OBJECTIVE: To assess the efficacy and safety of deucravacitinib, an oral, selective tyrosine kinase 2 inhibitor, in patients with psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs or received tumor necrosis factor inhibitors. METHODS: In the 52-week (W), double-blind, placebo-controlled, phase 3 POETYK PsA-2 study (NCT04908189), patients were randomized 3:3:1 to deucravacitinib 6 mg daily, placebo, or apremilast 30 mg twice daily (safety reference arm) through W16. From W16 to W52, patients continued receiving deucravacitinib or apremilast or switched from placebo to deucravacitinib. The primary endpoint was American College of Rheumatology 20% improvement in response (ACR20) at W16. Secondary endpoints were analyzed per prespecified order to control for multiplicity. RESULTS: Overall, 729 patients were randomized (312 deucravacitinib, 312 placebo, 105 apremilast). Significantly more patients achieved ACR20 at W16 with deucravacitinib versus placebo (54.2% vs 39.4%; P=0.0002); responses improved beyond W16 and were maintained through W52 (deucravacitinib-deucravacitinib, 62.2%; placebo-deucravacitinib, 67.3%). At W16, significant differences with deucravacitinib versus placebo were observed in hierarchal secondary endpoints of HAQ-DI, PASI-75, SF-36 PCS, and achievement of MDA. At W16, serious adverse events occurred in 1.0%, 1.9%, and 3.8% of patients with placebo, deucravacitinib, and apremilast, respectively. No new safety signals, deaths, or imbalances in cardiovascular events, malignancies, or opportunistic infections occurred through W52. CONCLUSION: Deucravacitinib was well-tolerated in patients with PsA and demonstrated superior efficacy versus placebo across multiple clinical endpoints and patient-reported outcomes, including functional ability and quality of life. Clinical responses and patient-reported outcomes were maintained through week 52.
OBJECTIVE: People with inflammatory arthritis (IA) frequently experience work instability, absenteeism, and reduced productivity, culminating in early job loss. This study evaluated the effectiveness and cost-effectiveness of WORKWELL job retention vocational rehabilitation (JRVR) delivered by occupational therapists, compared to a control group receiving written self-help advice. METHODS: A pragmatic, multi-centre randomised controlled trial was conducted across 18 UK NHS Trusts. Employed adults (n = 249) with IA experiencing moderate to severe work instability, were randomised (1:1) to intervention or control groups. WORKWELL included structured work assessment, individually tailored action plans, and interventions over 2-4 months. Follow-up was at 6, 12, and 36 months. The primary outcome was the Work Limitations Questionnaire-25 (WLQ-25). Analyses used linear mixed-effects regression adjusted for baseline characteristics and occupational skill level. An NHS perspective was used for the within-trial cost-effectiveness analysis. Much of the trial was affected by the COVID-19 pandemic. RESULTS: At 12 months, there was no significant difference in WLQ-25 between groups (adjusted mean difference: -1.8; 95% CI -7.4 to 3.8; p = 0.53), or in most secondary outcomes at 12- or 36-months. However, absenteeism showed a relative reduction of 46% at 12 months (p = 0.08), and employment retention at 36 months was higher in the intervention (93%) vs. control group (85%). The intervention was not cost-effective from an NHS perspective. CONCLUSION: WORKWELL did not lead to improved work productivity compared to self-help advice. Future research should explore more flexible delivery methods, including digital tools, to support sustainable employment for people with IA. A plain-language abstract is available in the supplementary material. TRIAL REGISTRATION: ClinicalTrials.gov; NCT03942783. ISRCTN Registry; ISRCTN61762297.
A newsletter apresenta os destaques do EULAR 2026, com foco na superioridade articular do bimequizumabe frente ao risanquizumabe na artrite psoriásica e o uso inovador de CAR-T in vivo para o lúpus. Também discute um grande estudo sobre as lesões cutâneas atípicas na Doença de Still e a rápida resposta dermatológica do brepocitinibe na dermatomiosite.
Background Several cases of pyoderma gangrenosum, a rare neutrophilic dermatosis, have been reported in patients initiating biological therapies for rheumatic health conditions. Despite this, systematic analysis across available therapies is lacking. This study investigated pyoderma gangrenosum reporting in association with antirheumatic biologics to the US Food and Drug Administration Adverse Event Reporting System (FAERS). Methods Reports from FAERS (2016–second quarter of 2025) were complied, deduplicated, and standardized. Pyoderma gangrenosum cases were classified according to the Medical Dictionary for Regulatory Activities. Proportional reporting ratios (PRRs) and 95% confidence intervals (CIs) were calculated to estimate disproportionality for 20 individual antirheumatic biologics from nine pharmacologic classes. Results During the study period, 13,284,367 adverse events were reported to FAERS, including 1316 pyoderma gangrenosum cases; 868 (65.96%) cases identified an antirheumatic biologic as the primary suspect product. Positive disproportionality signals were detected for 11 study biologics belonging to six pharmacologic classes. All four interleukin (IL)-17 inhibitors exhibited disproportionate pyoderma gangrenosum reporting, with brodalumab (PRR 23.02; 95% CI 8.64–61.36) and bimekizumab (PRR 9.10; 95% CI 4.08–20.29) demonstrating the strongest signals. Positive disproportionality signals were also observed among biologics targeting tumor necrosis factor alpha, IL-6, IL-12/23, IL-23, and CD20. Similar results were obtained in sensitivity analyses. Conclusion Despite its limitations, this hypothesis-generating analysis identified significantly disproportionate pyoderma gangrenosum reporting with several antirheumatic biologics. Clinicians should remain vigilant for these paradoxical reactions in patients undergoing biologic treatment for rheumatic conditions. Key points • Pyoderma gangrenosum has been reported in patients undergoing treatment with biologics for rheumatic indications. • This study analyzed spontaneous postmarketing pyoderma gangrenosum reporting in association with 20 antirheumatic biologics. • Pyoderma gangrenosum disproportionality signals were identified for 11 biologics targeting interleukin (IL)-6, IL-17, IL-12/23, IL-23,
OBJECTIVES: To describe the prevalence and extent of whole body (WB)-MRI detected joint disease features and their response to therapy in patients with early, active PsA. METHODS: Newly diagnosed PsA patients (treatment-naïve), recruited in GOLMePsA randomized trial (methotrexate plus golimumab and steroids, GOLMTX vs methotrexate plus steroids, PBOMTX), underwent a multi-joint MRI protocol (baseline; week 24 [primary outcome] and week 36). The validated WIPE (peripheral joints and entheses); HIMRISS, KIMRISS (hip and knee); HEMRIS (heel); and CANDEN and SPARCC (sacroiliac joints (SIJs), spine) scores were recorded. Exploratory estimates of difference or ratios (with confidence intervals - CI; 75-95%) between groups at weeks 24 and 36, were obtained using multiple binary logistic or quantile (median) regression. RESULTS: Overall, 93 paired scans from 31 participants (median symptom duration 10.5 months; IQR 4.2-18.3; absolute range 1.8-197.7; 68% polyarticular) were included. Baseline scores showed widespread low intensity inflammation in peripheral tissues (median MRI-WIPE score: 37 - CI 19.0-55.0). SIJs and spine inflammation (SPARCC score ≥2) was seen in 25.8% (10/31) and 32.3% (10/31), respectively. Participants achieved median MRI-WIPE delta (the difference between time-points) of -10 at week 24 and -7 at week 36 in the GOLMTX and -6 and -9 in PBOMTX arms respectively. No differences between treatment groups were observed. CONCLUSIONS: In this exploratory analysis, WB-MRI identified widespread although low intensity inflammation in peripheral joints and enthesis with improvements seen at 24 and 36 weeks and no meaningful differences between treatment arms. Axial abnormalities were seen in one third of patients at baseline. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov; NCT04108468.
