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Sample records for active psoriatic arthritis

  1. Physical Activity and Psoriatic Arthritis

    ... out more! Email * Zipcode Physical Activity and Psoriatic Arthritis Physical activity plays an important role in overall well-being. If you have psoriatic arthritis, moderate exercise may offer specific benefits, including improved ...

  2. Psoriatic arthritis

    This book contains 11 chapters. Some of the titles are: The history and epidemiologic definition of psoriatic arthritis as a distinct entity; Psoriatic arthritis: Further epidemiologic and genetic considerations; The radiologic features of psoriatic arthritis; and Laboratory findings and pathology of psoriatic arthritis

  3. Psoriatic arthritis

    Gerber, L.H.; Espinoza, L.R.

    1985-01-01

    This book contains 11 chapters. Some of the titles are: The history and epidemiologic definition of psoriatic arthritis as a distinct entity; Psoriatic arthritis: Further epidemiologic and genetic considerations; The radiologic features of psoriatic arthritis; and Laboratory findings and pathology of psoriatic arthritis.

  4. Psoriatic Arthritis

    ... your body. Some people with psoriasis have psoriatic arthritis. It causes pain, stiffness, and swelling of the ... physical exam and imaging tests to diagnose psoriatic arthritis. There is no cure, but medicines can help ...

  5. Psoriatic arthritis

    In the past 10 years, a number of well-controlled surveys of psoriatic patients selective for the presence of arthritis have been conducted. A Canadian group reported that of 100 patients admitted to the hospital for treatment of psoriasis, 32 had clinical or radiologic evidence of psoriatic arthritis, and 17 had both types of evidence. Eighty patients with radiologic evidence of spinal or sacroiliac involvement were asymptomatic, and seven had clinical evidence of peripheral arthritis but without radiologic evidence. The authors concluded that psoriatic arthritis is a common event in patients with severe psoriasis and that it is associated with more extensive skin disease than is found in patients without arthritis. The information gathered from these epidemiologic studies coupled with clinical, radiologic, and serologic characteristics have provided the basis for the current belief that psoriatic arthritis is indeed a distinct entity

  6. Diagnosing Psoriatic Arthritis

    ... to find out more! Email * Zipcode Diagnosing Psoriatic Arthritis Psoriatic arthritis can develop slowly with mild symptoms, or it ... severe. Early recognition, diagnosis and treatment of psoriatic arthritis can help prevent or limit extensive joint damage ...

  7. Treating Psoriatic Arthritis

    ... to find out more! Email * Zipcode Treating Psoriatic Arthritis Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints ... recommend treatments based on the type of psoriatic arthritis, its severity and your reaction to treatment. Download ...

  8. Psoriatic arthritis

    Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. It is characteristic that the rheumatoid factor in serum is absent. Etiology of the disease is still unclear but a number of genetic associations have been identified. Inheritance of the disease is multilevel and the role of environmental factors is emphasized. Immunology of PsA is also complex. Inflammation is caused by immunological reactions leading to release of kinins. Destructive changes in bones usually appear after a few months from the onset of clinical symptoms. Typically PsA involves joints of the axial skeleton with an asymmetrical pattern. The spectrum of symptoms include inflammatory changes in attachments of articular capsules, tendons, and ligaments to bone surface. The disease can have divers clinical course but usually manifests as oligoarthritis. Imaging plays an important role in the diagnosis of PsA. Classical radiography has been used for this purpose for over a hundred years. It allows to identify late stages of the disease, when bone tissue is affected. In the last 20 years many new imaging modalities, such as ultrasonography (US), computed tomography (CT) and magnetic resonance (MR), have been developed and became important diagnostic tools for evaluation of rheumatoid diseases. They enable the assessment and monitoring of early inflammatory changes. As a result, patients have earlier access to modern treatment and thus formation of destructive changes in joints can be markedly delayed or even avoided

  9. Genetics Home Reference: psoriatic arthritis

    ... Understand Genetics Home Health Conditions psoriatic arthritis psoriatic arthritis Enable Javascript to view the expand/collapse boxes. Print All Open All Close All Description Psoriatic arthritis is a condition involving joint inflammation (arthritis) that ...

  10. Imaging in Psoriatic Arthritis

    Poggenborg, René Panduro; Østergaard, Mikkel; Terslev, Lene

    2015-01-01

    Psoriatic arthritis (PsA) is an inflammatory joint disease characterized by arthritis and often enthesitis in patients with psoriasis, presenting a wide range of manifestations in various patterns. Imaging procedures are primarily conventional radiography, ultrasonography (US), and magnetic...

  11. Psoriatic arthritis

    ... that often occurs with a skin condition called psoriasis . ... inflammatory condition. About 1 in 20 people with psoriasis may develop arthritis with the skin condition. In most cases, psoriasis ...

  12. Genetic epidemiology: Psoriatic arthritis

    Barton, Anne C

    2002-01-01

    The existence of psoriatic arthritis as a distinct clinical entity remains a topic of debate; some authors propose that it is simply the co-occurrence of psoriasis and inflammatory arthritis. However, a distinct entity is likely to have distinct susceptibility factors in addition to those that contribute to psoriasis and inflammatory arthritis alone. These aetiological factors may be genetic and/or environmental, and in this review, the evidence for distinct psoriatic arthritis genetic suscep...

  13. Classification of Psoriatic Arthritis

    ... and psoriatic arthritis. Email * Zipcode The National Psoriasis Foundation (NPF) is a non-profit organization with a mission to drive efforts to cure psoriatic disease and improve the lives of those affected. Copyright © 1996-2015 National Psoriasis Foundation/USA Bottom Menu About NPF About Us Annual ...

  14. Epidemiology of psoriatic arthritis

    C. Salvarani

    2012-06-01

    Full Text Available Epidemiological studies on psoriatic arthritis have long been hampered by the absence of widely accepted classification criteria. The development of the CASPAR (ClASsification criteria for Psoriatic ARthritis criteria has recently provided the framework for conducting epidemiological studies in psoriatic arthritis using uniform recruitment criteria. However, so far, only a minority of studies have adopted such criteria. In addition to the lack of shared classification criteria, differences in study settings, designs, and ascertainment methods have contributed to yield substantial disparities in the estimates of the incidence (from 3,02 to 23,1 cases per 100,000 people and prevalence (from 49,1 to 420 cases per 100,000 people of psoriatic arthritis around the globe. Overall, the available data suggests that the prevalence of psoriasis in the general population is approximately 2-3%, with about a third of patients with psoriasis having arthritis. Therefore, psoriatic arthritis may affect 0,3- 1,0% of the population, a frequency not dissimilar from that of rheumatoid arthritis. Future epidemiological studies should be carried out in larger numbers of patients diagnosed using consistent criteria.

  15. IMAGING OF PSORIATIC ARTHRITIS

    S. D'Angelo

    2011-09-01

    Full Text Available Imaging of psoriatic arthritis (PsA is important for two reasons: the differential diagnosis from other arthritides and the assessment of structural damage that can be inhibited by the new drugs such as the anti-TNFα agents. Plain film radiographic findings of peripheral arthritis have been important in elaborating the concept of PsA as a separate disease entity. Characteristic aspects of psoriatic peripheral arthritis help the differentiation from rheumatoid arthritis. High-resolution ultrasonography (US, US combined with power Doppler (PDUS and magnetic resonance imaging (MRI can be used to image joint synovitis of PsA. Radiologic features of spondylitis associated with psoriasis are similar to spondylitis associated with reactive arthritis and differ from those of primary ankylosing spondylitis (AS and the spondylitis associated with inflammatory bowel disease. MRI is very sensitive for the early diagnosis of sacroiliitis. There have been no MRI studies on the spine of patients with PsA. In primary AS bone oedema in the vertebral bodies is an indicator of active disease and can ameliorate during anti-TNFα therapy. Historically, plain film radiography have played a pivotal role in defining enthesitis lesions of SpA. However, entheseal bone changes appear late. US and MRI have proved to be a highly sensitive and non invasive tools. Recent US and MRI studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and marked adjacent soft tissue swelling with a variable degree of small joint synovitis. There is no evidence of enthesitis of the insertion of the flexor digitorum tendons and of the attachment of the caspsule of the digit joints. Key words: Enthesitis, dactylitis, spondyloarthritis, ultrasound, magnetic resonance, imaging

  16. CLINICAL PRESENTATION OF PSORIATIC ARTHRITIS

    M. Atteno; Peluso, R.; R. Scarpa

    2011-01-01

    Psoriatic arthritis is a spondyloarthropathy, which occurs in patients with skin and/or nail psoriasis. Basing its characterization on morphological purposes, several types of arthritis have been described. Alternatively, we propose a simplified classification into three subsets, focusing on the levels of expression of cutaneous and articular elements which devise this syndrome. The first is established psoriatic arthritis which occurs in patients with evident or remittent skin and/or nail ps...

  17. Innovative medicines for treatment of psoriatic arthritis

    Levitan A.l.; Reshetko O.V.

    2015-01-01

    The problem of effective treatment of psoriatic arthritis has not been solved yet. The search for new therapeutic options is very active in many directions. At the stage of clinical trials are drugs that block interleukin-17-a (secukinumab, ixekizumab, brodalumab), drugs that suppress interleukin-12 and interleukin-23 (ustekinumab). To modern means to ensure psoriatic arthritis include drugs that are inhibitors of small molecules orkinase pathways (apremilast, tofacitinib).

  18. Innovative medicines for treatment of psoriatic arthritis

    Levitan A.l.

    2015-09-01

    Full Text Available The problem of effective treatment of psoriatic arthritis has not been solved yet. The search for new therapeutic options is very active in many directions. At the stage of clinical trials are drugs that block interleukin-17-a (secukinumab, ixekizumab, brodalumab, drugs that suppress interleukin-12 and interleukin-23 (ustekinumab. To modern means to ensure psoriatic arthritis include drugs that are inhibitors of small molecules orkinase pathways (apremilast, tofacitinib.

  19. Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis

    Højgaard, Pil; Christensen, Robin; Dreyer, Lene;

    2016-01-01

    INTRODUCTION: Persistent pain is a major concern for patients with psoriatic arthritis (PsA). Pain may be due to inflammatory activity or augmented central pain processing. Unawareness of the origin and mechanisms of pain can lead to misinterpretation of disease activity (by composite scores) and...... NCT02572700). Results will be disseminated through publication in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02572700, Pre-results....

  20. Psoriatic arthritis as a mountain

    Berthelot, J M

    2011-01-01

    There is no doubt that inflammatory arthritis/enthesitis and psoriasis coexist more frequently than would be expected by chance: for instance, in a study of 1285 patients with psoriasis seen in an hospital, 483 (38%) were suffering from arthritis/ enthesitis, including 40 patients classified as Rheumatoid Arthritis (RA) (3%), 177 (14%) as undifferentiated arthritis (UA), and 266 (21%) as Psoriatic Arthritis (PsA) (1). Although lower percentages have been noticed in the general population with...

  1. Psoriatic arthritis: imaging techniques

    E. Lubrano

    2012-06-01

    Full Text Available Imaging techniques to assess psoriatic arthritis (PsA include radiography, ultrasonography (US, magnetic resonance imaging (MRI, computed tomography (CT and bone scintigraphy. The radiographic hallmark of PsA is the combination of destructive changes (joint erosions, tuft resorption, osteolysis with bone proliferation (including periarticular and shaft periostitis, ankylosis, spur formation and non-marginal syndesmophytes. US has an increasing important role in the evaluation of PsA. In fact, power Doppler US is useful mainly for its ability to assess musculoskeletal (joints, tendons, entheses and cutaneous (skin and nails involvement, to monitor efficacy of therapy and to guide steroid injections at the level of inflamed joints, tendon sheaths and entheses. MRI allows direct visualization of inflammation in peripheral and axial joints, and peripheral and axial entheses, and has dramatically improved the possibilities for early diagnosis and objective monitoring of the disease process in PsA. MRI has allowed explaining the relationships among enthesitis, synovitis and osteitis in PsA, supporting a SpA pattern of inflammation where enthesitis is the primary target of inflammation. CT has little role in assessment of peripheral joints, but it may be useful in assessing elements of spine disease. CT accuracy is similar to MRI in assessment of erosions in sacroiliac joint involvement, but CT is not as effective in detecting synovial inflammation. Bone scintigraphy lacks specificity and is now supplanted with US and MRI techniques.

  2. Current concepts in psoriatic arthritis: pathogenesis and management.

    de Vlam, Kurt; Gottlieb, Alice B; Mease, Philip J

    2014-11-01

    Psoriatic arthritis occurs in a subset of psoriasis patients and is therefore commonly encountered in dermatology practice. Although its exact pathogenesis is unknown, psoriatic arthritis is thought to share common mechanisms with psoriatic skin symptoms. Innate and adaptive immune responses are abnormally activated in psoriasis and may acquire the ability to attack peripheral joints and other sites following an environmental trigger (e.g. mechanical stress, trauma, infection) in genetically susceptible patients. The increased cardiovascular risk inherent in psoriasis appears further enhanced in psoriatic arthritis, likely reflecting the overall burden of systemic inflammation contributing to atherogenic processes. Basic research and clinical trials have suggested that tumour necrosis factor is important in psoriatic arthritis pathophysiology, and accumulating evidence suggests that Th17 cells and interleukin-17A may also be important. Basic research and clinical trials inform our understanding of psoriatic arthritis pathophysiology and, in turn, help dermatologists to make better treatment decisions. PMID:24573106

  3. Genetics of psoriatic arthritis.

    O'Rielly, Darren D; Rahman, Proton

    2014-10-01

    Spondyloarthritis (SpA) represents a group of inflammatory rheumatic diseases that cluster within families and possess overlapping clinical features. The pathogenesis of SpA encompasses a complex array of genetic, immunological and environmental factors. In this article, we will briefly review the genetics of PsA, and then focus on the genes that may be potentially linked either directly or indirectly to the immunopathology of the Th-17 pathway. The most consistent and dominant genetic effect of PsV and PsA is located on chromosome 6p21.3 within the major histocompatibility complex (MHC) region, which accounts for approximately one-third of the genetic contribution of PsV and PsA. To date, 36 genes have reached genome-wide significance, accounting for approximately 22% of psoriasis (PsV) heritability. Prominent genes identified via GWAS include HLA-Cw6, IL12B, IL23R, IL23A, TNIP1, TNFAIP3, LCE3B-LCE3C, TRAF3IP2, NFkBIA, FBXL19, TYK2, IFIH1, REL, and ERAP1. Genes identified in psoriatic arthritis (PsA) has largely echoed those in PsV and include HLA-B/C, HLA-B, IL-12B, IL-23R, TNIP1, TRAF3IP2, FBXL19, and REL. The lack of identified genetic susceptibility loci is largely attributed to the much smaller number of PsA patients and the greater clinical heterogeneity of PsA. Searching for different types of genetic variants such as small CNVs and/or insertions/deletions has also led to the identification of several genes with a function relative to PsV in particular including DEFB4, LCE3C_LCE3B, and IL-22 gene (exon 1). The candidate genes identified in PsV/PsA have highlighted pathways of critical importance to psoriatic disease including distinct signaling pathways comprised of barrier integrity, innate immune response and adaptive immune response, mediated primarily by Th-17 and Th-1 signalling. While GWAS studies have yielded great insights into the genes that contribute to the pathogenesis of PsV and PsA, replication in large cohorts, fine-mapping and resequencing

  4. Which Psoriasis Patients Develop Psoriatic Arthritis?

    Busse, Kristine; Liao, Wilson

    2010-01-01

    Psoriatic arthritis is a major comorbidity of psoriasis that significantly impairs quality of life and physical function. Because skin lesions classically precede joint symptoms, dermatologists are in a unique position to identify patients at risk for psoriatic arthritis before irreversible joint damage occurs. Here we review the literature to identify the clinical and genetic factors most highly associated with development of psoriatic arthritis, with the goal of assisting dermatologists in ...

  5. Psoriatic arthritis as a mountain

    J.M. Berthelot

    2011-09-01

    Full Text Available There is no doubt that inflammatory arthritis/enthesitis and psoriasis coexist more frequently than would be expected by chance: for instance, in a study of 1285 patients with psoriasis seen in an hospital, 483 (38% were suffering from arthritis/ enthesitis, including 40 patients classified as Rheumatoid Arthritis (RA (3%, 177 (14% as undifferentiated arthritis (UA, and 266 (21% as Psoriatic Arthritis (PsA (1. Although lower percentages have been noticed in the general population with psoriasis (6% of PsA in an extensive study of 1844 patients with psoriasis (2, they were superior to 5% (i.e. at least 5 times greater than the figures found for patients without psoriasis (3-7.

  6. Development of a preliminary composite disease activity index in psoriatic arthritis.

    Mumtaz, Aizad

    2012-02-01

    OBJECTIVES: To develop a preliminary composite psoriatic disease activity index (CPDAI) for psoriasis and psoriatic arthritis. METHODS: Five domains were assessed and specific instruments were employed for each domain to determine the extent of domain involvement and the effect of that involvement on quality of life\\/function. Disease activity for each domain was then graded from 0 to 3 giving a CPDAI range of 0-15. Patient and physician global disease activity measures were also recorded and an independent physician was asked to indicate if treatment change was required. Bivariate correlation analysis was performed. Factor, tree analysis and standardised response means were also calculated. RESULTS: Significant correlation was seen between CPDAI and both patient (r = 0.834) and physician (r = 0.825) global disease activity assessments (p = 0.01). Tree analysis revealed that 96.3% of patients had their treatment changed when CPDAI values were greater than 6; no patient had their treatment changed when CPDAI values were less than 5. CONCLUSION: CPDAI correlates well with patient and physician global disease activity assessments and is an effective tool that clearly distinguishes those who require a treatment change from those who do not.

  7. Brief report: Enrichment of activated group 3 innate lymphoid cells in psoriatic arthritis synovial fluid

    Leijten, Emmerik F A; van Kempen, Tessa S.; Boes, Marianne; Michels-van Amelsfort, Jocea M R; Hijnen, Dirkjan; Hartgring, Sarita A Y; van Roon, Joel A G; Wenink, Mark H.; Radstake, Timothy R D J

    2015-01-01

    OBJECTIVE: Innate lymphoid cells (ILCs) are a recently discovered group of cells that are essential to epithelial homeostasis and are implicated in psoriasis pathogenesis, yet they have never been reported in psoriatic arthritis (PsA). METHODS: ILC classes and subsets were characterized in the perip

  8. Assessing disease activity in psoriasis and psoriatic arthritis: impact on management and therapy.

    Chandran, Vinod; Maharaj, Ajesh B

    2016-05-01

    The management of psoriatic arthritis (PsA) and psoriasis has undergone major advancements over the last decade. This has been made possible, in part, due to the introduction of new therapies for their management, as well as global collaboration in the development of outcome measures and "treat- to- target" paradigms. In this review article, we discuss how disease activity is measured and the outcome measures that have been recently developed for the management of PsA. The importance of assessing the individual domains as well as global assessments both from the physician and patient perspective, and the development of composite measures are discussed. The newer PsA specific measures are expected to be more commonly used in clinical trials as well as clinical practice. PMID:26807494

  9. Psoriatic arthritis: from pathogenesis to therapy.

    Fitzgerald, Oliver

    2012-02-01

    Psoriatic arthritis is a multigenic autoimmune disease that involves synovial tissue, entheseal sites and skin, and that may result in significant joint damage. Although there are no diagnostic tests for psoriatic arthritis, research has identified consistent features that help to distinguish the condition from other common rheumatic diseases. Comparison of HLA-B and HLA-C regions in psoriatic arthritis with those in psoriasis without joint involvement demonstrates significant differences, such that psoriatic arthritis cannot be viewed simply as a subset of genetically homogeneous psoriasis. T-cell receptor phenotypic studies have failed to identify antigen-driven clones, and an alternative hypothesis for CD8 stimulation involving innate immune signals is proposed. Finally, imaging studies have highlighted entheseal involvement in psoriatic arthritis, and it is possible that entheseal-derived antigens may trigger an immune response that is critically involved in disease pathogenesis.

  10. Diagnosing Psoriatic Arthritis from the Dermatologist’s View

    Cho, Hyun-Ho; Kim, Byung-Soo

    2013-01-01

    Psoriatic arthritis is a chronic inflammatory arthropathy associated with skin psoriasis. It is considered a unique arthropathy with distinct clinical and radiologic features. Up to 40% of patients with psoriasis may develop psoriatic arthritis. Psoriasis usually precedes psoriatic arthritis, so dermatologists are in a critical position for screening patients of psoriatic arthritis early in the disease course. Psoriatic arthritis may be challenging to diagnose, especially for dermatologists, ...

  11. Systematic review, network meta-analysis and economic evaluation of biological therapy for the management of active psoriatic arthritis

    Cawson, Matthew Richard; Mitchell, Stephen Andrew; Knight, Chris; Wildey, Henry; Spurden, Dean; Bird, Alex; Orme, Michelle Elaine

    2014-01-01

    Background An updated economic evaluation was conducted to compare the cost-effectiveness of the four tumour necrosis factor (TNF)-α inhibitors adalimumab, etanercept, golimumab and infliximab in active, progressive psoriatic arthritis (PsA) where response to standard treatment has been inadequate. Methods A systematic review was conducted to identify relevant, recently published studies and the new trial data were synthesised, via a Bayesian network meta-analysis (NMA), to estimate the relat...

  12. GENETICS OF PSORIASIS AND PSORIATIC ARTHRITIS

    V. Ibba

    2011-09-01

    Full Text Available Psoriasis and psoriatic arthritis are linked diseases characterised by (distinct ? immune-mediated pathogenetic mechanisms and by a genetic background interacting with environmental factors. Some candidate susceptibility genes have been studied extensively; they include HLA genes, genes within the HLA region and genes outside the HLA region; among them corneodesmosin and other genes of PSORS1 region, MICA and TNF-a polymorphisms. The main findings in the literature are discussed. Key words: Genetics, psosriasis, psoriatic arthritis

  13. Psoriasis and psoriatic arthritis treatment.

    Menter, Alan

    2016-06-01

    Over the past several years, an increased understanding of the pathophysiology of psoriasis and psoriatic arthritis (PsA) has led to the development of several new biologic therapies. Appropriate treatment selection and timing may slow, and even halt, the progression of psoriasis and PsA; as a result, it can decrease the economic burden. As treatment options vary based on individual disease characteristics and patient preferences, reviewing the patient's complete clinical picture is imperative. An updated treatment algorithm, based on patients' most severe disease domain, is now available to guide the selection of optimal therapy. Special care should be given to patients with both psoriasis and PsA who experience multiple disease domains, a heavy symptom burden, and an increased risk of comorbidities. PMID:27356194

  14. Psoriasis and psoriatic arthritis overview.

    Menter, Alan

    2016-06-01

    Psoriasis and psoriatic arthritis (PsA) are chronic immune-mediated diseases that primarily affect the skin and joints, respectively; these diseases are also associated with high rates of cardiovascular and other comorbidities. Despite over 40 genes proven to be related to the disease, the exact causes of psoriasis and PsA are still to be determined. Recent insights into the underlying pathophysiology of these diseases have revealed novel therapeutic targets. Effective management requires timely diagnosis and initiation of treatment. Yet, both psoriasis and PsA remain underrecognized and undertreated in current clinical practice. Recognizing the true physical, social, and emotional burden of psoriasis and PsA, as well as their associated comorbidities, is the first step to improving the prognosis for affected patients. PMID:27356193

  15. Disease activity, quality of life and indirect costs of psoriatic arthritis in Poland.

    Kawalec, Paweł; Malinowski, Krzysztof Piotr; Pilc, Andrzej

    2016-09-01

    The aim of the study was to assess the indirect costs, health-related quality of life and clinical characteristics of patients with psoriatic arthritis (PsA), measured using a PsA disease activity index in Poland. Additionally, we aimed to investigate the association between the activity, utility of PsA-affected patients and productivity loss in a Polish setting. A questionnaire survey was conducted to assess disease activity, as well as productivity loss, and a paper version of the EuroQoly-5D-3L questionnaire was used to assess productivity loss and the quality of life. Indirect costs were assessed with the human capital approach employing the gross domestic product (GDP) per capita, gross value added (GVA) and gross income (GI) per worker in 2014 in Poland and were expressed in Polish zlotys (PLN) as well as in euros. The correlation was presented using the Spearman correlation coefficient. Our analysis was performed on the basis of 50 full questionnaires collected. We observed a mean utility value of 0.6567. The mean number of days off work was 2.88 days per month, and mean on-the-job productivity loss was 24.1 %. Average monthly indirect costs per patient were €206.7 (864.01 PLN) calculated using the GDP; €484.56 (2025.46 PLN) calculated using the GVA; and €209.70 (876.56 PLN) calculated using the GI. PsA reduces the patients' quality of life as well as their productivity loss associated with both absenteeism and presenteeism. Total indirect costs were negatively correlated with utility. The greater the disease activity, the lower the utility and the greater the indirect costs. PMID:27339273

  16. [Imaging modalities in psoriatic arthritis].

    Hermann, K-G A; Ohrndorf, S; Werner, S G; Finzel, S; Backhaus, M

    2013-10-01

    This review presents an overview of the range of imaging modalities used in the diagnostic evaluation of patients with psoriatic arthritis (PsA). Conventional radiography is used to detect structural changes of the joints and tendon attachments. These changes occur late in the course of PsA hence conventional radiography contributes little to the early detection of PsA; however, the detection of periosteal proliferations on radiographs allows a relatively specific diagnosis of PsA. Skeletal scintigraphy and computed tomography are rarely used in PsA. Arthrosonography (ultrasound of the joints) is gaining increasing importance in the early identification of inflammatory soft tissue signs of PsA in the peripheral joints. Sonography enables early detection of synovitis and tenosynovitis as well as superficial erosions and also inflammatory processes of the tendon attachments. Magnetic resonance imaging (MRI) is indispensable for identifying possible involvement of the axial skeleton. Moreover, it allows good visualization of periostitis and arthritis. High resolution microcomputed tomography is an interesting novel diagnostic tool which allows highly sensitive evaluation of the bone structure and can detect very tiny bone lesions where typical signs of PsA are omega-shaped erosions and small corona-like spikes. Another interesting new diagnostic technique is fluorescence optical imaging (FOI) with the Xiralite system which is highly sensitive for detecting inflammatory processes of the hands. PMID:24085530

  17. Profile of ustekinumab and its potential in the treatment of active psoriatic arthritis

    Montepaone M

    2014-02-01

    Full Text Available Monica Montepaone,1 Ennio Lubrano,2 Alessia Carboni,1 Antonio Spadaro1 1Unità Operativa Complessa di Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, 2Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy Abstract: Psoriatic arthritis (PsA is a chronic inflammatory arthritis and considered to be a less severe condition than rheumatoid arthritis. PsA patients have been treated for a long time with a number of different agents, from non-steroidal anti-inflammatory drugs to one or more disease-modifying antirheumatic drugs. In the last decade, recognition of the central role of tumor necrosis factor-alpha (TNFα in the immunopathogenesis of many rheumatic diseases, including PsA, has led to the development of TNFα blockers. In PsA, these agents are uniquely efficacious in the treatment of different patterns of the disease, as well as slowing progression of erosive damage in the peripheral joints. However, a significant number of patients withdraw from therapy because of failure or poor tolerability. Among the novel therapeutic targets, interleukin (IL-23/IL-12 has been investigated for the treatment of chronic inflammatory disease. In particular, ustekinumab is a human monoclonal antibody that prevents human IL-12 and IL-23 from binding to the IL-12Rβ1 receptor chain of IL-12 (IL-12Rβ1/β2 and IL-23 (IL-12Rβ1/23R receptor complexes on the surface of natural killer cells and T-cells. Ustekinumab has been approved only for treatment of chronic plaque psoriasis, but also represents an interesting agent for treatment of PsA. Keywords: ustekinumab, psoriatic arthritis, psoriasis, interleukin-12, interleukin-23

  18. The occurrence of psoriatic arthritis in Denmark

    Pedersen, Ole Birger Vesterager; Svendsen, Anders Jørgen; Ejstrup, Leif;

    2008-01-01

    OBJECTIVE: To apply and compare different classification criteria on a representative nationwide sample of psoriatic arthritis (PsA) twins and to estimate the prevalence and incidence of PsA. METHODS: The study comprised three Danish nationwide twin cohorts. In 1994 37,388 Danish twin individuals...

  19. HLA antigens in psoriasis and psoriatic arthritis.

    Woodrow, J. C.; Ilchysyn, A

    1985-01-01

    HLA phenotypes were determined in 50 patients with psoriasis alone and in 50 patients with psoriasis and psoriatic arthritis. Positive associations were found in both groups with B13, B17, B37, Cw6, and DR7, and in addition with C4A6. Higher relative risks were found in respect to the patients with psoriasis alone compared with those with arthritis, and this suggests the involvement of additional genetic factors predisposing to peripheral arthritis. In patients with psoriasis only, the presen...

  20. Psoriatic arthritis: treatment strategies using biologic agents

    C. Palazzi

    2012-06-01

    Full Text Available The traditional management of psoriatic arthritis (PsA includes NSAIDs, corticosteroids and DMARDs. Advancement in the knowledge of the immunopathogenesis of PsA has been associated with the development of biologic agents which have revolutionized the management of the disease. Among biologics drugs, there are the 4 currently availablee anti-TNFα blocking agents (etanercept, infliximab, adalimumab and golimumab which are more effective than traditional DMARDs on symptoms/signs of inflammation, quality of life, function, and in inhibiting the progression of the structural joint damage. Despite of the high cost, TNF inhibitors are costeffective on both the musculoskeletal and skin manifestations of psoriatic disease.

  1. Altered Bone Biology in Psoriatic Arthritis

    Rahimi, Homaira; Ritchlin, Christopher T.

    2012-01-01

    Psoriatic arthritis (PsA) is characterized by focal bone erosions mediated by osteoclasts at the bone–pannus junction. The bulk of research over the past decade has centered on mechanisms that underlie osteoclastogenesis along with new insights into osteoimmunology; however, recent advances that focus on steps that lead to new bone formation are beginning to emerge. New revelations about bone formation may have direct relevance to PsA given the presence of enthesophytes, syndesmophytes, and b...

  2. GENETICS OF PSORIASIS AND PSORIATIC ARTHRITIS

    Chandran Vinod

    2010-01-01

    It is well established that psoriasis and psoriatic arthritis (PsA) have a strong genetic component. Recent advances in genetics have confirmed previous associations and new loci have been discovered. However, these loci do not fully account for the high heritability of psoriasis and PsA and therefore many genetic as well as environmental factors remain to be identified. This paper reviews the current status of genetic studies in psoriasis and PsA.

  3. Psoriasis and psoriatic arthritis: Topical issues

    Yulia Leonidovna Korsakova

    2012-01-01

    The topical issues of the diagnosis and treatment of psoriasis (Ps) and psoriatic arthritis (PsA) are discussed. The characteristics and treatments of Ps and the methods for the diagnosis of PsA in Ps are presented; the extraarticular manifestations of PsA, its radiological signs, criteria for a treatment response, the current principles of therapy, and prognosis in these patients are described.

  4. The radiographic features of psoriatic arthritis

    Psoriatic arthritis is a separate and distinct articular disorder with specific radiographic manifestations occurring in a specific distribution. It manifests a severe erosive element, as well as a bone productive element. The erosive changes help to distinguish it from ankylosing spondylitis, and the bone productive changes, from rheumatoid arthritis. The distribution of the changes, that is, preferential involvement of the hands, will help to distinguish it from Reiter's syndrome. In some patients, it is knowledge of the radiographic changes and distribution of these changes that establishes the correct diagnosis of psoriasis

  5. [Systemic treatments for psoriasis and psoriatic arthritis].

