Psoriasis

Patients with newly diagnosed systemic sclerosis should have a high-resolution lung CT and pulmonary function tests, because when assessed together, their findings identify patients at high risk of interstitial lung disease, researchers say.

In a study of 305 patients with systemic sclerosis (SSc), a baseline high-resolution lung CT showing no fibrosis was highly predictive of a fibrosis free follow-up scan at 3 years, reported the researchers from Oslo (Norway) University Hospital. SSc associated interstitial lung–disease (SSc-ILD) typically has an insidious onset with subtle clinical symptoms, accoording to the authors in background information to the paper published in Arthritis & Rheumatology (Arthritis & Rheumatology 2015; [doi:10.1002/art.39166]).

This may explain why SSc-ILD is often diagnosed at an advanced stage, when extensive lung fibrosis is already present. “Better, and more targeted, strategies for SSc-ILD identification and risk stratification early in the disease course are therefore warranted,” they wrote.

In order to assess serial lung fibrosis measurements and paired pulmonary function tests (PFTs) as outcome prediction tools, the researchers prospectively analyzed both modalities at baseline and at an average of 3 years follow-up in 305 patients with SSc. The extent of fibrosis was scored on 10 sections from every high-resolution CT (HRCT) and expressed as a percentage of total lung volumes.

The researchers identified three groups of patients: More than 20% lung fibrosis (n=40), between 1%- 20% fibrosis (n=157), and no fibrosis (n=108). Results showed that all 108 patients who had no lung fibrosis at baseline remained free of fibrosis at a 3-year follow-up scan. These patients were predominantly female (88%) had limited (lc) SSc (84%), and were positive for anticentromere antibodies (ACA) (70%). They also had a high baseline decline in diffusing lung capacity for carbon monoxide (DLCO) that declined by 8.2%, the same degree as patients with lung fibrosis.

“This finding emphasizes that the mechanics behind SSc related DCLO changes probably are multifactorial and may involve pathology in the vasculature,” the study authors wrote. This was underscored by the observation that pulmonary hypertension (PH) was present in all groups of patients and supported the notion that PH screening should be conducted independently of fibrosis screening, the researchers noted.

For patients in the 1%-20% group, 146 were the same at follow-up, whereas the remaining patients progressed to more than 20% fibrosis. These 11 patients were characterized by significantly shorter average disease duration at baseline (1.3 years) compared with the other groups.

The 40 patients with more than 20% fibrosis at baseline had a higher annual fibrosis progression rate (aFPR), declining PFT values, and development of pulmonary hypertension (PH). Most of this group had diffuse SSc (55%), were positive for anti-topoisomerase antiboidies (ATA) (48%), and had a higher frequency of PH (28%), the researchers said. The rate of annual fibrosis progression differed across all groups and correlated with total FVC decline.

Surprisingly, neither baseline fibrosis nor annual fibrosis progression significantly predicted mortality. This finding may be partly due to survival bias in the cohort and the statistical power of the study, the researchers said. “The results indicate that a baseline examination in newly diagnosed SSc patients should include lung HRCT and PFTs,” the researchers concluded. Patients with low ILD risk should not undergo serial HCRT examination but probably need serial PFTs as an adjunct PH detection tool, they said.

Patients with newly diagnosed systemic sclerosis should have a high-resolution lung CT and pulmonary function tests, because when assessed together, their findings identify patients at high risk of interstitial lung disease, researchers say.

In a study of 305 patients with systemic sclerosis (SSc), a baseline high-resolution lung CT showing no fibrosis was highly predictive of a fibrosis free follow-up scan at 3 years, reported the researchers from Oslo (Norway) University Hospital. SSc associated interstitial lung–disease (SSc-ILD) typically has an insidious onset with subtle clinical symptoms, accoording to the authors in background information to the paper published in Arthritis & Rheumatology (Arthritis & Rheumatology 2015; [doi:10.1002/art.39166]).

This may explain why SSc-ILD is often diagnosed at an advanced stage, when extensive lung fibrosis is already present. “Better, and more targeted, strategies for SSc-ILD identification and risk stratification early in the disease course are therefore warranted,” they wrote.

In order to assess serial lung fibrosis measurements and paired pulmonary function tests (PFTs) as outcome prediction tools, the researchers prospectively analyzed both modalities at baseline and at an average of 3 years follow-up in 305 patients with SSc. The extent of fibrosis was scored on 10 sections from every high-resolution CT (HRCT) and expressed as a percentage of total lung volumes.

