How do patient reported outcome measures affect treatment intensification and patient satisfaction in the management of psoriatic arthritis? A cross sectional study of 503 patients.

OBJECTIVES: The ASSIST study investigated prescribing in routine psoriatic arthritis (PsA) care and whether the patient reported outcome: PsA Impact of Disease questionnaire (PsAID-12), impacted treatment. This study also assessed a range of patient and clinician factors and their relationship to PsAID-12 scoring and treatment modification. METHODS: Patients with PsA were selected across the UK and Europe between July 2021-March 2022. Patients completed the PsAID questionnaire, with the results shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded. RESULTS: 503 patients recruited. 36.2% had changes made to treatment, 88.8% of this had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; the PsAID-12 score was associated with odds of treatment escalation (OR: 1.58; p< 0.0001). However, most clinicians reported PsAID-12 did not impact their decision to escalate treatment, instead supporting treatment reduction decisions. Physician's assessment of disease activity had the most statistically significant effect on likelihood of treatment escalation, (OR = 2.68, per 1-point score increase). Escalation was more likely in patients not treated with biologic therapies. Additional factors associated with treatment escalation included: patient characteristics, physician characteristics, disease activity and disease impact. CONCLUSION: This study highlights multiple factors impacting treatment decision making for individuals with PsA. PsAID-12 scoring correlates with multiple measures of disease severity and odds of treatment escalation. However, most clinicians reported the PsAID-12 did not influence treatment escalation decisions. PsAID scoring could be used to increase confidence in treatment de-escalation.

Core items to be included in a definition of moderate psoriatic arthritis: literature review and expert opinion.

Evidence-based treatment recommendations for psoriatic arthritis (PsA) suggest that treatment should be individualised but acknowledge the difficulty of correctly defining levels of activity (mild, moderate and severe). The aim of this study was to define the parameters or disease characteristics that should be included in a future definition of moderate PsA. Mixed. methods: (1) literature review to identify previous assessment tools used to classify patients into mild, moderate and severe forms, and (2) survey of rheumatologists, and experts in PsA, to obtain their opinion on the degree of validation and applicability of published definitions and tools, and on the parameters that should be included in a future definition of moderate PsA. We propose eight domains/items to be included in a definition of moderate PsA: number of active joints and inflamed entheses, physician global assessment (by visual analogue scale), dactylitis, body surface area (BSA) affected by psoriasis, psoriasis in special locations, and absence of hip involvement. The Disease Activity Index for Psoriatic Arthritis (DAPSA) score would be supported as part of this definition, as would the Psoriatic Arthritis Impact of Disease (PsAID) index. This study proposes a set of items/domains to be included in a definition of moderate PsA based on literature and expert opinion, which can be the starting point for further development and validation studies of the proposed items.

An international multi-centre analysis of current prescribing practices and shared decision-making in psoriatic arthritis.

OBJECTIVES: Shared decision-making (SDM) is advocated to improve patient outcomes in Psoriatic arthritis (PsA). We analysed current prescribing practices and the extent of SDM in PsA across Europe. METHODS: The ASSIST study was a cross-sectional observational study of PsA patients aged ≥18 years attending face-to-face appointments between July 2021-March 2022. Patient demographics, current treatment and treatment decisions were recorded. SDM was measured by the clinician's effort to collaborate (CollaboRATE questionnaire) and patient communication confidence (PEPPI-5 tool). RESULTS: 503 patients were included from 24 centres across the UK, France, Germany, Italy and Spain. Physician- and patient-reported measures of disease activity were highest in the UK. Conventional synthetic DMARDs constituted a higher percentage of current PsA treatment in UK than continental Europe (66.4% vs 44.9%), which differed from biologic DMARDs (36.4% vs 64.4%). Implementing treatment escalation was most common in the UK. CollaboRATE and PEPPI-5 scores were high across centres. Of 31 patients with low CollaboRATE scores (<4.5), no patients with low PsAID-12 scores (<5) had treatment escalation. However, of 465 patients with CollaboRATE scores ≥4.5, 59 patients with low PsAID-12 scores received treatment escalation. CONCLUSIONS: Higher rates of treatment escalation seen in the UK may be explained by higher disease activity and a younger cohort. High levels of collaboration in face-to-face PsA consultations suggests effective implementation of the SDM approach. Our data indicate that, in patients with mild disease activity, only those with higher perceived collaboration underwent treatment escalation. Prospective studies should examine the impact of SDM on PsA patient outcomes. TRIAL REGISTRATION: clinicaltrials.gov, NCT05171270.

