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Psoriasis: HELP
Articles by Arthur F. Kavanaugh
Based on 88 articles published since 2008
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Between 2008 and 2019, Arthur Kavanaugh wrote the following 88 articles about Psoriasis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. 2019

Menter, Alan / Strober, Bruce E / Kaplan, Daniel H / Kivelevitch, Dario / Prater, Elizabeth Farley / Stoff, Benjamin / Armstrong, April W / Connor, Cody / Cordoro, Kelly M / Davis, Dawn M R / Elewski, Boni E / Gelfand, Joel M / Gordon, Kenneth B / Gottlieb, Alice B / Kavanaugh, Arthur / Kiselica, Matthew / Korman, Neil J / Kroshinsky, Daniela / Lebwohl, Mark / Leonardi, Craig L / Lichten, Jason / Lim, Henry W / Mehta, Nehal N / Paller, Amy S / Parra, Sylvia L / Pathy, Arun L / Rupani, Reena N / Siegel, Michael / Wong, Emily B / Wu, Jashin J / Hariharan, Vidhya / Elmets, Craig A. ·Baylor Scott and White, Dallas, Texas. · University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada. · University of Pittsburgh, Pittsburgh, Pennsylvania. · University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. · Emory University School of Medicine, Atlanta, Georgia. · University of Southern California, Los Angeles, San Francisco. · University of Alabama, Birmingham, Alabama. · University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California. · Mayo Clinic, Rochester, Minnesota. · University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York. · University of California San Diego, San Diego, California. · National Psoriasis Foundation, Portland, Oregon. · University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Massachusetts General Hospital, Boston, Massachusetts. · Central Dermatology, St. Louis, Missouri. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Dermatology and Skin Surgery, Sumter, South Carolina. · Colorado Permanente Medical Group, Centennial, Colorado. · San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio. · Dermatology Research and Education Foundation, Irvine, California. · American Academy of Dermatology, Rosemont, Illinois. Electronic address: vhariharan@aad.org. ·J Am Acad Dermatol · Pubmed #30772098.

ABSTRACT: Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.

2 Guideline Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. 2019

Elmets, Craig A / Leonardi, Craig L / Davis, Dawn M R / Gelfand, Joel M / Lichten, Jason / Mehta, Nehal N / Armstrong, April W / Connor, Cody / Cordoro, Kelly M / Elewski, Boni E / Gordon, Kenneth B / Gottlieb, Alice B / Kaplan, Daniel H / Kavanaugh, Arthur / Kivelevitch, Dario / Kiselica, Matthew / Korman, Neil J / Kroshinsky, Daniela / Lebwohl, Mark / Lim, Henry W / Paller, Amy S / Parra, Sylvia L / Pathy, Arun L / Prater, Elizabeth Farley / Rupani, Reena / Siegel, Michael / Stoff, Benjamin / Strober, Bruce E / Wong, Emily B / Wu, Jashin J / Hariharan, Vidhya / Menter, Alan. ·University of Alabama, Birmingham, Alabama. · Central Dermatology, St. Louis, Missouri. · Mayo Clinic, Rochester, Minnesota. · University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · National Psoriasis Foundation, Portland, Oregon. · National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · University of Southern California, Los Angeles, California. · Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California. · Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York. · University of Pittsburgh, Pennsylvania. · University of California San Diego, San Diego, California. · Baylor Scott and White, Dallas, Texas. · University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Massachusetts General Hospital, Boston, Massachusetts. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Dermatology and Skin Surgery, Sumter, South Carolina. · Colorado Permanente Medical Group, Centennial, Colorado. · University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. · Icahn School of Medicine at Mount Sinai, New York, New York. · Emory University School of Medicine, Atlanta, Georgia. · University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada. · San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas. · Dermatology Research and Education Foundation, Irvine, California. · American Academy of Dermatology, Rosemont, Illinois. Electronic address: vhariharan@aad.org. ·J Am Acad Dermatol · Pubmed #30772097.

ABSTRACT: Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.

