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Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: closed (25 July 2022) | Viewed by 18377

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Prof. Dr. Vincent Goeb

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Rheumatology Department, University Hospital of Amiens, University of Picardie-Jules Verne, Amiens, France
Interests: rheumatoid arthritis; biomarkers; biologics; ankylosing spondylitis; robot-assisted biopsy
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Spondyloarthritis (SpA) and psoriatic arthritis (PsA) are topical diseases that continue to be fascinating. Different patient management strategies have been optimized and today allow rapid diagnosis as well as adapted and stratified management. The contribution of evermore innovative drugs— from methotrexate to leflunomide, apremilast, or anti-JAK, without neglecting the numerous biologics with various mechanisms of action (TNFi, IL-17i, IL12-23i)—is gripping. The clinical presentation of SpA and PsA changes, and thus, clinicians’ interest has been focused on certain extra-articular manifestations that may affect the skin, eyes, and bowels and on the management of various comorbidities such as cardiovascular risk that affects the life expectancy of our patients.

This Special Issue on “Ankylosing Spondylitis and Psoriatic Arthritis: Pathogenesis, Diagnosis, and Therapies” is now open to contributions. We look forward to receiving papers on the pathophysiology of SpA and PsA, diagnostic innovations (biomarkers, imaging, etc.), and therapeutic strategies, as well as articles that provide feedback on the various available treatments. Studies considering the coronavirus disease 2019 (COVID-19) pandemic and its consequences on our patients will also be welcome.

Respectfully,

Prof. Dr. Vincent Goeb
Guest Editor

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Keywords

Psoriatic Arthritis
Spondyloarthritis
Uveitis, Psoriasis
Ankylosing Spondylitis
Biologics
Crohn
HLA

Published Papers (7 papers)

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Research

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8 pages, 566 KiB

Open AccessArticle

Non-Physical Disease Facets in Spondyloarthritis: An ASAS Health Index-Based Analysis between Psoriatic Arthritis and Axial Spondyloarthritis

by Rubén Queiro, Sara Alonso, Isla Morante and Mercedes Alperi

J. Clin. Med. 2022, 11(20), 6094; https://doi.org/10.3390/jcm11206094 - 16 Oct 2022

Viewed by 2748

Abstract

Background: Psychosocial health is a key driver of quality of life (QoL) in axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), but it is often overlooked in clinical practice. We aimed to analyze this aspect of QoL by using the Assessment of SpA International Society–Health Index (ASAS HI) in both SpA phenotypes. Patients and methods: One hundred and eleven patients with axSpA and 90 with PsA were consecutively recruited from two rheumatology centers. In both populations, the categories of stress handling (ASAS HI items #11 and 17) and emotional functions (ASAS HI item #13) were analyzed based on the International Classification of Functioning, Disability, and Health (ICF). A multivariate regression model was used to analyze the explanatory factors associated with positive responses to these items. Results: Thirty-four of the 90 PsA patients (37.8%) and 37/111 of the patients (33.3%) with axSpA reported a positive response to at least one of the stress-handling items. Compared to the patients with PsA, patients with axSpA were less likely to report stress-handling issues (OR 0.48, p < 0.05). Thirty-one of the 90 PsA patients (34.4%) and 44/111 of the patients (39.6%) with axSpA reported positive responses to item #13. In both groups of SpA patients, disease activity and severity (OR 6.6, p < 0.001) were independently associated with alterations in psychosocial health. Compared with those in the axSpA group, the psychosocial health items were better correlated with each other and with the ASAS HI sum score in the PsA group. Conclusions: Psychosocial health is frequently altered in SpA. Both disease activity and severity are associated with this issue. However, psychosocial factors seem to have a greater impact on QoL in PsA than in axSpA. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

