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Psoriasis: HELP
Articles by Christopher T. Ritchlin
Based on 90 articles published since 2010
(Why 90 articles?)
||||

Between 2010 and 2020, C. Ritchlin wrote the following 90 articles about Psoriasis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. 2019

Singh, Jasvinder A / Guyatt, Gordon / Ogdie, Alexis / Gladman, Dafna D / Deal, Chad / Deodhar, Atul / Dubreuil, Maureen / Dunham, Jonathan / Husni, M Elaine / Kenny, Sarah / Kwan-Morley, Jennifer / Lin, Janice / Marchetta, Paula / Mease, Philip J / Merola, Joseph F / Miner, Julie / Ritchlin, Christopher T / Siaton, Bernadette / Smith, Benjamin J / Van Voorhees, Abby S / Jonsson, Anna Helena / Shah, Amit Aakash / Sullivan, Nancy / Turgunbaev, Marat / Coates, Laura C / Gottlieb, Alice / Magrey, Marina / Nowell, W Benjamin / Orbai, Ana-Maria / Reddy, Soumya M / Scher, Jose U / Siegel, Evan / Siegel, Michael / Walsh, Jessica A / Turner, Amy S / Reston, James. ·University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama. · McMaster University, Hamilton, Ontario, Canada. · University of Pennsylvania, Philadelphia. · University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada. · Cleveland Clinic, Cleveland, Ohio. · Oregon Health & Science University, Portland. · Boston Medical Center, Boston, Massachusetts. · New York, New York. · Premier Orthopaedics, Malvern, Pennsylvania. · Stanford University, Stanford, California. · Concorde Medical Group, New York, New York. · Swedish-Providence Health Systems and University of Washington, Seattle, Washington. · Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · Comprehensive Therapy Consultants and Therapy Steps, Roswell, Georgia. · University of Rochester Medical Center, Rochester, New York. · University of Maryland School of Medicine, Baltimore. · Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee. · Eastern Virginia Medical School, Norfolk. · American College of Rheumatology, Atlanta, Georgia. · ECRI Institute, Plymouth Meeting, Pennsylvania. · University of Oxford, Oxford, UK. · New York Medical College at Metropolitan Hospital, New York, New York. · Case Western/MetroHealth, Cleveland, Ohio. · Global Healthy Living Foundation, Nyack, New York. · Johns Hopkins University, Baltimore, Maryland. · New York University School of Medicine, New York, New York. · Arthritis & Rheumatism Associates, Rockville, Maryland. · National Psoriasis Foundation, Portland, Oregon. · University of Utah and George E. Wahlen VeteranS Affairs Medical Center, Salt Lake City, Utah. ·Arthritis Rheumatol · Pubmed #30499246.

ABSTRACT: OBJECTIVE: To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). METHODS: We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. RESULTS: The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. CONCLUSION: The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.

2 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.

3 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.

4 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 / Anonymous4220715. ·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.

5 Guideline European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. 2012

Gossec, L / Smolen, J S / Gaujoux-Viala, C / Ash, Z / Marzo-Ortega, H / van der Heijde, D / FitzGerald, O / Aletaha, D / Balint, P / Boumpas, D / Braun, J / Breedveld, F C / Burmester, G / Cañete, J D / de Wit, M / Dagfinrud, H / de Vlam, K / Dougados, M / Helliwell, P / Kavanaugh, A / Kvien, T K / Landewé, R / Luger, T / Maccarone, M / McGonagle, D / McHugh, N / McInnes, I B / Ritchlin, C / Sieper, J / Tak, P P / Valesini, G / Vencovsky, J / Winthrop, K L / Zink, A / Emery, P / Anonymous8421105. ·Paris Descartes University, Paris, France. laure.gossec@cch.aphp.fr ·Ann Rheum Dis · Pubmed #21953336.

ABSTRACT: BACKGROUND: Psoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD). METHODS: The recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement. RESULTS: Ten recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined. CONCLUSION: These recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

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 Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. 2019

Scher, Jose U / Ogdie, Alexis / Merola, Joseph F / Ritchlin, Christopher. ·Department of Medicine, Division of Rheumatology and Psoriatic Arthritis Center, New York University School of Medicine, New York, NY, USA. jose.scher@nyulangone.org. · Department of Medicine, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA. · Department of Medicine, Division of Rheumatology, and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Division of Allergy, Immunology and Rheumatology, Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Christopher_Ritchlin@URMC.Rochester.edu. ·Nat Rev Rheumatol · Pubmed #30742092.