Background The expanding use of biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) has substantially improved outcomes in autoimmune diseases but is accompanied by complex safety concerns. Risk management plans (RMPs) have been introduced to mitigate treatment-related risks; however, real-world adherence to these strategies and their broader clinical impact remain incompletely characterized. Methods We conducted a retrospective observational cohort study of adult patients with autoimmune diseases who received bDMARDs, tsDMARDs, or biosimilars at a tertiary medical center in southern Taiwan between October 2014 and December 2023. Patients were classified into RMP and non-RMP groups based on completion of predefined pre-treatment safety assessments within 6 months prior to therapy initiation, including pulmonary and tuberculosis evaluation, viral hepatitis screening, and documentation of cardiovascular and malignancy risk factors. Clinical outcomes included Pneumocystis jirovecii pneumonia (PJP), major adverse cardiovascular events (MACE), treatment-related respiratory adverse events, and all-cause mortality. Multivariable logistic regression and time-to-event analyses were performed to evaluate associations between RMP implementation and clinical outcomes. Results Among 1,078 patients included, only 348 (32.3%) fulfilled the predefined RMP criteria prior to treatment initiation. Compared with the RMP group, patients without RMP exhibited significantly higher incidences of PJP (11.9% vs. 2.3%), MACE (8.5% vs. 2.6%), treatment-related respiratory adverse events (50.4% vs. 42.8%), and all-cause mortality (7.3% vs. 1.7%) (all p < 0.05). After multivariable adjustment, RMP implementation remained independently associated with lower risks of PJP (adjusted odds ratio [aOR] 0.18, 95% CI 0.15–0.84), MACE (aOR 0.30, 95% CI 0.13–0.71), and all-cause mortality (aOR 0.21, 95% CI 0.07–0.61). Subgroup and time-to-event analyses demonstrated that anti-CD20 therapy was associated with the highest risk of early-onset PJP, MACE, and mortality, with most events occurring within the first three
PURPOSE OF REVIEW: Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory disease with highly heterogeneous clinical manifestations associated with psoriasis (PsO). The wide variability in presentation, together with the absence of definitive serological biomarkers, makes early diagnosis particularly challenging. This review evaluates the role of ultrasound in identifying and characterising musculoskeletal involvement across the psoriatic disease (PsD) continuum-from asymptomatic PsO to established PsA. RECENT FINDINGS: Ultrasound can detect subclinical synovitis, enthesitis, peritendonitis, tenosynovitis, bursitis, and structural damage in PsD. Evidence highlights its value in the early identification of musculoskeletal changes in patients with PsO who are at risk of progressing to PsA, with important implications for disease interception and prevention. Additional applications include differential diagnosis; assessment of enthesitis and distinction between inflammatory and non-inflammatory disease; and monitoring of therapeutic response, including in refractory disease. Ultrasound also demonstrates prognostic utility by detecting subclinical inflammation, predicting flares and future structural damage, and supporting personalized treatment strategies. Standardized ultrasound scoring systems and emerging methods for evaluating small hand entheses and dactylitis are also discussed. Ultrasound is an important tool for early detection, prognostic assessment, and management guidance in PsA, offering potential to prevent disease progression and inform precision medicine approach.
OBJECTIVES: Obesity is a prevalent comorbidity in psoriatic arthritis (PsA). We aimed to evaluate the association between body mass index (BMI) and minimal disease activity (MDA) state in PsA and examine this across different drug classes. METHODS: In a longitudinal observational study using the Gladman Krembil PsA Program cohort, patients with available BMI measurement over follow-up were included. Univariable and multivariable (MV) generalized estimating equations and linear mixed models were used to assess associations between BMI and MDA (and its components) over time, adjusting for age, sex, anxiety/depression, fibromyalgia, smoking, treatment type, and radiographic damage. Subgroup analyses evaluated this association across six drug classes: TNFi, IL-17i, IL-12/23i, IL-23i, JAKi, and PDE4i. RESULTS: In 1291 patients (mean age 44.7 years, 56% male, mean BMI 28.8 kg/m2), higher BMI was independently associated with lower odds for MDA (MV, OR 0.97, 95% CI 0.94-0.99) along with female sex, older age, smoking, fibromyalgia, and radiographic damage. BMI was negatively associated with all MDA components except swollen joint count. Higher BMI at drug initiation was associated with reduced odds for MDA state in TNFi-treated patients excluding infliximab (MV, OR 0.93, 95% CI 0.90-0.96), while no significant effect was seen for IL-17i, IL-12/23i, IL-23i, or JAKi. Longitudinal BMI assessment similarly showed reduced MDA odds with TNFi (excluding infliximab). CONCLUSIONS: High BMI decreases the odds for MDA in PsA, mainly affecting subjective disease measures. This effect is most pronounced in patients treated with TNFi (except infliximab). This underscores the importance of weight management in optimizing treatment response.
PURPOSE OF REVIEW: The concept of difficult-to-treat (D2T) disease is increasingly recognized across immune-mediated inflammatory diseases, and was recently introduced in spondyloarthritis (SpA). Several terms, including difficult-to-manage (D2M), complex-to-manage (C2M), and treatment-refractory (TR) describe disease states characterized by persistent symptoms and inadequate response to targeted therapies. This review aims to clarify the emerging constructs of D2M and TR disease in axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and their implications for emerging research in this area. RECENT FINDINGS: Recent initiatives from ASAS, EULAR, and GRAPPA have proposed definitions to frame D2T clinical scenarios in axSpA and PsA. These converge on distinguishing treatment-refractory disease, characterized by persistent objective inflammation despite multiple targeted therapies, from broader D2M/C2M states driven by multifactorial contributors including non-inflammatory factors. Emerging data suggest that clinical and biological heterogeneity across disease domains may contribute to these phenotypes. Challenging phenotypic presentations often display overlapping features between axSpA and PsA, supporting the concept of a continuum across the SpA spectrum. SUMMARY: Distinguishing TR disease from broader D2M/C2M states is essential for avoiding inappropriate treatment escalation, and supporting personalized multidisciplinary care. Further research is needed to validate these definitions, determine contributing factors and their prevalence, and clarify the molecular mechanisms underlying treatment refractory disease.
A newsletter apresenta os principais destaques do congresso EULAR 2026, abordando desde a eficácia da manutenção do alopurinol na gota até novos alvos terapêuticos para a Síndrome de Sjögren. Além das atualizações clínicas, explora como fatores psicossociais e a satisfação conjugal influenciam diretamente o prognóstico e a saúde mental de pacientes com doenças reumáticas crônicas.
Objective To assess the effectiveness and safety of apremilast in the treatment of psoriatic arthritis (PsA) in a real-world setting across multiple rheumatology centers in Italy. Methods MAPSI II is a multicenter, observational real-world study including adult patients with active PsA treated with apremilast. Patients were prospectively evaluated at baseline and after 6 and 12 months to assess effectiveness and safety. Clinical assessments included joint, skin, and patient-reported outcomes, namely Disease Activity Index for psoriatic arthritis based on 28 joint counts and C-reactive protein (DAPSA28-CRP), Leeds Enthesitis Index (LEI), dactylitis count, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Visual Analogue Scale (VAS) for pain and patient global assessment (PGA), Psoriatic Arthritis Impact of Disease questionnaire (PsAID-9), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and C-reactive protein (CRP). Safety was evaluated by recording adverse events (AEs) and serious adverse events (SAEs). Results Of the 139 enrolled patients, 100 completed the 6-month follow-up and 83 completed the 12-month visit. A significant reduction in PGA-VAS was observed from baseline (60.8 ± 20.5) to 12 months (30.3 ± 23.7; p < 0.001). LEI and CRP levels also improved significantly, while PASI and NAPSI remained unchanged. Apremilast was generally well tolerated; 38 AEs in 38 patients were recorded, mostly gastrointestinal. Two serious AEs were reported. Treatment discontinuation due to AEs occurred in 23 cases (60.5% of AE group). Conclusion Apremilast demonstrated real-world clinical benefit in reducing disease activity and enthesitis in PsA patients, especially those with moderate disease and limited treatment options. Its safety profile and tolerability support its use in selected patients, potentially even before failure of other DMARDs. Key Points • This multicenter Italian real-world study evaluated the effectiveness of apremilast
A newsletter apresenta os resultados do estudo REPLENISH, que valida o secuquinumabe como uma nova opção biológica para a polimialgia reumática, dobrando as taxas de remissão sustentada. São discutidos também novos insights do EULAR 2026, incluindo a distinção entre entesófitos inflamatórios e mecânicos, o valor prognóstico do fator reumatoide na GEPA e o potencial das fibras dietéticas em melhorar a resposta clínica ao metotrexato na artrite reumatoide.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting hosted a workshop entitled "Bridging generations: leveraging technology and AI for better research, outreach, and daily practice." This interactive session explored how digital tools and artificial intelligence (AI) can be applied to rheumatology research, education, and clinical care. The workshop was structured into 3 thematic presentations. The first focused on strategies for effective interaction with large language models (LLMs), highlighting prompt engineering, retrieval-augmented generation, and potential clinical applications, while also addressing the limitations and risks of unsupervised AI use. The second examined mobile and desktop applications for daily practice, presenting a tiered adoption framework to promote global equity in digital health and discussing the promise and challenges of AI-powered documentation tools. The third explored how social media platforms can increase research visibility, promote professional digital presence, and improve engagement with both peers and patients, emphasizing best practices and pitfalls. Interactive elements included prompting demonstrations and practical examples of application usability as well as social media do's and don't's . Patient research partners contributed perspectives on accessibility and generational differences in adopting technology. This workshop underscored the growing relevance of digital tools in rheumatology and the importance of equity, evidence-based adoption, and patient-centered design for their safe and effective integration.
Psoriasis is a chronic, immune-mediated disease affecting the skin. Its prevalence varies by region (0.2-9%), and some patients may develop joint involvement. For mild disease, and as adjuncts in moderate disease, topical therapies remain the foundation of care. Classical agents include topical corticosteroids and vitamin D analogs. Other legacy options (tazarotene, salicylic acid, coal tar, and calcineurin inhibitors) serve as adjuvants with variable efficacy. Recent advances have led to new targeted nonsteroidal topicals such as tapinarof (aryl hydrocarbon receptor agonist) and roflumilast (phosphodiesterase 4 inhibitor). We summarize evidence, propose practical prescribing recommendations for nondermatologists, and position new agents within a steroid-sparing, precision framework. A persistent challenge is affordability, in which high acquisition costs for novel topicals may restrict real-world access unless supported by pricing and reimbursement policies. This work was presented at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá as a concurrent session.
