New Updated GRAPPA Psoriatic Arthritis Recommendations

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The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nail psoriasis; with new PsA related domains uveitis and inflammatory bowel disease.

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FDA approved Abbvies risakizumab-rzaa (Skyrizi) as the 1st interleukin-23 inhibitor for use in adults with moderately to severely active Crohn's disease (600 mg IV at wk 0, 4, 8, &q8wk @ 360 mg SC). Approval based on ADVANCE, MOTIVATE & FORTIFY RCTs https://t.co/OMYNB1yr2R https://t.co/QMn9GWlYm9

Treatment of pyoderma gangrenosum is clinically empiric. Full read ref w/ Graded Rx Recommendations: - 1st line: Steriods or Cyclosporin - Consider biologics: TNFi, IL-1, IL-12/23, IL-17, IL-23 - Others: MTX, MMF, AZA, Dap, colchic, thalidomide, IVIG https://t.co/uMJyfFzsRB https://t.co/vw4VqbjZWh

FDA approved Abbvies risakizumab-rzaa (Skyrizi) as the 1st interleukin-23 inhibitor for use in adults with moderately to severely active Crohn's disease (600 mg IV at wk 0, 4, 8, &q8wk @ 360 mg SC). Approval based on ADVANCE, MOTIVATE & FORTIFY RCTs https://t.co/Y6FVcjHGr2 https://t.co/eTYedqiScE

JAK/STAT pathway in pyoderma gangrenosum: a new therapeutic highway?

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Pyoderma gangrenosum (PG) is rare, but often associated with different forms of arthritis, in particular rheumatoid arthritis and inflammatory bowel diseases. 

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Spondyloarthritis and COVID-19

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There are still questions surrounding COVID-19, and some common questions I receive from patients revolve around what to do with their current DMARDs or should they even start treatment during this pandemic. Two studies focused on this question. 

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Studies suggest that the IL-23/Th-17 axis is one of the key pathways involved in the pathogenesis of plaque psoriasis and psoriatic arthritis. Learn more here: https://t.co/oj00pk4dLT Sponsored by Janssen @JanssenUS https://t.co/4IhyX6sF7p

Key Psoriatic Arthritis topics and updates at EULAR 2022

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At EULAR 2022, I have been looking at topics and presentations in psoriatic arthritis (PsA).  Here are my top picks from this year's meeting.

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In vitro study shows Upadacitinib inhibits enthesis T cell derived TNFa and IL-17A, disrupting the prominent IL-23/IL-17/TNFa axis driving SpA. @RheumNow #EULAR2022 ABST#POS0331 https://t.co/pNL3Zlgmt7

Magrey et al. IL23i Risankizumab improves enthesitis in PsA @RheumNow #EULAR2022 POS1057 https://t.co/BjuYj6xUdZ

Dr Coates @DrLauraCoates et al. Domains contributing to MDA achievement in guselkumab treated PsA. Physican assessed improved faster than patient assessed. Age, fatigue, BMI, baseline domain score determinants @RheumNow #EULAR2022 POS1067 https://t.co/vPsmeyPjzG

Dr Nash @drpnash Baseline determinants of pain response in IL23i guselkumab. Gus improved pain by week 2. Higher baseline pain, lower fatigue, lower TJC + predictors, NSAID use - predictor @RheumNow #EULAR2022 POS1070 https://t.co/4aNz9IQySj

High markers at baseline of IL23 pathway better predict ACR20 response to #deucracitinib in #PsA #psoriatic arthritis. Analysis of RCT @eular_org @RheumNow #POS0005 Good proof of concept of TYK2 efficacy https://t.co/yyH5niUEEU

Kristensen et al. IL23i Risankizumab improves fatigue, health related quality of life, work productivity in PsA. @RheumNow #EULAR2022 POS1042 https://t.co/fnoCZCpwNM

Nash @drpnash et al. IL23i guselkumab improves pain in PsA. Good to see as it is a really important PRO, but there is still significant work to do, week 24 - 60% had <50% and 37% had <20% improvement in pain @RheumNow #EULAR2022 POS1044 https://t.co/H92r4leslT

Tillett et al. Baseline characteristics and achievement of MDA at week 24 with IL23i guselkumab in bDMARD experienced patients. Pattern of joint (wrist vs shoulder/hand) and skin (scalp vs hand/foot) involvement, as well as male sex, predictive @RheumNow #EULAR2022 POS1051 https://t.co/lHOTgMWgMA

Prof McInnes @IainBMcInnes1 et al. IL23i guselkumab efficacy maintained irrespective of baseline characteristics of patients. I kind of wish in some of these studies that we would see big differences to help us select between agents! @RheumNow #EULAR2022 POS0072 https://t.co/zJWvpwcDkt

Mease et al. Minimal radiographic progression in patients treated with IL-23i guselkumab over 2 years. This trial enriched for high-risk radiographic progression. Clinical response associated with less radiographic progression. @RheumNow #EULAR2022 POS1035 https://t.co/1C21MNVpV8

Dr Gossec et al. Multidomain indices show consistent benefit when applied to IL23i guselkumab COSMOS trial. I like MDA (because its simple and so am I) so showing that. But same benefits seen in DAPSA, PASDAS, mCPDAI, GRACE, PsARC. @RheumNow #EULAR2022 POS1038 https://t.co/EU2VHpEGc3