ATLANTA – About 10%-25% of patients with epithelial growth factor receptor–(EGFR) mutant non–small cell lung cancer (NSCLC) have tumors with either MET amplification or another MET-based mechanism that leads to drug resistance.

In the TATTON trial, investigators are evaluating a combination of the EGFR-targeted tyrosine kinase inhibitor (TKI) osimertinib (Tagrisso) with savolitinib, an investigational MET inhibitor, for safety and activity against MET-driven NSCLC in patients with disease that has progressed on one or more prior EGFR-targeted agents.

In a video interview at the annual meeting of the American Association for Cancer Research, Lecia Sequist, MD, from the Massachusetts General Hospital Cancer Center in Boston, discusses early results with the osimertinib/savolitinib combination in patients with disease progression after a first and/or second-generation EGFR TKI, or after a third-generation agent.

Dr. Sequist said results of TATTON suggest that it may be possible to overcome MET-driven drug-resistance mechanisms.

The TATTON trial is sponsored by AstraZeneca. Dr. Sequist reported serving as an advisory board member and receiving research support and honoraria from the company.

ATLANTA – About 10%-25% of patients with epithelial growth factor receptor–(EGFR) mutant non–small cell lung cancer (NSCLC) have tumors with either MET amplification or another MET-based mechanism that leads to drug resistance.

In the TATTON trial, investigators are evaluating a combination of the EGFR-targeted tyrosine kinase inhibitor (TKI) osimertinib (Tagrisso) with savolitinib, an investigational MET inhibitor, for safety and activity against MET-driven NSCLC in patients with disease that has progressed on one or more prior EGFR-targeted agents.

In a video interview at the annual meeting of the American Association for Cancer Research, Lecia Sequist, MD, from the Massachusetts General Hospital Cancer Center in Boston, discusses early results with the osimertinib/savolitinib combination in patients with disease progression after a first and/or second-generation EGFR TKI, or after a third-generation agent.

Dr. Sequist said results of TATTON suggest that it may be possible to overcome MET-driven drug-resistance mechanisms.

The TATTON trial is sponsored by AstraZeneca. Dr. Sequist reported serving as an advisory board member and receiving research support and honoraria from the company.

ATLANTA – About 10%-25% of patients with epithelial growth factor receptor–(EGFR) mutant non–small cell lung cancer (NSCLC) have tumors with either MET amplification or another MET-based mechanism that leads to drug resistance.

In the TATTON trial, investigators are evaluating a combination of the EGFR-targeted tyrosine kinase inhibitor (TKI) osimertinib (Tagrisso) with savolitinib, an investigational MET inhibitor, for safety and activity against MET-driven NSCLC in patients with disease that has progressed on one or more prior EGFR-targeted agents.

In a video interview at the annual meeting of the American Association for Cancer Research, Lecia Sequist, MD, from the Massachusetts General Hospital Cancer Center in Boston, discusses early results with the osimertinib/savolitinib combination in patients with disease progression after a first and/or second-generation EGFR TKI, or after a third-generation agent.

Dr. Sequist said results of TATTON suggest that it may be possible to overcome MET-driven drug-resistance mechanisms.

The TATTON trial is sponsored by AstraZeneca. Dr. Sequist reported serving as an advisory board member and receiving research support and honoraria from the company.

ATLANTA – Sarcomas of bone and soft tissues are considered to be “antigenically cold” tumors, with few identifiable mutations that may be susceptible to targeted therapies.

Some sarcoma subtypes such as osteosarcoma and rhabomyosarcoma, however, frequently express the human epidermal growth factor receptor 2 on tumor surfaces. Although HER2 expression in these tumors is at too low a level for HER2-targeted therapies such as trastuzumab (Herceptin), HER2 appears to be an opportunistic target for chimeric antigen receptor (CAR) T-cell therapy, according to Shoba Navai, MD, from Baylor College of Medicine, Houston.

In a video interview at the 2019 annual meeting of the American Association for Cancer Research, Dr. Navai describes her team’s early experience using a HER2-targeted CAR-T cell construct and preinfusion lymphodepletion in patients with advanced sarcomas.

Development of the CAR-T cell construct is supported by the Cancer Prevention & Research Institute of Texas, Stand Up to Cancer, the St. Baldrick’s Foundation, Cookies for Kids’ Cancer, Alex’s Lemonade Stand, and a grant from the National Institutes of Health. Dr. Navai reported having no disclosures.

ATLANTA – Sarcomas of bone and soft tissues are considered to be “antigenically cold” tumors, with few identifiable mutations that may be susceptible to targeted therapies.

Some sarcoma subtypes such as osteosarcoma and rhabomyosarcoma, however, frequently express the human epidermal growth factor receptor 2 on tumor surfaces. Although HER2 expression in these tumors is at too low a level for HER2-targeted therapies such as trastuzumab (Herceptin), HER2 appears to be an opportunistic target for chimeric antigen receptor (CAR) T-cell therapy, according to Shoba Navai, MD, from Baylor College of Medicine, Houston.

In a video interview at the 2019 annual meeting of the American Association for Cancer Research, Dr. Navai describes her team’s early experience using a HER2-targeted CAR-T cell construct and preinfusion lymphodepletion in patients with advanced sarcomas.

Development of the CAR-T cell construct is supported by the Cancer Prevention & Research Institute of Texas, Stand Up to Cancer, the St. Baldrick’s Foundation, Cookies for Kids’ Cancer, Alex’s Lemonade Stand, and a grant from the National Institutes of Health. Dr. Navai reported having no disclosures.

ATLANTA – Sarcomas of bone and soft tissues are considered to be “antigenically cold” tumors, with few identifiable mutations that may be susceptible to targeted therapies.

Some sarcoma subtypes such as osteosarcoma and rhabomyosarcoma, however, frequently express the human epidermal growth factor receptor 2 on tumor surfaces. Although HER2 expression in these tumors is at too low a level for HER2-targeted therapies such as trastuzumab (Herceptin), HER2 appears to be an opportunistic target for chimeric antigen receptor (CAR) T-cell therapy, according to Shoba Navai, MD, from Baylor College of Medicine, Houston.