3 Guideline Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. 2018

Smolen, Josef S / Schöls, Monika / Braun, Jürgen / Dougados, Maxime / FitzGerald, Oliver / Gladman, Dafna D / Kavanaugh, Arthur / Landewé, Robert / Mease, Philip / Sieper, Joachim / Stamm, Tanja / Wit, Maarten de / Aletaha, Daniel / Baraliakos, Xenofon / Betteridge, Neil / Bosch, Filip van den / Coates, Laura C / Emery, Paul / Gensler, Lianne S / Gossec, Laure / Helliwell, Philip / Jongkees, Merryn / Kvien, Tore K / Inman, Robert D / McInnes, Iain B / Maccarone, Mara / Machado, Pedro M / Molto, Anna / Ogdie, Alexis / Poddubnyy, Denis / Ritchlin, Christopher / Rudwaleit, Martin / Tanew, Adrian / Thio, Bing / Veale, Douglas / Vlam, Kurt de / van der Heijde, Désirée. ·Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. · 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria. · Health Consult, Vienna, Austria. · Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Paris Descartes University, Paris, France. · Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland. · Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada. · Division of Rheumatology, University of California, San Diego, CA, USA. · Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands. · Division of Rheumatology Research, Swedish-Providence St. Joseph Health System, University of Washington, Seattle, WA, USA. · Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany. · Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands. · Neil Betteridge Associates, UK. · Ghent University Hospital, Ghent, Belgium. · Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK. · Department of Medicine, University of California, San Francisco, CA, USA. · Department of Rheumatology, UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France. · Institute of Molecular Medicine, University of Leeds, Leeds, UK. · Seayn Medical, Voorschoten, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · University Health Network and University of Toronto, Toronto, Ontario, Canada. · University of Glasgow, College of Medical Veterinary and Life Sciences, Glasgow, UK. · A.DI.PSO. (Associazione per la Difesa degli Psoriasici)-PE.Pso.POF (Pan European Psoriasis Patients' Organization Forum), Rome, Italy. · Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK. · Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA. · German Rheumatism Research Centrer, Berlin, Germany. · Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center Rochester, New York, NY, USA. · Division of Internal Medicine and Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. · Department of Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. ·Ann Rheum Dis · Pubmed #28684559.

ABSTRACT: 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.

4 Guideline Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis. 2016

Coates, Laura C / Kavanaugh, Arthur / Mease, Philip J / Soriano, Enrique R / Laura Acosta-Felquer, Maria / Armstrong, April W / Bautista-Molano, Wilson / Boehncke, Wolf-Henning / Campbell, Willemina / Cauli, Alberto / Espinoza, Luis R / FitzGerald, Oliver / Gladman, Dafna D / Gottlieb, Alice / Helliwell, Philip S / Husni, M Elaine / Love, Thorvardur J / Lubrano, Ennio / McHugh, Neil / Nash, Peter / Ogdie, Alexis / Orbai, Ana-Maria / Parkinson, Andrew / O'Sullivan, Denis / Rosen, Cheryl F / Schwartzman, Sergio / Siegel, Evan L / Toloza, Sergio / Tuong, William / Ritchlin, Christopher T. ·Leeds Institute of Rheumatic and Musculoskeletal Medicine and University of Leeds, Leeds, UK. · University of California at San Diego. · Swedish Medical Center and University of Washington School of Medicine, Seattle, Washington. · Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. · University of Southern California, Keck School of Medicine, Los Angeles. · Hospital Militar Central and Universidad Militar Nueva Grenada, Bogotá, Colombia. · Geneva University Hospital, Geneva, Switzerland. · Toronto Western Hospital, Toronto, Ontario, Canada. · University of Cagliari, Monserrato Campus, Cagliari, Italy. · Louisiana State University Health Sciences Center, New Orleans. · St. Vincent's University Hospital, The Conway Institute for Biomolecular Research, and University College Dublin, Dublin, Ireland. · University of Toronto and Toronto Western Research Institute, Toronto, Ontario, Canada. · Tufts Medical Center, Boston, Massachusetts. · Leeds Institute of Rheumatic and Musculoskeletal Medicine and University of Leeds, Leeds, UK, and Bradford Hospitals NHS Foundation Trust, Bradford, UK. · Cleveland Clinic Foundation, Cleveland, Ohio. · University of Iceland and Landspitali University Hospital, Reykjavik, Iceland. · University of Molise, Campobasso, Italy. · Royal National Hospital for Rheumatic Diseases, Bath, UK. · University of Queensland, Brisbane, Queensland, Australia. · University of Pennsylvania, Philadelphia. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Chapel Allerton Hospital, Leeds, UK. · St. Vincent's University Hospital, Dublin, Ireland. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Hospital for Special Surgery, New York, New York. · Arthritis and Rheumatism Associates, Rockville, Maryland. · Ministry of Health, San Fernando del Valle de Catamarca, Argentina. · University of California, Davis. · University of Rochester Medical Center, Rochester, New York. ·Arthritis Rheumatol · Pubmed #26749174.

ABSTRACT: OBJECTIVE: To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA). METHODS: GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire. RESULTS: Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. CONCLUSION: We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.

