Psoriatic arthritis: Difference between revisions

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==Differentiating psoriatic arthritis from other Diseases==
==Differentiating psoriatic arthritis from other Diseases==
*Psoriatic arthritis must be differentiated from other arthritides including rheumatoid arthritis, reactive arthritis, ankylosing spondylitis, arthritis associated with inflammatory bowel disease, osteoarthritis, and gout.<ref name="pmid15708931">{{cite journal |vauthors=Helliwell PS, Taylor WJ |title=Classification and diagnostic criteria for psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=64 Suppl 2 |issue= |pages=ii3–8 |date=March 2005 |pmid=15708931 |pmc=1766878 |doi=10.1136/ard.2004.032318 |url=}}</ref><ref name="pmid5562018">{{cite journal |vauthors=McEwen C, DiTata D, Lingg C, Porini A, Good A, Rankin T |title=Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study |journal=Arthritis Rheum. |volume=14 |issue=3 |pages=291–318 |date=1971 |pmid=5562018 |doi= |url=}}</ref><ref name="pmid9640127">{{cite journal |vauthors=Helliwell PS, Hickling P, Wright V |title=Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis? |journal=Ann. Rheum. Dis. |volume=57 |issue=3 |pages=135–40 |date=March 1998 |pmid=9640127 |pmc=1752543 |doi= |url=}}</ref><ref name="pmid4604133">{{cite journal |vauthors=Moll JM, Haslock I, Macrae IF, Wright V |title=Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome |journal=Medicine (Baltimore) |volume=53 |issue=5 |pages=343–64 |date=September 1974 |pmid=4604133 |doi= |url=}}</ref>
*Psoriatic arthritis must be differentiated from other arthritides including rheumatoid arthritis, reactive arthritis, ankylosing spondylitis, arthritis associated with inflammatory bowel disease, osteoarthritis, and gout.<ref name="pmid15708931">{{cite journal |vauthors=Helliwell PS, Taylor WJ |title=Classification and diagnostic criteria for psoriatic arthritis |journal=Ann. Rheum. Dis. |volume=64 Suppl 2 |issue= |pages=ii3–8 |date=March 2005 |pmid=15708931 |pmc=1766878 |doi=10.1136/ard.2004.032318 |url=}}</ref><ref name="pmid5562018">{{cite journal |vauthors=McEwen C, DiTata D, Lingg C, Porini A, Good A, Rankin T |title=Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study |journal=Arthritis Rheum. |volume=14 |issue=3 |pages=291–318 |date=1971 |pmid=5562018 |doi= |url=}}</ref><ref name="pmid9640127">{{cite journal |vauthors=Helliwell PS, Hickling P, Wright V |title=Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis? |journal=Ann. Rheum. Dis. |volume=57 |issue=3 |pages=135–40 |date=March 1998 |pmid=9640127 |pmc=1752543 |doi= |url=}}</ref><ref name="pmid4604133">{{cite journal |vauthors=Moll JM, Haslock I, Macrae IF, Wright V |title=Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome |journal=Medicine (Baltimore) |volume=53 |issue=5 |pages=343–64 |date=September 1974 |pmid=4604133 |doi= |url=}}</ref>
*For the detailed description  
*For the detailed description
<small>
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
|-
|
|'''History of Psoriasis'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|[[Enthesopathy|'''Enthesopathy''']]
|'''[[Dactylitis]]'''
|'''[[Nail (anatomy)|Nail]] [[Dystrophy]]'''
|'''[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] association'''
|'''[[Upper extremity]]-hands'''
|'''[[Lower extremity]]'''
|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Spine]]'''
|'''[[Osteopenia]]'''
|'''[[Joint]] Space'''
|'''[[Ankylosis]]'''
|'''[[Periostitis]]'''
|'''[[Soft tissue]] swelling'''
|'''[[ESR]]'''
|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[HLA-B27]]'''
|-
|'''[[Psoriatic arthritis]]'''
| +
| +
| ++
| +
| +
| +
| +
| +++ ([[Distal interphalangeal joints|DIP]]/[[Proximal interphalangeal joints|PIP]])
| +++
| ++ (Unilateral)
| ++
| -
| ++ (Widening)
| ++
| +++ (Fluffy)
| ++
| +
| -
|30-75%
|-
|'''[[Rheumatoid arthritis]]'''
| -
| ++
| +
| -
| -
| -
| -
| +++
([[MCP joints|MCP]]/[[wrist]])
| +++
| + (Unilateral)
| ++([[Cervical spine|Cervical]])
| +++
| +++ (Narrowing)
| +
| + (Linear)
| +++
| +++
| +++
|6-8%
|-
|'''[[Ankylosing spondylitis]]'''
| -
| +++
| -
| +
| -
| -
| -
| +
| +
| +++ (Bilateral)
| +++
| +++
| ++ (Narrowing)
| +++
| +++ (Fluffy)
| +
| +++
| -
|90%
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
| -
| +++
| -
| +
| +
| -
| -
| ++
| +++
| ++ (Unilateral)
| +
| +
| + (Narrowing)
| -
| +++ (Fluffy)
| ++
| ++
| -
|75%
|}


