The predictors of paradoxical reactions, especially psoriasis, to biologic therapy-findings from the TReasure database: a 5-year follow-up study.

OBJECTIVES: The objectives of this study were to assess the clinical characteristics, predictive factors, and practical algorithms of paradoxical reactions (PRs), specifically paradoxical psoriasis (PP). METHODS: The TReasure database is a web-based prospective observational cohort comprised of patients with RA and SpA from 17 centres around Turkey since 2017. A cohort study and a case-control study nestled within the cohort were identified. RESULTS: In total, 2867 RA and 5316 SpA patients were evaluated. The first biologic agent was found to have caused PRs in 60% of the 136 patients (1.66%) who developed the PRs. The median time interval between the PRs and biological onset was 12 months (range 1-132 months, mean 21 months). The most common types of PP, constituting 92.6% of PRs, were pustular (60.3%) and palmoplantar (30.9%). Adalimumab (30.9%), infliximab (19%) and etanercept (17.4%) were the most common agents causing the PP. In the treatment of most PP patients (73.2%), switching biologic agents was favoured, with TNF inhibitor (TNFi) chosen in 46.03% and non-TNFi in 26.9% of cases. The three most frequently selected drugs were etanercept (24.6%), secukinumab (9.5%) and adalimumab (8.7%). Only 5.17% of patients who switched to another TNFi showed progression. The odds ratios (s) for SSZ, HCQ, and LEF use were significantly higher in RA controls than in PP patients (P = 0.033, OR = 0.15; P = 0.012, OR = 0.15; and P = 0.015, OR = 0.13, respectively). In the PP group with SpA, the number of smokers was significantly higher (P = 0.003, OR: 2.0, 95% CI: 1.05, 3.81). CONCLUSION: Contrary to expectations based on earlier research suggesting that paradoxical reactions develop with the class effect of biological agents, the response of patients who were shifted to another TNFi was favourable.

The reliability, validity, and responsiveness of Cognitive Exercise Therapy Approach: Biopsychosocial Questionnaire for patients with psoriatic arthritis.

Although the importance of the biopsychosocial model that aims the optimum treatment is emphasized in the literature, there is a lack of scales that evaluate individuals with PsA in a multi-dimensional way, including all areas of influence. This study aimed to determine the validity, reliability, and responsiveness of the Cognitive Exercise Therapy Approach-Biopsychosocial Questionnaire (BETY-BQ) in individuals diagnosed with Psoriatic Arthritis (PsA). Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL), Health Assessment Questionnaire, Hospital Anxiety and Depression Scale, and Short Form-36 were used for the validity of the BETY-BQ. For scale reliability, the test-retest method was performed, Intraclass Correlation Coefficient (ICC) was calculated, and Cronbach's alpha (α) coefficient was checked for internal consistency. For the responsiveness of the scale, all scales were re-applied with 3 months intervals. The correlations of BETY-BQ with the other scales were found medium to very high. ICC was analyzed to compare the reliability of the test-retest results and it was found to be excellent. Cronbach's α value was found to be 0.940 which showed an excellent internal consistency. The time-dependent change sensitivity of BETY-BQ was found to be highly correlated with the PsA-specific scale, the PsAQoL questionnaire. BETY-BQ was determined as a valid, reliable, and sensitive assessment tool that health professionals can use in individuals with PsA diagnosis. In this study, a scale that will reveal the biopsychosocial responses of individuals with PsA to pharmacological and non-pharmacological treatments was presented to the literature.

Spinal and cerebral hematoma in systemic lupus erythematosus and antiphospholipid syndrome: is drug interaction the culprit?

OBJECTIVES: Thrombotic events are common in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Warfarin is the most commonly used anticoagulant drug for thrombosis treatment, but it is can interact with many drugs, foods, or medicinal herbs. Herein, we presented a case with SLE and APS who was complicated by spinal and cerebral hematoma as a result of warfarin interaction. CASE PRESENTATION: Spinal subdural hematoma and frontal intraparenchymal hematoma were occurred in our patient, who was in remission for 2 years with rituximab, hydroxychloroquine and warfarin. We learned that she had been using some herbal products (shepherd's purse and horsetail) and phenyramidol for a few days. Spinal and cerebral hematomas caused by the interaction of phenyramidol and warfarin were treated with fresh frozen plasma and vitamin K without the need for surgery. CONCLUSIONS: The drug interactions with warfarin can cause fatal hemorrhagic or thrombotic events. Especially, the patients with SLE and/or APS using warfarin should be warned not to use different medications or herbal agents.