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Wearable devices show promise in monitoring multiple sclerosis
MILAN – , suggests a pilot study.
Twenty patients were enrolled, only half of whom correctly completed all of the assessments and wore the included smartwatch regularly. Importantly, the data reported back for analysis was in line with expectations, and the patient feedback was positive.
The tool kit “seems feasible and usable to remotely monitor multiple domains of health status in people with multiple sclerosis,” conclude Ludovico Pedullà, PhD, Italian Multiple Sclerosis Foundation, Genoa, and colleagues.
Further analysis of the dataset, including the artificial intelligence and machine-learning algorithms, may allow the prediction of “relevant changes throughout the course of multiple sclerosis” and anticipate the need for therapeutic interventions.
The findings were presented at the 9th Joint ECTRIMS-ACTRIMS meeting.
Leveraging big data to improve outcomes
The authors note that the primary aim of the pan-European ALAMEDA project is to leverage “big data” through artificial intelligence and machine learning to provide “clinically actionable information” on patients with brain disorders that “complements medical recommendations” and thus improves treatment.
For the current pilot study, the researchers developed an integrated platform to collect patient-centered data from wearables and mobile devices using digital patient-reported outcomes (ePROs), with the aim of testing the resulting tool kit’s feasibility and usability in people with MS.
Dr. Pedullà said that they wanted to have “passive monitoring” of patients over the course of their daily lives and therefore searched for the best devices and the most relevant patient reported outcomes as well as used “innovative algorithms” to analyze the data to try to predict the disease course.
To reduce dropouts and increase adherence to the tool kit, they described the project to patients with MS and asked for their feedback to determine whether what they had designed was feasible from the patient perspective, Dr. Pedullà said.
This led to some changes in the way data were collected, and the team developed a social network channel so patients would be able to ask for support and stay engaged in the study.
Feasible with high levels of confidence
Twenty people with relapsing-remitting MS were enrolled, of whom 14 were women. The mean age was 37.8 years, and the mean disease duration was 9.1 years. The mean Expanded Disability Status Scale was 2.2.
The participants were asked to use the tool kit for 1 year, with half reaching the 6-month milestone. Participants correctly completed 53% of the scheduled ePROs and regularly wore the smartwatch without reporting discomfort.
The team reports that the data from the tool kit “are in line with those reported in the literature.”
It showed that participants took an average of 8,415 steps per day and completed 9.8 minutes of vigorous activity and 14.5 minutes of moderate activity daily. Daily sedentary minutes were 705.1.
Patients had a mean Perceived Deficit Questionnaire score of 25.2, a Beck Anxiety Inventory score of 17.3, a score on the 12-Item Multiple Sclerosis Walking Scale of 37.2, and an arm function on the Multiple Sclerosis Questionnaire of 47.4.
The mean Modified Fatigue Impact Scale score was 18.5, and the Pittsburgh Sleep Quality Index score was 25.2. The System Usability Scale revealed “high levels of confidence” with the tool kit, the team says, as well as “very high” intention of using it in the future.
Dr. Pedullà said that the researchers now want to evaluate the feasibility of the tool kit further by analyzing the adherence and usability data and targeting it to the patients who are most likely to use it.
They also want to determine not only whether the use of wearables in this way can predict relapse in multiple sclerosis but also disease progression, particularly as the current definitions are evolving.
Reducing daily step count
Approached for comment, Riley M. Bove, MD, MSc, Assistant Professor, UCSF Weill Institute for Neurosciences, San Francisco, said that the study is “very interesting and in line with what has been previously published.”
She pointed to a recent study that she co-authored, in which remote monitoring via a continuous step counter revealed that a decreasing average daily step count was associated with the worsening of standard ambulatory measures.
“There are nice benefits of an integrated platform” such as what was used in the current study, Dr. Bove noted, adding that it is “even better if it can also send the data to clinicians.”
The ALAMEDA project has received funding from the European Union’s Horizon 2020 research and innovation program. No relevant financial relationships declared.
A version of this article first appeared on Medscape.com.
MILAN – , suggests a pilot study.
Twenty patients were enrolled, only half of whom correctly completed all of the assessments and wore the included smartwatch regularly. Importantly, the data reported back for analysis was in line with expectations, and the patient feedback was positive.
