Psoriatic Arthritis ICYMI

Key clinical point: COVID-19 vaccination was not associated with the worsening of disease activity in patients with psoriatic arthritis (PsA) who were treated with targeted therapies; however, COVID-19 vaccination may worsen disease activity in patients treated with interleukin-12/23 inhibitors (IL-12/23-i).

Major finding: The flare rate was not significantly different in the 6 months post-vaccination vs  the pre-vaccination period (P  =  .797), with no significant change in disease activity score in 28 joints before or after vaccination in the overall population. However, COVID-19 vaccination significantly worsened disease activity in patients treated with IL-12/23-i vs  tumor necrosis factor inhibitor (P  =  .019).

Study details: The data come from a prospective observational study including 1765 patients total with PsA (n = 587) or rheumatoid arthritis (n = 1178) treated with targeted therapies who were vaccinated for COVID-19 with any of the available vaccines.

Disclosures: This study was funded by Bristol-Myers Squibb, Galapagos Biopharma Spain SLU, and Roche Farma. Two authors reported ties with various sources, including Galapagos or Roche.

Source: Álvaro-Gracia JM et al. Effects of COVID-19 vaccination on disease activity in patients with rheumatoid arthritis and psoriatic arthritis on targeted therapy in the COVIDSER study. RMD Open. 2023;9(1):e002936 (Mar 16). Doi: 10.1136/rmdopen-2022-002936

Key clinical point: COVID-19 vaccination was not associated with the worsening of disease activity in patients with psoriatic arthritis (PsA) who were treated with targeted therapies; however, COVID-19 vaccination may worsen disease activity in patients treated with interleukin-12/23 inhibitors (IL-12/23-i).

Major finding: The flare rate was not significantly different in the 6 months post-vaccination vs  the pre-vaccination period (P  =  .797), with no significant change in disease activity score in 28 joints before or after vaccination in the overall population. However, COVID-19 vaccination significantly worsened disease activity in patients treated with IL-12/23-i vs  tumor necrosis factor inhibitor (P  =  .019).

Study details: The data come from a prospective observational study including 1765 patients total with PsA (n = 587) or rheumatoid arthritis (n = 1178) treated with targeted therapies who were vaccinated for COVID-19 with any of the available vaccines.

Disclosures: This study was funded by Bristol-Myers Squibb, Galapagos Biopharma Spain SLU, and Roche Farma. Two authors reported ties with various sources, including Galapagos or Roche.

Source: Álvaro-Gracia JM et al. Effects of COVID-19 vaccination on disease activity in patients with rheumatoid arthritis and psoriatic arthritis on targeted therapy in the COVIDSER study. RMD Open. 2023;9(1):e002936 (Mar 16). Doi: 10.1136/rmdopen-2022-002936

Key clinical point: COVID-19 vaccination was not associated with the worsening of disease activity in patients with psoriatic arthritis (PsA) who were treated with targeted therapies; however, COVID-19 vaccination may worsen disease activity in patients treated with interleukin-12/23 inhibitors (IL-12/23-i).

Major finding: The flare rate was not significantly different in the 6 months post-vaccination vs  the pre-vaccination period (P  =  .797), with no significant change in disease activity score in 28 joints before or after vaccination in the overall population. However, COVID-19 vaccination significantly worsened disease activity in patients treated with IL-12/23-i vs  tumor necrosis factor inhibitor (P  =  .019).

Study details: The data come from a prospective observational study including 1765 patients total with PsA (n = 587) or rheumatoid arthritis (n = 1178) treated with targeted therapies who were vaccinated for COVID-19 with any of the available vaccines.

Disclosures: This study was funded by Bristol-Myers Squibb, Galapagos Biopharma Spain SLU, and Roche Farma. Two authors reported ties with various sources, including Galapagos or Roche.

Source: Álvaro-Gracia JM et al. Effects of COVID-19 vaccination on disease activity in patients with rheumatoid arthritis and psoriatic arthritis on targeted therapy in the COVIDSER study. RMD Open. 2023;9(1):e002936 (Mar 16). Doi: 10.1136/rmdopen-2022-002936

Patients with active PsA require early effective therapy to improve long-term outcomes. The choice of therapy should balance effectiveness and potential toxicity. Janus kinase (JAK) inhibitors are a relatively new class of drugs that have been shown to be efficacious in treating PsA, but there are concerns about safety. To evaluate the efficacy and safety of JAK inhibitors in patients with psoriatic disease, Yang and colleagues conducted a systematic review and meta-analysis of 17 phase 2/3 randomized controlled trials including 6802 patients with PsA or moderate to severe plaque psoriasis who received at least one JAK inhibitor. They demonstrated that, compared with placebo, JAK inhibitors were associated with a significantly higher American College of Rheumatology 20 response rate (relative risk [RR] 2.09; P < .00001), with the response being the highest for filgotinib (RR 2.40; P < .00001), followed by upadacitinib, tofacitinib, and deucravacitinib. However, the overall incidence of adverse events was higher with JAK inhibitors vs placebo (RR 1.17; P < .00001) and significantly higher with 10-mg vs 5-mg tofacitinib (P = .03). Thus, JAK inhibitors are efficacious in the treatment of PsA but are associated with adverse effects, particularly at higher doses.