In a video interview at the 2019 annual meeting of the American Association for Cancer Research, Dr. Navai describes her team’s early experience using a HER2-targeted CAR-T cell construct and preinfusion lymphodepletion in patients with advanced sarcomas.

Development of the CAR-T cell construct is supported by the Cancer Prevention & Research Institute of Texas, Stand Up to Cancer, the St. Baldrick’s Foundation, Cookies for Kids’ Cancer, Alex’s Lemonade Stand, and a grant from the National Institutes of Health. Dr. Navai reported having no disclosures.

The Food and Drug Administration has approved cladribine (Mavenclad) tablets to treat adult patients with relapsing forms of multiple sclerosis (MS), including relapsing/remitting and active secondary progressive disease.

The drug’s manufacturer, EMD Serono, said in a press release that cladribine is the first short-course oral therapy for such patients, and its use is generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate drug indicated for the treatment of MS. Cladribine is not recommended for use in patients with clinically isolated syndrome.

The agency’s decision is based on results from a clinical trial of 1,326 patients with relapsing MS who had experienced at least one relapse in the previous 12 months. Patients who received cladribine had significantly fewer relapses than did those who received placebo; the progression of disability was also significantly reduced in the cladribine group, compared with placebo, according to the FDA’s announcement.

The most common adverse events associated with cladribine include upper respiratory tract infections, headache, and decreased lymphocyte counts. In addition, the medication must be dispensed with a patient medication guide because the label includes a boxed warning for increased risk of malignancy and fetal harm. Other warnings include a risk for decreased lymphocyte count, hematologic toxicity and bone marrow suppression, and graft-versus-host-disease.

“We are committed to supporting the development of safe and effective treatments for patients with multiple sclerosis. The approval of Mavenclad represents an additional option for patients who have tried another treatment without success,” Billy Dunn, MD, director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research, said in the announcement.

The approved dose of cladribine is 3.5 mg/kg body weight over 2 years, administered as one treatment course of 1.75 mg/kg per year, each consisting of 2 treatment weeks. Additional courses of cladribine are not to be administered because retreatment with cladribine during years 3 and 4 may further increase the risk of malignancy. The safety and efficacy of reinitiating cladribine more than 2 years after completing two treatment courses has not been studied, according to EMD Serono.

Cladribine is approved in more than 50 other countries and was approved for use in the European Union in August 2017.

lfranki@mdedge.com

The Food and Drug Administration has approved cladribine (Mavenclad) tablets to treat adult patients with relapsing forms of multiple sclerosis (MS), including relapsing/remitting and active secondary progressive disease.

The drug’s manufacturer, EMD Serono, said in a press release that cladribine is the first short-course oral therapy for such patients, and its use is generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate drug indicated for the treatment of MS. Cladribine is not recommended for use in patients with clinically isolated syndrome.

The agency’s decision is based on results from a clinical trial of 1,326 patients with relapsing MS who had experienced at least one relapse in the previous 12 months. Patients who received cladribine had significantly fewer relapses than did those who received placebo; the progression of disability was also significantly reduced in the cladribine group, compared with placebo, according to the FDA’s announcement.

The most common adverse events associated with cladribine include upper respiratory tract infections, headache, and decreased lymphocyte counts. In addition, the medication must be dispensed with a patient medication guide because the label includes a boxed warning for increased risk of malignancy and fetal harm. Other warnings include a risk for decreased lymphocyte count, hematologic toxicity and bone marrow suppression, and graft-versus-host-disease.

“We are committed to supporting the development of safe and effective treatments for patients with multiple sclerosis. The approval of Mavenclad represents an additional option for patients who have tried another treatment without success,” Billy Dunn, MD, director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research, said in the announcement.

The approved dose of cladribine is 3.5 mg/kg body weight over 2 years, administered as one treatment course of 1.75 mg/kg per year, each consisting of 2 treatment weeks. Additional courses of cladribine are not to be administered because retreatment with cladribine during years 3 and 4 may further increase the risk of malignancy. The safety and efficacy of reinitiating cladribine more than 2 years after completing two treatment courses has not been studied, according to EMD Serono.

Cladribine is approved in more than 50 other countries and was approved for use in the European Union in August 2017.

lfranki@mdedge.com

The Food and Drug Administration has approved cladribine (Mavenclad) tablets to treat adult patients with relapsing forms of multiple sclerosis (MS), including relapsing/remitting and active secondary progressive disease.

The drug’s manufacturer, EMD Serono, said in a press release that cladribine is the first short-course oral therapy for such patients, and its use is generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate drug indicated for the treatment of MS. Cladribine is not recommended for use in patients with clinically isolated syndrome.

The agency’s decision is based on results from a clinical trial of 1,326 patients with relapsing MS who had experienced at least one relapse in the previous 12 months. Patients who received cladribine had significantly fewer relapses than did those who received placebo; the progression of disability was also significantly reduced in the cladribine group, compared with placebo, according to the FDA’s announcement.

The most common adverse events associated with cladribine include upper respiratory tract infections, headache, and decreased lymphocyte counts. In addition, the medication must be dispensed with a patient medication guide because the label includes a boxed warning for increased risk of malignancy and fetal harm. Other warnings include a risk for decreased lymphocyte count, hematologic toxicity and bone marrow suppression, and graft-versus-host-disease.

“We are committed to supporting the development of safe and effective treatments for patients with multiple sclerosis. The approval of Mavenclad represents an additional option for patients who have tried another treatment without success,” Billy Dunn, MD, director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research, said in the announcement.

The approved dose of cladribine is 3.5 mg/kg body weight over 2 years, administered as one treatment course of 1.75 mg/kg per year, each consisting of 2 treatment weeks. Additional courses of cladribine are not to be administered because retreatment with cladribine during years 3 and 4 may further increase the risk of malignancy. The safety and efficacy of reinitiating cladribine more than 2 years after completing two treatment courses has not been studied, according to EMD Serono.

Cladribine is approved in more than 50 other countries and was approved for use in the European Union in August 2017.

lfranki@mdedge.com

Click here to read supplement.

