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Taliercio M, Lebwohl M. Psoriasis Comorbidities and Their Treatment Impact. Dermatol Clin 2024; 42:405-416. [PMID: 38796272 DOI: 10.1016/j.det.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Psoriasis, a systemic inflammatory disease classically presenting with cutaneous lesions, has significant involvement in other organ systems. This article explores the prevalence, clinical manifestations, screening mechanisms, and laboratory testing by which to evaluate these comorbidities. Treatment approach for these comorbidities must combine patient preference with established treatment algorithms while recognizing innovative therapeutics currently under development.
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Affiliation(s)
- Mark Taliercio
- Department of Dermatology Clinical Trials, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 5th Floor, New York, NY 10029, USA.
| | - Mark Lebwohl
- Department of Clinical Therapeutics, Icahn School of Medicine at Mount Sinai, 5, East 98th Street, 5th Floor, New York, NY 10029, USA
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2
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Albrecht K, Ohrndorf S, Strangfeld A. [Sex-specific aspects in rheumatology]. Z Rheumatol 2024:10.1007/s00393-024-01527-6. [PMID: 38869669 DOI: 10.1007/s00393-024-01527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
Women and men differ in terms of the development and manifestation of inflammatory rheumatic diseases and outcomes as well as with respect to disease perception, health behavior and response to antirheumatic treatment. Sex-specific aspects are increasingly being researched in nearly all medical disciplines to optimize treatment strategies with the aim to improve individual treatment success. This article describes sex differences that can even now be taken into account in rheumatological care.
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Affiliation(s)
- Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Sarah Ohrndorf
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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3
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Korsakova YL, Korotaeva TV, Loginova EI, Gubar EE, Petrov AV, Patrikeeva IM, Umnova IF, Sorotskaya VN, Pristavskii IN, Sedunova MV, Nasonov EL. [Clinical and instrumental characteristics of psoriatic arthritis in men and women. Data from a cohort observational study]. TERAPEVT ARKH 2024; 96:479-485. [PMID: 38829809 DOI: 10.26442/00403660.2024.05.202703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
AIM To study and compare the clinical and imaging characteristics of psoriatic arthritis (PsA) in men and women. MATERIALS AND METHODS The study included 956 PsA patients observed in the Russian register, 411 (43%) men and 545 (57%) women. The average age of men/women was 46.0±16.50/50.7±17.20 years (p<0.001), the duration of PsA was 9.9±6.4/10.3±7.6 years (p>0.05), the age at the time of PsA establishment was 37.1±12.30/41.8±13.5 years (p<0.001). Rheumatological examination, X-ray of the pelvis, hands, feet were performed, the LEI, plantar fascia tenderness, body surface area (BSA), body mass index (BMI), CRP,HLA-B27 were determined. Patients filled out assessment scales of pain (Pain), disease activity (patient global assessment of disease activity - PGA), questionnaires HAQ-DI. The indices of Disease Activity in PSoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), criteria of minimal disease activity (MDA) were evaluated. RESULTS The following differences in the course of PsA in men/women were revealed: X-ray sacroiliitis was detected in 175 (42.6%)/153 (28.1%); p<0.001; the presence of erosions of the joints of the hands and feet - 138 (33.6%)/170 (31.2%); p=0.435; LEI≥3 - 34 (11.4%)/78 (20.9%); p=0.001; Pain - at 48.5±22.60/51.5±22.80 mm VAS; p=0.043; PGA - 50.2±23.07/54.0±21.91 mm VAS; p=0.010; moderate and severe functional disorders (HAQ-DI) were more often observed in women (p=0.002 and p<0.001, respectively); the average value of DAPSA is 26.4±16.8/31.9±22.58; p<0.001; average BASDAI value: 2.7±2.83/1.8±2.78; p<0.001; MDA was achieved in 13 (3.2%)/22 (4.1%); p=0.486; BSA>10% - 54 (13.1%)/102 (18.7%); p=0.021; comorbid diseases - 154 (37%)/277 (51%); p<0.001. At the time of inclusion in the register, the proportion of patients receiving biologic disease-modifying anti-rheumatic drugs was higher in the group of men. CONCLUSION Our data, based on a large cohort study, demonstrate that PsA debuts in women at a later age than in men, the course of the disease is characterized by higher activity of peripheral arthritis, more pronounced functional disorders and a high prevalence of comorbid diseases. This creates a heavier burden of PsA in women and indicates that gender is an important characteristic of the patient that should be used to predict the course, therapeutic response and progression of the disease.
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Affiliation(s)
| | | | | | - E E Gubar
- Nasonova Research Institute of Rheumatology
| | - A V Petrov
- Vernadsky Crimean Federal University
- Semashko Clinical Hospital
- Ministry of Health of the Republic of Crimea
| | - I M Patrikeeva
- Tyumen Regional Clinical Hospitai No. 1
- Tyumen Regional Healthcare Department
| | | | | | | | | | - E L Nasonov
- Nasonova Research Institute of Rheumatology
- Sechenov First Moscow State Medical University (Sechenov University)
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Chhibba T, Wong ECL, Reinisch W, Targownik L, Narula N. Comparing the efficacy of vedolizumab between males and females: a post-hoc analysis of GEMINI-1 and VARSITY. Eur J Gastroenterol Hepatol 2024; 36:704-711. [PMID: 38526945 DOI: 10.1097/meg.0000000000002759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Vedolizumab is a first-line treatment option for ulcerative colitis. There are differences in incidence of ulcerative colitis between males and females, but whether sex affects treatment outcomes is less clear. We examined sex-based differences in patients with ulcerative colitis initiated on vedolizumab from two major randomized controlled trials (RCTs). We conducted a post-hoc analysis on participants with ulcerative colitis from the VARSITY and GEMINI-1 RCTs who received vedolizumab. Outcomes of interest were rates of clinical improvement, clinical remission, and endoscopic improvement at weeks 6, 14, and 52 in male and female participants, as were differences in concentrations of trough vedolizumab and C-reactive protein; 1009 persons in GEMINI-1 and VARSITY trials were included. Male and female patients had similar disease characteristics aside from males being more likely to have Mayo 3 grade endoscopic severity at baseline (62.8 vs. 48.9%, P < 0.001). At week 6, females were more likely to have endoscopic improvement (47.4 vs. 35.2%, P = 0.001) and increased vedolizumab trough levels [34.0 (23.0-44.5) vs. 28.9 (19.0-34.6), P < 0.001]. The probability of achieving clinical remission (28.9 vs. 34.5%, P = 0.057) or endoscopic improvement (35.5 vs. 39.3%, P = 0.212) at week 52 was not different between males and females. Females with ulcerative colitis treated with vedolizumab appear more likely to achieve early endoscopic improvement than males, though longer-term outcomes demonstrated no difference. Further studies are required to better understand mechanisms through which sex or sex-associated factors could influence response to therapy in ulcerative colitis.