Psoriatic arthritis (PsA) is a heterogeneous inflammatory disease characterized by diverse musculoskeletal manifestations, including peripheral and axial arthritis, enthesitis, and dactylitis, often in conjunction with skin and nail psoriasis. Imaging modalities, particularly musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI), are crucial for accurate diagnosis, monitoring disease activity, and assessing structural damage in PsA. This review summarizes key insights from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 session "Imaging in psoriatic arthritis: focus on axial MRI and peripheral musculoskeletal ultrasound," highlighting advancements in both peripheral and axial imaging. Efforts to standardize imaging protocols and scoring systems continue to enhance the utility and reliability of these tools in both research and daily practice, emphasizing the importance of nuanced interpretation to avoid common pitfalls. The session also underscored the valuable input from patient research partners, whose involvement highlights a crucial commitment to patient-centered research and care in rheumatology.
Despite international recommendations advocating for structured assessment of disease activity in psoriatic arthritis (PsA), the routine use of outcome measures in clinical practice remains inconsistent. Barriers such as limited time, lack of training, and restricted access to resources may be contributing to this implementation gap. To address this, the Global Exploration of Psoriatic Arthritis Disease Activity Assessment (EXPLORE-PsA) study aims to systematically evaluate how disease activity measures, including both composite and domain-specific tools, are used in PsA care across diverse global settings. This cross-sectional study will deploy a short English-language online survey targeting rheumatologists and allied health professionals involved in the assessment of people with PsA. Key objectives include the following: (1) characterizing the use of outcome measures in routine practice; (2) comparing usage patterns between academic and nonacademic settings; and (3) identifying perceived barriers and facilitators to implementation. Additional domains include preferences for digital vs paper-based tools, the inclusion of skin and nail assessments in rheumatology, the use of axial spondyloarthritis indices in axial PsA, and perspectives on treat-to-target strategies and patient-initiated follow-up. As the first research initiative led by the Young Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (Y-GRAPPA) network, EXPLORE-PsA not only aims to inform future strategies to enhance outcome assessment in PsA globally but also establishes a collaborative foundation for early career-led research in psoriatic disease. This study was presented at the GRAPPA 2025 annual meeting in Bogotá, Colombia.
Background To investigate the associations of circulating immune cell biomarkers with clinical manifestations and treatment response in Psoriatic Arthritis (PsA), and to evaluate whether these biomarkers improve prediction of individual response to tofacitinib, methotrexate, or etanercept. Methods Data from the TOFA-PREDICT development cohort (n = 80) were used. DMARD naïve patients were randomized to tofacitinib or methotrexate, and csDMARD inadequate responders were randomized to tofacitinib or etanercept. Treatment response (achievement of Minimal Disease Activity) was scored at week 16. Clinical data and peripheral blood mononuclear cells were analyzed at baseline and week 16. Relevant biomarkers for clinical manifestations or treatment response were selected using sparse partial least squares (sPLS) regression and extreme gradient boosting. Associations with PsA clinical manifestations were analyzed using multivariate linear regression. Biomarker profiles for treatment response were derived by sPLS regression. Lastly, a Ridge regression model was used to evaluate whether selected biomarkers improved the prediction of individual treatment response beyond a previously developed clinical model. Results The biomarkers explained up to 27% and 11% of observed variance for psoriasis severity and the swollen joint count, respectively. Baseline biomarker profiles classified etanercept and methotrexate responders relatively well, but did not distinguish tofacitinib responders. Adding biomarker data to clinical data did not improve the accuracy of individual response prediction (AUC-ROC 0.74). Conclusion Our comprehensive set of circulating immune cell biomarkers showed no additional value in precision medicine, when added to clinical predictors. However, the observed associations provide relevant insights into pathophysiological mechanisms underlying differential treatment response and clinical manifestations. Trial registration EudraCT Trial registration number 2017–003900-28, registration date January 25th 2018.
A newsletter analisa a busca por biomarcadores para a nefrite lúpica, destacando que, apesar de candidatos promissores como a IL-16 e o CD163 urinários, a biópsia renal ainda é o padrão-ouro indispensável. O conteúdo também aborda benefícios da combinação leflunomida e hidroxicloroquina no tratamento de Sjögren e a confiabilidade do PHQ-8 no rastreio de depressão em pacientes com dor crônica, sem viés de sobreposição somática.
A newsletter discute o uso de canabinoides na osteoartrite, destacando que o CBD tópico apresenta melhores sinais de eficácia que a via oral, embora ainda faltem evidências robustas para prescrição rotineira. O conteúdo também aborda novos protocolos de ultrassom para coluna vertebral, o potencial terapêutico da liraglutida e os marcadores de gravidade em uma coorte de 10 anos de Doença de Still.
At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 congress, 2 major research initiatives in psoriatic disease were highlighted: (1) the Axial Involvement in Psoriatic Arthritis (AXIS) study, and (2) the GRAPPA consensus definitions for complex-to-manage psoriatic arthritis (C2M-PsA) and treatment-refractory PsA (TR-PsA). The AXIS study, jointly led by Assessment of SpondyloArthritis international Society (ASAS) and GRAPPA, aims to establish internationally accepted classification criteria for axial PsA. In its recently completed phase, 409 patients were recruited across 41 centers in 19 countries. A comprehensive imaging and clinical dataset were collected and analyzed. The next phase will construct and validate a PsA-specific classification instrument to support future research. In parallel, GRAPPA developed consensus definitions for C2M-PsA and TR-PsA through a transparent, multistakeholder process. C2M-PsA refers to patients with persistent symptoms despite appropriate treatment, often complicated by comorbidities or overlapping conditions. TR-PsA is defined by failure to respond to multiple therapies and by confirmed persistent inflammation. These definitions were endorsed by 95% of GRAPPA members and are supported by practical checklists for clinical use. These initiatives represent a significant advancement in PsA research, offering clinicians structured tools to improve patient stratification, guide treatment decisions, and enhance personalized care.
At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 Collaborative Research Network meeting in Bogotá, Colombia, experts in dermatology and rheumatology presented complementary perspectives on the future of psoriatic disease management. Dr. Andrew Blauvelt introduced innovative approaches to achieving long-term remission or a cure for psoriasis, focusing on early intervention and "knockout" therapies with high-dose interleukin 23 inhibitors. Dr. Philip Mease presented evolving concepts in difficult-to-treat and complex-to-manage psoriatic arthritis, emphasizing the need for formal definitions and the growing role of dual therapy strategies. This session reflected a shift toward a more personalized, proactive, and multidisciplinary strategy to address unmet needs in psoriatic disease.
Plain radiographs have been widely used in psoriatic disease (PsD) for diagnosis, classification, and monitoring of structural damage. However, with the emergence of other imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography, the necessity of plain radiographs in PsD is debatable. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá, Colombia, Drs. William Tillett and Arthur Kavanaugh were invited to debate the topic "Plain radiography in psoriatic disease: is it still necessary?" Each presented evidence-based arguments, incorporating multiple data sources, including clinical trials, to support their positions for and against the topic, respectively. This article summarizes their debate for the broader PsD community.
Key advances from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) pilot research grant program were presented at the GRAPPA 2025 annual meeting. Areas of study included hypoxia-inducible factor 1α (HIF1A) as a potential factor in psoriatic arthritis (PsA), plasma extracellular vesicle cytokines as potential biomarkers for predicting response to tumor necrosis factor inhibitors in PsA, bone properties and biomechanics in psoriatic disease (PsD), better understanding of differences in body composition in PsD, and the effect of sleep on PsD severity.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting, held in Bogotá, Colombia, featured soapbox presentations highlighting innovative approaches to psoriatic disease (PsD) care. Dr. Vasileios Charisis presented the Psoriatic Arthritis Inflammation Explained Through Multi-Source Data Analysis Guiding a Novel Personalised Digital Care Ecosystem (iPROLEPSIS) project, which applies digital phenotyping and explainable artificial intelligence to monitor psoriatic arthritis (PsA) using smartphone-based typing dynamics and hand motion tracking. Pilot data demonstrated high accuracy in detecting functional impairments, underscoring the potential of digital biomarkers for personalized disease management. Dr. Rodrigo García-Salinas reported consensus recommendations from the Red de Excelenciaen Artritis para la América Latina-Pan American League of Associations for Rheumatology (REAL-PANLAR) group to establish PsD Centers of Excellence (CoEs) in Latin America. Through a Delphi process, experts from 12 countries defined structural, process, and outcome standards, resulting in 2 adaptable models-optimal and model-designed to reduce diagnostic delays, enhance multidisciplinary collaboration, and improve outcomes. Dr. Juan Raul Castro-Ayarza summarized real-world evidence on biologic drug survival in Latin America, emphasizing fragmented data and variability across national cohorts. Findings from Venezuela, Brazil, Argentina, and Colombia revealed differences in treatment persistence and predictors of discontinuation, reinforcing the need for a standardized regional registry. Collectively, these initiatives demonstrate the value of digital health tools, region-specific care frameworks, and real-world evidence in advancing PsD management globally.
