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Psoriasis: HELP
Articles by Jessica A. Walsh
Based on 17 articles published since 2010
(Why 17 articles?)
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Between 2010 and 2020, J. Walsh wrote the following 17 articles about Psoriasis.
 
+ Citations + Abstracts
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 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.

3 Review Diagnosing and treating psoriatic arthritis: an update. 2014

Boehncke, W H / Qureshi, A / Merola, J F / Thaçi, D / Krueger, G G / Walsh, J / Kim, N / Gottlieb, A B. ·Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland. ·Br J Dermatol · Pubmed #24266754.

ABSTRACT: Psoriatic arthritis (PsA) is an inflammatory arthritis of uncertain pathogenesis, affecting approximately one in four patients with psoriasis. Onset of psoriasis typically precedes the development of PsA. Therefore, the dermatologist is ideally positioned to recognize the early signs and symptoms of PsA for diagnosis and subsequent treatment. The role of the dermatologist in early diagnosis and treatment is essential for preventing pain and functional disabilities, as well as the joint deterioration that accompanies progressive forms of PsA. Diagnosis of PsA is a key aspect of the clinical decision process for the dermatologist, as psoriasis plus PsA requires a different therapeutic approach from that required for psoriasis alone. Furthermore, PsA is associated with an increased risk of cardiovascular comorbidities that present significant health concerns. In this review, the pathogenesis and comorbidities of PsA are discussed. In addition, screening and imaging tools that aid in the diagnosis of PsA, as well as tools used for efficacy assessment, are reviewed. Available therapies are presented, with a focus on targeted biologics and emerging treatments.

4 Clinical Trial Efficacy of certolizumab pegol with and without concomitant use of disease-modifying anti-rheumatic drugs over 4 years in psoriatic arthritis patients: results from the RAPID-PsA randomized controlled trial. 2018

Walsh, J A / Gottlieb, A B / Hoepken, B / Nurminen, T / Mease, P J. ·Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA. jessica.walsh@hsc.utah.edu. · Department of Dermatology, New York Medical College, Metropolitan Hospital, New York, NY, USA. · UCB Pharma, Monheim, Germany. · Swedish Medical Center and University of Washington, Seattle, WA, USA. ·Clin Rheumatol · Pubmed #30191421.

ABSTRACT: To report long-term efficacy of certolizumab pegol (CZP) treatment with and without concomitant DMARDs in patients with psoriatic arthritis (PsA). RAPID-PsA (NCT01087788) was double-blind and placebo-controlled to week 24, dose-blind to week 48, and open-label to week 216. Patients had active PsA with ≥ 1 failed DMARD. At baseline, patients were randomized 1:1:1 to CZP 200 mg every 2 weeks: CZP 400 mg every 4 weeks: placebo. CZP-randomized patients continued their dose into open-label. Observed case efficacy data are reported to week 216 for week 0 CZP-randomized patients (dose combined) with and without baseline DMARD use (DMARD+/DMARD-). Dactylitis (tenderness and ≥ 10% difference in swelling between affected and opposite digits) and enthesitis were measured using Leeds Dactylitis Index (LDI) and Leeds Enthesitis Index (LEI). 273/409 randomized patients received CZP from baseline: 199/273 (72.9%) DMARD+ and 74/273 (27.1%) DMARD- patients. 141/199 (70.9%) DMARD+ and 42/74 (56.8%) DMARD- patients completed Week 216. DMARD+ (79.7%) and 83.3% of DMARD- patients achieved ACR20 response at week 216; 79.2 and 78.1% achieved 75% improvement from baseline in Psoriasis Area and Severity Index (PASI75). High proportions of DMARD+/DMARD- patients with extra-articular manifestations at baseline reported total resolution at week 216; dactylitis 91.4% of DMARD+ and 93.3% of DMARD- patients, enthesitis 74.4% of DMARD+ and 87.5% of DMARD- patients. Long-term improvements in PsA symptoms were observed with CZP monotherapy or concomitant DMARDs, across important psoriatic disease domains, including joint disease, psoriasis, nail disease, dactylitis, and enthesitis.Trial registration: NCT01087788.

