521 results on '"Gladman, Dafna D"'
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2. Risk Stratification of Patients with Psoriatic Arthritis and Ankylosing Spondylitis for Treatment with Tofacitinib: A Review of Current Clinical Data
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Kristensen, Lars Erik, Deodhar, Atul, Leung, Ying-Ying, Vranic, Ivana, Mortezavi, Mahta, Fallon, Lara, Yndestad, Arne, Kinch, Cassandra D., and Gladman, Dafna D.
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In this commentary, we review clinical data which helps inform individualized benefit–risk assessment for tofacitinib in patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). ORAL Surveillance, a safety trial of patients ≥ 50 years of age with rheumatoid arthritis (RA) and cardiovascular risk factors, found increased rates of safety outcomes (including major adverse cardiovascular events [MACE], malignancies excluding non-melanoma skin cancer, and venous thromboembolism) with tofacitinib versus tumor necrosis factor inhibitors (TNFi). Post hoc analyses of ORAL Surveillance have identified subpopulations with different relative risk versus TNFi; higher risk with tofacitinib was confined to patients ≥ 65 years of age and/or long-time current/past smokers, and specifically for MACE, patients with a history of atherosclerotic cardiovascular disease (ASCVD). In patients without these risk factors, risk differences between tofacitinib and TNFi could not be detected. Given differences in demographics, pathophysiology, and comorbidities, we sought to examine whether the risk stratification observed in RA is also appropriate for PsA and AS. Data from the PsA tofacitinib development program show low absolute risk of safety outcomes in patients < 65 years of age and never smokers, and low MACE risk in patients with no history of ASCVD, consistent with results from ORAL Surveillance. No MACE, malignancies, or venous thromboembolism were reported in the tofacitinib AS development program. The mechanism of the ORAL Surveillance safety findings is unknown, and there are no similar prospective studies of sufficient size and duration. Accordingly, it is appropriate to use a precautionary approach and extrapolate differentiating risk factors identified from ORAL Surveillance (age ≥ 65 years, long-time current/past smoking, and history of ASCVD) to PsA and AS. We recommend an individualized approach to treatment decisions based on these readily identifiable risk factors, in line with updated labeling for Janus kinase inhibitors and international guidelines for the treatment of PsA and AS.
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- 2024
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3. Work Productivity and General Health Through 2 Years of Guselkumab Treatment in a Phase 3 Randomized Trial of Patients With Active Psoriatic Arthritis
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Curtis, Jeffrey R., McInnes, Iain B., Rahman, Proton, Gladman, Dafna D., Peterson, Steven, Yang, Feifei, Adejoro, Oluwakayode, Kollmeier, Alexa P., Shiff, Natalie J., Han, Chenglong, Shawi, May, Tillett, William, and Mease, Philip J.
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Introduction: To evaluate the effect of guselkumab on work productivity and nonwork daily activity impairment and general health status through 2 years in patients who were biologic-naïve with active psoriatic arthritis (PsA) in the phase 3 DISCOVER-2 clinical trial. Methods: Adult patients with PsA were randomized to subcutaneous injections of guselkumab 100 mg every 4 weeks (Q4W); at weeks 0, 4, then every 8 weeks (Q8W); or placebo (through week 24 with crossover to guselkumab Q4W). Work productivity and nonwork daily activity impairment were assessed using the Work Productivity and Activity Impairment Questionnaire for PsA (WPAI-PsA) and patient-reported general health status using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index and EQ-Visual Analog Scale (EQ-VAS). Least-squares (LS) mean changes from baseline in WPAI-PsA domains and EQ-5D-5L/EQ-VAS were assessed through week 100. Changes in employment status were utilized to estimate potential indirect savings from improved work productivity. Results: Of 739 randomized patients, 738 had available baseline data for the analyses (Q4W 245; Q8W 248; placebo 245). At week 24, greater improvements in work productivity, nonwork daily activity, and EQ-5D-5L/EQ-VAS were observed in the Q4W and Q8W groups versus the placebo group. At week 100, LS mean reductions in work productivity impairment (− 23.8% to − 28.0%) and nonwork daily activity impairment (– 26.6% to − 29.2%) and improvements in EQ-5D-5L/EQ-VAS (0.14 to 0.15/21.2 to 25.0) were maintained in patients receiving guselkumab. Among patients employed at baseline, 12.1–16.4% were not employed at week 100, and 20.0–25.3% shifted from not employed at baseline to employed at week 100. Potential yearly indirect cost savings (USD) from improved work productivity at week 100 ranged from $16,529 to $19,409. Conclusion: Patients with active PsA treated with guselkumab demonstrated reduced impairment in work productivity and nonwork daily activity, together with improvement in general health status and substantial potential cost savings, over a 2-year period. Trial Registration: Clinicaltrials.gov identifier: NCT03158285.
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- 2024
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4. Residual Disease Activity in Canadian Patients With Psoriatic Arthritis Treated With Advanced Therapies: Results From a Multiregistry Analysis (UNISON-PsA)
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Gladman, Dafna D., Chandran, Vinod, Rosen, Cheryl F., Rohekar, Sherry, Boyd, Tristan, Eder, Lihi, Rahman, Proton, Dutz, Jan, Chan, Jonathan, Haydey, Richard P., Barac, Snezana, Laliberté, Marie-Claude, Girard, Tanya, Fournier, Pierre-André, Sutton, Mitchell, Pereira, Daniel, Chim, Tina, Coupal, Louis, and Choquette, Denis
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ObjectiveAlthough patient outcomes in psoriatic arthritis (PsA) have improved with the advent of advanced therapies, there remains a high unmet need to treat residual disease activity. The objective of the current study was to quantify residual disease activity and burden of disease in Canadian patients with PsA.MethodsThis was a multiregion, observational, retrospective analysis of patient data extracted from the Rhumadata and the International Psoriasis and Arthritis Research Team (IPART) registries, analyzing deidentified data from patients who had initiated advanced therapy for the treatment of PsA between January 2010 and December 2019. The primary endpoint was the proportion of patients failing to achieve minimal disease activity (MDA) within 6 months; secondary endpoints included clinical and patient-reported burden of disease. Descriptive statistics included summaries by region, treatment class, and number of prior advanced therapies.ResultsOne thousand five hundred ninety-six patients were included. The proportions of patients who failed to achieve MDA within 6 months of an advanced therapy were 64.8% in Ontario, 68.3% in Western Canada, 74.8% in Quebec, and 75% in the Atlantic/East region. Failure to achieve MDA was higher among patients receiving an IL-17i compared with a TNFi in all regions except the Atlantic/East. Between 73.2% and 78.6% of patients reported pain at 6 months, and continuing functional impairment varied from 24% in the West to 83.3% in the Atlantic/East.ConclusionThere is substantial burden and unmet need for improved therapies for Canadians with PsA. There is a wide regional variation in outcomes that requires further assessment.
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- 2024
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5. Use of Apremilast to Achieve Psoriatic Arthritis Treatment Goals and Satisfaction at 1 Year in the Canadian Real-World APPRAISE Study
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Chandran, Vinod, Bessette, Louis, Thorne, Carter, Sheriff, Maqbool, Rahman, Proton, Gladman, Dafna D., Anwar, Sabeen, Jelley, Jennifer, Gaudreau, Anne-Julie, Chohan, Manprit, and Sampalis, John S.
