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People did not experience clinically significant differences in their psoriatic arthritis (PsA) between summer and winter weather, although differences were observed.

“It was previously shown that cutaneous lesions of psoriasis patients may do better in certain seasons like summer or winter. However, to date, PsA studies assessing the impact of weather variation on disease activity are very limited, near non-existent. Investigating the correlation between DA, PROs and weather variation in PsA can provide valuable insights into its disease mechanisms to improve patients' quality of life,” lead investigator Maxine Joly-Chevrier, MD Candidate, University of Montreal, Quebec, Canada, and colleagues wrote.

Joly-Chevrier and colleagues matched hourly data on temperature, relative humidity, and pressure between 2015 to 2020 from Montreal (Environment Canada) with disease activity (DA) and patients reported outcomes (PROs) of patients with PsA patients enrolled in RHUMADATA patient registry. They compared the difference in mean DA and between winter and summer and calculated Pearson Correlation Coefficients between clinical profile and weather measurements.

The investigators collected 2665 PROs from a total of 858 patients with PsA. Among DA/PRO data collected, only clinical disease activity index (CDAI) scores (mean, 8.2; standard deviation [SD], 7.8) and simplified disease activity index (SDAI) scores (mean, 8.6; SD, 7.6) were lower in winter compared to summer (CDAI [mean, 8.8; SD, 7.9; 

Joly-Chevrier and colleagues found that summer revealed positive correlations between humidity and scores on patient global assessment (PtGA), fatigue, pain, c- reactive protein (CRP), bath ankylosing spondylitis disease activity index (BASDAI), and bath ankylosing spondylitis functional index (BASFI) and negative correlations between temperature and health assessment questionnaire disability index (HAQ-DI) scores. Winter had positive correlations between temperature, fatigue, and pain.

However, the investigators found significant correlations between gender, age, and disease duration, and optimal regression models derived based on Akaike's Information Criteria suggested that weather may account for less than 1% of the variation in PROs, which may reflect disease activity.

“In conclusion, our study contributes to the growing body of evidence that challenges the direct association between weather conditions and IADs symptomatology, which are complex diseases influenced by multiple factors. Our findings suggest that weather-related factors play a limited role at the group level in the variability of PsA symptoms and that other factors may be more influential. However, at the individual level, some patients may experience a more significant impact from weather-related factors,” Joly-Chevrier and colleagues concluded.

Other recent research into PsA found that patinets 

 in clinical parameters before initiating biologic (b) and targeted synthetic (ts) disease modifying anti-rheumatic drugs (DMARDs) mono or methotrexate (MTX)-combination therapy and treatment decisions were driven by subjective tolerability of MTX.

The combination group had a mean drug retention time of 15.2 months and the monotherapy group had a mean drug retention time of 14.4 months. At 6 months, 48% of the combination group and 66% of the monotherapy group were still on their original treatment; at 12 months, these proportions were 48% and 67%, respectively. Adjusted treatment retention rates were found to be similar between groups (

Joly-Chevrier M, Coupal L, Sauvageau LC, Movahedi M, Choquette D. A Real-World Analysis on Weather Variation Disease Activity and Patient Reported Outcomes in Psoriatic Arthritis. 

Published online September 15, 2024. doi:10.3899/jrheum.2024-0520

Regierer AC, Kiefer D, Schett D, et al. No difference in clinical parameters and drug retention in PsA patients receiving b/tsDMARD monotherapy versus combination with methotrexate: data from the RABBIT-SpA registry. 

 2024;10:e004389. doi: 10.1136/rmdopen-2024-004389

Articles

Gender, age, and disease duration significantly affected symptom variations.

News

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On the HCPLive psoriatic arthritis page, resources on the topics of medical news and expert insight into PsA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on arthritis, and more.

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Weather Only Has Small Impact on Psoriatic Arthritis Symptoms

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Advanced fibrosis and obesity significantly, negatively impacted health-related quality of life (HRQL) in individuals with 

 treated in primary care, according to new data.

Individuals with T2D experience a high prevalence of SLD, particularly metabolic dysfunction-associated SLD (MASLD), affecting HRQL due to overlapping factors and liver-related comorbidities, including fibrosis.

“This has important implications for the consideration of SLD/MASLD and AF in the routine assessment of people with T2D in disease management programs,” wrote the investigative teams, led by Jörn M. Schattenberg, MD, department of Internal Medicine II, University Medical Centre Saarland.

