scholarly journals POS1001 CLINICAL AND SURROGATE CARDIOVASCULAR RISK ASSESSMENT AND ITS RELATIONSHIP WITH PSORIATIC ARTHRITIS PATHOGENESIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 769.1-769
Author(s):  
N. Barbarroja Puerto ◽  
I. Arias de la Rosa ◽  
C. Román-Rodriguez ◽  
I. Gómez García ◽  
C. Perez-Sanchez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Peripheral Blood ◽  
Molecular Mechanisms ◽  
Mononuclear Cells ◽  
Cv Disease

Background:Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with an increased prevalence of cardiovascular (CV) events. Traditional CV risk factors do not account for the increased CV disease mortality in PsA. Inflammation seems to have a key role in the development of this comorbidity, however the specific molecular mechanisms involved are not defined yet.Objectives:To evaluate clinical CV risk factors and surrogate markers and their relationship with inflammation, disease activity and metabolic comorbidities in PsA patientsMethods:This is a cross-sectional study including 100 PsA patients without CV disease recruited in the routine clinical practice at the Rheumatology Department, Reina Sofia Hospital of Cordoba and 100 age-matched healthy donors (HDs). Different parameters related to the cardiometabolic risk were analyzed. Clinical and analytical parameters were collected: lipid profile (cholesterol, HDL, LDL, TG, ApoA and ApoB), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAPSA, VAS, CRP and ESR. To measure the persistence of inflammation, CRP levels were recorded retrospectively once, twice, or three times during the 5 years prior to study and at the moment of the study. Increased levels of CRP in at least 50% of the determinations was considered as persistent inflammation. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood of patients and HDs. A panel of 92 proteins involved in CV disease and an adipocytokine profile was measured in plasma and PBMCs. In addition, activation of 18 intracellular pathways involved in cell activation was also measured in PBMCs. In vitro experiments in adipocytes treated with serum from PsA patients were also carried out.Results:Traditional CV risk factors including atherogenic risk, insulin resistance (IR), metabolic syndrome, smoking, obesity, arterial hypertension, apolipoprotein B/A risk, type 2 diabetes mellitus and the levels of SCORE were significantly increased in PsA patients. The presence of IR was associated with disease activity markers (DAPSA, ESR and CRP). In fact, the HOMA-IR index was related to the CRP persistence. PsA patients with obesity had significantly increased the number of tender and swollen joints, the levels of DAPSA and CRP. Twenty-eight proteins involved in CV disease and six adipocytokines were significantly elevated in the plasma of PsA patients. Several of these cardiovascular molecules were associated with higher levels of DAPSA (CTSD, GAL3, CD163, FABP4, IL6 and IL1RT2), acute phase reactants (GAL3, TNFα, Adiponectin, TNFR1 and IL6), affected body surface area (IL2RA, GAL3, CCL15, TRAP, CSTB, CD163, OPG and CNTN1) and onychopaty (TRAP, VWF, MCP-1, GAL3, LTBR, TFPI, CHI3L1, CTSZ and JAM-A). In addition, the mRNA expression of most of those 28 CV molecules were significantly increased in PBMCs from PsA patients. At intracellular level, the activation of 11 kinases (ERK1/2, AKT, S6 Ribosomal, mTOR, HSP27, Bad, p70 S6 kinase, PRAS40, p53 and caspase-3) involved in insulin signaling, inflammation, cell survival and apoptosis were altered in PBMCs. Finally, serum from PsA patients was able to modify the expression of these molecules in adipocytes.Conclusion:1) Disease activity and inflammatory burden are closely associated with the presence of metabolic alterations, specifically obesity and IR in patients with PsA. 2) The development of IR is extremely related to the persistence of CRP levels in the previous 5 years. 3) Inflammation is closely associated to the adipose tissue dysfunction in PsA and 4) FABP4, CD163 and GAL3 are surrogate CV markers commonly associated with clinical features of PsA, suggesting the role of these molecules linking CVD and PsA pathogenesis.Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.Disclosure of Interests:None declared.

