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Psoriasis: HELP
Articles by Christopher T. Ritchlin
Based on 62 articles published since 2008
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Between 2008 and 2019, C. T. Ritchlin wrote the following 62 articles about Psoriasis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 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.

2 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.

3 Guideline Treatment recommendations for psoriatic arthritis. 2009

Ritchlin, C T / Kavanaugh, A / Gladman, D D / Mease, P J / Helliwell, P / Boehncke, W-H / de Vlam, K / Fiorentino, D / Fitzgerald, O / Gottlieb, A B / McHugh, N J / Nash, P / Qureshi, A A / Soriano, E R / Taylor, W J / Anonymous6760613. ·Clinical Immunology Research Center, University of Rochester Medical Center, 601 Elmwood Avenue, Box 695, Rochester, New York 14642, USA. christopher_ritchlin@urmc.rochester.edu ·Ann Rheum Dis · Pubmed #18952643.

ABSTRACT: OBJECTIVE: To develop comprehensive recommendations for the treatment of the various clinical manifestations of psoriatic arthritis (PsA) based on evidence obtained from a systematic review of the literature and from consensus opinion. METHODS: Formal literature reviews of treatment for the most significant discrete clinical manifestations of PsA (skin and nails, peripheral arthritis, axial disease, dactylitis and enthesitis) were performed and published by members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Treatment recommendations were drafted for each of the clinical manifestations by rheumatologists, dermatologists and PsA patients based on the literature reviews and consensus opinion. The level of agreement for the individual treatment recommendations among GRAPPA members was assessed with an online questionnaire. RESULTS: Treatment recommendations were developed for peripheral arthritis, axial disease, psoriasis, nail disease, dactylitis and enthesitis in the setting of PsA. In rotal, 19 recommendations were drafted, and over 80% agreement was obtained on 16 of them. In addition, a grid that factors disease severity into each of the different disease manifestations was developed to help the clinician with treatment decisions for the individual patient from an evidenced-based perspective. CONCLUSIONS: Treatment recommendations for the cardinal physical manifestations of PsA were developed based on a literature review and consensus between rheumatologists and dermatologists. In addition, a grid was established to assist in therapeutic reasoning and decision making for individual patients. It is anticipated that periodic updates will take place using this framework as new data become available.

4 Review Psoriatic Arthritis. 2017

Ritchlin, Christopher T / Colbert, Robert A / Gladman, Dafna D. ·From the Allergy, Immunology, and Rheumatology Division, University of Rochester Medical School, Rochester, NY (C.T.R.) · the Pediatric Translational Research Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD (R.A.C.) · and the University Health Network (UHN) Krembil Research Institute, the Psoriatic Arthritis Program, and the Centre for Prognosis Studies in the Rheumatic Diseases - all at Toronto Western Hospital, Toronto (D.D.G.). ·N Engl J Med · Pubmed #28273019.

ABSTRACT: -- No abstract --

5 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.

6 Review New therapies for psoriasis and psoriatic arthritis. 2016

Ritchlin, Christopher T / Krueger, James G. ·aUniversity of Rochester Medical Center, RochesterbMilstein Medical Research Program, Rockefeller University, New York, New York, USA. ·Curr Opin Rheumatol · Pubmed #27022911.

ABSTRACT: PURPOSE OF REVIEW: Over the last several years, novel immunologic pathways pivotal in the development of the pathobiology of psoriasis and psoriatic arthritis (PsA) have been revealed. These discoveries catalyzed a search for new treatment targets resulting in many new therapies that are now available for patients with psoriatic disease. RECENT FINDINGS: Helper T cells that secrete interleukin-17 (TH17) along with CD8+ cells, innate lymphocyte cells, and gamma delta T cells are important in the pathogenesis of psoriasis and PsA. Recently, agents that target interleukin-17, the interleukin-17 receptor, and interleukin-23 (antip19) have been approved or are in clinical trials. Apremilast, a new oral agent, was approved for the treatment of psoriasis and PsA. SUMMARY: Secukinumab, an interleukin-17A antibody, has been approved for treatment of psoriasis and PsA in the United States. It is effective with a good safety profile. Ixekizumab, another anti-interleukin-17A antibody, is currently in clinical trials and brodalumab, an interleukin-17 receptor antagonist, was removed from clinical trials because of safety concerns despite demonstrated efficacy in psoriasis and PsA. Targeting interleukin-23 with antibodies to p19 is another approach with encouraging results in psoriasis. Apremilast, an oral agent, approved to treat psoriasis and PsA demonstrates moderate efficacy with an excellent safety record. The role of tofacitinib in psoriatic disease remains to be determined pending a safety review in psoriasis and completion of PsA trials.

