Introduction: Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic immune-mediated diseases frequently associated with metabolic dysfunction–associated steatotic liver disease (MASLD). Interleukin-17 (IL-17) contributes to both psoriatic inflammation and hepatic fibrogenesis. However, long-term real-world data on the hepatic safety of IL-17 inhibitors remain limited. Objectives: To evaluate longitudinal changes in hepatic fibrosis risk using the Fibrosis-4 (FIB-4) index in PsO and PsA patients treated with IL-17 inhibitors and to assess concurrent trends in skin activity and liver enzymes in a dual-center, retrospective cohort. Methods: Adults with PsO ± PsA who received secukinumab or ixekizumab for ≥12 months at two tertiary centers were retrospectively analyzed. FIB-4 index, liver enzymes (AST, ALT, GGT), and Psoriasis Area and Severity Index (PASI) were assessed at baseline, 3, 6, and 12 months. Patients with chronic liver disease, hepatotoxic drug exposure, or incomplete follow-up were excluded. Results: A total of 123 patients (mean age 45.2 ± 11.7 years; 59.3% male; 79.7% with PsA) were included. Median baseline FIB-4 was 1.06 (IQR 0.84–1.32); 17.9% of patients were in the intermediate-high risk category. FIB-4 values and risk distribution remained stable over 12 months (P=0.76). Liver enzyme levels did not change significantly, and no hepatotoxic event occurred. Median PASI improved from 12.3 (IQR 7.9–18.7) to 1.1 (IQR 0.5–2.2) at month 12 (P<0.001), with 68.1% of patients achieving PASI ≤1. There was no correlation between changes in PASI and FIB-4 (ρ= -0.08; P=0.27). Conclusions: IL-17 inhibitors provided substantial clinical efficacy and stable hepatic fibrosis risk over 12 months, including among patients with intermediate-high baseline FIB-4. These findings support the hepatic safety of IL-17 blockade in psoriatic disease and highlight the importance of routine fibrosis monitoring in metabolic-risk populations.

Objective: The objective of this study is to investigate the frequency and clinical spectrum of subclinical spondyloarthritis (SpA) manifestations among patients with hidradenitis suppurativa (HS) and to evaluate their association with cutaneous disease severity and clinical characteristics. Materials and Methods: In this prospective, cross-sectional real-world study, 120 adults with a confirmed diagnosis of HS were systematically assessed for musculoskeletal involvement. The evaluation included clinical examination for inflammatory back pain, peripheral arthritis, enthesitis, and targeted magnetic resonance imaging (MRI) for sacroiliitis when indicated. Laboratory analyses included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and human leukocyte antigen B27 (HLA-B27) status. Spearman’s rank correlation was used to analyze relationships between SpA-related features and HS clinical parameters, including the International Hidradenitis Suppurativa Severity Score System (IHS4) score, Hurley stage, and smoking. Results: Among the cohort, MRI-confirmed sacroiliitis was detected in 13.3%, enthesitis in 18.3%, HLA-B27 positivity in 12.5%, and peripheral arthritis in 10.0% of patients. A total of 12.5% fulfilled the modified New York criteria for ankylosing spondylitis. No statistically significant correlations were observed between SpA findings and HS severity indices. Weak associations were noted between smoking and both HLA-B27 positivity (ρ=0.27) and peripheral arthritis (ρ=0.21). Conclusion: Subclinical axial and peripheral SpA features are frequently encountered in patients with HS, often in the absence of musculoskeletal complaints. The lack of correlation with skin disease activity highlights the need for routine rheumatologic evaluation in this population to enable early recognition and tailored treatment of inflammatory joint disease.