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Introduction: The APPRAISE study was conducted to better understand the 12-month effectiveness, tolerability, and patient satisfaction with apremilast treatment for patients with psoriatic arthritis (PsA) in real-world settings. Methods: APPRAISE (NCT03608657), a prospective, multicenter, observational study, enrolled adults with active PsA prescribed apremilast per routine care between July 2018 and March 2020. Patients were followed for 12 months with visits suggested every 4 months. The primary outcome measure was achievement of remission (REM) or low disease activity (LDA), defined as a Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) score ≤ 13. Results: Of the 102 patients who enrolled, 45 (44.1%) discontinued the study by 12 months. Most patients (75.5%) had moderate or high disease activity, and 24.5% were in REM/LDA at baseline based on cDAPSA score. Achievement of cDAPSA REM/LDA was 63.7%, 67.2%, and 53.8% at months 4, 8, and 12, respectively. In those continuing in the study, significant improvements were seen in swollen and tender joint counts, pain visual analog scale, psoriasis body surface area, and complete dactylitis resolution. Enthesitis reduction was also observed. Improvements in treatment satisfaction and patient-reported outcomes, including Health Assessment Questionnaire-Disability Index and the 36-item Short Form physical and mental component scores, were observed over 12 months. The proportion of patients achieving a Patient-Acceptable Symptom State (PASS) increased significantly from baseline at months 4, 8, and 12 (P< 0.001). Apremilast was well tolerated; the most frequent adverse events (AEs) leading to discontinuation were diarrhea (9/102 [8.8%]), nausea (4/102 [3.9%]), and migraine (4/102 [3.9%]). Conclusion: In this real-world study conducted in Canadian rheumatology clinics, apremilast demonstrated clinical effectiveness in patients with active PsA, along with patient satisfaction with treatment. Safety findings were consistent with previously reported clinical data. Trial Registration: ClinicalTrials.gov identifier, NCT03608657.
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- 2024
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6. Psoriatic Arthritis and COVID-19: Patient Perspectives in a Large Psoriatic Arthritis Cohort.
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Pirouzmand, Neda, Pereira, Daniel, Sutton, Mitchell, Mathew, Ashish J., Chandran, Vinod, and Gladman, Dafna D.
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- 2023
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7. Proceedings of the GRAPPA 2022 Executive Retreat.
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Cheok Kuan Ng, Beverly, Jadon, Deepak, Adebajo, Adewale, Ayan, Gizem, Callis Duffin, Kristina, Chandran, Vinod, Coates, Laura C., D'Agostino, Maria Antonietta, de Vlam, Kurt, Deodhar, Atul, Eder, Lihi, Garg, Amit, Gladman, Dafna D., Goel, Niti, Gottlieb, Alice B., Husni, M. Elaine, Katz, Arnon, Kavanaugh, Arthur, Lubrano, Ennio, and Mease, Philip J.
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- 2023
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8. Proceedings of the Collaborative Research Network Meeting at the GRAPPA 2022 Annual Meeting.
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Cheok Kuan Ng, Beverly, Jadon, Deepak, Behrens, Frank, de Wit, Maarten, FitzGerald, Oliver, Gladman, Dafna D., Mease, Philip J., O'Sullivan, Denis, Pennington, Stephen R., Schett, Georg, Chandran, Vinod, and de Vlam, Kurt
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- 2023
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9. Initiating Evaluation of Composite Outcome Measures for Psoriatic Arthritis: 2022 Updates From the GRAPPA-OMERACT Working Group.
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Ying-Ying Leung, Tillett, William, de Wit, Maarten, Orbai, Ana-Maria, Coates, Laura C., FitzGerald, Oliver, Helliwell, Philip S., Strand, Vibeke, Mease, Philip J., Goel, Niti, Christensen, Robin, Merola, Joseph F., Lindsay, Christine A., Ogdie, Alexis, Gossec, Laure, and Gladman, Dafna D.
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- 2023
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10. Efficacy of Guselkumab on Axial-Related Symptoms Through up to 2 Years in Adults with Active Psoriatic Arthritis in the Phase 3, Randomized, Placebo-Controlled DISCOVER-2 Study
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Mease, Philip J., Gladman, Dafna D., Poddubnyy, Denis, Chakravarty, Soumya D., Shawi, May, Kollmeier, Alexa P., Xu, Xie L., Xu, Stephen, Deodhar, Atul, and Baraliakos, Xenofon
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Introduction: Guselkumab previously showed greater improvements versus placebo in axial symptoms in patients with psoriatic arthritis (PsA) (assessed by Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Ankylosing Spondylitis Disease Activity Score [ASDAS]), in post hoc analyses of the phase 3, placebo-controlled, randomized DISCOVER-1 and DISCOVER-2 studies. We now evaluate durability of response in axial-related outcomes through 2 years of DISCOVER-2. Methods: DISCOVER-2 biologic-naive adults with active PsA (≥ 5 tender/ ≥ 5 swollen joints, C-reactive protein ≥ 0.6 mg/dl) were randomized to guselkumab 100 mg every 4 weeks (Q4W) or at week 0, week 4, then Q8W, or placebo → guselkumab Q4W at week 24. Among patients with imaging-confirmed sacroiliitis (investigator-identified), axial symptoms were assessed through 2 years utilizing BASDAI, BASDAI Question #2 (spinal pain), modified BASDAI (mBASDAI; excludes Question #3 [peripheral joint pain]), and ASDAS. Mean changes in scores and proportions of patients achieving ≥ 50% improvement in BASDAI (BASDAI 50) and ASDAS responses, including major improvement (decrease ≥ 2.0), were determined through week 100. Treatment failure rules (through week 24) and nonresponder imputation of missing data (post-week 24) were utilized. Mean BASDAI component scores were assessed through week 100 (observed data). Exploratory analyses evaluated efficacy by sex and HLA-B*27 status. Results: Among 246 patients with PsA and imaging-confirmed sacroiliitis, guselkumab-treated patients had greater mean improvements in BASDAI, mBASDAI, spinal pain, and ASDAS scores, lower mean BASDAI component scores, and greater response rates in achieving BASDAI 50 and ASDAS major improvement vs. placebo at week 24. Differences from placebo were observed for guselkumab-treated patients in selected endpoints regardless of sex or HLA-B*27 status. At week 100, mean improvements were ~ 3 points for all BASDAI scores and 1.6–1.7 for ASDAS; 49–54% achieved BASDAI 50 and 39% achieved ASDAS major improvement at week 100. Conclusions: Guselkumab treatment provided durable and meaningful improvements in axial symptoms and disease activity in substantial proportions of patients with active PsA and imaging-confirmed sacroiliitis. Trial Registration: Clinicaltrials.gov NCT03158285.
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- 2023
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11. Persistence of Biologics in the Treatment of Psoriatic Arthritis: Data From a Large Hospital‐BasedLongitudinal Cohort
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Rida, Mohamad‐Ali, Lee, Ker‐Ai, Chandran, Vinod, Cook, Richard J., and Gladman, Dafna D.
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To analyze the trends in biologics use at a specialized center over a period of 20 years. We performed a retrospective analysis of 571 patients diagnosed with psoriatic arthritis enrolled in the Toronto cohort who initiated biologic therapy between January 1, 2000, and July 7, 2020. The probability of drug persistence over time was estimated nonparametrically. The time to discontinuation of first and second treatment was analyzed using Cox regression models, whereas a semiparametric failure time model with a gamma frailty was used to analyze the discontinuation of treatment over successive administrations of biologic therapy. The highest 3‐year persistence probability was observed with certolizumab when used as first biologic treatment, while interleukin‐17 inhibitors had the lowest probability. However, when used as second medication, certolizumab had the lowest drug survival even when accounting for selection bias. Depression and/or anxiety were associated with a higher rate of drug discontinuation due to all causes (relative risk [RR] 1.68, P= 0.01), while having higher education was associated with lower rates (RR 0.65, P= 0.03). In the analysis accommodating multiple courses of biologics, a higher tender joint count was associated with a higher rate of discontinuation due to all causes (RR 1.02, P= 0.01). Older age at the start of first treatment was associated with a higher rate of discontinuation due to side effects (RR 1.03, P= 0.01), while obesity had a protective role (RR 0.56, P= 0.05). Persistence in taking biologics depends on whether the biologic was used as first or second treatment. Depression and anxiety, higher tender joint count, and older age lead to drug discontinuation.
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- 2023
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12. Project Highlights From the GRAPPA 2022 Annual Meeting: Education Initiatives and Axial Involvement in Psoriatic Arthritis.
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Torgutalp, Murat, Gladman, Dafna D., FitzGerald, Oliver, Mease, Philip J., and Poddubnyy, Denis
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- 2023
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13. Prologue: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2022 Annual Meeting.
