Whats New PsA? (4.3.2026)

This episode of the RheumNow Podcast, hosted by Dr. Jack Cushwood on April 3, 2026, covers key updates from the American Academy of Dermatology (AAD) annual meeting, focusing on psoriatic arthritis (PsA) and psoriasis. Major highlights include the publication of the Affinity trial, which found combination therapy with goselcomab and galumab significantly improved ACR50, ACR20, and ACR70 responses in PsA patients—though it didn’t meet its primary MDA endpoint—suggesting potential for future combination biologic use. The AXIS study revealed that 27% of PsA patients have axial involvement via imaging, a higher rate than previously thought, which may influence treatment paradigms. The TOGETHER PSA trial demonstrated that adding terzepatide to ixakizumab led to dramatically higher ACR50 and weight loss rates in overweight/obese PsA patients, underscoring the value of combination metabolic and immunologic therapy. Additionally, breplositinib, a novel TIC2-JAK1 inhibitor, showed strong efficacy in refractory skin and muscle disease, though a 10% rate of serious infectious events at the 30mg dose raises safety concerns. The FDA issued a safety warning about Avacapan due to 76 cases of drug-induced liver injury, including 7 cases of rare vanishing bile duct syndrome (VBDS) with fatal outcomes, reinforcing the need for vigilance in monitoring. The episode also discusses broader healthcare trends, including the psychiatrist shortage and the growing role of advanced practice providers in managing chronic inflammatory diseases like rheumatology. Key takeaways include: 1) Combination therapies (biologic + metabolic agents) are emerging as powerful tools in PsA, especially in overweight patients; 2) Axial disease is more prevalent in PsA than previously recognized, warranting better imaging and treatment strategies; 3) New TIC2 inhibitors like envuducitinib and breplositinib show promise but require careful risk-benefit assessment due to infection and liver toxicity; 4) Aggressive, treat-to-target management improves pregnancy outcomes in autoimmune diseases; 5) The growing reliance on APPs in rheumatology demands structured training and collaboration. The overall tone is cautiously optimistic, emphasizing innovation while underscoring safety and patient-centered care.