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Background. Sex-related differences have been observed in psoriatic arthritis (PsA), with women often reporting a higher disease burden. Previous studies suggest that female patients experience more pain, fatigue, and reduced quality of life. However, it remains unclear whether this increased disease impact is primarily mediated by disease activity. Objective To evaluate whether the higher disease impact (measured by PSAID) observed in female patients with PsA is mediated by disease activity (measured by DAPSA).   Methods. A cross-sectional study was conducted on consecutive patients who met CASPAR criteria for PsA. Demographic, clinical, and lifestyle information was collected, including socio-economic characteristics and comorbidities (with a focus on fibromyalgia). Disease activity was assessed using the Disease Activity index for Psoriatic Arthritis (DAPSA), and disease impact was measured using the Psoriatic Arthritis Impact of Disease (PSAID) questionnaire. Comparisons between males and females were performed using Mann-Whitney U or Chi-square tests. Mediation analysis was conducted following the Baron and Kenny approach, testing the significance of each association across three linear regression models: (1) total effect of sex on PSAID; (2) effect of sex on DAPSA; and (3) effect of DAPSA on PSAID adjusted for sex (Figure). All models were adjusted for age, BMI, comorbidity index (RDCI), and fibromyalgia. Results were expressed as beta (95% confidence interval).   Results. A total of 136 PsA patients were included (54% female; mean age 58.9±12.0 years). The characteristics of female and male patients are displayed in Table. No major differences in disease manifestations were observed between sexes. Fybromialgia was more frequent in males. Females consistently reported higher scores in patient-reported outcomes, including DAPSA components related to pain and global disease activity, and across all PSAID items. In multivariable analysis, all associations required for mediation were significant: male sex was associated with lower PSAID scores ( = -1.73, 95% CI: -2.60 to -0.85) and lower DAPSA scores ( = -2.89, 95% CI: -5.57 to -0.22), while DAPSA was positively associated with PSAID ( = 0.20, 95% CI: 0.15 to 0.25), supporting a mediating role of DAPSA. However, the indirect effect through DAPSA accounted for 33% of the total effect of sex on PSAID, indicating partial mediation.   Conclusions. Disease activity explains only part of the higher disease impact experienced by female PsA patients. Additional contributor, such as altered pain perception, fibromyalgia, and possibly psychosocial or cultural factor, may significantly influence disease burden. These findings underscore the need for individualized, sex-aware management strategies and further research into non-inflammatory drivers of disease impact in PsA. 

Background. Psoriatic arthritis (PsA) presents several evidence of sex-related disparities, highlighting critical gaps in our understanding and management of PsA. This study aimed to evaluate b/ts-DMARDs effectiveness, drug survival and clinical response predictors in PsA patients, related to biological sex.   Patients and Methods. PsA patients starting a b-/ts-DMARDs between January 2016 and December 2023 were included in this multicentre real-world observational study based on the Italian GISEA prospective registry. Demographic, laboratory and clinical data were collected at baseline and at four-months interval thereafter.Logistic regression was used to investigate the association between selected variables and MDA achievement at T4, reporting as adjusted odds ratio (adjOR) with 95% confidence interval (CI), adjusting for age, BMI, csDMARDs and steroid user and baseline DAPSA score.   Results. A total of 4197 PsA patients were enrolled, comprising 1714 males (mPsA) and 2483 females (fPsA). Comparing to fPsA patients, mPsA were characterized by a higher BMI (p=0.01), longer disease duration (p=0.0001) and more frequent psoriasis (p<0.0001).Moreover, mPsA compared to fPsA exhibited a higher prevalence of the oligoarticular pattern (p=0.003), higher CRP levels (p<0.0001), and more presence of erosion (p=0.045), but lower DAPSA score (p<0.0001). Significant differences in clinical improvement were observed at each time point between mPsA and fPsA in terms of DAPSA remission and MDA achievement. Furthermore, female gender had a negative impact on retention rates of b/ts-DMARD therapy only at first- or second-line compared to male gender (p<0.0001 and p=0.023, respectively). PsA patients who achieved MDA at T4 were more likely to be male (p<0.0001), have an oligoarticular pattern (p<0.0001), lack enthesitis involvement (p<0.0001), be free of fibromyalgia comorbidity (p<0.0001) and be b-/ts-DMARDs naïve (p=0.001). Based on these findings, the five features were considered in a predictive model of MDA achievement at T4 with adjOR 9.826 (95% CI 3.215-30.035). Finally, fPsA with fibromyalgia (fibro/fPsA; n: 363) compared to fPsA without fibromyalgia (not-fibro/fPsA; n: 1132) were characterized by lower psoriasis involvement (p=0.015), associated to lower PASI (p=0.005), higher enthesitis involvement (p<0.0001), associated to higher LEI (p<0.0001), higher axial involvement (p<0.0001) and higher DAPSA (p=0.001). Furthermore, not-fibro/fPsA patients demonstrated significantly better clinical response compared to fibro/fPsA in terms of DAPSA remission and MDA achievement.   Conclusions. This large, multicentre real-world observational study reveals striking significant sex-related differences in clinical features, disease activity and treatment response among PsA treated patients. Notably, mPsA patients demonstrated better outcomes at every time points of follow-up compared to fPsA. The study also identified key predictive factors, including biological sex, for early MDA achievement, highlighting the importance of integrating sex-specific approaches into PsA management.