The tool kit “seems feasible and usable to remotely monitor multiple domains of health status in people with multiple sclerosis,” conclude Ludovico Pedullà, PhD, Italian Multiple Sclerosis Foundation, Genoa, and colleagues.
Further analysis of the dataset, including the artificial intelligence and machine-learning algorithms, may allow the prediction of “relevant changes throughout the course of multiple sclerosis” and anticipate the need for therapeutic interventions.
The findings were presented at the 9th Joint ECTRIMS-ACTRIMS meeting.
Leveraging big data to improve outcomes
The authors note that the primary aim of the pan-European ALAMEDA project is to leverage “big data” through artificial intelligence and machine learning to provide “clinically actionable information” on patients with brain disorders that “complements medical recommendations” and thus improves treatment.
For the current pilot study, the researchers developed an integrated platform to collect patient-centered data from wearables and mobile devices using digital patient-reported outcomes (ePROs), with the aim of testing the resulting tool kit’s feasibility and usability in people with MS.
Dr. Pedullà said that they wanted to have “passive monitoring” of patients over the course of their daily lives and therefore searched for the best devices and the most relevant patient reported outcomes as well as used “innovative algorithms” to analyze the data to try to predict the disease course.
To reduce dropouts and increase adherence to the tool kit, they described the project to patients with MS and asked for their feedback to determine whether what they had designed was feasible from the patient perspective, Dr. Pedullà said.
This led to some changes in the way data were collected, and the team developed a social network channel so patients would be able to ask for support and stay engaged in the study.
Feasible with high levels of confidence
Twenty people with relapsing-remitting MS were enrolled, of whom 14 were women. The mean age was 37.8 years, and the mean disease duration was 9.1 years. The mean Expanded Disability Status Scale was 2.2.
The participants were asked to use the tool kit for 1 year, with half reaching the 6-month milestone. Participants correctly completed 53% of the scheduled ePROs and regularly wore the smartwatch without reporting discomfort.
The team reports that the data from the tool kit “are in line with those reported in the literature.”
It showed that participants took an average of 8,415 steps per day and completed 9.8 minutes of vigorous activity and 14.5 minutes of moderate activity daily. Daily sedentary minutes were 705.1.
Patients had a mean Perceived Deficit Questionnaire score of 25.2, a Beck Anxiety Inventory score of 17.3, a score on the 12-Item Multiple Sclerosis Walking Scale of 37.2, and an arm function on the Multiple Sclerosis Questionnaire of 47.4.
The mean Modified Fatigue Impact Scale score was 18.5, and the Pittsburgh Sleep Quality Index score was 25.2. The System Usability Scale revealed “high levels of confidence” with the tool kit, the team says, as well as “very high” intention of using it in the future.
Dr. Pedullà said that the researchers now want to evaluate the feasibility of the tool kit further by analyzing the adherence and usability data and targeting it to the patients who are most likely to use it.
They also want to determine not only whether the use of wearables in this way can predict relapse in multiple sclerosis but also disease progression, particularly as the current definitions are evolving.
Reducing daily step count
Approached for comment, Riley M. Bove, MD, MSc, Assistant Professor, UCSF Weill Institute for Neurosciences, San Francisco, said that the study is “very interesting and in line with what has been previously published.”
She pointed to a recent study that she co-authored, in which remote monitoring via a continuous step counter revealed that a decreasing average daily step count was associated with the worsening of standard ambulatory measures.
“There are nice benefits of an integrated platform” such as what was used in the current study, Dr. Bove noted, adding that it is “even better if it can also send the data to clinicians.”
The ALAMEDA project has received funding from the European Union’s Horizon 2020 research and innovation program. No relevant financial relationships declared.
A version of this article first appeared on Medscape.com.
MILAN – , suggests a pilot study.
Twenty patients were enrolled, only half of whom correctly completed all of the assessments and wore the included smartwatch regularly. Importantly, the data reported back for analysis was in line with expectations, and the patient feedback was positive.
The tool kit “seems feasible and usable to remotely monitor multiple domains of health status in people with multiple sclerosis,” conclude Ludovico Pedullà, PhD, Italian Multiple Sclerosis Foundation, Genoa, and colleagues.
