2021 GRAPPA Recommendations - Looking Back, Looking Forward

Save

With the recent publication of the third iteration of the GRAPPA Psoriatic Arthritis (PsA) treatment recommendations, it seems to be an auspicious time to reflect on some key considerations that arose during the development of the recommendations, as well as to look towards what the future may hold.

The Contribution of the Gut Microbiome and Diet to Joint Inflammation in PsA

Save

Interactions of the gut microbiota in humans promote the release of a variety of metabolites with profound effects on human health and immune regulation.

Toss of a Coin - How do You Choose PsA Medication?

Save

When balancing all these disease domains, individual phenotypes, and comorbidities, sometimes treatment decisions can feel like tossing a coin. Fortunately, numerous guidelines have been published to help us do better than tossing a coin…or do they? 

Pain in Psoriatic Arthritis

Save

Pain is typically ranked by both patients and physicians as the most important symptom of psoriatic arthritis (PsA) to assess and treat. Although the predominant concept of the etiology of pain in PsA is that of inflammation in peripheral joints, entheses, and bone signaling through peripheral nociceptive fibers, perceived as pain in the central nervous system, it is actually more complex than that. The ability of a treatment to ameliorate pain is one of the principle measures of its effectiveness. Thus pain improvement or worsening are key determinants of shared decision making about treatment in PsA. 

Axial Disease in Psoriatic Arthritis

Save

Inflammatory involvement of the axial skeleton and sacroiliac joints occurs, on average, in 40-50% of patients with psoriatic arthritis (PsA). When present, axial involvement is a “biomarker” of more severe PsA disease: more severe peripheral joint disease, enthesitis, skin disease, pain, impaired function and quality of life, and work productivity. Thus, it is important to recognize and include in a comprehensive PsA treatment approach.

Complementary and Alternative Therapies in Psoriasis and Psoriatic Arthritis

Save

It’s been reported that approximately one-third to one-half of patients with psoriatic arthritis will try supplements and other complementary and alternative medicinal (CAM) practices without discussing with their rheumatologists.  Of those, nearly 90% of PsA patients using CAM report benefits!  Here is your updated review on common supplement data in psoriasis and PsA. 

Methotrexate in PsA

Save

Until the publication of the SEAM trial, evidence in the medical literature for the efficacy of the most commonly used drug for psoriatic arthritis worldwide, methotrexate, has been lukewarm at best. Yet we all employ it commonly, either as monotherapy or in combination with biologic or targeted synthetic DMARD treatment. It is inexpensive and widely available, and only modestly toxic.

Combined Clinics for PsA

Save

Recognizing the importance of addressing all aspects of disease, we started our joint rheum-derm psoriatic disease clinic at Northwestern shortly after I arrived at the institution, and it has been a tremendous success.

MDA: Aiming for Perfection in PsA

Save

When it comes to psoriatic arthritis clinical trials such as TICOPA (tight control in PsA)  have consistently shown that treating to target correlates with improved disease domain and patient reported outcomes.  Minimal disease activity (MDA) has become an oft used target and outcome in PsA trials. While many of us measure and record a variety of measures in our patient charts, we may be on our way to demonstrating MDA in practice. Here is a quick review of MDA components and how to capture them for your patients. 

The Enthesitis Challenge in Psoriatic Arthritis

Save

A colleague of mine once told me an interesting story of how her father, who was a doctor, misdiagnosed his wife with fibromyalgia when she actually had psoriatic arthritis with enthesitis all along. I would venture out and say that the average physician would have trouble evaluating enthesitis because even we, as rheumatologists do!