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Psoriatic disease (PsD) affects multiple clinical domains and causes a significant inflammatory burden in patients, requiring comprehensive evaluation and treatment. In recent years, new molecules such as JAK inhibitors (JAKinhibs) have been developed. These have very clear advantages: they act quickly, have a beneficial effect on pain, are well tolerated and the administration route is oral. Despite all this, there is still little scientific evidence in daily clinical practice. This observational, retrospective, single-center study was carried out in patients diagnosed with PsA in the last two years, who started treatment with Tofacitinib or Upadacitinib due to failure of a DMARD. The data of 32 patients were analyzed, and the majority of them (75%) started treatment with Tofacitinib. Most had moderate arthritis activity and mild psoriasis involvement according to activity indices. Both Tofacitinib and Upadacitinib demonstrated significant efficacy, with rapid and statistically significant improvement in joint and skin activity indices, C-reactive protein reduction, and objective measures of disease activity such as the number of painful and inflamed joints. Although there was some difference in the baseline characteristics of the cohort, treatment responses were comparable or even superior to those in the pivotal clinical trials. In addition, there was a low frequency of mild adverse events leading to treatment discontinuation and no serious adverse events. These findings emphasize the strong efficacy and tolerability of JAKinhibs in daily clinical practice, supporting their role as effective therapeutic options for patients with PsD. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to determine the feasibility of low-load resistance training with blood flow restriction (BFR) for people with advanced disability due to multiple sclerosis (MS). Methods In this prospective cohort study, 14 participants with MS (Expanded Disability Status Scale [EDSS] score = 6.0 to 7.0; mean age = 55.4 [SD = 6.2] years; 71% women) were asked to perform 3 lower extremity resistance exercises (leg press, calf press, and hip abduction) bilaterally twice weekly for 8 weeks using BFR. Feasibility criteria were as follows: enrollment of 20 participants, ≥80% retention and adherence, ≥90% satisfaction, and no serious adverse events related to the intervention. Other outcomes included knee extensor, ankle plantar flexor, and hip abductor muscle strength, 30-Second Sit-to-Stand Test, Berg Balance Scale, Timed 25-Foot Walk Test, 12-Item MS Walking Scale, Modified Fatigue Impact Scale, Patient-Specific Functional Scale, and daily step count. Results Sixteen participants consented, and 14 completed the intervention, with 93% adherence overall. All participants were satisfied with the intervention. A minor hip muscle strain was the only intervention-related adverse event. There were muscle strength improvements on the more-involved (16%–28%) and less-involved (12%–19%) sides. There were also changes in the 30-Second Sit-to-Stand Test (1.9 repetitions; 95% CI = 1.0 to 2.8), Berg Balance Scale (5.3 points; 95% CI = 3.2 to 7.4), Timed 25-Foot Walk Test (−3.3 seconds; 95% CI = −7.9 to 1.3), Modified Fatigue Impact Scale (−8.8 points; 95% CI = −16.5 to −1.1), 12-Item MS Walking Scale (−3.6 points; 95% CI = −11.5 to 4.4), Patient-Specific Functional Scale (2.9 points; 95% CI = 1.9 to 3.8), and daily step count (333 steps; 95% CI = −191 to 857). Conclusion Low-load resistance training using BFR in people with MS and EDSS scores of 6.0 to 7.0 appears feasible, and subsequent investigation into its efficacy is warranted. Impact Although efficacy data are needed, combining BFR with low-load resistance training may be a viable alternative for people who have MS and who do not tolerate conventional moderate- to high-intensity training because of more severe symptoms, such as fatigue and weakness. Lay Summary Low-load strength training with BFR was feasible in people who have advanced disability due to MS. Using BFR may provide an alternative for people with MS who do not tolerate higher intensity training due to more severe symptoms, such as fatigue and weakness. [ABSTRACT FROM AUTHOR]

The article presents arguments supporting the need for randomized clinical trials for testing disease-modifying therapies (DMTs) for treating multiple sclerosis (MS) in pregnant women. It talks about topics including DMT guidance for managing MS in women who wish to conceive, the impact of DMTs on breastfeeding, and testing the safety of DMTs to pregnant women and fetuses.

