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

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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

IMAGING OF PSORIATIC ARTHRITIS

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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

The joint in psoriatic arthritis.

Science.gov (United States)

Mortezavi, Mahta; Thiele, Ralph; Ritchlin, Christopher

2015-01-01

Psoriatic arthritis (PsA), a chronic inflammatory joint disease associated with psoriasis, is notable for diversity in disease presentation, course and response to treatment. Equally varied are the types of musculoskeletal involvement which include peripheral and axial joint disease, dactylitis and enthesitis. In this review, we focus on the psoriatic joint and discuss pathways that underlie synovial, cartilage and bone inflammation and highlight key histopathologic features. The pivotal inflammatory mechanisms and pathobiology of PsA parallel findings in other forms of spondyloarthritis but are distinct from disease pathways described in rheumatoid synovitis and bone disease. The diagnosis of PsA from both a clinical and imaging perspective is also discussed.

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

LENUS (Irish Health Repository)

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.

Magnetic resonance imaging in psoriatic arthritis: a review of the literature

DEFF Research Database (Denmark)

McQueen, F.M.; Lassere, M.; Østergaard, Mikkel

2006-01-01

Psoriatic arthritis is a diverse condition that may be characterized by peripheral inflammatory arthritis, axial involvement, dactylitis and enthesitis. Magnetic resonance imaging (MRI) allows visualization of soft tissue, articular and entheseal lesions, and provides a unique picture of the dise....../sacroiliitis and subclinical arthropathy. Comparisons have been drawn with the more extensive literature describing the MRI features of rheumatoid arthritis and ankylosing spondylitis....... of the disease process that cannot be gained using other imaging modalities. This review focuses on the literature on MRI in psoriatic arthritis published from 1996 to July 2005. The MRI features discussed include synovitis, tendonitis, dactylitis, bone oedema, bone erosions, soft tissue oedema, spondylitis...

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

LENUS (Irish Health Repository)

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).

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

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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.

Nail involvement in psoriatic arthritis

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Piotr Sobolewski

2017-07-01

Full Text Available Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and occupational activities and contribute to a worse quality of life. Almost 50% of patients with psoriasis vulgaris and up to 80% of patients with psoriatic arthritis are afflicted with nail lesions. The important correlation between psoriatic arthritis and nail changes is well established – the presence of the latter is a strong predictor of the development of arthritis. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting, subungual hyperkeratosis and loosening of the nail plate to less frequent discolouration and splinter haemorrhages. Some of these symptoms are also observed in other nail diseases, and further diagnostics should be performed. The assessment tools NAPSI (Nail Psoriasis Severity Index, mNAPSI (Modified Nail Psoriasis Severity Index, and PNSS (Psoriasis Nail Severity Score are most commonly used to grade the severity of nail involvement in psoriasis and enable the evaluation of therapy effectiveness. The treatment of nail psoriasis is a major clinical challenge. It should be adjusted to the extent of dermal, articular and ungual lesions. Systemic therapies of psoriasis, especially biological agents, are most likely to be effective in treating nail psoriasis. However, as their use is limited in scope and safety, topical therapy remains a mainstay, and the combination of corticosteroids and vitamin D3 analogues is considered to be most helpful.

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

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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.

Th17 Inhibitors in Active Psoriatic Arthritis

DEFF Research Database (Denmark)

Naik, Girish S; Ming, Wai K; Magodoro, Itai M

2018-01-01

BACKGROUND: Several biologics targeting the Th17 pathway have been developed for the treatment of psoriatic arthritis (PsA), a disabling disease with moderate response and an increased incidence of serious infections to first-line biologics (TNF-α antagonists). Th17 inhibitors could replace TNF-α...

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

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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

The ultrasound assessment of the psoriatic arthritis: from joint to skin

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A. Ariani

2011-06-01

Full Text Available There is a growing number of papers investigating the diagnostic potential of ultrasonography in the assessment of patients with psoriatic arthritis and supporting its higher sensitivity over clinical examination in the diagnosis of synovitis, enthesitis and tenosynovitis. Less attention has been paid on both skin and nail, frequently involved in this condition. The aim of this paper is to show the potential of ultrasound in a multi-target assessment (joints, tendons, entesis, skin and nails in patients with psoriatic arthritis, using the last generation ultrasound equipment.

Prologue: 2017 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

Science.gov (United States)

Helliwell, Philip S; Gladman, Dafna D; Gottlieb, Alice B

2018-06-01

The 2017 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in Amsterdam, the Netherlands, and was attended by rheumatologists, dermatologists, representatives of biopharmaceutical companies, and patients. As in previous years, GRAPPA members held a symposium for trainees to discuss their research in psoriatic disease with experts in the field. Other subjects featured during the annual meeting included a discussion of the history, clinical features, controversies, and immunogenetics of juvenile psoriatic arthritis; updates from working groups in Outcome Measures in Rheumatology and International Dermatology Outcome Measures; a discussion of the benefits and challenges of setting up a longitudinal psoriatic arthritis (PsA) database; 3 separate discussions of the effects of the microbiome on skin and joints in psoriasis and PsA; a discussion of options for assessing joints and entheses in PsA by ultrasonography and magnetic resonance imaging; an update on GRAPPA's research and educational projects; a discussion of patient centricity, including the incorporation of patient research partners (PRP) into psoriasis and PsA research and educational efforts, from GRAPPA's PRP; and a discussion of the GRAPPA-Collaborative Research Network's inaugural meeting. In this prologue, we introduce the papers that summarize that meeting.

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

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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

Psoriatic arthritis: treatment strategies using biologic agents

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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.

Psoriatic arthritis: an update.

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López-Ferrer, A; Laiz-Alonso, A

2014-12-01

Advances in our understanding of the pathogenesis of psoriatic arthritis and clinical aspects of the disease justify the present review. Studies have identified common inflammatory pathways related to the innate immune response, such as the IL-12/IL-23 axis, along with numerous genes that affect susceptibility to both diseases and influence phenotypic development. Interest has grown in biomarkers that can be used for early diagnosis or prognosis or to predict joint destruction and the response to treatment. Recent reports describe important differences between the effects of disease-modifying antirheumatic drugs and biologics on the process of new bone formation. Other issues that have been discussed include the need for reliable screening methods, particularly for early detection of oligoarticular arthritis, and for protocols to guide referral to specialists, especially in newly created multidisciplinary practices. Copyright © 2013 Elsevier España, S.L.U. y AEDV. All rights reserved.

Temporomandibular joint involvement in psoriatic arthritis | Okkesim ...

African Journals Online (AJOL)

Psoriasis is a chronic, papulosquamous, and an inflammatory skin disease. It has been found that between 5% and 24% of patients develop psoriatic arthritis (PA) at the same time after or even prior to skin findings. The involvement of temporomandibular joint (TMJ) is a rare condition. In this report, a-46-year-old male ...

Generalised pustular psoriasis, psoriatic arthritis and nephrotic syndrome associated with systemic amyloidosis.

Science.gov (United States)

David, M; Abraham, D; Weinberger, A; Feuerman, E J

1982-09-01

The case report is presented of a psoriatic patient with arthropathy, generalised pustular psoriasis and nephrotic syndrome, in whom systemic amyloidosis developed. The literature reports 13 cases of psoriasis associated with amyloidosis, 3 of whom suffered from pustular psoriasis as does our case. With the addition of our case, 12 of these 14 had concomitant arthropathy. This seems to suggest that arthritis is an important factor in the appearance of amyloidosis. Rectal biopsy and/or renal biopsy may be helpful in establishing the diagnosis of amyloidosis relatively early in patients with psoriatic arthritis.

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

International Nuclear Information System (INIS)

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, 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

Improvements in diagnostic tools for early detection of psoriatic arthritis.

Science.gov (United States)

D'Angelo, Salvatore; Palazzi, Carlo; Gilio, Michele; Leccese, Pietro; Padula, Angela; Olivieri, Ignazio

2016-11-01

Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory disease characterized by a wide clinical spectrum. The early diagnosis of PsA is currently a challenging topic. Areas covered: The literature was extensively reviewed for studies addressing the topic area "diagnosis of psoriatic arthritis". This review will summarize improvements in diagnostic tools, especially referral to the rheumatologist, the role of patient history and clinical examination, laboratory tests, and imaging techniques in getting an early and correct diagnosis of PsA. Expert commentary: Due to the heterogeneity of its expression, PsA may be easily either overdiagnosed or underdiagnosed. A diagnosis of PsA should be taken into account every time a patient with psoriasis or a family history of psoriasis shows peripheral arthritis, especially if oligoarticular or involving the distal interphalangeal joints, enthesitis or dactylitis. Magnetic resonance imaging and ultrasonography are useful for diagnosing PsA early, particularly when isolated enthesitis or inflammatory spinal pain occur.

The Cost of Psoriasis and Psoriatic Arthritis in 5 European Countries: A Systematic Review.

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Burgos-Pol, R; Martínez-Sesmero, J M; Ventura-Cerdá, J M; Elías, I; Caloto, M T; Casado, M Á

2016-09-01

While the introduction of biologics has improved the quality of life of patients with psoriasis and psoriatic arthritis, it may have increased the economic burden of these diseases. To perform a systematic review of studies on the costs associated with managing and treating psoriasis and psoriatic arthritis in 5 European countries: Germany, Spain, France, Italy, and the United Kingdom. We undertook a systematic review of the literature (up to May 2015) using the MEDLINE and EMBASE databases. The methodological quality of the studies identified was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. We considered both direct costs (medical and nonmedical) and indirect costs, adjusted for country-specific inflation and converted to international dollars using purchasing power parity exchange rates for 2015 ($US PPP). The search retrieved 775 studies; 68.3% analyzed psoriasis and 31.7% analyzed psoriatic arthritis. The total annual cost per patient ranged from US $2,077 to US $13,132 PPP for psoriasis and from US $10,924 to US $17,050 PPP for psoriatic arthritis. Direct costs were the largest component of total expenditure in both diseases. The severity of these diseases was associated with higher costs. The introduction of biologics led to a 3-fold to 5-fold increase in direct costs, and consequently to an increase in total costs. We have analyzed the economic burden of psoriasis and psoriatic arthritis and shown that costs increase with the treatment and management of more severe disease and the use of biologics. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

The Role of Smoking in the Development of Psoriatic Arthritis and Psoriasis

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I.Yu. Golovach

2016-08-01

Full Text Available The paper covers the new data on smoking effects on the development of psoriasis and psoriatic arthritis. It was found that smoking aggravates the severity of psoriasis, worsens the prognosis, and makes the smoking patients less sensitive to treatment. Pathogenic links indicate that smoke induces oxidative damage, promotes inflammatory chan­ges and increases the expression of genes associated with psoriasis. In addition, nicotine binds acetylcholine receptors on dendritic cells, macrophages, endothelial cells, and keratinocytes. This leads to inflammation and immune stimulation of Th1-cells and later severe leukocyte migration to skin due to the increased expression of intercellular adhesion molecule‑1 and vascular adhesion molecule‑1 on endothelial cells; to the increased angiogenesis and uncontrolled keratinocyte proli­feration as well. Information about the genetic predisposition to the development of arthritis and psoriasis, and the role of smoking in the modification of genetic factors is provi­ded. Smoking causes a specific metabolic and genetic psoriasis and psoriatic arthritis comorbidity, which determines the frequency of diseases flare, its severity and complications. Currently, physicians can prevent exacerbation of smoking-related di­seases such as psoriasis and psoriatic arthritis by persuading their patients to quit smoking.

Patient Participation in Psoriasis and Psoriatic Arthritis Outcome Research: A Report from the GRAPPA 2013 Annual Meeting

NARCIS (Netherlands)

de Wit, M.P.T.; Campbell, W.; Fitzgerald, O.; Gladman, D.D.; Helliwell, P.S.; James, J.; Lindsay, C.; MacDonald, R.; McHugh, N.J.; Mease, P.J.; Orbai, A.M.; Palominos, P.; Parkinson, A.; Tillett, W.; Goel, N.

2014-01-01

For the first time, 8 patients with psoriatic arthritis (PsA) participated as full delegates at the 2013 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Patients were invited to provide their perspective for different sessions of the conference

Early biomarkers of joint damage in rheumatoid and psoriatic arthritis.

LENUS (Irish Health Repository)

Mc Ardle, Angela

2015-01-01

Joint destruction, as evidenced by radiographic findings, is a significant problem for patients suffering from rheumatoid arthritis and psoriatic arthritis. Inherently irreversible and frequently progressive, the process of joint damage begins at and even before the clinical onset of disease. However, rheumatoid and psoriatic arthropathies are heterogeneous in nature and not all patients progress to joint damage. It is therefore important to identify patients susceptible to joint destruction in order to initiate more aggressive treatment as soon as possible and thereby potentially prevent irreversible joint damage. At the same time, the high cost and potential side effects associated with aggressive treatment mean it is also important not to over treat patients and especially those who, even if left untreated, would not progress to joint destruction. It is therefore clear that a protein biomarker signature that could predict joint damage at an early stage would support more informed clinical decisions on the most appropriate treatment regimens for individual patients. Although many candidate biomarkers for rheumatoid and psoriatic arthritis have been reported in the literature, relatively few have reached clinical use and as a consequence the number of prognostic biomarkers used in rheumatology has remained relatively static for several years. It has become evident that a significant challenge in the transition of biomarker candidates to clinical diagnostic assays lies in the development of suitably robust biomarker assays, especially multiplexed assays, and their clinical validation in appropriate patient sample cohorts. Recent developments in mass spectrometry-based targeted quantitative protein measurements have transformed our ability to rapidly develop multiplexed protein biomarker assays. These advances are likely to have a significant impact on the validation of biomarkers in the future. In this review, we have comprehensively compiled a list of candidate

Duration of Psoriatic Skin Disease as Risk Factor for Subsequent Onset of Psoriatic Arthritis

DEFF Research Database (Denmark)

Egeberg, Alexander; Skov, Lone; Zachariae, Claus

2018-01-01

It is unclear whether psoriasis is a progressive disease that requires early aggressive intervention. This population-based study identified patients with psoriasis and psoriatic arthritis (PsA). Survival analysis and Kaplan-Meier life table techniques were used. The study comprised 10,011 psoria......It is unclear whether psoriasis is a progressive disease that requires early aggressive intervention. This population-based study identified patients with psoriasis and psoriatic arthritis (PsA). Survival analysis and Kaplan-Meier life table techniques were used. The study comprised 10......,011 psoriasis patients (severe n = 4,618), and 1,269 patients also had PsA. Incidence of PsA increased with duration of cutaneous symptoms (p = 0.0001). Psoriasis diagnosed before age 20 or 30 years, respectively, suggested a lower risk of PsA than psoriasis diagnosed after age 50 years, yet age at first...... cutaneous symptoms did not predict development of PsA. No clear association with disease severity was found. PsA incidence appeared stable with longer duration of psoriasis, but further data are needed to firmly establish the relationship with age of psoriasis onset....

Secukinumab in the Treatment of Psoriasis and Psoriatic Arthritis: A Review of the Literature.

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Abrouk, M; Gandy, J; Nakamura, M; Lee, K; Brodsky, M; Singh, R; Zhu, H; Farahnik, B; Bhutani, T; Koo, J

2017-07-01

While there are several commercially available treatment options for psoriasis and psoriatic arthritis, there remains a large number of individuals who are refractory to current modalities. In the recent past, there has been increasing evidence that interleukin (IL)-17 plays a vital role in the pathophysiology of psoriasis. Preclinical, phase II, and phase III studies of secukinumab (Cosentyx®) targeting IL-17 and its receptor have thus far proved to be promising. We reviewed the results of phase II and phase III clinical trials for secukinumab in the treatment of psoriasis and psoriatic arthritis. Only published studies were considered in the present review. We also performed an English language literature search from January 2003 to September 2015 using PubMed with any of the following key words: (secukinumab OR AIN457) AND (psoriasis OR psoriatic arthritis). In our review of the literature, seven phase III and five phase II clinical trials, as well as open-label extension studies with unpublished findings were found. Results from phase III clinical trials indicated secukinumab to be efficacious and safe for the treatment of psoriasis and psoriatic arthritis according to Psoriasis Area and Severity Index (PASI) and American College of Rheumatology (ACR) scores. The safety profile of this agent was similar across all studies, with the most frequently reported adverse events of nasopharyngitis, upper respiratory infections, headache, and injection site reaction. Secukinumab demonstrates rapid and robust clinical improvement accompanied by a favorable short- term safety profile. The results of the phase III trials continue to reinforce the theory that the IL-17 pathway is an essential target in psoriasis and psoriatic arthritis treatment. Additional extension studies of lower level evidence are needed to further understand the safety profile of the drug.

