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Biologic disease-modifying antirheumatic drugs (bDMARD), in particular anti-tumor necrosis factor (anti-TNF) medications, which were developed in the 1990s, have improved the radiographic and functional status of patients with rheumatoid arthritis (RA)1. It has been thought as a corollary that rates of joint replacement in patients with RA would decrease. Results in various national databases since the advent of biologic medications have been discrepant; for example, in a US cohort there was a decrease in arthroplasty in juvenile idiopathic arthritis, but not RA from 1991 to 20052, whereas in Ireland the arthroplasty rate was halved from 1995 to 20103. In Japan there was no change in the rate up to 2008, while in Sweden the hip arthroplasty rate decreased, but the knee rate did not4. Overall, however, the trend seems to be toward lower rates of arthroplasty in patients with RA. An article in this issue of The Journal , by Stamp, et al 5, provides an interesting analysis of the rates of joint replacement in New Zealand from 1999 to 2015 in both OA and RA since the advent of … Address correspondence to Dr. B.K. Johnson, Jacobi/NCB, Rheumatology, 1400 Pelham Parkway, South Building 1, Suite 306, New York, New York 10461, USA. E-mail: beverly.johnson06{at}gmail.com

Objective We compared the prevalence and the clustering of the metabolic syndrome (MetS) components (obese body mass index [BMI; ≥30 kg/m2], hypertriglyceridemia, low high-density lipids, hypertension, and diabetes mellitus) in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. Methods We included CORRONA participants with a rheumatologist-confirmed clinical diagnosis of PsA or RA with complete data. We used a modified definition of MetS that did not include insulin resistance, waist circumference, or blood pressure measurements. Logistic regression models were adjusted for age, sex, and race. Results In the overall CORRONA population, the rates of diabetes mellitus and obesity were significantly higher in PsA compared with RA. In 294 PsA and 1,162 RA participants who had lipids measured, the overall prevalence of MetS in PsA versus RA was 27% versus 19%. The odds ratio (OR) of MetS in PsA versus RA was 1.44 (95% confidence interval [95% CI] 1.05–1.96, P = 0.02). The prevalence of hypertriglyceridemia was higher in PsA compared with RA (38% versus 28%; OR 1.51 [95% CI 1.15–1.98], P = 0.003). The prevalence of type 2 diabetes mellitus was also higher in PsA compared with RA (15% versus 11%; OR 1.56 [95% CI 1.07–2.28], P = 0.02) in the adjusted model. Similarly, higher rates of hypertriglyceridemia and diabetes mellitus were observed in the subgroup of PsA and RA patients with obese BMI. Conclusion Compared with RA, PsA is associated with higher rates of obesity, diabetes mellitus, and hypertriglyceridemia.

Objective The association between psoriatic arthritis (PsA) disease activity and lipid profiles has not been explored. We studied the association between active peripheral arthritis and/or enthesitis/daclylitis with lipid measurements in PsA. Methods We conducted a cross-sectional study of PsA patients enrolled in the Consortium of Rheumatology Researchers of North American (CORRONA) registry. Low activity was defined as Clinical Disease Activity Index (CDAI) ≤ 10 without enthesitis or dactylitis. Moderate-to-high peripheral disease activity was defined as CDAI > 10 and/or the presence of enthesitis/dactylitis. Results Of the 4672 patients with PsA enrolled in the CORRONA registry from June 2008 to October 2012, 725 (15.5%) had complete data on CDAI and lipid measurements. Of them, 284 (39%) patients had CDAI > 10 and/or enthesitis/dactylitis. Moderate-to-high group included more women and more current smokers. Patients with moderate-to-high disease activity had shorter duration of disease, and were more likely to be on prednisone, but less likely to use tumor necrosis factor (TNF) inhibitors. Moderate-to-high peripheral disease activity was associated with abnormal total cholesterol (TC) (>200mg/dl), odds ratio (OR) = 1.58; 95% CI: (1.11, 2.24); p = 0.01, and abnormal triglycerides (TG) (>150mg/dl), OR=1.64; 95% CI: (1.16, 2.32); p = 0.005, after adjusting for gender, duration of PsA, smoking, body mass index, diabetes, modified Heath Assessment Questionnaire scores, as well as the following medications: methotrexate, other non-biologic disease modifying anti-rheumatic drugs, prednisone, TNF inhibitors, cholesterol lowering medications, and fish oil. The presence of enthesitis and/or dactylitis, irrespective of CDAI scores, was associated with abnormal TC, OR=1.64; 95% CI: (1.08, 2.48); p = 0.02. Conclusion Our findings suggest an association between peripheral joint inflammation and lipid dysregulation in PsA. Further studies are needed to determine if treating PsA improves lipid profiles and cardiovascular mortality.

