Article

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Patients with chronic migraine may be informed that they should not expect a consistent wearing-off effect when being treated with erenumab or fremanezumab as anxiety regarding attacks toward the end of the month may potentially trigger further migraine episodes.

Major finding: Overall, 62% of patients treated with erenumab and fremanezumab achieved a consistent ≥30% reduction in migraine days over 2 consecutive months (≥30% responders), with no consistent wearing-off effect (ie, an increase of ≥2 weekly migraine days from week 2 to 4 over 2 consecutive treatment months) in the erenumab (P = .194) and fremanezumab (P = .581) groups. Among ≥30% responders, there was no significant wearing-off effect from week 2 to 4 over 2 consecutive months (1.43 vs 1.52 days; P = .573).

Study details: This single-center, real-world, observational study included 100 patients with chronic migraine (age ≥ 18 years) who received either erenumab (n = 60) or fremanezumab (n = 40).

Disclosures: This study was supported by Lundbeck Foundation. Two authors declared receiving personal fees or honoraria from or serving on advisory boards for various sources.

Source: Florescu AM, Lannov LV, Younis S et al. No wearing-off effect of erenumab or fremanezumab for chronic migraine prevention: A single-center, real-world, observational study. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231222 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Key clinical point: Women who had menarche at older age had a lower risk for migraine, whereas those who used oral contraceptives and those who had children had a higher risk for migraine.

Major finding: Older age at menarche decreased migraine risk (adjusted hazard ratio [aHR] 0.96; 95% CI 0.95-0.98), whereas oral contraceptive use (aHR 1.12; 95% CI 1.06-1.18) and having children (aHR 1.37; 95% CI 1.29-1.46) increased migraine risk.

Study details: This study evaluated the data of 62,959 women (age 30-70 years) from the Norwegian Women and Cancer Study, of whom 15,635 (24.8%) had migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T et al. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia. 2024 (Jan 12). doi: 10.1177/03331024231225 Source.

Dermatologists in training are exposed to many different clinical scenarios—from the quick 15-minute encounter to diagnose a case of atopic dermatitis to hours of digging through a medical record to identify a culprit medication in a hospitalized patient with a life-threatening cutaneous drug reaction. Amidst the day-to-day clinical work that we do, there inevitably are interactions we have with patients that are less than ideal. These challenging encounters—whether they be subtle microaggressions that unfortunately enter the workplace or blatant quarrels between providers and patients that leave both parties dissatisfied—are notable contributors to physician stress levels and can lead to burnout.^1,2 However, there are positive lessons to be learned from these challenging patient encounters if we manage to withstand them. When we start to understand the factors contributing to difficult clinical encounters, we can begin to develop and apply effective communication tools to productively navigate these experiences.

Defining the Difficult Patient

In 2017, the Global Burden of Disease study revealed that skin disease is the fourth leading cause of nonfatal disease burden worldwide.³ Based on this statistic, it is easy to see how some patients may experience frustration associated with their condition and subsequently displace their discontent on the physician. In one study, nearly 1 of every 6 (16.7%) outpatient encounters was considered difficult by physicians.⁴ Family medicine physicians defined the difficult patient as one who is violent, demanding, aggressive, and rude.⁵ Others in primary care specialties have considered difficult patients to have characteristics that include mental health problems, more than 5 somatic symptoms, and abrasive personalities.^4,6

Situational and Physician-Centered Factors in Difficult Patient Encounters

In our medical system, the narrative often is focused on the patient, for better or worse—the patient was difficult, thereby making the encounter difficult. However, it is important to remember that difficult encounters can be attributed to several different factors, including those related to the physician, the clinical situation, or both. For example, dermatology residents juggle their clinical duties; academic work including studying, teaching, and/or research; and systemic and personal pressures at all times, whether they are cognizant of it or not. For better or worse, by virtue of being human, residents bring these factors with them to each clinical encounter. The delicate balance of these components can have a considerable impact on our delivery of good health care. This is particularly relevant in dermatology, where residents are subject to limited time during visits, work culture among clinic staff that is out of our control, and prominent complex social issues (for those of us practicing in medically underserved areas). Poor communication skills, underlying bias toward specific health conditions, limited knowledge as a trainee, and our own personal stressors also may play large roles in perceiving a clinical encounter as difficult during dermatology residency.⁷

