Key clinical point: Patients with psoriatic arthritis (PsA) who were currently experiencing flares had worse quality of life (QoL), greater disability, and impaired work productivity compared with those who had not experienced flare ever or in the last 12 months.

Major finding: Currently, 168 patients were diagnosed with flare by a physician. Compared with patients who had not experienced flare ever or in the last 12 months, those who were currently experiencing flares had lower QoL scores and higher overall work impairment, disability, and a greater disease impact on patient’s QoL (all P < .01).

Study details: Findings are from the Adelphi PsA Disease Specific Programme, a cross-sectional survey including 2238 patients with PsA and physician-reported flare status data.

Disclosures: The Adelphi SpA IV Disease Specific Programme was funded by Janssen. Two authors declared being employees of Adelphi Real World, and two authors declared being employees of Janssen Pharmaceuticals. The other authors reported receiving research grants and consulting fees from several sources.

Source: Orbai AM et al. Impact of physician-defined flares on quality of life and work impairment: An international survey of 2,238 psoriatic arthritis patients. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.211302

Key clinical point: Patients with psoriatic arthritis (PsA) who were currently experiencing flares had worse quality of life (QoL), greater disability, and impaired work productivity compared with those who had not experienced flare ever or in the last 12 months.

Major finding: Currently, 168 patients were diagnosed with flare by a physician. Compared with patients who had not experienced flare ever or in the last 12 months, those who were currently experiencing flares had lower QoL scores and higher overall work impairment, disability, and a greater disease impact on patient’s QoL (all P < .01).

Study details: Findings are from the Adelphi PsA Disease Specific Programme, a cross-sectional survey including 2238 patients with PsA and physician-reported flare status data.

Disclosures: The Adelphi SpA IV Disease Specific Programme was funded by Janssen. Two authors declared being employees of Adelphi Real World, and two authors declared being employees of Janssen Pharmaceuticals. The other authors reported receiving research grants and consulting fees from several sources.

Source: Orbai AM et al. Impact of physician-defined flares on quality of life and work impairment: An international survey of 2,238 psoriatic arthritis patients. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.211302

Key clinical point: Patients with psoriatic arthritis (PsA) who were currently experiencing flares had worse quality of life (QoL), greater disability, and impaired work productivity compared with those who had not experienced flare ever or in the last 12 months.

Major finding: Currently, 168 patients were diagnosed with flare by a physician. Compared with patients who had not experienced flare ever or in the last 12 months, those who were currently experiencing flares had lower QoL scores and higher overall work impairment, disability, and a greater disease impact on patient’s QoL (all P < .01).

Study details: Findings are from the Adelphi PsA Disease Specific Programme, a cross-sectional survey including 2238 patients with PsA and physician-reported flare status data.

Disclosures: The Adelphi SpA IV Disease Specific Programme was funded by Janssen. Two authors declared being employees of Adelphi Real World, and two authors declared being employees of Janssen Pharmaceuticals. The other authors reported receiving research grants and consulting fees from several sources.

Source: Orbai AM et al. Impact of physician-defined flares on quality of life and work impairment: An international survey of 2,238 psoriatic arthritis patients. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.211302

Key clinical point: Methotrexate (MTX)-related side effects were more prevalent in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA), whereas tumor necrosis factor inhibitor (TNFi)-related side effects were equally prevalent in patients with PsA and RA.

Major finding: In the first year, a higher proportion of patients with PsA vs RA reported MTX-related side effects (44.8% vs 29.4%), but similar proportions of patients with PsA (24.2%) and RA (22.8%) reported TNFi-related side effects. Patients with PsA vs RA were 1.8 times more likely to experience side effects with MTX (odds ratio 1.77; 95% CI 1.21-2.60).

Study details: Findings are from a retrospective cohort study including new initiators of MTX (PsA: n = 116 and RA: n = 4247) and TNFi (PsA: n = 124 and RA: n = 4361).

Disclosures: This study was funded by Amgen Inc. Two authors declared being employees or owning stocks in Amgen. The other authors declared receiving grants, funding, honoraria, or consulting fees from several sources, including Amgen.

Source: Ogdie A et al. Side effects of methotrexate and tumor necrosis factor inhibitors: Differences in tolerability among patients with psoriatic arthritis and rheumatoid arthritis. ACR Open Rheumatol. 2022 (Aug 15). Doi: 10.1002/acr2.11467

Key clinical point: Methotrexate (MTX)-related side effects were more prevalent in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA), whereas tumor necrosis factor inhibitor (TNFi)-related side effects were equally prevalent in patients with PsA and RA.

Major finding: In the first year, a higher proportion of patients with PsA vs RA reported MTX-related side effects (44.8% vs 29.4%), but similar proportions of patients with PsA (24.2%) and RA (22.8%) reported TNFi-related side effects. Patients with PsA vs RA were 1.8 times more likely to experience side effects with MTX (odds ratio 1.77; 95% CI 1.21-2.60).

Study details: Findings are from a retrospective cohort study including new initiators of MTX (PsA: n = 116 and RA: n = 4247) and TNFi (PsA: n = 124 and RA: n = 4361).

Disclosures: This study was funded by Amgen Inc. Two authors declared being employees or owning stocks in Amgen. The other authors declared receiving grants, funding, honoraria, or consulting fees from several sources, including Amgen.