7 Review An Integrative Approach to Biomarker Development in Psoriatic Arthritis. 2015

Ritchlin, Christopher T. ·From the Allergy, Immunology and Rheumatology Division, Center for Musculoskeletal Medicine, University of Rochester Medical Center, Rochester, New York, USA.C.T. Ritchlin, MD, MPH, Professor of Medicine, Chief, Allergy, Immunology and Rheumatology Division, Center for Musculoskeletal Medicine. christopher_ritchlin@urmc.rochester.edu. ·J Rheumatol Suppl · Pubmed #26523056.

ABSTRACT: The recent discovery that the interleukin 23/Th17 pathway is pivotal in the pathogenesis of psoriatic arthritis (PsA) creates new opportunities for the development of mechanistic biomarkers that will assist in the diagnosis and management of this disorder. While biomarkers are still in the discovery phase, new approaches including multiplex panels, fine sequencing of epigenetic and genetic data in non-coding regions of the human genome, and improved imaging modalities will likely foster the development of actionable biomarkers in PsA. In this report, I review the field of biomarkers, underscore the importance of an integrative approach that incorporates both descriptive and mechanistic biomarkers, and discuss the status of biomarker discovery in PsA.

8 Review Etiology and Pathogenesis of Psoriatic Arthritis. 2015

Barnas, Jennifer L / Ritchlin, Christopher T. ·Allergy, Immunology and Rheumatology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 695, Rochester, NY 14642, USA. · Allergy, Immunology and Rheumatology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 695, Rochester, NY 14642, USA. Electronic address: Christopher_Ritchlin@urmc.rochester.edu. ·Rheum Dis Clin North Am · Pubmed #26476224.

ABSTRACT: The current model of psoriatic arthritis implicates both the IL-23/IL-17 axis and the tumor necrosis factor (TNF) pathways in disease pathogenesis. Although specific major histocompatibility complex class I molecules are associated with the psoriatic disease phenotype, no specific antigen or autoantibody has been identified. Instead, an array of genes may code for an autoinflammatory loop, potentially activated by mechanical stress and dysbiosis in the skin or gut. Danger signals released by innate immune cells activate a Th1 and Th17 response that leads to synovitis, enthesitis, axial inflammation, and altered bone homeostasis characterized by pathologic bone resorption and new bone formation.

9 Review Targeting extra-articular manifestations in PsA: a closer look at enthesitis and dactylitis. 2015

Siegel, Evan L / Orbai, Ana-Maria / Ritchlin, Christopher T. ·Division of Allergy, Immunology & Rheumatology, University of Rochester Medical Center, Rochester, New York, USA. ·Curr Opin Rheumatol · Pubmed #25603036.

ABSTRACT: PURPOSE OF REVIEW: Enthesitis and dactylitis are cardinal manifestations of psoriatic arthritis (PsA), but a limited understanding of underlying pathophysiologic mechanisms has hindered development of targeted therapies. This gap is of clinical relevance because these manifestations are clinically relevant to patients. Herein, we discuss new exciting findings in animal models with enthesitis and dactylitis, summarize developments in clinical and imaging assessments and review recent clinical trial data on the efficacy of targeted therapies for enthesitis and dactylitis. RECENT FINDINGS: Several different animal models reveal that cytokines in the interleukin-23/Th17 pathway and mechanical stress are key events in the development of enthesitis and dactylitis. Elevated levels of interleukin-23, generated in the gut, joint or skin, trigger subsequent tissue inflammation. Both enthesitis and dactylitis involve heterogeneous tissues, associate with specific Class I Major Histocompatibility Complex alleles, and enthesitis may be critical for the development of PsA, although a causal pathway remains unproven. Diagnosis is based on clinical and imaging assessments; however, Power Doppler ultrasound (PDUS) is more sensitive for diagnosis and longitudinal follow-up of enthesitis. Agents targeting tumor necrosis factor, interleukin-12/23, interleukin-17, interleukin-17 receptor (interleukin-17R) and PDE4 are effective therapies for psoriatic enthesitis and dactylitis. SUMMARY: Novel preclinical models established, for the first time, the importance of the interleukin-23/Th17 pathway and mechanical stress in pathogenesis of dactylitis and enthesitis. Advances in imaging, particular (PDUS), may improve sensitivity and specificity for diagnosis and longitudinal assessments. Many targeted therapies are effective for enthesitis and dactylitis.