    Philipp, S; Kokolakis, G; Sabat, R

    2016-06-01

    Psoriasis is one of the most common chronic dermatoses. More than 25 % of the affected individuals require effective systemic treatment because of severe symptoms and/or the significantly restricted quality of life. Thanks to intensive research and successful cooperation between academia and the pharmaceutical industry, the options for treating psoriasis have dramatically increased in recent years. Especially targeted therapies give us the opportunity for personalized regimen. This review describes the spectrum of the systemic treatments for psoriasis and psoriatic arthritis and discusses the efficacy, safety, and particular features of the individual substances. PMID:27240668

  6. Psoriatic arthritis management update - biotherapeutic options.

    Saber, Tajvur P

    2012-02-01

    Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy (SpA) occurring in up to 30% of patients with psoriasis. It has a wide variation of annual incidence (median 6.4, range 0.1-3.1 per 10(5) people), based on analysis of 13 incidence and prevalence reviews published between 1987 and December 2006. Conventional treatments with antiinflammatory and disease modifying or antirheumatic drugs are not efficacious in all patients, in particular those with axial disease. This review examines new pharmacological developments in the treatment of PsA with a focus on biologic therapies.

  7. Golimumab for the treatment of psoriatic arthritis.

    Yang, H; Epstein, D; Bojke, L; Craig, D; Light, K; Bruce, I; Sculpher, M; Woolacott, N

    2011-05-01

    This paper presents a summary of the evidence review group (ERG) report into the use of golimumab for the treatment of psoriatic arthritis (PsA). The main clinical effectiveness data were derived from a single phase III randomised controlled trial (RCT: GO-REVEAL) that compared golimumab with placebo for treating patients with active and progressive PsA who were symptomatic despite the use of previous disease-modifying antirheumatic drugs or non-steroidal anti-inflammatory drugs. The 14-week data showed that, compared with placebo, golimumab 50 mg significantly improved joint disease response as measured by American College of Rheumatology (ACR) 20 [relative risk (RR) 5.73, 95% confidence interval (CI) 3.24 to 10.56] and Psoriatic Arthritis Response Criteria (PsARC) (RR 3.45, 95% CI 2.49 to 4.87), and skin disease response as measured by the Psoriasis Area and Severity Index (PASI) 75 (RR 15.95, 95% CI 4.62 to 59.11). The 24-week absolute data showed that these treatment benefits were maintained. There was a significant improvement in patients' functional status as measured by the Health Assessment Questionnaire (HAQ) change from baseline at 24 weeks (-0.33, p patient crossover at week 16. The manufacturer conducted a mixed treatment comparison (MTC) analysis. The ERG considered the assumption of exchangeability between the trials for the purpose of the MTC analysis to be acceptable, and the statistical approach in the MTC analysis to be reliable. Regarding the safety evaluation of golimumab, the manufacturer failed to provide longer-term data or to consider adverse event data of golimumab from controlled studies in other conditions, such as rheumatoid arthritis and ankylosing spondylitis. Although the adverse effect profile of golimumab appears similar to other anti-tumour necrosis factor (TNF) agents, the longer-term safety profile of golimumab remains uncertain. The manufacturer's submission presented a decision model to compare etanercept, infliximab, golimumab

  8. Cardiovascular Risk in Patients with Psoriatic Arthritis

    Tracy Y. Zhu

    2012-01-01

    Full Text Available Psoriatic arthritis (PsA is an inflammatory arthritis associated with psoriasis. In addition to skin and joint involvement, there is increasing evidence suggesting that patients with PsA also have an increase in risk of clinical and subclinical cardiovascular diseases, mostly due to accelerating atherosclerosis. Both conventional and nonconventional cardiovascular risk factors contribute to the increased cardiovascular risk in PsA. Chronic inflammation plays a pivotal role in the pathogenesis of atherosclerosis in PsA, acting independently and/or synergistically with the conventional risk factors. In this paper, we discuss the current literature indicating that patients with PsA are at risk of cardiovascular diseases.

  9. T cell responses in psoriasis and psoriatic arthritis.

    Diani, Marco; Altomare, Gianfranco; Reali, Eva

    2015-04-01

    According to the current view the histological features of psoriasis arise as a consequence of the interplay between T cells, dendritic cells and keratinocytes giving rise to a self-perpetuating loop that amplifies and sustains inflammation in lesional skin. In particular, myeloid dendritic cell secretion of IL-23 and IL-12 activates IL-17-producing T cells, Th22 and Th1 cells, leading to the production of inflammatory cytokines such as IL-17, IFN-γ, TNF and IL-22. These cytokines mediate effects on keratinocytes thus establishing the inflammatory loop. Unlike psoriasis the immunopathogenic features of psoriatic arthritis are poorly characterized and there is a gap in the knowledge of the pathogenic link between inflammatory T cell responses arising in the skin and the development of joint inflammation. Here we review the knowledge accumulated over the years from the early evidence of autoreactive CD8 T cells that was studied mainly in the years 1990s and 2000s to the recent findings of the role of Th17, Tc17 cells and γδ T cells in psoriatic disease pathogenesis. The review will also focus on common and distinguishing features of T cell responses in psoriatic plaques and in synovial fluid of patients with psoriatic arthritis. The integration of this information could help to distinguish the role played by T cells in the initiation phase of the disease from the role of T cells as downstream effectors sustaining inflammation in psoriatic plaques and potentially leading to disease manifestation in distant joints. PMID:25445403

  10. Psoriatic arthritis as a distinct disease entity

    Leung Y

    2007-01-01

    Full Text Available Psoriatic arthritis (PsA is a chronic systemic inflammatory disease characterized by joint inflammation associated with cutaneous psoriasis. For many years, the amount of attention directed to PsA had been less than that for various other arthropathies. With the advances in understanding its pathogensis, it is now recognized as a distinct disease entity with characteristic features. Psoriatic arthritis has a greater tendency towards asymmetric oligoarticular involvement, distal interphalangeal involvement and spondylitis. Associated features such as enthesitis and dactylitis are more common. Specific radiological features include ankylosis and bone resorption. With the availability of potent new therapeutic agents for psoriasis and PsA, interest in research and clinical care for these conditions has been reinvigorated. Anti-TNF therapy has achieved encouraging efficacy in both the joints and skin disease, improving function and quality of life and inhibiting radiological progression measured in patients with PsA and psoriasis. Biologic agents may have the potential in addressing the unmet medical need in patients with PsA.

  11. IMMUNE PATHOGENESIS OF PSORIASIS AND PSORIATIC ARTHRITIS

    S. V. Smirnova

    2014-08-01

    Full Text Available Significance of psoriasis (PS research is determined by increasing incidence of this disorder, higher frequency of severe clinical forms, e.g., psoriatic arthritis (PsA. Clinical course and outcomes of psoriasis and psoriatic arthritis depend on degree of immunological disturbances and imbalance of cytokine regulation of intercellular interactions. The leading immune disorders involved in pathogenesis of psoriasis and PsA are those characterized by alterations of Th1-type cytokine profile (TNFα, IL-2, IFNγ, etc.. We have analyzed publications that reveal some features of PS and PsA immunopathogenesis associated with nature of the diseases. The review draws attention to relatively new and scarcely studied data concerning the role of cytokines produced by Th17- and Th22-cells (IL-17, IL-22, IL-23, IL-26, IL-19 subfamily (IL-19, IL-20, IL-24 in development of psoriasis and PsA. Search for the immunological markers predisposing for risk of psoriasis and PsA is an important step in personalized approach to their prediction and planning of preventive measures, in order to prevent progression of this pathology.

  12. A sonographic spectrum of psoriatic arthritis: "the five targets".

    Gutierrez, Marwin

    2010-02-01

    Ultrasound is a rapidly evolving technique that is gaining an increasing success in the assessment of psoriatic arthritis. Most of the studies have been aimed at investigating its ability in the assessment of joints, tendons, and entheses in psoriatic arthritis patients. Less attention has been paid to demonstrate the potential of ultrasound in the evaluation of skin and nail. The aim of this pictorial essay was to show the main high-frequency grayscale and power Doppler ultrasound findings in patients with psoriatic arthritis at joint, tendon, enthesis, skin, and nail level.

  13. Disease Activity in Psoriatic Arthritis: Comparison of the Discriminative Capacity and Construct Validity of Six Composite Indices in a Real World

    Fausto Salaffi

    2014-01-01

    Full Text Available Objective. To compare, “in a real world,” the performance of the most common composite activity indices in a cohort of PsA patients. Methods. A total of 171 PsA patients were involved. The following variables were evaluated: peripheral joint assessment, patient reported of pain, physician and patient assessments of disease activity, patient general health status, dactylitis digit count, Leeds Enthesitis Index, Health Assessment Questionnaire (HAQ, physical and mental component summary score of the Medical Outcome Survey (SF-36, Psoriasis Area and Severity Index (PASI, Dermatology Life Quality Index, C-reactive protein (CRP, and erythrocyte sedimentation rate (ESR. To measure the disease activity, the Disease Activity Score (DAS28-ESR and DAS28-CRP, Simple Disease Activity Index (SDAI, Composite Psoriatic Disease Activity Index (CPDAI, disease activity in psoriatic arthritis (DAPSA, and Psoriatic Arthritis Disease Activity Score (PASDAS have been calculated. The criteria for minimal disease activity (MDA and remission were applied as external criterion. Results. The ROC were similar in all the composite measures. Only the CPDAI showed less discriminative ability. There was a high degree of correlation between all the indices (P<0.0001. The highest correlations were between DAPSA and SDAI (rho = 0.996 and between DAPSA and DAS28-CRP (rho = 0.957. CPDAI, DAPSA, and PASDAS had the most stringent definitions of remission and MDA category. DAS28-ESR and DAS28-CRP had the highest proportions in remission and MDA. Conclusions. Although a good concurrent validity and discriminant capacity of six disease activity indices were observed, the proportions of patients classified in the disease activity levels differed. In particular, the rate of patients in remission was clearly different among the respective indices.

  14. Ustekinumab for the treatment of psoriatic arthritis: an update

    Davari P; Leo MS; Kamangar F; Fazel N

    2014-01-01

    Parastoo Davari, Michael S Leo, Faranak Kamangar, Nasim Fazel Department of Dermatology, University of California, Davis, CA, USA Abstract: Psoriatic arthritis occurs in 30% of psoriasis patients, and the treatment can be challenging in some patients. Recently, the US Food and Drug Administration approved ustekinumab, a fully human monoclonal antibody, for the management of psoriatic arthritis. In this article, we review large-scale randomized clinical trials addressing the efficacy and safe...

  15. Prevalence of eye disease in Brazilian patients with psoriatic arthritis

    Fernanda B. F. de Lima

    2012-01-01

    Full Text Available OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal. Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%, and the majority had polyarticular disease (57.5%. Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

  16. Psoriatic arthritis treatment: biological response modifiers.

    Mease, P J; Antoni, C E

    2005-03-01

    In recent years there has been a surge of interest in the treatment of chronic inflammatory disorders as a result of the development and application of targeted biological therapies. The elucidation of the overlapping cellular and cytokine immunopathology of such diverse conditions as rheumatoid arthritis (RA), Crohn's disease, and psoriasis points to specific targets for bioengineered proteins or small molecules. Similar to clinical trials in RA, trials in psoriatic arthritis (PsA) have shown excellent clinical results with the tumour necrosis factor (TNF) blockers, etanercept, infliximab, and adalimumab in a variety of domains including the joints, quality of life, function, and slowing of disease progress as evidenced radiologically. In addition, these agents have shown benefit in domains more unique to PsA, such as the skin lesions of psoriasis, enthesitis, and dactylitis, pointing out the similar pathogenesis of the disease in the skin, the tendons, and the synovial membrane. This therapy has been generally safe and well tolerated in clinical trials of PsA. Other logical candidates for targeted therapy in development include other anti-TNF agents, costimulatory blockade agents that affect T cell function, blockers of other cytokines such as interleukin (IL)-1, 6, 12, 15, or 18, and B cell modulatory medicines. Also, it will be useful to learn more about the effects of combining traditional disease modifying drugs and the newer biologicals. PMID:15708944

  17. [Psoriatic arthritis : Overview of drug therapy options and administration characteristics].

    Behrens, F; Thaçi, D; Wollenhaupt, J; Krüger, K

    2016-06-01

    Psoriatic arthritis is a chronic inflammatory disease of the musculoskeletal system with association to skin psoriasis and is characterized by variable clinical symptoms with very heterogeneous degrees of disease suffering for patients. Clinical manifestations essentially include alterations to the skin and nails, peripheral arthritis, enthesitis, dactylitis and/or spinal involvement. This variability necessitates an individualized therapy of patients with different therapy targets. Apart from international guidelines no therapy recommendations are available in Germany for treatment of psoriatic arthritis. For this reason this article summarizes the established points, characteristics and aspects to be considered in the therapy of psoriatic arthritis in Germany, taking the various main forms of the disease into consideration. PMID:27259913

  18. Metabolomics in psoriatic disease: pilot study reveals metabolite differences in psoriasis and psoriatic arthritis

    Armstrong, April W.; Julie Wu; Mary Ann Johnson; Dmitry Grapov; Baktazh Azizi; Jaskaran Dhillon; Oliver Fiehn

    2014-01-01

    Importance: While “omics” studies have advanced our understanding of inflammatory skin diseases, metabolomics is mostly an unexplored field in dermatology. Objective: We sought to elucidate the pathogenesis of psoriatic diseases by determining the differences in metabolomic profiles among psoriasis patients with or without psoriatic arthritis and healthy controls. Design: We employed a global metabolomics approach to compare circulating metabolites from patients with psoriasis, psoriasis and ...

  19. How effective is ustekinumab in controlling psoriatic arthritis?

    Bonifati, Claudio; Graceffa, Dario

    2016-05-01

    Recently ustekinumab has been approved for the therapy of psoriatic arthritis (PsA). Some case series have been published reporting new onset of inflammatory arthritis in psoriasis patients treated with ustekinumab. In addition, flare of joint inflammation in PsA patients has also been reported. We describe a case series of seven patients affected by PsA who experienced either a worsening or a flare of inflammatory arthritis during treatment with ustekinumab. PMID:26626908

  20. Fragility Fractures in Patients with Psoriatic Arthritis.

    Del Puente, Antonio; Esposito, Antonella; Costa, Luisa; Benigno, Carla; Del Puente, Aurora; Foglia, Francesca; Oriente, Alfonso; Bottiglieri, Paolo; Caso, Francesco; Scarpa, Raffaele

    2015-11-01

    Psoriatic arthritis (PsA) can have peculiar effects on bone, including mechanisms of bone loss such as erosions, but also of bone formation, such as ankylosis or periostitis. The aim of the present study was to describe the prevalence of fractures in patients with PsA as compared to healthy controls and to investigate determinants of fractures among cases. For both cases and controls, radiographs were read to identify vertebral fractures (VF), and the presence of femoral neck or other nonvertebral fractures was obtained from patients' medical history. The prevalence of fragility fractures on radiographic readings did not differ between cases and controls. The number of subjects showing a VF was 33 (36%) among PsA patients and 36 (36%) among controls, with a prevalence of severe VF of 8% among cases and 4% among controls. Controlling for covariates in a logistic model, the only variables showing a significant correlation with the presence of nonvertebral fractures (NVF) were disease duration (p=0.02), age (p=0.03), and bone mineral density at femoral neck (inverse correlation, p=0.04). Fractures should be carefully considered when evaluating the global picture of the patient with PsA for their contribution to the "fragility" profile. PMID:26523054

  1. Value of Entheseal Ultrasonography and Serum Cartilage Oligomeric Matrix Protein in the Preclinical Diagnosis of Psoriatic Arthritis

    Moataz Mohammed Samy Elbeblawy

    2010-03-01

    Full Text Available Objective: To evaluate the utility of entheseal ultrasonography and serum COMP in the preclinical diagnosis of psoriatic arthritis. Methods: 60 psoriatic patients were divided into: 30 patients with psoriasis (group I and 30 patients with psoriatic arthritis as control (group II. They underwent independent clinical and ultrasonographic examination of both lower limbs at the calcaneal insertions of Achilles tendons. Psoriatic arthritis disease activity and severity was assessed by modified DAS28 and Steinbrockers scores. Serum levels of COMP were measured for all patients by ELISA. Results: On clinical examination, no entheseal abnormalities were detected in group I while they were present in 23.3% of group II with statistically significant difference between them (P 0.05. Serum COMP were significantly elevated in group I and II with no statistically significant difference between them (mean ± SD 5.9 ± 3 and 6.8 ± 12 respectively, P > 0.05. Entheseal ultrasound was more specific (67% while serum COMP was more sensitive (87% in the preclinical diagnosis of psoriatic arthritis. Serum COMP levels were significantly correlated with CRP in both groups and with DAS28 and Steinbrockers scores in group II (P < 0.01. Conclusion: Entheseal ultrasonography and serum COMP levels may be used complementary to each other for preclinical diagnosis of psoriatic arthritis. Serum COMP seems to be promising prognostic marker for psoriatic arthritis patients.

  2. Association of IL1Β (-511 A/C) and IL6 (-174 G > C) polymorphisms with higher disease activity and clinical pattern of psoriatic arthritis.

    Cubino, N; Montilla, C; Usategui-Martín, R; Cieza-Borrela, C; Carranco, T; Calero-Paniagua, I; Quesada, A; Cañete, J D; Queiro, R; Sánchez, M D; Hidalgo, C; Martínez, O; Del Pino-Montes, J; Díaz-Álvarez, A; González-Sarmiento, R

    2016-07-01

    The objective of this study is to analyze whether IL1β (-511G > A) and IL6 (-174 G > C) polymorphisms are associated with inflammatory activity, radiographic damage or clinical pattern of psoriatic arthritis (PsA). One hundred twenty-five patients classified as PsA according to the Classification of Psoriatic Arthritis (CASPAR) criteria were included. Patients were stratified according to their clinical pattern at inclusion as peripheral, axial, or mixed involvement. Disease activity in peripheral or mixed forms was measured using the number of swollen and tender joints, pain analog visual scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and disease activity score 28 (DAS28). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used for axial and mixed forms, as were pain visual analog scale, ESR and CRP. Radiographic damage was evaluated using a modified Sharp score and modified stoke ankylosing spondylitis spinal score (SASSSm). The polymorphisms for the promoter region of IL1β (-511 G/A) and IL-6 (-174 G/C) were analyzed. The G allele of IL1B (-511G/A) polymorphism was associated with higher peripheral joint disease activity (OR 3.13; p  C) polymorphism presented a strong trend to be associated with peripheral forms (70.86 %) (OR 1.89; p HLA-B27 (15.78 %) compared with C allele (28.57 %) (OR 0.469; p = 0.02; CI 95 % 0.238-0.923, p-corrected 0.03). This study suggests that the G allele polymorphism of IL1B (-511 A/C) is associated with higher peripheral joint disease activity. On the other hand, the IL6 (-174 G/C) polymorphism showed a strong trend to be associated with the peripheral pattern of PsA. PMID:27188858

  3. Osteoscintigraphy in the diagnosis of psoriatic arthritis

    The authors presented the results of clinical, X-ray and osteoscintigraphic investigations of 133 psoriasic arthritis patients and 72 patients with common psoriasis. Osteoscintigraphy was performed using a routine method with 99mTc-pyrophos (USSR) and 99mTc-phosphone (Hungary) on gamma-camera LFOV (Nuclear-Chicago, USA). X-ray signs of the involvement of the osteoarticular system were noted in 69 (51%) patients with psoriasic arthritis and in 16 (22%) patients with common psoriasis. The method permitted the detection of the foci of RP hyperfixation in 129 (97%) potients with psoriasic arthritis and in 51 (70.8%) patients with common psoriasis. They were observed mostly in large and small limb joints, less frequently-in the vertebral column, cranial bones, thorax, and ribs. Thus, osteoscintigraphy is a highly sensitive method for the detection of active inflammatory foci of the osteoarticular system in psoriasis at all stages of arthritis development. It makes it possible to detect the spreading of arthritis and its preclinical forms

  4. MRI findings of juvenile psoriatic arthritis

    Lee, Edward Y.; Kleinman, Paul K. [Harvard Medical School, Department of Radiology, Boston, MA (United States); Children' s Hospital Boston, MA (United States); Sundel, Robert P.; Kim, Susan [Harvard Medical School, Rheumatology Program, Division of Immunology and the Department of Pediatrics, Boston, MA (United States); Children' s Hospital Boston, MA (United States); Zurakowski, David [Harvard Medical School, Department of Radiology, Boston, MA (United States); Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA (United States); Children' s Hospital Boston, MA (United States)

    2008-11-15

    The aim of this study was to describe the magnetic resonance imaging (MRI) features of juvenile psoriatic arthritis (JpsA) in children in order to facilitate early diagnosis and proper management. Two pediatric radiologists retrospectively reviewed in consensus a total of 37 abnormal MRI examinations from 31 pediatric patients (nine boys, 22 girls; age range 1-17 years; mean age 9.4 years) who had a definite diagnosis of JpsA and underwent MRI. Each MRI was evaluated for synovium abnormality (thickening and enhancement), joint effusion (small, moderate, and large), bone marrow abnormality (edema, enhancement, and location of abnormality), soft tissue abnormality (edema, enhancement, atrophy, and fatty infiltration), tendon abnormality (thickening, edema, tendon sheath fluid, and enhancement), and articular abnormality (joint space narrowing and erosion). The distribution of abnormal MRI findings among the six categories for the 37 MRI examinations was evaluated. The number of abnormal MRI findings for each MRI examination was assessed. Age at MRI examination and all six categories of abnormal MRI findings according to gender were evaluated. There were a total 96 abnormal MRI findings noted on 37 abnormal MRI examinations from 31 pediatric patients. The 37 abnormal MRI examinations included MRI of the hand (n=8), knee (n = 8), ankle (n = 5), pelvis (n = 5), temporomandibular joint (n = 4), wrist (n = 3), foot (n = 2), elbow (n = 1), and shoulder (n = 1). Twenty-eight diffuse synovial thickening and/or enhancement were the most common MRI abnormality (29.2%). Joint effusion comprised 22 abnormal MRI findings (22.9%). There were 16 abnormal MRI bone marrow edema and/or enhancement findings (16.7%), and in seven (7.3%) the edema involved non-articular sites. Soft tissue abnormality manifested as edema and/or enhancement constituted 14 abnormal MRI findings (14.5%). There were ten MRI abnormalities (10.4%) involving tendons. Articular abnormality seen as joint space

  5. MRI findings of juvenile psoriatic arthritis

    The aim of this study was to describe the magnetic resonance imaging (MRI) features of juvenile psoriatic arthritis (JpsA) in children in order to facilitate early diagnosis and proper management. Two pediatric radiologists retrospectively reviewed in consensus a total of 37 abnormal MRI examinations from 31 pediatric patients (nine boys, 22 girls; age range 1-17 years; mean age 9.4 years) who had a definite diagnosis of JpsA and underwent MRI. Each MRI was evaluated for synovium abnormality (thickening and enhancement), joint effusion (small, moderate, and large), bone marrow abnormality (edema, enhancement, and location of abnormality), soft tissue abnormality (edema, enhancement, atrophy, and fatty infiltration), tendon abnormality (thickening, edema, tendon sheath fluid, and enhancement), and articular abnormality (joint space narrowing and erosion). The distribution of abnormal MRI findings among the six categories for the 37 MRI examinations was evaluated. The number of abnormal MRI findings for each MRI examination was assessed. Age at MRI examination and all six categories of abnormal MRI findings according to gender were evaluated. There were a total 96 abnormal MRI findings noted on 37 abnormal MRI examinations from 31 pediatric patients. The 37 abnormal MRI examinations included MRI of the hand (n=8), knee (n = 8), ankle (n = 5), pelvis (n = 5), temporomandibular joint (n = 4), wrist (n = 3), foot (n = 2), elbow (n = 1), and shoulder (n = 1). Twenty-eight diffuse synovial thickening and/or enhancement were the most common MRI abnormality (29.2%). Joint effusion comprised 22 abnormal MRI findings (22.9%). There were 16 abnormal MRI bone marrow edema and/or enhancement findings (16.7%), and in seven (7.3%) the edema involved non-articular sites. Soft tissue abnormality manifested as edema and/or enhancement constituted 14 abnormal MRI findings (14.5%). There were ten MRI abnormalities (10.4%) involving tendons. Articular abnormality seen as joint space

  6. Application of the GRAPPA psoriatic arthritis treatment recommendations in clinical practice.

    Mumtaz, Aizad

    2012-02-01

    Psoriatic disease presents with a complex array of clinical features, including peripheral synovitis and skin psoriasis, but there is also variable involvement of the nail, dactylitis, enthesitis, and spinal disease. Composite assessment of disease activity and response taking into account the impact of the disease as a whole on an individual\\'s health and quality of life is of vital importance. Following an extensive literature review, discussions, and consensus, the Group for Research in Psoriasis and Psoriatic Arthritis (GRAPPA) published guidelines to help clinicians make treatment decisions. The utility of these guidelines in routine clinical practice is further enhanced by incorporating them into a Composite Psoriatic Disease Activity Index (CPDAI). The potential application of the CPDAI in typical psoriatic disease patients is presented and discussed. Validation and possible modification of a composite disease activity and responder index is currently being undertaken by GRAPPA.

  7. Treating psoriatic arthritis: how effective are TNF antagonists?

    Gottlieb, Alice B.; Antoni, Christian E

    2004-01-01

    Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy that commonly appears after the onset of the characteristic cutaneous lesions. This complication affects about 40% of patients with moderate to severe cutaneous disease. Analysis of synovial fluid and tissue in patients with PsA demonstrates a profile of high levels of tumor necrosis factor (TNF) plus other cytokines similar to those seen in patients with rheumatoid arthritis (RA). In the past, medical management of patients with...

  8. Self-reported adherence to a home-based exercise program among patients affected by psoriatic arthritis with minimal disease activity.

    Chimenti, Maria Sole; Triggianese, Paola; Conigliaro, Paola; Santoro, Matteo; Lucchetti, Ramona; Perricone, Roberto

    2014-11-01

    More than half of all patients with psoriatic arthritis (PsA) exhibit progressive erosive arthritis, associated with severe functional impairment and psychosocial disability. Biologics have been suggested to be more effective in inducing minimal disease activity" (MDA) than disease-modifying antirheumatic drugs (DMARDs). Behavioral patient education appears to be more effective in encouraging patients to increase their physical activity (PA) levels. The aim of the study was to evaluate the benefits of home-based exercises program on disease activity and quality of life in MDA-PsA patients treated with an anti-tumor necrosis factor (TNF) and DMARD therapy. We observed a self-reported adherence rate to home-based exercise of 76.6% and data showed the impact of the exercise program on self-reported health and mental assessment. A positive relationship between patient and therapist is crucial, influencing the quality of the performance, the emotional support, and increasing motivation in PsA patients. PMID:25381979

  9. The Role of p38 MAPK in the Aetiopathogenesis of Psoriasis and Psoriatic Arthritis

    Athanasios Mavropoulos

    2013-01-01

    Full Text Available The pathogenetic mechanisms responsible for the induction of immune-mediated disorders, such as psoriasis, remain not well characterized. Molecular signaling pathways are not well described in psoriasis, as well as psoriatic arthritis, which is seen in up to 40% of patients with psoriasis. Signaling pathway defects have long been hypothesized to participate in the pathology of psoriasis, yet their implication in the altered psoriatic gene expression still remains unclear. Emerging data suggest a potential pathogenic role for mitogen activated protein kinases p38 (p38 MAPK extracellular signal-regulated kinase 1/2 (ERK1/2, and c-Jun N-terminal kinase (JNK in the development of psoriasis. The data are still limited, though, for psoriatic arthritis. This review discusses the current data suggesting a crucial role for p38 MAPK in the pathogenesis of these disorders.

  10. Psoriatic arthritis: A retrospective study of 162 patients

    Pavlica Ljiljana

    2005-01-01

    Full Text Available Aim. The aim of our study was to determine the prevalence of psoriatic arthritis in the patients with psoriasis and to analyze retrospectively the results of a 34-year multidisciplinary management of the patients with psoriatic arthritis. Methods. The study included 162 out of 183 treated patients with psoriatic arthritis, aged 48 ± 15 years. All the patients satisfied the current diagnostic criteria for psoriasis and psoriatic arthritis according to the American College of Rheumatology. Results. Psoriatic arthritis developed in 183 (9.3% out of 1976 patients with psoriasis. Time interval for establishing the diagnosis was 4 years. A positive family history of the disease had 15.0% of the studied patients. Its onset was most often at 42 years of age in 70.4% of the cases, and 2 months to 59 years after the appearance of psoriasis. Psoriatic arthritis without psoriasis appeared in 1.8% of the patients. A severe form of arthritis had 64.2% of the patients, mainly the patients with scalp psoriasis (χ2=3.2; p<0.05. Nail changes had 35% of the patients. Distal interphalangeal joints were involved in 63.6%, axial skeleton in 36.4%, oligoarthritis in 45.0%, polyarthritis in 55.0%, and mutilating form in 6.8% of the patients. Elevated Erythrocyte Sedimentation Rate was reveald in 61.7% of the patients. Immunoglobulin M (IgM rheumatoid factor was altered in 4.3% of the patients. The human leukocyte antigen (HLA typing in the 28 patients were: A2 32.0%, A3 18.0%, Al and A9 14.0%, A28 and A29 3.5%, B8 and B16 14.0%, B5 and B12 11.0%, B13,B15, B18, B27 and B35 7.0%. Radiologic changes were most often in hand and foot joints, less frequently in the knees and quite infrequently in hips and shoulders joints. Sacroiliitis was found in 46.4% of the patients. Psoriasis was treated with topical corticosteroids and salicylic ointments in all the patients, ultraviolet (PUVA therapy in 5.6% and retinoids in 4.3% of them. Artrithis was treated with nonsteroidal anti

  11. Interplay between environmental factors, articular involvement, and HLA-B27 in patients with psoriatic arthritis.

    Scarpa, R.; DEL PUENTE A; di Girolamo, C; Della Valle, G.; E. Lubrano; Oriente, P

    1992-01-01

    Medical records of 138 patients with psoriatic arthritis and 138 with rheumatoid arthritis were reviewed for the occurrence of an environmental factor triggering arthritis. Twelve (9%) of the patients with psoriatic arthritis had had an acute disorder immediately preceding onset of arthritis (an operation in four cases, articular trauma in three, abortion in two, myocardial infarction, thrombophlebitis, and phosphoric ester intoxication in one case each). Peripheral arthritis occurred in all ...

  12. Why golimumab in the treatment of psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis?

    M. Rossini

    2015-03-01

    Full Text Available Golimumab is an anti-TNF monoclonal antibody administred subcutaneously once a month and produced with an innovative technology that minimizes immunogenicity. This paper reviews and updates the main studies on the efficacy, safety and pharmacoeconomic aspects of treatment with golimumab of psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis.

  13. Comprehensive assessment of rheumatoid arthritis susceptibility loci in a large psoriatic arthritis cohort.

    Bowes, John

    2012-08-01

    A number of rheumatoid arthritis (RA) susceptibility genes have been identified in recent years. Given the overlap in phenotypic expression of synovial joint inflammation between RA and psoriatic arthritis (PsA), the authors explored whether RA susceptibility genes are also associated with PsA.

  14. Diagnosis and management of psoriasis and psoriatic arthritis in adults : summary of SIGN guidance

    Burden, A. D.; Boon, M. Hilton; Leman, J.; Wilson, H; Richmond, R; Ormerod, A D; Guideline Dev Grp; Ozakinci, Gozde

    2010-01-01

    No funding was received for writing this summary. The degree of disability and negative impact on quality of life caused by psoriasis and psoriatic arthritis are comparable to those of ischaemic heart disease, diabetes, depression, and cancer.1 Severe psoriasis and psoriatic arthritis are associated with an increased risk of conditions such as cardiovascular disease, diabetes, and depression.2 3 4 5 Psoriatic arthritis is underdiagnosed; about a fifth of patients with psoriasis also have p...

  15. HLA associations reveal genetic heterogeneity in psoriatic arthritis and in the psoriasis phenotype.

    Winchester, Robert

    2012-04-01

    Rigorously ascertained cases of psoriatic arthritis in subjects presenting to a rheumatology unit were compared with cases of psoriasis in subjects presenting to a dermatology unit, where subjects with musculoskeletal features were excluded, to address 1) the extent to which the contribution of the major histocompatibility complex (MHC) to psoriatic arthritis susceptibility resembles that in psoriasis, and 2) whether MHC genes determine quantitative traits within the psoriatic arthritis phenotype.