Along the disease course of MASLD, the disease can progress to metabolic dysfunction-associated steatohepatitis (MASH), increasing scarring of liver tissue and advancing to liver fibrosis, including AF.

 Non-invasive tests, including vibration-controlled transient elastography (VCTE), have been developed to identify patients with MASLD who require intensive care, but few studies are available on its use in primary care settings.

The EQ-5D-3L, an HRQL-related questionnaire, estimates a patient’s functioning and well-being across 5 dimensions and perception of their health status over three response levels. It has been validated for T2D and SLD/MASLD, with higher disease stages typically reporting lower HRQL

. However, the independent effect size of the liver phenotype has not been established in patients with T2D, despite the prevalence of SLD and AF in this population.

For this study, Schattenberg and colleagues evaluated the influence of AF on HQRL in a population with T2D. A total of 149 patients with T2D, treated at a primary care provider with a German disease management program (BMP), met the criteria for inclusion in the final analysis. Hepatic steatosis and AF were non-invasively assessed using VTCE, while the EQ-5D-3L questionnaire evaluated the HRQL.

Independent predictions of impaired HRQL were categorized through univariable and multivariable linear regression models. Among the study population, the prevalence of SLD was 77.9% (n = 116), with the majority (70.7%; n = 104) having MASLD. AF was identified in 19.5% (n = 24) of patients.

Upon analysis, individuals with T2D and AF demonstrated an overall lower HRQL, compared with those without AF (

 <.001). In multivariable linear regression analysis, obesity (β, –0.247; 95% CI, –0.419 to –0.077) and AF (β, –0.222; 95% CI, –0.383 to –0.051) were the only independent predictors of a poor HRQL. However, T2D-related comorbidities, including cardiovascular disease (CVD), retinopathy, polyneuropathy, and diabetic foot syndrome, no longer predicted an impaired HRQL after the multivariable adjustment.

In their summary, Schattenberg and colleagues noted that while the study did not evaluate the number of comorbidities specifically, the strong effect of AF on HRQL could be an expression of these overlapping factors, particularly given the context of T2D.

“Implementing a routine assessment of liver fibrosis in people with T2D may aid in identifying those with an overall higher disease burden and a lower HRQL,” they wrote. “...Awareness of liver health and specific interventions may improve patient-reported and liver-related outcomes in people with T2D.”

Michel M, Funuyet-Salas J, Doll M, et al. Impairment of health-related quality of life among people with type 2 diabetes and advanced liver fibrosis. Sci Rep. 2024;14(1):21650. Published 2024 Sep 17. doi:10.1038/s41598-024-72105-8

Diehl AM, Day C. Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis. N Engl J Med. 2017;377(21):2063-2072. doi:10.1056/NEJMra1503519

Tapper EB, Loomba R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD. Nat Rev Gastroenterol Hepatol. 2018;15(5):274-282. doi:10.1038/nrgastro.2018.10

Younossi ZM, Stepanova M, Anstee QM, et al. Reduced Patient-Reported Outcome Scores Associate With Level of Fibrosis in Patients With Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol. 2019;17(12):2552-2560.e10. doi:10.1016/j.cgh.2019.02.024

Obesity and advanced fibrosis were independent predictors of impaired health-related quality of life in people with T2D.

Hepatology

Advanced Liver Fibrosis Negatively Impacts Quality of Life in T2D

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

In a talk titled ‘Acute & Chronic Spontaneous Urticaria: Diagnostic and Therapeutic Strategies,’ presented at the 

, attendees were given a series of challenging cases in urticaria designed to test their making of the correct diagnosis.

The talk was presented by Jason Ezra Hawkes, MD, a dermatologist and investigator at the Oregon Medical Research Center in Portland.

“I want you to think of urticaria in the same way that we think about alopecia,” Hawkes said. “It doesn't mean much by itself. So there’s alopecia, there’s scarring alopecia, there's non-scar alopecia. I want you to think of urticaria the same way. There's different types of urticaria. This is a heterogeneous group. This is a bucket that's going to capture all types of urticaria.”

He noted that urticaria typically has a 2 to 1 female predominance.

“Urticaria as a bucket is characterized by either wheals or angiodema,” Hawkes explained. “This is a superficial swelling in the skin…These, by definition, last less than 24 hours. If there’s 1 clinical pearl about how to tease out urticaria, this is it. Almost no other skin diseases that we see have transient wheals that last less than 24 hours.”