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Affiliation(s)
- Tarun Chhibba
- Department of Medicine, Massachusetts General Hospital (Division of Gastroenterology), Harvard University, Boston, MA, USA
| | - Emily C L Wong
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Walter Reinisch
- Department of Medicine (Division of Gastroenterology and Hepatology), Medical University of Vienna, Vienna, Austria
| | - Laura Targownik
- Department of Medicine (Division of Gastroenterology), University of Toronto, Toronto, ON, Canada
| | - Neeraj Narula
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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Ruscitti P, Cataldi G, Gentile M, Dionisi A, Volpe P, Finucci A, Verardi L, Di Muzio C, Italiano N, Celletti E, Di Penta M, Di Cola I, Marrelli A, Alfonsi A, Delle Monache F, Cipollone F, Gabini M, Cipriani P. The Evaluation of Effectiveness and Safety of Guselkumab in Patients with Psoriatic Arthritis in a Prospective Multicentre "Real-Life" Cohort Study. Rheumatol Ther 2024; 11:539-551. [PMID: 38436915 PMCID: PMC11111644 DOI: 10.1007/s40744-024-00649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Guselkumab is an interleukin-23 (IL-23) inhibitor licensed for the treatment of psoriatic arthritis (PsA). This study aimed to evaluate the 6-month effectiveness of guselkumab in patients with PsA in a "real-life" multicentre patient cohort. We also estimated the drug retention rate (DRR) of gusulkumab, also assessing the impact of comorbidities and patient clinical characteristics, in a collective 18-month prospective follow-up. METHODS Between December 2021 and September 2023, consecutive patients with PsA were evaluated if treated at least for 6 months with guselkumab in a prospective multicentre study to evaluate the effectiveness of the drug by means of disease activity index for psoriatic arthritis (DAPSA) and cumulative DRR. RESULTS A total of 111 patients with PsA were evaluated and treated with guselkumab (age 56.8 ± 9.9, male sex 20.7%). These patients were mainly characterised by active and long-standing PsA with median disease duration of 6.0 (7.0) years (55.9% disease duration ≥ 5 years), 55.0% showed comorbidities, 78.4% of patients were previously treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), and 60.4% concomitantly with conventional synthetic DMARDs (csDMARDs). After 6 months, a significant reduction of DAPSA was observed (β - 15.47, p = 0.001, 95% CI - 23.15 to - 9.79) with 39.6% of patients achieving a DAPSA ≤ 14. At the end of cumulative follow-up, 71.2% of patients were still treated with guselkumab whereas 24.3% discontinued the drug because of inefficacy. An 18-month DRR of guselkumab of 66.7% was estimated with a mean time of administration of 9.8 ± 4.1 months. The results of the DRR were stratified according to patient clinical characteristics. The DRR of guselkumab appeared to be not influenced by long disease duration, comorbidities, obesity, concomitant csDMARDs, and previous bDMARDs. CONCLUSION The "real-life" 6-month effectiveness of guselkumab was shown in patients with PsA, mainly characterised by active long-standing disease, previously treated with bDMARDs, and with comorbidities. Furthermore, a good DRR of guselkumab was estimated in the cumulative 18 months of follow-up and appeared to be not influenced by long disease duration, comorbidities, obesity, and previous bDMARDs.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy.
| | - Giulia Cataldi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy
| | - Martina Gentile
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy
| | - Alice Dionisi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy
| | - Paola Volpe
- Rheumatology Unit, "Santo Spirito" Hospital, Pescara, Italy
| | | | | | - Claudia Di Muzio
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy
| | - Noemi Italiano
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy
| | - Eleonora Celletti
- Department of Medicine and Science of Aging, Medical Clinic, SS. Annunziata Hospital of Chieti, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Myriam Di Penta
- Department of Medicine and Science of Aging, Medical Clinic, SS. Annunziata Hospital of Chieti, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy
| | | | - Alessia Alfonsi
- Internal Medicine Unit, "Giuseppe Mazzini" Hospital, Teramo, Italy
| | | | - Francesco Cipollone
- Department of Medicine and Science of Aging, Medical Clinic, SS. Annunziata Hospital of Chieti, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marco Gabini
- Rheumatology Unit, "Santo Spirito" Hospital, Pescara, Italy
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Delta 6 Building, P.O. box 67100, L'Aquila, Italy
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Xiao Y, Yi Y, Jing D, Yang S, Guo Y, Xiao H, Kuang Y, Zhu W, Zhao J, Li Y, Liu H, Li J, Chen X, Shen M. Age at Natural Menopause, Reproductive Lifespan, and the Risk of Late-Onset Psoriasis and Psoriatic Arthritis in Women: A Prospective Cohort Study. J Invest Dermatol 2024; 144:1273-1281.e5. [PMID: 38081449 DOI: 10.1016/j.jid.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 01/12/2024]
Abstract
Although a peak incidence of psoriasis in women aged around 60 years has been observed, the link between reproductive lifespan and late-onset psoriatic diseases is underexplored. This study aims to elucidate the association between reproductive lifespan and the risk of late-onset psoriasis and psoriatic arthritis (PsA). Utilizing the UK Biobank data, we conducted a prospective cohort study in postmenopausal women without baseline psoriatic diseases. The exposure variables included age at natural menopause (ANM) and duration from menarche to menopause, termed reproductive years. The outcome variables were incident psoriasis and PsA. We employed Cox regression analysis, factoring in polygenic risk scores for psoriatic diseases and recognized risk factors. We found that later ANM and longer reproductive years were significantly associated with decreased risks of late-onset psoriasis and PsA in a dose-dependent manner (P<.05). ANM after age 55 years led to a 34 and 46% risk reduction in late-onset psoriasis and PsA, respectively, compared with ANM before age 45 years (P<.001). The population-attributable risks of ANM were 17.4% for late-onset psoriasis and 21.6% for PsA. In conclusion, reproductive lifespan, with its inherent homeostasis, plays a pivotal yet overlooked role in late-onset psoriatic diseases. Investigations into estrogen-centric causes and sex-specific interventions are imperative.
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Affiliation(s)
- Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China
| | - Yan Yi
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Danrong Jing
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Songchun Yang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Yeye Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Hui Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Yehong Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China
| | - Jinchen Li
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China; Bioinformatics Center, Xiangya Hospital, Central South University, Changsha, China; Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
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Toledano E, Gómez-Lechón L, Chacón CC, Hidalgo C, Ibáñez M, Márquez A, Queiro R, Montilla C. Clinical Features and Disease Activity in Psoriatic Arthritis: A Sex-Related Perspective on Leptin and Comorbidity. J Clin Med 2024; 13:2959. [PMID: 38792501 PMCID: PMC11121807 DOI: 10.3390/jcm13102959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/04/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Many studies have addressed the sex differences in patients with psoriatic arthritis, although these are aimed more at describing the phenotype than at investigating the causes underlying these differences. The aims of our study were to assess the presence of clinical features in relation to sex, and to measure the effect on disease activity of different comorbidities in each sex. Methods: This was a cross-sectional study in which the following factors were measured: the clinical features of the disease, disease activity, the physical function and the disease impact. We measured serum leptin levels, to eliminate the effect of obesity on leptin levels, and a leptin/BMI ratio was calculated. The comorbid conditions evaluated included anxiety and depression, and sleep quality. Results: A total of 203 patients participated in this study. The mean age was 54.6 ± 11.3, and 46.8% of the patients were women. Women less frequently presented axial involvement (8% vs. 28%; p < 0.001) and more commonly had enthesitis (2 vs. 0.3; p < 0.001). They also had higher DAPSA (16.4 vs. 13.4; p < 0.001) and PsAID12 scores (4.1 vs. 2.9; p < 0.001), worse HAQ results (0.8 vs. 0.5; p < 0.001), and greater FACIT-F scores (32.7 vs. 38.1; p < 0.001). As for the comorbid conditions, women presented a higher leptin/BMI ratio (0.8 vs. 0.2; p < 0.001), higher levels of HADS-A (6.9 vs. 4.7; p < 0.001) and HADS-D (4.9 vs. 3.4; p < 0.001), and poorer ISI (9.3 vs. 7.0; p < 0.001). By sex, pain affecting women was associated with the leptin/BMI ratio (β: 0.29; p < 0.004; 95%CI: 0.3-1.6) and sleep quality (β: 0.31; p < 0.004; 95%CI: 0.04-0.25; R2: 0.26). The leptin/BMI ratio was not associated with pain in men (p = 0.46). Conclusions: Sex was associated with several clinical manifestations. Leptin/BMI ratio levels were associated with pain in women, but not in men.
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Affiliation(s)
- Esther Toledano
- Department of Rheumatology, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | - Luis Gómez-Lechón
- Department of Rheumatology, Francesc de Borja Hospital, 46702 Gandía, Spain;
| | - Carolina Cristina Chacón
- Department of Rheumatology, Clinical University Hospital of Salamanca, 37007 Salamanca, Spain; (C.C.C.); (C.H.); (M.I.)
| | - Cristina Hidalgo
- Department of Rheumatology, Clinical University Hospital of Salamanca, 37007 Salamanca, Spain; (C.C.C.); (C.H.); (M.I.)
| | - Marta Ibáñez
- Department of Rheumatology, Clinical University Hospital of Salamanca, 37007 Salamanca, Spain; (C.C.C.); (C.H.); (M.I.)
| | - Antonio Márquez
- Department of Physiotherapy, Clinical University Hospital of Salamanca, 37007 Salamanca, Spain;
| | - Rubén Queiro
- Department of Rheumatology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Carlos Montilla
- Department of Rheumatology, Clinical University Hospital of Salamanca, 37007 Salamanca, Spain; (C.C.C.); (C.H.); (M.I.)
