Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.

Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.

Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.

Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.

Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720

Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.

Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.

Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.

Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.

Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720

Key clinical point: This Mendelian randomization (MR) analysis established that there exists no causal association between psoriatic arthritis (PsA) and the genetic risk for skin cancer.

Major finding: PsA did not increase the genetic susceptibility to cutaneous squamous cell carcinoma (odds ratio [OR] 1.00; P = .214) and cutaneous melanoma (OR 1.00; P = .477). Although PsA decreased the genetic risk for basal cell carcinoma (OR 0.94; P = .016), the association disappeared when skin cancer risk factors like skin tanning, radiation-related disorders, and telomere length were considered.

Study details: Findings are from a multivariate MR analysis including 3186 patients with PsA and 240,862 control individuals without PsA.

Disclosures: This study was supported by the Natural Science Foundation of China and the Youth Science Foundation of Xiangya Hospital. The authors declared no conflicts of interest.

Source: Yu N et al. Multivariate Mendelian randomization provides no evidence for causal associations among both psoriasis and psoriatic arthritis, and skin cancer. Front Immunol. 2023;14:1252720 (Sep 19). doi: 10.3389/fimmu.2023.1252720

Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.

Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.

Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.

Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.

Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275

Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.

Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.

Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.

Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.

Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275

Key clinical point: Difficult-to-treat (D2T) psoriatic arthritis (PsA), a condition characterized by the failure of ≥2 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD), is associated with a higher prevalence of axial involvement, structural damage, and treatment discontinuation.

Major finding: Peripheral structural damage (odds ratio [OR] 2.57; P = .020), axial involvement (OR 2.37; P = .035), and the discontinuation of bDMARD due to poor dermatological control (OR 2.99; P = .008) were more prevalent in patients with D2T PsA vs non-D2T PsA.

Study details: Findings are from a retrospective cohort study including 150 patients with PsA who initiated treatment with ts/bDMARD and were followed up for ≥2 years, of whom 49 patients had D2T PsA.

Disclosures: This study did not receive any funding. Three authors declared receiving honorary fees or research grants or serving as advisory board members for various sources.

Source: Philippoteaux C et al. Characteristics of difficult-to-treat psoriatic arthritis: A comparative analysis. Semin Arthritis Rheum. 2023;63:152275 (Oct 5). doi: 10.1016/j.semarthrit.2023.152275

Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.

Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).

Study details: Findings are from a cross-sectional study including 1134 patients with PsA.

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

Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z

Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.

Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).

Study details: Findings are from a cross-sectional study including 1134 patients with PsA.

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

Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z

Key clinical point: Approximately one-third of patients with psoriatic arthritis (PsA) reported a diagnostic delay of >2 years, which can be attributed to a number of clinical and demographic factors.

Major finding: The mean diagnostic delay period was 35.1 months. A diagnostic delay of >2 years was seen in 32.98% of patients, with the occurrence of arthritis symptoms before skin manifestations (odds ratio [OR] 1.72; 95% CI 1.20-2.46) and low back pain at first visit (OR 1.60; 95% CI 1.21-2.11) being significant factors associated with this delay. However, generalized-type psoriasis was negatively associated with the diagnostic delay of >2 years (OR 0.25; 95% CI 0.07-0.98).

Study details: Findings are from a cross-sectional study including 1134 patients with PsA.

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

Source: Kılıç G et al. Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatol Int. 2023 (Oct 8). doi: 10.1007/s00296-023-05479-z

Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.

Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).

Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).

Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.

Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8

Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.

Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).

Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).

Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.

Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8

Key clinical point: In patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis, 100 mg guselkumab every 4 weeks (Q4W) or every 8 weeks (Q8W) yielded clinically meaningful and sustained improvements in axial symptoms through 2 years.

Major finding: At week 24, guselkumab Q4W and Q8W vs placebo showed significantly greater least-squares mean improvements (−2.5 and −2.4, respectively, vs −1.2; P < .001) in the total Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, with further improvements in the mean total BASDAI score for each group at week 100 (~3.0 points).

