Difficult-to-treat psoriatic arthritis 'not all about the therapies'
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DESTIN, Fla. — The course of difficult-to-treat psoriatic arthritis can be significantly impacted by a host of factors beyond choice of therapy, according to data presented at the Congress of Clinical Rheumatology East annual meeting.
“What we do in the clinic is a tiny sliver of what actually influences the patient’s outcome,” Alexis Ogdie-Beatty, MD, MSCE, associate professor of medicine and epidemiology at the University of Pennsylvania, told attendees. “It’s not all about the therapies or the biology — there’s also this concept of wellness.”
According to Ogdie-Beatty, comorbidities such as obesity, metabolic syndrome and fatty liver disease are all linked to reduced likelihood of positive outcomes in PsA.
“If you are obese, you have a substantially lower likelihood — at least half the chance — of getting minimal disease activity,” she said.
Similar associations can be seen with dyslipidemia, smoking, fibromyalgia, depression and anxiety, Ogdie-Beatty added.
“We actually have to manage those, too,” she said.
Meanwhile, research on food insecurity, specifically as a driver of poor primary care outcomes, have demonstrated that social determinants of health can also play a role.
“It’s important to think about all these other things in terms of how the patient’s doing,” Ogdie-Beatty said. “Not that we always know how to help with these things, but at least if we recognize that there are other barriers to them doing well, it helps us understand the position the patient is in, and what we may be able to do to help.”
In addition, although PsA drugs do work in terms of reducing inflammation, patient-reported scores such as the Patient Global Assessment and Health Assessment Questionnaire remain unsatisfactory, she said.
“We can do a pretty good job of getting the swelling down,” Ogdie-Beatty said. “It’s the other things that are a problem. Function remains diminished. And they tend to have more tender joints.”
She additionally stressed that since therapy is usually not the problem in difficult-to-treat PsA, switching from one therapy to another is “actually not the answer.”
“The more you cycle, the more you get into cycling,” Ogdie-Beatty said. “You could switch therapy, and that’s the least time-consuming thing to do from the rheumatologist perspective, but not necessarily the right thing to do from the patient perspective.”
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Ogdie-Beatty A. Psoriatic Arthritis in 2024. Presented at The Congress of Clinical Rheumatology East; May 9-12, 2024; Destin, Florida (hybrid meeting).
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