Sex-specific differences and how to handle them in early psoriatic arthritis

Objectives The prevalence of psoriatic arthritis (PsA) is the same in men and women; however, the latter experience a higher burden of disease and are affected more frequently by polyarthritis. Here, we performed an early PsA cohort analysis to assess sex-related differences in demographics, disease characteristics, and evolution over 1 year including applied treatment strategies. Methods Our study is embedded in the Dutch south-west Early Psoriatic Arthritis cohoRt. We described patient characteristics and treatment decisions. For the comparison across sexes and baseline and 1 year follow-up, appropriate tests depending on the distribution were used. Results Two hundred seventy-three men and 294 women with no significant differences in age and ethnicity were included. Women reported significantly longer duration of symptoms before diagnosis and significantly higher tender joint count, a higher disease activity, higher levels of pain, and lower functional capacity. Although minimal disease activity (MDA) rates increased over time for both sexes, MDA remained significantly more prevalent among men at 1 year (58.1% vs 35.7%, p < 0.00). Initially, treatment strategies were similar in both sexes with methotrexate being the most frequently used drug during the first year. Women received methotrexate for a shorter period [196 (93–364) vs 306 (157–365), p < 0.00] and therefore received a lower cumulative dose compared to men. Retention time was shorter for all DMARDs, and women had a delayed start on b-DMARDs. Conclusion After 1 year of standard-of-care treatment, women did not surpass their baseline disadvantages. Despite the overall improvement, they still presented higher disease activity, higher levels of pain, and lower functional capacity score than men. The nature of these findings may advocate a need for sex specific adjustment of treatment strategies and evaluation in early PsA patients.

A Retrospective Study on the Effectiveness of Ixekizumab After Treatment With Secukinumab for Patients With Active Psoriatic Arthritis

Objectives: This study aims to evaluate clinical responses in patients with active psoriatic arthritis who, despite secukinumab 300 mg subcutaneous monthly, are switched to ixekizumab 80 mg subcutaneous every four weeks. Methods: We conducted a chart review of adult patients with psoriatic arthritis treated at one clinical center. We identified all patients with active inflammatory arthritis who were switched from secukinumab to ixekizumab. Baseline demographics such as disease duration, age, gender, number of previous DMARDs, and previous time on secukinumab were collected. We collected clinical outcome data such as tender and swollen joint count, enthesitis based on SPARCC score, dactylitis, psoriasis severity, CRP, and BASDAI if axial involvement was present. Results: Eight of 10 patients were included in the analysis. Most patients were female, average age 62 years old, and had been on secukinumab for an average of 79 weeks. Twelve weeks following switch to ixekizumab, 6/8 had improvement in tender joint count, 6/8 improved in swollen joint count, 2/2 had resolution of enthesitis, 4/4 had resolution of dactylitis, 5/6 had improvement in psoriasis severity, 1 patient had absolute improvement of 2.3 in BASDAI, and 7/8 had improvement in the CRP level. Conclusions: Patients with active psoriatic arthritis despite treatment with secukinumab may still have a clinical response following treatment with another anti-IL17 agent. Larger studies will be required to confirm this finding, and studies which emphasize dactylitis and enthesitis outcomes will be needed as most patients did not have activity in these domains.

Dactylitis is an indicator of a more severe phenotype independently associated with greater SJC, CRP, ultrasound synovitis and erosive damage in DMARD-naive early psoriatic arthritis

