Long-term costs and outcomes in psoriatic arthritis patients not responding to conventional therapy treated with tumour necrosis factor inhibitors: the extension of the Psoriatic Arthritis Cost Evaluation (PACE) study.

Objectives: Poor information on long-term outcomes and costs on tumour necrosis factor (TNF) inhibitors in psoriatic arthritis (PsA) are available. Our aim was to evaluate long-term costs and benefits of TNF- inhibitors in PsA patients with inadequate response to conventional treatment with traditional disease-modifying anti-rheumatic drugs (tDMARDs).

Methods: Fifty-five out of 107 enrolled patients included in the study at one year, completed the 5-year follow-up period.

Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy: an Italian nationwide survey.

Aims: Primary: to investigate Italian rheumatology practice regarding latent tubercular infection (LTBI) detection and tuberculosis (TB) prevention in patients requiring anti-tumor necrosis factor (anti-TNF) therapy. Secondary: to assess the overall number of TB cases over 10 years and their distribution by drug.

Methods: An anonymous, 24 multiple-response questionnaire was completed by 393/449 (87.

Measuring psoriatic disease in clinical practice. An expert opinion position paper.

Psoriasis is a common, immune-mediated chronic inflammatory disease with a primary involvement of skin and joints, affecting approximately 2% of the population worldwide. Up to one third of patients with psoriasis are diagnosed with psoriatic arthritis (PsA). Psoriasis and PsA are heterogeneous diseases whose severity depends on a number of clinical factors, such as areas affected and pattern of involvement, and are associated with a range of comorbid diseases and risk factors, including obesity, metabolic syndrome, cardiovascular disease and liver disease.

Tumour necrosis factor alpha inhibitor therapy and rehabilitation for the treatment of ankylosing spondylitis: a systematic review.

Objectives: To systematically review the evidence for a synergistic effect of combining rehabilitation with biological anti-tumour necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS).

Methods: Data were analysed to identify the most effective rehabilitation programmes, the best endpoints for effectiveness, and patient subgroups most likely to benefit from combination therapy. Systematic MEDLINE and Embase searches were performed to identify studies evaluating rehabilitation programmes and biological therapy in patients with AS.

Beyond the joint: Subclinical atherosclerosis in rheumatoid arthritis.

Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with increased cardiovascular risk and higher mortality in respect to general population. Beyond joint disease, inflammation is the major determinant of accelerated atherosclerosis observed in rheumatoid arthritis. We review the relationship between inflammation, atherosclerosis and cardiovascular risk in rheumatoid arthritis, focusing on the assessment of subclinical atherosclerosis by functional and morphological methods.

A novel biological target for the treatment of psoriatic arthritis.

Evaluation of: Kavanaugh A, Ritchlin C, Rahman P et al.; on behalf of the PSUMMIT-1 and -2 Study Groups. Ustekinumab, an anti-IL-12/23 p40 monoclonal antibody, inhibits radiographic progression in patients with active psoriatic arthritis: results of an integrated analysis of radiographic data from the Phase 3, multicentre, randomised, double-blind, placebo-controlled PSUMMIT-1 and PSUMMIT-2 trials.

The adherence to ASAS classification criteria and to ASAS recommendations for the use of anti-TNH-alpha agents in axial spondyloarthritis.

Objectives: To determine the adherence of practicing rheumatologists, before and after an educational project, to Assessment of SpondyloArthritis international Society (ASAS) classification criteria and to ASAS recommendations for the use of anti-tumor necrosis factor (TNF)-alpha agents in patients with axial spondyloarthritis (SpA).

Methods: The project involved 53 rheumatologists attending 2 educational meetings on an update of SpA. Each meeting included interactive sessions on 1) clinical cases, 2) clinimetric evaluation, including ASAS core set for daily practice and 3) imaging.

Profile of ustekinumab and its potential in the treatment of active psoriatic arthritis.

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis and considered to be a less severe condition than rheumatoid arthritis. PsA patients have been treated for a long time with a number of different agents, from non-steroidal anti-inflammatory drugs to one or more disease-modifying antirheumatic drugs. In the last decade, recognition of the central role of tumor necrosis factor-alpha (TNFα) in the immunopathogenesis of many rheumatic diseases, including PsA, has led to the development of TNFα blockers.

