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Kragsnaes MS, Miguens Blanco J, Mullish BH, Serrano‐Contreras JI, Kjeldsen J, Horn HC, Pedersen JK, Munk HL, Nilsson AC, Salam A, Lewis MR, Chekmeneva E, Kristiansen K, Marchesi JR, Ellingsen T. Small Intestinal Permeability and Metabolomic Profiles in Feces and Plasma Associate With Clinical Response in Patients With Active Psoriatic Arthritis Participating in a Fecal Microbiota Transplantation Trial: Exploratory Findings From the FLORA Trial. ACR Open Rheumatol 2023; 5:583-593. [PMID: 37736702 PMCID: PMC10642255 DOI: 10.1002/acr2.11604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE We investigated intestinal permeability and fecal, plasma, and urine metabolomic profiles in methotrexate-treated active psoriatic arthritis (PsA) and how this related to clinical response following one sham or fecal microbiota transplantation (FMT). METHODS This exploratory study is based on the FLORA trial cohort, in which 31 patients with moderate-to-high peripheral PsA disease activity, despite at least 3 months of methotrexate-treatment, were included in a 26-week, double-blind, 1:1 randomized, sham-controlled trial. Participants were randomly allocated to receive either one healthy donor FMT (n = 15) or sham (n = 16) via gastroscopy. The primary trial end point was the proportion of treatment failures through 26 weeks. We performed a lactulose-to-mannitol ratio (LMR) test at baseline (n = 31) and at week 26 (n = 26) to assess small intestinal permeability. Metabolomic profiles in fecal, plasma, and urine samples collected at baseline, weeks 4, 12, and 26 were measured using 1 H Nuclear Magnetic Resonance. RESULTS Trial failures (n = 7) had significantly higher LMR compared with responders (n = 19) at week 26 (0.027 [0.017-0.33]) vs. 0.012 [0-0.064], P = 0.013), indicating increased intestinal permeability. Multivariate analysis revealed a significant model for responders (n = 19) versus failures (n = 12) at all time points based on their fecal (P < 0.0001) and plasma (P = 0.005) metabolomic profiles, whereas urine metabolomic profiles did not differ between groups (P = 1). Fecal N-acetyl glycoprotein GlycA correlated with Health Assessment Questionnaire Disability Index (coefficient = 0.50; P = 0.03) and fecal propionate correlated with American College of Rheumatology 20 response at week 26 (coefficient = 27, P = 0.02). CONCLUSION Intestinal permeability and fecal and plasma metabolomic profiles of patients with PsA were associated with the primary clinical trial end point, failure versus responder.
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Affiliation(s)
| | | | - Benjamin H. Mullish
- Imperial College London and St. Mary's Hospital, Imperial College Healthcare National Health Service TrustLondonUK
| | | | - Jens Kjeldsen
- Odense University Hospital and University of Southern DenmarkOdenseDenmark
| | | | | | | | | | - Ash Salam
- Imperial College London, Hammersmith Hospital CampusLondonUK
| | | | | | - Karsten Kristiansen
- University of Copenhagen, Copenhagen, Denmark, and Institute of Metagenomics, Qingdao‐Europe Advanced Institute for Life SciencesQingdaoChina
| | | | - Torkell Ellingsen
- Odense University Hospital and University of Southern DenmarkOdenseDenmark
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Queiro R, Aurrecoechea E, Alonso Castro S, Villa Blanco I, Brandy-Garcia A, Linge R. Interleukin-17-targeted treatment in patients with spondyloarthritis and associated cardiometabolic risk profile. Front Immunol 2023; 14:1203372. [PMID: 37533855 PMCID: PMC10391638 DOI: 10.3389/fimmu.2023.1203372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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Affiliation(s)
- Rubén Queiro
- Rheumatology and Health Research Institute of the Principality of Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- Oviedo University School of Medicine, Oviedo, Spain
| | - Elena Aurrecoechea
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sara Alonso Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa Blanco
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Caso F, Costa L, Triggianese P, Maione F, Bertolini N, Vastarella M, Chimenti MS, Tasso M. Recent developments for new investigational JAK inhibitors in psoriatic arthritis. Expert Opin Investig Drugs 2023:1-11. [PMID: 37096862 DOI: 10.1080/13543784.2023.2207737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting about one-third of subjects with psoriasis. Several treatment modalities targeting Janus Kinase pathways and intracellular inflammatory cascade are now available and under clinical investigation to treat this disease. AREAS COVERED This review describes ongoing and recently completed phase 2 and 3 Randomized Clinical Trials (RCTs) evaluating the efficacy and safety of approved JAK (Tofacitinib and Upadacitinib) and investigational JAK inhibitors (JAK1 inhibitors: Filgotinib and Ivarmacitinib (SHR0302); TYK2 inhibitors: Brepocitinib (PF-06700841) Deucravacitinib (BMS-986165), and NDI-034858) in PsA through February 2023. EXPERT OPINION Current standard of care has significantly improved the quality of life in PsA. Recently approved JAK inhibitors for PsA have addressed many of the unmet needs of PsA, particularly of those with severe phenotypes. Preliminary results from several RCTs have reported good and fast efficacy and an acceptable safety profile of investigational JAK inhibitors in PsA. Additional clinical trials and long-term outcome data on these agents are necessary for increasing available therapeutic options for PsA.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Paola Triggianese
- Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Maione
- ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nicoletta Bertolini
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Maria Vastarella
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Maria Sole Chimenti
- Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II
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Girbash EF, Abdelwahab SM, Atef RM, Sherif HE, Abdeldayem HM, Atta DS, Radwan AM. Maternal Interleukin-17 and disease activity influence pregnancy outcomes in women with psoriatic arthritis and ankylosing spondylitis. BMC Pregnancy Childbirth 2023; 23:35. [PMID: 36650451 PMCID: PMC9847183 DOI: 10.1186/s12884-023-05364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE We aimed in this study to evaluate the impact of maternal interleukin -17A and the activity of the illness on pregnancy outcomes in Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients. METHODS This prospective cohort research was carried out on 48 Psoriatic arthritis and ankylosing spondylitis pregnant women attending the inpatient and outpatient clinics of the Rheumatology & Rehabilitation and Obstetrics & Gynecology Departments, Faculty of Medicine, Zagazig University Hospitals in Egypt and 30 apparently healthy age- and sex-matched pregnant women between January 1,2018, and December 31, 2019. RESULTS The study group patients had a higher risk of preterm labour (32-36 weeks gestation) (aRR 1.80, 95% CI 0.79-4.17), oligohydramnios (aRR 3.15, 95% CI 1.26-8.42), Caesarean delivery (aRR 1.57, 95% CI 1.41-2.68), and delivering infants small for gestational age (aRR 7.04, 95% CI 2.36-12.42). There was significant difference between the control group and the study groups regarding the level of IL-17A. CONCLUSION Many females with PsA and AS have uninhibited pregnancy with regard to adverse events, but in comparison with normal pregnancies particularly with high IL-17A during the third trimester we noticed a growing risk of preterm labour, oligohydramnios and cesarean section. Further studies are needed to evaluate high maternal IL-17A levels and fetal outcomes.
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Affiliation(s)
- Ehab F. Girbash
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Shaimaa M. Abdelwahab
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt ,grid.31451.320000 0001 2158 2757Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Rehab M. Atef
- grid.31451.320000 0001 2158 2757 Clinical and Chemical Pathology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Hala E. Sherif
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Hussein M. Abdeldayem
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Doaa S. Atta
- grid.31451.320000 0001 2158 2757Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
| | - Ahmed M. Radwan
- grid.31451.320000 0001 2158 2757Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt
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Vallejo-Yagüe E, Burkard T, Micheroli R, Burden AM. Minimal disease activity and remission in patients with psoriatic arthritis with elevated body mass index: an observational cohort study in the Swiss Clinical Quality Management cohort. BMJ Open 2022; 12:e061474. [PMID: 36115672 PMCID: PMC9486340 DOI: 10.1136/bmjopen-2022-061474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the impact of elevated body mass index (BMI) in the achievement of minimal disease activity (MDA) and several definitions of remission in patients with psoriatic arthritis (PsA) in Switzerland. Secondarily, to assess the overlapping across the study outcomes. METHODS This observational cohort study in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry included patients with PsA starting their first biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) from 1997 to 30 June 2018. Exposure was BMI category at b/tsDMARD start: overweight, obese, and normal weight (reference). Logistic regression was used to assess the achievement of MDA and remission at ≤12 months, as well as treatment persistence at 1 year, in overweight patients and patients with obesity compared with the normal weight group. Remission was defined by Disease Activity for Psoriatic Arthritis (DAPSA), clinical DAPSA (cDAPSA) and 28-joint Disease Activity Score (DAS28). Additionally, overlapping across study outcomes was investigated. RESULTS The study included 306 (39.5%) normal weight patients, 285 (36.8%) overweight patients and 183 (23.6%) patients with obesity. Compared with the normal weight group, patients with obesity had lower odds of achieving MDA at ≤12 months (adjusted OR (ORadj) 0.45, 95% CI 0.24 to 0.82). This was consistent with the observed reduced odds of achieving DAPSA-remission (ORadj 0.42, 95% CI 0.21 to 0.85), cDAPSA-remission (ORadj 0.51, 95% CI 0.27 to 0.96) and DAS28-remission (ORadj 0.51, 95% CI 0.32 to 0.81) in patients with obesity versus normal weight patients. Among the 125 patients achieving MDA, the majority (81.8% normal weight, 80.0% overweight, 78.9% obese) achieved cDAPSA-remission. No differences were observed in the odds to achieving treatment persistence between the BMI strata. CONCLUSIONS Obesity halved the likelihood of achieving MDA and remission in patients with PsA with b/tsDMARDs compared with those with normal weight, while it did not impact treatment persistence. High overlapping of patients achieving the outcomes MDA and cDAPSA-remission was observed across every BMI group.