==Epidemiology and Demographics==
==Epidemiology and Demographics==

Revision as of 20:37, 19 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Chandrakala Yannam, MD [2]

Overview

Historical Perspective

  • [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
  • In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
  • In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

  • [Disease name] may be classified according to [classification method] into [number] subtypes/groups:
  • [group1]
  • [group2]
  • [group3]
  • Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

  • The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
  • The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
  • On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Clinical Features

Differentiating psoriatic arthritis from other Diseases

  • Psoriatic arthritis must be differentiated from other arthritides including rheumatoid arthritis, reactive arthritis, ankylosing spondylitis, arthritis associated with inflammatory bowel disease, osteoarthritis, and gout.[1][2][3][4]
  • For the detailed description

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History of Psoriasis Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Psoriatic arthritis + + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis - ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis - +++ - + - - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%
Reactive arthritis (Reiter's syndrome) - +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%

Epidemiology and Demographics

  • The prevalence of psoriatic arthritis in general population ranges from 6,000 - 25,000 cases per 100,000 individuals in United states.[5]
  • The prevalence of psoriatic arthritis ranges in genreal population from 5,000 - 21,000 cases per 100,000 individuals in Europe.[6]
  • The prevalence of psoriatic arthritis among psoriasis patients is 11,000 per 100,000 individuals.
  • The incidence of psoriatic arthritis is 3.6-6 per 100,000 individuals.[6]

Age

  • Psoriatic arthritis may commonly occur in age groups 40-50 yrs with mean age at diagnosis is 40.7 years.[7]

Gender

  • In general, there is no gender predilection to psoriatic arthritis.[8]

Race

  • There is insufficient data to support racial dominance of psoriatic arthritis.

Risk Factors

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • [Disease name] is usually asymptomatic.
  • Symptoms of [disease name] may include the following:
  • [symptom 1]
  • [symptom 2]
  • [symptom 3]
  • [symptom 4]
  • [symptom 5]
  • [symptom 6]

Physical Examination

  • Patients with [disease name] usually appear [general appearance].
  • Physical examination may be remarkable for:
  • [finding 1]
  • [finding 2]
  • [finding 3]
  • [finding 4]
  • [finding 5]
  • [finding 6]

Laboratory Findings

Imaging Findings

Psoriatic-arthritis of hands showing pencil-in-cup deformity - By Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8798">rID: 8798</a>
  • MRI: MRI may reveal the following findings:[16]
    • enthesitis
    • Periostitis
    • Joint erosions
    • Synovitis (articular or flexor tendon sheath)
    • Ankylosis
    • Bone marrow edema
  • Ulrasonography: Ultrasonography may reveal following findings.[17]
    • Joint effusions and widening of joint space
    • Synovitis (articular and flexor tenosynovitis)
    • Dactylitis
    • Thickening of the joint capsule

Other Diagnostic Studies

Treatment

Medical Therapy

  • Enthesitis:
    • Mild disease: NSAIDs, local corticosteroid injection, phycial therapy may be helpful.
    • Moderate to severe disease: TNF inhibitors
  • Dactylitis:[41]
    • NSAIDs, steroid injections, conventional DMARDs and TNF inhibitors can be helpful.
    • Biologic DMARDs can be considered for treatment of dactylitis if, therapy with NSAIDs, steroid injections, conventional DMARDs fails.
  • Non pharmacologic therapy:

Surgery

  • Surgery may be indicated in patients of psoriatic arthritis with severe joint damage that limit mobility.[42]
  • Common procedures include hand joint surgery involving PIP and DIP joints, hip or knee surgery.

Prevention

  • There are no established primary preventive measures for psoriatic arthritis.
  • Patients are monitored regularly for disease activity, drug efficacy, adverse effects and associated comorbid conditions.