Strategies to Mitigate Difficult Encounters

As a resident, if you make a statement that sparks a negative response from the patient, acknowledge their negative emotion, try to offer help, or rephrase the original statement to quickly dispel the tension. Validating a patient’s emotions and helping them embrace uncertainty can go a long way in the therapeutic relationship, especially in dermatology where so many of our diseases are chronic and without a definite cure.⁸ Additionally, it is important to apply strategies to redirect and de-escalate the situation during emotionally charged conversations, such as active listening, validating and empathizing with emotions, exploring alternative solutions, and providing closure to the conversation. Consensus recommendations for managing challenging encounters established by the American Academy of Family Physicians in 2013 include setting boundaries or modifying schedules, as needed, to handle difficult encounters; employing empathetic listening skills and a nonjudgmental attitude to facilitate trust and adherence to treatment; and assessing for underlying psychological illnesses with referral for appropriate diagnosis and treatment. Finally, the CALMER method—catalyst for change, alter thoughts to change feelings, listen and then make a diagnosis, make an agreement, education and follow-up, reach out and discuss feelings—is another approach that may be useful.⁷ In dermatology, this approach may not only dissipate unwanted tension but also make progress toward a therapeutic relationship. We cannot control the patient’s behavior in a visit, but we need to keep in mind that we are in control of our own reactions to said behavior.⁹ After first acknowledging this, we can then guide patients to take steps toward overcoming the issue. Within the time restrictions of a dermatology clinic visit, residents may use this approach to quickly feel more in control of a distressing situation and remain calm to better care for the patient.

Final Thoughts

Difficult patient encounters are impossible to avoid in any field of medicine, and dermatology is no exception. It will only benefit residents to recognize the multiple factors impacting a challenging encounter now and learn or enhance conflict resolution and communication skills to navigate these dissatisfying and uncomfortable situations, as they are inevitable in our careers.

Dermatologists in training are exposed to many different clinical scenarios—from the quick 15-minute encounter to diagnose a case of atopic dermatitis to hours of digging through a medical record to identify a culprit medication in a hospitalized patient with a life-threatening cutaneous drug reaction. Amidst the day-to-day clinical work that we do, there inevitably are interactions we have with patients that are less than ideal. These challenging encounters—whether they be subtle microaggressions that unfortunately enter the workplace or blatant quarrels between providers and patients that leave both parties dissatisfied—are notable contributors to physician stress levels and can lead to burnout.^1,2 However, there are positive lessons to be learned from these challenging patient encounters if we manage to withstand them. When we start to understand the factors contributing to difficult clinical encounters, we can begin to develop and apply effective communication tools to productively navigate these experiences.

Defining the Difficult Patient

In 2017, the Global Burden of Disease study revealed that skin disease is the fourth leading cause of nonfatal disease burden worldwide.³ Based on this statistic, it is easy to see how some patients may experience frustration associated with their condition and subsequently displace their discontent on the physician. In one study, nearly 1 of every 6 (16.7%) outpatient encounters was considered difficult by physicians.⁴ Family medicine physicians defined the difficult patient as one who is violent, demanding, aggressive, and rude.⁵ Others in primary care specialties have considered difficult patients to have characteristics that include mental health problems, more than 5 somatic symptoms, and abrasive personalities.^4,6

Situational and Physician-Centered Factors in Difficult Patient Encounters

In our medical system, the narrative often is focused on the patient, for better or worse—the patient was difficult, thereby making the encounter difficult. However, it is important to remember that difficult encounters can be attributed to several different factors, including those related to the physician, the clinical situation, or both. For example, dermatology residents juggle their clinical duties; academic work including studying, teaching, and/or research; and systemic and personal pressures at all times, whether they are cognizant of it or not. For better or worse, by virtue of being human, residents bring these factors with them to each clinical encounter. The delicate balance of these components can have a considerable impact on our delivery of good health care. This is particularly relevant in dermatology, where residents are subject to limited time during visits, work culture among clinic staff that is out of our control, and prominent complex social issues (for those of us practicing in medically underserved areas). Poor communication skills, underlying bias toward specific health conditions, limited knowledge as a trainee, and our own personal stressors also may play large roles in perceiving a clinical encounter as difficult during dermatology residency.⁷

Strategies to Mitigate Difficult Encounters

As a resident, if you make a statement that sparks a negative response from the patient, acknowledge their negative emotion, try to offer help, or rephrase the original statement to quickly dispel the tension. Validating a patient’s emotions and helping them embrace uncertainty can go a long way in the therapeutic relationship, especially in dermatology where so many of our diseases are chronic and without a definite cure.⁸ Additionally, it is important to apply strategies to redirect and de-escalate the situation during emotionally charged conversations, such as active listening, validating and empathizing with emotions, exploring alternative solutions, and providing closure to the conversation. Consensus recommendations for managing challenging encounters established by the American Academy of Family Physicians in 2013 include setting boundaries or modifying schedules, as needed, to handle difficult encounters; employing empathetic listening skills and a nonjudgmental attitude to facilitate trust and adherence to treatment; and assessing for underlying psychological illnesses with referral for appropriate diagnosis and treatment. Finally, the CALMER method—catalyst for change, alter thoughts to change feelings, listen and then make a diagnosis, make an agreement, education and follow-up, reach out and discuss feelings—is another approach that may be useful.⁷ In dermatology, this approach may not only dissipate unwanted tension but also make progress toward a therapeutic relationship. We cannot control the patient’s behavior in a visit, but we need to keep in mind that we are in control of our own reactions to said behavior.⁹ After first acknowledging this, we can then guide patients to take steps toward overcoming the issue. Within the time restrictions of a dermatology clinic visit, residents may use this approach to quickly feel more in control of a distressing situation and remain calm to better care for the patient.