Clinical and Patient-reported Outcomes in Patients with Psoriatic Arthritis (PsA) by Body Surface Area Affected by Psoriasis: Results from the Corrona PsA/Spondyloarthritis Registry

2017 ◽  
Vol 44 (8) ◽  
pp. 1151-1158 ◽  
Author(s):  
Philip J. Mease ◽  
Chitra Karki ◽  
Jacqueline B. Palmer ◽  
Carol J. Etzel ◽  
Arthur Kavanaugh ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Patient Reported Outcomes ◽  
Skin Lesions ◽  
Skin Involvement ◽  
Activity Impairment ◽  
Patient Reported

Objective.Psoriatic arthritis (PsA) is commonly comorbid with psoriasis; the extent of skin lesions is a major contributor to psoriatic disease severity/burden. We evaluated whether extent of skin involvement with psoriasis [body surface area (BSA) > 3% vs ≤ 3%] affects overall clinical and patient-reported outcomes (PRO) in patients with PsA.Methods.Using the Corrona PsA/Spondyloarthritis Registry, patient characteristics, disease activity, and PRO at registry enrollment were assessed for patients with PsA aged ≥ 18 years with BSA > 3% versus ≤ 3%. Regression models were used to evaluate associations of BSA level with outcome [modified minimal disease activity (MDA), Health Assessment Questionnaire (HAQ) score, patient-reported pain and fatigue, and the Work Productivity and Activity Impairment questionnaire score]. Adjustments were made for age, sex, race, body mass index, disease duration, and history of biologics, disease-modifying antirheumatic drug, and prednisone use.Results.This analysis included 1240 patients with PsA with known BSA level (n = 451, BSA > 3%; n = 789, BSA ≤ 3%). After adjusting for potential confounding variables, patients with BSA > 3% versus ≤ 3% had greater patient-reported pain and fatigue and higher HAQ scores (p = 2.33 × 10−8, p = 0.002, and p = 1.21 × 10−7, respectively), were 1.7× more likely not to be in modified MDA (95% CI 1.21–2.41, p = 0.002), and were 2.1× more likely to have overall work impairment (1.37–3.21, p = 0.0001).Conclusion.These Corrona Registry data show that substantial skin involvement (BSA > 3%) is associated with greater PsA disease burden, underscoring the importance of assessing and effectively managing psoriasis in patients with PsA because this may be a contributing factor in PsA severity.

Risk Factors for Bleeding during Treatment of Acute Venous Thromboembolism

1996 ◽  
Vol 76 (05) ◽  
pp. 682-688 ◽  
Author(s):  
Jos P J Wester ◽  
Harold W de Valk ◽  
Karel H Nieuwenhuis ◽  
Catherine B Brouwer ◽  
Yolanda van der Graaf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Small Body ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Risk Of Bleeding ◽  
Acute Venous Thromboembolism

Summary Objective: Identification of risk factors for bleeding and prospective evaluation of two bleeding risk scores in the treatment of acute venous thromboembolism. Design: Secondary analysis of a prospective, randomized, assessor-blind, multicenter clinical trial. Setting: One university and 2 regional teaching hospitals. Patients: 188 patients treated with heparin or danaparoid for acute venous thromboembolism. Measurements: The presenting clinical features, the doses of the drugs, and the anticoagulant responses were analyzed using univariate and multivariate logistic regression analysis in order to evaluate prognostic factors for bleeding. In addition, the recently developed Utrecht bleeding risk score and Landefeld bleeding risk index were evaluated prospectively. Results: Major bleeding occurred in 4 patients (2.1%) and minor bleeding in 101 patients (53.7%). For all (major and minor combined) bleeding, body surface area ≤2 m2 (odds ratio 2.3, 95% Cl 1.2-4.4; p = 0.01), and malignancy (odds ratio 2.4, 95% Cl 1.1-4.9; p = 0.02) were confirmed to be independent risk factors. An increased treatment-related risk of bleeding was observed in patients treated with high doses of heparin, independent of the concomitant activated partial thromboplastin time ratios. Both bleeding risk scores had low diagnostic value for bleeding in this sample of mainly minor bleeders. Conclusions: A small body surface area and malignancy were associated with a higher frequency of bleeding. The bleeding risk scores merely offer the clinician a general estimation of the risk of bleeding. In patients with a small body surface area or in patients with malignancy, it may be of interest to study whether limited dose reduction of the anticoagulant drug may cause less bleeding without affecting efficacy.