Hawkes added that if a clinician, physician assistant, or other provider is not sure if a patient has urticaria, 99 times out of 100 this observation will lead to such a conclusion.

“Angioedema is a little different from the wheals,” Hawkes said. “This involves deeper swelling…Notice the time frame, which is less than 72 hours. That means this type of swelling in the skin takes longer to resolve. So if you have a patient come in with a swollen lip or swollen eye, this can take longer to resolve but they can still have urticaria.”

Hawkes later noted that wheals are not a primary skin lesion, which he added is critical given the heterogeneity of wheals. He notes that providers should ask patients how long an individual wheal has lasted, as opposed to how long they have been experiencing them in general.

“What do you think drives people to the ER, urgent care, or the hospital?” he asked. “It's angiodema, not the hives as much. This is the scary part and it lasts for days…So remember, we're talking about urticaria and you can make a diagnosis of urticaria just based on angioedema.”

However, Hawkes noted that there is a caveat to reaching such a conclusion.

“We've talked a lot about T-cell disorders like eczema, psoriasis, vitiligo, even HS, and we've talked about B-cell disorders, autoimmune conditions, and lupus, for example,” Hawkes said. “We're now talking about mast cells, where the mas cell is the predominant immune cell found in the skin of these patients. We're not going to talk about the same mechanisms that we have with eczema or atopic dermatitis or psoriasis, for example, because we're not necessarily talking about the same player.”

He explained that mast cells are another immune cell that comes from the same bone marrow cells but have a different function.

“These cells get activated and then they degranulate,” Hawkes said. “They release the granules. All those proteins are going to contribute to the pathophysiology of this condition. All types of urticaria, and it doesn't matter if they're acute, inducible, or chronic spontaneous: mast cell degranulation is going to be the key feature, not T-cells as a predominant cell.”

For additional information on presentations such as these, view our 

coverage of the Maui Derm NP+PA Fall 2024 conference

The quotes included in this summary were edited for the purposes of clarity. Hawkes has served as an advisor or consultant for Apogee, Arcutis, Bl, Blueprint Medicines, BMS, Boxer Capital LLC, Cogent Biosciences, Dermavant, Galderma, Institute for Systems Biology (ISB), Jansen, LEO, Novartis, Regeneron, Sanofi, Sun Pharma, Takeda, and UCB. He is also on the Medical Board of the National Psoriasis Foundation (NPF).

This conference talk was titled Acute & Chronic Spontaneous Urticaria: Diagnostic and Therapeutic Strategies and presented a challenging case series to attendees.

Dermatology

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 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Jason Hawkes, MD: Strategies for Diagnosing Acute, Chronic Spontaneous Urticaria

Chelsie Derman is an assistant editor for 

who covers psychiatry, sleep medicine, and geriatrics. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Taking oral vitamin D supplementation may improve vitamin D status and quality of life in adults with 

 Yet, the study did not find vitamin D supplements improved symptom severity.

“Our results should come as no surprise to those in the field; IBS is a multifaceted disease and vitamin D, much like other classic nutrients, exhibits innate complexities in its actions and interactions, influencing countless biological mechanisms,” wrote investigators, led by Kelly C. Cara, from Friedman School of Nutrition Science and Policy, Tufts University, in Boston. “It is important to note that international recommendations for adequate serum 25(OH)D status, including those from the Endocrine Society, are based on bone-related outcome measures and not IBS.”

Research has revealed 82% of people with IBS are insufficient or deficient in serum 25-hydroxyvitamin D (25(OH)D) levels.

 Despite the common deficiency, it is not known if increasing vitamin D levels will improve symptom severity and quality of life.

Investigators conducted a systematic review and meta-analysis to see if changes in vitamin D levels impact symptom severity and quality of life in adults with IBS. The team leveraged data from MEDLINE, Cochrane Central Register of Controlled Trials, Global Health, EMBASE, and Web-of-Science databases up to August 12, 2024, and ultimately included 12 studies (RCT, n = 7; Single-arm interventions, n = 3; Mendelian randomization, n = 2).

Among the 12 studies, 7 study populations had deficient (< 20 ng/mL), and 3 had insufficient (21 – 29 ng/mL) baseline serum 25(OH)D levels. Mean baseline serum 25 (OH) D levels for intervention study groups ranged from 11.68 to 21.33 ng/mL.

