William Tillett

Objectives: Immune mediated inflammatory diseases (IMID) affect women of childbearing age, yet there is a lack of evidence about the risk of adverse pregnancy outcomes and the interaction with medication. This study aims to characterize prescribing patterns and pregnancy outcomes in women with an IMID diagnosis. Methods: Pregnancies to women with rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis (PsO), spondyloarthritis (SpA) and inflammatory bowel disease (IBD) were identified within the Clinical Practice Research Datalink, between 1 January 2000 and 31 June 2020, and matched to pregnancies in women with no such diagnosis. Drug prescribing patterns were described during and surrounding pregnancy. The risk of spontaneous pregnancy loss and major congenital malformations (MCMs) were evaluated compared with women without an IMID. Exposure to commonly prescribed disease-modifying anti-rheumatic drugs was evaluated. Results: The risk of a spontaneous pregnancy loss ranged from adjusted hazard ratio (HRadj) 1.01 (95% CI: 0.79, 1.28) for PsA to HRadj 1.18 (95% CI: 1.07, 1.30) for IBD when compared with women without these conditions. No significant increases in the overall risk of MCMs were observed, with the exception of IBD where it reached borderline significance based on sensitivity analyses [adjusted odds ratio 1.31 (95% CI: 1.00, 1.71)]. No evidence of an increased risk of spontaneous loss was observed in women taking azathioprine, mesalazine and sulfasalazine. Conclusion: We found no increased risk of spontaneous loss in women with RA, PsA or SpA but a small increase in women with psoriasis or IBD. There was a borderline increased risk of all MCMs in offspring of women with IBD, which should be interpreted cautiously because of potential residual confounding.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting was held from July 10 to 12, 2025, in Bogotá, Colombia. It was attended by 206 rheumatologists, dermatologists, trainees, patient research partners, representatives of patient organizations, industry partners, and others. Here we provide an overview of the workshops and symposia featured at the GRAPPA 2025 annual meeting and introduce the manuscripts published together in this supplement as a meeting report.

Objectives: To determine the prevalence of anti-drug antibodies (ADAs) in patients with psoriatic arthritis (PsA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) and to evaluate associations with serum drug levels, clinical efficacy and safety. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review was conducted. MEDLINE, Embase and Cochrane CENTRAL were searched from inception to September 2025. Randomised controlled trials and observational studies reporting ADA measurement in adults with PsA receiving bDMARDs were included. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2 and the Risk of Bias in Non-randomised Studies of Interventions. Results: 28 studies (19 randomised controlled trials and 9 observational studies) were included. ADA prevalence varied widely between bDMARDs and across studies of the same drug and was not directly comparable due to immunoassay heterogeneity. The highest ADA prevalence was observed with adalimumab, infliximab and golimumab followed by ustekinumab, ixekizumab, certolizumab pegol and guselkumab, while secukinumab and etanercept demonstrated very low or absent immunogenicity. Across tumour necrosis factor (TNF) inhibitor studies, ADAs were consistently associated with lower serum drug levels and reduced clinical response, while concomitant methotrexate was associated with lower ADA prevalence. In contrast, serum drug level and clinical outcome data for interleukin (IL)-17, IL-12/23 and IL-23 inhibitors were limited or lacking. Immunogenicity-related adverse events were uncommon, and evidence was insufficient to establish an association with ADAs across bDMARDs. Conclusion: ADA prevalence in PsA varies widely between bDMARDs and across studies of the same bDMARD. ADAs appear most clinically relevant for TNF inhibitors, whereas evidence for other biological classes remains limited. Immunoassay heterogeneity limits comparability, highlighting the need for standardised prospective studies. PROSPERO registration number: CRD420251121662.