Safety is best assessed in real-world observational studies. Clinical trials have raised concerns about a higher cancer risk in rheumatoid arthritis (RA) patients treated with JAK inhibitors compared with patients treated with tumor necrosis factor (TNF) inhibitors. To evaluate this further, Huss and colleagues conducted an observational cohort study that evaluated prospectively collected data from national Swedish data sources on 4443 patients with PsA and 10,447 patients with RA, all without previous cancer, who received JAK inhibitors, TNF inhibitors, or other non–TNF inhibitor biologic disease-modifying antirheumatic drugs. Overall, use of JAK inhibitors vs TNF inhibitors was not significantly associated with a higher risk for cancer other than nonmelanoma skin cancer, especially in RA. In patients with PsA, there was a trend toward higher risk for nonmelanoma skin cancer, but it was not statistically significant. The study provides reassurance that JAK inhibitors are generally as safe, as are TNF inhibitors in PsA, but continued vigilance is required.

There are limited data on the effect of disease activity on pregnancy outcomes in individuals with PsA. Using data from the Medical Birth Registry of Norway linked to data from a Norwegian nationwide observational register recruiting women with inflammatory rheumatic diseases, Skorpen and colleagues evaluated the association of active disease and cesarean section (CS) rates in singleton births in women with PsA (n = 121), axial spondyloarthritis (n = 312), and controls (n = 575,798). Compared with control individuals, women with PsA had a higher risk for CS (risk difference [RD] 15.0%; P < .001) and for emergency CS (RD 10.6%; P < .001), with active disease in the third trimester further amplifying both risks (CS: RD 17.7%; P = .028; emergency CS: RD 15.9%; P = .015). Thus, although in many patients disease activity decreases during pregnancy, this study highlights the importance of pregestational counseling and disease control along with regular monitoring of PsA during pregnancy such that disease activity remains well controlled.

Patients with active PsA require early effective therapy to improve long-term outcomes. The choice of therapy should balance effectiveness and potential toxicity. Janus kinase (JAK) inhibitors are a relatively new class of drugs that have been shown to be efficacious in treating PsA, but there are concerns about safety. To evaluate the efficacy and safety of JAK inhibitors in patients with psoriatic disease, Yang and colleagues conducted a systematic review and meta-analysis of 17 phase 2/3 randomized controlled trials including 6802 patients with PsA or moderate to severe plaque psoriasis who received at least one JAK inhibitor. They demonstrated that, compared with placebo, JAK inhibitors were associated with a significantly higher American College of Rheumatology 20 response rate (relative risk [RR] 2.09; P < .00001), with the response being the highest for filgotinib (RR 2.40; P < .00001), followed by upadacitinib, tofacitinib, and deucravacitinib. However, the overall incidence of adverse events was higher with JAK inhibitors vs placebo (RR 1.17; P < .00001) and significantly higher with 10-mg vs 5-mg tofacitinib (P = .03). Thus, JAK inhibitors are efficacious in the treatment of PsA but are associated with adverse effects, particularly at higher doses.

Safety is best assessed in real-world observational studies. Clinical trials have raised concerns about a higher cancer risk in rheumatoid arthritis (RA) patients treated with JAK inhibitors compared with patients treated with tumor necrosis factor (TNF) inhibitors. To evaluate this further, Huss and colleagues conducted an observational cohort study that evaluated prospectively collected data from national Swedish data sources on 4443 patients with PsA and 10,447 patients with RA, all without previous cancer, who received JAK inhibitors, TNF inhibitors, or other non–TNF inhibitor biologic disease-modifying antirheumatic drugs. Overall, use of JAK inhibitors vs TNF inhibitors was not significantly associated with a higher risk for cancer other than nonmelanoma skin cancer, especially in RA. In patients with PsA, there was a trend toward higher risk for nonmelanoma skin cancer, but it was not statistically significant. The study provides reassurance that JAK inhibitors are generally as safe, as are TNF inhibitors in PsA, but continued vigilance is required.

There are limited data on the effect of disease activity on pregnancy outcomes in individuals with PsA. Using data from the Medical Birth Registry of Norway linked to data from a Norwegian nationwide observational register recruiting women with inflammatory rheumatic diseases, Skorpen and colleagues evaluated the association of active disease and cesarean section (CS) rates in singleton births in women with PsA (n = 121), axial spondyloarthritis (n = 312), and controls (n = 575,798). Compared with control individuals, women with PsA had a higher risk for CS (risk difference [RD] 15.0%; P < .001) and for emergency CS (RD 10.6%; P < .001), with active disease in the third trimester further amplifying both risks (CS: RD 17.7%; P = .028; emergency CS: RD 15.9%; P = .015). Thus, although in many patients disease activity decreases during pregnancy, this study highlights the importance of pregestational counseling and disease control along with regular monitoring of PsA during pregnancy such that disease activity remains well controlled.