Pulmonary valve replacement following repair of tetralogy of Fallot: comparison of outcomes between bio- and mechanical prostheses

2021 ◽  
Author(s):  
Dong-Hee Kim ◽  
Eun Seok Choi ◽  
Bo Sang Kwon ◽  
Tae-Jin Yun ◽  
Seul Gi Cha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surface Area ◽  
Body Surface Area ◽  
Valve Replacement ◽  
Body Surface ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Prosthesis Failure ◽  
Mechanical Prosthesis ◽  
Mechanical Prostheses

Abstract OBJECTIVES The aims of this study were to evaluate and compare the outcomes after pulmonary valve replacement (PVR) with a mechanical prosthesis (MP) and a bioprosthesis (BP). METHODS From 2004 through 2017, a total of 131 patients, who had already been repaired for tetralogy or Fallot or its variants, underwent their first PVR with an MP or a BP. Outcomes of interests were prosthesis failure (stenosis >3.5 m/s, regurgitation >mild or infective endocarditis) and reintervention. RESULTS The median age at PVR was 19 years. BP and MP were used in 88 (67.2%) and 43 (32.8%) patients, respectively. The median follow-up duration was 7.4 years, and the 10-year survival rate was 96.4%. Risk factors for prosthesis failure were smaller body surface area [hazard ratio (HR) 0.23 per 1 m2, P = 0.047] and smaller prosthesis size (HR 0.73 per 1 mm, P = 0.039). Risk factors for prosthesis reintervention were smaller body surface area (HR 0.11 per 1 m2, P = 0.011) and prosthesis size (HR 0.67 per 1 mm, P = 0.044). Probability of prosthesis failure and reintervention at 10 years were 24.6% (19.5% in BP vs 34.8% in MP, P = 0.34) and 7.8% (5.6% in BP vs 11.9% in MP, P = 0.079), respectively. Anticoagulation-related major thromboembolic events were observed in 4 patients receiving an MP. CONCLUSIONS MP might not be superior to BP in terms of prosthesis failure or reintervention. MP should be carefully considered for highly selected patients in the era of transcatheter PVR.

Abstract P026: Early Repolarization Pattern is Associated With Increased Left Ventricular Mass and Left Ventricular Hypertrophy: Results From the Dallas Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
David A McNamara ◽  
Ari Bennett ◽  
Jarett D Berry ◽  
Mark S Link
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Left Ventricular ◽  
Percent Body Fat ◽  
Early Repolarization ◽  
Heart Study ◽  
Dallas Heart Study