ABSTRACT: Psoriasis is one of the most common chronic inflammatory skin diseases, affecting 3% of the world's population, and approximately one-third of patients with psoriasis will eventually transition to having psoriatic arthritis (PsA). The evolution from cutaneous to synovio-entheseal inflammation in these patients presents an opportunity to investigate the critical events linked to arthritis development. The events responsible for progression to PsA are currently unclear. Genetic and clinical-demographic risk factors (most notably familial aggregation and psoriasis sub-phenotypes) provide relevant insights into the variables that promote transition. The specific underlying molecular and cellular mechanisms, however, remain poorly defined. Intriguingly, although targeting the IL-23-IL-17 axis substantially improves psoriasis outcomes, this strategy is not more effective than TNF inhibitors in improving musculoskeletal symptoms in PsA. Major unmet needs in the field of PsA include defining those patients with psoriasis at increased risk of developing arthritis, improving our understanding of the natural history of disease and characterizing the immune, environmental and molecular subclinical events preceding PsA onset. Improving our knowledge of this transition is essential for designing clinical trials with treatments that can delay, attenuate or even prevent the development of PsA in patients with psoriasis.

8 Review Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. 2019

Singh, Jasvinder A / Guyatt, Gordon / Ogdie, Alexis / Gladman, Dafna D / Deal, Chad / Deodhar, Atul / Dubreuil, Maureen / Dunham, Jonathan / Husni, M Elaine / Kenny, Sarah / Kwan-Morley, Jennifer / Lin, Janice / Marchetta, Paula / Mease, Philip J / Merola, Joseph F / Miner, Julie / Ritchlin, Christopher T / Siaton, Bernadette / Smith, Benjamin J / Van Voorhees, Abby S / Jonsson, Anna Helena / Shah, Amit Aakash / Sullivan, Nancy / Turgunbaev, Marat / Coates, Laura C / Gottlieb, Alice / Magrey, Marina / Nowell, W Benjamin / Orbai, Ana-Maria / Reddy, Soumya M / Scher, Jose U / Siegel, Evan / Siegel, Michael / Walsh, Jessica A / Turner, Amy S / Reston, James. ·University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama. · McMaster University, Hamilton, Ontario, Canada. · University of Pennsylvania, Philadelphia. · University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada. · Cleveland Clinic, Cleveland, Ohio. · Oregon Health & Science University, Portland. · Boston Medical Center, Boston, Massachusetts. · New York, New York. · Premier Orthopaedics, Malvern, Pennsylvania. · Stanford University, Stanford, California. · Concorde Medical Group, New York, New York. · Swedish-Providence Health Systems and University of Washington, Seattle, Washington. · Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · Comprehensive Therapy Consultants and Therapy Steps, Roswell, Georgia. · University of Rochester Medical Center, Rochester, New York. · University of Maryland School of Medicine, Baltimore. · Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee. · Eastern Virginia Medical School, Norfolk. · American College of Rheumatology, Atlanta, Georgia. · ECRI Institute, Plymouth Meeting, Pennsylvania. · University of Oxford, Oxford, UK. · New York Medical College at Metropolitan Hospital, New York, New York. · Case Western/MetroHealth, Cleveland, Ohio. · Global Healthy Living Foundation, Nyack, New York. · Johns Hopkins University, Baltimore, Maryland. · New York University School of Medicine, New York, New York. · Arthritis & Rheumatism Associates, Rockville, Maryland. · National Psoriasis Foundation, Portland, Oregon. · University of Utah and George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. ·Arthritis Care Res (Hoboken) · Pubmed #30499259.

ABSTRACT: OBJECTIVE: To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). METHODS: We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. RESULTS: The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. CONCLUSION: The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.

9 Review The rationale for Janus kinase inhibitors for the treatment of spondyloarthritis. 2019

Veale, Douglas J / McGonagle, Dennis / McInnes, Iain B / Krueger, James G / Ritchlin, Christopher T / Elewaut, Dirk / Kanik, Keith S / Hendrikx, Thijs / Berstein, Gabriel / Hodge, Jennifer / Telliez, Jean-Baptiste. ·The Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Ireland. · University College, Dublin, Ireland. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK. · NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK. · Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Laboratory of Investigative Dermatology, The Rockefeller University, New York, USA. · Allergy, Immunology & Rheumatology Division, University of Rochester Medical Center, Rochester, NY, USA. · Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center, Ghent University and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium. · Pfizer Inc, Groton, CT, USA. · Pfizer Inc, Collegeville, PA, USA. · Pfizer Inc, Cambridge, MA, USA. · Pfizer Inc, New York, NY, USA. ·Rheumatology (Oxford) · Pubmed #29618084.