Patients with active PsA require early effective therapy to improve long-term outcomes. The choice of therapy should balance effectiveness and potential toxicity. Janus kinase (JAK) inhibitors are a relatively new class of drugs that have been shown to be efficacious in treating PsA, but there are concerns about safety. To evaluate the efficacy and safety of JAK inhibitors in patients with psoriatic disease, Yang and colleagues conducted a systematic review and meta-analysis of 17 phase 2/3 randomized controlled trials including 6802 patients with PsA or moderate to severe plaque psoriasis who received at least one JAK inhibitor. They demonstrated that, compared with placebo, JAK inhibitors were associated with a significantly higher American College of Rheumatology 20 response rate (relative risk [RR] 2.09; P < .00001), with the response being the highest for filgotinib (RR 2.40; P < .00001), followed by upadacitinib, tofacitinib, and deucravacitinib. However, the overall incidence of adverse events was higher with JAK inhibitors vs placebo (RR 1.17; P < .00001) and significantly higher with 10-mg vs 5-mg tofacitinib (P = .03). Thus, JAK inhibitors are efficacious in the treatment of PsA but are associated with adverse effects, particularly at higher doses.

Safety is best assessed in real-world observational studies. Clinical trials have raised concerns about a higher cancer risk in rheumatoid arthritis (RA) patients treated with JAK inhibitors compared with patients treated with tumor necrosis factor (TNF) inhibitors. To evaluate this further, Huss and colleagues conducted an observational cohort study that evaluated prospectively collected data from national Swedish data sources on 4443 patients with PsA and 10,447 patients with RA, all without previous cancer, who received JAK inhibitors, TNF inhibitors, or other non–TNF inhibitor biologic disease-modifying antirheumatic drugs. Overall, use of JAK inhibitors vs TNF inhibitors was not significantly associated with a higher risk for cancer other than nonmelanoma skin cancer, especially in RA. In patients with PsA, there was a trend toward higher risk for nonmelanoma skin cancer, but it was not statistically significant. The study provides reassurance that JAK inhibitors are generally as safe, as are TNF inhibitors in PsA, but continued vigilance is required.

There are limited data on the effect of disease activity on pregnancy outcomes in individuals with PsA. Using data from the Medical Birth Registry of Norway linked to data from a Norwegian nationwide observational register recruiting women with inflammatory rheumatic diseases, Skorpen and colleagues evaluated the association of active disease and cesarean section (CS) rates in singleton births in women with PsA (n = 121), axial spondyloarthritis (n = 312), and controls (n = 575,798). Compared with control individuals, women with PsA had a higher risk for CS (risk difference [RD] 15.0%; P < .001) and for emergency CS (RD 10.6%; P < .001), with active disease in the third trimester further amplifying both risks (CS: RD 17.7%; P = .028; emergency CS: RD 15.9%; P = .015). Thus, although in many patients disease activity decreases during pregnancy, this study highlights the importance of pregestational counseling and disease control along with regular monitoring of PsA during pregnancy such that disease activity remains well controlled.

Key clinical point: The psoriatic arthritis (PsA) disease burden had worse impact on women vs men with PsA, with women having a higher disease activity, worse function, and greater disease burden.

Major finding: Female vs male patients with PsA had a significantly higher mean patient global assessment score (P < .001), patient’s pain score (P = .003), tender joint count (P < .001), swollen joint count (P = .033), and Disease Activity Score for PsA (P < .001). Minimal disease activity was achieved by 44.0% of men vs 24.6% of women (P = .003).

Study details: Findings are from a cross-sectional analysis of 2 longitudinal cohorts including 141 male and 131 female patients with PsA who received treatment with conventional synthetic or biologic disease-modifying antirheumatic drugs for at least 6 months.

Disclosures: This study did not receive funding. The authors declared no conflicts of interest.

Source: Lubrano E et al. Psoriatic arthritis in males and females: Differences and similarities. Rheumatol Ther. 2023 (Feb 16). Doi: 10.1007/s40744-023-00535-3

Key clinical point: The psoriatic arthritis (PsA) disease burden had worse impact on women vs men with PsA, with women having a higher disease activity, worse function, and greater disease burden.

Major finding: Female vs male patients with PsA had a significantly higher mean patient global assessment score (P < .001), patient’s pain score (P = .003), tender joint count (P < .001), swollen joint count (P = .033), and Disease Activity Score for PsA (P < .001). Minimal disease activity was achieved by 44.0% of men vs 24.6% of women (P = .003).

Study details: Findings are from a cross-sectional analysis of 2 longitudinal cohorts including 141 male and 131 female patients with PsA who received treatment with conventional synthetic or biologic disease-modifying antirheumatic drugs for at least 6 months.

Disclosures: This study did not receive funding. The authors declared no conflicts of interest.

Source: Lubrano E et al. Psoriatic arthritis in males and females: Differences and similarities. Rheumatol Ther. 2023 (Feb 16). Doi: 10.1007/s40744-023-00535-3

Key clinical point: The psoriatic arthritis (PsA) disease burden had worse impact on women vs men with PsA, with women having a higher disease activity, worse function, and greater disease burden.

Major finding: Female vs male patients with PsA had a significantly higher mean patient global assessment score (P < .001), patient’s pain score (P = .003), tender joint count (P < .001), swollen joint count (P = .033), and Disease Activity Score for PsA (P < .001). Minimal disease activity was achieved by 44.0% of men vs 24.6% of women (P = .003).