The activity of psoriatic arthritis with axial involvement correlates with the PsAID12.

OBJECTIVE: To determine the impact of the disease in patients with PsA in daily clinical practice and to evaluate its relationship with its axial activity. METHODS: A cross-sectional study was conducted in consecutive patients attended from January 2021 to December 2021 who met the CASPAR criteria, with clinical of inflammatory back pain and positive axial imaging, with or without peripheral involvement. Demographic, clinical, analytical data, HAQ index, PsAID12 and activity index (BASDAI and ASDAS-PCR) were also collected. Patients were divided into two groups, those with high impact and those with low impact according to PsAID results. Continuous variables are shown as median (Q1-Q3) and categorical variables as percentages and frequencies. RESULTS: Of the 269 patients evaluated with PsA, 72 patients with axial involvement were included, 40 men (55.6%), with a median age of 54.1 years and disease duration of 7 years. 28.3% of the patients were obese and serum CRP level was 0.45 mg/dl (0.08-1.10). BASDAI was 4.2 (2.0-6.2) and ASDAS-PCR was 2.4 (1.5-3.2), which translates into 39.6% of patients in low activity or remission. The median PsAID total score was 3.9 (1.6-5.4), evaluated in 61 patients. The patients who achieved a PsAID12 ≤ 4 were 63%, mostly men and with lower CRP levels than PsAID ≥ 4 patients. In addition, low impact measured by the PsAID12 was associated with low results in BASDAI and ASDAS-PCR. CONCLUSIONS: Axial involvement reflected lower impact of the disease measured by PsAID12 and it is correlated with low activity measured by BASDAI and ASDAS-PCR.

Dual targeted therapy in patients with psoriatic arthritis and spondyloarthritis: a real-world multicenter experience from Spain.

Dual targeted therapy (DTT) has emerged as a promising approach in patients with refractory spondyloarthritis (SpA) or psoriatic arthritis (PsA) and extra-musculoskeletal manifestations of both diseases, but its effectiveness/safety ratio still remains unclear. This is a retrospective, real-world multicenter study in refractory SpA and PsA patients with simultaneous use of two biological or synthetic targeted agents. Effectiveness was assessed using Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Disease Activity in Psoriatic Arthritis (DAPSA) Score. We identified 39 different DTT combinations in 36 patients (22 SpA; 14 PsA), 25 of them with concomitant inflammatory bowel disease. The most commonly used combinations were TNF inhibitor plus antagonist of the IL12/23 pathway, followed by TNF inhibitor plus IL-17 antagonist. During a median exposure of 14.86 months (IQR 8-20.2), DTT retention rate was 69.4% (n=25/36; 19 SpA, 6 PsA). Major clinical improvement (change in ASDAS-CRP > 2 or improvement > 85% in DAPSA) was achieved in 69.4% of patients (n=25/36 therapeutical combinations; 17/21 SpA, 8/15 PsA), with a 58.3% (n=21/36 combinations; 15/20 SpA, 6/13 PsA) low-activity/remission rate. Of the patients who were receiving glucocorticoids, 55% managed to withdraw them during follow-up. Interestingly, only four serious adverse events in three patients were observed, leading to DTT discontinuation.

Epidemiological Characteristics and Adverse Events of Patients with Psoriatic Arthritis Undergoing Treatment with Biological Therapies in Galicia. / Características epidemiológicas y eventos adversos de los pacientes con artritis psoriásica en tratamiento con terapias biológicas en Galicia.