ObjectiveTo characterise the impact of dactylitis in disease-modifying antirheumatic drug (DMARD)-naive early psoriatic arthritis (PsA).MethodsPatients with early PsA meeting the classification criteria for PsA (CASPAR) were recruited. Clinical outcomes were recorded, and ultrasonography was conducted to assess grey scale (GS) and power Doppler (PD) synovitis, periarticular cortical bone erosions and enthesitis. The cohort was dichotomised by the presence or absence of dactylitis.ResultsOf 177 patients with PsA, those with dactylitis (dactylitic PsA (81/177, 46%)) had higher tender joint count (p<0.01), swollen joint count (SJC) (p<0.001) and C reactive protein (CRP) (p<0.01) than non-dactylitic PsA. Dactylitis was more prevalent in toes (146/214 (68.2%)) than fingers (68/214 (31.8%)); ‘hot’ dactylitis was more prevalent than ‘cold’ (83.6% vs 16.4%). Ultrasound (US) synovitis and erosions were significantly more prevalent in dactylitic PsA (p<0.001 and p<0.001, respectively). Exclusion of dactylitis in dactylitic PsA confirmed significantly greater SJC (3 vs 1, p=0.002), US synovitis (GS ≥2: 20.6% vs 16.1%, p<0.001, or PD ≥1: 5.1% vs 3.3%, p<0.001) and erosions (1.1% vs 0.5% joints, p=0.008; 26.1% vs 12.8% patients, p=0.035%) than non-dactylitic PsA. Synovitis (GS ≥2 and/or PD ≥1) occurred in 53.7% of dactylitis. No substantial differences were observed for US enthesitis.ConclusionDactylitis signifies a more severe disease phenotype independently associated with an increased disease burden with greater SJC, CRP, US-detected synovitis and bone erosions in DMARD-naive early PsA and may be a useful discriminator for early risk stratification.

Unravelling the Ameliorative Effects of Probiotics in Rheumatoid Arthritis: A Meta-analysis of Randomized, Controlled Trials

Background: Recent studies have shown that rational regulation of the gut microbiota, known as probiotic supplements, have beneficial consequences on rheumatoid arthritis (RA). However, their efficacy as an adjunct therapy remains controversial. Methods: PubMed, Embase, Scopus, Web of science and Cochrane Library was performed to retrieve the existing data from the published randomized, controlled trials (RCTs) comparing probiotics with placebo in RA through August 2021. Among eight RCTs were eligible for inclusion in this meta-analysis, and all data were analyzed by StataSE 12.1 software. Results: The probiotic has achieved significant improvement in visual analogue scales (VAS), high sensitive C-reactive protein (hs-CRP), tumor necrosis factor (TNF-α) and interleukin (IL-1β). Probiotic may have a beneficial role in disease activity score in 28 joints (DAS28). However, probiotic does not have a significant effect on tender joint, swollen joint and lipid levels and not yet achieve obvious improvement in American College of Rheumatology 20% improvement criteria (ACR20). Conclusion: Probiotics have a beneficial effect on improving RA to some extent, especially on alleviating joint inflammation. However, the number of studies was too small to determine if a strain-, dose-, or duration-response effect was present. More multi-centered, large-sample RCTs are needed to explore the benefits of probiotic to RA patients in the future.

A Cohort Study to Determine the Prevalence of Pulmonary Manifestations in Rheumatoid Arthritis

Background: Rheumatoid arthritis is an ailment that has an effect on the lungs in cases of pleural inflammation; it affects the lower as well as upper lung airways. Other effects of the disease can be seen in interstitial lung problems (parenchyma) and pulmonary vasculature. Aim: Evaluating the occurrence of pulmonary manifestations in RA patients was the objective of this study. Methods: An observatory method that was cross-section in nature was employed in this study which was held in the Rheumatology and Medicine department, Jinnah Medical and Dental College Karachi Pakistan for the one-year duration from June 2020 to June 2021. Eighty subjects were included in this study, and all of them underwent a general examination, their medical history was taken into account. Several lab tests were performed on the patients, ESR, BUN, CRP, HRCT, ALT, radiological investigations, and chest X-rays were included. Results: In this study42 percent of patients presented with pulmonary manifestations. About 45.70 percent of the patients presented with abnormalities in the spirometry test, 42.85 percent showed HRCT abnormalities. The HRCT scores vary with age, TJC (Tender Joint Count), ESR, and SJC.FEV, 1 HRCT, and FCV showed a negative correlation among each other. However other variables did not show any statistically significant correlation. Conclusion: RA showed the prevalence of pulmonary affection, and this can be observed in pulmonary and radiological functions. There was an associationof age, pulmonary functions, and ESR.

