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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPsoriatic arthritis (PsA) is a serious and progressive disease associated with significant morbidity and mortality. Defining outcome measures in PsA has been challenging because of the wide spectrum of clinical presentation, perceived low prevalence, and relapsing\/remitting cycle. None of the current methods for defining outcome have been validated in PsA patients.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Earthritis\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EPsoriatic arthritis (PsA) is a serious and progressive disease associated with significant morbidity and mortality. Seventeen percent (17%) of PsA patients have \u2265 5 deformed joints, 40% to 50% deforming arthritis, 20% to 40% spinal involvement, and 11% to 19% are disabled. Defining outcome measures in PsA has been challenging because of the wide spectrum of clinical presentation, perceived low prevalence, and relapsing\/remitting cycle. None of the current methods for defining outcome have been validated in PsA patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EBeginning with Moll and Wright, several attempts have been made to develop a standard set of criteria to differentiate PsA. Recently, domains for the assessment of PsA were identified by the ClASsification of Psoriatic ARthritis (CASPAR) (\u003Cem\u003EAnn Rheum Dis.\u003C\/em\u003E 2005;64:113\u2013118) group and further refined through the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) (\u003Cem\u003EAnn Rheum Dis.\u003C\/em\u003E 2005;64:111\u2013112). The following were identified as important in the assessment of patients with PsA: inflammation (peripheral joints, axial skeleton, physician global assessment), other features (dactylitis, enthesitis), skin and nails, imaging, biomarkers, and patient derived indices (pain, quality of life, itch, function). These are being further refined and instruments to measure individual items are being developed.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EWhat can imaging tell us about PsA? MRI\u0027s ability to assess both detailed changes in bone structure and synovial inflammation, combined with its multiplanar capability, makes it a potentially valuable tool for assessing patients with PsA. Possible uses include: diagnosis and classification; early assessment of bony erosions (to define patients who already have articular structural damage); quantification of primary site synovial inflammation (potentially allowing prediction of further erosions and disease progression); simultaneous assessment of synovitis and joint erosion; and long-term evaluation of treatment outcome.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EMost of the clinical trials that have evaluated the efficacy and safety of DMARDs in PsA have been small, had high placebo response rates and, particularly in the case of MTX, were underpowered to assess clinical benefit. In one of the larger trials conducted with sulfasalazine (SSZ), in which 221 PsA patients were followed over 36 weeks, significantly more patients in the SSZ group achieved PsARC (57.8% vs 44.6%; p=0.05, SSZ vs placebo, respectively). SSZ patients also showed a significant (p\u0026lt;0.001) decrease in ESR (\u003Cem\u003EArthritis Rheum.\u003C\/em\u003E 1996; 39:2013\u201320). Results from a 24-week double-blind RCT studying the safety and efficacy of leflunomide in the treatment of 139 patients with PsA were published in 2004 (\u003Cem\u003EArthritis Rheum.\u003C\/em\u003E 2004; 50:1939\u201350). In this study, significantly more patients in the leflunomide group achieved PsARC compared with the placebo group (59% vs 30%, p\u0026lt;0.0001, leflunomide and placebo respectively). ACR 20 was achieved in 36% of leflunomide-treated vs 20% of placebo-treated patients. PASI 50 and 75 scores (a score to assess improvement in cutaneous involvement) were also significantly improved in the leflunomide group (30% vs 19%; p=0.003 and 17% vs 8%; p=0.048, PASI 50 and 75, leflunomide and placebo, respectively).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/3\/31\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1491090895\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/3\/31\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/3\/31\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/3\/31\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10865\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ESeveral biologic agents have been studied in PsA including alefacept, which targets the inhibition of T-cell activation and migration, IL-1ra (anakinra), which targets immune deviation, as well as etanercept, infliximab, and adalimumab, which block the activity of inflammatory cytokines. Additional trials, in patients with PsA, with these compounds singly and in combination are needed. Future therapies include IL-15, IL-6, abatacept, rituximab, anti-angiogenesis, FVIII therapies, and B-cell blockade. Investigations should be undertaken to determine whether genetics could assist in determining the most appropriate therapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/3\/31.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm5lq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm5lq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}