Study details: Findings are from a cross-sectional analysis of 2 longitudinal cohorts including 141 male and 131 female patients with PsA who received treatment with conventional synthetic or biologic disease-modifying antirheumatic drugs for at least 6 months.

Disclosures: This study did not receive funding. The authors declared no conflicts of interest.

Source: Lubrano E et al. Psoriatic arthritis in males and females: Differences and similarities. Rheumatol Ther. 2023 (Feb 16). Doi: 10.1007/s40744-023-00535-3

Key clinical point: Early initiation of apremilast led to rapid and sustained improvements in psoriatic arthritis (PsA) manifestations with a consistent safety profile in a real-world cohort of biologic-naive patients who were intolerant of conventional synthetic disease-modifying antirheumatic drugs (csDMARD).

Major finding: Among patients with baseline swollen joint count (SJC) and tender joint count (TJC) of >0, significant median decreases in SJC (50% and 90%, respectively) and TJC (50% and 80%, respectively) were observed at 16 and 52 weeks (all P < .001), with 55.2% of evaluable patients achieving minimal disease activity at 52 weeks. Overall, 13.8% of patients experienced ≥1 adverse event, with all except one being non-serious.

Study details: This prospective study included 167 biologic-naive patients with early peripheral PsA and intolerance or inadequate response to csDMARD who initiated apremilast.

Disclosures: This study was funded by Genesis Pharma and Celgene. Some authors reported ties with various sources, including Genesis Pharma. A Kekki and N Antonakopoulos reported being employees of Genesis Pharma.

Source: Sfikakis PP et al. Apremilast for biologic-naïve, peripheral psoriatic arthritis, including patients with early disease: Results from the APROACH observational prospective study. Rheumatol Int. 2023 (Mar 1). Doi: 10.1007/s00296-022-05269-z

Key clinical point: Early initiation of apremilast led to rapid and sustained improvements in psoriatic arthritis (PsA) manifestations with a consistent safety profile in a real-world cohort of biologic-naive patients who were intolerant of conventional synthetic disease-modifying antirheumatic drugs (csDMARD).

Major finding: Among patients with baseline swollen joint count (SJC) and tender joint count (TJC) of >0, significant median decreases in SJC (50% and 90%, respectively) and TJC (50% and 80%, respectively) were observed at 16 and 52 weeks (all P < .001), with 55.2% of evaluable patients achieving minimal disease activity at 52 weeks. Overall, 13.8% of patients experienced ≥1 adverse event, with all except one being non-serious.

Study details: This prospective study included 167 biologic-naive patients with early peripheral PsA and intolerance or inadequate response to csDMARD who initiated apremilast.

Disclosures: This study was funded by Genesis Pharma and Celgene. Some authors reported ties with various sources, including Genesis Pharma. A Kekki and N Antonakopoulos reported being employees of Genesis Pharma.

Source: Sfikakis PP et al. Apremilast for biologic-naïve, peripheral psoriatic arthritis, including patients with early disease: Results from the APROACH observational prospective study. Rheumatol Int. 2023 (Mar 1). Doi: 10.1007/s00296-022-05269-z

Key clinical point: Early initiation of apremilast led to rapid and sustained improvements in psoriatic arthritis (PsA) manifestations with a consistent safety profile in a real-world cohort of biologic-naive patients who were intolerant of conventional synthetic disease-modifying antirheumatic drugs (csDMARD).

Major finding: Among patients with baseline swollen joint count (SJC) and tender joint count (TJC) of >0, significant median decreases in SJC (50% and 90%, respectively) and TJC (50% and 80%, respectively) were observed at 16 and 52 weeks (all P < .001), with 55.2% of evaluable patients achieving minimal disease activity at 52 weeks. Overall, 13.8% of patients experienced ≥1 adverse event, with all except one being non-serious.

Study details: This prospective study included 167 biologic-naive patients with early peripheral PsA and intolerance or inadequate response to csDMARD who initiated apremilast.

Disclosures: This study was funded by Genesis Pharma and Celgene. Some authors reported ties with various sources, including Genesis Pharma. A Kekki and N Antonakopoulos reported being employees of Genesis Pharma.

Source: Sfikakis PP et al. Apremilast for biologic-naïve, peripheral psoriatic arthritis, including patients with early disease: Results from the APROACH observational prospective study. Rheumatol Int. 2023 (Mar 1). Doi: 10.1007/s00296-022-05269-z

Key clinical point: Concurrent onset of skin lesions and joint symptoms increased the likelihood of moderate or high disease activity in patients with psoriatic arthritis (PsA), highlighting the importance of sequence in which skin and joint symptoms appear in disease management.

Major finding: Patients with concurrent onset of skin and joint symptoms (adjusted odds ratio 4.65; P = .007) were more likely to have a moderate or high disease activity (Psoriatic Arthritis Disease Activity Score >3.2).

Study details: Findings are from a retrospective cross-sectional study including 286 patients with PsA.

Disclosures: This study was funded by the National Natural Science Foundation of China. No conflicts of interest were declared.