5 Clinical Trial Early and sustained efficacy with apremilast monotherapy in biological-naïve patients with psoriatic arthritis: a phase IIIB, randomised controlled trial (ACTIVE). 2018

Nash, Peter / Ohson, Kamal / Walsh, Jessica / Delev, Nikolay / Nguyen, Dianne / Teng, Lichen / Gómez-Reino, Juan J / Aelion, Jacob A / Anonymous4280933. ·Department of Medicine, University of Queensland, Brisbane, Queensland, Australia. · Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. · Department of Internal Medicine, Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, Utah, USA. · Celgene Corporation, Summit, New Jersey, USA. · Hospital Clínico Universitario, Santiago, Spain. · West Tennessee Research Institute, Jackson, Tennessee, USA. ·Ann Rheum Dis · Pubmed #29343507.

ABSTRACT: OBJECTIVE: Evaluate apremilast efficacy across various psoriatic arthritis (PsA) manifestations beginning at week 2 in biological-naïve patients with PsA. METHODS: Patients were randomised (1:1) to apremilast 30 mg twice daily or placebo. At week 16, patients whose swollen and tender joint counts had not improved by ≥10% were eligible for early escape. At week 24, all patients received apremilast through week 52. RESULTS: Among 219 randomised patients (apremilast: n=110; placebo: n=109), a significantly greater American College of Rheumatology 20 response at week 16 (primary outcome) was observed with apremilast versus placebo (38.2% (42/110) vs 20.2% (22/109); P=0.004); response rates at week 2 (first assessment) were 16.4% (18/110) versus 6.4% (7/109) (P=0.025). Improvements in other efficacy outcomes, including 28-joint count Disease Activity Score (DAS-28) using C reactive protein (CRP), swollen joint count, Health Assessment Questionnaire-Disability Index (HAQ-DI), enthesitis and morning stiffness severity, were observed with apremilast at week 2. At week 16, apremilast significantly reduced PsA disease activity versus placebo, with changes in DAS-28 (CRP) (P<0.0001), HAQ-DI (P=0.023) and Gladman Enthesitis Index (P=0.001). Improvements were maintained with continued treatment through week 52. Over 52 weeks, apremilast's safety profile was consistent with prior phase 3 studies in psoriasis and PsA. During weeks 0-24, the incidence of protocol-defined diarrhoea was 11.0% (apremilast) and 8.3% (placebo); serious adverse event rates were 2.8% (apremilast) and 4.6% (placebo). CONCLUSIONS: In biological-naïve patients with PsA, onset of effect with apremilast was observed at week 2 and continued through week 52. The safety profile was consistent with previous reports. TRIAL REGISTRATION NUMBER: NCT01925768; Results.

6 Article The Physician Global Assessment and Body Surface Area composite tool is a simple alternative to the Psoriasis Area and Severity Index for assessment of psoriasis: post hoc analysis from PRISTINE and PRESTA. 2018

Walsh, Jessica A / Jones, Heather / Mallbris, Lotus / Duffin, Kristina Callis / Krueger, Gerald G / Clegg, Daniel O / Szumski, Annette. ·Division of Rheumatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA, jessica.walsh@hsc.utah.edu. · Inflammation and Immunology,Global Medical Affairs, Pfizer, Collegeville, PA, USA. · Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA. · Pfizer Business Unit (PBU) Syneos Health, Princeton, NJ, United States. ·Psoriasis (Auckl) · Pubmed #30324088.

ABSTRACT: Background: The product of Physician Global Assessment and Body Surface Area (PGA × BSA) is a new outcome measure for psoriasis severity and response to therapy. The objective of this study was to evaluate PGA × BSA as an alternative to Psoriasis Area and Severity Index (PASI) for psoriasis assessments. Methods: The relationship between PASI and PGA × BSA was assessed in a post hoc analysis of pooled data from the PRISTINE (NCT00663052) and PRESTA (NCT00245960) trials in patients with moderate-to-severe psoriasis who received etanercept 50 mg/week. Data were analyzed using Spearman and intra-class correlation coefficients, effect sizes, scatterplots, Bland-Altman plots, and Kappa statistics. Results: Spearman correlations at baseline, week 12, and week 24 were strong for PGA × BSA versus PASI ( Conclusion: PGA × BSA has advantages over PASI for measuring moderate-to-severe psoriasis; it is intuitive, sensitive, and easy to use.

7 Article Treatment Patterns Among Patients with Psoriatic Arthritis Treated with a Biologic in the United States: Descriptive Analyses from an Administrative Claims Database. 2018

Walsh, Jessica A / Adejoro, Oluwakayode / Chastek, Benjamin / Palmer, Jacqueline B / Hur, Peter. ·1 University of Utah School of Medicine and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah. · 2 Optum, Eden Prairie, Minnesota. · 3 Novartis Pharmaceuticals, East Hanover, New Jersey. ·J Manag Care Spec Pharm · Pubmed #29952704.

