Search

Background/Aims In axial spondyloarthritis, it has been shown that while some adverse lifestyle factors (smoking and high body mass index (BMI)) are less likely to respond to TNF inhibition (TNFi), those who drink alcohol are more likely to respond to treatment - a result currently unexplained, and unlikely to be causal. We aimed to investigate these associations in psoriatic arthritis (PsA) and to quantify the impact of lifestyle factors on TNFi treatment response. Methods Adults with PsA commencing TNFi were identified via the European Spondyloarthritis Research Collaboration Network (https://eurospa.eu). Participants were required to have data on lifestyle factors (smoking, alcohol consumption, and/or BMI) recorded within ±30 days of commencing TNFi. The relationship between lifestyle factors and treatment outcome (ACR-50 response criteria at 12 months) was assessed using logistic regression, adjusted for age, sex, country, year of TNFi initiation, disease duration and baseline disease activity (DAS28). The analysis was then repeated for other treatment response criteria: ACR-20, ACR-70, DAPSA28-remission, DAPSA68-remission and Minimal Disease Activity. Results From 12 PsA registries, 9409 participants were included, 21% of whom were current smokers, 54% drank alcohol, 38% were overweight and 29% were obese. Other baseline characteristics are shown in Table 1. Among smokers, 18% met ACR-50 response criteria at 12 months, versus 26% of non-smokers, an association that remained after adjusting for potential confounders (adjusted odds ratio: 0.59; 95%CI: 0.48-0.72). Participants who were overweight (adjusted odds ratio: 0.80; 0.64-0.99) or obese (0.57; 0.44-0.72) were also less likely to achieve treatment response, compared to patients of normal weight. Similar results were seen across other outcome measures. The proportion who achieved ACR-50 response did not differ between patients who did/did not consume alcohol (both 22%). Conclusion Smoking and high BMI were associated with substantial decreases in the likelihood of TNFi response. The addition of non-pharmacological therapy, including the modification of adverse lifestyle factors, may offer the potential to enhance treatment outcomes. For example, if 100 patients were able to give up smoking when commencing TNFi, an additional eight would achieve ACR-50 at 12 months. Previous findings regarding alcohol and treatment response in axSpA were not replicated in PsA. Disclosure G.T. Jones: None. O. Rotariu: None. B. Michelsen: None. B. Glintborg: None. B. Gudbjornsson: None. T.J. Love: None. D. Nordström: None. T. Sokka: None. J. Vencovský: None. P. Horák: None. Z. Rotar: None. M. Tomšič: None. M. van der Sande: None. M.J. Nissen: None. B. Möller: None. C. Codreanu: None. J.K. Wallman: None. K.M. Fagerli: None. S.H. Rasmussen: None. L.M. Ørnbjerg: None. M.J. Santos: None. P. Carvalho: None. M.L. Hetland: None. M. Østergaard: None. G.J. Macfarlane: None.

To identify the proportion of patients with psoriatic arthritis (PsA) who would meet inclusion criteria of the randomised clinical trials that were performed leading up to registration of the tumour necrosis factor inhibitors (TNFi).Data from 329 patients with PsA were obtained from an Icelandic database, ICEBIO, medical records at the University Hospital of Iceland, and the private out-patient clinic Laeknasetrid Ltd. The patients were classified according to whether they met the inclusion criteria of the clinical trials that were performed ahead of the registration of each respective TNFi. The reasons for exclusion were also explored.34% of the patients with complete data available met the inclusion criteria. Clinical data in respect to exclusion and inclusion criteria were incomplete for 13% of the cases. The proportion of patients who met the inclusion criteria was highest among those who received adalimumab and etanercept (53%). Patients who received in iximab had the lowest inclusion rate (23%). The main reason why patients did not meet the inclusion criteria was too few swollen and/or tender joints, or in 45% of excluded cases.Our results demonstrate that two thirds of patients with PsA in Iceland who are treated with TNFi would not have qualified for the randomised clinical trials performed leading up to the registration of the medications. Further studies with regards to whether outcomes are different between those who met the inclusion criteria and those who did not remain to be performed.

To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA).GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire.Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of80% was reached for approval of the individual recommendations and the overall schema.We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.

Introduction: Air travel associated venous thromboembolism (VTE) has been termed the economy class syndrome (ECS). Risk factors for ECS are divided into i) patient related; age, previous VTE, thrombophilia, malignancy and ii) cabin related; hypoxia, low humidity, dehydration and prolonged sitting. No study to date has looked at the incidence of VTE in healthy frequent flyers. The aim of this study was to see if professional pilots are at increased risk of VTE. Materials and methods: A retrospective cohort of 206 pilots working for a single airline operating on medium duration (3–7 hour) international routes from 1991–2000 was studied. Landspitali University Hospital is the only hospital serving Reykjavik, Iceland and its neighboring communities, and it is the sole primary hospital for approximately 130.000 people age 18 and over. Databases of clinical and radiographic diagnoses made at Landspitali University Hospital were searched for codes consistent with deep vein thrombosis (DVT) and pulmonary embolism (PE) occurring from 1991 to 2000. A computerized database of pilot personal identification numbers was then record linked to this VTE cohort from Landspitali University Hospital to see if any of the pilots had been diagnosed with VTE. For comparison purposes, a subgroup of the hospital database cohort and the underlying Reykjavik population was defined to match the gender and age characteristics of the pilot group. Expected number of cases with VTE among pilots was then calculated by extrapolating the observed prevalence of VTE among this subgroup to the pilot cohort. Finally, the relative risk of VTE for the pilots was calculated with p-value and 95% confidence interval. Results: Two hundred and six male pilots (median age 37 years, range 26–69) were included in the study. A total of 2263 patients were diagnosed with VTE at the Landspitali during the 10 year period, 931 with DVT and 1509 with PE, of whom 177 had both DVT and PE. There were 46,016 males aged 26 to 69 years living in the service area. Of these, 447 developed VTE. Extrapolating from the observed proportion of males age 26–69 diagnosed with VTE in the greater Reykjavik area, the expected number of VTE in the pilot cohort was found to be two. Of the 206 pilots, none was diagnosed with DVT or PE at Landspitali University Hospital during the study period. The relative risk of VTE in the pilot group was found to be 0, with no applicable lower limit to the 95% confidence interval, an upper limit of 1.83, and a p-value of 0.14. Conclusion: Professional airline pilots flying medium range distances do not have an increased risk of VTE and therefore they seem not to develop the ECS. This study does not point to an increased risk of VTE in healthy travelers in association with medium range flights.