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Affiliation(s)
- Enriqueta Vallejo-Yagüe
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Theresa Burkard
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Michelle Burden
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
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Toussirot E, Gallais-Sérézal I, Aubin F. The cardiometabolic conditions of psoriatic disease. Front Immunol 2022; 13:970371. [PMID: 36159785 PMCID: PMC9492868 DOI: 10.3389/fimmu.2022.970371] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Psoriasis (PsO) and psoriatic arthritis (PsA), together known as psoriatic disease (PsD), are immune-mediated diseases with a chronic and relapsing course that affect the skin, the joints or both. The pathophysiology of PsO is complex and involves abnormal expression of keratinocytes and infiltration of the skin with dendritic cells, macrophages, neutrophils and T lymphocytes. Around 30% of patients with PsO develop arthritis with axial and/or peripheral manifestations. Both PsO and PsA share similar Th1- and Th17-driven inflammation, with increased production of inflammatory cytokines, including TNFα, IFN-γ, IL-17, IL-22, IL-23 in the skin and the synovial membrane. PsD is associated with a high burden of cardiometabolic diseases such as hypertension, diabetes, dyslipidemia, obesity, metabolic syndrome and cardiovascular (CV) complications as compared to the general population. These comorbidities share common immunopathogenic pathways linked to systemic inflammation, and are associated with the extent and severity of the disease. Morever, they can influence treatment outcomes in PsD. In this short review, we summarize the available evidence on the epidemiology, clinical aspects and mechanisms of cardiometabolic conditions in patients with PsD. We also discuss the impact of targeted treatments such as methotrexate and biological agents on these cardiometabolic conditions.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, Centre d’Investigation Clinique, Pôle Recherche, CHU de Besançon, Besançon, France
- Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
- Département Universitaire de Thérapeutique, Université de Franche-Comté, 25000 Besançon, France
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- *Correspondence: Eric Toussirot,
| | - Irène Gallais-Sérézal
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
| | - François Aubin
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
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Galozzi P, Oliviero F, Scanu A, Lorenzin M, Ortolan A, Favero M, Doria A, Ramonda R. Acute joint swelling in psoriatic arthritis: Flare or "psout"-A 10-year-monocentric study on synovial fluid. Exp Biol Med (Maywood) 2022; 247:1650-1656. [PMID: 35876168 PMCID: PMC9597207 DOI: 10.1177/15353702221110666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a multifaceted inflammatory disease associated with psoriasis that can affect peripheral joints, entheses, and the axial skeleton with a variable clinical course. Acute episodes of joint swelling in PsA patients can have different causes and require specific treatments. We aimed to describe the acute joint swelling in PsA patients via synovial fluid (SF) analyses, assessing in particular the presence of pathogenic crystals, to determine whether it is a flare or an acute episode of gout ("psout") during the course of the disease. This retrospective study was based on the results of SF analysis of samples collected from unselected adult PsA patients referred to our clinic for acute joint swelling. Demographic characteristics, disease involvement, laboratory findings on SF, and treatment options were recorded and reviewed. Among 5,478 SF samples analyzed in a 10-year time span, 213 complete SF records from PsA patients were evaluated. Overall, after adjustment for the degree of synovial inflammation, significant differences were observed in term of sex (p = 0.0017) and ongoing therapy (p = 0.0246). Non-inflammatory SFs, indeed, were mainly described for female PsA patients under therapy. Regarding serum uric acid levels, there were 19/213 (8.9%) PsA with hyperuricemia (HU), who were older, mostly male, patients with mild articular involvement and rare pathogenic crystals in their SF. Although it is known that the risk of gout is higher among patients with PsA ("psout"), monosodium urate crystals were reported only in 5/213 SFs (2.4%) of our cohort and in 2/19 SFs (10.5%) of HU PsA patients. Moreover, hyperuricemia seems not to modify the SF features in PsA patients. This study results seem to suggest that the convergence of gout and PsA, involving the role of urate crystals, is a more intricate relationship, which needs further insights to be unraveled.
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Affiliation(s)
- Paola Galozzi
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Medicina Interna I, Ca’ Foncello
Hospital, 31100 Treviso, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Roberta Ramonda.
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Degboé Y, Koch R, Zabraniecki L, Jamard B, Couture G, Ruidavets JB, Ferrieres J, Ruyssen-Witrand A, Constantin A. Increased Cardiovascular Risk in Psoriatic Arthritis: Results From a Case-Control Monocentric Study. Front Med (Lausanne) 2022; 9:785719. [PMID: 35665348 PMCID: PMC9160333 DOI: 10.3389/fmed.2022.785719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Psoriatic arthritis (PsA) is associated with increased cardiovascular morbidity and mortality. The aims of our real-life study were to compare the prevalence of cardiovascular risk factors (CVRFs) and cardiovascular events (CVEs) among patients with PsA with a control population, to evaluate the impact of correcting factors in equations that assess cardiovascular risk (CVR) in PsA, and to determine the percentage of patients who reach the LDLc target as indicated by the European guidelines. Methods In this observational cross-sectional monocentric case-control study, we used a standardized procedure to systematically assess patients with PsA aged 25–85 years who met the Classification for Psoriatic Arthritis (CASPAR) criteria. Controls were extracted from the MOnitoring NAtionaL du rISque Artériel (MONALISA) study. We compared the prevalence of CVRFs, CVEs, the CVR, and the percentage of patients reaching recommended LDLc target in both populations. The CVR was first assessed using SCORE and QRISK2 equations. Then, the SCORE equation was corrected by applying a 1.5 multiplication factor, as recommended by EULAR for rheumatoid arthritis (SCORE-PsA), and the QRISK2 was corrected using the “rheumatoid arthritis” item (QRISK2-PsA). Results A total of 207 PsA and 414 controls were included. CVRFs and CVEs were more frequent in the PsA group. After controlling for age and gender, atherothrombotic disease was increased in the PsA population (SCORE p = 0.002, QRISK2 p = 0.001). Using the SCORE-PsA increased the percentage of patients with a high or very high CVR from 39.3 to 45.3% in the PsA group. Similarly, using the QRISK2-PsA increased the percentage of patients with a CVR ≥ 10% from 44.9 to 53.2%. The percentages of patients with PsA with high LDLc in the high and very high CVR groups were not significantly different from controls, despite a trend in favor of patients with PsA. Of the 83 PsA with a QRISK2 ≥ 10%, only 22.9% were treated with statin vs. 35.8% of the 134 controls. The QRISK2-PsA score did not alter these results. Conclusion In real-life, patients with PsA have a higher prevalence of CVRFs, as well as a higher prevalence of CVEs compared to the general population. The CVR is higher in the PsA population than in the controls either using the SCORE and QRISK2 equations or using the corrected SCORE- PsA and QRISK2-PsA equations.
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Ciaffi J, Mele G, Mancarella L, Brusi V, Lisi L, Faranda Cordella J, Lubrano E, D'Angelo S, Meliconi R, Ursini F. Prevalence of Type 2 and Type 1 Diabetes in Psoriatic Arthritis: An Italian Study. J Clin Rheumatol 2022; 28:e324-e329. [PMID: 35192591 DOI: 10.1097/rhu.0000000000001706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) is burdened by an increased susceptibility to cardiovascular diseases. Comorbid diabetes may represent one of the key factors contributing to this risk. The aim of our medical records review study was to investigate the prevalence of type 2 diabetes (T2D) and type 1 diabetes (T1D) in an Italian PsA cohort. METHODS The clinical records of all patients consecutively seen at our clinic with a diagnosis of PsA during a 12-month period were reviewed to identify comorbid T2D or T1D. For comparison, a 1:1 age- and sex-matched group of individuals with noninflammatory diseases was recruited. RESULTS The final study cohort comprised 408 patients. The prevalence of T2D was 7.8% (95% confidence interval, 5.6-10.8) in PsA and 4.4% in controls (95% confidence interval, 2.8-6.9; p = 0.04). Two cases (0.49%) of T1D were identified in the PsA cohort, whereas no cases were observed in controls. In a multivariate logistic regression model including age, disease duration, and body mass index (BMI) as covariates, increasing age (odds ratio [OR], 1.079; p = 0.006) and BMI (OR, 1.188; p = 0.011) but not PsA duration predicted being classified as having T2D. In a similar model accounting for age and BMI, average disease activity score including 28 joints and C-reactive protein showed a trend toward significance (OR, 1.639; p = 0.066). CONCLUSIONS In conclusion, our data provide further support to the emerging evidence of an increased risk of T2D in PsA patients. Cardiometabolic comorbidity represents a significant aspect of integrated arthritis management to improve long-term cardiovascular outcomes and to provide a comprehensive treatment.
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Affiliation(s)
- Jacopo Ciaffi
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Giulio Mele
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Luana Mancarella
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Veronica Brusi
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | - Lucia Lisi
- From the Medicine and Rheumatology Unit, Dipartimento di Patologie Ortopediche Complesse
| | | | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso
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Gialouri CG, Evangelatos G, Fragoulis GE. Choosing the Appropriate Target for the Treatment of Psoriatic Arthritis: TNFα, IL-17, IL-23 or JAK Inhibitors? Mediterr J Rheumatol 2022; 33:150-161. [PMID: 36127928 PMCID: PMC9450184 DOI: 10.31138/mjr.33.1.150] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
Psoriatic arthritis (PsA) is a highly heterogenous disease. Apart from arthritis and psoriasis, other manifestations can also occur, including enthesitis, dactylitis, axial-, nail-, eye- and bowel- involvement. Comorbidities are also frequent in the setting of PsA, with cardiovascular disease and mental-health disorders being the most frequent. The Rheumatologist's arsenal has many different treatment options for treating PsA. Despite their effectiveness, there are some differences in terms of efficacy and safety that might affect clinician's decision for one or the other drug. Comparing biologic DMARDs and JAK-inhibitors, one could say that they have similar effectiveness in terms of musculoskeletal manifestations. However, anti-IL-17 and anti-IL-23 drugs seem to be more effective for skin manifestations. In contrast, JAK-inhibitors and etanercept might be less effective for these manifestations. Inflammatory bowel disease and uveitis are non-responsive to etanercept and anti-IL-17 drugs. As regards to comorbidities, data are scarce, but future studies will shed light on possible differential effect of bDMARDs or JAK-inhibitors. Safety is always an important drive for choosing the appropriate treatment. Infections are the most common adverse event of these drugs. Etanercept and anti-IL-17 drugs are safer for patients having latent tuberculosis, while herpes zoster is more common in individuals receiving JAK-inhibitors. Finally, venous thromboembolism risk, should be taken into account when JAK-inhibitors are used. In this review, we comparatively present, as outlined above, the various aspects that could affect the choice of the appropriate bDMARD or JAK-inhibitor for the treatment of a PsA patient.
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Affiliation(s)
- Chrysoula G. Gialouri
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
| | - George E. Fragoulis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens,“Laiko” General Hospital, Athens, Greece
- Corresponding Author: George E. Fragoulis, MD, PhD Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens Laiko General Hospital, Mikras Asias 75 Str, 11527 Athens, Greece, Tel.: +30 210 746 2636, E-mail:
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11
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Psoriatic arthritis and psoriasis severity as metabolic syndrome and insulin resistance predictors. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220311056l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. The aim of this study was to evaluate psoriasis severity and psoriatic arthritis (PsA) as metabolic syndrome (MetS) and insulin resistance (IR) predictors in patients with chronic plaque psoriasis as well as to evaluate if psoriasis severity and PsA are independent predictors for IR regardless of the MetS presence. Methods. This prospective, observational descriptive cross-sectional study was conducted at Dermatovenereological Clinic of the University Clinical Centre of Vojvodina, and included a total of 105 psoriasis patients divided into three groups: group with mild psoriasis (Psoriasis Area Severity Index ? PASI score < 10), group with moderate to severe psoriasis (PASI ?10), and group with PsA diagnosed on the basis of the CASPAR criteria. Results. Percentage of patients who had MetS was higher in the group with the severe form of psoriasis (p < 0.05) as well as IR (p = 0.05). PsA was also more frequently associated with MetS (p = 0.05) and IR (p < 0.01). In patients without MetS, no association between psoriasis severity and IR was found (p = 1.0), although there was a positive correlation between PASI and index of ?-cells secretory capacity % (HOMA B), which shows tendency for IR development. The association between PsA and presence of IR in patients without MetS was statistically significant (p < 0.05). Conclusion. MetS and IR prevalence increases in patients with PsA and in patients with the moderate and severe form of chronic plaque psoriasis. Both psoriasis severity and PsA are independent predictors for IR regardless of the MetS presence.
