Treatment Algorithms for Early Psoriatic Arthritis: Do They Depend on Disease Phenotype?

Role of diagnostic imaging in psoriatic arthritis: how, when, and why

Psoriasis is a common skin disease. Up to 30% of patients with psoriasis develop psoriatic arthritis (PsA) resulting, by far, the most prevalent coexisting condition. Heterogeneity of clinical and radiological presentation is a major challenge to diagnosis of PsA. Initial reports about PsA emphasized a benign course in most patients, but it is now recognized that psoriatic arthritis often leads to impaired function and a reduced quality of life. PsA is a progressive disease characterized by diverse clinical features, often resulting in diagnostic delay and treatment that are associated with poor clinical and structural outcomes. New effective treatments may halt PsA progression, and consequently, treatment goals have evolved from simple reduction of pain to achieving full remission or minimal disease activity. This emerging treat-to-target strategy paradigm emphasize a need for early diagnosis; sensitive imaging techniques may be of value in this process. While radiography and CT depict structural damage, US and MRI have emerged as helpful tools to evaluate magnitude and severity of active inflammatory lesions. This review aims to describe the role of imaging modalities in diagnosis, follow-up and prognosis of PsA.

Treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs: British Society for Rheumatology guideline scope

The aim of this guideline is to provide an update on evidence-based recommendations for treatment of adult patients with PsA. The previous BSR guidelines for PsA were published in 2012 and since that time, there have been many new advanced therapies licensed for PsA. This update will provide practical guidance for clinicians on the optimal selection of advanced therapies taking into account different domains of PsA (arthritis, enthesitis, dactylitis, axial disease and psoriasis) and key associated comorbidities. It will also update guidance on treatment strategy including the use of a treat-to-target approach. The guideline will be developed using the methods and processes outlined in Creating Clinical Guidelines: Our Protocol. (1) This development process to produce guidance, advice and recommendations for practice has National Institute for Health and Care Excellence (NICE) accreditation.

The Changing Face of Clinical Trials in Psoriatic Arthritis

PURPOSE OF THE REVIEW

We will address current treatment and unmet needs in psoriatic arthritis (PsA), examine existing randomized controlled trials (RCTs), and consider options for new trial designs and challenges in their implementation.

RECENT FINDINGS

While therapeutic options for PsA have rapidly increased, there continues to be a need for clinical trials to test new therapies and establish optimal treatment strategies in order to improve the care for patients with PsA. In addition, more data is needed on how to select the best therapy for a given patient in clinical practice. Consideration of alternative outcome measures is also needed. Despite the rapid expansion in the number of therapy options available, there is still much to be learned about how to treat the individual patient with PsA.

The Epidemiology of Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disorder characterized by joint and entheseal inflammation with a prevalence of 0.05% to 0.25% of the population and 6% to 41% of patients with psoriasis. PsA is a highly heterogeneous inflammatory arthritis. In this review, current knowledge is discussed regarding the epidemiology of PsA, including disease manifestations, classification criteria for adult and juvenile PsA, methods for recognizing early PsA, including use of screening tools and knowledge of risk factors for PsA, and medical comorbidities associated with PsA.

The dermatologists' role in managing psoriatic arthritis: results of a Swiss Delphi exercise intended to improve collaboration with rheumatologists

BACKGROUND

Psoriatic arthritis (PsA) substantially impacts the management of psoriatic disease.

OBJECTIVE

This study aimed to generate an interdisciplinary national consensus on recommendations of how PsA should be managed.

METHODS

Based on a systematic literature search, an interdisciplinary expert group identified important domains and went through 3 rounds of a Delphi exercise, followed by a nominal group discussion to generate specific recommendations.

RESULTS

A strong consensus was reached on numerous central messages regarding the impact of PsA, screening procedures, organization of the interaction between dermatologists and rheumatologists, and treatment goals.

CONCLUSION

These recommendations can serve as a template for similar initiatives in other countries. At the same time, they highlight the need to take into account the impact of the respective national health care system.

Clinical Trial Study in the Treatment of Nail Psoriasis with Pulsed Dye Laser

Abstract Objective: The treatment options for nail psoriasis have been limited, and the management of nail psoriasis has been challenging for physicians. This study aimed at evaluating the effect of different pulse durations in the treatment of nail psoriasis with the 595-nm PDL to determine the optimal pulse duration. Methods: Forty patients with bilateral fingernail psoriasis were recruited and completed a 6-month trial. PDL was applied on the proximal and lateral nailfolds based on random assignment. Eghity nails were treated with 6-millisecond pulse duration and 9 J/cm(2) whereas 80 nails were treated with 0.45-millisecond pulse duration and 6 J/cm(2). Nail Psoriasis Severity Index (NAPSI) was used to assess the clinical outcome from pretreatment and posttreatment photographs. Results: After 6 months of first treatment, there was a significant reduction in overall NAPSI, nail matrix NAPSI, and nail bed NAPSI scores from baseline in both groups; however, no significant difference was found between the two pulse duration groups. Side effects were mild including transient petechiae and hyperpigmentation. Conclusion: Both the longer 6-millisecond and shorter 0.45-millisecond pulses of PDL (595 nm) have been clinically proven to be effective for the treatment of nail matrix and nail bed psoriasis.