10 Review Systematic review of treatment effectiveness and outcome measures for enthesitis in psoriatic arthritis. 2014

Orbai, Ana-Maria / Weitz, Joshua / Siegel, Evan L / Siebert, Stefan / Savage, Laura J / Aydin, Sibel Z / Luime, Jolanda J / Elkayam, Ori / Neerinckx, Barbara / Urbancek, Slavo / de Vlam, Kurt / Ritchlin, Christopher T / Anonymous5650810. ·From Johns Hopkins Arthritis Center, Baltimore, Maryland; Dermatology Associates of Rochester, Rochester, New York; Arthritis and Rheumatism Associates, Rockville, Maryland, USA; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Department of Rheumatology, Koc University, Faculty of Medicine, Istanbul, Turkey; Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rheumatology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; University Hospital Leuven, Leuven, Belgium; Department of Dermatology, F.D. Roosevelt Hospital, Banska Bystrica, Slovakia; and Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA.A.M. Orbai, MD, MHS, Johns Hopkins Arthritis Center; J. Weitz, MD, Dermatology Associates of Rochester; E.L. Siegel, MD, Arthritis and Rheumatism Associates; S. Siebert, MD, Institute of Infection, Immunity and Inflammation, University of Glasgow; L.J. Savage, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; S.Z. Aydin, Department of Rheumatology, Koc University Faculty of Medicine; J.J. Luime, PhD, Department of Rheumatology, Erasmus Medical Center; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Medical Center and Sackler Faculty of Medicine; B. Neerinckx, MD, University Hospital Leuven; S. Urbancek, MD, PhD, Department of Dermatology, F.D. Roosevelt Hospital; K. de Vlam, MD, PhD, University Hospital Leuven; C.T. Ritchlin, MD, MPH, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center. ·J Rheumatol · Pubmed #25362713.

ABSTRACT: Enthesitis is a characteristic feature of psoriatic arthritis (PsA) and is important in disease pathogenesis and classification. Use of clinical outcome measures for enthesitis is heterogeneous, and only 1 measure has been specifically developed and validated in PsA. Ultrasound and magnetic resonance imaging assessments of enthesitis may have advantages over clinical examination but are insufficiently studied. As part of an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we performed a systematic literature review and identified randomized controlled trials with enthesitis outcomes in PsA. For each treatment agent we calculated treatment effect sizes (where applicable) and graded the level of evidence.

11 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.

12 Review Ustekinumab : targeting the IL-17 pathway to improve outcomes in psoriatic arthritis. 2014

Weitz, Joshua E / Ritchlin, Christopher T. ·University of Rochester Medical Center, Division of Allergy/Immunology & Rheumatology , 601 Elmwood Ave, Box 695, Rochester, NY 14623 , USA joshua_weitz@urmc.rochester.edu. ·Expert Opin Biol Ther · Pubmed #24555741.

ABSTRACT: INTRODUCTION: Psoriatic arthritis (PsA) is a clinically diverse inflammatory arthritis that can affect peripheral joints and the axial skeleton. About 25% of psoriasis patients develop PsA and many suffer from reduced function and quality of life. Anti-TNF agents have emerged as a pivotal treatment for many patients but the lack of alternative biologics for those who become unresponsive and or tolerate these medications remain a major unmet need. Recently, ustekinumab (UST) an agent that targets the 12 - 23/Th17 pathway was approved by the FDA for the treatment of active PsA. AREAS COVERED: Herein, we provide a comprehensive overview of the pharmacology and clinical efficacy and safety of UST in the treatment of PsA. In addition, the position of UST in the treatment of PsA is discussed. EXPERT OPINION: The lack of alternative therapies for patients who cannot tolerate or fail anti-TNF agents remains a major challenge for clinicians who treat PsA. UST, an agent that has proven efficacy in psoriasis, has recently been shown to also be effective for a number of the manifestations associated with PsA, including peripheral arthritis, dactylitis and enthesitis. This agent also inhibits radiographic progression. FDA approval of UST provides a much needed addition to the treatment options for the heterogeneous clinical features of PsA.

13 Review Mechanistic insights from animal models of psoriasis and psoriatic arthritis. 2013

Weitz, Joshua E / Ritchlin, Christopher T. ·Division of Allergy/Immunology and Rheumatology, University of Rochester Medical Center, 601 Elmwood Ave. Box 695, Rochester, NY, 14642, USA, joshua_weitz@urmc.rochester.edu. ·Curr Rheumatol Rep · Pubmed #24072605.

