Clinical Features and Diagnostic Considerations in Psoriatic Arthritis

To develop a reference image atlas for the Outcome Measures in Rheumatology whole-body MRI scoring system for inflammation in peripheral joints and entheses (OMERACT MRI-WIPE) of the knee region.

Image examples of each pathology, location and grade, were collected and discussed at web-based, interactive meetings within the OMERACT MRI in Arthritis Working Group. Subsequently, reference images were selected by consensus.

Reference images for each grade, pathology and location are depicted, along with definitions, reader rules and recommended MRI-sequences.

The atlas guides scoring whole-body MRIs for inflammation in joints and entheses of the knee region according to MRI-WIPE methodology in clinical trials and cohorts.

Psoriatic arthritis is a chronic inflammatory arthropathy characterized by subtypes with distinct phenotypes and variable clinical course, which requires optimal management of joint manifestations and skin involvement.

This study aims to provide recommendations for the pharmacological treatment of psoriatic arthritis based on evidence and applicability to the Colombian health system.

These guidelines were developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Clinical experts, rheumatologists, and dermatologists formulated the recommendations based on clinical evidence, the disease's impact, patient values and preferences, and the resource availability in the country.

The guideline includes 12 recommendations related to the use of anti-inflammatory drugs, glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs), including conventional synthetics, biologics, and targeted synthetic DMARD, for the PsA domains: peripheral disease, axial disease, enthesitis, and dactylitis.

This document presents a set of updated and evidence-based recommendations that guide decision-making about pharmacological management of psoriatic arthritis in adults in Colombia. They constitute general guidelines that should be interpreted and implemented according to the individualized evaluation of the patient and the medical criteria in the different clinical settings.

La artritis psoriásica es una artropatía inflamatoria crónica con distintos fenotipos y curso clínico variable, que requiere un manejo óptimo de las manifestaciones articulares y del compromiso cutáneo.

Este documento pretende hacer recomendaciones para el tratamiento farmacológico de la artritis psoriásica basadas en la evidencia y la aplicabilidad al sistema de salud colombiano.

Estas guías fueron desarrolladas de acuerdo con la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Expertos clínicos, reumatólogos y dermatólogos formularon las recomendaciones con base en la evidencia clínica, el impacto de la enfermedad, los valores y las preferencias de los pacientes y la disponibilidad de recursos en el país.

La guía incluye 12 recomendaciones relacionadas con el uso de antiinflamatorios, glucocorticoides y fármacos antirreumáticos modificadores de la enfermedad (FAME), incluidos los sintéticos convencionales, los biológicos y los sintéticos dirigidos, para los dominios de la artritis psoriásica: enfermedad periférica, enfermedad axial, entesitis y dactilitis.

Este documento presenta un conjunto de recomendaciones actualizadas y basadas en la evidencia que orientan la toma de decisiones sobre el manejo farmacológico de la artritis psoriásica en adultos en Colombia. Estas recomendaciones constituyen lineamientos generales que deben ser interpretados e implementados de acuerdo con la evaluación individualizada del paciente y el criterio médico en los diferentes escenarios clínicos.

Psoriatic arthritis is an inflammatory arthropathy accompanied by peripheral and axial joint involvement. Hand involvement has been demonstrated by various imaging methods in patients with psoriatic arthritis. However, few studies evaluated the hand in terms of functionality. The aim of the study is to compare hand functions and wrist joint position sense in psoriatic arthritis with rheumatoid arthritis and healthy controls.

Patients with psoriatic arthritis (n = 21), rheumatoid arthritis (n = 21), and healthy controls (n = 21) were included in this cross-sectional study. The measurements were performed by a hand dynamometer for grip strength and endurance, and by a pinchmeter for pinch strength. Disability of Arm, Shoulder, and Hand Questionnaire was used to evaluate the functional disability. A goniometric test was used to assess wrist joint position sense.

Patients with psoriatic arthritis had worse hand functional outcomes and higher position errors than healthy controls (p < 0.05). In addition, in terms of all variables, patients with psoriatic arthritis were found to be similar to the patients with rheumatoid arthritis (p > 0.05).

