Journal of Rheumatology最新文献

Obtaining valid real-world evidence about intervention effects from observational cohorts or administrative health records data is challenging. Visits to healthcare providers tend to occur more often during periods of increased disease activity and symptom exacerbation, or upon disease progression. Treatments likewise tend to change when it is apparent that disease activity has increased or a meaningful progression has occurred. This creates a dual problem in which patient visits are disease-related and treatments changes are driven by disease condition and clinical presentation. Disease-related visits and treatment by indication can produce a biased impression of the disease process in the target population and of the effects of treatment. We discuss how these challenges can be addressed through the use of joint models for the disease, marker, and treatment processes, as well as the observation (visit) process. Using illustrative multistate models, we demonstrate the biases that can arise from various types of analyses and show how estimators from fitting such joint models to persons with psoriatic arthritis can be used to gain scientific insights and address common questions about treatment effects.

Objective: The Assessment of SpondyloArthritis international Society (ASAS) criteria classify spondyloarthritis (SpA) based on clinical presentation. Although widely applied, the measure's performance in Colombia's population remains unclear. This study aimed to characterize a Colombian SpA cohort, identify factors associated with peripheral SpA (pSpA), compare SpA subtypes, assess the performance of ASAS criteria, and compare the ASAS with modified New York (mNY) and European Spondyloarthropathy Study Group (ESSG) criteria.

Methods: This cross-sectional study included patients with newly diagnosed SpA by ≥ 1 expert rheumatologist. Participants completed a structured survey, physical examination, imaging, and laboratory tests. Researchers classified patients using ASAS, ESSG, and mNY criteria and compared clinical characteristics across groups. Finally, the performance of the ASAS criteria relative to the rheumatologist's diagnosis, mNY, and ESSG was analyzed.

Results: The study analyzed 461 patients with SpA, of whom 58.1% had pSpA. Patients with axial SpA (axSpA) and pSpA differed significantly in age at onset, initial symptoms, buttock pain, Schober test, sacroiliitis, and HLA alleles. The ASAS criteria demonstrated a sensitivity of 90.8% when compared to rheumatologist diagnosis. Notably, 33.6% and 36.6% of patients classified as having radiographic axSpA (r-axSpA) by mNY or ESSG, respectively, were misclassified as pSpA under ASAS due to unmet entry criteria for axSpA.

Conclusion: This large Colombian SpA cohort, predominantly comprising patients with pSpA, revealed distinct clinical and imaging features between axSpA and pSpA. The ASAS criteria showed high sensitivity but failed to classify a subset of patients with radiographic sacroiliitis as having r-axSpA, highlighting limitations in its entry criteria for axSpA.

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.

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.