The researchers identified three groups of patients: More than 20% lung fibrosis (n=40), between 1%- 20% fibrosis (n=157), and no fibrosis (n=108). Results showed that all 108 patients who had no lung fibrosis at baseline remained free of fibrosis at a 3-year follow-up scan. These patients were predominantly female (88%) had limited (lc) SSc (84%), and were positive for anticentromere antibodies (ACA) (70%). They also had a high baseline decline in diffusing lung capacity for carbon monoxide (DLCO) that declined by 8.2%, the same degree as patients with lung fibrosis.

“This finding emphasizes that the mechanics behind SSc related DCLO changes probably are multifactorial and may involve pathology in the vasculature,” the study authors wrote. This was underscored by the observation that pulmonary hypertension (PH) was present in all groups of patients and supported the notion that PH screening should be conducted independently of fibrosis screening, the researchers noted.

For patients in the 1%-20% group, 146 were the same at follow-up, whereas the remaining patients progressed to more than 20% fibrosis. These 11 patients were characterized by significantly shorter average disease duration at baseline (1.3 years) compared with the other groups.

The 40 patients with more than 20% fibrosis at baseline had a higher annual fibrosis progression rate (aFPR), declining PFT values, and development of pulmonary hypertension (PH). Most of this group had diffuse SSc (55%), were positive for anti-topoisomerase antiboidies (ATA) (48%), and had a higher frequency of PH (28%), the researchers said. The rate of annual fibrosis progression differed across all groups and correlated with total FVC decline.

Surprisingly, neither baseline fibrosis nor annual fibrosis progression significantly predicted mortality. This finding may be partly due to survival bias in the cohort and the statistical power of the study, the researchers said. “The results indicate that a baseline examination in newly diagnosed SSc patients should include lung HRCT and PFTs,” the researchers concluded. Patients with low ILD risk should not undergo serial HCRT examination but probably need serial PFTs as an adjunct PH detection tool, they said.

Patients with newly diagnosed systemic sclerosis should have a high-resolution lung CT and pulmonary function tests, because when assessed together, their findings identify patients at high risk of interstitial lung disease, researchers say.

In a study of 305 patients with systemic sclerosis (SSc), a baseline high-resolution lung CT showing no fibrosis was highly predictive of a fibrosis free follow-up scan at 3 years, reported the researchers from Oslo (Norway) University Hospital. SSc associated interstitial lung–disease (SSc-ILD) typically has an insidious onset with subtle clinical symptoms, accoording to the authors in background information to the paper published in Arthritis & Rheumatology (Arthritis & Rheumatology 2015; [doi:10.1002/art.39166]).

This may explain why SSc-ILD is often diagnosed at an advanced stage, when extensive lung fibrosis is already present. “Better, and more targeted, strategies for SSc-ILD identification and risk stratification early in the disease course are therefore warranted,” they wrote.

In order to assess serial lung fibrosis measurements and paired pulmonary function tests (PFTs) as outcome prediction tools, the researchers prospectively analyzed both modalities at baseline and at an average of 3 years follow-up in 305 patients with SSc. The extent of fibrosis was scored on 10 sections from every high-resolution CT (HRCT) and expressed as a percentage of total lung volumes.

The researchers identified three groups of patients: More than 20% lung fibrosis (n=40), between 1%- 20% fibrosis (n=157), and no fibrosis (n=108). Results showed that all 108 patients who had no lung fibrosis at baseline remained free of fibrosis at a 3-year follow-up scan. These patients were predominantly female (88%) had limited (lc) SSc (84%), and were positive for anticentromere antibodies (ACA) (70%). They also had a high baseline decline in diffusing lung capacity for carbon monoxide (DLCO) that declined by 8.2%, the same degree as patients with lung fibrosis.

“This finding emphasizes that the mechanics behind SSc related DCLO changes probably are multifactorial and may involve pathology in the vasculature,” the study authors wrote. This was underscored by the observation that pulmonary hypertension (PH) was present in all groups of patients and supported the notion that PH screening should be conducted independently of fibrosis screening, the researchers noted.

For patients in the 1%-20% group, 146 were the same at follow-up, whereas the remaining patients progressed to more than 20% fibrosis. These 11 patients were characterized by significantly shorter average disease duration at baseline (1.3 years) compared with the other groups.

The 40 patients with more than 20% fibrosis at baseline had a higher annual fibrosis progression rate (aFPR), declining PFT values, and development of pulmonary hypertension (PH). Most of this group had diffuse SSc (55%), were positive for anti-topoisomerase antiboidies (ATA) (48%), and had a higher frequency of PH (28%), the researchers said. The rate of annual fibrosis progression differed across all groups and correlated with total FVC decline.