Incidence and Prognosis of Psoriasis and Psoriatic Arthritis in Patients Undergoing Bariatric Surgery

DEFF Research Database (Denmark)

Egeberg, Alexander; Sørensen, Jens Ahm; Gislason, Gunnar Hilmar

2017-01-01

and psoriatic arthritis in patients undergoing bariatric surgery (gastric bypass and gastric banding). Design, Setting, and Participants: This population-based cohort study used individual-level linkage of administrative and public health registers in Denmark. All Danish citizens who received gastric bypass.......29 (95% CI, 0.12-0.71) and 0.53 (95% CI, 0.08-3.56) for gastric bypass and gastric banding, respectively. Conclusions and Relevance: Gastric bypass was associated with a significantly reduced risk and improved prognosis of psoriasis and psoriatic arthritis, whereas gastric banding was not. This finding...

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

International Nuclear Information System (INIS)

Battistone, M.J.; Clegg, D.O.; Manaster, B.J.; Reda, D.J.

1999-01-01

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.)

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

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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.

Comorbidities in Patients with Psoriatic Arthritis

Directory of Open Access Journals (Sweden)

Amir Haddad

2017-01-01

Full Text Available Epidemiological studies have shown that patients with psoriatic arthritis (PsA are often affected by numerous comorbidities that carry significant morbidity and mortality. Reported comorbidities include diabetes mellitus, obesity, metabolic syndrome, cardiovascular diseases, osteoporosis, inflammatory bowel disease, autoimmune eye disease, non-alcoholic fatty liver disease, depression, and fibromyalgia. All health care providers for patients with PsA should recognize and monitor those comorbidities, as well as understand their effect on patient management to ensure an optimal clinical outcome.

Ultrasonography of the nail unit reveals quantitative and qualitative alterations in patients with psoriasis and psoriatic arthritis.

Science.gov (United States)

Idolazzi, Luca; Gisondi, Paolo; Fassio, Angelo; Viapiana, Ombretta; Giollo, Alessandro; Rossini, Maurizio; Girolomoni, Giampiero; Gatti, Davide

2018-05-02

The nail unit is a matter of interest both for dermatologist and rheumatologist. The nail is considered one of the possible targets of assessment, especially when ultrasonography is performed. The aim of the study is to highlight peculiar features and alterations of the nail unit in patients affected by psoriasis and psoriatic arthritis versus healthy controls using ultrasonography. The study sample included 82 patients affected by psoriasis and/or psoriatic arthritis and 50 healthy controls. The patients were consecutively enrolled during their routine visit in the outpatient clinic and they performed clinical and ultrasonographic evaluation of the nail. The evaluationof disease activity was done using Disease Activity in Psoriatic Arthritis (DAPSA), Psoriasis Activity Severity Index (PASI), and Nail Psoriasi Severity Index (NAPSI). Multivariate analysis of variance was performed between groups. Post hoc analysis underlined the differences between healthy and affected regarding nail plate thickness (0.063±0.011 cm for patients with psoriasis, 0.065±0.014 cm for patients with psoriatic arthritis and 0.051±0.006 cm for healthy controls, p<0.05). Elementary lesions of nail plate and nail bed were compared using Pearson's chi square test between patients in psoriasis and psoriatic arthritis groups, with no differences except for a trend for onycholisis and crumbling (p=0.07 and 0.06, respectively) in the psoriatic arthritis group. ROC curves were calculated (AUC = 0.68) obtaining also quantitative cut offs for nail plate andnail bed thickness in the affected vs healthy patients. Our study shows that ultrasonography may be a potential advantage in clinical practice. Our results strengthen the information already available in the literature and add quantitative parameters for ultrasonography of the nail.

PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

Directory of Open Access Journals (Sweden)

T. V. Korotaev

2018-01-01

Full Text Available soriatic arthritis (PsA is a chronic inflammatory disease of the joints, spine and entheses from a group of spondyloarthritis (SpA, which is usually observed in patients with psoriasis (Ps. The diagnosis of PsA is based on the CASPAR criteria for psoriatic arthritis. The disease results from interactions between genetic, immunological and environmental factors. The main clinical manifestations of PsA include peripheral arthritis, enthesitis, dactylitis, and spondylitis. PsA must be differentiated from rheumatoid arthritis, gout, reactive arthritis, osteoarthritis, and ankylosing spondylitis. Due to the fact that PsA is a clinically heterogeneous disease, its activity is assessed using complex indices, by taking into account that the patient has arthritis, enthesitis, dactylitis, and spondylitis. The goal of treatment for PsA is to achieve remission or minimal activity of the main clinical manifestations of the disease, to slow down or prevent radiographic progression, to increase life expectancy and quality of life in the patients, and to reduce the risk of comorbidities, which is achieved through a wide range of drugs of different classes. Therapy should be chosen based on the clinical manifestations of PsA and comorbidities in the patients. 

Risk of periodontitis in patients with psoriasis and psoriatic arthritis

DEFF Research Database (Denmark)

Egeberg, A; Mallbris, L; Gislason, G

2017-01-01

BACKGROUND: Psoriasis and periodontitis are chronic inflammatory disorders with overlapping inflammatory pathways, but data on risk of periodontitis in psoriasis are scarce and a possible pathogenic link is poorly understood. OBJECTIVE: We investigated the association between psoriasis...... and periodontitis in a nationwide cohort study. METHODS: All Danish individuals aged ≥18 years between 1 January 1997 and 31 December 2011 (n = 5,470,428), including 54 210 and 6988 patients with mild and severe psoriasis, and 6428 with psoriatic arthritis, were linked through administrative registers. Incidence...... rate ratios (IRRs) were estimated by Poisson regression. RESULTS: Incidence rates of periodontitis per 10 000 person-years were 3.07 (3.03-3.12), 5.89 (1.07-6.84), 8.27 (5.50-12.45) and 11.12 (7.87-15.73) for the reference population, mild psoriasis, severe psoriasis and psoriatic arthritis...

Sacroiliac joint pain as an important element of psoriatic arthritis diagnosis.

Science.gov (United States)

Krawczyk-Wasielewska, Agnieszka; Skorupska, Elżbieta; Samborski, Włodzimierz

2013-04-01

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by the coexistence of arthritis with psoriasis of the skin and nails. The sacroiliac joints were observed in 34-78% of patients with psoriatic arthritis. Due to such a high prevalence of SIJ dysfunction, understanding pathophysiology of pain and the associated pain pattern becomes a very important aspect of PsA diagnosis. As far as the etiology of SI joint dysfunction is concerned, it has not been disambiguated yet. Among the main causative factors, injuries and strains of the structures surrounding the joint are noted. Joint pathology usually manifests itself by pain occurring within the area of the joint. The causes of pain may be divided into two categories: intra-articular and extra-articular. Pain caused by the SI joint may be nociceptive or neural in nature, whereas the pain pattern characteristic of the joint correlates with its innervation and is consistent with S2 dorsal rami.

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

NARCIS (Netherlands)

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

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

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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.

Golimumab in the treatment of psoriatic arthritis: efficacy and safety

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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.

Psoriatic arthritis management update - biotherapeutic options.

LENUS (Irish Health Repository)

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.

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

LENUS (Irish Health Repository)

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.

Challenges of biological therapy in patients with pustular psoriasis coexisting with psoriatic arthritis

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Joanna Narbutt

2017-04-01

Full Text Available Introduction . Psoriasis is a chronic inflammatory skin disease affecting approximately 2–3% of the general population. It is a condition with immunological and genetic background, coexisting with psoriatic arthritis in about 25% of cases. Biologic drugs have brought a significant improvement in managing the disease, however they are not approved for the treatment of pustular psoriasis. An increasing number of reports indicate the efficacy of biological drugs in pustular psoriasis. In some patients there are factors responsible for a worse clinical response to biologic therapy. Objective . Presentation of therapeutic difficulties identified in a patient with pustular psoriasis and psoriatic arthritis. Case report . We report a case of a 48-year-old man with generalized pustular psoriasis coexisting with psoriatic arthritis in whom therapy with multiple biologic drugs (adalimumab, infliximab, golimumab, ustekinumab has failed to bring a satisfactory improvement. Conclusions . Further studies are needed to verify the efficacy and pos­sibly approve biological drugs for the treatment of pustular psoriasis. Also, attempts should be made to identify predictors of poorer response to treatment in order to individualize therapy and prevent the loss of efficacy of biologic drugs during prolonged use.

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

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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.

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

DEFF Research Database (Denmark)

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...... at baseline, week 12 and week 24 of treatment. The questionnaire included employment status and changing job responsibilities and sick time taken due to psoriasis or PsA. The statistical methods included analysis of covariance, t-test, Fisher's exact test and McNemar's test. Last...

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

LENUS (Irish Health Repository)

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.

Clinical response, drug survival, and predictors thereof among 548 patients with psoriatic arthritis who switched tumor necrosis factor α inhibitor therapy

DEFF Research Database (Denmark)

Glintborg, Bente; Ostergaard, Mikkel; Krogh, Niels Steen

2013-01-01

To describe the frequency of treatment switching and outcomes among patients with psoriatic arthritis (PsA) who switched tumor necrosis factor α inhibitor (TNFi) agents in routine care.......To describe the frequency of treatment switching and outcomes among patients with psoriatic arthritis (PsA) who switched tumor necrosis factor α inhibitor (TNFi) agents in routine care....

Current views on the pharmacotherapy of psoriatic arthritis

Directory of Open Access Journals (Sweden)

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.

Disparity between ultrasound and clinical findings in psoriatic arthritis.

Science.gov (United States)

Husic, Rusmir; Gretler, Judith; Felber, Anja; Graninger, Winfried B; Duftner, Christina; Hermann, Josef; Dejaco, Christian

2014-08-01

To investigate the association between psoriatic arthritis (PsA)-specific clinical composite scores and ultrasound-verified pathology as well as comparison of clinical and ultrasound definitions of remission. We performed a prospective study on 70 consecutive PsA patients. Clinical assessments included components of Disease Activity Index for Psoriatic Arthritis (DAPSA) and the Composite Psoriatic Disease Activity Index (CPDAI). Minimal disease activity (MDA) and the following remission criteria were applied: CPDAI joint, entheses and dactylitis domains (CPDAI-JED)=0, DAPSA≤3.3, Boolean's remission definition and physician-judged remission (rem-phys). B-mode and power Doppler (PD-) ultrasound findings were semiquantitatively scored at 68 joints (evaluating synovia, peritendinous tissue, tendons and bony changes) and 14 entheses. Ultrasound remission and minimal ultrasound disease activity (MUDA) were defined as PD-score=0 and PD-score ≤1, respectively, at joints, peritendinous tissue, tendons and entheses. DAPSA but not CPDAI correlated with B-mode and PD-synovitis. Ultrasound signs of enthesitis, dactylitis, tenosynovitis and perisynovitis were not linked with clinical composites. Clinical remission or MDA was observed in 15.7% to 47.1% of PsA patients. Ultrasound remission and MUDA were present in 4.3% and 20.0% of patients, respectively. Joint and tendon-related PD-scores were higher in patients with active versus inactive disease according to CPDAI-JED, DAPSA, Boolean's and rem-phys, whereas no difference was observed regarding enthesitis and perisynovitis. DAPSA≤3.3 (OR 3.9, p=0.049) and Boolean's definition (OR 4.6, p=0.03) were more useful to predict MUDA than other remission criteria. PsA-specific composite scores partially reflect ultrasound findings. DAPSA and Boolean's remission definitions better identify MUDA patients than other clinical criteria. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound

DEFF Research Database (Denmark)

Kristensen, Salome; Christensen, Jeppe Hagstrup; Schmidt, Erik Berg

2016-01-01

BACKGROUND: Enthesitis is a major feature of psoriatic arthritis. However, clinical assessment of enthesitis is known to lack accuracy and have poor interobserver reliability. OBJECTIVE: To determine effect of training on clinical assessment of enthesitis and to compare ultrasonography with clini...

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

DEFF Research Database (Denmark)

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

2009-01-01

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 ...

The OMERACT Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) is reliable and sensitive to change: results from an OMERACT workshop

DEFF Research Database (Denmark)

Bøyesen, Pernille; McQueen, Fiona M; Gandjbakhch, Frédérique

2011-01-01

The aim of this multireader exercise was to assess the reliability and sensitivity to change of the psoriatic arthritis magnetic resonance imaging score (PsAMRIS) in PsA patients followed for 1 year.......The aim of this multireader exercise was to assess the reliability and sensitivity to change of the psoriatic arthritis magnetic resonance imaging score (PsAMRIS) in PsA patients followed for 1 year....

Psoriatic arthritis

International Nuclear Information System (INIS)

Sankowski, Artur Jacek; Łebkowska, Urszula Maria; Ćwikła, Jarosław; Walecka, Irena; Walecki, Jerzy

2013-01-01

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

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis/Outcome Measures in Rheumatology Consensus-Based Recommendations and Research Agenda for Use of Composite Measures and Treatment Targets in Psoriatic Arthritis

DEFF Research Database (Denmark)

Coates, Laura C; FitzGerald, Oliver; Merola, Joseph F

2018-01-01

OBJECTIVE: A meeting was convened by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and Outcome Measures in Rheumatology (OMERACT) to further the development of consensus among physicians and patients regarding composite disease activity measures and targets i...

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

LENUS (Irish Health Repository)

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.

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

LENUS (Irish Health Repository)

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.

Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial

NARCIS (Netherlands)

McInnes, Iain B.; Mease, Philip J.; Kirkham, Bruce; Kavanaugh, Arthur; Ritchlin, Christopher T.; Rahman, Proton; van der Heijde, Désirée; Landewé, Robert; Conaghan, Philip G.; Gottlieb, Alice B.; Richards, Hanno; Pricop, Luminita; Ligozio, Gregory; Patekar, Manmath; Mpofu, Shephard; Bird, Paul; Hall, Stephen; Nash, Peter; Zochling, Jane; de Vlam, Kurt; Langenaken, Christine; Geusens, Piet; Beaulieu, Andre; Tremblay, Jean-Luc; McCarthy, Tim; Papp, Kim; Poulin, Yves; Cohen, Martin; Galatikova, Dagmar; Dokoupilova, Eva; Dvorak, Zdenek; Mann, Herman; Sieper, Joachim; Spieler, Wolfgang; Kurthen, Reiner; Braun, Juergen; Wollenhaupt, Juergen; Tony, Hans-Peter; Schuch, Florian; Schulze-Koops, Hendrik; Rech, Juergen; Leszczynski, Piotr; Adamski, Zygmunt; Szepietowski, Jacek; Tlustochowicz, Witold; Kaszuba, Andrzej; Szymanska, Malgorzata; Stanislav, Marina; Nesmeyanova, Olga; Vezikova, Natalia; Ershova, Olga; Izmozherova, Nadezda; Zotkin, Eugeny; Petrova, Marianna; Kastanayan, Alexander; Yakupova, Svetlana; Agafina, Alina; Asavatanabodee, Paijit; Suwannalai, Parawee; Kerrane, Jerome; Tahir, Hasan; McInnes, Iain; Edwards, Christopher; Chinoy, Hector; Marzo-Ortega, Helena; Kaul, Arvind; Sheeran, Thomas; Clunie, Gavin; Schechtman, Joy; Gaylis, Norman; Kaine, Jeffrey; Lawson, Jeffrey; El-Kadi, Hisham; Flint, Kathleen; Kivitz, Alan; Churchhill, Melvin; Sikes, David; Lowenstein, Mitchell; Halpert, Elias; Abdulky, Mary; Palmer, William; Codding, Christine; Legerton, Clarence; Singhal, Atul; Sunkureddi, Prashanth; Gough, William; Forman, Seth; Box, Jane; Khan, Mohamed; Barranco, Elizabeth

2015-01-01

Background Interleukin 17A is a proinflammatory cytokine that is implicated in the pathogenesis of psoriatic arthritis. We assessed the efficacy and safety of subcutaneous secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis. Methods In this phase 3,

Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis.

