inhibitors, “we lost statistical significance,” he said.

“Longitudinal observational data is needed but currently remains limited,” Dr. Stovin concluded.

Dr. Stovin and Dr. Bharadwaj reported no relevant financial relationships. The meta-analysis was independently supported. Dr. Bharadwaj was not involved in the study and provided comment ahead of the presentation.

A version of this article first appeared on Medscape.com.

A position paper by the National Psoriasis Foundation’s Telemedicine Task Force outlines key principles and practices for managing psoriatic disease via telemedicine.

The success of telemedicine in managing chronic inflammatory skin conditions including psoriasis during the COVID-19 pandemic “highlighted that teledermatology can be used beyond the context of a global health crisis to provide continuity of care and improve access to health care more broadly,” the task force wrote in a paper published online in JAAD International.

Jean-philippe WALLET/Getty Images

Co–senior author George Han, MD, PhD, said in an interview that the impetus for the guidelines came from NPF patient advocates, who realized that the organization needed something to take to payers and governmental agencies to advocate for better access to dermatologic care. He is associate professor of dermatology and director of teledermatology at the Hofstra/Northwell department of dermatology, Hyde Park, New York.

“We realized that, in many places around the country, people don’t have access to dermatology.” In upstate New York, said Dr. Han, his anecdotal research has revealed wait times of 6 months or more.

As a guiding principle, the authors pronounce teledermatology “a reasonable alternative for providing long-term management of patients with psoriasis.” Research shows that nearly all dermatologists used teledermatology during the pandemic, the authors noted, and that well-run programs improve Psoriasis Area and Severity Index (PASI) scores and other measures on par with in-person care. Telemedicine may be especially useful for initial visits, they added, particularly when distance, patient incapacity, and circumstances prevent face-to-face evaluation.

Additional position statements emphasize that teledermatology should support rather than supplant in-person visits, and that this balance may be particularly important in cases involving psoriatic arthritis (PsA). “Even though we can’t do a physical exam and palpate some of those joints in person,” said Dr. Han, “tools have been developed that, through a series of questions the patient can answer, can guide you towards whether there is a high index of suspicion for psoriatic arthritis.” Such patients require in-person evaluation with urgency, he said, because delays in PsA diagnosis and treatment can lead to irreversible joint damage and significant functional impairment.

Another motivation for producing the guidelines, said Dr. Han, was that, even when underserved patients get a dermatology appointment, some providers may not have all the latest tools or medicines available for treating psoriasis. In such cases, telemedicine may allow dermatologists specializing in psoriasis care to extend their reach in comanaging patients with primary care physicians and community dermatologists.

Before the appointment, guidelines suggest determining what form of teledermatology will best suit each patient. Authors recommended gauging patients’ savviness with computers and cameras, and counseling patients regarding available virtual evaluation tools – such as live video visits, store-and-forward photo strategies, and assessment-tool training videos.

A subsequent guideline underscores the importance of continuously improving technology to support expeditious image capture and workflows that emulate in-person practice. Dr. Han explained, “we wanted to make sure that on the back end there’s adequate support such that – if through teledermatology, we determine that the patient should get, say, a systemic treatment – the patient is able to get the appropriate lab tests, get the medicine, and know how to inject it.”

Regarding reimbursement, Dr. Han said that policies varied prepandemic, but many commercial insurers covered telemedicine at a rate 20% lower than the in-person rate. During the pandemic, he said, insurers shifted to provide the higher rate for telemedicine, consistent with policies adopted by the Centers for Medicare & Medicaid Services.

“There are differences in coverage and reimbursement from plan to plan,” Dr. Han added. “And even within the same plan, there are carve-outs so that some plans don’t allow certain services. The big picture is that for the most part these services are covered at a level comparable to an in-person visit at present.”

With the Department of Health & Human Services’ public health emergency declaration expiring in May, he said, physicians have worried that some of the allowances made by CMS – such as lifting requirements that Medicare patients in rural areas be seen at care sites – will expire. “It seems that some of those limitations have been addressed, and those allowances are going to be extended until Congress is able to pass something that gives us durable access to telemedicine care. We think that based on the current environment telemedicine is here to stay.”

The study was funded by the NPF. Dr. Han has been an investigator, adviser, speaker, or researcher for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Athenex, Bausch Health, Beiersdorf, Boehringer Ingelheim, Bond Avillion, Bristol Myers Squibb, Celgene, CeraVe, Dermavant, DermTech, Eli Lilly, EPI Health, Janssen Pharmaceuticals, LEO Pharma, L’Oreal, MC2 Therapeutics, Novartis, Ortho Dermatologics, PellePharm, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, SUN Pharmaceuticals, and UCB.

A position paper by the National Psoriasis Foundation’s Telemedicine Task Force outlines key principles and practices for managing psoriatic disease via telemedicine.

The success of telemedicine in managing chronic inflammatory skin conditions including psoriasis during the COVID-19 pandemic “highlighted that teledermatology can be used beyond the context of a global health crisis to provide continuity of care and improve access to health care more broadly,” the task force wrote in a paper published online in JAAD International.

Jean-philippe WALLET/Getty Images

Co–senior author George Han, MD, PhD, said in an interview that the impetus for the guidelines came from NPF patient advocates, who realized that the organization needed something to take to payers and governmental agencies to advocate for better access to dermatologic care. He is associate professor of dermatology and director of teledermatology at the Hofstra/Northwell department of dermatology, Hyde Park, New York.