Patients with severe forms of psoriatic arthritis (PsA) usually require treatment with biological agents. A greater knowledge of this subgroup of patients and their treatment enables better decision making in real clinical practice. METHODS: Longitudinal, multicentric observational study. We included all patients older than 16 years diagnosed with PsA in treatment with biological therapies from January 1, 2011 to December 31, 2015 treated in 6 Galician hospitals. RESULTS: Six hundred and fourpatients with PsA received biological therapies. Etanercept was the most used biological treatment. The average time of follow-up was 2.5 years and 67.9% were being treated with the first biological treatment. They were mostly patients with the peripheral subtype and met the criteria for clinical remission. Thirty-two percent had positive HLA-B27 and it was associated with axial PA subtypes. The prevalence of tuberculosis treated previously was 5.9%, and 23% of patients received chemoprophylaxis for latent tuberculosis. Twenty-four patients had undergone a prosthetic replacement. Hip prosthesis was the most frequent. Ninety-nine cases were treated for affective disorders. A diagnosis of fibromyalgia was established in 11 cases mostly women. Of the cases, 6.6% had episodes of serious infections, with respiratory infections being the most frequent. Sixteen tumours were detected (2.9%). Prostate cancer and gynaecological tumours were the most frequent. As with infections, the greater the age the greater the risk of presenting a tumour. CONCLUSIONS: We describe the epidemiological and safety characteristics in real life of a Galician multicentre cohort of patients with psoriatic arthritis under biological treatment.

Efficacy and Safety of Combined Therapy With Synthetic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Systematic Literature Review. / Eficacia y seguridad de la terapia combinada con fármacos modificadores de la enfermedad sintéticos en la artritis reumatoide: revisión sistemática de la literatura.

OBJECTIVE: 1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODS: A systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTS: Ultimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONS: These recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA.

Lipoprotein(a) concentrations in rheumatoid arthritis on biologic therapy: Results from the CARdiovascular in rheuMAtology study project.

BACKGROUND: Plasma concentrations of lipoprotein (a) (Lp(a)), a lipoprotein with atherogenic and thrombogenic properties, have a strong genetic basis, although high concentrations of Lp(a) have also been reported in the context of inflammation, as in rheumatoid arthritis (RA). Few studies evaluate the impact of biologic therapies (BT) on Lp(a) in RA, taking into account that with these new therapies a better control of inflammation is achieved. OBJECTIVE: The aim of the study was to evaluate the plasma concentrations of Lp(a) in Spanish RA patients on BT attending rheumatology outpatient clinics. METHODS: Baseline analysis of the CARdiovascular in rheuMAtology project, a 10-year prospective study, evaluating the risk of cardiovascular events in RA and other forms of inflammatory arthritis. RA patients were classified according to treatment: no biologic, anti-tumor necrosis factor, anti-interleukin-6 receptor tocilizumab (TCZ), and other biologic (rituximab or abatacept). A model of linear multivariate regression was built in which the dependent variable was Lp(a) concentration and the explanatory variable was BT. The model was adjusted for confounding factors. RESULTS: Seven hundred and seventy-five RA patients were analyzed. Plasma concentrations of total cholesterol and triglyceride were significantly higher in TCZ-treated patients. Nevertheless, no significant difference in the atherogenic index between TCZ-treated patients and patients without BT was found. After adjusting for confounding factors, patients with BT had lower concentrations of Lp(a) than those without BT; however, only TCZ-treated patients achieved statistically significant differences (ß: -0.303, 95% confidence interval: -0.558 to -0.047; P = .02). CONCLUSIONS: RA patients treated with TCZ show lower plasma concentrations of Lp(a) compared with patients without BT.

Características epidemiológicas y eventos adversos de los pacientes con artritis psoriásica en tratamiento con terapias biológicas en Galicia / Epidemiological Characteristics and Adverse Events of Patients with Psoriatic Arthritis Undergoing Treatment with Biological Therapies in Galicia