Final Thoughts

Difficult patient encounters are impossible to avoid in any field of medicine, and dermatology is no exception. It will only benefit residents to recognize the multiple factors impacting a challenging encounter now and learn or enhance conflict resolution and communication skills to navigate these dissatisfying and uncomfortable situations, as they are inevitable in our careers.

Dermatologists in training are exposed to many different clinical scenarios—from the quick 15-minute encounter to diagnose a case of atopic dermatitis to hours of digging through a medical record to identify a culprit medication in a hospitalized patient with a life-threatening cutaneous drug reaction. Amidst the day-to-day clinical work that we do, there inevitably are interactions we have with patients that are less than ideal. These challenging encounters—whether they be subtle microaggressions that unfortunately enter the workplace or blatant quarrels between providers and patients that leave both parties dissatisfied—are notable contributors to physician stress levels and can lead to burnout.^1,2 However, there are positive lessons to be learned from these challenging patient encounters if we manage to withstand them. When we start to understand the factors contributing to difficult clinical encounters, we can begin to develop and apply effective communication tools to productively navigate these experiences.

Defining the Difficult Patient

In 2017, the Global Burden of Disease study revealed that skin disease is the fourth leading cause of nonfatal disease burden worldwide.³ Based on this statistic, it is easy to see how some patients may experience frustration associated with their condition and subsequently displace their discontent on the physician. In one study, nearly 1 of every 6 (16.7%) outpatient encounters was considered difficult by physicians.⁴ Family medicine physicians defined the difficult patient as one who is violent, demanding, aggressive, and rude.⁵ Others in primary care specialties have considered difficult patients to have characteristics that include mental health problems, more than 5 somatic symptoms, and abrasive personalities.^4,6

Situational and Physician-Centered Factors in Difficult Patient Encounters

In our medical system, the narrative often is focused on the patient, for better or worse—the patient was difficult, thereby making the encounter difficult. However, it is important to remember that difficult encounters can be attributed to several different factors, including those related to the physician, the clinical situation, or both. For example, dermatology residents juggle their clinical duties; academic work including studying, teaching, and/or research; and systemic and personal pressures at all times, whether they are cognizant of it or not. For better or worse, by virtue of being human, residents bring these factors with them to each clinical encounter. The delicate balance of these components can have a considerable impact on our delivery of good health care. This is particularly relevant in dermatology, where residents are subject to limited time during visits, work culture among clinic staff that is out of our control, and prominent complex social issues (for those of us practicing in medically underserved areas). Poor communication skills, underlying bias toward specific health conditions, limited knowledge as a trainee, and our own personal stressors also may play large roles in perceiving a clinical encounter as difficult during dermatology residency.⁷

Strategies to Mitigate Difficult Encounters

As a resident, if you make a statement that sparks a negative response from the patient, acknowledge their negative emotion, try to offer help, or rephrase the original statement to quickly dispel the tension. Validating a patient’s emotions and helping them embrace uncertainty can go a long way in the therapeutic relationship, especially in dermatology where so many of our diseases are chronic and without a definite cure.⁸ Additionally, it is important to apply strategies to redirect and de-escalate the situation during emotionally charged conversations, such as active listening, validating and empathizing with emotions, exploring alternative solutions, and providing closure to the conversation. Consensus recommendations for managing challenging encounters established by the American Academy of Family Physicians in 2013 include setting boundaries or modifying schedules, as needed, to handle difficult encounters; employing empathetic listening skills and a nonjudgmental attitude to facilitate trust and adherence to treatment; and assessing for underlying psychological illnesses with referral for appropriate diagnosis and treatment. Finally, the CALMER method—catalyst for change, alter thoughts to change feelings, listen and then make a diagnosis, make an agreement, education and follow-up, reach out and discuss feelings—is another approach that may be useful.⁷ In dermatology, this approach may not only dissipate unwanted tension but also make progress toward a therapeutic relationship. We cannot control the patient’s behavior in a visit, but we need to keep in mind that we are in control of our own reactions to said behavior.⁹ After first acknowledging this, we can then guide patients to take steps toward overcoming the issue. Within the time restrictions of a dermatology clinic visit, residents may use this approach to quickly feel more in control of a distressing situation and remain calm to better care for the patient.

Final Thoughts

Difficult patient encounters are impossible to avoid in any field of medicine, and dermatology is no exception. It will only benefit residents to recognize the multiple factors impacting a challenging encounter now and learn or enhance conflict resolution and communication skills to navigate these dissatisfying and uncomfortable situations, as they are inevitable in our careers.

Key clinical point: Compared with control individuals without psoriatic arthritis (PsA), the burden of headache and migraine without aura was significantly higher in patients with PsA.