Objectives: This study evaluated the relationship between the haemoglobin-albumin-lymphocyte-platelet (HALP) score and disease activity in patients with psoriatic arthritis (PsA), and compared HALP scores between PsA patients and healthy controls. Methods: This single-centre, cross-sectional study included 73 PsA patients and 59 healthy controls. Demographic, clinical and laboratory data were collected. Disease activity was assessed using the Ankylosing Spondylitis Disease Activity Score (ASDAS) based on C-reactive protein (CRP), the Disease Activity index for Psoriatic Arthritis (DAPSA), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the visual analogue scale (VAS), and the Psoriasis Area and Severity Index (PASI). HALP was calculated as haemoglobin × albumin × lymphocyte / platelet. Group comparisons, correlation analyses and ROC analyses were performed. Results: Compared with controls, PsA patients had higher CRP, erythrocyte sedimentation rate and platelet values, and lower albumin (all P<0.05). HALP scores did not differ significantly between groups (P=0.232). HALP correlated positively with age at diagnosis (r = 0.250; P=0.031) and negatively with ASDAS-CRP (r = −0.259; P=0.026). ROC analysis showed limited diagnostic performance (AUC = 0.561, P=0.228). Conclusions: Although HALP showed a significant inverse correlation with ASDAS-CRP, the association was weak and its diagnostic performance was poor. HALP alone has limited value in reflecting PsA disease activity or distinguishing patients from controls. This may relate to PsA’s heterogeneous inflammation and treatment status. Larger prospective studies in different PsA subgroups are needed to clarify the potential role of HALP as an objective biomarker.

Psoriatic arthritis (PsA) accounts for around 20% of referrals to the early arthritis clinic and presents a significant diagnostic and management challenge. Early diagnosis is important to prevent long term functional disability and to ensure optimal management of arthritis and key comorbidities. From the rheumatologist’s perspective, the differential diagnosis includes rheumatoid arthritis, gout and other inflammatory arthritides. Once diagnosed, it is essential to assess the disease fully, including arthritis, enthesitis, dactylitis, skin/nail disease and axial involvement. Using this information, appropriate treatment can be planned using therapies that are effective at treating the relevant domains of disease. Despite poor data, traditional disease-modifying anti-rheumatic drugs are commonly used and have been effective in observational studies. Following tumour necrosis factor inhibitors, which have proven excellent efficacy in multiple domains of PsA, new biologics are available or in development and will improve treatment options for people with refractory PsA.

