Objective To investigate the relationship between MRI inflammation at the vertebral unit and the formation and growth of syndesmophytes at the same vertebral unit. Methods An 80% random sample of the ASSERT database was analysed. MRI were scored using the ankylosing spondylitis (AS) spinal MRI activity score (at baseline, 24 and 102 weeks) and spinal x-rays were scored using the modified Stoke AS spine score (at baseline and 102 weeks). Data were analysed at the patient level and the vertebral unit level using a multilevel approach to adjust for within-patient correlation. Results There was a slightly increased probability of developing syndesmophytes in vertebral units with MRI activity, which was maintained after adjustment for within-patient correlation (per vertebral unit level) and treatment, and after further adjustment for potential confounders, resulting in significant OR ranging from 1.51 to 2.26. Growth of existing syndesmophytes at the vertebral unit level was not associated with MRI activity. At the patient level only a trend for an association was observed. Conclusion MRI inflammation in a vertebral unit slightly increases the propensity to form a new syndesmophyte in the same vertebral unit, but does not predict the growth of already existing syndesmophytes. Despite this association, the large majority of new syndesmophytes developed in vertebral units without inflammation. The subtle association at the vertebral unit level did not translate into an association at the patient level.

https://ard.bmj.com/content/annrheumdis/71/3/369.full.pdf

MRI inflammation at the vertebral unit only marginally predicts new syndesmophyte formation: a multilevel analysis in patients with ankylosing spondylitis

Patients with psoriatic arthritis (PsA) may not be optimally treated. The impact of the disease extends beyond skin and joint symptoms, impairing quality of life. This indicates that the adoption of a patient-focused approach to PsA management is necessary. An expert multidisciplinary working group was convened, with the objective of developing an informed perspective on current best practice and needs for the future management of PsA. Topics of discussion included the barriers to current best practice and calls to action for the improvement of three areas in PsA management: early and accurate diagnosis of PsA, management of disease progression and management of the impact of the condition on the patient. The working group agreed that, to make best use of the available of diagnostic tools, clinical care recommendations and effective treatments, there is a clear need for healthcare professionals from different disciplines to collaborate in the management of PsA. By facilitating appropriate and rapid referral, providing high quality information about PsA and its treatment to patients, and actively involving patients when choosing management plans and setting treatment goals, management of PsA can be improved. The perspective of the working group is presented here, with recommendations for the adoption of a multidisciplinary, patient-focused approach to the management of PsA.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.13306

Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience.

Psoriatic arthritis (PsA), which affects musculoskeletal structures, skin and nails, is a heterogeneous chronic inflammatory disease with a wide clinical spectrum and variable course. Patients with PsA are more likely than healthy individuals to have metabolic syndrome or cardiovascular disease. To include these comorbidities, 'psoriatic disease' has been suggested as an umbrella term. The management of PsA has changed tremendously over the past decade owing to early diagnosis and improvement in treatment strategies, including, early referral from dermatologists and primary-care physicians to rheumatologists, early initiation of therapy, treating to the target of remission or low disease activity, and advances in pharmacological therapy. Outcome assessment is also improving, because of validated instruments for clinical disease manifestations. The commercialization of TNF blockers, including adalimumab, etanercept, golimumab and infliximab, is representative of a revolution in the treatment of PsA. A new anti-TNF agent, certolizumab pegol, and a fully human monoclonal antibody against IL-12 and IL-23, ustekinumab, are approved for the treatment of active PsA. The efficacy of ustekinumab suggests that inhibiting the type 17 T helper pathway might be an alternative to blocking TNF. PsA management must now use improved measures to predict patient outcomes and define remission, and develop better-targeted therapies.

Advances in the management of psoriatic arthritis

Recommendations for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists: a Delphi study.

Introduction: Psoriasis is a common chronic skin condition that is prevalent worldwide. Despite the numerous treatment options available, discrepancies exist between international guidelines.Areas covered: This review aims to evaluate the current international guidelines for the systemic treatment of psoriasis and psoriatic arthritis.Expert commentary: Most guidelines are unanimous on medication dosing and laboratory monitoring. However, even the most up-to-date guidelines do not include many of the new biologic medications. Guidelines will require frequent updates to include the newer treatments and will soon need to state a recommendation on the use of biosimilars.

Current pharmacological treatment guidelines for psoriasis and psoriatic arthritis

OBJECTIVE: To update recommendationsforthe treatment
of psoriatic arthritis with biological therapies, endorsed
by the Portuguese Society of Rheumatology (SPR).
METHODS: These treatment recommendations were formulated
by Portuguese rheumatologists based on literature
evidence and consensus opinion. At a national
meeting the 16 recommendations included in this
document were discussed and updated. The level of
agreement among Portuguese Rheumatologists was assessed
using an online survey. A draft of the full text of
the recommendations was then circulated and suggestions
were incorporated. A final version was again circulated
before publication.
RESULTS: A consensus was achieved regarding the initiation,
assessment of response and switching biological
therapies in patients with psoriatic arthritis (PsA).
Specific recommendations were developed for several
disease domains: peripheral arthritis, axial disease, enthesitis
and dactylitis.
CONCLUSION: These recommendations may be used for
guidance in deciding which patients with PsA should be
treated with biological therapies. They cover a rapidly
evolving area oftherapeutic intervention.Asmore evidence
becomes available and more biological therapies are licensed,
these recommendations will have to be updated.

Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis - 2015 update

We studied systematically, for the first time, the utility of the six-minute walk test (6MWT) in Chagas disease. The walked distance at 6MWT correlated negatively with the increased circulating levels of monocyte chemoattractant protein (MCP-1, r= −0.358, p=0.04) and natriuretic peptide type B (BNP, r= −0.349, p=0.04), as well as positively with ejection fraction deterioration (r=0.451, p=0.004), indicating that submaximal functional capacity of chagasic patients is related to the severity of the cardiopathy. 6MWT may constitute an auxiliary tool in the evaluation of the clinical status of Chagas disease patients. © 2007 Elsevier Ireland Ltd. All rights reserved.

https://www.internationaljournalofcardiology.com/article/S0167-5273(07)00432-9/pdf

Letter to the Editor Six-minute walk test in Chagas cardiomyopathy

Linhas de pesquisa do programa de pós-graduação em ciências da saúde: infectologia e medicina tropical

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Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis - 2015 update

Letter to the Editor Six-minute walk test in Chagas cardiomyopathy

Linhas de pesquisa do programa de pós-graduação em ciências da saúde: infectologia e medicina tropical