Major finding: The prevalence of headache (39.81% vs 26.44%; P = .028) and migraine without aura (18.52% vs 9.2%; P = .044) was significantly higher in patients with PsA vs control individuals without PsA. Patients with PsA who did vs did not have headaches also presented with a higher burden of comorbidities and prevalence of enthesitis (P = .02 for both).

Study details: This cross-sectional, observational cohort study included 216 patients with PsA, 70 patients with axial spondyloarthritis, and 87 gender-matched control individuals.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Marino A, Currado D, Altamura C, et al. Increased prevalence of headaches and migraine in patients with psoriatic arthritis and axial spondyloarthritis: Insights from an Italian cohort study. Biomedicines. 2024;12(2):371. doi: 10.3390/biomedicines12020371 Source

Key clinical point: Compared with control individuals without psoriatic arthritis (PsA), the burden of headache and migraine without aura was significantly higher in patients with PsA.

Major finding: The prevalence of headache (39.81% vs 26.44%; P = .028) and migraine without aura (18.52% vs 9.2%; P = .044) was significantly higher in patients with PsA vs control individuals without PsA. Patients with PsA who did vs did not have headaches also presented with a higher burden of comorbidities and prevalence of enthesitis (P = .02 for both).

Study details: This cross-sectional, observational cohort study included 216 patients with PsA, 70 patients with axial spondyloarthritis, and 87 gender-matched control individuals.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Marino A, Currado D, Altamura C, et al. Increased prevalence of headaches and migraine in patients with psoriatic arthritis and axial spondyloarthritis: Insights from an Italian cohort study. Biomedicines. 2024;12(2):371. doi: 10.3390/biomedicines12020371 Source

Key clinical point: Compared with control individuals without psoriatic arthritis (PsA), the burden of headache and migraine without aura was significantly higher in patients with PsA.

Major finding: The prevalence of headache (39.81% vs 26.44%; P = .028) and migraine without aura (18.52% vs 9.2%; P = .044) was significantly higher in patients with PsA vs control individuals without PsA. Patients with PsA who did vs did not have headaches also presented with a higher burden of comorbidities and prevalence of enthesitis (P = .02 for both).

Study details: This cross-sectional, observational cohort study included 216 patients with PsA, 70 patients with axial spondyloarthritis, and 87 gender-matched control individuals.

Disclosures: This study did not receive any external funding. The authors declared no conflicts of interest.

Source: Marino A, Currado D, Altamura C, et al. Increased prevalence of headaches and migraine in patients with psoriatic arthritis and axial spondyloarthritis: Insights from an Italian cohort study. Biomedicines. 2024;12(2):371. doi: 10.3390/biomedicines12020371 Source

Key clinical point: In patients with psoriatic arthritis (PsA), etanercept improved disease remission in routine clinical practice without showing any new safety signals.

Major finding: At week 12, 38.3% of patients with PsA achieved disease remission, with the proportion of patients achieving remission increasing to 51% and 54% at weeks 24 and 52, respectively. Among patients who achieved remission at week 12, 52.2% maintained it up to week 52. The most common treatment-emergent serious adverse events were aggravated condition, injury, poisoning, procedural complications, cardiac disorders, gastrointestinal disorders, and neoplasms.

Study details: Findings are from the prospective, non-interventional ADEQUATE study including patients with PsA (n = 254), axial spondyloarthritis (n = 305), or psoriasis (n = 70) who received etanercept for up to 52 weeks.

Disclosures: This study was funded by Pfizer Pharma GmbH. Three authors declared being employees and shareholders of Pfizer. Other authors declared receiving consulting fees, speaker fees, honoraria, or grants from or having other ties with various sources, including Pfizer.

Source: Feist E, Baraliakos X, Behrens F, et al. Etanercept in axial spondyloarthritis, psoriatic arthritis, and plaque psoriasis: Real-world outcome data from German non-interventional study ADEQUATE. Rheumatol Ther. 2024 (Feb 3). doi: 10.1007/s40744-023-00633-2  Source

Key clinical point: In patients with psoriatic arthritis (PsA), etanercept improved disease remission in routine clinical practice without showing any new safety signals.

Major finding: At week 12, 38.3% of patients with PsA achieved disease remission, with the proportion of patients achieving remission increasing to 51% and 54% at weeks 24 and 52, respectively. Among patients who achieved remission at week 12, 52.2% maintained it up to week 52. The most common treatment-emergent serious adverse events were aggravated condition, injury, poisoning, procedural complications, cardiac disorders, gastrointestinal disorders, and neoplasms.

Study details: Findings are from the prospective, non-interventional ADEQUATE study including patients with PsA (n = 254), axial spondyloarthritis (n = 305), or psoriasis (n = 70) who received etanercept for up to 52 weeks.

Disclosures: This study was funded by Pfizer Pharma GmbH. Three authors declared being employees and shareholders of Pfizer. Other authors declared receiving consulting fees, speaker fees, honoraria, or grants from or having other ties with various sources, including Pfizer.