Psoriasis, a chronic inflammatory skin disease, is connected to psoriatic arthritis, a chronic inflammatory arthritis. Recent studies have also linked psoriasis and psoriatic arthritis to various renal disorders. This research aims to determine the prevalence and association of renal disorders in adult patients with psoriasis and compare those findings with adult patients with psoriatic arthritis. This retrospective cross-sectional study included 485 participants with psoriasis. The study evaluated demographics, psoriasis type, the presence of psoriatic arthritis, and related comorbidities, excluding individuals under the age of 18 or those with no verified diagnosis. Medical records were reviewed for renal problems, and a multivariate logistic regression was used to investigate the relationship between psoriasis and psoriatic arthritis. Overall, 10.1% of psoriatic individuals had psoriatic arthritis. The mean age at diagnosis was 41.59±15.58 years, with 54.2% female. Plaque psoriasis was identified in 87.2% of patients, with 46% classified as obese (BMI≥30). Chronic renal failure was seen in 6.2% of psoriasis patients, and 6.1% of psoriatic arthritis patients. In our study, chronic renal failure rates were similar in psoriasis and psoriatic arthritis. Psoriatic arthritis was associated with an increased risk of acute kidney damage, transplantation, and dialysis.

Risankizumab, an anti–IL-23 monoclonal antibody, is approved for the treatment of peripheral psoriatic arthritis (PsA), and increasing evidence suggests its potential efficacy in patients with concurrent axial involvement. This study presents a preliminary monocentric real-world experience on the use of risankizumab in PsA, with clinical follow-up over six months of treatment. 34 patients with PsA treated with risankizumab at our center were included in this study. Of these, 18 had peripheral involvement only, while 16 presented both peripheral and axial involvement. Clinical assessments included DAPSA for peripheral disease, ASDAS-CRP and modified BASDAI (mBASDAI) for axial involvement. Patients were further stratified by treatment line (naïve to fourth-line) and therapy regimen (monotherapy vs. combination with methotrexate). The aim was to evaluate the evolution of clinical parameters over the course of treatment. Moreover, MRI was used to assess sacroiliac joint inflammation in patients with axial involvement. At baseline (T0), all patients underwent clinical evaluation using DAPSA, ASDAS-CRP, and mBASDAI scores, with regular follow-up assessments over six months (T6). Among the 16 patients with both peripheral and axial involvement, there was a marked improvement in ASDAS-CRP and mBASDAI scores, indicating a beneficial effect of risankizumab in reducing both axial and peripheral symptoms, as shown in the graphs. Regarding treatment lines, 8.8% of patients were treatment-naïve, while 58.8% received risankizumab as second-line, 20.6% as third-line, and 8.8% as fourth-line therapy. Risankizumab was administered in combination with methotrexate (MTX) in 70% of cases, and as monotherapy in 30%, demonstrating efficacy across both treatment regimens, including in patients with prior biologic exposure. As a representative case, MRI images from a 50-year-old female with axial PsA are included, showing marked improvement after six months of risankizumab. Our findings are consistent with current literature supporting the efficacy of risankizumab in peripheral PsA, while also offering new insights into its potential benefits for patients with concurrent axial involvement. This therapeutic effect may be attributed to the distinct pathophysiology of axial PsA (axPsA) compared to ankylosing spondylitis (AS). According to McGonagle et al., axPsA is primarily driven by ligament-centered inflammation, in contrast to the deep bone inflammation of AS. This anatomical and immunological distinction provides a mechanistic rationale for the observed clinical efficacy of IL-23 inhibitors in axPsA—despite their failure in AS—by targeting soft tissue immune responses more responsive to IL-23 modulation. Our center’s experience confirms the efficacy of risankizumab not only in peripheral PsA but also in patients with axial PsA (axPsA), showed in clinical and clinimetric indices improvement. These findings contribute valuable real-world data to the growing body of evidence supporting the therapeutic potential of risankizumab in PsA, including cases with axial involvement.