Clinical Reviews in Allergy & Immunology, Jan 18, 2022
Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by psoriasis, synovit... more Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by psoriasis, synovitis, enthesitis, spondylitis, and the possible association with other extra-articular manifestations and comorbidities. It is a multifaceted and systemic disorder sustained by complex pathogenesis, combining aspects of autoinflammation and autoimmunity. Features of PsA autoinflammation include the role of biomechanical stress in the onset and/or exacerbation of the disease; the evidence of involvement of the innate immune response mediators in the skin, peripheral blood and synovial tissue; an equal gender distribution; the clinical course which may encounter periods of prolonged remission and overlapping features with autoinflammatory syndromes. Conversely, the role of autoimmunity is evoked by the association with class I major histocompatibility complex alleles, the polyarticular pattern of the disease which sometimes resembles rheumatoid arthritis and the presence of serum autoantibodies. Genetics also provide important insights into the pathogenesis of PsA, particularly related to class I HLA being associated with psoriasis and PsA. In this review, we provide a comprehensive review of the pathogenesis, genetics and clinical features of PsA that endorse the mixed nature of a disorder at the crossroads of autoinflammation and autoimmunity.
The development of the biological drugs has revolutionized the therapeutic approach of the chroni... more The development of the biological drugs has revolutionized the therapeutic approach of the chronic inflammatory rheumatic diseases, particularly in patients resistant to standard treatment. These drugs are characterized by an innovative mechanism of action, based on the targeted inhibition of specific molecular or cellular targets directly involved in the pathogenesis of the diseases: pro-inflammatory cytokines (tumor necrosis factor, interleukin-1 and 6), CTLA-4, and molecules involved in the activation, differentiation and maturation of B cells. Their use has indeed allowed for a better prognosis in several rheumatic diseases (such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus) and to obtain a clinical remission. In the present review we give an overview of the biological drugs currently available for the treatment of the rheumatic diseases, analyzing the different mechanism of action, the therapeutic indications and efficacy data, and adverse events.
Clinical and Experimental Rheumatology, Sep 6, 2021
OBJECTIVES Women of childbearing age may be affected by psoriatic arthritis (PsA) and ankylosing ... more OBJECTIVES Women of childbearing age may be affected by psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The aim was to assess the impact of biological agents (bDMARDs) on the fertility of women with PsA and AS by evaluating the serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and luteinising hormone (LH). METHODS Consecutive female patients (18-45 years) affected by PsA or AS starting a bDMARD were retrospectively evaluated at baseline (T0) and after 8 months (T8) of treatment. At both visits, demographic and clinical data were obtained. AMH, LH, and FSH serum levels were measured. A population of fertile women matched for age, body mass index and smoking habit was included as healthy controls (HCs). RESULTS Twenty-four patients with PsA, 20 with AS, and 44 HCs were included. The median (25th-75th percentile) levels of AMH in patients were 0.74 ng/ml (0.29-2) at baseline and 0.71 ng/ml (0.19-1.9) (p=n.s.) at T8. The median levels of AMH in HCs were 1.56 ng/ml (0.37-2.90), with no difference compared to patients. No correlation was found between the serum AMH levels and the indexes of disease activity for both PsA and AS. No differences were found in the serum levels of FSH and LH before and after treatment with bDMARDs. CONCLUSIONS Our results support the use of bDMARDs in female patients with SpA. AMH levels were not influenced by bDMARDs nor by disease activity. AMH could be useful to assess the quantitative aspect of ovarian reserve in female SpA patients.
Background/Aims Psoriatic arthritis (PsA) is a multi-system disease with a range of management op... more Background/Aims Psoriatic arthritis (PsA) is a multi-system disease with a range of management options. Treatment may vary by geographic location. We compared disease characteristics and prescribing practices in the UK and Europe in the post-Covid era. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patient and disease characteristics, current treatment and treatment decisions (medications unchanged, switched, added or reduced) were recorded. The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with arthritis subtype, patient age, disease activity and duration s...
ObjectivesPatient care can vary substantially by country. The objective was to explore difference... more ObjectivesPatient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments.MethodsA cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA >14) and no ongoing bDMARD prescription.ResultsIn 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease act...