  16. HLA-B27 frequency in a group of patients with psoriatic arthritis *

    Danilo Garcia Ruiz; Mário Newton Leitão de Azevedo; Omar Lupi

    2012-01-01

    BACKGROUND: HLA-B27 is associated with spondyloarthritis, a group of diseases that includes psoriatic arthritis. OBJECTIVES: To describe the HLA-B27 frequency in a group of Brazilian patients with psoriatic arthritis and correlate its presence or absence with their clinical manifestations. METHODS: Cross-sectional study with 44 psoriatic arthritis patients of a Rheumatology clinic. Demographic and social data were recorded, as were skin and joints clinical examination. HLA-B27 was tested. All...

  17. PSORIASIS AND PSORIATIC ARTHRITIS: CHARACTERISTICS AND RISK FACTORS AMONG ADULT PATIENTS IN EGYPT

    Essam A. El-Moselhy, Ibrahim Saad Nada, Hamed O. Khalifa,

    2012-01-01

    Background: Psoriasis and psoriatic arthritis are common, chronic, immune mediated disease of the skin and joints. Interaction between genes and environment are important in disease causation. Objectives: The aim of the present study was to determine the socioemographic and clinical characters of adult patients with psoriasis and those with psoriatic arthritis, to define psoriasis and psoriatic arthritis etiological risk factors, and to define the relationship between psoriasis severity and t...

  18. Psoriatic arthritis and temporomandibular joint involvement – literature review with a reported case

    Badel, Tomislav; Savić Pavičin, Ivana; Krapac, Ladislav; Zadravec, Dijana; Rosić, Davorka

    2014-01-01

    In addition to psoriasis, between 5% and 24% of patients will develop psoriatic arthritis simultaneously after or even prior to skin manifestations. Psoriatic arthritis belongs to the group of seronegative spondyloarthritis. Collaboration between a dermatologist and a rheumatologist plays a more important role in cases where there is a complete absence of clinical signs of psoriasis. Since rheumatic diseases may also involve the temporomandibular joints (TMJ), psoriatic arthritis can cause pr...

  19. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires.

    Haroon, Muhammad

    2013-05-01

    The objectives of this study were to: (1) assess the prevalence of psoriatic arthritis (PsA) among Psoriasis (Ps) patients attending dermatology clinics; (2) identify clinical predictors of the development of PsA; and (3) compare the performance of three PsA screening questionnaires: Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST) and Toronto Psoriatic Arthritis Screening (ToPAS).

  20. Composite Measures in Psoriatic Arthritis: a report from the GRAPPA 2009 annual meeting.

    Helliwell, Philip S; Fitzgerald, Oliver; Strand, C Vibeke; Mease, Philip J

    2011-03-01

    A composite measure is one way of incorporating an assessment of all relevant clinical outcomes into one single measure. By definition it incorporates several dimensions of disease status often by combining these different domains into a single score. Such instruments are well established in rheumatoid arthritis (RA), and these RA-specific measures have successfully been adopted for use in clinical trials involving patients with psoriatic arthritis (PsA). However, the need for a more PsA-specific composite measure has led to a number of proposals, which, for the large part, incorporate only peripheral articular disease activity. New indices that combine the diverse clinical manifestations of PsA are now under development. These issues were discussed at the 2009 annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) in Stockholm, Sweden, and are summarized here. PMID:21362782

  1. Golimumab in the treatment of psoriatic arthritis: efficacy and safety

    Tatiana Viktorovna Korotaeva

    2015-01-01

    Full Text Available Tumor necrosis factor-α (TNF-α holds a central position in the pathogenesis of autoimmune inflammatory diseases of the locomotor apparatus. A separate class of drugs, namely, TNF-α inhibitors, that are effective against multicomponent diseases, such as psoriatic arthritis (PsA, is now available to physicians. The paper reviews the results of clinical trials of the TNF-α inhibitor golimumab, a human TNF-α monoclonal antibody. Golimumab exerts a positive effect on all manifestations of PsA: arthritis, psoriatic skin and nail lesions, dactylitis, enthesitis, and quality of life. The drug is noted for its convenient route of administration – its standard dose is 50 mg injected subcutaneously once a month and for its low molecular immunogenicity. Recent data suggest that golimumab is an effective drug with a safety profile similar to that of the entire class of TNF-α inhibitors.

  2. Characterisation of uveitis in patients with psoriatic arthritis

    Paiva, E.; Macaluso, D.; Edwards, A.; ROSENBAUM, J.

    2000-01-01

    OBJECTIVE—The purpose of this study is to describe the clinical characteristics of uveitis related to psoriatic arthritis (PsA), and also to compare the uveitis in PsA to the uveitis in spondyloarthropathy (SA).
METHODS—Sixteen patients with uveitis and PsA were evaluated in a tertiary care uveitis clinic. These patients were compared retrospectively to a series of 89 patients with uveitis and SA.
RESULTS—Eight (50%) of the 16 patients with uveitis had strictly peripheral arthritis, while two...

  3. AUTONOMIC CARDIOVASCULAR REGULATION DISORDERS IN PATIENTS WITH PSORIATIC ARTHRITIS

    A. P. Rebrov

    2014-07-01

    Full Text Available Aim – to identify disorders of autonomic regulation of cardiac activity in patients with psoriatic arthritis (PsA by determining the heart rate variability (HRV, and also establish the relationship of HRV with systemic inflammation and traditional cardiovascular risk factors.Materials and methods. The study included 53 patients with PsA (mean age 43.64 ± 12.1 years, including 48.2 % men, mean disease durationwas 10.32 ± 10.2 years. The control group included 25 healthy volunteers (average age 46.7 ± 12.45 years, 49.1 % – men. Time andfrequency measures of HRV were analyzed. Active PsA was determined by an index DAS4, rate erythrocyte sedimentation rate (ESR, levels of C-reactive protein (CRP and fibrinogen. Patients with clinical manifestations of cardiovascular disease, and patients with symptomsof carotid atherosclerosis, detected by duplex study were excluded.Results. Deterioration of HRV in patients with PsA compared with those in patients of the control group, the availability of statistically significant reverse relationship of temporal and spectral parameters of HRV with PsA activity (ESR, CRP, entezit score, DAS4, duration of arthritis, the classical factors of cardiovascular risk were established.Conclusion. Patients with PsA had noted a violation of autonomic regulation of cardiac activity in the form of reduced HRV and activation of the sympathetic part of it. Identified changes were associated with activity of systemic inflammation and classical factors of cardiovascular risk.

  4. Prevalence of acute and chronic viral seropositivity and characteristics of disease in patients with psoriatic arthritis treated with cyclosporine: a post hoc analysis from a sex point of view on the observational study of infectious events in psoriasis complicated by active psoriatic arthritis

    Colombo D

    2015-12-01

    Full Text Available Delia Colombo,1 Sergio Chimenti,2 Paolo Antonio Grossi,3 Antonio Marchesoni,4 Federico Bardazzi,5 Fabio Ayala,6 Lucia Simoni,7 Donatella Vassellatti,1 Gilberto Bellia1 On behalf of SYNERGY Study Group 1Novartis Farma Italia, Origgio (VA, 2Tor Vergata Polyclinic Rome, 3Macchi Hospital and Foundation, Varese, 4Orthopaedic Institute Pini, Milan, 5S Orsola-Malpighi Polyclinic, Bologna, 6University Federico II Naples, 7MediData srl, Modena, Italy Background: Sex medicine studies have shown that there are sex differences with regard to disease characteristics in immune-mediated inflammatory diseases, including psoriasis, in immune response and susceptibility to viral infections. We performed a post hoc analysis of the Observational Study of infectious events in psoriasis complicated by active psoriatic arthritis (SYNERGY study in patients with psoriatic arthritis (PsA treated with immunosuppressive regimens including cyclosporine, in order to evaluate potential between-sex differences in severity of disease and prevalence of viral infections.Methods: SYNERGY was an observational study conducted in 24 Italian dermatology clinics, which included 238 consecutively enrolled patients with PsA, under treatment with immunosuppressant regimens including cyclosporin A. In this post hoc analysis, patients' demographical data and clinical characteristics of psoriasis, severity and activity of PsA, prevalence of seropositivity for at least one viral infection, and treatments administered for PsA and infections were compared between sexes.Results: A total of 225 patients were evaluated in this post hoc analysis, and 121 (54% were males. Demographic characteristics and concomitant diseases were comparable between sexes. Statistically significant sex differences were observed at baseline in Psoriasis Area and Severity Index score (higher in males, mean number of painful joints, Bath Ankylosing Spondylitis Disease Activity Index, and the global activity of disease

  5. Risk factors and predictors of psoriatic arthritis in patients with psoriasis *

    Azevedo, Valderilio Feijó; Buiar, Pedro Grachinski

    2013-01-01

    Given the potential consequences of joint damage for patients with psoriatic arthritis, we believe that the optimization of screening methods and the investigation of arthritis in patients with psoriasis are a medical priority. It is very useful to identify predictors of arthritis in patients with psoriasis. In fact, there is a consensus among doctors that the large gap between the diagnosis of psoriasis and that of psoriatic arthritis should be narrowed. In order to better manage patients wi...

  6. Long term efficacy and safety of etanercept in the treatment of psoriasis and psoriatic arthritis

    Kivelevitch D

    2014-04-01

    Full Text Available Dario Kivelevitch, Bobbak Mansouri, Alan Menter Department of Dermatology, Baylor University Medical Center, Dallas, TX, USA Abstract: Psoriasis is a chronic, immune-mediated inflammatory disease affecting both the skin and joints. Approximately 20% of patients suffer a moderate to severe form of skin disease and up to 30% have joint involvement. Standard therapies for psoriasis include topical medications, phototherapy, and both oral systemic and biological therapies whereas therapies for psoriatic arthritis include nonsteroidal anti-inflammatory drugs followed by disease modifying antirheumatic drugs and/or tumor necrosis factor (TNF-α inhibitors and interleukin-12/23p40 inhibitors. Treatment of both diseases is typically driven by disease severity. In the past decade, major advances in the understanding of the immunopathogenesis of psoriasis and psoriatic arthritis have led to the development of numerous biological therapies, which have revolutionized the treatment for moderate to severe plaque psoriasis and psoriatic arthritis. Anti-TNF-α agents are currently considered as first line biological therapies for the treatment of moderate to severe psoriasis and psoriatic arthritis. Currently approved anti-TNF-α agents include etanercept, adalimumab, and infliximab for psoriasis and psoriatic arthritis as well as golimumab and certolizumab for psoriatic arthritis. In this article, we aim to evaluate the long term safety and efficacy of etanercept in psoriasis and psoriatic arthritis. Keywords: psoriasis, psoriatic arthritis, etanercept, biological therapy, tumor necrosis factor, safety

  7. Current views on the pharmacotherapy of psoriatic arthritis

    G. G. Taradin

    2015-01-01

    Full Text Available The review deals with current pharmacological approaches to treating psoriatic arthritis (PsA. It gives data on the prevalence of psoriasis and psoriatic joint injury that is a common cause of early patient disability. Approaches to evaluating the efficacy of drugs are given on the basis of developed and used criteria with regard to the standardized assessment of the dynamics of joint injury in rheumatic diseases and PSA in particular. The review gives brief information on the mechanism of drug actions and the results of clinical trials evaluating the efficacy and safety of different medicaments in PsA. It also covers the experience in using nonsteroidal antiinflammatory drugs, glucocorticoids, synthetic diseasemodifying antirheumatic drugs (methotrexate, cyclosporine, leflunomide, sulfasalazine, and also a promising group of biologicals. Particular emphasis is placed on the results of using tumor necrosis factor inhibitors (etanercept, infliximab, golimumab, certolizumab pegol, adalimumab, interleukin inhibitors (ustekinumab, brodalumab, and phosphodiesterase 4 inhibitors (apremilast.

  8. A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis.

    Brigitte Michelsen

    Full Text Available The main objective of this study was to compare disease burden in rheumatoid arthritis (RA, psoriatic arthritis (PsA and axial spondyloarthritis (ax-SpA.In this cross-sectional study, all the RA (1093, PsA (365 and ax-SpA (333 patients who visited the out-patient clinic of the Hospital of Southern Norway Trust during the year 2013 were included; the RA patients all had a RA diagnosis verified by the treating rheumatologist, the PsA patients all fulfilled the ClASsification for Psoriatic ARthritis (CASPAR criteria and the ax-SpA patients all fulfilled the Assessment of SpondyloArthritis international Society (ASAS classification criteria for ax-SpA. Patient-reported health status, demographic variables, medications, and composite scores of disease activity were assessed. The main analyses were performed using General Linear Models adjusted for age, sex and multiple comparisons. Correlation analyses were performed using Spearman's rho.The reported pain, joint pain, patient's global assessment and fatigue were similar in PsA and ax-SpA, but significantly lower in RA. The 28-joint Disease Activity Score (DAS28 (0.3±0.1, p = 0.003, Clinical Disease Activity Index (CDAI (1.0±0.4, p = 0.028 and Routine Assessment of Patient Index Data 3 (RAPID3 (0.4±0.1, p = 0.004 were all significantly higher in PsA vs. RA. RAPID3 showed moderate to high correlation with DAS28 (rho = 0.521, p<0.001 and CDAI (rho = 0.768, p<0.001 in RA and PsA, and with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI (rho = 0.902, p<0.001 and Bath Ankylosing Spondylitis Functional Index (BASFI (0.865, p<0.001 in ax-SpA and PsA.In conclusion, patient- reported outcome measures were similar in our population of PsA and ax-SpA patients, but significantly lower for the RA patients. Composite disease activity measures were lower in RA than in PsA and ax-SpA, but the magnitude of these differences was small and probably not of clinical significance. Our study indicates that

  9. Clinical efficacy, radiographic and safety findings through 2 years of golimumab treatment in patients with active psoriatic arthritis: results from a long-term extension of the randomised, placebo-controlled GO-REVEAL study

    Kavanaugh, A.; McInnes, I B; Mease, P J; Krueger, G. G.; Gladman, D. D.; van der Heijde, D; Mudivarthy, S.; Xu, W; Mack, M.; Z. Xu; Beutler, A.

    2013-01-01

    Objectives: To assess long-term golimumab efficacy/safety in patients with active psoriatic arthritis (PsA). Methods Adult PsA patients (≥3 swollen, ≥3 tender joints, active psoriasis) were randomly assigned to subcutaneous injections of placebo, golimumab 50 mg or 100 mg every 4 weeks (q4wks) through week 20. All patients received golimumab 50 or 100 mg beginning week 24. Findings through 2 years are reported. Efficacy evaluations included ≥20% improvement in American C...

  10. Sensitivity and specificity of plain radiographic features of peripheral enthesopathy at major sites in psoriatic arthritis

    It has been proposed that the defining difference between rheumatoid arthritis and spondyloarthropathy (including psoriatic arthritis) is the initial pathological lesion where the emphasis in psoriatic arthritis is on the enthesis and in rheumatoid arthritis on the synovium. Classical radiological descriptions of seronegative spondyloarthropathy include enthesopathy at major entheseal insertions characterised by erosions and exuberant new bone formation. In this study, the plain radiographic features of spondyloarthropathy are compared between psoriatic arthritis, other spondyloarthropathies and rheumatoid arthritis. The CASPAR study collected clinical, radiological and laboratory data on 588 patients with physician diagnosed psoriatic arthritis and 525 controls with other inflammatory arthritis, 70% of which had rheumatoid arthritis. Plain radiographs of the pelvis and heels were part of the study protocol, although radiographs of other potential entheseal sites such as the knee, elbow and shoulder, were interpreted if available. All radiographs were read blind by two observers working in tandem. Significant differences in entheseal erosion and entheseal new bone formation were found between psoriatic arthritis, ankylosing spondylitis, undifferentiated spondyloarthropathy, rheumatoid arthritis and other diagnoses (entheseal erosion, chi-squared 20.8, p = 0.008; entheseal new bone formation, chi-squared 24.5, p = 0.001). These differences were mainly due to a higher proportion of these features in ankylosing spondylitis. No differences in the plain radiographic features of enthesopathy were found between psoriatic arthritis and rheumatoid arthritis except in the case of entheseal new bone formation at sites of attachment of inguinal ligament, sartorius and rectus femoris muscles to the ilium (OR 3.01, 95% CI 1.13-8.02). Very few subjects with symptomatic heel involvement had radiographic changes and minimal differences were found between those with and without

  11. Sensitivity and specificity of plain radiographic features of peripheral enthesopathy at major sites in psoriatic arthritis

    Helliwell, P.S. [University of Leeds, Academic Unit of Musculoskeletal and Rehabilitation Medicine, Leeds (United Kingdom); Porter, G. [Airedale Hospital NHS Trust, Keighley, West Yorkshire (United Kingdom)

    2007-11-15

    It has been proposed that the defining difference between rheumatoid arthritis and spondyloarthropathy (including psoriatic arthritis) is the initial pathological lesion where the emphasis in psoriatic arthritis is on the enthesis and in rheumatoid arthritis on the synovium. Classical radiological descriptions of seronegative spondyloarthropathy include enthesopathy at major entheseal insertions characterised by erosions and exuberant new bone formation. In this study, the plain radiographic features of spondyloarthropathy are compared between psoriatic arthritis, other spondyloarthropathies and rheumatoid arthritis. The CASPAR study collected clinical, radiological and laboratory data on 588 patients with physician diagnosed psoriatic arthritis and 525 controls with other inflammatory arthritis, 70% of which had rheumatoid arthritis. Plain radiographs of the pelvis and heels were part of the study protocol, although radiographs of other potential entheseal sites such as the knee, elbow and shoulder, were interpreted if available. All radiographs were read blind by two observers working in tandem. Significant differences in entheseal erosion and entheseal new bone formation were found between psoriatic arthritis, ankylosing spondylitis, undifferentiated spondyloarthropathy, rheumatoid arthritis and other diagnoses (entheseal erosion, chi-squared 20.8, p = 0.008; entheseal new bone formation, chi-squared 24.5, p = 0.001). These differences were mainly due to a higher proportion of these features in ankylosing spondylitis. No differences in the plain radiographic features of enthesopathy were found between psoriatic arthritis and rheumatoid arthritis except in the case of entheseal new bone formation at sites of attachment of inguinal ligament, sartorius and rectus femoris muscles to the ilium (OR 3.01, 95% CI 1.13-8.02). Very few subjects with symptomatic heel involvement had radiographic changes and minimal differences were found between those with and without

  12. [Update on current care guidelines: psoriasis and psoriatic arthritis].

    2012-01-01

    Psoriasis is a chronic, immune-mediated, inflammatory disorder of the skin and joints. Moderate-to-severe cases are associated with an independent risk of comorbidity (cardiovascular diseases and diabetes) even after adjusting for risk factors, known to be more prevalent in psoriatics compared to normal population. The underlying systemic inflammation, analogous to that observed in rheumatoid arthritis, calls for a long-term effective treatment. Screening and treatment of cardiovascular risk factors is highly recommended. The biologic drug arsenal has new additions. Long term treatment data from clinical study extensions and independent registries are reviewed. PMID:22970613

  13. Development of composite measures for psoriatic arthritis: a report from the GRAPPA 2010 annual meeting.

    Helliwell, Philip S; Fitzgerald, Oliver; Mease, Philip J

    2012-02-01

    Composite disease outcome measures have been used in rheumatology for some time, but a disease-specific composite measure for psoriatic arthritis (PsA) has not yet been validated. Currently, instruments developed for use in rheumatoid arthritis are employed in PsA and include the American College of Rheumatology response criteria (ACR20, 50, and 70) and the Disease Activity Score for 28 and 44 joints (DAS28 and DAS44); however, these instruments do not cover the full spectrum of psoriatic disease. A composite measure is one way of incorporating an assessment of all relevant clinical outcomes into one single measure. By definition, it incorporates several dimensions of disease status, often by combining these different domains into a single score, which in the case of PsA includes joints, skin, entheses, dactylitis, and axial disease. New indices that combine these diverse clinical manifestations of PsA are under development and, in some cases, in the validation phase. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) established the GRAPPA Composite Exercise (GRACE) project to compare existing and emerging composite measures and to develop a new index. At the GRAPPA 2010 meeting, initial results from this project were presented, and existing and new candidate measures were compared. PMID:22298265

  14. Subtype specific genetic associations for juvenile idiopathic arthritis: ERAP1 with the enthesitis related arthritis subtype and IL23R with juvenile psoriatic arthritis

    Hinks, Anne; Martin, Paul; Flynn, Edward; Eyre, Steve; Packham, Jon; Barton, Anne; Worthington, Jane; Thomson, Wendy

    2011-01-01

    Introduction Juvenile idiopathic arthritis (JIA) is an umbrella term for all chronic childhood arthropathies and can be divided into seven subtypes. It includes the enthesitis related arthritis (ERA) subtype which displays symptoms similar to ankylosing spondylitis (AS) and juvenile-onset psoriatic arthritis which has similarities to psoriatic arthritis (PsA) and psoriasis (Ps). We, therefore, hypothesized that two well-established susceptibility loci for AS and Ps, ERAP1 and IL23R, could als...

  15. Radiographic development during three decades in a patient with psoriatic arthritis mutilans

    Laasonen, Leena; Gudbjornsson, Björn; Ejstrup, Leif; Iversen, Lars; Ternowitz, Thomas; Ståhle, Mona; Lindqvist, Ulla

    2015-01-01

    Psoriatic arthritis mutilans (PAM) is the most severe and rare form of psoriatic arthritis (PsA). We describe radiological development in a typical case of PAM covering three decades in order to elucidate the need for early diagnosis of PAM. Radiographs of hands and feet, taken from 1981 to 2010......, were evaluated using the Psoriatic Arthritis Ratingen Score (PARS). When PsA was diagnosed, in 1981, gross deformity was observed in the second PIP joint of the left foot. Several pencil-in-cup deformities and gross osteolysis were present in the feet in the first decade of the disease. Over 10 years...

  16. Remission in psoriatic arthritis: is it possible and how can it be predicted?

    Saber, Tajvur P

    2010-01-01

    Since remission is now possible in psoriatic arthritis (PsA) we wished to examine remission rates in PsA patients following anti tumour necrosis factor alpha (TNFalpha) therapy and to examine possible predictors of response.

  17. Cartilage collagen type II seromarker patterns in axial spondyloarthritis and psoriatic arthritis: associations with disease activity, smoking and HLA-B27.

    Munk, Heidi Lausten; Gudmann, Natasja Staehr; Christensen, Anne Friesgaard; Ejstrup, Leif; Sorensen, Grith Lykke; Loft, Anne Gitte; Bay-Jensen, Anne C; Siebuhr, Anne Sofie; Junker, Peter

    2016-04-01

    The aim of the study was to assess the possible association between type II collagen turnover seromarkers and disease profile in patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA). Outpatients with axial SpA (n = 110) or PsA (n = 101) underwent clinical examination including disease activity measures and HLA-B27 typing. The procollagen IIA N-terminal peptide (PIIANP) and a matrix metalloproteinase-generated type II collagen fragment (C2M) were quantified in serum by ELISA. C2M was higher in SpA than in controls, 0.41 versus 0.36 ng/ml (p = 0.004), while PIIANP did not differ between patients and healthy subjects, 2252 versus 2142 ng/ml (p = 0.13). However, DMARD-naïve SpA patients had higher PIIANP, 2461 ng/ml (p = 0.01) and C2M, 0.44 ng/ml (p = 0.0007) levels than controls, and PIIANP correlated with CRP (ρ = 0.34). C2M was lower in SpA smokers, 0.36 ng/ml versus non-smokers, 0.43 ng/ml (p = 0.02), while PIIANP was higher in HLA-B27 positive, 2312 ng/ml versus negative patients, 2021 ng/ml (p = 0.03). In PsA, PIIANP and C2M did not differ between patients and controls, but PIIANP was elevated in patients not receiving DMARDs, 2726 ng/ml. In PsA, PIIANP and C2M did not differ according to smoking and HLA-B27. Cartilage degradation assessed by C2M is increased in SpA irrespective of treatment but not in PsA. Cartilage synthesis reflected by PIIANP is increased in untreated SpA and PsA. PIIANP correlates with CRP in SpA while not in PsA. In DMARD-naïve SpA but not in PsA, HLA-B27 positivity and smoking are associated with a chondro-proliferative metabolic pattern. PMID:26620690

  18. Magnetic resonance imaging of the peripheral joints in psoriatic arthritis

    M.A. Cimmino

    2011-09-01

    Full Text Available Objective: Magnetic resonance imaging (MRI has been widely used for the evaluation of rheumatoid arthritis (RA, with only a minority of studies considering other types of arthritis. This review is concerned with an evaluation of the MRI appearance of peripheral joints in psoriatic arthritis (PsA. Methods: A Medline search was performed to identify all publications from the years 1985 to 2006 concerning MRI of the peripheral joints and PsA. Additional papers were retrieved by scanning the references to the Medline-listed articles. Articles written in English, French, German, and Italian were included. Results: Most papers studied the hand and wrist, and only few of them were concerned with the knee, foot, temporomandibular joint, and elbow. Patients with PsA showed often, but not always, a pattern of joint inflammation which extended beyond the capsule into the extraarticular tissue. Bone oedema and erosions were less frequent than in RA. In particular, bone oedema at the entheseal junction was seen, especially in the knee. The degree of synovitis, assessed by dynamic MRI, was similar in PsA and RA. Discussion: Data on MRI of the peripheral joints in PsA are scanty. Only few studies were specifically designed to evaluate the pattern of arthritis in PsA, with most information deriving from papers where different types of arthritis were considered together. An enthesis-related origin of PsA has been proposed in contrast to the primarily synovial inflammation of RA. This pathogenic interpretation is likely to be true, but does not explain all cases of PsA, and needs to be confirmed by further studies.

  19. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis

    Sørensen, Jan; Hetland, Merete Lund

    2015-01-01

    BACKGROUND/PURPOSE: Early diagnosis of inflammatory rheumatic diseases is important in order to improve long-term outcome. We studied whether delay in diagnosis (time between onset of symptoms and establishment of diagnosis) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and......). Sensitivity analyses including patients who were included after 2005, patients who had received biological treatment or had symptom onset less than 2 and 5 years prior to first entry into DANBIO showed similar results. CONCLUSION: Since the year 2000, a significant reduction in diagnostic delay was observed...

  20. Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA)

    Augustin, M; Blome, C; Costanzo, A;

    2013-01-01

    assessing quality of life (NAPPA-QoL), a two-part questionnaire assessing patient-relevant treatment benefits (the Patient Benefit Index, NAPPA-PBI) and a psoriasis Clinical Assessment of Severity (NAPPA-CLIN). METHODS: Development of the questionnaires involved multiple steps: (i) collection of items about......BACKGROUND: Existing tools for nail psoriasis are complex and may not adequately measure outcomes that are important to patients. OBJECTIVES: We have developed and validated a new tool, the Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), with three components: a questionnaire...... nail psoriasis-related impairments and treatment goals; (ii) selection of 48 items by an expert panel, including patients; (iii) translation into eight languages; (iv) feasibility testing and (v) longitudinal validation in six countries. RESULTS: Patients found the questionnaires clear (84%) and...

  1. Biomarkers in psoriatic arthritis: a systematic literature review.

    Generali, Elena; Scirè, Carlo A; Favalli, Ennio G; Selmi, Carlo

    2016-06-01

    Psoriatic arthritis (PsA) is characterized by chronic inflammation of peripheral joints and axial skeleton, associated with a strong genetic background. Clinics include enthesitis or dactylitis and extra-articular involvement as uveitis or inflammatory bowel disease, while treatment options range from nonsteroidal anti-inflammatory drugs (NSAIDs) to biologics, targeting TNF α or Th17. No serum autoantibody is associated with PsA, while other biomarkers have been proposed for early diagnosis or to predict treatment response. To better discuss this area of growing interest we performed a systematic review of the literature on biomarkers in PsA. Our research retrieved 408 papers, and 38 were included in the analysis. Based on the available literature, we draw some recommendations for the use of biomarkers in the management of patients with PsA. PMID:26821681

  2. Apremilast (Otezla). No progress in plaque psoriasis or psoriatic arthritis.

    2016-06-01

    When PUVA therapy and immunosuppressants such as methotrexate are ineffective, TNF alpha antagonists are an option for patients with severe plaque psoriasis, in the absence of a better alternative. This is also the case for patients with psoriatic arthritis after failure of a "disease-modifying" antirheumatic drug. Apremilast, an oral immunosuppressant that inhibits phosphodiesterase type 4, has been authorised in the European Union for use in these settings. In patients with plaque psoriasis, oral apremilast was compared with subcutaneous etanercept, aTNF alpha antagonist, in a randomised, doubleblind, placebo-controlled trial lasting 16 weeks and involving 250 patients in whom other treatments had failed or were inappropriate. This trial failed to show that apremilast was more effective than etanercept. And about one-quarter more patients experienced symptom relief compared with placebo. In patients with psoriatic arthritis, there are no clinical trials comparing apremilast with TNF alpha antagonists, and no interpretable trials of apremilast after failure of a TNF alpha antagonist. In three randomised, double-blind trials including a total of 1493 patients treated for 16 weeks, at least a modest improvement in joint status was reported in about 35% of patients treated with apremilast versus 19% with placebo. This would suggest that apremilast is less effective than a TNF alpha antagonist. In the trial versus etanercept, serious adverse events occurred in 3.6% of patients treated with apremilast versus 1.2% of those treated with the TNF alpha antagonist. The main adverse effects of apremilast are diarrhoea, nausea and vomiting, headache, sometimes marked weight loss, and infections. A risk of depression and cardiac arrhythmia must also be taken into account. A risk of cancer in the long-term is likely, given the immunosuppressive action of apremilast. Apremilast is a substrate of cytochrome P450 isoenzyme 3A4 and accumulates in patients with renal failure. This

  3. Role of golimumab, a TNF-alpha inhibitor, in the treatment of the psoriatic arthritis

    Melissa A Michelon

    2010-05-01

    Full Text Available Melissa A Michelon1, Alice B Gottlieb1,21Tufts University School of Medicine, 2Department of Dermatology, Tufts Medical Center, Boston, MA, USAAbstract: Psoriatic arthritis (PsA is an inflammatory arthritis that affects many psoriasis patients and can often have a debilitating disease progression. Golimumab is a new tumor necrosis factor (TNF antagonist recently approved by the FDA for controlling signs and symptoms of psoriatic arthritis. In a Phase III clinical trial in patients with PsA, patients receiving golimumab showed significant improvement in the signs and symptoms of disease. It was usually well tolerated, but adverse events generally occurred more in patients receiving golimumab compared to placebo. Golimumab has also recently shown efficacy in slowing structural damage in PsA. This new biologic therapy provides physicians with another option in the treatment of this inflammatory arthritis while offering patients certain advantages over other TNF antagonists.Keywords: golimumab, psoriatic arthritis, TNF-alpha inhibitor

  4. CYCLOSPORIN A (SANDIMMUN NEORAL IN THERAPY FOR PSORIASIS AND PSORIATIC ARTHRITIS

    Yulia Leonodovna Korsakova

    2010-09-01

    Full Text Available The involvement of immune mechanisms in the pathogenesis of psoriatic arthritis (PA is noted to give grounds to use immunoactive compounds (disease- modifying agents - basic anti-inflammatory drugs -BAIDs, such as cyclosporin A (CsA, in this disease. The data available in the literature permit a high assessment of CsA as one of the BAIDs in the treatment of PA and psoriasis. CsA is stated to monitor the course of this disease, acts on inflamed peripheral joints, decreases the clinical and laboratory activity of PA, positively affects the PA-afflicted skin, and can induce remission of psoriasis.

  5. Inflammatory Polyarthritis in a Patient with Psoriasis: Is It Psoriatic Arthritis or Rheumatoid Arthrirtis?

    Lee, Kwang-Hoon; Son, Myoung-Kyun; Ha, You-Jung; Choi, Sang-Tae; Lee, Sang-Won; Park, Yong-Beom; Lee, Soo-Kon

    2010-01-01

    Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. There are no generally accepted diagnostic criteria for PsA. Indeed, the diagnosis of this inflammatory arthritis is made by exclusion of other possible diseases and based upon immunologic, radiologic, and clinical features which are consistent with the diagnosis. Inflammatory arthritis in a patient with psoriasis can be an important clue for the diagnosis of PsA, but the possibility for diagnosis of other infla...