References

  1. Helliwell PS, Taylor WJ (March 2005). "Classification and diagnostic criteria for psoriatic arthritis". Ann. Rheum. Dis. 64 Suppl 2: ii3–8. doi:10.1136/ard.2004.032318. PMC 1766878. PMID 15708931.
  2. McEwen C, DiTata D, Lingg C, Porini A, Good A, Rankin T (1971). "Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study". Arthritis Rheum. 14 (3): 291–318. PMID 5562018.
  3. Helliwell PS, Hickling P, Wright V (March 1998). "Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?". Ann. Rheum. Dis. 57 (3): 135–40. PMC 1752543. PMID 9640127.
  4. Moll JM, Haslock I, Macrae IF, Wright V (September 1974). "Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome". Medicine (Baltimore). 53 (5): 343–64. PMID 4604133.
  5. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, Stern RS, Feldman SR, Rolstad T (October 2005). "Epidemiology of psoriatic arthritis in the population of the United States". J. Am. Acad. Dermatol. 53 (4): 573. doi:10.1016/j.jaad.2005.03.046. PMID 16198775.
  6. 6.0 6.1 Hanova P, Pavelka K, Holcatova I, Pikhart H (August 2010). "Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic". Scand. J. Rheumatol. 39 (4): 310–7. doi:10.3109/03009740903544212. PMID 20476864.
  7. Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE (May 2000). "The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991". J. Rheumatol. 27 (5): 1247–50. PMID 10813295.
  8. Moll JM, Wright V (May 1973). "Familial occurrence of psoriatic arthritis". Ann. Rheum. Dis. 32 (3): 181–201. PMC 1006078. PMID 4715537.
  9. Punzi L, Podswiadek M, Oliviero F, Lonigro A, Modesti V, Ramonda R, Todesco S (2007). "Laboratory findings in psoriatic arthritis". Reumatismo. 59 Suppl 1: 52–5. PMID 17828345.
  10. Johnson SR, Schentag CT, Gladman DD (May 2005). "Autoantibodies in biological agent naive patients with psoriatic arthritis". Ann. Rheum. Dis. 64 (5): 770–2. doi:10.1136/ard.2004.031286. PMC 1755477. PMID 15834057.
  11. Chandran V, Bull SB, Pellett FJ, Ayearst R, Rahman P, Gladman DD (October 2013). "Human leukocyte antigen alleles and susceptibility to psoriatic arthritis". Hum. Immunol. 74 (10): 1333–8. doi:10.1016/j.humimm.2013.07.014. PMID 23916976.
  12. Eder L, Chandran V, Pellet F, Shanmugarajah S, Rosen CF, Bull SB, Gladman DD (January 2012). "Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis". Ann. Rheum. Dis. 71 (1): 50–5. doi:10.1136/ard.2011.155044. PMID 21900282.
  13. McGonagle D, Hermann KG, Tan AL (January 2015). "Differentiation between osteoarthritis and psoriatic arthritis: implications for pathogenesis and treatment in the biologic therapy era". Rheumatology (Oxford). 54 (1): 29–38. doi:10.1093/rheumatology/keu328. PMC 4269795. PMID 25231177.
  14. Siannis F, Farewell VT, Cook RJ, Schentag CT, Gladman DD (April 2006). "Clinical and radiological damage in psoriatic arthritis". Ann. Rheum. Dis. 65 (4): 478–81. doi:10.1136/ard.2005.039826. PMC 1798082. PMID 16126794.
  15. Haddad A, Chandran V (2013). "Arthritis mutilans". Curr Rheumatol Rep. 15 (4): 321. doi:10.1007/s11926-013-0321-7. PMID 23430715.
  16. Spira D, Kötter I, Henes J, Kümmerle-Deschner J, Schulze M, Boss A, Horger M (November 2010). "MRI findings in psoriatic arthritis of the hands". AJR Am J Roentgenol. 195 (5): 1187–93. doi:10.2214/AJR.10.4281. PMID 20966327.
  17. Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O (August 1999). "Ultrasonography in the diagnosis and management of psoriatic dactylitis". J. Rheumatol. 26 (8): 1746–51. PMID 10451072.
  18. Frediani B, Allegri A, Falsetti P, Storri L, Bisogno S, Baldi F, Filipponi P, Marcolongo R (January 2001). "Bone mineral density in patients with psoriatic arthritis". J. Rheumatol. 28 (1): 138–43. PMID 11196516.