Surprisingly, neither baseline fibrosis nor annual fibrosis progression significantly predicted mortality. This finding may be partly due to survival bias in the cohort and the statistical power of the study, the researchers said. “The results indicate that a baseline examination in newly diagnosed SSc patients should include lung HRCT and PFTs,” the researchers concluded. Patients with low ILD risk should not undergo serial HCRT examination but probably need serial PFTs as an adjunct PH detection tool, they said.

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

Psoriasis patients with ultrasonographic enthesitis who undergo systemic treatments can experience significant reductions in morphologic abnormalities in as little as 6 months, according to the findings of a two-center prospective study published in Joint Bone Spine.

“Here, we showed that subclinical enthesitis of both [psoriasis] and PsA [psoriatic arthritis] population improve under systemic treatment,” wrote lead author Dr. Emilie Acquacalda of the University Hospital of Nice (France) and her associates. “Both patients under methotrexate and biologics had a reduction of the enthesitis at US [ultrasonographic] examination.”

The investigators enrolled 34 patients – 22 with psoriasis and 12 with symptomatic PsA – for whom US assessments were taken at baseline. Abnormalities, specifically hypoechogenicity and thickness, were noted in 86.4% (19) of psoriasis patients and 97.1% (33) of the total population. Enthesitis was found in 95 of the 340 entheses examined at baseline, 57 of which were in psoriasis patients (Joint Bone Spine 2015 April 13 [doi:10.1016/j.jbspin.2015.01.016]).

Psoriasis patients were given systemic treatment consisting of methotrexate and/or biologic therapies, which were infliximab, adalimumab, etanercept, and ustekinumab. At 6 months, 23 patients were assessed (11 refused ultrasonography), 13 of whom had psoriasis and 10 of whom had PsA. Of these subjects, 12 received methotrexate alone and 11 received it with a biologic.

Morphologic abnormalities in the psoriasis population decreased significantly, from 30% (39 of 130) at baseline to 17.7% (23 of 130; P = .021). Psoriasis patients who took methotrexate had the most significant decreases, with methotrexate alone reducing the proportion of abnormalities from 28.8% (23 of 30) at baseline to 15% (12 of 80; P = .035), Dr. Acquacalda and her associates reported.

Treatment with biologics also showed promise, with abnormality rates dropping from 32% (16 of 80) to 22% (11 of 80), but the results were not statistically significant (P = .359). Overall, PsA patients saw enthesitis improvement from 33% (33 of 100) to 24% (24 of 100) over the 6-month study period, but the difference was not statistically significant (P = .164), they said.

The authors also noted that the relatively small number of subjects in their study prohibits them from making any definitive conclusions about the efficacy of systemic and biological treatments, but urged that “long-term follow-up studies of [psoriasis] patients with and without subclinical enthesitis are warranted to determine if they have a predictive value of future PsA, and to determine if rapid introduction of a systemic treatment could impact this evolution.”

The authors did not report any relevant conflicts of interest.

dchitnis@frontlinemedcom.com

Psoriasis patients with ultrasonographic enthesitis who undergo systemic treatments can experience significant reductions in morphologic abnormalities in as little as 6 months, according to the findings of a two-center prospective study published in Joint Bone Spine.

“Here, we showed that subclinical enthesitis of both [psoriasis] and PsA [psoriatic arthritis] population improve under systemic treatment,” wrote lead author Dr. Emilie Acquacalda of the University Hospital of Nice (France) and her associates. “Both patients under methotrexate and biologics had a reduction of the enthesitis at US [ultrasonographic] examination.”

The investigators enrolled 34 patients – 22 with psoriasis and 12 with symptomatic PsA – for whom US assessments were taken at baseline. Abnormalities, specifically hypoechogenicity and thickness, were noted in 86.4% (19) of psoriasis patients and 97.1% (33) of the total population. Enthesitis was found in 95 of the 340 entheses examined at baseline, 57 of which were in psoriasis patients (Joint Bone Spine 2015 April 13 [doi:10.1016/j.jbspin.2015.01.016]).

Psoriasis patients were given systemic treatment consisting of methotrexate and/or biologic therapies, which were infliximab, adalimumab, etanercept, and ustekinumab. At 6 months, 23 patients were assessed (11 refused ultrasonography), 13 of whom had psoriasis and 10 of whom had PsA. Of these subjects, 12 received methotrexate alone and 11 received it with a biologic.

Morphologic abnormalities in the psoriasis population decreased significantly, from 30% (39 of 130) at baseline to 17.7% (23 of 130; P = .021). Psoriasis patients who took methotrexate had the most significant decreases, with methotrexate alone reducing the proportion of abnormalities from 28.8% (23 of 30) at baseline to 15% (12 of 80; P = .035), Dr. Acquacalda and her associates reported.

