Difficult to treat psoriatic arthritis — how should we manage?

Kumthekar, Anand; Ashrafi, Maedeh; Deodhar, Atul

doi:10.1007/s10067-023-06605-9

Cited by 7 publications

(2 citation statements)

References 108 publications

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“…Myeloid- and lymphoid-associated gene signatures associate with response to rituximab or tocilizumab ( 20 ), while, on the other hand, a pauci-immune-fibroid pathotype, which is characterized by low immune cells infiltration, associated with worse response to csDMARDs and TNFis ( 18 , 21 ). With well-defined treatment schedules for patients with early RA and PsA, and in presence of an acceptable cost-effectiveness profile of first-line methotrexate (MTX) boundary for both the pathologies, a concept like the one explored in our study might apply more appropriately to difficult-to-treat diseases ( 54 , 55 ). Here, the characterization of the synovial tissue should inform on whether the disease is still supported by a pro-inflammatory movens (e.g.…”

Section: Discussionmentioning

confidence: 99%

High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study

Garaffoni,

Tamussin,

Calciolari

et al. 2024

Front. Immunol.

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BackgroundInflammatory arthritis (IAs), such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), are characterized by the presence of chronic synovitis. The Krenn’s synovitis score (KSS), a simple tool detectable by haematoxylin/eosin staining of synovial biopsy samples, allows the discrimination between high-grade and low-grade synovitis. The aim of this study was to identify the clinical associations of KSS and to evaluate the relationship between high-grade synovitis and treatment response in IA patients.MethodsClinical, laboratory and ultrasound data were retrieved from RA and PsA patients recruited in the prospective MATRIX cohort study. Inclusion criteria were age≥18 years, RA or PsA diagnosis, and presence of active disease with eligibility to start/modify therapy. Patients underwent ultrasound-guided synovial biopsy of one of the most involved joints before starting/modifying treatment according to treat-to-target strategy. The samples were analysed by an expert pathologist for KSS calculation. Univariable and multivariable logistic regression analyses were performed to evaluate the relationship between KSS and baseline variables. The association between KSS and treatment response at 24 weeks of follow-up was investigated in univariable logistic regression analysis.Results53 patients, 34 RA and 19 PsA, completed 24 weeks of follow-up after synovial biopsy. Patients were either treatment naïve (N=6, 11%), csDMARDs-experienced (N=46, 87%) or b/tsDMARDs-experienced (N=20, 38%). Median KSS was 6.00 (Q1-Q3 4.00-7.00) in RA and 4.00 (3.00-6.00) in PsA (p=0.040), and inflammatory infiltrates score was significantly higher in RA than in PsA patients (median 3.00 vs 2.00, p=0.021). In multivariable analysis, synovial effusion in the biopsied joint (OR 9.26, 95%CI 2.12-53.91) and erythrocyte sedimentation rate (ESR) (OR 1.04, 95%CI 1.01-1.08) associated with high KSS. High-grade synovitis significantly associated with a higher probability of achieving DAS28 remission, ACR20/50 response, and Boolean2.0 remission, independently from diagnosis.ConclusionSeveral markers of pro-inflammatory pathways associated with the presence of high-grade synovitis, and patients with higher KSS shared a higher probability of treatment targets achievement in the follow up. The integration of a simple and feasible tool like KSS in the clinical and prognostic stratification of patients with IA might help in intercepting patients with a disease more prone to respond to available treatment paradigms.

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Section: Discussionmentioning

confidence: 99%

High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study

Garaffoni,

Tamussin,

Calciolari

et al. 2024

Front. Immunol.

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“…y un seguimiento que permita evaluar los resultados de salud. 2,16,18 La incorporación de Enfermeras de Práctica Avanzada (EPA) con conocimiento clínico experto en el equipo multidisciplinar, garantiza el adecuado seguimiento del paciente, la coordinación interprofesional de los miembros del equipo y establecen un proceso de ayuda que contempla actividades de educación para la salud y apoyo psicológico a pacientes y familiares y/o cuidadores. Todo ello asegura la detección temprana de acontecimientos adversos, mejora en la adhesión a los tratamientos, incrementa los índices de remisión y, en consecuencia, disminuye el número de visitas a urgencias, aumentando la CVRS y satisfacción de los pacientes.…”

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Enfermería de Práctica Avanzada en enfermedades inmunomediadas: efectividad del cambio de paradigma

Lobo Rodríguez,

Flores García,

De los Ríos Luna

et al. 2023

Rev Tesela

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Objetivo principal: Estimar la efectividad, seguridad y calidad percibida de los pacientes atendidos por la Enfermera de Práctica Avanzada (EPA) en una Unidad de atención integral multiprofresional tras 4 años de funcionamiento. Metodología: Estudio de cohortes prospectivo en pacientes atendidos en las consultas de enfermería de Enfermedades Inmuno-mediadas Inflamatorias de enero/2019 a diciembre/2022. Resultados principales: Las EPA realizaron 43.339 consultas de los 2887 pacientes en seguimiento. Los pacientes con adherencia al tratamiento de 2019-2022 fueron 1397(81.6%), 2006(86.2%), 255 (97.3%) y 274 (95.0%) respectivamente. Los pacientes en remisión de 2019-2022 fueron 1070(62.5%), 1063(68.9%), 1888(71.9%) y 2098(72.9%) respectivamente. No se produjeron errores de medicación, reacciones infusionales o extravasaciones graves. El índice NPS de satisfacción/calidad percibida anual fue >70(Excelente). Conclusión principal: El modelo de atención integral con EPA mejora la calidad percibida, la efectividad y la seguridad de la atención

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Axial spondyloarthritis and inflammatory bowel disease: Therapeutic implications

Goupille,

Vuitton,

Wendling

2024

Joint Bone Spine

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Difficult to treat psoriatic arthritis — how should we manage?

Cited by 7 publications

References 108 publications

High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study

High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study

Enfermería de Práctica Avanzada en enfermedades inmunomediadas: efectividad del cambio de paradigma

Axial spondyloarthritis and inflammatory bowel disease: Therapeutic implications

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