Further analysis of the dataset, including the artificial intelligence and machine-learning algorithms, may allow the prediction of “relevant changes throughout the course of multiple sclerosis” and anticipate the need for therapeutic interventions.
The findings were presented at the 9th Joint ECTRIMS-ACTRIMS meeting.
Leveraging big data to improve outcomes
The authors note that the primary aim of the pan-European ALAMEDA project is to leverage “big data” through artificial intelligence and machine learning to provide “clinically actionable information” on patients with brain disorders that “complements medical recommendations” and thus improves treatment.
For the current pilot study, the researchers developed an integrated platform to collect patient-centered data from wearables and mobile devices using digital patient-reported outcomes (ePROs), with the aim of testing the resulting tool kit’s feasibility and usability in people with MS.
Dr. Pedullà said that they wanted to have “passive monitoring” of patients over the course of their daily lives and therefore searched for the best devices and the most relevant patient reported outcomes as well as used “innovative algorithms” to analyze the data to try to predict the disease course.
To reduce dropouts and increase adherence to the tool kit, they described the project to patients with MS and asked for their feedback to determine whether what they had designed was feasible from the patient perspective, Dr. Pedullà said.
This led to some changes in the way data were collected, and the team developed a social network channel so patients would be able to ask for support and stay engaged in the study.
Feasible with high levels of confidence
Twenty people with relapsing-remitting MS were enrolled, of whom 14 were women. The mean age was 37.8 years, and the mean disease duration was 9.1 years. The mean Expanded Disability Status Scale was 2.2.
The participants were asked to use the tool kit for 1 year, with half reaching the 6-month milestone. Participants correctly completed 53% of the scheduled ePROs and regularly wore the smartwatch without reporting discomfort.
The team reports that the data from the tool kit “are in line with those reported in the literature.”
It showed that participants took an average of 8,415 steps per day and completed 9.8 minutes of vigorous activity and 14.5 minutes of moderate activity daily. Daily sedentary minutes were 705.1.
Patients had a mean Perceived Deficit Questionnaire score of 25.2, a Beck Anxiety Inventory score of 17.3, a score on the 12-Item Multiple Sclerosis Walking Scale of 37.2, and an arm function on the Multiple Sclerosis Questionnaire of 47.4.
The mean Modified Fatigue Impact Scale score was 18.5, and the Pittsburgh Sleep Quality Index score was 25.2. The System Usability Scale revealed “high levels of confidence” with the tool kit, the team says, as well as “very high” intention of using it in the future.
Dr. Pedullà said that the researchers now want to evaluate the feasibility of the tool kit further by analyzing the adherence and usability data and targeting it to the patients who are most likely to use it.
They also want to determine not only whether the use of wearables in this way can predict relapse in multiple sclerosis but also disease progression, particularly as the current definitions are evolving.
Reducing daily step count
Approached for comment, Riley M. Bove, MD, MSc, Assistant Professor, UCSF Weill Institute for Neurosciences, San Francisco, said that the study is “very interesting and in line with what has been previously published.”
She pointed to a recent study that she co-authored, in which remote monitoring via a continuous step counter revealed that a decreasing average daily step count was associated with the worsening of standard ambulatory measures.
“There are nice benefits of an integrated platform” such as what was used in the current study, Dr. Bove noted, adding that it is “even better if it can also send the data to clinicians.”
The ALAMEDA project has received funding from the European Union’s Horizon 2020 research and innovation program. No relevant financial relationships declared.
A version of this article first appeared on Medscape.com.
VA and Non-VA Partners Improving Care by Sharing Data
The US Department of Veterans Affairs (VA) and 13 health care systems have signed a pledge for interoperability—to securely share data on veteran health care, regardless of whether it is provided inside the VA or not.
“This pledge will improve veteran health care by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” said VA Under Secretary for Health Shereef Elnahal, MD, MBA. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care—including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”
The pledge will allow the health systems to access local, state, and federal health resources and will provide the VA access to health system clinical and administrative data for quality assessment and care coordination. The pledge signers are committed to developing and providing capabilities that: (1) Accurately identify veterans when they seek care from clinicians in [the signers’] communities; (2) Connect veterans with VA and community resources that promote health and health care—especially VA services that lower veterans’ out-of-pocket expenses; and (3) Responsively and reliably coordinate care for shared patients—including exchanging care information requested and provided.