“We realized that, in many places around the country, people don’t have access to dermatology.” In upstate New York, said Dr. Han, his anecdotal research has revealed wait times of 6 months or more.

As a guiding principle, the authors pronounce teledermatology “a reasonable alternative for providing long-term management of patients with psoriasis.” Research shows that nearly all dermatologists used teledermatology during the pandemic, the authors noted, and that well-run programs improve Psoriasis Area and Severity Index (PASI) scores and other measures on par with in-person care. Telemedicine may be especially useful for initial visits, they added, particularly when distance, patient incapacity, and circumstances prevent face-to-face evaluation.

Additional position statements emphasize that teledermatology should support rather than supplant in-person visits, and that this balance may be particularly important in cases involving psoriatic arthritis (PsA). “Even though we can’t do a physical exam and palpate some of those joints in person,” said Dr. Han, “tools have been developed that, through a series of questions the patient can answer, can guide you towards whether there is a high index of suspicion for psoriatic arthritis.” Such patients require in-person evaluation with urgency, he said, because delays in PsA diagnosis and treatment can lead to irreversible joint damage and significant functional impairment.

Another motivation for producing the guidelines, said Dr. Han, was that, even when underserved patients get a dermatology appointment, some providers may not have all the latest tools or medicines available for treating psoriasis. In such cases, telemedicine may allow dermatologists specializing in psoriasis care to extend their reach in comanaging patients with primary care physicians and community dermatologists.

Before the appointment, guidelines suggest determining what form of teledermatology will best suit each patient. Authors recommended gauging patients’ savviness with computers and cameras, and counseling patients regarding available virtual evaluation tools – such as live video visits, store-and-forward photo strategies, and assessment-tool training videos.

A subsequent guideline underscores the importance of continuously improving technology to support expeditious image capture and workflows that emulate in-person practice. Dr. Han explained, “we wanted to make sure that on the back end there’s adequate support such that – if through teledermatology, we determine that the patient should get, say, a systemic treatment – the patient is able to get the appropriate lab tests, get the medicine, and know how to inject it.”

Regarding reimbursement, Dr. Han said that policies varied prepandemic, but many commercial insurers covered telemedicine at a rate 20% lower than the in-person rate. During the pandemic, he said, insurers shifted to provide the higher rate for telemedicine, consistent with policies adopted by the Centers for Medicare & Medicaid Services.

“There are differences in coverage and reimbursement from plan to plan,” Dr. Han added. “And even within the same plan, there are carve-outs so that some plans don’t allow certain services. The big picture is that for the most part these services are covered at a level comparable to an in-person visit at present.”

With the Department of Health & Human Services’ public health emergency declaration expiring in May, he said, physicians have worried that some of the allowances made by CMS – such as lifting requirements that Medicare patients in rural areas be seen at care sites – will expire. “It seems that some of those limitations have been addressed, and those allowances are going to be extended until Congress is able to pass something that gives us durable access to telemedicine care. We think that based on the current environment telemedicine is here to stay.”

The study was funded by the NPF. Dr. Han has been an investigator, adviser, speaker, or researcher for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Athenex, Bausch Health, Beiersdorf, Boehringer Ingelheim, Bond Avillion, Bristol Myers Squibb, Celgene, CeraVe, Dermavant, DermTech, Eli Lilly, EPI Health, Janssen Pharmaceuticals, LEO Pharma, L’Oreal, MC2 Therapeutics, Novartis, Ortho Dermatologics, PellePharm, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, SUN Pharmaceuticals, and UCB.

A position paper by the National Psoriasis Foundation’s Telemedicine Task Force outlines key principles and practices for managing psoriatic disease via telemedicine.

The success of telemedicine in managing chronic inflammatory skin conditions including psoriasis during the COVID-19 pandemic “highlighted that teledermatology can be used beyond the context of a global health crisis to provide continuity of care and improve access to health care more broadly,” the task force wrote in a paper published online in JAAD International.

Jean-philippe WALLET/Getty Images

Co–senior author George Han, MD, PhD, said in an interview that the impetus for the guidelines came from NPF patient advocates, who realized that the organization needed something to take to payers and governmental agencies to advocate for better access to dermatologic care. He is associate professor of dermatology and director of teledermatology at the Hofstra/Northwell department of dermatology, Hyde Park, New York.

“We realized that, in many places around the country, people don’t have access to dermatology.” In upstate New York, said Dr. Han, his anecdotal research has revealed wait times of 6 months or more.

As a guiding principle, the authors pronounce teledermatology “a reasonable alternative for providing long-term management of patients with psoriasis.” Research shows that nearly all dermatologists used teledermatology during the pandemic, the authors noted, and that well-run programs improve Psoriasis Area and Severity Index (PASI) scores and other measures on par with in-person care. Telemedicine may be especially useful for initial visits, they added, particularly when distance, patient incapacity, and circumstances prevent face-to-face evaluation.

Additional position statements emphasize that teledermatology should support rather than supplant in-person visits, and that this balance may be particularly important in cases involving psoriatic arthritis (PsA). “Even though we can’t do a physical exam and palpate some of those joints in person,” said Dr. Han, “tools have been developed that, through a series of questions the patient can answer, can guide you towards whether there is a high index of suspicion for psoriatic arthritis.” Such patients require in-person evaluation with urgency, he said, because delays in PsA diagnosis and treatment can lead to irreversible joint damage and significant functional impairment.