Science.gov (United States)

Mease, Philip; Hall, Stephen; FitzGerald, Oliver; van der Heijde, Désirée; Merola, Joseph F; Avila-Zapata, Francisco; Cieślak, Dorota; Graham, Daniela; Wang, Cunshan; Menon, Sujatha; Hendrikx, Thijs; Kanik, Keith S

2017-10-19

Tofacitinib is an oral Janus kinase inhibitor that is under investigation for the treatment of psoriatic arthritis. We evaluated tofacitinib in patients with active psoriatic arthritis who previously had an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (DMARDs). In this 12-month, double-blind, active-controlled and placebo-controlled, phase 3 trial, we randomly assigned patients in a 2:2:2:1:1 ratio to receive one of the following regimens: tofacitinib at a 5-mg dose taken orally twice daily (107 patients), tofacitinib at a 10-mg dose taken orally twice daily (104), adalimumab at a 40-mg dose administered subcutaneously once every 2 weeks (106), placebo with a blinded switch to the 5-mg tofacitinib dose at 3 months (52), or placebo with a blinded switch to the 10-mg tofacitinib dose at 3 months (53). Placebo groups were pooled for analyses up to month 3. Primary end points were the proportion of patients who had an American College of Rheumatology 20 (ACR20) response (≥20% improvement from baseline in the number of tender and swollen joints and at least three of five other important domains) at month 3 and the change from baseline in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score (scores range from 0 to 3, with higher scores indicating greater disability) at month 3. ACR20 response rates at month 3 were 50% in the 5-mg tofacitinib group and 61% in the 10-mg tofacitinib group, as compared with 33% in the placebo group (P=0.01 for the comparison of the 5-mg dose with placebo; Ptofacitinib group and -0.40 in the 10-mg tofacitinib group, as compared with -0.18 in the placebo group (P=0.006 for the comparison of the 5-mg dose with placebo; Ptofacitinib group, 71% in the 10-mg tofacitinib group, 72% in the adalimumab group, 69% in the placebo group that switched to the 5-mg tofacitinib dose, and 64% in the placebo group that switched to the 10-mg tofacitinib dose. There were four cases of cancer, three serious

Genetic polymorphisms associated with psoriasis and development of psoriatic arthritis in patients with psoriasis

DEFF Research Database (Denmark)

Loft, Nikolai Dyrberg; Skov, Lone; Rasmussen, Mads Kirchheiner

2018-01-01

BACKGROUND: Psoriasis (PsO) is a chronic inflammatory disease with predominantly cutaneous manifestations. Approximately one third of patients with PsO develop psoriatic arthritis (PsA), whereas the remaining proportion of patients has isolated cutaneous psoriasis (PsC). These two phenotypes share...... (rs6887695) was associated with PsO. CONCLUSION: Among a cohort of Danish patients with moderate-to-severe psoriasis, two SNPs in the IL12B and TNF genes were associated with susceptibility of psoriasis. None of the SNPs were specifically associated with isolated cutaneous psoriasis or psoriatic...

Successful ustekinumab treatment of noninfectious uveitis and concomitant severe psoriatic arthritis and plaque psoriasis.

Science.gov (United States)

Mugheddu, Cristina; Atzori, Laura; Del Piano, Maria; Lappi, Astrid; Pau, Monica; Murgia, Severino; Zucca, Ignazio; Rongioletti, Franco

2017-09-01

We report the first successful treatment of noninfectious uveitis with ustekinumab in a patient with severe concomitant psoriasis and psoriatic arthritis who failed to respond to conventional immune suppressants and with contraindications to tumor necrosis factor alpha inhibitors. © 2017 Wiley Periodicals, Inc.

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

Directory of Open Access Journals (Sweden)

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

Biomarkers in psoriasis and psoriatic arthritis.

Science.gov (United States)

Villanova, Federica; Di Meglio, Paola; Nestle, Frank O

2013-04-01

Psoriasis is a common immune-mediated disease of the skin, which associates in 20-30% of patients with psoriatic arthritis (PsA). The immunopathogenesis of both conditions is not fully understood as it is the result of a complex interaction between genetic, environmental and immunological factors. At present there is no cure for psoriasis and there are no specific markers that can accurately predict disease progression and therapeutic response. Therefore, biomarkers for disease prognosis and response to treatment are urgently needed to help clinicians with objective indications to improve patient management and outcomes. Although many efforts have been made to identify psoriasis/PsA biomarkers none of them has yet been translated into routine clinical practice. In this review we summarise the different classes of possible biomarkers explored in psoriasis and PsA so far and discuss novel strategies for biomarker discovery.

[Pharmaceutical care of patients with rheumatoid and psoriatic arthritis receiving etanercept].

Science.gov (United States)

Romero Crespo, I; Antón Torres, R; Borrás Blasco, J; Navarro Ruiz, A

2005-01-01

To evaluate a pharmaceutical care protocol for patients with rheumatoid arthritis (RA) or psoriatic arthritis who begin treatment with etanercept with the objective of identifying potential medication-related problems and implementing therapeutic measures to improve the way this drug is used. An observational, prospective, 3-month study of patients with RA receiving etanercept therapy from March to December 2003 was conducted and a pharmaceutical care protocol was set up. During the first visit, a pharmacotherapeutic record was initiated for each patient, including socio-demographic data, personal history, diagnosis, DMARDs (disease-modifying anti-rheumatic drugs) previously received, and concomitant therapies for other underlying conditions. Patients were briefed on dosage, administration route, and potential adverse events both orally and in writing. Correct drug administration and preservation were verified during the second visit, where potential adverse effects were identified, treatment adherence was confirmed, and, if needed, potential drug interactions with other ongoing medications were disclosed. During the third visit, adherence was assessed, adverse events were recorded, and patients evaluated their response to treatment. Fifty patients were included, 40 with a diagnosis of rheumatoid arthritis (80%) and 10 diagnosed with psoriatic arthritis (20%). In all, 72% had received previous treatment with methotrexate (MTX), 40% with leflunomide, 20% with infliximab, 56% with corticoids, 2% with analgesics, 56% with NSAIDs, and 30% with other DMARDs. No significant drug interactions were found. Regarding adherence to treatment, 7.7% of patients skipped one or more doses, with travelling being the most common reason. Adverse events reported included: injection site reaction (27%), headache (7.7%) and nausea (7.7%). At 3 months after treatment onset, a reduction of MTX doses was seen in 18% of patients, of leflunomide dosage in 8%, of corticoids in 18%, of

Association of systemic sclerosis and psoriatic arthritis: a case report

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A. Musio

2011-09-01

Full Text Available The association of Systemic Sclerosis (SSc and Psoriatic Arthritis (PsA is unfrequent; only few cases are reported in literature. We describe a case of a patient with SSc following the onset of PsA. The disease begun with tenosynovitis, polyarthritis in association with psoriasis. After two years, Raynaud’s phenomenon and sclerodactyly appeared, and, later, pulmonary interstizial fibrosis and esophageal dysfunction. The existence of a common pathogenesis of the two diseases, SSc and PsA, is discussed.

Modification of a sonographic enthesitis score to differentiate between psoriatic arthritis and young healthy volunteers

NARCIS (Netherlands)

Wervers, K. (K.); M. Vis (M.); Rasappu, N. (N.); M. van der Ven (Myrthe); I. Tchetverikov (Ilja); Kok, M. (M.); A.H. Gerards (Andreas); J.M.W. Hazes (Mieke); J.J. Luime (Jolanda)

2017-01-01

textabstractObjectives: We aimed to describe sonographic structural and inflammatory changes in entheses of patients with recently diagnosed psoriatic arthritis (PsA), patients with established PsA, and young healthy volunteers, and to investigate whether the MAdrid Sonographic Enthesitis Index

Nail findings in patients with psoriatic arthritis: A cross-sectional study with special reference to transverse grooves.

Science.gov (United States)

Zenke, Yukari; Ohara, Yuri; Kobayashi, Daiki; Arai, Satoru; Kishimoto, Mitsumasa; Okada, Masato; Eto, Hikaru

2017-11-01

Patients with psoriatic arthritis (PsA) commonly present with nail manifestations; however, little is known about these manifestations. This study investigated whether nail findings can be used to discriminate between PsA and psoriasis without arthritis. We performed a retrospective analysis of 118 patients with PsA and 974 patients with psoriasis without arthritis who visited St. Luke's International Hospital (Tokyo, Japan) between July 2003 and February 2015. Patients with PsA were classified according to the Classification of Psoriatic Arthritis criteria. Skin lesion severity was assessed by using the Psoriasis Area and Severity Index, and 9 types of nail findings were investigated. The incidence of nail involvement in patients with PsA was 67.6%. Female sex, presence of transverse grooves, onycholysis, and splinter hemorrhages were significantly related to PsA, with transverse grooves demonstrating the strongest association (odds ratio, 5.01; 95% confidence interval, 2.31-10.8; P transverse grooves was strongly related to both distal interphalangeal arthritis and enthesitis. The PsA population was relatively small. Nail findings enabled us to distinguish patients with PsA from those without arthritis. The presence of transverse grooves is significantly associated with PsA and may be associated with distal interphalangeal arthritis and enthesitis. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

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T. V. Korotaeva

2014-01-01

Full Text Available The lecture gives basic information about psoriatic arthritis (PsA, a chronic inflammatory disease of the joints, spine, and enthesises from a group of spondyloarthritis. It describes the epidemiology of the disease and considers current ideas on its pathogenesis and factors influencing the development of PsA in psoriatic patients. The classification and clinical forms of PsA are presented. The major clinical manifestations of the disease are indicated to include peripheral arthritis, enthesitis, dactylitis, and spondylitis. The diagnosis of the disease is noted to be established on the basis of its detected typical clinical and radiological signs, by applying the CASPAR criteria. A dermatologist, rheumatologist, and general practitioner screen PsA, by actively detecting complaints, characteristic clinical and radiological signs of damage to the joints, and/or spine, and/or enthesises and by using screening questionnaires. There are data that patients with PsA are observed to be at higher risk for a number of diseases type 2 diabetes mellitus hypertension, coronary heart disease, obesity, metabolic syndrome, inflammatory bowel diseases, etc. The aim of current pharmacotherapy for PsA is to achieve remission or minimal activity of clinical manifestations of the disease, to delay or prevent its X-ray progression, to increase survival, to improve quality of life in patients, and to reduce the risk of comorbidities. The paper considers groups of medicines used to treat the disease, among other issues, information about biological agents (BA registered in the Russian Federation for the treatment of PsA. Most patients are mentioned to show a good response to this therapy option just 3–6 months after treatment initiation; however, some of them develop primary inefficiency. In this case, switching one BA to another is recommended. Some patients using a BA develop secondary treatment inefficiency, which is firstly due to the appearance of

Reliability and Validity of the Turkish Adaptation of VITACORA-19 in Patients with Psoriatic Arthritis.

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Tander, Berna; Ulus, Yasemin; Terzi, Yüksel; Zahiroğlu, Yeliz; Kesmen, Hakan; Farisoğullari, Bayram; Akyol, Yeşim; Bilgici, Ayhan; Kuru, Ömer

2016-12-01

This study aims to evaluate the reliability and validity of the Turkish language version of VITACORA-19 (psoriatic arthritis quality of life questionnaire) in patients with psoriatic arthritis. The Turkish version of VITACORA-19 questionnaire was obtained after a translation and back translation process. The study sample included 61 PsA patients (22 males, 39 females; mean age 46.5±12.2 years; range 19 to 71 years). To assess the test-retest reliability of the Turkish VITACORA-19, the questionnaire was reapplied 10 to 15 days after the first interview (interclass correlation coefficient). Cronbach's alpha (a) was used to evaluate the internal consistency. VITACORA-19 was compared with visual analog scale for physician and patient global assessments, the Health Assessment Questionnaire, and Nottingham Health Profile for construct validity. The internal structure of VITACORA-19 was examined by factor analysis. The individual item intraclass correlation coefficient ranged from 0.77 to 0.98 and Cronbach's alpha ranged from 0.77 to 0.98. The Cronbach's alpha value for whole scale was determined as 0.96. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.90, and Bartlett's test of sphericity had a p<0.001. Turkish VITACORA-19 total scores were correlated negatively with Health Assessment Questionnaire, visual analog scale for pain, and Nottingham Health Profile subgroups, and positively with physician and patient global assessments (p<0.01). Turkish version of VITACORA-19 questionnaire is a reliable and valid measure for health-related quality of life in Turkish patients with psoriatic arthritis.

Psoriasis, Psoriatic Arthritis, and Thyroid Autoimmunity

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Ilaria Ruffilli

2017-06-01

Full Text Available Psoriasis (PsO is a chronic relapsing/remitting autoimmune skin disease, associated with an increased risk of other autoimmune disorders. Psoriatic arthritis (PsA is a chronic inflammatory arthritis occurring approximately in 30% of PsO patients. Sporadic cases of association between PsO and autoimmune thyroid disorders (AITDs have been reported. However, two different recent studies did not find any association between them. In patients with PsO and PsA, an association with AITD has been shown by most of the studies in adults, but not in the juvenile form. In PsA women and men, thyroid autoimmunity [positive antithyroid peroxidase (AbTPO antibodies, hypoechoic thyroid pattern] and subclinical hypothyroidism were more prevalent than in the general population. An association has been shown also in patients with PsO, arthritis, and inflammatory bowel disease, who have more frequently AITD. A Th1 immune predominance has been shown in early PsO, and PsA, with high serum CXCL10 (Th1 prototype chemokine, overall in the presence of autoimmune thyroiditis. This Th1 immune predominance might be the immunopathogenetic base of the association of these disorders. A raised incidence of new cases of hypothyroidism, thyroid dysfunction, positive AbTPO, and appearance of a hypoechoic thyroid pattern in PsA patients, especially in women, has been shown recently, suggesting to evaluate AbTPO levels, thyroid function, and thyroid ultrasound, especially in PsA women. Thyroid function follow-up and suitable treatments should be performed regularly in PsA female patients at high risk (thyroid-stimulating hormone within the normal range but at the higher limit, positive AbTPO, hypoechoic, and small thyroid.

Minimal Disease Activity as a Treatment Target in Psoriatic Arthritis

DEFF Research Database (Denmark)

Gossec, Laure; McGonagle, Dennis; Korotaeva, Tatiana

2018-01-01

As in other inflammatory rheumatic diseases, the objective of psoriatic arthritis (PsA) treatment is the achievement of a defined target. Recent recommendations propose aiming for remission or low disease activity; however, a consensual definition of remission is lacking. A state of minimal disease....... Since its development, MDA has been used increasingly in studies and clinical trials. In this article, the potential use of MDA as a treatment target in PsA is reviewed. The frequencies of MDA achievement with biologic disease-modifying antirheumatic drugs are summarized based on data from registries...

First Report of Psoriatic-Like Dermatitis and Arthritis in a 4-Year-Old Female Spayed Pug Mix

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Stephanie A. Regan

2015-01-01

Full Text Available Psoriasis manifests as chronic dermatitis and arthritis (PsA in people. Psoriasis with concurrent PsA is characterized by erythematous, silvery, scaly plaques, especially on the extremities, and concurrent arthritis with enthesitis, tenosynovitis, and dactylitis. To date, no such disease has spontaneously occurred in domestic animals. This case report aims to describe the clinical, radiographic, and histologic appearance of a psoriasis-like dermatitis and psoriatic-like arthritis in a dog. A 4-year-old female spayed pug mix presented for the evaluation of chronic history of hyperkeratotic footpads and deforming arthritis. After ruling out other differential diagnoses and based on the similarity of clinical, radiographic, and histologic findings to human psoriasis and PsA, a tentative diagnosis of psoriasis-like disease was made. Treatment was begun to control pain (tramadol, gabapentin, and carprofen and psoriatic dermatitis (clobetasol propionate 0.05%, calcipotriene 0.005%, and urea 40% ointment twice daily. Dramatic positive response to treatment was achieved confirming the tentative diagnosis. This case may provide preliminary evidence for the existence of a psoriasis-like condition in dogs and may elucidate treatment options in otherwise refractory cases of chronic dermatitis and polyarthropathy in dogs.