ABSTRACT: BACKGROUND: In patients with psoriatic arthritis (PsA), limited data exist regarding patterns of biologic therapy use. OBJECTIVE: To examine treatment patterns and therapy modifications in U.S. patients with PsA receiving a tumor necrosis factor inhibitor (TNFi) or an anti-interleukin (IL)-12/23 inhibitor. METHODS: Adults with PsA who newly initiated a biologic therapy (index biologic) between January 1, 2013, and January 31, 2015, were included from the Optum Research Database. Biologic therapies comprised those that were approved by the FDA for the treatment of PsA at the time of the study initiation (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, or ustekinumab). Outcomes included adherence, persistence, and discontinuation of the index biologic; initiation of adjunctive medications (nonbiologics, including those commonly used for pain and/or inflammation); and dose escalation of the index biologic during the 12-month follow-up period. RESULTS: Of the 1,235 patients included, 52.5% were female, and mean (SD) age was 50.3 (12.1) years. The mean (SD) duration of persistence with a newly initiated index biologic (etanercept [48.1%], adalimumab [24.0%], infliximab [10.4%], golimumab [8.3%], ustekinumab [7.2%], or certolizumab pegol [2.0%]) was 246 (128) days; 44.5% of patients persisted with the index biologic for ≥ 12 months. During the 12-month follow-up period, 22.9% of patients switched to a different biologic, 26.8% discontinued without switching or restarting, and 5.8% discontinued and restarted the index biologic. Of the 1,010 patients who persisted with the index biologic for > 90 days, 45.6% received ≥ 1 adjunctive medication during the period from 90 days after the index date to the end of persistence or 12 months. The most commonly initiated adjunctive medications were corticosteroids (22.0%), opioids (17.1%), and nonsteroidal anti-inflammatory drugs (12.9%). Overall, 9.6% of patients had a dose escalation of the index biologic in the immediate 12-month post-index period. CONCLUSIONS: This real-world study of treatment patterns for PsA, which used a large U.S. claims database, demonstrated that the majority of patients with PsA discontinued their index biologic (TNFi or anti-IL-12/23 inhibitor) before 12 months. Nearly half of patients initiated an adjunctive medication, many of which were pain and conventional anti-inflammatory medications. DISCLOSURES: This study was sponsored by Novartis Pharmaceuticals. Optum was commissioned by Novartis to conduct this study, but employment was not contingent on results of the study. Walsh is a paid consultant for Novartis. Adejoro was an employee of Optum at the time of the study and writing of the manuscript. Chastek is an employee of Optum. Palmer and Hur are employees of Novartis. Results of this study were presented as an abstract and poster at the Academy of Managed Care Pharmacy Nexus 2017; October 16-19, 2017; Dallas, TX; and the EULAR 2017 Annual European Congress of Rheumatology; June 14-17, 2017; Madrid, Spain.

8 Article PGA×BSA: A Measure of Psoriasis Severity Tested in Patients with Active Psoriatic Arthritis and Treated with Certolizumab Pegol. 2018

Walsh, Jessica A / Arledge, Terri / Nurminen, Tommi / Peterson, Luke / Stark, Jeffrey. ·From the Division of Rheumatology, University of Utah, Salt Lake City, Utah; UCB Pharma, Raleigh, North Carolina; UCB Pharma, Smyrna, Georgia, USA; UCB Pharma, Monheim, Germany. Jessica.Walsh@hsc.utah.edu. · J.A. Walsh, MD, Division of Rheumatology, University of Utah; T. Arledge, DVM, UCB Pharma; T. Nurminen, MSc, UCB Pharma; L. Peterson, MSc, UCB Pharma; J. Stark, MD, UCB Pharma. Jessica.Walsh@hsc.utah.edu. · From the Division of Rheumatology, University of Utah, Salt Lake City, Utah; UCB Pharma, Raleigh, North Carolina; UCB Pharma, Smyrna, Georgia, USA; UCB Pharma, Monheim, Germany. · J.A. Walsh, MD, Division of Rheumatology, University of Utah; T. Arledge, DVM, UCB Pharma; T. Nurminen, MSc, UCB Pharma; L. Peterson, MSc, UCB Pharma; J. Stark, MD, UCB Pharma. ·J Rheumatol · Pubmed #29717036.