Study details: This post hoc analysis of the DISCOVER-2 study included 246 biologic-naive patients with active PsA and sacroiliitis who were randomized to guselkumab Q4W (n = 82), guselkumab Q8W (n = 68), or placebo with crossover to guselkumab Q4W at week 24 (n = 96).

Disclosures: This study was funded by Janssen Research & Development, LLC. Five authors declared employment with Janssen and stockownership in Johnson & Johnson, and others reported ties with various sources, including Janssen.

Source: Mease PJ et al. Efficacy of guselkumab on axial-related symptoms through up to 2 years in adults with active psoriatic arthritis in the phase 3, randomized, placebo-controlled DISCOVER-2 study. Rheumatol Ther. 2023 (Oct 11). doi: 10.1007/s40744-023-00592-8

Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).

Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.

Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.

Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.

Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3

Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).

Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.

Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.

Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.

Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3

Key clinical point: The interim analysis of a real-world study confirmed the efficacy and safety of upadacitinib in patients with active psoriatic arthritis (PsA) who showed inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or biological DMARD (bDMARD).

Major finding: The proportion of patients treated with upadacitinib who achieved minimal disease activity was considerably higher at week 12 vs baseline (39.8% vs 2.7%), with the effect being maintained till week 24 (39.1%). No new adverse events were reported.

Study details: This 24-week interim analysis of the UPJOINT study included 296 patients with active oligoarticular or polyarticular PsA who were refractory to csDMARD or bDMARD and received upadacitinib.

Disclosures: This study was funded by AbbVie. Five authors declared being employees of or owing stocks or stock options in AbbVie. The other authors declared ties with various sources, including AbbVie.

Source: Werner SG et al. Treatment with upadacitinib in active psoriatic arthritis: Efficacy and safety data of the first 192 patients from the UPJOINT study, a multicentre, observational study in clinical practice. Rheumatol Ther. 2023 (Sep 11). doi: 10.1007/s40744-023-00589-3

Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).

Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.

Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.

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

Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849

Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).

Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.

Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.

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

Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849

Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).

Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.

Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.

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

Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849

Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.

Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.

Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).

Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.

Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604

Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.

Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.

Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).

Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.

Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604

Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.

Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.

Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).

Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.

Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604

Key clinical point: In patients with psoriatic arthritis (PsA), year-long treatment with interleukin-17 inhibitors (IL-17i) and IL-23(p19) inhibitors (IL23-[19]i), led to comparable drug survival and clinical response outcomes as tumor necrosis factor inhibitor (TNFi) treatment.

Major finding: At 12 months, the drug withdrawal rates for IL-17i (hazard ratio [HR] 1.36; 95% CI 0.59-3.14) and IL23-(19)i (HR 0.56; 95% CI 0.10-3.24) were comparable with those for TNFi. Moreover, the proportion of patients who achieved ≥50% improvement in the American College of Rheumatology scores was similar across the IL-17i, IL-23(19)i, and TNFi groups (19%, 29%, and 19%, respectively).

Study details: Findings are from a target trial emulation study including 109 patients with PsA who presented with peripheral manifestations and initiated either TNFi (n = 75), IL-7i (n = 26), or IL-23(19)i (n = 8).

Disclosures: This study was supported by the Danish Rheumatism Association and other sources. Some authors declared serving as speakers or consultants for or receiving research grants, fees, or other support from various sources.

Source: Stisen ZR et al. Tolerability and comparative effectiveness of TNF-, IL-17-, and IL-23(p19) inhibitors in psoriatic arthritis: A target trial emulation study. Rheumatology (Oxford). 2023 (Sep 15). doi: 10.1093/rheumatology/kead488

Key clinical point: In patients with psoriatic arthritis (PsA), year-long treatment with interleukin-17 inhibitors (IL-17i) and IL-23(p19) inhibitors (IL23-[19]i), led to comparable drug survival and clinical response outcomes as tumor necrosis factor inhibitor (TNFi) treatment.

Major finding: At 12 months, the drug withdrawal rates for IL-17i (hazard ratio [HR] 1.36; 95% CI 0.59-3.14) and IL23-(19)i (HR 0.56; 95% CI 0.10-3.24) were comparable with those for TNFi. Moreover, the proportion of patients who achieved ≥50% improvement in the American College of Rheumatology scores was similar across the IL-17i, IL-23(19)i, and TNFi groups (19%, 29%, and 19%, respectively).