Subpopulations Within Juvenile Psoriatic Arthritis: A Review of the Literature

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Matthew L. Stoll

2006-01-01

Full Text Available The presentation of juvenile psoriatic arthritis (JPsA has long been recognized to be clinically heterogeneous. As the definition of JPsA expanded to accommodate atypical manifestations of psoriasis in young children, studies began to reflect an increasingly clear biphasic distribution of age of onset, with peaks in the first few years of life and again in early adolescence. These two subpopulations differ in gender ratio, pattern of joint involvement, laboratory findings and potentially response to therapy. Intriguingly, a similar distribution of age of onset has been observed in juvenile rheumatoid arthritis (JRA, and correlates with patterns of HLA association. While a secure classification of subpopulations within JPsA awaits improved pathophysiologic understanding, future research must consider the possibility that different disease mechanisms may be operative in distinct subsets of patients with this disorder.

International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials

DEFF Research Database (Denmark)

Orbai, Ana-Maria; de Wit, Maarten; Mease, Philip

2017-01-01

OBJECTIVE: To identify a core set of domains (outcomes) to be measured in psoriatic arthritis (PsA) clinical trials that represent both patients' and physicians' priorities. METHODS: We conducted (1) a systematic literature review (SLR) of domains assessed in PsA; (2) international focus groups t...

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

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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

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

OpenAIRE

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. ...

Magnetic resonance imaging for diagnosing, monitoring and prognostication in psoriatic arthritis

DEFF Research Database (Denmark)

Poggenborg, René Panduro; Sørensen, Inge Juul; Pedersen, Susanne Juhl

2015-01-01

Psoriatic arthritis (PsA) is a chronic systemic, inflammatory disease associated with skin psoriasis. PsA may be difficult to assess with clinical examination and blood tests because of its complex and multifaceted clinical presentation. Magnetic resonance imaging (MRI) can visualise all peripheral...... and axial joints and entheses involved in PsA, and allow the rheumatologist to assess inflammation and structural damage in detail. In the present paper, we provide a brief overview of MRI to diagnose, monitor and prognosticate in PsA in clinical care....

Societal costs and patients' experience of health inequities before and after diagnosis of psoriatic arthritis

DEFF Research Database (Denmark)

Kristensen, Lars Erik; Jørgensen, Tanja S.; Christensen, Robin

2017-01-01

Objectives To comprehensively study the comorbidities, healthcare and public transfer (allowance) costs in patients with psoriatic arthritis (PsA) before and after diagnosis. Methods Nationwide cohort study, using data from Danish registries from January 1998 through December 2014. A total of 10â...... 525 patients with PsA and 20â 777 matched general population comparator (GPC) subjects were included. Societal costs, employment status and occurrence of comorbidities in patients with PsA both before and after diagnosis were compared with GPC subjects. Results At baseline, patients with PsA had...... significantly more comorbidities, including cardiovascular disease (OR 1. 70 95% CI 1. 55 to 1. 86), respiratory diseases (OR 1. 73 95% CI 1. 54 to 1. 96) and infectious diseases (OR 2. 03 95% CI 1. 69 to 2. 42) compared with GPC subjects. At all time points, patients with PsA had higher total healthcare...

The occurrence of psoriatic arthritis in Denmark

DEFF Research Database (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...... and in 2002 46,418 twin individuals received a questionnaire including questions on rheumatic diseases. Twins reporting PsA and their co-twins were classified according to the Moll and Wright (M&W) and CASPAR criteria based on interview, clinical examination, and scrutiny of medical records. RESULTS: A total...... of 228 twin individuals reported PsA and 184 (81%) participated in clinical validation. By using the M&W and CASPAR criteria 54 and 50 cases were diagnosed with PsA respectively. The positive predictive value of self-reported PsA was 31%. According to the M&W and CASPAR criteria the prevalence was 0...

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

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Iwona Sudoł-Szopińska

2016-03-01

Full Text Available 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.

The effect of smartphone addiction on hand joints in psoriatic patients: an ultrasound-based study.

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Megna, M; Gisonni, P; Napolitano, M; Orabona, G Dell'Aversano; Patruno, C; Ayala, F; Balato, N

2018-01-01

Distal interphalangeal (DIP) arthritis is a frequent form of psoriatic arthritis being often linked to nail psoriasis. Modern society is characterized by overuse of smartphones. Indeed, literature has recently focalized on research into smartphone addiction and health-related problems. As smartphone addiction is able to determine overuse and repeated movements of DIP joints and nails, the aim of this study was to evaluate the impact of smartphone use on hand joints of young psoriatic patients. An observational study involving four different groups such as non-smartphone-addicted (SA) psoriatic patients, SA psoriatic patients, non-SA controls and SA controls was performed. Each subject underwent an ultrasound examination of both hands by three independent and blinded to group assignment radiologists. A specific score was used to evaluate the inflammatory state of the analysed joints. The total ultrasound score was statistically significantly higher in SA controls respect to non-SA controls (3.4 vs. 1.4; P Smartphone overuse was found to be linked with higher signs of inflammation of musculoskeletal structures of hands joints in both psoriasis and controls through ultrasound examination. Therefore, smartphone overuse may be a factor which facilitate or speed up the possible development of psoriatic arthritis. © 2017 European Academy of Dermatology and Venereology.

Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease.

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Arvikar, Sheila L; Crowley, Jameson T; Sulka, Katherine B; Steere, Allen C

2017-01-01

To describe systemic autoimmune joint diseases that develop following Lyme disease, and to compare their clinical features with those of Lyme arthritis (LA). We reviewed records of all adult patients referred to our LA clinic over a 13-year period, in whom we had diagnosed a systemic autoimmune joint disease following Lyme disease. For comparison, records of patients enrolled in our LA cohort over the most recent 2-year period were analyzed. Levels of IgG antibodies to Borrelia burgdorferi and to 3 Lyme disease-associated autoantigens were measured. We identified 30 patients who had developed a new-onset systemic autoimmune joint disorder a median of 4 months after Lyme disease (usually manifested by erythema migrans [EM]). Fifteen had rheumatoid arthritis (RA), 13 had psoriatic arthritis (PsA), and 2 had peripheral spondyloarthritis (SpA). The 30 patients typically had polyarthritis, and those with PsA or SpA often had previous psoriasis, axial involvement, or enthesitis. In the comparison group of 43 patients with LA, the usual clinical picture was monoarticular knee arthritis, without prior EM. Most of the patients with systemic autoimmune joint disorders were positive for B burgdorferi IgG antibodies, as detected by enzyme-linked immunosorbent assay, but had significantly lower titers and lower frequencies of Lyme disease-associated autoantibodies than patients with LA. Prior to our evaluation, these patients had often received additional antibiotics for presumed LA, without benefit. We prescribed antiinflammatory agents, most commonly disease-modifying antirheumatic drugs, resulting in improvement. Systemic autoimmune joint diseases (i.e., RA, PsA, SpA) may follow Lyme disease. Development of polyarthritis after antibiotic-treated EM, previous psoriasis, or low-titer B burgdorferi antibodies may provide insight into the correct diagnosis. © 2016, American College of Rheumatology.

Duration of Psoriatic Skin Disease as Risk Factor for Subsequent Onset of Psoriatic Arthritis

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Alexander Egeberg

2018-03-01

Full Text Available It is unclear whether psoriasis is a progressive disease that requires early aggressive intervention. This population-based study identified patients with psoriasis and psoriatic arthritis (PsA. Survival analysis and Kaplan–Meier life table techniques were used. The study comprised 10,011 psoriasis patients (severe n = 4,618, and 1,269 patients also had PsA. Incidence of PsA increased with duration of cutaneous symptoms (p = 0.0001. Psoriasis diagnosed before age 20 or 30 years, respectively, suggested a lower risk of PsA than psoriasis diagnosed after age 50 years, yet age at first cutaneous symptoms did not predict development of PsA. No clear association with disease severity was found. PsA incidence appeared stable with longer duration of psoriasis, but further data are needed to firmly establish the relationship with age of psoriasis onset.

Ultrasound imaging for the rheumatologist. XXXII. Sonographic assessment of the foot in patients with psoriatic arthritis.

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Delle Sedie, A; Riente, L; Filippucci, E; Scirè, C A; Iagnocco, A; Meenagh, G; Gutierrez, M; Valesini, G; Montecucco, C; Grassi, W; Bombardieri, S

2011-01-01

Psoriatic arthritis (PsA) is an arthropathy associated with psoriasis, which is part of the spondyloarthropathy family, and which may present with various forms, from mono-oligoarthritis to symmetric polyarthritis mimicking rheumatoid arthritis. In longstanding disease, the symmetric polyarthritis is the most common pattern of PsA, involving the small joints of hands, feet (the involvement of which seems to be very common, ranging from 50 to 100% of patients), wrists, ankles and knees. Other common features are represented by the inflammation of enthesis and tendons. Its exact prevalence, in Italy, should be about 30% in psoriatic subjects or 0.42% when considering the general population. The aims of our study were to investigate, by US examination, the prevalence and the features of foot involvement in PsA and to describe their correlations with clinical findings. Ultrasound (US) examinations were performed using a Logiq 9 (General Electric Medical Systems, Milwaukee, WI) equipped with a multifrequency linear probe, working at 14 MHz. One hundred and eighty feet were investigated in a total of 101 patients. Prior to US assessment, all patients underwent a clinical examination by an expert rheumatologist who recorded the presence/absence of pain, tenderness (detected by palpation and/or active or passive mobilisation of the feet) and swelling. US finding indicative of metatarsophalangeal joint inflammation were obtained in 77 (76.2%) patients, while only 34 (33.7%) patients were positive to the clinical examination. This study demonstrates that US detected a higher number of inflamed joints with respect to clinical assessment in PsA patients.

Psoriatic arthritis: imaging techniques

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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.

Whole-body MR imaging in psoriatic arthritis: Additional value for therapeutic decision making

International Nuclear Information System (INIS)

Weckbach, Sabine; Schewe, Stefan; Michaely, Henrik J.; Steffinger, Denise; Reiser, Maximilian F.; Glaser, Christian

2011-01-01

Purpose: In psoriatic arthritis (PsA) multiple locations may show inflammatory changes not always readily accessible to clinical exam. Often, clinical exam is inconclusive and the decision to initiate or adapt therapy is difficult. Whole body (WB)-MRI may help in this situation by providing a comprehensive overview of affected areas/joints. The purpose of this study was to make a proof of concept whether WB-MRI in psoriatic arthritis is feasible and can provide additional information compared to clinical examination alone with regard to therapeutic decision making in patients with PsA and inconclusive clinical situation. Materials and Methods: 30 patients with PsA and diffuse musculoskeletal pain were examined. A WB-MRI protocol was implemented on a 1.5 Tesla scanner using coronal and sagittal STIR- (TR: 5800, TE: 54, matrix 384 2 pixels, FOV 400 mm) and pre- and steady-state-post-Gadolinium-VIBE sequences (TR: 9.82, TE: 4.53, matrix 384 x 307 pixels, FOV: 400 mm). MRI was evaluated for image quality and inflammatory findings by two readers in consensus and compared to clinical exam. Results: The WB-MR-exam was well tolerated by all patients. Image quality was rated good to excellent in 26 of 30 patients (86.6%). WB-MRI detected significantly (p < 0.001) more areas of synovitis/enthesitis than clinical exam except for the hands and feet. MRI was able to detect unknown destructive bony changes in 10 patients (53%). In 22 patients (73.3%) the therapy regimen was modified, in 18 patients (62%) TNF-alpha-inhibitors were started. Conclusion: Whole-body MRI (WB-MRI) may be integrated in the diagnostic work-up of patients with psoriatic arthropathy facilitating individual adaptation of therapeutic strategy.

Tofacitinib for Psoriatic Arthritis in Patients with an Inadequate Response to TNF Inhibitors.

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Gladman, Dafna; Rigby, William; Azevedo, Valderilio F; Behrens, Frank; Blanco, Ricardo; Kaszuba, Andrzej; Kudlacz, Elizabeth; Wang, Cunshan; Menon, Sujatha; Hendrikx, Thijs; Kanik, Keith S

2017-10-19

Tofacitinib is an oral Janus kinase inhibitor that is under investigation for the treatment of psoriatic arthritis. We evaluated tofacitinib in patients with active psoriatic arthritis who had previously had an inadequate response to tumor necrosis factor (TNF) inhibitors. In this 6-month randomized, placebo-controlled, double-blind, phase 3 trial, we randomly assigned 395 patients, in a 2:2:1:1 ratio, to four regimens: 5 mg of tofacitinib administered orally twice daily (132 patients); 10 mg of tofacitinib twice daily (132 patients); placebo, with a switch to 5 mg of tofacitinib twice daily at 3 months (66 patients); or placebo, with a switch to 10 mg of tofacitinib twice daily at 3 months (65 patients). Data from the patients who received placebo during the first 3 months of the trial were pooled. The primary end points were the percentage of patients who had at least 20% improvement according to the criteria of the American College of Rheumatology (ACR20 response) and the change from baseline score on the Health Assessment Questionnaire-Disability Index (HAQ-DI; scores range from 0 to 3, with higher scores indicating greater disability) at the month 3 analysis. At 3 months, the rates of ACR20 response were 50% with the 5-mg dose of tofacitinib and 47% with the 10-mg dose, as compared with 24% with placebo (Ptofacitinib continuously and in 6% who received the 10-mg dose continuously. Over the course of 6 months, there were four serious infections, three herpes zoster infections, one myocardial infarction, and one ischemic stroke among the patients who received tofacitinib continuously. Elevations of aspartate and alanine aminotransferase concentrations of three or more times the upper limit of the normal range occurred in more patients who received tofacitinib continuously than in patients who received placebo followed by tofacitinib. In this trial involving patients with active psoriatic arthritis who had had an inadequate response to TNF inhibitors, tofacitinib

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

International Nuclear Information System (INIS)

Koenoenen, M.; Helsinki Univ.

1987-01-01

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.)

Patients' perspectives in the management of psoriasis: the Italian results of the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey.

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Gisondi, Paolo; Girolomoni, Giampiero

2017-08-01

The perspective of patients with psoriasis about medical care treatment goals and strategies is receiving increasing attention. Here, we performed a country-based analysis of the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey, in order to provide specific information on patients' perspective of treatment of psoriasis in Italy. This was a systematic household telephone survey recruiting subjects by random digit dialing. Household members ≥18 years were included if they had ever been diagnosed with psoriasis. About 12,785 households were screened in Italy. 132 patients were ineligible for the analysis, including patients with psoriatic arthritis. 359 patients were surveyed. About half of the patients had very mild disease with less than 1 palm skin involvement, and 38% had 1-10 palm skin disease. It is noteworthy that 48% of patients with widespread disease were not taking any medication. Patients indicated the relief of symptoms, including itching (54.9%), as the main goal for their current therapy, whereas 14.2% reported no specific expectation from their medication. Overall, 70% of patients declared to be satisfied by their therapy, in terms of primary goal reached. Our findings suggest that most psoriasis patients have mild/moderate disease in Italy, and that a portion of patients with severe disease does not receive an adequate treatment.

Genetic polymorphisms associated with psoriasis and development of psoriatic arthritis in patients with psoriasis.