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Gottlieb, Alice B., Armstrong, April W., FitzGerald, Oliver, and Gladman, Dafna D.
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- 2023
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14. Real-World Retention and Clinical Effectiveness of Secukinumab for Psoriatic Arthritis: Results From the Canadian Spondyloarthritis Research Network.
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Gladman, Dafna D., Choquette, Denis, Khraishi, Majed, Inman, Robert D., Hussein, Shamiza, Neish, Drew, and Leclerc, Patrick
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- 2023
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15. Real-World Retention and Clinical Effectiveness of Secukinumab for Axial Spondyloarthritis: Results From the Canadian Spondyloarthritis Research Network.
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Inman, Robert D., Choquette, Denis, Khraishi, Majed, Gladman, Dafna D., Hussein, Shamiza, Neish, Drew, and Leclerc, Patrick
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- 2023
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16. Evaluating the threshold score for classification of systemic lupus erythematosus using the EULAR/ACR criteria.
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Johnson, Sindhu R., Diaz Martinez, Juan P., Whittall-Garcia, Laura, Urowitz, Murray B., Gladman, Dafna D., and Touma, Zahi
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- 2023
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17. Musculoskeletal Surgery in Psoriatic Arthritis: Prevalence and Risk Factors.
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Kwok, Timothy S. H., Sutton, Mitchell, Cook, Richard J., Pereira, Daniel, Chandran, Vinod, and Gladman, Dafna D.
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- 2023
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18. Assessing the Costs of Neuropsychiatric Disease in the Systemic Lupus International Collaborating Clinics Cohort Using Multistate Modeling
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Clarke, Ann E., Hanly, John G., Urowitz, Murray B., St. Pierre, Yvan, Gordon, Caroline, Bae, Sang‐Cheol, Romero‐Diaz, Juanita, Sanchez‐Guerrero, Jorge, Bernatsky, Sasha, Wallace, Daniel J., Isenberg, David A., Rahman, Anisur, Merrill, Joan T., Fortin, Paul R., Gladman, Dafna D., Bruce, Ian N., Petri, Michelle, Ginzler, Ellen M., Dooley, Mary Anne, Ramsey‐Goldman, Rosalind, Manzi, Susan, Jönsen, Andreas, Alarcón, Graciela S., Van Vollenhoven, Ronald F., Aranow, Cynthia, Mackay, Meggan, Ruiz‐Irastorza, Guillermo, Lim, S. Sam, Inanc, Murat, Kalunian, Kenneth C., Jacobsen, Soren, Peschken, Christine A., Kamen, Diane L., Askanase, Anca, and Farewell, Vernon
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To estimate direct and indirect costs associated with neuropsychiatric (NP) events in the Systemic Lupus International Collaborating Clinics inception cohort. NP events were documented annually using American College of Rheumatology definitions for NP events and attributed to systemic lupus erythematosus (SLE) or non‐SLE causes. Patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). Change in NP status was characterized by interstate transition rates using multistate modeling. Annual direct costs and indirect costs were based on health care use and impaired productivity over the preceding year. Annual costs associated with NP states and NP events were calculated by averaging all observations in each state and adjusted through random‐effects regressions. Five‐ and 10‐year costs for NP states were predicted by multiplying adjusted annual costs per state by expected state duration, forecasted using multistate modeling. A total of 1,697 patients (49% White race/ethnicity) were followed for a mean of 9.6 years. NP events (n = 1,971) occurred in 956 patients, 32% attributed to SLE. For SLE and non‐SLE NP events, predicted annual, 5‐, and 10‐year direct costs and indirect costs were higher in new/ongoing versus no events. Direct costs were 1.5‐fold higher and indirect costs 1.3‐fold higher in new/ongoing versus no events. Indirect costs exceeded direct costs 3.0 to 5.2 fold. Among frequent SLE NP events, new/ongoing seizure disorder and cerebrovascular disease accounted for the largest increases in annual direct costs. For non‐SLE NP events, new/ongoing polyneuropathy accounted for the largest increase in annual direct costs, and new/ongoing headache and mood disorder for the largest increases in indirect costs. Patients with new/ongoing SLE or non‐SLE NP events incurred higher direct and indirect costs.
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- 2023
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19. Inhibition of Interleukin-17 in Patients with Oligoarticular Psoriatic Arthritis
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Ogdie, Alexis, Gladman, Dafna D., Coates, Laura C., Pournara, Effie, Parikh, Bhumik, and Mease, Philip J.
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Introduction: This study evaluated the efficacy of the interleukin-17A inhibitor secukinumab in patients with oligoarticular psoriatic arthritis (PsA). Methods: A total of 84 patients with oligoarticular PsA, defined as 1–4 tender joints and 1–4 swollen joints, were pooled from the FUTURE 2–5 and MAXIMISE trials (NCT01752634, NCT01989468, NCT02294227, NCT02404350, and NCT02721966). Patients were grouped by treatment received at week 12 (secukinumab 300 mg, secukinumab 150 mg, or placebo) and week 52 (any secukinumab 300 mg or any secukinumab 150 mg). Efficacy was assessed by the proportion of patients achieving selected clinical outcomes. The predictors of Disease Activity index for Psoriatic Arthritis (DAPSA) responses at weeks 12 and 52 were identified by logistic regression analysis. Results: Secukinumab treatment resulted in greater achievement of DAPSA-based low disease activity (LDA), DAPSA-based remission (REM), DAPSA50, and DAPSA75 than placebo at week 12, with improvements sustained or further increased through week 52. LDA or REM was achieved at week 52 by more than 90% of patients who received either secukinumab dose, although secukinumab 300 mg resulted in the highest achievement of the stringent DAPSA75 and DAPSA REM outcomes. At week 12, younger age was associated with DAPSA LDA or REM and DAPSA50, while lower baseline swollen joint count was associated with DAPSA REM. No predictors were identified at week 52. The safety profile was consistent with the full study populations. Conclusion: Secukinumab demonstrated efficacy vs placebo across several outcome measures in patients with oligoarticular PsA at week 12, with sustained or improved responses through week 52.
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- 2023
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20. Management of Axial Disease in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.
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Lubrano, Ennio, Chan, Jon, Queiro-Silva, Ruben, Cauli, Alberto, Goel, Niti, Poddubnyy, Denis, Nash, Peter, and Gladman, Dafna D.
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- 2023
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21. Evaluating the Construct of Damage in Systemic Lupus Erythematosus
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Johnson, Sindhu R., Gladman, Dafna D., Brunner, Hermine I., Isenberg, David, Clarke, Ann E., Barber, Megan R. W., Arnaud, Laurent, Fortin, Paul R., Mosca, Marta, Voskuyl, Alexandre E., Manzi, Susan, Aranow, Cynthia, Askanase, Anca, Alarcón, Graciela S., Bae, Sang‐Cheol, Costedoat‐Chalumeau, Nathalie, English, Jessica A., Pons‐Estel, Guillermo J., Pons‐Estel, Bernardo A., Gilman, Rebecca, Ginzler, Ellen M., Hanly, John G., Jacobsen, Soren, Kalunian, Kenneth, Kamen, Diane L., Lambalgen, Chynace, Legge, Alexandra, Lim, S. Sam, Mak, Anselm, Morand, Eric F., Peschken, Christine A., Petri, Michelle, Rahman, Anisur, Ramsey‐Goldman, Rosalind, Reynolds, John A., Romero‐Diaz, Juanita, Ruiz‐Irastorza, Guillermo, Sanchez‐Guerrero, Jorge, Svenungsson, Elisabet, Touma, Zahi, Urowitz, Murray, Vinet, Evelyne, Vollenhoven, Ronald F., Waldhauser, Heather, Wallace, Daniel J., Zoma, Asad, and Bruce, Ian N.