Source: Feist E, Baraliakos X, Behrens F, et al. Etanercept in axial spondyloarthritis, psoriatic arthritis, and plaque psoriasis: Real-world outcome data from German non-interventional study ADEQUATE. Rheumatol Ther. 2024 (Feb 3). doi: 10.1007/s40744-023-00633-2  Source

Key clinical point: In patients with psoriatic arthritis (PsA), etanercept improved disease remission in routine clinical practice without showing any new safety signals.

Major finding: At week 12, 38.3% of patients with PsA achieved disease remission, with the proportion of patients achieving remission increasing to 51% and 54% at weeks 24 and 52, respectively. Among patients who achieved remission at week 12, 52.2% maintained it up to week 52. The most common treatment-emergent serious adverse events were aggravated condition, injury, poisoning, procedural complications, cardiac disorders, gastrointestinal disorders, and neoplasms.

Study details: Findings are from the prospective, non-interventional ADEQUATE study including patients with PsA (n = 254), axial spondyloarthritis (n = 305), or psoriasis (n = 70) who received etanercept for up to 52 weeks.

Disclosures: This study was funded by Pfizer Pharma GmbH. Three authors declared being employees and shareholders of Pfizer. Other authors declared receiving consulting fees, speaker fees, honoraria, or grants from or having other ties with various sources, including Pfizer.

Source: Feist E, Baraliakos X, Behrens F, et al. Etanercept in axial spondyloarthritis, psoriatic arthritis, and plaque psoriasis: Real-world outcome data from German non-interventional study ADEQUATE. Rheumatol Ther. 2024 (Feb 3). doi: 10.1007/s40744-023-00633-2  Source

Key clinical point: Patients with multimorbid psoriasis should be monitored for the potential development of psoriatic arthritis (PsA) as the presence of ≥2 morbidities at psoriasis incidence has been associated with an increased risk for PsA.

Major finding: The cumulative incidence of PsA in patients with psoriasis was 1.7%, 2.5%, and 2.9% at 5, 10, and 15 years after psoriasis incidence, respectively, with the risk for PsA being higher in those with ≥2 morbidities (hazard ratio 2.46; 95% CI 1.01-6.01).

Study details: Findings are from a retrospective cohort study including 817 patients with incident psoriasis and 849 age- and sex-matched comparator individuals without psoriasis; of these, 23 patients with psoriasis developed PsA during a median follow-up of 13.3 years.

Disclosures: This study was sponsored by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and other sources. Two authors declared serving as consultants for or receiving research support and grants from various sources.

Source: Karmacharya P, Chakradhar R, Hulshizer CA, et al. Multimorbidity in psoriasis as a risk factor for psoriatic arthritis: A population-based study. Rheumatology (Oxford). 2024 (Jan 30). doi: 10.1093/rheumatology/keae040 Source

Key clinical point: Patients with multimorbid psoriasis should be monitored for the potential development of psoriatic arthritis (PsA) as the presence of ≥2 morbidities at psoriasis incidence has been associated with an increased risk for PsA.

Major finding: The cumulative incidence of PsA in patients with psoriasis was 1.7%, 2.5%, and 2.9% at 5, 10, and 15 years after psoriasis incidence, respectively, with the risk for PsA being higher in those with ≥2 morbidities (hazard ratio 2.46; 95% CI 1.01-6.01).

Study details: Findings are from a retrospective cohort study including 817 patients with incident psoriasis and 849 age- and sex-matched comparator individuals without psoriasis; of these, 23 patients with psoriasis developed PsA during a median follow-up of 13.3 years.

Disclosures: This study was sponsored by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and other sources. Two authors declared serving as consultants for or receiving research support and grants from various sources.

Source: Karmacharya P, Chakradhar R, Hulshizer CA, et al. Multimorbidity in psoriasis as a risk factor for psoriatic arthritis: A population-based study. Rheumatology (Oxford). 2024 (Jan 30). doi: 10.1093/rheumatology/keae040 Source

Key clinical point: Patients with multimorbid psoriasis should be monitored for the potential development of psoriatic arthritis (PsA) as the presence of ≥2 morbidities at psoriasis incidence has been associated with an increased risk for PsA.

Major finding: The cumulative incidence of PsA in patients with psoriasis was 1.7%, 2.5%, and 2.9% at 5, 10, and 15 years after psoriasis incidence, respectively, with the risk for PsA being higher in those with ≥2 morbidities (hazard ratio 2.46; 95% CI 1.01-6.01).

Study details: Findings are from a retrospective cohort study including 817 patients with incident psoriasis and 849 age- and sex-matched comparator individuals without psoriasis; of these, 23 patients with psoriasis developed PsA during a median follow-up of 13.3 years.

Disclosures: This study was sponsored by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and other sources. Two authors declared serving as consultants for or receiving research support and grants from various sources.

