Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Lihi Eder¹, Ashish J Mathew², Philippe Carron³, Heidi Bertheussen⁴, Juan D Cañete⁵, May Azem⁶, Andrea Delle Sedie⁷, Carlo Salvarani⁸, Roberto Ranza⁹, Ashley Elliott¹⁰, Anthony Turkiewicz¹¹, Ricardo Acayaba de Toledo¹², Hulya Bukulmez¹³, Maria S Stoenoiu¹⁴, Arthur M Mandelin 2nd¹⁵, Michaela Koehm¹⁶, Chris A Lindsay¹⁷, Evan Siegel¹⁸, Philip J Mease¹⁹

Affiliations

¹ L. Eder, MD, PhD, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada; Lihi.EDER@wchospital.ca.
² A.J. Mathew, MBBS, DNB, DM, The Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.
³ P. Carron, MD, PhD, Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, and VIB Center for Inflammation Research, Ghent, Belgium.
⁴ H. Bertheussen, Patient Research Partner, Oslo, Norway.
⁵ J.D. Cañete, DMD, PhD, Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain.
⁶ M. Azem, MD, Solo Private Practice, and Department of Internal Medicine, Lake Hospital, University Hospital Systems, Cleveland, Ohio, USA.
⁷ A. Delle Sedie, MD, Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
⁸ C. Salvarani, MD, Dipartimento Specialità Mediche, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia and Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università di Modena e Reggio Emilia, Modena, Italy.
⁹ R. Ranza, MD, PhD, Rheumatology Unit, Hospital de Clinicas, EBSERH, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil.
¹⁰ A. Elliott, MB Bch BAO, MSc, MRCP, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
¹¹ A. Turkiewicz, MD, Rheumatology Associates, Birmingham, Alabama, USA.
¹² R.A. de Toledo, MD, MSc, Regional School of Medicine Foundation of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
¹³ H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
¹⁴ M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
¹⁵ A.M. Mandelin II, MD, PhD, Northwestern University, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁶ M. Koehm, MD, Rheumatology Division, University Hospital Frankfurt and Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany.
¹⁷ C.A. Lindsay, PharmD, GRAPPA Patient Research Partner, Aurinia Pharmaceuticals Inc., Rockville, Maryland, USA.
¹⁸ E. Siegel, MD, Arthritis and Rheumatism Associates, Rockville, Maryland, and Georgetown University School of Medicine, Washington, DC, USA.
¹⁹ P.J. Mease MD, MACR, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA.

PMID: 36319005
DOI: 10.3899/jrheum.220312

Free article

Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Lihi Eder et al. J Rheumatol. 2023 Feb.

Free article

. 2023 Feb;50(2):258-264.

doi: 10.3899/jrheum.220312. Epub 2022 Nov 1.

Authors

Affiliations

¹ L. Eder, MD, PhD, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada; Lihi.EDER@wchospital.ca.
² A.J. Mathew, MBBS, DNB, DM, The Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.
³ P. Carron, MD, PhD, Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, and VIB Center for Inflammation Research, Ghent, Belgium.
⁴ H. Bertheussen, Patient Research Partner, Oslo, Norway.
⁵ J.D. Cañete, DMD, PhD, Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain.
⁶ M. Azem, MD, Solo Private Practice, and Department of Internal Medicine, Lake Hospital, University Hospital Systems, Cleveland, Ohio, USA.
⁷ A. Delle Sedie, MD, Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
⁸ C. Salvarani, MD, Dipartimento Specialità Mediche, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia and Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università di Modena e Reggio Emilia, Modena, Italy.
⁹ R. Ranza, MD, PhD, Rheumatology Unit, Hospital de Clinicas, EBSERH, Universidade Federal de Uberlandia, Uberlandia, Minas Gerais, Brazil.
¹⁰ A. Elliott, MB Bch BAO, MSc, MRCP, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
¹¹ A. Turkiewicz, MD, Rheumatology Associates, Birmingham, Alabama, USA.
¹² R.A. de Toledo, MD, MSc, Regional School of Medicine Foundation of São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
¹³ H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
¹⁴ M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
¹⁵ A.M. Mandelin II, MD, PhD, Northwestern University, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁶ M. Koehm, MD, Rheumatology Division, University Hospital Frankfurt and Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany.
¹⁷ C.A. Lindsay, PharmD, GRAPPA Patient Research Partner, Aurinia Pharmaceuticals Inc., Rockville, Maryland, USA.
¹⁸ E. Siegel, MD, Arthritis and Rheumatism Associates, Rockville, Maryland, and Georgetown University School of Medicine, Washington, DC, USA.
¹⁹ P.J. Mease MD, MACR, Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA.

PMID: 36319005
DOI: 10.3899/jrheum.220312

Abstract

Objective: Enthesitis is a key pathological and clinical feature of psoriatic arthritis (PsA) in children and adults. Enthesitis is typically assessed clinically using several validated enthesitis scoring systems that have been used in clinical trials. Enthesitis treatment response has been reported as change in the total enthesitis score or the proportion of patients who achieved complete resolution. The majority of trials in PsA did not require patients to have enthesitis at study entry since enthesitis was evaluated only as a secondary outcome. Despite the inherent limitations of the clinical assessment of enthesitis, imaging of the entheses using ultrasound or magnetic resonance imaging has rarely been used in clinical trials to assess response to treatment of enthesitis. This systematic review summarizes existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA to facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA.

Methods: We performed a systematic literature review to identify 41 randomized clinical trials that reported enthesitis treatment response in patients with PsA. For each intervention, the response effect size was summarized and the quality of evidence was graded. Recommendations were then formulated for the various pharmacological and nonpharmacological therapies.

Results: We included 41 randomized clinical trials in our review and graded each intervention.

Conclusion: Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA.

Keywords: GRAPPA; psoriasis; psoriatic arthritis.

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Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

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Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Authors

Affiliations

Abstract

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous