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Explore This IssueSeptember 2013
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MADRID—A robust level of research into psoriatic arthritis (PsA) and osteoarthritis (OA) over the past year has led to new insights in a variety of areas, including the pathogenesis of PsA and the role of subchondral bone in OA, experts in these areas said here at the European League Against Rheumatism (EULAR) 2013 Annual European Congress of Rheumatology, held June 12–15.
Targets and Treatments for PsA
Juan Jesus Gomez-Reino Carnota, MD, PhD, professor of rheumatology at Universidad de Santiago de Compostela in Spain, said emerging pathways, including interleukin (IL) 23, IL-17, and IL-22, and IL-1, seem to play important roles and might be worthwhile treatment targets.
“There is quite interesting and exciting information regarding the pathogenesis of psoriatic arthritis,” he said.
A comprehensive study examining data from the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals’ Follow-up Study found that the relative risk of developing psoriasis was higher for those who’ve smoked in the past than it was for those who’ve never smoked. And it was even higher for current smokers, generally with a larger quantity of cigarettes smoked per day correlating with a higher risk.1 “We have a lot of different reasons here to advise our patients not to smoke,” Dr. Gomez-Reino said.
As far as new agents, fresh research is being published all time, he said. One randomized, placebo-controlled trial from last year found that methotrexate’s effects on PsA response were minimal on the Psoriatic Arthritis Response Criteria index (PsARC), ACR20 index, and Disease Activity 28 (DAS28).2
But, he emphasized that the evidence available on this is relatively thin. “I would not use this trial to discourage you from using methotrexate,” he said. “I think we need much more information about this before we decide.” And EULAR still recommends methotrexate for OA, he noted.
Leflunomide, a disease-modifying drug, was found to be effective for PsA in a large observational study, the European Prospective Observational Study (OSPAL).3
In another interesting study, the TNF-blocker certolizumab was found to be just as effective for those with prior anti-TNF exposure as for those without it, Dr. Gomez-Reino said.4
Results also emerged showing that rituximab might be an option for PsA patients. An exploratory study including nine patients treated with rituximab showed improvements across a wide range of disease-activity scales for those patients, he said.5
Secukinumab, an IL-17 inhibitor, and usketinumab, an IL-12/IL-23 inhibitor, also showed promise in trials over the last year—secukinumab in a variety of arthritic conditions and usketinumab in PsA.6,7 But they generally did not produce better results than TNF-inhibitors have shown, Dr. Gomez-Reino said. Still, he reserves judgment on the agents for now. “The clinical trials have to go on, and we’ll see what happens,” he said.
Medical and Nonmedical Approaches to OA
Margreet Kloppenburg, MD, PhD, professor of rheumatology at Leiden University Medical Center in The Netherlands, said that the 3,500 published manuscripts on osteoarthritis over the last year produced two main themes: the importance of the role of subchrondral bone as a target for therapy, and the role of nonpharmacological therapy, especially physical therapy.