Treatment with biologics also showed promise, with abnormality rates dropping from 32% (16 of 80) to 22% (11 of 80), but the results were not statistically significant (P = .359). Overall, PsA patients saw enthesitis improvement from 33% (33 of 100) to 24% (24 of 100) over the 6-month study period, but the difference was not statistically significant (P = .164), they said.

The authors also noted that the relatively small number of subjects in their study prohibits them from making any definitive conclusions about the efficacy of systemic and biological treatments, but urged that “long-term follow-up studies of [psoriasis] patients with and without subclinical enthesitis are warranted to determine if they have a predictive value of future PsA, and to determine if rapid introduction of a systemic treatment could impact this evolution.”

The authors did not report any relevant conflicts of interest.

dchitnis@frontlinemedcom.com

Psoriasis patients with ultrasonographic enthesitis who undergo systemic treatments can experience significant reductions in morphologic abnormalities in as little as 6 months, according to the findings of a two-center prospective study published in Joint Bone Spine.

“Here, we showed that subclinical enthesitis of both [psoriasis] and PsA [psoriatic arthritis] population improve under systemic treatment,” wrote lead author Dr. Emilie Acquacalda of the University Hospital of Nice (France) and her associates. “Both patients under methotrexate and biologics had a reduction of the enthesitis at US [ultrasonographic] examination.”

The investigators enrolled 34 patients – 22 with psoriasis and 12 with symptomatic PsA – for whom US assessments were taken at baseline. Abnormalities, specifically hypoechogenicity and thickness, were noted in 86.4% (19) of psoriasis patients and 97.1% (33) of the total population. Enthesitis was found in 95 of the 340 entheses examined at baseline, 57 of which were in psoriasis patients (Joint Bone Spine 2015 April 13 [doi:10.1016/j.jbspin.2015.01.016]).

Psoriasis patients were given systemic treatment consisting of methotrexate and/or biologic therapies, which were infliximab, adalimumab, etanercept, and ustekinumab. At 6 months, 23 patients were assessed (11 refused ultrasonography), 13 of whom had psoriasis and 10 of whom had PsA. Of these subjects, 12 received methotrexate alone and 11 received it with a biologic.

Morphologic abnormalities in the psoriasis population decreased significantly, from 30% (39 of 130) at baseline to 17.7% (23 of 130; P = .021). Psoriasis patients who took methotrexate had the most significant decreases, with methotrexate alone reducing the proportion of abnormalities from 28.8% (23 of 30) at baseline to 15% (12 of 80; P = .035), Dr. Acquacalda and her associates reported.

Treatment with biologics also showed promise, with abnormality rates dropping from 32% (16 of 80) to 22% (11 of 80), but the results were not statistically significant (P = .359). Overall, PsA patients saw enthesitis improvement from 33% (33 of 100) to 24% (24 of 100) over the 6-month study period, but the difference was not statistically significant (P = .164), they said.

The authors also noted that the relatively small number of subjects in their study prohibits them from making any definitive conclusions about the efficacy of systemic and biological treatments, but urged that “long-term follow-up studies of [psoriasis] patients with and without subclinical enthesitis are warranted to determine if they have a predictive value of future PsA, and to determine if rapid introduction of a systemic treatment could impact this evolution.”

The authors did not report any relevant conflicts of interest.

dchitnis@frontlinemedcom.com

Austrian researchers have developed and validated a new five-question self-assessment survey for psoriatic arthritis patients to monitor their disease activity, according to a report published online in BMC Musculoskeletal Disorders.

The Stockerau Activity Score for Psoriatic Arthritis (SASPA) was developed by the team responsible for the Rheumatoid Arthritis Disease Activity Index (RADAI-5) and is similar to it. Using a variety of statistical tests, Dr. Burkhard F. Leeb of the Karl Landsteiner Institute for Clinical Rheumatology in Stockerau, Austria, and his colleagues demonstrated SASPA’s reliability, convergent validity, and sensitivity to change in 152 adult psoriatic arthritis outpatients. For example, they found a Cronbach’s alpha for SASPA of 0.875, indicating high internal consistency and reliability (BMC Musculoskelet. Disord. 2015;16:73).

There are several psoriatic arthritis assessment tools already that work for between-group comparisons but “may not be fully suitable for assessing individual patients,” the investigators wrote.

With SASPA, however, they noted that “inter-physician, but also intra-physician variations in assessing joints or global disease activity are eliminated, and other pitfalls of joint counts are avoided.”

The study was supported by the Karl Landsteiner Institute for Clinical Rheumatology. The authors said that they had no financial disclosures.

aotto@frontlinemedcom.com

Austrian researchers have developed and validated a new five-question self-assessment survey for psoriatic arthritis patients to monitor their disease activity, according to a report published online in BMC Musculoskeletal Disorders.