Gene therapy is a contemporary therapeutic intervention with recent positive results and regulatory approvals either completed or expected in the next several years for various con­ditions. In this supplement, learn more about:

• Basic principles of gene therapy
• In vivo vs ex vivo methods of gene transfer
• Vector types
• Clinical Considerations

About the Author

Click here to read supplement.

Click here to read supplement.

Gene therapy is a contemporary therapeutic intervention with recent positive results and regulatory approvals either completed or expected in the next several years for various con­ditions. In this supplement, learn more about:

• Basic principles of gene therapy
• In vivo vs ex vivo methods of gene transfer
• Vector types
• Clinical Considerations

About the Author

Click here to read supplement.

Click here to read supplement.

Gene therapy is a contemporary therapeutic intervention with recent positive results and regulatory approvals either completed or expected in the next several years for various con­ditions. In this supplement, learn more about:

• Basic principles of gene therapy
• In vivo vs ex vivo methods of gene transfer
• Vector types
• Clinical Considerations

About the Author

Click here to read supplement.

The PA Section steering committee has been hard at work developing session programming for the 2019 Vascular Annual Meeting. Vascular PAs can look forward to a four-hour session on Thursday, June 13, completely dedicated to them. The program will focus on a variety of topics that include optimal team practice, vascular diagnostics, venous disease and wound management, an “Ask the Expert” portion and much more. Know a vascular PA who needs to become an SVS member? Encourage them to apply today.

The PA Section steering committee has been hard at work developing session programming for the 2019 Vascular Annual Meeting. Vascular PAs can look forward to a four-hour session on Thursday, June 13, completely dedicated to them. The program will focus on a variety of topics that include optimal team practice, vascular diagnostics, venous disease and wound management, an “Ask the Expert” portion and much more. Know a vascular PA who needs to become an SVS member? Encourage them to apply today.

The PA Section steering committee has been hard at work developing session programming for the 2019 Vascular Annual Meeting. Vascular PAs can look forward to a four-hour session on Thursday, June 13, completely dedicated to them. The program will focus on a variety of topics that include optimal team practice, vascular diagnostics, venous disease and wound management, an “Ask the Expert” portion and much more. Know a vascular PA who needs to become an SVS member? Encourage them to apply today.

The SVS is excited to announce that within your online community, SVSConnect, there will be an “Ask Us Anything” session at 2 p.m. CDT on April 8. Drs. Daniel McDevitt and William Shutze will be available in real time to answer questions about building relationships in a competitive environment. SVSConnect users will be able to chime in during the session to ask them anything. If you can’t make it to the live Q&A on April 8, all the questions and responses will be available in the SVSConnect library. More information will come soon.

The SVS is excited to announce that within your online community, SVSConnect, there will be an “Ask Us Anything” session at 2 p.m. CDT on April 8. Drs. Daniel McDevitt and William Shutze will be available in real time to answer questions about building relationships in a competitive environment. SVSConnect users will be able to chime in during the session to ask them anything. If you can’t make it to the live Q&A on April 8, all the questions and responses will be available in the SVSConnect library. More information will come soon.

The SVS is excited to announce that within your online community, SVSConnect, there will be an “Ask Us Anything” session at 2 p.m. CDT on April 8. Drs. Daniel McDevitt and William Shutze will be available in real time to answer questions about building relationships in a competitive environment. SVSConnect users will be able to chime in during the session to ask them anything. If you can’t make it to the live Q&A on April 8, all the questions and responses will be available in the SVSConnect library. More information will come soon.

Every ob.gyn. expects that the topic of gender will come up at some point in a patient’s pregnancy. “When will I find out the gender?” asks the 24-year-old at her first prenatal visit. “We want the gender to be a surprise!” exclaims the couple at their anatomy scan for their second in vitro fertilization pregnancy. “Do you know what you’re having?” asks the obstetrician anticipating an imminent delivery.

gorodenkoff/Getty Images

The topic of gender is in fact so ingrained in our practice that we don’t bat an eye when approached with questions about fetal gender. But what exactly are we talking about when we discuss the gender of an unborn baby?

As we established in our previous column, gender identity is an internal experience of gender that one feels to be a part of oneself. Gender identity is distinct from sex assigned at birth because sex assigned at birth is based on an external anatomical structure. So, then, what does an ultrasound actually reveal? Objectively, ultrasound can show the provider the presence or absence of a hyperechoic anatomical structure between the fetal legs that may become a penis, a vagina, or an ambiguous form of genitalia. While ultrasound is an incredible tool for anatomical and other forms of antenatal testing, ultrasound cannot detect identity characteristics because identities are, by definition, socially and internally experienced without respect to anatomy.

The distinction between gender identity and sex assigned at birth in discussions of antenatal ultrasonography is more than just a simple problem of semantics or vocabulary. To describe a fetus as a boy or a girl based on the presence/absence of a projection between the fetal legs seen on ultrasound is to reinforce the idea that gender identity and sex assigned at birth are equivalent. This conflation also erases nonbinary, genderqueer, and many other groups that identify with genders other than “boy” or “girl.” To be clear, unborn fetuses do not have a gender identity. Studies have shown that children begin to self-label their gender as early as 18-24 months of age, and similarly those who grow up to inhabit gender-nonconforming identities usually already are starting to show signs of their nonconformity starting at age 2 years.¹ Some of the deepest traumas that trans and gender-nonconforming people experience are rated to the enforcement of unwritten gender laws during early childhood that are applied based on the sex assigned at birth.

Obstetricians can help to break the cycle of inappropriate gender assignment by correctly using the terms “gender” and “sex assigned at birth.” One opportunity for addressing patients’ questions about fetal gender might be to avoid the term “gender” altogether when discussing fetal sex assigned at birth, emphasizing instead what fetal ultrasound is actually able to do: Give us information about the appearance of external genitalia to help predict what sex will be assigned at birth.² We have used this strategy when performing anatomy scans, and our experience has been that patients often will make their own assumptions about what it means to see certain external genitalia on ultrasound between the fetal legs. Motivated providers who want to go the extra mile may use a patient’s exclamation about their understanding of the fetus’s gender as an opportunity to educate the patient on the distinction between gender and sex assigned at birth, but even just smiling and moving onto the next part of the scan is an appropriate way of maintaining an atmosphere of inclusion and respect.

