Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients With Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations

Jadon, Deepak R.; Corp, Nadia; Windt, D.A.W.M. van der; Coates, Laura C.; Soriano, Enrique R.; Kavanaugh, Arthur; Raine, Tim; Rieder, Florian; Siebert, Stefan; Zummer, Michel; Schwartzman, Sergio; Rosenbaum, James T.; Michelsen, Brigitte; Laxminarayan, Ramasharan; Wu, Donghai; Gupta, Latika; Ng, Beverly; Johnsson, Hanna; Windt, Nick De; Gudu, T.; Hutton, J.P.; O’Sullivan, Denis; Luchetti, Michele Maria; Stoll, Matthew L.; Singh, Jasvinder A.; Peluso, Rosario; Rademacher, Judith; Husni, Elaine

doi:10.3899/jrheum.220317

Cited by 8 publications

(3 citation statements)

References 50 publications

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“…Indeed, ADA was the first anti-TNF approved for intermediate, posterior, and panuveitis. As already extensively discussed in rheumatology [127], not all available treatments for IBD are equally effective for o-EIMs, particularly for uveitis, and for some classes of treatment a discrepant efficacy across o-EIMs has been observed. RCTs specifically addressing o-EIMs and conducted in IBD patients with these conditions are currently lacking.…”

Section: Discussionmentioning

confidence: 99%

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Migliorisi,

Vella,

Dal Buono

et al. 2024

Cells

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Background and aims: Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn’s disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. Methods: PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. Results: The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs’ pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs.

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Section: Discussionmentioning

confidence: 99%

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Migliorisi,

Vella,

Dal Buono

et al. 2024

Cells

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“…9 10 Therefore, IBD-SpA requires a multidisciplinary approach coordinated by both rheumatologist and gastroenterologist for an early diagnosis and combined therapeutic strategy. [11][12][13][14][15] Recently, knowledge on disease interception emerged regarding the role of bDMARDs for psoriasis (PsO) in reducing not only skin inflammation but also the incidence of psoriatic arthritis. 16 17 Considering this hypothesis as biologically and clinically relevant, we aimed at evaluating the incidence of SpA in patients affected by IBD with a follow-up of 10 years, focusing on IBD therapy and associated risk factors to SpA development.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Impact of biological therapy in reducing the risk of arthritis development in inflammatory bowel diseases

Fatica,

Monosi,

Conigliaro

et al. 2024

RMD Open

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ObjectiveEvaluate spondyloarthritis (SpA) incidence in inflammatory bowel diseases (IBD) between patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) and conventional DMARDs (cDMARDs) and define risk factors associated with SpA development.MethodsRetrospective cohort study was conducted on patients with Crohn’s disease (CD) or ulcerative colitis (UC) and divided into two cohorts: cDMARDs or bDMARDs/targeted synthetic (ts) DMARDs treated patients. Rheumatological assessment was performed in patients presenting musculoskeletal symptoms. Multivariate analysis and Kaplan-Meier curves were used to evaluate the adjusted SpA risk development.Results507 patients were included in the study. 176 patients with CD received bDMARDs, 112 cDMARDs and 106 new SpA diagnosies were formulated. Females (OR 1.7 (95% CI 1.1 to 3), adjusted p=0.04), non-stricturing/non-penetrating phenotype (OR 2 (95% CI 1.1 to 3.4), adjusted p=0.01), psoriasis (OR 2.1 (95% CI 1 to 4.6), adjusted p=0.04) and non-infectious uveitis (OR 6.8 (95% CI 1.4 to 33.4), adjusted p=0.01) were associated with increased SpA risk development, while bDMARDs usage was protective (OR 0.4 (95% CI 0.2 to 0.8), adjusted p=0.01), statistically higher than cDMARDs throughout the entire follow-up (effect size 0.47). 98 patients with UC received b-tsDMARDs, 121 cDMARDs and 56 new SpA diagnoses were formulated. Females (OR 2.1 (95% CI 1 to 4.3), adjusted p=0.02) and psoriasis (OR 2.7 (95% CI 1 to 6.8), adjusted p=0.03) were associated with increased SpA risk development, while bDMARDs were protective for SpA development for up to 12 months of treatment compared with cDMARDs (p=0.03).ConclusionsbDMARDs treatment had an impact in reducing SpA development and clinical associated risk factors to transition from IBD to IBD-SpA emerged.

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“…Quality of evidence showing benefit from the use of interleukin‐17 inhibitors (IL‐17i), IL‐23 inhibitors (IL‐23i), and JAK inhibitiors (JAKi) for the treatment of enthesitis and dactylitis among patients who are TNFi‐IRs remains low (47,48). Similarly, the evidence for treatment recommendations for patients with skin and nail involvement is based, in large part, from studies of PsO rather than PsA patients (49); the same is true for the IBD and uveitis domains (50).…”

Section: Therapeutic Approachmentioning

confidence: 99%

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

Leung

Kavanaugh

Ritchlin

2023

Arthritis & Rheumatology

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The index case, a 36-year-old woman, had psoriasis (PsO) on her scalp, arms, legs, and trunk since age 25 years that was inadequately controlled with topical agents. She has a past medical history of treated hypertension and depression. She is an active smoker. Three years prior to our case evaluation, she developed polyarthritis, inflammatory back pain, and plantar fasciitis. Methotrexate (MTX) was added to her treatment regimen, first administered orally then subcutaneously, but the patient stated she could only tolerate 12.5 mg/week due to gastrointestinal and systemic adverse events. The dose of 12.5 mg/week resulted in minimal benefit. In addition, the patient was recently married and reported that pregnancy was being considered, and therefore treatment with MTX was stopped. She then experienced a flare of PsO and arthritis.Physical examination was notable for the presence of moderate-to-severe PsO (12% affected body surface area [BSA]), 6-7 swollen and tender joints, and evidence of mild erosive changes on hand radiographs. Monotherapy with adalimumab 40 mg every other week was initiated. The patient improved during treatment with adalimumab over 10 weeks, with 60-70% improvement in her clinical symptoms overall, but continued to experience mild residual joint pain and signs of PsO (2-4% BSA). Approximately 3 months ago, she noted profound fatigue, 90 minutes of morning stiffness, and diffuse joint pain. She found it difficult to continue her work in retail and reported feeling frustrated, anxious, and depressed. Her skin PsO also worsened and became more bothersome to her. On physical examination, her blood pressure was 140/90 mm Hg, pulse rate was 72 beats per minute, and body mass index was 35 kg/m 2 . She had psoriasiform plaques on her trunk and extremities (8% BSA). Musculoskeletal examination revealed 6 tender and 4 swollen joints, and she had a Disease Activity Index for PsA (DAPSA) score of 29 (a DAPSA score of >28 represents high disease activity). There were multiple tender entheses, most notably in the plantar fasciae, left Achilles tendon, and the left elbow lateral condyle. Pain was elicited in the right sacroiliac (SI) joint on provocative testing, and also at several locations unassociated with entheses.

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Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients With Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations

Cited by 8 publications

References 50 publications

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Impact of biological therapy in reducing the risk of arthritis development in inflammatory bowel diseases

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

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