A clinical review of structural damage in psoriatic arthritis for dermatologists: From pathogenesis to ongoing controversies

Merola, Joseph F.; Chakravarty, Soumya D.; Choi, Olivia; Chan, Daphne; Gottlieb, Alice B.

doi:10.1016/j.jaad.2023.10.021

Cited by 6 publications

(1 citation statement)

References 65 publications

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“…Psoriatic arthritis (PsA) is a clinically heterogeneous, progressive, chronic inflammatory disease involving the skin and musculoskeletal systems with potential to irreversibly damage joints and impair health-related quality of life (HRQoL). [1][2][3] PsA affects approximately 30% of individuals with psoriasis 4 and has an estimated worldwide prevalence between 0.3% and 1%. 5 The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recognises six disease domains (peripheral arthritis, axial disease, enthesitis, dactylitis, skin psoriasis and psoriatic nail disease), two related conditions (inflammatory bowel disease (IBD) and uveitis) 6 and several comorbidities (eg, obesity, metabolic syndrome, diabetes mellitus) of PsA, all of which impact patients' HRQoL.…”

Section: Introductionmentioning

confidence: 99%

Guselkumab provides durable improvement across psoriatic arthritis disease domains: post hoc analysis of a phase 3, randomised, double-blind, placebo-controlled study

Coates,

Gossec,

Zimmermann

et al. 2024

RMD Open

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ObjectiveEvaluate long-term guselkumab effectiveness across Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-recognised domains/related conditions of psoriatic arthritis (PsA).MethodsPost hoc analyses used data from DISCOVER-2 (NCT03158285) biologic/Janus-kinase inhibitor-naïve participants with active PsA (≥5 swollen/≥5 tender joints, C-reactive protein ≥0.6 mg/dL), randomised (1:1:1) to guselkumab every 4 or 8 weeks (Q4W/Q8W) or placebo with crossover to guselkumab. Outcomes aligned with key GRAPPA-recognised domains of overall disease activity, peripheral arthritis, axial disease, enthesitis/dactylitis and skin psoriasis (nail psoriasis was not evaluated). PsA-related conditions (inflammatory bowel disease (IBD)/uveitis) were assessed via adverse events through W112. Least squares mean changes from baseline through W100 in continuous outcomes employed repeated measures mixed-effects models adjusting for baseline scores. Binary measure response rates were determined with non-responder imputation for missing data.Results442/493 (90%) of guselkumab-randomised patients completed treatment through W100. Following early reductions in disease activity with guselkumab, durable improvements were observed across key PsA domains (swollen/tender joints, psoriasis, spinal pain, enthesitis/dactylitis) through W100. Response rates of therapeutically relevant targets generally increased through W100 with guselkumab Q4W/Q8W: Disease Activity Index for PsA low disease activity (LDA) 62%/59%, enthesitis resolution 61%/70%, dactylitis resolution 72%/83%, 100% improvement in Psoriasis Area and Severity Index 59%/53%, Psoriatic Arthritis Disease Activity Score LDA 51%/49% and minimal disease activity 38%/40%. Through W112, no cases of IBD developed among guselkumab-randomised patients and one case of uveitis was reported.ConclusionIn biologic-naïve patients with active PsA, guselkumab provided early and durable improvements in key GRAPPA-recognised domains through 2 years, with substantial proportions achieving important treatment targets.

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