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8
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Gossec L, Kerschbaumer A, Ferreira RJO, Aletaha D, Baraliakos X, Bertheussen H, Boehncke WH, Esbensen BA, McInnes IB, McGonagle D, Winthrop KL, Balanescu A, Balint PV, Burmester GR, Cañete JD, Claudepierre P, Eder L, Hetland ML, Iagnocco A, Kristensen LE, Lories R, Queiro R, Mauro D, Marzo-Ortega H, Mease PJ, Nash P, Wagenaar W, Savage L, Schett G, Shoop-Worrall SJW, Tanaka Y, Van den Bosch FE, van der Helm-van Mil A, Zabotti A, van der Heijde D, Smolen JS. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis 2024; 83:706-719. [PMID: 38499325 PMCID: PMC11103320 DOI: 10.1136/ard-2024-225531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. METHODS Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. RESULTS The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. CONCLUSION These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.
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Affiliation(s)
- Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Higher School of Nursing of Lisbon, Lisbon, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dennis McGonagle
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Kevin L Winthrop
- Division of Infectious Diseases, School of Medicine, School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Andra Balanescu
- Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Peter V Balint
- Medical Imaging Centre, Semmelweis University, 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Juan D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic Barcelona, Barcelona, Spain
- FCRB, IDIBAPS, Barcelona, Spain
| | - Pascal Claudepierre
- Rheumatology, AP-HP, Henri Mondor University Hospital, Creteil, France
- EA Epiderme, UPEC, Creteil, France
| | - Lihi Eder
- Department of Medicine, University of Toronto, Women's College Hospital, Toronto, Toronto, Canada
| | - Merete Lund Hetland
- The Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche Biologiche, Università di Torino - AO Mauriziano Torino, Turin, Italy
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg, Denmark
- Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Translational Immunology Division, Biohealth Research Institute of the Principality of Asturias, Oviedo University School of Medicine, Oviedo, Spain
| | - Daniele Mauro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Helena Marzo-Ortega
- LTHT, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Philip J Mease
- Rheumatology Research, Providence Swedish, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Wendy Wagenaar
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Young PARE Patient Research Partner, EULAR, Zurich, Switzerland
| | - Laura Savage
- School of Medicine and Dermatology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology and Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie J W Shoop-Worrall
- Children and Young Person's Rheumatology Research Programme, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium
| | | | - Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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Kang Z, Zhang X, Du Y, Dai SM. Global and regional epidemiology of psoriatic arthritis in patients with psoriasis: A comprehensive systematic analysis and modelling study. J Autoimmun 2024; 145:103202. [PMID: 38493674 DOI: 10.1016/j.jaut.2024.103202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To provide a comprehensive analysis and modelling of the global epidemiology of psoriatic arthritis (PsA) in patients with psoriasis. METHODS We reviewed and analysed PsA epidemiology studies over the past 45 years. A Bayesian hierarchical linear mixed model was developed to provide comprehensive age- and sex-specific epidemiologic estimates in different countries and regions. RESULTS Three hundred and sixty-three studies were systematically reviewed. The incidence of PsA in patients with psoriasis varied from 2.31 per 1000 person-years in the United Kingdom to 74.00 per 1000 person-years in several Western European countries. The global prevalence of PsA in patients with psoriasis is estimated to be 17.58% (3.33%, 43.69%). Regionally, the overall prevalence of PsA in patients with psoriasis varies from 7.62% (4.18%, 12.28%) in Australasia to 26.59% (18.89%, 35.76%) in North America. The Caribbean and Central Latin America also have relatively high prevalence and are estimated at 23.14% (14.06%, 35.17%) and 22.81% (14.36%, 32.25%), respectively. The prevalence of PsA is higher in adults than children (23.93% vs 8.59%) and also slightly higher in females than males (19.14% vs 16.01%). CONCLUSIONS This study provides valuable insights into the global epidemiology of PsA. It also serves as a useful resource for researchers in areas lacking relevant studies. These findings have important implications for clinicians managing the course of PsA and for health policymakers in resource allocation.
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Affiliation(s)
- Zijian Kang
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueliang Zhang
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Du
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng-Ming Dai
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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10
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Fagni F, Motta F, Schett G, Selmi C. Difficult-to-Treat Psoriatic Arthritis: A Conceptual Approach. Arthritis Rheumatol 2024; 76:670-674. [PMID: 38108094 DOI: 10.1002/art.42780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/23/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Filippo Fagni
- Friedrich-Alexander University Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Francesca Motta
- IRCCS Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Carlo Selmi
- IRCCS Humanitas Research Hospital and Humanitas University, Milan, Italy
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11
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Conigliaro P, Minerba C, Vendola A, Fiannacca L, Triggianese P, Kroegler B, Greco E, Bergamini A, Chimenti MS. The steroid-sparing effect of JAK inhibitors across multiple patient populations. Front Immunol 2024; 15:1376476. [PMID: 38680499 PMCID: PMC11045928 DOI: 10.3389/fimmu.2024.1376476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction JAK-inhibitors (JAK-i) represent an effective treatment in Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA). Oral glucocorticoids (OGC) are commonly used in combination with JAK-i to reach therapeutic target. We aimed to assess, in a real-life setting, the reduction of OGC dose during JAK-i treatment in active RA and PsA patients. Methods We prospectively enrolled 103 patients (88 RA, 15 PsA) treated with JAK-i: 24% bio-naïve (b-naïve), 76% bDMARD-insufficient responders (bDMARD-IR) and 40% difficult to treat (D2T), defined as failure of ≥2 bDMARDs with different mechanism of action. Disease activity (DAS28 and DAPSA, VAS-pain, GH) and OGC dose was collected at baseline and after 3, 6 and 12 months (T3, T6, T12) of treatment. Results In all the cohort and in b-naïve patients we reported a reduction of OGC dose at all time-points; bDMARD-IR patients were able to reduce OGC dose at T3 and T12; D2T ones only at T3. We reported an improvement of disease activity and withdrawal of OGC as early as three months of therapy, at all time-points, regardless of line of bDMARD treatment. Conclusion Chronic OGC may cause detrimental bone, metabolic, cardiovascular side effects and infections; therefore JAK-i steroid-sparing effect may be beneficial for patients in long-term treatment.
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Affiliation(s)
- Paola Conigliaro
- U.O.C. Reumatologia, Dipartimento di Medicina dei Sistemi, Universitá di Roma “Tor Vergata”, Roma, Italy
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12
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Ørnbjerg LM, Rugbjerg K, Georgiadis S, Rasmussen SH, Jacobsson L, Loft AG, Iannone F, Fagerli KM, Vencovsky J, Santos MJ, Möller B, Pombo-Suarez M, Rotar Z, Gudbjornsson B, Cefle A, Eklund K, Codreanu C, Jones G, van der Sande M, Wallman JK, Sebastiani M, Michelsen B, Závada J, Nissen MJ, Sanchez-Piedra C, Tomšič M, Love TJ, Relas H, Mogosan C, Hetland ML, Østergaard M. Patient-Reported Outcomes (PROs) and PRO Remission Rates in 12,262 Biologic-Naïve Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitors in Routine Care. J Rheumatol 2024; 51:378-389. [PMID: 38224992 DOI: 10.3899/jrheum.2023-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To evaluate patient-reported outcomes (PROs) after initiation of tumor necrosis factor inhibitor (TNFi) treatment in European real-world patients with psoriatic arthritis (PsA). Further, to investigate PRO remission rates across treatment courses, registries, disease duration, sex, and age at disease onset. METHODS Visual analog scale or numerical rating scale scores for pain, fatigue, patient global assessment (PtGA), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) from 12,262 patients with PsA initiating a TNFi in 13 registries were pooled. PRO remission rates (pain ≤ 1, fatigue ≤ 2, PtGA ≤ 2, and HAQ-DI ≤ 0.5) were calculated for patients still on the treatment. RESULTS For the first TNFi, median pain score was reduced by approximately 50%, from 6 to 3, 3, and 2; as were fatigue scores, from 6 to 4, 4, and 3; PtGA scores, from 6 to 3, 3, and 2; and HAQ-DI scores, from 0.9 to 0.5, 0.5, and 0.4 at baseline, 6, 12, and 24 months, respectively. Six-month Lund Efficacy Index (LUNDEX)-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 24%, 31%, 36%, and 43% (first TNFi); 14%, 19%, 23%, and 29% (second TNFi); and 9%, 14%, 17%, and 20% (third TNFi), respectively. For biologic-naïve patients with disease duration < 5 years, 6-month LUNDEX-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 22%, 28%, 33%, and 42%, respectively. Corresponding rates for patients with disease duration > 10 years were 27%, 32%, 41%, and 43%, respectively. Remission rates were 33%, 40%, 45%, and 56% for men and 17%, 23%, 24%, and 32% for women, respectively. For patients aged < 45 years at diagnosis, 6-month LUNDEX-adjusted remission rate for pain was 29% vs 18% for patients ≥ 45 years. CONCLUSION In 12,262 biologic-naïve patients with PsA, 6 months of treatment with a TNFi reduced pain by approximately 50%. Marked differences in PRO remission rates across treatment courses, registries, disease duration, sex, and age at onset of disease were observed, emphasizing the potential influence of factors other than disease activity on PROs.