Study details: Findings are from a target trial emulation study including 109 patients with PsA who presented with peripheral manifestations and initiated either TNFi (n = 75), IL-7i (n = 26), or IL-23(19)i (n = 8).

Disclosures: This study was supported by the Danish Rheumatism Association and other sources. Some authors declared serving as speakers or consultants for or receiving research grants, fees, or other support from various sources.

Source: Stisen ZR et al. Tolerability and comparative effectiveness of TNF-, IL-17-, and IL-23(p19) inhibitors in psoriatic arthritis: A target trial emulation study. Rheumatology (Oxford). 2023 (Sep 15). doi: 10.1093/rheumatology/kead488

Key clinical point: In patients with psoriatic arthritis (PsA), year-long treatment with interleukin-17 inhibitors (IL-17i) and IL-23(p19) inhibitors (IL23-[19]i), led to comparable drug survival and clinical response outcomes as tumor necrosis factor inhibitor (TNFi) treatment.

Major finding: At 12 months, the drug withdrawal rates for IL-17i (hazard ratio [HR] 1.36; 95% CI 0.59-3.14) and IL23-(19)i (HR 0.56; 95% CI 0.10-3.24) were comparable with those for TNFi. Moreover, the proportion of patients who achieved ≥50% improvement in the American College of Rheumatology scores was similar across the IL-17i, IL-23(19)i, and TNFi groups (19%, 29%, and 19%, respectively).

Study details: Findings are from a target trial emulation study including 109 patients with PsA who presented with peripheral manifestations and initiated either TNFi (n = 75), IL-7i (n = 26), or IL-23(19)i (n = 8).

Disclosures: This study was supported by the Danish Rheumatism Association and other sources. Some authors declared serving as speakers or consultants for or receiving research grants, fees, or other support from various sources.

Source: Stisen ZR et al. Tolerability and comparative effectiveness of TNF-, IL-17-, and IL-23(p19) inhibitors in psoriatic arthritis: A target trial emulation study. Rheumatology (Oxford). 2023 (Sep 15). doi: 10.1093/rheumatology/kead488

Key clinical point: Bimekizumab led to sustained improvements in clinical response up to week 52 and had a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, 43.9% of patients receiving bimekizumab achieved ≥50% improvement in the American College of Rheumatology scores (ACR50), with the response being maintained until week 52 (54.5%). Among patients who switched from placebo to bimekizumab at week 16, a similar proportion (53.0%) achieved ACR50 at week 52. No new safety signals were observed.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 bDMARD-naive patients with active PsA who were randomly assigned to receive bimekizumab, adalimumab, or placebo.

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

Source: Ritchlin CT et al. Bimekizumab treatment in biologic DMARD-naïve patients with active psoriatic arthritis: 52-week efficacy and safety results from the phase III, randomised, placebo-controlled, active reference BE OPTIMAL study. Ann Rheum Dis. 2023;82:1404-1414 (Sep 11). doi: 10.1136/ard-2023-224431

Key clinical point: Bimekizumab led to sustained improvements in clinical response up to week 52 and had a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, 43.9% of patients receiving bimekizumab achieved ≥50% improvement in the American College of Rheumatology scores (ACR50), with the response being maintained until week 52 (54.5%). Among patients who switched from placebo to bimekizumab at week 16, a similar proportion (53.0%) achieved ACR50 at week 52. No new safety signals were observed.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 bDMARD-naive patients with active PsA who were randomly assigned to receive bimekizumab, adalimumab, or placebo.

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

Source: Ritchlin CT et al. Bimekizumab treatment in biologic DMARD-naïve patients with active psoriatic arthritis: 52-week efficacy and safety results from the phase III, randomised, placebo-controlled, active reference BE OPTIMAL study. Ann Rheum Dis. 2023;82:1404-1414 (Sep 11). doi: 10.1136/ard-2023-224431

Key clinical point: Bimekizumab led to sustained improvements in clinical response up to week 52 and had a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, 43.9% of patients receiving bimekizumab achieved ≥50% improvement in the American College of Rheumatology scores (ACR50), with the response being maintained until week 52 (54.5%). Among patients who switched from placebo to bimekizumab at week 16, a similar proportion (53.0%) achieved ACR50 at week 52. No new safety signals were observed.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 bDMARD-naive patients with active PsA who were randomly assigned to receive bimekizumab, adalimumab, or placebo.

