No abstract

Background JAK inhibitors are a relatively new class of medications that may be useful in the treatment of moderate-to-severe psoriasis and psoriatic arthritis (PsA). The objective of this study was to determine the efficacy of several JAK inhibitors in treating psoriasis and PsA and examine safety concerns. Methods MEDLINE, Cochrane and EMBASE were searched for randomized controlled trials and observational studies comparing any JAK inhibitor to placebo. The primary outcomes were a 75% improvement in the Psoriasis Area and Severity Index (PASI75) and a 20% improvement in the American College of Rheumatology composite score (ACR20). A secondary outcome was the proportion of patients achieving a “0” or “1” on the static Physician Global Assessment scale. Odds ratios were used to compare the proportion of patients reaching these targets in the max dose intervention group vs. the placebo group. A random effects model was used to account for heterogeneity. Results In total, 15 RCTs were included in the study and no observational studies. This encompassed 6757 patients in total. When the results were combined, the calculated odds ratio for PASI75 amongst tofacitinib vs. placebo was OR 14.35 [95%CI 7.65, 26.90], for PASI75 amongst non-tofacitinib JAK inhibitors vs. placebo it was OR 6.42 [95%CI 4.89, 8.43], for ACR20 amongst all JAK inhibitors versus placebo was OR 5.87 [95%CI 4.39, 7.85]. There was no significant difference in prevalence of serious adverse events between intervention and control in any of these studies. Conclusion JAK inhibitors show promise for safely treating moderate-to-severe psoriasis and psoriatic arthritis.

Objective To describe the pattern of musculoskeletal symptoms and their correlation with clinical and sonographic findings among psoriasis patients with suspected psoriatic arthritis (PsA). Methods Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their musculoskeletal complaints. The study included the following steps: 1) assessment by an advanced practice physiotherapist; 2) targeted musculoskeletal ultrasound and 3) assessment by a rheumatologist. In addition, patients were asked to complete questionnaires about the nature and duration of their musculoskeletal symptoms and to mark the location of their painful joints on a homunculus. Each patient was classified by a rheumatologist as: “Not PsA”, “Possibly PsA” of “PsA”. Musculoskeletal symptoms and patient-reported outcomes were compared between patients with “PsA” and “possible/not PsA”. Agreement between modalities was assessed using Kappa statistics. Results 203 patients with psoriasis and musculoskeletal symptoms were enrolled (8.8% PsA, 23.6% possible PsA). Patients classified as “PsA” had worse scores on the PsA Impact of Disease (PSAID, p=0.004) and Functional Assessment of Chronic Illness Therapy (FACIT, p=0.02). There was no difference between the two groups in the presence, distribution and duration of musculoskeletal symptoms. Analysis of agreement in physical examination between modalities revealed the strongest agreement between the rheumatologist and physiotherapist (k=0.28). The lowest levels of agreement were found between ultrasound and patient (k=0.08) and physiotherapist and ultrasound (k=0.08). Conclusion The results of this study suggest that the intensity, rather than the type, duration or distribution of musculoskeletal symptoms is associated with PsA among patients with psoriasis.

CAPLET improves the feasibility of capturing detailed assessments of patient-reported physical function in cancer outpatients.