Los pacientes con formas graves de artritis psoriásica (APs) habitualmente requieren tratamiento con agentes biológicos. Un mayor conocimiento de este subgrupo de pacientes permite una mejor toma de decisiones en la práctica clínica real. Métodos: Estudio observacional retrospectivo, multicéntrico. Se incluyó a todos los pacientes mayores de 16 años diagnosticados de APs en tratamiento con terapias biológicas desde el 1 de enero de 2011 hasta el 31 de diciembre del 2015. Resultados: Recibieron terapias biológicas 604 pacientes con APs. El etanercept fue el tratamiento más utilizado. En su mayoría eran pacientes con el subtipo periférico y cumplían criterios de remisión clínica. Un 32% presentaba HLA-B27 positivo, que se asociaba a subtipos de APs axial. La prevalencia de tuberculosis tratada previa fue del 5,9% y el 23% de los pacientes recibió quimioprofilaxis por tuberculosis latente. Tuvieron sustitución protésica 24 pacientes. La prótesis de cadera fue la más frecuente. Fueron tratados por trastornos afectivos 94 casos. El diagnóstico de fibromialgia fue establecido en 11, mayormente en mujeres. El 6,6% de los casos tuvieron episodios de infecciones graves; las infecciones respiratorias fueron las más frecuentes. Se detectaron 16 tumores (2,9%). El cáncer de próstata y los tumores ginecológicos fueron los más frecuentes. Al igual que ocurría con las infecciones, a mayor edad, mayor riesgo de presentar tumor. Conclusiones:Describimos las características epidemiológicas y de seguridad en vida real de una cohorte multicéntrica gallega de pacientes con APs en tratamiento biológico.(AU)

Patients with severe forms of psoriatic arthritis (PsA) usually require treatment with biological agents. A greater knowledge of this subgroup of patients and their treatment enables better decision making in real clinical practice.MethodsLongitudinal, multicentric observational study. We included all patients older than 16 years diagnosed with PsA in treatment with biological therapies from January 1, 2011 to December 31, 2015 treated in 6 Galician hospitals. Results: Six hundred and fourpatients with PsA received biological therapies. Etanercept was the most used biological treatment. The average time of follow-up was 2.5 years and 67.9% were being treated with the first biological treatment. They were mostly patients with the peripheral subtype and met the criteria for clinical remission. Thirty-two percent had positive HLA-B27 and it was associated with axial PA subtypes. The prevalence of tuberculosis treated previously was 5.9%, and 23% of patients received chemoprophylaxis for latent tuberculosis. Twenty-four patients had undergone a prosthetic replacement. Hip prosthesis was the most frequent. Ninety-nine cases were treated for affective disorders. A diagnosis of fibromyalgia was established in 11 cases mostly women. Of the cases, 6.6% had episodes of serious infections, with respiratory infections being the most frequent. Sixteen tumours were detected (2.9%). Prostate cancer and gynaecological tumours were the most frequent. As with infections, the greater the age the greater the risk of presenting a tumour. Conclusions: We describe the epidemiological and safety characteristics in real life of a Galician multicentre cohort of patients with psoriatic arthritis under biological treatment.(AU)

Utilidad de las técnicas de imagen para el control de la actividad de la espondiloartritis / Utility of imaging techniques for monitoring disease activity in spondyloarthritis

Si bien la radiografía es la técnica de imagen de primera línea en las espondiloartritis (EspA), tanto esta como la tomografía computarizada permiten apreciar la evolución del daño estructural a medio y largo plazo, pero son insensibles para demostrar entesitis, sacroilitis, sinovitis o tenosinovitis (salvo con contraste), y su rápida modificación con el tratamiento. El uso de técnicas como la ecografía o la resonancia magnética facilitan el diagnóstico precoz, lo que permite modificar el curso de la enfermedad con tratamientos más tempranos y controlar de forma más precisa la respuesta al tratamiento, así como controlar los cambios inflamatorios a corto plazo, apoyados por los hallazgos clínicos y de laboratorio, principalmente aquellos que puedan ofrecer dudas. El uso generalizado de estas técnicas de imagen para el control de las EspA no está aceptado, por costes y falta de evidencia, pero en casos seleccionados y con la colaboración entre radiólogos y reumatólogos pueden ser sumamente importantes en la evaluación de pacientes con sospecha de actividad, y de ella depende tanto la buena evolución del paciente como el uso adecuado de los recursos. El gasto en las pruebas de diagnóstico por la imagen es importante, pero puede ayudar a aprovechar mejor los recursos en las EspA

Although radiography is the first-line imaging technique in spondyloarthritis (SpA), both radiography and computed tomography allow assessment of the progression of structural damage in the medium- and long-term. However, both have poor sensitivity in demonstrating enthesitis, sacroiliitis, synovitis and tenosynovitis (except with contrast medium) and its rapid modification with treatment. The use of techniques such as ultrasound and magnetic resonance aid early diagnosis, which allows modification of the course of the disease with earlier treatment and more precise control of treatment response by monitoring shortterm inflammatory changes and supporting clinical and laboratory findings, mainly those that may raise doubts. The generalised use of these imaging techniques to monitor SpA is not accepted, due to their costs and lack of evidence. However, in selected patients, and with collaboration between radiologists and rheumatologists, they can be extremely important in the assessment of patients with suspected activity, which is essential for both good patient outcomes and adequate resource use. Imaging tests are expensive but may help to make better use of resources in SpA

