Management of Psoriatic Arthritis in Patients With Comorbidities: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Campanholo, Cristiano; Maharaj, Ajesh B.; Corp, Nadia; Bell, SJ; Costa, Luisa; Vlam, Kurt de; Gullick, Nicola; Khraishi, Majed; Kishimoto, Mitsumasa; Palmou-Fontana, Natalia; Reddy, Soumya; Scarpa, Raffaele; Vega, Luis; Duarte, Gleison Vieira; Zisman, Devy; Windt, D.A.W.M. van der; Duruöz, Mehmet Tuncay; Ogdie, Alexis

doi:10.3899/jrheum.220310

Cited by 8 publications

(2 citation statements)

References 49 publications

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“…For patients who have relevant comorbidities, nonpharmacologic interventions may improve treatment response (Figure 2). Obesity is associated with the incident risk of PsA, and obese patients have a lower probability of achieving sustained minimal disease activity and report experiencing lower therapeutic efficacy and declining persistence of treatment effect following receipt of a TNFi (28). Obesity is more prevalent in female patients, and weight loss and low-inflammation diets are associated with lessening of joint activity (29)(30)(31).…”

Section: General Principlesmentioning

confidence: 99%

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

Leung

Kavanaugh

Ritchlin

2023

Arthritis & Rheumatology

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The index case, a 36-year-old woman, had psoriasis (PsO) on her scalp, arms, legs, and trunk since age 25 years that was inadequately controlled with topical agents. She has a past medical history of treated hypertension and depression. She is an active smoker. Three years prior to our case evaluation, she developed polyarthritis, inflammatory back pain, and plantar fasciitis. Methotrexate (MTX) was added to her treatment regimen, first administered orally then subcutaneously, but the patient stated she could only tolerate 12.5 mg/week due to gastrointestinal and systemic adverse events. The dose of 12.5 mg/week resulted in minimal benefit. In addition, the patient was recently married and reported that pregnancy was being considered, and therefore treatment with MTX was stopped. She then experienced a flare of PsO and arthritis.Physical examination was notable for the presence of moderate-to-severe PsO (12% affected body surface area [BSA]), 6-7 swollen and tender joints, and evidence of mild erosive changes on hand radiographs. Monotherapy with adalimumab 40 mg every other week was initiated. The patient improved during treatment with adalimumab over 10 weeks, with 60-70% improvement in her clinical symptoms overall, but continued to experience mild residual joint pain and signs of PsO (2-4% BSA). Approximately 3 months ago, she noted profound fatigue, 90 minutes of morning stiffness, and diffuse joint pain. She found it difficult to continue her work in retail and reported feeling frustrated, anxious, and depressed. Her skin PsO also worsened and became more bothersome to her. On physical examination, her blood pressure was 140/90 mm Hg, pulse rate was 72 beats per minute, and body mass index was 35 kg/m 2 . She had psoriasiform plaques on her trunk and extremities (8% BSA). Musculoskeletal examination revealed 6 tender and 4 swollen joints, and she had a Disease Activity Index for PsA (DAPSA) score of 29 (a DAPSA score of >28 represents high disease activity). There were multiple tender entheses, most notably in the plantar fasciae, left Achilles tendon, and the left elbow lateral condyle. Pain was elicited in the right sacroiliac (SI) joint on provocative testing, and also at several locations unassociated with entheses.

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Section: General Principlesmentioning

confidence: 99%

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

Leung

Kavanaugh

Ritchlin

2023

Arthritis & Rheumatology

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“…Patients with PsA have an increased cardiovascular risk due to the chronic inflammation and increased prevalence of obesity (Body Mass Index (BMI)) ≥ 30 kg/m 2 ), hypertension and diabetes compared to individuals without PsA [ 2 , 3 ]. Obesity is associated with augmented risk of PsA [ 4 ], more severe disease [ 5 ] and poorer treatment outcomes [ 6 – 8 ]. In obesity, the white adipose tissue undergoes immunological changes including macrophage infiltration resulting in a proinflammatory milieu and secretion of several cytokines and adipokines, such as tumor necrosis (TNF)-α, interleukin (IL)-17, IL-23, leptin, resistin and adiponectin, that may be important in PsA [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention

et al. 2023

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Introduction Patients with psoriatic arthritis (PsA) are frequently obese. We have previously shown decreased disease activity in patients with PsA with a body mass index (BMI) ≥ 33 kg/m2 following weight loss treatment with Very Low Energy Diet (VLED), resulting in a median weight loss of 18.6% at six months (M6) after baseline (BL). In this study we assessed the effects of VLED on cytokines and adipokines at M6 in the same patients with PsA and controls (matched on sex, age and weight). Methods VLED (640 kcal/day) during 12 or 16 weeks, depending on BL BMI < 40 or ≥ 40 kg/m2, was taken and followed by an energy-restricted diet. Cytokines and adipokines were measured with Magnetic Luminex Assays at BL and M6. Results Serum interleukin (IL)-23, (median (interquartile range) 0.40 (0.17–0.54) ng/mL vs. 0.18 (0.10–0.30) ng/mL, p < 0.001) and leptin (26.28 (14.35–48.73) ng/mL vs. 9.25 (4.40–16.24) ng/mL, p < 0.001) was significantly decreased in patients with PsA. Serum total (tot)-adiponectin and high molecular weight (HMW) adiponectin increased significantly. Similar findings were found in controls. Also, in patients with PsA, ∆BMI was positively correlated with ∆IL-23 (rS = 0.671, p < 0.001). In addition, significant positive correlations were found between ΔBMI and ΔDisease Activity Score (DAS28CRP), ΔCRP, Δtumor necrosis factor (TNF)-α, ΔIL-13, ∆IL-17 and Δleptin, and negative correlations between ΔBMI and Δtot-adiponectin. Conclusions Weight loss was associated with decreased levels of leptin and cytokines, in particular IL-23. These findings may partly explain the anti-inflammatory effect of weight reduction in PsA. Trial registration ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered.

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Exploring 5-year changes in general and skin health-related quality of life in psoriatic arthritis patients

Wilk,

Michelsen,

Łosińska

et al. 2024

Rheumatol Int

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Management of Psoriatic Arthritis in Patients With Comorbidities: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Cited by 8 publications

References 49 publications

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention

Exploring 5-year changes in general and skin health-related quality of life in psoriatic arthritis patients

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