  6. MRI of the hand in psoriatic and rheumatical arthritis

    Magnetic resonance imaging (MRI) of the hand in patients with psoriatic arthritis (PA) was evaluated and compared with MRI of the hand in patients with rheumatoid arthritis (RA). Both MRI and X-ray examinations of the hands were performed in 28 PA patients and 18 RA patients. The MRI showed a PA pattern characterized by a more pronounced soft tissue swelling as compared with RA patients. Diffuse and pronounced periarticular oedema that spread to the subcutis was evident in 24 (85.7 %) PA patients. Subchondral changes were characteristic of PA patients, and were observed in 12 of 28 PA patients (42.8 %). In these cases, conventional X-ray examination failed to show any bone change. These two changes were not seen in RA patients. Our preliminary results indicate that MRI might play a role in differential diagnosis between PA and RA especially in the early phase of the disease in which conventional radiological examination is negative. (orig.). With 5 figs., 2 tabs

  7. Erosive osteoarthritis, psoriatic arthritis and pseudogout; a casual association?

    Hoxha, Ariela; Ruffatti, Amelia; Alberioli, Enrico; Lorenzin, Mariagrazia; Oliviero, Francesca; Mattia, Elena; Punzi, Leonardo; Ramonda, Roberta

    2016-07-01

    According to recent hypothesis, the inflammation has a pivotal role in the onset and progression of erosive hand osteoarthritis (EHOA), psoriatic arthritis (PsA) and chondrocalcinosis (CC)/pseudogout. Albeit, it has been recognised for years as an association between EHOA and radiographic evidence of CC, but there are few reports of coexistence of microcrystalline arthritis and PsA. This is the first report that described a clinical experience concerning two consecutive cases of patients presented with EHOA, PsA and pseudogout. Two Caucasian women of 71 and 85 years old with a history of OA and mild psoriasis are presented with tenderness and swelling of first interphalangeal (IP) and wrist joint, respectively. Arthrocentesis performed at the first IP and wrist joint, respectively, showed an inflammatory synovial fluid with presence of calcium pyrophosphate dehydrate crystals. X-rays of hands, feet and knees showed characteristic features of EHOA, PsA and CC. Furthermore, HLA typing evinces the presence of HLA C*06; DRB*01 07 and HLA C*07; DRB*01 *11 alleles, respectively, predisposing factors of these inflammatory diseases. The relationship between these aggressive rheumatic diseases along with their clinical, radiographic, laboratory and genetic features is discussed. PMID:25833145

  8. MRI of the hand in psoriatic and rheumatical arthritis

    Giovagnoni, A. [Department of Radiology and NMR Center, Univ. of Ancona (Italy); Grassi, W. [Department of Rheumatology, Univ. of Ancona (Italy); Terilli, F. [Department of Radiology and NMR Center, Univ. of Ancona (Italy); Blasetti, P. [Department of Rheumatology, Univ. of Ancona (Italy); Paci, E. [Department of Radiology and NMR Center, Univ. of Ancona (Italy); Ercolani, P. [Department of Radiology and NMR Center, Univ. of Ancona (Italy); Cervini, C. [Department of Rheumatology, Univ. of Ancona (Italy)

    1995-12-01

    Magnetic resonance imaging (MRI) of the hand in patients with psoriatic arthritis (PA) was evaluated and compared with MRI of the hand in patients with rheumatoid arthritis (RA). Both MRI and X-ray examinations of the hands were performed in 28 PA patients and 18 RA patients. The MRI showed a PA pattern characterized by a more pronounced soft tissue swelling as compared with RA patients. Diffuse and pronounced periarticular oedema that spread to the subcutis was evident in 24 (85.7 %) PA patients. Subchondral changes were characteristic of PA patients, and were observed in 12 of 28 PA patients (42.8 %). In these cases, conventional X-ray examination failed to show any bone change. These two changes were not seen in RA patients. Our preliminary results indicate that MRI might play a role in differential diagnosis between PA and RA especially in the early phase of the disease in which conventional radiological examination is negative. (orig.). With 5 figs., 2 tabs.

  9. The efficacy and tolerability of leflunomide (Arava® in therapy for psoriatic arthritis

    Vladimir Vasilyevich Badokin

    2013-12-01

    Full Text Available The paper gives data on differentiated disease-modifying anti-rheumatic therapy for psoriatic arthritis (PsA. When performing the therapy, account must be taken of the presence and magnitude of the major manifestations of this disease: the pattern of arthritis and spondylosis, the number of inflamed entheses, the number of swollen fingers or toes, the pattern of psoriasis in terms of its extent and stage, the presence and magnitude of systemic manifestations and the functional state of involved organs. There are data on the biological activity of leflunomide, its effect on the main manifestations of PsA with an analysis of its efficacy and tolerability, as well as the results of a comparative investigation of disease-modifying anti-rheumatic drugs used for the therapy of this disease.

  10. The Role of p38 MAPK in the Aetiopathogenesis of Psoriasis and Psoriatic Arthritis

    Mavropoulos, Athanasios; Eirini I. Rigopoulou; Liaskos, Christos; Bogdanos, Dimitrios P.; Sakkas, Lazaros I.

    2013-01-01

    The pathogenetic mechanisms responsible for the induction of immune-mediated disorders, such as psoriasis, remain not well characterized. Molecular signaling pathways are not well described in psoriasis, as well as psoriatic arthritis, which is seen in up to 40% of patients with psoriasis. Signaling pathway defects have long been hypothesized to participate in the pathology of psoriasis, yet their implication in the altered psoriatic gene expression still remains unclear. Emerging data sugges...

  11. Novel Oral Therapies for Psoriasis and Psoriatic Arthritis.

    Yiu, Zenas Z N; Warren, Richard B

    2016-06-01

    Several classes of new oral therapy are in use or in development for the treatment of psoriasis. Despite the high efficacy of biologics, new oral therapies remain important as patients generally prefer this mode of administration and they offer an alternative risk-benefit profile. In this review, we discuss the novel modes of action of these drugs, including modulation of cellular pathways involving diverse targets such as Janus kinase, phosphodiesterase 4, sphingosine 1-phosphate, A3 adenosine receptor and rho-associated kinase 2. We review the available evidence around licensed drugs (apremilast) and drugs that are advanced (tofacitinib) or early (ponesimod, baricitinib, peficitinib, INCB039110, CF101, KD025) in the development pipeline. The key limitations of these oral therapies are their modest efficacy profile (apremilast, ponesimod) and the limitations of their safety profile (tofacitinib, ponesimod), while the evidence for the early pipeline drugs are at phase II level only. Potential niches of current unmet needs include apremilast for patients with concomitant psoriatic arthritis, as combination treatments with biologic therapies, and/or for patients in whom multiple biologic therapies have failed due to immunogenicity and secondary inefficacy. The present knowledge gap regarding these novel drugs includes the need for longer clinical trials or observational studies to evaluate safety, and randomised phase III trials for the early pipeline drugs. We conclude that further research and data are necessary to conclusively establish the role of these agents in the current psoriasis treatment paradigm. PMID:26923915

  12. Effect of Vitamin D on Peripheral Blood Mononuclear Cells from Patients with Psoriasis Vulgaris and Psoriatic Arthritis

    Cubillos, Susana; Krieg, Nadine; Norgauer, Johannes

    2016-01-01

    Background Psoriasis, a chronic skin disease with or without joint inflammation, has increased circulating proinflammatory cytokine levels. Vitamin D is involved in calcium homeostasis, bone formation, osteoclastogenesis and osteoclast activity, as well as regulation of immune response. We aimed to study osteoclast differentiation and cytokine secretion of peripheral blood mononuclear cells (PBMCs) from patients with psoriasis vulgaris and psoriatic arthritis, in response to 1,25(OH)2D3. Meth...

  13. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis

    Sørensen, Jan; Hetland, Merete Lund

    2014-01-01

    BACKGROUND/PURPOSE: Early diagnosis of inflammatory rheumatic diseases is important in order to improve long-term outcome. We studied whether delay in diagnosis (time between onset of symptoms and establishment of diagnosis) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and...... ankylosing spondylitis (AS) changed from year 2000 to 2011. METHODS: Month and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13 721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset...... and diagnosis was modelled using generalised linear regression to predict the average duration for each calendar year of initial symptoms with adjustments for gender, year of birth and date of DANBIO entry. RESULTS: Patients with valid data (RA: 10 416 (73%); PSA: 1970 (68%); AS: 1335 (65%)) did not...

  14. IFN-αα induced psoriatic arthritis and HCV-related liver cirrhosis. Therapeutic options and patient’s opinion

    M. Piga

    2011-09-01

    Full Text Available Hepatitis C virus (HCV infection in the setting of Psoriatic Arthritis is an additional variable to be considered in the therapeutic approach to the disease because of the complications of an immunosuppressive treatment in the course of a chronic infection and the possible hepatotoxicity of many drugs conventionally used to treat psoriatic arthritis. The case reported explores the therapeutic options in a patient with IFN-α induced psoriatic arthritis, characterised by severe arthritis and psoriasis but also the concomitant presence of HCV chronic hepatitis, in light of the patient’s concerns

  15. MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINT IN DIFFERENTIAL DIAGNOSIS OF EARLY POLYARTICULAR PSORIATIC AND RHEUMATOID ARTHRITIS (STUDY DATA REMARKA)

    Elena Yu Loginova; T. V. Korotaeva; E L Luchihina; Smirnov, A. V.; A A Glazkov; D E Karateev

    2014-01-01

    Diagnosis of lesions of the spine and sacroiliac joints may be helpful in discrimination between early psoriatic arthritis (ePsA) and early rheumatoid arthritis (eRA).Objective. To assess the significance of inflammatory back pain (IBP), HLA-B27, and active sacroiliitis (ASI) confirmed by magnetic resonance imaging (MRI) for differential diagnosis of polyarticular ePsA and eRA.Materials and Methods. The study included 29 patients with ePsA (13 males and 16 females, mean age 36.52 ± 11.27 year...

  16. Frequency of HLA antigens in patients with psoriasis or psoriatic arthritis.

    McKendry, R. J.; Sengar, D P; DesGroseilliers, J. P.; Dunne, J V

    1984-01-01

    A study of 138 patients with psoriasis--74 with psoriasis alone and 64 with psoriatic arthritis--revealed a significantly increased frequency of the HLA antigens A1, A28, B13, DR7 and MT3 in those with psoriasis alone and of Bw39 in those with psoriatic arthritis. The frequency of B17 was higher in both patient groups than in a control group of healthy individuals. The frequency of DRw6 was slightly higher in the patients with psoriasis alone (17.8%) than in the controls (4.7%), and that of D...

  17. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype.

    FitzGerald, Oliver

    2015-05-07

    This review focuses on the genetic features of psoriatic arthritis (PsA) and their relationship to phenotypic heterogeneity in the disease, and addresses three questions: what do the recent studies on human leukocyte antigen (HLA) tell us about the genetic relationship between cutaneous psoriasis (PsO) and PsA - that is, is PsO a unitary phenotype; is PsA a genetically heterogeneous or homogeneous entity; and do the genetic factors implicated in determining susceptibility to PsA predict clinical phenotype? We first discuss the results from comparing the HLA typing of two PsO cohorts: one cohort providing the dermatologic perspective, consisting of patients with PsO without evidence of arthritic disease; and the second cohort providing the rheumatologic perspective, consisting of patients with PsA. We show that these two cohorts differ considerably in their predominant HLA alleles, indicating the heterogeneity of the overall PsO phenotype. Moreover, the genotype of patients in the PsA cohort was shown to be heterogeneous with significant elevations in the frequency of haplotypes containing HLA-B*08, HLA-C*06:02, HLA-B*27, HLA-B*38 and HLA-B*39. Because different genetic susceptibility genes imply different disease mechanisms, and possibly different clinical courses and therapeutic responses, we then review the evidence for a phenotypic difference among patients with PsA who have inherited different HLA alleles. We provide evidence that different alleles and, more importantly, different haplotypes implicated in determining PsA susceptibility are associated with different phenotypic characteristics that appear to be subphenotypes. The implication of these findings for the overall pathophysiologic mechanisms involved in PsA is discussed with specific reference to their bearing on the discussion of whether PsA is conceptualised as an autoimmune process or one that is based on entheseal responses.

  18. Long-term survival of methotrexate in psoriatic arthritis

    N. Battafarano

    2011-06-01

    Full Text Available Objective. The purpose of this study was to evaluate the long-term survival rate of Methotrexate (MTX in the peripheral joint involvement of psoriatic arthritis (PsA in a setting of everyday clinical practice. Methods. This was an observational restrospective study performed using the data from a dermatological-rheumatological PsA clinic. All of the patients evaluated at this clinic from March 1997 to December 2007 who were started on MTX alone, had a three-year follow-up time or had discontinued the therapy were included into the survey. Results. Of the 174 evaluable patients, 104 (59.8% were still taking MTX after three years of treament. The reasons of therapy discontinuation in the remaining 70 (40.2% patients were: 34 (19.5% lost-to-follow-up, 18 (10.3% adverse events, 14 (8% inefficacies, and 4 (2.3% deaths (none related to the therapy. MTX was effective in controlling joint inflammation but not in preventing their deterioration. Overall, adverse events were recorded in 43 patients (36.4% of the 114 patients with a three-year follow-up. No serious side effect occurred in the study population. Conclusions. The results of this study showed that, in a setting of clinical pratice, MTX had a good three-year performance in patients with peripheral PsA. Almost 60% of them were still taking this drug at the end of the study period and the toxicity was more than acceptable. In our opinion, MTX might be considered the non-biological DMARD of choice for the treatment of this condition. However it should be used earlier and at higher doses.

  19. The involvement of the spine in psoriatic arthritis.

    Baraliakos, Xenofon; Coates, Laura C; Braun, Juergen

    2015-01-01

    Although different classification criteria have been developed for psoriatic arthritis (PsA) and spondyloarthritis (SpA), a clear distinction is still not always possible in daily practice. In addition, clinical examination of patients initially diagnosed as PsA due to peripheral symptoms and skin lesions may also show inflammation in the axial skeleton causing inflammatory back pain, stiffness and changes on imaging including sacroiliitis, spondylitis and syndesmophyte formation, similar to what is known from ankylosing spondylitis (AS), the prototype of SpA. However, and in contrast to patients with AS, the long-term radiographic progression of patients with axial disease in PsA seems to be rather independent from spinal mobility. If axial symptoms predominate, diagnosis and classification can be made as axSpA - with or without psoriasis. Furthermore, also the role of HLA-B27 appears to be different in patients with PsA. Overall, the most data about axial involvement in SpA come from AS and axSpA studies, while data about the axial involvement in PsA is limited. Finally, there are no approved therapies for treatment of axial PsA at present, despite significant clinical morbidity. In recent years, anti-TNF therapies have revolutionised the management of ax-SpA. The new GRAPPA treatment recommendations have given specific management advice for patients with axial involvement based on literature from AS and axial SpA. This review aims to give an overview of the existing evidence, the clinical and imaging presentation, and therapeutic consequences of axial involvement in patients with PsA. PMID:26471338

  20. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis.

    Chandran, Vinod; Raychaudhuri, Siba P

    2010-05-01

    Psoriasis and Psoriatic Arthritis (PsA) are chronic inflammatory diseases that have a major impact on health. The prevalence and incidence estimates of these two closely related diseases show ethnic and geographic variations, being generally more common in the colder north than in the tropics. In Europe the prevalence of psoriasis varies anywhere from 0.6 to 6.5%. In the USA, the estimated prevalence of diagnosed psoriasis is 3.15%. The prevalence in Africa varies depending on geographic location, being lowest in West Africa. Psoriasis is less prevalent in China and Japan than in Europe, and is entirely absent in natives of the Andean region of South America. There are fewer reports on the incidence of psoriasis, but a recent study from Rochester, USA showed an increasing trend over the last 2 decades. The prevalence of PsA also shows similar variation, being highest in people of European descent and lowest in the Japanese. Although, study methodology and case definition may explain some of the variations, genetic and environmental factors are important. Genetic epidemiologic studies have shown that both diseases have a strong genetic component. The strongest association is with HLA-Cw*06. Associations with a number of genes including IL12B and IL23R have recently been confirmed. Environmental risk factors including streptococcal pharyngitis, stressful life events, low humidity, drugs, HIV infection, trauma, smoking and obesity have been associated with psoriasis and PsA. Here we have reviewed the current literature on the epidemiology and genetics of psoriasis and PsA. PMID:20034760

  1. The pharmacokinetic effect of coadministration of apremilast and methotrexate in individuals with rheumatoid arthritis and psoriatic arthritis

    Liu, Yong; Zhou, Simon; Nissel, James; Wu, Anfan; Lau, Henry; Palmisano, Maria

    2014-01-01

    Apremilast is a novel agent for the treatment of inflammatory based autoimmune disorders. The objective of this study was to assess the pharmacokinetic effects of co administration of apremilast and methotrexate on both agents. This was an open-label, multi-center, 3-treatment period, sequential study conducted in otherwise healthy subjects with psoriatic arthritis or rheumatoid arthritis who were receiving a stable oral dose of methotrexate between 7.5 to 20 mg once weekly. Subjects received...

  2. Update on the treatment of psoriasis and psoriatic arthritis – role of apremilast

    Forchhammer S; Ghoreschi K

    2015-01-01

    Stephan Forchhammer, Kamran GhoreschiDepartment of Dermatology, University Medical Center, Eberhard Karls University of Tübingen, Tübingen, GermanyAbstract: Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis (PsO). The treatment of PsA can be challenging and includes non-steroidal anti-inflammatory drugs, synthetic disease modifying antirheumatic drugs, and biologicals. One novel oral compound that has been recently established for the treatment of PsO ...

  3. Use of Ultrasound for Diagnosis and Follow-Up of Psoriatic Arthritis

    Rusmir Husic; Anja Ficjan; Christina Duftner; Christian Dejaco

    2014-01-01

    Musculoskeletal ultrasound (US) is increasingly used as a bedside tool for diagnostic and monitoring purposes in patients with psoriatic arthritis (PsA). The sonographic differentiation between PsA and rheumatoid arthritis (RA) may be challenging because the morphological appearance of synovitis is similar in both conditions. In contrast, perisynovial inflammation is a specific finding of early PsA, and enthesitis is more frequently detected in PsA than in RA. After initiation of effective th...

  4. Temporomandibular Disorders in Psoriasis Patients with and without Psoriatic Arthritis: An Observational Study

    Crincoli, Vito; Di Comite, Mariasevera; Di Bisceglie, Maria Beatrice; Fatone, Laura; Favia, Gianfranco

    2015-01-01

    AIMS: Psoriasis is a chronic, remitting and relapsing inflammatory disorder, involving the skin, nails, scalp and mucous membranes, that impairs patients' quality of life to varying degrees. Psoriatic arthritis is a chronic seronegative, inflammatory arthritis, usually preceded by psoriasis. Temporomandibular disorders is a generic term referred to clinical conditions involving the jaw muscles and temporomandibular joint. The aim of this study was to assess symptoms and signs of temporomandib...

  5. Profile of certolizumab and its potential in the treatment of psoriatic arthritis

    Chimenti MS

    2013-04-01

    Full Text Available Maria Sole Chimenti,1 Rosita Saraceno,2 Andrea Chiricozzi,2,3 Alessandro Giunta,2 Sergio Chimenti,2 Roberto Perricone11Unit of Rheumatology, Allergology, and Clinical Immunology, 2Unit of Dermatology, University of Rome Tor Vergata, Rome, Italy; 3Laboratory for Investigative Dermatology, Rockefeller University, New York, NY, USAAbstract: Psoriatic arthritis (PsA is a chronic inflammatory arthropathy associated with psoriasis (PsO. PsA could be considered an enthesal disease because of the link between mechanical stress (entheses and immunologically active tissue (synovium. Evidence of efficacy of anti-tumor necrosis factor alpha (TNF-α is supported by reduction of histological vascularity and immune cell infiltrates in synovial tissue after treatment. Certolizumab pegol (CZP is a polyethylene glycolylated (PEGylated Fab′ fragment of a humanized monoclonal antibody that binds and neutralizes human TNF-α. The PEG moiety of the Fab fragment, markedly increases the half-life of CZP and confers to the drug a unique structure that differs from the other anti-TNF-α agents tested for the treatment of Crohn’s disease, rheumatoid arthritis, ankylosing spondylitis, axial spondyloarthritis, nonradiographic spondyloarthritis, PsO, and PsA. In contrast to other anti-TNF-α agents, CZP did not mediate increased levels of apoptosis, suggesting that these mechanisms are not essential for the anti-TNF-α efficacy in Crohn’s disease. As CZP, infliximab, and adalimumab, but not etanercept, almost completely inhibited lipopolysaccharide-induced interleukin-1 beta release from monocytes, this cytokine-production inhibition may be relevant for drug efficacy. Due to these characteristics, it has been demonstrated in clinical studies that CZP effectively improves signs and symptoms of arthritis and physical function and skin manifestations of PsO, with a safety profile similar to rheumatoid arthritis. This drug can be considered as a valid treatment in patients

  6. Confirmation of TNIP1 and IL23A as susceptibility loci for psoriatic arthritis.

    Bowes, John

    2011-09-01

    To investigate a shared genetic aetiology for skin involvement in psoriasis and psoriatic arthritis (PsA) by genotyping single-nucleotide polymorphisms (SNPs), reported to be associated in genome-wide association studies of psoriasis, in patients with PsA.

  7. Developing a magnetic resonance imaging scoring system for peripheral psoriatic arthritis

    McQueen, Fiona; Lassere, Marissa; Bird, Paul;

    2007-01-01

    We describe the first steps in developing an OMERACT magnetic resonance imaging (MRI) scoring system for peripheral psoriatic arthritis (PsA). A preexisting MRI dataset (finger joints) from 10 patients with PsA was scored by 4 readers for bone erosion, bone edema, synovitis, tendinopathy, and...

  8. EFFICACY OF UNDERWATER INTERFERENTIAL CURRENT ON HAND FUNCTION IN PSORIATIC ARTHRITIS PATIENTS

    Ahmed Fathy Samhan. PhD PT

    2014-04-01

    Full Text Available Background: Psoriatic arthritis is an entity of inflammatory joint disease associated with psoriasis. Purpose: The purpose of this study was to evaluate the efficacy of underwater interferential current therapy on hand function in psoriatic arthritis of both hands. Method: Thirty patients (18 females and 12 males had psoriatic arthritis of hands, aged 42 to 50 years with 45.77 ± 3.52 mean, were assigned randomly into two groups of equal number: study group received 20 minutes underwater interferential current for one month, 3 times per week (12 sessions and control group received placebo interferential current. Visual analogue scale for patient-reported pain, the Disability of Arm, Shoulder and Hand questionnaire score, and hand function (grip force in Pound of dominant hand were assessed pretreatment and post-treatment. Results: showed significant improvement in the 3 outcomes in study group (p 0.005. Visual analogue scale had a strong positive correlation (p < 0.001 with the disability score and a strong negative correlation (p < 0.001 with the grip force. Conclusion: Using underwater interferential current therapy in patient with psoriatic arthritis of hands was effective in improvement of hand function and quality of life.

  9. X-ray diagnosis of mutilating arthritis in patients with psoriatic arthritis Smirnov A.V.

    A.V. Smirnov

    2014-05-01

    Full Text Available The typical X-ray symptoms of psoriatic arthritis (PsA in joints of hands and distal sections of feet (asymmetric lesions; isolated lesion of distal interphalangeal joints (DIJ of hands with no changes in other small joints of hands; axial lesion of three joints in a single finger; transverse lesion of joints of the hand at the same level; destruction of distal phalanges; narrowing of the distal epiphysis of hand finger phalanges and metacarpal bones; cup-shaped deformity of the proximal portion of hand finger phalanges and narrowing of distal epiphysis; osseous ankyloses; multiple osteolytic lesions and destruction of bone epiphysis and joint deformities; inflammatory changes in the sacroiliac joints; and typical degenerative changes in the spine are described. It is especially important to know X-ray manifestations of PsA when there are no typical cutaneous manifestations of psoriasis. 

  10. PSORIASIS AND PSORIATIC ARTHRITIS: CHARACTERISTICS AND RISK FACTORS AMONG ADULT PATIENTS IN EGYPT

    Essam A. El-Moselhy, Ibrahim Saad Nada, Hamed O. Khalifa,

    2012-04-01

    Full Text Available Background: Psoriasis and psoriatic arthritis are common, chronic, immune mediated disease of the skin and joints. Interaction between genes and environment are important in disease causation. Objectives: The aim of the present study was to determine the socioemographic and clinical characters of adult patients with psoriasis and those with psoriatic arthritis, to define psoriasis and psoriatic arthritis etiological risk factors, and to define the relationship between psoriasis severity and these items. Subjects and methods: This study was conducted at Dermatology Clinic, Al-Hussein University Hospital. A case-control study design was chosen to perform this research. The study was conducted on 100 adult patients with psoriasis and an equal number of free adults as controls. Criteria for diagnosis of psoriasis and psoriatic arthritis were used. A comprehensive questionnaire was used to survey the studied groups. Body surface area of the affected patients was used as a marker of disease severity.Results: The study showed that 44.0% of the cases had psoriasis age of onset; 22-45 years. Stress was the most common etiological risk factor, 67.0%. While, the most important risk factors were family history of psoriasis, recurrent pharyngitis, smoking ≥20 cigarettes/ day and higher level of education, odds ratio (OR=7.58, 5.94, 2.78 and 2.69, respectively. Also, 32.0% of the patients had psoriatic arthritis. Psoriatic arthritis comes after psoriasis and had mild severity in 65.6% and 68.7% of the cases, respectively. The most important etiological risk factors were severe psoriasis, smoking ≥20 cigarettes/day and early onset of psoriasis, OR=9.64, 3.06 and 2.72, respectively.Conclusions and recommendations: The epidemiology of psoriasis is not well defined in Egypt. The heredity and environmental factors are the most important risk factors. Also, psoriatic arthritis is an important associated disease. The fact that it has no cure has important

  11. Occurrence of Psoriatic Arthritis during Interferon Beta 1a Treatment for Multiple Sclerosis

    Éric Toussirot

    2014-01-01

    Full Text Available Interferon beta (IFN-β is the first line therapy of relapsing-remitting multiple sclerosis. IFN-β is a cytokine that can contribute to the development of systemic autoimmune disease including psoriasis. The development or the exacerbation of psoriasis during IFN-β treatment has been previously observed. We report the occurrence of arthritis and dactylitis in a multiple sclerosis patient with preexisting psoriasis diagnosed as a psoriatic arthritis. The IL-23/Th17 pathway is involved in psoriasis and psoriatic arthritis and it has been suggested that IFN-β therapy in patients with Th17-mediated disease may be detrimental. Together with previous similar reports, our case suggests that IFN-β should certainly be used with caution in patients with concomitant systemic autoimmune disease with IL-23/Th17 involvement.

  12. Use of Ultrasound for Diagnosis and Follow-Up of Psoriatic Arthritis

    Rusmir Husic

    2014-07-01

    Full Text Available Musculoskeletal ultrasound (US is increasingly used as a bedside tool for diagnostic and monitoring purposes in patients with psoriatic arthritis (PsA. The sonographic differentiation between PsA and rheumatoid arthritis (RA may be challenging because the morphological appearance of synovitis is similar in both conditions. In contrast, perisynovial inflammation is a specific finding of early PsA, and enthesitis is more frequently detected in PsA than in RA. After initiation of effective therapies, a reduction of US signs of synovitis and enthesitis can be seen along with clinical improvement. A numeric US score for regular monitoring of disease activity and damage in PsA patients has not been established yet. While sonographic findings can be discordant from clinical results, their relevance is unclear, although it is a concern that ongoing subclinical inflammation results in worse structural outcomes. Ongoing studies address the value of sonography as a diagnostic and prognostic marker in PsA, and we expect that these results will emphasise the role of diagnostic US for the routine evaluation of PsA patients.

  13. Adalimumab for long-term treatment of psoriatic arthritis: 2-year data from the Adalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT)

    Mease, P J; Ory, P; Sharp, J T; Ritchlin, C T; Van den Bosch, F; Wellborne, F; Birbara, C.; Thomson, G T D; Perdok, R J; Medich, J; Wong, R L; Gladman, D D

    2008-01-01

    Objective: To evaluate the long-term effectiveness and tolerability of adalimumab in the treatment of psoriatic arthritis (PsA). Methods: Patients with PsA who completed a 24-week, double-blind study of adalimumab versus placebo were eligible to enroll in an open-label extension study and receive adalimumab 40 mg subcutaneously every other week for up to an additional 120 weeks. At the time of this analysis, available efficacy evaluations throughout 2 years of treatment (n  =  245) included A...

  14. Magnetic resonance imaging in psoriatic arthritis -- update on current status and future perspectives

    Østergaard, Mikkel; Poggenborg, René Panduro

    2012-01-01

    Measures in Rheumatology) may contribute to facilitating research, identifying appropriate areas for use, and reaching consensus on the optimal examination technique. Accordingly, GRAPPA, a primary driver of international research in psoriasis and psoriatic arthritis (PsA), has focused on the current use......The potential of magnetic resonance imaging (MRI) for use in clinical practice and research has gained increasing interest over the last decade. International collaborative initiatives from GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) and/or OMERACT (Outcome...... and future development of MRI and other modern imaging modalities in PsA. This review, presented at the GRAPPA 2010 annual meeting, describes the current status of MRI in PsA, with a focus on its use in diagnosis, monitoring, and prediction of the disease course and treatment response. Important areas...

  15. CLINICAL EXPERIENCE WITH USTEKINUMAB IN THE TREATMENT OF EARLY PSORIATIC ARTHRITIS USING TREAT-TO-TARGET STRATEGY

    E. Yu. Loginova

    2015-09-01

    Full Text Available The new Treat-to-Target (T2T strategy in the treatment of early psoriatic arthritis (PsA is aimed at achieving remission or low disease activity. As of now, the new biological agent ustekinumb (UST, anti-interleukin (IL 12/23 monoclonal antibodies, was used to treat psoriasis and PsA. The paper presents clinical observations of the efficacy of UST in early PsA treated according T2T strategy. The described clinical cases demonstrate that use of UST 45 mg both alone and in combination with methotrexate for early PsA with moderate and high activity reduced manifestations of peripheral arthritis and psoriasis, promoting rapid achievement of remission or minimal disease activity. Overall, UST is well tolerated by the patients.

  16. Rheumatoid Arthritis Educational Video Series

    Full Text Available ... Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos was designed ... Activity Role of Body Weight in Osteoarthritis Educational Videos for Patients Rheumatoid Arthritis Educational Video Series Psoriatic ...

  17. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate

    Štuhec, Matej

    2015-01-01

    The yellow fever vaccines on the market are contraindicated for immunocompromised and elderly patients. A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were noadverse effects in concurrent administration of yellow fever vaccine and methotrexate. This patient did not show severe adverse reactions and did not contract yellow fever despite potential exposure. ...

  18. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate: a case report:

    Štuhec, Matej

    2014-01-01

    The yellow fever vaccines on the market are contraindicated for immunocompromised and elderly patients. A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were noadverse effects in concurrent administration of yellow fever vaccine and methotrexate. This patient did not show severe adverse reactions and did not contract yellow fever despite potential exposure. ...

  19. Depression and Insomnia in Patients With Psoriasis and Psoriatic Arthritis Taking Tumor Necrosis Factor Antagonists

    Wu, Chun-Ying; Chang, Yun-Ting; Juan, Chao-Kuei; Shen, Jui-Lung; Lin, Yu-Pu; Shieh, Jeng-Jer; Liu, Han-Nan; Chen, Yi-Ju

    2016-01-01

    Abstract Psoriasis patients with moderate to severe disease often present with depression and insomnia. Treatment targeting both psoriasis and psychological comorbidities is needed to improve the quality of life of these patients. In this nationwide cohort study, a total of 980 patients with psoriatic arthritis or psoriasis who had received nonbiological disease-modifying antirheumatic drugs and biologics therapy between 2009 and 2012 were identified. The prevalence rates of patients taking m...

  20. Pneumocystis carinii pneumonia in a patient on etanercept for psoriatic arthritis.

    Lahiff, C

    2007-12-01

    Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells\\/mm(3). We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept.