Science.gov (United States)

Loft, Nikolai Dyrberg; Skov, Lone; Rasmussen, Mads Kirchheiner; Gniadecki, Robert; Dam, Tomas Norman; Brandslund, Ivan; Hoffmann, Hans Jürgen; Andersen, Malene Rohr; Dessau, Ram Benny; Bergmann, Ann Christina; Andersen, Niels Møller; Abildtoft, Mikkel Kramme; Andersen, Paal Skytt; Hetland, Merete Lund; Glintborg, Bente; Bank, Steffen; Vogel, Ulla; Andersen, Vibeke

2018-01-01

Psoriasis (PsO) is a chronic inflammatory disease with predominantly cutaneous manifestations. Approximately one third of patients with PsO develop psoriatic arthritis (PsA), whereas the remaining proportion of patients has isolated cutaneous psoriasis (PsC). These two phenotypes share common immunology, but with different heredity that might in part be explained by genetic variables. Using a candidate gene approach, we studied 53 single nucleotide polymorphisms (SNPs) in 37 genes that regulate inflammation. In total, we assessed 480 patients with PsO from DERMBIO, of whom 151 had PsC for 10 years or more (PsC10), 459 patients with PsA from DANBIO, and 795 healthy controls. Using logistic regression analysis, crude and adjusted for age and gender, we assessed associations between genetic variants and PsO, PsC10, and PsA, as well as associations between genetic variants and development of PsA in PsO. Eleven polymorphisms in 10 genes were nominally associated with PsO and/or PsC and/or PsA (P psoriasis, two SNPs in the IL12B and TNF genes were associated with susceptibility of psoriasis. None of the SNPs were specifically associated with isolated cutaneous psoriasis or psoriatic arthritis.

Comparison of three radiographic methods in screening of temporomandibular joint involvement in patients with psoriatic arthritis

International Nuclear Information System (INIS)

Koenoenen, M.; Kilpinen, E.

1990-01-01

Fifty-three randomly selected subjects with psoriatic arthritis (PA) were examined radiographically by means of orthopantomography, transcranial radiography, and transmaxillary radiography. Two examiners graded the radiographic signs of flattening, osteophytes, erosion, and sclerosis. The findings obtained were then compared to determine the best technique for screening of temporomandibular joint (TMJ) bone changes. Together the techniques showed definite (24%) and possible (6%) changes, suggesting TMJ involvement in 31 of 106 joints. In all projections, radiographic signs suggesting TMJ involvement were most frequent in the condyle. Erosion in the condyle was the most frequent finding. Agreement with regard to definite changes in the condyle was found in only one-third to half of the cases. It is concluded that in radiography of the TMJ in subjects with PA, a combination of radiographic techniques should be used to obtain maximum information. However, orthopantomography is well suited for screening of TMJ involvement in subjects with PA. 30 refs., 2 figs., 3 tabs

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.

Science.gov (United States)

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

2012-05-15

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.

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

LENUS (Irish Health Repository)

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.

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

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Vladimir Vasilyevich Badokin

2013-01-01

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.

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

Directory of Open Access Journals (Sweden)

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

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

LENUS (Irish Health Repository)

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.

Immune-Mediated Inflammation Promotes Subclinical Atherosclerosis in Recent-Onset Psoriatic Arthritis Patients without Conventional Cardiovascular Risk Factors

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Rodolfo A. Kolliker Frers

2018-02-01

Full Text Available Studies on the inflammatory burden in recent-onset psoriatic arthritis (PsA patients without conventional cardiovascular risk factors (CVRFs are not available. This preliminary study focuses on cardiovascular risk in cutaneous psoriasis (CPs and recent-onset PsA patients. Blood biochemistry (glucose, cholesterol, uric acid, lipid profile and apolipoprotein B was analyzed using standard kits. Proatherogenic inflammation markers, C-reactive protein (CRP and interleukin-6 (IL-6, and endothelial activators monocyte chemoattractant protein-1 (MCP-1 and soluble intercellular adhesion molecule-1 (sICAM-1, were determined by enzyme-linked immunosorbent assay. Ultrasound images allowed measuring carotid intima–media thickness (cIMT. Our study first shows an increase in cIMT, and in serum levels of sICAM-1 and CRP in recent-onset PsA patients not presenting conventional CVRFs over the non-medicated time-period, from disease diagnosis to the beginning of pharmacological treatment, compared with healthy subjects. The outcome highlights the importance of monitoring serum level of sICAM1, CRP, and cIMT, and the value of primary prevention in psoriatic patients even with no history of cardiovascular events.

MRI findings of juvenile psoriatic arthritis

International Nuclear Information System (INIS)

Lee, Edward Y.; Kleinman, Paul K.; Sundel, Robert P.; Kim, Susan; Zurakowski, David

2008-01-01

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

MRI findings of juvenile psoriatic arthritis

Energy Technology Data Exchange (ETDEWEB)

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

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

Directory of Open Access Journals (Sweden)

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

Psoriatic Arthritis Quality of Life questionnaire: translation, cultural adaptation and validation into Portuguese language.

Science.gov (United States)

Barcelos, Anabela; Ambrósio, Catarina; Pereira da Silva, J A; McKenna, Stephen; Wilburn, Jeanette; Lopes Ferreira, Pedro

2018-02-01

Psoriatic arthritis (PsA) has a strong negative impact on the quality of life of patients. The Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire is a disease-specific instrument developed to measure the quality of life in patients with PsA. The aims of this study were to culturally adapt the questionnaire for Portugal and evaluate its reliability and validity in patients with PsA. The original UK English version of the PsAQoL was translated into Portuguese by a bilingual and lay panel. Structured cognitive debriefing interviews were conducted with ten PsA patients. The Portuguese PsAQoL was subsequently applied to PsA patients followed at the Rheumatology Department of Centro Hospitalar do Baixo Vouga, E.P.E. To assess reproducibility, 30 patients with PsA completed the Portuguese PsAQoL on two occasions, 2 weeks apart. A larger sample was recruited to determine internal consistency and construct validity. The Nottingham Health Profile (NHP) was used as a comparator instrument. Translation and adaptation were successful. Cronbach´s alpha for the Portuguese version of the PsAQoL was 0.91 and the test-retest reliability was 0.93. The PsAQoL could distinguish between groups of patients defined by self-reported general health status, self-reported severity of PsA and flare of arthritis. There was a positive correlation between the total score of the PsAQoL and each of the sections of the NHP. The Portuguese version of the PsAQoL was found to be relevant, understandable and easy to complete, reliable and valid.

Incidence and prevalence of psoriatic arthritis in Denmark

DEFF Research Database (Denmark)

Egeberg, Alexander; Kristensen, Lars Erik; Thyssen, Jacob P.

2017-01-01

Objectives: To examine the incidence and temporal trends of psoriatic arthritis (PsA) in the general population in Denmark. Methods: Using nationwide registry data, we estimated the number of patients with incident PsA within each 1-year period between 1997 and 2011 and calculated the rate of PsA...... cases within gender and age subgroups. Incidence rates were presented per 100 000 person-years. Results: There was a female predominance ranging from 50.3% (1998) to 59.2% (2010), and the mean age at time of diagnosis was 47-50 years. We identified a total of 12 719 patients with PsA (prevalence=0.......22%), including 9034 patients where the PsA diagnosis was made by a rheumatologist (prevalence=0.16%). Incidence rates of PsA (per 100 000 person-years) increased from 7.3 in 1997 to a peak incidence of 27.3 in 2010. Incidence rates were highest for women and patients aged 50-59 years, respectively. The use...

Updating the Psoriatic Arthritis (PsA) Core Domain Set

DEFF Research Database (Denmark)

Orbai, Ana-Maria; de Wit, Maarten; Mease, Philip J

2017-01-01

OBJECTIVE: To include the patient perspective in accordance with the Outcome Measures in Rheumatology (OMERACT) Filter 2.0 in the updated Psoriatic Arthritis (PsA) Core Domain Set for randomized controlled trials (RCT) and longitudinal observational studies (LOS). METHODS: At OMERACT 2016, research...... conducted to update the PsA Core Domain Set was presented and discussed in breakout groups. The updated PsA Core Domain Set was voted on and endorsed by OMERACT participants. RESULTS: We conducted a systematic literature review of domains measured in PsA RCT and LOS, and identified 24 domains. We conducted...... and breakout groups at OMERACT 2016 in which findings were presented and discussed. The updated PsA Core Domain Set endorsed with 90% agreement by OMERACT 2016 participants included musculoskeletal disease activity, skin disease activity, fatigue, pain, patient's global assessment, physical function, health...

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

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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

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

OpenAIRE

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. ...

The relationship between vitamin D, vertebral deformity and quality of life in psoriatic arthritis.

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Bedriye Baskan

2016-10-01

Full Text Available Objective: The aim of this study is to investigate the relation between vitamin D levels, vertebral deformities, functional status, quality of life, acute phase reactants and enthesopathy in patients with psoriatic arthritis (PsA. Patients and Methods: Fifty-two patients with PsA and 52 controls were enrolled to the study. Routine blood tests and serums 25-(OHD3 were measured. The thoracic and lumbar vertebrae deformities identified in the radiographies were evaluated by a radiologist. Psoriatic Arthritis Quality of Life (PSAQoL was used for evaluating quality of life and disease activity parameters for PsA were assessed. In PsA patients, correlations was performed between the 25(OH-D3 levels and PGE (patient global assessment, PHGE (Physician global assessment, tender JC (joint count, HAQ-S (Health Assessment Questionnaire for the Spondyloarthropathies, PSAQoL, MASES (Maastricht Ankylosing Spondylitis Enthesitis Score and BASDAI(Bath Ankylosing Spondylitis Disease Activity Index values. Results: The results showed that 25(OH-D3 levels was not correlated with these values. (p>0.05 for r = -0.171, r = -0.167, r=-0.069, r=-0.236, r=-0.062, r= -0.058 and r = -0.106 respectively. It was determined that the PSAQoL score had a positive and statistically significant correlation with the DGD, swollen JC, CRP, HGD, tender JC, VAS-pain, HAQ-S, MASES and BASDAI values in PsA patients. (p>0.05 for r=0.291, r=0.324, r=0.346, r=0.312; and p=0.001 for r=0.472, r=0.380, r=0.565, r=0.696, r=0.359, r=0.633, respectively Statistical analyses demonstrated that PsA patients with vertebral deformities had higher numbers of tender joints, more prolonged periods of morning stiffness, higher DAS28-ESR (Disease Activity Score scores, and higher levels of vitamin D (p<0.05, p<0.05, p=0.05 and p<0.05, respectively. The multiple logistic regression analysis indicated that the only factor which had an effect on the development of vertebral deformities was the use of steroids

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

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A.V. Smirnov

2014-01-01

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. 

C5a and C5aR are elevated in joints of rheumatoid and psoriatic arthritis patients, and C5aR blockade attenuates leukocyte migration to synovial fluid

DEFF Research Database (Denmark)

Hornum, Lars; Hansen, Anker Jon; Tornehave, Ditte

2017-01-01

synovial fluid was significantly inhibited by anti-C5aR. The data support that the C5a-C5aR axis may be driving the infiltration of inflammatory cells into the synovial fluid and synovium in both rheumatoid and psoriatic arthritis, and suggest that C5a or C5aR may be a promising treatment target in both...... a Boyden chamber. Appropriate statistical tests were applied for comparisons. C5aR+ cells were detected in most rheumatoid arthritis, in all psoriatic arthritis, but not in non-inflammatory control synovia. C5aR+ cells were primarily neutrophils and macrophages. C5aR+ macrophages were mainly found...

Rheumatoid Arthritis Educational Video Series

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Full Text Available Appointments • Support Our Research Arthritis Information Disease Information Rheumatoid Arthritis Psoriatic Arthritis Ankylosing Spondylitis Osteoarthritis Gout Lyme Disease Osteoporosis News Rheumatoid Arthritis News ...

AUTONOMIC CARDIOVASCULAR REGULATION DISORDERS IN PATIENTS WITH PSORIATIC ARTHRITIS

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A. P. Rebrov

2011-01-01

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.

AUTONOMIC CARDIOVASCULAR REGULATION DISORDERS IN PATIENTS WITH PSORIATIC ARTHRITIS

Directory of Open Access Journals (Sweden)

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.

Psoriatic arthropathy in a 17th century archaeological protestant ...

African Journals Online (AJOL)

Besides a plague epidemic that appeared as soon as 1636 or even before in the area of the Marne mander, and more precisely in Saint-Maurice, psoriatic arthropathy (or psoriatic arthritis) lesions were diagnosed on the skeletons of an important population that had never been described before. The lesion symptoms of this ...

Juvenil idiopatisk arthritis

DEFF Research Database (Denmark)

Herlin, Troels

2002-01-01

The new classification of juvenile idiopathic arthritis (JIA) is described in this review. Clinical characteristics divide JIA in to subtypes: systemic, oligoarticular (persistent and extended type), RF-positive and--negative polyarticular, enthesitis-related arthritis and psoriatic arthritis...

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

DEFF Research Database (Denmark)

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 important...... pathologies in peripheral PsA and suggestions concerning appropriate MRI sequences for use in PsA hands are also provided....

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

LENUS (Irish Health Repository)

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%.

Interaction between microbiome and host genetics in psoriatic arthritis.

Science.gov (United States)

Chimenti, Maria Sole; Perricone, Carlo; Novelli, Lucia; Caso, Francesco; Costa, Luisa; Bogdanos, Dimitrios; Conigliaro, Paola; Triggianese, Paola; Ciccacci, Cinzia; Borgiani, Paola; Perricone, Roberto

2018-03-01

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease, seen in combination with psoriasis. Both genetic and environmental factors are responsible for the development of PsA, however little is known about the different weight of these two distinctive components in the pathogenesis of the disease. Genomic variability in PsA is associated with the disease and/or some peculiar clinical phenotypes. Candidate genes involved are crucial in inflammation, immune system, and epithelial permeability. Moreover, the genesis and regulation of inflammation are influenced by the composition of the human intestinal microbiome that is able to modulate both mucosal and systemic immune system. It is possible that pro-inflammatory responses initiated in gut mucosa could contribute to the induction and progression of autoimmune conditions. Given such premises, the aim of this review is to summarize immune-mediated response and specific bacterial changes in the composition of fecal microbiota in PsA patients and to analyze the relationships between bacterial changes, immune system, and host genetic background. Copyright © 2018 Elsevier B.V. All rights reserved.

The sesamoid index in psoriatic arthropathy

International Nuclear Information System (INIS)

Whitehouse, Richard W.; Aslam, Rizwan; Bukhari, Marwan; Groves, Clare; Cassar-Pullicino, Victor

2005-01-01

The sesamoid index was originally described as an aid to the diagnosis of acromegaly. We performed this study to assess the value of the thumb sesamoid index in the diagnosis of psoriatic arthropathy. Retrospective measurement of the sesamoid index (length x width of the medial thumb sesamoid), along with the age and sex were recorded for patients as described below. Patients with psoriasis were subdivided into those with or without radiographic evidence of hand arthropathy. Fifty-nine consecutive patients attending rheumatology clinics with arthralgia and psoriasis were studied. Comparison groups with radiographic evidence of rheumatoid arthritis (52 patients), osteoarthritis (44) or normal hands (55) were also recorded. Twenty-one of 59 patients with psoriasis and arthropathy had a sesamoid index >40, compared with two of 52 with rheumatoid arthritis, none of 44 with osteoarthritis and none of 55 normals. Psoriatic arthropathy is a recognised cause of bone enlargement, usually in the phalanges due to periostitis and proliferative enthesopathy. We have confirmed that psoriatic hand arthropathy can cause significant enlargement of the thumb sesamoids, a feature which is easily quantified and may assist diagnosis. (orig.)

The sesamoid index in psoriatic arthropathy

Energy Technology Data Exchange (ETDEWEB)

Whitehouse, Richard W.; Aslam, Rizwan [Manchester Royal Infirmary, Department of Clinical Radiology, Manchester (United Kingdom); Bukhari, Marwan [Manchester Royal Infirmary, Department of Rheumatology, Manchester (United Kingdom); Groves, Clare; Cassar-Pullicino, Victor [Agnes Hunt and Robert Jones Hospital, Department of Radiology, Oswestry (United Kingdom)

2005-04-01

The sesamoid index was originally described as an aid to the diagnosis of acromegaly. We performed this study to assess the value of the thumb sesamoid index in the diagnosis of psoriatic arthropathy. Retrospective measurement of the sesamoid index (length x width of the medial thumb sesamoid), along with the age and sex were recorded for patients as described below. Patients with psoriasis were subdivided into those with or without radiographic evidence of hand arthropathy. Fifty-nine consecutive patients attending rheumatology clinics with arthralgia and psoriasis were studied. Comparison groups with radiographic evidence of rheumatoid arthritis (52 patients), osteoarthritis (44) or normal hands (55) were also recorded. Twenty-one of 59 patients with psoriasis and arthropathy had a sesamoid index >40, compared with two of 52 with rheumatoid arthritis, none of 44 with osteoarthritis and none of 55 normals. Psoriatic arthropathy is a recognised cause of bone enlargement, usually in the phalanges due to periostitis and proliferative enthesopathy. We have confirmed that psoriatic hand arthropathy can cause significant enlargement of the thumb sesamoids, a feature which is easily quantified and may assist diagnosis. (orig.)