ABSTRACT: Psoriasis and psoriatic arthritis are common chronic inflammatory conditions associated with substantial local and systemic morbidity. The genetic and phenotypic heterogeneity of these disorders presents great challenges to investigators of disease mechanisms. Valid and reliable animal models that combine the main elements of human skin and joint disease have not been developed, and this has hindered our ability to understand the complex immunopathology and develop treatments. Recently, novel animal models have been developed with the potential to greatly increase our knowledge of important mechanisms that underlie psoriatic skin and joint inflammation and bone remodeling. Herein, we discuss how recent models generated by use of promising new technologies are revealing novel inflammatory pathways that have promising therapeutic potential.

14 Review Altered bone biology in psoriatic arthritis. 2012

Rahimi, Homaira / Ritchlin, Christopher T. ·Department of Pediatrics, Division of Rheumatology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA. homaira_rahimi@urmc.rochester.edu ·Curr Rheumatol Rep · Pubmed #22592745.

ABSTRACT: Psoriatic arthritis (PsA) is characterized by focal bone erosions mediated by osteoclasts at the bone-pannus junction. The bulk of research over the past decade has centered on mechanisms that underlie osteoclastogenesis along with new insights into osteoimmunology; however, recent advances that focus on steps that lead to new bone formation are beginning to emerge. New revelations about bone formation may have direct relevance to PsA given the presence of enthesophytes, syndesmophytes, and bony ankylosis frequently observed in patients with this disorder. In this review, we discuss current developments in the pathogenesis of new bone formation, novel imaging approaches to study bone remodeling and highlight innovative approaches to study the effect of inflammation on bone. Lastly, we discuss promising therapies that target joint inflammation and osteitis with the potential to mediate pathologic bone formation.

15 Review Summary of the International Federation of Psoriasis Associations (IFPA) meeting: a report from the GRAPPA 2009 annual meeting. 2011

Coates, Laura C / Jonckheere, Christine L / Molin, Sonja / Mease, Philip J / Ritchlin, Christopher T. ·University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK. l.c.coates@leeds.ac.uk ·J Rheumatol · Pubmed #21362781.

ABSTRACT: The International Federation of Psoriasis Associations (IFPA) organized the second World Psoriasis and Psoriatic Arthritis Conference in Stockholm, Sweden, in June 2009. The 2009 collaborative multidisciplinary meeting attracted nearly 1000 clinicians and investigators from dermatology, rheumatology, basic science, and industry, as well as patients and leaders of patient organizations, from 68 countries. The major theme of the meeting was "Psoriasis - Skin and Beyond," and the primary aim was to highlight the significant effects of psoriasis and related comorbidities on patient function and quality of life. The annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) was held concurrently, and several GRAPPA members attended both meetings. Key presentations at IFPA that GRAPPA members believed were highlights of that meeting are summarized here.

16 Review Therapeutic considerations in spondyloarthritis patients who fail tumour necrosis factor antagonists. 2010

Ritchlin, C T. ·Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA. christopher_ritchlin@urmc.rochester.edu ·Best Pract Res Clin Rheumatol · Pubmed #21035088.

ABSTRACT: The tumour necrosis factor (TNF) antagonists have significantly improved quality of life and functional status in patients with spondyloarthritis (SpA). The excitement regarding the remarkable success of these agents is justified but challenges remain. In particular, alternative systemic therapies with proven efficacy for patients who fail TNF antagonists have been developed in rheumatoid arthritis but are not yet available in SpA. In this article, the approach to patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) who fail TNF antagonists will be discussed with the goal of providing a path to the clinician, who must manage these patients amidst uncertainty. Three central questions will be addressed. Why does a particular SpA patient not respond to a TNF antagonist? How can the clinician improve the probability of treatment response in patients who fail a TNF antagonist? What specific approaches can be taken to control disease activity in PsA or AS following treatment failure with a TNF antagonist? Data from controlled trials, registries and pilot studies will be combined with expert opinion to address these important questions.

17 Review The diagnosis and treatment of early psoriatic arthritis. 2009

Anandarajah, Allen P / Ritchlin, Christopher T. ·Clinical Immunology Research Center, Allergy, Immunology & Rheumatology Research Division, University of Rochester Medical Center, 601 Elmwood Avenue, P. O. Box 695, Rochester, NY 14642, USA. allen_anandarajah@urmc.rochester.edu ·Nat Rev Rheumatol · Pubmed #19806150.