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Affiliation(s)
- Lykke M Ørnbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark;
| | - Kathrine Rugbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lennart Jacobsson
- L. Jacobsson, MD, PhD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne G Loft
- A.G. Loft, MD, PhD, The DANBIO registry and Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Florenzo Iannone
- F. Iannone, MD, PhD, DETO - Rheumatology Unit, University of Bari, Bari, Italy
| | - Karen M Fagerli
- K.M. Fagerli, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Jiri Vencovsky
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria J Santos
- M.J. Santos, MD, PhD, Rheumatology Department, Hospital Garcia de Orta, Rheumatology Research Unit, Faculdade de Medicina, Lisboa, and Reuma.pt, Portugal
| | - Burkhard Möller
- B. Möller, MD, Department for Rheumatology and Immunology, Inselspital - University Hospital Bern, University of Bern, Bern, Switzerland
| | - Manuel Pombo-Suarez
- M. Pombo-Suarez, MD, PhD, Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ziga Rotar
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- B. Gudbjornsson, MD, PhD, Centre for Rheumatology Research, Landspitali University Hospital (ICEBIO), and the Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Ayse Cefle
- A. Cefle, MD, TURKBIO Registry and Division of Rheumatology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kari Eklund
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Catalin Codreanu
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Gareth Jones
- G. Jones, PhD, BSRBR-AS and Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marleen van der Sande
- M. van der Sande, MD, PhD, Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology, and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - Johan K Wallman
- J.K. Wallman, MD, PhD, Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marco Sebastiani
- M. Sebastiani, MD, PhD, Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Brigitte Michelsen
- B. Michelsen, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, and Research Unit, Sørlandet Hospital, Kristiansand, Norway, and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Jakub Závada
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael J Nissen
- M.J. Nissen, MD, PhD, Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Carlos Sanchez-Piedra
- C. Sanchez-Piedra, MD, PhD, Spanish Agency of Health Technology Assessment, Instituto de Salud Carlos III, Madrid, Spain
| | - Matija Tomšič
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thorvardur J Love
- T.J. Love, MD, PhD, Faculty of Medicine, University of Iceland, and Department of Science, Landspitali University Hospital, Reykjavík, Iceland
| | - Heikki Relas
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Corina Mogosan
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Merete L Hetland
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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13
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Anger JT, Case LK, Baranowski AP, Berger A, Craft RM, Damitz LA, Gabriel R, Harrison T, Kaptein K, Lee S, Murphy AZ, Said E, Smith SA, Thomas DA, Valdés Hernández MDC, Trasvina V, Wesselmann U, Yaksh TL. Pain mechanisms in the transgender individual: a review. FRONTIERS IN PAIN RESEARCH 2024; 5:1241015. [PMID: 38601924 PMCID: PMC11004280 DOI: 10.3389/fpain.2024.1241015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/25/2024] [Indexed: 04/12/2024] Open
Abstract
Specific Aim Provide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research. Methods A team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research. Results While transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain. Conclusions While significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.
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Affiliation(s)
- Jennifer T. Anger
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Laura K. Case
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Andrew P. Baranowski
- Pelvic Pain Medicine and Neuromodulation, University College Hospital Foundation Trust, University College London, London, United Kingdom
| | - Ardin Berger
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States
| | - Rebecca M. Craft
- Department of Psychology, Washington State University, Pullman, WA, United States
| | - Lyn Ann Damitz
- Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, United States
| | - Rodney Gabriel
- Division of Regional Anesthesia, University of California San Diego, San Diego, CA, United States
| | - Tracy Harrison
- Department of OB/GYN & Reproductive Sciences, University of California San Diego, San Diego, CA, United States
| | - Kirsten Kaptein
- Division of Plastic Surgery, University of California San Diego, San Diego, CA, United States
| | - Sanghee Lee
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Anne Z. Murphy
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States
| | - Engy Said
- Division of Regional Anesthesia, University of California San Diego, San Diego, CA, United States
| | - Stacey Abigail Smith
- Division of Infection Disease, The Hope Clinic of Emory University, Atlanta, GA, United States
| | - David A. Thomas
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, United States
| | - Maria del C. Valdés Hernández
- Department of Neuroimaging Sciences, Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Victor Trasvina
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Ursula Wesselmann
- Departments of Anesthesiology and Perioperative Medicine/Division of Pain Medicine, Neurology and Psychology, and Consortium for Neuroengineering and Brain-Computer Interfaces, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tony L. Yaksh
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
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14
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Landgren AJ, Jonsson CA, Bilberg A, Eliasson B, Torres L, Dehlin M, Jacobsson L, Gjertsson I, Larsson I, Klingberg E. Sex differences in cytokines and adipokines in obese patients with PsA and controls undergoing a weight loss intervention. RMD Open 2024; 10:e003821. [PMID: 38519111 PMCID: PMC10961525 DOI: 10.1136/rmdopen-2023-003821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/20/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE In this post hoc analysis of a previously published study, we compared cytokines and adipokine levels in women and men with psoriatic arthritis (PsA) at baseline (BL) and 6 months (M6) following a weight loss intervention. METHODS Patients with PsA (n=41) between 25 and 75 years of age, with body mass index (BMI)≥33 kg/m2 were included in a weight loss intervention with a very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI<40 or ≥40 kg/m2. As controls (n=39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the patients with PsA. Cytokines and adipokines were measured at BL and M6. RESULTS At BL, serum levels of interleukin (IL)-23, leptin and high molecular weight-adiponectin were higher in women with PsA compared with men, whereas serum levels of interferon (IFN)-γ, IL-12/IL-23 p40 and IL-13 were significantly lower in women. Serum IL-23 was significantly reduced at M6 compared with BL in women but not in men with PsA. In women with PsA, the reduction in IL-23 at M6, ∆IL-23, were positively correlated with ∆Disease Activity Score 28 C reactive protein (CRP) (Spearman's correlation (rS)=0.486, p=0.016), ∆CRP (rS=0.468, p=0.021), ∆leptin (rS=0.683, p<0.001) and negatively correlated with ∆total-adiponectin (rS=-0.433, p=0.035). Also in women, ∆Disease Activity in Psoriatic Arthritis was positively correlated with ∆tumour necrosis factor-α (rS=0.417, p=0.034), ∆IL-1β (rS=0.550, p=0.034), ∆IFN-γ (rS=0.414, p=0.035) and ∆leptin (rS=0.410, p=0.038). None of these correlations were significant in men with PsA. CONCLUSIONS Women and men with PsA differed with regard to serum levels of cytokines and adipokines before and after weight loss.
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Affiliation(s)
- Anton Jonatan Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Södra Bohuslän, Gothenburg, Sweden
| | - Charlotte A Jonsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Torres
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Perrotta FM, Scriffignano S, Triggianese P, Ferraioli M, Chimenti MS, Lubrano E. Sensitivity and Specificity of Composite Indices of Remission in Male and Female Patients With Psoriatic Arthritis: A Multicenter Cross-Sectional Study of Longitudinal Cohorts. J Rheumatol 2024; 51:257-262. [PMID: 38101911 DOI: 10.3899/jrheum.2023-0786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The aim was to evaluate the sex differences in sensitivity, specificity, positive and negative predictive values, and likelihood ratio of the outcome indices minimal disease activity (MDA), Disease Activity Score for Psoriatic Arthritis (DAPSA), and Psoriatic Arthritis Impact of Disease (PsAID) with respect to clinical remission, evaluated from both the physician and patient perspective, in a multicenter cohort of patients with PsA. METHODS In this cross-sectional analysis of 2 longitudinal cohorts, all patients with PsA consecutively attending our rheumatology units were considered potentially eligible for the study. In all patients, a complete clinical examination was carried out. The DAPSA was calculated for each patient (DAPSA values ≤ 4 were considered as remission) and MDA was also evaluated. Patient and physician global assessment values ≤ 1 were considered as a surrogate of remission from the patient and physician perspective, respectively. RESULTS Two hundred seventy-two patients with PsA were enrolled (mean age 55.7 [SD 12.4]; 141 male, 131 female). In both sexes, MDA had good sensitivity and specificity toward remission as assessed by the rheumatologist. Remission according to DAPSA had excellent values of specificity but lacks sensitivity in both sexes. PsAID ≤ 4 had excellent values of sensitivity but lacked specificity in both sexes. Remission defined by DAPSA values was found to be more sensitive and specific in female patients (45.4% and 100%, respectively) than in male patients (33.3% and 84.2%, respectively) with respect to physician-judged remission. CONCLUSION The results of this study demonstrate for the first time, to our knowledge, that some differences between the 2 sexes on the different outcome indices are possible. This could be important in the clinical management of patients with PsA.