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

International Nuclear Information System (INIS)

Fischer, E.

1989-01-01

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.) [de

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

Science.gov (United States)

Stuhec, 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 no adverse 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. More research is needed on possible adverse effects of concurrent administration of yellow fever vaccine and methotrexate to determine the potential of this method for more frequent use.

Cardiovascular and metabolic risks in psoriasis and psoriatic arthritis: pragmatic clinical management based on available evidence.

Science.gov (United States)

Johnsson, Hanna; McInnes, Iain B; Sattar, Naveed

2012-04-01

Several studies suggest that patients with psoriasis and, in particular, psoriatic arthritis (PsA) are at increased risk of cardiovascular disease. These patients are also more likely to be obese and to have diabetes and fatty liver disease. This article discusses the association between psoriasis and PsA and cardiometabolic disorders, emphasising the need for better consideration of simple lifestyle interventions. It also highlights areas for future research and proposes a simple and pragmatic test portfolio to screen for cardiovascular risk and metabolic disorders in patients at higher risk.

Administration of phospholipide hepatoprotective drug Phosphogliv in patients with psoriatic arthritis (preliminary results

Directory of Open Access Journals (Sweden)

T. V. Korotaeva

2004-01-01

Full Text Available Considering membrane-reparative properties of a new phospholipid hepatoprotector Phosphogliv (FG its therapeutic efficacy was assessed in 9 pts with psoriatic arthritis (PA accompanied by prominent disturbances of blood rheology. FG was given 0,6 g a day during 3 months. Significant decrease of erythrocyte aggregation resulting in increase of erythrocyte aggregation formation time and diminishment of their hydrodynamic resistance without changes of whole blood general caisson viscosity was achieved. Significant improvement of Richie index, tender joint count and pt assessment was noted. The results prove availability of PG administration in PA therapy and possibility of enlargement PG application area owing to membrane-reparative properties of contained in it polyunsaturated phosphatidilcholin in combination with immunomodulating and anti-inflammatory action of glycyrrhizinic acid.

Interleukin-9 Overexpression and Th9 Polarization Characterize the Inflamed Gut, the Synovial Tissue, and the Peripheral Blood of Patients With Psoriatic Arthritis

NARCIS (Netherlands)

Ciccia, Francesco; Guggino, Giuliana; Ferrante, Angelo; Raimondo, Stefania; Bignone, Rodolfo; Rodolico, Vito; Peralta, Sergio; van Tok, Melissa; Cannizzaro, Alessandra; Schinocca, Claudia; Ruscitti, Piero; Cipriani, Paola; Giacomelli, Roberto; Alessandro, Riccardo; Dieli, Francesco; Rizzo, Aroldo; Baeten, Dominique; Triolo, Giovanni

2016-01-01

To investigate the expression and tissue distribution of Th9-related cytokines in patients with psoriatic arthritis (PsA). Quantitative gene expression analysis of Th1, Th17, and Th9 cytokines was performed in intestinal biopsy samples obtained from patients with PsA, HLA-B27-positive patients with

Cardiovascular risk profiles in a hospital-based population of patients with psoriatic arthritis and ankylosing spondylitis

DEFF Research Database (Denmark)

Nissen, Christoffer B; Hørslev-Petersen, Kim; Primdahl, Jette

2017-01-01

The objective of the study was to investigate the frequency of traditional risk factors for the cardiovascular (CV) disease, to calculate the Systematic COronary Risk Evaluation (SCORE) for CV-related mortality in Danish patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS......), and to compare with results from patients with rheumatoid arthritis (RA) from the same settlement. All PsA and AS patients aged 18-85 years from one outpatient clinic were invited. A rheumatology nurse conducted 30-min screening consultation, preceded by a lipid and glucose profile. High SCORE risk led...... to recommendation of follow-up by general practitioners. Multiple and logistic regression analyses, adjusted for age and gender, were performed, to compare risk factors and risk SCOREs. Participants were 116 AS (29.3% female) and 170 PsA (54.7% female). AS had opposed PsA patients' lower 10-year risk SCOREs of CV...

KIF3A and IL-4 are disease-specific biomarkers for psoriatic arthritis susceptibility

Science.gov (United States)

Ragazzo, Michele; Manzo, Laura; Costanza, Gaetana; Bowes, John; Hüffmeier, Ulrike; Potenza, Saverio; Sangiuolo, Federica; Reis, André; Barton, Anne; Novelli, Giuseppe; Orlandi, Augusto; Giardina, Emiliano

2017-01-01

To date, the genes associated with Psoriatic Arthritis (PsA) are principally involved in inflammation, immune response and epidermal differentiation, without any information about the relationship between disease and bone metabolism genes. Our work was focused on 5q31 locus, which contains several genetic variants significantly associated with PsA. The study involved 1526 subjects (500 PsA, 426 PsV, 600 controls). The region was evaluated by selecting and genotyping the SNPs of interest by Real Time PCR and direct sequencing. The results were subjected to biostatistic and bioinformatic analysis. The case-control study highlighted a significant association between KIF3A/IL-4 and PsA, but not with PsV (Psoriasis Vulgaris) patients. In addition, the haplotype analysis revealed two haplotypes significantly associated with PsA susceptibility. The Linkage Disequilibrium (LD) study showed the presence of a specific block in high LD within 132,692,628-132,737,638 bp of 5q31, giving additional evidence of specific association of the 5q31 region in PsA patients. Moreover, KIF3A expression was assessed by immunohistochemistry assays which showed a marked and significant difference of KIF3A expression between pathological and normal tissues. Our analysis described KIF3A and IL-4 as novel susceptibility genes for PsA, suggesting a clear implication of bone metabolism genes in the disease etiopathogenesis. PMID:29221136

Recurrent erythema nodosum and pulmonary lymph node tuberculosis in a patient treated for psoriatic arthritis and psoriasis with TNF inhibitors

Directory of Open Access Journals (Sweden)

Piotr Parcheta

2014-10-01

Full Text Available Introduction. Psoriasis is a chronic inflammatory disease affecting approximately 2% of the population. Biologic agents are the new treatment options for patients with moderate to severe plaque psoriasis who have failed traditional systemic therapies. The therapy with tumor necrosis factor antagonists significantly increases the risk of reactivation of latent tuberculosis; therefore, screening is important before the introduction of biological treatment. Objective. Presentation of diagnostic difficulties in establishing an etiological factor of recurrent erythema nodosum in a 46-year-old woman treated with anti-TNF-α agents (etanercept and adalimumab for plaque psoriasis and psoriatic arthritis. Case report. We present a case of a 46-year-old woman, treated with etanercept and adalimumab for plaque psoriasis and psoriatic arthritis. Despite prophylactic antituberculosis treatment before introduction of biological therapy, the patient developed erythema nodosum most likely caused by lymph node tuberculosis. Conclusions . The development of erythema nodosum, especially the recurrent form, in a patient with a positive tuberculin skin test and negative IGRA test treated with anti-TNF should always prompt increased vigilance and exclusion of active tuberculosis, which may develop even in patients who have undergone prophylactic antituberculosis treatment.

Rheumatoid Arthritis Educational Video Series

Medline Plus

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 ...

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

Directory of Open Access Journals (Sweden)

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.

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

Directory of Open Access Journals (Sweden)

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.

Clinical and immunogenetic characterization in psoriatic arthritis patients.

Science.gov (United States)

Schneeberger, Emilce Edith; Citera, Gustavo; Rodríguez Gil, Gustavo; Granel, Amelia; Arturi, Alfredo; Rosemffet, Gabriel Marcos; Maldonado Cocco, José Antonio; Berman, Alberto; Spindler, Alberto; Morales, Victor Hugo

2015-08-01

In psoriatic arthritis (PsA), genetic factors play a substantial role in disease susceptibility as well as in its expression. This study aims to determine the distribution of class I and class II HLA antigens in PsA patients and secondly to analyze the influence of genetic factors in the clinical expression of the disease. Consecutive PsA patients (CASPAR criteria) with less than 1 year of disease duration were included. Sociodemographic and clinical data were recorded. Blood samples were obtained, DNA was extracted by polymerase chain reaction (PCR), and class I (A, B, and C) and class II (DR) HLA antigens were determined by oligotyping. A control group of 100 nonrelated healthy controls from the general population served as control. p values were corrected (pc) according to the number of alleles tested. A total of 73 patients were included, 37 were females (50.7 %) with a median disease duration of 72 months (interquartile range (IQR) 24-149). Thirty-three patients (45.2 %) had a family history of psoriasis. When analyzing all the class I and class II HLA antigens, a significantly higher frequency of B38 (odds ratio (OR) 2.95, p = 0.03) and Cw6 (OR 2.78, p = 0.009) was found in PsA patients compared to the control group. On the contrary, the HLA-A11 (OR 0.14, p = 0.04) and B7 (OR 0.31, p = 0.03) were significantly more frequent among healthy controls. Furthermore, B18 was significantly more frequent in patients with early arthritis onset (less than 40 years): seven patients (22.6 %) with early onset compared to two patients (4.8 %) with late onset (p = 0.03). No association between HLA-B27 and spondylitis or HLA-DR4 with polyarticular involvement was observed. The HLA-B38 and Cw6 alleles are associated with a greater PsA susceptibility in Argentine population.

Incidence of rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica in an inland area of central Italy: results of the CAMPO-RHE study.

Science.gov (United States)

De Socio, Antonia; Perrotta, Fabio Massimo; Grasso, Guido Maria; Lubrano, Ennio

2018-01-01

The aim of the CAMPO-RHE study was to determine the incidence of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and polymyalgia rheumatica (PMR) in patients attending a rheumatologic outpatient's clinic of a new institution in Campobasso, Italy. Campobasso is a small town of approximately 50,000 inhabitants located in the inland territory of central Italy (Molise), and Public Health is managed from a single health authority. In Italy, all citizens are registered with a National Health System of General Practitioner (GP) Physicians. Between the 1 st of June 2014 and the 31 st of May 2016, all consecutive adult patients, sent by a GP, of Campobasso with any diagnosis of musculoskeletal symptoms/signs/complaints were evaluated in a single rheumatology outpatient clinic of our Academic Unit. The clinic represents the first and unique reference for GPs about rheumatic diseases in the territory. Subjects were classified using the 2010 EULAR criteria for RA, the CASPAR criteria for PsA and the 2012 ACR classification criteria for PMR. 1003 adult patients, sent by GPs, with articular or musculoskeletal complaints visited our clinic. Of these, 409 inhabitants of the municipality of Campobasso were evaluated for the study. During the 2-year study period we diagnosed 18, 19 and 12 new cases of RA, PsA and PMR respectively, with a new incident cases rate of 21.4, 22.59 and 27.43/100,000/year on the population at risk. The results of our study could contribute to better define the incidence of these rheumatic diseases classified with the new classification criteria.

Disease activity in and quality of life of patients with psoriatic arthritis mutilans: the Nordic PAM Study.

Science.gov (United States)

Lindqvist, U; Gudbjornsson, B; Iversen, L; Laasonen, L; Ejstrup, L; Ternowitz, T; Ståhle, M

2017-11-01

To describe the social status and health-related quality of life of patients with psoriatic arthritis mutilans (PAM) in the Nordic countries. Patients with at least one mutilated joint confirmed by radiology were studied. Disease activity involving joints and skin, physician-assessed disease activity, and patient's education and work status were recorded. Data from the 36-item Short Form Health Survey, Health Assessment Questionnaire and Dermatology Life Quality Index questionnaire were gathered and correlated with disease duration, pain, and general well-being (visual analogue scale). The controls were 58 Swedish patients with long-standing psoriatic arthritis sine PAM. Sixty-seven patients were included. Patients with PAM had a protracted disease history (33 ± 14 years) and disease onset at a relatively early age (30 ± 12 years). Overall inflammatory activity at inclusion was mild to moderate. The mean number of mutilated joints was 8.2 and gross deformity was found in 16% of patients. Forty per cent were treated with biological and 32% with conventional synthetic disease-modifying anti-rheumatic drugs. Forty-two per cent had retired early or were on sick leave. Impaired functional capacity with little or no ability to perform self-care or everyday tasks was reported by 21% of the patients. Patients between 45 and 60 years of age reported the most impaired quality of life in comparison to the control group. PAM seriously affects social functioning. Whether early recognition of PAM and new forms of therapy can improve disease outcome and quality of life remains to be studied.

The psychosocial burden of psoriatic arthritis.

Science.gov (United States)

Husni, M Elaine; Merola, Joseph F; Davin, Sara

2017-12-01

To assess the psychosocial impact of psoriatic arthritis (PsA), describe how health-related quality of life (QoL) is affected in patients with PsA, discuss measures used to evaluate the psychosocial impact of PsA, and review studies examining the effect of therapy on QoL. A targeted review on the impact of PsA on QoL and the role of tailored psychosocial management in reducing the psychosocial burden of the disease was performed. PubMed literature searches were conducted using the terms PsA, psychosocial burden, QoL, and mood/behavioral changes. Articles were deemed relevant if they presented information regarding the psychosocial impact of PsA, methods used to evaluate these impacts, or ways to manage/improve management of PsA and its resulting comorbidities. The findings of this literature search are descriptively reviewed and the authors׳ expert opinion on their interpretation is provided. The psychosocial burden of PsA negatively affects QoL. Patients suffer from sleep disorders, fatigue, low-level stress, depression and mood/behavioral changes, poor body image, and reduced work productivity. Additionally, each patient responds to pain differently, depending on a variety of psychological factors including personality structure, cognition, and attention to pain. Strategies for evaluating the burdens associated with PsA and the results of properly managing patients with PsA are described. PsA is associated with a considerable psychosocial burden and new assessment tools, specific to PsA, have been developed to help quantify this burden in patients. Future management algorithms of PsA should incorporate appropriate assessment and management of psychological and physical concerns of patients. Furthermore, patients with PsA should be managed by a multidisciplinary team that works in coordination with the patient and their family or caregivers. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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

LENUS (Irish Health Repository)

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.

Subjective Health Complaints in Individuals with Psoriasis and Psoriatic Arthritis: Associations with the Severity of the Skin Condition and Illness Perceptions - A Cross-Sectional Study.

Science.gov (United States)

Nordbø, Emma Charlott Andersson; Aamodt, Geir; Ihlebæk, Camilla Martha

2017-06-01

High comorbidity has been reported among persons with psoriasis and psoriatic arthritis (PsA), but the occurrence of subjective health complaints (SHCs) in these patient groups is poorly understood. The study aimed to describe the prevalence of SHCs among individuals with psoriasis and PsA in Norway, and investigate whether the severity of their skin condition and their illness perceptions were associated with the number and severity of health complaints. Participants were recruited through the Psoriasis and Eczema Association of Norway (PEF) (n = 942). The participants answered a self-administered questionnaire covering subjective health complaints, the severity of their skin condition, and their illness perceptions measured with the Brief Illness Perception Questionnaire (BIPQ-R). The prevalence and severity of SHCs were high. Participants with PsA reported more complaints and higher severity of complaints compared with participants with psoriasis. In both groups, the severity of the skin condition was associated with the number and severity of SHCs. Cognitive illness perceptions (consequences) and emotional illness perceptions (emotional affect) were associated with SHCs in participants with psoriasis, whereas only cognitive illness perceptions (consequences and identity) were associated with SHCs in participants with PsA. The high prevalence and severity of SHCs among individuals with psoriasis and PsA were associated with the severity of the skin condition and illness perceptions. Somatic and cognitive sensitizations are proposed as possible mechanisms. The findings suggest that holistic approaches are essential when managing these patient groups in health care institutions and clinical practice.