In addition to helping reduce the financial burden for veterans, the VA says, the information sharing could help clinicians outside the VA system to provide more targeted care: “[I]t will also allow us to send helpful information to our partner health systems that they can then offer to veterans in their care,” Elnahal said, “to include information about new benefits we are offering under the PACT Act and other resources that assist with suicide prevention and identifying social risk factors."
The first pledge partners are Emory Healthcare, Inova, Jefferson Health, Sanford Health, University of California Davis Health, Intermountain Health, Mass General Brigham, Rush Health, Tufts Medicine, Marshfield Clinic, Kaiser Permanente Health Plan and Hospitals, University of Pittsburg Medical Center, and Atrium Health. Any health system or clinician that supports the pledge’s objectives is encouraged to participate, the VA says. Signers have begun work, and aim to provide proof-of-concept in early 2024.
The US Department of Veterans Affairs (VA) and 13 health care systems have signed a pledge for interoperability—to securely share data on veteran health care, regardless of whether it is provided inside the VA or not.
“This pledge will improve veteran health care by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” said VA Under Secretary for Health Shereef Elnahal, MD, MBA. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care—including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”
The pledge will allow the health systems to access local, state, and federal health resources and will provide the VA access to health system clinical and administrative data for quality assessment and care coordination. The pledge signers are committed to developing and providing capabilities that: (1) Accurately identify veterans when they seek care from clinicians in [the signers’] communities; (2) Connect veterans with VA and community resources that promote health and health care—especially VA services that lower veterans’ out-of-pocket expenses; and (3) Responsively and reliably coordinate care for shared patients—including exchanging care information requested and provided.
In addition to helping reduce the financial burden for veterans, the VA says, the information sharing could help clinicians outside the VA system to provide more targeted care: “[I]t will also allow us to send helpful information to our partner health systems that they can then offer to veterans in their care,” Elnahal said, “to include information about new benefits we are offering under the PACT Act and other resources that assist with suicide prevention and identifying social risk factors."
The first pledge partners are Emory Healthcare, Inova, Jefferson Health, Sanford Health, University of California Davis Health, Intermountain Health, Mass General Brigham, Rush Health, Tufts Medicine, Marshfield Clinic, Kaiser Permanente Health Plan and Hospitals, University of Pittsburg Medical Center, and Atrium Health. Any health system or clinician that supports the pledge’s objectives is encouraged to participate, the VA says. Signers have begun work, and aim to provide proof-of-concept in early 2024.
The US Department of Veterans Affairs (VA) and 13 health care systems have signed a pledge for interoperability—to securely share data on veteran health care, regardless of whether it is provided inside the VA or not.
“This pledge will improve veteran health care by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” said VA Under Secretary for Health Shereef Elnahal, MD, MBA. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care—including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”
The pledge will allow the health systems to access local, state, and federal health resources and will provide the VA access to health system clinical and administrative data for quality assessment and care coordination. The pledge signers are committed to developing and providing capabilities that: (1) Accurately identify veterans when they seek care from clinicians in [the signers’] communities; (2) Connect veterans with VA and community resources that promote health and health care—especially VA services that lower veterans’ out-of-pocket expenses; and (3) Responsively and reliably coordinate care for shared patients—including exchanging care information requested and provided.
In addition to helping reduce the financial burden for veterans, the VA says, the information sharing could help clinicians outside the VA system to provide more targeted care: “[I]t will also allow us to send helpful information to our partner health systems that they can then offer to veterans in their care,” Elnahal said, “to include information about new benefits we are offering under the PACT Act and other resources that assist with suicide prevention and identifying social risk factors."
The first pledge partners are Emory Healthcare, Inova, Jefferson Health, Sanford Health, University of California Davis Health, Intermountain Health, Mass General Brigham, Rush Health, Tufts Medicine, Marshfield Clinic, Kaiser Permanente Health Plan and Hospitals, University of Pittsburg Medical Center, and Atrium Health. Any health system or clinician that supports the pledge’s objectives is encouraged to participate, the VA says. Signers have begun work, and aim to provide proof-of-concept in early 2024.
