Psoriatic arthritis (PsA) is an autoimmune disease that generally causes problems in both the skin and the joints. An estimated 1.5 million Americans are affected by this rheumatological disease, which strikes about one-third of all people who have psoriasis.
Yet compared with other forms of arthritis, including the autoimmune condition rheumatoid arthritis (RA), PsA isn’t as well understood. Too few rheumatologists sufficiently understand the disease, in part because there hasn’t been enough research, according to the National Psoriasis Foundation.
Thankfully, several important studies were presented at ACR Convergence, the annual conference of the American College of Rheumatology, held virtually November 1 through 9, 2021.
Top 4 Conference Takeaways for People With Psoriatic Arthritis (PsA)
1. Infection Rates in People With Psoriatic Arthritis Aren’t Rising, They’re Declining
What’s New Biologic therapies now available are an important tool for treating people with psoriatic arthritis because they may control disease activity and prevent joint damage. One limitation of these drugs, however, is that they can increase the risk of infection.
Researchers from Boston University Medical Center decided to see if infection rates have indeed gone up in recent years, a time when the use of biologics has grown.
Research Details The scientists examined data from the National Inpatient Sample, a database that includes a sample of discharge information from community hospitals, containing approximately seven million records.
They compared the discharge records by type of infection during the five-years studied, from 2012 and 2017, standardizing the results to match the age distribution in the U.S. population during that time.
These hospital records revealed that major infections of the skin, soft tissue, and urinary tract, as well as the blood infection known as sepsis, all declined. Pneumonia was the only infectious disease whose rate stayed the same.
Why It Matters “Some patients are initially hesitant to start immunosuppressive agents for treatment and understanding this information can provide a clearer idea of how this risk of infection is translated in real life,” Vagishwari Murugesan, MD, a senior rheumatology clinical and research fellow at Boston University’s Medical Center and coauthor of the study, said in a statement.
With infection rates declining, people can feel more comfortable knowing that the increasing use of biologics has not translated into a corresponding growth in serious infections.
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2. Active Psoriatic Arthritis Improves With the Monoclonal Antibody Drug Risankizumab
What’s New Two studies presented at the conference found that risankizumab (Skyrizi) is effective against PsA. Currently the prescription injectable drug is approved only to treat adults with plaque psoriasis.
In the randomized clinical trials, considered the best way to evaluate a drug, people with PsA reduced the severity of their disease by taking this medication.
Research Details Both studies were part of a research effort known as KEEPsAKE, conducted by an international team of scientists working with the manufacturer.
One study, known as KEEPsAKE 2, involved 443 adults with active cases of PsA who had not been sufficiently helped by prior disease modifying drugs (DMARD) or one or two biologic therapies. Half received a 150 milligram (mg) shot of risankizumab at the start of the trial, one month later, and three months after that. The other group received placebo injections.
More patients reported an improvement in their symptoms after taking risankizumab, regardless of what drugs they might have taken in the past.
The second study combined results from KEEPsAKE 1 and 2. It included 1407 people with active disease who had not found relief with prior meds and who were randomized to the same study protocol.
When everyone was evaluated six months after starting the study, people taking risankizumab were again more likely to have significant improvements with their disease.
There were adverse reactions in both groups (around 45 percent), but most were minor. The small number of serious events was actually higher in the placebo group (4.4 percent compared with 3 percent).
Why It Matters People who had not had their disease improve with the currently available drugs may benefit from risankizumab if the FDA evaluates all the data and concludes it should be used for PsA. Currently, the drug is approved only for moderate to severe plaque psoriasis, but doctors can prescribe it for other indications.
3. Cannabidiol (CBD) Was Not Found to Help With PsA Pain
What’s New Cannabidiol (CBD) is increasingly sold in stores and websites, and is discussed in many online chat groups as a potentially useful way to deal with pain, including for PsA.
But while patients were asking Jonathan Vela, MD, a rheumatologist at Aalborg University Hospital in Denmark, whether they should take it for their condition, he didn’t have an answer. “I first heard about CBD in 2017, but at that time no proper study had been done, making it hard to counsel patients,” he says.
So Dr. Vela set out to study it. What he and his colleagues eventually found is that people taking CBD had no better response than the placebo.
Research Details The study enrolled 136 people with PsA or osteoarthritis (OA). Half were told to take 20 to 30 mg of synthetic CBD daily for three months; the rest swallowed a placebo during that time.
When people were evaluated at the end of the clinical trial, no statistically significant differences were found between the two groups for pain intensity, sleep quality, depression, anxiety, or pain catastrophizing.
Why It Matters Like other therapies, it is important for research to prove the effectiveness of any treatment before people decide to take it.
Although there’s a lot of buzz around CBD, “at present there is no proper study showing the effect of CBD for pain relief if you have psoriatic arthritis,” Vela says.
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4. People Taking Anti-Inflammatory Meds for PsA Pain Have Fewer Heart Disease Events
What’s New People with psoriatic arthritis often take nonsteroidal anti-inflammatory drugs (NSAIDs) to quell their pain.
When Chinese researchers looked back at the health history of PsA patients on these meds, they found those on these meds also had lower rates of cardiovascular events.
Research Details For this study, the scientists examined a database of 200 people with psoriatic arthritis whose health had been closely followed for several years. They looked at their levels of C-reactive protein (CRP), a sign of inflammation in the body and a potential risk factor for heart disease. And they tracked whether any of them developed problems with their heart.
During the mean nine years of the study, 15 percent of PsA patients experienced a cardiovascular event. Those who had more inflammation as indicated by elevated CRP levels were more likely to be in this group.
But people taking NSAIDs for their PsA pain actually had lower odds of having cardiovascular problems than others.
Why It Matters “People who have psoriatic arthritis have a higher risk of coronary disease compared to general population,” says Juan J. Maya, MD, a rheumatologist at the Rheumatology Center of Palm Beach and medical advisor to CreakyJoints. Any study that examines how that risk might be reduced are therefore helpful.
However, Dr. Maya cautions that the study is small and was a retrospective examination and not a randomized controlled trial. Plus, NSAIDs are known to have side effects, including gastrointestinal bleeding and ulcers.
“At this point I would not prescribe NSAIDs as a prevention for cardiovascular disease. But it’s definitely interesting that NSAIDs used for pain relief might have this extra benefit,” he says.