scholarly journals Using Acute-phase Reactants to Inform the Development of Instruments for the Updated Psoriatic Arthritis Core Outcome Measurement Set

2018 ◽  
Vol 46 (3) ◽  
pp. 266-273 ◽  
Author(s):  
Musaab Elmamoun ◽  
Ying Ying Leung ◽  
Denis O’Sullivan ◽  
Ingrid Steinkoenig ◽  
Vinod Chandran ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Construct Validity ◽  
Acute Phase ◽  
Systemic Inflammation ◽  
Outcome Measurement ◽  
Cardiovascular Outcomes ◽  
Inflammatory Biomarkers ◽  
Response Criteria ◽  
Acute Phase Reactants

Objective.Systemic inflammationˆ is assessed through measurement of acute-phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). With few exceptions, most randomized controlled trials (RCT) have assessed acute-phase reactants (CRP and ESR) as part of the American College of Rheumatology (ACR) 20 response criteria. As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)–Outcome Measures in Rheumatology (OMERACT) working group, we performed a systematic review of the literature to assess the performance of inflammatory biomarkers in psoriatic arthritis (PsA).Methods.A systematic search of PubMed and Embase was performed. The search included peer-reviewed articles and scientific meeting abstracts about RCT and longitudinal observational studies that assessed systemic inflammation using acute-phase reactants in PsA. Studies were assessed following the components of the OMERACT filter including construct validity, responsiveness, and predictive validity.Results.There were 2764 articles retrieved, and 71 articles were included for this systematic review. Twenty-eight articles reported CRP and/or ESR separately, and the remaining articles reported CRP and/or ESR as part of the ACR response criteria. Studies assessing OMERACT responsiveness provided conflicting reports. Inflammatory biomarkers had construct validity for more active disease. Evidence suggests that an elevation of ESR predicts cardiovascular outcomes.Conclusion.Data regarding assessment of systemic inflammation using acute-phase reactants (CRP and ESR) are limited. There is only weak evidence to support normalization of these biomarkers in predicting good clinical outcomes/remission criteria. The predictive value for cardiovascular outcomes was generally good. Further studies to assess systemic inflammation in PsA using acute-phase reactants and other laboratory biomarkers are needed.

scholarly journals AB0027 B CELL SYNOVITIS IN RELATION TO DIAGNOSIS AND CLINICAL PHENOTYPE: COMPARISON BETWEEN RHEUMATOID AND PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1316.2-1317
Author(s):  
L. De Stefano ◽  
S. Bugatti ◽  
S. Rossi ◽  
C. Montecucco ◽  
A. Manzo
Keyword(s):  
Psoriatic Arthritis ◽  
B Cell ◽  
Clinical Features ◽  
Acute Phase ◽  
Inflammatory Arthritis ◽  
Clinical Phenotype ◽  
Serum Levels ◽  
Germinal Centre ◽  
Cell Infiltration ◽  
Acute Phase Reactants

Background:Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are both characterized by significant heterogeneity in terms of clinical presentation and outcomes. Furthermore, RA and PsA may share some overlapping features such as autoantibody-negativity, polyarticular involvement, response to certain therapies and pattern of joint damage. The pathobiological bases underlying the intra-disease heterogeneity and the inter-disease similiarities between RA and PsA are however unkown.Objectives:Aim of the current study was to investigate the relationship between the synovial immune phenotype and different clinical subsets in patients with RA and PsA.Methods:The study population included 96 patients undergoing ultrasound-guided synovial biopsy of the knee and serum sampling on the same day. Patients were recruited according to defined clinical subtypes: anti-citrullinated positive (ACPA) RA (n=26), ACPA-negative RA (n=32), polyarticular (≥5 involved joints) PsA (n=15), and oligoarticular PsA (n=23). Patients were compared for: (i) demographic and clinical features; (ii) synovial histopathological characteristics including CD68-positive infiltrating macrophages, CD3-positive T lymphocytes, CD20-positive B lymphocytes (semi-quantitative scores 0-3); (iii) serum levels of the lymphoid chemokine CXCL13 as a marker of germinal centre activity.Results:Collectively, ACPA-positive RA patients, ACPA-negative RA patients and patients with polyarticular PsA presented comparable demographic and clinical features including gender distribution, age, number of involved joints and levels of acute phase reactants. Patients with oligoarticular PsA were instead younger, more frequently males, and with lower levels of acute phase reactants. The degree of macrophage and T cell infiltration correlated with the erythrocyte sedimentation rate (rho 0.38, p=0.001 and rho 0.24, p=0.04 respectively) and C-reactive protein levels (rho 0.38, p=0.001 and rho 0.28, p=0.01 respectively) irrespective of diagnosis, and was significantly lower in oligoarticular PsA (Figure 1A,B). In contrast, the degree of B cell infiltration showed significant differences in relation to the disease subtype: the lowest levels were found in oligoarticular PsA, the highest levels in ACPA-positive RA, whilst ACPA-negative RA and polyarticular PsA presented with intermediate and comparable levels between the two extremes (Figure 1C). Serum levels of CXCL13 correlated with the synovial B cell score (rho 0.30, p=0.03) and, similarly to synovial B cell infiltration, were differentially increased according to the clinical phenotype, with again similarities between ACPA-negative RA and polyarticular PsA (Figure 1D).Figure 1.Conclusion:In patients with chronic inflammatory arthritis, synovial B cell infiltration and systemic markers of germinal centre activity are heterogeneously increased irrespective of disease diagnosis. ACPA-positive RA and oligoarticular PsA appear located at the extremes of a pathobiological continuum, whilst ACPA-negative RA and polyarticular PsA present with intermediate and comparable degrees of B cell involvement. Collectively, our findings open the interesting perspective of a tailored management of patients with inflammatory arthritis based on the disease pathotype rather than on clinical diagnosis.Disclosure of Interests:Ludovico De Stefano: None declared, Serena Bugatti Speakers bureau: Bristol-Myers Squibb, Sanofi, Lilly, Novartis, Pfizer, Abbvie, Silvia Rossi: None declared, Carlomaurizio Montecucco: None declared, Antonio Manzo Speakers bureau: Bristol-Myers Squibb, Abbvie, Pfizer