Objective: To assess the 3-year effect of bimekizumab on health status, work productivity, and productivity-related costs in patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA). Methods: BE MOBILE 1 ( ClinicalTrials.gov : NCT03928704 ) and BE MOBILE 2 ( NCT03928743 ), phase III trials in axSpA, and BE OPTIMAL ( NCT03895203 ) and BE COMPLETE ( NCT03896581 ), phase III trials in PsA, evaluated subcutaneous bimekizumab 160 mg every 4 weeks. Patients who completed these studies were eligible to enter the open-label extension studies BE MOVING ( NCT04436640 ; axSpA) or BE VITAL ( NCT04009499 ; PsA). Outcomes are reported by indication for observed cases among patients originally randomized to placebo or bimekizumab through year 3. These included changes in health status (EQ-5D-3L and the EQ visual analog scale [VAS; 0-100]), work productivity (Work Productivity and Activity Impairment Questionnaire–Specific Health Problem v2.0 [WPAI-SHP]), and annualized productivity cost savings associated with improvements in work impairment. Results: Among 586 patients with axSpA and 1112 patients with PsA, mean EQ VAS scores improved by 20.2-21.3 points in axSpA and 17.1-17.3 points in PsA from baseline to year 3. At year 3, most patients reported clinically meaningful improvements in work impairment (axSpA: 74.2-81.1%; PsA: 71.2-71.3%) and achieved an acceptable work state, defined by WPAI-SHP presenteeism < 40% (axSpA: 83.7-84.2%; PsA: 84.1-87.2%). In the US, productivity cost savings (in US dollars) were sustained to year 3 ($22,012.14-22,549.32 in axSpA, and $13,327.60-16,428.25 in PsA); similar trends were observed in Europe and Japan. Conclusion: Bimekizumab demonstrated sustained improvements in health status and work productivity to year 3 across axSpA and PsA. Health status was comparable to population norms at year 3. Productivity cost savings from reduced work impairment were observed, reflecting a reduced economic and social burden of axSpA and PsA.

Objectives: Data regarding progression from oligoarticular to polyarticular psoriatic arthritis (PsA) are sparse. Using FOREMOST, we identify progression predictors and evaluate apremilast’s treatment effect in early PsA. Methods: FOREMOST (NCT03747939) randomised N = 308 patients with early (mean duration, 9.9 months) PsA and limited joint involvement (>1 to ≤ 4 swollen and >1 to ≤ 4 tender joints; not confirmed by imaging) to apremilast or placebo for 24 weeks, followed by open-label apremilast through week 48. Multivariable logistic regression modelled predictors of progression from oligoarticular (≤4 active [swollen and/or tender] joints) to polyarticular (>4 active joints) PsA at week 16 and the effect of apremilast. Disease progression, disease activity, clinical signs/symptoms, and tolerability were summarized through week 48 for N = 291 patients receiving ≥1 apremilast dose (from randomization or switched from placebo). Results: Most (268/308 [87.0%]) patients had oligoarticular PsA at baseline; 25.1% (59/235) progressed to polyarticular PsA by week 16 (data as observed). Apremilast reduced odds of progression vs placebo by 58% (Odds Ratio [OR; 95% CI]: 0.42 [0.22, 0.77]). In placebo-treated patients, being female, being csDMARD-naïve, and having dactylitis significantly increased odds of progression (OR: 3.35 [1.20, 9.34], 3.42 [1.18, 9.93], and 9.26 [1.32, 65.09], respectively). Apremilast treatment for up to 48 weeks maintained low rates of disease progression and improvements in disease activity/clinical signs and symptoms, with no new safety signals. Conclusion: Initiating apremilast treatment during the early, oligoarticular phase of PsA reduced disease activity and delayed progression to polyarticular disease, with benefits maintained with up to 48 weeks of treatment. Trial Registration: ClinicalTrials.gov; NCT03747939

Plain radiographs have been widely used in psoriatic disease (PsD) for diagnosis, classification, and monitoring of structural damage. However, with the emergence of other imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography, the necessity of plain radiographs in PsD is debatable. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá, Colombia, Drs. William Tillett and Arthur Kavanaugh were invited to debate the topic "Plain radiography in psoriatic disease: is it still necessary?" Each presented evidence-based arguments, incorporating multiple data sources, including clinical trials, to support their positions for and against the topic, respectively. This article summarizes their debate for the broader PsD community.

Background/purpose: The treat-to-target (T2T) strategy in psoriatic arthritis (PsA) is supported by International PsA recommendations. The aim of the Multicentre Observational Initiative in Treat-to-Target Outcomes in Psoriatic Arthritis (MONITOR-PsA) cohort was to assess clinical and patient-reported outcomes through pragmatic implementation of a T2T approach. Methods: Patients from secondary care rheumatology departments in the UK were included using a Trials Within Cohorts design if they were 18 years old or over; had a clinical diagnosis of PsA confirmed by the ClAsSification of Psoriatic ARthritis (CASPAR) criteria; active PsA with ≥ 1 tender or swollen joints or enthesis; not previously treated with DMARDs for articular disease. Patients were assessed every 12 weeks using a T2T strategy during the first year of therapy. The primary outcome was the proportion of patients achieving the PsA Disease Activity Score (PASDAS) ‘good’ response at 48 weeks. Findings: We recruited 300 patients, 195 with polyarticular PsA and 105 with oligoarticular (<4 active joints) PsA from April 2018 to October 2022. Sixty-six patients were in an embedded trial of intensive medication, so the analysis population consisted of 234 patients receiving step-up T2T care. At baseline, the median [interquartile range (IQR)] symptom duration prior to PsA diagnosis was 12.0 [4.9, 34.1] months. The mean PsA disease activity was moderate, and 19.7% of patients had structural damage. The proportion of patients achieving the PASDAS ‘moderate’ and ‘good’ responses at 48 weeks were 36/108 (33.3%) (95%CI: 25%-43%) and 39/108 (36.1%) (95%CI: 28%-46%), respectively. DAPSA remission and MDA were achieved in 39/146 (26.7%) and 60/161 (37.3%) patients at 48 weeks, respectively. The majority of patients (117/168 or 69.6%) achieved PSAID patient acceptable symptom state (≤4) at 48 weeks. Interpretation: In this pragmatic routine implementation of a T2T approach, we report results similar to the T2T outcomes in the TICOPA trial, suggesting that a pragmatic T2T approach can be implemented with good outcomes in routine practice.