Source: Tan M et al. Concurrent onset of skin and joint symptoms correlates with higher psoriatic arthritis disease activity: A single-center retrospective study. J Am Acad Dermatol. 2023 (Mar 6). Doi: 10.1016/j.jaad.2023.02.045

Key clinical point: Concurrent onset of skin lesions and joint symptoms increased the likelihood of moderate or high disease activity in patients with psoriatic arthritis (PsA), highlighting the importance of sequence in which skin and joint symptoms appear in disease management.

Major finding: Patients with concurrent onset of skin and joint symptoms (adjusted odds ratio 4.65; P = .007) were more likely to have a moderate or high disease activity (Psoriatic Arthritis Disease Activity Score >3.2).

Study details: Findings are from a retrospective cross-sectional study including 286 patients with PsA.

Disclosures: This study was funded by the National Natural Science Foundation of China. No conflicts of interest were declared.

Source: Tan M et al. Concurrent onset of skin and joint symptoms correlates with higher psoriatic arthritis disease activity: A single-center retrospective study. J Am Acad Dermatol. 2023 (Mar 6). Doi: 10.1016/j.jaad.2023.02.045

Key clinical point: Concurrent onset of skin lesions and joint symptoms increased the likelihood of moderate or high disease activity in patients with psoriatic arthritis (PsA), highlighting the importance of sequence in which skin and joint symptoms appear in disease management.

Major finding: Patients with concurrent onset of skin and joint symptoms (adjusted odds ratio 4.65; P = .007) were more likely to have a moderate or high disease activity (Psoriatic Arthritis Disease Activity Score >3.2).

Study details: Findings are from a retrospective cross-sectional study including 286 patients with PsA.

Disclosures: This study was funded by the National Natural Science Foundation of China. No conflicts of interest were declared.

Source: Tan M et al. Concurrent onset of skin and joint symptoms correlates with higher psoriatic arthritis disease activity: A single-center retrospective study. J Am Acad Dermatol. 2023 (Mar 6). Doi: 10.1016/j.jaad.2023.02.045

Key clinical point: In patients with moderate-to-severe psoriasis, the presence of synovio-enthesitis on ultrasound, particularly in lower limbs, indicated progression to subclinical psoriatic arthritis (PsA). Therefore, routine ultrasound screening should be performed irrespective of arthritis symptoms.

Major finding: Only synovio-enthesitis diagnosis differed significantly among patients with silent psoriasis vs control individuals (16.1% vs 1.3%; P < .001), with 12.7% of patients diagnosed with synovio-enthesitis progressing to subclinical PsA and the top four sites with synovio-enthesitis involvement being in lower limbs. Body surface area and Psoriasis Area and Severity Index scores were not different in psoriasis, subclinical PsA, and prodromal/active PsA phases.

Study details: This cross-sectional study included 490 patients with moderate-to-severe psoriasis, of which 384 and 106 patients without and with arthritis symptoms formed the silent psoriasis and clinical PsA groups, respectively, and 80 age- and sex-matched control individuals without psoriasis.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Chen ZT et al. The role of ultrasound in screening subclinical psoriatic arthritis in patients with moderate to severe psoriasis. Eur Radiol. 2023 (Feb 28). Doi: 10.1007/s00330-023-09493-4

Key clinical point: In patients with moderate-to-severe psoriasis, the presence of synovio-enthesitis on ultrasound, particularly in lower limbs, indicated progression to subclinical psoriatic arthritis (PsA). Therefore, routine ultrasound screening should be performed irrespective of arthritis symptoms.

Major finding: Only synovio-enthesitis diagnosis differed significantly among patients with silent psoriasis vs control individuals (16.1% vs 1.3%; P < .001), with 12.7% of patients diagnosed with synovio-enthesitis progressing to subclinical PsA and the top four sites with synovio-enthesitis involvement being in lower limbs. Body surface area and Psoriasis Area and Severity Index scores were not different in psoriasis, subclinical PsA, and prodromal/active PsA phases.

Study details: This cross-sectional study included 490 patients with moderate-to-severe psoriasis, of which 384 and 106 patients without and with arthritis symptoms formed the silent psoriasis and clinical PsA groups, respectively, and 80 age- and sex-matched control individuals without psoriasis.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Chen ZT et al. The role of ultrasound in screening subclinical psoriatic arthritis in patients with moderate to severe psoriasis. Eur Radiol. 2023 (Feb 28). Doi: 10.1007/s00330-023-09493-4

Key clinical point: In patients with moderate-to-severe psoriasis, the presence of synovio-enthesitis on ultrasound, particularly in lower limbs, indicated progression to subclinical psoriatic arthritis (PsA). Therefore, routine ultrasound screening should be performed irrespective of arthritis symptoms.

Major finding: Only synovio-enthesitis diagnosis differed significantly among patients with silent psoriasis vs control individuals (16.1% vs 1.3%; P < .001), with 12.7% of patients diagnosed with synovio-enthesitis progressing to subclinical PsA and the top four sites with synovio-enthesitis involvement being in lower limbs. Body surface area and Psoriasis Area and Severity Index scores were not different in psoriasis, subclinical PsA, and prodromal/active PsA phases.