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Affiliation(s)
- Fabio Massimo Perrotta
- F.M. Perrotta, MD, PhD, S. Scriffignano, MD, MSc, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Silvia Scriffignano
- F.M. Perrotta, MD, PhD, S. Scriffignano, MD, MSc, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Paola Triggianese
- P. Triggianese, MD, PhD, M. Ferraioli, MD, M.S. Chimenti, MD, PhD, Rheumatology, Allergology and Clinical Immunology, Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Rome, Italy
| | - Mario Ferraioli
- P. Triggianese, MD, PhD, M. Ferraioli, MD, M.S. Chimenti, MD, PhD, Rheumatology, Allergology and Clinical Immunology, Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- P. Triggianese, MD, PhD, M. Ferraioli, MD, M.S. Chimenti, MD, PhD, Rheumatology, Allergology and Clinical Immunology, Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Rome, Italy
| | - Ennio Lubrano
- E. Lubrano, MD PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy, and Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven & Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
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16
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He S, Yang F, Lu C, Wang Y, Duan X, Li H, Wu L, Wang Y, Su J, Li M, Leng X, Zeng X. Sex-specific differences in patients with psoriatic arthritis:a nationwide study from the Chinese Registry of Psoriatic Arthritis (CREPAR IV). Clin Rheumatol 2024; 43:1063-1071. [PMID: 38200254 DOI: 10.1007/s10067-023-06859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To elucidate the sex-specific differences in demographic features, clinical characteristics, and quality of life in Chinese patients with psoriatic arthritis (PsA). METHODS A total of 1,074 patients with PsA registered between December 2018 and June 2021 from the Chinese REgistry of Psoriatic ARthritis (CREPAR) cohort were selected. The baseline data on demographics, clinical characteristics, commonly used laboratory tests, comorbidities, and quality of life assessments were collected for this cross-sectional analysis. RESULTS A total of 1,074 patients were included in this study, 585 (54.47%) of them were male and 489 (45.53%) were female. The age at PsA onset in male patients was earlier than that in female patients (38.10 ± 12.79 vs 40.37 ± 13.41, p = 0.005). For clinical characteristics, male patients presented with higher rates of axial involvement (43.89% vs 37.74%, p = 0.044) and nail involvement (66.15% vs 58.08%, p = 0.006), while female patients presented with higher rates of peripheral arthritis (89.57% vs 83.93%, p = 0.007). For laboratory tests, men presented with a higher percentage of HLA-B27 positivity than women (24.65% vs 16.70%, p = 0.002) and had higher levels of CRP (median 9.70 vs 5.65, p < 0.001). Regarding disease assessment indices, male patients scored higher in PASI and BASFI (median 5.00 vs 3.00, p = 0.007 and 1.80 vs 1.40, p = 0.012, respectively). No sex difference was found in rates of achieving remission. Factors associated with disease remission were also analyzed in both sexes. CONCLUSION Demographic and clinical characteristics tend to vary between male and female patients with PsA. Male patients reported more functional limitations in daily life. Key Points • The demographic and clinical features vary greatly between male and female patients with PsA. • Male patients reported more functional burden in daily life as measured by BASFI.
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Affiliation(s)
- Shihao He
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China
| | - Fan Yang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China
| | - Chaofan Lu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Hongbin Li
- Department of Rheumatology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - Lijun Wu
- Department of Rheumatology, The People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, 830001, Xinjiang, China
| | - Yongfu Wang
- Department of Rheumatology, First Affiliated Hospital of Baotou Medical College, Baotou, 014010, Inner Mongolia, China
| | - Jinmei Su
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China
| | - Xiaomei Leng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Wangfujing Ave, Beijing, 100730, China.
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17
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Snoeck Henkemans SVJ, de Jong PHP, Luime JJ, Kok MR, Tchetverikov I, Korswagen LA, van der Kooij SM, van Oosterhout M, Baudoin P, Bijsterbosch J, van der Kaap JH, van der Helm-van Mil AHM, Vis M. Window of opportunity in psoriatic arthritis: the earlier the better? RMD Open 2024; 10:e004062. [PMID: 38413172 PMCID: PMC10900390 DOI: 10.1136/rmdopen-2023-004062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To investigate whether there is a window of opportunity for psoriatic arthritis (PsA) patients and to assess which patient characteristics are associated with a longer diagnostic delay. METHODS All newly diagnosed, disease-modifying antirheumatic drug-naïve PsA patients who participated in the Dutch southwest Early PsA cohoRt and had ≥3 years of follow-up were studied. First, total delay was calculated as the time period between symptom onset and PsA diagnosis made by a rheumatologist and then split into patient and physician delays. The total delay was categorised into short (<12 weeks), intermediate (12 weeks to 1 year) or long (>1 year). These groups were compared on clinical (Minimal Disease Activity (MDA) and Disease Activity index for PSoriatic Arthritis (DAPSA) remission) and patient-reported outcomes during 3 years follow-up. RESULTS 708 PsA patients were studied of whom 136 (19%), 237 (33%) and 335 (47%) had a short, intermediate and long total delay, respectively. Patient delay was 1.0 month and physician delay was 4.5 months. Patients with a short delay were more likely to achieve MDA (OR 2.55, p=0.003) and DAPSA remission (OR 2.35,p=0.004) compared with PsA patients with a long delay. Patient-reported outcomes showed numerical but non-significant differences between the short and long delay groups. Female patients and those presenting with enthesitis, chronic back pain or normal C-reactive protein (CRP) had a longer delay. CONCLUSIONS In PsA, referral and diagnosis within 1 year is associated with better clinical outcomes, suggesting the presence of a window of opportunity. The most gain in referral could be obtained in physician delay and in females, patients with enthesitis, chronic back pain or normal CRP.
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Affiliation(s)
| | | | | | - Marc R Kok
- Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | | | - Paul Baudoin
- Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | | | | | | | - Marijn Vis
- Rheumatology, Erasmus MC, Rotterdam, The Netherlands
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18
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Pina Vegas L, Penso L, Sbidian E, Claudepierre P. Influence of sex on the persistence of different classes of targeted therapies for psoriatic arthritis: a cohort study of 14 778 patients from the French health insurance database (SNDS). RMD Open 2023; 9:e003570. [PMID: 38114199 DOI: 10.1136/rmdopen-2023-003570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Sex differences in phenotype presentation, disease trajectory and treatment response in psoriatic arthritis (PsA) have been reported. Nevertheless, whether classes of targeted therapies differentially affect men and women with PsA remains unclear. OBJECTIVES To assess the effect of sex on the long-term persistence of each class of targeted therapies in PsA. METHODS This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA who were new users of targeted therapies (not in the year before the index date) during 2015-2021 and studied all treatment lines during the study period. Persistence was defined as the time from treatment initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by sex involved multivariate frailty models with conventional synthetic disease-modifying antirheumatic drugs and prednisone as time-dependant variables. RESULTS We included 14 778 patients with PsA who were new users of targeted therapies: 8475 (57%) women (mean age 50±13 years; 15 831 lines), 6303 (43%) men (mean age 51±13 years; 10 488 lines). Overall, 1-year persistence was 52% for women and 62% for men and at 3 years it was 27% and 39%, respectively. After adjustments, persistence was lower for women than men for inhibitors of tumour necrosis factor (TNFi) (adjusted HR (HRa) 1.4, 99% CI 1.3 to 1.5) and interleukin 17 inhibitor (IL17i) (HRa 1.2, 99% CI 1.1 to 1.3) but not IL12/23i (HRa 1.1, 99% CI 0.9 to 1.3), IL23i (HRa 1.1, 99% CI 0.7 to 1.5) or Janus kinase inhibitor (JAKi) (HRa 1.2, 99% CI 0.9 to 1.6). CONCLUSION The treatment persistence was lower for women than men for TNFi and IL17i but not for IL12/23i, IL23i or JAKi.
