title: Sustained improvement in joint pain and nail symptoms with etanercept therapy in patients with moderate-to-severe psoriasis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Klinik und Poliklinik für Dermatologie, University of Münster, Münster, Germany. luger@uni-muenster.de
authors.forename: T A
authors.initials: TA
authors.lastname: Luger
authors.forename: J
authors.initials: J
authors.lastname: Barker
authors.forename: J
authors.initials: J
authors.lastname: Lambert
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: D
authors.initials: D
authors.lastname: Robertson
authors.forename: J
authors.initials: J
authors.lastname: Foehl
authors.forename: C T
authors.initials: CT
authors.lastname: Molta
authors.forename: R
authors.initials: R
authors.lastname: Boggs
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018771:Arthralgia / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D011584:Psychology; D011788:Quality of Life / Q000523:psychology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept