Gender-specific differences in patients with psoriatic arthritis receiving ustekinumab or tumour necrosis factor inhibitor: real-world data

Objective: Investigate effects of gender on disease characteristics and treatment impact in patients with psoriatic arthritis (PsA). Methods: PsABio is a non-interventional European study in patients with PsA starting a biological disease-modifying anti-rheumatic drug (bDMARD; ustekinumab or tumour necrosis factor inhibitor [TNFi]). This post-hoc analysis compared persistence, disease activity, patient-reported outcomes and safety between male and female patients at baseline and 6 and 12 months of treatment. Results: At baseline, disease duration was 6.7 and 6.9 years for 512 females and 417 males respectively. Mean (95% CI) scores for females versus males were: clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA), 32.3 (30.3;34.2) versus 26.8 (24.8;28.9); Health Assessment Questionnaire-Disability Index (HAQ-DI), 1.3 (1.2;1.4) versus 0.93 (0.86;0.99); total Psoriatic Arthritis Impact of Disease-12 (PsAID-12) score, 6.0 (5.8;6.2) versus 5.1 (4.9;5.3), respectively. Improvements in scores were smaller in female than male patients. At 12 months, 175/303 (57.8%) female and 212/264 (80.3%) male patients achieved cDAPSA low disease activity, 96/285 (33.7%) and 137/247 (55.5%), achieved minimal disease activity (MDA), respectively. HAQ-DI scores were 0.85 (0.77;0.92) versus 0.50 (0.43;0.56), PsAID-12 scores 3.5 (3.3;3.8) versus 2.4 (2.2;2.6), respectively. Treatment persistence was lower in females than males (p = <0.001). Lack of effectiveness was the predominant reason to stop, irrespective of gender and bDMARD. Conclusions: Before starting bDMARDs, females had more severe disease than males and a lower percentage reached favourable disease states, with lower persistence of treatment after 12 months. A better understanding of the mechanisms underlying these differences may improve therapeutic management in females with PsA. Trial registration: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02627768

Management of Dactylitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

OBJECTIVE: This literature review aimed to identify the most efficacious current interventions for dactylitis and provide up-to-date scientific evidence to support the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommendations on the management of psoriatic arthritis. METHODS: Original articles published from 2013 to 2020, registered in MEDLINE, Embase, and Cochrane Library, describing interventional trials and reporting dactylitis-related outcomes were included. The 20 members of the GRAPPA dactylitis group were divided into 9 subgroups according to treatment, and members of each group independently extracted data from articles/abstracts corresponding to their group by using a standardized data extraction form. RESULTS: Forty-nine publications were analyzed, representing 40 randomized clinical trials (RCTs) and including 16,752 patients. Dactylitis was assessed as a secondary outcome in 97.5% of these trials and more than 40% of RCTs did not employ a specific dactylitis measure or instrument. CONCLUSION: The emergence of agents with novel mechanisms of action in recent years, such as interleukin 17 (IL-17), IL-12/23, IL-23, and Janus kinase inhibitors, has significantly expanded the available treatment options for dactylitis. This article points out the lack of consensus regarding dactylitis assessment and the paucity of data concerning the effect of local steroid injections, nonsteroidal antiinflammatory drugs, and conventional disease-modifying antirheumatic drugs. Clinical trials evaluating the effect of these traditional and low-cost medications used to treat dactylitis should be encouraged