Psoriatic arthritis (PsA) is an inflammatory arthritis with as yet unclear pathophysiology. This retrospective, multicenter, cross‐sectional study was conducted in 19 facilities in western Japan and aimed to identify patients’ characteristics and factors that affect the results of treatment with biologic agents. Of 2116 patients with psoriasis, 285 (13.5%) had PsA. Skin manifestations preceded joint manifestations in 69.8%, the onset was simultaneous in 17.2%, whereas PsA preceded skin manifestations in 2.5%. Peripheral arthritis was most common, occurring in 73.7%, compared with axial disease in 21.8%, enthesitis in 23.5% and dactylitis in 35.4%. Patients with severe skin manifestations were significantly younger at onset (P = 0.02) and more frequently had axial disease (P < 0.01). Biologic agents were used in 206 patients (72.3%), anti‐tumor necrosis factor (TNF)‐α antibodies being prescribed first to 157 of them. Anti‐TNF‐α antibodies were continued by 105 participants and discontinued by 47, the remaining five patients being lost to follow up. Patients who discontinued anti‐TNF‐α antibodies were significantly older than those who continued (55 vs 51 years, P = 0.04) and significantly older at onset of joint manifestations (50 vs 44 years, P = 0.01). Multivariate analysis revealed that patients over 50 years significantly more frequently terminated anti‐TNF‐α antibodies (P < 0.01). In conclusion, patients with PsA and severe skin manifestations have earlier onset and axial disease, which seriously impacts on quality of life. Anti‐TNF‐α antibodies were generally effective enough to continue but less so in patients aged over 50 years. Further detailed research is needed.

Patients with dermatomyositis positive for anti‐aminoacyl tRNA synthetase (ARS) antibodies, also known as antisynthetase syndrome (ASS), frequently present with mechanic's hand and interstitial lung disease (ILD). We first screened the antibody profiles of 59 patients with dermatomyositis, and then examined the cutaneous, muscular and pulmonary manifestations characteristic for patients with ASS. The anti‐ARS antibodies Jo‐1, PL‐7, PL‐12, EJ and KS, along with antibodies to TIF1‐γ, MDA5 and Mi‐2, were examined. Among the 59 patients, 20, 21, 15 and three patients were classified into the ASS, non‐ASS, myositis‐specific antibody‐negative and unknown groups, respectively. Five of 16 patients (31%) with ASS had six relatives with a history of collagen diseases, within the second degree of relationship, including two cases of dermatomyositis (vs the non‐ASS group, P = 0.018). Patients with ASS more frequently presented with fever and arthralgia, and had elevated levels of C‐reactive protein. Nine of the 11 finger lesions (82%) clinically diagnosed as mechanic's hands showed a psoriasiform tissue reaction. ILD was observed in 19 of 20 patients (95%) with ASS, and eight of 21 patients (38%) in the non‐ASS group, in which six patients possessed anti‐MDA5 antibody. Patients with ASS showed higher serum levels of muscle enzymes, and four of 12 patients (33%) had fasciitis‐dominant myopathy, while only one of 11 patients (9%) in the non‐ASS group had fasciitis‐dominant myopathy. Patients with ASS often present with a psoriasiform tissue reaction in the hand lesions and fasciitis‐dominant myopathy, and the relatives of those with ASS are at high risk for collagen diseases.

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A group of patients with anti-aminoacyl tRNA synthetase (ARS) antibody, or anti-synthetase syndrome (ASS), may constitute a unique subtype of dermatomyositis. We compared the cutaneous, muscular and pulmonary manifestations between the ASS and non-ASS groups of dermatomyositis. We analyzed 59 patients with dermatomyositis referred to our university hospital from 2008 to 2016. The patients were examined for skin lesions, routine blood tests, autoantibody profiles using ELISA kits, skin biopsy, and radiological imaging of the lung and muscle diseases. The ELISA kit for measurement of anti-ARS antibodies is prepared to detect antibodies to Jo-1, PL-7, PL-12, EJ, and KS. We also examined antibodies to TIF1-g, MDA5 and Mi-2. Of 59 patients with dermatomyositis, 20 patients were classified into the ASS group, and the remaining 39 patients were of the non-ASS. Patients with ASS more frequently presented with mechanic's hands (p¼0.012), and systemic symptoms such as fever (p¼0.019) and arthralgia (p¼0.0037), associated with elevated serum levels of C-reactive protein (p¼0.0029). Nineteen of 20 (95%) patients with ASS had interstitial lung disease (ILD) with fibrotic non-specific interstitial pneumonia (fNSIP) or organizing pneumonia/eosinophilic pneumonia (OP/EP) pattern by computed tomographic imaging. Blood chemistry tests revealed significantly higher serum levels of aldolase (ALD) in the ASS group (p¼0.0022), although no clear difference in the serum levels of creatinine phosphokinase (CK). As for magnetic resonance imaging of myopathy, patients with ASS showed the presence of fasciitis as well as myositis more frequently (p¼0.0041). Patients with ASS are characterized by the higher incidence of mechanic's hands, systemic inflammation, ILD, and inflammatory myopathy associated with fasciitis, and elevated serum levels of ALD. ABSTRACTS | Clinical Outcomes