The edition · Rheumatology
Signals a decade before the diagnosis, and an oral TYK2 inhibitor at 52 weeks
Predictors of psoriatic arthritis are present the day psoriasis is diagnosed; Swedish registry data show healthcare patterns diverging ten years before rheumatoid arthritis; a masked Lancet trial finds no benefit from robotic knee replacement; and deucravacitinib reports a full year in psoriatic arthritis.
The edition in brief
An inception cohort of 628 people enrolled within a year of their first psoriasis lesion found 13% already had concomitant psoriatic arthritis, and built prediction models with optimism-adjusted areas under the curve of 0.76-0.84. Recursive partitioning on arthralgia, fatigue, psoriasis phenotype, high-sensitivity CRP and psoriasis activity separated groups with concomitant psoriatic arthritis risks from 1% to 62%; pain, HLA-B27 and systemic inflammation were the strongest predictors of future disease, and the models were unstable and need external validation. A meta-analysis of 53 studies and 33,694 lupus pregnancies put structural cardiovascular malformations in offspring at 3.29% (95% CI 2.48-4.21) and congenital heart block at 1.29% (0.82-1.88); the malformation risk against healthy controls was an odds ratio of 3.52 (2.13-5.81) unadjusted and 1.70 (1.22-2.36) across five multivariable-adjusted studies. Swedish multiregister data on 6,824 patients with seropositive rheumatoid arthritis identified five pre-diagnosis healthcare trajectories, with divergence from matched controls beginning as early as ten years before diagnosis. RACER-Knee, a pragmatic masked randomised trial in 339 patients at ten British hospitals, found robotic-arm-assisted total knee replacement no better than conventional instruments on the Forgotten Joint Score at 12 months (adjusted mean difference -1.5, 95% CI -7.5 to 4.5) and more costly. And POETYK PsA-1 randomised 670 biologic-naive patients with active psoriatic arthritis to oral deucravacitinib 6 mg daily or placebo: ACR20 at week 16 was 54.2% against 34.1% (P<0.001), with responses maintained to week 52, structural damage inhibition, and serious adverse events in 1.8% against 2.4%.
The predictors of psoriatic arthritis are already there on the day psoriasis is diagnosed
Screen for joint symptoms and check a CRP at the first psoriasis visit - one in eight already has psoriatic arthritis at that point, and the features that identify them are all available on day one.
Structural heart malformations in lupus pregnancy, and a more honest reading of congenital heart block
Base the pregnancy risk conversation on anti-Ro status and disease activity rather than on the lupus diagnosis - heart block risk follows the antibody, and the structural malformation estimate falls by half once confounders are adjusted for.
Healthcare use diverged from the general population ten years before rheumatoid arthritis was diagnosed
In a patient with years of analgesic use and musculoskeletal admissions, or with recurrent infections and new joint symptoms, check inflammatory markers and serology - these were the patterns diverging years before diagnosis.
Robotic knee replacement cost more and did not help, in a properly masked trial
For routine primary knee replacement, robotic assistance gave no patient-reported benefit at a year and cost more - though patients with inflammatory arthritis were excluded, so the question is untested in them.
Ask about the skin, and then look at it
In inflammatory joint pain, ask about the scalp, umbilicus and natal cleft by name and look at the nails yourself - a general question about skin problems misses most psoriasis.
An oral TYK2 inhibitor held its psoriatic arthritis response through a year
Deucravacitinib is a genuine oral option in biologic-naive active psoriatic arthritis, with an ACR20 of 54.2% against 34.1% and low serious adverse events to a year - but treat the reassuring safety profile as provisional, not settled.
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