Another motivation for producing the guidelines, said Dr. Han, was that, even when underserved patients get a dermatology appointment, some providers may not have all the latest tools or medicines available for treating psoriasis. In such cases, telemedicine may allow dermatologists specializing in psoriasis care to extend their reach in comanaging patients with primary care physicians and community dermatologists.

Before the appointment, guidelines suggest determining what form of teledermatology will best suit each patient. Authors recommended gauging patients’ savviness with computers and cameras, and counseling patients regarding available virtual evaluation tools – such as live video visits, store-and-forward photo strategies, and assessment-tool training videos.

A subsequent guideline underscores the importance of continuously improving technology to support expeditious image capture and workflows that emulate in-person practice. Dr. Han explained, “we wanted to make sure that on the back end there’s adequate support such that – if through teledermatology, we determine that the patient should get, say, a systemic treatment – the patient is able to get the appropriate lab tests, get the medicine, and know how to inject it.”

Regarding reimbursement, Dr. Han said that policies varied prepandemic, but many commercial insurers covered telemedicine at a rate 20% lower than the in-person rate. During the pandemic, he said, insurers shifted to provide the higher rate for telemedicine, consistent with policies adopted by the Centers for Medicare & Medicaid Services.

“There are differences in coverage and reimbursement from plan to plan,” Dr. Han added. “And even within the same plan, there are carve-outs so that some plans don’t allow certain services. The big picture is that for the most part these services are covered at a level comparable to an in-person visit at present.”

With the Department of Health & Human Services’ public health emergency declaration expiring in May, he said, physicians have worried that some of the allowances made by CMS – such as lifting requirements that Medicare patients in rural areas be seen at care sites – will expire. “It seems that some of those limitations have been addressed, and those allowances are going to be extended until Congress is able to pass something that gives us durable access to telemedicine care. We think that based on the current environment telemedicine is here to stay.”

The study was funded by the NPF. Dr. Han has been an investigator, adviser, speaker, or researcher for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Athenex, Bausch Health, Beiersdorf, Boehringer Ingelheim, Bond Avillion, Bristol Myers Squibb, Celgene, CeraVe, Dermavant, DermTech, Eli Lilly, EPI Health, Janssen Pharmaceuticals, LEO Pharma, L’Oreal, MC2 Therapeutics, Novartis, Ortho Dermatologics, PellePharm, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, SUN Pharmaceuticals, and UCB.

The history and findings in this case are suggestive of axial psoriatic arthritis (PsA).

Psoriasis is a complex, chronic, inflammatory, immune-mediated disease that is associated with significant morbidity, reduced quality of life, and increased mortality. Approximately 7.4 million adults in the United States have psoriasis; worldwide, approximately 2%-3% of the population is affected. Patients with psoriasis frequently have comorbidities; PsA, an inflammatory, seronegative musculoskeletal disease, is among the most common. It is estimated that 25%-30% of patients with psoriasis develop PsA. 

PsA is a heterogeneous disease. Patients may present with nail and skin changes, peripheral arthritis, enthesitis, dactylitis, and axial spondyloarthritis (SpA), either alone or in combination. Men and women are equally affected by PsA, which typically develops when patients are age 30-50 years. Like psoriasis, PsA is associated with numerous comorbidities, including cardiovascular disease, metabolic syndrome, obesity, diabetes, depression, uveitis, and anxiety.

PsA is a potentially erosive disease. Structural damage and functional impairment occurs within 2 years of initial assessment in approximately 50% of patients; as the disease progresses, patients may experience irreversible joint damage and disability. Axial involvement occurs in 25%-70% of patients with PsA; exclusive axial involvement is uncommon, occurring in 5% of patients. Common symptoms of axial PsA include inflammatory back pain (eg, pain that improves with activity but worsens with rest, morning stiffness lasting longer than 30 minutes). Some patients with axial involvement may be asymptomatic. If untreated, cervical spinal mobility and lateral flexion significantly decline within 5 years in patients with axial PsA. In addition, sacroiliitis worsens over time; 37% and 52% of patients develop grade 2 or higher sacroiliitis within 5 and 10 years, respectively. This highlights the importance of early identification and treatment of patients with axial PsA.

The diagnosis of axial PsA 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 fibrosis). PsA can be differentiated from ankylosing spondylitis by the asymmetric and frequently unilateral presentation of sacroiliitis and syndesmophytes, which frequently presents as nonmarginal, bulky, asymmetric, and discontinuous skipping vertebral levels.

Plain radiography, CT, ultrasound, and MRI are all useful tools for evaluating patients with PsA. MRI and ultrasound may be more sensitive than plain radiography is for detecting early joint inflammation and damage as well as axial changes, including sacroiliitis; however, they are not required for a diagnosis of PsA.

The treatment of axial PsA is based on international guidelines 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 and the Assessment of SpondyloArthritis International Society–European League Against Rheumatism. Treatment focuses on minimizing pain, stiffness, and fatigue; improving and preserving spinal flexibility and posture; enhancing functional capacity; and maintaining the ability to work, with a target of remission or minimal/low disease activity.