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12
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Adeodato Ramos LM, Gomes KWP, de Saboia Mont'Alverne AR, Braga MV, Costa Vasconcelos AH, Rodrigues CEM. High Prevalence of Metabolic Syndrome in Patients With Psoriatic Arthritis From Northeastern Brazil: Association With Traditional Cardiovascular Risk Factors and Biologic Disease-Modifying Antirheumatic Drugs. J Clin Rheumatol 2021; 27:S186-S192. [PMID: 33298819 DOI: 10.1097/rhu.0000000000001631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this cross-sectional study were to evaluate the prevalence of MetS in PsA patients compared with sex- and age-matched healthy controls and to test possible associations with clinical and laboratory variables. METHODS The prevalence of MetS was determined for 76 PsA patients and 76 sex- and age-matched healthy controls, using the criteria of NCEP/ATPIII and Harmonizing, adjusted for South Americans. Multivariate logistic regression analysis was used to identify independent risk factors for MetS. RESULTS Metabolic syndrome was significantly more prevalent in the PsA group than in the control group (53.9% vs 18.4%, p < 0.001). Psoriatic arthritis was associated with hypertension, diabetes mellitus, increased waist circumference (WC), elevated body mass index, and raised levels of blood glucose and triglycerides. When comparing MetS and non-Mets PsA patients, MetS was not significantly associated with disease activity, skin involvement, or quality of life. In the logistic regression model, the variables independently associated with MetS were use of biologic disease-modifying antirheumatic drugs (p = 0.001), elevated arterial pressure (p = 0.006), age (p = 0.0015), WC (p = 0.004), and low HDL (p = 0.042). CONCLUSIONS In this study on PsA patients from Northeastern Brazil, MetS was highly prevalent and associated with biologic disease-modifying antirheumatic drugs use, increased WC, and low HDL.
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13
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Ramonda R, Lorenzin M, Carriero A, Chimenti MS, Scarpa R, Marchesoni A, Lubrano di Scorpaniello E, Salvarani C, Cauli A, Semeraro A, Santo L, Ortolan A, Doria A, Fracassi E, Virelli G, Masia M, Fanizzi R, Visalli E, Amato G, Carletto A, Foti R. Effectiveness and safety of secukinumab in 608 patients with psoriatic arthritis in real life: a 24-month prospective, multicentre study. RMD Open 2021; 7:rmdopen-2020-001519. [PMID: 33593933 PMCID: PMC7888309 DOI: 10.1136/rmdopen-2020-001519] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To evaluate in a multicentric Italian cohort of patients with psoriatic arthritis (PsA) on secukinumab followed for 24 months: (1) the long-term effectiveness and safety of secukinumab, (2) the drug retention rate and minimal disease activity (MDA), (3) differences in the outcomes according to the biological treatment line: biologic-naïve patients (group A) versus multifailure (group B) patients. METHODS Consecutive patients with PsA receiving secukinumab were evaluated prospectively. Disease characteristics, previous/ongoing treatments, comorbidities and follow-up duration were collected. Disease activity/functional/clinimetric scores and biochemical values were recorded at baseline (T0), 6(T6), 12(T12) and 24(T24) months. Effectiveness was evaluated overtime with descriptive statistics; multivariate Cox and logistic regression models were used to evaluate predictors of drug-discontinuation and MDA at T6. Infections and adverse events were recorded. RESULTS 608 patients (41.28% men; mean (SD) age 52.78 (11.33)) were enrolled; secukinumab was prescribed as first-line biological treatment in 227 (37.34%) patients, as second (or more)-line biological treatment in 381 (62.66%). Effectiveness of secukinumab was shown with an improvement in several outcomes, such as Ankylosing Spondylitis Disease Activity Score (T0=3.26 (0.88) vs T24=1.60 (0.69) ;p=0.02) and Disease Activity Index for Psoriatic Arthritis (T0=25.29 (11.14) vs T24=7.69 (4.51); p<0.01). At T24, group A showed lower Psoriasis Area Severity Index (p=0.04), erythrocyte sedimentation rate and C reactive protein (p=0.03 ;p=0.05) and joint count (p=0.03) compared with group B. At T24, MDA was achieved in 75.71% of group A and 70.37% of group B. Treatment was discontinued in 123 (20.23%) patients, mainly due to primary/secondary loss of effectiveness, and in 22 due to adverse events. Retention rate at T24 was 71% in the whole population, with some difference depending on secukinumab dosage (p=0.004) and gender (p=0.05). CONCLUSIONS In a real-life clinical setting, secukimumab proved safe and effective in all PsA domains, with notable drug retention rate.
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Affiliation(s)
- Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Veneto, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Veneto, Italy
| | - Antonio Carriero
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza Local Health System, Potenza, Basilicata, Italy.,Department of Medicine and Health Sciences, University of Molise, Campobasso, Molise, Italy
| | - Maria Sole Chimenti
- Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Roma, Lazio, Italy
| | - Raffaele Scarpa
- Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University of Naples Federico II, Napoli, Campania, Italy
| | - Antonio Marchesoni
- Rheumatology Unit, Department of Rheumatology, ASST Gaetano Pini-CTO, Milano, Lombardia, Italy
| | - Ennio Lubrano di Scorpaniello
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze per la Salute "Vincenzo Tiberio", University of Molise, Campobasso, Molise, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda USL-IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.,University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences, AOU and University of Cagliari, Cagliari, Sardegna, Italy
| | - Angelo Semeraro
- Rheumatology Unit, Martina Franca-ASL Taranto, Martina Franca Hospital, Martina Franca, Puglia, Italy
| | - Leonardo Santo
- Rheumatology Service, Azienda Sanitaria Locale Barletta Andria Trani-DSS4 Barletta, Andria, Puglia, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Veneto, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Veneto, Italy
| | - Elena Fracassi
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| | - Giulia Virelli
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| | - Marco Masia
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| | - Rosalinda Fanizzi
- Rheumatology Unit, Martina Franca-ASL Taranto, Martina Franca Hospital, Martina Franca, Puglia, Italy
| | - Elisa Visalli
- Rheumatology Unit, A.O.U. Policlinico S. Marco, University of Catania, Catania, Sicilia, Italy
| | - Giorgio Amato
- Rheumatology Unit, A.O.U. Policlinico S. Marco, University of Catania, Catania, Sicilia, Italy
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, AOUI University of Verona, Verona, Veneto, Italy
| | - Rosario Foti
- Rheumatology Unit, A.O.U. Policlinico S. Marco, University of Catania, Catania, Sicilia, Italy
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Atzeni F, Gerratana E, Francesco Masala I, Bongiovanni S, Sarzi-Puttini P, Rodríguez-Carrio J. Psoriatic Arthritis and Metabolic Syndrome: Is There a Role for Disease Modifying Anti-Rheumatic Drugs? Front Med (Lausanne) 2021; 8:735150. [PMID: 34527685 PMCID: PMC8435605 DOI: 10.3389/fmed.2021.735150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 01/09/2023] Open
Abstract
Although psoriatic arthritis (PsA) primarily leads to joint and skin damage, it is associated with higher prevalence of metabolic syndrome (MetS) and its components, namely hypertension, dyslipidemia, obesity, and type II diabetes. Additionally, chronic inflammation is known to aggravate these cardiometabolic factors, thus explaining the enhanced cardiovascular (CV) morbidity and mortality in RA. Furthermore, emerging evidence suggest that some risk factors can fuel inflammation, thus pointing to a bidirectional crosstalk between inflammation and cardiometabolic factors. Therefore, dampening inflammation by disease-modifying anti-rheumatic drugs (DMARDs) may be thought to ameliorate MetS burden and thus, CV risk and disease severity. In fact, recommendations for PsA management emphasize the need of considering comorbidities to guide the treatment decision process. However, the existing evidence on the impact of approved DMARDs in PsA on MetS and MetS components is far from being optimal, thus representing a major challenge for the clinical setting. Although a beneficial effect of some DMARDs such as methotrexate, TNF inhibitors and some small molecules is clear, no head-to-head studies are published and no evidence is available for other therapeutic approaches such as IL-23 or IL-17 inhibitors. This narrative review summarizes the main evidence related to the effect of DMARDs on MetS outcomes in PsA patients and identify the main limitations, research needs and future perspectives in this scenario.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy,*Correspondence: Fabiola Atzeni
| | - Elisabetta Gerratana
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | | | - Sara Bongiovanni
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Javier Rodríguez-Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain,Area of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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15
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Chimenti MS, Conigliaro P, Caso F, Costa L, Ortolan A, Triggianese P, Tasso M, Fonti GL, Lorenzin MG, Perricone R, Ramonda R. Long-term effectiveness and drug survival of golimumab in patients affected by psoriatic arthritis with cutaneous involvement. Clin Rheumatol 2021; 41:75-84. [PMID: 34410550 PMCID: PMC8724144 DOI: 10.1007/s10067-021-05874-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine the effectiveness of golimumab (GLM) in improving joint, periarticular structures and cutaneous manifestations in patients with moderate to severe psoriatic arthritis (PsA) with cutaneous psoriasis in different real-life clinical settings and 48-month drug survival. METHODS Clinical and laboratory records were collected from PsA patients treated with GLM at baseline (T0) and after 6, 12, 24, 36, and 48 months of treatment. Comparisons were performed using a paired t-test or Wilcoxon test. Drug survival rates were analyzed using Kaplan-Meier estimates. p value < 0.05 was considered statistically significant. RESULTS Data from 105 patients were collected. PsO occurred in 80% of patients and enthesitis in 78%, peripheral and axial arthritis in 63.8% and 35.3%, respectively, while erosions in 36.2%. The main comorbidities were cardiovascular diseases (31.4%) and metabolic syndrome (MetS) (19%). A statistically significant improvement in articular and cutaneous psoriasis was registered at T48 of GLM-therapy in clinical (DAPSA p < 0.0001; PASI p < 0.01; BASDAI p < 0.0001) and laboratory (CRP < 0.05) indexes. Gender (p = 0.652), BMI (p = 0.655), smoking habit (p = 0.466), and line of treatment (p = 0.208) did not affect treatment efficacy nor persistence. At T48, 42% of patients discontinued GLM: the most frequent reason was an insufficient response or loss of efficacy (28.6%). CONCLUSION A 48-month GLM high drug persistence of PsA patients was observed in real-life, in patients presenting high disease activity, elevated prevalence of comorbidities, and more than one line of treatment at baseline. Patients' characteristics as gender, smoke, BMI, different lines of treatment, and concomitant methotrexate treatment affected treatment persistence, making GLM effective and safe in moderate-severe PsA in a long-term real-life setting. Key Points • Golimumab was effective in psoriatic arthritis, including both musculoskeletal and cutaneous manifestations. • Golimumab effectiveness and drug survival were not affected by comorbidities and patient-related characteristics. • The 4-year drug survival curves confirm the efficacy and safety of golimumab in psoriatic arthritis patients in a real-life setting.
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Affiliation(s)
- Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Via Montpellier 1, Rome, Italy.