Our study revealed that hand functions and wrist joint position sense were affected as much in patients with psoriatic arthritis as in patients with rheumatoid arthritis whose hand involvement is frequently reported in the literature. The grip endurance in psoriatic arthritis was assessed for the first time. Our results highlighted the necessity of treatment programs that include strength, endurance, and proprioception in patients with psoriatic arthritis who have hand involvement at least as much as those with rheumatoid arthritis.

Psoriatic arthritis (PsA) is associated with decreased quality of life. As delayed diagnosis may lead to progressive joint destruction and long-term disability, the key clinical features of PsA should be recognizable to a wide range of clinicians to facilitate early diagnosis. In addition to assessment and identification of skin and nail lesions, which occur in up to 85% of those with musculoskeletal manifestations, clinicians should be aware of both the peripheral and axial manifestations of musculoskeletal disease reviewed here. Peripheral joint diseases include polyarticular, oligoarticular, distal, and arthritis mutilans subtypes, and cognizance of these patterns of disease, as well as periarticular manifestations, including dactylitis and enthesitis, is useful for swift diagnosis of PsA. Axial psoriatic arthritis (axial PsA), also known as the spondylitis subtype, may be limited to the spine and sacroiliac joints, but may also affect peripheral structures. Meticulous history-taking and physical examination and familiarity with appropriate imaging studies are often necessary to distinguish axial-PsA from other differential diagnoses. Swift diagnosis and treatment are necessary to both control PsA disease and mitigate the risks of the many associate comorbidities that may accompany it.

Los ensayos clínicos de secukinumab han demostrado su eficacia y seguridad en la artritis psoriásica como biológico de primera opción o tras respuesta inadecuada a otros tratamientos biológicos.

Analizar la eficacia y seguridad de secukinumab en la artritis psoriásica periférica durante 12 meses en práctica clínica real.

Se incluyó a pacientes con artritis psoriásica periférica activa que iniciaron tratamiento con secukinumab según ficha técnica. Se evaluó la eficacia y seguridad desde la situación basal hasta los 12 meses, comparando la respuesta de pacientes naive y no naive al biológico.

Se incluyó a 76 pacientes (22 naive y 54 no naive al biológico) con una edad de 51,9 años (10,3) y una duración de la enfermedad de 9,5 años (7,1). El 31,6% con dactilitis, el 51,3% con entesitis y el índice DAPSA basal fue 19 (9,8). La tasa de retención fue elevada: 90,9% en naive y 81,5% en no naive, y el porcentaje de pacientes con un DAPSA menor o igual a 14 fue mayor en pacientes naive, incluso después de ajustar por edad, sexo y fármacos modificadores del curso de la enfermedad (p = 0,016). Los datos de seguridad fueron similares a los descritos en los ensayos clínicos.

Secukinumab es eficaz y seguro en el tratamiento a 12 meses en la artritis psoriásica periférica activa en la práctica clínica real, tras respuesta inadecuada a los iTNF o como primer biológico.

Clinical trials of secukinumab have demonstrated their efficacy and safety in psoriatic arthritis as biological first choice or after inadequate response to other biological treatments.

To analyze the efficacy and safety of secukinumab in peripheral psoriatic arthritis over 12 months in real clinical practice.

Patients with active peripheral psoriatic arthritis who started treatment with secukinumab according to the technical specifications were included. Efficacy and safety were evaluated from baseline to 12 months comparing naive and non-naive to biological therapy patients.

A total of 76 patients were included (22 naive and 54 non-naive to biological) with an age of 51.9 years (10.3) and duration of the disease of 9.5 years (7.1). Of them, 31.6% with dactylitis, 51.3% with enthesitis and the baseline DAPSA was 19.0 (9.8). The retention rate was high, 90.9% in naive and 81.5% in non-naïve patients, and the percentage of patients with a DAPSA less than or equal to 14 was higher in the naive patients even after adjusting for age, sex and FAMEsc (P = .016). The safety data were similar to those described in the clinical trials.

Secukinumab is effective and safe in 12-month treatment in peripheral active psoriatic arthritis in real clinical practice, after inadequate response to TNF or as first biological treatment.