Dr. Orbai noted that TNF inhibitor therapy may be protective against cardiovascular disease in patients with PsA, but management of cardiovascular risk factors remains essential for all patients.3,4
Other Options
An important point in the discussion related to the potential to decrease PsA disease activity by reducing the burden of metabolic syndrome through diet, exercise and appropriate medications. Given these approaches, increasing immunosuppression for patients with PsA and ongoing disease activity may not always be the answer. Rather, managing such conditions as diabetes, hypertension, hyperlipidemia and obesity, and working together with the patient, primary care physician and cardiologist, when needed, may help a great deal.
PsA Subtypes
Dr. Orbai concluded by discussing ways to classify the subtypes of PsA. In a study conducted by Eder et al., ultrasound imaging and gene expression clustering were used to identify subtypes of patients with PsA based on location of inflammation (i.e., synovitis-predominant disease, enthesitis-predominant disease and peritendonitis-predominant disease). Among these groups, patients with peritendonitis-predominant disease had the most active overall disease, and it appeared more men than women were in this group.5 This study provides interesting insights into better understanding the heterogeneity of PsA and more work is needed on this subject.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Kristensen LE, Keiserman M, Papp K, et al. Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 1 trial. Ann Rheum Dis. 2022 Feb;81(2):225–231.
- Coates LC, Tillett W, D’Agostino MA, et al. Comparison between adalimumab introduction and methotrexate dose escalation in patients with inadequately controlled psoriatic arthritis (CONTROL): A randomised, open-label, two-part, phase 4 study. Lancet Rheumatol. 2022 Apr 1;4(4):e262–e273.
- Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019 Sep;81(3):775–804.
- Wu JJ, Guérin A, Sundaram M, et al. Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus methotrexate. J Am Acad Dermatol. 2017 Jan;76(1):81–90.
- Eder L, Li Q, Rahmati S, et al. Defining imaging sub-phenotypes of psoriatic arthritis: Integrative analysis of imaging data and gene expression in a PsA patient cohort. Rheumatology (Oxford). 2022 Feb 14;keac078. Online ahead of print.