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13 pages, 978 KiB

Open AccessArticle

Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study

by Salvatore D’Angelo, Carlo Salvarani, Francesca Marando, Giuliana Gualberti, Lucia Novelli, Giacomo Curradi, Giovanni Tripepi, Annalisa Pitino, Roberta Ramonda and Antonio Marchesoni

J. Clin. Med. 2022, 11(12), 3553; https://doi.org/10.3390/jcm11123553 - 20 Jun 2022

Cited by 3 | Viewed by 1364

Abstract

In this study, we evaluated the presence of residual disease in patients with axial spondyloarthritis (axSpA) in remission/low disease activity (LDA) status. This cross-sectional post-hoc analysis of the QUASAR study involving 23 rheumatology centres across Italy included adults with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Patients with inactive disease (score < 1.3) or at least LDA status (score < 2.1) at baseline visit according to Ankylosing Spondylitis Disease Activity Score were investigated to evaluate how residual disease activity impacts patients’ quality of life. They were assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaires. This study included 480 patients with axSpA (mean age, 47.5 ± 12.9 years, 64% male). In total, 123 patients (25.6%) had inactive disease and 262 (54.6%) had at least LDA. Using the ASQoL, ranges of 10–25% and 20–40% of patients with inactive disease and with LDA status, respectively, experienced tiredness/fatigue. Despite being classified with inactive disease, 48.8% of patients reported light pain/discomfort according to the EQ-5D-5L, with 4.1% reporting moderate pain/discomfort, whereas 55.7% of patients with LDA reported light pain/discomfort and 13% had moderate pain/discomfort. Using the ASQoL questionnaire, in patients with at least LDA, a higher proportion of women compared with males and a higher proportion of patients > 48 years of age (vs. patients ≤ 48 years) experienced tiredness. In this post-hoc analysis, ≥25% of axSpA patients in remission/LDA status were still burdened by residual disease, mainly characterised by pain and fatigue. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

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17 pages, 351 KiB

Open AccessArticle

Searching for New Genetic Biomarkers of Axial Spondyloarthritis

by Bartosz Bugaj, Joanna Wielińska, Katarzyna Bogunia-Kubik and Jerzy Świerkot

J. Clin. Med. 2022, 11(10), 2912; https://doi.org/10.3390/jcm11102912 - 20 May 2022

Cited by 2 | Viewed by 1819

Abstract

Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory condition of the spine. In addition to musculoskeletal symptoms, there are also extra-articular manifestations. The aim of this study was to search for new biomarkers associated with the clinical presentation and treatment response in axSpA patients. Methods: In this study, 106 axSpA patients and 110 healthy controls were enrolled. Six single-nucleotide polymorphisms (SNPs) were selected for genotyping: ERAP1 rs2287987, ERAP2 rs2549782, TNF rs1800629, TNFRSF1A rs767455, TNFRSF1B rs1061622, and FCGR2A rs1801274. Participants were examined at baseline and after 12 and 24 weeks of anti-TNF therapy. Results: SNPs associated with high axSpA initial activity were TNFRSF1A rs767455 and TNFRSF1B rs1061622 (p < 0.008). The ERAP1 rs2287987 AA genotype was more frequently observed in patients with enthesitis (AA vs. G+, p = 0.049), while the TNFRSF1B rs1061622 GG genotype was more common in participants with uveitis (GG vs. TT, p = 0.042). Potential in predicting anti-TNF treatment response was demonstrated by ERAP1 rs2287987, ERAP2 rs2549782, TNFRSF1B rs1061622, and FCGR2A rs1801274. Conclusions: SNPs can be used to identify patients at risk of severe disease to initiate treatment earlier. Genetic testing will allow clinicians to choose the right drug for the patient. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

14 pages, 2278 KiB

Open AccessArticle

Associations of IL-18 with Altered Cardiovascular Risk Profile in Psoriatic Arthritis and Ankylosing Spondylitis

by Krzysztof Bonek, Ewa Kuca-Warnawin, Anna Kornatka, Agnieszka Zielińska, Małgorzata Wisłowska, Ewa Kontny and Piotr Głuszko