Dactylitis in psoriatic arthritis: clinical features, diagnosis, immunopathogenesis, and treatment

Directory of Open Access Journals (Sweden)

T. V. Korotaeva

2018-01-01

Full Text Available When dactylitis is detected in a patient with psoriatic arthritis (PsA, it is necessary to use active treatment as soon as possible, since in the absence of therapy the disease progresses to joint erosion and  functional disorders. The paper considers the clinical signs and  diagnosis of PsA and notes the importance of differential diagnosis in this sign with other joint inflammatory diseases. It points to the  necessity of elaborating common approaches to an objective  assessment of the severity of dactylitis. Its immunopathogenesis and main treatment areas, including the use of biological agents (BAs,  are detailed. There are data of clinical trials that have evaluated the  efficiency of treatment for dactylitis and established that in most  cases, the use of BAs considerably reduce not only the severity of its clinical signs, but also concomitant bone marrow edema. It is noted  that the development of new pathogenetic treatments targeting a number of currently established biologically active molecules that  play an important role in the pathogenesis of dactylitis will enhance  the efficiency of treatment in patients with PsA.

The indirect costs of psoriatic arthritis: systematic review and meta-analysis.

Science.gov (United States)

Kawalec, Paweł; Malinowski, Krzysztof Piotr

2015-02-01

The aim of this systematic review is to collect all current data on the indirect costs (IC) related to psoriatic arthritis (PsA). The search was conducted using MEDLINE (via PubMed), Embase and Centre for Reviews and Dissemination databases. We considered original studies, systematic reviews, economic evaluations, conference abstracts and posters. All collected data were recalculated to average annual cost per patient, expressed using the consumer price index for 2013 and converted to US dollars using purchasing power parity. Eight of the identified publications presented IC of PsA. Average annual IC per patient calculated using the friction cost approach range from US$1693.83 to $12,318.45, while using the human capital approach they range from US$1750.68 to $50,270.52. Result of the meta-analysis was a basis for calculating cost of work disability equaled US$10,754.04 per patient per year in 2013 prices. This systematic review revealed a great economic burden of the disease to the society. A small number of studies on IC in PsA justify further investigations.

Multidisciplinary Care Models for Patients With Psoriatic Arthritis.

Science.gov (United States)

Queiro, Rubén; Coto, Pablo; Rodríguez, Jesús; Notario, Jaume; Navío Marco, Teresa; de la Cueva, Pablo; Pujol Busquets, Manel; García Font, Mercè; Joven, Beatriz; Rivera, Raquel; Alvarez Vega, Jose Luis; Chaves Álvarez, Antonio Javier; Sánchez Parera, Ricardo; Ruiz Carrascosa, Jose Carlos; Rodríguez Martínez, Fernando José; Pardo Sánchez, José; Feced Olmos, Carlos; Pujol, Conrad; Galindez, Eva; Pérez Barrio, Silvia; Urruticoechea Arana, Ana; Hergueta, Mercedes; Luelmo, Jesús; Gratacós, Jordi

To describe (structure, processes) of the multidisciplinary care models in psoriatic arthritis (PsA) in Spain, as well as barriers and facilitators of their implementation. A qualitative study was performed following structured interviews with 24 professionals (12 rheumatologists, 12 dermatologists who provide multidisciplinary care for patients with PsA). We collected data related to the hospital, department, population and multidisciplinary care model (type, physical and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision- making, research and education, clinical sessions, development and planning of the model, advantages and disadvantages of the model, barriers and facilitators in the implementation of the model. The models characteristics are described. We analyzed 12 multidisciplinary care models in PsA, with at least 1-2 years of experience, and 3 subtypes of models, face-to-face, parallel, and preferential circuit. All are adapted to the hospital and professionals characteristics. A proper implementation planning is essential. The involvement and empathy between professionals and an access and well-defined referral criteria are important facilitators in the implementation of a model. The management of agendas and data collection to measure the multidisciplinary care models health outcomes are the main barriers. There are different multidisciplinary care models in PsA that can improve patient outcomes, system efficiency and collaboration between specialists. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Development and validation of a new instrument to measure health-related quality of life in patients with psoriatic arthritis: the VITACORA-19.

Science.gov (United States)

Torre-Alonso, Juan Carlos; Gratacós, Jordi; Rey-Rey, José Santos; Valdazo de Diego, Juan Pablo; Urriticoechea-Arana, Ana; Daudén, Esteban; Moreno, Mireia; Zarco-Montejo, Pedro; Collantes-Estévez, Eduardo; Fernández-López, Juan Antonio

2014-10-01

To develop/validate an instrument to measure health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA), for use in clinical studies. An item pool of 35 items was generated following standardized procedures. Item reduction was performed using clinimetric and psychometric approaches after administration to 66 patients with PsA. The resulting instrument, the VITACORA-19, consists of 19 items. Its validity content, internal consistency, test-retest reliability, known groups/convergent validity, and sensitivity to change were tested in a longitudinal and multicenter study conducted in 10 hospitals in Spain, with 323 patients who also completed the EuroQol 5-dimensional questionnaire (EQ-5D) and a health status transition item. There were 3 study groups: group A (n = 209, patients with PsA), group B (n = 71, patients with arthritis without psoriatic aspect, patients with arthrosis, and patients with dermatitis), and group C (n = 43, healthy controls). The questionnaire was considered easy/very easy to answer by 94.7% of the patients with PsA. The factorial analysis clearly identified only 1 factor. Cronbach's alpha coefficient and interclass correlation coefficients exceeded 0.90. Statistically significant differences (p measure HRQoL in patients with PsA, has good validity, reliability, and sensitivity to change.

On the heritability of psoriatic arthritis. Disease concordance among monozygotic and dizygotic twins

DEFF Research Database (Denmark)

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

2008-01-01

OBJECTIVE: In a nationwide unselected twin population to estimate the relative importance of genetic and environmental effectors in the etiopathogenesis of psoriatic arthritis (PsA). METHODS: The study comprised three Danish nationwide twin cohorts. In 1994 and 2002 a total of 37,388 and 46......,418 Danish twin individuals respectively were asked by questionnaire if they had PsA. Twins reporting PsA were invited to participate in a clinical examination. Patients were classified according to the Moll and Wright (M&W) and the CASPAR criteria. Heritability was estimated by probandwise concordance rates...... and variance component analysis. RESULTS: 228 twin individuals reported PsA. Following diagnostic validation in 184 (81%), 50 probands were diagnosed with PsA according to the M&W criteria. Five of their co-twins were either dead, had emigrated, or did not participate in the twin study and nine did not respond...

Imaging in the diagnosis and management of peripheral psoriatic arthritis-The clinical utility of magnetic resonance imaging and ultrasonography

DEFF Research Database (Denmark)

Østergaard, Mikkel; Eder, Lihi; Christiansen, Sara Nysom

2016-01-01

Psoriatic arthritis (PsA) is an inflammatory joint disease characterised by the presence of arthritis and often enthesitis and/or spondylitis in patients with psoriasis. However, it presents a wide range of disease manifestations in various patterns. Imaging is an important part of management of PsA...... or clinical studies. Magnetic resonance imaging (MRI) allows detailed assessment of all peripheral and axial joints involved in PsA, and can visualise both inflammation and structural changes. Ultrasonography (US) can visualise many of the peripheral heterogeneous tissue compartments affected by PsA....... In contrast to MRI, US is not useful for assessing axial involvement in the spine and sacroiliac joints. In this paper, we will provide an overview of the status, strengths and limitations of MRI and US in peripheral PsA in routine clinical practice and clinical trials....

Marine n-3 Polyunsaturated Fatty Acids in Psoriatic Arthritis – Inflammation and Cardiac Autonomic and Hemodynamic Function

DEFF Research Database (Denmark)

Kristensen, Salome

This thesis is based on three studies of patients with established psoriatic arthritis (PsA) aiming at investigating the effect of marine n-3 polyunsaturated fatty acids (PUFA) on clinical symptoms and selected measures of inflammation, cardiac autonomic and hemodynamic function in these patients...... with either 3 g of marine n-3 PUFA (6 capsules of fish oil) or 3 g of olive oil daily for 24 weeks. A total of 133 patients (92%) completed the study. The difference in the outcomes between baseline and 24 weeks was analysed within and between the two supplemented groups. In Study II, the effects of n-3 PUFA...

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

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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.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... and what other conditions are associated with RA. Learning more about your condition will allow you to ... Arthritis Educational Video Series Psoriatic Arthritis 101 2010 E.S.C.A.P.E. Study Patient Update Transitioning ...

Optimal management of dactylitis in patients with psoriatic arthritis

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Yamamoto T

2015-09-01

Full Text Available Toshiyuki YamamotoDepartment of Dermatology, Fukushima Medical University, Fukushima, JapanAbstract: Psoriatic arthritis (PsA is an inflammatory arthropathy associated with cutaneous psoriasis, which is currently classified as a seronegative spondyloarthropathy. The presence of cutaneous psoriasis is important for correct and early diagnosis of PsA, because the onset of cutaneous lesions usually precedes the appearance of joint manifestation. Thus, dermatologists are able to detect the condition at its inception. PsA has several unique characteristics such as enthesopathy, dactylitis, and abnormal bone remodeling. In particular, dactylitis occurs on the easily observed sites such as digits, and is thus a significant indicator of PsA. It is important to observe not only the fingers but also the toes, because dactylitis involves both digits of the hands and feet. Recently, new ideas regarding the involvement of the interleukin (IL-23/Th17 axis have emerged, and the dramatic effects of targeting therapies have highlighted the physiological roles of key cytokines such as tumor necrosis factor-α, IL-17A, and IL-23 in psoriasis. As recent insights are shedding light on the pathogenesis of PsA, understanding of the pathogenesis of dactylitis and enthesitis are also progressing. In this article, current views on the optimal management of dactylitis are discussed.Keywords: pathogenesis, therapy, enthesitis, tenosynovitis

A systematic review of measurement properties of patient reported outcome measures in psoriatic arthritis

DEFF Research Database (Denmark)

Højgaard, Pil; Klokker, Louise; Orbai, Ana Maria

2018-01-01

Background: An updated psoriatic arthritis (PsA) core outcome set (COS) for randomized controlled trials (RCTs) was endorsed at the Outcome Measures in Rheumatology (OMERACT) meeting in 2016. Objectives: To synthesize the evidence on measurement properties of patient reported outcome measures...... (PROMs) for PsA and thereby contribute to development of a PsA core outcome measurement set (COMS) as described by the OMERACT Filter 2.0. Methods: A systematic literature search was performed in EMBASE, MEDLINE and PsycINFO on Jan 1, 2017 to identify full-text articles with an aim of assessing...... the measurement properties of PROMs in PsA. Two independent reviewers rated the quality of studies using the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, and performed a qualitative evidence synthesis. Results: Fifty-five studies were included in the systematic...

The expression of selected molecular markers of immune tolerance in psoriatic patients.

Science.gov (United States)

Bartosińska, Joanna; Purkot, Joanna; Kowal, Małgorzata; Michalak-Stoma, Anna; Krasowska, Dorota; Chodorowska, Grażyna; Giannopoulos, Krzysztof

2018-04-24

Psoriasis is a chronic autoinflammatory disease whose underlying molecular mechanisms remain unclear. The disease is mediated by the cells and molecules of both the innate and adaptive immune systems. Some T cell surface molecules, including neuropilin-1 (NRP1), programmed death 1 (PD-1) and the human leukocyte antigen G (HLA-G), are known to play a role in the maintenance of immune tolerance. The aim of this study was to investigate HLA-G, NRP1 and programmed cell death gene (PDCD1) mRNA expression in psoriatic patients. The study included 72 psoriatic patients and 35 healthy individuals. Twentyone patients (29.17%) suffered from concomitant psoriatic arthritis. The mRNA expression of HLA-G, NRP1, and PDCD1 were determined using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The severity of skin lesions was assessed by means of the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), the Patient Global Assessment (PGA), and the Dermatology Life Quality Index (DLQI). The median value of the PASI was 11.5, and of BSA was 15.8%. The expressions of NRP1 and PDCD1, but not HLA-G, were significantly lower in psoriatic patients in comparison with the control group. The expression of HLA-G, NRP1 and PDCD1 were not significantly different in the psoriatic arthritis and psoriasis vulgaris patients. The results of this study suggest that the molecular markers of immune tolerance, i.e., HLA-G, NRP1, and PD-1, may be involved in the immune response in psoriatic patients.

Comprehensive evaluation of finger flexor tendon entheseal soft tissue and bone changes by ultrasound can differentiate psoriatic arthritis and rheumatoid arthritis.

Science.gov (United States)

Tinazzi, Ilaria; McGonagle, Dennis; Zabotti, Alen; Chessa, Donatella; Marchetta, Antonio; Macchioni, Pierluigi

2018-02-28

To determine whether a detailed sonographic evaluation of the hand flexor tendon compartment could help differentiate between psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Thirty-seven patients with PsA, 47 with RA and 10 healthy controls (HC) had flexor tendon (FT) compartment imaging of the dominant hand 2nd to 4th tendons using grey scale (GS) and power Doppler (PD) ultrasound (US) with evaluation for tenosynovitis, peri-tendinous lesions, soft tissue oedema and bony changes at FT insertions. 24/37 PsA and 19/47 RA cases had morning stiffness and 19/37 PsA and 10/47 RA had swollen and/or tender fingers. Tenosynovitis was more common in PsA (25/37) despite higher DAS28 scores in RA (25/37 versus 10/45; pthe insertional site was significantly more common in PsA (p=0.001). Considering a total inflammatory score per patient summing up the three modifications of the flexor tendon (tenosynovitis, peri-tendinous oedema and insertional enthesophytes) the difference between PsA and RA remained statistically significant (pthe growing body of literature that high resolution US of the hand FT compartment may help differentiate between RA and PsA, which needs assessment in the diagnostic setting.

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

DEFF Research Database (Denmark)

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

2016-01-01

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......-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...

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

LENUS (Irish Health Repository)

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.

Risk of Incident Liver Disease in Patients with Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis: A Population-Based Study.

Science.gov (United States)

Ogdie, Alexis; Grewal, Sungat K; Noe, Megan H; Shin, Daniel B; Takeshita, Junko; Chiesa Fuxench, Zelma C; Carr, Rotonya M; Gelfand, Joel M

2018-04-01

Relatively little is known about the risk for incident liver disease in psoriasis (PsO), psoriatic arthritis (PsA), and rheumatoid arthritis (RA). We performed a cohort study among patients with PsO, PsA, or RA and matched controls in The Health Improvement Network from 1994 to 2014. Outcomes of interest were any liver disease, nonalcoholic fatty liver disease, and cirrhosis (any etiology). Among patients with PsO (N = 197,130), PsA (N = 12,308), RA (N = 54,251), and matched controls (N = 1,279,754), the adjusted hazard ratios for any liver disease were elevated among patients with PsO (without systemic therapy [ST] 1.37; with ST 1.97), PsA (without ST 1.38; with ST 1.67), and RA without an ST (1.49) but not elevated in patients with RA prescribed an ST (0.96). Incident nonalcoholic fatty liver disease was highest in patients with PsO prescribed an ST (2.23) and PsA with an ST (2.11). The risk of cirrhosis was highest among patients with PsO with an ST (2.62) and PsA without an ST (3.15). Additionally, the prevalence of liver disease and cirrhosis increased in a stepwise fashion with increasing body surface area affected by PsO (P for trend <0.001). More so than RA, PsO and PsA are associated with liver disease, particularly nonalcoholic fatty liver disease and cirrhosis, and this was true even among patients without ST exposure. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Patients from Johns Hopkins Stategies to Increase your Level of Physical Activity Role of Body Weight in Osteoarthritis Educational Videos for Patients Rheumatoid Arthritis Educational Video Series Psoriatic Arthritis 101 2010 E.S.C.A.P.E. Study Patient Update Transitioning the JRA ...