Introduction: Recent studies have shown an association between early repolarization pattern (ERP) ECG morphology and sudden cardiac death. The role of left ventricular mass (LVM) as a potential mediator of ERP has not been well explored. Methods: Participants in the Dallas Heart Study who underwent an ECG and cardiac MRI (CMR) were assessed for ERP, defined as J-point elevation ≥1 mm in any 2 contiguous leads. We compared participants with and without ERP by age, gender, race/ethnicity, established cardiovascular risk factors of diabetes, hypertension and hyperlipidemia, lean body mass and percent body fat, and CMR-derived LVM, LVM/body surface area, and LVH defined by standard criteria, using Student’s T-tests and chi-squared tests where appropriate. Results: Of the 3,015 participants in our study, 276 (9.2%) had ERP. Participants with ERP were younger (43±9 vs 44±10 yrs, p=0.04), more prevalent in blacks than non-blacks (14 vs 5.0%, p<0.00001), and in men than women (18 vs 2.0%, p<0.00001). Baseline cardiovascular risk factors were not significantly different. Participants with ERP demonstrated higher lean body mass (59±10 vs 52±11 kg, p<0.00001) and lower percent body fat (27±8 vs 36±9%, p<0.00001). The presence of ERP was associated with greater LVM, increased LVM/body surface area, and the presence of LVH in the overall population and in analyses stratified by sex (Table 1). Conclusion: In a large, multi-ethnic cohort, ERP is associated with increased total LVM, increased LVM/body surface area, and LVH. These novel associations may provide insight into the biology of ERP. Further studies investigating the relationship of LVM and LVH with ERP are warranted.

scholarly journals Identification of risk factors for bleeding during treatment of acute venous thromboembolism with heparin or low molecular weight heparin

Blood ◽  
1991 ◽  
Vol 78 (9) ◽  
pp. 2337-2343 ◽  
Author(s):  
HK Nieuwenhuis ◽  
J Albada ◽  
JD Banga ◽  
JJ Sixma
Keyword(s):  
Risk Factors ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Performance Status ◽  
Bleeding Tendency ◽  
Who Grade ◽  
Risk Of Bleeding ◽  
History Of ◽  
Acute Venous Thromboembolism

Abstract In a prospective double-blind trial, we treated 194 patients with acute venous thromboembolism with heparin or low molecular weight heparin (LMWH; Fragmin). To evaluate the most important prognostic factors for bleeding, the presenting clinical features of the patients, the patients' anticoagulant responses, and the doses of the drugs were analyzed using univariate and multivariate regression analyses. No significant differences in clinical risk factors associated with bleeding were observed between heparin and LMWH. The univariate analyses ranked the parameters in the following order of importance: World Health Organization (WHO) performance status, history of bleeding tendency, cardiopulmonary resuscitation, recent trauma or surgery, leukocyte counts, platelet counts, duration of symptoms, and body surface area. Patients with WHO grade 4 had an eightfold increase in risk of bleeding as compared with WHO grade 1. Assessment of the individual contribution of each variable using multivariate regression analysis showed that the WHO performance status was the most important independent factor predicting major bleeding. A history of a bleeding tendency, recent trauma or surgery, and body surface area were also independent risk factors. The risk of bleeding was influenced by two factors related to the treatment, the patient's anticoagulant response as measured with the anti-Xa assay and the dose of the drug expressed as U/24 h/m2. An increased risk of bleeding was only observed at mean anti-Xa levels greater than 0.8 U/mL for both drugs. Significantly more major bleedings occurred in patients treated with high doses of the drugs, an observation that was independent of the concomitant anti-Xa levels. It should be considered whether choosing an appropriate initial dose adapted to the patient's body surface area and clinical risk factors can improve the efficacy to safety ratio of heparin treatment.

scholarly journals Body surface area, height, and body fat percentage as more sensitive risk factors of cancer and cardiovascular disease

2020 ◽  
Vol 9 (12) ◽  
pp. 4433-4446 ◽  
Author(s):  
Shucheng Si ◽  
Marlvin A. Tewara ◽  
Xiaokang Ji ◽  
Yongchao Wang ◽  
Yanxun Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Fat ◽  
Body Surface ◽  
Body Fat Percentage ◽  
Fat Percentage

Practical Assessment of Psoriasis Clinical Severity in both Clinical Trials and Clinical Practice Settings: A Report from the GRAPPA 2016 Annual Meeting

2017 ◽  
Vol 44 (5) ◽  
pp. 691-692 ◽  
Author(s):  
Joseph F. Merola ◽  
Alice B. Gottlieb
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Surface Area ◽  
Annual Meeting ◽  
Body Surface Area ◽  
Body Surface ◽  
Clinical Setting ◽  
Global Assessment ◽  
Clinical Severity