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Affiliation(s)
- Laura Pina Vegas
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
- Service de Rhumatologie, Hopital Henri Mondor, Créteil, France
| | - Laetitia Penso
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Emilie Sbidian
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
- Inserm, Centre d'investigation clinique 1430, Hopital Henri Mondor, Créteil, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France
- Service de Rhumatologie, Hopital Henri Mondor, Créteil, France
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Lubrano E, Massimo Perrotta F. Sex-related differences in psoriatic arthritis. THE LANCET. RHEUMATOLOGY 2023; 5:e699-e701. [PMID: 38251557 DOI: 10.1016/s2665-9913(23)00274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute Vincenzo Tiberio, Università degli Studi del Molise, Campobasso 86100, Italy; Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, Leuven, Belgium.
| | - Fabio Massimo Perrotta
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, Leuven, Belgium
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20
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Ristic B, Carletto A, Fracassi E, Pacenza G, Zanetti G, Pistillo F, Cristofalo D, Bixio R, Bonetto C, Tosato S. Comparison and potential determinants of health-related quality of life among rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis: A cross-sectional study. J Psychosom Res 2023; 175:111512. [PMID: 37844390 DOI: 10.1016/j.jpsychores.2023.111512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES This study aimed to compare the health-related quality of life scores among rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis and to evaluate socio-demographic and clinical determinantes of quality of life across diseases. METHODS The sample comprised 490 patients with rheumatoid arthritis, 198 with psoriatic arthritis, and 119 with spondyloarthritis who completed a series of health examinations and self-reported questionnaires. Quality of life was evaluated using the Short-Form 36 Health Survey, disease activity by DAS28-CRP, DAPSA, and ASDAS-CRP (for rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis, respectively), depression and anxiety using the Hospital Anxiety and Depression Scale. ANOVA was used to compare the quality of life dimensions and their physical and mental summary measures among rheumatic diseases, and multivariate analysis was used to explore their potential determinants. RESULTS Rheumatoid arthritis had significantly worse scores than spondyloarthritis in the following dimensions: physical functioning, role limitation due to physical health, physical component score, and mental health. Psoriatic arthritis was not significantly different from the other two diseases. Multivariate analysis revealed that physical quality of life was mainly associated with disease activity across rheumatic diseases, rheumatological treatment and depression in rheumatoid arthritis and psoriatic arthritis. Mental quality of life is primarily associated with depression and anxiety across rheumatic diseases. CONCLUSION There were differences in quality of life among patients with inflammatory rheumatic diseases, but overall, approximately uniform factors explained the variance in quality of life across diseases. Clinicians should develop general approaches and strategies for inflammatory rheumatic diseases to improve patients' quality of life.
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Affiliation(s)
- Branko Ristic
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona; Verona, Italy
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Fracassi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Giulio Pacenza
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona; Verona, Italy
| | - Giulia Zanetti
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Pistillo
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona; Verona, Italy
| | - Riccardo Bixio
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona; Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona; Verona, Italy.
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21
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Eder L, Mylvaganam S, Pardo Pardo J, Petkovic J, Strand V, Mease P, Colaco K. Sex-related differences in patient characteristics, and efficacy and safety of advanced therapies in randomised clinical trials in psoriatic arthritis: a systematic literature review and meta-analysis. THE LANCET. RHEUMATOLOGY 2023; 5:e716-e727. [PMID: 38251562 DOI: 10.1016/s2665-9913(23)00264-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Sex-related differences in clinical manifestations and disease outcomes exist in psoriatic arthritis, however, there is limited information on sex-related differences in randomised controlled trials of psoriatic arthritis. We aimed to compare patient characteristics and efficacy and safety of advanced therapies (including biological and targeted synthetic therapies) between male and female patients with psoriatic arthritis participating in randomised controlled trials. METHODS In this systematic review and meta-analysis, we searched Medline, Embase, and Central databases, and conference abstract archives, from their inception to June 10, 2022, for randomised controlled trials that assessed the efficacy of advanced therapies in psoriatic arthritis. Two reviewers extracted information on participants' characteristics and rates of American College of Rheumatology (ACR) 20 and ACR50 response and minimal disease activity (MDA) by sex. Random-effects models were used to calculate pooled effects of ACR20, ACR50, and MDA in male versus female patients by drug class. FINDINGS We included 54 trials (11 514 [50·9%] of 22 621 participants were female and 11 107 [49·1%] were male). Sex-disaggregated results were reported in a minority of studies (nine [17%] of 54 reported baseline characteristics by sex, 18 [33%] reported efficacy by sex, and two [4%] reported safety endpoints by sex). At baseline, male patients had lower baseline tender joint count (mean difference -3·01 [95% CI -3·83 to -2·18], health assessment questionnaire scores (-0·28 [-0·33 to -0·24]), pain scores (-4·58 [-6·86 to -2·30]), patient global assessment (-3·22 [-5·27 to -1·17]), and physician global assessment (-1·34 [-2·08 to -0·08]) than did female patients. Male patients had higher baseline psoriasis area and severity index scores (mean difference 1·95 [95% CI 0·78 to 3·11]) and C-reactive protein concentrations (2·57 [0·40 to 4·74]) than did female patients. ACR20 response by sex varied across drug classes, with higher rates in males than females with interleukin (IL)-17 inhibitors (odds ratio [OR] 1·70 [95% CI 1·38-2·11]), IL-23 inhibitor (1·46 [1·20-1·78]), IL-12 and IL-23 inhibitor (2·67 [1·39-5·09]), and tumour necrosis factor (TNF) inhibitors (1·55 [1·11-2·18]), but no difference with JAK and TYK2 inhibitors (1·10 [0·87-1·38]). Similarly, ACR50 response rates were higher in male patients versus female patients in all drug classes, with exception of JAK and TYK2 inhibitors (TNF inhibitors, OR 2·17 [95% CI 1·62-2·90]; IL-17 inhibitors, 1·93 [1·56-2·38]; IL-23 inhibitor, 1·71 [1·25-2·34]; IL-12 and 23 inhibitor, 2·43 [1·14-5·20]; and JAK and TYK2 inhibitors, 1·09 [0·73-1·62]). Male patients were more likely to reach MDA with most drug classes, including IL-17 inhibitors (OR 1·99 [95% CI 1·50-2·63]), IL-23 inhibitors (1·79 [1·29-2·50]), TNF inhibitors (2·62 [1·54-4·44]), and JAK and TYK2 inhibitors (1·77 [1·15-2·73]). Risk of bias was low for most studies. INTERPRETATION Biological sex of patients with psoriatic arthritis influences their response to advanced therapies, but the effect varies by drug class. Selective reporting might have influenced these results. Future trials should report baseline characteristics and endpoint results by sex. FUNDING Canadian Rheumatology Association.