5 Guideline Consensus guidelines for the management of plaque psoriasis. 2012

Hsu, Sylvia / Papp, Kim Alexander / Lebwohl, Mark G / Bagel, Jerry / Blauvelt, Andrew / Duffin, Kristina Callis / Crowley, Jeffrey / Eichenfield, Lawrence F / Feldman, Steven R / Fiorentino, David F / Gelfand, Joel M / Gottlieb, Alice B / Jacobsen, Carmen / Kalb, Robert E / Kavanaugh, Arthur / Korman, Neil J / Krueger, Gerald G / Michelon, Melissa A / Morison, Warwick / Ritchlin, Christopher T / Stein Gold, Linda / Stone, Stephen P / Strober, Bruce E / Van Voorhees, Abby S / Weiss, Stefan C / Wanat, Karolyn / Bebo, Bruce F / Anonymous4210715. ·Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA. shsu@bcm.edu ·Arch Dermatol · Pubmed #22250239.

ABSTRACT: The Canadian Guidelines for the Management of Plaque Psoriasis were reviewed by the entire National Psoriasis Foundation Medical Board and updated to include newly approved agents such as ustekinumab and to reflect practice patterns in the United States, where the excimer laser is approved for psoriasis treatment. Management of psoriasis in special populations is discussed. In the updated guidelines, we include sections on children, pregnant patients or pregnant partners of patients, nursing mothers, the elderly, patients with hepatitis B or C virus infections, human immunodeficiency virus-infected patients, and patients with malignant neoplasms, as well as sections on tumor necrosis factor blockers, elective surgery, and vaccinations.

6 Editorial New GRAPPA and EULAR recommendations for the management of psoriatic arthritis. 2017

Coates, Laura C / Gossec, Laure / Ramiro, Sofia / Mease, Philip / van der Heijde, Désirée / Smolen, Josef S / Ritchlin, Christopher / Kavanaugh, Arthur. ·Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds UK. · Department of rheumatology, Sorbonne Universités, UPMC Univ Paris 06; AP-HP, Pitié Salpêtrière Hospital, Paris, France. · Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands. · Swedish Medical Center Seattle, WA, USA. · Division of Rheumatology, Department of Medicine 3, Medical University of Vienna. · 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria. · Allergy, Immunology & Rheumatology Division, University of Rochester Medical Center, Rochester, NY. · Division of Rheumatology, Allergy Immunology, University of California San Diego, USA. ·Rheumatology (Oxford) · Pubmed #28077693.

ABSTRACT: -- No abstract --

7 Review Management of psoriatic arthritis in 2016: a comparison of EULAR and GRAPPA recommendations. 2016

Gossec, Laure / Coates, Laura C / de Wit, Maarten / Kavanaugh, Arthur / Ramiro, Sofia / Mease, Philip J / Ritchlin, Christopher T / van der Heijde, Désirée / Smolen, Josef S. ·Sorbonne Universités, Université Pierre and Marie Curie - Paris 6, 4 Place Jussieu 75005, Paris, France; and at the Service de Rhumatologie, L'Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière Hôpital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds; and at the Leeds Musculoskeletal Biomedical Research Unit, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK. · Department of Medical Humanities, Vrije Universiteit Medical Centre, POBox 7057, 1007 MB Amsterdam, Netherlands. · Division of Rheumatology, Allergy &Immunology, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, California 92093-0656, USA. · Department of Rheumatology, Leiden University Medical Centre, POBox 9600, 2300 RC Leiden, Netherlands. · Rheumatology Clinical Research Division, Swedish Medical Center, 601 Broadway, Suite 600, Seattle, Washington 98102, USA. · Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, BOX 695, Rochester, New York 14642, USA. · Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; and at the 2nd Department of Medicine, Hietzing Hospital, Wolkersbergenstraße 1, 1130 Vienna, Austria. ·Nat Rev Rheumatol · Pubmed #27829672.

ABSTRACT: Psoriatic arthritis (PsA) is a heterogeneous, potentially severe disease. Many therapeutic agents are now available for PsA, but treatment decisions are not always straightforward. To assist in this decision making, two sets of recommendations for the management of PsA were published in 2016 by international organizations - the European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). In both sets of recommendations, the heterogeneity of PsA is recognized and the place of various drugs in the therapeutic armamentarium is discussed. Such agents include conventional DMARDs, such as methotrexate, and targeted therapies including biologic agents, such as ustekinumab, secukinumab and TNF inhibitors, or the targeted synthetic drug apremilast. The proposed sequential use of these drugs, as well as some other aspects of PsA management, differ between the two sets of recommendations. This disparity is partly the result of a difference in the evaluation process; the focus of EULAR was primarily rheumatological, whereas that of GRAPPA was balanced between the rheumatological and dermatological aspects of disease. In this Perspectives article, we address the similarities and differences between these two sets of recommendations and the implications for patient management.