ABSTRACT: OBJECTIVE: The product of physician's global assessment and body surface area (PGA×BSA) to assess psoriasis severity has previously been investigated in patients with psoriasis, with the aim of assessing PGA×BSA as an alternative to the time-consuming Psoriasis Area and Severity Index (PASI). Here, we investigate PGA×BSA as an alternative to PASI in patients with psoriatic arthritis (PsA). METHODS: Analyses used data from the double-blind, placebo-controlled, RAPID-PsA trial (NCT01087788) that investigated the efficacy of certolizumab pegol (CZP) in patients with PsA. Outcomes assessed whether the PGA×BSA and PASI results were comparable, and whether these outcomes correlated with one another or with the Dermatology Life Quality Index (DLQI). RESULTS: For CZP-treated patients, both PGA×BSA and PASI demonstrated similar sensitivities to treatment between baseline and Week 24, with mean improvements of 77.4% and 69.0%, respectively. Similar improvements were also seen with placebo (PGA×BSA: 3.2%, PASI: 6.1%). Achievement of 75% response criterion in PGA×BSA and PASI was attained by similar proportions of patients with CZP (PGA×BSA75: 59.0%, PASI75: 61.4%) and placebo (PGA × BSA75: 15.1%, PASI75: 15.1%). Cross tabulations showed high concordance between achievement of response outcomes in PGA×BSA and PASI (79.6-95.2%). Spearman correlations revealed strong correlations between PGA×BSA and PASI at baseline (r = 0.78; n = 225) and percentage improvement to Week 24 (r = 0.85; n = 186). Both outcomes were only moderately correlated with DLQI (r = 0.41-0.50; n = 179-249). CONCLUSION: PGA×BSA is sensitive to changes in skin manifestations in patients with PsA treated with CZP. Further, PGA×BSA correlates strongly with PASI, and achievement of 75% improvement was similar for PGA×BSA and PASI.

9 Article Use of Disease-modifying Antirheumatic Drugs for Inflammatory Arthritis in US Veterans: Effect of Specialty Care and Geographic Distance. 2018

Walsh, Jessica A / Pei, Shaobo / Burningham, Zachary / Penmetsa, Gopi / Cannon, Grant W / Clegg, Daniel O / Sauer, Brian C. ·From the Salt Lake City Veterans Affairs Medical Center and University of Utah School of Medicine, Department of Internal Medicine, Divisions of Rheumatology and Epidemiology, Salt Lake City, Utah. jessica.walsh@hsc.utah.edu. · J.A. Walsh, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; S. Pei, MS, Salt Lake City Veterans Affairs Medical Center and University of Utah; Z. Burningham, PhD, Salt Lake City Veterans Affairs Medical Center; G. Penmetsa, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; G.W. Cannon, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; D.O. Clegg, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; B.C. Sauer, PhD, Salt Lake City Veterans Affairs Medical Center and University of Utah. jessica.walsh@hsc.utah.edu. · From the Salt Lake City Veterans Affairs Medical Center and University of Utah School of Medicine, Department of Internal Medicine, Divisions of Rheumatology and Epidemiology, Salt Lake City, Utah. · J.A. Walsh, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; S. Pei, MS, Salt Lake City Veterans Affairs Medical Center and University of Utah; Z. Burningham, PhD, Salt Lake City Veterans Affairs Medical Center; G. Penmetsa, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; G.W. Cannon, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; D.O. Clegg, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; B.C. Sauer, PhD, Salt Lake City Veterans Affairs Medical Center and University of Utah. ·J Rheumatol · Pubmed #29142040.

ABSTRACT: OBJECTIVE: To evaluate the effect of access to and distance from rheumatology care on the use of disease-modifying antirheumatic drugs (DMARD) in US veterans with inflammatory arthritis (IA). METHODS: Provider encounters and DMARD dispensations for IA (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) were evaluated in national Veterans Affairs (VA) datasets between January 1, 2015, and December 31, 2015. RESULTS: Among 12,589 veterans with IA, 23.5% saw a rheumatology provider. In the general IA population, 25.3% and 13.6% of veterans were exposed to a synthetic DMARD (sDMARD) and biologic DMARD (bDMARD), respectively. DMARD exposure was 2.6- to 3.4-fold higher in the subpopulation using rheumatology providers, compared to the general IA population. The distance between veterans' homes and the closest VA rheumatology site was < 40 miles (Near) for 55.9%, 40-99 miles (Intermediate) for 31.7%, and ≥ 100 miles (Far) for 12.4%. Veterans in the Intermediate and Far groups were less likely to see a rheumatology provider than veterans in the Near group (RR = 0.72 and RR = 0.49, respectively). Exposure to bDMARD was 34% less frequent in the Far group than the Near group. In the subpopulation who used rheumatology care, the bDMARD exposure discrepancy did not persist between distance groups. CONCLUSION: Use of rheumatology care and DMARD was low for veterans with IA. DMARD exposure was strongly associated with rheumatology care use. Veterans in the general IA population living far from rheumatology sites accessed rheumatology care and bDMARD less frequently than veterans living close to rheumatology sites.