OBJECTIVES Recently, research has been focused on the identification of predictors of response to... more OBJECTIVES Recently, research has been focused on the identification of predictors of response to treatment in patients with active psoriatic arthritis (PsA). The objective of this study was to develop a model to predict the clinical response at 6 months in patients with PsA starting the anti-tumour necrosis factor-α golimumab. METHODS This prospective observational study explored a range of factors, including demographic data and baseline characteristics of the disease, measures of disease activity and functional disability, and potential laboratory biomarkers in the prediction of response, defined as the achievement of modified-minimal disease activity (mMDA), to golimumab in PsA patients. RESULTS We studied 151 PsA patients starting golimumab because of their active disease. After 6 months, the rate of drug persistence on golimumab was 80%, and mMDA was achieved in 44.3% of patients. Using univariate and multivariate logistic regression models, lower disease activity in PsA score...
In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activ... more In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activity(1). Many treatments are now available, though some are costly and not widely available in all countries. Country of patient care, and in particular Gross Domestic Product (GDP) may be linked to PsA outcomes(2). Although patients with high disease activity are eligible for targeted therapies such as biologic disease-modifying anti-rheumatic drugs (bDMARDs), they may not be able to get the benefits from these efficacious treatments in all countries equally.The objective was to explore the rate of PsA patients with high to moderate disease activity, not receiving bDMARDs across countries, and to assess the consequences on functional incapacity.This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805)(3), which included adult patients with PsA with ≥ 2 years disease duration from 14 countries. One country was excluded from this analysis since only 7 patients wer...
SUMMARY Objective: To assess the role of anti-cyclic citrullinated peptide (CCP) antibody detecti... more SUMMARY Objective: To assess the role of anti-cyclic citrullinated peptide (CCP) antibody detection in synovial fluid (SF) of RA patients compared to OA patients. Methods: We evaluated in 25 RA subjects and 14 OA patients, presenting a knee-joint effusion, the main clinical and laboratory parameters including the number of painful and/or swollen joints, Ritchie index, morning stiffness, ESR, CRP and analysis of SF obtained by therapeutic arthrocentesis. IgG anti-CCP (ELISA), rheumatoid factor (RF) and total IgG (nephelometry method) were measured in SF and paired serum samples. Results: We found anti-CCP antibodies and RF in 64% (16/25) and 60% (15/25) of RA sera, respectively; 72% (18/25) of RA patients were positive for anti-CCP antibodies or RF. We found a higher SF/serum ratio for anti-CCP (p<0.004) compared to that for total IgG. The calculation of anti-CCP concentration as IgG anti-CCP (units)/total IgG (g L -1 ) revealed higher values in SF than in serum (p<0.046) in RA...
Background The objective of treatment in psoriatic arthritis (PsA) is remission or low disease (r... more Background The objective of treatment in psoriatic arthritis (PsA) is remission or low disease (ref1). However, there may remain residual patient burden in patients where inflammation is controlled. Objectives To explore patient-perceived burden of disease in PsA patients in remission or low disease, when using different definitions of remission. Methods ReFlap (NCT03119805, ref2) was an observational study in 14 countries of consecutive adult patients with definite PsA and >2 years of disease duration. Remission/low disease status was defined at the baseline visit using composite scores: Minimal Disease Activity (MDA), and Disease Activity in PSoriatic Arthritis (DAPSA)<=14 (both corresponding to a status of remission or low disease). Patient-perceived burden of disease was assessed through the PsA Impact of Disease (PsAID12) composite score and its individual components assessing physical and psychological impact (0-10 where 0 is the optimal status). Mean and median levels o...
Background:Identifying psoriatic arthritis (PsA) among people with psoriasis is often challenging... more Background:Identifying psoriatic arthritis (PsA) among people with psoriasis is often challenging due to low specificity of symptoms at early PsA stage and/or delayed referral to the rheumatologist. Screening instruments -assisting the dermatologist to decide when rheumatological assessment is beneficial- have potential to reduce the diagnostic delay.Objectives:To evaluate the accuracy of a dermatologist-filled-out questionnaire designed for screening PsA among psoriatic patients under dermatology care.Methods:HERACLES is a multicentre, cross-sectional study running at 9 Italian dermatology and rheumatology tertiary centres. All participants were under dermatology care for skin psoriasis. Previous diagnosis of PsA precluded eligibility. Dermatologists at each site assessed consecutive psoriatic subjects, filled in the specifically-designed HERACLES questionnaire (HQ, Figure 1) and finally referred the participants to rheumatologists for clinical evaluation. All participants filled i...