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

Source: Ritchlin CT et al. Bimekizumab treatment in biologic DMARD-naïve patients with active psoriatic arthritis: 52-week efficacy and safety results from the phase III, randomised, placebo-controlled, active reference BE OPTIMAL study. Ann Rheum Dis. 2023;82:1404-1414 (Sep 11). doi: 10.1136/ard-2023-224431

GLASGOW – ChatGPT failed to pass the U.K.’s National Primary Care examinations in a new study, highlighting how artificial intelligence (AI) does not necessarily match human perceptions of medical complexity.

ChatGPT also provided novel explanations – it frequently “hallucinates” – by describing inaccurate information as if they were facts, according to Shathar Mahmood, BA, a fifth-year medical student at the University of Cambridge, England, who presented the findings at the annual meeting of the Royal College of General Practitioners. The study was published in JMIR Medical Education earlier this year.

“Artificial intelligence has generated impressive results across medicine, and with the release of ChatGPT there is now discussion about these large language models taking over clinicians’ jobs,” Arun James Thirunavukarasu, MB BChir, of the University of Oxford, England, and Oxford University Hospitals NHS Foundation Trust, who is the lead author of the study, told this news organization.

Performance of AI on medical school examinations has prompted much of this discussion, often because performance does not reflect real-world clinical practice, he said. “We used the Applied Knowledge Test instead, and this allowed us to explore the potential and pitfalls of deploying large language models in primary care and to explore what further development of medical large language model applications is required.”

The researchers investigated the strengths and weaknesses of ChatGPT in primary care using the Membership of the Royal College of General Practitioners Applied Knowledge Test. The computer-based, multiple-choice assessment is part of the U.K.’s specialty training to become a general practitioner (GP). It tests knowledge behind general practice within the context of the United Kingdom’s National Health Service.

The researchers entered a series of 674 questions into ChatGPT on two occasions, or “runs.” “By putting the questions into two separate dialogues, we hoped to avoid the influence of one dialogue on the other,” Ms. Mahmood said. To validate that the answers were correct, the ChatGPT responses were compared with the answers provided by the GP self-test and past articles.
 

Docs 1, AI 0

Overall performance of the algorithm was good across both runs (59.94% and 60.39%); 83.23% of questions produced the same answer on both runs.

But 17% of the answers didn’t match, Ms. Mahmood reported, a statistically significant difference. “And the overall performance of ChatGPT was 10% lower than the average RCGP pass mark in the last few years, which informs one of our conclusions about it not being very precise at expert level recall and decision-making,” she said.

Also, a small percentage of questions (1.48% and 2.25% in each run) produced an uncertain answer or there was no answer.
 

Say what?

Novel explanations were generated upon running a question through ChatGPT that then provided an extended answer, Ms. Mahmood said. When the accuracy of the extended answers was checked against the correct answers, no correlation was found. “ChatGPT can hallucinate answers, and there’s no way a nonexpert reading this could know it is incorrect,” she said.

Regarding the application of ChatGPT and similar algorithms to clinical practice, Ms. Mahmood was clear. “As they stand, [AI systems] will not be able to replace the health care professional workforce, in primary care at least,” she said. “I think larger and more medically specific datasets are required to improve their outputs in this field.”

Sandip Pramanik, MBcHB, a GP in Watford, Hertfordshire, England, said the study “clearly showed ChatGPT’s struggle to deal with the complexity of the exam questions that is based on the primary care system. In essence, this in indicative of the human factors involved in decision-making in primary care.”

The applied knowledge test is designed to test the knowledge required to be a generalist in the primary care setting, and as such, there are lots of nuances reflecting this within the questions, Dr. Pramanik said.