The randomized controlled trials (RCTs) and single-arm intervention studies had between 40 – 135 participants, aged 18 – 75 years. The 2 Mendelian randomization studies ranged from 187,028 to 496,946 participants and did not report ages. Studies were conducted in various countries, including Iran (n = 4), Egypt (n = 2), Pakistan (n = 1), China (n = 2), the UK (n = 2), and the US (n = 1).

Participants in the randomized controlled trials received 3,000 IU daily to 50,000 IU biweekly vitamin D dosages. The change in vitamin D levels was measured after 6 – 26 weeks.

Meta-analyses of these randomized controlled trials showed patients on oral vitamin D had increased 25(OH)D levels compared with placebo (pooled mean difference, 20.33; 95% confidence interval [CI], 12.91 to 27.74 ng/mL). Taking oral vitamin D significantly improved quality of life scores in participants deficient in serum 25(OH)D levels at baseline (3.19; 95%, CI 2.14 to 4.24).

However, participants had a nonsignificant reduction in IBS symptom severity (-55.26; 95% CI, -55.26 to 3.48). Subgroup analyses also produced similar results among populations with deficient vitamin D status at baseline (-31.22; 95% CI, -65.61 to 3.18) and with overweight BMI status (−22.23; 95% CI, –65.03 to 20.56).

In contrast, when investigators examined the 3 single arm intervention studies, they noted vitamin D supplements improved IBS symptom severity. Among 97 analyzed patients, 56.7% on vitamin D experienced complete relief from IBS symptoms, including abdominal fullness, bloating, heartburn, constipation, and diarrhea. Moreover, 36.1% demonstrated considerable improvement, and 6.2% had moderate relief.

Another single-arm intervention study found 12 weeks of vitamin D supplementation resulted in 97.5% of participants repleting vitamin D status, 47.5% with no IBS symptoms, and 52.5% with a partial relief of symptoms. Participants with no IBS symptoms at follow-up had significantly greater 25(OH)D levels compared with those who only experienced partial relief (

The third single-arm intervention study also found a similar finding: vitamin D not only increased their 25(OH)D levels (P < .0001) but improved their symptoms. Participants on placebo had a significantly reduced number of bowel movements a day (

As for the Mendelian randomization studies, one study found there was no causal association between serum 25(OH)D levels and genetically predicted risk of IBS, as seen by inverse variance weighted (

 = .76). Another study found vitamin D intake was not causally associated with IBS (

 > .01) and serum 25(OH)D was not causally associated with IBS (

“It is likely that (if present) vitamin D asserts a threshold effect; therefore, consideration of participant baseline status in the inclusion and exclusion criteria of future trials can help ensure accuracy of the response to treatment with vitamin D,” investigators wrote. “Future RCTs with sufficient power are greatly needed to fully elucidate the effects of vitamin D supplementation, past repleting inadequate or deficient serum 25(OH)D levels, in adults with IBS.”

Cara KC, Taylor SF, Alhmly HF, Wallace TC. The effects of vitamin D intake and status on symptom severity and quality-of-life in adults with irritable bowel syndrome (IBS): a systematic review and meta-analysis. 

. Published online September 5, 2024. doi:10.1080/10408398.2024.2400603

Khayyat Y, Attar S. Vitamin D Deficiency in Patients with Irritable Bowel Syndrome: Does it Exist?. 

. 2015;30(2):115-118. doi:10.5001/omj.2015.25

Oral vitamin D improves vitamin D status and quality of life in IBS patients but does not significantly reduce symptom severity, a new study suggests.

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, IBS and IBD, Crohn's disease, and more.

Irritable Bowel Syndrome

On the HCPLive irritable bowel syndrome page, resources on the topics of medical news and expert insight into IBS can be found. Content includes articles, interviews, videos, podcasts, and breaking news on IBS, IBD, and more.

Vitamin D Supplementation Boosts Quality of Life in IBS Without Easing Symptoms

On March 14, 2024, the US Food and Drug Administration granted accelerated approval to resmetirom (Rezdiffra) for noncirrhotic 

, now known as metabolic dysfunction-associated steatohepatitis (MASH), with moderate to advanced fibrosis, making it the first and only treatment to receive approval for the progressive liver disease.