Medications for symptomatic relief include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and sacroiliac joint injections with glucocorticoids for mild disease; however, long-term treatment with systemic glucocorticoids is not recommended. If patients remain symptomatic or if erosive disease or other indications of high disease activity is observed, guidelines recommend initiation of a TNF inhibitor. Disease-modifying antirheumatic drugs, such as methotrexate, are not routinely prescribed for patients with axial disease because they have not been shown to be effective.

If symptoms of axial PsA are not controlled by NSAIDs, tumor necrosis factor (TNF) inhibitors are recommended. However, interleukin 17A inhibitors may be used in preference to TNF inhibitors in patients with significant skin involvement. In the United States, adalimumab, certolizumab pegol, golimumab, and infliximab are recommended over etanercept for patients with axial SpA in the presence of concomitant inflammatory bowel disease (IBD) or recurrent uveitis (although there is no evidence for golimumab) because etanercept has contradictory results for uveitis and has not been shown to have efficacy in IBD.

If patients fail to respond to a first trial of a TNF inhibitor, trying a second TNF inhibitor before switching to a different class of biologic is recommended by US guidelines. A Janus kinase inhibitor (tofacitinib) may be considered for patients who do not respond to TNF inhibitors. 

Nonpharmacologic therapies (ie, 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 suggestive of axial psoriatic arthritis (PsA).

Psoriasis is a complex, chronic, inflammatory, immune-mediated disease that is associated with significant morbidity, reduced quality of life, and increased mortality. Approximately 7.4 million adults in the United States have psoriasis; worldwide, approximately 2%-3% of the population is affected. Patients with psoriasis frequently have comorbidities; PsA, an inflammatory, seronegative musculoskeletal disease, is among the most common. It is estimated that 25%-30% of patients with psoriasis develop PsA. 

PsA is a heterogeneous disease. Patients may present with nail and skin changes, peripheral arthritis, enthesitis, dactylitis, and axial spondyloarthritis (SpA), either alone or in combination. Men and women are equally affected by PsA, which typically develops when patients are age 30-50 years. Like psoriasis, PsA is associated with numerous comorbidities, including cardiovascular disease, metabolic syndrome, obesity, diabetes, depression, uveitis, and anxiety.

PsA is a potentially erosive disease. Structural damage and functional impairment occurs within 2 years of initial assessment in approximately 50% of patients; as the disease progresses, patients may experience irreversible joint damage and disability. Axial involvement occurs in 25%-70% of patients with PsA; exclusive axial involvement is uncommon, occurring in 5% of patients. Common symptoms of axial PsA include inflammatory back pain (eg, pain that improves with activity but worsens with rest, morning stiffness lasting longer than 30 minutes). Some patients with axial involvement may be asymptomatic. If untreated, cervical spinal mobility and lateral flexion significantly decline within 5 years in patients with axial PsA. In addition, sacroiliitis worsens over time; 37% and 52% of patients develop grade 2 or higher sacroiliitis within 5 and 10 years, respectively. This highlights the importance of early identification and treatment of patients with axial PsA.

The diagnosis of axial PsA 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 fibrosis). PsA can be differentiated from ankylosing spondylitis by the asymmetric and frequently unilateral presentation of sacroiliitis and syndesmophytes, which frequently presents as nonmarginal, bulky, asymmetric, and discontinuous skipping vertebral levels.

Plain radiography, CT, ultrasound, and MRI are all useful tools for evaluating patients with PsA. MRI and ultrasound may be more sensitive than plain radiography is for detecting early joint inflammation and damage as well as axial changes, including sacroiliitis; however, they are not required for a diagnosis of PsA.

The treatment of axial PsA is based on international guidelines 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 and the Assessment of SpondyloArthritis International Society–European League Against Rheumatism. Treatment focuses on minimizing pain, stiffness, and fatigue; improving and preserving spinal flexibility and posture; enhancing functional capacity; and maintaining the ability to work, with a target of remission or minimal/low disease activity.

Medications for symptomatic relief include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and sacroiliac joint injections with glucocorticoids for mild disease; however, long-term treatment with systemic glucocorticoids is not recommended. If patients remain symptomatic or if erosive disease or other indications of high disease activity is observed, guidelines recommend initiation of a TNF inhibitor. Disease-modifying antirheumatic drugs, such as methotrexate, are not routinely prescribed for patients with axial disease because they have not been shown to be effective.

If symptoms of axial PsA are not controlled by NSAIDs, tumor necrosis factor (TNF) inhibitors are recommended. However, interleukin 17A inhibitors may be used in preference to TNF inhibitors in patients with significant skin involvement. In the United States, adalimumab, certolizumab pegol, golimumab, and infliximab are recommended over etanercept for patients with axial SpA in the presence of concomitant inflammatory bowel disease (IBD) or recurrent uveitis (although there is no evidence for golimumab) because etanercept has contradictory results for uveitis and has not been shown to have efficacy in IBD.

If patients fail to respond to a first trial of a TNF inhibitor, trying a second TNF inhibitor before switching to a different class of biologic is recommended by US guidelines. A Janus kinase inhibitor (tofacitinib) may be considered for patients who do not respond to TNF inhibitors. 

Nonpharmacologic therapies (ie, 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 suggestive of axial psoriatic arthritis (PsA).

Psoriasis is a complex, chronic, inflammatory, immune-mediated disease that is associated with significant morbidity, reduced quality of life, and increased mortality. Approximately 7.4 million adults in the United States have psoriasis; worldwide, approximately 2%-3% of the population is affected. Patients with psoriasis frequently have comorbidities; PsA, an inflammatory, seronegative musculoskeletal disease, is among the most common. It is estimated that 25%-30% of patients with psoriasis develop PsA. 