Clinical Reviews in Allergy & Immunology, Jan 18, 2022
Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by psoriasis, synovit... more Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by psoriasis, synovitis, enthesitis, spondylitis, and the possible association with other extra-articular manifestations and comorbidities. It is a multifaceted and systemic disorder sustained by complex pathogenesis, combining aspects of autoinflammation and autoimmunity. Features of PsA autoinflammation include the role of biomechanical stress in the onset and/or exacerbation of the disease; the evidence of involvement of the innate immune response mediators in the skin, peripheral blood and synovial tissue; an equal gender distribution; the clinical course which may encounter periods of prolonged remission and overlapping features with autoinflammatory syndromes. Conversely, the role of autoimmunity is evoked by the association with class I major histocompatibility complex alleles, the polyarticular pattern of the disease which sometimes resembles rheumatoid arthritis and the presence of serum autoantibodies. Genetics also provide important insights into the pathogenesis of PsA, particularly related to class I HLA being associated with psoriasis and PsA. In this review, we provide a comprehensive review of the pathogenesis, genetics and clinical features of PsA that endorse the mixed nature of a disorder at the crossroads of autoinflammation and autoimmunity.
The development of the biological drugs has revolutionized the therapeutic approach of the chroni... more The development of the biological drugs has revolutionized the therapeutic approach of the chronic inflammatory rheumatic diseases, particularly in patients resistant to standard treatment. These drugs are characterized by an innovative mechanism of action, based on the targeted inhibition of specific molecular or cellular targets directly involved in the pathogenesis of the diseases: pro-inflammatory cytokines (tumor necrosis factor, interleukin-1 and 6), CTLA-4, and molecules involved in the activation, differentiation and maturation of B cells. Their use has indeed allowed for a better prognosis in several rheumatic diseases (such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus) and to obtain a clinical remission. In the present review we give an overview of the biological drugs currently available for the treatment of the rheumatic diseases, analyzing the different mechanism of action, the therapeutic indications and efficacy data, and adverse events.
Clinical and Experimental Rheumatology, Sep 6, 2021
OBJECTIVES Women of childbearing age may be affected by psoriatic arthritis (PsA) and ankylosing ... more OBJECTIVES Women of childbearing age may be affected by psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The aim was to assess the impact of biological agents (bDMARDs) on the fertility of women with PsA and AS by evaluating the serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and luteinising hormone (LH). METHODS Consecutive female patients (18-45 years) affected by PsA or AS starting a bDMARD were retrospectively evaluated at baseline (T0) and after 8 months (T8) of treatment. At both visits, demographic and clinical data were obtained. AMH, LH, and FSH serum levels were measured. A population of fertile women matched for age, body mass index and smoking habit was included as healthy controls (HCs). RESULTS Twenty-four patients with PsA, 20 with AS, and 44 HCs were included. The median (25th-75th percentile) levels of AMH in patients were 0.74 ng/ml (0.29-2) at baseline and 0.71 ng/ml (0.19-1.9) (p=n.s.) at T8. The median levels of AMH in HCs were 1.56 ng/ml (0.37-2.90), with no difference compared to patients. No correlation was found between the serum AMH levels and the indexes of disease activity for both PsA and AS. No differences were found in the serum levels of FSH and LH before and after treatment with bDMARDs. CONCLUSIONS Our results support the use of bDMARDs in female patients with SpA. AMH levels were not influenced by bDMARDs nor by disease activity. AMH could be useful to assess the quantitative aspect of ovarian reserve in female SpA patients.
Background/Aims Psoriatic arthritis (PsA) is a multi-system disease with a range of management op... more Background/Aims Psoriatic arthritis (PsA) is a multi-system disease with a range of management options. Treatment may vary by geographic location. We compared disease characteristics and prescribing practices in the UK and Europe in the post-Covid era. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patient and disease characteristics, current treatment and treatment decisions (medications unchanged, switched, added or reduced) were recorded. The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with arthritis subtype, patient age, disease activity and duration s...
ObjectivesPatient care can vary substantially by country. The objective was to explore difference... more ObjectivesPatient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments.MethodsA cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA >14) and no ongoing bDMARD prescription.ResultsIn 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease act...