Source: Ogdie A et al. Side effects of methotrexate and tumor necrosis factor inhibitors: Differences in tolerability among patients with psoriatic arthritis and rheumatoid arthritis. ACR Open Rheumatol. 2022 (Aug 15). Doi: 10.1002/acr2.11467

Key clinical point: Methotrexate (MTX)-related side effects were more prevalent in patients with psoriatic arthritis (PsA) vs rheumatoid arthritis (RA), whereas tumor necrosis factor inhibitor (TNFi)-related side effects were equally prevalent in patients with PsA and RA.

Major finding: In the first year, a higher proportion of patients with PsA vs RA reported MTX-related side effects (44.8% vs 29.4%), but similar proportions of patients with PsA (24.2%) and RA (22.8%) reported TNFi-related side effects. Patients with PsA vs RA were 1.8 times more likely to experience side effects with MTX (odds ratio 1.77; 95% CI 1.21-2.60).

Study details: Findings are from a retrospective cohort study including new initiators of MTX (PsA: n = 116 and RA: n = 4247) and TNFi (PsA: n = 124 and RA: n = 4361).

Disclosures: This study was funded by Amgen Inc. Two authors declared being employees or owning stocks in Amgen. The other authors declared receiving grants, funding, honoraria, or consulting fees from several sources, including Amgen.

Source: Ogdie A et al. Side effects of methotrexate and tumor necrosis factor inhibitors: Differences in tolerability among patients with psoriatic arthritis and rheumatoid arthritis. ACR Open Rheumatol. 2022 (Aug 15). Doi: 10.1002/acr2.11467

Key clinical point: Among patients with psoriatic arthritis (PsA) women experienced significantly higher disease burden than men despite similar disease activity and comparable treatments.

Major finding: Despite similar disease duration (P  =  .42), disease presentation, and biologic use (P  =  .38), women vs men had worse mean quality-of-life (0.80 vs 0.82; P  =  .02) and disability and physical functioning (0.56 vs 0.41; P < .01) scores, greater degree of work activity impairment (27.9% vs 24.6%; P < .01), and higher pain and fatigue scores (P < .01).

Study details: This study analyzed the data of 2270 patients with PsA (1223 men and 1047 women) from the Adelphi PsA Disease Specific Programme.

Disclosures: This study was funded by Janssen Research & Development, LLC. Three authors declared being employees of Janssen and owning stocks in Janssen/Johnson and Johnson. Some authors declared receiving research grants and consulting fees from several sources, including Janssen.

Source: Gossec L et al. Women with psoriatic arthritis experience higher disease burden than men: Findings from a real-world survey in the USA and Europe. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220154

Key clinical point: Among patients with psoriatic arthritis (PsA) women experienced significantly higher disease burden than men despite similar disease activity and comparable treatments.

Major finding: Despite similar disease duration (P  =  .42), disease presentation, and biologic use (P  =  .38), women vs men had worse mean quality-of-life (0.80 vs 0.82; P  =  .02) and disability and physical functioning (0.56 vs 0.41; P < .01) scores, greater degree of work activity impairment (27.9% vs 24.6%; P < .01), and higher pain and fatigue scores (P < .01).

Study details: This study analyzed the data of 2270 patients with PsA (1223 men and 1047 women) from the Adelphi PsA Disease Specific Programme.

Disclosures: This study was funded by Janssen Research & Development, LLC. Three authors declared being employees of Janssen and owning stocks in Janssen/Johnson and Johnson. Some authors declared receiving research grants and consulting fees from several sources, including Janssen.

Source: Gossec L et al. Women with psoriatic arthritis experience higher disease burden than men: Findings from a real-world survey in the USA and Europe. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220154

Key clinical point: Among patients with psoriatic arthritis (PsA) women experienced significantly higher disease burden than men despite similar disease activity and comparable treatments.

Major finding: Despite similar disease duration (P  =  .42), disease presentation, and biologic use (P  =  .38), women vs men had worse mean quality-of-life (0.80 vs 0.82; P  =  .02) and disability and physical functioning (0.56 vs 0.41; P < .01) scores, greater degree of work activity impairment (27.9% vs 24.6%; P < .01), and higher pain and fatigue scores (P < .01).

Study details: This study analyzed the data of 2270 patients with PsA (1223 men and 1047 women) from the Adelphi PsA Disease Specific Programme.

Disclosures: This study was funded by Janssen Research & Development, LLC. Three authors declared being employees of Janssen and owning stocks in Janssen/Johnson and Johnson. Some authors declared receiving research grants and consulting fees from several sources, including Janssen.

Source: Gossec L et al. Women with psoriatic arthritis experience higher disease burden than men: Findings from a real-world survey in the USA and Europe. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220154

Key clinical point: Among patients with psoriatic arthritis (PsA) women experienced significantly higher disease burden than men despite similar disease activity and comparable treatments.

Major finding: Despite similar disease duration (P  =  .42), disease presentation, and biologic use (P  =  .38), women vs men had worse mean quality-of-life (0.80 vs 0.82; P  =  .02) and disability and physical functioning (0.56 vs 0.41; P < .01) scores, greater degree of work activity impairment (27.9% vs 24.6%; P < .01), and higher pain and fatigue scores (P < .01).

Study details: This study analyzed the data of 2270 patients with PsA (1223 men and 1047 women) from the Adelphi PsA Disease Specific Programme.

Disclosures: This study was funded by Janssen Research & Development, LLC. Three authors declared being employees of Janssen and owning stocks in Janssen/Johnson and Johnson. Some authors declared receiving research grants and consulting fees from several sources, including Janssen.