PsA is a heterogeneous disease. Patients may present with nail and skin changes, peripheral arthritis, enthesitis, dactylitis, and axial spondyloarthritis (SpA), either alone or in combination. Men and women are equally affected by PsA, which typically develops when patients are age 30-50 years. Like psoriasis, PsA is associated with numerous comorbidities, including cardiovascular disease, metabolic syndrome, obesity, diabetes, depression, uveitis, and anxiety.

PsA is a potentially erosive disease. Structural damage and functional impairment occurs within 2 years of initial assessment in approximately 50% of patients; as the disease progresses, patients may experience irreversible joint damage and disability. Axial involvement occurs in 25%-70% of patients with PsA; exclusive axial involvement is uncommon, occurring in 5% of patients. Common symptoms of axial PsA include inflammatory back pain (eg, pain that improves with activity but worsens with rest, morning stiffness lasting longer than 30 minutes). Some patients with axial involvement may be asymptomatic. If untreated, cervical spinal mobility and lateral flexion significantly decline within 5 years in patients with axial PsA. In addition, sacroiliitis worsens over time; 37% and 52% of patients develop grade 2 or higher sacroiliitis within 5 and 10 years, respectively. This highlights the importance of early identification and treatment of patients with axial PsA.

The diagnosis of axial PsA 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 fibrosis). PsA can be differentiated from ankylosing spondylitis by the asymmetric and frequently unilateral presentation of sacroiliitis and syndesmophytes, which frequently presents as nonmarginal, bulky, asymmetric, and discontinuous skipping vertebral levels.

Plain radiography, CT, ultrasound, and MRI are all useful tools for evaluating patients with PsA. MRI and ultrasound may be more sensitive than plain radiography is for detecting early joint inflammation and damage as well as axial changes, including sacroiliitis; however, they are not required for a diagnosis of PsA.

The treatment of axial PsA is based on international guidelines 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 and the Assessment of SpondyloArthritis International Society–European League Against Rheumatism. Treatment focuses on minimizing pain, stiffness, and fatigue; improving and preserving spinal flexibility and posture; enhancing functional capacity; and maintaining the ability to work, with a target of remission or minimal/low disease activity.

Medications for symptomatic relief include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and sacroiliac joint injections with glucocorticoids for mild disease; however, long-term treatment with systemic glucocorticoids is not recommended. If patients remain symptomatic or if erosive disease or other indications of high disease activity is observed, guidelines recommend initiation of a TNF inhibitor. Disease-modifying antirheumatic drugs, such as methotrexate, are not routinely prescribed for patients with axial disease because they have not been shown to be effective.

If symptoms of axial PsA are not controlled by NSAIDs, tumor necrosis factor (TNF) inhibitors are recommended. However, interleukin 17A inhibitors may be used in preference to TNF inhibitors in patients with significant skin involvement. In the United States, adalimumab, certolizumab pegol, golimumab, and infliximab are recommended over etanercept for patients with axial SpA in the presence of concomitant inflammatory bowel disease (IBD) or recurrent uveitis (although there is no evidence for golimumab) because etanercept has contradictory results for uveitis and has not been shown to have efficacy in IBD.

If patients fail to respond to a first trial of a TNF inhibitor, trying a second TNF inhibitor before switching to a different class of biologic is recommended by US guidelines. A Janus kinase inhibitor (tofacitinib) may be considered for patients who do not respond to TNF inhibitors. 

Nonpharmacologic therapies (ie, 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.

Key clinical point: Age, body mass index (BMI), chronic-plaque psoriasis, hospitalization for psoriasis, use of systemic therapy, and genital and nail involvement in psoriasis were the risk factors for psoriatic arthritis (PsA) occurrence in patients with psoriasis.

Major finding: Overall, 226 patients were diagnosed with PsA, with an incidence of 1.9 cases per 100 patient-years. Age between 40-59 years (P < .001), BMI ≥25 (P  =  .015), genital psoriasis (P  =  .027), nail psoriasis (P  =  .038), classic chronic-plaque psoriasis (P  =  .014), previous hospitalization for psoriasis (P < .001), previous use of systemic therapy for psoriasis (P  =  .003), and use of conventional nonbiologic agents (P  =  .014) were significantly associated with PsA occurrence.

Study details: This cohort study included 8895 patients with a confirmed diagnosis of psoriasis from the PsoReal registry.

Disclosures: This study was sponsored by Bristol Myers Squibb. K Heidemeyer and L Naldi declared receiving honoraria from various sources, including AbbVie, Almirall, or Bristol Myers Squibb.

Source: Heidemeyer K et al. Variables associated with joint involvement and development of a prediction rule for arthritis in psoriasis patients. An analysis of the Italian PsoReal database. J Am Acad Dermatol. 2023 (Mar 23). Doi: 10.1016/j.jaad.2023.02.059

Key clinical point: Age, body mass index (BMI), chronic-plaque psoriasis, hospitalization for psoriasis, use of systemic therapy, and genital and nail involvement in psoriasis were the risk factors for psoriatic arthritis (PsA) occurrence in patients with psoriasis.