One of the roots of gender-based violence and gender dysphoria later in life is the conflation of gender and sex assigned at birth. While there is an entire social and political framework that enforces and polices gender after birth, the obstetrician can take steps to break the cycle starting before the birth has even occurred. Obstetricians are tasked with the unique challenge of providing care for the mother-fetus dyad, and much of the work is in setting up the fetus for the best possible life. Our scope of inclusion should be sufficiently wide to account for nonanatomical variations that could develop later in life in the infants we deliver.

Dr. Bahng is a PGY-1 resident physician in the gynecology & obstetrics residency program at Emory University, Atlanta. Dr. Bahng identifies as nonbinary and uses they/them/their as their personal pronouns. Dr. Joyner is an assistant professor at Emory University and is the director of gynecologic services in the Gender Center at Grady Memorial Hospital in Atlanta. Dr. Joyner identifies as a cisgender female and uses she/hers/her as her personal pronouns. Dr. Bahng and Dr. Joyner reported no financial disclosures.

References

1. Horm Behav. 2013 Jul;64(2):288-97.

2. Obstet Gynecol Surv. 2009 Jan;64(1):50-7.

Every ob.gyn. expects that the topic of gender will come up at some point in a patient’s pregnancy. “When will I find out the gender?” asks the 24-year-old at her first prenatal visit. “We want the gender to be a surprise!” exclaims the couple at their anatomy scan for their second in vitro fertilization pregnancy. “Do you know what you’re having?” asks the obstetrician anticipating an imminent delivery.

gorodenkoff/Getty Images

The topic of gender is in fact so ingrained in our practice that we don’t bat an eye when approached with questions about fetal gender. But what exactly are we talking about when we discuss the gender of an unborn baby?

As we established in our previous column, gender identity is an internal experience of gender that one feels to be a part of oneself. Gender identity is distinct from sex assigned at birth because sex assigned at birth is based on an external anatomical structure. So, then, what does an ultrasound actually reveal? Objectively, ultrasound can show the provider the presence or absence of a hyperechoic anatomical structure between the fetal legs that may become a penis, a vagina, or an ambiguous form of genitalia. While ultrasound is an incredible tool for anatomical and other forms of antenatal testing, ultrasound cannot detect identity characteristics because identities are, by definition, socially and internally experienced without respect to anatomy.

The distinction between gender identity and sex assigned at birth in discussions of antenatal ultrasonography is more than just a simple problem of semantics or vocabulary. To describe a fetus as a boy or a girl based on the presence/absence of a projection between the fetal legs seen on ultrasound is to reinforce the idea that gender identity and sex assigned at birth are equivalent. This conflation also erases nonbinary, genderqueer, and many other groups that identify with genders other than “boy” or “girl.” To be clear, unborn fetuses do not have a gender identity. Studies have shown that children begin to self-label their gender as early as 18-24 months of age, and similarly those who grow up to inhabit gender-nonconforming identities usually already are starting to show signs of their nonconformity starting at age 2 years.¹ Some of the deepest traumas that trans and gender-nonconforming people experience are rated to the enforcement of unwritten gender laws during early childhood that are applied based on the sex assigned at birth.

Obstetricians can help to break the cycle of inappropriate gender assignment by correctly using the terms “gender” and “sex assigned at birth.” One opportunity for addressing patients’ questions about fetal gender might be to avoid the term “gender” altogether when discussing fetal sex assigned at birth, emphasizing instead what fetal ultrasound is actually able to do: Give us information about the appearance of external genitalia to help predict what sex will be assigned at birth.² We have used this strategy when performing anatomy scans, and our experience has been that patients often will make their own assumptions about what it means to see certain external genitalia on ultrasound between the fetal legs. Motivated providers who want to go the extra mile may use a patient’s exclamation about their understanding of the fetus’s gender as an opportunity to educate the patient on the distinction between gender and sex assigned at birth, but even just smiling and moving onto the next part of the scan is an appropriate way of maintaining an atmosphere of inclusion and respect.

One of the roots of gender-based violence and gender dysphoria later in life is the conflation of gender and sex assigned at birth. While there is an entire social and political framework that enforces and polices gender after birth, the obstetrician can take steps to break the cycle starting before the birth has even occurred. Obstetricians are tasked with the unique challenge of providing care for the mother-fetus dyad, and much of the work is in setting up the fetus for the best possible life. Our scope of inclusion should be sufficiently wide to account for nonanatomical variations that could develop later in life in the infants we deliver.

Dr. Bahng is a PGY-1 resident physician in the gynecology & obstetrics residency program at Emory University, Atlanta. Dr. Bahng identifies as nonbinary and uses they/them/their as their personal pronouns. Dr. Joyner is an assistant professor at Emory University and is the director of gynecologic services in the Gender Center at Grady Memorial Hospital in Atlanta. Dr. Joyner identifies as a cisgender female and uses she/hers/her as her personal pronouns. Dr. Bahng and Dr. Joyner reported no financial disclosures.

References

1. Horm Behav. 2013 Jul;64(2):288-97.

2. Obstet Gynecol Surv. 2009 Jan;64(1):50-7.

Every ob.gyn. expects that the topic of gender will come up at some point in a patient’s pregnancy. “When will I find out the gender?” asks the 24-year-old at her first prenatal visit. “We want the gender to be a surprise!” exclaims the couple at their anatomy scan for their second in vitro fertilization pregnancy. “Do you know what you’re having?” asks the obstetrician anticipating an imminent delivery.

gorodenkoff/Getty Images

The topic of gender is in fact so ingrained in our practice that we don’t bat an eye when approached with questions about fetal gender. But what exactly are we talking about when we discuss the gender of an unborn baby?

As we established in our previous column, gender identity is an internal experience of gender that one feels to be a part of oneself. Gender identity is distinct from sex assigned at birth because sex assigned at birth is based on an external anatomical structure. So, then, what does an ultrasound actually reveal? Objectively, ultrasound can show the provider the presence or absence of a hyperechoic anatomical structure between the fetal legs that may become a penis, a vagina, or an ambiguous form of genitalia. While ultrasound is an incredible tool for anatomical and other forms of antenatal testing, ultrasound cannot detect identity characteristics because identities are, by definition, socially and internally experienced without respect to anatomy.