Source: Karmacharya P, Chakradhar R, Hulshizer CA, et al. Multimorbidity in psoriasis as a risk factor for psoriatic arthritis: A population-based study. Rheumatology (Oxford). 2024 (Jan 30). doi: 10.1093/rheumatology/keae040 Source

Key clinical point: Elevated baseline levels of interleukin (IL)-22, IL-17A, and β-defensin (BD)-2 were linked to the achievement of robust skin response with guselkumab in difficult to treat patients with psoriatic arthritis (PsA) who showed inadequate response to tumor necrosis factor inhibitors (TNFi-IR).

Major finding: Levels of IL-22 and BD-2 were elevated in TNFi-IR patients with PsA who did vs did not achieve a ≥90% improvement in Psoriasis Area and Severity Index with guselkumab (P < .05). Levels of IL-17A and BD-2 were similarly elevated in patients who did vs did not respond to Investigator’s Global Assessment 0/1 criteria with guselkumab (all P < .05).

Study details: This post hoc analysis of pooled data from DISCOVER-1, DISCOVER-2, and COSMOS studies included patients with active PsA who were biologic-naive (n = 251) or had TNFi-IR (n = 93) and who received 100 mg guselkumab every 8 weeks.

Disclosures: This study was sponsored by Janssen Research & Development. Ten authors declared being employees of Janssen or subsidiaries or owning stocks or stock options in Johnson & Johnson. Several authors declared other ties with various sources, including Janssen. Other authors had no conflicts of interest.

Source: Siebert S, Coates LC, Schett G, et al. Modulation of IL-23 signaling with guselkumab in biologic-naïve patients versus TNF inhibitor-inadequate responders with active psoriatic arthritis. Arthritis Rheumatol. 2024 (Jan 22). doi: 10.1002/art.42803 Source

Key clinical point: Elevated baseline levels of interleukin (IL)-22, IL-17A, and β-defensin (BD)-2 were linked to the achievement of robust skin response with guselkumab in difficult to treat patients with psoriatic arthritis (PsA) who showed inadequate response to tumor necrosis factor inhibitors (TNFi-IR).

Major finding: Levels of IL-22 and BD-2 were elevated in TNFi-IR patients with PsA who did vs did not achieve a ≥90% improvement in Psoriasis Area and Severity Index with guselkumab (P < .05). Levels of IL-17A and BD-2 were similarly elevated in patients who did vs did not respond to Investigator’s Global Assessment 0/1 criteria with guselkumab (all P < .05).

Study details: This post hoc analysis of pooled data from DISCOVER-1, DISCOVER-2, and COSMOS studies included patients with active PsA who were biologic-naive (n = 251) or had TNFi-IR (n = 93) and who received 100 mg guselkumab every 8 weeks.

Disclosures: This study was sponsored by Janssen Research & Development. Ten authors declared being employees of Janssen or subsidiaries or owning stocks or stock options in Johnson & Johnson. Several authors declared other ties with various sources, including Janssen. Other authors had no conflicts of interest.

Source: Siebert S, Coates LC, Schett G, et al. Modulation of IL-23 signaling with guselkumab in biologic-naïve patients versus TNF inhibitor-inadequate responders with active psoriatic arthritis. Arthritis Rheumatol. 2024 (Jan 22). doi: 10.1002/art.42803 Source

Key clinical point: Elevated baseline levels of interleukin (IL)-22, IL-17A, and β-defensin (BD)-2 were linked to the achievement of robust skin response with guselkumab in difficult to treat patients with psoriatic arthritis (PsA) who showed inadequate response to tumor necrosis factor inhibitors (TNFi-IR).

Major finding: Levels of IL-22 and BD-2 were elevated in TNFi-IR patients with PsA who did vs did not achieve a ≥90% improvement in Psoriasis Area and Severity Index with guselkumab (P < .05). Levels of IL-17A and BD-2 were similarly elevated in patients who did vs did not respond to Investigator’s Global Assessment 0/1 criteria with guselkumab (all P < .05).

Study details: This post hoc analysis of pooled data from DISCOVER-1, DISCOVER-2, and COSMOS studies included patients with active PsA who were biologic-naive (n = 251) or had TNFi-IR (n = 93) and who received 100 mg guselkumab every 8 weeks.

Disclosures: This study was sponsored by Janssen Research & Development. Ten authors declared being employees of Janssen or subsidiaries or owning stocks or stock options in Johnson & Johnson. Several authors declared other ties with various sources, including Janssen. Other authors had no conflicts of interest.

Source: Siebert S, Coates LC, Schett G, et al. Modulation of IL-23 signaling with guselkumab in biologic-naïve patients versus TNF inhibitor-inadequate responders with active psoriatic arthritis. Arthritis Rheumatol. 2024 (Jan 22). doi: 10.1002/art.42803 Source

Key clinical point: Compared with the general population, the prevalence of psychotic disorders was significantly lower in patients with psoriatic arthritis (PsA), but a co-diagnosis of PsA and psychotic disorders was associated with an increased mortality rate, that too at a lower age.

Major finding: The prevalence of psychotic disorders was significantly lower in patients with PsA vs the general population (0.61% vs 0.72%; P = .006). Patients with PsA who did vs did not have psychotic disorders had an increased likelihood of death (9.3% vs 4.9%; P = .005) and significantly lower age at death (64.7 years vs 74.5 years; P < .001).