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Via Montpellier 1, Rome, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, Padua, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Via Montpellier 1, Rome, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Giulia Lavinia Fonti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Via Montpellier 1, Rome, Italy
| | - Maria Grazia Lorenzin
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, Padua, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina Dei Sistemi, University of Rome Tor Vergata, Via Montpellier 1, Rome, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, Padua, Italy
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Ballegaard C, Skougaard M, Guldberg-Møller J, Nissen CV, Amris K, Jørgensen TS, Dreyer L, Kristensen LE. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford) 2021; 60:3289-3300. [PMID: 33325531 DOI: 10.1093/rheumatology/keaa780] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To explore the prognostic value of pre-specified comorbidities on treatment outcomes in PsA, and to compare baseline data with cutaneous psoriasis without arthritis and healthy controls (HC). METHODS Patients initiating conventional synthetic/biological disease-modifying antirheumatic drugs were enrolled in this clinical observational cohort study, and data on comorbidities, and clinical and patient-reported outcomes were retrieved at baseline and after 4 months. Pearson's chi-squared tests were performed to investigate the prognostic value of pre-specified comorbidities and achievement of ACR20, DAPSA50 and MDA. Mann-Whitney U tests were used to compare OMERACT PsA Core Outcome Set (COS) measures at baseline and follow-up for the pre-specified comorbidities. RESULTS A total of 100 PsA patients were included at baseline. Statistically significantly fewer patients with obesity achieved DAPSA50 compared with patients without obesity (P =0.035), and fewer patients with hypertension (P =0.034) and Charlson Comorbidity Index (CCI) ≥1 (P =0.027), respectively, achieved MDA compared with patients without these comorbidities. Patients with obesity, hypertension, widespread pain, and CCI ≥1 had significantly worse COS measures at follow-up compared with patients without these comorbidities. At baseline, patients with PsA had higher disease burden compared with patients with cutaneous psoriasis and HC, including higher pain (P <0.001) and fatigue (P <0.001) scores, and more widespread pain (P =0.002). CONCLUSION Obesity, hypertension and CCI ≥1 were prognostic factors for poorer treatment outcome rates in PsA. Pain and fatigue were more frequently reported among patients with PsA compared with patients with cutaneous psoriasis and HC. TRIAL REGISTRATION The Danish National Committee on Health Research Ethics: H-15009080; Data Protection Agency: 2012-58-0004; ClinicalTrials.gov: NCT02572700.
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Affiliation(s)
- Christine Ballegaard
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marie Skougaard
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jørgen Guldberg-Møller
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christoffer V Nissen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kirstine Amris
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Tanja S Jørgensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lene Dreyer
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars E Kristensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Loganathan A, Kamalaraj N, El-Haddad C, Pile K. Systematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis. Int J Rheum Dis 2021; 24:1112-1120. [PMID: 34076348 DOI: 10.1111/1756-185x.14147] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Psoriatic arthritis (PsA), rheumatoid arthritis (RA) and psoriasis (PsO) are associated with systemic inflammation and increased cardiovascular mortality and morbidity. Metabolic syndrome (MetS) is associated with systemic inflammation, and conditions associated with MetS, such as obesity, are associated with difficulty in attaining minimal disease activity (MDA) in individuals with inflammatory arthritis. This systematic review aims to determine whether there is an increased prevalence of MetS in PsA populations compared with PsO and RA populations. METHODS A systematic review was conducted to assess the prevalence of MetS in PsA, PsO, and RA populations following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of the studies reviewed was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. RESULTS The pooled prevalence of MetS in PsA populations was 0.46 ± 0.06 (95% CI 0.40-0.51). In comparison, the prevalence of MetS in PsO and RA populations was 0.34 ± 0.03 (95% CI 0.32-0.37) and 0.31 ± 0.04 (95% CI 0.27-0.35), respectively. Patients with PsA were 1.62 ± 0.036 (95% CI 1.50-1.74) and 1.66 ± 0.038 (95% CI 1.54-1.79) times more likely to have MetS compared with PsO and RA populations. CONCLUSION The prevalence of MetS is significantly increased in PsA populations compared with PsO and RA populations. Further studies should be performed using a standardized definition of MetS in PsA, RA, and PsO populations to determine whether addressing the metabolic components in MetS offers any therapeutic benefits and in terms of attaining MDA and improving cardiovascular health.
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Affiliation(s)
- Aravinthan Loganathan
- Rheumatology Department, Campbelltown Hospital, Campbelltown, NSW, Australia.,Rheumatology, Wollongong Hospital, Campbelltown, NSW, Australia.,University of Western Sydney - Campbelltown Campus, Campbelltown, NSW, Australia
| | - Narainraj Kamalaraj
- Rheumatology Department, Campbelltown Hospital, Campbelltown, NSW, Australia.,School of Medicine, Western Sydney University - Campbelltown Campus, Campbelltown, NSW, Australia
| | - Carlos El-Haddad
- Rheumatology Department, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Kevin Pile
- Rheumatology Department, Campbelltown Hospital, Campbelltown, NSW, Australia.,University of Western Sydney - Campbelltown Campus, Campbelltown, NSW, Australia
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Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21998279. [PMID: 33737966 PMCID: PMC7934027 DOI: 10.1177/1759720x21998279] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Psoriatic arthritis (PsA) is associated with a higher burden of cardiometabolic disorders, such as hypertension, dyslipidemia, diabetes, obesity, and cardiovascular disease (CVD), compared with the general population. These comorbidities are associated with the severity of disease, and adversely affect treatment outcomes in PsA. Comorbidities lead to increased physician visits and medications for patients and make the selection and maintenance of therapies challenging for physicians. Moreover, CVD is a leading cause of mortality in PsA. Therefore, optimal management of PsA should include not only treating the skin and joint disease, but also identifying comorbidities early, and managing them to improve long-term outcomes. Further studies are needed to understand the complex mechanisms, interactions, and trajectories of cardiometabolic comorbidities in psoriatic disease.
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Affiliation(s)
| | - Alexis Ogdie
- Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lihi Eder
- Department of Medicine/Rheumatology, Women's College Hospital, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
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Navarini L, Currado D, Costa L, Tasso M, Chimenti MS, Caso F. Experimental and Investigational Pharmacotherapy for Psoriatic Arthritis: Drugs of the Future. J Exp Pharmacol 2020; 12:487-502. [PMID: 33235521 PMCID: PMC7679354 DOI: 10.2147/jep.s265633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/24/2020] [Indexed: 12/28/2022] Open
Abstract
In recent years, different studies have shown in psoriatic arthritis (PsA), the pathogenetic role of multiple cytokines other than tumor necrosis factor-α, such as interleukin-17 (IL-17), and IL-23 and dysfunction of Janus kinase (JAK)-signal family pathway. These molecules also represent the target of recently developed biologic (bDMARDs) and targeted synthetic disease modifying antirheumatic drugs (DMARDs) (tsDMARDs) currently investigated in several Phase II and III randomized controlled trials (RCTs). This review examines the therapeutic efficacy and safety of most recent developed IL-17, IL-23 and JAK inhibitors and highlights how these new PsA therapies are going to revolutionize the management of PsA in the next few years. Ongoing RCTs of these molecules in PsA are also described. Available literature on new anti-IL-17 and anti-IL-23 agents and JAK inhibitors demonstrates the potential role of these molecules as effective therapeutic strategies across multiple PsA clinical domains, along with an acceptable tolerability and safety profile, thus expanding the treatment options available for PsA patients. Of note, other molecules are under investigation, and among those, potential therapeutic strategies seem to be represented by single antibodies blocking simultaneously two cytokines, the agents inhibiting mammalian target of rapamycin (mTOR), receptor retinoic acid receptor-related orphan receptor gamma (RORγt), A3 adenosine receptor (A3 AR), and K+ channel voltage channel inhibitors. Remarkable progress has been made in PsA pharmacotherapy, and novel bDMARDs targeting IL17A and tsDMARDs (JAK-inhibitors) represent promising therapies. More clinical trials are needed to better characterize the efficacy and safety profile of these therapeutic agents in PsA treatment.
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Affiliation(s)
- Luca Navarini
- Unit of Rheumatology, Immunology and Clinical Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Damiano Currado
- Unit of Rheumatology, Immunology and Clinical Medicine, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Ritchlin CT, Giles JT, Ogdie A, Gomez‐Reino JJ, Helliwell P, Young P, Wang C, Wu J, Romero AB, Woolcott J, Stockert L. Tofacitinib in Patients With Psoriatic Arthritis and Metabolic Syndrome: A Post hoc Analysis of Phase 3 Studies. ACR Open Rheumatol 2020; 2:543-554. [PMID: 32910531 PMCID: PMC7571390 DOI: 10.1002/acr2.11166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Metabolic syndrome (MetS) is a cluster of concurrent risk factors for cardiovascular disease and type 2 diabetes. This post hoc analysis explored key efficacy and safety endpoints in patients with psoriatic arthritis (PsA) and MetS treated with tofacitinib. METHODS Tofacitinib 5 and 10 mg twice daily and placebo data were pooled from two Phase 3 studies (OPAL Broaden [12 months; ClinicalTrials.gov identifier NCT01877668]; OPAL Beyond [6 months; ClinicalTrials.gov identifier NCT01882439]); patients received one background conventional synthetic disease-modifying antirheumatic drug. Patients were stratified by baseline presence/absence of MetS. Efficacy and safety were reported to month 3 (tofacitinib and placebo) and 6 (tofacitinib only). Efficacy outcomes included: American College of Rheumatology (ACR)20/50/70, Health Assessment Questionnaire-Disability Index (HAQ-DI) response, Psoriasis Area Severity Index (PASI)75 response, and enthesitis/dactylitis resolution rates; and changes from baseline (Δ) in C-reactive protein, HAQ-DI, Patient's/Physician's Global Assessment of Arthritis, and patient-reported outcomes. Safety outcomes included treatment-emergent all-causality adverse events (AEs), Δ in lipid/hepatic values, and liver parameter increases. RESULTS Of 710 patients, 41.4% (n = 294) had baseline MetS. All efficacy outcomes improved with both tofacitinib doses versus placebo, to month 3; tofacitinib efficacy was consistent to month 6, regardless of MetS status. MetS did not appear to affect the incidence of AEs or Δ in lipid/hepatic values with tofacitinib up to month 3 or 6. Arterial thromboembolism and myocardial infarction (adjudicated major adverse cardiovascular events) were each reported once in tofacitinib-treated patients with MetS. CONCLUSION Regardless of baseline MetS status, tofacitinib showed greater efficacy versus placebo in patients with active PsA. The tofacitinib safety profile appeared similar in patients with versus without MetS.
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Affiliation(s)
| | | | - Alexis Ogdie
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania
| | | | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
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21
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Genre F, Rueda-Gotor J, Quevedo-Abeledo JC, Corrales A, Hernández-Hernández V, Fañanas-Rodríguez N, Lavín-Gómez B, Delgado-Frías E, de Vera-González A, González-Delgado A, de Armas-Rillo L, García-Unzueta MT, González-Gay MÁ, Ferraz-Amaro I. Insulin resistance in non-diabetes patients with spondyloarthritis. Scand J Rheumatol 2020; 49:476-483. [PMID: 32648492 DOI: 10.1080/03009742.2020.1751272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Insulin resistance (IR) constitutes a major underlying abnormality driving cardiovascular disease in the general population and has been linked to inflammatory diseases. In this study, we aimed to determine the prevalence of IR in patients with spondyloarthritis (SpA) and whether IR can be explained by disease-related features in such cases. Method: The study included 577 subjects: 306 patients diagnosed with SpA according to Assessment of SpondyloArthritis international Society criteria and 271 controls. Insulin and C-peptide serum levels, IR and β-cell function (%B) indices by homoeostatic model assessment (HOMA2), and lipid profiles were assessed in patients and controls. A multivariable regression analysis was performed to evaluate the differences in IR indices between patients and controls and to determine how IR is associated with disease-related characteristics in SpA patients. Results: HOMA2-%B and HOMA2-IR scores, both calculated with insulin or C-peptide, had significantly higher values in SpA patients compared to controls in multivariable analysis adjusted for age, gender, traditional IR-related factors, and glucocorticoid intake. Disease activity, functional status, and metrological SpA indices were positively related to IR, but only in univariable analysis. Disease duration and positivity for human leucocyte antigen-B27 were independently associated with a higher HOMA2-%B after multivariable analysis. Conclusion: Patients with SpA have an increased IR compared to controls. SpA disease-related data are independently associated with β-cell dysfunction.