The distinction between gender identity and sex assigned at birth in discussions of antenatal ultrasonography is more than just a simple problem of semantics or vocabulary. To describe a fetus as a boy or a girl based on the presence/absence of a projection between the fetal legs seen on ultrasound is to reinforce the idea that gender identity and sex assigned at birth are equivalent. This conflation also erases nonbinary, genderqueer, and many other groups that identify with genders other than “boy” or “girl.” To be clear, unborn fetuses do not have a gender identity. Studies have shown that children begin to self-label their gender as early as 18-24 months of age, and similarly those who grow up to inhabit gender-nonconforming identities usually already are starting to show signs of their nonconformity starting at age 2 years.¹ Some of the deepest traumas that trans and gender-nonconforming people experience are rated to the enforcement of unwritten gender laws during early childhood that are applied based on the sex assigned at birth.

Obstetricians can help to break the cycle of inappropriate gender assignment by correctly using the terms “gender” and “sex assigned at birth.” One opportunity for addressing patients’ questions about fetal gender might be to avoid the term “gender” altogether when discussing fetal sex assigned at birth, emphasizing instead what fetal ultrasound is actually able to do: Give us information about the appearance of external genitalia to help predict what sex will be assigned at birth.² We have used this strategy when performing anatomy scans, and our experience has been that patients often will make their own assumptions about what it means to see certain external genitalia on ultrasound between the fetal legs. Motivated providers who want to go the extra mile may use a patient’s exclamation about their understanding of the fetus’s gender as an opportunity to educate the patient on the distinction between gender and sex assigned at birth, but even just smiling and moving onto the next part of the scan is an appropriate way of maintaining an atmosphere of inclusion and respect.

One of the roots of gender-based violence and gender dysphoria later in life is the conflation of gender and sex assigned at birth. While there is an entire social and political framework that enforces and polices gender after birth, the obstetrician can take steps to break the cycle starting before the birth has even occurred. Obstetricians are tasked with the unique challenge of providing care for the mother-fetus dyad, and much of the work is in setting up the fetus for the best possible life. Our scope of inclusion should be sufficiently wide to account for nonanatomical variations that could develop later in life in the infants we deliver.

Dr. Bahng is a PGY-1 resident physician in the gynecology & obstetrics residency program at Emory University, Atlanta. Dr. Bahng identifies as nonbinary and uses they/them/their as their personal pronouns. Dr. Joyner is an assistant professor at Emory University and is the director of gynecologic services in the Gender Center at Grady Memorial Hospital in Atlanta. Dr. Joyner identifies as a cisgender female and uses she/hers/her as her personal pronouns. Dr. Bahng and Dr. Joyner reported no financial disclosures.

References

1. Horm Behav. 2013 Jul;64(2):288-97.

2. Obstet Gynecol Surv. 2009 Jan;64(1):50-7.

Despite their known teratogenic risks, both valproate and topiramate are being prescribed relatively often in women of childbearing age, results of a retrospective analysis suggest.

Antonio_Diaz/Thinkstock

Topiramate, linked to increased risk of cleft palate and smaller-than-gestational-age newborns, was among the top three antiepileptic drugs (AEDs) prescribed to women 15-44 years of age in the population-based cohort study.

Valproate, linked to increases in both anatomic and behavioral teratogenicity, was less often prescribed, but nevertheless still prescribed in a considerable proportion of patients in the study, which looked at U.S. commercial, Medicare, and Medicaid claims data from 2009 to 2013.

Presence of comorbidities could be influencing whether or not a woman of childbearing age receives one of these AEDs, the investigators said. Specifically, they found valproate more often prescribed for women with epilepsy who also had mood or anxiety and dissociative disorder, while topiramate was more often prescribed in women with headaches or migraines.

Taken together, these findings suggest a lack of awareness of the teratogenic risks of valproate and topiramate, said the investigators, led by Hyunmi Kim, MD, PhD, MPH, of the department of neurology at Stanford (Calif.) University.

“To improve current practice, knowledge of the teratogenicity of certain AEDs should be disseminated to health care professionals and patients,” they wrote. The report is in JAMA Neurology.

The findings of Dr. Kim and her colleagues were based on data for 46,767 women of childbearing age: 8,003 incident (new) cases with a mean age of 27 years, and 38,764 prevalent cases with a mean age of 30 years.

Topiramate was the second- or third-most prescribed AED in the analyses, alongside levetiracetam and lamotrigine. In particular, topiramate prescriptions were found in incident cases receiving first-line monotherapy (15%), prevalent cases receiving first-line monotherapy (13%), and prevalent cases receiving polytherapy (29%).

Valproate was the fifth-most prescribed AED for incident and prevalent cases receiving first-line monotherapy (5% and 10%, respectively), and came in fourth place among prevalent cases receiving polytherapy (22%).

The somewhat lower rate of valproate prescriptions tracks with other recent analyses showing that valproate use decreased among women of childbearing age following recommendations against its use during pregnancy, according to Dr. Kim and her coauthors.

However, topiramate is another story: “Although the magnitude of risk and range of adverse reproductive outcomes associated with topiramate use appear substantially less than those associated with valproate, some reduction in the use of topiramate in this population might be expected after evidence emerged in 2008 of its association with cleft palate,” they said in their report.

UCB Pharma sponsored this study. Study authors reported disclosures related to UCB Pharma, Biogen, Eisai, SK Life Science, Brain Sentinel, UCB Pharma, and the University of Alabama at Birmingham.

SOURCE: Kim H et al. JAMA Neurol. 2019 Apr 1. doi: 10.1001/jamaneurol.2019.0447.

Despite their known teratogenic risks, both valproate and topiramate are being prescribed relatively often in women of childbearing age, results of a retrospective analysis suggest.

Antonio_Diaz/Thinkstock

Topiramate, linked to increased risk of cleft palate and smaller-than-gestational-age newborns, was among the top three antiepileptic drugs (AEDs) prescribed to women 15-44 years of age in the population-based cohort study.

