Rheumatology News

SCCA2: Potential biomarker for psoriasis severity and

treatment efficacy

BY ALICE GOODMAN

Frontline Medical News

From the British Journal of Dermatology

he level of serum squamous

cell carcinoma antigen 2 – an

isoform of SCCA that is widely

used as a tumour marker for SCC –

was significantly higher in both skin

and serum of patients with psoriasis,

compared with healthy volunteers

in a recent study, correlating with

psoriasis severity score and reflect-

ing treatment efficacy.

The intensity of skin and serum

levels of SCCA2 was correlated

in patients with psoriasis, and the

study results also suggest that Th17

cytokines (IL-17 and IL-22) induce

SCCA 2 elevation in serum and skin.

“Significant elevation of SCCA2 is

associated with disease severity and

reflects treatment efficacy. SCCA2

may be a useful biomarker in psoria-

sis, reflecting Th17-type inflamma-

tion – the main determinant of the

severity of psoriasis,” wrote Dr Yuko

Watanabe of Yokohama (Japan) City

University and associates.

According to the investigators, the

commonly used psoriasis area severity

index (PASI) is suboptimal because

it is not truly quantitative and varies

among clinicians. Since there are

several new treatment options for

psoriasis, including biologics, the au-

thors believe that a new serummarker

for psoriasis is needed to evaluate dis-

ease activity and manage treatment.

The prospective, cross-sectional

study included 123 patients with

psoriasis and 25 healthy controls.

Serum SCCA2 levels were signifi-

cantly higher in patients with pso-

riasis, compared with controls: a

median of 2.7 ng/mL versus 0.70 ng/

mL, respectively (P < 0.0001). Se-

rum SCCA2 levels were positively

correlated with PASI for all patients

with psoriasis, regardless of subtype.

In 38 patients on monotherapy or

combination therapy with drugs

to treat psoriasis, SCCA2 levels

decreased in the 35 patients whose

PASI improved on treatment

(P < 0.0001) and increased in the

three cases of clinical deterioration.

The study was supported by a grant

from Japan’s Ministry of Education,

Culture, Sports, Science and Technol-

ogy. The investigators declared that

they had no conflicts of interest.

Significant elevation of SCCA2 is associated with disease

severity and reflects treatment efficacy. SCCA2 may be a useful

biomarker in psoriasis, reflecting Th17-type inflammation –

the main determinant of the severity of psoriasis.

Janssen

Simponi

1, 5

The pain of inflammatory disease goes beyond

the physical

BY M. ALEXANDER OTTO

Frontline Medical News

At the American College of Rheumatology

annual meeting, San Francisco, California

he most common fear of rheumatoid arthri-

tis (RA) and axial spondyloarthritis (axSpA)

patients is that their future suffering will

be as bad as their past suffering, according to

a French survey of 474 patients.

Overall, 182 of the 303 RA patients (60%)

and 122 of the 171 axSpA patients (71%) in

the study ranked that fear as at least a 7 on a

10-point scale, and it remained a serious and

common concern even among the roughly half

of patients who were in remission.

Majorities in both groups were highly con-

cerned about deformity, wheel chair depend-

ence, burdening loved ones, losing autonomy,

and disease spread to other joints. Less com-

mon fears, but still ranked at least a 7 by about

one-third to well over half of patients, were

more frequent flares, inability to care for others,

losing friends, loss of treatment effectiveness,

fear of treatment side effects, and not finding

help if independence is lost.

In general, axSpA was perceived as the more

frightening disease, with patients more likely

than those with RA to give fears presented

on the survey a score of 7 or higher; axSpA

patients also were more likely to fear the im-

pact of disease on pregnancy and work, and

more worried about passing disease onto their

children. Fears about joints seizing up, bone

and spine fusion, and increased flare activity

were far more prevalent in the axSpA group.

The findings are from a test run of a new

questionnaire being developed in France to

capture the psychological burden of chronic

inflammatory disease. The idea is to make

patients’ fears and convictions explicit so that

providers know what they are and can help

patients cope.

“We’ve had this idea for a long time. Patients

have fears and beliefs that” are difficult to ex-

press, and they get in the way of effective of-

fice communication. The questionnaire might

break down the walls, so “patients know their

doctors understand and are concerned” about

their overall well-being, said senior investigator

Dr Francis Berenbaum, chief of rheumatology

at Saint Antoine Hospital in Paris.

It’s hoped that the efforts will improve trust

and dialogue between patients and doctors and

lead to better treatment adherence and follow-

up, more effective counselling, and perhaps

even new patient-related outcomes for clinical

trials, he said at the annual meeting of

theAmerican College of Rheumatology.

To create the survey, the team con-

ducted semi-structured patient inter-

views at rheumatology practices across

France. They whittled the responses

down to identify 23 common fears and

19 disease-related beliefs in RA and

axSpA. The resulting 44-item survey

– there are two additional items about

pregnancy and work-related concerns

– asks patients to rate each one on a

scale of 1–10. The team hopes to have

data soon to show whether or not the

efforts improve outcomes.

Common beliefs in both groups were

that fatigue, over-exertion, stress, and

weather changes trigger flares, but that

moderate physical activity reduces

them.

Almost half of RA patients, versus

about a quarter of axSpA patients, be-

lieved that their disease was triggered by

an emotional shock or stressful event,

and small minorities in both groups

attributed their disease to pollution,

vaccines, or passive or active smoking.

About 70% of patients in both groups

were on biologics, and about one-third

in each were very worried that their

treatments would cause cancer.

Some “disease perceptions may not

be accurate” and “provide a basis for

discussion … to dispel misconcep-

tions, align treatment expectations, and

provide reassurance,” the investigators

noted.

The RA patients were 60 years old

on average, and about three-quarters

were women. The median disease dura-

tion was 10 years, and mean Disease

Activity Score (DAS28) was 2.7; axSpA

patients were a mean age of 47 years,

43% were women, and the median dis-

ease duration was 12 years. Their mean

Bath Ankylosing Spondylitis Disease Activity

Index score was 3.2.

Foundation Arthritis Jacques Courtin and UCB

Pharma funded the work. Dr Berenbaum has no

relevant disclosures. Two investigators are UCB

employees.

The questionnaire might break

down the walls, so “patients know

their doctors understand and are

concerned” about their overall

well-being.

Vol. 4 • No. 1 • 2016 •

heumatology

ews

SPONDYLOARTHROPATHIES