The Stockerau Activity Score for Psoriatic Arthritis (SASPA) was developed by the team responsible for the Rheumatoid Arthritis Disease Activity Index (RADAI-5) and is similar to it. Using a variety of statistical tests, Dr. Burkhard F. Leeb of the Karl Landsteiner Institute for Clinical Rheumatology in Stockerau, Austria, and his colleagues demonstrated SASPA’s reliability, convergent validity, and sensitivity to change in 152 adult psoriatic arthritis outpatients. For example, they found a Cronbach’s alpha for SASPA of 0.875, indicating high internal consistency and reliability (BMC Musculoskelet. Disord. 2015;16:73).

There are several psoriatic arthritis assessment tools already that work for between-group comparisons but “may not be fully suitable for assessing individual patients,” the investigators wrote.

With SASPA, however, they noted that “inter-physician, but also intra-physician variations in assessing joints or global disease activity are eliminated, and other pitfalls of joint counts are avoided.”

The study was supported by the Karl Landsteiner Institute for Clinical Rheumatology. The authors said that they had no financial disclosures.

aotto@frontlinemedcom.com

Austrian researchers have developed and validated a new five-question self-assessment survey for psoriatic arthritis patients to monitor their disease activity, according to a report published online in BMC Musculoskeletal Disorders.

The Stockerau Activity Score for Psoriatic Arthritis (SASPA) was developed by the team responsible for the Rheumatoid Arthritis Disease Activity Index (RADAI-5) and is similar to it. Using a variety of statistical tests, Dr. Burkhard F. Leeb of the Karl Landsteiner Institute for Clinical Rheumatology in Stockerau, Austria, and his colleagues demonstrated SASPA’s reliability, convergent validity, and sensitivity to change in 152 adult psoriatic arthritis outpatients. For example, they found a Cronbach’s alpha for SASPA of 0.875, indicating high internal consistency and reliability (BMC Musculoskelet. Disord. 2015;16:73).

There are several psoriatic arthritis assessment tools already that work for between-group comparisons but “may not be fully suitable for assessing individual patients,” the investigators wrote.

With SASPA, however, they noted that “inter-physician, but also intra-physician variations in assessing joints or global disease activity are eliminated, and other pitfalls of joint counts are avoided.”

The study was supported by the Karl Landsteiner Institute for Clinical Rheumatology. The authors said that they had no financial disclosures.

aotto@frontlinemedcom.com

Serious adverse events are more likely in patients older than 65 years undergoing psoriasis therapy, though whether these events are because of the treatment itself or other risk factors remains unclear, according to Dr. Carolina Medina and her associates.

In a review of data from 1,793 psoriasis patients enrolled in a national registry in Spain (10% of whom were older than 65 years), the overall risk of any adverse event was not significantly higher in the older group (drug group adjusted hazard ratio 1.09). However, the risk of serious adverse events was much greater (drug group adjusted HR, 3.2). Biologic exposure decreased the risk of adverse events in both younger and older patients, compared with those receiving classic therapy, even after adjustments for age (HR, 0.7, age adjusted), the researchers noted.

“These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low,” they concluded.

Find the full study in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.12688).

Serious adverse events are more likely in patients older than 65 years undergoing psoriasis therapy, though whether these events are because of the treatment itself or other risk factors remains unclear, according to Dr. Carolina Medina and her associates.

In a review of data from 1,793 psoriasis patients enrolled in a national registry in Spain (10% of whom were older than 65 years), the overall risk of any adverse event was not significantly higher in the older group (drug group adjusted hazard ratio 1.09). However, the risk of serious adverse events was much greater (drug group adjusted HR, 3.2). Biologic exposure decreased the risk of adverse events in both younger and older patients, compared with those receiving classic therapy, even after adjustments for age (HR, 0.7, age adjusted), the researchers noted.

“These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low,” they concluded.

Find the full study in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.12688).

Serious adverse events are more likely in patients older than 65 years undergoing psoriasis therapy, though whether these events are because of the treatment itself or other risk factors remains unclear, according to Dr. Carolina Medina and her associates.

In a review of data from 1,793 psoriasis patients enrolled in a national registry in Spain (10% of whom were older than 65 years), the overall risk of any adverse event was not significantly higher in the older group (drug group adjusted hazard ratio 1.09). However, the risk of serious adverse events was much greater (drug group adjusted HR, 3.2). Biologic exposure decreased the risk of adverse events in both younger and older patients, compared with those receiving classic therapy, even after adjustments for age (HR, 0.7, age adjusted), the researchers noted.

“These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low,” they concluded.

Find the full study in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.12688).

Certain genetic loci are likely associated with late-onset psoriasis, based on data from a study of 543 cases and 4,373 healthy controls. Previous studies have shown 36 genetic loci linked to early-onset psoriasis (younger than 40 years), but the genetics of late-onset psoriasis (aged 40 years and older) have not been well studied, wrote Harry L. Hébert, a PhD candidate at the University of Manchester, England, and his colleagues.

In their genotyping analysis, the two loci HLA-C and IL12B, shown to be associated with early-onset psoriasis, also were significantly associated with late-onset disease, as were six other loci. In addition, IL1R1 on chromosome 2q13 was uniquely associated with late-onset psoriasis.

Find the full study online in the British Journal of Dermatology (2015;172:933-9 [doi:10.1111/bjd.13340]).

Certain genetic loci are likely associated with late-onset psoriasis, based on data from a study of 543 cases and 4,373 healthy controls. Previous studies have shown 36 genetic loci linked to early-onset psoriasis (younger than 40 years), but the genetics of late-onset psoriasis (aged 40 years and older) have not been well studied, wrote Harry L. Hébert, a PhD candidate at the University of Manchester, England, and his colleagues.

In their genotyping analysis, the two loci HLA-C and IL12B, shown to be associated with early-onset psoriasis, also were significantly associated with late-onset disease, as were six other loci. In addition, IL1R1 on chromosome 2q13 was uniquely associated with late-onset psoriasis.

Find the full study online in the British Journal of Dermatology (2015;172:933-9 [doi:10.1111/bjd.13340]).

Certain genetic loci are likely associated with late-onset psoriasis, based on data from a study of 543 cases and 4,373 healthy controls. Previous studies have shown 36 genetic loci linked to early-onset psoriasis (younger than 40 years), but the genetics of late-onset psoriasis (aged 40 years and older) have not been well studied, wrote Harry L. Hébert, a PhD candidate at the University of Manchester, England, and his colleagues.

In their genotyping analysis, the two loci HLA-C and IL12B, shown to be associated with early-onset psoriasis, also were significantly associated with late-onset disease, as were six other loci. In addition, IL1R1 on chromosome 2q13 was uniquely associated with late-onset psoriasis.

Find the full study online in the British Journal of Dermatology (2015;172:933-9 [doi:10.1111/bjd.13340]).

Mylan N.V. has announced a voluntary recall of specific lots of injectable products for conditions including rheumatoid arthritis, severe psoriasis, lung cancer, breast cancer, ovarian cancer, and acute nonlymphocytic leukemia because foreign particles were observed during testing of retention samples, according to a statement issued by the company on April 23.

The specific lot numbers can be found on the company’s website.

Affected products include methotrexate injection, USP 25 mg/mL, which is indicated for adult rheumatoid arthritis, severe psoriasis, and some neoplastic diseases. According to Mylan, the contaminated lot was distributed in the United States between Jan. 16, 2014, and March 25, 2014.

Other recalled injectable products include gemcitabine, USP 200 mg, an intravenous product for ovarian cancer, breast cancer, non–small cell lung cancer, and pancreatic cancer; carboplatin 10 mg/mL, indicated for advanced ovarian cancer; and cytarabine, indicated for remission induction in acute nonlymphocytic leukemia in adults and children. The lots for these products were distributed in the United States in various periods of several months during 2014.

The recall is being conducted with the knowledge of the Food and Drug Administration, and any adverse events or quality problems should be reported to the FDA’s MedWatch adverse event reporting program.

hsplete@frontlinemedcom.com

Mylan N.V. has announced a voluntary recall of specific lots of injectable products for conditions including rheumatoid arthritis, severe psoriasis, lung cancer, breast cancer, ovarian cancer, and acute nonlymphocytic leukemia because foreign particles were observed during testing of retention samples, according to a statement issued by the company on April 23.

The specific lot numbers can be found on the company’s website.

Affected products include methotrexate injection, USP 25 mg/mL, which is indicated for adult rheumatoid arthritis, severe psoriasis, and some neoplastic diseases. According to Mylan, the contaminated lot was distributed in the United States between Jan. 16, 2014, and March 25, 2014.

Other recalled injectable products include gemcitabine, USP 200 mg, an intravenous product for ovarian cancer, breast cancer, non–small cell lung cancer, and pancreatic cancer; carboplatin 10 mg/mL, indicated for advanced ovarian cancer; and cytarabine, indicated for remission induction in acute nonlymphocytic leukemia in adults and children. The lots for these products were distributed in the United States in various periods of several months during 2014.