Valproate, linked to increases in both anatomic and behavioral teratogenicity, was less often prescribed, but nevertheless still prescribed in a considerable proportion of patients in the study, which looked at U.S. commercial, Medicare, and Medicaid claims data from 2009 to 2013.

Presence of comorbidities could be influencing whether or not a woman of childbearing age receives one of these AEDs, the investigators said. Specifically, they found valproate more often prescribed for women with epilepsy who also had mood or anxiety and dissociative disorder, while topiramate was more often prescribed in women with headaches or migraines.

Taken together, these findings suggest a lack of awareness of the teratogenic risks of valproate and topiramate, said the investigators, led by Hyunmi Kim, MD, PhD, MPH, of the department of neurology at Stanford (Calif.) University.

“To improve current practice, knowledge of the teratogenicity of certain AEDs should be disseminated to health care professionals and patients,” they wrote. The report is in JAMA Neurology.

The findings of Dr. Kim and her colleagues were based on data for 46,767 women of childbearing age: 8,003 incident (new) cases with a mean age of 27 years, and 38,764 prevalent cases with a mean age of 30 years.

Topiramate was the second- or third-most prescribed AED in the analyses, alongside levetiracetam and lamotrigine. In particular, topiramate prescriptions were found in incident cases receiving first-line monotherapy (15%), prevalent cases receiving first-line monotherapy (13%), and prevalent cases receiving polytherapy (29%).

Valproate was the fifth-most prescribed AED for incident and prevalent cases receiving first-line monotherapy (5% and 10%, respectively), and came in fourth place among prevalent cases receiving polytherapy (22%).

The somewhat lower rate of valproate prescriptions tracks with other recent analyses showing that valproate use decreased among women of childbearing age following recommendations against its use during pregnancy, according to Dr. Kim and her coauthors.

However, topiramate is another story: “Although the magnitude of risk and range of adverse reproductive outcomes associated with topiramate use appear substantially less than those associated with valproate, some reduction in the use of topiramate in this population might be expected after evidence emerged in 2008 of its association with cleft palate,” they said in their report.

UCB Pharma sponsored this study. Study authors reported disclosures related to UCB Pharma, Biogen, Eisai, SK Life Science, Brain Sentinel, UCB Pharma, and the University of Alabama at Birmingham.

SOURCE: Kim H et al. JAMA Neurol. 2019 Apr 1. doi: 10.1001/jamaneurol.2019.0447.

Despite their known teratogenic risks, both valproate and topiramate are being prescribed relatively often in women of childbearing age, results of a retrospective analysis suggest.

Antonio_Diaz/Thinkstock

Topiramate, linked to increased risk of cleft palate and smaller-than-gestational-age newborns, was among the top three antiepileptic drugs (AEDs) prescribed to women 15-44 years of age in the population-based cohort study.

Valproate, linked to increases in both anatomic and behavioral teratogenicity, was less often prescribed, but nevertheless still prescribed in a considerable proportion of patients in the study, which looked at U.S. commercial, Medicare, and Medicaid claims data from 2009 to 2013.

Presence of comorbidities could be influencing whether or not a woman of childbearing age receives one of these AEDs, the investigators said. Specifically, they found valproate more often prescribed for women with epilepsy who also had mood or anxiety and dissociative disorder, while topiramate was more often prescribed in women with headaches or migraines.

Taken together, these findings suggest a lack of awareness of the teratogenic risks of valproate and topiramate, said the investigators, led by Hyunmi Kim, MD, PhD, MPH, of the department of neurology at Stanford (Calif.) University.

“To improve current practice, knowledge of the teratogenicity of certain AEDs should be disseminated to health care professionals and patients,” they wrote. The report is in JAMA Neurology.

The findings of Dr. Kim and her colleagues were based on data for 46,767 women of childbearing age: 8,003 incident (new) cases with a mean age of 27 years, and 38,764 prevalent cases with a mean age of 30 years.

Topiramate was the second- or third-most prescribed AED in the analyses, alongside levetiracetam and lamotrigine. In particular, topiramate prescriptions were found in incident cases receiving first-line monotherapy (15%), prevalent cases receiving first-line monotherapy (13%), and prevalent cases receiving polytherapy (29%).

Valproate was the fifth-most prescribed AED for incident and prevalent cases receiving first-line monotherapy (5% and 10%, respectively), and came in fourth place among prevalent cases receiving polytherapy (22%).

The somewhat lower rate of valproate prescriptions tracks with other recent analyses showing that valproate use decreased among women of childbearing age following recommendations against its use during pregnancy, according to Dr. Kim and her coauthors.

However, topiramate is another story: “Although the magnitude of risk and range of adverse reproductive outcomes associated with topiramate use appear substantially less than those associated with valproate, some reduction in the use of topiramate in this population might be expected after evidence emerged in 2008 of its association with cleft palate,” they said in their report.

UCB Pharma sponsored this study. Study authors reported disclosures related to UCB Pharma, Biogen, Eisai, SK Life Science, Brain Sentinel, UCB Pharma, and the University of Alabama at Birmingham.

SOURCE: Kim H et al. JAMA Neurol. 2019 Apr 1. doi: 10.1001/jamaneurol.2019.0447.

Mutations in the PAD13 gene were significantly more common in 58 patients with central centrifugal cicatricial alopecia, compared with 2,702 controls, in a study of women of African ancestry.

Central centrifugal cicatricial alopecia (CCCA) often runs in families, suggesting a possible genetic component, but specific genes have not been explored, wrote Liron Malki, of Tel Aviv Medical Center and his colleagues.

In a study published in the New England Journal of Medicine, the researchers used a genetic sequencing procedure to examine genes in 16 women with African ancestry with CCCA who served as a discovery set; they identified four heterozygous mutations in the PAD13 gene in 5 women, which included one splice site and three missense mutations. The PAD13 gene “is responsible for mediating the modification of proteins critical for normal hair shaft formation and shaping, such as trichohyalin, and may also play a role in interfollicular epidermal differentiation,” they wrote.

Mr. Malki and his associates then identified an additional 42 patients of African descent with CCCA and directly sequenced PADI3; they found 9 patients with genetic variations.

