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Psoriatic arthritis

384 Psoriasis pts followed mean 33 mos, 56 (14.6%) developed new-onset PsA. 311/384 (81%) had arthralgia (subclinical PsA) & 9.4% got PsA within 12 mos (23% by 36%). Subclinical more likely than PSO to get PsA (OR 11.7) https://t.co/9t41cjROwW https://t.co/9AelBwoRzs
Dr. John Cush @RheumNow( View Tweet )
Window of Opportunity in Psoriatic Arthritis The Dutch southwest Early psoriatic arthritis (PsA) cohort study has demonstrated that the earlier the referral and diagnosis of PsA, the better the outcome. https://t.co/eUL1wzrXVt https://t.co/XSETW2zpGs
Dr. John Cush @RheumNow( View Tweet )

The Window of Opportunity (5.24.2024)

Dr. Jack Cush reviews the journal reports and news from the past week on RheumNow.com. This week: blockbuster drugs, opioids in rheumatology and nontreatment of inflammatory arthritis?

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Biomarkers Predictive of a Deucravacitinib Response in Psoriatic Arthritis

A phase II trial demonstrating the clinical efficacy of deucravacitinib, a TYK2 inhibitor, in psoriatic arthritis (PsA) suggests specific biologic effects identified by biomarkers may predict clinical responses.

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Window of Opportunity in Psoriatic Arthritis

The Dutch southwest Early psoriatic arthritis (PsA) cohort study has demonstrated that the earlier the referral and diagnosis of PsA, the better the outcome. 

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NON-treatment of 18,318 VA pts (RA, SpA, PsA) = 41% not Rx DMARDs w/in 12 mos of Dx. Signif higher odds if Black (HR 1.13), Hispanic (1.14), Charlson Comorbidity ≥2 (1.15), opiate use (1.09). DMARD use ^ if married, w/ erosions, female MD, Rheum Dx https://t.co/TaYC27oIOz https://t.co/qjfAGI5L5g
Dr. John Cush @RheumNow( View Tweet )
MarketScan Claims & Medicaid study of incident AS, PsA, or RA (2010–2017) that Opioid use was highly prevalent in AS (36%), PsA (30%), & RA (44%) in the year prior to Dx & during the 1st Yr. Is this PCP or Rheumatologist mismanagement? https://t.co/YsCOLZUCfS https://t.co/b33uNg6Ucx
Dr. John Cush @RheumNow( View Tweet )
Save the date! We’ll be covering #EULAR24! https://t.co/HGjP2SFyOp
Dr. John Cush @RheumNow( View Tweet )

"Don't You Know Who I am?" (5.17.2024)

Dr. Jack Cush reviews the news and journal reports from the past 2 weeks. This week's question: can we prevent gout, ILD or psoriasis?

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2023 Top 3 paper from JAMA Derm - 122 plaque psoriasis pts (mild-mod w/ PASI=3.1) & low vit D levels (~14.9), Rx w/ PBO vs vit D 20 000 IU/wk x 4 mos during winter; no signif vit D Rx benefit for PASI, MD global, DLQI or 25-OH levels(< than expected) https://t.co/8W5abvydY6 https://t.co/rKJjkiHwC6
Dr. John Cush @RheumNow( View Tweet )
French insurance claims study of 12071 #PsA pts on biologics (2015-2021) found total of 367 serious infections (3%; IR 1.7/100PY). SIR risk significantly lower for new users of etanercept (wHR 0.72) & ustekinumab (wHR 0.57) (vs ADA new users https://t.co/CutqoxA05e https://t.co/OUCUbrKnFF
Dr. John Cush @RheumNow( View Tweet )
In biologic-naïve active PsA pts Rx w/ guselkumab & achieving enthesitis (ER) or dactylitis resolution (DR), had better PRO outcomes. GUS - ER or DR was assoc w/ minimal pain (p < 0.001), normalized HAQ-DI (p < 0.001), , better FACIT-Fatigue responses https://t.co/HymI7CBfXh https://t.co/dYk9qXdVpt
Dr. John Cush @RheumNow( View Tweet )

ICYMI: Five Takeaways in PsA/SpA at RNL 2024

Continuing with the theme of clinical pearls, the PsA and SpA speakers also provided a wealth of information. Here are my five key takeaways and clinical pearls. 

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Canary in a Coal Mine (4.19.2024)

Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.

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FDA has approved a ustekinumab biosimilar (ustekinumab-aekn; AKA Selardsi), made by Teva & Alvotech, for the treatment of moderate to severe plaque psoriasis (PsO) and active psoriatic arthritis (PsA) in both adults and pediatric pts.https://t.co/ZXvFjjH7Qt https://t.co/7FJKxSVAgL
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Sex Disparities in PsA/SpA https://t.co/55zwjR8mNR https://t.co/fhhekNpHVA
Dr. John Cush @RheumNow( View Tweet )
BASDAI tends to be higher in women while there is no appreciable difference in ASDAS scoring in men compared to women. Dr. L. Eder believes this could be due to the pain scoring in both indices. #RNL2024 @RheumNow @lihi_eder https://t.co/PSnFwX3eHu

Dr. John Cush @RheumNow( View Tweet )

ICYMI: Sex Disparities in PsA/SpA

Dr. Eder delivered an illuminating talk at RheumNow Live 2024 on sex differences in psoriatic arthritis; the disease may manifest differently in men and women, and therapeutic responses may differ between the sexes.

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2018 ACR/National Psoarasis Foundation Guidelines for Treatment of PsA - Created helpful definitions of Severe PsA and Severe PsO #RNL2024 @RheumNow @AlexisOgdie https://t.co/mYOWNEevfW

Dr. John Cush @RheumNow( View Tweet )

#RNL2024 @RheumNow @_AprilArmstrong Choosing a biologic in Psoriasis TNF - great in PsA, pregnancy. Avoid in demyelinating, hep B IL-17 - robust skin, PsA (axial too). Avoid in IBD IL-23 - robust skin, PsA evidence, fewer injections https://t.co/42kUaIZxKs

Dr. John Cush @RheumNow( View Tweet )

ICYMI: Co-management of Psoriatic Disease

It is a common clinical scenario to see someone with both severe psoriatic arthritis and skin psoriasis. In an ideal world this would involve a combined clinic with our local friendly dermatologist. For many of us, however, this is not practical for many reasons. The excellent Saturday morning

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vedolizumab-induced enthesitis @lihi_eder #RNL2024 @RheumNow 11/90 (12.2%) of pts on VDZ for IBD w/ develop new-onset enthesitis Is this true drug rxn or previously masked by prior meds (TNF)? Usually unilateral +/- oligo, dactylitis Most respond to NSAID or injxn, 27% change Rx

Dr. John Cush @RheumNow( View Tweet )

We're back on 4/9 with another Tuesday Night Rheumatology! We'll be focusing on PsA Hot Topics. Register to attend today! https://t.co/Ay0uxyfYDk https://t.co/QxZSI9EzTg
Dr. John Cush @RheumNow( View Tweet )

1/600 Falls May Die (4.5.2024)

Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com -  including problems w/ falls, pain and treatment of Dupuytren’s contractures.

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Mortality in Psoriatic Arthritis

The Annals of Rheumatic Disease reports that mortality risk in psoriatic arthritis (PsA) is about 10% higher than in the general population, primarily from excess comorbidity and with increased risks in women, with longer disease durations.

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