Major finding: Overall, 226 patients were diagnosed with PsA, with an incidence of 1.9 cases per 100 patient-years. Age between 40-59 years (P < .001), BMI ≥25 (P  =  .015), genital psoriasis (P  =  .027), nail psoriasis (P  =  .038), classic chronic-plaque psoriasis (P  =  .014), previous hospitalization for psoriasis (P < .001), previous use of systemic therapy for psoriasis (P  =  .003), and use of conventional nonbiologic agents (P  =  .014) were significantly associated with PsA occurrence.

Study details: This cohort study included 8895 patients with a confirmed diagnosis of psoriasis from the PsoReal registry.

Disclosures: This study was sponsored by Bristol Myers Squibb. K Heidemeyer and L Naldi declared receiving honoraria from various sources, including AbbVie, Almirall, or Bristol Myers Squibb.

Source: Heidemeyer K et al. Variables associated with joint involvement and development of a prediction rule for arthritis in psoriasis patients. An analysis of the Italian PsoReal database. J Am Acad Dermatol. 2023 (Mar 23). Doi: 10.1016/j.jaad.2023.02.059

Key clinical point: Age, body mass index (BMI), chronic-plaque psoriasis, hospitalization for psoriasis, use of systemic therapy, and genital and nail involvement in psoriasis were the risk factors for psoriatic arthritis (PsA) occurrence in patients with psoriasis.

Major finding: Overall, 226 patients were diagnosed with PsA, with an incidence of 1.9 cases per 100 patient-years. Age between 40-59 years (P < .001), BMI ≥25 (P  =  .015), genital psoriasis (P  =  .027), nail psoriasis (P  =  .038), classic chronic-plaque psoriasis (P  =  .014), previous hospitalization for psoriasis (P < .001), previous use of systemic therapy for psoriasis (P  =  .003), and use of conventional nonbiologic agents (P  =  .014) were significantly associated with PsA occurrence.

Study details: This cohort study included 8895 patients with a confirmed diagnosis of psoriasis from the PsoReal registry.

Disclosures: This study was sponsored by Bristol Myers Squibb. K Heidemeyer and L Naldi declared receiving honoraria from various sources, including AbbVie, Almirall, or Bristol Myers Squibb.

Source: Heidemeyer K et al. Variables associated with joint involvement and development of a prediction rule for arthritis in psoriasis patients. An analysis of the Italian PsoReal database. J Am Acad Dermatol. 2023 (Mar 23). Doi: 10.1016/j.jaad.2023.02.059

Key clinical point: Patients with psoriatic arthritis (PsA) had lower serum vitamin D (25(OH)D₃) levels and bone mineral density (BMD) compared with the general population; however, serum vitamin D levels were higher in patients with PsA vs  psoriasis.

Major finding: The serum 25(OH)D₃ levels in patients with PsA were lower than those in control individuals (mean difference [MD] −6.42; P < .01) but higher than those in patients with psoriasis (MD 2.37; P < .01). Lumbar spine BMD was significantly lower in patients with PsA vs  control individuals (MD −0.08).

Study details: This was a meta-analysis of nine studies, of which four studies included patients with PsA (n = 264) and control individuals from the general population (n = 287) and five studies included patients with PsA (n = 225) and psoriasis (n = 391).

Disclosures: This study was supported by the project “Digitalization and improvement of nutritional care for patients with chronic diseases” cofinanced by the European Regional Development Fund. The authors declared no conflicts of interest.

Source: Radić M et al. Vitamin D in psoriatic arthritis – A systematic review and meta-analysis. Semin Arthritis Rheum. 2023;60:152200 (Apr 1). Doi: 10.1016/j.semarthrit.2023.152200

Key clinical point: Patients with psoriatic arthritis (PsA) had lower serum vitamin D (25(OH)D₃) levels and bone mineral density (BMD) compared with the general population; however, serum vitamin D levels were higher in patients with PsA vs  psoriasis.

Major finding: The serum 25(OH)D₃ levels in patients with PsA were lower than those in control individuals (mean difference [MD] −6.42; P < .01) but higher than those in patients with psoriasis (MD 2.37; P < .01). Lumbar spine BMD was significantly lower in patients with PsA vs  control individuals (MD −0.08).

Study details: This was a meta-analysis of nine studies, of which four studies included patients with PsA (n = 264) and control individuals from the general population (n = 287) and five studies included patients with PsA (n = 225) and psoriasis (n = 391).

Disclosures: This study was supported by the project “Digitalization and improvement of nutritional care for patients with chronic diseases” cofinanced by the European Regional Development Fund. The authors declared no conflicts of interest.

Source: Radić M et al. Vitamin D in psoriatic arthritis – A systematic review and meta-analysis. Semin Arthritis Rheum. 2023;60:152200 (Apr 1). Doi: 10.1016/j.semarthrit.2023.152200

Key clinical point: Patients with psoriatic arthritis (PsA) had lower serum vitamin D (25(OH)D₃) levels and bone mineral density (BMD) compared with the general population; however, serum vitamin D levels were higher in patients with PsA vs  psoriasis.

Major finding: The serum 25(OH)D₃ levels in patients with PsA were lower than those in control individuals (mean difference [MD] −6.42; P < .01) but higher than those in patients with psoriasis (MD 2.37; P < .01). Lumbar spine BMD was significantly lower in patients with PsA vs  control individuals (MD −0.08).

Study details: This was a meta-analysis of nine studies, of which four studies included patients with PsA (n = 264) and control individuals from the general population (n = 287) and five studies included patients with PsA (n = 225) and psoriasis (n = 391).