Objectives: To assess the 2-year impact of bimekizumab on health status, work productivity and indirect cost savings in patients with active PsA. Methods: BE OPTIMAL [NCT03895203; biologic disease-modifying anti-rheumatic drug (bDMARD)-naïve] and BE COMPLETE [NCT03896581; tumor necrosis factor inhibitor inadequate response/intolerance (TNFi-IR)] assessed subcutaneous bimekizumab 160 mg every 4 weeks. BE OPTIMAL week 52/BE COMPLETE week 16 completers could enter BE VITAL (NCT04009499; open-label extension), where all patients received bimekizumab. Outcomes reported for placebo- and bimekizumab-randomized patients to year 2 were changes in health status (EQ-5D-3L) and work productivity [Work Productivity and Activity Impairment Questionnaire—Specific Health Problem v2.0 (WPAI-SHP)], associations between disease control criteria and WPAI-SHP, and annualized indirect cost savings (estimated by multiplying 2022 average wages by improvements in overall work impairment). Missing data were imputed using multiple (continuous) or non-responder (binary) imputation. Results: Among 712 bDMARD-naïve and 400 TNFi-IR patients, improvements from baseline in mean EQ-5D-3L visual analog scale scores were sustained to year 2, with scores improving by 24.6–38.9%. A minimal clinically important difference in overall work impairment was achieved by 51.1–64.8% of patients at year 1, and this was largely sustained to year 2 (44.3–51.6%). The greatest work productivity improvements were observed in patients who achieved stringent disease control across both musculoskeletal and skin domains. In Europe, indirect cost savings at year 1 (US$7965–11 517) were sustained to year 2 (US$7789–12 018); trends were similar in the USA and Japan. Conclusion: Bimekizumab treatment resulted in sustained improvements in health status and work productivity to year 2, with substantial potential for long-term indirect cost savings, regardless of prior TNFi experience.

Objective: To evaluate the validity of the 3-item visual analog scale (3VAS) and 4-item VAS (4VAS) and determine the minimal clinically important difference (MCID) and minimal detectable change (MDC) for each measure using data from 3 phase III randomized clinical trials of guselkumab in psoriatic arthritis (PsA). Methods: Pooled data (1405 participants) from the DISCOVER-1, DISCOVER-2, and COSMOS studies were used. 3VAS/4VAS MCID and MDC were estimated using established formulas. Receiver-operating characteristic curve analysis was used to identify 3VAS/4VAS thresholds for low, moderate, and high disease activity. Criterion validity was assessed by correlating 3VAS/4VAS with other PsA measures. Mixed models evaluated the association between changes from baseline in 3VAS/4VAS at week 8 of guselkumab treatment with the total PsA-modified Sharp-van der Heijde (SvdH) score through week 100. Results: 3VAS/4VAS showed moderate-to-strong correlation with all outcome measures assessed, with coefficients ranging from 0.56/0.62 for Health Assessment Questionnaire–Disability Index to 0.92/0.94 for patient global assessment. MCID was 0.9 for both 3VAS (range 0.7-1.3 depending on method used) and 4VAS (0.6-1.3); MDC was 3.1 and 3.0, respectively. 3VAS cutoffs for low, moderate, and high disease activity were 2.1, 3.3, and 4.8, respectively, and 2.1, 3.4, and 5.0 for 4VAS. Change in 4VAS at week 8 of guselkumab treatment significantly associated with change in SvdH score through week 100 ( P = 0.04). Conclusion: These analyses support the validity of 3VAS/4VAS as multidimensional measures of PsA disease activity. 4VAS may be preferred owing to its greater face validity and separate measurements of the 2 cardinal aspects of PsA (joint/skin disease) and pain.