At the 2016 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we presented the case for quantitatively assessing the extent of both psoriasis and psoriatic arthritis in the clinical setting, with a particular focus on the validation and expanded novel use of the PGAxBSA (static physician’s global assessment × body surface area of involvement) in the era of targeted metrics. Herein, we summarize our presentation.

scholarly journals POS0413 COMPREHENSIVE IMMUNE PROFILING OF PERIPHERAL BLOOD IN PSORIATIC ARTHRITIS (PsA) PATIENTS: EXPANSION OF INTERMEDIATE MONOCYTES AND DECREASED T REG AND CD8 T CELLS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 436.1-436
Author(s):  
A. Grivas ◽  
M. Grigoriou ◽  
P. Katsimpri ◽  
P. Verginis ◽  
D. Boumpas
Keyword(s):  
T Cells ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Immune Cell ◽  
Psoriatic Skin ◽  
Parametric Data ◽  
Hla Dr ◽  
Intermediate Monocytes

Background:Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis that develops in a subset of patients with psoriasis. According to the current paradigm, cells of the innate and adaptive immunity interact with resident tissue fibroblasts mounting an inflammatory response via complex cytokine networks in the skin and joints in which type 1 and type 17 T cells play a dominant role. The abundance and relative contribution of other peripheral blood immune cells to disease pathogenesis as well the molecular signature of peripheral blood mononuclear cells and tissue fibroblasts remain ill defined.Objectives:To comprehensively characterize immune cell subsets driving inflammation in the peripheral blood of patients with active PsA and their impact on psoriatic skin fibroblasts.Methods:Peripheral blood was collected from PsA patients (n=31) and age-/sex-matched healthy individuals (HI) (n=9), after informed consent. Psoriatic skin biopsies were acquired from a subset of 5 patients and 3 HI. All patients fulfilled the CASPAR criteria for the diagnosis and displayed peripheral polyarthritis of moderate- to high-disease activity. Patients’ demographic and clinical data were recorded at time of sampling. Disease activity was assessed using the Disease Activity Index for Psoriatic arthritis (DAPSA) score. Skin psoriasis activity indices, enthesitis and dactylitis were also recorded. Peripheral blood mononuclear cells (PBMCs) were isolated by ficoll density gradient centrifugation. Flow cytometry was performed using a BD FACS-Aria-III and analyzed using FlowJo software. The antibody staining panel utilized aimed at the identification of the following immune cell subsets: Monocyte subsets (HLA-DR+ CD14+/- CD16+/-), Plasmacytoid dendritic cells (HLA- DR+ CD123+), T helper (CD4+), cytotoxic T (CD8+), regulatory T (CD4+ CD25+ CD127-) and B cells (CD19+). Statistical analyses were performed using GraphPad Prism software. Differences between groups were compared using unpaired T test for parametric data; Mann-Whitney and Kruskal Wallis tests for non-parametric data. The level of significance was set at P<0.05.Results:9 males and 22 females PsA patients are included (mean age 50 years and the mean disease duration 19.2 years for skin disease and 5.9 years for arthritis). The mean DAPSA score was 43.4, suggestive of high disease activity, while 8 (26%) patients displayed clinical enthesitis at time of sampling. Flow cytometry analysis revealed aberrancies in peripheral blood immune cell populations. More specifically, PsA patients displayed a significant increase in intermediate monocyte subset (HLA-DR+ CD14+ CD16+) compared to HI with patients with clinical enthesitis demonstrating a more exaggerated expansion of intermediate monocytes compared to patients without enthesitis. A trend towards increased patrolling monocytes (HLA-DR+ CD14- CD16+) was also noted although this did not reach statistical significance. In contrast, both regulatory T cells and cytotoxic CD8+ T cells were significantly decreased probably due to their selective migration at the sites of inflammation. RNA-seq from whole blood and skin fibroblasts from affected skin are in progress.Conclusion:These data demonstrate significant expansion of intermediate monocytes -more pronounced in the enthesitis affected individuals- and decrease in T regulatory cells and T cytotoxic cells in PsA peripheral blood. Increased antigen presentation and co-stimulation mediated via intermediate monocytes in combination with their proangiogenic properties may contribute to disease pathogenesisReferences:[1]Veale, D. J. & Fearon, U. The pathogenesis of psoriatic arthritis. The Lancet (2018) doi:10.1016/S0140-6736(18)30830-4.Disclosure of Interests:None declared