Background: Diroximel fumarate (DRF) is a novel oral fumarate recently approved in the United States for relapsing forms of multiple sclerosis (MS). Currently, there are no published data demonstrating the efficacy of DRF in patients with highly active relapsing-remitting MS (RRMS). Increased frequency of relapses and high magnetic resonance imaging lesion load are associated with an increased risk of MS progression. Objectives: To evaluate clinical and radiologic efficacy of DRF in patients with highly active RRMS. Methods: EVOLVE-MS-1 (trial registration: NCT02634307) is an ongoing, open-label, phase 3 study of long-term safety, tolerability, and treatment effect of DRF over 96 weeks in adults with RRMS. Efficacy outcomes were assessed in a post hoc subgroup analysis of patients from EVOLVE-MS-1 with highly active RRMS (≥2 relapses in the year before study entry and ≥1 gadolinium-enhancing [Gd+] lesion at baseline). Assessments included adjusted annualized relapse rate (ARR), Gd+ lesion count, and 12-week confirmed disability progression (CDP; ≥1.5-point increase in Expanded Disability Status Scale score from a baseline score of 0, or a ≥1-point increase from a baseline score of 1.0-5.5, sustained for 12 weeks). Results: A total of 57 patients with highly active RRMS were enrolled in EVOLVE-MS-1 as of November 30, 2018, 14 of whom were newly diagnosed and naive to disease-modifying therapy. Patients had a mean (SD) time since diagnosis of 4.2 (4.6) years and 2.2 (0.6; range 2-5) relapses in the 12 months before study entry. Median (range) DRF exposure for the highly active subgroup was 84 (1-100) weeks; 72% of patients were on treatment for ≥1 year. Adjusted ARR was reduced by 83.3% (95% CI 72.0%-90.7%; P < .0001) with DRF treatment compared with the 12 months before study entry (0.36 [95% CI 0.20-0.65] vs 2.22 [95% CI 2.06-2.40]), and 73.7% of patients were relapse-free. Estimated proportion of patients with 12-week CDP at week 48 was 8.3%. Mean (SD) time to disability progression for patients who progressed was 5.4 (4.8) months. Significant reductions in mean (SD) Gd+ lesion counts were observed at week 48 (1.0 [4.7]; n = 41) compared with baseline (5.0 [7.7]; n = 53; 80% reduction; P = .0003), and a greater percentage were Gd+ lesion-free (week 48: 80.5% vs baseline: 9.4%). Conclusions: DRF demonstrated notable benefits on clinical and radiologic outcomes in patients with highly active RRMS. These data and comparison with similar cohorts (DEFINE/CONFIRM highly active RRMS) support DRF as a treatment option for patients with MS with active disease. [ABSTRACT FROM AUTHOR]

Abstract: Dialectical behaviour therapy (DBT) has proven to be an effective treatment in borderline personality disorder (BPD). However, the effectiveness in BPD of DBT skills training (DBT-ST) alone is not known. This study aimed at comparing the efficacy of DBT-ST and standard group therapy (SGT) for outpatients with BPD. Sixty patients meeting the DSM-IV diagnostic criteria for BPD, as assessed by two semi-structured diagnostic interviews, were included in a 3-month, single-blind randomised controlled trial. A total of 13 weekly group psychotherapy sessions of 120min of either SGT or DBT-ST were conducted. Assessments were carried out every 2 weeks by two blinded evaluators. Observer-rater, self-report scales and behavioural reports were used as outcome measures. DBT-ST was associated with lower dropout rates, 34.5% compared to 63.4% with SGT. It was superior to SGT in improving several mood and emotion areas, such as: depression, anxiety, irritability, anger and affect instability. A reduction in general psychiatric symptoms was also observed. Three-months weekly DBT-ST proved useful. This therapy was associated with greater clinical improvements and lower dropout rates than SGT. DBT-ST seems to play a role in the overall improvement of BPD seen with standard DBT intervention. It allows straightforward implementation in a wide range of mental health settings and provides the additional advantage that it is cost effective. [Copyright &y& Elsevier]