  1. Clinical and immunogenetic characteristics of psoriatic arthritis: a single-center experience from South India

    CB Mithun; Paul T Antony; Christina M Mariaselvam; Vir S Negi

    2013-01-01

    AimThe aim of this study was to determine the clinical characteristics and prevalence of HLA B27 in patients with psoriatic arthritis presenting to a tertiary care centre in South India. BackgroundAlthough the prevalence of psoriasis is high in India, there is paucity of data, especially on Ps A. Materials and methodsThis retrospective study included 141 patients satisfying the ClASsification criteria for Ps A (CASPAR). Demographic, clinical, and laboratory data of the patients were collected...

  2. Long term efficacy and safety of etanercept in the treatment of psoriasis and psoriatic arthritis

    Kivelevitch, Dario; Mansouri, Bobbak; Menter, Alan

    2014-01-01

    Psoriasis is a chronic, immune-mediated inflammatory disease affecting both the skin and joints. Approximately 20% of patients suffer a moderate to severe form of skin disease and up to 30% have joint involvement. Standard therapies for psoriasis include topical medications, phototherapy, and both oral systemic and biological therapies whereas therapies for psoriatic arthritis include nonsteroidal anti-inflammatory drugs followed by disease modifying antirheumatic drugs and/or tumor necrosis ...

  3. Pharmacoeconomic burden in the treatment of psoriatic arthritis: from systematic reviews to real clinical practice studies

    Lubrano, Ennio; Spadaro, Antonio

    2014-01-01

    The economic assessment of treatment options in a chronic and severe disease like Psoriatic Arthritis (PsA) is crucial to estimate the burden of costs. In particular, the impact of new costly medications such as biologic agents have been studied to figure this important aspect of a multifaceted disease. In a previous observational, longitudinal multicentre cost evaluation study, the results showed that biologic agents are cost-effective. This study was obtained from the real clinical practice...

  4. New developments in the management of psoriasis and psoriatic arthritis: a focus on apremilast

    Palfreeman AC; McNamee KE; McCann FE

    2013-01-01

    Andrew C Palfreeman, Kay E McNamee, Fiona E McCann The Kennedy Institute of Rheumatology, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, London, UK Abstract: Psoriasis is a chronic inflammatory skin disease, most commonly resulting in the occurrence of red and silver scaly plaques. About 30% of psoriasis sufferers develop psoriatic arthritis (PsA), a disorder that presents with additional joint inflammation and other clinical features. At ...

  5. Remission of Psoriasis and Psoriatic Arthritis During Bevacizumab Therapy for Renal Cell Cancer

    Ananaya Datta-Mitra; Riar, Navdeep K; Raychaudhuri, Siba P

    2014-01-01

    Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), is employed for treatment of several cancers and retinopathies. Although previous reports of remission of psoriasis with bevacizumab do exist, but its current experience for psoriatic arthritis (PsA) is still limited. In this report, we describe a patient with metastatic renal cell cancer, psoriasis and PsA, who experienced a complete remission of psoriasis and PsA during bevacizumab therapy without any othe...

  6. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity in patients with psoriatic arthritis

    Osterhaus, Jane T; Purcaru, Oana

    2014-01-01

    Introduction The novel arthritis-specific Work Productivity Survey (WPS) was developed to estimate patient productivity limitations associated with arthritis within and outside the home, which is an unmet need in psoriatic arthritis (PsA). The WPS has been validated in rheumatoid arthritis. This report assesses the discriminant validity, responsiveness and reliability of the WPS in adult-onset PsA. Methods Psychometric properties were assessed using data from the RAPID-PsA trial (NCT01087788)...

  7. Radiographic development during three decades in a patient with psoriatic arthritis mutilans

    Psoriatic arthritis mutilans (PAM) is the most severe and rare form of psoriatic arthritis (PsA). We describe radiological development in a typical case of PAM covering three decades in order to elucidate the need for early diagnosis of PAM. Radiographs of hands and feet, taken from 1981 to 2010, were evaluated using the Psoriatic Arthritis Ratingen Score (PARS). When PsA was diagnosed, in 1981, gross deformity was observed in the second PIP joint of the left foot. Several pencil-in-cup deformities and gross osteolysis were present in the feet in the first decade of the disease. Over 10 years, many joints had reached maximum scores. During the follow-up, other joints became involved and the disease developed clinically. Reporting early signs suggestive of PAM, e.g. pencil-in cup deformities and gross osteolysis in any joint, should be mandatory and crucial. This would heighten our awareness of PAM, accelerate the diagnosis, and lead to improved effective treatment in order to minimize joint damages resulting in PAM

  8. Prologue: 2015 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

    Boehncke, Wolf-Henning; Gladman, Dafna D; Helliwell, Philip S

    2016-05-01

    The 2015 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in Stockholm, Sweden, and attended by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups. In this prologue, we introduce the articles that summarize that meeting. As in previous years, GRAPPA members held a Trainees Symposium, providing an opportunity for trainees to discuss their research in psoriatic disease with experts in the field. Two dermatology sessions were held: an update on the International Dermatology Outcome Measures group; and a description of a new tool, the Comprehensive Assessment of the Psoriasis Patient, to more accurately assess the full burden of plaque psoriasis and its subtypes. Four distinct plenary sessions were held to update members on the status of the Outcome Measures in Rheumatology (OMERACT) initiative. GRAPPA's patient research partners discussed their 2 years of involvement in GRAPPA activities and were active in several sessions before and during the 2015 annual meeting. New work was presented toward developing a patient-reported instrument to measure flare in psoriatic disease, and the status of GRAPPA's multiple research and continuing education programs in psoriasis and PsA was summarized. Finally, a Presidential Round Table was held in which the past, current, and incoming presidents reflected on GRAPPA's history and provided insights about its future. PMID:27134267

  9. Is the HLA B27 genotype a risc faktor for psoriatic arthritis and psoriasis vulgaris?

    Zerrin Öğretmen

    2014-09-01

    Full Text Available Backround and Design: Psoriasis is a common inflammatory dermatological disease which may be complicated with joint involvement. It has been suggested that there is an association between HLA-B27 positivity and early onset psoriasis. The purpose of the current study was to investigate the incidence of HLA-B27 positivity in psoriasis patients with arthritis. Materials and Methods: In a total of 96 patients with psoriasis, age of onset, family history, and Psoriasis Area and Severity Index (PASI values were recorded. The patients were evaluated with regard to physical examination (presence of arthritis, acute phase reactants, HLA-B27 positivity and joint radiographs. Control group comprised of 100 randomly selected healthy individuals. Results: Thirty (31.250% patients were with psoriasis alone, 66 (68.75% were with the findings of psoriasis and arthritis. Of the 66 patients, 17 (17.708% were symptomatic (clinical and radiologic findings and 49 (51.042% subjects were asymptomatic (radiologic findings only. Nine patients (6 with psoriasis only and 3 with psoriatic arthritis and 2 healthy controls were positive for HLA-B27. Conclusion: To carry HLA-B27 antigen increased the risk of psoriasis with an OR of 5.06, and clinically proven psoriatic arthritis with an OR of 10.5 compared to healthy controls. These results need confirmation in a larger group of patients with the inclusion of proper positive and healthy controls.

  10. TNF-α in a molecularly targeted therapy of psoriasis and psoriatic arthritis.

    Wcisło-Dziadecka, Dominika; Zbiciak-Nylec, Martyna; Brzezińska-Wcisło, Ligia; Mazurek, Urszula

    2016-03-01

    Psoriasis is a chronic immunological skin disease and patients with this disorder typically experience a significant decrease in their quality of life. The disease is traditionally managed with topical and systemic agents (retinoids, ciclosporin A, methotrexate), but these treatment options are often long-term and their effects can be inconsistent and not ideal. The use of biological drugs in dermatological treatment is relatively new and began in the early 2000s. It should be noted that, in most countries, in order for biological treatment to be administered, specific criteria must be met. The current treatment options for psoriasis and psoriatic arthritis include tumour necrosis factor alpha (TNF-α) blockers, interleukin (IL)-12 and IL-23 inhibitors, T cell inhibitors and B cell inhibitors. These classes of biological drugs are characterised by protein structure as well as high molecular weight and their effectiveness is evaluated based on the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI). TNF-α antagonists are one such class of biological drugs which includes infliximad, etanercept and adalimumab. Infliximab is a chimeric protein that is administered via intravenous infusions as a monotherapy in psoriasis vulgaris. Etanercept is indicated for use in both psoriasis vulgaris and psoriatic arthritis and it is the only drug that can be used as a treatment for children under the age of 8 with psoriasis. The drug is administered subcutaneously. Finally, adalimumab is a fully human monoclonal antibody that neutralises both free and membrane-bound TNF-α and is used in the treatment of psoriasis vulgaris and psoriatic arthritis. This article reviews the latest research in the use of TNF-α for the treatment of moderate to severe psoriasis and psoriatic arthritis. The results of research in this field are promising and confirm the effectiveness and safety of biological drugs as dermatological treatments

  11. Proposal for levels of evidence schema for validation of a soluble biomarker reflecting damage endpoints in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, and recommendations for study design

    Maksymowych, W.P.; Fitzgerald, O.; Wells, G.A.; Gladman, D.D.; Landewe, R.; Østergaard, Mikkel; Taylor, W.J.; Christensen, R.; Tak, P.P.; Boers, M.; Syversen, S.W.; Bathon, J.M.; Ritchlin, C.J.; Mease, P.J.; Bykerk, V.P.; Garnero, P.; Geusens, P.; El-Gabalawy, H.; Aletaha, D.; Inman, R.D.; Kraus, V.B.; Kvien, T.K.; der, Heijde D. van

    2009-01-01

    arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). We also aimed to generate consensus on minimum standards for the design of longitudinal studies aimed at validating biomarkers. METHODS: Before the meeting, the Soluble Biomarker Working Group prepared a preliminary framework and...

  12. Soluble P-selectin levels in synovial fluid and serum from patients with psoriatic arthritis

    G. Valesini

    2011-09-01

    Full Text Available Objective: P-selectin is an adhesion molecule expressed by activated endothelial cells and platelets favouring the leukocyte adherence to microvascular endothelium. A soluble form of this molecule has been described, whose serum levels were found to be elevated and correlate with disease activity in rheumatoid arthritis (RA patients. Aim of this study was to determine soluble P-selectin levels in synovial fluid (SF and serum from patients with psoriatic arthritis (PsA, where it has never been investigated, to define its involvement in PsA synovial damage. Methods: we analysed, by ELISA, soluble P-selectin serum and SF levels in 100 patients presenting a knee joint effusion: 38 of them presented PsA, 40 RA and 22 osteoarthritis (OA. We examined the main clinical and laboratory parameters of these patients. Soluble P-selectin serum levels were also detected in 15 healthy subjects. Results: soluble P-selectin SF levels were significantly higher in PsA and RA patients respect to OA subjects. Soluble P-selectin SF levels were lower than those found in serum and the SF/serum ratio was higher in PsA and RA patients respect to OA. Soluble P-selectin serum levels were not significantly different among patients and controls. No correlation was found between SF and serum levels of soluble P-selectin and the main clinical parameters. Conclusions: our study of soluble P-selectin in PsA reveals a prominent local role of this molecule, with no differences respect to RA. Histological findings may be of help in understanding the role of this adhesion molecule in PsA.

  13. Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis

    Højgaard, Pil; Glintborg, Bente; Hetland, Merete Lund;

    2015-01-01

    OBJECTIVES: To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses among patients with psoriatic arthritis (PsA) initiating the first tumour necrosis factor α inhibitor therapy (TNFi) in routine care. METHODS: Observational cohort...... study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, logistic and Cox regression analyses by smoking status (current/previous/never smoker) were calculated for treatment adherence, ACR20/50/70-responses and EULAR-good-response. Additional stratified analyses were performed according...... Body Mass Index (27 kg/m(2) (23-30)/28 kg/m(2) (24-31)) (median (IQR)), shorter disease duration (3 years (1-8)/5 years (2-10)), lower swollen joint count (2 (0-5)/3 (1-6)), higher visual-analogue-scale (VAS) patient global (72 mm (54-87)/68 mm (50-80)), VAS fatigue (72 mm (51-86)/63 mm (40-77)) and...

  14. Diagnostic imaging of psoriatic arthritis. Part I: etiopathogenesis, classifications and radiographic features.

    Sudoł-Szopińska, Iwona; Matuszewska, Genowefa; Kwiatkowska, Brygida; Pracoń, Grzegorz

    2016-03-01

    Psoriatic arthritis is one of the spondyloarthritis. It is a disease of clinical heterogenicity, which may affect peripheral joints, as well as axial spine, with presence of inflammatory lesions in soft tissue, in a form of dactylitis and enthesopathy. Plain radiography remains the basic imaging modality for PsA diagnosis, although early inflammatory changes affecting soft tissue and bone marrow cannot be detected with its use, or the image is indistinctive. Typical radiographic features of PsA occur in an advanced disease, mainly within the synovial joints, but also in fibrocartilaginous joints, such as sacroiliac joints, and additionally in entheses of tendons and ligaments. Moll and Wright classified PsA into 5 subtypes: asymmetric oligoarthritis, symmetric polyarthritis, arthritis mutilans, distal interphalangeal arthritis of the hands and feet and spinal column involvement. In this part of the paper we discuss radiographic features of the disease. The next one will address magnetic resonance imaging and ultrasonography. PMID:27104004

  15. Remission of psoriasis and psoriatic arthritis during bevacizumab therapy for renal cell cancer

    Ananaya Datta-Mitra

    2014-01-01

    Full Text Available Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF, is employed for treatment of several cancers and retinopathies. Although previous reports of remission of psoriasis with bevacizumab do exist, but its current experience for psoriatic arthritis (PsA is still limited. In this report, we describe a patient with metastatic renal cell cancer, psoriasis and PsA, who experienced a complete remission of psoriasis and PsA during bevacizumab therapy without any other management for psoriasis and PsA. We also found a flare up of his psoriatic disease after switching to other kinase inhibitors like sorafenib or sunitinib. This suggests that bevacizumab might have a promising future in the treatment of psoriasis and PsA.

  16. Validity and Reliability of the Dutch Adaptation of the Psoriatic Arthritis Quality of Life (PsAQoL) Questionnaire

    Wink, Freke; Arends, Suzanne; McKenna, Stephen P; Houtman, Pieternella M.; Brouwer, Elisabeth; Spoorenberg, Anneke

    2013-01-01

    Objective The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire is a disease- specific instrument developed to measure quality of life (QoL) in patients with psoriatic arthritis (PsA). The aim of this study was to translate the measure into Dutch and to determine its psychometric properties. Method Translation of the original English PsAQoL into Dutch was performed by bilingual and lay panel. Ten field-test interviews with PsA patients were performed to assess face and content validi...

  17. Genetics of Psoriasis and Psoriatic Arthritis: A Report from the GRAPPA 2010 Annual Meeting

    Rahman, Proton; Elder, James T.

    2012-01-01

    Psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) are inter-related disorders, with PsA representing a disease within a disease. From an epidemiological perspective, the genetic contributions of PsV and PsA are now well documented. HLA-C is firmly established as a PsV/PsA gene, with HLA-Cw*0602 as a major risk allele. Fine mapping studies within the MHC region in PsV and PsA have identified novel loci that are independent of the HLA-Cw6 allele. Recent genome-wide association scans have l...

  18. The use of TNF-α blockers in psoriatic arthritis patients with latent tuberculosis infection

    Atteno, Mariangela; Costa, Luisa; Matarese, Alessandro; Caso, Francesco; Del Puente, Antonio; Cantarini, Luca; Bocchino, Maria Luisa; Sanduzzi, Alessandro; Scarpa, Raffaele

    2014-01-01

    Psoriatic arthritis (PsA) is an inflammatory arthropathy associated with skin and/or nail psoriasis. TNF-α is an essential cytokine for the host defense, and its depletion by treatment may facilitate the risk of infections or their reactivation. The aim of this study was to evaluate the efficacy and safety of TNF-α blockers in patients with PsA and concomitant latent tuberculosis infection (LTBI) comparing their outcome with non-infected PsA patients. This is a retrospective study in 321 pati...

  19. Radiographic changes in the condyle of the temporomandibular joint in psoriatic arthritis

    One hundred and ten patients with psoriatic arthritis (PA) and 100 matched control patients were examined by using orthopantomography to discover radiographic changes in the condyle of the temporomandibular joint (TMJ). 31% of the PA patients and 13% of the control patients had radiographic changes in the condyle of the TMJ. The most common radiographic finding in PA patients was unilateral erosion of the condyle. Of the radiographic changes in the PA group, cortical erosions correlated negatively with age, whereas osteophytes correlated positively with the duration of PA. (orig.)

  20. Radiographic changes in the condyle of the temporomandibular joint in psoriatic arthritis

    Koenoenen, M.

    One hundred and ten patients with psoriatic arthritis (PA) and 100 matched control patients were examined by using orthopantomography to discover radiographic changes in the condyle of the temporomandibular joint (TMJ). 31% of the PA patients and 13% of the control patients had radiographic changes in the condyle of the TMJ. The most common radiographic finding in PA patients was unilateral erosion of the condyle. Of the radiographic changes in the PA group, cortical erosions correlated negatively with age, whereas osteophytes correlated positively with the duration of PA.

  1. CYCLOSPORIN A (SANDIMMUN NEORAL) IN THERAPY FOR PSORIASIS AND PSORIATIC ARTHRITIS

    2010-01-01

    The involvement of immune mechanisms in the pathogenesis of psoriatic arthritis (PA) is noted to give grounds to use immunoactive compounds (disease- modifying agents - basic anti-inflammatory drugs -BAIDs), such as cyclosporin A (CsA), in this disease. The data available in the literature permit a high assessment of CsA as one of the BAIDs in the treatment of PA and psoriasis. CsA is stated to monitor the course of this disease, acts on inflamed peripheral joints, decreases the clinical and ...

  2. Clinical experience in 115 patients with arthritis and/or enthesitis who met the classification criteria for psoriatic arthritis (CASPAR) within the last two years-Possible association with malignant disorders.

    Hagiwara, Kiyofumi; Suyama, Yasuhiro; Fukuda, Kunihiko

    2016-07-01

    Among about 400 patients with active arthritis and/or enthesitis who were referred to our department within the last two years, 140 of them were strongly suspected as having psoriatic arthritis by a comprehensive diagnostic procedure and after consulting specialists from dermatology, orthopedics, and radiodiagnostics at our institution and other institutions. Among them, 115 patients strictly met the classification criteria for psoriatic arthritis (CASPAR). Among the 115 patients, 19 patients (9 males and 10 females) had current psoriasis and 96 patients (22 males and 74 females) did not have current psoriasis. Nineteen (16.5%) of the 115 patients had developed malignant tumor before the onset of arthritis, and 4 (3.5%) developed malignant tumor after the onset of arthritis. Twenty-two of the 23 patients who developed malignancy were female and 10 patients developed breast cancer. Differential diagnoses in these 23 patients may include paraneoplastic syndrome. We consider that it is important to take into account the possibility of paraneoplastic syndrome in patients with arthritis and/or enthesitis who apparently meet the CASPAR criteria, and detailed screening and monitoring of malignant disease may be beneficial to the patients. PMID:26391911

  3. Prevalence and clinical patterns of psoriatic arthritis in Indian patients with psoriasis

    Ramesh Kumar

    2014-01-01

    Full Text Available Background: The prevalence and clinical patterns of psoriatic arthritis (PsA varies in different parts of the world and there is little clinical and epidemiological data from the Indian subcontinent. Aims: Our study was designed to evaluate the prevalence and clinical patterns of PsA in Indian patients. Methods: This was a non-interventional, cross-sectional study, in which 1149 consecutive psoriasis patients seen over 1 year were screened for PsA according to classification of psoriatic arthritis (CASPAR criteria. Demographic and disease parameters were recorded including Psoriasis Area and Severity Index (PASI, Nail Psoriasis Severity Index (NAPSI, and number of swollen and tender joints. Results: Among 1149 patients with psoriasis, 100 (8.7% patients had PsA, of which 83% were newly diagnosed. The most common pattern was symmetrical polyarthritis (58%, followed by spondyloarthropathy 49%, asymmetric oligoarthritis (21%, isolated spondyloarthropathy (5%, predominant distal interphalangeal arthritis (3%, and arthritis mutilans (1%. Enthesitis and dactylitis were present in 67% and 26% of cases, respectively. The mean number of swollen and tender joints were 3.63 ± 3.59 (range, 0-22 and 7.76 ± 6.03 (range, 1-26, respectively. Nail changes were present in 87% of the cases. The median PASI and NAPSI of the subjects with PsA was 3.6 and 20, respectively. There was no significant correlation of number of swollen/tender joints with PASI or NAPSI. Conclusion: There is a relatively low prevalence of PsA among Indian psoriasis patients presenting to dermatologists. No correlation was found between the severity of skin and nail involvement and articular disease.

  4. Employment is maintained and sick days decreased in psoriasis/psoriatic arthritis patients with etanercept treatment

    Boggs, Robert L; Kárpáti, Sarolta; Li, Wenzhi;

    2014-01-01

    BACKGROUND: Psoriasis and psoriatic arthritis (PsA) impair quality of life, including reduction in employment or job duties. The PRESTA (Psoriasis Randomized Etanercept STudy in Patients with Psoriatic Arthritis) study, a randomized, double-blind, two-dose trial, examined the efficacy of etanerce...... disease and in reducing sick time. Effective treatment of psoriasis and PsA may reduce missed work days....... treatment in patients with moderate-to-severe plaque psoriasis and PsA and the main results have been presented previously. This analysis examined employment status, job duties and sick days, pre-defined endpoints in PRESTA, among this patient population. METHODS: Participants (N=752) were randomized to...... PsA decreased significantly from baseline to week 24 (17-23% to 5-8%; p<0.01). Similar results were seen with job responsibility changes due to psoriasis (11-14% to 4%; p<0.01). The number of monthly sick days also decreased from baseline to week 24 (2.4 days for both treatment groups to 0.7 (BIW...

  5. Golimumab 3-year safety update: an analysis of pooled data from the long-term extensions of randomised, double-blind, placebo-controlled trials conducted in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis

    Kay, Jonathan; Fleischmann, Roy; Keystone, Edward; Hsia, Elizabeth C.; Hsu, Benjamin; Mack, Michael; Goldstein, Neil; Braun, Jürgen; Kavanaugh, Arthur

    2013-01-01

    Objective To assess pooled golimumab safety up to year 3 of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) trials. Methods Golimumab 50 and 100 mg, administered subcutaneously (SC) every 4 weeks (q4wk), were assessed in patients with active RA (methotrexate-naïve, methotrexate-experienced and anti-TNF (tumour necrosis factor)-experienced), PsA or AS, despite conventional therapy. Placebo control continued up to week (wk) 24 (wk 52, methotrexate-naïve), wi...

  6. The prevalence of sacroilitis in psoriatic arthritis: new perspectives from a large, multicenter cohort. A Department of Veterans Affairs Cooperative Study

    Objective. To determine the prevalence of radiographic evidence of sacroiliitis in a large population of patients with psoriatic arthritis. Patients and design. Patients were recruited from 15 clinical centers. This was part of a large, multicenter study of patients with an established diagnosis of ankylosing spondylitis, psoriatic arthritis, or reactive arthritis. For this cohort, an established diagnosis of psoriatic arthritis was required, with cutaneous manifestations and involvement of at least three appendicular joints. At entry, patients were not selected for the presence of axial involvement. Radiographs - one anteroposterior view of the pelvis and one oblique view of each sacroiliac joint - were graded using the New York classification scale by a musculoskeletal radiologist masked to the specific diagnosis and clinical symptoms. Re-evaluation of 10% of the films 3 years later quantified intraobserver variability. Results. Two hundred and two patients with psoriatic arthritis were studied. Duration of the disease averaged 12 years; all patients had psoriasis and peripheral arthritis. The prevalence of radiographic evidence of sacroiliitis (grade 2 or higher) was 78%; 71% of these had grade 3 disease. Conclusions. Previously reported prevalence of sacroiliitis in patients with psoriatic arthritis ranges from 30% to 50%. The prevalence of radiographic evidence of sacroiliitis in this large multicenter cohort of patients with appendicular psoriatic arthritis was substantially higher. (orig.)

  7. The prevalence of sacroilitis in psoriatic arthritis: new perspectives from a large, multicenter cohort. A Department of Veterans Affairs Cooperative Study

    Battistone, M.J.; Clegg, D.O. [Division of Rheumatology, University of Utah Medical Center, Salt Lake City, UT (United States)]|[Department of Medicine, Division of Rheumatology, Veterans Affairs Medical Center, Salt Lake City, UT (United States); Manaster, B.J. [Department of Radiology, Division of Musculoskeletal Imaging, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA (United States); Reda, D.J. [Cooperative Studies Program Coordinating Center, VA Hospital, Hines, IL (United States)

    1999-04-01

    Objective. To determine the prevalence of radiographic evidence of sacroiliitis in a large population of patients with psoriatic arthritis. Patients and design. Patients were recruited from 15 clinical centers. This was part of a large, multicenter study of patients with an established diagnosis of ankylosing spondylitis, psoriatic arthritis, or reactive arthritis. For this cohort, an established diagnosis of psoriatic arthritis was required, with cutaneous manifestations and involvement of at least three appendicular joints. At entry, patients were not selected for the presence of axial involvement. Radiographs - one anteroposterior view of the pelvis and one oblique view of each sacroiliac joint - were graded using the New York classification scale by a musculoskeletal radiologist masked to the specific diagnosis and clinical symptoms. Re-evaluation of 10% of the films 3 years later quantified intraobserver variability. Results. Two hundred and two patients with psoriatic arthritis were studied. Duration of the disease averaged 12 years; all patients had psoriasis and peripheral arthritis. The prevalence of radiographic evidence of sacroiliitis (grade 2 or higher) was 78%; 71% of these had grade 3 disease. Conclusions. Previously reported prevalence of sacroiliitis in patients with psoriatic arthritis ranges from 30% to 50%. The prevalence of radiographic evidence of sacroiliitis in this large multicenter cohort of patients with appendicular psoriatic arthritis was substantially higher. (orig.) With 3 figs., 4 tabs., 29 refs.

  8. Golimumab for the treatment of psoriatic arthritis: a NICE single technology appraisal.

    Yang, Huiqin; Craig, Dawn; Epstein, David; Bojke, Laura; Light, Kate; Bruce, Ian N; Sculpher, Mark; Woolacott, Nerys

    2012-04-01

    The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of golimumab (Schering-Plough/Centocor) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of active and progressive psoriatic arthritis (PsA) in patients who have responded inadequately to previous disease-modifying anti-rheumatic drugs (DMARDs). The Centre for Reviews and Dissemination and the Centre for Health Economics at the University of York were commissioned to act as the Evidence Review Group (ERG) to critically appraise the evidence presented by the manufacturer. This article provides a description of the company submission, the ERG review and the resulting NICE guidance. The ERG critically reviewed the evidence presented in the manufacturer's submission and identified areas requiring clarification, for which the manufacturer provided additional evidence. The main clinical effectiveness data were derived from a single phase III randomized controlled trial (GO-REVEAL) that compared golimumab with placebo for the treatment of active and progressive patients who were symptomatic despite the use of previous DMARDs or NSAIDs. The 14-week data showed that, compared with placebo, golimumab 50 mg significantly improved joint disease response as measured by American College of Rheumatology (ACR) 20 (relative risk [RR] 5.73, 95% CI 3.24, 10.56) and Psoriatic Arthritis Response Criteria (PsARC) [RR 3.45, 95% CI 2.49, 4.87], and significantly improved skin disease response as measured by Psoriasis Area and Severity Index (PASI) 75 (RR 15.95, 95% CI 4.62, 59.11). The 24-week absolute data showed that these treatment benefits were maintained. There was a significant improvement in patients' functional status as measured by Health Assessment Questionnaire change from baseline at 24 weeks (-0.33; p patient crossover at week 16. It was also unclear if these results were generalizable to clinical practice. No randomized controlled trial

  9. Clinical and immunogenetic characteristics of psoriatic arthritis: a single-center experience from South India

    CB Mithun

    2013-02-01

    Full Text Available AimThe aim of this study was to determine the clinical characteristics and prevalence of HLA B27 in patients with psoriatic arthritis presenting to a tertiary care centre in South India. BackgroundAlthough the prevalence of psoriasis is high in India, there is paucity of data, especially on Ps A. Materials and methodsThis retrospective study included 141 patients satisfying the ClASsification criteria for Ps A (CASPAR. Demographic, clinical, and laboratory data of the patients were collected through personal interviews, clinical examination, appropriate investigations, and analysis of case records. HLA-B27 typing by PCR method was done for all patients. ResultsAmong the 141 patients, 89 subjects were males and 52 were females, and the male to female ratio was 1.7:1. Polyarthritis (n=51, 36.2% was the most common Ps A subtype noted during the study, followed by oligoarthritis (n=48, 34%, spondyloarthropathy (n=29, 20.6%, distal interphalangeal (DIP predominant arthritis (n=25, 7.8%, and arthritis mutilans (n=2, 1.4%. Arthritis preceded skin involvement in 9.2% (n=13 of the cases. Dactylitis was seen in 24.1% (n=34 of the patients. Extra-articular features like enthesitis (n=16, 11.3% and eye involvement (n=1, 0.7% were also observed. Deformities were seen in 32.6% (n=46 of the subjects. The most common type of psoriatic skin lesion noted was psoriasis vulgaris (n=119, 84.4%. Nail involvement was seen in 17.7% (n=25 of the patients and it was observed in all subjects with DIP predominant arthritis (100%. Family history of psoriasis was present in 11.3% (n=16 of the patients. The number of patients positive for HLA B27 was 16 (11.3%. Additionally, the antigen positivity was noted in 35.7% (n=10 of the patients with spondyloarthropathy. ConclusionPs A was more common in males. Polyarthritis and oligoarthritis were the most prevalent subtypes. The prevalence of HLA-B27 in our study population was 11.3% and was found to be strongly associated with

  10. Clinical subgroups and HLA antigens in Italian patients with psoriatic arthritis.

    Salvarani, C; Macchioni, P L; Zizzi, F; Mantovani, W; Rossi, F; Baricchi, R; Ghirelli, L; Frizziero, L; Portioli, I

    1989-01-01

    The frequencies of HLA antigens were studied in 101 Italian patients with psoriatic arthritis. The total group showed a significant increase in frequency of A1 and B38, and a reduction of B5 when compared to healthy controls. No association between DR and/or DQw antigens and PA were demonstrated. The comparisons between the clinical subgroups and normal controls revealed a significant association of B38 with asymmetric peripheral arthritis, B27 and B39 with spondylitis (with or without peripheral involvement). When intergroup comparison were made, the patients with spondylitis had an increase in frequency of B27 and DQw3 as compared to those with symmetric and asymmetric peripheral disease. DR4 and DRw53 were associated with earlier age of onset of arthritis. There were also significant associations between DQw3 and severe disease, and between A9, B5 and presence of erosions and joint space narrowing. No association with DR4 was showed in a subgroup of patients with symmetric polyarthritis without DIP involvement. PMID:2591112

  11. Golimumab: A novel human anti-TNF-α monoclonal antibody for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis

    Jonathan Kay

    2009-07-01

    Full Text Available Jonathan Kay1, Mahboob U Rahman2,31Division of Rheumatology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA; 2Centocor Research and Development, inc., Malvern, PA, USA; 3University of Pennsylvania School of Medicine, Philadelphia, PA, USAIntroduction: The introduction of tumor necrosis factor-α (TNF-α inhibitors represented a significant advance in the management of rheumatoid arthritis (RA and other chronic inflammatory diseases. Although three TNF-α inhibitors have been approved for the treatment of RA by the US Food and Drug Administration (FDA and the European Medicinal Products Evaluation Agency (EMEA, not all patients achieve a satisfactory clinical improvement with these therapeutic agents. The mode of administration of these medications is inconvenient for some patients.Aims: Golimumab is a novel anti-TNF-α monoclonal antibody that is in clinical development for the treatment of RA, psoriatic arthritis (PsA, and ankylosing spondylitis (AS, either as a first-line biologic therapy or an alternative after other TNF-α inhibitors have been discontinued. This review summarizes the development of, and clinical evidence achieved with, golimumab.Evidence review: Golimumab has demonstrated significant efficacy in randomized, double-blind, placebo-controlled trials when administered subcutaneously once every four weeks. It has been generally well tolerated in clinical trials and demonstrates a safety profile comparable with currently available TNF-α inhibitors.Outcomes summary: Golimumab has been confirmed to be an effective treatment for patients with RA, PsA, and AS in phase III clinical trials as evaluated by traditional measures of disease activity, such as signs and symptoms, as well as measures of physical function, patient reported outcomes, and health economic measures. The efficacy and safety profile of golimumab in RA, PsA, and AS appears to be similar to other anti-TNF agents. However

  12. Proposal for levels of evidence schema for validation of a soluble biomarker reflecting damage endpoints in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, and recommendations for study design

    Maksymowych, Walter P; Fitzgerald, Oliver; Wells, George A;

    2009-01-01

    arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). We also aimed to generate consensus on minimum standards for the design of longitudinal studies aimed at validating biomarkers. METHODS: Before the meeting, the Soluble Biomarker Working Group prepared a preliminary framework and...... discussed various models for association and prediction related to the statistical strength domain. In addition, 3 Delphi exercises addressing longitudinal study design for RA, PsA, and AS were conducted within the working group and members of the Assessments in SpondyloArthritis International Society (ASAS...