ABSTRACT: Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder associated with a heterogeneous disease presentation, varied disease expression and an unpredictable but often chronically destructive clinical course. Joint damage can occur early in the disease; indeed, several imaging modalities have demonstrated subclinical joint involvement in psoriasis patients without musculoskeletal signs or symptoms. Efforts are underway to validate questionnaires that will enable dermatologists to screen patients with psoriasis for the presence of musculoskeletal disease. To date, the use of therapies in patients with early PsA has not been reported in randomized controlled trials. Moreover, conventional agents are partially effective in established PsA but, in general, trials with DMARDS have not included validated outcome measures for the different manifestations of PsA. Tumor necrosis factor antagonists can alleviate the signs and symptoms of established psoriatic arthritis and inhibit radiographic progression, but the therapeutic impact of early intervention with these agents requires further study. The extent of disease and the presence of comorbidities should be used to guide treatment decisions and to minimize adverse events.

18 Review Translational perspectives on psoriatic arthritis. 2009

Ritchlin, Christopher T / Proulx, Steven / Schwarz, Edward S. ·University of Rochester Medical Center, Rochester, New York, USA. christopher_ritchlin@urmc.rochester.edu ·J Rheumatol Suppl · Pubmed #19661536.

ABSTRACT: The term psoriatic disease encompasses the array of disorders (arthritis, inflammatory bowel disease, uveitis, obesity, metabolic syndrome, type II diabetes, and cardiovascular disease) that are associated with psoriasis. Psoriatic arthritis (PsA) is present in about 25% of patients with psoriasis; in most cases, the psoriasis precedes joint disease by about 10 years. Previous studies revealed that osteoclast precursors (OCP) are elevated in PsA and that the frequency of these circulating cells correlates with bone destruction. More recently OCP were found to be increased also in early rheumatoid arthritis and in 25% of psoriasis patients without arthritis. Bone marrow edema, observed on magnetic resonance imaging, in PsA represents infiltration of underlying marrow with inflammatory cells based on studies in transgenic tumor necrosis factor (TNF) arthritis murine models. Studies in the TNF transgenic mouse model also revealed that changes in lymph node volume precede joint flare. These translational studies point to potential biomarkers of arthritis in psoriasis patients and generate alternative hypotheses to explain the events that lead to arthritic flare.

19 Review Altered bone remodeling in psoriatic arthritis. 2008

Mensah, Kofi A / Schwarz, Edward M / Ritchlin, Christopher T. ·Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA. edward_schwarz@urmc.rochester.edu ·Curr Rheumatol Rep · Pubmed #18662512.

ABSTRACT: Bone is a highly dynamic organ that interacts with a wide array of cells and tissues. Recent studies have unveiled unanticipated connections between the immune and skeletal systems, and this relationship led to the development of a new field called osteoimmunology. This field will enable investigators to translate basic science findings in bone biology to clinical applications for inflammatory joint diseases such as psoriatic arthritis (PsA). This review examines the disruption of bone homeostasis in PsA and discusses the pivotal role of osteoclasts, osteoblasts, and signaling pathways in the altered remodeling observed in this inflammatory arthritis. It also discusses the effects of tumor necrosis factor inhibition on bone resorption and new bone formation in PsA.

20 Review Clues to the pathogenesis of psoriasis and psoriatic arthritis from imaging: a literature review. 2008

Coates, Laura C / Anderson, R Rox / Fitzgerald, Oliver / Gottlieb, Alice B / Kelly, Stephen G / Lubrano, Ennio / McGonagle, Dennis G / Olivieri, Ignazio / Ritchlin, Christopher T / Tan, Ai Lyn / De Vlam, Kurt / Helliwell, Philip S. ·Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom. ·J Rheumatol · Pubmed #18609741.