P028 Impact of Juvenile Idiopathic Arthritis on schooling

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is one of the major causes of morbidity and physical disability. Due to frequent absences, children with chronic health impairments are also often confronted with educational difficulties. The aims of this study were to assess the impact of JIA on children’s schooling and to determine the factors that influence their school level. Methods This is a cross-sectional study including patients with JIA (ILAR criteria). A detailed questionnaire was completed for each participant by interviewing them or their parents as well as by information obtained from their medical records. Collected data included age, sex, subtype of JIA, disease duration, level of disability according to the Childhood Heath Assessment Questionnaire (CHAQ), visual analogue scale for patient’s overall assessment of disease activity (VASOA), duration of morning stiffness, tender joint counts (TJCs), swollen joint counts (SJCs), erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), Disease Activity Score (DAS28) for polyarticular and oligoarticular JIA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for Enthesitis-related arthritis. Medications used for JIA treatment were also documented. Data on the school performance of patients and their siblings were obtained using telephone interviews (educational level, absenteeism, school delay by repetition, drop-out). Results A total of 43 patients with JIA were included, 25 female and 18 male, with a mean age of 26 years [12–51] and a mean disease duration of 237 months (5–496). The average age of the onset of the disease was 7.4 years [1.5–16]. The most common subtype was rheumatoid factor-positive polyarthritis (n = 18) followed by systematic (n = 8), oligoarticular (n = 8), rheumatoid factor-negative polyarthritis (n = 5) and Enthesitis-related arthritis (n = 4). The mean DAS28 was 3.02 [0.76 – 5.55] and the median CHAQ was 0.66 [0–3]. Twenty-nine of the children were receiving corticosteroid. Disease-modifying anti-rheumatic drugs were used by 38 of the 43 patients: methotrexate (n = 27), sulfasalazine (n = 8), leflunomide (n = 7), biotherapies (n = 16). Twenty patients had complications: Hip arthritis (n = 18), growth stunting (n = 14), uveitis (n = 5). Joint replacement was required in 11 cases. Four patients were illiterate, 14 had dropped out of school, 24 reported repeated absences due to illness. A year of schooling was repeated by 50.85% of patients. Eleven out of 32 patients over the age of 20 had an university level. Almost 80% of patients were exempted of physical education. There were no significant associations between the school-related problems, the socio-demographic characteristics and the various parameters of clinical and biological activity studied. Conclusion Our study suggested that JIA negatively affects schooling of children. More studies, with a larger sample of children, are needed to identify the variables associated with school failure in order to ensure the proper management of these patients and to increase their academic performance.

Tender and swollen joint counts are poorly associated with disability in chikungunya arthritis compared to rheumatoid arthritis

Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) are described after chikungunya virus infection. We aimed to compare the relevance of joint counts and symptoms to clinical outcomes in RA and chronic chikungunya disease. Forty patients with chronic chikungunya arthralgia and 40 patients with RA were enrolled in a cross-sectional study. The association of tenderness and swelling, clinically assessed in 28 joints, and patient evaluations of pain and musculoskeletal stiffness with modified Health Assessment Questionnaire (HAQ) and quality of life (QoL) assessments were investigated. Tender and swollen joint counts, pain and stiffness scores were all associated with the HAQ disability index in RA (all r > 0.55, p ≤ 0.0002), but only stiffness was significantly associated with disability in chikungunya (r = 0.38, p = 0.02). Joint counts, pain and stiffness were also associated with most QoL domains in RA patients. In contrast, in chikungunya disease, tender joint counts were associated only with one QoL domain and swollen joints for none, while pain and stiffness were associated with several domains. Our results confirm the relevance of joint counts in RA, but suggest that in chronic chikungunya disease, joint counts have more limited value. Stiffness and pain score may be more important to quantify chikungunya arthritis impact.

Platelet indices parameters in the new disease activity score of rheumatoid arthritis with ankle involvement: A comparative analytic study

Background: Platelet indices (PIs) are platelet parameters that are correlated with platelet activity. Despite being widely available, inexpensive, and feasible; their use in clinical settings is limited. Recently, we developed a new score (EgyDAS), which relies on PIs and assesses disease activity in rheumatoid arthritis (RA). Objectives: This study explored the practicability and validity of EgyDAS in RA with ankle involvement, considering that ankle is neglected in the commonly used DAS28 score. Methods: This comparative case-control study included 2-groups of RA patients, group1 (control): without and group 2: with ankle involvement. Results: Ankle involvement in RA showed no gender or age differences, however, it was associated with higher platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet distribution width (PDW), visual analogue scale (VAS), tender joint count (TJC), and lower hemoglobin (Hb) and mean platelet volume (MPV). DAS28 categorized a higher proportion of patients to have high disease activity compared with EgyDAS; moreover, it did not detect those in remission in group 2 patients. Highly significant differences in the 2-scores were observed between the two groups. Further analyses revealed superiority of EgyDAS in assessing disease activity in group 2 patients. Finally, both scores were found correlated together in the study groups. Conclusions: Over or underestimation of RA disease activity could occur when using DAS28. PIs were found correlated with ankle involvement in RA. PIs and EgyDAS are the best tools to assess disease activity in RA patients with ankle involvement. However, the study recommended the use of both scores together.

