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Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field. orcid-numbers: Machado, Pedro/0000-0002-8411-7972 Inman, Robert/0000-0002-4750-1422 unique-id: ISI:000417778700007 ispartof: Annals Of The Rheumatic Diseases vol:77 issue:1 pages:3-17 ispartof: location:England status: published

Resume Objectif L’evaluation globale par le patient (EVAgb) est une methode d’evaluation essentielle dans le rhumatisme psoriasique. L’objectif etait d’analyser l’interet de l’evaluation globale par le patient dans le rhumatisme psoriasique en etudiant les associations avec les domaines de sante du questionnaire PsAID (Psoriatic Arthritis Impact of Disease). Methodes Analyse post-hoc d’une etude transversale multicentrique de patients atteints de rhumatisme psoriasique. Les donnees collectees comprenaient l’evaluation globale par le patient, les evaluations globales specifiques d’articulation et de peau par le patient, le questionnaire PsAID couvrant l’impact physique (y compris les manifestations articulaires et cutanees) et l’impact psychologique et social ainsi que d’autres elements de comparaison. Une analyse univariee (correlation de Pearson) et une regression lineaire multivariee ont ete menees pour expliquer l’evaluation globale par le patient et les evaluations globales specifiques d’articulation et de peau par le patient. Resultats Parmi les 223 patients (âge moyen 51,0 [ecart type ± 13,3] ans, duree moyenne de la maladie 9,9 [± 10,1] ans, nombre d’articulations gonflees 4,1 [± 5,1], 84,3 % ayant un psoriasis [pour la plupart moins de 5 % de la surface corporelle]), 50,2 % etaient des femmes. Les valeurs moyennes de l’EVAgb etaient de 4,8 (± 2,7), les valeurs moyennes respectives des evaluations d’articulation et de peau etaient de 5,6 (± 2,5) et de 4,1 (± 3,0). La correlation intra-classe entre l’EVAgb et les evaluations d’articulation et de peau etait respectivement de 0,71 (IC a 95 %, 0,64–0,77) et de 0,52 (IC a 95 %, 0,42–0,60). D’apres l’analyse multivariee, l’EVAgb du patient etait bien expliquee (R2 du modele 0,754) par le « coping » ou capacite a faire face (β = 0,287) ; la douleur (β = 0,240) ; les activites de travail et/ou de loisir (β = 0,141) ; et l’anxiete (β = 0,109). Conclusions L’evaluation globale par le patient dans le rhumatisme psoriasique s’expliquait principalement par les composantes physiques mais egalement psychologiques de la maladie.

This review will outline the current pharmacogenomics knowledge about psoriatic arthritis with a special attention to the perspectives and the challenges for its implementation in the clinical practice. To date, different drugs have been developed to contrast the symptoms and the progression of psoriatic arthritis. However, patients have shown high variability of drug response in relation to their genetic makeup. In this context, the advances made in the knowledge and the potentialities of genome-drugs associations paved the path for the development of a precision medicine. In fact, these associations may be successfully combined with the environment information to provide new strategies able to prevent and improve the disease management as well as to enhance the patients quality of life.

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International audience; Objectifs: dans le rhumatisme psoriasique (RPso), la fatigue est un aspect important pour les patients. L’objectif était d’évaluer l’ampleur de la fatigue chez les patients souffrant de RPso et les facteurs susceptibles d’expliquer une fatigue intense.Méthodes: il s’agissait d’une analyse ancillaire d’une étude transversale menée dans 13 pays sur des patients non sélectionnés atteints de RPso qui remplissaient les critères CASPAR. L’importance de la fatigue pour les patients a été évaluée par un exercice de hiérarchisation au moyen d’une échelle numérique (EN) (plage 0-10). Les facteurs pouvant être associés à une intensité de fatigue > 5/10, à savoir des variables démographiques (âge, sexe, durée de la maladie, niveau d’éducation) et des caractéristiques de la maladie (nombre d’articulations touchées, protéine réactive C, psoriasis cutané, atteinte axiale, enthésite, dactylite, dommages structuraux) ont été évalués par une analyse logistique univariée et multivariée et une analyse par régression linéaire multiple.Résultats: au total, 246 patients ont été analysés : âge moyen ± écart-type 51,2 ± 13,0 ans ; durée moyenne de la maladie 9,9 ± 10,1 ans ; score DAS 28 moyen 3,5 ± 1,3. La fatigue a été classée en deuxième position d’importance pour les patients après la douleur. Son intensité était élevée : fatigue moyenne 5,0 ± 3,0. L’intensité de fatigue > 5/10 a été bien expliquée (variance expliquée 73 %) par le psoriasis cutané (Odds Ratio 4,67 [intervalle de confiance 95 % 1,05 ; 20,72]), les articulations douloureuses (1,30 [1,01 ; 1,68]) et un faible niveau d’éducation (1,09 [1,02 ; 1,23]). Dans le modèle de régression linéaire multiple, la fatigue a été expliquée par le psoriasis cutané, les articulations douloureuses, l’enthésite, le sexe féminin et le niveau d’éducation.Conclusions: la fatigue est un problème prioritaire chez les patients atteints de RPso. La fatigue mesurée est intense chez ces patients. Les cas d’intensité > 5/10 étaient majoritairement associés à des facteurs liés à la maladie mais aussi à des variables caractéristiques des patients. La fatigue, dans le RPso, indique une étiologie multifactorielle.