Ultrasound assessment of flexor retinacula can help¬ distinguish PsA from RA in patients with ankle pain
Key clinical point: Ultrasound assessment of individuals with painful ankles revealed that abnormalities of the flexor retinacula (FR) were more common in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA).
Major finding: The FR were thicker in patients with PsA vs patients with RA and control individuals (0.96 vs 0.64 and 0.56, respectively; both P < .001), with abnormalities, such as retinaculitis (39.0% vs 2.7%), hypoechogenicity (46.0% vs 6.8%), power Doppler positivity (43.0% vs 8.1%), and periostosis (43.0% vs 8.1%), being significantly more prevalent in patients with PsA vs RA (all P < .001).
Study details: Findings are from a cross-sectional observational study including patients with PsA (n = 23) and RA (n = 37) who reported painful ankles and control individuals (n = 20) without rheumatic disease or ankle pain.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Forien M et al. Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study. Joint Bone Spine. 2023 (Oct 4). doi: 10.1016/j.jbspin.2023.105649
Key clinical point: Ultrasound assessment of individuals with painful ankles revealed that abnormalities of the flexor retinacula (FR) were more common in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA).
Major finding: The FR were thicker in patients with PsA vs patients with RA and control individuals (0.96 vs 0.64 and 0.56, respectively; both P < .001), with abnormalities, such as retinaculitis (39.0% vs 2.7%), hypoechogenicity (46.0% vs 6.8%), power Doppler positivity (43.0% vs 8.1%), and periostosis (43.0% vs 8.1%), being significantly more prevalent in patients with PsA vs RA (all P < .001).
Study details: Findings are from a cross-sectional observational study including patients with PsA (n = 23) and RA (n = 37) who reported painful ankles and control individuals (n = 20) without rheumatic disease or ankle pain.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Forien M et al. Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study. Joint Bone Spine. 2023 (Oct 4). doi: 10.1016/j.jbspin.2023.105649
Key clinical point: Ultrasound assessment of individuals with painful ankles revealed that abnormalities of the flexor retinacula (FR) were more common in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA).
Major finding: The FR were thicker in patients with PsA vs patients with RA and control individuals (0.96 vs 0.64 and 0.56, respectively; both P < .001), with abnormalities, such as retinaculitis (39.0% vs 2.7%), hypoechogenicity (46.0% vs 6.8%), power Doppler positivity (43.0% vs 8.1%), and periostosis (43.0% vs 8.1%), being significantly more prevalent in patients with PsA vs RA (all P < .001).
Study details: Findings are from a cross-sectional observational study including patients with PsA (n = 23) and RA (n = 37) who reported painful ankles and control individuals (n = 20) without rheumatic disease or ankle pain.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Forien M et al. Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study. Joint Bone Spine. 2023 (Oct 4). doi: 10.1016/j.jbspin.2023.105649
No causal association between PsA and the genetic risk for skin cancer
Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.
Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.
Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.
Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.
Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720
Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.
Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.
Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.
Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.
Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720
Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.
Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.
Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.
Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.
Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720
Identifying characteristics of difficult-to-treat PsA in real-world conditions
Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.
Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.
Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.
Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.
Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275
Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.
Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.
Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.
Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.
Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275
Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.
Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.
Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.
Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.
Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275
What factors are responsible for a delayed diagnosis of PsA?
Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.
Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).
Study details: Findings are from a cross-sectional study including 1134 patients with PsA.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z
Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.
Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).
Study details: Findings are from a cross-sectional study including 1134 patients with PsA.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z
Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.
Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).
Study details: Findings are from a cross-sectional study including 1134 patients with PsA.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z
Durable improvement in axial symptoms with guselkumab in PsA
Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.
Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).
Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).
Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.
Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8
Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.
Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).
Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).
Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.
Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8
Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.
Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).
Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).
Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.
Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8
Preliminary results of a real-world study confirm the efficacy and safety of upadacitinib in PsA
Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).
Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.
Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.
Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.
Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3
Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).
Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.
Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.
Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.
Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3
Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).
Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.
Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.
Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.
Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3
IL-23 inhibitors effective and safe for PsA patients in real-world settings
Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).
Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.
Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849
Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).
Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.
Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849
Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).
Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.
Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849
Factors affecting clinical response to fecal microbial transplantation in PsA
Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.
Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.
Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).
Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.
Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604
Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.
Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.
Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).
Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.
Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604
Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.
Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.
Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).
Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.
Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604