Disclosures: This study was supported by the project “Digitalization and improvement of nutritional care for patients with chronic diseases” cofinanced by the European Regional Development Fund. The authors declared no conflicts of interest.

Source: Radić M et al. Vitamin D in psoriatic arthritis – A systematic review and meta-analysis. Semin Arthritis Rheum. 2023;60:152200 (Apr 1). Doi: 10.1016/j.semarthrit.2023.152200

Key clinical point: Patients with psoriatic arthritis (PsA) are at a higher risk for overall cancer compared with the general population, highlighting the importance of regular cancer screening among these patients.

Major finding: The risk for overall cancer was slightly higher among patients with PsA vs  age- and sex-matched control individuals (adjusted hazard ratio [aHR] 1.20; 95% CI 1.02-1.41), with the risk being mainly driven by non-melanoma skin cancer (aHR 3.64; 95% CI 1.61-8.23), lymphoma (aHR 2.63, 95% CI 1.30-5.30), and thyroid cancer (aHR 1.83, 95% CI 1.18-2.85).

Study details: The data come from a population-based cohort study including 4688 patients with newly diagnosed PsA and 46,880 age- and sex-matched control individuals without a history of cancer and other coexisting autoimmune diseases from the general population.

Disclosures: This study did not report the source of funding. The authors did not declare conflicts of interest.

Source: Eun Y et al. Risk of cancer in Korean patients with psoriatic arthritis: A nationwide population-based cohort study. RMD Open. 2023;9(1):e002874 (Mar 23). Doi: 10.1136/rmdopen-2022-002874

Key clinical point: Patients with psoriatic arthritis (PsA) are at a higher risk for overall cancer compared with the general population, highlighting the importance of regular cancer screening among these patients.

Major finding: The risk for overall cancer was slightly higher among patients with PsA vs  age- and sex-matched control individuals (adjusted hazard ratio [aHR] 1.20; 95% CI 1.02-1.41), with the risk being mainly driven by non-melanoma skin cancer (aHR 3.64; 95% CI 1.61-8.23), lymphoma (aHR 2.63, 95% CI 1.30-5.30), and thyroid cancer (aHR 1.83, 95% CI 1.18-2.85).

Study details: The data come from a population-based cohort study including 4688 patients with newly diagnosed PsA and 46,880 age- and sex-matched control individuals without a history of cancer and other coexisting autoimmune diseases from the general population.

Disclosures: This study did not report the source of funding. The authors did not declare conflicts of interest.

Source: Eun Y et al. Risk of cancer in Korean patients with psoriatic arthritis: A nationwide population-based cohort study. RMD Open. 2023;9(1):e002874 (Mar 23). Doi: 10.1136/rmdopen-2022-002874

Key clinical point: Patients with psoriatic arthritis (PsA) are at a higher risk for overall cancer compared with the general population, highlighting the importance of regular cancer screening among these patients.

Major finding: The risk for overall cancer was slightly higher among patients with PsA vs  age- and sex-matched control individuals (adjusted hazard ratio [aHR] 1.20; 95% CI 1.02-1.41), with the risk being mainly driven by non-melanoma skin cancer (aHR 3.64; 95% CI 1.61-8.23), lymphoma (aHR 2.63, 95% CI 1.30-5.30), and thyroid cancer (aHR 1.83, 95% CI 1.18-2.85).

Study details: The data come from a population-based cohort study including 4688 patients with newly diagnosed PsA and 46,880 age- and sex-matched control individuals without a history of cancer and other coexisting autoimmune diseases from the general population.

Disclosures: This study did not report the source of funding. The authors did not declare conflicts of interest.

Source: Eun Y et al. Risk of cancer in Korean patients with psoriatic arthritis: A nationwide population-based cohort study. RMD Open. 2023;9(1):e002874 (Mar 23). Doi: 10.1136/rmdopen-2022-002874

Key clinical point: Age at onset of psoriatic arthritis (PsA) influences disease characteristics, with individuals developing PsA at older age having worse functionality and greater structural damage but a lower frequency of enthesitis and dactylitis.

Major finding: Patients with late vs early onset PsA showed greater structural damage (odds ratio [OR] 3.3; 95% CI 1.3-8.1), higher frequency of arthritis in upper limbs (OR 2.8; 95% CI 1.0-7.7), greater loss of functionality (OR 1.3; 95% CI 1.0-1.6), and lower frequency of enthesitis (OR 0.1; 95% CI 0-0.5) and sacroiliitis (OR 0.06; 95% CI 0-0.5).

Study details: This observational cross-sectional study included 231 patients with PsA with <10 years of disease duration from the REGISPONSER and RESPONDIA registries who were categorized into the early onset (≤40 years) or late onset (≥60 years) group depending on age at PsA symptom onset.

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

Source: Puche-Larrubia MÁ et al. Differences between early vs  late-onset of psoriatic arthritis: Data from the respondia and regisponser registries. Joint Bone Spine. 2023;105563 (Mar 17). Doi: 10.1016/j.jbspin.2023.105563

Key clinical point: Age at onset of psoriatic arthritis (PsA) influences disease characteristics, with individuals developing PsA at older age having worse functionality and greater structural damage but a lower frequency of enthesitis and dactylitis.