10 Article Treatment patterns and annual biologic costs in US veterans with rheumatic conditions or psoriasis. 2016

Sauer, Brian C / Teng, Chia-Chen / He, Tao / Leng, Jianwei / Lu, Chao-Chin / Walsh, Jessica A / Shah, Neel / Harrison, David J / Tang, Derek H / Cannon, Grant W. ·a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA. · b b Rheumatology, SLC VA Medical Center and University of Utah , Salt Lake City , UT , USA. · c c Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA. ·J Med Econ · Pubmed #26337538.

ABSTRACT: OBJECTIVE: To determine annual biologic drug and administration costs to the US Veterans Health Administration (VHA) per treated patient with rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who received abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab, or ustekinumab. METHODS: Adults with at least one biologic claim between January 1, 2008 and December 31, 2011 were included. Evidence of enrollment in the VHA was required from 365 days before (pre-index) to 360 days after (post-index) the date of the first biologic claim (index date). Included patients had pre-index diagnoses of RA, PsO, PsA, and/or AS. Drug costs were from Federal Supply Schedule or 'Big Four' in November 2014. Administration costs were VHA fixed costs for infused ($169) and subcutaneous ($25) biologics. RESULTS: Of the 20,465 patients in the analysis, 10,711 received etanercept, 7838 received adalimumab, and 1196 received infliximab as the index biologic. In these patients, across all uses studied, the VHA incurred greater annual cost per treated patient for infliximab ($18,066) compared with adalimumab ($16,523) and etanercept ($16,526). In the first year post-index, ∼80% of patients were either persistent on these index biologics or re-started these index biologics after a ≥45-day treatment gap. Other biologics comprised <5% of the study population, with sample sizes ranging from 3-374 patients each. Cost by indication for biologics used by >20 patients ranged from $15,056 (etanercept) to $17,050 (abatacept) for RA; $16,697 (adalimumab) to $33,163 (ustekinumab) for PsO; $15,035 (etanercept) to $20,465 (infliximab) for PsA; and $14,239 (etanercept) to $18,536 (infliximab) for AS. LIMITATIONS: The model was limited to the VHA. Results for biologics other than adalimumab, etanercept, and infliximab were difficult to interpret because of small sample sizes. CONCLUSIONS: Infliximab has higher cost to the VHA than adalimumab or etanercept.

11 Article Mortality in American Veterans with the HLA-B27 gene. 2015

Walsh, Jessica A / Zhou, Xi / Clegg, Daniel O / Teng, Chiachen / Cannon, Grant W / Sauer, Brian. ·From the Division of Rheumatology, and the Division of Epidemiology, Department of Internal Medicine, George E. Wahlen Department of Veterans Affairs (VA) Medical Center, and University of Utah Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, George E. Wahlen VA Medical Center and University of Utah Medical Center; X. Zhou, MS, Biostatistician, Division of Epidemiology, Department of Internal Medicine, George E. Wahlen VA Medical Center; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, George E. Wahlen VA Medical Center and University of Utah Medical Center; C. Teng, MS, Biostatistician, Division of Epidemiology, Department of Internal Medicine, George E. Wahlen VA Medical Center; G.W. Cannon, MD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine, George E. Wahlen VA Medical Center and University of Utah Medical Center; B. Sauer, PhD, Assistant Professor of Epidemiology, Division of Epidemiology, Department of Internal Medicine, George E. Wahlen VA Medical Center. ·J Rheumatol · Pubmed #25684766.