Overall, the researchers found six mutations in PAD13 that appeared in 14 of the 58 patients (24%) with CCCA.

In a post hoc analysis, the mutations were significantly more prevalent among CCCA patients, compared with 2,702 control women of African ancestry (P = .03 by the chi-square test and P = 0.04 by Fisher’s exact test after adjusting for relatedness of study participants).

The results were limited by several factors, including the small sample size and lack of data on individual hair grooming habits. However, the findings support data from previous studies indicating that PAD13 plays an important role in proper hair shaft formation, the researchers wrote.

“The different properties of hair among persons of African ancestry and those of European ancestry may explain, in part, the different clinical consequences of PADI3 mutations in CCCA and in the uncombable hair syndrome,” Mr. Malki and his associates wrote. “Alternatively, the distinct variants in PADI3 in each of the disorders may account for the difference in clinical outcomes.”

The study was supported in part by a grant to Eli Sprecher, MD, PhD, from the Ram Family Foundation and a grant to Dr. Sprecher and Regina C. Betz, MD, from the German-Israeli Foundation, a L’Oreal African Hair and Skin Research grant to Ncoza C. Dlova, a research grant from the Skin of Color Society to Amy McMichael, MD, and the Deutsche Forschungsgemeinschaft–funded Cluster of Excellence ImmunoSensation grant to Dr. Betz. Several other researchers – but not all – reported numerous financial disclosures from pharmaceutical and technology companies and universities and organizations.

SOURCE: Malki L et al. N Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMoa1816614.

Mutations in the PAD13 gene were significantly more common in 58 patients with central centrifugal cicatricial alopecia, compared with 2,702 controls, in a study of women of African ancestry.

Central centrifugal cicatricial alopecia (CCCA) often runs in families, suggesting a possible genetic component, but specific genes have not been explored, wrote Liron Malki, of Tel Aviv Medical Center and his colleagues.

In a study published in the New England Journal of Medicine, the researchers used a genetic sequencing procedure to examine genes in 16 women with African ancestry with CCCA who served as a discovery set; they identified four heterozygous mutations in the PAD13 gene in 5 women, which included one splice site and three missense mutations. The PAD13 gene “is responsible for mediating the modification of proteins critical for normal hair shaft formation and shaping, such as trichohyalin, and may also play a role in interfollicular epidermal differentiation,” they wrote.

Mr. Malki and his associates then identified an additional 42 patients of African descent with CCCA and directly sequenced PADI3; they found 9 patients with genetic variations.

Overall, the researchers found six mutations in PAD13 that appeared in 14 of the 58 patients (24%) with CCCA.

In a post hoc analysis, the mutations were significantly more prevalent among CCCA patients, compared with 2,702 control women of African ancestry (P = .03 by the chi-square test and P = 0.04 by Fisher’s exact test after adjusting for relatedness of study participants).

The results were limited by several factors, including the small sample size and lack of data on individual hair grooming habits. However, the findings support data from previous studies indicating that PAD13 plays an important role in proper hair shaft formation, the researchers wrote.

“The different properties of hair among persons of African ancestry and those of European ancestry may explain, in part, the different clinical consequences of PADI3 mutations in CCCA and in the uncombable hair syndrome,” Mr. Malki and his associates wrote. “Alternatively, the distinct variants in PADI3 in each of the disorders may account for the difference in clinical outcomes.”

The study was supported in part by a grant to Eli Sprecher, MD, PhD, from the Ram Family Foundation and a grant to Dr. Sprecher and Regina C. Betz, MD, from the German-Israeli Foundation, a L’Oreal African Hair and Skin Research grant to Ncoza C. Dlova, a research grant from the Skin of Color Society to Amy McMichael, MD, and the Deutsche Forschungsgemeinschaft–funded Cluster of Excellence ImmunoSensation grant to Dr. Betz. Several other researchers – but not all – reported numerous financial disclosures from pharmaceutical and technology companies and universities and organizations.

SOURCE: Malki L et al. N Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMoa1816614.

Mutations in the PAD13 gene were significantly more common in 58 patients with central centrifugal cicatricial alopecia, compared with 2,702 controls, in a study of women of African ancestry.

Central centrifugal cicatricial alopecia (CCCA) often runs in families, suggesting a possible genetic component, but specific genes have not been explored, wrote Liron Malki, of Tel Aviv Medical Center and his colleagues.

In a study published in the New England Journal of Medicine, the researchers used a genetic sequencing procedure to examine genes in 16 women with African ancestry with CCCA who served as a discovery set; they identified four heterozygous mutations in the PAD13 gene in 5 women, which included one splice site and three missense mutations. The PAD13 gene “is responsible for mediating the modification of proteins critical for normal hair shaft formation and shaping, such as trichohyalin, and may also play a role in interfollicular epidermal differentiation,” they wrote.

Mr. Malki and his associates then identified an additional 42 patients of African descent with CCCA and directly sequenced PADI3; they found 9 patients with genetic variations.

Overall, the researchers found six mutations in PAD13 that appeared in 14 of the 58 patients (24%) with CCCA.

In a post hoc analysis, the mutations were significantly more prevalent among CCCA patients, compared with 2,702 control women of African ancestry (P = .03 by the chi-square test and P = 0.04 by Fisher’s exact test after adjusting for relatedness of study participants).

The results were limited by several factors, including the small sample size and lack of data on individual hair grooming habits. However, the findings support data from previous studies indicating that PAD13 plays an important role in proper hair shaft formation, the researchers wrote.

“The different properties of hair among persons of African ancestry and those of European ancestry may explain, in part, the different clinical consequences of PADI3 mutations in CCCA and in the uncombable hair syndrome,” Mr. Malki and his associates wrote. “Alternatively, the distinct variants in PADI3 in each of the disorders may account for the difference in clinical outcomes.”

The study was supported in part by a grant to Eli Sprecher, MD, PhD, from the Ram Family Foundation and a grant to Dr. Sprecher and Regina C. Betz, MD, from the German-Israeli Foundation, a L’Oreal African Hair and Skin Research grant to Ncoza C. Dlova, a research grant from the Skin of Color Society to Amy McMichael, MD, and the Deutsche Forschungsgemeinschaft–funded Cluster of Excellence ImmunoSensation grant to Dr. Betz. Several other researchers – but not all – reported numerous financial disclosures from pharmaceutical and technology companies and universities and organizations.

