Treatment with tumor necrosis factor inhibitors (TNFis) vs methotrexate alone is not associated with a decreased risk for progression to psoriatic arthritis (PsA) in patients with psoriasis, according to study results presented at the European League Against Rheumatism (EULAR) 2020 E-Congress, held online from June 3 to 6, 2020.

To determine if treatment with TNFis vs methotrexate alone reduce the risk of developing PsA in patients with existing psoriasis, researchers from Oregon Health and Science University, School of Medicine, Portland, assessed data from all patients with psoriasis seen at their clinic from January 2006 to June 2019. Diagnosis of PsA was made by a rheumatologist. Continuous covariates and categoric covariates were compared by the Student’s t-test and Pearson’s chi-squared test or Fisher’s test, respectively.

A total of 154 patients (51.3% women) with psoriasis who did not have PsA at baseline were included in the study. A TNFi was administered to 55.2% (n=85) and methotrexate to 44.8% (n=69) of the patients during the study period. Patients in the TNFi cohort received therapy for a mean duration of 3.95±0.50 years and patients in the methotrexate cohort had a mean duration of therapy of 1.93±0.28 years. Mean follow-up time was 5.18±0.49 years and 2.71±0.37 years for the TNFi and methotrexate cohorts, respectively.


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During the study period, 22.7% of patients (n=35) developed PsA. After adjusting for propensity score, nail pitting, body surface area involved in psoriasis, and depression, the investigators found that treatment with TNFi did not significantly reduce the risk for PsA, as compared with treatment with methotrexate (HR, 0.68; 95% CI, 0.32-1.41).

“Use of TNFi was not associated with a statistically significant decreased risk of incident PsA compared to methotrexate in this study, but a larger cohort with longer follow-up will have better power to estimate the true association,” the researchers concluded.

Researchers observed brain abnormalities in magnetic resonance imaging (MRI) data among patients with neurological manifestations who were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These findings were published in the Journal of Infectious Diseases.

Patients (N=58) hospitalized at Strasbourg University, France hospitals with confirmed SARS-CoV-2 and neurological manifestations were included in this study. Most patients underwent an MRI (91%) and all had a lumbar puncture to test their cerebrospinal fluid (CSF) for SARS-CoV-2.

Patients were 66% men aged a median of 62 years. The majority (81%) were admitted to the intensive care unit (ICU). The median between the onset of COVID-19 symptoms, primarily respiratory, to lumbar puncture was 30 days.

Patients presented with encephalopathy (81%), clinical signs of corticospinal tract involvement (16%), seizures (10%), headache (5%), binocular diplopia (2%), cerebellar syndrome (2%), and peripheral nervous system disorders (2%). Patients admitted to the ICU were more likely to have encephalopathy (87% vs 55%; P =.03).


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Most patients (68%) had abnormal brain pathologies identified in their MRI. Brain abnormalities included focal leptomeningeal enhancement (38%), acute cerebrovascular injuries (23%), acute ischemic stroke (17%), white matter lesions (8%), and grey matter lesions (2%). Patients presented with a single (n=21), double (n=11), or triple (n=1) neuroimaging patterns.

A total of 4 patients (7%) had SARS-CoV-2 present in their CSF; of these, 3 patients had viral loads below the detection limit, and blood contamination could not be ruled out. The other patient had viral load of 4.3 log10/mL. All 4 patients were admitted to the ICU and presented with delirium.

Of the 4 patients with positive CSF, 2 had normal brain MRIs and 2 had abnormal brain MRI morphology (focal leptomeningeal enhancement).

This study was limited by its small sample size, retrospective design, and prevalence missing data.

The study authors concluded that although neurological manifestations due to a SARS-CoV-2 infection caused abnormal brain morphologies, there was little evidence to suggest a direct involvement of SARS-CoV-2 with CSF. Rather, it is more likely to be a systemic reaction, such as cytokine release syndrome or a hypercoagulable state.

Reference

Lersy F, Benotmane I, Helms J, et al. Cerebrospinal fluid features in COVID-19 patients with neurologic manifestations: correlation with brain MRI findings in 58 patients. J Infect Dis. Published online November 29, 2020. doi:10.1093/infdis/jiaa745.

Reference

Lininger N, Siegel S, Kiwalkar S, Winthrop K, Ortega Loayza A, Deodhar A. Do TNF inhibitors decrease risk of incident psoriatic arthritis in psoriasis patients compared to those treated with methotrexate alone? Presented at: EULAR 2020 E-Congress; June 3-6, 2020. Abstract FRI0555.

This article originally appeared on Rheumatology Advisor