8 Review Secukinumab for the treatment of psoriatic arthritis. 2016

Baronaite Hansen, Renata / Kavanaugh, Arthur. ·a Department of Medicine , Copenhagen University Hospital Gentofte , Copenhagen , Denmark. · b Center for Innovative Therapy , University of California , San Diego , CA , USA. ·Expert Rev Clin Immunol · Pubmed #27550397.

ABSTRACT: INTRODUCTION: Secukinumab (Cosentyx) is an interleukin-17A (IL-17A) inhibitor administered subcutaneously. Through 2016, it had received approval in a number of countries, including the USA, Japan and in the EU for the treatment of plaque psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis (AS). AREAS COVERED: This review addresses the mechanism of action, efficacy and safety of secukinumab observed in clinical studies of patients with PsA. Data from recent studies of secukinumab in psoriasis, PsA and AS are included. Expert commentary: Secukinumab appears to be effective in improving various aspects of PsA, including improvements in psoriatic skin, enthesitis and dactylitis, as well as inhibition of the radiographic progression of peripheral arthritis. Secukinumab was in general well tolerated; the most common adverse events were nasopharyngitis, headache, and upper respiratory tract infection.

9 Review Novel approaches to biological therapy for psoriatic arthritis. 2016

Boyd, Tristan / Kavanaugh, Arthur. ·a Division of Rheumatology, Schulich School of Medicine & Dentistry , Western University , London , ON , Canada. · b Division of Rheumatology, Allergy, and Immunology, School of Medicine , University of California at San Diego , La Jolla , CA , USA. ·Expert Opin Biol Ther · Pubmed #26572089.

ABSTRACT: INTRODUCTION: Improved understanding of the immunopathogenic mechanisms in psoriatic arthritis (PsA) has led to the development of targeted biological therapies, which demonstrate superior clinical efficacy to traditional disease-modifying antirheumatic drugs (DMARDs). There are currently 3 classes of biological agents that are approved for the treatment of psoriatic disease: tumor necrosis factor alpha inhibitors (TNFi), including etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol; ustekinumab, a monoclonal antibody (mAb) directed against interleukin (IL)-12 and IL-23; and secukinumab, a human anti-IL-17A mAb. Other agents are in development. Our growing experience with these medications has revolutionized the approach to disease management in PsA. AREAS COVERED: This article discusses the rationale for using biological therapies in PsA, highlighting clinical trial evidence that supports the use of these agents. We summarize novel treatment approaches using biological therapies in the management of PsA, including early intervention, targeted therapy, TNFi switching, combination therapy, and tapering or discontinuation of biological therapy. We conclude with a discussion of the importance comorbidities have on selection of therapy. EXPERT OPINION: The advent of highly effective biological therapies has revolutionized the management of patients with PsA. Growing experience with these agents has led to novel treatment approaches that may improve clinical outcomes for PsA patients.

10 Review Novel Treatment Concepts in Psoriatic Arthritis. 2015

Boyd, Tristan / Kavanaugh, Arthur. ·Division of Rheumatology, Western University, Schulich School of Medicine, St. Joseph's Health Care London, Room D2-161, 268 Grosvenor Street, London, ON N6A 4V2, Canada. Electronic address: tboyd9@uwo.ca. · Division of Rheumatology, Allergy and Immunology, University of California, San Diego, School of Medicine, 9500 Gilman Drive MC 0943, La Jolla, CA, 92093-0943, USA. ·Rheum Dis Clin North Am · Pubmed #26476230.

ABSTRACT: The introduction of highly effective therapies and clearly defined targets has altered the treatment paradigm in psoriatic arthritis (PsA). Validated classification criteria and outcome measures specific to PsA have helped standardize a therapeutic approach to this heterogeneous disease that affects multiple clinical domains. This article discusses the importance of early intervention using a treat-to-target strategy; emerging evidence for tight control based on minimal disease activity criteria; disease considerations specific to PsA (prognostic markers, biomarkers, subclinical disease, comorbidities); and new treatment strategies to deal with refractory disease (eg, tumor necrosis factor inhibitor switching and use of novel disease-modifying therapies) and controlled disease (eg, tapering or discontinuing biologic therapy).