“ChatGPT may look at these in a more black and white way, whereas the generalist needs to be reflective of the complexities involved and the different possibilities that can present rather than take a binary ‘yes’ or ‘no’ stance,” he said. “In fact, this highlights a lot about the nature of general practice in managing uncertainty, and this is reflected in the questions asked in the exam,” he remarked. He noted, “Being a generalist is about factoring in human emotion and human perception as well as knowledge.”

Ms. Mahmood, Dr. Thirunavukarasu, and Dr. Pramanik have disclosed no relevant financial relationships.

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

GLASGOW – ChatGPT failed to pass the U.K.’s National Primary Care examinations in a new study, highlighting how artificial intelligence (AI) does not necessarily match human perceptions of medical complexity.

ChatGPT also provided novel explanations – it frequently “hallucinates” – by describing inaccurate information as if they were facts, according to Shathar Mahmood, BA, a fifth-year medical student at the University of Cambridge, England, who presented the findings at the annual meeting of the Royal College of General Practitioners. The study was published in JMIR Medical Education earlier this year.

“Artificial intelligence has generated impressive results across medicine, and with the release of ChatGPT there is now discussion about these large language models taking over clinicians’ jobs,” Arun James Thirunavukarasu, MB BChir, of the University of Oxford, England, and Oxford University Hospitals NHS Foundation Trust, who is the lead author of the study, told this news organization.

Performance of AI on medical school examinations has prompted much of this discussion, often because performance does not reflect real-world clinical practice, he said. “We used the Applied Knowledge Test instead, and this allowed us to explore the potential and pitfalls of deploying large language models in primary care and to explore what further development of medical large language model applications is required.”

The researchers investigated the strengths and weaknesses of ChatGPT in primary care using the Membership of the Royal College of General Practitioners Applied Knowledge Test. The computer-based, multiple-choice assessment is part of the U.K.’s specialty training to become a general practitioner (GP). It tests knowledge behind general practice within the context of the United Kingdom’s National Health Service.

The researchers entered a series of 674 questions into ChatGPT on two occasions, or “runs.” “By putting the questions into two separate dialogues, we hoped to avoid the influence of one dialogue on the other,” Ms. Mahmood said. To validate that the answers were correct, the ChatGPT responses were compared with the answers provided by the GP self-test and past articles.
 

Docs 1, AI 0

Overall performance of the algorithm was good across both runs (59.94% and 60.39%); 83.23% of questions produced the same answer on both runs.

But 17% of the answers didn’t match, Ms. Mahmood reported, a statistically significant difference. “And the overall performance of ChatGPT was 10% lower than the average RCGP pass mark in the last few years, which informs one of our conclusions about it not being very precise at expert level recall and decision-making,” she said.

Also, a small percentage of questions (1.48% and 2.25% in each run) produced an uncertain answer or there was no answer.
 

Say what?

Novel explanations were generated upon running a question through ChatGPT that then provided an extended answer, Ms. Mahmood said. When the accuracy of the extended answers was checked against the correct answers, no correlation was found. “ChatGPT can hallucinate answers, and there’s no way a nonexpert reading this could know it is incorrect,” she said.

Regarding the application of ChatGPT and similar algorithms to clinical practice, Ms. Mahmood was clear. “As they stand, [AI systems] will not be able to replace the health care professional workforce, in primary care at least,” she said. “I think larger and more medically specific datasets are required to improve their outputs in this field.”

Sandip Pramanik, MBcHB, a GP in Watford, Hertfordshire, England, said the study “clearly showed ChatGPT’s struggle to deal with the complexity of the exam questions that is based on the primary care system. In essence, this in indicative of the human factors involved in decision-making in primary care.”

The applied knowledge test is designed to test the knowledge required to be a generalist in the primary care setting, and as such, there are lots of nuances reflecting this within the questions, Dr. Pramanik said.

“ChatGPT may look at these in a more black and white way, whereas the generalist needs to be reflective of the complexities involved and the different possibilities that can present rather than take a binary ‘yes’ or ‘no’ stance,” he said. “In fact, this highlights a lot about the nature of general practice in managing uncertainty, and this is reflected in the questions asked in the exam,” he remarked. He noted, “Being a generalist is about factoring in human emotion and human perception as well as knowledge.”

