Rheumatology News

Vol. 4 • No. 1 • 2016 • R heumatology N ews 15 SPONDYLOARTHROPATHIES

The pain of inflammatory disease goes beyond the physical

trials, he said at the annual meeting of theAmerican College of Rheumatology. To create the survey, the team con- ducted semi-structured patient inter- views at rheumatology practices across France. They whittled the responses down to identify 23 common fears and 19 disease-related beliefs in RA and axSpA. The resulting 44-item survey – there are two additional items about pregnancy and work-related concerns – asks patients to rate each one on a scale of 1–10. The team hopes to have data soon to show whether or not the efforts improve outcomes. Common beliefs in both groups were that fatigue, over-exertion, stress, and weather changes trigger flares, but that moderate physical activity reduces them. Almost half of RA patients, versus about a quarter of axSpA patients, be- lieved that their disease was triggered by an emotional shock or stressful event, and small minorities in both groups attributed their disease to pollution, vaccines, or passive or active smoking. About 70% of patients in both groups were on biologics, and about one-third in each were very worried that their treatments would cause cancer. Some “disease perceptions may not be accurate” and “provide a basis for discussion … to dispel misconcep- tions, align treatment expectations, and provide reassurance,” the investigators noted. The RA patients were 60 years old on average, and about three-quarters were women. The median disease dura- tion was 10 years, and mean Disease Activity Score (DAS28) was 2.7; axSpA patients were a mean age of 47 years, 43% were women, and the median dis- ease duration was 12 years. Their mean Bath Ankylosing Spondylitis Disease Activity Index score was 3.2. Foundation Arthritis Jacques Courtin and UCB Pharma funded the work. Dr Berenbaum has no relevant disclosures. Two investigators are UCB employees.

BY M. ALEXANDER OTTO Frontline Medical News

At the American College of Rheumatology annual meeting, San Francisco, California

T he most common fear of rheumatoid arthri- tis (RA) and axial spondyloarthritis (axSpA) patients is that their future suffering will be as bad as their past suffering, according to a French survey of 474 patients. Overall, 182 of the 303 RA patients (60%) and 122 of the 171 axSpA patients (71%) in the study ranked that fear as at least a 7 on a 10-point scale, and it remained a serious and common concern even among the roughly half of patients who were in remission. The questionnaire might break down the walls, so “patients know their doctors understand and are concerned” about their overall well-being. Majorities in both groups were highly con- cerned about deformity, wheel chair depend- ence, burdening loved ones, losing autonomy, and disease spread to other joints. Less com- mon fears, but still ranked at least a 7 by about one-third to well over half of patients, were more frequent flares, inability to care for others, losing friends, loss of treatment effectiveness, fear of treatment side effects, and not finding help if independence is lost. In general, axSpA was perceived as the more frightening disease, with patients more likely than those with RA to give fears presented on the survey a score of 7 or higher; axSpA patients also were more likely to fear the im- pact of disease on pregnancy and work, and more worried about passing disease onto their children. Fears about joints seizing up, bone and spine fusion, and increased flare activity were far more prevalent in the axSpA group. The findings are from a test run of a new questionnaire being developed in France to capture the psychological burden of chronic inflammatory disease. The idea is to make patients’ fears and convictions explicit so that providers know what they are and can help patients cope.

Dr Francis Berenbaum, chief of rheumatology at Saint Antoine Hospital in Paris. It’s hoped that the efforts will improve trust and dialogue between patients and doctors and lead to better treatment adherence and follow- up, more effective counselling, and perhaps even new patient-related outcomes for clinical

“We’ve had this idea for a long time. Patients have fears and beliefs that” are difficult to ex- press, and they get in the way of effective of- fice communication. The questionnaire might break down the walls, so “patients know their doctors understand and are concerned” about their overall well-being, said senior investigator

SCCA2: Potential biomarker for psoriasis severity and treatment efficacy

combination therapy with drugs to treat psoriasis, SCCA2 levels decreased in the 35 patients whose PASI improved on treatment (P < 0.0001) and increased in the three cases of clinical deterioration. The study was supported by a grant from Japan’s Ministry of Education, Culture, Sports, Science and Technol- ogy. The investigators declared that they had no conflicts of interest.

psoriasis, including biologics, the au- thors believe that a new serummarker for psoriasis is needed to evaluate dis- ease activity and manage treatment. The prospective, cross-sectional study included 123 patients with psoriasis and 25 healthy controls. Serum SCCA2 levels were signifi- cantly higher in patients with pso- riasis, compared with controls: a median of 2.7 ng/mL versus 0.70 ng/ mL, respectively (P < 0.0001). Se- rum SCCA2 levels were positively correlated with PASI for all patients with psoriasis, regardless of subtype. In 38 patients on monotherapy or

BY ALICE GOODMAN Frontline Medical News

Significant elevation of SCCA2 is associated with disease severity and reflects treatment efficacy. SCCA2 may be a useful biomarker in psoriasis, reflecting Th17-type inflammation – the main determinant of the severity of psoriasis.

From the British Journal of Dermatology T he level of serum squamous cell carcinoma antigen 2 – an isoform of SCCA that is widely used as a tumour marker for SCC – was significantly higher in both skin and serum of patients with psoriasis, compared with healthy volunteers in a recent study, correlating with psoriasis severity score and reflect- ing treatment efficacy. The intensity of skin and serum levels of SCCA2 was correlated in patients with psoriasis, and the

severity of psoriasis,” wrote Dr Yuko Watanabe of Yokohama (Japan) City University and associates. According to the investigators, the commonly used psoriasis area severity index (PASI) is suboptimal because it is not truly quantitative and varies among clinicians. Since there are several new treatment options for

study results also suggest that Th17 cytokines (IL-17 and IL-22) induce SCCA 2 elevation in serum and skin. “Significant elevation of SCCA2 is associated with disease severity and reflects treatment efficacy. SCCA2 may be a useful biomarker in psoria- sis, reflecting Th17-type inflamma- tion – the main determinant of the

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