Impact of Baricitinib on Patients' Quality of Life after One Year of Treatment for Atopic Dermatitis in Real-World Practice: Results of the Observatory of Chronic Inflammatory Skin Diseases Registry.

The efficacy and safety of baricitinib for treatment of atopic dermatitis have been demonstrated in clinical trials; however, very few real-life studies have been published to date. The Observatory of Chronic Inflammatory Skin Diseases (OMCCI) registry was initiated to prospectively determine the long-term impairment caused by chronic inflammatory dermatoses on patients' lives. The study included 88 patients starting baricitinib for treatment of atopic dermatitis. Clinical evaluation and patient-reported outcomes were recorded at baseline and after 6 and 12 months. After 6 months and 1 year of follow-up, 65 and 47 patients, respectively, were still being treated with baricitinib. Treatment failure was the main reason for discontinuation. Only 1 patient stopped baricitinib because of a side-effect. After 1 year of follow-up, the mean Eczema Area and Severity Index score decreased significantly from 20.7 to 6.4; the percentage of patients with severe atopic dermatitis decreased from 42.9% to 6.5% and a significant improvement in most patient-reported outcomes was noted. There was no difference in terms of efficacy whether or not patients were previously treated with dupilumab. The results remained stable after 6 and 12 months of treatment, which suggests a sustained efficacy of the treatment in patients who initially responded well.

Long-term topical management of psoriasis: the road ahead.

Topical therapies have been available for the treatment of psoriasis for several decades. Despite this and the availability of several types of topicals, with varying potency, and numerous vehicles of administration, the majority of clinical data and guidance is on short-term use in the management of psoriasis. The aim of this manuscript is to review the unmet needs that exist in the long-term management of psoriasis and provide the dermatology community with an understanding that a treatment regimen with topical therapies could be the best treatment option at least for some phases of this chronic relapsing disease. We present a 'call to action' on the need for clinical alignment on terminology in the field and recommend the term 'long-term management' be adopted as the most appropriate in the context of this manuscript. This expert opinion report provides a detailed review of the limited evidence available regarding long-term use of topical therapies for the management of psoriasis, alongside our key considerations and recommendations to assist dermatologists with the implementation of topicals as part of long-term management strategies. Long-term management should be considered mandatory to ensure patients receive appropriate proactive treatment which may help optimize adherence and long-term outcomes.

[Psoriatic arthritis, a difficult diagnosis due to clinical polymorphism]. / Rhumatisme psoriasique, un diagnostic difficile du fait du polymorphisme clinique.

Psoriatic arthritis, a difficult diagnosis due to clinical polymorphism. Psoriatic arthritis (PsA) is a chronic inflammatory spondyloarthritis that occurs in combination with psoriasis. The prevalence is similar to rheumatoid arthritis. The diagnosis is difficult because the disease is heterogeneous, involving skin, nails and different musculoskeletal structures. There are no pathognomonic serological marker. Psoriasis usually appears 5-10 years before PsA, although some patients presents with PsA without psoriasis. TNF inhibitors (tumor necrosis factor: biological agents) have revolutionized therapy for PsA; there are effective against all disease characteristics, however not all patients achieve clinically meaningful responses and some may respond initially but lose treatment responses over time. With a better understanding of immunological mechanisms underlying psoriasis and PsA, new therapies have been developed to target specific components of the inflammatory pathway. IL17-17A and IL23 inhibitors agents (Th 17-IL17A pathway) has been shown to be efficacious. PsA is associated with a premature mortality, increased cardio vascular morbidity, obesity, metabolic syndrome. Collaboration between rheumatologist, dermatologist and general practitioner for the evaluation of morbidities, is be necessary in managing patients with PsA.

Rhumatisme psoriasique, un diagnostic du fait du polymorphisme clinique. Le rhumatisme psoriasique appartient au groupe des spondyloarthrites dont la prévalence est proche de celle de la polyarthrite rhumatoïde. Son diagnostic est difficile en raison d'une grande hétérogénéité clinique et de l'absence de marqueur biologique spécifique. L'atteinte rhumatologique se développe le plus souvent dans les 5 à 10 ans qui suivent l'apparition des lésions cutanées de psoriasis. Les biothérapies avec les anti-tumornecrosis factor alpha (anti-TNF alpha) ont révolutionné sa prise en charge thérapeutique. Les avancées récentes dans la physiopathologie de la maladie, dont le rôle de la voie IL23/Th17 dans le développement du psoriasis mais aussi du rhumatisme psoriasique, ont permis le développement de nouveaux traitements. Par ailleurs, il existe au cours du rhumatisme psoriasique une surmortalité, une fréquence augmentée des complications cardiovasculaires, du syndrome métabolique et de la surcharge pondérale. La prise en charge du rhumatisme psoriasique est pluridisciplinaire, rhumatologique et dermatologique, en lien avec le médecin généraliste pour la prise en charge des facteurs de comorbidités.