Journal of Rheumatology最新文献

Significant progress toward several key initiatives was presented during the Project Key Advances session of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting. Highlights included advancements from the Collaborative Research Network (CRN), with contributions from the Health Initiatives in Psoriasis and Psoriatic Arthritis Consortium European States (HIPPOCRATES) and developments in the complex-to-manage (C2M)/difficult-to-treat (D2T) psoriatic arthritis project. The presentation also included an update on the GRAPPA educational slide library. These activities underscore GRAPPA's continued dedication to fostering collaboration that advances psoriatic disease education and research toward improved patient outcomes.

Interstitial lung disease (ILD), characterized by pulmonary fibrosis and/or inflammation, is a common and severe extra-articular manifestation of rheumatoid arthritis (RA). RA-ILD is associated with reduced quality of life and increased mortality. Among people with RA, up to15% develop clinically significant ILD, and even more have subclinical disease (radiologic abnormalities without symptoms). The most common RA-ILD patterns on chest high-resolution computed tomography (HRCT) imaging are usual interstitial pneumonia (UIP, the prototypic fibrotic subtype) and non-specific interstitial pneumonia (the subtype characterized by inflammation). In this narrative review, we detail the current state of evidence for RA-ILD screening, and the next steps needed to justify screening in some subgroups. Some current or former smokers with RA may currently qualify for lung cancer screening with low-dose CT imaging, which may also detect ILD. The 2023 American College of Rheumatology/American College of Chest Physicians guideline for screening and monitoring of ILD conditionally recommended screening people with RA with an ILD risk factor (male sex, older age, smoking, RA-related autoantibody elevation, obesity, and high RA disease activity). Several genetic and blood biomarkers are associated with RA-ILD. The MUC5B promoter variant is the strongest genetic risk factor for RA-ILD, specifically the UIP subtype. Proposed screening strategies show promise for accurately detecting RA-ILD. However, there has been less research on other consequences of screening for RA-ILD, including cost, anxiety, radiation exposure, incidental findings, and downstream clinical follow-up. Trials are needed to identify an intervention that alters the natural history for those found to have subclinical RA-ILD on screening.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting included a lively debate regarding the optimal management of musculoskeletal (MSK) symptoms in patients with psoriasis (PsO) at risk of or with early psoriatic arthritis (PsA). Drs. Fabian Proft and Laura Savage presented comprehensive, evidence-based retrospective arguments from the perspectives of rheumatology and dermatology. Proft advocated for rheumatologists to lead PsA management by highlighting the specialized training that allows rheumatologists to identify inflammatory diseases and use advanced imaging techniques to differentiate PsA from mechanical MSK conditions. In contrast, Savage emphasized the pivotal role of dermatologists, who often serve as the first healthcare providers (HCPs) to encounter emergent PsA in their patients with PsO. Dermatologists are increasingly aware of the importance of early detection and timely intervention, as well as of the new data that support the concept of "treating to intercept" in patients at risk of transition from PsO to PsA. Both experts highlighted systemic barriers hindering collaborative care and underscored the necessity of patient-centered approaches that effectively address skin and joint manifestations. This article summarizes the insightful debate, reinforcing the importance of a multidisciplinary approach to optimize patient outcomes with PsA.

Psoriatic disease (PsD) is a complex, heterogeneous disease with unmet medical needs in terms of its diagnosis, management, and prognosis. The identification of biomarkers could improve the implementation of precision medicine in PsD, but to date, none of these biomarkers have been clinically validated. Biomarkers can support clinical trials in several ways, including (1) diagnostics, (2) drug pharmacodynamics, (3) prognostics for patient selection and monitoring of drug efficacy, and (4) predictive models for clinical outcomes. Biomarkers can sometimes be used for both diagnosis and prognosis. Benefits of biomarkers use may include shorter duration of clinical trials, faster access to new treatments, and a personalized approach to disease management. Several potential biomarkers have recently demonstrated promise for use in PsD, including C1M, a serum biomarker reflecting collagen type I collagen degradation, and C4M, a type IV collagen metabolite, but clinical validation has not yet been completed. Here, and as presented at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2024 annual meeting, we summarize the status of biomarker discovery for PsD and their overlap with other musculoskeletal diseases such as rheumatoid arthritis and axial spondyloarthritis.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Patient Research Partner (PRP) Network conducted a survey to identify its key strengths and gaps, with the goal of enhancing its global reach and representation. The survey revealed strong gender parity and high long-term project participation among PRP members. However, it also indicated a need for greater ethnic and geographical diversity among the members. To address this, the PRP Network will expand its membership and specifically recruit partners from underrepresented regions such as Africa, Asia, Australia/New Zealand, South America, and Eastern Europe. Additionally, the network aims to expand its age range to include a more representative selection of research partners, thereby advancing GRAPPA's overarching objectives. The results of the survey were presented at the GRAPPA 2024 annual meeting.

Rheumatologists and other nondermatologists often encounter patients with psoriatic arthritis (PsA) who present with cutaneous diseases that mimic psoriasis (PsO). Cutaneous disorders including tinea, seborrheic dermatitis, eczema, pityriasis rubra pilaris, syphilis, or cutaneous lymphoma are commonly mistaken for PsO. It is crucial for rheumatologists and other nondermatologists to recognize alternative conditions and to consider referral to dermatology when skin disease is not responding to therapy. Correct diagnosis is important when assessing disease severity in clinical practice as well. Although the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) are gold standards for physician- and patient-reported outcomes in clinical trials, they are not practical to deploy in busy clinical practice. Use of a physician global assessment (PGA), body surface area using a handprint method, and informal patient-reported outcomes can be useful in documenting the burden of disease. A treat-to-target approach using a PGA of clear/almost clear is ideal. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, a 2-part workshop was conducted for rheumatologists to first review skin disorders commonly mistaken for PsO, and second, to review outcome measures best suited for clinical practice.

The International Dermatology Outcome Measures (IDEOM) organization presented updates on its patient-reported outcome measures (PROMs) for psoriasis (PsO), psoriatic arthritis (PsA), and other immune-mediated skin diseases at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting. The Hidradenitis Suppurativa working group reported on the IDEOM Musculoskeletal Questionnaire (MSK-Q), a PROM for MSK manifestations of psoriatic disease. Advances in PsA screening included integrating the Psoriasis Epidemiology Screening Tool (PEST) and 12-item Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaires into the Epic electronic health record system to streamline detection and management of emerging PsA cases. The Connective Tissue Disease working group discussed upcoming trials and tools for addressing significant unmet needs in cutaneous lupus erythematosus. Finally, the Patient Satisfaction working group provided updates on the 7-item Dermatology Treatment Satisfaction Instrument (DermSat-7) and DermSat-11 for clinical trials and real-world studies. The DermSat-7 has been validated in a multicenter study of patients with PsO, whereas the DermSat-11 is currently undergoing validation. IDEOM continues to work to significantly improve patient outcomes and satisfaction in dermatology.