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The Systemic Lupus International Collaborating Clinics (SLICC), American College of Rheumatology (ACR), and the Lupus Foundation of America are developing a revised systemic lupus erythematosus (SLE) damage index (the SLICC/ACR Damage Index [SDI]). Shifts in the concept of damage in SLE have occurred with new insights into disease manifestations, diagnostics, and therapy. We evaluated contemporary constructs in SLE damage to inform development of the revised SDI. We conducted a 3‐part qualitative study of international SLE experts. Facilitated small groups evaluated the construct underlying the concept of damage in SLE. A consensus meeting using nominal group technique was conducted to achieve agreement on aspects of the conceptual framework and scope of the revised damage index. The framework was finally reviewed and agreed upon by the entire group. Fifty participants from 13 countries were included. The 8 thematic clusters underlying the construct of SLE damage were purpose, items, weighting, reversibility, impact, time frame, attribution, and perspective. The revised SDI will be a discriminative index to measure morbidity in SLE, independent of activity or impact on the patient, and should be related to mortality. The SDI is primarily intended for research purposes and should take a life‐course approach. Damage can occur before a diagnosis of SLE but should be attributable to SLE. Damage to an organ is irreversible, but the functional consequences on that organ may improve over time through physiological adaptation or treatment. We identified shifts in the paradigm of SLE damage and developed a unifying conceptual framework. These data form the groundwork for the next phases of SDI development.
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- 2023
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22. Cardiac Magnetic Resonance Imaging T1 and T2 Mapping in Systemic Lupus Erythematosus in Relation to Antimalarial Treatment
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Shalmon, Tamar, Thavendiranathan, Paaladinesh, Seidman, Michael A., Wald, Rachel M., Karur, Gauri Rani, Harvey, Paula J., Akhtari, Shadi, Osuntokun, Tosin, Tselios, Kostantinos, Gladman, Dafna D., and Hanneman, Kate
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- 2023
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23. Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: a randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE)
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Merola, Joseph F, Landewé, Robert, McInnes, Iain B, Mease, Philip J, Ritchlin, Christopher T, Tanaka, Yoshiya, Asahina, Akihiko, Behrens, Frank, Gladman, Dafna D, Gossec, Laure, Gottlieb, Alice B, Thaçi, Diamant, Warren, Richard B, Ink, Barbara, Assudani, Deepak, Bajracharya, Rajan, Shende, Vishvesh, Coarse, Jason, and Coates, Laura C
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Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A. This study compared the efficacy and safety of bimekizumab with placebo over 16 weeks in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α (TNFα) inhibitors.
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- 2023
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24. Psoriatic Arthritis and COVID-19: Patient Perspectives in a Large Psoriatic Arthritis Cohort
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Pirouzmand, Neda, Pereira, Daniel, Sutton, Mitchell, Mathew, Ashish J., Chandran, Vinod, and Gladman, Dafna D.
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ObjectiveTo estimate the prevalence of coronavirus disease 2019 (COVID-19) infection among patients with psoriatic arthritis (PsA), understand patients’ perspectives regarding their risk of COVID-19 infection, and evaluate the standard of virtual care offered during the early phases of the pandemic.MethodsAn online survey was conducted between June 2021 and September 2021 in patients with PsA who had consented to email contact. The survey was completed by 152/193 (79%) patients who had consented to the study.ResultsThere were 86 (56.6%) men and 66 (43.4%) women with a mean age of 58 years and mean disease duration of 19 years. During the pandemic, the mean patient-reported symptom severity was 4.10, 3.24, and 3.72 for joint, skin, and overall symptom severity, respectively. Seventy-four percent of respondents would accept the effect of their PsA over the past month for the next few months. Of 79 patients who were tested for severe acute respiratory syndrome coronavirus 2, 4 tested positive. All 4 were admitted to hospital; 2 required oxygen. One hundred fifty-one patients (99%) had received at least 1 vaccine dose. Fifty-nine (38.8%) participants believed their PsA medications increased their COVID-19 infection risk. Of the 130 patients who had a telemedicine assessment, 83.1% were happy with their virtual consultations. Most were happy to continue with virtual consultations until the pandemic resolved. The average satisfaction level regarding pandemic care was 7.87 on a sliding 10-point scale.ConclusionCOVID-19 prevalence was low among our patients. Patients were satisfied with their care during the pandemic. Most patients would happily continue with virtual care for the duration of the pandemic.
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- 2023
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25. Proceedings of the Collaborative Research Network Meeting at the GRAPPA 2022 Annual Meeting
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Ng, Beverly Cheok Kuan, Jadon, Deepak, Behrens, Frank, de Wit, Maarten, FitzGerald, Oliver, Gladman, Dafna D., Mease, Philip J., O’Sullivan, Denis, Pennington, Stephen R., Schett, Georg, Chandran, Vinod, and de Vlam, Kurt
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At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2022 annual meeting, the Collaborative Research Network (CRN) met to present updates on several projects. These included the GRAPPA-Industry biomarker projects, Axial Psoriatic Arthritis Molecular and Clinical Characterisation Study, Axial Involvement in Psoriatic Arthritis Cohort (AXIS) study, and the Health Initiatives in Psoriasis and Psoriatic Arthritis Consortium European States (HIPPOCRATES). The meeting concluded with a discussion on pathways to further academia-industry collaboration.
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- 2023
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26. Initiating Evaluation of Composite Outcome Measures for Psoriatic Arthritis: 2022 Updates From the GRAPPA-OMERACT Working Group
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Leung, Ying-Ying, Tillett, William, de Wit, Maarten, Orbai, Ana-Maria, Coates, Laura C., FitzGerald, Oliver, Helliwell, Philip S., Strand, Vibeke, Mease, Philip J., Goel, Niti, Christensen, Robin, Merola, Joseph F., Lindsay, Christine A., Ogdie, Alexis, Gossec, Laure, and Gladman, Dafna D.
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The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)–Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis (PsA) working group—comprising rheumatologists, dermatologists, methodologists, and patient research partners—provided updates at the GRAPPA 2022 annual meeting on its work to evaluate composite outcome measures for PsA. Ten composite outcome measures were considered. Initial steps were to define the population, the purpose of use, and the proposed pros and cons of the 10 candidate composite instruments for PsA. Preliminary Delphi exercises within the working group and GRAPPA stakeholders confirmed high priority for evaluating minimal disease activity (MDA); moderate priority for Disease Activity in PsA (DAPSA), American College of Rheumatology (ACR) response criteria, Psoriatic Arthritis Disease Activity Score (PASDAS), Composite Psoriatic Disease Activity Index (CPDAI), 3 visual analog scale (VAS), and 4VAS; and low priority for Disease Activity Score in 28 joints (DAS28), Psoriatic Arthritis Responder Criteria (PsARC), and Routine Assessment of Patient Index Data 3 (RAPID3). Further appraisal of candidate composite instruments is ongoing.
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- 2023
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27. Evaluating the Threshold Score for Classification of Systemic Lupus Erythematosus Using the EULAR/ACR Criteria
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Johnson, Sindhu R., Diaz Martinez, Juan P., Whittall-Garcia, Laura, Urowitz, Murray B., Gladman, Dafna D., and Touma, Zahi
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ObjectiveTo evaluate whether a change in the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria threshold score affects accurate classification of SLE cases compared to disease-based control subjects. We evaluated a range of threshold scores to determine the score that maximizes the accurate classification of early SLE.MethodsWe conducted a cross-sectional study comparing SLE cases and control patients. A EULAR/ACR criteria score was calculated using baseline information. Sensitivity, specificity, positive likelihood ratios (+LRs), and negative likelihood ratios (−LRs) with 95% CIs were used to evaluate operating characteristics. Threshold scores of 6 to 12 were evaluated in subjects with early disease (ie, disease duration of ≤ 5 years). +LRs > 10 and −LRs < 0.1 provide evidence to rule in or rule out SLE.ResultsA total of 2764 patients were included: 1980 SLE cases who fulfilled either the ACR or Systemic Lupus International Collaborating Clinics criteria and 784 control subjects. The EULAR/ACR SLE criteria had a sensitivity of 98% (95% CI 97-98), a specificity of 99% (95% CI 98-100), a +LR of 95.5 (95% CI 48.0-190), and a −LR 0.03 (95% CI 0.02-0.03). The criteria operated well in those with early disease, in women, in men, and in White, Black, Chinese, and Filipino people. A score of 10 maximized the accurate classification of patients with early disease (+LR 174.4, 95% CI 43.8-694.6; −LR 0.03, 95% CI 0.02-0.04). An increase in the threshold score from 10 to 11 resulted in significant worsening in the −LR (threshold score 10: −LR 0.03, 95% CI 0.02-0.03 vs threshold score 11: −LR 0.05, 95% CI 0.04-0.06).ConclusionThe EULAR/ACR SLE classification criteria threshold score of 10 performs well, particularly among those with early disease and across sexes and ethnicities.