11 Review Interleukin-17 inhibition in psoriatic arthritis. 2015

Boyd, Tristan / Kavanaugh, Arthur. ·Western University, London, ON, Canada. · Division of Rheumatology, Allergy and Immunology, Center for Innovative Therapy (CIT), University of California, La Jolla, CA, USA. akavanaugh@ucsd.edu. ·Clin Exp Rheumatol · Pubmed #26471234.

ABSTRACT: Greater understanding of the underlying disease process has led to the development of targeted therapeutic agents and innovative strategies in the treatment of psoriatic arthritis (PsA). This report addresses novel medications targeting the T helper 17 cell pathway, specifically those inhibiting interleukin-17A and its receptor, and discusses their role as effective therapies in the management of PsA.

12 Review An overview of low disease activity and remission in psoriatic arthritis. 2015

Lubrano, Ennio / Perrotta, Fabio Massimo / Kavanaugh, Arthur. ·Academic Rheumatology Unit, Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Italy. enniolubrano@hotmail.com. · Academic Rheumatology Unit, Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Italy. · Division of Rheumatology, Allergy, and Immunology Center for Innovative Therapy (CIT), University of California, San Diego, La Jolla, CA, USA. ·Clin Exp Rheumatol · Pubmed #26470835.

ABSTRACT: Psoriatic arthritis (PsA) is a complex, multisystem and potentially disabling disease with musculoskeletal and skin manifestations. In PsA, as well as in the other chronic rheumatic conditions, a state of low disease activity or remission should be the target of treatment but to reach this objective, in the assessment of PsA patients, is still an unmet need due to the heterogeneity of disease manifestations. With the introduction of anti-TNF treatment, low disease activity or remission become an achievable and suitable state that could be reached by 50%-60% of PsA patients. The aim of this paper is to briefly summarise the concept of low disease activity and remission in PsA, with particular focus on anti-TNF therapy.

13 Review Trial design in psoriatic arthritis: what could be changed? 2015

Kavanaugh, Arthur / Boyd, Tristan. ·Division of Rheumatology, Allergy and Immunology, University of California, La Jolla, CA, USA. akavanaugh@ucsd.edu. · Division of Rheumatology, University of California, La Jolla, CA, USA. ·Clin Exp Rheumatol · Pubmed #26458015.

ABSTRACT: A greater understanding of the underlying disease process, combined with the development of novel therapeutic agents, has led to innovative strategies in the treatment of psoriatic arthritis (PsA). This report addresses unmet needs in clinical trial design in PsA, and proposes some amendments that may yield data that can potentially improve patient outcomes in the management of PsA.

14 Review Drug safety evaluation of apremilast for treating psoriatic arthritis. 2015

Busa, Swapna / Kavanaugh, Arthur. ·University of California San Diego, Division of Rheumatology, Allergy and Immunology , La Jolla, CA , USA sbusa@ucsd.edu. ·Expert Opin Drug Saf · Pubmed #25827658.

ABSTRACT: INTRODUCTION: Apremilast is an orally available small molecule that targets PDE4. PDE4 modulates intracellular signaling and thereby can impact various proinflammatory and anti-inflammatory mediators. Apremilast has been approved by the USA FDA for the treatment of active psoriatic arthritis (PsA) and moderate-to-severe psoriasis (PsO). Although there are several therapies approved and used for the treatment of PsA, there is still an unmet need for additional effective and well-tolerated therapeutic options. In PsA clinical trials, apremilast has been shown to be efficacious and to have an acceptable safety profile. AREAS COVERED: This review article covers the mechanism of action of apremilast, its efficacy in clinical trials and a detailed focus on its safety profile, mainly from Phase III clinical trials. EXPERT OPINION: Based on the available literature, apremilast has proven to be an efficacious therapy for PsA and PsO. It may offer some advantage as compared to other therapeutic options given its favorable safety profile, including a lack of need for routine laboratory monitoring.

15 Review Certolizumab pegol for the treatment of psoriatic arthritis. 2015

Hansen, Renata Baronaite / Kavanaugh, Arthur. ·Copenhagen University Hospitals, Copenhagen, Denmark. ·Expert Rev Clin Immunol · Pubmed #25651776.

ABSTRACT: Certolizumab pegol (CZP) is a TNF-α inhibitor approved for the treatment of psoriatic arthritis in 38 countries, including many European countries and the USA. It is a pegylated humanized anti-TNF-α antigen-binding fragment, administered subcutaneously. As other TNF-α antibodies, CZP binds to and neutralizes both soluble and membrane TNF-α. In contrast to whole antibodies and etanercept, CZP does not activate antibody-dependent cell-mediated cytotoxicity or complement-dependent cytotoxicity, as it does not have an Fc piece. CZP showed efficacy in improving skin scores and patient reported outcomes in a Phase II study of 176 adults with moderate-to-severe plaque psoriasis. In a Phase III study of CZP in 409 psoriatic arthritis patients, CZP treatment resulted in improvements in peripheral arthritis, as well as dactylitis, enthesitis, nail disease and quality of life. The safety profile of CZP appears to be similar to that of other TNF-α inhibitor.