OBJECTIVES Recently, research has been focused on the identification of predictors of response to... more OBJECTIVES Recently, research has been focused on the identification of predictors of response to treatment in patients with active psoriatic arthritis (PsA). The objective of this study was to develop a model to predict the clinical response at 6 months in patients with PsA starting the anti-tumour necrosis factor-α golimumab. METHODS This prospective observational study explored a range of factors, including demographic data and baseline characteristics of the disease, measures of disease activity and functional disability, and potential laboratory biomarkers in the prediction of response, defined as the achievement of modified-minimal disease activity (mMDA), to golimumab in PsA patients. RESULTS We studied 151 PsA patients starting golimumab because of their active disease. After 6 months, the rate of drug persistence on golimumab was 80%, and mMDA was achieved in 44.3% of patients. Using univariate and multivariate logistic regression models, lower disease activity in PsA score...
In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activ... more In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activity(1). Many treatments are now available, though some are costly and not widely available in all countries. Country of patient care, and in particular Gross Domestic Product (GDP) may be linked to PsA outcomes(2). Although patients with high disease activity are eligible for targeted therapies such as biologic disease-modifying anti-rheumatic drugs (bDMARDs), they may not be able to get the benefits from these efficacious treatments in all countries equally.The objective was to explore the rate of PsA patients with high to moderate disease activity, not receiving bDMARDs across countries, and to assess the consequences on functional incapacity.This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805)(3), which included adult patients with PsA with ≥ 2 years disease duration from 14 countries. One country was excluded from this analysis since only 7 patients wer...
SUMMARY Objective: To assess the role of anti-cyclic citrullinated peptide (CCP) antibody detecti... more SUMMARY Objective: To assess the role of anti-cyclic citrullinated peptide (CCP) antibody detection in synovial fluid (SF) of RA patients compared to OA patients. Methods: We evaluated in 25 RA subjects and 14 OA patients, presenting a knee-joint effusion, the main clinical and laboratory parameters including the number of painful and/or swollen joints, Ritchie index, morning stiffness, ESR, CRP and analysis of SF obtained by therapeutic arthrocentesis. IgG anti-CCP (ELISA), rheumatoid factor (RF) and total IgG (nephelometry method) were measured in SF and paired serum samples. Results: We found anti-CCP antibodies and RF in 64% (16/25) and 60% (15/25) of RA sera, respectively; 72% (18/25) of RA patients were positive for anti-CCP antibodies or RF. We found a higher SF/serum ratio for anti-CCP (p<0.004) compared to that for total IgG. The calculation of anti-CCP concentration as IgG anti-CCP (units)/total IgG (g L -1 ) revealed higher values in SF than in serum (p<0.046) in RA...
Background The objective of treatment in psoriatic arthritis (PsA) is remission or low disease (r... more Background The objective of treatment in psoriatic arthritis (PsA) is remission or low disease (ref1). However, there may remain residual patient burden in patients where inflammation is controlled. Objectives To explore patient-perceived burden of disease in PsA patients in remission or low disease, when using different definitions of remission. Methods ReFlap (NCT03119805, ref2) was an observational study in 14 countries of consecutive adult patients with definite PsA and >2 years of disease duration. Remission/low disease status was defined at the baseline visit using composite scores: Minimal Disease Activity (MDA), and Disease Activity in PSoriatic Arthritis (DAPSA)<=14 (both corresponding to a status of remission or low disease). Patient-perceived burden of disease was assessed through the PsA Impact of Disease (PsAID12) composite score and its individual components assessing physical and psychological impact (0-10 where 0 is the optimal status). Mean and median levels o...
Background:Identifying psoriatic arthritis (PsA) among people with psoriasis is often challenging... more Background:Identifying psoriatic arthritis (PsA) among people with psoriasis is often challenging due to low specificity of symptoms at early PsA stage and/or delayed referral to the rheumatologist. Screening instruments -assisting the dermatologist to decide when rheumatological assessment is beneficial- have potential to reduce the diagnostic delay.Objectives:To evaluate the accuracy of a dermatologist-filled-out questionnaire designed for screening PsA among psoriatic patients under dermatology care.Methods:HERACLES is a multicentre, cross-sectional study running at 9 Italian dermatology and rheumatology tertiary centres. All participants were under dermatology care for skin psoriasis. Previous diagnosis of PsA precluded eligibility. Dermatologists at each site assessed consecutive psoriatic subjects, filled in the specifically-designed HERACLES questionnaire (HQ, Figure 1) and finally referred the participants to rheumatologists for clinical evaluation. All participants filled i...
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