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- 2023
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28. Musculoskeletal Surgery in Psoriatic Arthritis: Prevalence and Risk Factors
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Kwok, Timothy S.H., Sutton, Mitchell, Cook, Richard J., Pereira, Daniel, Chandran, Vinod, and Gladman, Dafna D.
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ObjectiveDespite medical therapy, damage occurs in patients with psoriatic arthritis (PsA) requiring musculoskeletal (MSK) surgery. We aimed to describe MSK surgery in patients with PsA and identify risk factors for undergoing first MSK surgery attributable to PsA.MethodsA single-center cohort identified patients with PsA fulfilling Classification Criteria for Psoriatic Arthritis who had MSK surgery between January 1978 and December 2019 inclusive. Charts were reviewed to confirm surgeries were MSK-related and attributable to PsA. Descriptive statistics determined MSK surgery prevalence and types. Cox proportional hazards models evaluated clinical variables for undergoing first MSK surgery using time-dependent covariates. Using a dataset with 1-to-1 matching on markers of PsA disease severity, a Cox proportional hazards model evaluated the effect of targeted therapies, namely biologics on time to first MSK surgery.ResultsOf 1574 patients, 185 patients had 379 MSK surgeries related to PsA. The total number of damaged joints (hazard ratio [HR] 1.03, P< 0.001), tender/swollen joints (HR 1.04, P= 0.01), presence of nail lesions (HR 2.08, P< 0.01), higher Health Assessment Questionnaire scores (HR 2.01, P< 0.001), elevated erythrocyte sedimentation rate (HR 2.37, P= 0.02), and HLA-B27 positivity (HR 2.22, P= 0.048) were associated with increased risk of surgery, whereas higher Psoriasis Area Severity Index (HR 0.88, P< 0.002) conferred a protective effect in a multivariate model. The effect of biologics did not reach statistical significance.ConclusionMSK surgery attributable to PsA is not rare, affecting 11.8% of patients. Markers of cumulative disease activity and damage are associated with a greater risk of requiring surgery.
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- 2023
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29. Real-World Retention and Clinical Effectiveness of Secukinumab for Psoriatic Arthritis: Results From the Canadian Spondyloarthritis Research Network
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Gladman, Dafna D., Choquette, Denis, Khraishi, Majed, Inman, Robert D., Hussein, Shamiza, Neish, Drew, and Leclerc, Patrick
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ObjectivePsoriatic arthritis (PsA) is an immune-mediated disease characterized by pain, stiffness, and swelling of peripheral joints, with an estimated prevalence in Canada of 0.45%. Treatment aims to minimize disease activity, reduce progression of damage, and improve quality of life. Secukinumab (SEC) is a biologic disease-modifying antirheumatic drug (bDMARD) that has demonstrated efficacy and safety for PsA in clinical trials; however, there is limited real-world evidence on its use in Canada. The objective of this study was to use the Canadian Spondyloarthritis (CanSpA) Research Network to describe real-world retention and effectiveness of SEC among Canadian patients with PsA.MethodsThis was an observational cohort study of Canadian patients with PsA, 18 to 65 years of age, who attended a clinic of the CanSpA network and received treatment with SEC. Patients were indexed on the date they first initiated SEC. Retention was assessed at 12 months postindex. Clinical effectiveness was measured as the proportion of patients in remission and change in disease activity from baseline to 12 months using several clinical indices.ResultsIn total, 213 patients were included. Overall retention was estimated at 73.6% at 12 months (81.8% for bDMARD- or targeted synthetic DMARD-nai¨ve patients). Out of 110 patients, 17 (15.5%) were in remission based on the Disease Activity Index in Psoriatic Arthritis in 28 joints, and 10 out of 70 patients (14.3%) were in remission based on the Psoriatic Arthritis Disease Activity Score at 12 months. The Psoriasis Area and Severity Index improved by 65.8%; the tender joint count in 68 joints and the swollen joint count in 66 joints improved by 65.5% and 73.7%, respectively.ConclusionThis is the first nationwide study that we know of to describe real-world use of SEC in Canada for PsA, and the results support its effectiveness in a Canadian real-world setting. The CanSpA network represents a unique opportunity to build and improve the real-world evidence base for SpA treatment in Canada.
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- 2023
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30. Real-World Retention and Clinical Effectiveness of Secukinumab for Axial Spondyloarthritis: Results From the Canadian Spondyloarthritis Research Network
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Inman, Robert D., Choquette, Denis, Khraishi, Majed, Gladman, Dafna D., Hussein, Shamiza, Neish, Drew, and Leclerc, Patrick
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ObjectiveAxial spondyloarthritis (axSpA) is a chronic, immune-mediated, inflammatory condition consisting of 2 clinical subsets: nonradiographic axSpA and ankylosing spondylitis, the latter having an estimated prevalence of 0.2% to 1% in Canada. Secukinumab (SEC) received Health Canada approval in 2016 for the treatment of adults with axSpA who have responded inadequately to conventional treatment, and has demonstrated efficacy and safety through extensive clinical trials. However, there is limited evidence on its real-world use in Canada. The objective of this study was to use the Canadian Spondyloarthritis (CanSpA) Research Network to describe real-world retention and effectiveness of SEC in the Canadian axSpA population.MethodsThis was an observational cohort study of Canadian patients with axSpA aged 18 to 65 years within the CanSpA network who had received treatment with SEC. Patients were indexed on the first date of SEC initiation. Retention and clinical effectiveness were assessed at 12 months postindex. Clinical effectiveness was measured as the proportion in remission and change in disease activity using multiple clinical indices.ResultsA total of 146 patients were included. Overall retention was estimated at 62.9%. Low disease activity (ie, Bath Ankylosing Spondylitis Disease Activity Index < 4) was achieved in 29.2% of patients, and 2% had achieved remission based on the Ankylosing Spondylitis Disease Activity Score. Bath Ankylosing Spondylitis Metrology Index scores improved by more than 60% from baseline to 12 months.ConclusionThe results of this real-world study of Canadian patients with axSpA, one of the first of its kind, support the effectiveness of SEC for treatment of axSpA. The CanSpA network presents an opportunity to continue building and improving the real-world evidence base for treatment of Canadian patients with spondyloarthritis.
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- 2023
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31. Management of Axial Disease in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations
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Lubrano, Ennio, Chan, Jon, Queiro-Silva, Ruben, Cauli, Alberto, Goel, Niti, Poddubnyy, Denis, Nash, Peter, and Gladman, Dafna D.
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ObjectiveAxial involvement in patients with psoriatic arthritis (PsA) is a common subset of this condition, but a unanimous definition has yet to be established. It has been defined by using different criteria, ranging from the presence of at least unilateral grade 2 sacroiliitis to those used for ankylosing spondylitis (AS), or simply the presence of inflammatory low back pain (IBP). Our aim was to identify and evaluate the efficacy of therapeutic interventions for treatment of axial disease in PsA.MethodsThis systematic review is an update of the axial PsA (axPsA) domain of the treatment recommendations project by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).ResultsThe systematic review of the literature showed that new biologic and targeted synthetic disease-modifying antirheumatic drug classes, namely interleukin (IL)-17A and Janus kinase inhibitors, could be considered for the treatment of axPsA. This would be in addition to previously recommended treatments such as nonsteroidal antiinflammatory drugs, physiotherapy, simple analgesia, and tumor necrosis factor inhibitors. Conflicting evidence still remains regarding the use of IL-12/23 and IL-23 inhibitors.ConclusionFurther studies are needed for a better understanding of the treatment of axPsA, as well as validated outcome measures.