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Affiliation(s)
- Lihi Eder
- Women's College Research Institute and Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Jordi Pardo Pardo
- Cochrane Equity Thematic Network, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Petkovic
- Cochrane Equity Thematic Network, University of Ottawa, Ottawa, ON, Canada
| | - Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Philip Mease
- Swedish Medical Center, Seattle, WA, USA; Providence St Joseph Hospital, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA
| | - Keith Colaco
- Women's College Research Institute and Department of Medicine, University of Toronto, Toronto, ON, Canada
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Xie W, Bian W, Song Z, Deng X, Qu J, Zhang Z. Association between triglyceride-glucose index and carotid atherosclerosis in patients with psoriatic arthritis. Rheumatology (Oxford) 2023; 62:3584-3591. [PMID: 36897031 DOI: 10.1093/rheumatology/kead100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To investigate the association of the triglyceride-glucose (TyG) index with atherosclerotic risk among patients with PsA. METHODS This cross-sectional study included 165 consecutive PsA patients receiving carotid ultrasonography with integrated TyG index, calculated as ln [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. Logistic regression models were applied to analyse the association of TyG index as continuous variables and tertiles with carotid atherosclerosis and carotid artery plaque. Fully adjusted model included sex, age, smoking, BMI, comorbidities and psoriatic-related variables. RESULTS Overall, PsA patients with carotid atherosclerosis had substantially higher TyG index than those without [8.82 (0.50) vs 8.54 (0.55), P = 0.002]. The frequency of carotid atherosclerosis was increased with increases in TyG index tertiles, showing 14.8%, 34.5%, 44.6% for tertile 1, 2 and 3, respectively (P = 0.003). Multivariate logistic analyses showed that each 1-unit increase in TyG index was significantly associated with prevalent carotid atherosclerosis [unadjusted odds ratio (OR) 2.65 (1.39-5.05); fully adjusted OR 2.69 (1.02-7.11)]. Compared with patients in tertile 1 of TyG index, the unadjusted and fully adjusted OR for occurrence of carotid atherosclerosis were 4.64 (1.85-11.60) and 5.10 (1.54-16.93) in patients in tertile 3. Similarly, higher prevalent carotid artery plaque was observed with increasing TyG index [unadjusted OR 3.11 (1.54-6.26); fully adjusted OR 3.61 (1.15-11.38)] or in tertile 3 vs tertile 1 [unadjusted OR 10.20 (2.83-36.82); fully adjusted OR 17.89 (2.88-111.11)]. Additionally, TyG index provided incremental predictive capacity beyond established risk factors, shown by an increase in discrimination ability (all P < 0.001). CONCLUSIONS TyG index was positively correlated with the burden of atherosclerosis in PsA patients, independent of traditional cardiovascular risk factors and psoriatic-related factors. These findings suggest that TyG index may be a promising atherosclerotic marker for the PsA population.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Wei Bian
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Zhibo Song
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Jiahao Qu
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
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23
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Ng BCK, Jadon D, Adebajo A, Ayan G, Duffin KC, Chandran V, Coates LC, D'Agostino MA, de Vlam K, Deodhar A, Eder L, Garg A, Gladman DD, Goel N, Gottlieb AB, Husni ME, Katz A, Kavanaugh A, Lubrano E, Mease PJ, Merola JF, Nash P, Ogdie A, Pennington SR, Perez-Chada LM, Proft F, Rosen CF, Savage L, Goldenstein-Schainberg C, Siebert S, Soriano ER, Steinkoenig I, Tillett W, Armstrong AW, FitzGerald O. Proceedings of the GRAPPA 2022 Executive Retreat. J Rheumatol 2023; 50:71-77. [PMID: 37527861 DOI: 10.3899/jrheum.2023-0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) leadership congregated for a strategic planning meeting before the 2022 GRAPPA annual meeting in New York, USA. Meeting aims were to review GRAPPA's performance in relation to its 2016 goals and identify successes and areas for further improvement, identify key GRAPPA priorities and activities for the next 5 years, and explore committee structures to best support these aims.
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Affiliation(s)
- Beverly Cheok Kuan Ng
- B.C.K. Ng, MBBS, MSc, D. Jadon, MBBCh, PhD, Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Deepak Jadon
- B.C.K. Ng, MBBS, MSc, D. Jadon, MBBCh, PhD, Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Adewale Adebajo
- A. Adebajo, MD, MBE, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Gizem Ayan
- G. Ayan, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Kristina Callis Duffin
- K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Vinod Chandran
- V. Chandran, MD, DM, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Laura C Coates
- L.C. Coates, MD, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Kurt de Vlam
- K. de Vlam, MD, PhD, University Hospitals Leuven, Leuven, Belgium
| | - Atul Deodhar
- A. Deodhar, MD, Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute and University of Toronto, Toronto, Ontario, Canada
| | - Amit Garg
- A. Garg, MD, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Dafna D Gladman
- D.D. Gladman, MD, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Niti Goel
- N. Goel, MD, Patient Research Partner, Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alice B Gottlieb
- A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Elaine Husni
- M.E. Husni, MD, MPH, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arnon Katz
- A. Katz, MSc, Technion Israel Institute of Technology, Haifa, Israel
| | - Arthur Kavanaugh
- A. Kavanaugh, MD, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA
| | - Ennio Lubrano
- E. Lubrano, MD, PhD, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Philip J Mease
- P.J. Mease, MD, Rheumatology Research, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Nash
- P. Nash, MBBS, MD, School of Medicine, Griffith University, Brisbane, Australia
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Stephen R Pennington
- S.R. Pennington, PhD, O. FitzGerald, MBBCh, MD, School of Medicine, and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Lourdes M Perez-Chada
- L.M. Perez-Chada, MD, MMSc, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabian Proft
- F. Proft, MD, Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cheryl F Rosen
- C.F. Rosen, MD, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laura Savage
- L. Savage, MBChB, PhD, Department of Dermatology, University of Leeds, Leeds, UK
| | - Claudia Goldenstein-Schainberg
- C. Goldenstein-Schainberg, MD, PhD, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Stefan Siebert
- S. Siebert, MD, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Enrique R Soriano
- E.R. Soriano, MD, MS, University Institute and Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - William Tillett
- W. Tillet, MBChB, PhD, Department of Life Sciences, Centre for Therapeutic Innovation, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - April W Armstrong
- A.W. Armstrong, MD, MPH, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Oliver FitzGerald
- S.R. Pennington, PhD, O. FitzGerald, MBBCh, MD, School of Medicine, and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland;
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Eder L, James AJ, van der Horst-Bruinsma I, Coates LC, Goel N. Diversity, Equity, and Inclusion: Sex and Gender and Intersectionality With Race and Ethnicity in Psoriatic Disease. J Rheumatol 2023; 50:38-40. [PMID: 37527854 DOI: 10.3899/jrheum.2023-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
Sex (biological attributes associated with being male or female) and gender (sociocultural-driven traits and behaviors related to being a man or a woman) are emerging as important determinants of disease course and response to therapy in patients with psoriasis and psoriatic arthritis (PsA). Although psoriatic disease (PsD) is equally prevalent in men and women, the condition affects them in different and unique ways, giving rise to sex- and gender-related differences in clinical presentation, including baseline disease activity, disease course, and response to treatment. Better understanding of the roles sex and gender play in the development and evolution of PsD has the potential to improve patient care. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) continues its effort to highlight issues related to diversity, equity, and inclusion in people with PsD by dedicating a session during the annual meeting to sex and gender and their intersectionality with race and ethnicity in individuals with PsA.
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Affiliation(s)
- Lihi Eder
- L. Eder, MD, PhD, Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada;
| | - Alaina J James
- A.J. James, MD, PhD, Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Irene van der Horst-Bruinsma
- I. van der Horst-Bruinsma, MD, Radboud University Medical Centre, Department of Rheumatology, Nijmegen, the Netherlands
| | - Laura C Coates
- L.C. Coates, MD, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Niti Goel
- N. Goel, MD, GRAPPA Patient Research Partner, Durham, Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, and DurTrialSpark Inc., Durham, North Carolina, USA
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Ruscitti P, Esposito M, Di Cola I, Pellegrini C, De Berardinis A, Mastrangelo M, Gianneramo C, Barile A, Fargnoli MC, Cipriani P. Cytokine profile characterization of naïve patients with psoriasis and psoriatic arthritis: implications for a pathogenic disease continuum. Front Immunol 2023; 14:1229516. [PMID: 37520537 PMCID: PMC10373502 DOI: 10.3389/fimmu.2023.1229516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background The idea of psoriatic disease continuum has been progressively prompted based on the advances of the knowledge about the pathogenic steps underpinning the occurrence of psoriasis (PSO) and psoriatic arthritis (PSA). To evaluate biomolecules (inflammatory cytokines, inflammatory chemokines, cell adhesion and cellular mediators) in naïve patients with PSO, PSA with PSO, and PSA sine PSO. To stratify the results considering the presence of psoriatic nail involvement, extensive skin disease and obesity evaluating all involved patients. Methods By multiplex technology, 20 serum biomolecules were assessed with the inclusion of pro-inflammatory cytokines (GM-CSF, IFN-γ, IL-1α, IL-1β, IL-6, IL-8, IL-12p70, IL-17A, IL-23, TNF), anti-inflammatory cytokines (IFN-α, IL-4, IL-10, IL-13), inflammatory chemokines (IP-10, MCP-1, MIP-1α, MIP-1β), cell adhesion and cellular mediators (ICAM-1, E-selectin, P-selectin). The assessment of possible statistical differences between the means of the three groups was performed by One-Way ANOVA. In addition, by non-parametric T-tests, we stratified the results according to selected clinical characteristics (psoriatic nail involvement, PASI ≥ 10, BMI ≥ 30). Results In 80 assessed naïve patients, patients with PSO showed significant increases of E-selectin (p=0.021) and IL-8 (0.041) than other groups. In patients with PSA with PSO, significant higher levels of ICAM-1 were observed (p=0.009) than other groups. We did not observe further differences comparing pro-inflammatory and anti-inflammatory cytokines, inflammatory chemokines, and cell adhesion and cellular mediators in patients with PSO, PSA with PSO, and PSA sine PSO. Patients with psoriatic onychopathy showed significant increased levels of ICAM-1 (p=0.010) and IP-10 (0.030) than others. In patients with PASI ≥ 10, significantly enhanced values of IL-8 (p=0.004), TNF (p=0.013), E-selectin (p=0.004), MIP-1α (p=0.003), and MIP-1β (p=0.039). In patients with BMI ≥ 30, significantly higher levels of E-selectin were pointed out (p=0.035) than others. Conclusion Our findings may suggest that a similar cytokine profile may characterize naïve patients with PSO, PSA with PSO, and PSA sine PSO, reinforcing the concept of psoriatic disease continuum. However, some differences may be also shown, underlying possible pathogenic differences and leading to the clinical heterogeneity of these patients.