Rheumatoid arthritis activity scores in patients with and without fibromyalgia syndrome

BACKGROUND: Fibromyalgia syndrome (FM) is a systemic disease of unknown etiology, which can cause widespread musculoskeletal pain. In patients with rheumatoid arthritis (RA), FM can cause an additional symptom burden, which can affect some variables on the RA disease activity score 28 (DAS28), a tool that evaluates 28 joints in RA patients. OBJECTIVE: Compare the results of four different versions of the DAS28 and the parameters used to determine disease activity scores in RA patients with and without FM, and determine whether there are treatment differences between RA patients with and without FM. DESIGN: Retrospective, cross-sectional. SETTING: Tertiary hospital. PATIENTS AND METHODS: We identified patients diagnosed with RA between 1 September 2016 and 1 February 2020 and identified patients with and without FM. MAIN OUTCOME MEASURES: Differences between variables in the DAS28 calculations (tender joint count [TJC], patient global assessment [PGA], and others), between patients with and without FM, and differences between patients with and without FM who were using or not using biological agents. SAMPLE SIZE: 381, including 322 females (84.5%). RESULTS: The frequency of FM in RA patients was 25.7% (89 females, 24.6%). In RA patients with FM, the TJC and PGA median values were significantly higher than in patients without FM ( P <.05). The use of corticosteroids and biological therapy in patients with FM was more frequent than in patients without FM ( P <.05). Compared to patients without FM, patients with FM switched treatment more often because of non-response to treatment ( P =.01) Median values of the DAS28 scores (calculated by four different versions of the instrument) in RA patients with FM were higher than in patients without FM ( P <.05). CONCLUSION: The presence of FM in RA patients may affect the subjective variables in different versions of DAS28 scores, causing the disease activity to score higher on the instrument, erroneously indicating worse disease than is actually present. LIMITATIONS: A single center, retrospective study. CONFLICTS OF INTEREST: None.

Clinical and Psychological Assessment of Patients With Rheumatoid Arthritis and Fibromyalgia

ObjectiveThis study aimed to assess the clinical features as well as the functional and psychological status of patients with rheumatoid arthritis and fibromyalgia in a real-world setting in China.MethodsA total of 202 inpatients with rheumatoid arthritis from the Department of Rheumatology and Immunology at Peking University People’s Hospital were enrolled between December 2018 and April 2019. These inpatients were assessed for the presence of fibromyalgia using the 1990 American College of Rheumatology’s classification criteria for fibromyalgia. Disease activity and functional and psychological status were assessed using the Disease Activity Score in 28 Joints (DAS-28), Short Form-36 health survey questionnaire (SF-36), Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale, and Visual Analog Scale.ResultsOf 202 patients with rheumatoid arthritis, 42 (20.8%) had concurrent fibromyalgia. Compared to patients without fibromyalgia, those with rheumatoid arthritis and fibromyalgia had higher DAS-28 scores (6.0 vs. 4.4, P=0.011) and notably higher tender joint counts (16.5 vs. 4.5, P<0.001). Patients with rheumatoid arthritis and fibromyalgia had worse HAQ scores (1.24 vs. 0.66, P<0.001) and lower SF-36 scores (28.6 vs. 58.2, P<0.001). Additionally, patients with rheumatoid arthritis and fibromyalgia experienced more fatigue (88.1% vs. 50.6%, P<0.001) and had higher anxiety (10 vs. 4, P<0.001) and depression scores (12 vs. 6, P<0.001). No significant differences in erythrocyte sedimentation rate, C-reactive protein concentration, morning stiffness period, or swollen joint counts were identified between the groups.ConclusionsPatients with rheumatoid arthritis and fibromyalgia had higher disease activity, worse functional and psychological status, and poorer quality of life. DAS-28 scores may have been overestimated in these patients. When patients with rheumatoid arthritis do not achieve remission, the possibility of fibromyalgia should be considered.