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- 2023
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32. Proceedings of the GRAPPA 2022 Executive Retreat
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Ng, Beverly Cheok Kuan, Jadon, Deepak, Adebajo, Adewale, Ayan, Gizem, Duffin, Kristina Callis, Chandran, Vinod, Coates, Laura C., D’Agostino, Maria Antonietta, de Vlam, Kurt, Deodhar, Atul, Eder, Lihi, Garg, Amit, Gladman, Dafna D., Goel, Niti, Gottlieb, Alice B., Husni, M. Elaine, Katz, Arnon, Kavanaugh, Arthur, Lubrano, Ennio, Mease, Philip J., Merola, Joseph F., Nash, Peter, Ogdie, Alexis, Pennington, Stephen R., Perez-Chada, Lourdes M., Proft, Fabian, Rosen, Cheryl F., Savage, Laura, Goldenstein-Schainberg, Claudia, Siebert, Stefan, Soriano, Enrique R., Steinkoenig, Ingrid, Tillett, William, Armstrong, April W., and FitzGerald, Oliver
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The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) leadership congregated for a strategic planning meeting before the 2022 GRAPPA annual meeting in New York, USA. Meeting aims were to review GRAPPA’s performance in relation to its 2016 goals and identify successes and areas for further improvement, identify key GRAPPA priorities and activities for the next 5 years, and explore committee structures to best support these aims.
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- 2023
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33. Effectiveness of Disease-Modifying Antirheumatic Drugs for Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort.
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Mathew, Ashish J., Sutton, Mitchell, Pereira, Daniel, Gladman, Dafna D., and Chandran, Vinod
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- 2022
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34. Potential Impact of Sex and BMI on Response to Therapy in Psoriatic Arthritis: Post Hoc Analysis of Results From the SEAM-PsA Trial.
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Mease, Philip J., Gladman, Dafna D., Merola, Joseph F., Deodhar, Atul, Ogdie, Alexis, Collier, David H., Liu, Lyrica, and Kavanaugh, Arthur
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- 2022
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35. Baseline Disease Activity Predicts Achievement of cDAPSA Treatment Targets With Apremilast: Phase III Results in DMARD-naïve Patients With Psoriatic Arthritis.
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Mease, Philip J., Kavanaugh, Arthur, Ogdie, Alexis, Wells, Alvin F., Bergman, Martin, Gladman, Dafna D., Richter, Sven, Lichen Teng, Jardon, Shauna, Smolen, Josef S., and Teng, Lichen
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- 2022
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36. Plain Radiographic Instruments for Structural Damage in Peripheral Joints in Psoriatic Arthritis: A Report From the GRAPPA-OMERACT Working Group.
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Antony, Anna, Holland, Richard, Mathew, Ashish J., D'Agostino, Maria-Antoinetta, Maksymowych, Walter P., Mease, Philip J., Goel, Niti, Ogdie, Alexis, Coates, Laura C., Strand, Vibeke, Christensen, Robin, Gladman, Dafna D., Orbai, Ana-Maria, Ying Ying Leung, Tillett, William, and Leung, Ying Ying
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- 2022
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37. Cardiac Magnetic Resonance Imaging and Clinical Follow-up in Antimalarial-induced Cardiomyopathy in Patients With Systemic Lupus Erythematosus
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Shalmon, Tamar, Thavendiranathan, Paaladinesh, Harvey, Paula, Akhtari, Shadi, Tselios, Kostantinos, Gladman, Dafna D., and Hanneman, Kate
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Antimalarial-induced cardiomyopathy is under-recognized in clinical practice and there is limited data on the evolution of cardiac imaging abnormalities after cessation of anti-malarial therapy. In this case series of 9 patients with antimalarial-induced cardiomyopathy, follow-up cardiac magnetic resonance imaging demonstrated interval increase in late gadolinium enhancement extent in 89% of patients and interval decrease in left ventricular ejection fraction in all, despite cessation of anti-malarial therapy. Progression of cardiac abnormalities despite cessation of therapy underscores the important role of imaging in the early recognition of antimalarial-related treatment changes.
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- 2023
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38. Depression and Anxiety Reduce the Probability of Achieving a State of Sustained Minimal Disease Activity in Patients With Psoriatic Arthritis
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Wong, Antonio, Ye, Justine Y., Cook, Richard J., Gladman, Dafna D., and Chandran, Vinod
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We aimed to determine whether the presence of depression or anxiety is associated with the achievement of sustained minimal disease activity (MDA) in patients with psoriatic arthritis (PsA). Adult patients satisfying classification criteria for PsA prospectively followed from 2008 to 2017 were included. A standard protocol including physician assessment and patient‐reported outcomes determined whether patients achieved sustained MDA, which was defined as meeting MDA criteria for ≥2 consecutive visits. The presence of depression/anxiety was determined using 3 definitions: 1) a score of ≤38 on the mental component summary of the Medical Outcomes Study Short Form 36 (SF‐36) health survey, 2) a score of ≤56 on the mental health domain of the SF‐36 health survey, and 3) a rheumatologist's report of a diagnosis or treatment for depression/anxiety. A discrete time‐to‐event analysis was conducted based on a proportional odds model to identify factors associated with achieving sustained MDA. A total of 743 patients were included in the study. The number of patients identified as having depression/anxiety at baseline included 331 patients (44.54%) according to definition 1, 364 patients (48.99%) according to definition 2, and 211 patients (28.4%) according to definition 3. A total of 337 patients (45.36%) did not achieve sustained MDA. The presence of depression/anxiety was associated with reduced probability of achieving sustained MDA, with odds ratio (OR) 0.30 (P< 0.0001), OR 0.34 (P< 0.0001), and OR 0.47 (P< 0.0001) for definitions 1, 2, and 3, respectively. Other variables associated with a reduced probability of achieving sustained MDA included the Charlson comorbidity index and fibromyalgia. Symptoms of anxiety/depression reduce the probability of achieving sustained MDA in PsA. Comprehensive management of PsA should include measures for addressing these comorbidities.
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- 2022
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39. Medium Versus High Initial Prednisone Dose for Remission Induction in Lupus Nephritis: A Propensity Score–Matched Analysis
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Tselios, Konstantinos, Gladman, Dafna D., Al‐Sheikh, Haifa, Su, Jiandong, and Urowitz, Murray B.
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The existing guidelines for lupus nephritis (LN) recommend initial prednisone doses of 0.3–1.0 mg/kg/day. However, recent studies reported noninferior outcomes with lower doses. The aim of this study was to compare the complete renal response rates in LN patients treated with prednisone ≤30 mg/day or ≥40 mg/day. Patients with new‐onset LN and standard immunosuppressive treatment were followed for at least 12 months, divided into medium (≤30 mg/day) and high prednisone groups (≥40 mg/day) and matched (propensity score) based on the baseline differences. Complete renal response was defined as proteinuria <0.5 gm/day and no worsening in renal function. Glucocorticoid‐related damage was also assessed. High‐dose prednisone patients (n = 103; mean ± SD dose 48.6 ± 12.3 mg/day) achieved better rates of complete response compared to the medium group (n = 103; mean ± SD dose 24.2 ± 4.6 mg/day) (61.8% versus 38.2%; P= 0.024) at 12 months. The difference in response rates was reproduced for several subgroups (concomitant immunosuppressive treatment, proliferative/nonproliferative LN). Complete remission rates were higher at 2 years (67.8% versus 39%; P= 0.002) and 3 years (64.9% versus 49.1%; P= 0.025) after LN diagnosis. Cumulative glucocorticoid dose was comparable at 2 and 3 years. Glucocorticoid‐related damage was accelerated in both groups for the same period. Higher initial prednisone doses (median 45 mg/day) achieved significantly better rates of complete renal response at 12 months in new‐onset LN. Cumulative glucocorticoid dose and damage accrual were not different at 2 and 3 years after LN. Damage was more prominent in the late phases of LN in both groups, underlining the importance of rapid tapering and the need to implement alternative strategies.