Source: Gossec L et al. Women with psoriatic arthritis experience higher disease burden than men: Findings from a real-world survey in the USA and Europe. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220154

Key clinical point: Among patients with psoriatic arthritis (PsA) women experienced significantly higher disease burden than men despite similar disease activity and comparable treatments.

Major finding: Despite similar disease duration (P  =  .42), disease presentation, and biologic use (P  =  .38), women vs men had worse mean quality-of-life (0.80 vs 0.82; P  =  .02) and disability and physical functioning (0.56 vs 0.41; P < .01) scores, greater degree of work activity impairment (27.9% vs 24.6%; P < .01), and higher pain and fatigue scores (P < .01).

Study details: This study analyzed the data of 2270 patients with PsA (1223 men and 1047 women) from the Adelphi PsA Disease Specific Programme.

Disclosures: This study was funded by Janssen Research & Development, LLC. Three authors declared being employees of Janssen and owning stocks in Janssen/Johnson and Johnson. Some authors declared receiving research grants and consulting fees from several sources, including Janssen.

Source: Gossec L et al. Women with psoriatic arthritis experience higher disease burden than men: Findings from a real-world survey in the USA and Europe. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220154

Key clinical point: Among patients with psoriatic arthritis (PsA) women experienced significantly higher disease burden than men despite similar disease activity and comparable treatments.

Major finding: Despite similar disease duration (P  =  .42), disease presentation, and biologic use (P  =  .38), women vs men had worse mean quality-of-life (0.80 vs 0.82; P  =  .02) and disability and physical functioning (0.56 vs 0.41; P < .01) scores, greater degree of work activity impairment (27.9% vs 24.6%; P < .01), and higher pain and fatigue scores (P < .01).

Study details: This study analyzed the data of 2270 patients with PsA (1223 men and 1047 women) from the Adelphi PsA Disease Specific Programme.

Disclosures: This study was funded by Janssen Research & Development, LLC. Three authors declared being employees of Janssen and owning stocks in Janssen/Johnson and Johnson. Some authors declared receiving research grants and consulting fees from several sources, including Janssen.

Source: Gossec L et al. Women with psoriatic arthritis experience higher disease burden than men: Findings from a real-world survey in the USA and Europe. J Rheumatol. 2022 (Aug 15). Doi: 10.3899/jrheum.220154

Key clinical point: Levels of C-reactive protein (CRP), a classic inflammatory marker, do not adequately reflect the level of disease activity (DA) in patients with psoriatic arthritis (PsA).

Major finding: CRP status was only associated with the erythrocyte sedimentation rate (odds ratio 1.04; P  =  .005) and not with any DA-related parameter. Among patients with normal CRP levels, a substantial proportion (45.9%) of patients were in non-minimal DA state, with 21.2% having moderate DA and 5.9% having high DA.

Study details: Findings are from a cross-sectional study including 128 patients with PsA, of which 66.4% had normal CRP levels (≤0.5 mg/dL) and the remaining had high CRP levels (>0.5 mg/dL).

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

Source: Gialouri CG et al. Normal C-reactive protein in active psoriatic arthritis: Results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022 (Sep 5). Doi: 10.1177/1759720X221122417

Key clinical point: Levels of C-reactive protein (CRP), a classic inflammatory marker, do not adequately reflect the level of disease activity (DA) in patients with psoriatic arthritis (PsA).

Major finding: CRP status was only associated with the erythrocyte sedimentation rate (odds ratio 1.04; P  =  .005) and not with any DA-related parameter. Among patients with normal CRP levels, a substantial proportion (45.9%) of patients were in non-minimal DA state, with 21.2% having moderate DA and 5.9% having high DA.

Study details: Findings are from a cross-sectional study including 128 patients with PsA, of which 66.4% had normal CRP levels (≤0.5 mg/dL) and the remaining had high CRP levels (>0.5 mg/dL).

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

Source: Gialouri CG et al. Normal C-reactive protein in active psoriatic arthritis: Results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022 (Sep 5). Doi: 10.1177/1759720X221122417

Key clinical point: Levels of C-reactive protein (CRP), a classic inflammatory marker, do not adequately reflect the level of disease activity (DA) in patients with psoriatic arthritis (PsA).

Major finding: CRP status was only associated with the erythrocyte sedimentation rate (odds ratio 1.04; P  =  .005) and not with any DA-related parameter. Among patients with normal CRP levels, a substantial proportion (45.9%) of patients were in non-minimal DA state, with 21.2% having moderate DA and 5.9% having high DA.

Study details: Findings are from a cross-sectional study including 128 patients with PsA, of which 66.4% had normal CRP levels (≤0.5 mg/dL) and the remaining had high CRP levels (>0.5 mg/dL).

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

Source: Gialouri CG et al. Normal C-reactive protein in active psoriatic arthritis: Results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022 (Sep 5). Doi: 10.1177/1759720X221122417

Key clinical point: Levels of C-reactive protein (CRP), a classic inflammatory marker, do not adequately reflect the level of disease activity (DA) in patients with psoriatic arthritis (PsA).

Major finding: CRP status was only associated with the erythrocyte sedimentation rate (odds ratio 1.04; P  =  .005) and not with any DA-related parameter. Among patients with normal CRP levels, a substantial proportion (45.9%) of patients were in non-minimal DA state, with 21.2% having moderate DA and 5.9% having high DA.

Study details: Findings are from a cross-sectional study including 128 patients with PsA, of which 66.4% had normal CRP levels (≤0.5mg/dL) and the remaining had high CRP levels (>0.5mg/dL).