Pharmacoeconomic burden in the treatment of psoriatic arthritis: from systematic reviews to real clinical practice studies.

The economic assessment of treatment options in a chronic and severe disease like Psoriatic Arthritis (PsA) is crucial to estimate the burden of costs. In particular, the impact of new costly medications such as biologic agents have been studied to figure this important aspect of a multifaceted disease. In a previous observational, longitudinal multicentre cost evaluation study, the results showed that biologic agents are cost-effective.

Unmet needs in outcome measures of Psoriatic Arthritis: focus on axial radiographic and nail involvement.

This article reviews some unmet needs on the outcome measures in Psoriatic Arthritis (PsA). In particular, the radiological assessment of axial PsA and the assessment of nail involvement still remain problematic and this, in turn, could affect the best management. At present, the radiological assessment of spine has been evaluated by using scoring systems borrowed from Ankylosing Spondylitis (AS).

Long-term safety of anti-TNF-α in PsA patients with concomitant HCV infection: a retrospective observational multicenter study on 15 patients.

Psoriatic arthritis (PsA) is an inflammatory arthropathy associated with skin and/or nail psoriasis. TNF-α, in addition to its pro-inflammatory role, is an essential cytokine for the host's defense, and its depletion by treatment may facilitate the risk of viral infections or their reactivation. The aim of this study was to evaluate the efficacy and safety of TNF-α blockers in PsA patients with concurrent hepatitis C virus (HCV) infection.

Remission in ankylosing spondylitis treated with anti-TNF-α drugs: a national multicentre study.

Objective: The primary objective of this retrospective study was to investigate the possibility of achieving partial remission (PR) in AS patients treated with anti-TNF-α antagonists, such as adalimumab (ADA), etanercept (ETA) and infliximab (INF), in a real clinical practice setting. Predictors of PR were also evaluated.

Methods: A retrospective study was conducted in patients with AS treated with ADA, ETA and INF from 2000 to 2012.

Beyond anti-TNF-α agents in psoriatic arthritis.

The IL-23/IL-17 pathway may be a novel therapeutic target for the treatment of psoriatic arthritis (PsA). The potential beneficial effect of Th-17A antagonism has been investigated by a randomized controlled trial in PsA patients with secukinumab, a fully human, high-affinity, monoclonal antibody in a cohort of patients with active PsA. Although this Phase II study presents bias that limits the ability of this drug to meet the primary and some secondary end points, the authors suggest that secukinumab may have biological effects and some clinical benefits in PsA patients.

Etanercept in psoriatic arthritis.

In this update on etanercept (ETN) in psoriatic arthritis (PsA) we analyze this drug's mechanism of action, clinical efficacy/effectiveness, optimal dosage, disease-modifying antirheumatic drugs (DMARD) association, radiological progression, safety, switching aspects, and pharmacoeconomy. The efficacy/effectiveness of ETN in PsA has been demonstrated in randomized placebo-controlled trials as well as in observational studies representing routine clinical practice. At 1 and 2 years, ETN inhibited radiographic disease progression, assessed by the modified total Sharp score.

The radiological assessment of axial involvement in psoriatic arthritis.

This article summarizes the state of radiological assessment of axial involvement in psoriatic arthritis (PsA). The definition and measurement of axial disease in PsA remain problematic and this situation in turn could affect the choice of approach to evaluate radiological findings of the spine. At present, the radiological assessment has been evaluated by using scoring systems borrowed from ankylosing spondylitis (AS).

Axial psoriatic arthritis: an intriguing clinical entity or a subset of an intriguing disease?

This article summarizes the state of the art of axial involvement in psoriatic arthritis (axial PsA). The definition and measurement of axial disease in PsA still remain problematic, and this, in turn, could affect the best approach of recognition and treatment of this intriguing subset of the psoriatic disease. Axial PsA has been studied over the last few years looking at the difference in function and radiological finding compared to ankylosing spondylitis (AS), trying to differentiate it from a coincidental AS with psoriasis.

Biomarkers of subclinical atherosclerosis in patients with autoimmune disorders.