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Affiliation(s)
- F Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Marqués de Valdecilla University Hospital, IDIVAL , Santander, Spain
| | - J Rueda-Gotor
- Division of Rheumatology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - J C Quevedo-Abeledo
- Division of Rheumatology, University Hospital of Gran Canaria Dr Negrin , Las Palmas, Gran Canaria, Spain
| | - A Corrales
- Division of Rheumatology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - V Hernández-Hernández
- Division of Rheumatology, University Hospital of the Canary Islands , Tenerife, Spain
| | - N Fañanas-Rodríguez
- Division of Endocrinology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - B Lavín-Gómez
- Division of Endocrinology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - E Delgado-Frías
- Division of Rheumatology, University Hospital of the Canary Islands , Tenerife, Spain
| | - A de Vera-González
- Central Laboratory Division, University Hospital of the Canary Islands , Tenerife, Spain
| | - A González-Delgado
- Central Laboratory Division, University Hospital of the Canary Islands , Tenerife, Spain
| | - L de Armas-Rillo
- Department of Health Sciences, European University of the Canary Islands , Tenerife, Spain
| | - M T García-Unzueta
- Division of Endocrinology, Marqués de Valdecilla University Hospital , Santander, Spain
| | - M Á González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Marqués de Valdecilla University Hospital, IDIVAL , Santander, Spain.,Division of Rheumatology, Marqués de Valdecilla University Hospital , Santander, Spain.,School of Medicine, University of Cantabria , Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
| | - I Ferraz-Amaro
- Division of Rheumatology, University Hospital of the Canary Islands , Tenerife, Spain
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22
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Caso F, Chimenti MS, Navarini L, Ruscitti P, Peluso R, Girolimetto N, Del Puente A, Giacomelli R, Scarpa R, Costa L. Metabolic Syndrome and psoriatic arthritis: considerations for the clinician. Expert Rev Clin Immunol 2020; 16:409-420. [PMID: 32149545 DOI: 10.1080/1744666x.2020.1740593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Metabolic Syndrome (MetS) is strictly interconnected with systemic inflammation, and increased evidence has described a close link between this condition and Psoriatic Arthritis (PsA).Areas covered: This review summarizes main studies exploring clinical aspects and prevalence of MetS in PsA cohorts. Further, there is accumulating evidence showing shared inflammatory pathways between MetS, its components, and PsA.Expert opinion: The high prevalence of MetS in PsA highlights the need for screening, evaluation, and close monitoring of MetS and its components (namely, diabetes mellitus, obesity, hypertension, and dyslipidemia) in psoriatic patients.Further studies should focus on the pathogenetic link between MetS and PsA. More studies are required to identify appropriate algorithms for the assessment and management of MetS in PsA patients.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Nicolò Girolimetto
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.,Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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Caso F, Navarini L, Ruscitti P, Chimenti MS, Girolimetto N, Del Puente A, Giacomelli R, Scarpa R, Costa L. Targeted synthetic pharmacotherapy for psoriatic arthritis: state of the art. Expert Opin Pharmacother 2020; 21:785-796. [PMID: 32057269 DOI: 10.1080/14656566.2020.1726317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION In recent years, different studies regarding psoriatic arthritis (PsA) have shown the pathogenetic role of dysfunction of signaling pathways involving the phosphodiesterase-4 enzyme and transcription factors or enzymes belonging to the kinase (JAK)-signal family pathway. These also represent the target of several drugs known as targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs). AREAS COVERED The authors performed a systematic literature search using the PubMed database, as well as through retrieving data from randomized controlled trials, their post-hoc analysis, and pooled data analysis on the efficacy and safety profile of the PDE4 inhibitor (PDE4i), apremilast, and the inhibitors of JAK (JAKis), tofacitinib, filgotinib, baricitinib, and upadacitinib, in PsA. EXPERT OPINION In PsA, the PDE4i, apremilast, and the JAKi, tofacitinib, are effective across multiple clinical domains and have an acceptable tolerability profile, thus expanding the treatment options available for PsA patients. Apremilast and tofacitinib show several advantages mainly represented by their oral administration, a fast onset of action, and a short half-life. Data on tsDMARDs in PsA are still limited, and randomized trials and real-life studies are advocated.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II , Naples, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico Di Roma , Rome, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata , Rome, Italy
| | - Nicolò Girolimetto
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II , Naples, Italy.,Department of Rheumatology, Azienda USL-IRCCS Di Reggio Emilia , Reggio Emilia, Italy
| | - Antonio Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II , Naples, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila , L'Aquila, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II , Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II , Naples, Italy
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Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clin Rheumatol 2020; 39:1039-1047. [DOI: 10.1007/s10067-020-04963-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/05/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
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Gratacós J, Galíndez E, Otón T. Is obesity a predictor for lack of response to treatment in psoriatic arthritis? A systematic review. ACTA ACUST UNITED AC 2019; 17:268-278. [PMID: 31708450 DOI: 10.1016/j.reuma.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To update the study of the association between obesity and treatment response in psoriatic arthritis. METHODS Updating a systematic review of clinical trials, prospective or retrospective longitudinal studies and case-control studies in psoriatic arthritis in which obesity was assessed as a predictor of efficacy or toxicity. Risks of bias were assessed with validated scales. A meta-analysis of the results of studies with similar outcome variables and weight measurements was performed. RESULTS Twenty-one studies were included (6 review of clinical trials, 6 longitudinal studies, 7 registers and one case-control studie), with moderate quality. The risk of achieving an ACR20 response if weight≥100kg was estimated at OR=1.42 (1-2.08) and that of withdrawing treatment in an OR of 1.60 (95% CI: 1.34 - 1.92). CONCLUSIONS There seems to be a greater risk of withdrawal of treatment due to inefficacy and difficulty in achieving remission in patients with psoriatic arthritis if they are obese.
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Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Barcelona), España
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, Madrid, España.
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Özkul Ö, Yazıcı A, Aktürk AS, Karadağ DT, Işık ÖO, Tekeoğlu S, Cefle A. Are there any differences among psoriasis, psoriatic arthritis and rheumatoid arthritis in terms of metabolic syndrome and cardiovascular risk factors? Eur J Rheumatol 2019; 6:174-178. [PMID: 31657699 DOI: 10.5152/eurjrheum.2019.19029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although the frequency of metabolic syndrome has been studied separately in psoriasis, psoriatic arthritis (PsA), and rheumatoid arthritis (RA) patients, there is no study that compares the prevalence of metabolic syndrome in all three diseases. The purpose of this study is to evaluate the relationship between metabolic syndrome (MetS) and chronic low-grade inflammatory diseases, and to determine the frequency of MetS and insulin resistance in psoriasis and PsA as compared to RA. METHODS A total of 155 patients were included in this cross-sectional study. Fifty patients who were diagnosed with psoriasis, 55 PsA patients who were diagnosed according to the CASPAR criteria, and 50 seropositive RA patients who were diagnosed according to the ACR/EULAR 2010 classification criteria were included in this study. MetS was diagnosed by the 2005 criteria of International Diabetes Federation. The cardiovascular risk factors and parameters associated with MetS were evaluated. RESULTS The patients' mean age was significantly higher in the RA. MetS was determined in 33.5% of all patients and MetS and insulin resistance showed no significant difference among the three groups (psoriasis: 36%, PsA: 29%, RA: 36%; p: 0.684 and psoriasis: 70%, PsA: 64%, RA: 66%, respectively; p: 0.785). Triglyceride levels were higher in psoriasis and PsA as compared to the RA (psoriasis: 34%, PsA: 32.7%, RA: 16%, respectively; p: 0.045). The frequency of hypertension was 38% in the RA, which was higher than PsA and psoriasis (p: 0.011). CONCLUSION In all three groups, the prevalence of MetS was shown to be higher than the general population. The lack of difference between these groups may be due to the small number of patients, the retrospective study design, and the inequality of the population with respect to age and gender.
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Affiliation(s)
- Özlem Özkul
- Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ayten Yazıcı
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Aysun S Aktürk
- Department of Dermatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Duygu T Karadağ
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Özlem O Işık
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Senem Tekeoğlu
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ayşe Cefle
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey
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Caso F, Navarini L, Carubbi F, Picchianti-Diamanti A, Chimenti MS, Tasso M, Currado D, Ruscitti P, Ciccozzi M, Annarumma A, Laganà B, Perricone R, Afeltra A, Giacomelli R, Scarpa R, Costa L. Mediterranean diet and Psoriatic Arthritis activity: a multicenter cross-sectional study. Rheumatol Int 2019; 40:951-958. [PMID: 31605152 DOI: 10.1007/s00296-019-04458-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022]
Abstract
Diet is a modifiable factor implicated in chronic systemic inflammation, and the mediterranean dietary pattern is considered to be a healthy model in terms of morbidity and mortality. The main aim of this study was to evaluate the adherence to the mediterranean diet in patients with Psoriatic Arthritis (PsA) and its impact on disease activity. A cross-sectional observational study was conducted in a cohort of 211 consecutive PsA patients. We evaluated PsA activity by disease activity index for PSoriatic Arthritis (DAPSA) and composite psoriatic disease activity index (CPDAI). The NCEP-ACT III criteria were used to identify subjects with MetS, and in each subject, we evaluated body mass index (BMI). A validated 14-item questionnaire for the assessment of adherence to the mediterranean diet (PREDIMED) was recorded for all the enrolled subjects. Patients showed a median age of 55 (48-62) and disease duration was 76 (36-120) months. 27.01% of patients were classified as having MetS. The median of the mediterranean diet score (MDS) was 7 (6-9). A moderate adherence to mediterranean diet was found in 66.35% of the entire cohort; 15.64% and 18.01% of the patients showed low- and high adherence to the dietary pattern, respectively. We found a negative association between DAPSA and adherence to mediterranean diet (B = - 3.291; 95% CI - 5.884 to - 0.698). DAPSA was positively associated with BMI (B = 0.332; 95% CI 0.047-0.618) and HAQ ( B = 2.176; 95% CI 0.984-3.368). Results from our study evidenced that in PsA patients, higher levels of disease activity as measured by DAPSA correlated with low adherence to mediterranean diet, suggesting potential benefit of antinflammatory properties of this dietary pattern.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Damiano Currado
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonio Annarumma
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, 00185, Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
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Zardin-Moraes M, da Silva ALFA, Saldanha C, Kohem CL, Coates LC, Henrique LR, Palominos PE, Chakr RMDS. Prevalence of Psoriatic Arthritis Patients Achieving Minimal Disease Activity in Real-world Studies and Randomized Clinical Trials: Systematic Review with Metaanalysis. J Rheumatol 2019; 47:839-846. [DOI: 10.3899/jrheum.190677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 01/07/2023]
Abstract
Objective.To estimate the frequency of patients with psoriatic arthritis (PsA) achieving minimal disease activity (MDA) status in real-world studies and randomized controlled trials (RCT).Methods.A systematic literature search for 2009–2017 was performed in PubMed, Embase, Cochrane Library, and LILACS. Study selection and data extraction were performed by 2 independent researchers. Random-effects single-arm metaanalyses were performed and heterogeneity was assessed using I2.Results.A total of 405 records were identified and 45 studies were analyzed: 39 (86.7%) observational studies and 6 (13.3%) RCT; they included 12,469 patients. The overall prevalence of MDA in cross-sectional studies was 35% (95% CI 30%–41%, I2 = 94%), varying from 17% (95% CI 7%–34%) in patients taking synthetic disease-modifying antirheumatic drugs (DMARD) to 57% (95% CI 41%–71%) in those taking biological DMARD. Prevalence of MDA in cohort studies increased with longer followup time, ranging from 25% (95% CI 15%–40%) with 3- to 4-month followup to 42% (95% CI 38%–45%) with > 24-month followup. Patients with PsA receiving biological DMARD in a real-world context and RCT had similar prevalence of MDA at 6-month followup: 30% (95% CI 21%–41%, I2 = 85%) versus 32% (95% CI 26%–39%, I2 = 79%), respectively.Conclusion.Patients with PsA included in real-world studies had similar prevalence of MDA compared to those in controlled clinical trials. This finding suggests that MDA is a useful treatment target for PsA in the real-world setting.