Study details: This cohort study included 449,392 patients with psoriasis and 47,825 patients with PsA.

Disclosures: The lead author Emilie Brenaut declared receiving a postdoctoral fellowship from the French Society of Dermatology and the Collège des Enseignants en Dermatologie de France as well as personal fees and nonfinancial support from various sources. The other authors reported no conflicts of interest.

Source: Brenaut E, Godin O, Leboyer M, et al. Association between psychotic disorders and psoriasis or psoriatic arthritis: Cohort study of French health insurance database. J Invest Dermatol. 2024 (Jan 19). doi: 10.1016/j.jid.2024.01.005  Source

Key clinical point: Compared with the general population, the prevalence of psychotic disorders was significantly lower in patients with psoriatic arthritis (PsA), but a co-diagnosis of PsA and psychotic disorders was associated with an increased mortality rate, that too at a lower age.

Major finding: The prevalence of psychotic disorders was significantly lower in patients with PsA vs the general population (0.61% vs 0.72%; P = .006). Patients with PsA who did vs did not have psychotic disorders had an increased likelihood of death (9.3% vs 4.9%; P = .005) and significantly lower age at death (64.7 years vs 74.5 years; P < .001).

Study details: This cohort study included 449,392 patients with psoriasis and 47,825 patients with PsA.

Disclosures: The lead author Emilie Brenaut declared receiving a postdoctoral fellowship from the French Society of Dermatology and the Collège des Enseignants en Dermatologie de France as well as personal fees and nonfinancial support from various sources. The other authors reported no conflicts of interest.

Source: Brenaut E, Godin O, Leboyer M, et al. Association between psychotic disorders and psoriasis or psoriatic arthritis: Cohort study of French health insurance database. J Invest Dermatol. 2024 (Jan 19). doi: 10.1016/j.jid.2024.01.005  Source

Key clinical point: Compared with the general population, the prevalence of psychotic disorders was significantly lower in patients with psoriatic arthritis (PsA), but a co-diagnosis of PsA and psychotic disorders was associated with an increased mortality rate, that too at a lower age.

Major finding: The prevalence of psychotic disorders was significantly lower in patients with PsA vs the general population (0.61% vs 0.72%; P = .006). Patients with PsA who did vs did not have psychotic disorders had an increased likelihood of death (9.3% vs 4.9%; P = .005) and significantly lower age at death (64.7 years vs 74.5 years; P < .001).

Study details: This cohort study included 449,392 patients with psoriasis and 47,825 patients with PsA.

Disclosures: The lead author Emilie Brenaut declared receiving a postdoctoral fellowship from the French Society of Dermatology and the Collège des Enseignants en Dermatologie de France as well as personal fees and nonfinancial support from various sources. The other authors reported no conflicts of interest.

Source: Brenaut E, Godin O, Leboyer M, et al. Association between psychotic disorders and psoriasis or psoriatic arthritis: Cohort study of French health insurance database. J Invest Dermatol. 2024 (Jan 19). doi: 10.1016/j.jid.2024.01.005  Source

Key clinical point: Tofacitinib improved disease activity outcomes and clinical manifestations in patients with psoriatic arthritis (PsA) who initiated and continued treatment with tofacitinib.

Major finding: At 6 ± 3 months of follow-up, 25.0% and 7.8% of patients achieved Clinical Disease Activity Index for PsA-defined low disease activity and remission, respectively, and 18.2% of patients achieved minimal disease activity. A substantial proportion of patients also reported the resolution of dactylitis (29.4%) and enthesitis (42.9%).

Study details: Findings are from an observational study including 222 patients with PsA from the CorEvitas PsA/Spondyloarthritis Registry who initiated treatment with tofacitinib, of whom 123 patients had 6 ± 3 months of follow-up.

Disclosures: This study was funded by Pfizer. Four authors declared being employees and stockholders of Pfizer Inc. The other authors declared having ties with various sources, including Pfizer.

Source: Mease PJ, Young P, Fallon L, et al. Effectiveness of tofacitinib in patients initiating therapy for psoriatic arthritis: Results from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry. Rheumatol Ther. 2024 (Jan 22). doi: 10.1007/s40744-023-00631-4 Source

Key clinical point: Tofacitinib improved disease activity outcomes and clinical manifestations in patients with psoriatic arthritis (PsA) who initiated and continued treatment with tofacitinib.

Major finding: At 6 ± 3 months of follow-up, 25.0% and 7.8% of patients achieved Clinical Disease Activity Index for PsA-defined low disease activity and remission, respectively, and 18.2% of patients achieved minimal disease activity. A substantial proportion of patients also reported the resolution of dactylitis (29.4%) and enthesitis (42.9%).

Study details: Findings are from an observational study including 222 patients with PsA from the CorEvitas PsA/Spondyloarthritis Registry who initiated treatment with tofacitinib, of whom 123 patients had 6 ± 3 months of follow-up.