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- 2022
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40. Incidence of and Risk Factors for Heart Failure in Patients With Psoriatic Disease: A Cohort Study
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Koppikar, Sahil, Colaco, Keith, Harvey, Paula, Akhtari, Shadi, Chandran, Vinod, Gladman, Dafna D., Cook, Richard, and Eder, Lihi
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To assess the incidence and risk factors for heart failure in patients with psoriatic disease and to describe their electrocardiographic and echocardiographic findings. A cohort analysis was conducted involving patients with psoriatic disease followed prospectively from 1978 to 2018. Participants were assessed according to a standard protocol every 6 to 12 months. The primary outcome was the time to first event of heart failure, further classified into ischemic and nonischemic heart failure (secondary outcomes). The association between cardiovascular risk factors, measures of disease activity, and heart failure events was assessed using Cox proportional hazards regression. Electrocardiographic and echocardiographic findings associated with heart failure events were described. A total of 1,994 patients with psoriatic disease were analyzed, with 64 incident heart failure events (38 ischemic, 26 nonischemic). The incidence rate of first heart failure event was 2.85 per 1,000 patient‐years. In all events, the most common electrocardiographic findings were atrial fibrillation (22%) and bundle branch blocks (29%). Echocardiogram revealed 37% reduced ejection fraction and 63% preserved ejection fraction. In multivariable analysis, independent risk factors for all heart failure events were ischemic heart disease, adjusted mean tender joint count, adjusted mean swollen joint count, adjusted mean erythrocyte sedimentation rate, adjusted mean C‐reactive protein level, and physical function (by Health Assessment Questionnaire) (all P< 0.05). Minimal disease activity state was protective for all heart failure (P< 0.05). Increased risk of heart failure is associated with a combination of known cardiovascular risk factors and measures of disease activity, particularly in nonischemic heart failure. The effect of inflammation on heart failure may be partially independent of atherosclerotic disease.
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- 2022
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41. Oligoarticular vs Polyarticular Psoriatic Arthritis: A Longitudinal Study Showing Similar Characteristics.
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Gladman, Dafna D., Ye, Justine Y., Chandran, Vinod, Lee, Ker-Ai, and Cook, Richard J.
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- 2021
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42. Canadian Rheumatologists' Perspectives on Moderate Psoriatic Arthritis and Oligoarticular Psoriatic Arthritis.
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Gladman, Dafna D., Starr, Michael, Cividino, Alfred, Gaudreau, Anne-Julie, Jelley, Jennifer, Nicholson, Denise, and Karsh, Jacob
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- 2021
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43. Test-retest Reliability for HAQ-DI and SF-36 PF for the Measurement of Physical Function in Psoriatic Arthritis.
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Ying Ying Leung, Tillett, William, Hojgaard, Pil, Orbai, Ana-Maria, Holland, Richard, Mathew, Ashish J., Goel, Niti, Chau, Jeffrey, Lindsay, Christine A., Ogdie, Alexis, Coates, Laura C., Christensen, Robin, Mease, Philip J., Strand, Vibeke, and Gladman, Dafna D.
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- 2021
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44. OMERACT Filter 2.1 instrument selection for physical function domain in psoriatic arthritis: Provisional endorsement for HAQ-DI and SF-36 PF.
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Leung, Ying-Ying, Orbai, Ana-Maria, Hojgaard, Pil, Holland, Richard, Mathew, Ashish J, Goel, Niti, Chau, Jeffrey, Tillett, William, Lindsay, Christine, Ogdie, Alexis, Coates, Laura C, Gladman, Dafna D, Christensen, Robin, Mease, Philip, and Strand, Vibeke
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• HAQ-DI and SF-36 PF have the necessary measurement properties for the measurement of physical function in PsA to be provisionally endorsed by the OMERACT Filter 2.1. This provisional endorsement has provided justification for the use and reporting of HAQ-DI and SF-36 PF to assess physical function in both randomized controlled trials and longitudinal observational studies in PsA. • These instruments have achieved consensus (i.e., >70% endorsement votes) from the GRAPPA community. • This effort demonstrated the ongoing commitment of GRAPPA to standardize the core outcome measurement set for PsA. • This work showed the relevance and feasibility of implementing a data-driven, evidence-based process laid out in the OMERACT Filter 2.1 for instrument selection. Physical function is one of the core domains to be measured in all trials in psoriatic arthritis (PsA). We aimed to evaluate two instruments for physical function in PsA: The Health Assessment Questionnaire-disability index (HAQ-DI) and the physical functioning subscale of the Medical Outcome Survey Short-Form 36 items (SF-36 PF). We followed guidelines set out by the OMERACT Filter 2.1. A working group was formed to evaluate each instrument for domain match and feasibility to reach consensus. Two systematic literature reviews (SLRs) were conducted to identify the relevant articles supporting measurement properties of both instruments. Five additional measurement properties were appraised: construct validity, test-retest reliability, longitudinal construct validity, clinical trial discrimination, and threshold of meaning. New evidence was synthesized to fill the gap. Data were presented to the OMERACT technical advisory group (TAG) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) community for endorsement. The results for seven measurement properties for HAQ-DI and SF-36 PF were presented in Summary of Measurement Property (SOMP) tables. The working group proposed "Provisional Endorsement" for both instruments. The body of evidence was approved by the OMERACT TAG. In two Delphi exercises among GRAPPA members, HAQ-DI received 93.9% and 97.5% endorsement votes, while that for SF-36 PF were 86.7% and 77.3%. Both HAQ-DI and SF-36 PF were provisionally endorsed for the measurement of physical function in PsA trials, using the OMERACT Filter 2.1. [ABSTRACT FROM AUTHOR]
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- 2021
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45. Prevalence and Factors Associated With Osteoporosis and Bone Mineral Density Testing in Psoriatic Arthritis
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Kwok, Timothy S. H., Sutton, Mitchell, Ye, Justine Yang, Pereira, Daniel, Chandran, Vinod, and Gladman, Dafna D.
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To determine bone mineral density (BMD) in psoriatic arthritis (PsA) patients, factors associated with undergoing BMD testing, and the effect of PsA clinical activity on BMD. Patients attending the University of Toronto PsA Clinic with BMD testing results from cohort inception to January 2019 were included. Descriptive statistics summarized lumbar spine, femoral neck, and total hip T scores. Cox proportional hazards regression identified predictors for BMD testing. Logistic regression analysis determined odds of having normal (T score −1.0 or more) versus osteoporotic‐range BMD (T score −2.5 or less). A multistate model determined factors associated with BMD state changes over time. Of the 1,479 patients, 214 had BMD tests performed. The mean ± SD T scores at the lumbar spine, femoral neck, and total hip were −0.30 ± 0.32, −1.10 ± 1.04, and −0.45 ± 0.42, respectively. Osteopenia and osteoporosis occurred in 45.27% and 12.94% of patients. Increasing age, menopause, elevated acute‐phase reactants, and biologics, methotrexate, and systemic glucocorticoids use were associated with a higher chance of undergoing BMD testing. Increased body mass index (BMI) and biologics use were associated with a lower chance of having osteoporotic‐range BMD test results. In multistate analysis, polyarthritis may portend lower BMD results over time, although this did not achieve statistical significance due to low patient numbers. The prevalence of osteopenia and osteoporosis in the PsA cohort was similar to that of the general population. Clinicians are using osteoporosis risk factors and PsA disease severity markers to select patients for BMD testing. Polyarticular disease may portend worse BMD test results. Biologic use and increased BMI appear to have a protective effect.