A newsletter discute os desafios práticos e emocionais da maternidade em mulheres com doenças reumáticas, destacando que o cuidado médico deve transcender métricas clínicas como o DAS-28. Além disso, apresenta atualizações científicas sobre novos biomarcadores de inflamação coronariana na artrite reumatoide e a caracterização de fenótipos específicos em pacientes com anticorpos anti-CENP-B e anti-SSA.
Sex and gender shape disease presentation, diagnostic accuracy, treatment response and clinical outcomes in rheumatology, yet these dimensions remain insufficiently embedded in clinical practice. Owing to the markedly unbalanced sex prevalence ratios across many rheumatic diseases, the ‘minority’ sex is consistently under-represented in clinical studies, limiting the interpretation of long-term outcomes and treatment effectiveness. Sex-related differences in pain perception, inflammatory biomarkers and imaging patterns further complicate disease assessment, and treatment allocation and drug persistence also differ between women and men. Gender-related factors — including disparities in care-seeking behaviours, social roles and lifestyle factors — additionally modulate symptom burden and disease trajectories. Evidence remains particularly scarce for transgender, gender-diverse and intersex individuals, who are rarely captured in clinical cohorts, restricting the development of inclusive and generalizable evidence. Embedding sex-aware and gender-aware approaches into diagnostic reasoning, risk assessment and therapeutic decision-making is therefore essential for advancing precision, equity and truly personalized rheumatological care. Such integration enables clinicians to interpret disease signals more accurately, anticipate divergent multimorbidity trajectories and tailor treatment strategies to the biological and sociocultural contexts of each patient.
OBJECTIVE: This study aims to estimate the incidence rate of psoriatic disease (psoriasis [PSO] and psoriatic arthritis [PSA]), both crude and age- and sex-standardized from the Peruvian healthcare system. METHODS: A secondary data analysis was conducted using nationwide records (2016-2023) from the National Health Superintendence (SUSALUD), encompassing both public and private sectors. Incidence rates were calculated per 100,000 person-years (py). RESULTS: Evaluating 195,866 PSO and 6,786 PSA cases, the overall incidence rates were 102.99 (95% CI 102.54-103.45) and 3.57 (95% CI 3.48-3.65) per 100,000py, respectively. Both conditions displayed increasing trends from 2016 to 2023. PSO incidence peaked in adults ≥65 years (300.46) and showed male predominance (130.04 vs. 76.94 in females). Conversely, PSA demonstrated a bimodal age distribution with an early peak at 40-44 years and a later, higher peak at 60-64 years, while maintaining a balanced sex distribution. Regional disparities were prominent; Lima-Callao reported the highest rates, whereas the Macro Central region recorded the lowest. CONCLUSION: PSO and PSA incidence rates are rising in Peru, presenting notable demographic and regional variations. The lower incidence in the Andean macro-regions may reflect a combination of healthcare access barriers and a protective genetic profile inherent to Native American ancestry. These findings emphasize the need for improved public health policies to address the growing demand for psoriatic care.
A newsletter discute a necessidade de ajustar os pontos de corte dos índices CDAI e SDAI para a realidade brasileira, visando uma identificação mais precisa da remissão na artrite reumatoide e evitando o sobretratamento. Além disso, revisa as diretrizes de rastreio para doença pulmonar intersticial associada à AR e destaca o potencial condroprotetor da metformina em pacientes diabéticos com osteoartrite.
A newsletter aborda a importância da reabilitação imunológica pós-transplante renal em pacientes com doenças reumáticas, focando no equilíbrio entre evitar a rejeição e prevenir a recorrência da doença de base. Destaca o sucesso do brepocitinibe (inibidor de TYK2/JAK1) no tratamento da dermatomiosite refratária e discute o uso de terapias biológicas combinadas para artrite psoríasica. O conteúdo também revisa biomarcadores preditivos e estratégias de monitoramento personalizado para otimizar a sobrevida do enxerto e do paciente.
Assessing the presence and degree of synovitis is the cornerstone of managing patients with arthritis. Ultrasound has been shown to be a valuable tool for this in routine care, and several scoring systems have been developed over time. Although there is an overall good validity across several different semi-quantitative scoring systems, they lack reliability when applied in the same patient cohort, emphasising the need for a consensus-based scoring system. A European Alliance of Associations for Rheumatology (EULAR) and Outcome Measures in Rheumatology (OMERACT) collaboration developed, almost 10 years ago, the consensus-based EULAR-OMERACT scoring system, which has subsequently been validated. It has face and content validity as it makes sense and allows to visualise all components constituting the synovitis complex. It has discriminant validity as it is sensitive to change during treatment, can discriminate between active treatment and placebo in clinical trials and has a moderate-to-excellent inter-observer and intra-observer reliability. It has construct validity by showing a parallel improvement in ultrasound sum scores and Disease Activity Score 28 and joint assessment, respectively. It has criterion validity with a predictive validity for biological disease-modifying antirheumatic drug (bDMARD) discontinuation and for flares while tapering bDMARDs. In addition, a correlation between the scoring system and histological inflammation was established. Finally, the EULAR-OMERACT scoring system is feasible, as a 24-joint assessment can be performed in 20 min. In conclusion, the EULAR-OMERACT scoring system is a valid scoring system that also fulfils the OMERACT 2.1 filter for instrument selection.
The psoriatic arthritis phenotype has evolved over the past several decades. The original description of 5 clinical patterns has been expanded into 6 domains including peripheral arthritis (which includes 3 of the patterns described by Moll and Wright namely distal, oligoarticular and polyarticular), axial disease, dactylitis, enthesitis, skin and nails. In this article we review the evolution of the PsA phenotype, from the Moll and Wright subtypes described in 1973 and how they might have changed, evolution of our understanding of axial PsA, consider race and geographic differences in disease expression, role of obesity and sex on the PsA phenotype, effect of co-expression of PsA and FM as well as OA on the phenotype, and consider difficult to treat PsA.
Objectives To characterize complex-to-manage PsA (C2M-PsA) and, within it, treatment-refractory PsA (TR-PsA), using a pragmatic registry-based operationalization of emerging GRAPPA-adapted constructs, and to describe prevalence, drivers, and real-world treatment trajectories in Argentina. Methods Multicenter cross-sectional analysis of 350 adults with PsA from the RECCAPSO network. C2M-PsA was defined per GRAPPA (PsA-related and/or comorbidity drivers). TR-PsA required objective inflammatory activity plus failure of ≥ 2 distinct mechanisms among biologics or JAK inhibitors. We summarized clinical features, comorbidities, current therapies, and sequencing across lines. Results C2M-PsA prevalence was 49.4% (173/350), most commonly mixed drivers (PsA + comorbidity, 59.5%), followed by PsA-only (31.8%) and comorbidity-only (8.7%). TR-PsA accounted for 9.7% (34/350) overall and 19.7% (34/173) within C2M. In C2M, current treatment was dominated by TNF inhibitors and IL17 inhibitors. In D2T, sequencing typically started with TNF inhibition and shifted toward IL17 pathways in later lines. Conclusions Using a pragmatic real-world operationalization of emerging GRAPPA-adapted constructs, about half of patients met C2M-PsA criteria, largely driven by mixed PsA-comorbidity factors; approximately one in five of these fulfilled TR-PsA criteria. Key Points • A GRAPPA-aligned initiative: Operationalized C2M-PsA and TR-PsA in a national cohort; ~ 50% were C2M, predominantly with mixed (PsA + comorbidity) drivers. • TR within C2M: ≈1 in 5 C2M cases were TR-PsA; most frequent domains were skin, arthritis, enthesitis; ~ 50% had ≥ 2 active domains; one dactylitis. • Treatment trajectories: Real-world sequencing commonly shifted from TNF to IL-17 over successive lines, with later diversification to IL-12/23, IL-23, and JAK inhibitors.
Objective Overweight or obesity is prevalent in 72% to 82% of individuals with psoriatic arthritis (PsA). We assessed the efficacy and safety of ixekizumab (IXE) concomitantly administered with tirzepatide (TZP) compared with IXE alone in adult participants with active PsA and overweight with at least one weight‐related comorbidity or obesity. Methods TOGETHER‐PsA ( ClinicalTrials.gov identifier: NCT06588296) is a phase 3b, randomized, 52‐week trial in adults with active PsA and overweight (body mass index [BMI] ≥27 to <30) with at least one weight‐related comorbidity or obesity (BMI ≥30) using US‐approved doses for IXE and TZP. The primary end point was simultaneous achievement of 50% improvement in American College of Rheumatology response criteria (ACR50) and ≥10% weight reduction at 36 weeks. Key secondary outcomes included ACR50. Additional secondary outcomes and patient‐reported outcomes (PROs) were assessed. Safety was assessed as adverse events (AEs), treatment‐emergent AEs, and serious AEs. Results A total of 271 participants were randomized (IXE + TZP, n = 138; IXE, n = 133). The primary end point was achieved with significant improvements in the IXE + TZP arm (31.7%) compared to IXE alone (0.8%) ( P < 0.001). Greater improvements in ACR50 were demonstrated in IXE + TZP (33.5%) versus IXE alone (20.4%) ( P = 0.02), with significant early separation at week 4 (nominal P < 0.05). IXE + TZP demonstrated nominally significant improvements in ACR20 ( P < 0.001), minimal disease activity ( P < 0.05), and absolute Psoriasis Area and Severity Index score ( P < 0.01) compared to IXE alone. IXE + TZP demonstrated significant improvements in PROs, including Health Assessment Questionnaire–Disability Index (∆ −0.2; nominal P < 0.001) and Functional Assessment of Chronic Illness Therapy–Fatigue
A newsletter destaca o estudo RESET-RA, que apresenta a estimulação do nervo vago como uma alternativa promissora para pacientes com Artrite Reumatoide de difícil tratamento. São detalhadas as atualizações das diretrizes EULAR 2025, que reforçam o uso precoce de anti-TNF na Síndrome de Behçet e simplificam o manejo da Artrite Reumatoide após falha ao metotrexato. O conteúdo ainda aborda um caso clínico de tuberculose óssea e revisões rápidas sobre fibromialgia e gota.