  13. Evidence to support IL-13 as a risk locus for psoriatic arthritis but not psoriasis vulgaris.

    Bowes, John

    2011-06-01

    There is great interest in the identification of genetic factors that differentiate psoriatic arthritis (PsA) from psoriasis vulgaris (PsV), as such discoveries could lead to the identification of distinct underlying aetiological pathways. Recent studies identified single nucleotide polymorphisms (SNPs) in the interleukin 13 (IL-13) gene region as risk factors for PsV. Further investigations in one of these studies found the effect to be primarily restricted to PsA, thus suggesting the discovery of a specific genetic risk factor for PsA. Given this intriguing evidence, association to this gene was investigated in large collections of PsA and PsV patients and healthy controls.

  14. Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study

    Baranauskaite, Asta; Raffayová, Helena; Kungurov, NV; Kubanova, Anna; Venalis, Algirdas; Helmle, Laszlo; Srinivasan, Shankar; Nasonov, Evgeny; Vastesaeger, Nathan; ,

    2011-01-01

    Objective To compare the efficacy and safety of treatment with infliximab plus methotrexate with methotrexate alone in methotrexate-naive patients with active psoriatic arthritis (PsA). Methods In this open-label study, patients 18 years and older with active PsA who were naive to methotrexate and not receiving disease-modifying therapy (N=115) were randomly assigned (1:1) to receive either infliximab (5 mg/kg) at weeks 0, 2, 6 and 14 plus methotrexate (15 mg/week); or methotrexate (15 mg/wee...

  15. The OMERACT psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS): definitions of key pathologies, suggested MRI sequences, and preliminary scoring system for PsA Hands

    Østergaard, Mikkel; McQueen, Fiona; Wiell, Charlotte;

    2009-01-01

    This article describes a preliminary OMERACT psoriatic arthritis magnetic resonance image scoring system (PsAMRIS) for evaluation of inflammatory and destructive changes in PsA hands, which was developed by the international OMERACT MRI in inflammatory arthritis group. MRI definitions of importan...... pathologies in peripheral PsA and suggestions concerning appropriate MRI sequences for use in PsA hands are also provided.......This article describes a preliminary OMERACT psoriatic arthritis magnetic resonance image scoring system (PsAMRIS) for evaluation of inflammatory and destructive changes in PsA hands, which was developed by the international OMERACT MRI in inflammatory arthritis group. MRI definitions of important...

  16. Psoriatic Arthritis

    ... disease-modifying antirheumatic drugs (DMARDs) and/or antitumor necrosis factor (TNF) agents may be needed to control the disease. 2 1 Warning: Side effects of NSAIDs include stomach problems; skin rashes; high blood pressure; fluid retention; and liver, ...

  17. Psoriatic Arthritis

    ... RhMSUS FAQs RhMSUS Designees RhMSUS Volunteer Opportunities Publications & Communications Journals A&R Table of Contents AC&R Table ... by the American College of Rheumatology Committee on Communications and Marketing. This information is provided for general education only. ...

  18. Termination of disease-modifying antirheumatic drugs in rheumatoid arthritis and in psoriatic arthritis. A comparative study of 270 cases.

    Ujfalussy, I; Koó, E; Seszták, M; Gergely, P

    2003-04-01

    102 rheumatoid arthritis (RA) and 104 psoriatic arthritis (PsA) patients' records were analysed according to a standardised protocol. Using Cox regression, life-table analysis and log rank test, the effectiveness and toxicity of, and duration of disease modifying antirheumatic drug (DMARD) treatment were compared in RA and PsA. RA patients were treated with gold sodium thiomalate (GST), methotrexate (MTX) and sulphasalazine (SSZ) for a median duration of 35, 72 and 12 months respectively, whereas PsA patients were treated for 12, 12 and 17 months. The differences for GST and MTX were statistically significant (p=0.0043 and 0.0447). Drug toxicity was more frequently seen among patients with PsA (p=0.0023). No difference in efficacy could be proved. Results suggest that there is a significant difference between RA and PsA patients in terms of toxicity of these agents. Therefore, separate treatment strategies are needed, and earlier results with RA may not be directly applicable to PsA. PMID:12721703

  19. Rheological blood properties in psoriatic arthritis: relationship with inflammation and cardiovascular risk

    T V Korotaeva

    2009-10-01

    Full Text Available Objective. To study possibility of using blood rheological parameters as markers of inflammation and cardiovascular risk (CVR in pts with psoriatic arthritis (PA. Material and methods. 130 pts (51 male and 79 female with PA aged from 39 to 48 years (mean age 43 years without clinical signs of coronary heart disease (CHD and stroke were included. Duration of PA varied from 2 months to 42 years (mean 7 years, duration of psoriasis (PS – from 5,5 to 26 years (mean 15 years. Main measures of erythrocyte aggregation (EA including Kt (c-1 – total speed of erythrocytes aggregates formation, T (c – time of linear erythrocytes aggregates formation, I2,5 [%] – parameter characterizing durability of most large erythrocytes aggregates, β (c-1 – hydrodynamic durability of erythrocytes aggregates were evaluated in erythroaggregometer by registration of intensity of inverse light scattering from blood sample. PA activity was measured with DAS4. CHD development risk score was determined considering traditional CVR factors – age, total cholesterol (TCH and high density lipoproteins (HDLP level, systolic blood pressure (SBP, presence of diabetes, smoking. Serum C-reactive protein (CRP and fibrinogen concentration was measured with standard methods. Correlation analysis was performed with Spearman range correlation coefficient (R, Mann-Whitney (U test was used for groups comparison and p<0,05 was considered as statistically significant level. Results. EA disturbances corresponding to 2nd stage of severity were present in all pts with PA. Significant correlation between EA parameters (T , Kt, I2,5, β and DAS4 (R=-0,32/0,32/0,33/0,25, p<0,001 as well as significant correlation of all EA parameters (T , Kt, I2,5, β with laboratory inflammation markers: CRP (R=-0,37/0,41/0,46/0,32, ESR (R=-0,34/0,35/0,42/0,26 and most strong – with fibrinogen (R=-0,55/0,55/0,49/0,32 were revealed. Significant correlations of all EA parameters and fibrinogen with CVR

  20. How early should psoriatic arthritis be treated with a TNF-blocker?

    Harty, Leonard

    2012-02-01

    PURPOSE OF REVIEW: Psoriatic arthritis (PsA) is the second most commonly identified inflammatory arthropathy in early arthritis clinics. It is a complex multisystem disease involving the skin and joints, but may also present with inflammation of the spine - spondylitis, digits - dactylitis, eyes - uveitis and ligamentous insertions - enthesitis. The skin manifestations may be mild or patchy and often precede the joint inflammation. Joint erosions, however, may occur within the first 2 years in up to half of PsA patients and an erosion rate of 11% per annum has been reported suggesting it is not a benign disease as it was once regarded. RECENT FINDINGS: Therapy with mild anti-inflammatories is only beneficial in very mild or localized disease. In cases of more widespread joint involvement systemic therapy with disease-modifying antirheumatic drugs (DMARDs) such as methotrexate may be required and in the case of extra-articular or spinal disease, in which DMARDs have failed to show efficacy, biologic therapy may be highly effective. SUMMARY: The question of how early treatment should be instituted should be decided in a specialist rheumatology referral centre following appropriate assessment. Optimal therapy with combination DMARD and biologics may result in remission rates of up to 60%.

  1. Use of methotrexate in the treatment of psoriasis and psoriatic arthritis

    Tatiana Viktorovna Korotaeva

    2013-06-01

    Full Text Available Objective: To analyze the results of using methotrexate (MT in the treatment of psoriasis and psoriatic arthritis (PsA. Results. The mechanism of action of MT, the historical aspects of its use in the treatment of psoriasis and PsA, and the data of clinical trials of the efficacy and safety of the drug are considered. MT therapy is shown to cause a high rate of adverse reactions, which requires measures to prevent and treat adverse events. MT has been found to be frequently used in different combinations, including with other disease-modifying antirheumatic drugs (sulfasalazine, prednisolone, and biological agents, such as tumor necrosis factor inhibitors. In accordance with the European S3-guidelines S3 on the systemic treatment of psoriasis, MT (15-22.5 mg weekly should be recommended from the results of randomized clinical trials and the extensive clinical experience with this drug. In terms of the present-day views, the indications for immunosuppressive therapy for PsA may be expanded it should be initiated in the early stage of the disease, particularly in its severe forms, until there are destructive changes in the osteoarticular apparatus. Conclusion. MT is an effective drug to treat psoriasis and PsA. It is recommended for use in moderate and severe peripheral arthritis (Grade B and skin lesions (Grade A.

  2. Plantar forefoot pressures in psoriatic arthritis-related dactylitis: an exploratory study.

    Wilkins, Richard A; Siddle, Heidi J; Redmond, Anthony C; Helliwell, Philip S

    2016-09-01

    Dactylitis is a common feature of psoriatic arthritis (PsA); local physical trauma has been identified as a possible contributing factor. The aim of this study was to explore differences in forefoot plantar pressures in patients with PsA with and without dactylitis and compare to healthy controls. Thirty-six participants were recruited into three groups: group A PsA plus a history of dactylitis; group B PsA, no dactylitis; group C control participants. Forefoot plantar pressures were measured barefoot and in-shoe at the left second and fourth toes and corresponding metatarsophalangeal joints. Temporal and spatial parameters were measured and data from the foot impact scale for rheumatoid arthritis (FIS-RA), EQ5D and health assessment questionnaire (HAQ) were collected. Pressure time integral peak plantar pressure, and contact time barefoot and in-shoe were not significantly different between groups. Temporal and spatial parameters reported no significant differences between groups. ANOVA analysis and subsequent post hoc testing using Games-Howell test yielded significance in FIS-RA scores between both PsA groups versus controls, A p ≤ 0.0001 and PsA group B p history of dactylitis does not appear to worsen patient reported outcomes. PMID:27225246

  3. A genome-wide association study of psoriasis and psoriatic arthritis identifies new disease loci.

    Ying Liu

    2008-03-01

    Full Text Available A genome-wide association study was performed to identify genetic factors involved in susceptibility to psoriasis (PS and psoriatic arthritis (PSA, inflammatory diseases of the skin and joints in humans. 223 PS cases (including 91 with PSA were genotyped with 311,398 single nucleotide polymorphisms (SNPs, and results were compared with those from 519 Northern European controls. Replications were performed with an independent cohort of 577 PS cases and 737 controls from the U.S., and 576 PSA patients and 480 controls from the U.K.. Strongest associations were with the class I region of the major histocompatibility complex (MHC. The most highly associated SNP was rs10484554, which lies 34.7 kb upstream from HLA-C (P = 7.8x10(-11, GWA scan; P = 1.8x10(-30, replication; P = 1.8x10(-39, combined; U.K. PSA: P = 6.9x10(-11. However, rs2395029 encoding the G2V polymorphism within the class I gene HCP5 (combined P = 2.13x10(-26 in U.S. cases yielded the highest ORs with both PS and PSA (4.1 and 3.2 respectively. This variant is associated with low viral set point following HIV infection and its effect is independent of rs10484554. We replicated the previously reported association with interleukin 23 receptor and interleukin 12B (IL12B polymorphisms in PS and PSA cohorts (IL23R: rs11209026, U.S. PS, P = 1.4x10(-4; U.K. PSA: P = 8.0x10(-4; IL12B:rs6887695, U.S. PS, P = 5x10(-5 and U.K. PSA, P = 1.3x10(-3 and detected an independent association in the IL23R region with a SNP 4 kb upstream from IL12RB2 (P = 0.001. Novel associations replicated in the U.S. PS cohort included the region harboring lipoma HMGIC fusion partner (LHFP and conserved oligomeric golgi complex component 6 (COG6 genes on chromosome 13q13 (combined P = 2x10(-6 for rs7993214; OR = 0.71, the late cornified envelope gene cluster (LCE from the Epidermal Differentiation Complex (PSORS4 (combined P = 6.2x10(-5 for rs6701216; OR 1.45 and a region of LD at 15q21 (combined P = 2.9x10(-5 for rs

  4. Intra-articular therapy with infliximab in psoriatic arthritis: efficacy and safety in refractory monoarthritis

    A. Minosi

    2011-06-01

    Full Text Available Objective: To evaluate efficacy and safety of intra-articular therapy (IA with infliximab (IFX, in patients with psoriatic arthritis (PsA and refractory monoarthritis. Methods: Four male and 1 female aged from 25 to 71 years and disease duration from 1 to 25 years, affected by PsA (CASPAR criteria were observed . All patients were treated with immunomodulators (methotrexate, leflunomide, cyclosporin A, 3/5 with concomitant steroids, 4/5 with NSAID’s. Only 1 patient were treated with IFX 5 mg/kg IV every 6 weeks. Before the IFX injection an amount of synovial fluid was aspired from the inflamed site and the anti-TNF injection was echographic guided. Patients were evaluated at regular intervals through clinical and echographic examination and retreated in case of flare. Results: At follow-up visit after 7 days, in all patients treated with the first injection was detected total regression of the inflammation and no new inflamed synovial fluid was observed; power doppler examination shows reduction of local vascularization. Two patients experienced full remission after 6 months and only one injection, 1 patient (arthritis of the wrist was in remission after 2 injections (3 months of interval. In 2 patients with knee arthritis and important synovial hypertrophy good results obtained after the first injection were not maintained afterwards and second injection was ineffective: these patients were evaluated for surgical intervention. Conclusions: Local injections of IFX were safe and well tolerated in all patients. The efficacy in short term was observed in all cases; our supposition is that presence of synovial hypertrophy is cause of worsening.

  5. The impact of physical therapy on the quality of life of patients with rheumatoid and psoriatic arthritis

    Mustur Dušan

    2007-01-01

    Full Text Available Introduction: This open, uncontrolled study examined the effects of physical therapy and rehabilitation on the quality of life in patients with rheumatoid arthritis (RA and psoriatic arthritis (PsA. Material and methods: The study included a total of 109 patients (69 with RA and 40 with PsA. Patients came from Norway for a four-week rehabilitation period at the Institute of Physical Medicine, Rehabilitation & Rheumatology - Igalo from June till October, 2003. This was a self-controlled, pretest/posttest study. All patients had six days of physical therapy per week, during a four-week stay, which made a total of 24 therapy days. Basic therapy included mud packs/baths, kinesitherapy, hydrokinesitherapy and electrotherapy with analgesic effects. Quality of Life measurements were conducted two times (on admission and discharge using questionnaire EuroQoL (EQ-5D. The research also included evaluation of ACR improvement. Results: Pain/disability scale and the well being scale showed that quality of life in patients with PsA was significantly lower in comparison with RA patients. However, after 4 weeks, quality of life was much better in most dimensions of the EuroQoL questionnaire. Patients showed no improvement in self-care activities (in both groups and daily activities (in group with PsA. Significant improvement was measured also in ACR improvement criteria (around 30%. Conclusions: Physical therapy at the Igalo Institute and good climate conditions have significantly improved the Health-Related-Quality-of-Life in both groups of patients. ACR index showed great improvement after a four-week rehabilitation period.

  6. Interactions of the Immune System with Skin and Bone Tissue in Psoriatic Arthritis: A Comprehensive Review.

    Sukhov, Andrea; Adamopoulos, Iannis E; Maverakis, Emanual

    2016-08-01

    Cutaneous psoriasis (e.g., psoriasis vulgaris (PsV)) and psoriatic arthritis (PsA) are complex heterogeneous diseases thought to have similar pathophysiology. The soluble and cellular mediators of these closely related diseases are being elucidated through genetic approaches such as genome-wide association studies (GWAS), as well as animal and molecular models. Novel therapeutics targeting these mediators (IL-12, IL-23, IL-17, IL-17 receptor, TNF) are effective in treating both the skin and joint manifestations of psoriasis, reaffirming the shared pathophysiology of PsV and PsA. However, the molecular and cellular interactions between skin and joint disease have not been well characterized. Clearly, PsV and PsA are highly variable in terms of their clinical manifestations, and this heterogeneity can partially be explained by differences in HLA-associations (HLA-Cw*0602 versus HLA-B*27, for example). In addition, there are numerous other genetic susceptibility loci (LCE3, CARD14, NOS2, NFKBIA, PSMA6, ERAP1, TRAF3IP2, IL12RB2, IL23R, IL12B, TNIP1, TNFAIP3, TYK2) and geoepidemiologic factors that contribute to the wide variability seen in psoriasis. Herein, we review the complex interplay between the genetic, cellular, ethnic, and geographic mediators of psoriasis, focusing on the shared mechanisms of PsV and PsA. PMID:26780035

  7. Detection of asymptomatic enthesitis in psoriasis patients: An onset of psoriatic arthritis?

    Takata, Tomoya; Takahashi, Aya; Taniguchi, Yoshinori; Terada, Yoshio; Sano, Shigetoshi

    2016-06-01

    Presence of asymptomatic joint involvement is recognized in patients with psoriasis. However, it remains elusive whether such patients develop psoriatic arthritis (PsA). The aim of the present study was to examine the incidence of asymptomatic joint lesions, in particular, enthesitis in patients with psoriasis vulgaris (PsV) and to further assess the clinical features. Eighteen PsV and 28 PsA patients were enrolled for examination by positron emission tomography/computed tomography (PET/CT) using (18) F-fluorodeoxyglucose (FDG). Any nail, scalp and intergluteal involvements were reported. Levels of serum C-reactive protein (CRP), white blood cell (WBC) counts and erythrocyte sedimentation rate (ESR) were examined. All of the PsA patients showed FDG accumulation in the affected joints. Notably, asymptomatic enthesitis was detected in six out of 18 PsV patients (33%), and they were diagnosed as having subclinical PsA. Incidences of scalp, intergluteal and nail psoriasis in subclinical PsA patients were 100%, 83% and 64%, respectively, which were higher than those in PsV patients (67%, 25% and 40%, respectively). CRP, WBC counts and ESR were invariable between PsV and subclinical PsA groups. PET/CT imaging could discover asymptomatic enthesitis. Our data suggested that the subpopulation of subclinical PsA was much higher than expected. Higher prevalence of nail, scalp and intergluteal psoriasis confirmed the risk of PsA as previously described. PMID:26666215

  8. Progress in understanding and utilizing TNF-α inhibition for the treatment of psoriatic arthritis.

    Caso, Francesco; Lubrano, Ennio; Del Puente, Antonio; Caso, Paolo; Peluso, Rosario; Foglia, Francesca; Benigno, Carolina; Girolimetto, Nicolò; Bottiglieri, Paolo; Scarpa, Raffaele; Costa, Luisa

    2016-03-01

    The improved recognition of pathogenetic molecular mechanisms has led to the use of drugs targeting cytokines in different inflammatory arthropathies as well psoriatic arthritis (PsA). In particular, the progress in knowledge on tumor necrosis factor (TNF)-α in the pathogenesis of PsA has changed the therapeutic approach by use of direct and receptor cytokine antagonists. Currently, infliximab (IFX), adalimumab, etanercept, golimumab and certolizumab pegol represent the five anti-TNF-α available for the treatment of PsA. This review describes evidence on treatment aimed at neutralizing TNF-α in PsA patients, from the first study in 2000 until today, mainly derived from randomized clinical trials. In comparison with traditional therapies, anti-TNF-α agents have shown to have more efficacy both in treating clinical aspects, including enthesitis, dactylitis, joint pain and swelling, axial involvement, nail and skin lesions, and in reducing radiographic progression. Moreover, anti-TNF-α agents have been demonstrated to be reasonably safe in PsA, as confirmed by data derived by different registries. PMID:26558483

  9. Cardiovascular disease and risk factors in patients with psoriasis and psoriatic arthritis.

    Tobin, Anne-Marie

    2012-02-01

    OBJECTIVE: Patients with psoriasis and psoriatic arthritis (PsA) have an increased incidence of cardiovascular disease (CVD) and cardiovascular risk factors such as smoking, hypertension, and metabolic syndrome compared to the normal population. Patients with psoriasis and PsA may also have increased risk from nonconventional risk factors such as raised levels of homocysteine and excessive alcohol consumption. We conducted a comprehensive review of the literature on CVD and all cardiovascular risk factors in patients with psoriasis and PsA. METHODS: Data sources: All studies identified from a Medline (www.ncbi.nlm.nih.gov) search pertaining to CVD, individual risk factors in psoriasis, and PsA were included. Study selection: Studies included a healthy reference population, were published between 1975 and 2009, and were written in English. RESULTS: Our search yielded 14 studies that documented rates of CVD in patients with psoriasis and PsA compared to controls. Substantial evidence points to elevated risk of CVD in patients with psoriasis and PsA. CONCLUSION: It remains difficult to conclude if risk factors are caused by psoriasis or share a common pathogenesis. Physicians treating patients with psoriasis and PsA must be aware of all potential cardiovascular risk factors in their patients.

  10. The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people

    Intorcia Michele

    2009-03-01

    Full Text Available Abstract Background The health-related quality of life (HRQL is an important indicator of the burden of musculoskeletal disease. The Medical Outcome Study Short-Term 36 (SF-36 is the most used tool that evaluates HRQL as a subjective perception about psychological and physical limitations due to an underlying illness. The purpose of this study was to compare the HRQL scores among patients with rheumatoid arthritis (RA, psoriatic arthritis (PsA and ankylosing spondylitis (AS and a selected sample of health people and determine their relationship with measures of clinical condition. Methods 799 patients (469 with RA, 164 with AS, 65 with axial PsA and 101 with peripheral PsA accepted the invitation to participate. 1579 healthy controls were used for the comparison. We calculated scores for the eight SF-36 subscales, the Physical Component Summary (PCS score, and the Mental Component Summary (MCS score, according to published algorithms. Disease-related characteristics included disease duration, comorbidity, a measure for disease activity and for radiographic damage. The presence of comorbidity was ascertained through patient's self-reports by the Self-Administered Comorbidity Questionnaire (SCQ. Comparison were performed with respect to sex and age, and s-scores were calculated for comparison with the norm. Multivariate analyses were used to assess the relationship between HRQL and radiographic damage, disease activity, and socio-demographic data. Results The four inflammatory rheumatic diseases (IRD, compared to controls, significantly impaired all eight health concepts of the SF-36 (p Conclusion Chronic IRD have a clearly detrimental effect on the HRQL in both sex and in age groups, and physical domain is more impaired than mental and social ones.

  11. Assessing the effectiveness of synthetic and biologic disease-modifying antirheumatic drugs in psoriatic arthritis – a systematic review

    Kingsley GH

    2015-05-01

    Full Text Available Gabrielle H Kingsley, David L Scott Rheumatology Unit, Kings College London, London, UK Background: Psoriatic arthritis is an inflammatory arthritis the primary manifestations of which are locomotor and skin disease. Although a number of guidelines have been published citing strategies for reducing disease progression, the evidence base for disease-modifying agents is unclear. This forms the focus of this systematic review. Methods: The systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist. We selected randomized controlled trials (RCTs that looked at the impact of interventions with disease-modifying agents, either synthetic drugs or biologics on musculoskeletal outcomes, notably American College of Rheumatology 20 percent responders. Results were analyzed using Review Manager 5.1.6 (Cochrane Collaboration, Oxford, UK. Whilst our primary focus was on published trials, we also looked at new trials presented in abstract form in 2013–2014 that were not yet published to avoid omitting important and up-to-date information on developing treatments. Results: Our in-depth analysis included 28 trials overall enrolling 5,177 patients published between the 1980s and now as well as limited analysis of some studies in abstract form as described earlier. The most frequently available locomotor outcome measure was the American College of Rheumatology 20 percent responders. The risk ratio for achieving an American College of Rheumatology 20 percent responders response was positive in favor of treatment (risk ratio 2.30; 95% confidence interval 1.78–2.96; however, there was evidence of considerable heterogeneity between trials. Overall randomized controlled trials of established synthetic disease-modifying agents were largely negative (methotrexate, ciclosporin and sulfasalazine though leflunomide showed a small positive effect. A new synthetic agent, apremilast, did show a

  12. Variants in linkage disequilibrium with the late cornified envelope gene cluster deletion are associated with susceptibility to psoriatic arthritis.

    Bowes, John

    2010-12-01

    A common deletion mapping to the psoriasis susceptibility locus 4 on chromosome 1q21, encompassing two genes of the late cornified envelope (LCE) gene cluster, has been associated with an increased risk of psoriasis vulgaris (PsV). One previous report found no association of the deletion with psoriatic arthritis (PsA), suggesting it may be a specific risk factor for PsV. Given the genetic overlap between PsA and PsV, a study was undertaken to investigate whether single nucleotide polymorphisms (SNPs) mapping to this locus are risk factors for PsA in a UK and Irish population.

  13. Anti-tumor necrosis factor (TNF drugs for the treatment of psoriatic arthritis: an indirect comparison meta-analysis

    Thorlund K

    2012-12-01

    Full Text Available Kristian Thorlund,1 Eric Druyts,2 J Antonio Aviña-Zubieta,3,4 Edward J Mills1,21Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; 2Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; 3Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; 4Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, CanadaObjective: To evaluate the comparative effectiveness of available tumor necrosis factor-a inhibitors (anti-TNFs for the management of psoriatic arthritis (PsA in patients with an inadequate response to disease-modifying antirheumatic drugs (DMARDs.Methods: We used an exhaustive search strategy covering randomized clinical trials, systematic reviews and health technology assessments (HTA published on anti-TNFs for PsA. We performed indirect comparisons of the available anti-TNFs (adalimumab, etanercept, golimumab, and infliximab measuring relative risks (RR for the psoriatic arthritis response criteria (PsARC, mean differences (MDs for improvements from baseline for the Health Assessment Questionnaire (HAQ by PsARC responders and non-responders, and MD for the improvements from baseline for the psoriasis area and severity index (PASI. When the reporting of data on intervention group response rates and improvements were incomplete, we used straightforward conversions based on the available data.Results: We retrieved data from 20 publications representing seven trials, as well as two HTAs. All anti-TNFs were significantly better than control, but the indirect comparison did not reveal any statistically significant difference between the anti-TNFs. For PsARC response, golimumab yielded the highest RR and etanercept the second highest; adalimumab and infliximab both yielded notably smaller RRs. For HAQ improvement, etanercept and infliximab yielded the largest MD among PsARC responders

  14. Self-reported health outcomes in patients with psoriasis and psoriatic arthritis randomized to two etanercept regimens

    Gniadecki, R; Robertson, David; Molta, C T;

    2012-01-01

    Background Moderate/severe psoriasis combined with psoriatic arthritis (PsA) impairs health-related quality of life (QoL). Etanercept, a fully human tumour necrosis factor-a receptor fusion protein, is approved for treatment of both diseases. Objective To compare patient-reported health outcomes...... additional weeks. PROs included: the EuroQOL-5D (EQ-5D), which measures general health status and consists of the utility index measuring five dimensions of health, and a visual analogue scale (VAS) allowing patients to assess health status; the Dermatology Life Quality Index (DLQI), which measures the...

  15. MRI bone oedema scores are higher in the arthritis mutilans form of psoriatic arthritis and correlate with high radiographic scores for joint damage

    Tan, Yu M; Østergaard, Mikkel; Doyle, Anthony;

    2009-01-01

    sequences. Scans were scored separately by two readers for bone erosion, oedema and proliferation using a PsA MRI scoring system. X-rays were scored for erosions and joint space narrowing. RESULTS: On MRI, 1013 bones were scored by both readers. Reliability for scoring erosions and bone oedema was high......INTRODUCTION: The aim of this study was to investigate the magnetic resonance imaging (MRI) features of bone disease in the arthritis mutilans (AM) form of psoriatic arthritis (PsA). METHODS: Twenty-eight patients with erosive PsA were enrolled (median disease duration of 14 years). Using x-rays of...... both hands and feet, 11 patients were classified as AM and 17 as non-AM (erosive psoriatic arthritis without bone lysis)by two observers. MRI scans (1.5T) of the dominant hand (wrist and fingers scanned separately) were obtained using standard contrast-enhanced T1-weighted and fat-saturated T2-weighted...

  16. Carotid plaque and bone density and microarchitecture in psoriatic arthritis: the correlation with soluble ST2.

    Shen, Jiayun; Shang, Qing; Wong, Chun-Kwok; Li, Edmund K; Kun, Emily W; Cheng, Isaac T; Li, Martin; Li, Tena K; Zhu, Tracy Y; Yu, Cheuk-Man; Qin, Ling; Tam, Lai-Shan

    2016-01-01

    Psoriatic arthritis (PsA) patients have increased risk of both atherosclerosis and osteoporosis. Previous studies revealed that IL-33/ST2 axis may be related to both conditions; however, these associations were never evaluated in a single patients' group. Here we explored the association among plasma levels of IL-33 and its decoy receptor soluble ST2 (sST2), carotid plaque determined by ultrasound, and volumetric bone mineral density (vBMD)/microstructure of distal radius measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 80 PsA patients (55% male; 53.0 ± 10.1 years). Plasma sST2 levels were significantly higher in 33 (41%) patients with carotid plaques (11.2 ± 4.5 vs 7.7 ± 3.7 ng/ml, P independent explanatory variable associated with carotid plaques (OR = 1.296, 95% CI: [1.091,1.540]; P = 0.003). After adjustment for the osteoporotic risk factors, sST2 was significantly associated with higher cortical porosity (β = 0.184, [0.042,0.325]; P = 0.012) and cortical pore volume (2.247, [0.434,4.060]; P = 0.016); and had a trend to be associated with lower cortical vBMD (-2.918, [-6.111,0.275]; P = 0.073). IL-33 was not associated with carotid plaque or vBMD/microstructure. In conclusion, plasma sST2 levels were independently correlated with both carotid plaque and compromised cortical vBMD/microstructure in PsA patients. IL-33/ST2 axis may be a link between accelerated atherosclerosis and osteoporosis in PsA. PMID:27554830

  17. The pattern of psoriatic arthritis in Kashmir: A 6-year prospective study

    Shagufta Rather

    2015-01-01

    Full Text Available Background: The prevalence, clinical presentation, and patterns of psoriatic arthritis (PsA vary in different parts of the world. The scenario of PsA in west is different from that of Asia. Moreover, the oligoarticular type which was considered most prevalent earlier has been replaced by polyarticular type. Aim: The study was to the clinical profile of psoriasis patients associated with PsA in Kashmir valley of India. Materials and Methods: This was a noninterventional, observational, prospective, hospital-based study involving 150 successive patients of PsA over a span of 6 years. Severity of the skin and nail involvement was assessed by Psoriasis Area and Severity Index (PASI and Nail Psoriasis Severity Index (NAPSI, respectively. PsA was diagnosed by classification criteria for PsA. The number and pattern of swollen and tender joints was counted and classified by Moll and Wright′s classification criteria. Results: Plaque-type psoriasis was the most common clinical type, observed in 122 (81.33% patients followed by erythrodermic psoriasis in 10 (6.66% patients and pustular psoriasis in eight (5.33% patients. PsA occurred between 30 and 40 years of age in 105 (70% patients. The cutaneous involvement occurred before joint involvement in 113 (75.33%, while they occurred simultaneously in 30 (20% cases and the PsA preceded the skin involvement in seven (4.66% cases. Symmetrical polyarthritis was the commonest clinical presentation and was seen in 90 (60% patients. Nail involvement due to psoriasis was present in 120 (80% patients. Commonest nail change found was pitting and seen in 60 (40% patients. Conclusion: The clinical pattern of PsA varies in different parts of the world. Knowledge of the clinical presentation of PsA in a given area is necessary for the successful management of this disease.

