Search

IntroductionPsoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with cutaneous psoriasis (PsO), first defined by Moll and Wright. Initially perceived as relatively benign, PsA is now recognized for its chronic, progressive, and destructive nature, significantly impacting patients' quality of life, similar to Rheumatoid Arthritis (RA). Globally, PsA represents about 20% of cases in early arthritis clinics, posing diagnostic and management challenges. Early diagnosis is crucial to prevent long-term disability and prevent comorbidities. While classification criteria for PsA are widely accepted, the lack of specific diagnostic criteria may delay diagnosis, with many patients experiencing delays of over a year before receiving an accurate diagnosis. For this reason, the exact prevalence of PsA remains uncertain.MethodsThe MAnagement of PSoriatic Arthritis in Italy (MAPSI) project is a multicenter observational study aimed to investigate the prevalence of PsA and characteristics in an Italian cohort. This study included 454 patients diagnosed or confirmed by a rheumatologist across 25 Rheumatology Units in Italy. Data were collected on demographics, clinical features, and treatment histories. In our cohort, distinct gender differences were observed in PsA phenotype and disease impact.ResultsMen had a higher prevalence of axial involvement and were more likely to be current or former smokers, while women showed greater rates of enthesitis and reported higher perceived disease activity. Additionally, women had a higher prevalence of psychological comorbidities, whereas men had more severe skin involvement; laboratory tests were often unhelpful in diagnosing PsA, with elevated inflammatory markers in only about half of the cases.DiscussionThese findings highlight the need for gender-sensitive approaches in the management of PsA. Our findings highlight the importance of comprehensive patient evaluation, including extramuscoloskeletal manifestation with a gender-sensitive approaches, focusing on a prompt diagnosis to prevent systemic comorbidities. Real-world data, such as those provided by the MAPSI study, are essential for understanding the burden of PsA and developing effective management strategies tailored to patient characteristics.

BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease involving several articular and extra-articular structures. Despite the important progresses recently made in all of the aspects of this disease, its management is still burdened by unresolved issues. The aim of this exercise was to provide a set of statements that may be helpful for the management of PsA.MethodsA group of 38 Italian rheumatologists with recognized expertise in PsA selected and addressed the following four topics: “early PsA,” “axial-PsA,” “extra-articular manifestations and comorbidities,” “therapeutic goals.” Relevant articles from the literature (2016–2022) were selected by the experts based on a PubMed search. A number of statements for each topic were elaborated.ResultsNinety-four articles were selected and evaluated, 68 out of the 1,114 yielded by the literature search and 26 added by the Authors. Each of the four topic was subdivided in themes as follows: transition from psoriasis to PsA, imaging vs. CASPAR criteria in early diagnosis, early treatment for “early PsA”; axial-PsA vs. axialspondyloarthritis, diagnosis, clinical evaluation, treatment, standard radiography vs. magnetic resonance imaging for “axial PsA”; influence of inflammatory bowel disease on the therapeutic choice, cardiovascular comorbidity, bone damage, risk of infection for “comorbidities and extra-articular manifestations”; target and tools, treat-to-target strategy, role of imaging for “therapeutic goals.” The final document consisted of 49 statements.DiscussionThe final product of this exercise is a set of statements concerning the main issues of PsA management offering an expert opinion for some unmet needs of this complex disease.

Loss of bone and muscle mass and strength (i. e., osteosarcopenia) is a highly prevalent clinical condition in older adults, associated with an increased risk of fragility fractures and unfavorable clinical outcomes. Although sarcopenia is a potential risk factor for osteoporosis and subsequent fracture, and the management of this hazardous duet is the key to preventing osteoporotic fracture, evidence pertaining to the treatment of sarcopenia for the purpose of preventing fragile fractures remains insufficient. Given this scenario we aimed at prospectively compare the long-term effectiveness of bisphosphonates vs. denosumab, on bone and muscle, in a cohort of old age hip fractured patients by virtue of a timely osteo-metabolic and sarcopenic assessment. Ninety-eight patients consecutively enrolled at the IRCCS Hospital San martino, Genoa, Italy, received at baseline comprehensive geriatric assessment and Bone Densitometry (DXA) with the quantitative and quantitative bone analysis and evaluation of relative skeletal muscle index (RSMI) and longitudinally after 1 year form hip surgery. The results showed a slightly and non-significant osteo-metabolic improvement in the Alendronate group compared to the Denosumab group, and a positive trend of RSMI measurements in the Denosumab group. Although preliminary in nature, this is the first report to longitudinally analyze osteosarcopenia in a real-world cohort of very old age patients after hip fracture and moved a step forward in the understanding of the best osteo-metabolic therapy for long- term treatment, exploring as well the potential dual role of denousumab as antiresorptive and muscle strength specific drug for osteosarcopenia in this vulnerable population.