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Remaeus K, Stephansson O, Johansson K, Granath F, Hellgren K. Maternal and infant pregnancy outcomes in women with psoriatic arthritis: a Swedish nationwide cohort study. BJOG 2019; 126:1213-1222. [DOI: 10.1111/1471-0528.15836] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Affiliation(s)
- K Remaeus
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
| | - O Stephansson
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
- Department of Women's and Children's Health Karolinska Institutet Solna Sweden
| | - K Johansson
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
| | - F Granath
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
| | - K Hellgren
- Clinical Epidemiology Unit Department of Medicine Karolinska Institutet Solna Sweden
- Rheumatology Unit Department of Medicine Karolinska Institutet Solna Sweden
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Metabolic syndrome, non-alcoholic fatty liver disease and liver stiffness in psoriatic arthritis and psoriasis patients. Clin Rheumatol 2019; 38:2843-2850. [DOI: 10.1007/s10067-019-04646-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 12/16/2022]
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Chimenti MS, Triggianese P, De Martino E, Conigliaro P, Fonti GL, Sunzini F, Caso F, Perricone C, Costa L, Perricone R. An update on pathogenesis of psoriatic arthritis and potential therapeutic targets. Expert Rev Clin Immunol 2019; 15:823-836. [PMID: 31177868 DOI: 10.1080/1744666x.2019.1627876] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Innate immune response and bone remodeling are key factors contributing to the pathogenesis of psoriatic arthritis (PsA). Moreover, the evidence of autoantibodies in patients' sera suggests an autoimmune side in PsA. Besides the immune pathways, studies strongly support the role of genetic risk alleles in affecting the clinical heterogeneity of PsA as well as the response to therapy. A good clinical response to treatment, indeed, represents a challenge in PsA patients and the identification of patient-targeted therapies is still a critical issue. Areas covered: We performed a systematic review aiming at describing new evidence on PsA pathogenesis and treatments. Reported items for systematic reviews (PRISMA checklist) were analyzed. Studies included from the PubMed database addressed the following items: innate immunity, autoimmunity, bone remodeling, and therapeutic targets in PsA; time frame of research 1970-2019. Specifically, we reviewed data on IL-17 inhibitors, abatacept, JAK inhibitors, ABT 122, and A (3) adenosine receptors agonist, CF101. Expert opinion: In PsA an intriguing pathogenetic network has been documented. Several biological and synthetic drugs are promising in terms of efficacy and safety profile.
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Affiliation(s)
- Maria Sole Chimenti
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Paola Triggianese
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Erica De Martino
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Paola Conigliaro
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Giulia Lavinia Fonti
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Flavia Sunzini
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Francesco Caso
- b Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University Federico II , Naples , Italy
| | - Carlo Perricone
- c Arthritis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome , Rome , Italy
| | - Luisa Costa
- b Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University Federico II , Naples , Italy
| | - Roberto Perricone
- a Rheumatology, allergology and clinical immunology, Department of Systems Medicine, University of Rome Tor Vergata , Rome , Italy
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Chimenti MS, Caso F, Alivernini S, De Martino E, Costa L, Tolusso B, Triggianese P, Conigliaro P, Gremese E, Scarpa R, Perricone R. Amplifying the concept of psoriatic arthritis: The role of autoimmunity in systemic psoriatic disease. Autoimmun Rev 2019; 18:565-575. [DOI: 10.1016/j.autrev.2018.11.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/30/2018] [Indexed: 02/08/2023]
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Pro-inflammatory adipokine profile in psoriatic arthritis: results from a cross-sectional study comparing PsA subset with evident cutaneous involvement and subset “sine psoriasis”. Clin Rheumatol 2019; 38:2547-2552. [DOI: 10.1007/s10067-019-04619-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/12/2019] [Accepted: 05/19/2019] [Indexed: 12/27/2022]
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Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol 2019; 32:369-389. [PMID: 31171309 DOI: 10.1016/j.berh.2019.01.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022]
Abstract
The cardiovascular burden in inflammatory rheumatic diseases is well recognized. Recently, this burden has been highlighted in ankylosing spondylitis (also known as radiographic axial spondyloarthritis) and psoriatic arthritis. We review the cardiovascular morbidity and mortality in these diseases, as well as the prevalence and incidence of traditional cardiovascular risk factors. We examine the contribution of anti-inflammatory therapy with nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and TNF inhibitors on the cardiovascular risk profile. Finally, we examine the available recommendations for the management of cardiovascular comorbidity, as they apply to the spondyloarthritis population.
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Affiliation(s)
- Jean W Liew
- University of Washington, 1959 NE Pacific St, BB561, Seattle, 98195, WA, USA.
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands.
| | - Lianne S Gensler
- University of California, San Francisco, 400 Parnassus Ave, Box 0326, San Francisco, 94143-0326, CA, USA.
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Ogdie A, Palmer JL, Greenberg J, Curtis JR, Harrold LR, Solomon DH, Kavanaugh A, Kremer JM, Mease PJ. Predictors of Achieving Remission among Patients with Psoriatic Arthritis Initiating a Tumor Necrosis Factor Inhibitor. J Rheumatol 2019; 46:475-482. [DOI: 10.3899/jrheum.171034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/17/2022]
Abstract
Objective.To examine predictors of remission among patients with psoriatic arthritis (PsA) initiating a tumor necrosis factor (TNF) inhibitor.Methods.Patients with PsA enrolled in the Corrona Registry between 2005 and 2013 were followed from initiation of a TNF inhibitor (TNFi; etanercept, adalimumab, infliximab, certolizumab, or golimumab) to the visit closest to 12 months. Additional inclusion criteria included 3 tender or 3 swollen joints. Outcomes of interest were Clinical Disease Activity Index (CDAI) ≤ 2.8 (remission), low disease activity (LDA; CDAI ≤ 10), change in the modified Health Assessment Questionnaire (mHAQ) ≥ 0.35 and achievement of mHAQ < 0.30. Predictors were measured on or before TNFi initiation. Covariates significant in univariable logistic regression models and ≤ 5% missing values were included in a multivariable model and removed individually until all remaining variables were significant (p < 0.05).Results.Among 1832 TNFi initiations, 774 initiations (624 patients) met inclusion criteria. Median age at initiation was 52 years [interquartile range (IQR) 44–60], 56% were female, median PsA duration was 4 years (IQR 2–11), and median CDAI at baseline was 20 (IQR 14.5–28). Remission was achieved by 14% and LDA (or remission) by 37%. Achieving remission was positively associated with college education (OR 1.88, 95% CI 1.11–3.19) but negatively associated with female sex (0.62, 95% CI 0.40–0.97), obese body mass index (0.51, 95% CI 0.32–0.81), hypertension (0.55, 95% CI 0.32–0.95), previous biologic use (0.41, 95% CI 0.26–0.65), and baseline pain (0.80 per 10 mm visual analog scale, 95% CI 0.73–0.87). Predictors for LDA, mHAQ < 0.30, and mHAQ change were similar.Conclusion.Few patients with PsA in a US-based registry achieved remission by CDAI criteria. Female sex, obesity, comorbidities, and education influence achievement of remission on a TNFi.
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Costa L, Perricone C, Chimenti MS, Del Puente A, Caso P, Peluso R, Bottiglieri P, Scarpa R, Caso F. Switching Between Biological Treatments in Psoriatic Arthritis: A Review of the Evidence. Drugs R D 2018; 17:509-522. [PMID: 29058302 PMCID: PMC5694428 DOI: 10.1007/s40268-017-0215-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy. Therapy with anti-tumor necrosis factor (TNF)-α agents represents the first therapeutic choice for moderate and severe forms; however, PsA patients can experience anti-TNFα failure, lack of efficacy, or adverse events. Several evidences exist on the effectiveness of switching among different TNFα inhibitors, and we reviewed the published data on the effectiveness of anti-TNFα first-, second- and third-line. Most of the studies report that the main reason for switching to a second anti-TNFα agent is represented by lack of efficacy (primary or secondary) and, more rarely, adverse events. Switchers receiving their second anti-TNFα agent have considerably poorer responses compared with non-switchers. Survival of anti-TNFα treatment appears to be superior in PsA patients when compared with rheumatoid arthritis patients. Switching from anti-TNF agents to ustekinumab or secukinumab or apremilast can represent a valid alternative therapeutic strategy.
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Affiliation(s)
- Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Carlo Perricone
- Rheumatology, Department of Internal Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata", Rome, Italy
| | - Antonio Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Paolo Caso
- Geriatric Unit, Faculty of Medicine and Psychology, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Paolo Bottiglieri
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy.