ABSTRACT: OBJECTIVE: To compare survival in American veterans with and without the HLA-B27 (B27) gene. METHODS: Mortality was evaluated in a national cohort of veterans with clinically available B27 test results between October 1, 1999, and December 31, 2011. The primary outcome was the mortality difference between B27-positive and B27-negative veterans, adjusted for age, sex, race, and diagnoses codes for diseases that may have influenced both B27 testing and mortality, including psoriasis, inflammatory bowel disease, spondyloarthritis (SpA), and other types of inflammatory arthritis. The secondary outcomes were the adjusted mortality HR for B27+ and B27- veterans, in subgroups with and without SpA. RESULTS: Among veterans with available B27 test results, 27,652 (84.7%) were B27- and 4978 (15.3%) were B27+. The mean followup time was 4.6 years. Mortality was higher in the B27+ group than in the B27- group (HR 1.15, 95% CI 1.03-1.27). Mortality was also higher in the B27+ subgroups with SpA (HR 1.35, 95% CI 1.06-1.72) and without SpA (HR 1.11, 95% CI 0.99-1.24), but the difference was significant only in the subgroup with SpA. CONCLUSION: B27 positivity was associated with an increased mortality rate in a cohort of veterans clinically selected for B27 testing, after adjustment for SpA. In the subgroup with SpA, the mortality rate was associated with B27 positivity, and in the subgroup without SpA, there was a nonsignificant association between B27+ and mortality.

12 Article Work productivity loss and fatigue in psoriatic arthritis. 2014

Walsh, Jessica A / McFadden, Molly L / Morgan, Michael D / Sawitzke, Allen D / Duffin, Kristina Callis / Krueger, Gerald G / Clegg, Daniel O. ·From the Division of Rheumatology, Division of Epidemiology, Department of Dermatology, University of Utah; Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.J.A. Walsh, MD, Assistant Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; M.L. McFadden, MS, Biostatistician III, Division of Epidemiology, University of Utah; M.D. Morgan, MD, Fellow of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center; A.D. Sawitzke, MD, Professor of Rheumatology, Division of Rheumatology; K. Callis Duffin, MD, Assistant Professor of Dermatology; G.G. Krueger, MD, Professor of Dermatology, Department of Dermatology, University of Utah; D.O. Clegg, MD, Professor of Rheumatology, Division of Rheumatology, University of Utah, and Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center. ·J Rheumatol · Pubmed #25028377.

ABSTRACT: OBJECTIVE: To explore the relationship between fatigue and work productivity loss (WPL) in people with psoriatic arthritis (PsA). METHODS: Data were collected from participants in the Utah Psoriasis Initiative Arthritis registry between January 2010 and May 2013. WPL was measured with the 8-item Work Limitations Questionnaire. Fatigue was assessed with question 1 from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI#1), "How would you describe the overall level of fatigue/tiredness you have experienced?" and with question 1 from the Psoriatic Arthritis Quality of Life Questionnaire (PsAQOL#1) "I feel tired whatever I do." Psoriatic activity was evaluated with tender joint count (TJC), swollen joint count (SJC), dactylitis count, enthesitis count, inflammatory back pain (IBP), physician global assessment, body surface area, and psoriasis pain and itch. RESULTS: Among 107 participants, work productivity was reduced by 6.7%, compared to benchmark employees without limitations. Fatigue was reported by 54 patients (50.5%) on PsAQOL#1, and 64 (60.0%) were classified as high fatigue by BASDAI#1. TJC, SJC, enthesitis count, IBP, and depressed mood were highest or most frequent in participants reporting fatigue. After adjustments for psoriatic activity and depressed mood, WPL was associated with fatigue, as measured by PsAQOL#1 (p = 0.01) and BASDAI#1 (p = 0.002). CONCLUSION: WPL was associated with fatigue, and the association was not entirely explained by the evaluated musculoskeletal, cutaneous, or psychiatric manifestations of PsA.

13 Article Development and testing of new candidate psoriatic arthritis screening questionnaires combining optimal questions from existing tools. 2014

Coates, Laura C / Walsh, Jessica / Haroon, Muhammad / FitzGerald, Oliver / Aslam, Tariq / Al Balushi, Farida / Burden, A D / Burden-Teh, Esther / Caperon, Anna R / Cerio, Rino / Chattopadhyay, Chandrabhusan / Chinoy, Hector / Goodfield, Mark J D / Kay, Lesley / Kelly, Stephen / Kirkham, Bruce W / Lovell, Christopher R / Marzo-Ortega, Helena / McHugh, Neil / Murphy, Ruth / Reynolds, Nick J / Smith, Catherine H / Stewart, Elizabeth J C / Warren, Richard B / Waxman, Robin / Wilson, Hilary E / Helliwell, Philip S. ·Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK. ·Arthritis Care Res (Hoboken) · Pubmed #24470406.