ABSTRACT: This article summarizes a presentation on imaging of skin and joints in patients with psoriasis and psoriatic arthritis (PsA) from the 2007 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Plain radiography provides valuable insights into the pathogenesis of PsA but is limited because only calcified tissue can be imaged. Newer techniques such as magnetic resonance imaging (MRI) and ultrasound (US) provide additional clues to the pathogenesis of this peripheral, axial, and dermatologic disease. MRI and to a lesser extent US allow visualization of articular and periarticular structures, showing widespread juxtaarticular inflammation in PsA. Bone edema, a surrogate marker of inflammation, can occur throughout the digit in psoriatic dactylitis. Localization of inflammatory change at the juxtaarticular entheses suggests this as the primary site of inflammation. Recent imaging studies provide insights into the relationship between nail and articular disease, demonstrating extension of inflammation from entheseal structures at the distal interphalangeal joint to the nail bed, but the temporal or anatomical progression of these changes remains elusive. Imaging of the skin lags behind that of the articular structures, partly because the skin is readily available for biopsy; however, newer techniques such as laser Doppler imaging provide insights into angiogenesis at the advancing edge of psoriatic plaques. Future work will explore the relationship between immunohistology and imaging of skin and joints. Improvements in imaging articular soft tissues with ultra-short echo time MRI and skin with multiphoton fluorescence microscopy promise insights into anatomical and functional changes.

21 Review From skin to bone: translational perspectives on psoriatic disease. 2008

Ritchlin, Christopher T. ·Clinical Immunology Research Center, University of Rochester Medical Center, Rochester, New York 14642, USA. christopher_ritchlin@urmc.rochester.edu ·J Rheumatol · Pubmed #18609740.

ABSTRACT: In recent years, translational research has provided fresh insights into the mechanisms that underlie both skin and joint inflammation in psoriatic arthritis (PsA). Application of immunological and molecular techniques to the study of involved tissues, combined with magnetic resonance imaging and relevant preclinical models, has unveiled pivotal inflammatory cascades and cytokine networks that lead to sustained inflammation and altered tissue architecture. In this brief overview of a presentation from the 2007 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) the key pathophysiologic events associated with inflammation in psoriatic plaques, synovial membranes, and soft tissues (entheses, tendons), and with abnormal bone remodeling are discussed.

22 Clinical Trial Secukinumab sustains improvement in signs and symptoms of psoriatic arthritis: 2 year results from the phase 3 FUTURE 2 study. 2017

McInnes, Iain B / Mease, Philip J / Ritchlin, Christopher T / Rahman, Proton / Gottlieb, Alice B / Kirkham, Bruce / Kajekar, Radhika / Delicha, Eumorphia-Maria / Pricop, Luminita / Mpofu, Shephard. ·Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Division of Rheumatology Clinical Research, Swedish Medical Centre and University of Washington, Seattle, WA. · Allergy/Immunology and Rheumatology Division, University of Rochester, Rochester, NY, USA. · Faculty of Medicine, Memorial University, St. John's, NL, Canada. · Department of Dermatology, New York Medical College, Valhalla, NY, USA. · Rheumatology Department, Guy's & St Thomas' NHS Foundation Trust, London, UK. · Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. · Novartis Pharma, Basel, Switzerland. ·Rheumatology (Oxford) · Pubmed #28968735.

ABSTRACT: Objectives: To assess long-term efficacy, safety and tolerability of secukinumab up to 104 weeks in patients with active PsA. Methods: Patients with PsA (n = 397) were randomized to s.c. secukinumab 300, 150 or 75 mg or placebo at baseline, weeks 1, 2, 3 and 4 and every 4 weeks thereafter. Placebo-treated patients were re-randomized to receive secukinumab 300 or 150 mg s.c. from week 16 (placebo non-responders) or week 24 (placebo responders). Exploratory endpoints at week 104 included 20, 50 and 70% improvement in ACR criteria (ACR20, 50, 70); 75 and 90% improvement in the Psoriasis Area Severity Index, 28-joint DAS with CRP, presence of dactylitis and enthesitis and other patient-reported outcomes. For binary variables, missing values were imputed; continuous variables were analysed by a mixed-effects model for repeated measures. Results: A total of 86/100 (86%), 76/100 (76%) and 65/99 (66%) patients in the secukinumab 300, 150 and 75 mg groups, respectively, completed 104 weeks. At week 104, ACR20 response rates after multiple imputation in the 300, 150 and 75 mg groups were 69.4, 64.4 and 50.3%, respectively. Sustained clinical improvements were observed through week 104 with secukinumab across other clinically important domains of PsA. Responses were sustained through week 104 regardless of prior anti-TNF-α use. Over the entire treatment period the incidence, type and severity of adverse events were consistent with those reported previously. Conclusion: Secukinumab provided sustained improvements in signs and symptoms and multiple clinical domains in patients of active PsA through 2 years of therapy. Secukinumab was well tolerated, with a safety profile consistent with that reported previously. Trial registration: ClinicalTrials.gov (https://clinicaltrials.gov), NCT01752634.

