Sustained improvement in joint pain and nail symptoms with etanercept therapy in patients with moderate-to-severe psoriasis.

To determine the prevalence of joint and nail symptoms, impact of these symptoms on health-related quality of life (HR-QoL), and the effects of etanercept on them in patients with moderate-to-severe plaque psoriasis.
In CRYSTEL, patients with psoriasis received etanercept continuously (n = 357) or as paused therapy (n = 363) for 54 weeks. In post hoc analyses, baseline characteristics and after-treatment changes were evaluated in patients with baseline joint pain or nail psoriasis, pooling across treatment groups. Assessments of symptom severity and HR-QoL included the Subject Global Assessment question on joint pain, NAPSI, DLQI and EQ-5D.
Of 711 patients, 64% reported joint pain and 79% nail psoriasis at baseline. Patients with baseline joint pain or nail psoriasis had significantly worse HR-QoL than unaffected patients. Mean baseline differences between patients with and without joint pain in DLQI (3.3), EQ-5D utility (0.2), and EQ-5D VAS (7.3) were clinically meaningful. In patients with nail psoriasis, a clinically meaningful difference in EQ-5D VAS (5.0) was seen. Etanercept significantly improved symptom severity and HR-QoL. Patients with joint pain had improvements of 47%, 61%, 29%, and 23% in mean joint pain score, DLQI, EQ-5D utility, and EQ-5D VAS, respectively, at Week 54. Patients with nail psoriasis had improvements of 51%, 63%, and 24% in NAPSI, DLQI, and EQ-5D VAS.
In this study of moderate-to-severe plaque psoriasis, joint and nail symptoms were prevalent and patients with these symptoms had significantly greater HR-QoL impairment at baseline than unaffected patients. Etanercept provided significant improvement in symptom severity and HR-QoL.
AuthorsT A Luger, J Barker, J Lambert, S Yang, D Robertson, J Foehl, C T Molta, R Boggs
JournalJournal of the European Academy of Dermatology and Venereology : JEADV (J Eur Acad Dermatol Venereol) Vol. 23 Issue 8 Pg. 896-904 (Aug 2009) ISSN: 1468-3083 [Electronic] Netherlands
PMID19453794 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Etanercept
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
  • Arthralgia (drug therapy, etiology, psychology)
  • Dose-Response Relationship, Drug
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G (therapeutic use)
  • Male
  • Middle Aged
  • Nail Diseases (drug therapy, etiology, psychology)
  • Psoriasis (complications, drug therapy, psychology)
  • Psychology
  • Quality of Life (psychology)
  • Receptors, Tumor Necrosis Factor (therapeutic use)
  • Severity of Illness Index
  • Treatment Outcome

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