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

Source: Gialouri CG et al. Normal C-reactive protein in active psoriatic arthritis: Results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022 (Sep 5). Doi: 10.1177/1759720X221122417

Key clinical point: Levels of C-reactive protein (CRP), a classic inflammatory marker, do not adequately reflect the level of disease activity (DA) in patients with psoriatic arthritis (PsA).

Major finding: CRP status was only associated with the erythrocyte sedimentation rate (odds ratio 1.04; P  =  .005) and not with any DA-related parameter. Among patients with normal CRP levels, a substantial proportion (45.9%) of patients were in non-minimal DA state, with 21.2% having moderate DA and 5.9% having high DA.

Study details: Findings are from a cross-sectional study including 128 patients with PsA, of which 66.4% had normal CRP levels (≤0.5mg/dL) and the remaining had high CRP levels (>0.5mg/dL).

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

Source: Gialouri CG et al. Normal C-reactive protein in active psoriatic arthritis: Results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022 (Sep 5). Doi: 10.1177/1759720X221122417

Key clinical point: Levels of C-reactive protein (CRP), a classic inflammatory marker, do not adequately reflect the level of disease activity (DA) in patients with psoriatic arthritis (PsA).

Major finding: CRP status was only associated with the erythrocyte sedimentation rate (odds ratio 1.04; P  =  .005) and not with any DA-related parameter. Among patients with normal CRP levels, a substantial proportion (45.9%) of patients were in non-minimal DA state, with 21.2% having moderate DA and 5.9% having high DA.

Study details: Findings are from a cross-sectional study including 128 patients with PsA, of which 66.4% had normal CRP levels (≤0.5mg/dL) and the remaining had high CRP levels (>0.5mg/dL).

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

Source: Gialouri CG et al. Normal C-reactive protein in active psoriatic arthritis: Results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022 (Sep 5). Doi: 10.1177/1759720X221122417

Key clinical point: Patients with active psoriatic arthritis (PsA) who received ustekinumab for 160 weeks showed rapid and sustained improvements in the signs and symptoms of PsA.

Major finding: A decrease in both tender joint count (TJC; 8.0 to 5.8) and swollen joint count (SJC; 4.5 to 3.1) was observed from baseline to week 4, with further decrease until week 28. Improvements were sustained up to week 160 (TJC 1.0; SJC 0.4). Minimal disease activity was achieved by 31.9% of patients at week 28 and 33.6% of patients at week 52.

Study details: Findings are from the prospective, non-interventional SUSTAIN study including 129 patients with active PsA and a previous inadequate response to disease-modifying antirheumatic drugs who were followed up to week 160.

Disclosures: The SUSTAIN study was funded by Janssen-Cilag GmbH. Three authors declared being employees of Janssen-Cilag GmbH and holding stocks in Johnson and Johnson, the parent company of Janssen. The other authors declared no conflicts of interest.

Source: Wendler J et al. Ustekinumab is rapid-acting and is an effective long-term treatment for patients with active psoriatic arthritis: Real-world evidence from the non-interventional SUSTAIN study. Rheumatol Ther. 2022 (Sep 6). Doi: 10.1007/s40744-022-00484-3

Key clinical point: Patients with active psoriatic arthritis (PsA) who received ustekinumab for 160 weeks showed rapid and sustained improvements in the signs and symptoms of PsA.

Major finding: A decrease in both tender joint count (TJC; 8.0 to 5.8) and swollen joint count (SJC; 4.5 to 3.1) was observed from baseline to week 4, with further decrease until week 28. Improvements were sustained up to week 160 (TJC 1.0; SJC 0.4). Minimal disease activity was achieved by 31.9% of patients at week 28 and 33.6% of patients at week 52.

Study details: Findings are from the prospective, non-interventional SUSTAIN study including 129 patients with active PsA and a previous inadequate response to disease-modifying antirheumatic drugs who were followed up to week 160.

Disclosures: The SUSTAIN study was funded by Janssen-Cilag GmbH. Three authors declared being employees of Janssen-Cilag GmbH and holding stocks in Johnson and Johnson, the parent company of Janssen. The other authors declared no conflicts of interest.

Source: Wendler J et al. Ustekinumab is rapid-acting and is an effective long-term treatment for patients with active psoriatic arthritis: Real-world evidence from the non-interventional SUSTAIN study. Rheumatol Ther. 2022 (Sep 6). Doi: 10.1007/s40744-022-00484-3

Key clinical point: Patients with active psoriatic arthritis (PsA) who received ustekinumab for 160 weeks showed rapid and sustained improvements in the signs and symptoms of PsA.

Major finding: A decrease in both tender joint count (TJC; 8.0 to 5.8) and swollen joint count (SJC; 4.5 to 3.1) was observed from baseline to week 4, with further decrease until week 28. Improvements were sustained up to week 160 (TJC 1.0; SJC 0.4). Minimal disease activity was achieved by 31.9% of patients at week 28 and 33.6% of patients at week 52.

Study details: Findings are from the prospective, non-interventional SUSTAIN study including 129 patients with active PsA and a previous inadequate response to disease-modifying antirheumatic drugs who were followed up to week 160.

Disclosures: The SUSTAIN study was funded by Janssen-Cilag GmbH. Three authors declared being employees of Janssen-Cilag GmbH and holding stocks in Johnson and Johnson, the parent company of Janssen. The other authors declared no conflicts of interest.