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- 2022
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46. Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index
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Legge, Alexandra, Kirkland, Susan, Rockwood, Kenneth, Andreou, Pantelis, Bae, Sang‐Cheol, Gordon, Caroline, Romero‐Diaz, Juanita, Sanchez‐Guerrero, Jorge, Wallace, Daniel J., Bernatsky, Sasha, Clarke, Ann E., Merrill, Joan T., Ginzler, Ellen M., Fortin, Paul R., Gladman, Dafna D., Urowitz, Murray B., Bruce, Ian N., Isenberg, David A., Rahman, Anisur, Alarcón, Graciela S., Petri, Michelle, Khamashta, Munther A., Dooley, M. A., Ramsey‐Goldman, Rosalind, Manzi, Susan, Zoma, Asad A., Aranow, Cynthia, Mackay, Meggan, Ruiz‐Irastorza, Guillermo, Lim, S. Sam, Inanc, Murat, Vollenhoven, Ronald F., Jonsen, Andreas, Nived, Ola, Ramos‐Casals, Manuel, Kamen, Diane L., Kalunian, Kenneth C., Jacobsen, Søren, Peschken, Christine A., Askanase, Anca, and Hanly, John G.
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The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC‐FI values with future hospitalizations in the SLICC inception cohort. Baseline SLICC‐FI scores were calculated. The number and duration of inpatient hospitalizations during follow‐up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC‐FI values and the rate of hospitalizations per patient‐year of follow‐up. Linear regression was used to estimate the association of baseline SLICC‐FI scores with the proportion of follow‐up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics. The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9–1.5) at baseline. Mean ± SD baseline SLICC‐FI was 0.17 ± 0.08. During mean ± SD follow‐up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC‐FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow‐up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13–1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC‐FI values predicted a greater proportion of follow‐up time spent hospitalized (relative rate 1.09 [95% CI 1.02–1.16]). The SLICC‐FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC‐FI as a valid health measure in SLE.
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- 2022
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47. Prologue: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2022 Annual Meeting
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Gottlieb, Alice B., Armstrong, April W., FitzGerald, Oliver, and Gladman, Dafna D.
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The 2022 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held from July 14 to 17, 2022, in New York City, New York, USA, and was attended by 420 rheumatologists, dermatologists, basic scientists, allied health professionals, patient research partners, and industry partners from 31 countries. A GRAPPA executive retreat, a Trainee Symposium, and the Patient Research Partners Network meeting were held prior to the annual meeting. Presentations included updates in basic research, focusing on biomarkers, personalization of treatments, and the promise of single-cell omics, elucidating the pathogenesis of psoriatic disease (PsD). Presentations also highlighted guttate and plaque psoriasis (PsO), the impact of coronavirus disease 2019 (COVID-19) and its treatments on patients with PsD globally, and the effects of sex and gender in PsD. Reports of ongoing projects included an update on the recently published treatment recommendations, educational initiatives, and the Diagnostic Ultrasound Enthesitis Tool (DUET) study. A session on early identification of psoriatic arthritis (PsA) among patients with PsO included an update on PsA screening tools. Debates were held on whether early intervention for PsO will reduce PsA, whether interleukin (IL)-17 or IL-23 inhibition is a better treatment for PsO and PsA, similarities and differences between axial PsA and axial spondyloarthritis with PsO, and data affecting the understanding of guttate and plaque PsO. Reports from the International Dermatology Outcome Measures (IDEOM) and Young GRAPPiAns concurrent sessions were presented in addition to reports of several other partner groups. Here, we highlight features of the annual meeting and introduce the manuscripts published together as a meeting report.
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- 2023
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48. Project Highlights From the GRAPPA 2022 Annual Meeting: Education Initiatives and Axial Involvement in Psoriatic Arthritis
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Torgutalp, Murat, Gladman, Dafna D., FitzGerald, Oliver, Mease, Philip J., and Poddubnyy, Denis
- Abstract
A core mission of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is to provide education about psoriasis and psoriatic arthritis globally. This is a multifaceted endeavor involving in-person and virtual lectures, discussions, podcasts, and archived videos directed toward clinicians and researchers who are involved with psoriatic disease (PsD) care. In partnership with patient service leagues, we also aim to provide education to patients with PsD. At the 2022 annual meeting, an update of the ongoing and expected educational initiatives was presented. A project with a high educational and research value is the Axial Involvement in Psoriatic Arthritis (AXIS) cohort established in collaboration with the Assessment of Spondyloarthritis international Society (ASAS). Here we summarize the status of the project.
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- 2023
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49. Axial involvement in psoriatic arthritis: An update for rheumatologists.
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Poddubnyy, Denis, Jadon, Deepak R., Van den Bosch, Filip, Mease, Philip J., and Gladman, Dafna D.
- Abstract
• Psoriatic arthritis (PsA) can manifest with axial involvement (axPsA). • There is no consensus on definition, screening, monitoring, or treatment of axPsA. • Thus, rheumatologists face an array of challenges in diagnosing and treating axPsA. Psoriatic arthritis (PsA) is a heterogenous, chronic, inflammatory musculoskeletal disease that can lead to peripheral and axial damage and loss of function. Axial involvement occurs in 25% to 70% of patients with PsA, varying greatly depending on its definition, with the key manifestations being sacroiliitis and/or spondylitis. However, there are no agreed-upon classification or diagnostic criteria for axial involvement in PsA and no consensus on treatment paradigms, which complicates management of PsA. There have only been a few studies assessing biologics in patients with PsA with axial involvement, and most treatment plans are based on evidence from patients with axial spondyloarthritis. Rheumatologists therefore face many challenges in the management of axial PsA, including diagnosis, differential diagnosis, and choice of appropriate treatment. In this review, we summarize the clinical presentation, imaging characteristics, differential diagnoses, treatment options, and prognosis of axial PsA, with the aim of increasing rheumatologists' knowledge of this phenotype of PsA and thereby aiding its optimal management. [ABSTRACT FROM AUTHOR]
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- 2021
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50. Potential Impact of Sex and BMI on Response to Therapy in Psoriatic Arthritis: Post Hoc Analysis of Results From the SEAM-PsA Trial
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Mease, Philip J., Gladman, Dafna D., Merola, Joseph F., Deodhar, Atul, Ogdie, Alexis, Collier, David H., Liu, Lyrica, and Kavanaugh, Arthur
- Abstract
ObjectiveIn this post hoc analysis, we examined the potential impact of sex and BMI on response in the Study of Etanercept and Methotrexate in Combination or as Monotherapy in Subjects with Psoriatic Arthritis (SEAM-PsA) trial (NCT02376790), a 48-week, phase III, randomized controlled trial that compared outcomes with methotrexate (MTX) monotherapy, etanercept (ETN) monotherapy, and MTX+ETN combination therapy in patients with psoriatic arthritis (PsA) who were nai¨ve to MTX and biologics.MethodsWe evaluated key outcomes at week 24 stratified by sex (male vs female) and BMI (kg/m2; ≤ 30 vs > 30), including the American College of Rheumatology 20 (ACR20) criteria, minimal disease activity (MDA), very low disease activity (VLDA), and Psoriatic Arthritis Disease Activity Score (PASDAS). We analyzed data using descriptive statistics, normal approximation, logistic model, and analysis of covariance.ResultsA total of 851 patients completed the SEAM-PsA trial. Higher proportions of men than women who received MTX+ETN combination therapy achieved ACR20 (71.5% vs 58.3%; P= 0.02), MDA (45.8% vs 25.2%; P= 0.0003), and VLDA (19.1% vs 9.5%; P= 0.03), and men achieved better PASDAS (-3.0 vs -2.3; P= 0.0004). Patients with BMI ≤ 30 generally had better outcomes than those with BMI > 30 in some treatment arms for ACR20, MDA, VLDA, and PASDAS; however, there was no consistent pattern regarding the treatment arm in which the difference occurred.ConclusionImproved outcomes were observed more in men than in women for MDA and PASDAS with MTX+ETN combination therapy. Patients with BMI ≤ 30 had better outcomes than those with BMI > 30, with no clear pattern regarding treatment received. These findings suggest that contextual factors such as sex and BMI may affect response to PsA therapy.
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- 2022
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