Management of Nail Disease in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.

OBJECTIVE: Nail psoriasis is common, impairs fine motor finger functioning, affects cosmesis, and is associated with a lower quality of life. This review updates the previous Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for nail psoriasis. METHODS: This systematic literature review of the PubMed, MEDLINE, Embase, and Cochrane databases examined the updated evidence since the last GRAPPA nail psoriasis treatment recommendations published in 2014. Recommendations are based on preformed PICO (Patient/Population - Intervention - Comparison/Comparator - Outcome) questions formulated by an international group of dermatologists, rheumatologists, and patient panel members. Data from this literature review were evaluated in line with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. RESULTS: Overall, there is insufficient evidence to make any recommendation for the use of topical corticosteroids, topical calcipotriol, topical tazarotene, topical cyclosporine, dimethyl fumarates/fumaric acid esters, phototherapy, and alitretinoin. There is a low strength of evidence to support the use of calcipotriol and corticosteroid preparations, topical tacrolimus, oral cyclosporine, oral methotrexate, intralesional corticosteroids, pulsed dye laser, acitretin, Janus kinase inhibitors, and apremilast. CONCLUSION: The highest strength of supporting evidence is for the recommendation of biologic agents including tumor necrosis factor inhibitors, and interleukin 12/23, 17, and 23 inhibitors.

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021.

Since the second version of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations were published in 2015, therapeutic options for psoriatic arthritis (PsA) have advanced considerably. This work reviews the literature since the previous recommendations (data published 2013-2020, including conference presentations between 2017 and 2020) and reports high-quality, evidence-based, domain-focused recommendations for medication selection in PsA developed by GRAPPA clinicians and patient research partners. The overarching principles for the management of adults with PsA were updated by consensus. Principles considering biosimilars and tapering of therapy were added, and the research agenda was revised. Literature searches covered treatments for the key domains of PsA: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail psoriasis; additional searches were performed for PsA-related conditions (uveitis and inflammatory bowel disease) and comorbidities. Individual subcommittees used a GRADE-informed approach, taking into account the quality of evidence for therapies, to generate recommendations for each of these domains, which were incorporated into an overall schema. Choice of therapy for an individual should ideally address all disease domains active in that patient, supporting shared decision-making. As safety issues often affect potential therapeutic choices, additional consideration was given to relevant comorbidities. These GRAPPA treatment recommendations provide up-to-date, evidence-based guidance on PsA management for clinicians and people with PsA.

Assessing hip abduction and adduction strength: can greater segmental fixation enhance the reproducibility?

OBJECTIVE: To improve the reproducibility of testing hip abduction and adduction using an isokinetic dynamometer by a novel testing protocol. DESIGN: Test-retest design. SETTING: Biodynamics laboratory. PARTICIPANTS: Fifteen healthy subjects (9 men, 6 women; age, 22.4+/-0.5 y) were recruited. INTERVENTIONS: Two setups were compared: the first according to manufacturer's guidelines (setup A) and the second a novel setup incorporating pelvic fixation (setup B). Setups A and B were performed in a random order. Both setups included the same battery of isokinetic (30 degrees/s, 60 degrees/s) and isometric tests, and were repeated 1 week later. MAIN OUTCOME MEASURES: The peak torque for each abduction and adduction exercise was noted and pelvic motion during testing was recorded. RESULTS: Setup B significantly (P<.05) reduced transverse pelvic rotation by between 7.5 degrees and 8.0 degrees dependent on test speed. Mean differences for reproducibility of peak torque, ranged from 0.8 to 11.7 Nm. The coefficients of repeatability of both setups were similar, ranging from 21.4 to 56.3 Nm across isokinetic exercises. A similar observation was noted for isometric exercises, with the differences between the coefficients of repeatability ranging from 18.6 to 40.0 Nm. CONCLUSIONS: Reducing pelvic rotation does not enhance reproducibility of the system and is not related to torque production. Further research is required to determine the optimal test setup.