ABSTRACT: The pathogenesis of SpA is multifactorial and involves a range of immune cell types and cytokines, many of which utilize Janus kinase (JAK) pathways for signaling. In this review, we summarize the animal and pre-clinical data that have demonstrated the effects of JAK blockade on the underlying molecular mechanisms of SpA and provide a rationale for JAK inhibition for the treatment of SpA. We also review the available clinical trial data evaluating JAK inhibitors tofacitinib, baricitinib, peficitinib, filgotinib and upadacitinib in PsA, AS and related inflammatory diseases, which have demonstrated the efficacy of these agents across a range of SpA-associated disease manifestations. The available clinical trial data, supported by pre-clinical animal model studies demonstrate that JAK inhibition is a promising therapeutic strategy for the treatment of SpA and may offer the potential for improvements in multiple articular and extra-articular disease manifestations of PsA and AS.

10 Review Opportunities and challenges in the treatment of psoriatic arthritis. 2018

FitzGerald, Oliver / Ritchlin, Christopher. ·St. Vincent's University Hospital, Conway Institute for Biomolecular Research, University College Dublin, Ireland. Electronic address: oliver.fitzgerald@ucd.ie. · Chief, Allergy, Immunology & Rheumatology Division, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA. ·Best Pract Res Clin Rheumatol · Pubmed #31171314.

ABSTRACT: In this chapter, we review the opportunities and challenges posed by the treatment options currently available in the treatment of psoriatic arthritis. Both established and new or emerging treatment options are discussed using a domain-based approach. Finally, approaches to how treatment can be optimized together with some clinical pearls are presented and discussed. With the increasing treatment options available, we need a better way of deciding which treatment should be considered for which patient. On the basis of current knowledge, some guidance is provided on how these choices might best be made.

11 Review Altered Bone Remodeling in Psoriatic Disease: New Insights and Future Directions. 2018

Paine, Ananta / Ritchlin, Christopher. ·Allergy, Immunology & Rheumatology Division, University of Rochester Medical Center, Rochester, NY, 14623, USA. ananta_paine@urmc.rochester.edu. · Allergy, Immunology & Rheumatology Division, University of Rochester Medical Center, Rochester, NY, 14623, USA. ·Calcif Tissue Int · Pubmed #29330560.

ABSTRACT: Psoriatic arthritis (PsA) is an inflammatory rheumatic disorder that occurs in patients with psoriasis and predominantly affects musculoskeletal structures, skin, and nails. The etiology of PsA is not well understood but evidence supports an interplay of genetic, immunologic, and environmental factors which promote pathological bone remodeling and joint damage in PsA. Localized and systemic bone loss due to increased activity of osteoclasts is well established in PsA based on animal models and translational studies. In contrast, the mechanisms responsible for pathological bone remodeling in PsA remain enigmatic although new candidate molecules and pathways have been identified. Recent reports have revealed novel findings related to bone erosion and pathologic bone formation in PsA. Many associated risk factors and contributing molecular mechanisms have also been identified. In this review, we discuss new developments in the field, point out unresolved questions regarding the pathogenetic origins of the wide array of bone phenotypes in PsA, and discuss new directions for investigation.

12 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 --

13 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.

14 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.

15 Review Bone remodeling in psoriasis and psoriatic arthritis: an update. 2016

Paine, Ananta / Ritchlin, Christopher. ·Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA. ·Curr Opin Rheumatol · Pubmed #26555451.

ABSTRACT: PURPOSE OF REVIEW: This article reviews and outlines recent advances in the field of bone remodeling in psoriatic disease and identify avenues for further research. RECENT FINDINGS: High-resolution imaging revealed that new bone formation, observed in psoriatic arthritis (PsA) is centered at enthesial sites in contrast to hand osteoarthritis, and new bone formation is also present in psoriasis patients without arthritis. Accumulating evidence strongly suggests that the IL-23/IL-17 pathway is directly involved in altered bone phenotypes in PsA. Apart from Th17 and Th22 cells, CD8IL-17 T cells, γδT cells, and type 3 innate lymphoid cells also secrete IL-17 and IL-22. Further studies will be needed to clarify the role of these cells in bone remodeling in the context of psoriatic disease. Recent research also strengthened the earlier viewpoint that mechanical stress can serve as a trigger for joint inflammation and arthritis development. Recent findings suggest that inflammation beginning in the skin may become more generalized and involve musculoskeletal structures. Other reports suggest that gut microbiota might have a role in joint inflammatory responses and bone remodeling in psoriatic disease. Successful application of omics approaches and advance imaging studies also revealed many novel aspects of psoriatic diseases and joint-related pathologies which will likely help pinpoint causal genes, pathways, and novel biomarkers in the near future. SUMMARY: Imaging studies have provided new insights into new bone formation phenotypes in PsA. The IL-23/IL-17 pathway is of central importance in psoriatic bone remodeling where, apart from CD4 T helper cells, other IL-17 and IL-22-secreting innate and adaptive cells may also be involved. Insights from study of the microbiome and from omics technologies will set the stage for new advances in our understanding of bone disorders in psoriatic diseases.