Source: Wendler J et al. Ustekinumab is rapid-acting and is an effective long-term treatment for patients with active psoriatic arthritis: Real-world evidence from the non-interventional SUSTAIN study. Rheumatol Ther. 2022 (Sep 6). Doi: 10.1007/s40744-022-00484-3

Key clinical point: Patients with isolated axial psoriatic arthritis (PsA) had a better functional status than those with both axial and peripheral disease. Human leucocyte antigen (HLA)-B*27 positivity was associated with isolated axial PsA and predicted the development of peripheral disease over time.

Major finding: Compared with patients with concomitant axial and peripheral disease, HLA-B*27 positivity (odds ratio [OR] 25.00; P < .003) and lower Health Assessment Questionnaire scores (OR 0.004; P < .01) were associated with isolated axial disease. HLA-B*27 positivity predicted the development of peripheral PsA in patients with isolated axial PsA (hazard ratio 7.544; P < .006).

Study details: Findings are from a longitudinal study including 1688 patients with ankylosing spondylitis and psoriasis and 1576 patients with PsA, of which 32 had isolated axial disease and 463 had axial with peripheral disease.

Disclosures: The University of Toronto Psoriatic Arthritis Program is supported by a grant from the Krembil Foundation. The authors declared no conflicts of interest.

Source: Kwok TSH et al. Isolated axial disease in psoriatic arthritis and ankylosing spondylitis with psoriasis. Ann Rheum Dis. 2022 (Aug 16). Doi: 10.1136/ard-2022-222537

Key clinical point: Patients with isolated axial psoriatic arthritis (PsA) had a better functional status than those with both axial and peripheral disease. Human leucocyte antigen (HLA)-B*27 positivity was associated with isolated axial PsA and predicted the development of peripheral disease over time.

Major finding: Compared with patients with concomitant axial and peripheral disease, HLA-B*27 positivity (odds ratio [OR] 25.00; P < .003) and lower Health Assessment Questionnaire scores (OR 0.004; P < .01) were associated with isolated axial disease. HLA-B*27 positivity predicted the development of peripheral PsA in patients with isolated axial PsA (hazard ratio 7.544; P < .006).

Study details: Findings are from a longitudinal study including 1688 patients with ankylosing spondylitis and psoriasis and 1576 patients with PsA, of which 32 had isolated axial disease and 463 had axial with peripheral disease.

Disclosures: The University of Toronto Psoriatic Arthritis Program is supported by a grant from the Krembil Foundation. The authors declared no conflicts of interest.

Source: Kwok TSH et al. Isolated axial disease in psoriatic arthritis and ankylosing spondylitis with psoriasis. Ann Rheum Dis. 2022 (Aug 16). Doi: 10.1136/ard-2022-222537

Key clinical point: Patients with isolated axial psoriatic arthritis (PsA) had a better functional status than those with both axial and peripheral disease. Human leucocyte antigen (HLA)-B*27 positivity was associated with isolated axial PsA and predicted the development of peripheral disease over time.

Major finding: Compared with patients with concomitant axial and peripheral disease, HLA-B*27 positivity (odds ratio [OR] 25.00; P < .003) and lower Health Assessment Questionnaire scores (OR 0.004; P < .01) were associated with isolated axial disease. HLA-B*27 positivity predicted the development of peripheral PsA in patients with isolated axial PsA (hazard ratio 7.544; P < .006).

Study details: Findings are from a longitudinal study including 1688 patients with ankylosing spondylitis and psoriasis and 1576 patients with PsA, of which 32 had isolated axial disease and 463 had axial with peripheral disease.

Disclosures: The University of Toronto Psoriatic Arthritis Program is supported by a grant from the Krembil Foundation. The authors declared no conflicts of interest.

Source: Kwok TSH et al. Isolated axial disease in psoriatic arthritis and ankylosing spondylitis with psoriasis. Ann Rheum Dis. 2022 (Aug 16). Doi: 10.1136/ard-2022-222537

Key clinical point: Secukinumab significantly delayed disease flare compared with placebo and showed a consistent safety profile in patients with juvenile psoriatic arthritis (JPsA).

Major finding: Secukinumab vs placebo was associated with a significant delay in disease flare (hazard ratio 0.15; P < .001) and a higher proportion of patients achieving juvenile idiopathic arthritis American College of Rheumatology 30 response at week 104 (86.7% vs 62.5%). No new safety concerns were observed.

Study details: Findings are from a treatment-withdrawal, phase 3 study including 86 biologic-naive patients with active enthesitis-related arthritis (n = 52) or JPsA (n = 34) who were randomly assigned to receive secukinumab or placebo for up to 104 weeks.

Disclosures: This study was sponsored by Novartis Pharma AG. Four authors declared being employees and shareholders of Novartis. The other authors reported ties with several sources, including Novartis.

Source: Brunner HI et al on behalf of Paediatric Rheumatology INternational Trials Organization (PRINTO) and Pediatric Rheumatology Collaborative Study Group (PRCSG). Secukinumab in enthesitis-related arthritis and juvenile psoriatic arthritis: A randomised, double-blind, placebo-controlled, treatment withdrawal, phase 3 trial. Ann Rheum Dis. 2022 (Aug 12). Doi: 10.1136/ard-2022-222849

Key clinical point: Secukinumab significantly delayed disease flare compared with placebo and showed a consistent safety profile in patients with juvenile psoriatic arthritis (JPsA).

Major finding: Secukinumab vs placebo was associated with a significant delay in disease flare (hazard ratio 0.15; P < .001) and a higher proportion of patients achieving juvenile idiopathic arthritis American College of Rheumatology 30 response at week 104 (86.7% vs 62.5%). No new safety concerns were observed.