scholarly journals Endorsement of the 66/68 Joint Count for the Measurement of Musculoskeletal Disease Activity: OMERACT 2018 Psoriatic Arthritis Workshop Report

2019 ◽  
Vol 46 (8) ◽  
pp. 996-1005 ◽  
Author(s):  
Alí Duarte-García ◽  
Ying Ying Leung ◽  
Laura C. Coates ◽  
Dorcas Beaton ◽  
Robin Christensen ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Construct Validity ◽  
Disease Activity ◽  
Selection Process ◽  
Outcome Measurement ◽  
Measurement Instrument ◽  
Measurement Properties ◽  
Tender Joint Count ◽  
Peripheral Arthritis ◽  
Activity Domain

Objective.The Psoriatic Arthritis (PsA) Core Domain Set for randomized controlled trials and longitudinal observational studies has recently been updated. The joint counts are central to the measurement of the peripheral arthritis component of the musculoskeletal (MSK) disease activity domain. We report the Outcome Measures in Rheumatology (OMERACT) 2018 meeting’s approaches to seek endorsement of the 66/68 swollen and tender joint count (SJC66/TJC68) for inclusion in the PsA Core Outcome Measurement Set (COS).Methods.Using the OMERACT Filter 2.1 Instrument Selection Process, the SJC66/TJC68 was assessed for (1) domain match, (2) feasibility, (3) numerical sense (construct validity), and (4) discrimination (test retest reliability, longitudinal construct validity, sensitivity in clinical trials, and thresholds of meaning). A protocol was designed to assess the measurement properties of the SJC66/TJC68 joint count. The results were summarized in a Summary of Measurement Properties table developed by OMERACT. OMERACT members discussed and voted on whether the strength of the evidence supported that the SJC66/TJC68 had passed the OMERACT Filter as an outcome measurement instrument for the PsA COS.Results.OMERACT delegates endorsed the use of the SJC66/TJC68 for the measurement of the peripheral arthritis component of the MSK disease activity domain. Among patient research partners, 100% voted for a “green” endorsement, whereas among the group of other stakeholders, 88% voted for a “green” endorsement.Conclusion.The SJC66/TJC68 is the first fully endorsed outcome measurement instrument using the OMERACT Filter 2.1 and the first instrument fully endorsed within the PsA COS.

Psoriatic Arthritis Sonographic Enthesitis Instruments: A Systematic Review of the Literature

2018 ◽  
Vol 46 (1) ◽  
pp. 43-56 ◽  
Author(s):  
Ofir Elalouf ◽  
Sibel Bakirci Ureyen ◽  
Zahi Touma ◽  
Melanie Anderson ◽  
Gurjit S. Kaeley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Construct Validity ◽  
Clinical Assessment ◽  
Search Strategy ◽  
Data Extraction ◽  
Review Of The Literature ◽  
Discriminative Validity ◽  
Feasibility Test ◽  
Test Retest Reliability

Objective.As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) ultrasound working group, we performed a systematic review of the literature to assess the evidence and knowledge gaps in scoring instruments of enthesitis in psoriatic arthritis (PsA).Methods.A systematic search of PubMed, EMBase, and Cochrane databases was performed. The search strategy was constructed to find original publications containing terms related to ultrasound, enthesitis, spondyloarthritis (SpA) or PsA. Data extraction focused on the properties of the sonographic enthesitis instruments used in each study following components of the Outcome Measures in Rheumatology (OMERACT) filter: feasibility, test-retest reliability, construct validity as related to clinical assessment of enthesitis, biomarkers of inflammation and imaging of enthesitis by other modalities, discriminative validity, and responsiveness to treatment.Results.Fifty-one of 310 identified manuscripts were included. Only 1 scoring instrument of enthesitis was specifically developed and validated in patients with PsA. Only 18 (35%) of the studies involved patients with PsA, while the remaining studies focused on SpA. In PsA, construct validity was assessed using biomarkers and clinical examination in 1 (2%) and 11 (21.5%) of the studies, respectively, whereas no studies used imaging for the same purpose. Only 2 (4%) of the studies assessed discriminative validity in PsA. Responsiveness to treatment was assessed in 7 studies, none of which included patients with PsA.Conclusion.Although sonographic enthesitis scoring instruments have been developed for SpA, only a few have been validated in PsA. None of them passed the OMERACT filter in patients with PsA. Additional research is required before endorsing a specific instrument for the assessment of enthesitis in patients with PsA.

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