16 Review Psoriatic arthritis: current therapy and future approaches. 2015

Huynh, DoQuyen / Kavanaugh, Arthur. ·Division of Rheumatology and Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, USA. d4huynh@ucsd.edu doquyen9@gmail.com. · Division of Rheumatology and Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, USA. ·Rheumatology (Oxford) · Pubmed #25125588.

ABSTRACT: PsA is a systemic inflammatory condition that affects 20-30% of patients with psoriasis. It is characterized by potential involvement of diverse tissues, including peripheral and axial joints, enthesitis, dactylitis and skin and nail disease. The degree of involvement in each domain can vary over time in individual patients and can differ substantially between PsA patients. The clinical heterogeneity along with the varying extent of severity and activity can pose significant challenges to treatment. Although some studies had suggested immunopathophysiological similarities between PsA and RA, more recently important distinctions have been defined. Similarly, although some immunomodulatory therapies have proved effective for both PsA and RA, recent data suggest distinct responses to certain targeted therapies. Herein, current DMARDs and biologic agents as well as the potential role of emerging therapeutics will be reviewed.

17 Review Treatments for nail psoriasis: a systematic review by the GRAPPA Nail Psoriasis Work Group. 2014

Armstrong, April W / Tuong, William / Love, Thorvardur J / Carneiro, Sueli / Grynszpan, Rachel / Lee, Steve S / Kavanaugh, Arthur. ·From the Psoriasis Program, Department of Dermatology, Colorado Health Outcomes Program (COHO), University of Colorado Denver, Denver, Colorado; Department of Dermatology, University of California Davis, Davis, California, USA; Faculty of Medicine, University of Iceland, Department of Research, Landspitali University Hospital, Reykjavik, Iceland; Sector of Dermatology and Department of Medical Clinic, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Southern California Permanente Medical Group, Fontana, California; and University of California, San Diego, California, USA.A.W. Armstrong, MD, MPH, Vice Chair for Clinical Research, Associate Professor of Dermatology, Director, Clinical Trials and Outcomes Research, Director, Psoriasis Program, Department of Dermatology, COHO, University of Colorado Denver; W. Tuong, BA, Department of Dermatology, University of California Davis; T.J. Love, MD, PhD, Faculty of Medicine, University of Iceland, Department of Research, Landspitali University Hospital; S. Carneiro, MD, PhD; R. Grynszpan, MD, Sector of Dermatology and Department of Medical Clinic, University Hospital and School of Medicine, Federal University of Rio de Janeiro; S.S. Lee, DO, FACR, Southern California Permanente Medical Group; A. Kavanaugh, MD, University of California. ·J Rheumatol · Pubmed #25362716.

ABSTRACT: Nail involvement in psoriatic diseases causes significant physical and functional disabilities. Evaluating, measuring, and treating nail involvement is important in improving the health outcomes and quality of life among patients with psoriasis and psoriatic arthritis (PsA). We performed a systematic analysis of the literature on nail psoriasis to help inform an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

18 Review Systematic review of treatments for psoriatic arthritis: 2014 update for the GRAPPA. 2014

Coates, Laura C / Kavanaugh, Arthur / Ritchlin, Christopher T / Anonymous5640810. ·From the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; University of California, San Diego, California; and Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA.L.C. Coates, MRCP, PhD, NIHR Clinical Lecturer, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; A. Kavanaugh, MD, University of California; C.T. Ritchlin, MD, MPH, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center. Dr. Kavanaugh and Dr. Ritchlin contributed equally to this report. ·J Rheumatol · Pubmed #25362710.

ABSTRACT: Psoriatic arthritis (PsA) is a chronic systemic inflammatory disorder characterized by the association of arthritis and periarticular inflammation in patients with psoriasis. In addition to a heterogeneous and variable clinical course, PsA is complex and multifaceted and may include prominent involvement in the peripheral and axial diarthrodial joints, the skin and nails, and in periarticular structures such as entheses. Simultaneous inflammation in the skin and musculoskeletal structures in a single patient, a relatively common scenario, often leads to marked decrease in function and quality of life. Thus, it is essential for the clinician to document the extent of disease involvement and craft a therapeutic plan that addresses the different domains of disease. In an effort to update previous treatment recommendations developed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), several evidence-based, systemic reviews of therapies for PsA were completed, analyzed, and circulated for consensus.