Study details: Findings are from a treatment-withdrawal, phase 3 study including 86 biologic-naive patients with active enthesitis-related arthritis (n = 52) or JPsA (n = 34) who were randomly assigned to receive secukinumab or placebo for up to 104 weeks.

Disclosures: This study was sponsored by Novartis Pharma AG. Four authors declared being employees and shareholders of Novartis. The other authors reported ties with several sources, including Novartis.

Source: Brunner HI et al on behalf of Paediatric Rheumatology INternational Trials Organization (PRINTO) and Pediatric Rheumatology Collaborative Study Group (PRCSG). Secukinumab in enthesitis-related arthritis and juvenile psoriatic arthritis: A randomised, double-blind, placebo-controlled, treatment withdrawal, phase 3 trial. Ann Rheum Dis. 2022 (Aug 12). Doi: 10.1136/ard-2022-222849

Key clinical point: Secukinumab significantly delayed disease flare compared with placebo and showed a consistent safety profile in patients with juvenile psoriatic arthritis (JPsA).

Major finding: Secukinumab vs placebo was associated with a significant delay in disease flare (hazard ratio 0.15; P < .001) and a higher proportion of patients achieving juvenile idiopathic arthritis American College of Rheumatology 30 response at week 104 (86.7% vs 62.5%). No new safety concerns were observed.

Study details: Findings are from a treatment-withdrawal, phase 3 study including 86 biologic-naive patients with active enthesitis-related arthritis (n = 52) or JPsA (n = 34) who were randomly assigned to receive secukinumab or placebo for up to 104 weeks.

Disclosures: This study was sponsored by Novartis Pharma AG. Four authors declared being employees and shareholders of Novartis. The other authors reported ties with several sources, including Novartis.

Source: Brunner HI et al on behalf of Paediatric Rheumatology INternational Trials Organization (PRINTO) and Pediatric Rheumatology Collaborative Study Group (PRCSG). Secukinumab in enthesitis-related arthritis and juvenile psoriatic arthritis: A randomised, double-blind, placebo-controlled, treatment withdrawal, phase 3 trial. Ann Rheum Dis. 2022 (Aug 12). Doi: 10.1136/ard-2022-222849

Early, aggressive fluid resuscitation in acute pancreatitis led to a higher incidence of fluid overload without improving clinical outcomes in the landmark WATERFALL trial.

Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited.

“The WATERFALL trial demonstrates that aggressive fluid resuscitation in acute pancreatitis is not safe, it is not associated with improved outcomes, and it should be abandoned,” Enrique de-Madaria, MD, PhD, with Hospital General Universitario Dr. Balmis, Alicante, Spain, told this news organization.

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The trial settles a “new and clear reference for fluid resuscitation in this frequent disease: lactated Ringer’s solution 1.5 mL/kg per hour (preceded by a 10 mL/kg bolus over 2 hours only in case of hypovolemia),” added Dr. de-Madaria, president of the Spanish Association of Gastroenterology.

“This moderate fluid resuscitation strategy is associated with a much lower frequency of fluid overload and a trend toward improved outcomes. For such reasons, it should be considered as a new standard of care in the early management of acute pancreatitis,” Dr. de-Madaria said.

The WATERFALL trial results were published in the New England Journal of Medicine.

The results are “stunning and, given the carefully crafted trial methods, irrefutable,” Timothy Gardner, MD, with the section of gastroenterology and hepatology, Dartmouth–Hitchcock Medical Center, Lebanon, N.H., wrote in a linked editorial.
 

Trial details

The trial was conducted at 18 centers across India, Italy, Mexico, and Spain. Patients who presented with acute pancreatitis were randomly allocated to aggressive or moderate resuscitation with lactated Ringer’s solution.

Aggressive fluid resuscitation consisted of a bolus of 20 mL/kg of body weight, followed by 3 mL/kg per hour. Moderate fluid resuscitation consisted of a bolus of 10 mL/kg in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 mL/kg per hour in all patients in this group.

Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to clinical status.

A total of 249 patients were included in the interim analysis – 122 in the aggressive-resuscitation group and 127 in the moderate-resuscitation group.

The data and safety monitoring board terminated the trial at the first interim safety analysis as a result of the development of fluid overload in 20.5% of the patients in the aggressive-resuscitation group versus 6.3% of those in the moderate-resuscitation group (adjusted relative risk, 2.85; 95% confidence interval, 1.36-5.94; P = .004).

“An increased risk of fluid overload was detected in the overall population of patients and also in subgroups of patients without systemic inflammatory response syndrome at baseline, patients with SIRS at baseline (thus, with a higher risk of development of severe pancreatitis), and patients with hypovolemia,” the investigators reported.

This clear signal of harm was coupled with no significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; aRR, 1.30; 95% CI, 0.78-2.18; P = .32).

Patients in the aggressive-resuscitation group spent a median of 6 days in the hospital, compared with 5 days for patients in the moderate-resuscitation group.

“These findings do not support current management guidelines, which recommend early aggressive resuscitation for the treatment of acute pancreatitis,” the study team wrote.
 

‘Landmark’ trial

This is a “landmark” trial and “so clinically relevant because of its choice of real world-appropriate aggressive-resuscitation and moderate-resuscitation treatment groups, its use of pancreatitis severity as the main clinical outcome, and its reliance on the carefully defined variable of fluid overload as the main safety outcome,” Dr. Gardner wrote in his editorial.