Atherosclerosis is accelerated in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). We investigated a possible association of oxidized low-density lipoproteins (ox-LDLs), nitric oxide (NO), 3-nitrotyrosine, vitamin A, vitamin E, and β-carotene serum levels with subclinical atherosclerosis in RA and PsA. By the use of ELISA, we observed higher ox-LDL levels in patients with intima-media thickness (IMT) > 1 than in patients with IMT ≤ 1 and a negative correlation between NO levels and IMT values.

Identification of the clinical features distinguishing psoriatic arthritis and fibromyalgia.

Objective: To identify the clinical features that can help to distinguish between psoriatic arthritis (PsA) and fibromyalgia (FM).

Methods: Our cross-sectional study was carried out in 10 Italian rheumatology centers between January and September 2009, and enrolled all consecutive patients with PsA and FM who agreed to participate. Standard clinical and laboratory data for PsA and FM were collected from all patients.

Is the Nail Psoriasis Severity Index reliable in the assessment of nail psoriasis by rheumatologists?

Objective: To determine the agreement and reliability of the Nail Psoriasis Severity Index (NAPSI) in the assessment of nail involvement in patients with psoriatic arthritis (PsA) when performed by rheumatologists with no experience in using this instrument.

Methods: In total, 3 women with PsA, satisfying the Classification of Psoriatic Arthritis Study Group criteria, with nail involvement were selected from an outpatient clinic devoted to PsA. The assessors consisted of 2 groups: 8 expert rheumatologists in the field of PsA who were members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and had extensive experience of >10 years, and 69 rheumatologists who had never previously used the NAPSI.

Certolizumab: efficacy and safety profile of a novel pegylated TNF-alpha blocking agent.

The treatment of Rheumatoid Arthritis (RA) has changed since the introduction of biological agents. In particular, the anti Tumor Necrosis Factor (TNF)-alpha molecules have been the first group of drugs showing a good efficacy and safety profile. Among these, a new anti TNF-alpha antibody has been recently indicated for the treatment of RA: certolizumab pegol (CZP).

Etanercept in spondyloarthopathies. Part II: safety and pharmacoeconomic issues.

Etanercept (ETN) and other anti-TNF-α agents have revolutionised the management of spondyloarthropathies (SpA). With the increasingly widespread and prolonged use of these drugs an assessment of their long-term safety is extremely important. An additional concern regarding biological agents is their higher costs compared with conventional drugs.

Etanercept in spondyloarthropathies. Part I: current evidence of efficacy.

Etanercept is a recombinant soluble tumour necrosis factor alpha receptor administered subcutaneously at the dose of 50 mg weekly (or 25 mg/twice weekly) for the treatment of the main chronic arthritides: rheumatoid arthritis and spondyloarthropathies. It shows high qualities in terms of efficacy and manageability. Favourable results were reported in all localisations of spondyloarthropathies: axial disease, peripheral arthritis, and enthesitis.

Recommendations for the use of biologic therapy in the treatment of psoriatic arthritis: update from the Italian Society for Rheumatology.

Objectives: To update the 2006 Italian Society for Rheumatology recommendations for the use of biologic (TNF-α blocking) agents in the treatment of psoriatic arthritis (PsA).

Methods: A panel of experts performed a literature search and identified the items that required updating on the basis of new published data. A draft of the updated recommendations was circulated to a group of Italian Rheumatologists with a specific expertise in PsA and in therapy with biologic agents, and their suggestions were incorporated in the final version.

Clinical and ultrasonography assessment of peripheral enthesitis in ankylosing spondylitis.

Objective: The aim of this study was to compare clinical examination with power Doppler US (PDUS) in the detection of entheseal abnormalities in patients with AS.

Methods: Thirty-six AS patients underwent clinical and PDUS examination of the following bilateral entheseal sites: common extensor tendon at its insertion at the lateral humeral epicondyle; gluteus tendons at their insertion at the greater trochanter; quadriceps tendon at its insertion at the superior pole of the patella; patellar tendon at its proximal insertion at the inferior pole of the patella; patellar tendon at its distal insertion at the tibial tuberosity; Achilles tendon at its insertion at the calcaneus; and plantar aponeuroses at its insertion at the calcaneus.

Results: Clinical and PDUS examination revealed at least one abnormal enthesis in 23 (63.