19 Review A review of disease activity measures for psoriatic arthritis: what is the best approach? 2014

Her, Minyoung / Kavanaugh, Arthur. ·Division of Rheumatology, Busan Paik Hospital, Inje University, Busan, South Korea. ·Expert Rev Clin Immunol · Pubmed #25088300.

ABSTRACT: The measuring tools for disease activity of rheumatoid arthritis have long been adapted for assessing the disease activity of psoriatic arthritis (PsA), particularly as regards peripheral arthritis. However, because of the multifactorial aspects and multiple domains of PsA, such as axial and peripheral joints, skin and nails, enthesitis and dactylitis, must also be considered when measuring activity. After the introduction of biologic agents, it became clear that more objective measuring tools were needed to assess the varied aspects of disease activity, as well as the effect of treatment. Collaborations among international groups of rheumatologists and dermatologists have helped define key or core domains of PsA that were recommended for inclusion in clinical trials and potentially clinical practice. Groups such as the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis have tried to develop and validate new outcome measures in PsA. Several new composite measures for specific PsA have been recently developed. The domains, instruments and traditional and new composite measures for PsA are reviewed herein.

20 Review Qualifying unmet needs and improving standards of care in psoriatic arthritis. 2014

Helliwell, Philip / Coates, Laura / Chandran, Vinod / Gladman, Dafna / de Wit, Maarten / FitzGerald, Oliver / Kavanaugh, Arthur / Strand, Vibeke / Mease, Philip J / Boehncke, Wolf-Henning / Langley, Richard G / Lubrano, Ennio / Maccarone, Mara / Schulze-Koops, Hendrik / Miceli-Richard, Corinne / Queiro, Ruben. ·Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK. ·Arthritis Care Res (Hoboken) · Pubmed #25047391.

ABSTRACT: -- No abstract --

21 Review Novel treatments with small molecules in psoriatic arthritis. 2014

Hansen, Renata Baronaite / Kavanaugh, Arthur. ·Copenhagen University Hospitals, Copenhagen, Denmark, renatabhansen@gmail.com. ·Curr Rheumatol Rep · Pubmed #25027606.

ABSTRACT: Current treatment options for patients with active psoriatic arthritis (PsA) include synthetic disease-modifying antirheumatic drugs and biologic agents. Propelled by increased understanding of immunopathogenesis of PsA, new therapeutic agents targeting different biologic pathways have been evaluated. This article discusses novel small-molecule, orally available treatments that are currently in clinical development for the treatment of psoriasis and PsA. This includes the phosphodiesterase 4 inhibitor apremilast and Janus kinase (JAK) inhibitors. Apremilast has demonstrated significant improvements in patients with moderate to severe psoriasis and PsA in phase II and III clinical trials and has recently been approved for the treatment of PsA. Tofacitinib, an oral inhibitor of JAK3, JAK1, and, to a lesser degree, JAK2, approved for the treatment of rheumatoid arthritis in several countries, has demonstrated positive results in psoriasis in phase II studies. Studies in PsA are ongoing. With these new developments, treatment options will continue to improve in the future.

22 Review Interleukin-17A: a unique pathway in immune-mediated diseases: psoriasis, psoriatic arthritis and rheumatoid arthritis. 2014

Kirkham, Bruce W / Kavanaugh, Arthur / Reich, Kristian. ·Department of Rheumatology, Guy's & St Thomas' NHS Foundation Trust, London, UK. ·Immunology · Pubmed #23819583.

ABSTRACT: Experimental evidence points to the importance of the cytokine interleukin-17A (IL-17A) in the pathogenesis of several immunoinflammatory diseases including psoriasis, psoriatic arthritis and rheumatoid arthritis. Although a principal effector of T helper type 17 cells, IL-17A is produced by many other cell types including CD8(+) T cells and γδ T cells, and is found at high levels associated with mast cells and neutrophils at sites of skin and joint disease in humans. IL-17A up-regulates expression of numerous inflammation-related genes in target cells such as keratinocytes and fibroblasts, leading to increased production of chemokines, cytokines, antimicrobial peptides and other mediators that contribute to clinical disease features. Importantly, IL-17A must be considered within the context of the local microenvironment, because it acts synergistically or additively with other pro-inflammatory cytokines, including tumour necrosis factor. Several direct IL-17A inhibitors have shown promising activity in proof of concept and phase 2 clinical studies, thereby providing confirmation of experimental data supporting IL-17A in disease pathogenesis, although levels of response are not predicted by pre-clinical findings. IL-17A inhibitors produced rapid down-regulation of the psoriasis gene signature and high clinical response rates in patients with moderate-to-severe plaque psoriasis, consistent with an important role for IL-17A in psoriasis pathogenesis. Clinical response rates with IL-17A inhibitors in psoriatic arthritis and rheumatoid arthritis, however, were improved to a lesser degree compared with placebo, suggesting that IL-17A is either important in a subset of patients or plays a relatively minor role in inflammatory joint disease. Ongoing phase 3 clinical trials should provide further information on the role of IL-17A in these diseases.