ABSTRACT: OBJECTIVE: Several questionnaires have been developed to screen for psoriatic arthritis (PsA), but head-to-head studies have found limitations. This study aimed to develop new questionnaires encompassing the most discriminative questions from existing instruments. METHODS: Data from the CONTEST study, a head-to-head comparison of 3 existing questionnaires, were used to identify items with a Youden index score of ≥0.1. These were combined using 4 approaches: CONTEST (simple additions of questions), CONTESTw (weighting using logistic regression), CONTESTjt (addition of a joint manikin), and CONTESTtree (additional questions identified by classification and regression tree [CART] analysis). These candidate questionnaires were tested in independent data sets. RESULTS: Twelve individual questions with a Youden index score of ≥0.1 were identified, but 4 of these were excluded due to duplication and redundancy. Weighting for 2 of these questions was included in CONTESTw. Receiver operating characteristic (ROC) curve analysis showed that involvement in 6 joint areas on the manikin was predictive of PsA for inclusion in CONTESTjt. CART analysis identified a further 5 questions for inclusion in CONTESTtree. CONTESTtree was not significant on ROC curve analysis and discarded. The other 3 questionnaires were significant in all data sets, although CONTESTw was slightly inferior to the others in the validation data sets. Potential cut points for referral were also discussed. CONCLUSION: Of 4 candidate questionnaires combining existing discriminatory items to identify PsA in people with psoriasis, 3 were found to be significant on ROC curve analysis. Testing in independent data sets identified 2 questionnaires (CONTEST and CONTESTjt) that should be pursued for further prospective testing.

14 Article Product of the Physician Global Assessment and body surface area: a simple static measure of psoriasis severity in a longitudinal cohort. 2013

Walsh, Jessica A / McFadden, Molly / Woodcock, Jamie / Clegg, Daniel O / Helliwell, Philip / Dommasch, Erica / Gelfand, Joel M / Krueger, Gerald G / Duffin, Kristina Callis. ·Division of Rheumatology, University of Utah, Salt Lake City, Utah. Electronic address: jessica.walsh@hsc.utah.edu. ·J Am Acad Dermatol · Pubmed #24054760.

ABSTRACT: BACKGROUND: The Psoriasis Area and Severity Index (PASI) is considered the gold standard assessment tool for psoriasis severity, but PASI is limited by its complexity and insensitivity in people with mild psoriasis. OBJECTIVE: We sought to evaluate the product of a Physician Global Assessment (PGA) and Body Surface Area (BSA) (PGAxBSA) as an alternative to PASI. METHODS: Psoriasis severity was evaluated at 6-month intervals in participants of the Utah Psoriasis Initiative registry. Correlation coefficients were used to compare PGAxBSA with PASI and the Simplified PASI (SPASI). RESULTS: Between August 2008 and November 2010, 435 assessments were completed in 226 participants. The median PASI score was 3.2 (interquartile range 1.8-5.4) and the median BSA was 3.0% (interquartile range 1.0%-5.0%). PGAxBSA had higher correlations with PASI than SPASI (0.87 vs 0.76, P < .001). PGAxBSA also had higher correlations with a Global Patient Assessment of psoriasis severity (0.65) than both PASI (0.59, P < .001) and SPASI (0.51, P < .001). LIMITATIONS: The use of PGAxBSA for measuring severe psoriasis and response to therapy is unclear, because most participants had mild to moderate psoriasis and data were not collected at predefined intervals in relation to therapy initiation. Interrater reliability was not assessed. CONCLUSIONS: PGAxBSA is a simple and sensitive instrument for measuring psoriasis severity.

15 Article Limitations in screening instruments for psoriatic arthritis: a comparison of instruments in patients with psoriasis. 2013

Walsh, Jessica A / Callis Duffin, Kristina / Krueger, Gerald G / Clegg, Daniel O. ·Division of Rheumatology and the Department of Dermatology, University of Utah, Salt Lake City, UT 84109, USA. jessica.walsh@hsc.utah.edu ·J Rheumatol · Pubmed #23378465.