23 Clinical Trial Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. 2017

Mease, Philip J / van der Heijde, Désirée / Ritchlin, Christopher T / Okada, Masato / Cuchacovich, Raquel S / Shuler, Catherine L / Lin, Chen-Yen / Braun, Daniel K / Lee, Chin H / Gladman, Dafna D / Anonymous1101036. ·Department of Rheumatology, Swedish Medical Center, and University of Washington, Seattle, Washington, USA. · Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands. · Allergy, Immunology, & Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA. · Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan. · Eli Lilly and Company, Indianapolis, Indiana, USA. · Rheumatology Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. · Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. ·Ann Rheum Dis · Pubmed #27553214.

ABSTRACT: OBJECTIVE: To assess the safety and efficacy of ixekizumab, a monoclonal antibody that inhibits interleukin-17A, in a double-blind phase III trial enrolling patients with active psoriatic arthritis (PsA). METHODS: Patients naive to biologic therapy with active PsA were randomised to subcutaneous injections of placebo (N=106), adalimumab 40 mg once every 2 weeks (active reference; N=101), ixekizumab 80 mg once every 2 weeks (IXEQ2W) (N=103), or ixekizumab 80 mg once every 4 weeks (IXEQ4W) (N=107). Both ixekizumab regimens included a 160-mg starting dose. The primary objective was to assess the superiority of IXEQ2W or IXEQ4W versus placebo as measured by the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 24. RESULTS: Significantly more patients treated with ixekizumab achieved an ACR20 response with IXEQ2W (62.1%) or IXEQ4W (57.9%) than placebo (30.2%) (p≤0.001; non-responder imputation method). Disease activity and functional disability were significantly improved with both ixekizumab doses versus placebo at weeks 12 and 24, and there was significantly less progression of structural damage at week 24 (p≤0.01). Clearance of plaque psoriasis was greater with ixekizumab than placebo (p≤0.001). Efficacy results with adalimumab, the active reference arm, showed significant improvements versus placebo. Treatment-emergent adverse events were more frequent with ixekizumab (65.7-66.4%) and adalimumab (64.4%) than placebo (47.2%) (p<0.05). CONCLUSIONS: In biologic-naive patients with active PsA, ixekizumab treatment resulted in improvements in disease activity and physical function, as well as in the inhibition of structural damage progression. Overall, adverse events were more frequent in all active groups compared with placebo. TRIAL REGISTRATION NUMBER: NCT01695239; EudraCT2011-002326-49; Results.

24 Clinical Trial Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. 2015

McInnes, Iain B / Mease, Philip J / Kirkham, Bruce / Kavanaugh, Arthur / Ritchlin, Christopher T / Rahman, Proton / van der Heijde, Désirée / Landewé, Robert / Conaghan, Philip G / Gottlieb, Alice B / Richards, Hanno / Pricop, Luminita / Ligozio, Gregory / Patekar, Manmath / Mpofu, Shephard / Anonymous1170835. ·Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. Electronic address: Iain.McInnes@glasgow.ac.uk. · Swedish Medical Center and University of Washington, Seattle, WA, USA. · Guy's and St Thomas' NHS Foundation Trust, London, UK. · Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, University of California San Diego School of Medicine, San Diego, CA, USA. · Allergy/Immunology and Rheumatology Division, University of Rochester, Rochester, NY, USA. · Memorial University, Newfoundland, NL, Canada. · Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands. · Amsterdam Rheumatology and Immunology Center, Amsterdam, and Atrium Medical Center, Heerlen, Netherlands. · NIHR Leeds Musculoskeletal Biomedical Research Unit and University of Leeds, Leeds, UK. · Department of Dermatology, Tufts Medical Center, Boston, MA, USA. · Novartis Pharma, Basel, Switzerland. · Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. · Novartis Healthcare, Hyderabad, India. ·Lancet · Pubmed #26135703.