16 Review Immunologic advances reveal new targets in psoriasis and psoriatic arthritis. 2015

Mortezavi, Mahta / Ritchlin, Christopher. ·Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, NY 14642, USA. ·Discov Med · Pubmed #26562469.

ABSTRACT: Psoriatic arthritis (PsA) is a chronic inflammatory joint disorder with heterogeneous clinical features that may include plaque psoriasis, joint inflammation, enthesitis, dactylitis, and abnormal bone turn over. This disease is common, affecting up to 0.5% of the population with equal male and female prevalence. Until recently, few treatment options were available for PsA and patients suffered immense physical and social burden. Traditional disease modifying agents show limited efficacy in the treatment of PsA. Anti-tumor necrosis factor (TNF) drugs are effective for all the manifestations, yet recent studies show that up to 50% of patients either do not tolerate these medications or do not maintain a clinical response. The evolution in the treatment of PsA emerged from improved understanding of the pathophysiology of the disease with Th1 and Th17 cells taking center stage. Targeting TNF along with cytokines in the IL-23/TH17 pathway (IL-23, IL-17, and IL-22) holds great promise for improved treatment outcomes in PsA.

17 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.

18 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.

19 Review The joint in psoriatic arthritis. 2015

Mortezavi, Mahta / Thiele, Ralph / Ritchlin, Christopher. ·Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, USA. mahta_mortezavi@urmc.rochester.edu. · Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, USA. ·Clin Exp Rheumatol · Pubmed #26472472.

ABSTRACT: Psoriatic arthritis (PsA), a chronic inflammatory joint disease associated with psoriasis, is notable for diversity in disease presentation, course and response to treatment. Equally varied are the types of musculoskeletal involvement which include peripheral and axial joint disease, dactylitis and enthesitis. In this review, we focus on the psoriatic joint and discuss pathways that underlie synovial, cartilage and bone inflammation and highlight key histopathologic features. The pivotal inflammatory mechanisms and pathobiology of PsA parallel findings in other forms of spondyloarthritis but are distinct from disease pathways described in rheumatoid synovitis and bone disease. The diagnosis of PsA from both a clinical and imaging perspective is also discussed.

20 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.

21 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.

22 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.

23 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.

24 Review Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis. 2014

Schoels, M M / Braun, J / Dougados, M / Emery, P / Fitzgerald, O / Kavanaugh, A / Kvien, T K / Landewé, R / Luger, T / Mease, P / Olivieri, I / Reveille, J / Ritchlin, C / Rudwaleit, M / Sieper, J / Smolen, J S / Wit, M de / van der Heijde, D. ·2nd Department of Internal Medicine, Center for Rheumatic Diseases, Hietzing Hospital, , Vienna, Austria. ·Ann Rheum Dis · Pubmed #23740234.

ABSTRACT: BACKGROUND: Current recommendations for the management of axial spondyloarthritis (SpA) and psoriatic arthritis are to monitor disease activity and adjust therapy accordingly. However, treatment targets and timeframes of change have not been defined. An international expert panel has been convened to develop 'treat-to-target' recommendations, based on published evidence and expert opinion. OBJECTIVE: To review evidence on targeted treatment for axial and peripheral SpA, as well as for psoriatic skin disease. METHODS: We performed a systematic literature search covering Medline, Embase and Cochrane, conference abstracts and studies in http://www.clinicaltrials.gov. RESULTS: Randomised comparisons of targeted versus routine treatment are lacking. Some studies implemented treatment targets before escalating therapy: in ankylosing spondylitis, most trials used a decrease in Bath Ankylosing Spondylitis Disease Activity Index; in psoriatic arthritis, protocols primarily considered a reduction in swollen and tender joints; in psoriasis, the Modified Psoriasis Severity Score and the Psoriasis Area and Severity Index were used. Complementary evidence correlating these factors with function and radiographic damage at follow-up is sparse and equivocal. CONCLUSIONS: There is a need for randomised trials that investigate the value of treat-to-target recommendations in SpA and psoriasis. Several trials have used thresholds of disease activity measures to guide treatment decisions. However, evidence on the effect of these data on long-term outcome is scarce. The search data informed the expert committee regarding the formulation of recommendations and a research agenda.

25 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.

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