  18. Valuation of scleroderma and psoriatic arthritis health states by the general public

    Hays Ron D

    2010-10-01

    Full Text Available Abstract Objective Psoriatic arthritis (PsA and scleroderma (SSc are chronic rheumatic disorders with detrimental effects on health-related quality of life. Our objective was to assess health values (utilities from the general public for health states common to people with PsA and SSc for economic evaluations. Methods Adult subjects from the general population in a Midwestern city (N = 218 completed the SF-12 Health Survey and computer-assisted 0-100 rating scale (RS, time trade-off (TTO, range: 0.0-1.0 and standard gamble (SG, range: 0.0-1.0 utility assessments for several hypothetical PsA and SSc health states. Results Subjects included 135 (62% females, 143 (66% Caucasians, and 62 (28% African-Americans. The mean (SD scores for the SF-12 Physical Component Summary scale were 52.9 (8.3 and for the SF-12 Mental Component Summary scale were 49.0 (9.1, close to population norms. The mean RS, TTO, and SG scores for PsA health states varied with severity, ranging from 20.2 to 63.7 (14.4-20.3 for the RS 0.29 to 0.78 (0.24-0.31 for the TTO, and 0.48 to 0.82 (0.24-0.34 for the SG. The mean RS, TTO, and SG scores for SSc health states were 25.3-69.7 (15.2-16.3 for the RS, 0.36-0.80 (0.25-0.31 for the TTO, and 0.50-0.81 (0.26-0.32 for the SG, depending on disease severity. Conclusion Health utilities for PsA and SSc health states as assessed from the general public reflect the severity of the diseases. These descriptive findings could have implications regarding comparative effectiveness research for tests and treatments for PsA and SSc.

  19. Anti-inflammatory efficacy of low-dose cyclosporin A in psoriatic arthritis. A prospective multicentre study.

    Mahrle, G; Schulze, H J; Bräutigam, M; Mischer, P; Schopf, R; Jung, E G; Weidinger, G; Färber, L

    1996-11-01

    Fifty-five patients with psoriatic arthritis were treated with a low dose of cyclosporin A (CyA) (mean dose 2.7 mg/kg per day) for a period of 6 months to investigate the efficacy of CyA on disease parameters. Significant improvement in the joint complaints and inflammation parameters was observed including a decrease in the number of painful (-46%) and swollen (-45%) joints, tenderness (Ritchie Index: -50%) and degree of swelling (-46%), patient's assessment of pain (-35%), the duration of morning joint stiffness (-37%), as well as a decrease in C-reactive protein (-52%). A 50% reduction of joint complaints required a total of 24 weeks, whereas a 50% reduction of skin involvement was achieved after 5-6 weeks of treatment. Four patients left the study due to adverse events: creatinine level increase in two patients, hypertension in one patient and gastroenteritis in the fourth patient. Joint scintigraphy in 18 patients indicated an improvement or stable condition in 61% of cases after a mean follow-up of approximately 8 months. The results of this prospective study show that low-dose CyA effectively improves not only skin lesions, but also joint complaints in psoriatic arthritis. PMID:8977676

  20. PTPN22 is associated with susceptibility to psoriatic arthritis but not psoriasis: evidence for a further PsA-specific risk locus.

    Bowes, John

    2015-04-28

    Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis; it has a higher estimated genetic component than psoriasis alone, however most genetic susceptibility loci identified for PsA to date are also shared with psoriasis. Here we attempt to validate novel single nucleotide polymorphisms selected from our recent PsA Immunochip study and determine specificity to PsA.

  1. Enthesopathic reactions at the wrist in psoriatic arthritis, rheumatoid arthritis and diffuse idiopathic skeletal hyperostosis. Results of low-kV radiographs in three views

    Twenty-six sites of muscle and ligament attachment around the wrist were evaluated for enthesopathic proliferative bone changes in psoriatic arthritis (PA), rheumatoid arthritis (RA), and diffuse idiopathic skeletal hyperostosis (DISH). Proliferations were found to be most frequent, most irregular, and largest in PA, followed in declining order by RA and DISH. In PA only, the bony proliferations and the underlying bone often had the appearance of mineralized woven bone, though smooth proliferations with a regular bone structure do occur in PA as well as in RA. The entheses of the trapezium, scaphoid and the radial styloid process are most frequently affected, followed by the bases of the first and fifth metacarpals and the pisiform. It is exceptional for huge bony proliferations to be observed at the entheses in DISH. (orig.)

  2. Demographics, clinical disease characteristics, and quality of life in a large cohort of psoriasis patients with and without psoriatic arthritis

    Truong B

    2015-11-01

    Full Text Available B Truong,1,* N Rich-Garg,2,* BD Ehst,1 AA Deodhar,2 JH Ku,2 K Vakil-Gilani,2 A Danve,2 A Blauvelt,1,3 1Department of Dermatology, Oregon Health and Science University, 2Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, 3Oregon Medical Research Center, Portland, OR, USA *These authors contributed equally to this work Innovation: What is already known about the topic: psoriasis (PsO is a common skin disease with major impact on quality of life (QoL. Patient-reported data on QoL from large number of PsO patients with and without psoriatic arthritis (PsA are limited. What this study adds: In a large cohort referred to a university psoriasis center, patients with PsO and concomitant PsA (~30% in this group had greater degrees of skin and nail involvement and experienced greater negative impacts on QoL. Despite large numbers of patients with moderate-to-severe disease, use of systemic therapy by community practitioners was uncommon. Background: PsO and PsA are common diseases that have marked adverse impacts on QoL. The disease features and patient-reported QoL data comparing PsO and PsA patients are limited. Objective: To identify and compare demographics, clinical disease characteristics, and QoL scores in a large cohort of PsO patients with and without PsA. Methods: All PsO patients seen in a psoriasis specialty clinic, named the Center of Excellence for Psoriasis and Psoriatic Arthritis, were enrolled in an observational cohort. Demographic, QoL, and clinical data were collected from patient-reported questionnaires and from physical examinations performed by Center of Excellence for Psoriasis and Psoriatic Arthritis dermatologists and a rheumatologists. Cross sectional descriptive data were collected and comparisons between patients with PsO alone and those with concomitant PsA are presented. Results: A total of 568 patients were enrolled in the database. Mean age of PsO onset was 28 years and mean disease

  3. Ultrasound and psoriatic arthritis – Review of the literature and general considerations

    Solivetti, F.M.; Andreoli, G.M.; Bacaro, D.

    2007-01-01

    The authors review the recent literature on the use of ultrasonography in psoriatic arthropathy. The results are discussed in light of the authors' experience and with reference to technological advances and processes.

  4. A Patient with Psoriatic Arthritis Imaged with FDG PET/CT Demonstrated an Unusual Imaging Pattern with Muscle and Fascia Involvement: A Case Report

    We describe the case of a patient with known history of psoriasis that presented with 1 year of unexplained fever, muscle weakness and marked weight loss, suspicious for B symptoms of a malignant origin. [18F]-Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) scans demonstrated an unusual serpiginous pattern of uptake in the fascia and muscles as well as lymph node activity. Multiple histological samples, including a final PET-probe guided lymph node surgical resection, excluded malignancy and confirmed the diagnosis of reactive inflammatory changes, with a plausible diagnosis of autoimmune lymphoproliferative syndrome with associated lymphadenitis, fasciitis and myositis, possibly mediated by tumor necrosis factor (TNF) inhibitor. To our knowledge, there is no evidence of a previously reported FDG uptake pattern of fascia and muscle involvement in psoriatic arthritis

  5. A Patient with Psoriatic Arthritis Imaged with FDG PET/CT Demonstrated an Unusual Imaging Pattern with Muscle and Fascia Involvement: A Case Report

    Bains, Sukharn; Khan, Sana; Aparici, Carina Mari [Univ. of California, San Francisco (United States); Win, Aung Zaw; Reimert, Matthew [San Fracisco Veterans Affairs Medical Center, San Francisco (United States)

    2012-06-15

    We describe the case of a patient with known history of psoriasis that presented with 1 year of unexplained fever, muscle weakness and marked weight loss, suspicious for B symptoms of a malignant origin. [{sup 18}F]-Fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) scans demonstrated an unusual serpiginous pattern of uptake in the fascia and muscles as well as lymph node activity. Multiple histological samples, including a final PET-probe guided lymph node surgical resection, excluded malignancy and confirmed the diagnosis of reactive inflammatory changes, with a plausible diagnosis of autoimmune lymphoproliferative syndrome with associated lymphadenitis, fasciitis and myositis, possibly mediated by tumor necrosis factor (TNF) inhibitor. To our knowledge, there is no evidence of a previously reported FDG uptake pattern of fascia and muscle involvement in psoriatic arthritis.

  6. Bioboosters in the treatment of rheumatic diseases: a comprehensive review of currently available biologics in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis

    Fabrizio Cantini

    2009-12-01

    Full Text Available Fabrizio Cantini, Carlotta Nannini, Laura NiccoliSecond Division of Medicine, Rheumatology Unit, Hospital of Prato, ItalyAbstract: Immunologic research has clarified many aspects of the pathogenesis of inflammatory rheumatic disorders. Biologic drugs acting on different steps of the immune response, including cytokines, B- and T-cell lymphocytes, have been marketed over the past 10 years for the treatment of rheumatoid arthritis (RA, ankylosing spondylitis (AS, and psoriatic arthritis (PsA. Randomized controlled trials (RCTs of anti-cytokine agents in RA (including the anti-tumor necrosis factor alpha (TNFα drugs infliximab, etanercept, adalimumab, golimumab, certolizumab, anti-interleukin (IL-1 anakinra, and anti-IL-6 tocilizumab demonstrated a significant efficacy compared to traditional therapies, if combined with methotrexate (MTX, as measured by ACR 20, 50 and 70 response criteria. The new therapies have also been demonstrated to be superior to MTX in slowing or halting articular damage. RCTs have shown the efficacy of anti-TNFα in AS patients through significant improvement of symptoms and function. Trials of anti-TNFα in PsA patients showed marked improvement of articular symptoms for psoriasis and radiological disease progression. More recent studies have demonstrated the efficacy of B-cell depletion with rituximab, and T-cell inactivation with abatacept. All these drugs have a satisfactory safety profile. This paper reviews the different aspects of efficacy and tolerability of biologics in the therapy of RA, AS, and PsA.Keywords: anti-TNF, anti-cytokine agents, rituximab, abatacept, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis

  7. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

    Tehranzadeh, Jamshid [University of California, Department of Radiological Sciences, Irvine (United States); University of California Medical Center, Department of Radiological Sciences R-140, Orange, CA (United States); Ashikyan, Oganes; Anavim, Arash; Shin, John [University of California, Department of Radiological Sciences, Irvine (United States)

    2008-05-15

    The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The 'rheumatoid' type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with

  8. Role of HLA class I antigens in the development of psoriatic arthritis and its clinical presentation

    Irina Aleksandrovna Troshkina

    2012-01-01

    Full Text Available Objective: to investigate the association of HLA Class I antigens with the predisposition to psoriatic arthritis (PsA and the severity and types of articular syndrome in PsA. Subjects and methods. The investigation enrolled 99 patients (56 females and 43 males aged 43.5+13 years with PA with a median duration of 2 (range 0.8-10 years. An oligoarthritic type was observed in 28 patients, polyarthritic, distal, and spondyloarthritic types were present in 28, 39, and 10 patients, respectively. Two patient groups were formed according to the age at onset of psoriasis: 1 71 patients aged less than 40 years and 2 23 patients aged over 40 years. Results. As compared with the control group, the patients with PsA were found to have a higher frequency of HLA-B13 (odds ratio [OR] 2.72; p < 0.004, HLA-В16 (OR 3.95; p < 0.0001, and HLA-B27 (OR 3.2; p < 0.003. There was an association of the types of joint injury with HLA antigens: the distal type with HLA-B13 (OR 3.38; p < 0.02 and HLA-В16 (OR 3.95; p < 0.01, the polyarthritic type with HLA-В16 (OR 5.90; p < 0.0001 and HLA-B27 (OR 3.26; p < 0.01, and the spondyloarthritic type with HLA-B27 (OR 6.32; p < 0.001. The young onset of psoriasis was associated with HLA-B13 (OR 3.29; p < 0.001. The detection rate of the B38 antigen (the subtype of HLA-B16 was higher in all X-ray stages of PsA and was 16.4% in Stages I-IIA, 25% in Stage IIB, and 40.9% in Stages III-IV versus 8.7% in the control group, the magnitude of the association being increased with the higher degree of joint destruction. Conclusion. The detailed analysis of the investigation revealed that HLA system antigens were differently involved in the development of PsA and clinical types of articular syndrome.

  9. Carotid plaque and bone density and microarchitecture in psoriatic arthritis: the correlation with soluble ST2

    Shen, Jiayun; Shang, Qing; Wong, Chun-Kwok; Li, Edmund K.; Kun, Emily W.; Cheng, Isaac T.; Li, Martin; Li, Tena K.; Zhu, Tracy Y.; Yu, Cheuk-Man; Qin, Ling; Tam, Lai-Shan

    2016-01-01

    Psoriatic arthritis (PsA) patients have increased risk of both atherosclerosis and osteoporosis. Previous studies revealed that IL-33/ST2 axis may be related to both conditions; however, these associations were never evaluated in a single patients’ group. Here we explored the association among plasma levels of IL-33 and its decoy receptor soluble ST2 (sST2), carotid plaque determined by ultrasound, and volumetric bone mineral density (vBMD)/microstructure of distal radius measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 80 PsA patients (55% male; 53.0 ± 10.1 years). Plasma sST2 levels were significantly higher in 33 (41%) patients with carotid plaques (11.2 ± 4.5 vs 7.7 ± 3.7 ng/ml, P < 0.001). In multivariate analysis, sST2 was an independent explanatory variable associated with carotid plaques (OR = 1.296, 95% CI: [1.091,1.540]; P = 0.003). After adjustment for the osteoporotic risk factors, sST2 was significantly associated with higher cortical porosity (β = 0.184, [0.042,0.325]; P = 0.012) and cortical pore volume (2.247, [0.434,4.060]; P = 0.016); and had a trend to be associated with lower cortical vBMD (−2.918, [−6.111,0.275]; P = 0.073). IL-33 was not associated with carotid plaque or vBMD/microstructure. In conclusion, plasma sST2 levels were independently correlated with both carotid plaque and compromised cortical vBMD/microstructure in PsA patients. IL-33/ST2 axis may be a link between accelerated atherosclerosis and osteoporosis in PsA. PMID:27554830

  10. Validity and reliability of the Dutch adaptation of the Psoriatic Arthritis Quality of Life (PsAQoL Questionnaire.

    Freke Wink

    Full Text Available OBJECTIVE: The Psoriatic Arthritis Quality of Life (PsAQoL questionnaire is a disease- specific instrument developed to measure quality of life (QoL in patients with psoriatic arthritis (PsA. The aim of this study was to translate the measure into Dutch and to determine its psychometric properties. METHOD: Translation of the original English PsAQoL into Dutch was performed by bilingual and lay panel. Ten field-test interviews with PsA patients were performed to assess face and content validity. In total, 211 PsA patients were included in a test-retest postal survey to investigate the reliability and construct validity of the Dutch adaptation of the PsAQoL. The PsAQoL, Health Assessment Questionnaire (HAQ and Skindex-17 were administered on two different occasions approximately two weeks apart. RESULTS: The Dutch version of the PsAQoL was found to be relevant, understandable and easy to complete in only a few minutes. It correlated as expected with the HAQ (Spearman's ρ = 0.72 and the 2 subscales of the Skindex-17 (ρ = 0.40 for the psychosocial and ρ = 0.46 for the symptom scale. Furthermore, the measure had good internal consistency (Cronbach's α = 0.92 and test-retest reliability (ρ = 0.89. The PsAQoL was able to define groups of patients based on self-reported general health status, self-reported severity of PsA and flare of arthritis. Duration of PsA did not influence PsAQoL scores. CONCLUSIONS: The Dutch version of the PsAQoL is a valid and reliable questionnaire suitable for use in clinical or research settings to asses PsA-specific QoL.

  11. Women and Psoriatic Disease

    ... and psoriatic arthritis. Email * Zipcode The National Psoriasis Foundation (NPF) is a non-profit organization with a mission to drive efforts to cure psoriatic disease and improve the lives of those affected. Copyright © 1996-2015 National Psoriasis Foundation/USA Bottom Menu About NPF About Us Annual ...

  12. MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINT IN DIFFERENTIAL DIAGNOSIS OF EARLY POLYARTICULAR PSORIATIC AND RHEUMATOID ARTHRITIS (STUDY DATA REMARKA

    Elena Yu Loginova

    2014-01-01

    Full Text Available Diagnosis of lesions of the spine and sacroiliac joints may be helpful in discrimination between early psoriatic arthritis (ePsA and early rheumatoid arthritis (eRA.Objective. To assess the significance of inflammatory back pain (IBP, HLA-B27, and active sacroiliitis (ASI confirmed by magnetic resonance imaging (MRI for differential diagnosis of polyarticular ePsA and eRA.Materials and Methods. The study included 29 patients with ePsA (13 males and 16 females, mean age 36.52 ± 11.27 years, average duration of the disease 13.03 ± 9.77 months and 25 patients with eRA (7 males and 18 females, mean age 52.68 ± 14.7 years, average duration of the disease 4.0 ± 1.72 months. Presence of IBP (according to the ASAS criteria and HLA-B27 were assessed (in 27 patients with PsA and in 20 patients with RA; ASI signs were assessed based on the MRI data (bone marrow edema/osteitis. DAS, DAS28, M ± SD, Fisher's exact test, t-test, χ2, the Yule coefficients of association (Q: level from -1 to +1 and Phi were calculated; differences were considered to be statistically significant at p <0.05.Results. In patients with ePsA, ASI was detected by MRI significantly more frequently than in patients with eRA (41.4% and 12% of cases respectively, p < 0.016. No correlation between the presence of ASI and DAS28 was observed in both groups. In the ePsA group, IBP was detected in 17 patients (58.6%; it was long-term in 10 (58.8% of the patients and episodic – in 7 (41.2% patients. Back pain with mechanical rhythm was observed in 3 (12% patients with eRA. HLA-B27 was detected in 9 (33.3% of 27 patients with ePsA and in 3 (15% of 20 patients with eRA (p < 0.014. In patients with ePsA, a very high level of association between ASI and IBP (Q = 0.91, Phi = 0.56; p < 0.003 and a high level of association between ASI and HLA-B27 (Q = 0.75, Phi = 0.56; p < 0.039 were detected. MRI showed no association between the presence of HLA-B27 and ASI signs in patients with RA

  13. [Development of mesangial immunoglobulin IgA glomerulonephritis and p-ANCA positivity in a patient with psoriatic arthritis].

    Nazzaro, Paola; Battaglia, Ruggiero; D'Altri, Christian; Marangi, Anna Lisa; Perniola, Mariantonietta; Rodio, Angela; De Padova, Francesco

    2016-01-01

    Tumor necrosis factor (TNF) inhibitors are widely used for the treatment of various rheumatic diseases. These agents may lead to development of systemic autoimmune diseases and renal complications. We report a patient with psoriatic arthritis and renal failure treated with two TNF inhibitors (Etanercept and then Adalimumab). After this treatment he developed proteinuria with nephrotic syndrome. A renal biopsy was performed highlighting GN with mesangial IgA deposits. Then he developed p-ANCA positivity. Following that, etanercept and adalimumab were stopped and a treatment by corticosteroids was initiated, but renal function decreased. Currently the patient is treated by haemodialysis. In our patient, the pathogenic role for anti-TNF therapy is suggested by the close temporal relationship with development of glomerular disease and by the improvement in proteinuria after drug withdrawal. However, the patient was treated once more with TNF agents, so he developed end stage renal disease. PMID:27067220

  14. Association of Psoriatic Disease With Uveitis

    Egeberg, Alexander; Khalid, Usman; Gislason, Gunnar Hilmar;

    2015-01-01

    IMPORTANCE: Psoriasis, psoriatic arthritis, and uveitis are inflammatory disorders with significant overlap in their inflammatory pathways. Limited evidence is available about the relationship between psoriatic disease and uveitis. OBJECTIVE: To investigate the potential bidirectional relationship...... between psoriatic disease, including psoriasis and psoriatic arthritis, and uveitis. DESIGN, SETTING, AND PARTICIPANTS: We performed a nationwide cohort study of the Danish population from January 1, 1997, through December 31, 2011. We included 74,129 Danish patients with psoriasis who were 18 years or......, 2015. EXPOSURES: Diagnosis of mild or severe psoriasis or psoriatic arthritis for uveitis risk and diagnosis of uveitis for the risk for psoriasis or psoriatic arthritis. MAIN OUTCOMES AND MEASURES: Diagnosis of uveitis, mild psoriasis, severe psoriasis, or psoriatic arthritis. We calculated incidence...

  15. Novel approach to utilizing electronic health records for dermatologic research: developing a multi-institutional federated data network for clinical and translational research in psoriasis and psoriatic arthritis.

    Armstrong, April W; Reddy, Shalini B; Garg, Amit

    2012-05-01

    The implementation of Electronic Health Records (EHR) in the United States has created new opportunities for research using automated data extraction methods. A large amount of information from the EHR can be utilized for clinical and translational research. To date, a number of institutions have the capability of extracting clinical data from EHR to create local repositories of de-identified data amenable to research queries through the Informatics for Integrated Biology and the Bedside (i2b2) platform. Collaborations among institutions sharing a common i2b2 platform hold exciting opportunities for research in psoriasis and psoriatic arthritis. With the automated extraction of patient-level data from multiple institutions, this novel informatics network has the ability to address high-priority research questions. With commitment to high-quality data through applied algorithms for cohort identification and validation of outcomes, the creation of Psoriasis and Psoriatic Arthritis Integrated Research Data Network (PIONEER) will make a significant contribution to psoriasis and psoriatic arthritis research. PMID:22630572

  16. The Psoriatic Arthritis Impact of Disease 12-item questionnaire: equivalence, reliability, validity, and feasibility of the touch-screen administration versus the paper-and-pencil version

    Salaffi F

    2016-04-01

    Full Text Available Fausto Salaffi,1 Marco Di Carlo,1 Marina Carotti,2 Sonia Farah,3 Marwin Gutierrez1,4 1Rheumatology Department, Polytechnic University of Marche, 2Radiology Department, Polytechnic University of Marche, 3DII, Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy; 4Musculoskeletal Department, National Rehabilitation Institute, Mexico City, Mexico Background: Over the last few years, there has been a shift toward a more patient-centered perspective of the disease by adopting patient-reported outcomes. Touch-screen formats are increasingly being used for data collection in routine care and research. Objectives: The aim of this study is to examine the equivalence, reliability, validity and respondent preference for a computerized touch-screen version of the Psoriatic Arthritis Impact of Disease 12-item (PsAID-12 questionnaire in comparison with the original paper-and-pencil version, in a cohort of patients with psoriatic arthritis (PsA. Methods: One hundred and fifty-nine patients with PsA completed both the touch screen- and the conventional paper-and-pencil administered PsAID-12 questionnaire. Agreement between formats was assessed by intraclass correlation coefficients. Spearman’s rho correlation coefficient was used to test convergent validity of the touch screen format of PsAID-12, while receiver operating characteristic curve analysis was performed to test discriminant validity. In order to assess the patient’s preference, the participants filled in an additional questionnaire. The time taken to complete both formats was measured. Results: A high concordance between the responses to the two modes of the PsAID-12 tested was found, with no significant mean differences. Intraclass correlation coefficients between data obtained for touch-screen and paper versions ranged from 0.801 to 0.962. There was a very high degree of correlation between the touch-screen format of PsAID-12 and composite disease activity

  17. Estimation of the sensitivity and specificity of ASAS criteria for peripheral spondyloarthritis in patients with early psoriatic arthritis

    E. Yu. Loginova

    2015-01-01

    Full Text Available Objective: to estimate the sensitivity and specificity of ASAS (Assessment of Spondyloarthritis International Society criteria for peripheral spondyloarthritis (SpA in patients with early psoriatic arthritis (ePsA.Subjects and methods. Examinations was made in 45 patients (17 men and 28 women with ePsA meeting the CASPAR (ClASsification criteria for Psoriatic ARthritis criteria (mean age, 37 years; disease duration, 1 year and in 20 patients (9 men and 11 women with signs of peripheral SpA meeting the ESSG (European Spondyloarthropathy Study Group criteria (mean age, 23 years; disease duration, 2.25 years; control group. The investigators estimated 78/76 tender/swollen joints and enthuses using MASES (Maastricht Ankylosing Spondylitis Enthesitis Score and assessed the presence of inflammatory spinal pain according to the ASAS criteria, psoriasis, uveitis, inflammatory bowel diseases, genitourinary and/or enteric infections, and a family history of SpA. They also performed X-ray studies of the hand and distal portions of the foot and pelvis and graded sacroilitis using the Kellgren scores. HLA-B27, C-reactive protein, and erythrocyte sedimentation rate were determined. The sensitivity/specificity, likelihood ratios, and clinical value of criteria were calculated.Results. 41/4 and 31/14 patents with ePsA met/unmet Criteria Sets I and II. The sensitivity/specificity of Sets I and II was 91.1/10% and 68.8/95%, respectively. One patient with ePsA and two patients in the control group did not meet one of the sing sets. The total sensitivity/specificity was 97.8/10%. In the control group, the sensitivity/specificity of Sets I and II was 91.1/100% and 68.8/100%, respectively. For ePsA, the positive likelihood ratio proved to be high for Set II (13.78% and low for Set I (1.01.Conclusion. ASAS Criteria Set I for peripheral SpA is of low value in identifying ePsA and Sign Set II shows a high value in diagnosing ePsA as it includes the major clinical

  18. The Clinical and Cost Effectiveness of Ustekinumab for the Treatment of Psoriatic Arthritis: A Critique of the Evidence.

    O'Connor, Joanne; Rice, Stephen; Smith, Alison; Rodgers, Mark; Lopez, Rocio Rodriguez; Craig, Dawn; Woolacott, Nerys

    2016-04-01

    The National Institute for Health and Care Excellence (NICE) invited the manufacturer of ustekinumab (Janssen) to submit evidence for the clinical and cost effectiveness of ustekinumab for the treatment of active psoriatic arthritis (PsA) as part of the Institute's single technology appraisal (STA) process. The Centre for Reviews and Dissemination and the Centre for Health Economics Technology Appraisal Group at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the ERG review of the manufacturer's evidence submission, and summarises the NICE Appraisal Committee's final guidance (TA340) issued in June 2015. The manufacturer presented evidence on ustekinumab for two patient populations: (1) a tumour necrosis factor-α (TNFα)-inhibitor-naïve population who had not previously received any TNFα inhibitors (biologics); and (2) a TNFα-inhibitor-exposed population who had previously received at least one TNFα inhibitor. The clinical evidence for ustekinumab was derived from two randomised controlled trials (PSUMMIT 1 and 2), in which a total of 927 patients who had not responded to previous disease-modifying antirheumatic drug therapies received ustekinumab 45 mg, ustekinumab 90 mg, or placebo. These data suggested that ustekinumab is more effective than placebo over 16-24 weeks in terms of both joint and skin response. In the absence of head-to-head comparisons between different biologics (ustekinumab, golimumab, etanercept, adalimumab and infliximab), the manufacturer conducted a network meta-analysis to estimate the relative efficacy of treatments for the TNFα-inhibitor-naïve population. Results of this analysis were marked as academic in confidence and are therefore not reported. For the TNFα-inhibitor-exposed population, the clinical analysis was limited to ustekinumab versus conventional management only, and was based on a subgroup of 180 patients from the PSUMMIT 2 trial

  19. RHEUMATOID FACTOR AND ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODIES IN PATIENTS WITH PSORIATIC ARTHRITIS

    V. V. Badokin

    2011-06-01

    Full Text Available Objective: to define the clinical value of rheumatoid factor (RF and anti-cyclic citrullinated peptide antibodies (anti-CCP in early psori- atic arthritis (PA. Subjects and methods. Fifty-six patients (32 females and 24 males with early PA with a mean duration of 12±6.7 months were studied. The examinees' age ranged from 18 to 76 years (mean age 44±15.5 years. Mean psoriasis duration was 12.5±2.2 years. RF IgM was determined using a high-sensitive nephelometric method on a BN Pro-Spec analyzer (Siemens, Germany and serum anti-CCP concentra- tions were measured by immunochemiluminescence on a COBAS e411 analyzer (Roche, Switzerland. Group 1 included 10 patients with anti-CCP and/or RF (a study group; Group 2 comprised 46 patients without anti-CCP and RF (a control group. Results. There was anti-CCP in 7 (12.5% of the patients with early PA, RF in 8 (14.3%, both of them in 5 (9%. The study group had a severer course of PA accompanied by polyarthritis, inflamed distal interphalangeal joints, axial arthritis, dactylitis, enthesitis, and, in some cases spondylitis and sacroiliitis. In groups 1 and 2, the number of tender joints was 17.6±4 and 10±1.5, respectively (p = 0.04; that of swollen ones, 12.6±1.5 and 7.0±1.1 (p = 0.02; DAS28 index, 5.9±1.7 and 4.5±1.5 (p = 0.02; ESR, 34.5±5.9 and 22±2.3 (p = 0.04, high-sensitive C reactive protein, 70±25.3 and 24.9±5.0 (p = 0.06; and Sharp ratio, 68.7±14.3 and 21.3±3.8 (p < 0.004. Conclusion. In patients with early PA, anti-CCP and RF were encountered with an approximately equal frequency; at the same time, they were associated with polyarthritis, high disease activity, and an erosive process. 

  20. Golimumab therapy-induced indicators of X-ray inflammation progression and magnitude according to magnetic resonance imaging evidence in patients with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis

    Aleksandr Viktorovich Smirnov

    2013-01-01

    Full Text Available The paper gives data on the progression of X-ray and magnetic resonance imaging changes in the hand and foot joints of patients with rheumatoid arthritis and psoriatic arthropathy and in the axial skeleton of those with ankylosing spondylitis when golimumab is used. Golimumab therapy is shown to retard the progression of structural changes in the peripheral joints and vertebral column. There is a significant correlation between magnetic resonance imaging evidence and blood C-reactive protein concentrations.

  1. Uso do abatacepte em uma paciente com artrite psoriásica Use of the abatacept in a patient with psoriatic arthritis

    Carlos Ewerton Maia Rodrigues

    2010-06-01

    Full Text Available Artrite psoriásica (AP é uma artrite inflamatória soronegativa de causa desconhecida. Classicamente, a AP apresenta cinco formas clínicas, sendo a oligoartrite assimétrica a mais comum. Descrevemos o caso de uma paciente com AP refratária às drogas modificadoras da doença, que evoluiu com hepatite medicamentosa após quimioprofilaxia com isoniazida, administrada previamente ao tratamento com anti-TNFα. Em virtude do risco de ativação de tuberculose (TB latente pela administração de anti-TNFα, da hepatotoxicidade decorrente do tratamento da TB, e baseado no fato de o tratamento da AP se assemelhar ao da artrite reumatoide, optou-se pelo tratamento empírico com abatacepte. Aproximadamente vinte dias após a segunda dose do biológico, a paciente evoluiu com importante melhora clínica, resolução da artrite, regressão das lesões de pele e melhora da anemia e das provas de atividade inflamatória.Psoriatic arthritis (PA is an inflammatory seronegative arthritis of unknown origin. Classically, PA has five clinical forms, and asymmetric oligoarthritis is the most common type. We describe the case of a patient with PA refractory to disease-modifying drugs, who developed drug-induced hepatitis after chemoprophylaxis with isoniazid, administered prior to the treatment with an anti-TNFα agent. Due to the risk of activating latent tuberculosis with the administration of anti-TNFα and hepatotoxicity onset caused by the TB treatment and based on the fact that the treatment of PA is similar to the treatment of rheumatoid arthritis, a decision was made to use the empirical treatment with abatacept. Approximately twenty days after the second infusion of the drug, the patient showed clinical improvement, resolution of the arthritis, almost complete disappearance of the skin lesions and improvement of anemia and inflammatory tests.