Major finding: Patients with late vs early onset PsA showed greater structural damage (odds ratio [OR] 3.3; 95% CI 1.3-8.1), higher frequency of arthritis in upper limbs (OR 2.8; 95% CI 1.0-7.7), greater loss of functionality (OR 1.3; 95% CI 1.0-1.6), and lower frequency of enthesitis (OR 0.1; 95% CI 0-0.5) and sacroiliitis (OR 0.06; 95% CI 0-0.5).

Study details: This observational cross-sectional study included 231 patients with PsA with <10 years of disease duration from the REGISPONSER and RESPONDIA registries who were categorized into the early onset (≤40 years) or late onset (≥60 years) group depending on age at PsA symptom onset.

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

Source: Puche-Larrubia MÁ et al. Differences between early vs  late-onset of psoriatic arthritis: Data from the respondia and regisponser registries. Joint Bone Spine. 2023;105563 (Mar 17). Doi: 10.1016/j.jbspin.2023.105563

Key clinical point: Age at onset of psoriatic arthritis (PsA) influences disease characteristics, with individuals developing PsA at older age having worse functionality and greater structural damage but a lower frequency of enthesitis and dactylitis.

Major finding: Patients with late vs early onset PsA showed greater structural damage (odds ratio [OR] 3.3; 95% CI 1.3-8.1), higher frequency of arthritis in upper limbs (OR 2.8; 95% CI 1.0-7.7), greater loss of functionality (OR 1.3; 95% CI 1.0-1.6), and lower frequency of enthesitis (OR 0.1; 95% CI 0-0.5) and sacroiliitis (OR 0.06; 95% CI 0-0.5).

Study details: This observational cross-sectional study included 231 patients with PsA with <10 years of disease duration from the REGISPONSER and RESPONDIA registries who were categorized into the early onset (≤40 years) or late onset (≥60 years) group depending on age at PsA symptom onset.

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

Source: Puche-Larrubia MÁ et al. Differences between early vs  late-onset of psoriatic arthritis: Data from the respondia and regisponser registries. Joint Bone Spine. 2023;105563 (Mar 17). Doi: 10.1016/j.jbspin.2023.105563

Key clinical point: Vitamin D deficiency in patients with psoriatic arthritis (PsA) had worse impact on the retention rate of the first biological disease-modifying antirheumatic drug (bDMARD) and response to methotrexate and was associated with severe disease course in terms of sacroiliitis.

Major finding: The risk for discontinuation of the first bDMARD (hazard ratio [HR] 2.129; P  =  .011) and methotrexate discontinuation because of therapy failure (HR 2.168; P  =  .002) were significantly higher among patients with 25(OH)D level of ≤20 vs  20-30 and ≥30 ng/mL, with the prevalence of sacroiliitis being significantly higher in patients with 25(OH)D level of ≤20 vs  ≥30 ng/mL (P  =  .0001).

Study details: Findings are from a retrospective study including 233 patients with PsA.

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

Source: Rotondo C et al. Vitamin D status and psoriatic arthritis: Association with the risk for sacroiliitis and influence on the retention rate of methotrexate monotherapy and first biological drug survival—A retrospective study. Int J Mol Sci. 2023;24(6):5368 (Mar 10). Doi: 10.3390/ijms24065368

Key clinical point: Vitamin D deficiency in patients with psoriatic arthritis (PsA) had worse impact on the retention rate of the first biological disease-modifying antirheumatic drug (bDMARD) and response to methotrexate and was associated with severe disease course in terms of sacroiliitis.

Major finding: The risk for discontinuation of the first bDMARD (hazard ratio [HR] 2.129; P  =  .011) and methotrexate discontinuation because of therapy failure (HR 2.168; P  =  .002) were significantly higher among patients with 25(OH)D level of ≤20 vs  20-30 and ≥30 ng/mL, with the prevalence of sacroiliitis being significantly higher in patients with 25(OH)D level of ≤20 vs  ≥30 ng/mL (P  =  .0001).

Study details: Findings are from a retrospective study including 233 patients with PsA.

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

Source: Rotondo C et al. Vitamin D status and psoriatic arthritis: Association with the risk for sacroiliitis and influence on the retention rate of methotrexate monotherapy and first biological drug survival—A retrospective study. Int J Mol Sci. 2023;24(6):5368 (Mar 10). Doi: 10.3390/ijms24065368

Key clinical point: Vitamin D deficiency in patients with psoriatic arthritis (PsA) had worse impact on the retention rate of the first biological disease-modifying antirheumatic drug (bDMARD) and response to methotrexate and was associated with severe disease course in terms of sacroiliitis.

Major finding: The risk for discontinuation of the first bDMARD (hazard ratio [HR] 2.129; P  =  .011) and methotrexate discontinuation because of therapy failure (HR 2.168; P  =  .002) were significantly higher among patients with 25(OH)D level of ≤20 vs  20-30 and ≥30 ng/mL, with the prevalence of sacroiliitis being significantly higher in patients with 25(OH)D level of ≤20 vs  ≥30 ng/mL (P  =  .0001).

Study details: Findings are from a retrospective study including 233 patients with PsA.

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

Source: Rotondo C et al. Vitamin D status and psoriatic arthritis: Association with the risk for sacroiliitis and influence on the retention rate of methotrexate monotherapy and first biological drug survival—A retrospective study. Int J Mol Sci. 2023;24(6):5368 (Mar 10). Doi: 10.3390/ijms24065368