23 Review Psoriatic arthritis: current therapy and future directions. 2013

Huynh, DoQuyen / Kavanaugh, Arthur. ·University of California, Division of Rheumatology, 9444 Medical Center Dr. Suite, La Jolla, San Diego, California, CA 92093-0943, USA. d4huynh@ucsd.edu ·Expert Opin Pharmacother · Pubmed #23815157.

ABSTRACT: INTRODUCTION: Psoriatic arthritis (PsA) once regarded as an auto-inflammatory arthritis that involves the skin is proving to be more complex with a different driver of disease process compared to rheumatoid arthritis. As growing differences emerge between PsA and rheumatoid arthritis so have the experiences and responses to therapeutics used in both disease processes. AREAS COVERED: This review highlights articles of interest in the past 10 years in the OVID and PubMed database and focuses on major concepts regarding current disease-modifying anti-rheumatic drugs in PsA as well as newer target agents. EXPERT OPINION: Presently, it is agreed upon that use of tumor necrosis factor inhibitors (TNFi) has greatly changed our ability to manage varying aspects of disease in PsA. However, there remain many unanswered questions in which research in PsA is mirroring RA work, these include: i) the need for outcome measures that are more specific to PsA, ii) the concept of early and treat to target, iii) the role of highly sensitive imaging, and iv) efficacy of combination therapy and further targets in those unable to tolerate or fail TNFi.

24 Review Treatment of spondyloarthropathy: the potential for agents other than TNF inhibitors. 2013

Her, Minyoung / Kavanaugh, Arthur. ·Division of Rheumatology, Pusan Paik Hospital, Inje University, Busan, South Korea. ·Curr Opin Rheumatol · Pubmed #23680779.

ABSTRACT: PURPOSE OF REVIEW: Inhibitors of tumor necrosis factor (TNF) have demonstrated dramatic clinical efficacy in patients with spondyloarthropathy (SpA). However, not all patients respond, and some patients who initially improve, subsequently lose response. Therefore, there is still an unmet clinical need for additional therapies. Herein we describe the recent data on newer treatments for SpA patients. RECENT FINDINGS: Treatments targeting various cytokines, cell surface molecules, and signaling molecules have been assessed. The effects of taregeting B cells with rituximab, T-cell costimulation with abatacept, and interleukin (IL)-6 with tocilizumab have been disappointing in ankylosing spondylitis (AS). Abatacept appears to have a modest effect in patients with psoriatic arthritis (PsA). Targeting IL-17 with secukinumab, IL-12/23 with ustekinumab, and phosphodiesterase 4 (PDE4) with apremilast may prove to be promising treatments for SpA. SUMMARY: There are several newer therapies that may emerge for SpA, particularly those targeting IL-17, IL-23/IL-12, and PDE4.

25 Review Treatment of psoriatic arthritis with biological agents. 2010

Ceponis, Arnold / Kavanaugh, Arthur. ·Division of Rheumatology, Allergy, and Immunology, University of California, San Diego, La Jolla, CA 92037-0943, USA. ·Semin Cutan Med Surg · Pubmed #20430309.

ABSTRACT: Psoriatic arthritis (PsA) is an inflammatory arthritis that occurs in individuals with psoriasis. The primary goals in the treatment of PsA are reduction of pain; improvement in the other signs and symptoms of disease, including skin and nail involvement; optimization of functional capacity and quality of life; and inhibition of the progression of joint damage. These goals should be achieved while minimizing potential toxicities from treatment. The management of PsA should simultaneously target arthritis, skin disease, and other manifestations of PsA, including involvement of the axial skeleton, dactylitis, enthesitis, and eye inflammation. In this respect targeted biological agents, primarily tumor necrosis factor inhibitors, have emerged as generally well tolerated and highly effective alternatives to traditional disease modifying antirheumatic drugs. Herein we review the evidence regarding the treatment of PsA arthritis with biological agents.

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