Psoriatic arthritis that fails several biologics is rarely truly refractory

The edition in brief

Five Nordic biologics registries followed 14,362 patients with psoriatic arthritis starting biologic or targeted synthetic DMARDs (1999–2020). Over a median of 6.3 years, 36% stopped at least two such drugs, but after applying components of the EULAR framework only about 2% were difficult to manage and 1.2% treatment-refractory with objective inflammation. Female sex, depression and opioid use became more common with each additional discontinuation, pointing to non-inflammatory drivers of apparent failure. In 301 treatment-naive patients with systemic sclerosis-associated pulmonary arterial hypertension in EUSTAR, sustained initial therapy was associated with lower mortality (monotherapy HR 0.50, combination HR 0.40) and less progression in as-treated analyses, though intention-to-treat analyses showed no association, and only 31% with milder haemodynamics were treated. A 12-week randomised trial of the DASH diet in 82 seropositive RA patients found a 0.75-point greater fall in DAS28-ESR, with high attrition. A cross-sectional study of 240 people with lupus linked comorbidity burden to poorer dexterity, grip and daily function. The pearl covers annual PAH screening in systemic sclerosis.