Measuring Disease Activity in Psoriatic Arthritis

Wong, Priscilla; Leung, Ying Ying; Li, Edmund K.; Tam, Lai‐Shan

doi:10.1155/2012/839425

Cited by 47 publications

(56 citation statements)

References 62 publications

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“…Physical examination included the number of tender and swollen joints using the 68 tender/66 swollen joint count, and the number of permanently deformed joints. The Health Assessment Questionnaire was used to evaluate physical function, and the Psoriasis Area and Severity Index was used to assess the extent of skin involvement 30. Overall disease activity was assessed using minimal disease activity (MDA)31 and Disease Activity in Psoriatic Arthritis (DAPSA) 32.…”

Section: Methodsmentioning

confidence: 99%

Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease

et al. 2017

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Section: Methodsmentioning

confidence: 99%

Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease

et al. 2017

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“…The Cochrane highly sensitive search strategy for identifying randomised trials in Ovid MEDLINE: sensitivity maximising version was used to limit retrieval to clinical trials (lines [25][26][27][28][29][30][31][32][33][34][35]. 148 The search was updated on 28 April 2016 and retrieved 749 records.…”

Section: Doi: 103310/hta21560mentioning

confidence: 99%

“…Furthermore, it has been stated that the correlation with quality-of-life measures is poor. 26 In addition, it is time-consuming and not practically very feasible in daily clinical practice. l PsARC identifies only relative changes from baseline and overestimates the number of responders.…”

Section: Introductionmentioning

confidence: 99%

Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation

Corbett

Chehadah

Biswas

et al. 2017

Health Technol Assess

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BackgroundSeveral biologic therapies are approved by the National Institute for Health and Care Excellence (NICE) for psoriatic arthritis (PsA) patients who have had an inadequate response to two or more synthetic disease-modifying antirheumatic drugs (DMARDs). NICE does not specifically recommend switching from one biologic to another, and only ustekinumab (UST; STELARA®, Janssen Pharmaceuticals, Inc., Horsham, PA, USA) is recommended after anti-tumour necrosis factor failure. Secukinumab (SEC; COSENTYX®, Novartis International AG, Basel, Switzerland) and certolizumab pegol (CZP; CIMZIA®, UCB Pharma, Brussels, Belgium) have not previously been appraised by NICE.ObjectiveTo determine the clinical effectiveness and cost-effectiveness of CZP and SEC for treating active PsA in adults in whom DMARDs have been inadequately effective.DesignSystematic review and economic model.Data sourcesFourteen databases (including MEDLINE and EMBASE) were searched for relevant studies from inception to April 2016 for CZP and SEC studies; update searches were run to identify new comparator studies.Review methodsClinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis (NMA) methods to investigate the relative efficacy of SEC and CZP compared with comparator therapies. A de novo model was developed to assess the cost-effectiveness of SEC and CZP compared with the other relevant comparators. The model was specified for three subpopulations, in accordance with the NICE scope (patients who have taken one prior DMARD, patients who have taken two or more prior DMARDs and biologic-experienced patients). The models were further classified according to the level of concomitant psoriasis.ResultsNineteen eligible RCTs were included in the systematic review of short-term efficacy. Most studies were well conducted and were rated as being at low risk of bias. Trials of SEC and CZP demonstrated clinically important efficacy in all key clinical outcomes. At 3 months, patients taking 150 mg of SEC [relative risk (RR) 6.27, 95% confidence interval (CI) 2.55 to 15.43] or CZP (RR 3.29, 95% CI 1.94 to 5.56) were more likely to be responders than patients taking placebo. The NMA results for the biologic-naive subpopulations indicated that the effectiveness of SEC and CZP relative to other biologics and each other was uncertain. Limited data were available for the biologic-experienced subpopulation. Longer-term evidence suggested that these newer biologics reduced disease progression, with the benefits being similar to those seen for older biologics. The de novo model generated incremental cost-effectiveness ratios (ICERs) for three subpopulations and three psoriasis subgroups. In subpopulation 1 (biologic-naive patients who had taken one prior DMARD), CZP was the optimal treatment in the moderate–severe psoriasis subgroup and 150 mg of SEC was optimal in the subgroups of patients with mild–moderate psoriasis or no concomitant psoriasis. In subpopulation 2 (biologic-naive patients who had taken two or more prior DMARDs), etanercept (ETN; ENBREL®, Pfizer Inc., New York City, NY, USA) is likely to be the optimal treatment in all subgroups. The ICERs for SEC and CZP versus best supportive care are in the region of £20,000–30,000 per quality-adjusted life-year (QALY). In subpopulation 3 (biologic-experienced patients or patients in whom biologics are contraindicated), UST is likely to be the optimal treatment (ICERs are in the region of £21,000–27,000 per QALY). The optimal treatment in subpopulation 2 was sensitive to the choice of evidence synthesis model. In subpopulations 2 and 3, results were sensitive to the algorithm for Health Assessment Questionnaire-Disability Index costs. The optimal treatment is not sensitive to the use of biosimilar prices for ETN and infliximab (REMICADE®, Merck Sharp & Dohme, Kenilworth, NJ, USA).ConclusionsSEC and CZP may be an effective use of NHS resources, depending on the subpopulation and subgroup of psoriasis severity. There are a number of limitations to this assessment, driven mainly by data availability.Future workTrials are needed to inform effectiveness of biologics in biologic-experienced populations.Study registrationThis study is registered as PROSPERO CRD42016033357.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Several other domains (spinal disease, dactylitis, enthesitis, fatigue, nail disease, radiography, physician global assessment, and acute-phase reactants) are considered important [15]. …”

Section: Resultsmentioning

confidence: 99%

“…PGA nail bed assesses the % affected area: 0 means clear, i.e. when the free edge of the nail plate conforms to the arcuate shape of the distal groove, 1 (almost clear) means 10% or less of the area is changed by onycholysis and/or salmon patches, 2 (mild) means 11 to 25%, 3 (moderate) means 26–50%, and 4 (severe) means that 51% or more of the nail bed is affected any onycholysis and/or salmon patches [15]. …”

Section: Resultsmentioning

confidence: 99%

Nail psoriasis – what a rheumatologist should know about

Nieradko-Iwanicka

2017

Reumatologia

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Psoriasis is a chronic recurrent inflammatory skin disease with prevalence of 1–3%. Nail psoriasis affects 10–90% of patients with plaque psoriasis.The aim of the article is to review the literature for the correlation between nail psoriasis and psoriatic arthritis (PsA) to provide rheumatologists a short review on features of nail psoriasis, methods of their assessment and possible clinical repercussions.The PubMed database was searched using the key words ‘nail psoriasis’ and ‘psoriatic arthritis’. Psoriasis involving the nail matrix shows up as changes such as pitting, Beau lines, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis manifests as onycholysis, oil drops (or salmon patches), dyschromia, splinter hemorrhages, or subungual hyperkeratosis. Nail psoriasis and psoriatic lesions in the gluteal cleft and on the scalp usually accompany PsA, especially in adult men.

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Measuring Disease Activity in Psoriatic Arthritis

Cited by 47 publications

References 62 publications

Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease

Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease

Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation

Nail psoriasis – what a rheumatologist should know about

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