J. Clin. Med. 2022, 11(3), 766; https://doi.org/10.3390/jcm11030766 - 30 Jan 2022

Cited by 7 | Viewed by 4136

Abstract

Objective: To investigate the associations of IL-18 serum levels with serum lipids, cardiovascular risk, and disease activity in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with axial (axPsA) and peripheral (perPsA) joint involvement. Methods: 155 adult patients (PsA 61/AS 94) were enrolled in the study. Standard disease activity indices, BASDAI, and ASDAS, were calculated for AS and PsA and DAPSA for PsA. Sera from peripheral blood samples were obtained after night fasting. Serum concentrations of cytokines (IL-18, IL-17) were measured by ELISA, while lipid profile with total cholesterol (TC), triglycerides (TG), low-density cholesterol-(LDL), high-density cholesterol (HDL), and C-reactive protein (CRP) concentrations were determined using routine procedures. The atherogenic index was calculated using the standard formula AI = TC/HDL. Results: Patients with PsA and peripheral joint involvement (perPsA) had significantly higher IL-18 serum levels than axial PsA and AS patients (medians 160 vs. 116 vs. 80 pg/mL). In patients with PsA and in the subgroup with PsA+ ischemic heart disease (IHD), IL-18 positively correlated with atherogenic index (AI) (rho = 0.46 and rho = 0.67, respectively) and TG serum concentrations (rho = 0.4 and rho = 0.675), while negatively with HDL levels (rho = −0.37 and rho = −0.608). In PsA + IHD subgroup IL-18 serum levels correlated positively also with disease activity (DAPSA) (rho = 0.613). Importantly, in patients with perPsA, characterized by the highest IL-18 serum levels, cardiovascular risk, and frequency of both hypertriglyceridemia and IHD, positive correlations between IL-18 and IL-17 (rho = 0.47, p = 0.002), TG (rho = 0.45 p = 0.01) levels and AI (rho = 0.63 p = 0.021) were found. Whereas linear regression models revealed that IL-17, TG concentrations and the tender joint count had an impact on IL-18 Conclusions: We confirmed that patients with perPsA are characterized by a more pronounced proinflammatory and proatherogenic cardiovascular risk profile than patients with axPsA and AS. Importantly our study indicates that in PsA, but not in AS, elevated serum concentration of IL-18 is associated with higher disease activity and proatherogenic lipid profile, leading to a higher cardiovascular risk. Thus, our results point out IL-18 as a critical contributor in these pathological processes and possible therapeutic targets. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

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10 pages, 854 KiB

Open AccessArticle

Risk of Acute Anterior Uveitis in Ankylosing Spondylitis According to the Type of Tumor Necrosis Factor-Alpha Inhibitor and History of Uveitis: A Nationwide Population-Based Study

by Soo Min Ahn, Minju Kim, Ye-Jee Kim, Yusun Lee and Yong-Gil Kim

J. Clin. Med. 2022, 11(3), 631; https://doi.org/10.3390/jcm11030631 - 26 Jan 2022

Cited by 3 | Viewed by 2481

Abstract

Background: We evaluated the risk of acute anterior uveitis (AAU) in patients with ankylosing spondylitis (AS) during treatment with tumor necrosis factor-alpha inhibitors (TNFis). Methods: This study was performed on AS patients using the Korean National Health Insurance claims database. We analyzed the first and total occurrence of AAU during the first 2 years of TNFis use according to the type of TNFis. Additionally, the occurrence of AAU was assessed in subgroups with or without prior AAU before TNFis initiation. Results: In total, 5938 AS patients initiated TNFis use between 2009 and 2017 and used them for more than 2 years. Among them, 1488 (25.1%) patients had a history of AAU before starting TNFis treatment. Compared to adalimumab, the use of etanercept (hazard ratio [HR] 1.77) increased the risk of AAU. The incidence rate ratio (IRR) of AAU with etanercept was significantly higher than that of adalimumab (IRR 1.78). The IRR of AAU was also higher for etanercept than adalimumab use in patients with (IRR 1.86) and without (IRR 2.92) a history of AAU. Conclusion: These data suggest that compared to anti-TNF-alpha monoclonal antibodies, etanercept has a higher incidence of AAU regardless of a history of AAU. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