Body surface area affected by psoriasis and the risk for psoriatic arthritis: a prospective population-based cohort study

Rheumatology ◽  
2021 ◽  
Author(s):  
Alexis Ogdie ◽  
Daniel B Shin ◽  
Thorvardur Jon Love ◽  
Joel M Gelfand
Keyword(s):  
Cohort Study ◽  
Psoriatic Arthritis ◽  
Surface Area ◽  
Body Surface Area ◽  
General Practitioners ◽  
Body Surface ◽  
Strong Predictor ◽  
Population Based ◽  
Health Improvement ◽  
Psoriasis Severity

Abstract Objective Increasing psoriasis severity has been associated with comorbidities including cardiovascular disease. The objective of this study was to examine the association of psoriasis severity with the development of psoriatic arthritis (PsA). Methods A prospective population-based cohort study was performed within The Health Improvement Network, a United Kingdom medical record database. Patients aged 25–60 years with a code for psoriasis were randomly selected between 2008–2011. Questionnaires were sent to their general practitioners to confirm the diagnosis of psoriasis and provide the patient’s approximate body surface area (BSA). Incidence of PsA was calculated by BSA, and Cox proportional hazard ratios were used to examine the risk of developing PsA by BSA category after adjusting for other covariates. Results Among 10 474 questionnaires sent, 9,987 (95%) were returned, 9,069 (91%) had confirmed psoriasis, and BSA was provided for 8,881 patients: 52% had mild psoriasis, 36% moderate psoriasis, and 12% severe psoriasis. The mean age was 46, and 49% were female. Mean follow-up time was 4.2 years (SD 2.1); the incidence of PsA was 5.4 cases per 1,000 person years. After adjusting for age and sex, BSA &gt;10% (HR 2.01, 95% CI: 1.29–3.13), BSA 3–10% (HR 1.44, 95% CI: 1.02–2.03), obesity (HR 1.64, 95% CI: 1.19–2.26), and depression (HR 1.68, 95% CI: 1.21–2.33) were associated with incident PsA. Conclusions In this large prospective cohort study, BSA assessed by general practitioners was a strong predictor of developing PsA, and obesity and depression were additive risk factors.

Two Cases of Worsening Psoriasis After Switching From Ustekinumab to Guselkumab

2019 ◽  
Vol 4 (3) ◽  
pp. 153-154 ◽  
Author(s):  
Rachel G. Casseres ◽  
David Rosmarin
Keyword(s):  
Psoriatic Arthritis ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Inadequate Response ◽  
Joint Symptoms ◽  
Interleukin 23

Introduction: Guselkumab is an Interleukin-23 inhibitor that has been shown to be effective for the treatment of psoriasis even in patients with an inadequate response to ustekinumab. At this time, there are no published reports of worsening psoriasis or psoriatic arthritis on guselkumab compared to ustekinumab. Methods: We reviewed the charts of two patients with psoriasis who were treated in our clinic with guselkumab after failing treatment with ustekinumab. Results: The patient in case 1 experienced a psoriasis flare after switching from ustekinumab to guselkumab. The patient in case 2 has an increase in body surface area of her psoriasis as well as worsening joint symptoms while on guselkumab compared to ustekinumab. Discussion: Not all patients will have a superior response to guselkumab than ustekinumab.

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