This United States (US)-based claims analysis evaluated the real-world safety of tofacitinib versus biologic treatments in patients with psoriatic arthritis (PsA). Risk of serious infections, myocardial infarction (MI) or stroke, venous thromboembolism (VTE), and malignancy (excluding non-melanoma skin cancer) were assessed using data from a US real-world database of administrative data and claims from medical/pharmacy insurances (Komodo Health). Patients with PsA aged ≥ 18 years who initiated tofacitinib or a biologic treatment (tumor necrosis factor inhibitors [TNFi], interleukin-17 A inhibitors [IL-17Ai], risankizumab or ustekinumab) between December 2017–February 2023, with ≥ 12 months of prior continuous enrollment, were included. Crude incidence rates (IRs)/100 patient-years (PY) and stabilized inverse probability treatment weighting (sIPTW) were calculated. Cox proportional hazards models with sIPTW were used to calculate adjusted hazard ratios with bootstrapping for 95% confidence intervals. In total, 48,167 patients were included (tofacitinib, N = 3,166; TNFi, N = 26,760; IL-17Ai, N = 20,252; risankizumab, N = 4,381; ustekinumab, N = 4,499). Mean age at index ranged from 48.2 to 50.3 years; mean follow-up was 288.5–347.0 days. Crude IRs/100 PY ranged from 1.78 to 2.53 for serious infections, 0.27–0.61 for MI/stroke, 0.17–0.42 for VTE, and 0.74–1.06 for malignancy. In the main analysis, there were no statistically significant differences in the risk of developing serious infections, MI or stroke, or malignancy between treatments. Patients initiating tofacitinib versus TNFi (but not other biologics) had significantly higher VTE risk. A higher proportion of tofacitinib initiators had surgery (potential VTE risk factor) during the baseline period (45.9–46.7%) and 6 months post-index (28.1–28.9%), versus biologic initiators (40.2–44.3% and 22.2–27.4%, respectively). In patients with PsA who were not enriched for cardiovascular/VTE risk factors, no significant differences in the risk of
Objective Assess guselkumab+golimumab combination versus guselkumab monotherapy in participants with active PsA and inadequate response to tumor necrosis factor inhibitors (TNFi‐IR). Methods Adults with active TNFi‐IR PsA (≥3 tender/swollen joints) were randomized (2:1) to subcutaneous guselkumab (100mg)+golimumab (50mg) combination (N=59) or guselkumab monotherapy (N=32) every‐4‐weeks (Q4W) through W20. The primary endpoint was W24 minimal disease activity (MDA) achievement. Additional endpoints included ACR20/50/70 response rates; improvements in psoriasis/dactylitis/enthesitis; changes in patient‐reported physical function; and impact of screening CRP on MDA/ACR50 response. Results At baseline, participants had a median of 13/8 tender/swollen joints and psoriatic body surface area of 3%; 23% had dactylitis. At W24, 29% and 22% of participants achieved MDA with guselkumab+golimumab combination and guselkumab monotherapy, respectively (odds ratio [OR], 90% confidence interval: 1.4 [0.6, 3.3]; P =0.557); 44% and 22% achieved ACR50 (nominal P =0.034). Participants with CRP ≥0.3mg/dL (intended enrollment population) receiving combination therapy (n=40; monotherapy n=22) had greater odds of achieving MDA (OR: 12.3; nominal P =0.025; 32% vs. 5%) and ACR50 (OR: 9.6; nominal P =0.003; 55% vs. 14%) at W24. Combination therapy was associated with higher ACR20 (66% vs. 44%)/ACR70 (27% vs. 16%) responses and greater physical function improvements than monotherapy. Psoriasis/dactylitis/enthesitis improvements were similar across groups. No new safety signals, and no tuberculosis/opportunistic infections, occurred through W36. Conclusion Although the primary endpoint was not achieved, secondary endpoints and exploratory analyses suggest that participants with TNFi‐IR PsA, particularly those with elevated CRP, could derive clinically meaningful benefits with guselkumab+golimumab combination therapy, with no new safety concerns, warranting further investigation.
Summary Background Patient-initiated follow-up (PIFU) is designed to give patients more control over their follow-up care in rheumatology and relies on patients coming forward to schedule appointments and understand how and when to contact their rheumatology team. Additionally, rheumatology teams need to establish suitable criteria and have systems in place to support PIFU. Resources to inform patients with rheumatic disease about PIFU or to support its implementation in rheumatology clinics is scarce. The aim of this study was to co-design resources with patients and clinicians to support the implementation of PIFU across the UK. Methods This co-design study was done across four research centres in the UK: University of Oxford, University of Plymouth, King's College London, and the University of the West of England. The study was overseen by a steering group, who met on a monthly basis. Patients were invited through online advertisements disseminated via patient charities and clinicians were invited via email. Patients aged 18 years or older with a self-reported inflammatory arthritis and clinicians with and without experience in PIFU were included. Online patient-led and clinician-led workshops were conducted to discuss their views and experiences of PIFU, to identify the needs of both groups, and to develop PIFU resources to support its implementation. Findings Between Oct 3, 2023, and April 30, 2024, ten online workshops were conducted (including seven patient-led [61 patients] and three clinician-led workshops [nine clinicians]). Based on discussions from these workshops several patient and clinician PIFU resources were designed. For patients, this included a PIFU video in English (with subtitles available in Welsh, Polish, Urdu, Punjabi, Romanian, and Cantonese), a frequently asked questions document, and an infographic with links to patient organisations. For clinicians,
There are previously stated risk factors for the transition from psoriasis to psoriatic arthritis, but the immune mechanisms in this regard have not been adequately explained. In this study, we aimed to investigate this transition in terms of the complement system. Study was planned as a prospective analytical type. 46 psoriasis and 45 psoriatic arthritis patients were included in this study. Morning stiffness, nail involvement, disease activation questionnaire scores, neutrophil and lymphocyte percentage, neutrophil-lymphocyte rate, high-density lipoprotein, low-density lipoprotein, triglyceride, erythrocyte sedimentation rate, C-reactive protein, uric acid, complement 3 (C3) and 4 (C4) values were evaluated. Enthesis clinical assessment was done with the Leeds enthesis index (LEI). Ultrasonography was used to evaluate the enthesis sites. The severity of skin involvement in psoriasis was evaluated with the psoriasis area severity index (PASI). PASI scores were higher in psoriasis patients, while LEI scores, erythrocyte sedimentation rate and C-reactive protein levels were higher in psoriatic arthritis patients ( P = .016, P = <.001, P = .016, P = .027, P = .020, respectively). Among psoriasis patients, C3 levels were higher in the patients with nail involvement ( P = .035). C3 levels of psoriasis patients showed a moderate positive correlation between PASI and LEI scores ( r = 0.368, r = 0.404, respectively). In psoriasis patients, high-density lipoprotein values were found to be moderately negatively correlated with both C3 and C4 ( r = −0.311, r = −0.388, respectively). As a result of this study, C3 levels may play a role in the progression to psoriatic arthritis.
Radiographic structural damage, particularly severe joint destruction, is independently associated with impaired PF in PsA, highlighting the importance of early detection and prevention of damage.
Purpose of review Psoriatic arthritis (PsA) outcomes have improved, yet many patients do not achieve sustained control, and a meaningful proportion develop difficult-to-treat disease. This review summarizes relevant new therapies in the PsA pipeline and highlights emerging strategies likely to shape near-term care, including interception, metabolic targeting, combination/sequence approaches, and early precision-medicine efforts. Recent findings Pipeline innovation clusters in three areas: interleukin (IL)-17 pathway advances, including dual IL-17A/IL-17F blockade and engineered formats (nanobodies/small scaffolds) that may alter tissue pharmacology; selective tyrosine kinase 2 inhibition (allosteric and highly selective catalytic-site inhibitors) expanding oral options; and oral IL-23 receptor antagonism progressing from strong psoriasis efficacy into phase 3 PsA development. Beyond new molecules, strategies are evolving. Exploratory evidence supports further evaluation of dual-targeted approaches for highly refractory PsA, while metabolic targeting with incretin-based therapy is being tested as an adjunct to immunomodulation to address obesity-linked inflammatory amplification and cardiometabolic risk. EULAR transition frameworks, prodromal musculoskeletal symptoms and imaging abnormalities support a plausible interception window in at risk psoriasis. Summary The next wave in PsA will be defined by both new agents and smarter strategies: more oral/selective therapies, testing interception in risk-enriched psoriasis, integrating metabolic approaches, and evaluating optimized sequencing and selected combination therapy while precision tools mature.
