Objective: To determine the proportion of axial psoriatic arthritis (axPsA), describe how it is diagnosed in clinical practice, and identify clinical and demographic characteristics independently associated with axPsA. Methods : A multicentre retrospective observational study was conducted using data from patients registered in the Rheumatic Diseases Portuguese Registry (Reuma.pt) with a diagnosis of PsA or spondyloarthritis with psoriasis. Peripheral involvement was defined as the presence of peripheral joint disease. Axial involvement was defined by the presence of physician-reported spondylitis and/or imaging findings suggestive of axial disease. Patients were divided into four non-exclusive groups: axPsA, axial involvement with or without peripheral joint disease; ax-PsA_only, axial involvement exclusively; peripheral PsA (pPsA)_only, peripheral joint disease, without axial involvement; pPsA, peripheral joint disease with or without axial disease. Results : This study included 2,304 patients. axPsA was present in 37.1% of patients and axPsA_only in 8.1%. The diagnosis was made based on suggestive imaging findings in 30.1%, and on physician judgement in 69.9%. axPsA was independently associated with HLA-B27 positivity (odds ratio [OR]=2.90; p<0.001), enthesitis (OR=1.64; p<0.001), and younger age at symptom onset (OR=0.97; p<0.001); pPsA_only with dactylitis (OR=1.89; p<0.001) and nail dystrophy (OR=1.42; p=0.010). axPsA_only was independently associated HLA-B27 positivity (OR=3.35; p<0.001) and uveitis (OR=2.56; p=0.004); pPsA with nail dystrophy (OR=2.11; p=0.002), dactylitis (OR=18.18; p<0.001), and enthesitis (OR=1.74; p=0.031). Conclusion : Axial involvement is present in over one-third of PsA patients, often in association with peripheral joint disease. ax-PsA patients demonstrate distinct clinical and demographic characteristics compared to those without axial disease.
Abstract Background and aims Data on upadacitinib maintenance therapy in pediatric Crohn’s disease (CD) are scarce. We aimed to evaluate the effectiveness, safety, and dosing of upadacitinib as maintenance therapy in pediatric CD. Methods Children treated with upadacitinib for maintenance of remission of active CD from 35 centers affiliated with the Porto Group of ESPGHAN were included in this retrospective cohort study. Data on demographic, clinical, laboratory, endoscopic, and imaging findings and on adverse events (AEs) were recorded over 52 weeks of follow-up. Results A total of 120 children were included (91 receiving upadacitinib as monotherapy and 29 as combination advanced therapy, mean age 15.4 ± 2.5 years). Prior to upadacitinib induction, 119/120 (99%) children had been treated with biologic therapies, 104 (87%) with two or more biologics and 98 (82%) had failed both vedolizumab and ustekinumab. Clinical remission and corticosteroid-free clinical remission (CFR) were observed after upadacitinib induction in 77 (64%) and 72 (60%) children, respectively. By week 52, 74 (62%) children achieved both clinical remission and CFR, and CFR was sustained in 66 (55%) children. CFR with normal C-reactive protein levels was achieved in 50% of children and CFR with fecal calprotectin levels <150 µg/g was achieved in 33% of children by week 52. Fifty-three (44%) children sustained AEs, two of which were serious (severe acne and intestinal perforation). The most frequent AEs were acne (n = 23), hyperlipidemia (n = 18), and infections (n = 14). Conclusion Upadacitinib is an effective maintenance therapy for refractory pediatric CD. Effectiveness should be weighed against the potential risks of AEs.