Utilidad de las técnicas de imagen en la valoración de la respuesta al tratamiento en las espondiloartritis / Utility of imaging techniques in the assessment of treatment response in spondyloarthritis

La ausencia de consenso sobre la evaluación óptima de la actividad de la espondiloartritis obstaculiza el desarrollo de un tratamiento por objetivos. Es cierto que existen medidas de respuesta, tanto para la afectación axial como para la periférica, como ASAS, BASDAI o ASDAS, DAS28 o DAPSA, basadas esencialmente en las manifestaciones clínicas. Esta medidas valoran función e inflamación aunque excluyen progresión radiográfica, por lo que parece importante el apoyo de determinadas pruebas de imagen para una valoración más objetiva del resultado. Entre ellas, las pruebas que han demostrado más utilidad son la ecografía y la resonancia magnética. La ecografía se utiliza fundamentalmente en la afectación periférica (articular, entesis y dactilitis) para evaluar inflamación y progresión radiográfica, y la resonancia fundamentalmente en la afectación axial. Por todo ello se requiere más formación para la autosuficiencia del reumatólogo en la utilización de la ecografía, así como protocolos bien establecidos con el servicio de radiología para una mejor disposición de pruebas, como la resonancia magnética

The lack of consensus on optimal assessment of disease activity in spondyloarthritis has hampered the development of targeted therapy. Although there are response measures, both for axial and peripheral involvement, such as ASAS, BASDAI or ASDAS, DAS28 or DAPSA, which are principally symptom-based and assess functional status and inflammation but exclude radiographic progression, imaging studies are an important support for more objective assessment of the results. Among them, the techniques that have been shown to be most useful are ultrasound and magnetic resonance. Ultrasound is mainly useful in peripheral involvement (joints, enthesis, dactilitis) to assess inflammation and radiological progression and magnetic resonance to assess mainly axial involvement. Consequently, more training is required for rheumatologists to be self-sufficient in the use of ultrasound, as well as well-established protocols with the radiology service for better provision of tests such as magnetic resonance

La actividad de la artritis psoriásica con afectación axial se correlaciona con el PsAID12 / The activity of psoriatic arthritis with axial involvement correlates with the PsAID12

Objetivo: Determinar el impacto de la enfermedad en pacientes con artritis psoriásica (APs) en la práctica clínica diaria, y evaluar su relación con la actividad axial.Métodos: Se realizó un estudio transversal multicéntrico en pacientes consecutivos vistos desde enero 2021 hasta diciembre 2021 que cumplieron con los criterios CASPAR, con clínica dolor lumbar inflamatorio y prueba de imagen positiva, con o sin afectación periférica. También se recogieron datos demográficos, clínicos, analíticos, índice Health Assessment Questionnaire, PsAID12 e índices de actividad axial (BASDAI y ASDAS-PCR). Se dividió a los pacientes en 2 grupos según el alto o bajo impacto del cuestionario PsAID. Las variables continuas se mostraron como mediana (Q1-Q3) y las categóricas como porcentajes y frecuencias. Resultados: Se incluyeron 72 pacientes con afectación axial de los 269 evaluados con APs, 40 varones (55,6%), con una mediana de edad de 54,1 años y duración de la enfermedad de 7 años. El 28,3% de los pacientes eran obesos y el nivel sérico de PCR fue de 0,45mg/dl (0,08-1,10). El BASDAI fue de 4,2 (2,0-6,2) y el ASDAS-PCR de 2,4 (1,5-3,2), estando en baja actividad o remisión el 39,6%. La mediana de la puntuación total de PsAID fue de 3,9 (1,6-5,4), evaluado en 61 pacientes. Los pacientes que alcanzaron un PsAID12≤4 fueron el 63%, predominantemente varones, presentaron valores de PCR menores y se asoció a una menor puntuación de BASDAI y ASDAS-PCR. Conclusiones: Los pacientes con afectación axial reflejaban un bajo impacto de la enfermedad medido por PsAID12 y este se correlacionaba con baja actividad medido por BASDAI y el ASDAS-PCR.(AU)

Objective: To determine the impact of the disease in patients with PsA in daily clinical practice and to evaluate its relationship with its axial activity. Methods: A cross-sectional study was conducted in consecutive patients attended from January 2021 to December 2021 who met the CASPAR criteria, with clinical of inflammatory back pain and positive axial imaging, with or without peripheral involvement. Demographic, clinical, analytical data, HAQ index, PsAID12 and activity index (BASDAI and ASDAS-PCR) were also collected. Patients were divided into two groups, those with high impact and those with low impact according to PsAID results. Continuous variables are shown as median (Q1-Q3) and categorical variables as percentages and frequencies. Results: Of the 269 patients evaluated with PsA, 72 patients with axial involvement were included, 40 men (55.6%), with a median age of 54.1 years and disease duration of 7 years. 28.3% of the patients were obese and serum CRP level was 0.45mg/dl (0.08-1.10). BASDAI was 4.2 (2.0-6.2) and ASDAS-PCR was 2.4 (1.5-3.2), which translates into 39.6% of patients in low activity or remission. The median PsAID total score was 3.9 (1.6–5.4), evaluated in 61 patients. The patients who achieved a PsAID12≤4 were 63%, mostly men and with lower CRP levels than PsAID≥4 patients. In addition, low impact measured by the PsAID12 was associated with low results in BASDAI and ASDAS-PCR. Conclusions: Axial involvement reflected lower impact of the disease measured by PsAID12 and it is correlated with low activity measured by BASDAI and ASDAS-PCR.(AU)

Eficacia y seguridad de los fármacos inhibidores de la interleucina-17 en la artritis psoriásica / Efficacy and safety of interleukin-17 inhibiting drugs in psoriatic arthritis

En los últimos años se ha avanzado en el entendimiento de los mecanismos patogénicos de la artritis psoriásica, dando protagonismo a citocinas implicadas en el eje interleucina (IL)-23/Th17, fundamentalmente la IL-17. Así, se han desarrollado fármacos que inhiben la acción de esta citocina de forma eficaz y segura a tenor de los resultados de los distintos ensayos clínicos realizados. Este artículo revisa la eficacia terapéutica del secukinumab, ixekizumab y brodalumab en el tratamiento de la artritis psoriásica, así como la tolerabilidad y las seguridad de estos fármacos, y que muestran los datos de los ensayos clínicos que se han comunicado en distintas publicaciones o presentado en los últimos congresos de reumatología y que demostraron que, en comparación con placebo, son eficaces para mejorar los signos y síntomas de la artritis psoriásica en pacientes con enfermedad activa a pesar del tratamiento previo con fármacos antiinflamatorios no esteroideos, fármacos reumáticos modificadores de la enfermedad o inhibidores del factor de necrosis tumoral alfa. Aunque será la práctica clínica la que dirá a medio y largo plazo cuál es su sitio en el arsenal terapéutico de la artritis psoriásica, los datos clínicos actuales son muy prometedores

In recent years, our understanding of the pathogenic mechanisms of psoriatic arthritis (PsA) has improved, lending prominence to cytokines involved in the interleukin-23 (IL-23)/Th17 axis, basically IL-17. Consequently, drugs have been developed that effectively and safely inhibit the action of that cytokine, as demonstrated by the results of the various clinical trials carried out. This article reviews the therapeutic efficacy of secukinumab, ixekizumab and brodalumab in the treatment of PsA, in addition to the tolerability and safety of these agents. We provide the data of the clinical trials reported in different publications or presented at the latest rheumatology meetings, that reveal their efficacy, as compared to placebo, in improving the signs and symptoms of PsA in patients with active disease, despite previous treatment with nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs or tumor necrosis factor a inhibitors. The findings in clinical practice over the medium and long term will indicate their place in the therapeutic arsenal of PsA. However, the clinical data at this time are very promising

Índice de fibrosis hepática 4: uso en la evaluación de la enfermedad del hígado graso no alcohólico en pacientes con artritis psoriásica / Liver fibrosis 4 score: Use in the evaluation of non-alcoholic fatty liver disease in patients with psoriatic arthritis

Objetivos: Describir la prevalencia de la enfermedad del hígado graso no alcohólico (EHGNA), la asociación entre el índice de fibrosis hepática 4 (FIB4) y los hallazgos en la ecografía y las características clínicas de los pacientes con artritis psoriásica. Material y métodos: Estudio transversal observacional de todos los pacientes con artritis psoriásica vistos de forma consecutiva en consulta desde el 01/01/2020 hasta el 30/11/2020. Resultados: De los 90 pacientes estudiados, la prevalencia de EHGNA fue del 56,67%. EL FIB4 presenta asociación con la ecografía (p=0,030), la ausencia de entesitis (p=0,036) y la mayor duración de la enfermedad (Rho 0,213, p=0,042). También con la presencia de hipertensión (p=0,027) y el consumo de alcohol (p=0,021). Sin embargo, el tratamiento biológico puede considerarse como un factor protector (p=0,005). El FIB4 actúa como predictor de EHGNA con una sensibilidad del 69,2% y una especificidad del 70,4%. Conclusiones: La prevalencia de EHGNA fue superior a la población general. El índice FIB4 puede ser una herramienta válida en el cribado de EHGNA en nuestra práctica clínica diaria.(AU)

Objectives: To describe the prevalence of non-alcoholic fatty liver disease (NAFLD), the association between Liver fibrosis 4 score (FIB4) and ultrasound findings, and the clinical characteristics of psoriatic arthritis patients. Material and methods: We carried out an observational cross-sectional study of patients seen in the outpatient clinic from January 1st, 2020, to November 30th, 2020, with psoriatic arthritis. Results: Of the 90 patients studied, the prevalence of NAFLD was 56.67%. FIB4 presents an association with ultrasound findings (p=.030), the absence of enthesitis (p=.036), and longer duration of disease (Rho .213 p=.042). It also presents an association with hypertension (p=.027) and alcohol consumption (p=.021). However, biological treatment can be considered as a protective factor (p=.005). FIB4 acts as a NAFLD predictor with 69.2% sensitivity and 70.4% specificity.Conclusion: The prevalence of NAFLD was higher in our sample than in the standard population. FIB4 index may be useful in screening for silent liver damage in psoriatic arthritis in clinical practice.(AU)

Eficacia y seguridad de la terapia combinada con fármacos modificadores de la enfermedad sintéticos en la artritis reumatoide: revisión sistemática de la literatura / Efficacy and safety of combined therapy with synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: systematic literature review

OBJETIVO: 1) Revisar sistemática y críticamente la evidencia sobre eficacia y seguridad de la terapia combinada con fármacos modificadores de la enfermedad (FAME) sintéticos en la artritis reumatoide (AR); 2) Emitir recomendaciones prácticas sobre su uso. MÉTODOS: Se realizó una revisión sistemática de la literatura con una estrategia de búsqueda bibliográfica sensible en Medline, Embase y Cochrane Library. Se seleccionaron ensayos clínicos aleatorizados que analizasen la eficacia y/o seguridad de 1) la terapia combinada con FAME sintéticos comparada con la terapia secuencial con FAME sintético en la AR de inicio; y 2) la combinación metotrexato+leflunomida o la triple terapia de FAME sintéticos en la AR establecida refractaria a FAME sintéticos. Dos revisores realizaron la primera selección por título y abstract y 11 la selección tras lectura en detalle y la recogida de datos. La calidad se evaluó con la escala de Jadad. En una reunión de grupo nominal en base sus resultados se consensuaron una serie de recomendaciones. RESULTADOS: Finalmente no se incluyó ningún artículo en la RSL. Del análisis de los artículos revisados se encontró la eficacia en las AR de inicio del tratamiento precoz con FAME sintéticos siguiendo una estrategia «treat to target» y en AR establecidas refractarias a FAME sintéticos la de la terapia combinada con FAME sintéticos. Con ello se generaron 5 recomendaciones sobre la terapia combinada con FAME sintéticos. CONCLUSIONES: Estas recomendaciones pretenden facilitar la toma de decisiones con el uso de la terapia combinada con FAME sintéticos en la AR

OBJECTIVE: 1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODS: A systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTS: Ultimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONS: These recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA