Psoriatic Arthritis Review

12/04/2018
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Early Initiation of Biologic Improves PsA Disease Outcomes  

Golimumab (Simponi) was associated with rapid and significant improvements in disease outcomes, including remission, among participants with early active psoriatic arthritis (PsA), according to a recent study. 

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The multicenter, double-blind, randomized, placebo-controlled trial included participants with active PsA who had not received treatment with methotrexate (MTX) or biologic disease modifying antirheumatic drugs. A total of 26 participants received 50 mg subcutaneous golimumab and MTX and 24 participants received matched placebo and MTX. MTX was started at 15 mg per week and increased to 25 mg per week over 8 weeks. 

The percentage of participants achieving remission on the disease activity score (DAS) at week 22 was assessed as the primary efficacy endpoint. Secondary endpoints included DAS C-reactive protein, visual analogue scale (VAS) global, VAS pain, VAS physician, swollen joint count (66) and tender joint count (68), and achievement of minimal disease activity (MDA), as well as safety.

DAS remission was seen in 81% of participants who received golimumab by week 22 compared with 42% of participants who received MTX only. At week 22, MDA was achieved by 85% of participants who received golimumab compared with 29% of participants who received MTX only. The researchers observed differences in DAS remission and MDA as early as week 8 among 73% and 58% of participants who received golimumab, respectively, compared with 42% and 21% of participants who received MTX only.  

In addition, golimumab treatment was associated with significant improvements in several secondary endpoints compared with MTX, most of which were seen as early as week 8. 

Mild to moderate adverse events occurred in 43 of 50 participants, and the occurrence rates were similar for both treatment arms. One participant in the MTX and placebo group experienced a serious adverse event (cervical spine stenosis), but it was not considered study related and did not result in withdrawal.

“DAS remission at week 22 was achieved by almost double the number of patients with early PsA treated with golimumab + MTX versus placebo + MTX. This double-blind, randomized, placebo-controlled study supports the concept that early initiation of [tumor necrosis factor inhibitors] in patients with active PsA favors rapid and sustained remission.”

Reference

van Mens L, de Jong J, Fluri I, et al. Achieving remission in psoriatic arthritis by early initiation of TNF inhibition: A double-blind, randomized, placebo-controlled trial of golimumab + methotrexate versus placebo + methotrexate. Presented at: American College of Rheumatology Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 1655.

Does PsA Increases Mortality Risk Following Heart Attack? 

Psoriatic arthritis (PsA) was associated with younger age at hospitalization for acute myocardial infarction (AMI), according to the findings of a recent study. However, PsA was not associated with higher risk for inpatient mortality.

Using data from a nationwide inpatient sample, the researchers identified adult patients who had been hospitalized between 2010 and 2014. They used ICD-9 CM codes to identify patients with AMI and PsA and calculated the odds of inpatient mortality.

A total of 2691 patients hospitalized with AMI had underlying PsA (mean age, 63.7 years; 37.9% were female). Among the patients with AMI and PsA, most had private insurance (42.6%) and were white (89.7%). Additionally, patients with AMI and underlying PsA were younger compared with those without underlying PsA. “This could likely reflect a cumulative effect of inflammatory burden as well as cardiovascular risk factors,” the researchers stated.

Within the 5 years of follow up, 52 deaths occurred.

The researchers found that higher age was significantly associated with greater odds of inpatient mortality. However, the odds of mortality among patients with AMI and underlying PsA were lower compared with those without PsA.

“Decrease in odds of cardiovascular mortality associated with PsA possibly reflects increased awareness of cardiovascular risks in patients with PsA, as well increase treatment options to control inflammatory burden,” the researchers concluded. “Reinforcing and educating involved stakeholders will continue to improve cardiovascular outcomes in patients with PsA.” 

Reference

Jatwani S, Chugh K, Jatwani K, Modi V, Kaur J. A 5-year national trend in acute myocardial infarction among hospitalized patients with psoriatic arthritis: Data from National Inpatient Sample. Presented at: American College of Rheumatology Annual Meeting; October 19-24, 2018; Chicago, IL, Abstract 2171.

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PsA Linked to Catabolic and Anabolic Bone Damage

Results from a recent study showed significant destructive bone changes among participants with psoriatic arthritis (PsA), which were affected by disease duration and age.

“Next to inflammation, bone destruction is a hallmark of the disease, especially in PsA. Surprisingly few studies, however, have yet comprehensively addressed bone changes in PsA,” the researchers wrote. 

They assessed the extent of bone erosions and enthesiophytes according to categories of age, duration of psoriasis, and duration of PsA among 101 participants with PsA, 55 participants with psoriasis, and 47 healthy controls. All participants were enrolled in the Erlangen Imaging Cohort and underwent high-resolution peripheral quantitative computed tomography. In addition, demographic and disease-specific data, including physical function, were collected.

Participants with PsA had significantly more and larger erosions and enthesiophytes compared with participants with psoriasis and healthy controls. While enthesiophytes were more frequent among participants with psoriasis, erosions did not differ between those with psoriasis and healthy controls.

In addition, only bone erosions showed strong age-dependency among all 3 groups whereas enthesiophytes were predominately influenced by disease duration. Enthesiophytes, in contrast to bone erosions, were associated with poorer physical function.

“PsA acts as a strong enhancer of age-related catabolic bone damage. In contrast, enthesiophytes, as signs of anabolic bone damage, are less age-dependent but primarily depend on the duration of PsA. Small enthesiophytes occur before clinical joint involvement and increase in size with progressive disease,” the researchers concluded. “Taken together, these findings highlight the destructive nature of PsA and the necessity for an early intervention to limit the burden of bone damage in PsA.” 

Reference

Simon D, Kleyer A, Faustini F, et al. Simultaneous quantification of bone erosions and enthesiophytes in the joints of patients with psoriasis or psoriatic arthritis - effects of age and disease duration. Arthritis Res Ther. 2018;20(1):203. doi:10.1186/s13075-018-1691-z

Psoriatic Arthritis Increases Diabetes Risk

Psoriatic arthritis (PsA) increases the risk of developing type 2 diabetes, according to the findings of a recent study.

In the study, the researchers identified 6783 individuals with PsA enrolled in the UK Clinical Practice Research Datalink between 1998 and 2014. They matched individuals with PsA to a general population cohort and psoriasis cohort. The incidence of type 2 diabetes, cerebrovascular disease, ischemic heart disease, and peripheral vascular disease were assessed for individuals with PsA, psoriasis, and the general population, and relative risks were calculated.

Individuals with PsA had a significantly higher risk for type 2 diabetes compared with the general population and individuals with psoriasis (adjusted relative risk [aRR], 1.4; 95% CI, 1.15-1.70 and aRR, 1.53; 95% CI, 1.19-19.7, respectively). Compared with the general population, the incidence of ischemic heart disease, peripheral vascular disease, and all 3 cardiovascular outcomes combined were significantly higher among those with PsA. However, no significant differences in the risk of any cardiovascular outcome was observed between the PsA and psoriasis cohorts. 

“The development of type 2 diabetes in an incident population of PsA is significantly higher than in psoriasis alone or in a general population,” the researchers concluded. “Whereas the increased risk of cardiovascular disease in PsA and psoriasis is similar.” 

Reference

Charlton R, Green A, Shaddick G, et al. Risk of type 2 diabetes and cardiovascular disease in an incident cohort of people with psoriatic arthritis: a population-based cohort study [published online September 6, 2018]. Rheumatology. doi:10.1093/rheumatology/key286