ABSTRACT: OBJECTIVE: To compare the abilities of 3 validated screening instruments to predict the diagnosis of psoriatic arthritis (PsA) in patients with psoriasis. METHODS: Prior to a rheumatologic evaluation, 213 participants in the Utah Psoriasis Initiative completed the Psoriasis Epidemiology Screening project (PEST), the Toronto Psoriatic Arthritis Screen (ToPAS), and the Psoriatic Arthritis Screening and Evaluation (PASE). Previously established instrument cutoff scores were used to designate positive and negative classifications. Sensitivities and specificities were determined by comparing instrument classifications to the rheumatologist's diagnosis. Phenotypic features and alternative diagnoses were compared between participants who screened positively and negatively on each instrument. Discrepancies between the rheumatologist's examination findings and responses to specific instrument questions were compared. RESULTS: The sensitivities of PEST, ToPAS, and PASE were 85%, 75%, and 68%, and the specificities were 45%, 55%, and 50%, respectively. The instruments were less sensitive in patients with lower disease activity, fewer PsA features, and shorter disease duration. The instruments did not consistently differentiate between PsA and other types of musculoskeletal disease. Discrepancies between examination findings and responses to instrument questions occurred more frequently with ToPAS than with PEST and PASE. CONCLUSION: Sensitivities and specificities for PEST, ToPAS, and PASE were lower than previously reported. This population included patients with PsA and other types of musculoskeletal disease and may represent those most likely to complete a screening instrument and follow through with a rheumatology referral. Further analyses may enable the development of more successful screening strategies for PsA in psoriasis patients with musculoskeletal complaints.

16 Article The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). 2013

Helliwell, Philip S / FitzGerald, Oliver / Fransen, Jaap / Gladman, Dafna D / Kreuger, Gerald G / Callis-Duffin, Kristina / McHugh, Neil / Mease, Philip J / Strand, Vibeke / Waxman, Robin / Azevedo, Valderilio Feijo / Beltran Ostos, Adriana / Carneiro, Sueli / Cauli, Alberto / Espinoza, Luis R / Flynn, John A / Hassan, Nada / Healy, Paul / Kerzberg, Eduardo Mario / Lee, Yun Jong / Lubrano, Ennio / Marchesoni, Antonio / Marzo-Ortega, Helena / Porru, Giovanni / Moreta, Elvia G / Nash, Peter / Raffayova, Helena / Ranza, Roberto / Raychaudhuri, Siba P / Roussou, Euthalia / Scarpa, Raphael / Song, Yeong Wook / Soriano, Enrique R / Tak, Paul P / Ujfalussy, Ilona / de Vlam, Kurt / Walsh, Jessica A. ·Academic Unit of Musculoskeletal Medicine, University of Leeds, Leeds, UK. ·Ann Rheum Dis · Pubmed #22798567.

ABSTRACT: OBJECTIVE: To develop new composite disease activity indices for psoriatic arthritis (PsA). METHODS: Data from routine clinic visits at multiple centres were collected in a systematic manner. Data included all domains identified as important in randomised controlled trials in PsA. Decisions to change treatment were used as surrogates for high disease activity. New indices were developed by multiple linear regression (psoriatic arthritis disease activity score: PASDAS) and empirically, utilising physician-defined cut-offs for disease activity (arithmetic mean of desirability functions: AMDF). These were compared with existing composite measures: Composite Psoriatic arthritis Disease Activity Index (CPDAI), Disease Activity for PSoriatic Arthritis (DAPSA), and Disease Activity Score for rheumatoid arthritis (DAS28). RESULTS: 161/503 (32%) subjects had treatment changes. Although all measures performed well, compared with existing indices, PASDAS was better able to discriminate between high and low disease activity (area under receiver operating curves (ROC)) curve with 95% CI: PASDAS 0.773 (0.723, 0.822); AMDF 0.730 (0.680, 0.780); CPDAI 0.719 (0.668, 0.770); DAPSA 0.710 (0.654, 0.766); DAS28 0.736 (0.680, 0.792). All measures were able to discriminate between disease activity states in patients with oligoarthritis, although area under the receiver operating curves (AUC) were generally smaller. In patients with severe skin disease (psoriasis area and severity index>10) both nonparametric and AUC curve statistics were nonsignificant for all measures. CONCLUSIONS: Two new composite measures to assess disease activity in PsA have been developed. Further testing in other datasets, including comparison with existing measures, is required to validate these instruments.

17 Minor Onset of psoriatic arthritis during ustekinumab treatment for psoriasis: a case series of seven patients. 2015

Jones, B B / Millsop, J W / Walsh, J A / Krueger, G G / Callis Duffin, K. ·School of Medicine, University of Utah, 30N 1900 East, Salt Lake City, UT, 84132, U.S.A. · University of California, Davis, Department of Dermatology, Sacramento, CA, U.S.A. · Division of Rheumatology, University of Utah, 30N 1900 East, Salt Lake City, UT, 84132, U.S.A. · Department of Dermatology, University of Utah, 30N 1900 East, Salt Lake City, UT, 84132, U.S.A. ·Br J Dermatol · Pubmed #25557081.

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