Background Interstitial lung disease (ILD) is not classically considered an extra-articular manifestation of psoriatic arthritis (PsA). However, emerging evidence suggests that pulmonary involvement may be more common than previously recognized. The prevalence of ILD in PsA remains poorly defined. Objectives To estimate the pooled prevalence of ILD among patients with PsA and to evaluate associated risk factors and comparative risk with other populations. Methods We conducted a systematic review and meta-analysis registered in PROSPERO. MEDLINE (PubMed), EMBASE (Scopus), and the Cochrane Library were searched from inception to January 2026. Observational studies reporting ILD prevalence in PsA were included. Random-effects models with logit-transformed proportions were used to pool prevalence estimates. Subgroup analyses were performed based on ILD diagnostic method. Results Six studies comprising 14,272 patients with PsA were included. The pooled prevalence of ILD was 3% (95% confidence interval [CI]: 1%–7%; I2 = 96.6%). Prevalence was significantly higher in studies using imaging-based diagnosis with computed tomography or high-resolution computed tomography (6%, 95% CI: 4%–10%; I2 = 55%) compared with studies relying on non-imaging identification (1%, 95% CI: 1%–11%; I2 = 0). The difference between subgroups was statistically significant (p < 0.0001). Smoking was associated with a significantly increased risk of ILD in PsA (pooled odds ratio 2.94, 95% CI: 1.22–7.12; I2 = 1.8%). Conclusions Interstitial lung disease affects a meaningful proportion of patients with psoriatic arthritis, particularly when imaging-based diagnostic methods are used. ILD may be underrecognized in routine clinical practice. Increased awareness, standardized diagnostic approaches, and prospective studies are needed to define optimal screening and management strategies for ILD in PsA. PROSPERO registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278657 Key Points • Interstitial lung disease may be an underrecognized comorbidity in psoriatic arthritis. • The prevalence appears
Objective To analyze unselected routine care patients with all rheumatic diagnoses for positive anxiety, depression, and/or fibromyalgia screening within a single MDHAQ (multidimensional health assessment questionnaire), and for pain and RAPID3 (routine assessment of patient index data) in patients with positive vs negative screens. Methods Each rheumatology patient with any diagnosis at Rush University is given an MDHAQ at each encounter to provide comprehensive medical history information, completed by most patients in 5-10 minutes and scored by a professional in <30 seconds. Frequencies of positive MDHAQ anxiety, depression, and fibromyalgia screening indices were computed in patients with 15 rheumatic diagnoses in 5 categories: inflammatory, connective tissue, non-inflammatory, bone mineral disorders, and primary fibromyalgia. Median pain 0-10 visual numeric scale (VNS) and 0-30 RAPID3 scores were compared in patients with positive vs negative screens. Results In 1,337 study patients (excluding primary fibromyalgia), 30% had positive screens for anxiety, 24% for depression, and 25% for (non-primary) fibromyalgia, and 44% any of these 3 multimorbidity screens. Positive screens in different rheumatic diagnosis categories ranged from 17%-39% for anxiety, 9%-33% for depression, 7%-31% for (non-primary) fibromyalgia, and 30%-52% for any multimorbidity screen. Median pain was 7.0/10 vs 4.0/10 and median (RAPID3) 17.0/30 vs 8.2/30 in patients with any of 3 positive vs all negative screens (p< 0.001). Conclusion Positive anxiety, depression, and/or fibromyalgia screens in 44% of routine care patients who have significantly higher pain scores agree with extensive research findings, suggesting inclusion of pragmatic screening for clinical decisions at all routine encounters.
Objective The previously developed FLARE questionnaire assesses the multidimensional aspects of a flare of psoriatic arthritis (PsA). We aimed to further validate this questionnaire. Methods Reanalysis of data from the ReFLAP study ( NCT03119805 ), a longitudinal observational study carried out in 14 countries. Demographic, clinical and patient reported data were collected at baseline and one follow up visit. A previously developed PsA-specific flare instrument (FLARE), range 0-10 was completed at both time points: mean interval 4.5 months. Using a patient-anchor question for perceived flare (yes/no), the optimal cut-off for defining a flare was obtained using ROC analysis. Based on this cut-off, patients were compared for flare yes/no using clinical and self-reported data, including composite measures of disease activity. The magnitude of score differences in people newly developing a disease flare were compared with independent samples t scores. Results Of 147 patients, 61 (41%) reported a flare at baseline; the optimal score cut-off from the FLARE questionnaire was 4 (sensitivity 0.86, specificity 0.76) and, using this cut-off patients in flare had significantly worse clinical and patient reported outcomes. Of those patients reporting a flare, the most frequently affirmed items from the questionnaire referred to pain, mobility, frustration and fatigue. Those with a new flare at the second visit had patient-reported and clinical change scores significantly worse than those not reporting a flare. Conclusion This study has provided further data on the FLARE questionnaire performance and validity. The instrument is ready for use in clinical trials and longitudinal observational studies.
Janus kinase inhibitors (JAKis) have emerged as effective treatments for several skin immune-mediated inflammatory diseases (IMIDs). However, safety concerns have been raised due to boxed warnings from rheumatoid arthritis trials, and whether these risks apply to skin IMIDs remains uncertain. This multinational retrospective cohort study used the TriNetX database to compare the real-world safety of JAKis and conventional immunomodulators (cIMs) in patients aged 12 years or older with skin IMIDs (psoriatic disease, atopic dermatitis, or alopecia areata). Patients newly prescribed JAKis (tofacitinib, upadacitinib, deucravacitinib, baricitinib, abrocitinib, or ritlecitinib) were propensity score-matched (1:1) with those prescribed cIMs (methotrexate or cyclosporine) based on demographics, baseline skin IMIDs, and comorbidities, yielding 17,068 matched patients. Over 2 years, the JAKi cohort showed lower incidences of all-cause mortality (0.28% vs. 0.62%; P = 0.015) and major adverse cardiovascular events (MACE; 1.15% vs. 1.95%; P = 0.005) than the cIM cohort, corresponding to reduced risks (mortality: HR, 0.47; 95% CI, 0.25-0.88; MACE: HR, 0.63; 95% CI, 0.46-0.88). Risks of venous thromboembolism (HR, 0.80; 95% CI, 0.43-1.48) and malignancy (HR, 0.85; 95% CI, 0.63-1.16) were not increased. Subgroup analyses, including older adults and those with cardiometabolic risk factors, showed no signal of increased risk, with consistent findings across available agent-level and sensitivity analyses. These results suggest that, over 2 years, JAKis are not associated with increased risks of mortality, MACE, venous thromboembolism, or malignancy compared with conventional systemic agents in patients with skin IMIDs.
Vaccination uptake was relatively low in this vulnerable population. Strategies promoting discussion with the rheumatologist about vaccination and before treatment could play a pivotal role in improving vaccination uptake among patients with AIIRD.
Background The therapeutic response to disease-modifying antirheumatic drugs (DMARDs) remains relatively low in psoriatic arthritis (PsA), leading to delayed disease control and frequent treatment switches. Predictive biomarkers may enable personalized treatment and earlier disease control. We aimed to identify transcriptomic and proteomic markers for tofacitinib or comparator treatment outcomes and develop a prediction model to support treatment decisions in PsA patients. Methods Baseline CD4+ T-cell transcriptomics and proteomics data from 80 PsA patients in the development cohort of the TOFA-PREDICT trial were analyzed. The TOFA-PREDICT trial is a four-arm randomized trial that was designed to discover profiles of PsA patients that predict response to tofacitinib as compared with methotrexate or etanercept. Forty DMARD-naïve patients were randomized to tofacitinib or methotrexate, and 40 patients who failed DMARD-treatment were randomized to add-on tofacitinib or etanercept. Treatment response was defined as reaching minimal disease activity at 16 weeks. Feature selection was performed in the full cohort and in each treatment subgroup using XGBoost and sPLS-DA. Using different modeling strategies, prediction models were developed that combine clinical variables with transcriptomic, proteomic, or integrated multi-omics predictors. The models were cross-validated and compared using AUC-ROC and their ability to identify the most promising treatment (tofacitinib versus control) per patient. Results Fifty percent of patients responded to treatment. Eighteen transcriptomic, ten proteomic, and two clinical predictors were selected. The integrated multi-omics model incorporating treatment–predictor interactions achieved the highest performance (AUC = 0.70 ± 0.19; variation (SD) in treatment-effects in patients 15.2% ± 14.8%). The selected proteins were significantly interconnected (p-value = 3.41E-5) and related to immune system processes. Conclusions Integrated baseline gene and protein expression profiles combined with clinical variables can predict treatment response and identify differential treatment
Arthritis comprises a spectrum of immune-mediated joint disorders, with rheumatoid arthritis (RA) representing prototypic autoimmunity and psoriatic arthritis (PsA) and ankylosing spondylitis (AS) spanning an autoinflammation–autoimmunity continuum. Across this spectrum, oxidative stress and inflammatory signaling reinforce each other within synovial/entheseal niches, sustaining immune activation and progressive structural damage. Excess reactive oxygen species (ROS) injure chondrocytes and synoviocytes, activate NF-κB and the NLRP3 inflammasome, and reprogram stromal–immune interactions; inflammatory mediators further increase ROS via NADPH oxidases, mitochondrial dysfunction, and immunometabolic perturbations, sustaining a “ROS–inflammation–ROS” loop. Nuclear factor erythroid 2–related factor 2 (Nrf2) is a redox-responsive transcription factor that, upon release from Keap1, drives antioxidant response element–dependent cytoprotective programs. Beyond antioxidation, Nrf2 can dampen NF-κB-linked transcription and modulate ferroptosis, pyroptosis, and autophagy while shaping macrophage and fibroblast-like synoviocyte states. Collectively, these actions position Nrf2 as a context-dependent redox checkpoint that may constrain inflammatory amplification and tune autoimmune-relevant processes (e.g., inflammatory antigen presentation and effector persistence) largely via microenvironmental remodeling rather than direct TCR/BCR inhibition. Here, we (i) map Nrf2-dependent versus Nrf2-independent nodes in the oxidative stress–inflammation circuit; (ii) compare cell type– and subtype-specific Nrf2 functions across RA, PsA, and AS; (iii) summarize pharmacologic and natural-product Nrf2 activators together with joint-targeted delivery strategies; and (iv) discuss evidence and gaps for Nrf2 in core autoimmune mechanisms, including self-tolerance, antigen handling, and pathogenic immune memory. This synthesis highlights Nrf2 as a mechanistic bridge between redox balance and immune regulation, informing Nrf2-centered therapies for autoimmune and immune-mediated arthritides.
Radiographic axial spondyloarthritis (r-axSpA), non-radiographic axial spondyloarthritis (nr-axSpA), and psoriatic arthritis (PsA) represent distinct yet overlapping entities within the spondyloarthritis (SpA) spectrum. Enthesitis has emerged as a unifying hallmark of these diseases, linking mechanical stress, immune dysregulation, and structural remodeling. Understanding similarities and differences in entheseal pathology among these entities may elucidate shared and divergent mechanisms driving disease pathogenesis and progression. Mechanical stress at entheses activates mechanosensitive pathways leading to inflammatory changes and eventually new bone formation. In both research and clinical practice, enthesitis is assessed though the use of clinical indices and imaging modalities, particularly ultrasound and Magnetic Resonance Imaging (MRI), while modern modalities emerge on. Despite shared inflammatory mechanisms, variations in cytokine profiles, soft tissue and underlying bone involvement drive disease-specific patterns of damage and repair in axial and peripheral sites. Combining standardized multimodal imaging with molecular biomarkers holds promise for refining classification, improving early diagnosis, and guiding targeted therapeutic strategies across the SpA spectrum. In this review we explore enthesitis from various standpoints, including pathophysiology, clinical and imaging approaches under the prism of the similarities and differences between PsA and AxSpA.
A newsletter aborda os avanços e desafios das mulheres na reumatologia e analisa o risco de recorrência oncológica em pacientes com miopatias inflamatórias, destacando a importância da vigilância nos primeiros três anos. São apresentadas as novas diretrizes da PANLAR para artrite reumatoide e estudos sobre a prevenção de osteonecrose no lúpus e o diagnóstico de osteoporose transitória do quadril em gestantes.
Objective This study aimed to identify distinct clinical phenotypes within a Chinese cohort of patients with psoriatic arthritis (PsA). Methods A total of 1074 patient data were analyzed from the Chinese Psoriatic Arthritis Registry (CREPAR). A two-step clustering approach was used to identify patient subtypes based on the unsupervised clustering of baseline clinical characteristics. Kaplan–Meier curves were used to compare long-term remission probabilities across subtypes, and Cox proportional hazards regression models were used to identify independent risk factors. Results The cluster analysis identified three subtypes of patients with distinct clinical presentations, laboratory tests, and prognoses. Cluster 1 patients presented with the most extensive and intense polyarticular inflammation, accompanied by a 'concentrated-severe' pattern of dactylitis across multiple sites. Patients in Cluster 2 had the least peripheral joint involvement, with an extremely low incidence of dactylitis (0.8%). Cluster 3 is characterised by dactylitis in almost all patients (98.9%), presenting a extensive pattern with moderate frequency across sites, alongside common peripheral arthritis. A survival analysis revealed highly significant differences between subtypes in the probability curves for non-remission. Across all subtypes, the Cox regression identified the following independent risk factors: a later age at onset of arthritis, a longer duration of psoriasis, and high baseline DAPSA scores. Conclusion The purpose of this study is to establish a clinical risk framework for Chinese PsA patients. Identification of high-risk patients based on specific joint/dactylitis patterns is crucial to guiding intensive treatment.
Objective Fecal microbiota transplantation (FMT) holds promises as a beneficial supplement to methotrexate in patients with psoriatic arthritis (PsA). We therefore investigated how gut bacterial signatures in patients and donor strain engraftment were associated with long‐term response to FMT. Methods This exploratory study is based on the FLORA trial cohort, encompassing 31 patients with moderate‐to‐high PsA disease activity and four FMT donors. Of the 15 patients receiving one single‐donor FMT, 13 were included in the per‐protocol (PP) population. Stool samples were collected before and after FMT (week 4, 12, and 26). We performed shotgun metagenomics to characterize gut microbiota features. Results At baseline, 17 patients (55%) had a gut microbiota community type dominated by the Bacteroides genus (B‐type), whereas 14 (45%) had a Prevotella ‐driven community type (P‐type). The B‐ and P‐type patients did not differ in disease activity or demographics, but the B‐type had a significantly higher species diversity compared to the P‐type ( P = 0.005). In the PP population, five of seven B‐type patients versus none of six P‐type patients ( P = 0.021) achieved a long‐term clinical beneficial response at week 26. Bacterial strain richness increased significantly from baseline to week 4 and week 26 in B‐type ( P = 0.016), but not in P‐type, patients. Eighteen engrafted strains persisted only in B‐type recipients by week 26, including a Bacteroides clarus strain, which demonstrated a negative effect size regarding arthritis pain and the patients’ global assessment of disease. Conclusion Recipients with a Bacteroides ‐dominated community structure were more likely to achieve long‐term beneficial response following one FMT.
Objective Cellular mechanisms driving transition from psoriasis to psoriatic arthritis have remained largely elusive. Thus, we investigated changes within the peripheral blood T cell compartment associated with the transition phase. Methods In an observational study, 116 patients were examined and categorized into subgroups including psoriasis with at least one risk factor for transition to psoriatic arthritis, subclinical psoriatic arthritis according to EULAR taskforce recommendations from 2023, and definitive psoriatic arthritis meeting the Classification Criteria for Psoriatic Arthritis. Demographic and clinical characteristics of patient subgroups were analyzed. Deep T cell phenotyping using multicolor flow cytometry and machine‐learning techniques were applied. Results Overlapping T cell endotypes were found among patients with subclinical psoriatic arthritis exhibiting the most notable divergence from the others. Frequencies of effector memory CD4 + T cells, Th17, and Tc17 cells differed among patients with psoriasis with at least one risk factor for transition, subclinical psoriatic arthritis, and psoriatic arthritis. Transition‐associated changes of Tc17 cell frequencies were confirmed by machine‐learning–assisted unsupervised clustering analysis. Moreover, patients with enthesitis could be distinguished from those without, with Tc17 cells being the main distinctive feature. Conclusion Transition from psoriasis to psoriatic arthritis was associated with distinct alterations of the peripheral blood T cell compartment, with Tc17 cells exhibiting the greatest discriminatory power. These findings provide insight into pathomechanisms driving disease progression during transition from psoriasis to psoriatic arthritis and identify Tc17 cells as the foremost novel potential therapeutic target for the prevention of transition.
Objective Glucagon‐like peptide 1 receptor agonists (GLP‐1RAs) and sodium‐glucose cotransporter 2 inhibitors (SGLT2i) facilitate weight loss and exhibit immunomodulatory effects, but their impact on the risk of developing autoimmune rheumatic diseases (ARDs) is unclear. We compared ARD incidence following initiation of GLP‐1RAs or SGLT2i versus a weight‐neutral comparator (dipeptidyl peptidase 4 inhibitors [DPP4i]). Methods We performed a population‐based cohort study using administrative health data from a Canadian province with universal health care. We included adults with type 2 diabetes (T2D) and no prior ARD initiating a GLP‐1RA, SGLT2i, or DPP4i between January 1, 2014, and December 31, 2022. Incident ARD cases, including rheumatoid arthritis, psoriatic disease, axial spondyloarthritis, and systemic ARDs (SARDs; systemic lupus erythematosus, systemic sclerosis, Sjögren disease, idiopathic inflammatory myopathies, and systemic vasculitides), were identified using validated algorithms. Propensity score (PS) weighting was used to balance cohorts at treatment initiation. Then hazard ratios (HRs) were estimated using Cox regression. Results Among 229,300 adults, 49,514 initiated GLP‐1RAs, 101,925 initiated SGLT2i, and 77,861 initiated DPP4i. After PS weighting, ARD incidence per 10,000 person‐years was 29.1 (95% confidence interval [CI] 23.5–35.5) with GLP‐1RAs, 24.4 (95% CI 19.8–29.7) with SGLT2i, and 27.3 (95% CI 22.1–33.4) with DPP4i. Mean follow‐up was 1.3 to 1.6 years. Relative to DPP4i, adjusted HRs (aHRs) of ARD were 1.04 (95% CI 0.81–1.33) with GLP‐1RAs and 0.93 (95% CI 0.75–1.16) with SGLT2i. Risk of SARDs, but not other diseases, was lower with SGLT2i versus DPP4i (aHR 0.51 [95% CI 0.31–0.84]). Conclusion Neither GLP‐1RA nor SGLT2i treatment was associated with increased or decreased ARD risk versus DPP4i in adults with T2D; however, SGLT2i use was associated with significantly lower risk of SARDs, warranting further study. image
Objective To evaluate the clinical characteristics, social deprivation, insurance coverage, and medication use across regional subsets of patients with psoriatic arthritis (PsA) in the US. Methods A cross‐sectional study of patients with PsA in the Rheumatology Informatics System for Effectiveness (RISE) registry between January 2020 and March 2023 was conducted. Distribution of high disease activity (HDA; Routine Assessment of Patient Index Data >12), high comorbidity (RxRisk ≥90th percentile), high Area Deprivation Index (ADI ≥80), insurance coverage, prednisone ≥10 mg daily, and all disease‐modifying antirheumatic drug (DMARD) therapies across geographic regions were evaluated. Logistic regression models were used to identify regional correlates of HDA and comorbidity. Results Of the 32,732 RISE patients with PsA, 58.8% were White women (mean age 57.7 [SD 13.5] years) with private insurance (60%); 55.8% resided in the South. A majority (81.8%) had a body mass index of ≥25, highest in the Midwest (mean 32.4 ± SD 7.8). Women, despite having prevalent HDA, received less biologic DMARD therapy. Both HDA and ADI of ≥80 were more prevalent in the South and Midwest. Compared to the Northeast, Midwest patients had a higher burden of comorbidity (adjusted odds ratio 1.59, 95% confidence interval 0.98 – 2.59) with frequent use of prednisone in conjunction with conventional DMARDs (31.3% vs Northeast 20.5%, South 13.6%, West 17.6%). Uveitis affected 1.2% of the cohort. Only 14 (7.1%) and 20 (10.1%) RISE practices provided care for half of all Medicaid and high‐deprivation patients, respectively. Conclusion PsA disease characteristics and care vary across the US, with higher‐than‐expected prednisone use and unequal provider care burden in some regions. Further work is needed to assess the impact of varied regional care on disease outcomes.
Immune-mediated inflammatory arthritides (IMIA), including rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis, are chronic immune-driven disorders in which long-term malignancy safety has become a key determinant of therapeutic decision-making. Patients with IMIA are not oncologically neutral at baseline; persistent inflammatory burden, smoking exposure, age, and cumulative immunosuppressive treatment all modify cancer susceptibility. Against this background, biologic and targeted synthetic disease-modifying antirheumatic drugs may both reduce inflammation-associated oncogenic pressure and attenuate antitumor immune surveillance. In this narrative review, we synthesize current evidence on tumor safety across major biologic classes and Janus kinase inhibitors, with emphasis on data emerging through early 2026. Overall, most biologic therapies appear broadly reassuring with respect to overall malignancy, although non-melanoma skin cancer remains the most reproducible treatment-associated signal, particularly with tumor necrosis factor inhibitors and possibly abatacept. Rituximab retains a favorable profile in patients with prior lymphoproliferative disease, whereas IL-6 and IL-17/23 pathway inhibitors appear largely neutral or reassuring in currently available datasets. By contrast, JAK inhibitors require greater caution in risk-enriched rheumatoid arthritis populations, especially older patients, smokers, and those with prior malignancy or prolonged treatment exposure. Recent register-based studies have shown that overall cancer incidence with JAK inhibitors is comparable to that with TNF inhibitors, although lung and keratinocyte cancers occur more frequently in certain risk groups; accordingly, updated 2025 EULAR guidance recommends early initiation of targeted therapy after cancer remission and tailoring drug choice to prior cancer type and patient-specific factors. We further examine tumor-type-specific patterns, major modifiers of risk, and practical risk-stratified management strategies. The central clinical message is that malignancy safety in IMIA should be interpreted through an individualized framework that balances inflammatory control against oncologic vulnerability rather
Rheumatic and musculoskeletal diseases (RMDs) confer an increased cardiovascular risk beyond traditional factors, with peripheral artery disease (PAD) being an important source of morbidity and disability in these patients. This review summarizes current evidence on PAD across RMDs, including rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, systemic sclerosis, polymyalgia rheumatica, psoriatic arthritis, and primary Sjögren's syndrome. Physiopathological mechanisms involved include persistent inflammation, immune dysregulation, and the presence of pathogenic autoantibodies. Protective humoral responses have also been linked to reduced CV risk and may serve as future biomarkers. Clinical studies reveal variable PAD prevalence across diseases but consistent high underdiagnosis. Optimal management requires aggressive CV risk control, including lipid-lowering, immunomodulatory, and biologic therapies. This review underscores PAD as a distinct and clinically relevant manifestation of systemic autoimmunity, calling for targeted screening and prevention strategies in rheumatic populations.
Background While ankylosing spondylitis (AS) and psoriatic arthritis (PsA) share similar immune dysregulation, their relative risks for inflammatory bowel disease (IBD), including definitive subtypes (Crohn’s disease [CD] and ulcerative colitis [UC]) and possible subtypes (indeterminate colitis [IC] and microscopic colitis [MC]), remain unquantified. We aimed to establish comparative IBD risk gradients among AS, psoriasis (PSO), and PsA cohorts. Methods The study utilized a long-term retrospective cohort design by analyzing an electronic health record database. Propensity score matching (PSM) was used to adjust multiple confounders. Cox proportional hazards models and log rank test were employed to evaluate the risk of IBD development. Results The study included 26,610 patients with AS and 322,317 with PSO (2005–2023). After PSM, 26,569 matched pairs were analyzed. Compared to PSO, AS was associated with a significantly higher risk of definite IBD [hazard ratio (HR) = 2.96, 95% CI: 2.64–3.33], CD (HR = 3.38, 95% CI: 2.90–3.94), UC (HR = 2.43, 95% CI: 2.07–2.85), and IC (HR = 2.45, 95% CI: 1.33–4.51), but not MC. Subgroup analyses confirmed a consistently higher IBD risk in AS across all ages, sexes, races, BMI categories, and comorbidity profiles. Compared to the general population, AS conferred the highest independent risk for definite IBD (HR = 4.22, 95% CI: 3.60–4.94), followed by PsA (HR = 1.52) and PSO (HR = 1.37). AS also showed a 2.60-fold higher definite IBD risk than PsA (95% CI: 2.32–2.92). Conclusions AS is the phenotype most strongly associated with IBD among the studied spectrum. Compared to PSO, AS confers a significantly higher risk of CD, UC, and IC, and it carries a greater burden of definite IBD than PsA or the general population.
Sex differences in axial spondyloarthritis (axSpA) are increasingly recognized, with women often reporting higher disease burden despite similar objective inflammatory markers. This study aimed to compare clinical features, disease activity, function, quality of life, and treatment patterns between men and women with axSpA and identify sex-specific predictors of disease outcomes using data from the Brazilian Registry of Spondyloarthritis (RBE). This was a cross-sectional, observational study based on data from the RBE, a nationwide multicenter cohort including 828 patients (568 men and 260 women) from 17 referral centers across Brazil. Standardized clinical and demographic data were collected using the REDCap platform. Disease activity (ASDAS-CRP, BASDAI), physical function (BASFI), spinal mobility (BASMI), and quality of life (ASQoL) were assessed with validated instruments. Sex-stratified multivariable linear regression models were constructed to identify independent predictors of each outcome. Women presented higher disease activity (median BASDAI 4.5 vs. 3.2; ASDAS-CRP 2.2 vs. 1.9), greater functional limitation (BASFI 5.0 vs. 4.0), and poorer quality of life (ASQoL 9.0 vs. 7.0) compared to men, despite similar CRP levels. Psychological distress was more frequent in women, while men had worse spinal mobility (BASMI 4.0 vs. 3.5) and higher HLA-B27 positivity. Regression models revealed that shoulder and hip pain were relevant predictors of disease activity in both sexes, but psychological factors and work activity more strongly influenced outcomes in women. Men’s disease burden was more associated with structural damage and cardiometabolic comorbidities. This study highlights distinct sex-related clinical patterns in axSpA. Women reported higher symptom burden, functional limitations, and reduced quality of life, largely influenced by subjective symptoms and comorbidities. Conversely, men presented greater structural impairment and different comorbidity profiles. These findings support the need for sex-informed clinical assessments