Is All Inflammation the Same? Study Looks at Similarities, Differences in Treatment

Despite recent, rapid development of highly effective therapies, patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis still face challenges research has yet to meet according to the authors of a recent review of existing research on the three conditions. The review was conducted by Laura Coates, PhD, of the University of Leeds in the UK, and colleagues, and was published in journal Seminars in Arthritis & Rheumatism recently.

The authors gathered articles published between 2000 and 2015 using the PubMed database; they identified 198 relevant articles. Because the review was not systemic, there were no inclusion/exclusion criteria. Each article was summarized according to the disease discussed: psoriasis, psoriatic arthritis, or rheumatoid arthritis. They said that the review was conducted “in an attempt to better understand the similarities and differences in treatment paradigms in the management of each disease.”

In examining the immunopathogenesis of each disease, the reviewers say, “it is clear that for all three diseases, both innate as well as adaptive immune responses are involved.” Each disease has some degree of heritability, and the reviewers say “genetic factors play a vital role in susceptibility to rheumatoid arthritis, with heritability between 50% and 60%.”

When the authors looked at comorbidities for each disease they found the risk of adverse cardiovascular events was higher than the general population for patients with any of the three conditions. However, people with rheumatoid arthritis being treated with TNF inhibitors had “a significantly reduced risk of all cardiovascular events” said the reviewers.

Patients with psoriasis and rheumatoid arthritis have a greater risk of developing malignancies than the general population, but those with psoriatic arthritis seem to have the same risk as the general population.

“Given the commonality of comorbidities across all three disease, there is a degree of overlap in their management,” say the authors. They go on to cite combination therapy as “an especially important strategy in the clinical management of immunological diseases.”

The reviewers suggest that advances in genetic analyses will lead to “treatment tailored on the basis of an individual’s genetic and immunological profile.” They conclude with the hope that future research should investigate the effects of new therapies on comorbidities.