tofacitinib and Arthralgia

Nail involvement is common in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, which has a strong association with quality of life in patients with SAPHO. Tofacitinib is an oral Janus kinase inhibitor that has been previously shown to be effective for nail psoriasis.. To assess the efficacy and safety of tofacitinib for the treatment of nail involvement in SAPHO syndrome.. Participants received tofacitinib, 5 mg, twice daily, for 12 weeks.. This open-label, single-arm, prospective pilot study included 13 patients with SAPHO syndrome accompanied by nail lesions and active palmoplantar pustulosis who were recruited from Peking Union Medical College Hospital from September 2019 to December 2019. Follow-up was completed in March 2020. Analysis began March 2020.. The primary end point was the percentage of the change from baseline in Nail Psoriasis Severity Index scores at week 12. Secondary end points included the percentage of the change from baseline in Palmoplantar Psoriasis Area and Severity Index scores, change from baseline in Visual Analogue Scale scores in global osteoarticular pain, Dermatology Life Quality Index scores, and inflammatory markers. Adverse events were recorded throughout the study.. Thirteen female Asian patients (means [SD] age, 39.7 [12.3] years) were included, all of whom completed the study. At week 12, significant improvements were observed in Nail Psoriasis Severity Index scores (median, -67% [interquartile range (IQR), -56% to -77%]; P < .001) and Palmoplantar Psoriasis Area and Severity Index scores (median, -71% [IQR, -58% to -78%]; P < .001). Significant improvement was also noted in Dermatology Life Quality Index scores (median, -12 [IQR, -8.5 to -15]; P < .001) at week 12. A significant decrease in Visual Analogue Scale scores in global osteoarticular pain was observed at week 8 (median, -4 [IQR, 0 to -5]; P = .02) but was not significant at week 12. Inflammatory marker levels were decreased, as indicated by erythrocyte sedimentation rate (median, -8 mm/h [IQR, -4 mm/h to -11 mm/h]; P < .001) and high-sensitivity C-reactive protein levels (median, -1.6 [IQR, -0.3 to -4.1]; P = .01). No severe adverse events were observed.. In this pilot study, tofacitinib yielded significant remission of nail lesions and palmoplantar psoriasis accompanied by an improvement in quality of life in patients with SAPHO syndrome. Additional follow-up studies to evaluate the long-term efficacy and safety of tofacitinib for nail involvement in SAPHO syndrome are warranted.. Chinese Clinical Trial Registry number: ChiCTR1900025941.

Topics: Acquired Hyperostosis Syndrome; Adult; Arthralgia; Child; Female; Humans; Middle Aged; Nail Diseases; Pain Measurement; Pilot Projects; Piperidines; Prospective Studies; Psoriasis; Pyrimidines; Quality of Life; Severity of Illness Index; Treatment Outcome; Young Adult

We present a case of a 34-year-old man with long-term diagnosis of eosinophilic oesophagitis (EoE) who did not achieve control of disease after multiple therapies including topical and systemic steroids, immune modulators and biologics. Initial endoscopic findings showed signs of active eosinophilic oesophagitis and biopsies were significant for up to 100 eosinophils per high power field during his various treatments. There was a significant improvement in the appearance of the oesophagus as well as the least number of eosinophils found in oesophagus biopsies after 3 months of treatment with tofacitinib. There are no cases of EoE treated with tofacitinib. Tofacitinib should be considered for the treatment of eosinophilic oesophagitis given its evolving role as an immunosuppressive agent.

Topics: Adult; Arthralgia; Diagnosis, Differential; Eosinophilic Esophagitis; Humans; Male; Piperidines; Protein Kinase Inhibitors; Pyrimidines; Pyrroles; Treatment Outcome