Psoriatic arthritis (PsA) is an inflammatory arthritis with deleterious effects on health-related quality of life (HRQOL). We evaluated the effect of apremilast (APR) on patient-reported outcomes (PROs) in PsA subjects and the correlation between the 36-Item Short-Form Health Survey (SF-36) domains and disease-specific measures of physical function and fatigue. METHODS: A phase II, multicentre, double-blind, placebo-controlled study randomised 204 subjects with active PsA (duration Ͼ6 months; Ն3 swollen joints; Ն3 tender joints) 1:1:1 to oral APR 20mg BID (APR20), 40mg QD (APR40), or placebo for 12 weeks. PROs included Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Health Assessment Questionnaire-Disability Index (HAQ-DI), pain visual analogue scale (VAS), and SF-36 domain scores. Correlations between the HAQ-DI, pain VAS, and FACIT-F and the SF-36 Physical Function (PF), Bodily Pain (BP) and Vitality (VT) domains were described with statistical significance. RESULTS: At week 12, mean change in PF, BP, and VT was Ϫ2.1, 2.7, and 3.1 with placebo; 6.2 (Pϭ0.012 versus placebo), 11.5 (Pϭ0.001 versus placebo), and 6.6 (PϽ0.05 versus placebo) with APR20; and 3.8, 7.9 (Pϭ0.037 versus placebo), and 3.7 with APR40, respectively. Mean change in HAQ-DI was Ϫ0.1, Ϫ0.2, and Ϫ0.2 with placebo, APR20, and APR40. Mean change in FACIT-F was 0.5, Ϫ4.1 (PϽ0.025), and Ϫ4.3 with placebo, APR20, and APR40. Mean percent change in pain VAS was 7.4%, Ϫ14.5%, and Ϫ15.1% with placebo, APR20, and APR40. Moderate (Ͼ0.30Յ0.60) and statistically significant (PϽ0.001) correlations were evident between pain VAS and BP (Ϫ0.55), HAQ-DI and PF (Ϫ0.43), and FACIT-F and VT (0.55). High (Ͼ0.60), statistically significant (PϽ0.001) correlations were observed for FACIT-F versus VT (0.66) with APR20 and HAQ-DI versus PF (Ϫ0.73) with APR40. CONCLUSIONS: Treatment of PsA with APR20 was associated with statistically significant improvements versus placebo in FACIT-F and HRQOL. Moderate to high correlations were evident among PROs.

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BACKGROUNDThis study aimed to describe the least invasive surgical technique of endoscopic decompression for thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) and to review the literature available on the diagnosis and treatment of OLF.OBSERVATIONSThe mean age of the patients was 51.2 (range, 40–62) years, and the mean preoperative, 2-week postoperative, and last follow-up modified Japanese Orthopaedic Association scores were 6.6 (range, 4–10), 9.6 (range, 7–11), and 13 (range, 10–14), respectively. All patients were discharged within 48 hours after the surgery. The mean follow-up period was 13.2 (range, 7–18) months. No complication was found perioperatively, and none of the patients had postoperative instability during the follow-up period.LESSONSBased on this clinical case series and literature review, the authors conclude that endoscopic decompression surgery is feasible and effective for managing thoracic myelopathy caused by OLF while minimizing surrounding tissue damage. Additionally, it enables shorter periods of hospital stay.