Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients with Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations

Deepak R Jadon¹, Nadia Corp², Danielle A van der Windt², Laura C Coates³, Enrique R Soriano⁴, Arthur Kavanaugh⁵, Tim Raine⁶, Florian Rieder⁷, Stefan Siebert⁸, Michel Zummer⁹, Sergio Schwartzman¹⁰, James T Rosenbaum¹¹, Brigitte Michelsen¹², Ramasharan Laxminarayan¹³, Dongze Wu¹⁴, Latika Gupta¹⁵, Beverly Ng¹⁶, Hannah Jethwa¹⁷, Nick De Windt¹⁸, Tania Gudu¹⁹, Joseph Hutton²⁰, Denis O'Sullivan²¹, Michele M Luchetti²², Matthew Stoll²³, Jasvinder A Singh²⁴, Rosario Peluso²⁵, Judith Rademacher²⁶, M Elaine Husni²⁷

Affiliations

¹ D.R. Jadon, MBBCh, PhD, Department of Rheumatology, University of Cambridge, Cambridge, UK; dj351@medschl.cam.ac.uk.
² N. Corp, PhD, D.A. van der Windt, PhD, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK.
³ L.C. Coates, MBChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁴ E.R. Soriano, MD, MSc, Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
⁵ A. Kavanaugh, MD, Division of Rheumatology Allergy and Immunology, University of California, San Diego, California, USA.
⁶ T. Raine, MB, BChir, PhD, Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁷ F. Rieder, MD, Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁸ S. Siebert, MD, Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK.
⁹ M. Zummer, MD, Division of Rheumatology, CH Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada.
¹⁰ S. Schwartzman, MD, Hospital for Special Surgery, Weill Cornell Medical Center, New York City, New York, USA.
¹¹ J.T. Rosenbaum, MD, Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and the Legacy Devers Eye Institute, Portland, Oregon, USA.
¹² B. Michelsen, MD, PhD, Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway.
¹³ R. Laxminarayan, MD, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, UK.
¹⁴ D. Wu, PhD, Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
¹⁵ L. Gupta, MD, DM, Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, and Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK.
¹⁶ B. Ng, MBBS, MSc, Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁷ H. Jethwa, MBChB, PhD, Department of Rheumatology, Royal Free London NHS Foundation Trust, Imperial College Healthcare NHS Trust, London, UK.
¹⁸ N. De Windt, BS, Department of Rheumatology, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁹ T. Gudu, MD, PhD, Rheumatology Department, Cambridge University Hospitals NHS FT, Cambridge, UK.
²⁰ J. Hutton, MBChB, University of Cambridge, Cambridge, UK.
²¹ D. O'Sullivan, BE, Rheumatic & Musculoskeletal Disease Unit, Our Lady's Hospice & Care Services, Dublin, Ireland.
²² M.M. Luchetti, MD, Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.
²³ M. Stoll, MD, PhD, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
²⁴ J.A. Singh, MBBS, MPH, Medicine Service, VA Medical Center, and Department of Medicine, School of Medicine, University of Alabama at Birmingham, and Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama, USA.
²⁵ R. Peluso, MD, PhD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, School of Medicine, University Federico II of Naples, Naples, Italy.
²⁶ J. Rademacher, MD, Department of Gastroenterology, Infection, and Rheumatology, Universitätsmedizin Berlin, and Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.
²⁷ M.E. Husni, MD, MPH, Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA.

PMID: 36455946
PMCID: PMC10921838
DOI: 10.3899/jrheum.220317

Review

Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients with Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations

Deepak R Jadon et al. J Rheumatol. 2023 Mar.

. 2023 Mar;50(3):438-450.

doi: 10.3899/jrheum.220317. Epub 2022 Dec 1.