The recall is being conducted with the knowledge of the Food and Drug Administration, and any adverse events or quality problems should be reported to the FDA’s MedWatch adverse event reporting program.

hsplete@frontlinemedcom.com

Mylan N.V. has announced a voluntary recall of specific lots of injectable products for conditions including rheumatoid arthritis, severe psoriasis, lung cancer, breast cancer, ovarian cancer, and acute nonlymphocytic leukemia because foreign particles were observed during testing of retention samples, according to a statement issued by the company on April 23.

The specific lot numbers can be found on the company’s website.

Affected products include methotrexate injection, USP 25 mg/mL, which is indicated for adult rheumatoid arthritis, severe psoriasis, and some neoplastic diseases. According to Mylan, the contaminated lot was distributed in the United States between Jan. 16, 2014, and March 25, 2014.

Other recalled injectable products include gemcitabine, USP 200 mg, an intravenous product for ovarian cancer, breast cancer, non–small cell lung cancer, and pancreatic cancer; carboplatin 10 mg/mL, indicated for advanced ovarian cancer; and cytarabine, indicated for remission induction in acute nonlymphocytic leukemia in adults and children. The lots for these products were distributed in the United States in various periods of several months during 2014.

The recall is being conducted with the knowledge of the Food and Drug Administration, and any adverse events or quality problems should be reported to the FDA’s MedWatch adverse event reporting program.

hsplete@frontlinemedcom.com

The effectiveness of treating lupus with a drug approved for treating plaque psoriasis and active psoriatic arthritis will be tested in a clinical study.

The study, which will be conducted by the Alliance for Lupus Research and Janssen Research & Development, LLC, will evaluate the drug, ustekinumab (Stelara) for the treatment of systemic lupus erythematosus, the Alliance announced in a written statement.

Ustenkinumab was selected for this study as part of the LRxL-STAT Lupus Drug Repositioning Initiative, which seeks to find therapies approved for indications other than lupus that can also treat lupus. Ustenkinumab was identified as the most promising biologic candidate for treating lupus over hundreds of other potential lupus therapies.

The ALR and Janssen will begin recruiting patients for the study later this year.

The effectiveness of treating lupus with a drug approved for treating plaque psoriasis and active psoriatic arthritis will be tested in a clinical study.

The study, which will be conducted by the Alliance for Lupus Research and Janssen Research & Development, LLC, will evaluate the drug, ustekinumab (Stelara) for the treatment of systemic lupus erythematosus, the Alliance announced in a written statement.

Ustenkinumab was selected for this study as part of the LRxL-STAT Lupus Drug Repositioning Initiative, which seeks to find therapies approved for indications other than lupus that can also treat lupus. Ustenkinumab was identified as the most promising biologic candidate for treating lupus over hundreds of other potential lupus therapies.

The ALR and Janssen will begin recruiting patients for the study later this year.

The effectiveness of treating lupus with a drug approved for treating plaque psoriasis and active psoriatic arthritis will be tested in a clinical study.

The study, which will be conducted by the Alliance for Lupus Research and Janssen Research & Development, LLC, will evaluate the drug, ustekinumab (Stelara) for the treatment of systemic lupus erythematosus, the Alliance announced in a written statement.

Ustenkinumab was selected for this study as part of the LRxL-STAT Lupus Drug Repositioning Initiative, which seeks to find therapies approved for indications other than lupus that can also treat lupus. Ustenkinumab was identified as the most promising biologic candidate for treating lupus over hundreds of other potential lupus therapies.

The ALR and Janssen will begin recruiting patients for the study later this year.

At the 73rd Annual Meeting of the American Academy of Dermatology in San Francisco, California, Dr. Jashin J. Wu spoke about the risk for cancer, infection, and MACE (major adverse cardiovascular events) in psoriasis patients on a biologic. Dr. Wu provides an overview of the data evaluating biologics versus nonbiologic therapies. He discusses biologics such as infliximab, ustekinumab, etanercept, and adalimumab, as well as tumor necrosis factor inhibitors.

At the 73rd Annual Meeting of the American Academy of Dermatology in San Francisco, California, Dr. Jashin J. Wu spoke about the risk for cancer, infection, and MACE (major adverse cardiovascular events) in psoriasis patients on a biologic. Dr. Wu provides an overview of the data evaluating biologics versus nonbiologic therapies. He discusses biologics such as infliximab, ustekinumab, etanercept, and adalimumab, as well as tumor necrosis factor inhibitors.

At the 73rd Annual Meeting of the American Academy of Dermatology in San Francisco, California, Dr. Jashin J. Wu spoke about the risk for cancer, infection, and MACE (major adverse cardiovascular events) in psoriasis patients on a biologic. Dr. Wu provides an overview of the data evaluating biologics versus nonbiologic therapies. He discusses biologics such as infliximab, ustekinumab, etanercept, and adalimumab, as well as tumor necrosis factor inhibitors.

The second version of the Toronto Psoriatic Arthritis screen performed well at identifying psoriatic arthritis in 336 psoriasis patients, 131 psoriatic arthritis patients, and 89 individuals in the general population, according to Dr. Brian Tom and his associates.

The sensitivities of the capped and uncapped version of the ToPAS 2 system were the same across all measured groups (92.0%) when the cutpoint was 7 for ToPAS2_cap and 8 for ToPAS2_uncap, although the sensitivity for ToPAS2_uncap was slightly lower when the cutpoint was 9 (84.0% vs. 87.2)%. Both were higher than the original ToPAS index (sensitivity 86.6%), which did not include a spinal domain. However, the specificity of the original ToPAS index across all measured groups was slightly higher (80.5%-95.5%) than with ToPAS2_cap and ToPAS2_uncap (73.8%-89.9% and 71.6%-91.0%).

Besides the addition of a spinal domain, the ToPAS 2 “incorporates further pictures of cutaneous psoriasis, joint inflammation, and dactylitis to improve its performance, as well as more carefully worded questions regarding spinal involvement,” the investigators wrote.

While the specificity is lower with ToPAS 2, this should not be a major issue, because “for the purposes of identifying patients whom dermatologists or primary care physicians should refer to a rheumatologist, the specificity is not as important, because patients with rheumatological disorders other than PsA would benefit from a rheumatologist’s consultation,” the investigators said.

Find the full study in Journal of Rheumatology (doi:10.3899/jrheum.140857).

The second version of the Toronto Psoriatic Arthritis screen performed well at identifying psoriatic arthritis in 336 psoriasis patients, 131 psoriatic arthritis patients, and 89 individuals in the general population, according to Dr. Brian Tom and his associates.

The sensitivities of the capped and uncapped version of the ToPAS 2 system were the same across all measured groups (92.0%) when the cutpoint was 7 for ToPAS2_cap and 8 for ToPAS2_uncap, although the sensitivity for ToPAS2_uncap was slightly lower when the cutpoint was 9 (84.0% vs. 87.2)%. Both were higher than the original ToPAS index (sensitivity 86.6%), which did not include a spinal domain. However, the specificity of the original ToPAS index across all measured groups was slightly higher (80.5%-95.5%) than with ToPAS2_cap and ToPAS2_uncap (73.8%-89.9% and 71.6%-91.0%).

Besides the addition of a spinal domain, the ToPAS 2 “incorporates further pictures of cutaneous psoriasis, joint inflammation, and dactylitis to improve its performance, as well as more carefully worded questions regarding spinal involvement,” the investigators wrote.

While the specificity is lower with ToPAS 2, this should not be a major issue, because “for the purposes of identifying patients whom dermatologists or primary care physicians should refer to a rheumatologist, the specificity is not as important, because patients with rheumatological disorders other than PsA would benefit from a rheumatologist’s consultation,” the investigators said.

Find the full study in Journal of Rheumatology (doi:10.3899/jrheum.140857).

The second version of the Toronto Psoriatic Arthritis screen performed well at identifying psoriatic arthritis in 336 psoriasis patients, 131 psoriatic arthritis patients, and 89 individuals in the general population, according to Dr. Brian Tom and his associates.

The sensitivities of the capped and uncapped version of the ToPAS 2 system were the same across all measured groups (92.0%) when the cutpoint was 7 for ToPAS2_cap and 8 for ToPAS2_uncap, although the sensitivity for ToPAS2_uncap was slightly lower when the cutpoint was 9 (84.0% vs. 87.2)%. Both were higher than the original ToPAS index (sensitivity 86.6%), which did not include a spinal domain. However, the specificity of the original ToPAS index across all measured groups was slightly higher (80.5%-95.5%) than with ToPAS2_cap and ToPAS2_uncap (73.8%-89.9% and 71.6%-91.0%).

Besides the addition of a spinal domain, the ToPAS 2 “incorporates further pictures of cutaneous psoriasis, joint inflammation, and dactylitis to improve its performance, as well as more carefully worded questions regarding spinal involvement,” the investigators wrote.

While the specificity is lower with ToPAS 2, this should not be a major issue, because “for the purposes of identifying patients whom dermatologists or primary care physicians should refer to a rheumatologist, the specificity is not as important, because patients with rheumatological disorders other than PsA would benefit from a rheumatologist’s consultation,” the investigators said.

Find the full study in Journal of Rheumatology (doi:10.3899/jrheum.140857).