Background/Aims: Patients with axial spondyloarthritis (axSpA) who fail tumor necrosis factor inhibitors (TNFi) represent a treatment-refractory subgroup with limited options. Real-world evidence (RWE) on the effectiveness and safety of selective Janus kinase 1 (JAK1) inhibition in this setting remains scarce. This study aimed to evaluate the 52-week real-world effectiveness, persistence, and safety of upadacitinib in TNFi-refractory axSpA patients. Materials and Methods: In this retrospective, single-center study, 45 Turkish axSpA patients with prior TNFi failure received upadacitinib 15 mg daily and were assessed at weeks 12, 24, and 52. Effectiveness outcomes included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Health Assessment Questionnaire (HAQ), Visual Analog Scale for pain, and Assessment of SpondyloArthritis International Society (ASAS) 20/40/70 responses analyzed with non-responder imputation (NRI). Treatment persistence was evaluated by Kaplan–Meier analysis, predictors of discontinuation by Cox regression, and safety outcomes as incidence per 100 patient-years (PY). Results: Mean age was 48.1 years; 53.3% were male; 68.9% human leukocyte antigen B27 positive. At week 52, BASDAI and ASDAS decreased significantly (both P < .001), with parallel improvements in BASFI, BASMI, HAQ, and pain. The ASAS20/40/70 responses were achieved by 75.6%, 60.0%, and 26.7% of patients (NRI). Drug retention was 75.6% at 1 year; discontinuations occurred due to adverse events (AEs) (4.4%), treatment failure (11.1%), patient decision (6.7%), and pregnancy (2.2%). Prior interleukin-17 inhibitor (IL-17i) exposure (HR 3.88) and multiple TNFi use (HR 3.02) predicted shorter drug survival. Across 38.3 PY, no serious infections, malignancies, or thromboembolic events were observed; AEs were infrequent and manageable. Conclusion: Upadacitinib provided sustained improvements in disease activity, function, and patient-reported outcomes in TNFi-refractory axSpA, with favorable persistence and safety. Despite limitations of the retrospective, single-center design and modest sample size, these findings complement pivotal trials and global real-world data and represent the first RWE of upadacitinib use in Türkiye, supporting JAK1 inhibition as a therapeutic option in difficult-to-treat populations.Cite this article as: Bakay U, Duran Tİ. Real-world effectiveness and safety of upadacitinib in tumor necrosis factor-inhibitor refractory axial spondyloarthritis: 52-week outcomes from a single-center cohort. Arch Rheumatol. 2025;40(4):465-473.

Amaç: Hidradenitis süppürativa (HS) hastaların hayat kalitesini belirgin olarak etkileyen ağrılı abse ve nodüller, sinus traktüsleri ve skarlarla karakterize kronik inflamatuar bir hastalıktır. Hastalığa metabolik sendrom, kardiyovasküler hastalıklar ve artrit gibi komorbiditeler eşlik etmektedir. Asemptomatik hiperüriseminin sıklığı günümüzde giderek artmaktadır ve inflamasyonu şiddetlendirdiğine dair veriler mevcuttur. Bu çalışmada hiperüriseminin HS hastalarında hastalık şiddeti, klinik ve laboratuvar bulgularıyla ilişkisini incelemeyi amaçladık. Gereç ve Yöntemler: Bu kesitsel çalışmaya Pamukkale Üniversitesi dermatoloji kliniğinde HS tanısı alan hastaların yanı sıra beden kitle indeksi (BKİ), yaş, cinsiyet açısından benzer nitelikte olan, inflamatuar dermatolojik hastalığı olmayan gönüllüler dahil edildi. Serum ürik asit (SÜA), C-reaktif protein (CRP), açlık glukoz, yüksek yoğunluklu lipoprotein kolesterol (HDL), total kolesterol ve trigliserid değerleri kaydedildi. Hastalık şiddetinin belirlenmesi için Hurley sınıflaması ve Uluslararası Hidradenitis Suppurativa Şiddet Skorlaması (IHS4) kullanıldı. Tüm hastalara dermatoloji yaşam kalite indeksi (DYKİ) uygulanarak hastalığın hayat kaliteleri üzerine etkisi incelendi. Bulgular: Çalışmaya 53 HS tanılı hasta, 44 gönüllü dahil edildi. HS hastalarının 23’ünde (%43.4) hiperürisemi mevcuttu. Hastaların ortalama SÜA seviyeleri, kontrol grubundan yüksek olarak saptandı (6.4±1.4 mg/dL, 4.8±1.4 mg/dL, sırasıyla p