“Unlike in most other randomized, controlled trials of fluid resuscitation in acute pancreatitis, patients with varying baseline pancreatitis severity were included, and changes in the rate of resuscitation were determined on the basis of a dynamic assessment of hemodynamic testing, imaging, and clinical factors,” he added.

Dr. Gardner said the WATERFALL trial results lead to several conclusions.

First, the need to focus on a steady rate of initial resuscitation – no more than 1.5 mL/kg of body weight per hour. Clinicians should administer a bolus of 10 mL/kg only if there are signs of initial hypovolemia.

Second, that careful clinical and hemodynamic monitoring are essential during the first 72 hours after admission to make sure that patients remain euvolemic and to avoid fluid overload.

Third, that diuresis in patients with fluid overload in the first 72 hours is most likely beneficial and certainly not detrimental to important clinical outcomes.

Dr. Gardner said the trial also highlights the need to focus research efforts on evaluating other pharmacologic therapies instead of crystalloid fluids.

“Performing randomized controlled trials in acute pancreatitis is notoriously difficult, and the limited human and financial resources that are available for appropriately powered trials in this field post WATERFALL are much better spent on comparative-effectiveness and placebo-controlled trials evaluating new therapeutic agents,” Dr. Gardner said.

“Now that we have gone over the WATERFALL, it is time to look downstream at new targets to treat this challenging disease,” he concluded.

Support for the trial was provided by Instituto de Salud Carlos III, the Spanish Association of Gastroenterology, and ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante).

A version of this article first appeared on Medscape.com.

Early, aggressive fluid resuscitation in acute pancreatitis led to a higher incidence of fluid overload without improving clinical outcomes in the landmark WATERFALL trial.

Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited.

“The WATERFALL trial demonstrates that aggressive fluid resuscitation in acute pancreatitis is not safe, it is not associated with improved outcomes, and it should be abandoned,” Enrique de-Madaria, MD, PhD, with Hospital General Universitario Dr. Balmis, Alicante, Spain, told this news organization.

iStock/ThinkStock

The trial settles a “new and clear reference for fluid resuscitation in this frequent disease: lactated Ringer’s solution 1.5 mL/kg per hour (preceded by a 10 mL/kg bolus over 2 hours only in case of hypovolemia),” added Dr. de-Madaria, president of the Spanish Association of Gastroenterology.

“This moderate fluid resuscitation strategy is associated with a much lower frequency of fluid overload and a trend toward improved outcomes. For such reasons, it should be considered as a new standard of care in the early management of acute pancreatitis,” Dr. de-Madaria said.

The WATERFALL trial results were published in the New England Journal of Medicine.

The results are “stunning and, given the carefully crafted trial methods, irrefutable,” Timothy Gardner, MD, with the section of gastroenterology and hepatology, Dartmouth–Hitchcock Medical Center, Lebanon, N.H., wrote in a linked editorial.
 

Trial details

The trial was conducted at 18 centers across India, Italy, Mexico, and Spain. Patients who presented with acute pancreatitis were randomly allocated to aggressive or moderate resuscitation with lactated Ringer’s solution.

Aggressive fluid resuscitation consisted of a bolus of 20 mL/kg of body weight, followed by 3 mL/kg per hour. Moderate fluid resuscitation consisted of a bolus of 10 mL/kg in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 mL/kg per hour in all patients in this group.

Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to clinical status.

A total of 249 patients were included in the interim analysis – 122 in the aggressive-resuscitation group and 127 in the moderate-resuscitation group.

The data and safety monitoring board terminated the trial at the first interim safety analysis as a result of the development of fluid overload in 20.5% of the patients in the aggressive-resuscitation group versus 6.3% of those in the moderate-resuscitation group (adjusted relative risk, 2.85; 95% confidence interval, 1.36-5.94; P = .004).

“An increased risk of fluid overload was detected in the overall population of patients and also in subgroups of patients without systemic inflammatory response syndrome at baseline, patients with SIRS at baseline (thus, with a higher risk of development of severe pancreatitis), and patients with hypovolemia,” the investigators reported.

This clear signal of harm was coupled with no significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; aRR, 1.30; 95% CI, 0.78-2.18; P = .32).

Patients in the aggressive-resuscitation group spent a median of 6 days in the hospital, compared with 5 days for patients in the moderate-resuscitation group.

“These findings do not support current management guidelines, which recommend early aggressive resuscitation for the treatment of acute pancreatitis,” the study team wrote.
 

‘Landmark’ trial

This is a “landmark” trial and “so clinically relevant because of its choice of real world-appropriate aggressive-resuscitation and moderate-resuscitation treatment groups, its use of pancreatitis severity as the main clinical outcome, and its reliance on the carefully defined variable of fluid overload as the main safety outcome,” Dr. Gardner wrote in his editorial.

“Unlike in most other randomized, controlled trials of fluid resuscitation in acute pancreatitis, patients with varying baseline pancreatitis severity were included, and changes in the rate of resuscitation were determined on the basis of a dynamic assessment of hemodynamic testing, imaging, and clinical factors,” he added.

Dr. Gardner said the WATERFALL trial results lead to several conclusions.

First, the need to focus on a steady rate of initial resuscitation – no more than 1.5 mL/kg of body weight per hour. Clinicians should administer a bolus of 10 mL/kg only if there are signs of initial hypovolemia.

Second, that careful clinical and hemodynamic monitoring are essential during the first 72 hours after admission to make sure that patients remain euvolemic and to avoid fluid overload.

Third, that diuresis in patients with fluid overload in the first 72 hours is most likely beneficial and certainly not detrimental to important clinical outcomes.