Authors

Affiliations

¹ D.R. Jadon, MBBCh, PhD, Department of Rheumatology, University of Cambridge, Cambridge, UK; dj351@medschl.cam.ac.uk.
² N. Corp, PhD, D.A. van der Windt, PhD, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK.
³ L.C. Coates, MBChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁴ E.R. Soriano, MD, MSc, Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
⁵ A. Kavanaugh, MD, Division of Rheumatology Allergy and Immunology, University of California, San Diego, California, USA.
⁶ T. Raine, MB, BChir, PhD, Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁷ F. Rieder, MD, Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁸ S. Siebert, MD, Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK.
⁹ M. Zummer, MD, Division of Rheumatology, CH Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada.
¹⁰ S. Schwartzman, MD, Hospital for Special Surgery, Weill Cornell Medical Center, New York City, New York, USA.
¹¹ J.T. Rosenbaum, MD, Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and the Legacy Devers Eye Institute, Portland, Oregon, USA.
¹² B. Michelsen, MD, PhD, Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway.
¹³ R. Laxminarayan, MD, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, UK.
¹⁴ D. Wu, PhD, Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
¹⁵ L. Gupta, MD, DM, Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, and Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK.
¹⁶ B. Ng, MBBS, MSc, Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁷ H. Jethwa, MBChB, PhD, Department of Rheumatology, Royal Free London NHS Foundation Trust, Imperial College Healthcare NHS Trust, London, UK.
¹⁸ N. De Windt, BS, Department of Rheumatology, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁹ T. Gudu, MD, PhD, Rheumatology Department, Cambridge University Hospitals NHS FT, Cambridge, UK.
²⁰ J. Hutton, MBChB, University of Cambridge, Cambridge, UK.
²¹ D. O'Sullivan, BE, Rheumatic & Musculoskeletal Disease Unit, Our Lady's Hospice & Care Services, Dublin, Ireland.
²² M.M. Luchetti, MD, Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.
²³ M. Stoll, MD, PhD, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
²⁴ J.A. Singh, MBBS, MPH, Medicine Service, VA Medical Center, and Department of Medicine, School of Medicine, University of Alabama at Birmingham, and Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama, USA.
²⁵ R. Peluso, MD, PhD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, School of Medicine, University Federico II of Naples, Naples, Italy.
²⁶ J. Rademacher, MD, Department of Gastroenterology, Infection, and Rheumatology, Universitätsmedizin Berlin, and Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.
²⁷ M.E. Husni, MD, MPH, Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA.

PMID: 36455946
PMCID: PMC10921838
DOI: 10.3899/jrheum.220317

Abstract

Objective: Several advanced therapies have been licensed across the related conditions of psoriatic arthritis (PsA), Crohn disease (CD), ulcerative colitis (UC), and noninfectious uveitis. We sought to summarize results from randomized controlled trials (RCTs) investigating the efficacy and safety of advanced therapies for these related conditions in patients with PsA.

Methods: We updated the previous systematic search conducted in 2013 with literature reviews of MEDLINE, Embase, and the Cochrane Library (from February 2013 to August 2020) on this subject; only those new studies are presented here. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Results: The number of RCTs meeting eligibility criteria were 12 for CD, 15 for UC, and 5 for uveitis. The tumor necrosis factor inhibitor (TNFi) class appears to be efficacious and safe across CD, UC, and uveitis, with the exception of etanercept. Interleukin 12/23 inhibitors (IL-12/23i) are efficacious for CD and UC. Phase II and III RCTs of Janus kinase inhibitors (JAKi) and IL-23i in CD and UC are promising in terms of efficacy and safety. IL-17i must be used with great caution in patients with PsA at high risk of inflammatory bowel disease (IBD). RCTs in uveitis have mainly studied adalimumab.

Conclusion: We have identified 32 recent RCTs in IBD and uveitis and updated recommendations for managing patients with PsA and these related conditions. A multispecialty approach is essential to effectively, safely, and holistically manage such patients. Advanced therapies are not equally efficacious across these related conditions, with dosing regimens and safety varying.

Keywords: GRAPPA; psoriasis; psoriatic arthritis.

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References

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Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients with Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations

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Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients with Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations

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