The IL-17A inhibitor secukinumab may improve pain and disease activity among patients with psoriatic arthritis or axial spondyloarthritis and imaging-confirmed enthesitis at the Achilles tendon, suggest findings from the ACHILLES trial.

The IL-17A inhibitor secukinumab may improve pain and disease activity among patients with psoriatic arthritis or axial spondyloarthritis and imaging-confirmed enthesitis at the Achilles tendon, suggest findings from the ACHILLES trial.

A post-hoc analysis of the SPIRIT-P1 and SPIRIT-P2 trials suggests that treatment with ixekizumab is associated with improvements in enthesitis and dactylitis among patients with psoriatic arthritis.

Apremilast is an effective treatment for enthesitis and dactylitis in individuals with psoriatic arthritis, according to a pooled analysis of three phase III trials.

Elalouf O et al. J Rheumatol 2018. doi: 10.3899/jrheum.171466

These findings are based on the phase 3 JUVE-BASIS trial, which included 220 patients aged 2–17 years with polyarticular course juvenile idiopathic arthritis (JIA), enthesitis-related arthritis, or juvenile psoriatic arthritis and an inadequate response to at least one conventional or biologic DMARD.

Enthesitis and dactylitis as secondary outcomes were also reviewed.

They continue, however, that “their effect in polyarticular [juvenile idiopathic arthritis] and adults with axial SpA supports their use in children and adolescents with JoSpA and enthesitis-related arthritis.”

The authors, led by Laura Coates (University of Oxford, UK), say that their recommendations “utilize a domain-based approach,” with subcommittees developing guidance spanning the six domains of PsA: peripheral arthritis; axial disease; enthesitis; dactylitis; skin psoriasis; and nail psoriasis.

Following the latest announcement, it may now be given to patients aged 6 years and older with active juvenile PsA or enthesitis-related arthritis (ERA) and an inadequate response or intolerance to conventional therapy.

Multivariable regression analysis revealed that the presence of psoriasis was associated with a significantly increased likelihood of diagnostic delay and enthesitis, at odds ratios (ORs) of 1.06 and 2.39 per year, respectively.

Patients with nADAb reported significantly worse joint pain, patient’s global assessment, Health Assessment Questionnaire, Bath Ankylosing Spondylitis Disease Activity/Functional Index and Short-Form-36 physical functioning scale score than patients without nADAb ( p  < 0.04, adjusted analyses). 28-joint Disease Activity Score, Simplified Disease Activity Index and Maastricht Ankylosing Spondylitis Enthesitis score were also significantly worse in the nADAb-positive patients ( p  < 0.04, adjusted analyses), as were serum calprotectin, C-reactive protein and numbers of circulating peripheral leukocytes ( p  ≤ 0.001).

Laura Sawyer (Symmetron Limited, London, UK) report in RMD Open that most agents “were better than placebo and similar to one another” for the outcomes of ACR response , PASI response , and resolution of enthesitis and dactylitis.

Moreover, patients with dactylitis were significantly more likely than those without to have clinical enthesitis (51.9 vs 35.4%) and elevated C-reactive protein levels (>10 mg/L; 44.4 vs 25.0%).

In addition, there was consistency between the monotherapy and combination therapy groups for placebo-subtracted ACR50 and ACR70 response rates at week 12, as well as rates of minimal disease activity and resolution of enthesitis and dactylitis at week 24, say Nash et al.

Patients with musculoskeletal symptoms, namely arthralgia, were a significant two times more likely to develop PsA than those without, while those with imaging-detected musculoskeletal inflammation (inflammation synovitis, enthesitis, or tenosynovitis) or structural damage (erosion and entheseal new bone formation) were almost four times more likely.

The poster by Köhm and co-authors also demonstrated that changes in other outcomes such as joint counts, DAPSA , PASI , enthesitis, dactylitis, and quality of life were similar between the two groups at week 24.