Dr. Gardner said the trial also highlights the need to focus research efforts on evaluating other pharmacologic therapies instead of crystalloid fluids.

“Performing randomized controlled trials in acute pancreatitis is notoriously difficult, and the limited human and financial resources that are available for appropriately powered trials in this field post WATERFALL are much better spent on comparative-effectiveness and placebo-controlled trials evaluating new therapeutic agents,” Dr. Gardner said.

“Now that we have gone over the WATERFALL, it is time to look downstream at new targets to treat this challenging disease,” he concluded.

Support for the trial was provided by Instituto de Salud Carlos III, the Spanish Association of Gastroenterology, and ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante).

A version of this article first appeared on Medscape.com.

Early, aggressive fluid resuscitation in acute pancreatitis led to a higher incidence of fluid overload without improving clinical outcomes in the landmark WATERFALL trial.

Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited.

“The WATERFALL trial demonstrates that aggressive fluid resuscitation in acute pancreatitis is not safe, it is not associated with improved outcomes, and it should be abandoned,” Enrique de-Madaria, MD, PhD, with Hospital General Universitario Dr. Balmis, Alicante, Spain, told this news organization.

iStock/ThinkStock

The trial settles a “new and clear reference for fluid resuscitation in this frequent disease: lactated Ringer’s solution 1.5 mL/kg per hour (preceded by a 10 mL/kg bolus over 2 hours only in case of hypovolemia),” added Dr. de-Madaria, president of the Spanish Association of Gastroenterology.

“This moderate fluid resuscitation strategy is associated with a much lower frequency of fluid overload and a trend toward improved outcomes. For such reasons, it should be considered as a new standard of care in the early management of acute pancreatitis,” Dr. de-Madaria said.

The WATERFALL trial results were published in the New England Journal of Medicine.

The results are “stunning and, given the carefully crafted trial methods, irrefutable,” Timothy Gardner, MD, with the section of gastroenterology and hepatology, Dartmouth–Hitchcock Medical Center, Lebanon, N.H., wrote in a linked editorial.
 

Trial details

The trial was conducted at 18 centers across India, Italy, Mexico, and Spain. Patients who presented with acute pancreatitis were randomly allocated to aggressive or moderate resuscitation with lactated Ringer’s solution.

Aggressive fluid resuscitation consisted of a bolus of 20 mL/kg of body weight, followed by 3 mL/kg per hour. Moderate fluid resuscitation consisted of a bolus of 10 mL/kg in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 mL/kg per hour in all patients in this group.

Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to clinical status.

A total of 249 patients were included in the interim analysis – 122 in the aggressive-resuscitation group and 127 in the moderate-resuscitation group.

The data and safety monitoring board terminated the trial at the first interim safety analysis as a result of the development of fluid overload in 20.5% of the patients in the aggressive-resuscitation group versus 6.3% of those in the moderate-resuscitation group (adjusted relative risk, 2.85; 95% confidence interval, 1.36-5.94; P = .004).

“An increased risk of fluid overload was detected in the overall population of patients and also in subgroups of patients without systemic inflammatory response syndrome at baseline, patients with SIRS at baseline (thus, with a higher risk of development of severe pancreatitis), and patients with hypovolemia,” the investigators reported.

This clear signal of harm was coupled with no significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; aRR, 1.30; 95% CI, 0.78-2.18; P = .32).

Patients in the aggressive-resuscitation group spent a median of 6 days in the hospital, compared with 5 days for patients in the moderate-resuscitation group.

“These findings do not support current management guidelines, which recommend early aggressive resuscitation for the treatment of acute pancreatitis,” the study team wrote.
 

‘Landmark’ trial

This is a “landmark” trial and “so clinically relevant because of its choice of real world-appropriate aggressive-resuscitation and moderate-resuscitation treatment groups, its use of pancreatitis severity as the main clinical outcome, and its reliance on the carefully defined variable of fluid overload as the main safety outcome,” Dr. Gardner wrote in his editorial.

“Unlike in most other randomized, controlled trials of fluid resuscitation in acute pancreatitis, patients with varying baseline pancreatitis severity were included, and changes in the rate of resuscitation were determined on the basis of a dynamic assessment of hemodynamic testing, imaging, and clinical factors,” he added.

Dr. Gardner said the WATERFALL trial results lead to several conclusions.

First, the need to focus on a steady rate of initial resuscitation – no more than 1.5 mL/kg of body weight per hour. Clinicians should administer a bolus of 10 mL/kg only if there are signs of initial hypovolemia.

Second, that careful clinical and hemodynamic monitoring are essential during the first 72 hours after admission to make sure that patients remain euvolemic and to avoid fluid overload.

Third, that diuresis in patients with fluid overload in the first 72 hours is most likely beneficial and certainly not detrimental to important clinical outcomes.

Dr. Gardner said the trial also highlights the need to focus research efforts on evaluating other pharmacologic therapies instead of crystalloid fluids.

“Performing randomized controlled trials in acute pancreatitis is notoriously difficult, and the limited human and financial resources that are available for appropriately powered trials in this field post WATERFALL are much better spent on comparative-effectiveness and placebo-controlled trials evaluating new therapeutic agents,” Dr. Gardner said.

“Now that we have gone over the WATERFALL, it is time to look downstream at new targets to treat this challenging disease,” he concluded.

Support for the trial was provided by Instituto de Salud Carlos III, the Spanish Association of Gastroenterology, and ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante).

A version of this article first appeared on Medscape.com.