Quantitative analysis of therapeutic response in psoriatic arthritis of digital joints with Dual-energy CT iodine maps.

The aim of this study was to investigate the feasibility of quantitative assessment of the therapeutic response in psoriatic arthritis (PsA) by measuring iodine uptake using a Dual-energy CT (DECT) iodine map. The study included 74 symptomatic and 74 matching non-symptomatic joints of 26 consecutive PsA patients who underwent two contrast enhanced DECTs of the hand or foot, pre and post medical interventions. Symptomatic and matched non-symptomatic control joints were scored with the PsA DECT Scoring System (PsADECTS), which was derived by modifying the PsA MRI Scoring System (PsAMRIS), a recently validated scoring system that assesses PsA changes on MRI. Quantified iodine uptake measured using the DECT iodine map was compared to the PsADECTS score. Efficacy of PsA treatment was confirmed by the improved clinical findings. Both PsADECTS and iodine uptake also showed significant improvement after treatment (Wilcoxon signed-rank test: z = 7.38, p < 0.005; z = 6.20, p < 0.005, respectively). The treatment effects of PsADECTS score and iodine uptake showed a good correlation with each other (Spearman's ρ = 0.58 p < 0.005). Inter-reader agreement for PsADECTS score and iodine uptake were either moderate or good. In conclusion, our study showed that the DECT iodine map is a valid tool for quantitative assessment of the therapeutic response of PsA.

Evaluation of epicardial adipose tissue volume and coronary artery calcification in Japanese patients with psoriasis vulgaris.

Epicardial adipose tissue (EAT) is implicated in the development of coronary atherosclerosis by secretion of inflammatory adipocytokines. Recent studies have shown significantly higher EAT volume in psoriatic patients compared with that in control subjects, but this has not been validated in Japanese patients. We enrolled 86 Japanese patients with moderate to severe psoriasis vulgaris and 31 control subjects, and evaluated EAT volume and coronary artery calcification (CAC) by retrospectively assessing non-enhanced computed tomography obtained through routine examinations. Both mean EAT volume and mean CAC score were not significantly different between the two groups. Interestingly, however, a subanalysis with those of 50 years of age or less (28 psoriatic patients and seven non-psoriatic subjects) showed significantly higher mean EAT volume in psoriatic patients. Similarly, the ratio of the presence of at least one CAC was significantly higher in this group. Our findings suggest that Japanese psoriatic patients should also be aware of the cardiovascular risk, and EAT volume and CAC may be useful tools to predict such risk.

Successful Certolizumab Pegol Treatment of Chronic Anterior Uveitis Associated with Psoriasis Vulgaris.

This report presents details on a 45-year-old male Japanese patient with chronic and refractory anterior uveitis associated with psoriasis vulgaris who was administered certolizumab pegol (CZP), which is an anti-tumor necrosis factor alpha (TNF-α) monoclonal antibody. Although CZP has only been formally approved for rheumatoid arthritis treatment in Japan, a clinical trial allowed us to assess CZP effectiveness in this patient. The grade 3+ anterior chamber inflammation (for both the cells and flare) observed at baseline improved to grade 0 at 3 months post-treatment. Dermatologically, the psoriasis area severity index (PASI) score was 25.4, while the body surface area (BSA) was 88% at baseline. At 3 months after treatment, the scores improved to 2.8 for PASI and less than 1% for BSA. After the treatment, remission has lasted for at least 9 months. No adverse events were seen during the CZP treatment. These findings suggest that CZP could be an effective therapeutic alternative in some refractory anterior uveitis patients with psoriasis vulgaris.

Long-term clinical efficacy and safety of secukinumab for Japanese patients with psoriasis: A single-center experience.

Secukinumab is a fully human monoclonal antibody that can selectively neutralize interleukin-17A, and its excellent efficacy has been demonstrated in clinical trials for psoriasis. The aim of our study is to assess long-term efficacy and safety of secukinumab for 52 weeks in real-world clinical practise in our facility. A total of 83 patients (71 with psoriasis vulgaris and 12 with psoriatic arthritis) were included, and 49 of them were bio-switched patients. Psoriasis Area and Severity Index (PASI) 75 and PASI-90 responses were 80% and 64% at week 12, 77% and 65% at week 24, and 76% and 58% at week 52, respectively. No significant differences were observed in efficacy between bio-naive and bio-switched patients. Arthralgia showed improvement by week 12 in all patients with psoriatic arthritis with a reduction of serum C-reactive protein level. Treatment was discontinued in 22% (18/83), including eight patients with no improvement or exacerbation of cutaneous manifestations, one patient with new onset of arthritis and two patients with transient infection. Overall, secukinumab showed a sustained clinical response with an acceptable safety profile through week 52 in Japanese psoriatic patients.

New onset or transition of disease state of psoriatic arthritis during treatment with ustekinumab: A single-center retrospective study.

Ustekinumab (UST) is a treatment option for psoriatic arthritis (PsA), but recent observations indicate that some psoriatic patients may experience new onset of PsA or worsening of pre-existent PsA. We retrospectively analyzed all cases of psoriasis vulgaris (PsV) and PsA treated with UST in our facility between 2011 and 2015. PsA developed in eight out of 179 PsV patients, mostly later than 8 months after initiation of UST. It was generally not severe, and none had received tumor necrosis factor (TNF)-α inhibitors previously, indicating that the possibility of unmasking pre-existing subclinical arthritis is minimal. The eruptions were well controlled at the time of the onset of arthritis in most cases. Interestingly, those who developed arthritis showed a significantly lower body mass index. Regarding pre-existing PsA, nine PsA patients received UST, and at least partial improvement of PsA could be achieved in two out of three bio-naive and three out of six bio-switched patients from TNF-α inhibitors. PsA was largely more refractory to UST than the eruptions. Altogether, our present study is in agreement with the notion that UST may be less efficient than TNF-α inhibitors for PsA. While UST cannot fully prevent new development of PsA, it is unlikely that UST increases the risk of new onset of PsA as a paradoxical adverse reaction.

Biologic treatments for elderly patients with psoriasis.

The number of elderly patients with psoriasis is increasing in Japan. However, biologic treatment is generally considered to be challenging in elderly patients, due to their increased risk of complications compared with younger patients. Our retrospective study aimed to evaluate the safety profile and efficacy of biologics in senior elderly patients (≥75 years old) with psoriasis. The study involved a cohort of 27 patients aged 75-88 years who were being treated with biologics over a period of more than 1 year. Initial biologics administrated to were adalimumab (five cases) and ustekinumab (22 cases). Eight patients discontinued treatment: two developed cancer; one was transferred to hospital; and five others experienced either bone fracture, interstitial pneumonia, cerebral hemorrhage resulting in death, decrepitude or developed hepatopathy following prophylactic tuberculosis treatment. Efficacy, evaluated by the percentage of patients achieving 75% reduction of Psoriasis Area and Severity Index score, was 76.9% at week 16 (n = 26), 88.0% at week 24 (n = 25) and 90.5% at week 52 (n = 21). Biologic treatments thus show clear efficacy in elderly patients with psoriasis, however, the increased frequency of adverse events requires rigorous patient observation.