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Queiro R, Loredo M, Braña I, Pardo E, Alonso S, Alperi M. Managing psoriatic arthritis in different clinical scenarios. Expert Rev Clin Immunol 2023; 19:1469-1484. [PMID: 37589128 DOI: 10.1080/1744666x.2023.2249235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic, immune-mediated disease characterized by synovio-entheseal inflammation. It is estimated to affect around 30% of patients with psoriasis and significantly reduces patients' physical function and quality of life. There is a growing number of treatment options for PsA, but due to the heterogeneous clinical features of the disease and prevalence of comorbidities, managing PsA can be challenging. AREAS COVERED In this article, we review current understanding of the disease and available pharmacological options. Based on published treatment guidelines, emerging evidence and clinical experience, we provide our expert opinion on treatment strategies, taking into consideration the predominant disease domain and the presence of comorbidities, which can impact treatment decisions and clinical outcomes. EXPERT OPINION Biological and targeted synthetic disease-modifying agents are dramatically improving the lives of patients with PsA. Biosimilar TNF inhibitors offer a particularly versatile and cost-effective option, whilst newer biologics and targeted synthetic molecules that can be used to treat most domains of psoriatic disease are an attractive alternative to TNF inhibitors. Despite a lack of consensus on treatment sequencing and tapering, it is important that PsA patients, especially those with comorbidities, are looked after by a multidisciplinary team to optimize their care.
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Affiliation(s)
- Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division, Central University Hospital of Asturias, Oviedo, Spain
- Department of Medicine, Oviedo University School of Medicine, Oviedo, Spain
| | - Marta Loredo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Ignacio Braña
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Estefanía Pardo
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Sara Alonso
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
| | - Mercedes Alperi
- Rheumatology Division, Central University Hospital of Asturias, Oviedo, Spain
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Bergman MJ, Zueger P, Patel J, Saffore CD, Topuria I, Cavanaugh C, Fang S, Clewell J, Ogdie A. Clinical and Economic Benefit of Achieving Disease Control in Psoriatic Arthritis and Ankylosing Spondylitis: A Retrospective Analysis from the OM1 Registry. Rheumatol Ther 2023; 10:187-199. [PMID: 36333490 PMCID: PMC9931970 DOI: 10.1007/s40744-022-00504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is limited evidence on the clinical and economic benefit of achieving disease control in psoriatic arthritis (PsA) and ankylosing spondylitis (AS), thus we aimed to assess the impact of disease control on healthcare resource use (HCRU) and direct medical costs among US patients with PsA or AS over 1 year. METHODS Data were derived from the US OM1 PsA/AS registries (PsA: 1/2013-12/2020; AS: 01/2013-4/2021) and the Optum Insight Clinformatics® Data Mart to identify adult patients with PsA or AS. Two cohorts were created: with disease control and without disease control. Disease control was defined as modified Disease Activity Index for Psoriatic Arthritis (DAPSA28) ≤ 4 for PsA and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) < 4 for AS. Outcomes were all-cause inpatient, outpatient, and emergency department (ED) visits and associated costs over a 1-year follow-up period. Mean costs per person per year (PPPY) were assessed descriptively and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated for the likelihood of HCRU by logistic regression. RESULTS The study included 1235 PsA (with disease control: N = 217; without: N = 1018) and 581 AS patients (with disease control: N = 342; without: N = 239). Patients without disease control were more likely to have an inpatient (aOR [95% CI]; PsA: 3.0 [0.9, 10.1]; AS: 7.7 [2.3, 25.1]) or ED (PsA: 1.6 [0.6, 4.2]; AS: 3.5 [1.5, 8.3]) visit than those with disease control. Those without disease control, vs. those with disease control, had greater PPPY costs associated with inpatient (PsA: $1550 vs. $443), outpatient (PsA: $1789 vs. $1327; AS: $2498 vs. $2023), and ED (PsA: $114 vs. $57; AS: $316 vs. $50) visits. CONCLUSIONS Findings from this study demonstrate lower disease activity among patients with PsA and AS is associated with less HCRU and lower costs over the following year.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alexis Ogdie
- University of Pennsylvania, Philadelphia, PA, USA
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Kobak S, Atabay T, Akyildiz M, Gokduman A, Vural H. Serum salusin-α and salusin-β levels in patients with psoriatic arthritis. Reumatologia 2022; 60:306-310. [PMID: 36381209 PMCID: PMC9661408 DOI: 10.5114/reum.2022.120753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/03/2022] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by skin lesions and joint involvement. Salusin-α and salusin-β are two new bioactive molecules. It is reported that salusins may have role in regulation of the immune system and inflammation. The aim of our study was to evaluate the serum salusin-α and salusin-β levels in PsA patients and to establish the possible relationship with the disease features. MATERIAL AND METHODS Our study included 40 PsA patients who fulfilled the CASPAR criteria and 40 healthy volunteers. Demographic, clinical, laboratory and radiological data and disease activity indices (PASI, BASDAI, BASFI, HAQ) were recorded in all patients. The enzyme-linked immunosorbent assay (ELISA) method was used to measure serum salusin-α and salusin-β levels. RESULTS The demographic data were as follows: 13 patients (32.5%) were males and 27 (67.5%) were female, mean age was 48.5 years and mean disease duration was 2.4 years. Patients' history was taken and clinical assessment was performed; 20 (50%) patients had a family history, 18 (45%) patients were smoker, 19 (47.5%) patients had HLA-B27 positivity, 33 (82.5%) had sacroiliitis, 36 (90%) had enthesitis, 23 (57.5%) had distal interphalangeal (DIP) joint and nail involvement, 26 (65%) had wrist involvement, and 11 (27.5%) had ankle involvement. Laboratory data of the patients were recorded; 20 (50%) patients had elevated CRP level and 25 (62.5%) patients had an elevated ESR level. The study results showed that PsA patients had an elevated serum salusin-α level when compared with the control group (p = 0.004). The association between serum salusin-α level and ankle arthritis was found (p = 0.04). Serum levels of salusin-β were similar in PsA patients and controls both (p = 0.285). CONCLUSIONS We found elevated serum salusin-α in PsA patients while the serum salusin-β levels were normal. Salusin-α may have a possible role in disease pathogenesis and it may be use as a reliable biomarker in PsA patients. Multicenter prospective studies are needed in this regard.
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Affiliation(s)
- Senol Kobak
- Department of Internal Medicine and Rheumatology, Istinye University, Faculty of Medicine LIV Hospital, Istanbul, Turkey
| | - Tennur Atabay
- Department of Physiology, Faculty of Medicine, Sifa University Izmir, Turkey
| | - Muhittin Akyildiz
- Department of Biochemistry, Faculty of Medicine, Sifa University Izmir, Turkey
| | - Ayse Gokduman
- Department of Biochemistry, Faculty of Medicine, Sifa University Izmir, Turkey
| | - Huseyin Vural
- Department of Biochemistry, Faculty of Medicine, Sifa University Izmir, Turkey
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Queiro R. Commentary: Sex-based medicine in psoriatic arthritis: Lessons learned from machine learning-based prediction models. Front Immunol 2022; 13:1038270. [PMID: 36263046 PMCID: PMC9575989 DOI: 10.3389/fimmu.2022.1038270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
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