The decision followed 18 clinical studies in the oral, thyroid hormone receptor (THR)-β selective agonist’s clinical development program: 12 phase 1 studies, a pair of phase 2 studies, and 4 phase 3 studies. MAESTRO-NASH is an ongoing phase 3, double-blind, randomized, placebo-controlled trial, and is 1 of 4 phase 3 studies in resmetirom’s clinical development program supporting its approval in adult patients with NASH and fibrosis.

Test your knowledge of MAESTRO-NASH with this clinical quiz!

Please click here after submitting answer

Both NASH resolution and improvement in fibrosis

A hepatocellular ballooning score of 0 and a lobular inflammation score of 0 or 1

A reduction in the NAFLD activity score by ≥ 2 points

A hepatocellular ballooning score of 0, a lobular inflammation score of 0 or 1, and a reduction in the NAFLD activity score by ≥ 2 points

Percent change from baseline in LDL cholesterol level at week 24

Brooks, A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed September 20, 2024. 

https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash

Harrison SA, Bedossa P, Guy CD, et al. A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. N Eng J Med. doi:10.1056/NEJMoa2309000

Test your knowledge of the phase 3 MAESTRO-NASH trial supporting resmetirom (Rezdiffra)’s FDA accelerated approval for MASH with this quiz.

MASH / MASLD

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Clinical Quiz: MAESTRO-NASH Trial Participants, Endpoints for Resmetirom in MASH

Extended follow-up with more cases is ongoing and will allow risk factors for psoriatic arthritis to also be further explored.

Arthritis Incidence in Psoriasis Higher Than EHR Records Suggest

Videos

Del Rosso highlights points from his conference talk on benzoyl peroxide (BPO) use among patients with acne and other updates.

Acne

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Updates on Benzoyl Peroxide Use for Acne, with James Del Rosso, DO

With HepQuant DuO and SHUNT tests, investigators could categorize patients with sclerosing cholangitis into low, moderate, and high disease severity subgroups.

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HepQuant Tests Accurately Assess Primary Sclerosing Cholangitis Disease Severity

Abigail Brooks is an assistant editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

Reau explains the importance of second- and third-line treatment in PBC and the potential implications of no longer having OCA after a negative FDA advisory committee meeting.

Nancy Reau, MD: Obeticholic Acid’s Future in PBC After FDA Advisory Committee Meeting

The model gave special emphasis to words noting pain, fatigue and depressed moods.

Fibromyalgia

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AI Language Model Distinguishes Fibromyalgia From Other Chronic Pain Conditions

Arimoclomol, in combination with miglustat, is approved to treat neurological symptoms associated with NPC in adults and children aged ≥2 years.

FDA News

Rare Disease Report®

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Dyslipidemia

FDA Approves Arimoclomol, First Drug for Niemann-Pick Disease, Type C

As advancements in valvular technology progress, Nguyen highlights the need for long-term data and multidisciplinary collaboration to improve patient outcomes.

Cardiology

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Structural Heart Disease

Tom C. Nguyen, MD: Evolving Roles of TAVR, SAVR in Aortic Valve Disease

Nehad Soloman, MD, FACR; Andrew Sharobeem, DO, FACR, and Sunil Patel, MD, explore the nephrologist's vital role in gout diagnosis, treatment options for gout patients with chronic kidney disease, and strategies for managing refractory gout and its associated challenges.

Gout

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Medcast Videos

Moving Beyond the Joint: The Interplay Between Gout and Kidney Disease 

This segment of her interview featured a conversation about the biggest takeaways and notable case series presented in Culton’s talk at Maui Derm NP+PA Fall.

Atypical Clinical Presentations of Blistering Disease, with Donna Culton, MD, PhD

A new study finds causal links between schizophrenia and MDD on IBS, highlighting the need for integrated care addressing both psychiatric and gastrointestinal symptoms.


Psychiatry

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Major Depressive Disorder

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Latest News

Weather Only Has Small Impact on Psoriatic Arthritis Symptoms

Advanced Liver Fibrosis Negatively Impacts Quality of Life in T2D

Jason Hawkes, MD: Strategies for Diagnosing Acute, Chronic Spontaneous Urticaria

Vitamin D Supplementation Boosts Quality of Life in IBS Without Easing Symptoms

Clinical Quiz: MAESTRO-NASH Trial Participants, Endpoints for Resmetirom in MASH