Disclosures: This study was funded by Pfizer. Four authors declared being employees and stockholders of Pfizer Inc. The other authors declared having ties with various sources, including Pfizer.

Source: Mease PJ, Young P, Fallon L, et al. Effectiveness of tofacitinib in patients initiating therapy for psoriatic arthritis: Results from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry. Rheumatol Ther. 2024 (Jan 22). doi: 10.1007/s40744-023-00631-4 Source

Key clinical point: Tofacitinib improved disease activity outcomes and clinical manifestations in patients with psoriatic arthritis (PsA) who initiated and continued treatment with tofacitinib.

Major finding: At 6 ± 3 months of follow-up, 25.0% and 7.8% of patients achieved Clinical Disease Activity Index for PsA-defined low disease activity and remission, respectively, and 18.2% of patients achieved minimal disease activity. A substantial proportion of patients also reported the resolution of dactylitis (29.4%) and enthesitis (42.9%).

Study details: Findings are from an observational study including 222 patients with PsA from the CorEvitas PsA/Spondyloarthritis Registry who initiated treatment with tofacitinib, of whom 123 patients had 6 ± 3 months of follow-up.

Disclosures: This study was funded by Pfizer. Four authors declared being employees and stockholders of Pfizer Inc. The other authors declared having ties with various sources, including Pfizer.

Source: Mease PJ, Young P, Fallon L, et al. Effectiveness of tofacitinib in patients initiating therapy for psoriatic arthritis: Results from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry. Rheumatol Ther. 2024 (Jan 22). doi: 10.1007/s40744-023-00631-4 Source

Key clinical point: In patients with moderate to severe psoriatic arthritis (PsA), risankizumab demonstrated superior efficacy vs placebo in improving disease activity outcomes with a favorable safety profile.

Major finding: A significantly higher number of patients receiving risankizumab vs placebo achieved more than 20% improvement in American College of Rheumatology score at week 24 (risk ratio [RR] 1.760; P < .001) and higher minimal disease activity response (RR 1.827; P < .05). The incidences of serious adverse events and serious treatment-emergent adverse events were similar between the risankizumab and placebo groups (P = .31 and P = .97, respectively).

Study details: This meta-analysis of six randomized controlled trials included 5038 patients with PsA who received either risankizumab or placebo.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Natural Science Foundation of Shanxi Province. The authors declared no conflicts of interest.

Source: Su QY, Zhou HN, Xia GM, et al. Efficacy and safety of risankizumab in patients with psoriatic arthritis: A systematic review and meta-analysis of randomized controlled trials. Rheumatol Ther. 2024 (Feb 1). doi: 10.1007/s40744-024-00638-5 Source

Key clinical point: In patients with moderate to severe psoriatic arthritis (PsA), risankizumab demonstrated superior efficacy vs placebo in improving disease activity outcomes with a favorable safety profile.

Major finding: A significantly higher number of patients receiving risankizumab vs placebo achieved more than 20% improvement in American College of Rheumatology score at week 24 (risk ratio [RR] 1.760; P < .001) and higher minimal disease activity response (RR 1.827; P < .05). The incidences of serious adverse events and serious treatment-emergent adverse events were similar between the risankizumab and placebo groups (P = .31 and P = .97, respectively).

Study details: This meta-analysis of six randomized controlled trials included 5038 patients with PsA who received either risankizumab or placebo.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Natural Science Foundation of Shanxi Province. The authors declared no conflicts of interest.

Source: Su QY, Zhou HN, Xia GM, et al. Efficacy and safety of risankizumab in patients with psoriatic arthritis: A systematic review and meta-analysis of randomized controlled trials. Rheumatol Ther. 2024 (Feb 1). doi: 10.1007/s40744-024-00638-5 Source

Key clinical point: In patients with moderate to severe psoriatic arthritis (PsA), risankizumab demonstrated superior efficacy vs placebo in improving disease activity outcomes with a favorable safety profile.

Major finding: A significantly higher number of patients receiving risankizumab vs placebo achieved more than 20% improvement in American College of Rheumatology score at week 24 (risk ratio [RR] 1.760; P < .001) and higher minimal disease activity response (RR 1.827; P < .05). The incidences of serious adverse events and serious treatment-emergent adverse events were similar between the risankizumab and placebo groups (P = .31 and P = .97, respectively).

Study details: This meta-analysis of six randomized controlled trials included 5038 patients with PsA who received either risankizumab or placebo.

Disclosures: This study was supported by grants from the National Natural Science Foundation of China and the Natural Science Foundation of Shanxi Province. The authors declared no conflicts of interest.

Source: Su QY, Zhou HN, Xia GM, et al. Efficacy and safety of risankizumab in patients with psoriatic arthritis: A systematic review and meta-analysis of randomized controlled trials. Rheumatol Ther. 2024 (Feb 1). doi: 10.1007/s40744-024-00638-5 Source