Study details: This cross-sectional study included 490 patients with moderate-to-severe psoriasis, of which 384 and 106 patients without and with arthritis symptoms formed the silent psoriasis and clinical PsA groups, respectively, and 80 age- and sex-matched control individuals without psoriasis.

Disclosures: This study was supported by the National Natural Science Foundation of China and other sources. The authors declared no conflicts of interest.

Source: Chen ZT et al. The role of ultrasound in screening subclinical psoriatic arthritis in patients with moderate to severe psoriasis. Eur Radiol. 2023 (Feb 28). Doi: 10.1007/s00330-023-09493-4

Key clinical point: The short-term risk for cancer other than non-melanoma skin cancer (NMSC) or NMSC was not significantly higher among patients with psoriatic arthritis (PsA) who initiated Janus kinase inhibitors (JAKi) than those who initiated tumor necrosis factor inhibitors (TNFi).

Major finding: JAKi vs TNFi was not significantly associated with a higher risk for cancer other than NMSC (adjusted hazard ratio [aHR] 1.88; 95% CI 0.68-5.16) or NMSC (aHR 2.05; 95% CI 0.79-5.31) in patients with PsA.

Study details: The data come from an observational cohort study that evaluated prospectively collected data of 4443 patients with PsA and 10,447 patients with RA, all without previous cancer, who received JAKi, TNFi, or other non-TNFi biologic disease-modifying antirheumatic drugs.

Disclosures: This study was funded by the Karolinska Institute Region Stockholm funds (ALF), Swedish Research Council, and others. T Frisell and H Bower declared being partly employed by the ARTIS project. J Askling reported research agreements with various sources.

Source: Huss V et al on behalf of the ARTIS group. Cancer risks with JAKi and biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis or psoriatic arthritis: A national real-world cohort study. Ann Rheum Dis. 2023 (Mar 3). Doi: 10.1136/ard-2022-223636

Key clinical point: The short-term risk for cancer other than non-melanoma skin cancer (NMSC) or NMSC was not significantly higher among patients with psoriatic arthritis (PsA) who initiated Janus kinase inhibitors (JAKi) than those who initiated tumor necrosis factor inhibitors (TNFi).

Major finding: JAKi vs TNFi was not significantly associated with a higher risk for cancer other than NMSC (adjusted hazard ratio [aHR] 1.88; 95% CI 0.68-5.16) or NMSC (aHR 2.05; 95% CI 0.79-5.31) in patients with PsA.

Study details: The data come from an observational cohort study that evaluated prospectively collected data of 4443 patients with PsA and 10,447 patients with RA, all without previous cancer, who received JAKi, TNFi, or other non-TNFi biologic disease-modifying antirheumatic drugs.

Disclosures: This study was funded by the Karolinska Institute Region Stockholm funds (ALF), Swedish Research Council, and others. T Frisell and H Bower declared being partly employed by the ARTIS project. J Askling reported research agreements with various sources.

Source: Huss V et al on behalf of the ARTIS group. Cancer risks with JAKi and biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis or psoriatic arthritis: A national real-world cohort study. Ann Rheum Dis. 2023 (Mar 3). Doi: 10.1136/ard-2022-223636

Key clinical point: The short-term risk for cancer other than non-melanoma skin cancer (NMSC) or NMSC was not significantly higher among patients with psoriatic arthritis (PsA) who initiated Janus kinase inhibitors (JAKi) than those who initiated tumor necrosis factor inhibitors (TNFi).

Major finding: JAKi vs TNFi was not significantly associated with a higher risk for cancer other than NMSC (adjusted hazard ratio [aHR] 1.88; 95% CI 0.68-5.16) or NMSC (aHR 2.05; 95% CI 0.79-5.31) in patients with PsA.

Study details: The data come from an observational cohort study that evaluated prospectively collected data of 4443 patients with PsA and 10,447 patients with RA, all without previous cancer, who received JAKi, TNFi, or other non-TNFi biologic disease-modifying antirheumatic drugs.

Disclosures: This study was funded by the Karolinska Institute Region Stockholm funds (ALF), Swedish Research Council, and others. T Frisell and H Bower declared being partly employed by the ARTIS project. J Askling reported research agreements with various sources.

Source: Huss V et al on behalf of the ARTIS group. Cancer risks with JAKi and biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis or psoriatic arthritis: A national real-world cohort study. Ann Rheum Dis. 2023 (Mar 3). Doi: 10.1136/ard-2022-223636

Key clinical point: All Janus kinase inhibitors (JAKi) were more effective than placebo in patients with psoriatic arthritis (PsA), but led to a higher overall incidence of adverse events, particularly at higher doses.

Major finding: JAKi vs placebo were associated with a significantly higher American College of Rheumatology 20 response rate (relative risk [RR] 2.09; P < .00001), with the response being the highest for filgotinib (RR 2.40; P < .00001), followed by upadacitinib, tofacitinib, and deucravacitinib. However, the overall incidence of adverse events was higher with JAKi vs placebo (RR 1.17; P < .00001) and significantly higher with 10 mg vs 5 mg tofacitinib (P = .03).