  2. Involvement of the Inconstant Bursa of the Fifth Metatarsophalangeal Joint in Psoriatic Arthritis: A Clinical and Ultrasonographic Study

    Giovanni Ciancio

    2014-01-01

    Full Text Available Objective. To evaluate the involvement of the bursa located next to the head of the 5th metatarsal bone in patients with psoriatic arthritis (PsA in comparison with the other seronegative spondyloarthritis (SpA. Methods. All patients with PsA seen during a period of 24 months were enrolled. The control group included healthy subjects and patients with the other SpA. All subjects underwent clinical and ultrasound (US examination of the lateral surface of the 5th metatarsal. Results. 150 PsA patients (88 M; 62 F, 172 SpA (107 M; 65 F, and 95 healthy controls (58 M; 37 F were evaluated. Based on clinical and US evaluation, bursitis was diagnosed in 17/150 (11.3% PsA patients but in none of the SpA (P<0.0001 and healthy (P=0.0002 controls. In detecting bursitis, US was more sensitive than clinical examination, although the difference did not reach statistical significance (P=0.09. Conclusion. The bursa of the 5th metatarsophalangeal joint appears to be involved in PsA more frequently than by chance. If confirmed by other studies, this finding could be considered as a distinctive clinical sign of PsA, useful for differential diagnosis with the other SpA. In asymptomatic patients, US proved to be more sensitive in the detection of bursitis.

  3. Safety profiles and efficacy of infliximab therapy in Japanese patients with plaque psoriasis with or without psoriatic arthritis, pustular psoriasis or psoriatic erythroderma: Results from the prospective post-marketing surveillance.

    Torii, Hideshi; Terui, Tadashi; Matsukawa, Miyuki; Takesaki, Kazumi; Ohtsuki, Mamitaro; Nakagawa, Hidemi

    2016-07-01

    A large-scale prospective post-marketing surveillance was conducted to evaluate the safety and efficacy of infliximab in Japanese patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis and psoriatic erythroderma. This study was conducted in all psoriasis patients treated with infliximab after its Japanese regulatory approval. Infliximab was administrated at 5 mg/kg at weeks 0, 2 and 6, and every 8 weeks thereafter. Patients were serially enrolled and observed for 6 months to evaluate the safety and efficacy. The safety and efficacy were evaluated in 764 and 746 patients, respectively. Incidences of any and serious adverse drug reactions were 22.51% and 6.94%, respectively, and those of any and serious infusion reactions were 6.15% and 1.31%, respectively, which were comparable with the results in the post-marketing surveillance with 5000 rheumatoid arthritis patients in Japan. Major adverse drug reactions during the follow-up period were infections (5.10%) including pneumonia, cellulitis and herpes zoster, however, no tuberculosis was observed. The safety profiles were equivalent, regardless of the psoriasis types. No new safety problems were identified. The response rates on global improvement and median improvement rate of Psoriasis Area and Severity Index in all patients were 88.0% and 85.0%, respectively. Of note, the efficacy was equivalent for each psoriasis type as well as for each body region. Infliximab was also effective in pustular psoriasis symptoms, joint symptoms and nail psoriasis, as well as improvement of quality of life. Infliximab was confirmed to be highly effective and well tolerated in treating refractory psoriasis, including pustular psoriasis and psoriatic erythroderma. PMID:26704926

  4. Is the HLA B27 genotype a risc faktor for psoriatic arthritis and psoriasis vulgaris?

    Zerrin Öğretmen; Merve Meliha Hız; Fatma Sılan; Şule Koşar; Öztürk Özdemir

    2014-01-01

    Backround and Design: Psoriasis is a common inflammatory dermatological disease which may be complicated with joint involvement. It has been suggested that there is an association between HLA-B27 positivity and early onset psoriasis. The purpose of the current study was to investigate the incidence of HLA-B27 positivity in psoriasis patients with arthritis. Materials and Methods: In a total of 96 patients with psoriasis, age of onset, family history, and Psoriasis Area and Severity Index (...

  5. Validity of Diagnostic Codes and Prevalence of Physician-Diagnosed Psoriasis and Psoriatic Arthritis in Southern Sweden – A Population-Based Register Study

    Löfvendahl, Sofia; Theander, Elke; Svensson, Åke; Steen Carlsson, Katarina; Englund, Martin; Petersson, Ingemar

    2014-01-01

    Objective To validate diagnostic codes for psoriasis and psoriatic arthritis (PsA) and estimate physician-diagnosed prevalence of psoriasis and PsA in the Skåne region, Sweden. Methods In the Skåne Healthcare Register (SHR), all healthcare consultations are continuously collected for all inhabitants in the Skåne region (population 1.2 million). During 2005–2010 we identified individuals with ≥1 physician-consultations consistent with psoriasis (ICD-10). Within this group we also identified th...

  6. Early treatment with addition of low dose prednisolone to methotrexate improves therapeutic outcome in severe psoriatic arthritis

    Vikram K Mahajan

    2013-01-01

    Full Text Available Psoriatic arthritis (PsA is increasingly being recognized to cause progressive joint damage and disability. PsA unresponsive to non-steroidal anti-inflammatory drugs (NSAIDs, the conventional first-line choice of treatment, is usually managed with disease-modifying antirheumatic drugs (DMARDs especially methotrexate. An 18-year-old HIV-negative male had progressively severe PsA of 4-month duration that was nearly confining him to a wheel chair. He did not respond to multiple NSAIDs, alone or in combination with methotrexate (15 mg/week, given for 4 weeks. Addition of prednisolone (10 mg on alternate days controlled his symptoms within a week. The NSAIDs could be withdrawn after 4 weeks as the treatment progressed. The doses were tapered for methotrexate (5 mg/week and prednisolone (2.5 mg on alternate days every 8 weekly subsequently during 15 months of follow-up without recurrence/deformities or drug toxicity. For years, the use of corticosteroids in psoriasis has been criticized for their propensity to exacerbate the skin disease on withdrawal. However, monitored use of corticosteroids, even in low doses, combined with DMARDs may be a good therapeutic option in early stage of the PsA rather than ′steroid rescue′ later. This will help in early control of joint inflammation, prevent joint damage and maintain long-term good functional capacity and quality of life. This may be useful when the cost or availability of biologics precludes their use. However, we discourage the use of corticosteroids as monotherapy.

  7. Gold in psoriatic arthopathy.

    Richter, M B; Kinsella, P; Corbett, M

    1980-01-01

    It has been suggested that gold is not effective in psoriatic arthropathy. We did not agree and therefore did a retrospective study of 98 patients. Gold had been given to 27 and was effective in 22, 14 of whom are still receiving it. The incidence of side effects was low and comparable to those in rheumatoid arthritis.

  8. Change in CD3 positive T-cell expression in psoriatic arthritis synovium correlates with change in DAS28 and magnetic resonance imaging synovitis scores following initiation of biologic therapy--a single centre, open-label study.

    Pontifex, Eliza K

    2011-01-01

    With the development of increasing numbers of potential therapeutic agents in inflammatory disease comes the need for effective biomarkers to help screen for drug efficacy and optimal dosing regimens early in the clinical trial process. This need has been recognized by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group, which has established guidelines for biomarker validation. To seek a candidate synovial biomarker of treatment response in psoriatic arthritis (PsA), we determined whether changes in immunohistochemical markers of synovial inflammation correlate with changes in disease activity scores assessing 28 joints (ΔDAS28) or magnetic resonance imaging synovitis scores (ΔMRI) in patients with PsA treated with a biologic agent.

  9. Cytokine profile in psoriatic arthritis: search for relationships with inflammation and blood rheological properties

    Tat'yana Viktorovna Korotaeva

    2011-01-01

    Conclusion. The enhanced clinical and laboratory activity of PSA is attended by the systemic activation of immunological mediators of inflammation and neoangiogenesis and by impaired blood rheological properties, which supports the interaction of these factors in the immunopathogenesis of the diseases.

  10. Serum C-reactive protein levels in Japanese patients with psoriasis and psoriatic arthritis: Long-term differential effects of biologics.

    Asahina, Akihiko; Umezawa, Yoshinori; Yanaba, Koichi; Nakagawa, Hidemi

    2016-07-01

    Psoriasis has been shown to accompany systemic inflammation. We aimed to examine serum C-reactive protein (CRP) levels in Japanese psoriatic patients, and to elucidate their long-term as well as short-term changes by treatment with different biologics. A retrospective study was conducted in those who initiated and successfully continued the treatment for up to 24 months with either infliximab, adalimumab or ustekinumab, at the psoriasis special clinic of Jikei University School of Medicine. A total of 212 patients were included, 171 with plaque-type psoriasis (PsV) and 41 with psoriatic arthritis (PsA). A statistically significant elevation of CRP values was found in the group with a Psoriasis Area and Severity Index (PASI) of 12 or more compared with the PASI of less than 12 for both PsV and PsA. The CRP-positive patients had a higher proportion of PsA compared with the CRP-negative patients, and they had significantly higher PASI scores. Serum CRP values declined as early as at 3 months after systemic treatment with biologics. Tumor necrosis factor (TNF)-α antagonists did lead to a notable and sustained CRP decline up to 24 months. Infliximab showed rapid decline, while CRP decline by adalimumab treatment was time-dependent. The interleukin-12/23 p40 antagonist, ustekinumab, appeared to be less potent than TNF-α antagonists in stabilizing CRP values at low levels despite good control of cutaneous lesions. In conclusion, serum CRP levels can be used to assess disease severity in Japanese psoriatic patients as a marker of systemic inflammation. TNF-α antagonists may be more beneficial than ustekinumab in this regard. PMID:26704718

  11. Cartilage collagen type II seromarker patterns in axial spondyloarthritis and psoriatic arthritis

    Munk, Heidi Lausten; Gudmann, Natasja Staehr; Christensen, Anne Friesgaard;

    2016-01-01

    disease activity measures and HLA-B27 typing. The procollagen IIA N-terminal peptide (PIIANP) and a matrix metalloproteinase-generated type II collagen fragment (C2M) were quantified in serum by ELISA. C2M was higher in SpA than in controls, 0.41 versus 0.36 ng/ml (p = 0.004), while PIIANP did not differ......-smokers, 0.43 ng/ml (p = 0.02), while PIIANP was higher in HLA-B27 positive, 2312 ng/ml versus negative patients, 2021 ng/ml (p = 0.03). In PsA, PIIANP and C2M did not differ between patients and controls, but PIIANP was elevated in patients not receiving DMARDs, 2726 ng/ml. In PsA, PIIANP and C2M did not...... differ according to smoking and HLA-B27. Cartilage degradation assessed by C2M is increased in SpA irrespective of treatment but not in PsA. Cartilage synthesis reflected by PIIANP is increased in untreated SpA and PsA. PIIANP correlates with CRP in SpA while not in PsA. In DMARD-naïve SpA but not in Ps...

  12. Evaluation of Clinical and Ultrasonographic Parameters in Psoriatic Arthritis Patients Treated with Adalimumab: A Retrospective Study

    M. Teoli

    2012-01-01

    Full Text Available Objectives. The aim of this study was to evaluate clinical and US-PD parameters in PsA during adalimumab treatment. Methods. A retrospective study has been conducted in forty patients affected by moderate-to-severe peripheral PsA. Clinical, laboratory, and US-PD evaluations were performed at baseline, after 4, 12, and 24 weeks of treatment. They included erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, visual analogue scale (VAS, Health Assessment Questionnaire (HAQ modified for Spondyloarthritis, Psoriasis Area Severity Index (PASI score, the 28-joint Disease Activity Score (DAS 28, and US-PD assessment. US-PD findings were scored according to a semiquantitative scale (ranging 0–3 for synovial proliferation (SP, joint effusion (SE, bone erosions (BE, and PD. Results. Data obtained for clinical, laboratory findings and US-PD evaluation showed statistical significant improvement in all the measures performed except for BE. A significant parallel decrease in SE, SP, and PD values were demonstrated. Conclusion. This study demonstrated that US-PD is a valid technique in monitoring the response to adalimumab in moderate-to-severe PsA.

  13. Living with Psoriatic Arthritis

    ... on a biologic, to compensate for the biologic's lag time, and then transition you off the pain ... text: Please join us at one of our educational events designed for health care providers. Continuing Education ...

  14. Hair-zinc levels determination in Algerian psoriatics using Instrumental Neutron Activation Analysis (INAA)

    Psoriasis is a multifactorial skin disease with an unknown etiology. Zinc has a positive impact on psoriasis. The aim of this study is to determine hair-zinc concentration in Algerian psoriatics. 58 psoriatics and 31 normal controls of both genders were selected. Hair zinc levels were determined using Instrumental Neutron Activation Analysis technique (INAA). Student's t-test and One-Way ANOVA were applied. The average zinc concentration for controls and patients were 152±53 μg/g and 167±52 μg/g respectively. They are not significantly different (p>0.05). Zn concentration for males and females controls and patients were 171±27 μg/g, 151±37 μg/g and 145±59 μg/g, 178±58 μg/g respectively. However, for females we have observed a significant difference (p<0.05). - Highlights: ► Psoriasis is a multifactorial skin disease with an unknown etiology. ► About 2–5% of global population in the world suffers from psoriasis. ► The aim of this study is to determine hair-zinc concentration in Algerian psoriatics. ► The average zinc concentration for controls and patients were 152±53 μg/g and 167±52 μg/g respectively.

  15. Rheumatoid Arthritis Educational Video Series

    Full Text Available ... of Body Weight in Osteoarthritis Educational Videos for Patients Rheumatoid Arthritis Educational Video Series Psoriatic Arthritis 101 ... Patient to an Adult Rheumatologist Drug Information for Patients Arthritis Drug Information Sheets Benefits and Risks of ...

  16. Radiological aspects of psoriatic osteoarthropathia

    Psoriatic osteoarthropathia is a disease of the joints, spine, and bones. It belongs to the category of ''seronegative spondarthritis'', the prototype of which is ankylosing spondylitis. Contrary to earlier assumptions, morphological changes in the X-ray picture are frequent if the joints (psoriatic arthritis) or axial skeleton (psoriatic spondylitis) are affected. Radiographic signs are listed and scintigraphic findings discussed. The morphological changes in the X-ray picture are characteristic, even without psoriatic lesions of the skin. Sacro-iliac changes in the axial skeleton are frequent. In other parts of the skeleton, typical parasyndesmophytes are slightly less frequent, and changes as in ankylosing spondylitis may occur. The diagnosis is easier with whole-body scintiscanning as this technique is able to detect early changes which are not noticeable clinically or radiologically. (orig.)

  17. Radiological aspects of psoriatic osteoarthropathia

    Ellegast, H.H.; Haydl, H.; Petershofer, H.; Prohaska, E.

    1984-03-01

    Psoriatic osteoarthropathia is a disease of the joints, spine, and bones. It belongs to the category of ''seronegative spondarthritis'', the prototype of which is ankylosing spondylitis. Contrary to earlier assumptions, morphological changes in the X-ray picture are frequent if the joints (psoriatic arthritis) or axial skeleton (psoriatic spondylitis) are affected. Radiographic signs are listed and scintigraphic findings discussed. The morphological changes in the X-ray picture are characteristic, even without psoriatic lesions of the skin. Sacro-iliac changes in the axial skeleton are frequent. In other parts of the skeleton, typical parasyndesmophytes are slightly less frequent, and changes as in ankylosing spondylitis may occur. The diagnosis is easier with whole-body scintiscanning as this technique is able to detect early changes which are not noticeable clinically or radiologically.

  18. Arthritis in psoriasis.

    Green, L.; Meyers, O L; Gordon, W.; Briggs, B

    1981-01-01

    A group of 61 unselected patients with psoriasis attending a dermatology clinic were studied to determine the prevalence of psoriatic arthritis. On defined criteria arthritis was present in 41.6%. Peripheral arthritis was present in 15.5%, and sacroiliitis in 43%. A strong association of distal interphalangeal arthritis with psoriasis and nail dystrophy was confirmed. Tissue typing showed a strong association of B23, 17, in Caucasoid psoriatics, while the haplotype A1/B8 was increased in mixe...

  19. Periarticular uptake of /sup 99m/technetium diphosphonate in psoriatics. Correlation with cutaneous activity

    Namey, T.C. (Medical Univ. of South Carolina, Charleston); Rosenthall, L.

    1976-01-01

    The periarticular uptake of /sup 99m/technetium-labeled diphosphonate (/sup 99m/TcDP) was compared in 12 patients hospitalized for psoriasis and in 12 hospitalized for other dermatoses not associated with arthropathy. The 12 patients with psoriasis had recent onset disease of less than 5 years duration; neither group had historical or clinical evidence of arthritis. All psoriatics had markedly abnormal scans with symmetrically increased periarticular uptake about the imaged joints. None of the controls had similar findings. In 4 patients scanned with /sup 99m/technetium-pertechnetate within 24 hours of their /sup 99m/TcDP scan, no evidence of inflammatory synovitis was found. Three of these patients were serially imaged with /sup 99m/TcDP at intervals of 2 weeks to 3 months after their initial study, when obvious clinical improvement in their psoriasis was apparent. Improvement in the radionuclide joint images was demonstrated in some of the patients, but none reverted to normal during the study period. In light of recent evidence for the preferential binding of /sup 99m/TcDP to immature collagen, it is suggested that psoriasis may represent a generalized, but uncharacterized, collagen disorder present in bone as well as skin, linking the cutaneous disease with the potential for arthropathy.

  20. Periarticular uptake of /sup 99m/technetium diphosphonate in psoriatics. Correlation with cutaneous activity

    The periarticular uptake of /sup 99m/technetium-labeled diphosphonate (/sup 99m/TcDP) was compared in 12 patients hospitalized for psoriasis and in 12 hospitalized for other dermatoses not associated with arthropathy. The 12 patients with psoriasis had recent onset disease of less than 5 years duration; neither group had historical or clinical evidence of arthritis. All psoriatics had markedly abnormal scans with symmetrically increased periarticular uptake about the imaged joints. None of the controls had similar findings. In 4 patients scanned with /sup 99m/technetium-pertechnetate within 24 hours of their /sup 99m/TcDP scan, no evidence of inflammatory synovitis was found. Three of these patients were serially imaged with /sup 99m/TcDP at intervals of 2 weeks to 3 months after their initial study, when obvious clinical improvement in their psoriasis was apparent. Improvement in the radionuclide joint images was demonstrated in some of the patients, but none reverted to normal during the study period. In light of recent evidence for the preferential binding of /sup 99m/TcDP to immature collagen, it is suggested that psoriasis may represent a generalized, but uncharacterized, collagen disorder present in bone as well as skin, linking the cutaneous disease with the potential for arthropathy

  1. The comparison of efficacy of different imaging techniques (conventional radiography, ultrasonography, magnetic resonance) in assessment of wrist joints and metacarpophalangeal joints in patients with psoriatic arthritis

    Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. The rheumatoid factor is characteristically absent in the serum of PsA patients. Etiology of the disease is still unclear but a number of genetic associations have been identified. Inheritance of the disease is multilevel and the role of environmental factors is emphasized. Immunology of PsA is also quite complex. Inflammation is caused by immunological reactions leading to a release of kinins. Destructive changes in bones usually appear after a few months from the onset of clinical symptoms. PsA typically involves joints of the axial skeleton with an asymmetrical patern. The spectrum of symptoms includes inflammatory changes in attachments of articular capsules, tendons, and ligaments to bone surface. The disease can have a diverse clinical course but usually manifests as oligoarthritis. Imaging plays an important role in the diagnosis of PsA. Classical radiography has been used for this purpose for over a hundred years. It allows to identify late stages of the disease, when bone tissue is affected. In the last 20 years however many new imaging modalities, such as ultrasonography (US), computed tomography (CT) and magnetic resonance (MR), have been developed and became important diagnostic tools for evaluating rheumatoid diseases. They enable the assessment and monitoring of early inflammatory changes. As a result, patients have earlier access to modern treatment and thus formation of destructive changes in joints can be markedly delayed or even avoided

  2. Radiological changes in psoriatic arthropathy

    Mittal R

    1997-01-01

    Full Text Available Forty-one cases of psoriatic arthropathy (PA were selected for the study. Biopsy, x rays of hands, feet, cervical and dorsolumbar spine, sacro-iliac joints and routine investigations were carried out. Clinical diagnosis of psoriasis was confirmed histopathologically. Radiological changes in order of frequency were most common in feet - 26/41, hands - 24/41, sacro-iliac joints -11/41, dorso-lumbar spine - 4/41 and cervical spine - 3/41. Distinctive radiological changes were seen in psoriatic arthritis.

  3. Screening of flavonoid “quercetin” from the rhizome of Smilax china Linn. for anti-psoriatic activity

    Vijayalakshmi A; Ravichandiran V; Malarkodi Velraj; Nirmala S; Jayakumari S

    2012-01-01

    Objective: To assess anti-psoriatic activity of the methanol extract and the isolated flavonoid quercetin from the rhizome of Smilax china (S. china) Linn. Methods: Mouse tail test was used for the evaluation of anti-psoriatic activity. Methanol extract (100 and 200 mg/kg b.w.) and isolated flavonoid quercetin (25 and 50 mg/kg b.w.) were tested in Swiss albino mice. Parameters studied in the mouse tail test were changes in epidermal thickness and percentage orthokeratotic values. The anti-inflammatory role of the methanol extract and isolated flavonoid quercetin was evaluated using carrageenan-induced pleurisy in rats. In vitro antiproliferant assay on HaCaT cell lines was also carried out. Results: The isolated flavonoid quercetin from the rhizome of S. china produced significant orthokeratosis (P<0.01) in the mouse tail test. In epidermal thickness, a significant reduction with respect to control was observed in groups treated with retinoic acid and isolated flavonoid quercetin. The methanol extract (200 mg/kg) and isolated flavonoid quercetin (50 mg/kg) showed anti-inflammatory effect in terms of significant inhibition (P<0.001) in leukocyte migration. Maximum antiproliferant activity was shown by isolated flavonoid quercetin (IC50, 62.42±10.20 μg/mL). Conclusions: From the above data, the flavonoid quercetin shows significant orthokeratosis, anti-inflammatory and maximum antiproliferant activities. To our knowledge, this is the first report on the anti-psoriatic effect of the flavonoid quercetin which is promising for further investigations to prove its anti-psoriatic activity.

  4. Technetium-99m human immunoglobulin scintigraphy in psoriatic arthropathy: first results

    Preliminary results of this study reveal that 99mTc human immunoglobulin (HIG) scintigraphy demonstrates a typical premature pattern of extradermal psoriatic disease in digits indicative of the early stage of psoriatic arthritis. This pattern was also found in a rare case of psoriatic arthropathy without skin lesions. 99mTc-HIG scintigraphy appears to reveal the initial inflammatory characteristics of later bone lesions. In the advanced stage of psoriatic arthritis, 99mTc-MDP and 99mTc-HIG scans were found to be equally sensitive in the detection of the affected joints. Thus 99mTc-HIG scintigraphy seems to be useful in the early detection of psoriatic arthropathy and also in advanced psoriatic arthritis, as well as for the detection of psoriatic arthropathy without skin lesions. (orig./MG)

  5. Technetium-99m human immunoglobulin scintigraphy in psoriatic arthropathy: first results

    Stoeger, A. (Dept. of Radiodiagnostics, Univ. Hospital, Innsbruck (Austria)); Mur, E. (Dept. of Internal Medicine, Univ. Hospital, Innsbruck (Austria)); Penz-Schneeweiss, D. (Dept. of Dermatology, Univ. Hospital, Innsbruck (Austria)); Moncayo, R. (Dept. of Nuclear Medicine, Univ. Hospital, Innsbruck (Austria)); Decristoforo, C. (Dept. of Nuclear Medicine, Univ. Hospital, Innsbruck (Austria)); Riccabona, G. (Dept. of Nuclear Medicine, Univ. Hospital, Innsbruck (Austria)); Fridrich, L. (Dept. of Nuclear Medicine, Univ. Hospital, Innsbruck (Austria))

    1994-04-01

    Preliminary results of this study reveal that [sup 99m]Tc human immunoglobulin (HIG) scintigraphy demonstrates a typical premature pattern of extradermal psoriatic disease in digits indicative of the early stage of psoriatic arthritis. This pattern was also found in a rare case of psoriatic arthropathy without skin lesions. [sup 99m]Tc-HIG scintigraphy appears to reveal the initial inflammatory characteristics of later bone lesions. In the advanced stage of psoriatic arthritis, [sup 99m]Tc-MDP and [sup 99m]Tc-HIG scans were found to be equally sensitive in the detection of the affected joints. Thus [sup 99m]Tc-HIG scintigraphy seems to be useful in the early detection of psoriatic arthropathy and also in advanced psoriatic arthritis, as well as for the detection of psoriatic arthropathy without skin lesions. (orig./MG)

  6. Tailored treatment options for patients with psoriatic arthritis and psoriasis: review of established and new biologic and small molecule therapies.

    Elyoussfi, Sarah; Thomas, Benjamin J; Ciurtin, Coziana

    2016-05-01

    The diverse clinical picture of PsA suggests the need to identify suitable therapies to address the different combinations of clinical manifestations. This review aimed to classify the available biologic agents and new small molecule inhibitors (licensed and nonlicensed) based on their proven efficacy in treating different clinical manifestations associated with psoriasis and PsA. This review presents the level of evidence of efficacy of different biologic treatments and small molecule inhibitors for certain clinical features of treatment of PsA and psoriasis, which was graded in categories I-IV. The literature searches were performed on the following classes of biologic agents and small molecules: TNF inhibitors (adalimumab, etanercept, infliximab, golimumab, certolizumab), anti-IL12/IL23 (ustekinumab), anti-IL17 (secukinumab, brodalumab, ixekizumab), anti-IL6 (tocilizumab), T cell modulators (alefacept, efalizumab, abatacept, itolizumab), B cell depletion therapy (rituximab), phosphodiesterase 4 inhibitor (apremilast) and Janus kinase inhibitor (tofacitinib). A comprehensive table including 17 different biologic agents and small molecule inhibitors previously tested in psoriasis and PsA was generated, including the level of evidence of their efficacy for each of the clinical features included in our review (axial and peripheral arthritis, enthesitis, dactylitis, and nail and skin disease). We also proposed a limited set of recommendations for a sequential biologic treatment algorithm for patients with PsA who failed the first anti-TNF therapy, based on the available literature data. There is good evidence that many of the biologic treatments initially tested in psoriasis are also effective in PsA. Further research into both prognostic biomarkers and patient stratification is required to allow clinicians the possibility to make better use of the various biologic treatment options available. This review showed that there are many potentially new treatments that are

  7. Validity of diagnostic codes and prevalence of physician-diagnosed psoriasis and psoriatic arthritis in southern Sweden--a population-based register study.

    Sofia Löfvendahl

    Full Text Available OBJECTIVE: To validate diagnostic codes for psoriasis and psoriatic arthritis (PsA and estimate physician-diagnosed prevalence of psoriasis and PsA in the Skåne region, Sweden. METHODS: In the Skåne Healthcare Register (SHR, all healthcare consultations are continuously collected for all inhabitants in the Skåne region (population 1.2 million. During 2005-2010 we identified individuals with ≥1 physician-consultations consistent with psoriasis (ICD-10. Within this group we also identified those diagnosed with PsA. We performed a validation by reviewing medical records in 100 randomly selected cases for psoriasis and psoriasis with PsA, respectively. Further, we estimated the pre- and post-validation point prevalence by December 31, 2010. RESULTS: We identified 16 171 individuals (psoriasis alone: n = 13 185, psoriasis with PsA n = 2 986. The proportion of ICD-10 codes that could be confirmed by review of medical records was 81% for psoriasis and 63% for psoriasis with PsA with highest percentage of confirmed codes for cases diagnosed ≥2 occasions in specialized care. For 19% and 29% of the cases respectively it was not possible to determine diagnosis due to insufficient information. Thus, the positive predicted value (PPV of one ICD-10 code for psoriasis and psoriasis with PsA ranged between 81-100% and 63-92%, respectively. Assuming the most conservative PPV, the post-validation prevalence was 1.23% (95% CI: 1.21-1.25 for psoriasis (with or without PsA, 1.02% (95% CI: 1.00-1.03 for psoriasis alone and 0.21% (95% CI: 0.20-0.22 for psoriasis with PsA. The post-validation prevalence of PsA in the psoriasis cohort was 17.3% (95% CI: 16.65-17.96. CONCLUSIONS: The proportion of diagnostic codes in SHR that could be verified varied with frequency of diagnostic codes and level of care highlighting the importance of sensitivity analyses using different case ascertainment criteria. The prevalence of physician-diagnosed psoriasis and Ps

  8. Update on the genetic pathogenesis and treatment of psoriatic arthritis%关节病性银屑病遗传学发病机制和治疗进展

    孟丽; 王培光; 张学军

    2013-01-01

    关节病性银屑病是一种慢性炎症性关节病变,与该病发病显著相关的易感基因或易感位点有IL-23R、IL-12B、HLA-Cw6、TRAF3IP2、NO、FBXL19、PSMA6-NFKBIA附近区域,可能相关的易感基因有IL-23A、TNIP1、TNF*-857T、LCE3C-LCE3Bdel变异体、REL基因、IL-13.针对关节病性银屑病发病环节中的一些重要免疫分子或免疫细胞,多种靶向生物制剂包括细胞因子拮抗剂(英夫利西、益赛普、阿达木、戈利木、优斯它单抗)、磷酸二酯酶抑制剂、T细胞抑制剂(阿贝西普)和B淋巴细胞耗竭剂(利妥昔单抗)用于该病的治疗,疗效好,安全性较高.%Psoriatic arthritis is a chronic inflammatory disorder mainly affecting joints.Recent studies have revealed that the development of psoriatic arthritis is associa with many susceptible genes or loci,including interleukin-23 receptor (IL-23R),IL-12B,HLA-Cw6,TRAF3IP2,NO,FBXL19 and PSMA6-NFKBIA nearby,and likely associated with some genes or single nucleotide polymorphisms (SNPs),such as IL-23A,TNIP1,tumor necrosis factor*-857T,LCE3C-LCE3Bdel variant,REL gene and IL-13.Multiple biological agents targeting some key immune molecules or cells in the pathogenesis of psoriatic arthritis have been used to its treatment with a favorable efficacy and safety,including cytokine inhibitors (infliximab,etanercept,adalimumab,golimumab,ustekinumab),phosphodiesterase inhibitors (apremilast),T-cell inhibitors (abatacept),and B lymphocyte-depleting agent (rituximab).

  9. The psoriatic great toe or the psoriatic onycho-pachydermo-periostitis of great toe (OP3gt

    C. Contessa

    2011-09-01

    Full Text Available The onycho-pachydermo-periostitis of the great toe is a characteristic feature of psoriatic arthritis first described by Fournié in 1980. In the affected patients, the great toe involvement is characterised by a relevant osteo-periostitis of the distal phalanx, a thickening of the distal soft tissues associated with a psoriatic onychopathy. In most cases, the distal interphalangeal joint is spared. Radiographic and scintigraphic osteo-periostitis of distal phalanx of the great toe are frequent, being found in about 44% of patients with psoriatic arthritis. However, clinical manifestations, with inflammatory inflammation of the great toe, are rare.

  10. Dynamic contrast-enhanced magnetic resonance imaging of articular and extraarticular synovial structures of the hands in patients with psoriatic arthritis

    Cimmino, Marco Amedeo; Barbieri, Francesca; Boesen, Mikael;

    2012-01-01

    Dynamic, contrast-enhanced magnetic resonance imaging (DCE-MRI), the quantification of enhancement within the synovial membrane and bone by extracting curves using fast T1-weighted sequences during intravenous administration of contrast agent, evaluates synovitis and bone marrow edema in psoriatic...