  19. Gossec L, Smolen JS, Ramiro S, de Wit M, Cutolo M, Dougados M, Emery P, Landewé R, Oliver S, Aletaha D, Betteridge N, Braun J, Burmester G, Cañete JD, Damjanov N, FitzGerald O, Haglund E, Helliwell P, Kvien TK, Lories R, Luger T, Maccarone M, Marzo-Ortega H, McGonagle D, McInnes IB, Olivieri I, Pavelka K, Schett G, Sieper J, van den Bosch F, Veale DJ, Wollenhaupt J, Zink A, van der Heijde D (March 2016). "European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update". Ann. Rheum. Dis. 75 (3): 499–510. doi:10.1136/annrheumdis-2015-208337. PMID 26644232.
  20. Gossec L, Smolen JS, Gaujoux-Viala C, Ash Z, Marzo-Ortega H, van der Heijde D, FitzGerald O, Aletaha D, Balint P, Boumpas D, Braun J, Breedveld FC, Burmester G, Cañete JD, de Wit M, Dagfinrud H, de Vlam K, Dougados M, Helliwell P, Kavanaugh A, Kvien TK, Landewé R, Luger T, Maccarone M, McGonagle D, McHugh N, McInnes IB, Ritchlin C, Sieper J, Tak PP, Valesini G, Vencovsky J, Winthrop KL, Zink A, Emery P (January 2012). "European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies". Ann. Rheum. Dis. 71 (1): 4–12. doi:10.1136/annrheumdis-2011-200350. PMID 21953336.
  21. Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ, Helliwell P, Boehncke WH, de Vlam K, Fiorentino D, Fitzgerald O, Gottlieb AB, McHugh NJ, Nash P, Qureshi AA, Soriano ER, Taylor WJ (September 2009). "Treatment recommendations for psoriatic arthritis". Ann. Rheum. Dis. 68 (9): 1387–94. doi:10.1136/ard.2008.094946. PMC 2719080. PMID 18952643.
  22. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R (July 2011). "Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions". J. Am. Acad. Dermatol. 65 (1): 137–74. doi:10.1016/j.jaad.2010.11.055. PMID 21306785.
  23. Coates LC, Tillett W, Chandler D, Helliwell PS, Korendowych E, Kyle S, McInnes IB, Oliver S, Ormerod A, Smith C, Symmons D, Waldron N, McHugh NJ (October 2013). "The 2012 BSR and BHPR guideline for the treatment of psoriatic arthritis with biologics". Rheumatology (Oxford). 52 (10): 1754–7. doi:10.1093/rheumatology/ket187. PMID 23887065.
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  25. Sarzi-Puttini P, Santandrea S, Boccassini L, Panni B, Caruso I (2001). "The role of NSAIDs in psoriatic arthritis: evidence from a controlled study with nimesulide". Clin. Exp. Rheumatol. 19 (1 Suppl 22): S17–20. PMID 11296544.
  26. Mease P (2013). "Methotrexate in psoriatic arthritis". Bull Hosp Jt Dis (2013). 71 Suppl 1: S41–5. PMID 24219040.
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  28. Steinsson K, Jónsdóttir I, Valdimarsson H (August 1990). "Cyclosporin A in psoriatic arthritis: an open study". Ann. Rheum. Dis. 49 (8): 603–6. PMC 1004173. PMID 2396865.
  29. Mease PJ, Gladman DD, Ritchlin CT, Ruderman EM, Steinfeld SD, Choy EH, Sharp JT, Ory PA, Perdok RJ, Weinberg MA (October 2005). "Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial". Arthritis Rheum. 52 (10): 3279–89. doi:10.1002/art.21306. PMID 16200601.
  30. Mease PJ, Kivitz AJ, Burch FX, Siegel EL, Cohen SB, Ory P, Salonen D, Rubenstein J, Sharp JT, Tsuji W (July 2004). "Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression". Arthritis Rheum. 50 (7): 2264–72. doi:10.1002/art.20335. PMID 15248226.
  31. Antoni C, Krueger GG, de Vlam K, Birbara C, Beutler A, Guzzo C, Zhou B, Dooley LT, Kavanaugh A (August 2005). "Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trial". Ann. Rheum. Dis. 64 (8): 1150–7. doi:10.1136/ard.2004.032268. PMC 1755609. PMID 15677701.
  32. Kavanaugh A, McInnes I, Mease P, Krueger GG, Gladman D, Gomez-Reino J, Papp K, Zrubek J, Mudivarthy S, Mack M, Visvanathan S, Beutler A (April 2009). "Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: Twenty-four-week efficacy and safety results of a randomized, placebo-controlled study". Arthritis Rheum. 60 (4): 976–86. doi:10.1002/art.24403. PMID 19333944.
  33. Mease PJ, Fleischmann R, Deodhar AA, Wollenhaupt J, Khraishi M, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D (January 2014). "Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a Phase 3 double-blind randomised placebo-controlled study (RAPID-PsA)". Ann. Rheum. Dis. 73 (1): 48–55. doi:10.1136/annrheumdis-2013-203696. PMC 3888622. PMID 23942868.
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