SOURCE: Malki L et al. N Engl J Med. 2019 Feb 13. doi: 10.1056/NEJMoa1816614.

A systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation.

Baumrin E, Van Voorhees A, Garg A, Feldman SR, Merola JF. J Am Acad Dermatol. 2019 Mar 15

A systematic literature search was performed of HZ in patients with PsO/PsA. HZ vaccination guidelines were reviewed and the medical board of the National Psoriasis Foundation made consensus recommendations in PsO/PsA patients based on graded evidence. HZ risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all PsO/PsA patients >50 years old and younger patients at increased risk.

Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study.

Macchioni P, Salvarani C, Possemato N, et al. J Rheumatol. 2019 Mar 15.

The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.

The development of a modified Psoriatic Arthritis Disease Activity Score (mPASDAS) using SF-12 as a measure of quality of life.

Perruccio AV, Got M, Li S, Ye Y, Gladman DD, Chandran V. Arthritis Care Res (Hoboken). 2019 Mar 15.

The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite measure of psoriatic arthritis (PsA) disease activity. The length of its patient-reported components raises concern about questionnaire burden. The PASDAS includes the SF-36 measure. The study investigated the agreement between PASDAS and a modified PASDAS (mPASDAS) which substituted the SF-36 with the shortened SF-12.

The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study.

Adawi M, Damiani G, Bragazzi NL, et al. Nutrients. 2019 Mar 12;11(3).

Fasting was found to be a predictor of a decrease in PsA disease activity scores (DAPSA, BASDAI, LEI, DSS) even after adjustment for weight loss. IL-17 therapy was found to be an independent predictor of decreases in LEI after fasting.

Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition.

Scher JU, Ogdie A, Merola JF, Ritchlin C. Nat Rev Rheumatol. 2019 Mar;15(3):153-166.

The events responsible for progression to PsA are currently unclear. Genetic and clinical–demographic risk factors (most notably familial aggregation and psoriasis sub-phenotypes) provide relevant insights into the variables that promote transition.

A systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation.

Baumrin E, Van Voorhees A, Garg A, Feldman SR, Merola JF. J Am Acad Dermatol. 2019 Mar 15

A systematic literature search was performed of HZ in patients with PsO/PsA. HZ vaccination guidelines were reviewed and the medical board of the National Psoriasis Foundation made consensus recommendations in PsO/PsA patients based on graded evidence. HZ risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all PsO/PsA patients >50 years old and younger patients at increased risk.

Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study.

Macchioni P, Salvarani C, Possemato N, et al. J Rheumatol. 2019 Mar 15.

The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.

The development of a modified Psoriatic Arthritis Disease Activity Score (mPASDAS) using SF-12 as a measure of quality of life.

Perruccio AV, Got M, Li S, Ye Y, Gladman DD, Chandran V. Arthritis Care Res (Hoboken). 2019 Mar 15.

The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite measure of psoriatic arthritis (PsA) disease activity. The length of its patient-reported components raises concern about questionnaire burden. The PASDAS includes the SF-36 measure. The study investigated the agreement between PASDAS and a modified PASDAS (mPASDAS) which substituted the SF-36 with the shortened SF-12.

The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study.

Adawi M, Damiani G, Bragazzi NL, et al. Nutrients. 2019 Mar 12;11(3).

Fasting was found to be a predictor of a decrease in PsA disease activity scores (DAPSA, BASDAI, LEI, DSS) even after adjustment for weight loss. IL-17 therapy was found to be an independent predictor of decreases in LEI after fasting.

Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition.

Scher JU, Ogdie A, Merola JF, Ritchlin C. Nat Rev Rheumatol. 2019 Mar;15(3):153-166.

The events responsible for progression to PsA are currently unclear. Genetic and clinical–demographic risk factors (most notably familial aggregation and psoriasis sub-phenotypes) provide relevant insights into the variables that promote transition.

A systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation.

Baumrin E, Van Voorhees A, Garg A, Feldman SR, Merola JF. J Am Acad Dermatol. 2019 Mar 15

A systematic literature search was performed of HZ in patients with PsO/PsA. HZ vaccination guidelines were reviewed and the medical board of the National Psoriasis Foundation made consensus recommendations in PsO/PsA patients based on graded evidence. HZ risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all PsO/PsA patients >50 years old and younger patients at increased risk.

Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study.

Macchioni P, Salvarani C, Possemato N, et al. J Rheumatol. 2019 Mar 15.

The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.

The development of a modified Psoriatic Arthritis Disease Activity Score (mPASDAS) using SF-12 as a measure of quality of life.

Perruccio AV, Got M, Li S, Ye Y, Gladman DD, Chandran V. Arthritis Care Res (Hoboken). 2019 Mar 15.

The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite measure of psoriatic arthritis (PsA) disease activity. The length of its patient-reported components raises concern about questionnaire burden. The PASDAS includes the SF-36 measure. The study investigated the agreement between PASDAS and a modified PASDAS (mPASDAS) which substituted the SF-36 with the shortened SF-12.

The Impact of Intermittent Fasting (Ramadan Fasting) on Psoriatic Arthritis Disease Activity, Enthesitis, and Dactylitis: A Multicentre Study.

Adawi M, Damiani G, Bragazzi NL, et al. Nutrients. 2019 Mar 12;11(3).

Fasting was found to be a predictor of a decrease in PsA disease activity scores (DAPSA, BASDAI, LEI, DSS) even after adjustment for weight loss. IL-17 therapy was found to be an independent predictor of decreases in LEI after fasting.

Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition.

Scher JU, Ogdie A, Merola JF, Ritchlin C. Nat Rev Rheumatol. 2019 Mar;15(3):153-166.

The events responsible for progression to PsA are currently unclear. Genetic and clinical–demographic risk factors (most notably familial aggregation and psoriasis sub-phenotypes) provide relevant insights into the variables that promote transition.