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Are MDA criteria created equal in PsA?

Rachel Tate, DO

Minimal Disease Activity criteria are used to evaluate PsA disease activity and response to treatment. Given that a patient only has to meet 5 of the 7 criteria, should the individual components be weighted equally? 

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Are we really treating Psoriatic disease if we only address active disease domains and T2T?

Rachel Tate, DO

It’s widely accepted that Psoriatic disease has multi-system, multi-domain potential that can lead to life altering complications if left untreated or undertreated. Rheumatologists have shifted the way we discuss treatment options and disease state expectations with patients. Two #ACR22 abstracts stood out to me regarding the Psoriatic disease patient experience and will, ultimately, add to what I do in clinic. 

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Don’t be ‘ticked’: TYK2 is not a JAK!

Janet Pope, MD, MPH, FRCPC

Recently the FDA approved deucravacitinib, a highly selective TYK2 inhibitor for psoriasis. Trials are positive in psoriatic arthritis and a phase II study in SLE. What about the effects? Presentations from the ACR22 meeting may provide answers.

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“Hey PRESTO!” – Early identification of psoriatic arthritis

Patricia Harkins, MD

Despite a wealth of treatment options, a number of notable unmet needs remain in PsA, most notably the significant diagnostic delay that many patients endure. We are all aware that those with psoriatic skin disease are the most at risk cohort for PsA. Identifying patients with psoriasis who have, or are at increased risk of PsA, appears to be the low hanging fruit that we just can’t fully seem to grasp.

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JAK and TYK-2 inhibitors and indications in SpA: ● Tofacitinib ➣ Pan JAKi (AS, PsA) ● Baricitinib ➣ JAK1,2 ● Upadacitinib ➣ JAK1 (AxSpA, PsA) ● Deucravacitinib ➣ TYK2 (PsA) Carol Langford, Year in Review #ACR22 @RheumNow https://t.co/EMLEvptySS
Dr. Antoni Chan synovialjoints ( View Tweet)
Differences between #uveitis pattern in AS vs. PsA and IBD 👇 This is always asked to our rheum fellows during Kelley's hour 🤓 #ACR22 @RheumNow @rheumarhyme @trishiemd @RheumaRamblings @RheumaRambolMD https://t.co/gWxQ9xdb06
sheila RHEUMarampa ( View Tweet)
Across 9 trials of Upadacitinib in RA, PsA and AS, 40%–50% of patients had ≥ 2 CV risk factors, ≥ 65 years 6%–23%. Rates of adjudicated MACE and VTE with UPA were infrequent, consistent with background rates in RA, PsA, and AS Abst 0510 https://t.co/HDkQ6ELnAy #ACR22 @RheumNow https://t.co/SRJYdFFNIQ

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Dr. Antoni Chan synovialjoints ( View Tweet)
In this study, Dr. Niti Goel shows the under-reporting of race & ethnicity in publications of #psoriaticarthritis clinical trials 🧐Participant diversity is important to consider since different races & ethnicities may respond differently to therapies #ACR22 @RheumNow ABST0090 https://t.co/BzHpuHYVI5
sheila RHEUMarampa ( View Tweet)
Post hoc analysis from the SELECT-PsA 1 trial by Dr. @DrLauraCoates and team: 💊Pts on UPA showed greater improvement from BL in RAPID3 vs. ADA in all visits 💊Pts on UPA had better responses in all assessments vs. PBO Reassuring data. #ACR22 @RheumNow ABST0192 https://t.co/NgeUU5bPPf
sheila RHEUMarampa ( View Tweet)
🤕 Late onset PsA associated with ⬆️ structural damage 💪🏻UL > LL arthritis ⬆️ BASFI 🙋‍♂️ males ⬇️ enthesitis/ sacroilitis Abst# 0377 #ACR22 @RheumNow

Patricia Harkins DrTrishHarkins ( View Tweet)

What’s new to treat PsA? Let’s discuss anti-IL-17A, Izokibep #ACR22 @RheumNow Abstract #0199 💪 Izokibep 40 v. 80 mg q2 weeks SQ v. placebo 💪 135 patients, 28 sites 💪 At 12 weeks, all patient reported outcomes and PsAID subdomains significantly improved (dose dependent)

Catherine Sims, MD DrCassySims ( View Tweet)

Clinical pearl! Patient-reported treatment success in PsA assoc'd w/ control of arthritis, dactylitis, psoriasis, and health-related QoL. Top 3 pt-reported reasons for tx failure were pain, psoriasis and fatigue. Abs0393 #ACR22 @RheumNow https://t.co/F9RNI7EXcL https://t.co/7DcLaqUqnm

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Dr. Rachel Tate uptoTate ( View Tweet)
Rates of MACE and VTE with upadacitinib were infrequent and consistent with background rates in RA, PsA and AS patients. Factors associated with MACE/VTE: age>65, HTN, DM, smoking, history CV event/VTE Abs#0510 @RheumNow #ACR22 https://t.co/AjtJF0p3QK
Robert B Chao, MD doctorRBC ( View Tweet)
Do you consider ttmt successful? Question Christeen et al. asked to 100+ PsA pts. 1/3 pts said no, they had > TJC, > SJC, > Pso & > dactylitis. Failure also w/: pain 24%, pso 15%, fatigue 12% and < ability to be active 9%. https://t.co/dQseCNSDBS Abstr #0393 #ACR22 @Rheumnow https://t.co/kGlmscsKL7

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Aurelie Najm AurelieRheumo ( View Tweet)
Interesting observation: Late-onset PsA assoc'd w/ male sex, greater structural damage, higher frequency of arthritis, and greater loss of functionality (BASFI). Interestingly, shorter time of symptom duration to dx. Abs 0377 #ACR22 @RheumNow https://t.co/m15c37FltD https://t.co/3LRy4Ltde6

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Dr. Rachel Tate uptoTate ( View Tweet)
So does PsA affect your capacity to work? DISCOVER-2 analysis: It’s presenteeism, not absenteeism which is the issue PsA pts drag themselves into work, but treating them helps them actually do their job. We need to fund more rheumatologists! ABST0509 @RADoctor #ACR22 @RheumNow https://t.co/Jnac6mV9O5
David Liew drdavidliew ( View Tweet)
@DiegoBenavent et al: Gender impacts disease outcomes in PsA and SpA. Women > BASDAI, >BASFI, > ASDAS, >ASDAS Hi, and > EQ-5D. Not so surprising considering higher ratio for Fibromyalgia in W ASDAS not asso w/ gender in AxSPA. https://t.co/kBxvAi5qZw Abstr #0381 #ACR22 @Rheumnow https://t.co/vxdtlKpT3l

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Aurelie Najm AurelieRheumo ( View Tweet)
Dr Scher shares his algorithm Rx for #PsA in clinical practice #acrreview #acr22 ⁦@RheumNow⁩ https://t.co/0xB1KwpfW7
TheDaoIndex KDAO2011 ( View Tweet)
Does #COVID19 #vaccine work in #psoriaticarthritis? @RheumNow #ACR22 Abstract #0389 🤚 HR for infection and hospitalization similar between controls and PsA after 2nd vaccination 🤚#Enbrel (OR 2.39) and #JAKi (OR 9.90) higher risk of infection and hospitalization

Catherine Sims, MD DrCassySims ( View Tweet)

Withdrawing IL17i will more likely cause a relapse, but pts will respond when reintroduced -Dr Scher #PsA @rheumnow #acr22 #acrreview https://t.co/FvWVuQGJda
TheDaoIndex KDAO2011 ( View Tweet)
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