Ms. Mahmood, Dr. Thirunavukarasu, and Dr. Pramanik have disclosed no relevant financial relationships.

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

GLASGOW – ChatGPT failed to pass the U.K.’s National Primary Care examinations in a new study, highlighting how artificial intelligence (AI) does not necessarily match human perceptions of medical complexity.

ChatGPT also provided novel explanations – it frequently “hallucinates” – by describing inaccurate information as if they were facts, according to Shathar Mahmood, BA, a fifth-year medical student at the University of Cambridge, England, who presented the findings at the annual meeting of the Royal College of General Practitioners. The study was published in JMIR Medical Education earlier this year.

“Artificial intelligence has generated impressive results across medicine, and with the release of ChatGPT there is now discussion about these large language models taking over clinicians’ jobs,” Arun James Thirunavukarasu, MB BChir, of the University of Oxford, England, and Oxford University Hospitals NHS Foundation Trust, who is the lead author of the study, told this news organization.

Performance of AI on medical school examinations has prompted much of this discussion, often because performance does not reflect real-world clinical practice, he said. “We used the Applied Knowledge Test instead, and this allowed us to explore the potential and pitfalls of deploying large language models in primary care and to explore what further development of medical large language model applications is required.”

The researchers investigated the strengths and weaknesses of ChatGPT in primary care using the Membership of the Royal College of General Practitioners Applied Knowledge Test. The computer-based, multiple-choice assessment is part of the U.K.’s specialty training to become a general practitioner (GP). It tests knowledge behind general practice within the context of the United Kingdom’s National Health Service.

The researchers entered a series of 674 questions into ChatGPT on two occasions, or “runs.” “By putting the questions into two separate dialogues, we hoped to avoid the influence of one dialogue on the other,” Ms. Mahmood said. To validate that the answers were correct, the ChatGPT responses were compared with the answers provided by the GP self-test and past articles.
 

Docs 1, AI 0

Overall performance of the algorithm was good across both runs (59.94% and 60.39%); 83.23% of questions produced the same answer on both runs.

But 17% of the answers didn’t match, Ms. Mahmood reported, a statistically significant difference. “And the overall performance of ChatGPT was 10% lower than the average RCGP pass mark in the last few years, which informs one of our conclusions about it not being very precise at expert level recall and decision-making,” she said.

Also, a small percentage of questions (1.48% and 2.25% in each run) produced an uncertain answer or there was no answer.
 

Say what?

Novel explanations were generated upon running a question through ChatGPT that then provided an extended answer, Ms. Mahmood said. When the accuracy of the extended answers was checked against the correct answers, no correlation was found. “ChatGPT can hallucinate answers, and there’s no way a nonexpert reading this could know it is incorrect,” she said.

Regarding the application of ChatGPT and similar algorithms to clinical practice, Ms. Mahmood was clear. “As they stand, [AI systems] will not be able to replace the health care professional workforce, in primary care at least,” she said. “I think larger and more medically specific datasets are required to improve their outputs in this field.”

Sandip Pramanik, MBcHB, a GP in Watford, Hertfordshire, England, said the study “clearly showed ChatGPT’s struggle to deal with the complexity of the exam questions that is based on the primary care system. In essence, this in indicative of the human factors involved in decision-making in primary care.”

The applied knowledge test is designed to test the knowledge required to be a generalist in the primary care setting, and as such, there are lots of nuances reflecting this within the questions, Dr. Pramanik said.

“ChatGPT may look at these in a more black and white way, whereas the generalist needs to be reflective of the complexities involved and the different possibilities that can present rather than take a binary ‘yes’ or ‘no’ stance,” he said. “In fact, this highlights a lot about the nature of general practice in managing uncertainty, and this is reflected in the questions asked in the exam,” he remarked. He noted, “Being a generalist is about factoring in human emotion and human perception as well as knowledge.”

Ms. Mahmood, Dr. Thirunavukarasu, and Dr. Pramanik have disclosed no relevant financial relationships.

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