International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings.

BACKGROUND: Psoriatic arthritis (PsA) is a challenging heterogeneous disease. The European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) last published their respective recommendations for the management of PsA in 2015. However, these guidelines are primarily based on studies conducted in resource replete countries and may not be applicable in countries in the Americas (except Canada and USA) and Africa. We sought to adapt the existing recommendations for these regions under the auspices of the International League of Associations for Rheumatology (ILAR). PROCESS: The ADAPTE Collaboration (2009) process for guideline adaptation was followed to adapt the EULAR and GRAPPA PsA treatment recommendations for the Americas and Africa. The process was conducted in three recommended phases: set-up phase; adaptation phase (defining health questions, assessing source recommendations, drafting report), and finalization phase (external review, aftercare planning, and final production). RESULT: ILAR recommendations have been derived principally by adapting the GRAPPA recommendations, additionally, EULAR recommendations where appropriate and supplemented by expert opinion and literature from these regions. A paucity of data relevant to resource-poor settings was found in PsA management literature. CONCLUSION: The ILAR Treatment Recommendations for PsA intends to serve as reference for the management of PsA in the Americas and Africa. This paper illustrates the experience of an international working group in adapting existing recommendations to a resource-poor setting. It highlights the need to conduct research on the management of PsA in these regions as data are currently lacking.Key Points• The paper presents adapted recommendations for the management of psoriatic arthritis in resource-poor settings.• The ADAPTE process was used to adapt existing GRAPPA and EULAR recommendations by collaboration with practicing clinicians from the Americas and Africa.• The evidence from resource-poor settings to answer clinically relevant questions was scant or non-existent; hence, a research agenda is proposed.

BIOBADASER, BIOBADAMERICA, and BIOBADADERM: safety registers sharing commonalities across diseases and countries.

Registers facilitate the collection and communication of safety concerns. There are as many different register structures as registers, making the merging of rare data and comparison between registers difficult. BIOBADASER, the Safety Register of the Spanish Society of Rheumatology has served as template for other registers within the specialty, BIOBADAMERICA, and outside rheumatology, BIOBADADERM. Here we present the limitations and strengths of such template registers.

Effect of lactation on postmenopausal bone mineral density of the lumbar spine.

OBJECTIVE: To investigate the relationship between lactation and bone mineral density (BMD) of the lumbar spine in a cohort of 540 healthy, postmenopausal women. STUDY DESIGN: Women were selected who experienced long-term lactation (n = 155, median 18 months) or short-term lactation (n = 168, median 3 months) or who were parous, nonlactating subjects (n = 217). The groups were homogeneous in age and differed in body mass index, parity and age at menopause. Vertebral BMD was measured by x-ray absorptiometry. RESULTS: No statistically significant difference in BMD was found between groups or after adjusting for body mass index, number of live births and age at menopause. Even when the 86 women with the longest lactation history (median 22 months) were matched with 112 parous women with the same parity who did not lactate, we could not find any significant difference. CONCLUSION: Long-term lactation did not significantly affect postmenopausal vertebral BMD in a cohort of healthy women.

Methotrexate in psoriatic polyarthritis.

Methotrexate (MTX) is widely accepted as an effective treatment for psoriasis and chronic polyarthrides. We report data from 54 psoriatic polyarthritis patients (354 encounters) treated with MTX. 65% were males, mean age 47.9 years, mean disease duration 9.8 years for arthritis, 14.2 years for psoriasis. The MTX dose was 10-12.5 mg/week. 32 patients are still on MTX after a mean treatment time of 1.6 years. 22 patients discontinued MTX treatment: 11 felt it to be ineffective, in 6 patients there were side effects, 3 patients obtained remission, while 2 patients underwent surgery. Efficacy was good on the whole: number of swollen and tender joints, global disease activity score, ESR, and CRP all underwent a significant reduction. The intake of symptomatic drugs was reduced in 40%. Psoriasis as assessed with the Psoriasis Activity and Severity Index showed a significant improvement. Our data confirm that MTX is of value in most psoriatic polyarthritis patients (60%). In our experience, this drug, gives the maximum efficacy within 6 months of therapy.

The Italian version of the Functional Disability Index of the Health Assessment Questionnaire. A reliable instrument for multicenter studies on rheumatoid arthritis.

A working group of ten rheumatology institutes (UNIREUM) was formed in Italy to promote multicenter therapeutic studies on rheumatoid arthritis. The Functional Disability Index (FDI) of the Health Assessment Questionnaire (HAQ) was chosen as a measure of disability. This paper reports the results of a multicenter study to validate an Italian translation of the instrument and to assess its reliability and validity. Two questions were modified to achieve cross-cultural equivalence. Back-translation into English showed agreement with the American instrument. Reproducibility was high: the test-retest correlation coefficient was 0.989 and ranged from 0.81 to 0.99 for the centers taken separately. Validity was confirmed by a correlation coefficient of 0.95 between the patient self-attributed and the physician-attributed FDI scores. We conclude that our Italian version of the HAQ FDI is a reliable and valid self-administered instrument.

Rifamycin SV versus triamcinolone in local treatment of rheumatoid synovitis.

This study was aimed to evaluate the usefulness of rifamycin SV as an agent for local treatment of rheumatoid synovitis. Rifamycin SV was compared with triamcinolone acetonide in a randomized controlled trial on 87 patients with rheumatoid arthritis and with persistent knee synovitis. The treatment with rifamycin consisted of several weekly intra-articular injections, whereas triamcinolone was given as a single intra-articular injection. At the end of the therapy, 27 (61.4%) of the 44 rifamycin patients and 39 (91%) of the 43 steroid patients responded well to the treatment, and this difference was significant (p < 0.01). Rifamycin SV was responsible for unpleasant local side effects in all cases. In both groups, after 1 year of follow-up the synovitis had relapsed in about 42% of cases. We conclude that rifamycin SV is less useful than triamcinolone acetonide in the local treatment of rheumatoid synovitis.

Immunoglobulin heavy chain gene polymorphisms in Italian patients with psoriasis and psoriatic arthritis.

A polymorphism of the switch region of the mu IgH gene (S mu) is associated with arthritis in English patients with psoriasis. In this study, Italian patients with psoriasis alone (PS) or psoriatic arthritis (PSA) were analysed by Southern blot using DNA probes for the S mu region and a hypervariable locus 5' of the joining (JH) region of IgH (5' JH). No association between PSA and IgH gene polymorphisms was found. However, an association was found between PS and a genotype of the 5' JH region (Fisher's P = 0.0002, RR = 27). Additional DNA markers around the S mu region may reveal more accurate markers for PS or PSA.

[Clinical framework of psoriatic arthropathy. Proposal of an evaluation protocol]. / Inquadramento clinico dell'artropatia psoriasica. Proposta di un protocollo di valutazione.

Psoriatic arthropathy is an inflammatory seronegative arthritis characterized by an involvement of peripheral or axial joints in association with psoriasis. In this study the clinical features of both skin and joints have been observed simultaneously by a rheumatologist and a dermatologist. We have finally proposed a clinical protocol based on PASI to evaluate psoriasis and on a simple subset classification to estimate joint involvement.