In order to describe the clinical and serologic features of a cutaneous vasculitis due to cocaine contaminated with the adulterant levamisole, we report four new cases of this syndrome along with 12 previously reported cases identified through a PubMed Literature search (1964 to March 2011). Of the 16 patients described, the average age was 43, with a female predominance (81% of patients). Over half of patients had involvement of the earlobes, and the rash frequently affected the extremities in a "retiform" pattern. Leukopenia or neutropenia was reported in 56% of patients. Ninety-three percent were anti-neutrophil cytoplasmic antibody positive, and 63% tested positive for anti-phospholipid antibodies. The predominant pattern seen on histopathological examination of the skin was small vessel vasculitis and/or a thrombotic vasculopathy. Treatment in these patients varied widely, with several patients showing improvement or resolution of the rash without specific therapy following cessation of illicit drug use. This new cutaneous vasculitis syndrome can be recognized by its characteristic rash and skin pathology, together with leukopenia and autoantibody production. Certain clinical features can be attributed to the adulterant levamisole, though cocaine as well may play a role in its pathogenesis.

Background Psoriatic arthritis (PsA) is associated with a higher frequency of abnormal lipids and obesity compared with healthy controls and rheumatoid arthritis. There is also an increased risk of developing PsA in obese individuals, perhaps related to the inflammatory milieu provided by excess adiposity. It is also known that inflammatory cytokines contribute to derangements in lipid metabolism. However, the relationship between disease activity and lipid profiles in PsA is not well studied. Objectives To assess the cross-sectional relationship between PsA disease activity and lipid profiles in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. Methods We analyzed PsA patients followed in CORRONA between 6/2008 and 10/2012 with complete data for lipids and disease activity. Moderate to high disease activity was defined as CDAI>10 and/or presence of enthesitis/dactylitis. Abnormal lipids were defined as: total cholesterol (TC)>200 mg/dl (5.17 mmol/L), High Density Lipoprotein (HDL) 100 mg/dl (2.59 mmol/L), Triglycerides (TG)>150 mg/dl (1.7 mmol/L), and atherogenic ratio (TC/HDL) >5. Models were adjusted for gender, duration of PsA, mHAQ, disease-related medication use, smoking, body mass index (BMI), diabetes (DM), use of cholesterol medications and fish oil. Results Of the 725 PsA patients included in this study, 284 (39%) had moderate to high disease activity. Compared to the low disease activity group, the moderate to high disease activity group had a higher proportion of women (57% vs 46%, p=0.006) and smokers (12.7% vs 7.7%, p=0.029), higher log ESR (2.44 vs 2.13, p=0.003) and log CRP (1.63 vs 1.31, p=0.002), and shorter disease duration (mean 8.7 vs 11.2 years, p=0.001). Those with moderate to high disease activity were more likely to be prescribed prednisone (13% vs 4.5%, p Moderate to high disease activity was associated with higher odds of TC>200 mg/dl, OR 1.6 (1.1, 2.2 95%CI), p=0.010, and higher odds of TG>150 mg/dl, OR 1.6 (1.2, 2.3 95% CI), p=0.005. Enthesitis/dactylitis was positively associated with TC>200 mg/dl, OR 1.6 (1.1, 2.5), p=0.02. There was no significant association found between disease activity and other lipid measures in the moderate to high disease vs low disease groups. Conclusions Moderate to high disease activity in PsA is associated with increased levels of total cholesterol and triglycerides, suggesting a commonality between PsA disease mechanisms and lipid metabolism that deserves further exploration. The implications of this association for cardiovascular disease in PsA need to be studied further. Disclosure of Interest None Declared