ACR 2025 PsA Topic Podcasts Compilation 1 Save

This is an ACR twenty twenty five podcast coming to you from Chicago. Hope you enjoy it.

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Hi. This is doctor Artie Kavanagh, University of California San Diego. Very happy to be here at the ACR Convergence in Chicago 2025 at RheumNow. Of course, the greatest coverage of the meeting. And it took on a hot topic, hot topic in psoriatic arthritis, and that is imaging.

And imaging, of course, as one of the forms of inflammatory arthritis, we looked imaging as a measure of damage to the joint, and we extrapolate what we had learned early in rheumatoid arthritis to psoriatic arthritis. But over the years, we've seen, as has been seen in rheumatoid arthritis, it's really hard to discern a therapeutic effect at inhibiting structural damage using plain x rays because the patients are not progressing to the degree that they used to before we had so many therapeutic interventions. Now we see progressions of just a couple of units in the Sharp modified van der Heide score, and whether or not that has any clinical relevance is a subject of intense debate. What that has done in psoriatic arthritis is drive interest in other forms of imaging, particularly ultrasound. It's come a long way in ultrasound, and ultrasound has a number of benefits in imaging peripheral arthritis and psoriatic arthritis.

Also, it's able to image the entheses, which are not visualized well by other techniques such as plain x-ray. In addition to being able to find damage, the ultrasound is able to look at inflammation. Very important. So the question, how do we best do ultrasound, is one that's been actively studied. There's a study called DUET that collected data from ultrasonographers on PSA patients, from multiple investigators around the world to try to create a scoring system by which we could accurately quantify the important aspects of inflammation and also structural damage in patients with psoriatic arthritis.

In addition to that, there are a number of other ways that we can look at the joints. Big interest in using quantitative CAT scan, which can image bone in a much greater detail than plain radiograph can and give important information, for example, on the potential healing of erosions that we see in inflammatory peripheral arthritis, including that in psoriatic arthritis. Then fancy techniques, I would call them, like the PET scan, positron emission tomography with the CAT scan, which can look at inflammation. I think, like MRI, can offer us valuable information on many of the domains of involvement, the peripheral arthritis, enthesitis, dactylitis, also the axial disease. And then MR, how best do we use MR?

If it was widely available and had no downside, will we do it on all the patients all the time? Quite possibly. And I think there's a lot of work in MRI looking at novel ways to both set up the exam and then to interpret it. So what's being looked at are the higher strength magnets and beyond the three Tesla magnet, and also novel sequences like the ultra short time echo recovery sequence. So imaging, super hot topic in psoriatic arthritis.

Historically, we had plain x rays, and they showed us a lot of good information, but I think more exciting is the future with novel methods to assess the joints. It's doctor Arty Kavanaugh from ACR in Chicago, and you're watching RoomNow. Welcome

to day one at, ACR Convergence. My name is doctor Elaine Husney, a rheumatologist at the Cleveland Clinic, and I wanted to pick, several abstracts out today on, specialized biomarkers for psoriatic arthritis. I have abstract zero one one one, which is called predicting response to adalimumab in patients with psoriatic arthritis using an epigenetic chromosome conformational signature. So that was a mouthful, but what I found this was, so interesting is that we all know that, TNF is commonly a first line drug used in psoriatic arthritis, but we're not really sure if all patients respond. And wouldn't it be wonderful if we kind of knew ahead of time who was gonna be a better responder to, adalimumab and who might not be as good a responder.

So in this particular abstract, we saw a cohort about 91 patients that they saw. And what they did is, using ACR response criteria, they looked at a group of what we call extreme responders and a group of extreme non responders. And they looked at these two cohorts, and they were able to find a signature using a very sort of specialized chromosomal assay. So this was called an Epi Switch Explorer microarray. And so using this technology in their 22 patients, they were actually able to find or conclude that there's a potential biomarker for predicting therapeutic response to adalimumab in psoriatic arthritis patients.

So very interesting, more to come. This model, they said, had an accuracy of 96.4% specificity. So something that will really help us out to see if we can, rather than kind of just doing, know, trying and trying different ones, maybe ahead of time we can, maybe predict, whether or they're going to respond to a TNF class, of medication.

Hi. This is doctor Arti Kavanagh coming to you from ACR Convergence in Chicago, ACR twenty twenty five. And I'm at RheumNow, you're watching RheumNow, the best place to go to catch highlights on many of the important topics happening. So an interesting topic in psoriatic arthritis has been sex. So now that I have your attention, it's something that we are paying a lot more attention to.

Specifically, do men and women respond differently to therapeutic intervention? Backing up from that, do they have different baseline characteristics? Even though all patients have psoriatic arthritis, what impact does that have on our approach to the patients and our approach to therapy? So there's a number of ways that have looked at this, and this is something we've seen in psoriatic arthritis maybe more so than in rheumatoid arthritis even, where there seems to be a discrepancy. Definitely women compared to men seem to have higher levels of disease activity across certain domains, particularly those related to pain.

Men may have more severe skin manifestations, and we see this in a lot of studies. It's a super interesting area and one about which we don't have a lot of history. Only recently have we started to look at data according to sex, and once you do, it's very striking that we really need to do that pretty much for all studies going forward. If you had an imbalance in the sex distribution between an active treatment and another active treatment or placebo, that would definitely impact the results. So we're learning that we need to pay attention to this to help us interpret the results of psoriatic arthritis studies.

This has not been looked at a lot in rheumatoid arthritis. It's been looked at in ankylosing spondylitis, where we see similar things that you really have to consider in a group of patients the sex distribution to make sense of the baseline characteristics, more importantly, the response to any particular therapeutic intervention. We're seeing this has become more standard now in the reporting of studies, including some that are present at this meeting. We see a new psoriatic arthritis study, we want to know, is there an impact of the sex difference in the baseline characteristics or in the response to therapy? Another aspect of that that we have not really considered a lot in psoriatic arthritis relates to change in the hormonal status.

I'm thinking specifically of the perimenopausal and postmenopausal status. We've thought of this in rheumatoid arthritis, and there, of course, it makes sense. The average age of the patients being a little higher in rheumatoid arthritis than psoriatic arthritis in general. The sex distribution being many more women with rheumatoid arthritis, whereas the sex distribution, psoriatic arthritis, relatively equal men and women. But we haven't paid attention to changes in hormones over time.

That's something that's getting us a little bit of attention at this meeting, and I think it's something we're going to have to factor. Sex is important, then hormonal changes, and as they occur over time, how that influences the patients, how it influences the activity across different domains of disease, and most importantly, how that influences the response to therapy. So, kind of a newish area, one that very rapidly has become the center of a lot of attention. We need to pay attention to this if we're able to really understand the data that we're seeing from so many of the new studies that are happening. Very exciting.

Psoriatic arthritis continues to blaze trails and have important new information across multiple areas such as the impact of sex. I'm Doctor. Arti Kavanaugh reporting from the ACR Convergence in Chicago for RheumNow.

Hi, everybody, and welcome from ACR Convergence in beautiful downtown Chicago. My name is Professor Peter Nash from Griffith University in Brisbane, and I'm going to review what you should be in the water supply given the data, the g l s g l p one agonists in rheumatic diseases because there were 14 abstracts on this topic. And if you need the numbers of some of the important ones, eight forty one, eight forty nine, a 27, twenty six eighty five, o one six five, 2658, and o 233. Now a lot of these used huge databases, including massive numbers of patients. At least three of them use the TriNetX database.

Now this is a conglomerate of electronic medical record and claims data from 83 different sites in many different countries. And there was another one called the RISE database, the RISE registry, which also had very large numbers of patients. And when I say large numbers, I mean a couple of 100,000 compared to say 10 or 20,000. So with those kinds of numbers, it's very easy to make significant differences with small changes. So these abstracts looked at lupus nephritis, They looked at psoriatic arthritis.

They looked at total knee replacement. They looked the incidence of inflammatory rheumatic diseases and infections in patients taking the STLP one agonists. They even had one study where they injected it into the knee joint of an animal model of osteoarthritis. But it's the PSA ones. Sorry.

I just have to mention these studies are all retrospective, observational. They use propensity matching. And at some time, we have to talk about TriNetX and the issues of TriNetX, has a propensity score matching, program built in. And there's lots of issues with that database even though it's vast in data capture, missing data, misclassification, different clinicians deciding on line of therapy and which therapy and recording date of onset at different times and data garbage in and garbage out make it that you have to take it all with a grain of salt, but the actual numbers are huge. All the studies, and this one I'm particularly talking about, they followed people for ten years with PSA.

They compared eighty six thousand patients without PSA with four thousand who had PSA. They all lost weight. They showed that the patients on the agonists had less CRP, dapsa, and pain, but they also had, and this is the key, they had less ischemic heart disease, less acute myocardial infarction, less cardiac failure, less cerebrovascular disease, and even less deaths in the patients on these drugs with active PSA. Now the number needed to treat was in the order of thirty to fifty over this ten year period to prevent one death and to prevent some of those other morbidities that I mentioned. Another study looked at five year risk reduced incidence of knee replacement.

Another study looked at diabetics and they looked at seven hundred and ninety thousand diabetics and they compared them with eighty thousand non diabetics and they looked at mortality, dementia, Parkinson's disease and cardiovascular disease with very significant reductions both in the diabetic patients and the obesity patients who are on these drugs. So across the board, they were trying to show that these SGLP1 agonists led to marked and significant benefits as far as cardiovascular risk, particularly in these PSA patients they studied. They had less cerebrovascular disease, They had less cardiac failure and less deaths. So it looks like it should be in the water supply of all our patients. And the take home message is if you have patients with morbid obesity, BMI over 30, you have to think long and hard about using these drugs, and you have to take them off the endocrinologists.

Think about cost, but also think about the benefits, particularly in a PSA population who have metabolic syndrome, fatty liver, drink too much alcohol, and have premature atherosclerosis because all the hard endpoints are significantly improved. It's just a question of how much. Thank you very much.