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
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Singh S, Facciorusso A, Singh AG, Casteele NV, Zarrinpar A, Prokop LJ, Grunvald EL, Curtis JR, Sandborn WJ. Obesity and response to anti-tumor necrosis factor-α agents in patients with select immune-mediated inflammatory diseases: A systematic review and meta-analysis. PLoS One 2018; 13:e0195123. [PMID: 29771924 PMCID: PMC5957395 DOI: 10.1371/journal.pone.0195123] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/17/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We sought to evaluate the association between obesity and response to anti-tumor necrosis factor-α (TNF) agents, through a systematic review and meta-analysis. METHODS Through a systematic search through January 24, 2017, we identified randomized controlled trials (RCTs) or observational studies in adults with select immune-mediated inflammatory diseases-inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), spondyloarthropathies (SpA), psoriasis and psoriatic arthritis (PsA)-treated with anti-TNF agents, and reporting outcomes, stratified by body mass index (BMI) categories or weight. Primary outcome was failure to achieve clinical remission or response or treatment modification. We performed random effects meta-analysis and estimated odds ratios (OR) and 95% confidence interval (CI). RESULTS Based on 54 cohorts including 19,372 patients (23% obese), patients with obesity had 60% higher odds of failing therapy (OR,1.60; 95% CI,1.39-1.83;I2 = 71%). Dose-response relationship was observed (obese vs. normal BMI: OR,1.87 [1.39-2.52]; overweight vs. normal BMI: OR,1.38 [1.11-1.74],p = 0.11); a 1kg/m2 increase in BMI was associated with 6.5% higher odds of failure (OR,1.065 [1.043-1.087]). These effects were observed across patients with rheumatic diseases, but not observed in patients with IBD. Effect was consistent based on dosing regimen/route, study design, exposure definition, and outcome measures. Less than 10% eligible RCTs reported outcomes stratified by BMI. CONCLUSIONS Obesity is an under-reported predictor of inferior response to anti-TNF agents in patients with select immune-mediated inflammatory diseases. A thorough evaluation of obesity as an effect modifier in clinical trials is warranted, and intentional weight loss may serve as adjunctive treatment in patients with obesity failing anti-TNF therapy.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
- Division of Biomedical Informatics, University of California San Diego, La Jolla, California, United States of America
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Abha G. Singh
- Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, California, United States of America
| | - Niels Vande Casteele
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
| | - Amir Zarrinpar
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
- Institute for Diabetes and Metabolic Health, University of California, San Diego, La Jolla, California, United States of America
- VA San Diego Health Systems, La Jolla, California, United States of America
| | - Larry J. Prokop
- Department of Library Services, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Eduardo L. Grunvald
- Weight Management Program, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Jeffrey R. Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - William J. Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, United States of America
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Caso F, Del Puente A, Oliviero F, Peluso R, Girolimetto N, Bottiglieri P, Foglia F, Benigno C, Tasso M, Punzi L, Scarpa R, Costa L. Metabolic syndrome in psoriatic arthritis: the interplay with cutaneous involvement. Evidences from literature and a recent cross-sectional study. Clin Rheumatol 2018; 37:579-586. [DOI: 10.1007/s10067-017-3975-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 12/13/2022]
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40
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Stober C, Ye W, Guruparan T, Htut E, Clunie G, Jadon D. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis. Rheumatology (Oxford) 2017; 57:158-163. [PMID: 29077973 DOI: 10.1093/rheumatology/kex387] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives To evaluate TNF-α inhibitor (TNFi) persistence when used as first- or second-line biologic therapy for the management of PsA, and to determine baseline clinical and laboratory parameters associated with TNFi persistence. Methods A retrospective single-centre cohort study was performed on all patients with PsA initiated on TNFi therapy between 2003 and 2015. Demographic, clinical and laboratory characteristics were compared with TNFi persistence, using Kaplan-Meier survival and Cox proportional hazards models. Results One hundred and eighty-eight patients with PsA were prescribed TNFi therapy as first-line biologic therapy over a period of 635 person-years [46% male, mean (s.d.) age 47.3 (11.4) years; median (interquartile range) disease duration 11 (7-16) years]. At 12 months of follow-up 79% of patients persisted with TNFi therapy, and 73% at 24 months. Of those discontinuing TNFi, 35% stopped due to primary inefficacy, 22% secondary inefficacy and 43% adverse events. Multivariable analysis identified female sex (hazard ratio (HR) 2.57; 95% CI: 1.26, 5.24; P = 0.01) and the presence of metabolic syndrome-related co-morbidities (HR = 2.65, 95% CI: 1.24, 5.69; P = 0.01) as predictors of lower persistence. Of 32 cases treated with a second TNFi, persistence at 12 months was 56%. TNFi persistence was 2-fold less likely in these 32 cases compared with first-line TNFi users (HR = 2.02, 95% CI: 1.20, 3.42; P = 0.01). Conclusion Patients with PsA who are female and have metabolic syndrome-related co-morbidities have lower TNFi persistence. Although persistence was lower in patients who had switched to a second TNFi, a substantial proportion of these cases responded, advocating switching to a second TNFi as a valid therapeutic strategy.
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Affiliation(s)
- Carmel Stober
- Department of Rheumatology, Addenbrooke's Hospital.,Department of Medicine, Cambridge University Hospitals NHS FT
| | - Weiyu Ye
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Eiphyu Htut
- Department of Rheumatology, Addenbrooke's Hospital
| | - Gavin Clunie
- Department of Rheumatology, Addenbrooke's Hospital
| | - Deepak Jadon
- Department of Rheumatology, Addenbrooke's Hospital.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Gossec L, McGonagle D, Korotaeva T, Lubrano E, de Miguel E, Østergaard M, Behrens F. Minimal Disease Activity as a Treatment Target in Psoriatic Arthritis: A Review of the Literature. J Rheumatol 2017; 45:6-13. [PMID: 29142032 DOI: 10.3899/jrheum.170449] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 02/08/2023]
Abstract
As in other inflammatory rheumatic diseases, the objective of psoriatic arthritis (PsA) treatment is the achievement of a defined target. Recent recommendations propose aiming for remission or low disease activity; however, a consensual definition of remission is lacking. A state of minimal disease activity (MDA) has been established and is defined by low activity assessed by tender/swollen joint counts, tender entheseal points, Psoriasis Area and Severity Index or body surface area, patient pain and global activity visual analog scale, and functional evaluation by Health Assessment Questionnaire. Since its development, MDA has been used increasingly in studies and clinical trials. In this article, the potential use of MDA as a treatment target in PsA is reviewed. The frequencies of MDA achievement with biologic disease-modifying antirheumatic drugs are summarized based on data from registries, observational studies, and clinical trials. Predictors and the prognostic effect of attaining MDA are also evaluated.
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Affiliation(s)
- Laure Gossec
- From Sorbonne Universités, UPMC Univ Paris 06; Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rheumatology University Hospital Frankfurt and Project Group Translational Medicine and Pharmacology TMP, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Goethe University Frankfurt am Main, Frankfurt, Germany. .,L. Gossec, Professor, MD, PhD, AP-HP, Pitié Salpêtrière Hospital; D. McGonagle, Professor, PhD, FRCPI, NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine; T. Korotaeva, Professor, MD, PhD, Department of Psoriatic Arthritis, V.A. Nasonova Research Institute of Rheumatology; E. Lubrano, Aggregate Professor, MD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; E. de Miguel, Associate Professor, MD, PhD, Academic Rheumatology Unit, Hospital Universitario La Paz; M. Østergaard, Professor, MD, PhD, Copenhagen University Hospital, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases; F. Behrens, MD, Head Clinical Research Rheumatology and Fraunhofer Institute IME.
| | - Dennis McGonagle
- From Sorbonne Universités, UPMC Univ Paris 06; Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rheumatology University Hospital Frankfurt and Project Group Translational Medicine and Pharmacology TMP, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Goethe University Frankfurt am Main, Frankfurt, Germany.,L. Gossec, Professor, MD, PhD, AP-HP, Pitié Salpêtrière Hospital; D. McGonagle, Professor, PhD, FRCPI, NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine; T. Korotaeva, Professor, MD, PhD, Department of Psoriatic Arthritis, V.A. Nasonova Research Institute of Rheumatology; E. Lubrano, Aggregate Professor, MD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; E. de Miguel, Associate Professor, MD, PhD, Academic Rheumatology Unit, Hospital Universitario La Paz; M. Østergaard, Professor, MD, PhD, Copenhagen University Hospital, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases; F. Behrens, MD, Head Clinical Research Rheumatology and Fraunhofer Institute IME
| | - Tatiana Korotaeva
- From Sorbonne Universités, UPMC Univ Paris 06; Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rheumatology University Hospital Frankfurt and Project Group Translational Medicine and Pharmacology TMP, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Goethe University Frankfurt am Main, Frankfurt, Germany.,L. Gossec, Professor, MD, PhD, AP-HP, Pitié Salpêtrière Hospital; D. McGonagle, Professor, PhD, FRCPI, NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine; T. Korotaeva, Professor, MD, PhD, Department of Psoriatic Arthritis, V.A. Nasonova Research Institute of Rheumatology; E. Lubrano, Aggregate Professor, MD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; E. de Miguel, Associate Professor, MD, PhD, Academic Rheumatology Unit, Hospital Universitario La Paz; M. Østergaard, Professor, MD, PhD, Copenhagen University Hospital, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases; F. Behrens, MD, Head Clinical Research Rheumatology and Fraunhofer Institute IME
| | - Ennio Lubrano
- From Sorbonne Universités, UPMC Univ Paris 06; Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rheumatology University Hospital Frankfurt and Project Group Translational Medicine and Pharmacology TMP, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Goethe University Frankfurt am Main, Frankfurt, Germany.,L. Gossec, Professor, MD, PhD, AP-HP, Pitié Salpêtrière Hospital; D. McGonagle, Professor, PhD, FRCPI, NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine; T. Korotaeva, Professor, MD, PhD, Department of Psoriatic Arthritis, V.A. Nasonova Research Institute of Rheumatology; E. Lubrano, Aggregate Professor, MD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; E. de Miguel, Associate Professor, MD, PhD, Academic Rheumatology Unit, Hospital Universitario La Paz; M. Østergaard, Professor, MD, PhD, Copenhagen University Hospital, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases; F. Behrens, MD, Head Clinical Research Rheumatology and Fraunhofer Institute IME
| | - Eugenio de Miguel
- From Sorbonne Universités, UPMC Univ Paris 06; Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rheumatology University Hospital Frankfurt and Project Group Translational Medicine and Pharmacology TMP, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Goethe University Frankfurt am Main, Frankfurt, Germany.,L. Gossec, Professor, MD, PhD, AP-HP, Pitié Salpêtrière Hospital; D. McGonagle, Professor, PhD, FRCPI, NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine; T. Korotaeva, Professor, MD, PhD, Department of Psoriatic Arthritis, V.A. Nasonova Research Institute of Rheumatology; E. Lubrano, Aggregate Professor, MD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; E. de Miguel, Associate Professor, MD, PhD, Academic Rheumatology Unit, Hospital Universitario La Paz; M. Østergaard, Professor, MD, PhD, Copenhagen University Hospital, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases; F. Behrens, MD, Head Clinical Research Rheumatology and Fraunhofer Institute IME
| | - Mikkel Østergaard
- From Sorbonne Universités, UPMC Univ Paris 06; Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rheumatology University Hospital Frankfurt and Project Group Translational Medicine and Pharmacology TMP, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Goethe University Frankfurt am Main, Frankfurt, Germany.,L. Gossec, Professor, MD, PhD, AP-HP, Pitié Salpêtrière Hospital; D. McGonagle, Professor, PhD, FRCPI, NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine; T. Korotaeva, Professor, MD, PhD, Department of Psoriatic Arthritis, V.A. Nasonova Research Institute of Rheumatology; E. Lubrano, Aggregate Professor, MD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; E. de Miguel, Associate Professor, MD, PhD, Academic Rheumatology Unit, Hospital Universitario La Paz; M. Østergaard, Professor, MD, PhD, Copenhagen University Hospital, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases; F. Behrens, MD, Head Clinical Research Rheumatology and Fraunhofer Institute IME
| | - Frank Behrens
- From Sorbonne Universités, UPMC Univ Paris 06; Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rheumatology University Hospital Frankfurt and Project Group Translational Medicine and Pharmacology TMP, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Goethe University Frankfurt am Main, Frankfurt, Germany.,L. Gossec, Professor, MD, PhD, AP-HP, Pitié Salpêtrière Hospital; D. McGonagle, Professor, PhD, FRCPI, NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine; T. Korotaeva, Professor, MD, PhD, Department of Psoriatic Arthritis, V.A. Nasonova Research Institute of Rheumatology; E. Lubrano, Aggregate Professor, MD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; E. de Miguel, Associate Professor, MD, PhD, Academic Rheumatology Unit, Hospital Universitario La Paz; M. Østergaard, Professor, MD, PhD, Copenhagen University Hospital, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases; F. Behrens, MD, Head Clinical Research Rheumatology and Fraunhofer Institute IME
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Mease PJ, Coates LC. Considerations for the definition of remission criteria in psoriatic arthritis. Semin Arthritis Rheum 2017; 47:786-796. [PMID: 29566966 DOI: 10.1016/j.semarthrit.2017.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Psoriatic arthritis (PsA) is an autoimmune disease that can cause progressive structural damage of the joints and irreversible disability. The potentially achievable results of biologic therapy for PsA has led to the view that disease remission should be the goal of treatment. However, the heterogeneity of disease manifestations and need for validated outcome measures makes defining remission in PsA challenging. This article evaluates proposed criteria for defining remission in PsA and discusses how these criteria can be applied in clinical practice. METHODS A primary literature search was conducted in PubMed to identify articles discussing potential PsA treatment goals or targets, including minimal disease activity. English-language publications from the last 10 years were included in this assessment. RESULTS There are 5 clinical domains in PsA that must be considered when evaluating remission: synovitis, enthesitis, dactylitis, spondylitis, and psoriasis/nail psoriasis. Due to variability in the completeness of remission and time to achieve remission with different therapies between these domains, remission should be measured clinically through a combination of objective measures, or a composite assessment tool. Composite measures are more efficient than unidimensional instruments in measuring remission, but remission rates differ between the available composite indices. CONCLUSION Although the concept of remission as a treatment goal in PsA is gaining acceptance among rheumatologists, further work is necessary to develop a broadly acceptable definition of remission.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, United States of America.
| | - Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Costa L, Del Puente A, Peluso R, Tasso M, Caso P, Chimenti MS, Sabbatino V, Girolimetto N, Benigno C, Bertolini N, Del Puente A, Perricone R, Scarpa R, Caso F. Small molecule therapy for managing moderate to severe psoriatic arthritis. Expert Opin Pharmacother 2017; 18:1557-1567. [PMID: 28891341 DOI: 10.1080/14656566.2017.1378343] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The majority of psoriatic arthritis (PsA) patients experience a good clinical response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic therapies (bDMARDs). However, treatment failure with these drugs can represent a relevant clinical problem. Moreover, in daily clinical practice, the appropriate identification of patients eligible for these agents can be conditioned by numerous aspects, mainly represented by comorbidities, such as history of malignancies, chronic and recurrent infectious diseases. Areas covered: We searched in the PUBMED database and review published data on the efficacy and safety profile of the small molecules, inhibitor of phosphodiesterase 4, apremilast, and of JAK/STAT pathways, tofacitinib, in PsA. Moreover, we report data on the other JAK inhibitor, baricitinib, and the A(3) adenosine receptors agonist, CF101, emerging by studies conducted in psoriasis patients. Expert opinion: In Psoriatic Arthritis, apremilast appears promising for PsA and recent studies have shown a good efficacy and an acceptable safety profile. Data on tofacitinib in PsA are limited. Studies on the small molecules, baricitinib and CF101 are still incomplete and limited to trials conducted in Rheumatoid Arthritis and in psoriasis. Further studies on small molecules and on their underlining mechanisms are advocated in PsA.
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Affiliation(s)
- Luisa Costa
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Antonio Del Puente
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Rosario Peluso
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Marco Tasso
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Paolo Caso
- b Geriatric Unit, Faculty of Medicine and Psychology , "Sapienza" University of Rome, S. Andrea, Hospital , Rome , Italy
| | - Maria Sole Chimenti
- c Rheumatology, allergology and clinical immunology, Department of System Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Vincenzo Sabbatino
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Nicolò Girolimetto
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Carolina Benigno
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Nicoletta Bertolini
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Aurora Del Puente
- d Department of Medicine and Surgery , University of Milan "Bicocca" , Naples , Italy
| | - Roberto Perricone
- c Rheumatology, allergology and clinical immunology, Department of System Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Raffaele Scarpa
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Francesco Caso
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
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SCARPA RAFFAELE, CASO FRANCESCO, COSTA LUISA, PELUSO ROSARIO, DEL PUENTE ANTONIO, OLIVIERI IGNAZIO. Psoriatic Disease 10 Years Later. J Rheumatol 2017; 44:1298-1301. [DOI: 10.3899/jrheum.161402] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Chimenti MS, Triggianese P, Conigliaro P, Tonelli M, Gigliucci G, Novelli L, Teoli M, Perricone R. A 2-year observational study on treatment targets in psoriatic arthritis patients treated with TNF inhibitors. Clin Rheumatol 2017; 36:2253-2260. [DOI: 10.1007/s10067-017-3769-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/20/2017] [Accepted: 07/18/2017] [Indexed: 01/22/2023]
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Minimal disease activity in patients with psoriatic arthritis treated with ustekinumab: results from a 24-week real-world study. Clin Rheumatol 2017; 36:1589-1593. [DOI: 10.1007/s10067-017-3700-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 12/29/2022]
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47
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Queiro R, Cañete JD, Montilla C, Abad M, Montoro M, Gómez S, Cábez A. Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study. Arthritis Res Ther 2017; 19:72. [PMID: 28356155 PMCID: PMC5372277 DOI: 10.1186/s13075-017-1277-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/10/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with psoriatic arthritis (PsA) experience functional impairment and reduced quality of life, and thus patient global assessment in PsA is explained mainly by the physical, but also by the psychological, aspect of the disease. To assess the prevalence of minimal disease activity (MDA) in Spanish patients with PsA, we examined their characteristics and the association between MDA and the impact of the disease as assessed by the PsA Impact of Disease (PsAID) questionnaire. METHODS A cross-sectional multicenter study was carried out in patients who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least 1 year of disease duration, and who were treated with biological or conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) according to routine clinical practice in Spain. Patients were considered in MDA if they met at least 5/7 of the MDA criteria. The association between MDA and the recently developed PsAID questionnaire was also recorded. RESULTS Of 227 patients included, 133 (58.6%) were in the MDA state (52% with antitumor necrosis factor (anti-TNF)α monotherapy, 24% with csDMARD monotherapy, and 24% with anti-TNFα in combination with csDMARD). Using multivariate logistic regression analysis, male gender (odds ratio (OR) 2.74, p = 0.001), a sedentary lifestyle (OR 3.13, p = 0.002), familial history of PsA (OR 0.38, p = 0.036), C-reactive protein (CRP) level (OR 0.92, p = 0.010), and use of corticoids (OR 0.33, p = 0.007) were considered features related to MDA. MDA patients had a significantly lower impact of the disease according to PsAID (mean total score (SD): MDA 3.3 (3.1) vs. non-MDA 7.1 (5.2); p < 0.001). CONCLUSIONS Nearly 60% of Spanish PsA patients achieve MDA in routine clinical practice. MDA remains one of the most useful therapeutic targets for PsA since patients who reached this state also had a significantly lower impact of disease according to PsAID.
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Affiliation(s)
- Rubén Queiro
- Department of Rheumatology, HU, Central de Asturias, Av. Roma, s/n, 33011, Oviedo, Asturias, Spain.
| | - Juan D Cañete
- Department of Rheumatology, HU, Clinic and IDIBAPS, C/Villarroel, 170-08036, Barcelona, Spain
| | - Carlos Montilla
- Department of Rheumatology, HU, Parque Natural de las Batuecas 17, Cabrerizos, Salamanca, Cp 37193, Spain
| | - Miguel Abad
- Department of Rheumatology HU, Virgen del Puerto, Paraje Valcorchero s/n, 10600, Plasencia, Spain
| | - María Montoro
- Medical Department, Pfizer, Avenida de Europa, 20 B, 28108, Alcobendas, Madrid, Spain
| | - Susana Gómez
- Medical Department, Pfizer, Avenida de Europa, 20 B, 28108, Alcobendas, Madrid, Spain
| | - Ana Cábez
- Medical Department, Pfizer, Avenida de Europa, 20 B, 28108, Alcobendas, Madrid, Spain
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Haroon M, Rafiq Chaudhry AB, Fitzgerald O. Higher Prevalence of Metabolic Syndrome in Patients with Psoriatic Arthritis: A Comparison with a Control Group of Noninflammatory Rheumatologic Conditions. J Rheumatol 2016; 43:463-4. [PMID: 26834258 DOI: 10.3899/jrheum.150757] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Muhammad Haroon
- Division of Rheumatology, Department of Medicine, University Hospital Kerry, Tralee, and Department of Rheumatology, St. Vincent's University Hospital, Dublin, and Clinical Senior Lecturer, University College Cork, Cork;
| | | | - Oliver Fitzgerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
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Ursini F, D’Angelo S, Russo E, Nicolosi K, Gallucci A, Chiaravalloti A, Bruno C, Naty S, De Sarro G, Olivieri I, Grembiale RD. Complement C3 Is the Strongest Predictor of Whole-Body Insulin Sensitivity in Psoriatic Arthritis. PLoS One 2016; 11:e0163464. [PMID: 27656896 PMCID: PMC5033360 DOI: 10.1371/journal.pone.0163464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022] Open
Abstract
Objectives To evaluate the correlation between inflammatory measures and whole-body insulin sensitivity in psoriatic arthritis (PsA) patients. Methods For the present study, 40 nondiabetic PsA patients were recruited. A standard oral glucose tolerance test (OGTT) was performed. The insulin sensitivity index (ISI), insulinogenic index (IGI) and oral disposition index (ODI) were calculated from dynamic values of glucose and insulin obtained during OGTT. Results In our study population, mean ISI was 3.5 ± 2.5, median IGI was 1.2 (0.7–1.8), mean ODI 4.5 ± 4.5. In univariate correlation analysis, ISI correlated inversely with systolic blood pressure (sBP) (R = -0.52, p = 0.001), diastolic blood pressure (dBP) (R = -0.45, p = 0.004) and complement C3 (R = -0.43, p = 0.006) and ODI correlated inversely with sBP (R = -0.38, p = 0.02), dBP (R = -0.35, p = 0.03) and complement C3 (R = -0.37, p = 0.02). No significant correlations were found between analyzed variables and IGI. In a stepwise multiple regression, only complement C3 entered in the regression equation and accounted for approximately 50% of the variance of ISI. Using a receiver operating characteristic (ROC) curve we identified the best cut-off for complement C3 of 1.32 g/L that yielded a sensitivity of 56% and a specificity of 96% for classification of insulin resistant patients. Conclusions In conclusion, our data suggest that serum complement C3 could represent a useful marker of whole-body insulin sensitivity in PsA patients.
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Affiliation(s)
- Francesco Ursini
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
- * E-mail:
| | - Salvatore D’Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Emilio Russo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Kassandra Nicolosi
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | | | | | - Caterina Bruno
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Saverio Naty
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | | | - Ignazio Olivieri
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Rosa Daniela Grembiale
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
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Napolitano M, Caso F, Scarpa R, Megna M, Patrì A, Balato N, Costa L. Psoriatic arthritis and psoriasis: differential diagnosis. Clin Rheumatol 2016; 35:1893-1901. [PMID: 27156076 DOI: 10.1007/s10067-016-3295-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 12/19/2022]
Abstract
Psoriasis frequency ranges from 1 to 3 % in white population, and arthritis occurs in 10-40 % of psoriasis patients, representing a relevant health issue. Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with psoriasis, in which ocular-, intestinal-, metabolic-, and cardiovascular-related manifestations can variably coexist. In order to favor early PsA and psoriasis diagnosis, it is crucial to rule out other conditions that can resemble the disease and delay appropriate therapeutic approach. Therefore, the aim of this review is to focus on PsA and psoriasis differential diagnosis.
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Affiliation(s)
- Maddalena Napolitano
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Angela Patrì
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Nicola Balato
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy.
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