Objectives Fatigue is an aspect of psoriatic arthritis (PsA), which is important to patients. The objective was to evaluate magnitude of fatigue in PsA patients and to assess factors that might explain high levels of fatigue. Methods This was an ancillary analysis of a cross-sectional study in 13 countries of unselected PsA patients who fulfilled the CASPAR criteria. Patient-perceived importance of fatigue was assessed through a priority exercise. Levels of fatigue were assessed by a numeric rating scale (range 0–10). Factors potentially associated with fatigue > 5/10: i.e., demographic variables (age, gender, disease duration, education level) and disease related characteristics including joint counts, C-reactive protein, skin psoriasis, axial involvement, enthesitis, dactylitis, structural damage, were assessed by univariate, multivariate logistic and multiple linear regression. Results In all, 246 patients were analysed: mean ± standard deviation age 51.2 ± 13.0 years, mean disease duration 9.9 ± 10.1 years, mean DAS28 3.5 ± 1.3. Fatigue was ranked second in patient-perceived importance, after pain. Magnitude of fatigue was high: mean fatigue 5.0 ± 3.0. Fatigue > 5/10 was well explained (variance explained 73%) by skin psoriasis (odds ratio 4.67 [95% confidence interval 1.05; 20.72]), tender joints (1.30 [1.01; 1.68]) and lower education level (1.09 [1.02; 1.23]). In the multiple linear regression model, fatigue was explained by skin psoriasis, tender joints, enthesitis, female gender, education level. Conclusions Fatigue is a priority for PsA patients. Fatigue levels were high in these patients and fatigue > 5/10 was mainly associated with disease-related factors but also patient-related variables, indicating that the etiology of fatigue in PsA is multifactorial.

Objective Patient global assessment is a key outcome measure in psoriatic arthritis. To explore the meaning of patient global assessment in psoriatic arthritis by examining associations to domains of health assessed by the Psoriatic arthritis impact of disease score. Methods Post-hoc analysis of a multicentre cross-sectional study of patients with psoriatic arthritis. Data collection included patient global assessment, specific joint and skin global patient assessments, Psoriatic arthritis impact of disease questions covering physical (including joints and skin), psychological and social impact, and other comparator outcomes. Univariate analyses (Pearson correlation) and multivariate linear regression were performed to explain patient global assessment and the specific joint and skin global patient assessments. Results Among 223 patients (mean age: 51.0 [standard deviation, ±13.3] years; mean disease duration: 9.9 [±10.1] years; mean swollen joint count: 4.1 [±5.1]; 84.3% with current psoriasis [mainly of less than 5% body surface area]), 50.2% were females. Mean patient global assessment was 4.8 (±2.7), mean joint and skin patient assessments were respectively 5.6 (±2.5) and 4.1 (±3.0). Intraclass correlation between patient global assessment and joint or skin patient assessment was respectively 0.71 (95% confidence interval, 0.64–0.77) and 0.52 (95% confidence interval, 0.42–0.60). In multivariate analyses, patient global assessment was explained (R2 of model: 0.754) by coping (β = 0.287); pain (β = 0.240); work and/or leisure activities (β = 0.141); and anxiety (β = 0.109). Conclusions Patient global assessment in psoriatic arthritis was explained mainly by physical, but also psychological aspects of the disease.

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