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13 pages, 856 KiB

Open AccessArticle

The Prevalence of Atopy in Biologically Treated Spondyloarthropathies: A Retrospective Study of 200 Patients

by Georgiana Strugariu, Cristina Pomîrleanu, Codruța Bran, Andrei Costea, Andrei Vicovan, Diana Tatarciuc, Irina Eșanu, Eugen Ancuța, Rodica Chirieac and Codrina Ancuța

J. Clin. Med. 2022, 11(1), 55; https://doi.org/10.3390/jcm11010055 - 23 Dec 2021

Cited by 2 | Viewed by 2018

Abstract

(1) Background: Recent data shed light on the association between atopic disorders (ADs) (atopic dermatitis, allergic asthma, allergic rhinitis) and spondyloarthropathies (SpAs), underpinning the critical role of T helper (Th)1-Th17/Th2-T regulatory cells disbalance. We evaluated the prevalence of AD in axial SpAs (axSpAs) and psoriatic arthritis (PsA) and explored the potential association between atopic status, disease-related parameters, and biological therapy. (2) Methods: A monocentric, retrospective study was conducted that enrolled 200 patients taking biologics. Demographics, disease, and drug-related variables, along with a screening questionnaire focused on Ads, were systematically collected. (3) Results: Overall, 51 patients (25.5%) had atopy—namely, 24.4% of axSpA and 28% of PsA, with a higher frequency of rhinitis (43%) vs. atopic dermatitis (37.2%) or asthma (21.5%). We failed to demonstrate any statistically significant difference in demographics, SpA-related parameters excepting concomitant inflammatory bowel disease, and biologic drug exposure in patients with and without atopy (p > 0.05). However, significantly more non-atopic patients need only one TNF inhibitor (54%) vs. atopic patients (28%) (p < 0.05) to control active SpA. (4) Conclusions: We successfully demonstrated that AD is associated with one out of four SpA. Irrespective of the SpA subtype, atopic patients require more frequent switching among biologics, as significantly more non-atopic patients remain on their first anti-TNF. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

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18 pages, 820 KiB

Open AccessReview

Exploring the Diverse Immune and Genetic Landscape of Psoriatic Arthritis

by Bogdan Batko

J. Clin. Med. 2021, 10(24), 5926; https://doi.org/10.3390/jcm10245926 - 17 Dec 2021

Cited by 2 | Viewed by 2710

Abstract

Psoriatic arthritis (PsA) is characterized by delays in diagnosis and modest effect of treatment in terms of joint response. An understanding of molecular pathomechanisms may aid in developing diagnostic and prognostic models. Genetic susceptibility (e.g., HLA class I genes, IL-23-related genes) can be responsible for the pattern of psoriatic manifestations and affinity for tissue involvement. Gene expression analysis indicates an inflammatory profile that is distinct for PsA, but disparate across tissues. This has clinical implications, as for example, dual blockade of IL-17A and IL-17F can lead to superior clinical effects if there is differential expression of IL-17 receptors in tissues. Structural and functional impairment of barrier tissue, including host-microbiome interactions, may be the source of immune activation. Interplay between different cell populations of innate and adaptive immunity is emerging, potentially providing a link between the transition of skin-to-joint disease. Th17 subsets, IL-17A, IL-17F and IL-23 are crucial in PsA pathogenesis, with both clinical and experimental evidence suggesting a differential molecular landscape in cutaneous and articular compartments. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

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