Fatigue following acute COVID-19 is common and can be significantly disabling. However, little is known about the severity of fatigue in long COVID (LC) and its connection to co-existing depression and cognitive impairment. Our prospective study assessed patients at the LC Clinic (LCC) at Henry Ford St. John Hospital in Detroit, MI, using the Fatigue Assessment Scale (FAS). On their first visit to LCC, patients completed a standardized form documenting their demographics, comorbidities, and symptoms experienced during acute COVID-19 and their symptoms at the time of the visit. Patients were classified by fatigue severity based on FAS scores: mild to moderate (22-34) and severe (over 34). All patients were asked to complete the Patient Health Questionnaire (PHQ)-2, PHQ-9, and the Montreal Cognitive Assessment (MoCA). The assessments from these questionnaires were compared between two cohorts. Of the 35 patients evaluated, 18 (51.5%) had severe fatigue. The median duration of their first clinic visit to LCC from their acute COVID was 641 days (range=46-1571 days). Self-reported symptoms between these cohorts indicated that shortness of breath (SOB) (p=0.01), chest pain (p=0.05), and feeling down and depressed (p=0.03) from acute COVID were significantly higher among patients with severe fatigue. Similarly, self-reported SOB (p=0.04), dry cough (p=0.02), loss of appetite (p=0.03), headache (p=0.02), and abdominal (p=0.01) and muscle pain (p=0.02) were significantly higher among patients with severe fatigue than those with mild-moderate fatigue. Patients with severe fatigue reported significantly feeling down, depressed, and hopeless (p=0.04), along with little interest and no pleasure in doing things (p=0.01). However, the cognitive impairment assessed by MoCA (p=0.2) did not correlate with the degree of fatigue. Patients with severe fatigue were more likely to report symptoms like shortness of breath, dry cough, loss of appetite, headaches, and muscle pain than those with mild to moderate fatigue during their first LCC visit. Higher PHQ-2 and PHQ-9 scores, indicating greater neurological symptom burden, were linked to increased fatigue severity, but these symptoms did not significantly impact cognitive impairment in long-haul patients. All Authors: No reported disclosures
Breast cancer (BC) treatment is increasingly complex, with a strong need for coordinated decision-making among specialists within multidisciplinary teams (MDTs). Despite their critical role in optimizing patient care, limited data exist on the structure and functioning of BC MDTs in Portugal. To address this gap, the PRISMA study collected both qualitative and quantitative data to characterize the organization, composition, and operational practices of BC MDT meetings across various regions and healthcare sectors nationwide. A mixed-methods approach was used to analyze multidisciplinary team practices from January 2022 to June 2023. For qualitative data, a Delphi methodology was applied through a questionnaire developed from a systematic literature review. Sixty-four Portuguese specialists involved in BC MDT meetings during this period were invited to participate. Two rounds of anonymous online voting were conducted from October 2024 to December 2024, using a five-point Linkert scale; consensus was defined as ≥ 80% concordance among responses. For the quantitative data, retrospective aggregated information from MDT meetings were collected. Forty-six specialists from 13 Portuguese centers participated in the Delphi panel, including representatives from 3 cancer institutes, 3 university hospitals, and 9 general hospitals, encompassing the private (3 centers) and public (10 centers) healthcare sectors. Ten centers also participated in the quantitative phase of the study, where MDT meetings have been held for an average of 18 years. During the study period, each center held an average of 88 meetings, with each meeting lasting approximately 2.3 hours. Most teams had 5-10 members (70%), including medical oncologists (100%), breast surgeons (100%), radiologists (90%), radiation oncologists (90%), pathologists (70%), and oncology nurses (60%). Additional medical and other specialties represented in at least one center included gynecology, nuclear medicine, social service, geriatrics, and data managers. These findings were validated by the Delphi panel, which underscored the role of specialized MDTs with core and supplementary members. During the study period, most meetings were conducted in a hybrid format (60%), with presential (40%) and virtual (30%) formats also reported. On average, 15 cases were discussed per meeting, totaling approximately 767 annually. Of these, on average 45 cases were revised, mainly due to missing prior information (70%). Experts participating in the Delphi panel considered MDT meetings crucial for delivering evidence-based, personalized treatment and minimizing patient care disparities. Key challenges identified included time constraints, delays in diagnosis and staging procedures, and staff shortages. MDT meetings are well established in Portuguese centers and align with international recommendations. This study, through a mixed-methods approach, identified both strengths and operational challenges in MDT practices. Experts emphasize their critical role in ensuring evidence-based, patient-centered care. Findings support efforts to standardize and strengthen MDT functioning to ensure high-quality breast cancer care nationwide. G. Sousa, A. M. Ferreira, I. Pereira, C. Abreu, D. Simão, F. Machado, G. Fernandes, R. A. Leonor, J. Fougo, M. C. Nogueira, P. H. Meireles, J. Abreu Sousa, P. F. Cortes. Multidisciplinary Team Decision-Making in Breast Cancer: Real-World Insights from the PRISMA Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-05.