Study details: The data come from a systematic review and meta-analysis of 17 phase 2/3 randomized controlled trials including 6802 patients with PsA or moderate-to-severe plaque psoriasis who received ≥1 JAKi.

Disclosures: This study was supported by the National Basic Research Program of China. The authors declared no conflicts of interest.

Source: Yang F et al. Efficacy and safety of Janus kinase inhibitors in patients with psoriasis and psoriatic arthritis: A systematic review and meta‑analysis. Clin Rheumatol. 2023 (Feb 10). Doi: 10.1007/s10067-023-06529-4

Key clinical point: All Janus kinase inhibitors (JAKi) were more effective than placebo in patients with psoriatic arthritis (PsA), but led to a higher overall incidence of adverse events, particularly at higher doses.

Major finding: JAKi vs placebo were associated with a significantly higher American College of Rheumatology 20 response rate (relative risk [RR] 2.09; P < .00001), with the response being the highest for filgotinib (RR 2.40; P < .00001), followed by upadacitinib, tofacitinib, and deucravacitinib. However, the overall incidence of adverse events was higher with JAKi vs placebo (RR 1.17; P < .00001) and significantly higher with 10 mg vs 5 mg tofacitinib (P = .03).

Study details: The data come from a systematic review and meta-analysis of 17 phase 2/3 randomized controlled trials including 6802 patients with PsA or moderate-to-severe plaque psoriasis who received ≥1 JAKi.

Disclosures: This study was supported by the National Basic Research Program of China. The authors declared no conflicts of interest.

Source: Yang F et al. Efficacy and safety of Janus kinase inhibitors in patients with psoriasis and psoriatic arthritis: A systematic review and meta‑analysis. Clin Rheumatol. 2023 (Feb 10). Doi: 10.1007/s10067-023-06529-4

Key clinical point: All Janus kinase inhibitors (JAKi) were more effective than placebo in patients with psoriatic arthritis (PsA), but led to a higher overall incidence of adverse events, particularly at higher doses.

Major finding: JAKi vs placebo were associated with a significantly higher American College of Rheumatology 20 response rate (relative risk [RR] 2.09; P < .00001), with the response being the highest for filgotinib (RR 2.40; P < .00001), followed by upadacitinib, tofacitinib, and deucravacitinib. However, the overall incidence of adverse events was higher with JAKi vs placebo (RR 1.17; P < .00001) and significantly higher with 10 mg vs 5 mg tofacitinib (P = .03).

Study details: The data come from a systematic review and meta-analysis of 17 phase 2/3 randomized controlled trials including 6802 patients with PsA or moderate-to-severe plaque psoriasis who received ≥1 JAKi.

Disclosures: This study was supported by the National Basic Research Program of China. The authors declared no conflicts of interest.

Source: Yang F et al. Efficacy and safety of Janus kinase inhibitors in patients with psoriasis and psoriatic arthritis: A systematic review and meta‑analysis. Clin Rheumatol. 2023 (Feb 10). Doi: 10.1007/s10067-023-06529-4

Key clinical point: Guselkumab effectively resolved dactylitis in the majority of patients with psoriatic arthritis (PsA), with improvements sustained through 1 year, which in turn improved other clinical outcomes.

Major finding: At week 24, a significantly higher proportion of patients receiving guselkumab every 4 or 8 weeks (Q4W or Q8W) vs placebo (63.5% or 59.4% vs 42.2%, respectively; P < .05) achieved dactylitis resolution; approximately 80% of patients receiving guselkumab achieved ≥70% improvement in dactylitis severity score by week 52. Patients with resolved dactylitis at week 24 were more likely to achieve American College of Rheumatology 50 response and other clinical outcomes (P < .05).

Study details: This pooled analysis included 1120 patients with active PsA from the phase 3 DISCOVER-1 and DISCOVER-2 studies who were randomly assigned to receive 100 mg guselkumab Q4W or Q8W or placebo.

Disclosures: This study was supported by Janssen Research & Development, LLC. Several authors declared being employees, holding patents, or having other ties with Janssen or other sources.

Source: McGonagle D et al. Guselkumab, a selective Interleukin-23 p19 subunit Inhibitor, resolves dactylitis in patients with active psoriatic arthritis: Pooled results through week 52 from two phase 3 studies. ACR Open Rheumatol. 2023 (Mar 7). Doi: 10.1002/acr2.11537

Key clinical point: Guselkumab effectively resolved dactylitis in the majority of patients with psoriatic arthritis (PsA), with improvements sustained through 1 year, which in turn improved other clinical outcomes.

Major finding: At week 24, a significantly higher proportion of patients receiving guselkumab every 4 or 8 weeks (Q4W or Q8W) vs placebo (63.5% or 59.4% vs 42.2%, respectively; P < .05) achieved dactylitis resolution; approximately 80% of patients receiving guselkumab achieved ≥70% improvement in dactylitis severity score by week 52. Patients with resolved dactylitis at week 24 were more likely to achieve American College of Rheumatology 50 response and other clinical outcomes (P < .05).

Study details: This pooled analysis included 1120 patients with active PsA from the phase 3 DISCOVER-1 and DISCOVER-2 studies who were randomly assigned to receive 100 mg guselkumab Q4W or Q8W or placebo.