ABSTRACT: BACKGROUND: Interleukin 17A is a proinflammatory cytokine that is implicated in the pathogenesis of psoriatic arthritis. We assessed the efficacy and safety of subcutaneous secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis. METHODS: In this phase 3, double-blind, placebo-controlled study undertaken at 76 centres in Asia, Australia, Canada, Europe, and the USA, adults (aged ≥18 years old) with active psoriatic arthritis were randomly allocated in a 1:1:1:1 ratio with computer-generated blocks to receive subcutaneous placebo or secukinumab 300 mg, 150 mg, or 75 mg once a week from baseline and then every 4 weeks from week 4. Patients and investigators were masked to treatment assignment. The primary endpoint was the proportion of patients achieving at least 20% improvement in the American College of Rheumatology response criteria (ACR20) at week 24. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01752634. FINDINGS: Between April 14, and Nov 25, 2013, 397 patients were randomly assigned to receive secukinumab 300 mg (n=100), 150 mg (n=100), 75 mg (n=99), or placebo (n=98). A significantly higher proportion of patients achieved an ACR20 at week 24 with secukinumab 300 mg (54 [54%] patients; odds ratio versus placebo 6·81, 95% CI 3·42-13·56; p<0·0001), 150 mg (51 [51%] patients; 6·52, 3·25-13·08; p<0·0001), and 75 mg (29 [29%] patients; 2·32, 1·14-4·73; p=0·0399) versus placebo (15 [15%] patients). Up to week 16, the most common adverse events were upper respiratory tract infections (four [4%], eight [8%], ten [10%], and seven [7%] with secukinumab 300 mg, 150 mg, 75 mg, and placebo, respectively) and nasopharyngitis (six [6%], four [4%], six [6%], and eight [8%], respectively). Serious adverse events were reported by five (5%), one (1%), and four (4%) patients in the secukinumab 300 mg, 150 mg, and 75 mg groups, respectively, compared with two (2%) in the placebo group. No deaths were reported. INTERPRETATION: Subcutaneous secukinumab 300 mg and 150 mg improved the signs and symptoms of psoriatic arthritis, suggesting that secukinumab is a potential future treatment option for patients with this disorder. FUNDING: Novartis.

25 Clinical Trial Brodalumab, an anti-IL17RA monoclonal antibody, in psoriatic arthritis. 2014

Mease, Philip J / Genovese, Mark C / Greenwald, Maria W / Ritchlin, Christopher T / Beaulieu, André D / Deodhar, Atul / Newmark, Richard / Feng, JingYuan / Erondu, Ngozi / Nirula, Ajay. ·From the Swedish Medical Center and University of Washington, Seattle (P.J.M.) · Oregon Health and Science University, Portland (A.D.) · Stanford University, Palo Alto (M.C.G.), Desert Medical Advances, Palm Desert (M.W.G.), and Amgen, Thousand Oaks (R.N., J.Y.F., N.E., A.N.) - all in California · University of Rochester Medical Center, Rochester, NY (C.T.R.) · and Laval University, Quebec, QC, Canada (A.D.B.). ·N Engl J Med · Pubmed #24918373.

ABSTRACT: BACKGROUND: We assessed the efficacy and safety of brodalumab, a human monoclonal antibody against interleukin-17 receptor A (IL17RA), in a phase 2, randomized, double-blind, placebo-controlled study involving patients with psoriatic arthritis. METHODS: We randomly assigned patients with active psoriatic arthritis to receive brodalumab (140 or 280 mg subcutaneously) or placebo on day 1 and at weeks 1, 2, 4, 6, 8, and 10. At week 12, patients who had not discontinued their participation in the study were offered open-label brodalumab (280 mg) every 2 weeks. The primary end point was 20% improvement in American College of Rheumatology response criteria (ACR 20) at week 12. RESULTS: Of the 168 patients who underwent randomization (57 in the brodalumab 140-mg group, 56 in the brodalumab 280-mg group, and 55 in the placebo group), 159 completed the double-blind phase and 134 completed 40 weeks of the open-label extension. At week 12, the brodalumab 140-mg and 280-mg groups had higher rates of ACR 20 than the placebo group (37% [P=0.03] and 39% [P=0.02], respectively, vs. 18%); they also had higher rates of 50% improvement (ACR 50) (14% [P=0.05] and 14% [P=0.05] vs. 4%). Rates of 70% improvement were not significantly higher in the brodalumab groups. Similar degrees of improvement were noted among patients who had received previous biologic therapy and those who had not received such therapy. At week 24, ACR 20 response rates in the brodalumab 140-mg and 280-mg groups were 51% and 64%, respectively, as compared with 44% among patients who switched from placebo to open-label brodalumab; responses were sustained through week 52. At week 12, serious adverse events had occurred in 3% of patients in the brodalumab groups and in 2% of those in the placebo group. CONCLUSIONS: Brodalumab significantly improved response rates among patients with psoriatic arthritis. Larger studies of longer duration are necessary to assess adverse events. (Funded by Amgen; ClinicalTrials.gov number, NCT01516957 .).

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