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Safety of Combination Targeted Therapies in Psoriatic Arthritis
MedPage Today
Treating psoriatic arthritis (PsA) patients with more than one targeted therapy appears to be just fine, with no increased risk of serious infections, insurance claims data indicate.
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Teaching You How to Think… (8.15.2025)
Dr. Jack Cush reviews the news, journal reports and press clippings from the past week on RheumNow. Positive results in a Sjogren's trial, to PT or not to PT, and aphorisms to live by.
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The Patient Journey with Rheumatic Disease
Oton and colleagues have reviewed the "patient journey" - from symptoms to specialty referral in those diagnosed with rheumatic and musculoskeletal diseases (RMDs).
Biologic Switching in Psoriasis
A systematic review and meta-analysis found that biologic switching was effective in a significant number of psoriasis patients; but there may be a price to pay.
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Juvenile Idiopathic Arthritis - NEJM Review
Sandborg et al. has published an overview of juvenile idiopathic arthritis (JIA) - its classification, biology, genetics, , clinical presentations and treatment advances in the New England Journal of Medicine (NEJM).
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A New RA Approval (8.1.2025)
Dr. Jack Cush reviews the news, journal reports and a new treatment for RA from the FDA.
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Options for Refractory axSpA or PsA
MedPage Today
Although most patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) didn't respond adequately to the interleukin-17 (IL-17) inhibitor ixekizumab (Taltz), enough did that it should still be considered in such cases, a Danish registry study indicated.
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Practical management of rheumatic immune-related adverse events with immune checkpoint inhibitors
Joint Bone Spine has published a full read review of the management of immune-related adverse events (irAEs) in patients receiving Immune checkpoint inhibitors (ICIs) for cancer.
Cohort study of 1,553 Biologic or JAKi Rx IBD (Crohns; UC) pts (SpA excluded) found 106 (6.8%) w/ MSK Sxs & 30 (1.9%) later Dx w/ SpA (20: axial, 10: peripheral) after median F/U 5.2 yrs. SpA risk factors: partial Mayo UC (HR 1.57) & HLA-B27 positivity (HR 3.70) https://t.co/WgLLUjlLMk
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Biologic Switching in Psoriasis
A systematic review and meta-analysis found that biologic switching was effective in a significant number of psoriasis patients; but there may be a price to pay.
https://t.co/QEv5jx9AIo https://t.co/06keUfXwRT
Dr. John Cush RheumNow ( View Tweet)
There's a transient (1 yr) increase in New Abx Rx among 399 PsA pts after starting a TNF inhibitor. Pre-TNFi, PsA pts were more likely to recv Abx vs controls (1.26 vs. 0.60/yr; p<0.001). Post TNFi Abx use incr to 1.64/yr (p<0.001) but returned to baseline thereafter. https://t.co/LHXn5d7oC9
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Study of 94 children w/ Enthesitis-related arthritis (ERA) - 45 Tunisian, 49 Turkish. While similar demographics, Turkish ERA had signif. more heel pain (61% vs 9%), enthesitis (69% v 40%), &biologics (50 vs 9%); but Tunisian ERA had more sacroiliitis (91% v 55%), Axial Dz (98% v https://t.co/AKNEYoO0C6
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945 consecutive severe psoriasis pts Rx TNFi or nbUVB phototherapy (2005-2010) w/ median F/U > 9 yrs. After propensity matching, incidence of future PsA was 1.18/100 w/ TNFi vs 2.48/100 w/ nbUVB (IRR 2.1; 1.37–2.98, P = 0.0002). TNFi lowered PsA risk (HR = 0.32). PsA predictors https://t.co/aBsXs6RpCY
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Review of macrophage phenotypes (M1, M2, etc) in rheumatic diseases. In RA synovial Tiss macrophages - are MerTK+CD206+ w/ remission and MerTK−CD206− w/ active inflammation. Tissue fibrosis in PSS driven by Profibrotic CD206+ and CD163+ cell subsets https://t.co/vIG7SYsaWq https://t.co/OKnzOFIlKr
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Pregnant Women on TNFi more likely to use throughout gestation, w/ less steroids. 3711 preg on TNFi in 49,925 F (w/ RA, AS, PsA, PsO, IBD) -- 64% had 3 trimester TNFi use. 89% exposed preconception & 68% cont postpartum. TNFi use incr from 55% to 73% i(20111-21) https://t.co/DVvbwx6MoW
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PsA is worse in women--why? 100 PsA pts, serum study of differentially expressed proteins - 20 times more sex-specific DEPs in PsA males than females (PsA vs controls). In women leukotriene A-4; and in men IL-36, NEK7 & PIK3CA/PIK3R1 were significant predictors. https://t.co/JzI1n6Hf5G
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Systemic immune-inflammation index (SII), as a potential biomarker -- computed as platelet count × neutrophil count/lymphocyte count. SII has been shown to be useful in RA, PsA, SpA, SLE and vasculitis, reflecting disease activity, drug responses & supplements ESR & CRP levels https://t.co/LuFaYbWiWN
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Review of risankizumab efficacy & safety included 545 psoriasis pts showing Mean PASI decreased from 14 to 0.5 at 208Wk. PASI100 achieved in 33% and 74% at 16Wk & 208Wk. Bio-naïve responded faster bio-experienced pts - only 5 pts D/C for adverse events https://t.co/VklLWpD0SF https://t.co/zZfuiFijd4
Links:
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Subclinical Synovitis Among Psoriasis Patients
A systematic review shows that imaging can be used to detect subclinical synovitis among patients with psoriasis and may identify individuals at risk for future psoriatic arthritis.
https://t.co/2603Aax8PP https://t.co/2XDtDg1QHh
Dr. John Cush RheumNow ( View Tweet)
40 kids w/ Psoriasis compared to 40 juvenile PsA pts. Those w/ jPsA were more likely to be:
- Obese/overweight (80 vs 17.5%)
- passive smoking (37.5 vs (25%)
- Signif higher ESR and CRP (P < 0.001)
- Nail PsO (65 vs 22%) https://t.co/3uBHnxZYC2 https://t.co/rW48EQta2s
Dr. John Cush RheumNow ( View Tweet)