Disclosures: This study was supported by Janssen Research & Development, LLC. Several authors declared being employees, holding patents, or having other ties with Janssen or other sources.

Source: McGonagle D et al. Guselkumab, a selective Interleukin-23 p19 subunit Inhibitor, resolves dactylitis in patients with active psoriatic arthritis: Pooled results through week 52 from two phase 3 studies. ACR Open Rheumatol. 2023 (Mar 7). Doi: 10.1002/acr2.11537

Key clinical point: Guselkumab effectively resolved dactylitis in the majority of patients with psoriatic arthritis (PsA), with improvements sustained through 1 year, which in turn improved other clinical outcomes.

Major finding: At week 24, a significantly higher proportion of patients receiving guselkumab every 4 or 8 weeks (Q4W or Q8W) vs placebo (63.5% or 59.4% vs 42.2%, respectively; P < .05) achieved dactylitis resolution; approximately 80% of patients receiving guselkumab achieved ≥70% improvement in dactylitis severity score by week 52. Patients with resolved dactylitis at week 24 were more likely to achieve American College of Rheumatology 50 response and other clinical outcomes (P < .05).

Study details: This pooled analysis included 1120 patients with active PsA from the phase 3 DISCOVER-1 and DISCOVER-2 studies who were randomly assigned to receive 100 mg guselkumab Q4W or Q8W or placebo.

Disclosures: This study was supported by Janssen Research & Development, LLC. Several authors declared being employees, holding patents, or having other ties with Janssen or other sources.

Source: McGonagle D et al. Guselkumab, a selective Interleukin-23 p19 subunit Inhibitor, resolves dactylitis in patients with active psoriatic arthritis: Pooled results through week 52 from two phase 3 studies. ACR Open Rheumatol. 2023 (Mar 7). Doi: 10.1002/acr2.11537

Key clinical point: Women with psoriatic arthritis (PsA) were at an increased risk for emergency caesarean section, with active disease in the third trimester further amplifying the risk, highlighting the importance of pregestational counseling and disease control along with systematic monitoring during pregnancy.

Major finding: Compared with control individuals, women with PsA had a higher risk for caesarean section (risk difference [RD] 15.0%; P < .001) and for emergency caesarean section (RD 10.6%; P < .001), with active disease in the third trimester further amplifying both risks (caesarean section: RD 17.7%; P = .028; emergency caesarean section: RD 15.9%; P = .015).

Study details: The data come from a population-based cohort study that included women with PsA (n = 121), women with axial spondyloarthritis (n = 312), and control individuals (n = 575,798) with singleton births.

Disclosures: This study was funded by The Norwegian Women’s Public Health Association. The authors did not declare any conflicts of interest.

Source: Skorpen CG et al. Caesarean section in women with axial spondyloarthritis and psoriatic arthritis: A population-based study. RMD Open. 2023;9(1):e002760 (Mar 2). Doi: 10.1136/rmdopen-2022-002760

Key clinical point: Women with psoriatic arthritis (PsA) were at an increased risk for emergency caesarean section, with active disease in the third trimester further amplifying the risk, highlighting the importance of pregestational counseling and disease control along with systematic monitoring during pregnancy.

Major finding: Compared with control individuals, women with PsA had a higher risk for caesarean section (risk difference [RD] 15.0%; P < .001) and for emergency caesarean section (RD 10.6%; P < .001), with active disease in the third trimester further amplifying both risks (caesarean section: RD 17.7%; P = .028; emergency caesarean section: RD 15.9%; P = .015).

Study details: The data come from a population-based cohort study that included women with PsA (n = 121), women with axial spondyloarthritis (n = 312), and control individuals (n = 575,798) with singleton births.

Disclosures: This study was funded by The Norwegian Women’s Public Health Association. The authors did not declare any conflicts of interest.

Source: Skorpen CG et al. Caesarean section in women with axial spondyloarthritis and psoriatic arthritis: A population-based study. RMD Open. 2023;9(1):e002760 (Mar 2). Doi: 10.1136/rmdopen-2022-002760

Key clinical point: Women with psoriatic arthritis (PsA) were at an increased risk for emergency caesarean section, with active disease in the third trimester further amplifying the risk, highlighting the importance of pregestational counseling and disease control along with systematic monitoring during pregnancy.

Major finding: Compared with control individuals, women with PsA had a higher risk for caesarean section (risk difference [RD] 15.0%; P < .001) and for emergency caesarean section (RD 10.6%; P < .001), with active disease in the third trimester further amplifying both risks (caesarean section: RD 17.7%; P = .028; emergency caesarean section: RD 15.9%; P = .015).

Study details: The data come from a population-based cohort study that included women with PsA (n = 121), women with axial spondyloarthritis (n = 312), and control individuals (n = 575,798) with singleton births.

Disclosures: This study was funded by The Norwegian Women’s Public Health Association. The authors did not declare any conflicts of interest.

Source: Skorpen CG et al. Caesarean section in women with axial spondyloarthritis and psoriatic arthritis: A population-based study. RMD Open. 2023;9(1):e002760 (Mar 2). Doi: 10.1136/rmdopen-2022-002760