Insight into the Endocrine System and the Immune System: A Review of the Inflammatory Role of Prolactin in Rheumatoid Arthritis and Psoriatic Arthritis

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Man W. Tang

2017-06-01

Full Text Available Rheumatoid arthritis (RA is a chronic autoimmune disease that affects females three times more frequently than males. A potential role for hormones, such as prolactin (PRL, may in part explain this phenomenon. The risk of developing RA is increased in women who are lactating after the first pregnancy, which might be related to breastfeeding and the release of PRL. Other studies found a protective effect of PRL on RA development. Some studies have reported that hyperprolactinemia is more common in RA and serum PRL levels are correlated with several disease parameters, although others could not confirm these findings. Overall the plasma PRL levels are on average not elevated in RA. Previously, a small number of open-label clinical trials using bromocriptine, which indirectly decreases PRL levels, were performed in RA patients and showed clinical benefit, although others found the opposite effect. Locally produced PRL at the site of inflammation may have a crucial role in RA as well, as it has been shown that PRL can be produced by synovial macrophages. Locally produced PRL has both pro-inflammatory and anti-inflammatory effects in arthritis. Psoriatic arthritis (PsA is also an autoinflammatory disease, in which the prolactin receptor is also expressed in macrophages. The aim of this review is to provide an overview of the potential role of PRL signaling in inflammatory joint diseases (RA and PsA and its potential as a therapeutic target.

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

Science.gov (United States)

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) investigating certolizumab pegol (CZP) efficacy and safety in PsA. WPS was completed at baseline and every 4 weeks until Week 24. Validity was evaluated at baseline via known-groups defined using first and third quartiles of patients’ Disease Activity Score 28 based on C-reactive protein (DAS28(CRP)), Health Assessment Questionnaire-Disability Index (HAQ-DI), Short Form-36 (SF-36) items and PsA Quality of Life (PsAQoL) scores. Responsiveness and reliability were assessed by comparing WPS mean changes at Week 12 in American College of Rheumatology 20% improvement criteria (ACR20) or HAQ-DI Minimal Clinically Important Difference (MCID) 0.3 responders versus non-responders, as well as using standardized response means (SRM). All comparisons were conducted on the observed cases in the Randomized Set, regardless of the randomization group, using a non-parametric bootstrap-t method. Results Compared with patients with a better health state, patients with a worse health state had on average 2 to 6 times more household work days lost, more days with reduced household productivity, more days missed of family/social/leisure activities, more days with outside help hired and a significantly higher interference of arthritis per month. Among employed patients, those with a worse health state had 2 to 4 times more workplace days lost, more days with patient workplace productivity reduced, and a significantly higher interference of arthritis on patient workplace productivity versus

Long-term survival of methotrexate in psoriatic arthritis

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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.

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

DEFF Research Database (Denmark)

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

2012-01-01

the impact of skin disease on QoL; the Health Assessment Questionnaire-Disability Index (HAQ-DI), an assessment of physical function; the Hospital Anxiety and Depression Scale (HADS), which screens for anxiety and depression symptoms; and individual questions on general health, disease activity, fatigue......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...

Psoriasis and psoriasic arthritis

International Nuclear Information System (INIS)

Cortes Vera, Sandra Liliana; Iglesias Gamarra, Antonio; Restrepo Suarez, Jose Felix

2003-01-01

The psoriasis is an skin inflammatory disease characterized by chronic and recurrent red skin covered with silver scales. In their pathogenesis, immunogenetic and environmental factors are conjugated. Psoriatic arthritis. That is a seronegative arthropathy. In the greater part of cases follow to a chronic course of cutaneous psoriasis. In this paper, we analyzed the most frequent forms of presentation of cutaneous psoriasis and we revised the psoriatic arthropathy, with some indications about its treatment

Osteoscintigraphy in the diagnosis of psoriatic arthritis

International Nuclear Information System (INIS)

Milevskaya, S.G.; Borodulin, V.F.

1989-01-01

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 99m Tc-pyrophos (USSR) and 99m Tc-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

Overview of the radiology of juvenile idiopathic arthritis (JIA)

International Nuclear Information System (INIS)

Cohen, P.A.; Job-Deslandre, C.H.; Lalande, G.; Adamsbaum, C.

2000-01-01

Plain films remain the basic tool for diagnosis and follow-up evaluation of juvenile idiopathic arthritis (JIA). In this paper, we review the new classification of JIA: systemic arthritis, oligoarthritis (persistent), oligoarthritis (extended), polyarticular arthritis (rheumatoid factor negative), polyarticular arthritis (rheumatoid factor positive), enthesitis related arthritis, psoriatic arthritis and unclassified arthritis. We will also review regional abnormalities of three stages: an early stage, an intermediate stage, a late stage, as well as the differential diagnosis

Arthritis mutilans due to chronic tophaceous gout | Akintayo | African ...

African Journals Online (AJOL)

Background: Arthritis mutilans is a form of destructive arthritis which is often characterized with severe osteolysis. It is more commonly described in association with the most severe forms of psoriatic and rheumatoid arthritis. Case presentation: A 69-year old man presented with a fifteen-year history of recurrent inflammatory ...

Validation of the OMERACT Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) for the Hand and Foot in a Randomized Placebo-controlled Trial

DEFF Research Database (Denmark)

Glinatsi, Daniel; Bird, Paul; Gandjbakhch, Frederique

2015-01-01

Objective. To assess changes following treatment and the reliability and responsiveness to change of the Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) in a randomized controlled trial. Methods. Forty patients with PsA randomized to either...... placebo or abatacept (ABA) had MRI of either 1 hand (n = 20) or 1 foot (n = 20) at baseline and after 6 months. Images were scored blindly twice by 3 independent readers according to the PsAMRIS (for synovitis, tenosynovitis, periarticular inflammation, bone edema, bone erosion, and bone proliferation...

Crossreactive autoantibodies directed against cutaneous and joint antigens are present in psoriatic arthritis.

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Marzia Dolcino

Full Text Available Psoriatic arthritis (PsA is a chronic inflammatory disease of unknown origin, characterized by erosions and new bone formation. Diagnosis of PsA is mainly clinical and there are no biomarkers available. Moreover in PsA autoantibodies have not been described so far. Indeed an autoimmune origin has been suggested but never proven. Aim of the study was to investigate the possible presence of autoantibodies typically associated with PsA.We used pooled IgG immunoglobulins derived from 30 patients with PsA to screen a random peptide library in order to identify disease relevant autoantigen peptides.Among the selected peptides, one was recognised by nearly all the patients' sera. The identified peptide (PsA peptide: TNRRGRGSPGAL shows sequence similarities with skin autoantigens, such as fibrillin 3, a constituent of actin microfibrils, desmocollin 3, a constituent of the desmosomes and keratin 78, a component of epithelial cytoskeleton. Interestingly the PsA peptide shares homology with the nebulin-related anchoring protein (N-RAP, a protein localized in the enthesis (point of insertion of a tendon or ligament to the bone, which represents the first affected site during early PsA. Antibodies affinity purified against the PsA peptide recognize fibrillin, desmocollin, keratin and N-RAP. Moreover antibodies directed against the PsA peptide are detectable in 85% of PsA patients. Such antibodies are not present in healthy donors and are present in 13/100 patients with seroposive rheumatoid arthritis (RA. In seronegative RA these antibodies are detectable only in 3/100 patients.Our results indicate that PsA is characterized by the presence of serum autoantibodies crossreacting with an epitope shared by skin and joint antigens.

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

LENUS (Irish Health Repository)

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.

The OMERACT MRI inflammatory arthritis group: advances and future research priorities

DEFF Research Database (Denmark)

Conaghan, Philip G; Bird, Paul; McQueen, Fiona

2009-01-01

The OMERACT magnetic resonance imaging (MRI) in inflammatory arthritis group previously developed the rheumatoid arthritis MRI score (RAMRIS) for use in clinical studies, evaluated the use of extremity MRI, and initiated development of a psoriatic arthritis MRI score (PsAMRIS). At OMERACT 9 the g...

Candida infections in psoriasis and psoriatic arthritis patients treated with IL-17 inhibitors and their practical management

DEFF Research Database (Denmark)

Saunte, D M; Mrowietz, U; Puig, L

2017-01-01

infections, especially those due to Candida sp., as evidenced by findings in patients with genetic defects in IL-17 related immune responses. To assess the potential of anti-Il-17 treatment to promote Candida infections, here we have systematically reviewed published clinical trials of patients...... with psoriasis or psoriatic arthritis. Candida infections were reported in 4.0% of patients treated with brodalumab, 2.1% with secukinumab, and 3.3% with ixekizumab, compared with 0.3%, 2.3% and 0.8% of those assigned to placebo, ustekinumab or etanercept, respectively. Although the incidence of Candida...... infection was found to be increased by a only small degree during anti-IL-17 therapy, patients undergoing such treatment should be monitored for fungal infection and treated as necessary. We propose to adopt the recently updated recommendations for the practical management of Candida infection in patients...

Effectiveness of early adalimumab therapy in psoriatic arthritis patients from Reuma.pt - EARLY PsA.

Science.gov (United States)

Santos, Helena; Eusébio, Mónica; Borges, Joana; Gonçalves, Diana; Ávila-Ribeiro, Pedro; Faria, Daniela Santos; Lopes, Carina; Rovisco, João; Águeda, Ana; Nero, Patrícia; Valente, Paula; Cravo, Ana Rita; Santos, Maria José

2017-01-01

Objective To compare outcomes in psoriatic arthritis (PsA) patients initiating adalimumab (ADA), with short- and long-term disease duration and to evaluate the potential effect of concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or glucocorticoids. Methods Analyses included adult PsA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) between June 2008-June 2016 who received ADA for ≥3 months. Psoriatic Arthritis Response Criteria (PsARC) response, tender and swollen joint count, inflammatory parameters, patient (PtGA) and physician global assessment (PhGA), Disease Activity Score-28 joints (DAS28), and Health Assessment Questionnaire Disability Index (HAQ-DI) were compared between patients with PsA) and those with ≥5 years of disease duration (late PsA). Time to achieving PsARC response was estimated using the Kaplan-Meier method. Results Of 135 PsA patients treated with ADA, 126 had information on disease duration (earlyPsA, n=41). PsARC response was achieved by 72.9% of the patients (88.0% early PsA vs 62.2% late PsA; P=0.022) after 3 months and by 85.4% after 24 months (100% early PsA vs 75.9% late PsA; P=0.044). Early PsA patients achieved significantly less painful joints (2.7 vs 6.7, p=0.006), lower mean C-reactive protein (0.5 mg/dL vs 1.3 mg/dL; P=0.011), and PhGA (18.3 vs 28.1; P=0.020) at 3 months. In the long term, early PsA patients also had fewer swollen joints (0.3 vs 1.7; P=0.030) and lower PhGA (6.3 vs 21.9; PPsA, respectively. Early PsA patients obtained PsARC response more rapidly than late PsA (3.8 and 7.4 months, respectively; P=0.008). Concomitant csDMARDs showed clinical benefit (2-year PsARC response, 88.3% vs 60.0%; P=0.044). Concomitant glucocorticoids had no effect on PsARC response over 2 years of follow-up. Persistence on ADA was similar in both groups. Conclusion Early PsA patients had a greater chance of improvement after ADA therapy and better functional outcome, and

Can magnetic resonance imaging differentiate undifferentiated arthritis?

DEFF Research Database (Denmark)

Østergaard, Mikkel; Duer, Anne; Hørslev-Petersen, K

2005-01-01

A high sensitivity for the detection of inflammatory and destructive changes in inflammatory joint diseases makes magnetic resonance imaging potentially useful for assigning specific diagnoses, such as rheumatoid arthritis and psoriatic arthritis in arthritides, that remain undifferentiated after...... conventional clinical, biochemical and radiographic examinations. With recent data as the starting point, the present paper describes the current knowledge on magnetic resonance imaging in the differential diagnosis of undifferentiated arthritis....

Functional bone marrow scintigraphy in psoriatics

International Nuclear Information System (INIS)

Munz, D.; Altmeyer, P.; Chilf, G.; Schlesinger, G.; Holzmann, H.; Hoer, G.

1982-01-01

24 psoriatics as well as 24 normal healthy adults were studied by functional bone marrow scintigraphy using Tc-99m-labeled human serum albumin millimicrospheres (Tc-99m-HSA-MM). Functional bone marrow scintigraphy is an in vivo test system for the assessment of various functional properties of fixed macrophages. 58% of psoriatics who had no systemic drug treatment demonstrated peripheral extension of the bone marrow space indicating hyperplasia of bone marrow macrophages. This phenomenon could be observed only in one normal subject who was a high-performance sportsman. 83% (n=6) of psoriatics with cirrhosis of liver demonstrated bone marrow extension. The 'capacity' of bone marrow macrophages to engulf Tc-99m-HSA-MM ('uptake ratio') was diminished in 42% of non-treated as well as 66% of psoriatics treated with aromatic retinoid. The phagocytic and proteolytic turnover of Tc-99m-HSA-MM in bone marrow, spleen, and liver was found to be accelerated in 66% of non-treated psoriatics, normal, accelerated or delayed in psoriatics treated with aromatic retinoid as well as considerably delayed in all of the psoriatics with cirrhosis of liver. Functional bone marrow scintigraphy proved to be an appropriate in vivo test system to reveal abnormalities of fixed macrophages in psoriatics. Furthermore, theratpeutic effects as well as influences of pre-existing disorders on different macrophage populations can be assessed. (Author)

IgA deficiency evidence after anti-TNF-α treatment in a psoriatic arthritis patient: case report

Directory of Open Access Journals (Sweden)

R. Scarpa

2012-03-01

Full Text Available It is known that the use of anti-TNF-α drugs is related to an increased incidence of infective diseases. This therapy can not be administered to patients having active infections and it has to be considered with caution in case of acquired or congenital immunodeficiency diseases. We report the case of a 28-years-old man affected by psoriatic arthritis; he developed some infections during treatment with TNF-α blockers. The infections were caused by a selective IgA deficiency, that was not evident before the anti-TNF-α blockers administration and disappeared after withdrawing the biological therapy. This case-report draws our attention to the possibility of cases of subclinical immunodeficiency, unknown by the patients, but important in the prognosis and in the therapeutic approach to these diseases. Therefore, it is important to evaluate carefully the immunologic status of patients during the pre-therapeutic screening for TNF-α blocking therapy.

Review of the treatment of psoriatic arthritis with biological agents: choice of drug for initial therapy and switch therapy for non-responders

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D'Angelo S

2017-03-01

Full Text Available Salvatore D’Angelo,1 Giuseppina Tramontano,1 Michele Gilio,1 Pietro Leccese,1 Ignazio Olivieri1,2 1Rheumatology Institute of Lucania (IRel - Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, 2Basilicata Ricerca Biomedica (BRB Foundation, Potenza, Italy Abstract: Psoriatic arthritis (PsA is a heterogeneous chronic inflammatory disease with a broad clinical spectrum and variable course. It can involve musculoskeletal structures as well as skin, nails, eyes, and gut. The management of PsA has changed tremendously in the last decade, thanks to an earlier diagnosis, an advancement in pharmacological therapies, and a wider application of a multidisciplinary approach. The commercialization of tumor necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab as well as interleukin (IL-12/23 (ustekinumab and IL-17 (secukinumab inhibitors is representative of a revolution in the treatment of PsA. No evidence-based strategies are currently available for guiding the rheumatologist to prescribe biological drugs. Several international and national recommendation sets are currently available with the aim to help rheumatologists in everyday clinical practice management of PsA patients treated with biological therapy. Since no specific biological agent has been demonstrated to be more effective than others, the drug choice should be made according to the available safety data, the presence of extra-articular manifestations, the patient’s preferences (e.g., administration route, and the drug price. However, future studies directly comparing different biological drugs and assessing the efficacy of treatment strategies specific for PsA are urgently needed. Keywords: psoriatic arthritis, treatment, biological drugs, TNF inhibitors, ustekinumab, secukinumab

Association between use of disease-modifying antirheumatic drugs and diabetes in patients with ankylosing spondylitis, rheumatoid arthritis, or psoriasis/psoriatic arthritis: a nationwide, population-based cohort study of 84,989 patients

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Chen HH

2017-05-01

Full Text Available Hsin-Hua Chen,1–7 Der-Yuan Chen,1–6 Chi-Chen Lin,1,2 Yi-Ming Chen,1–4 Kuo-Lung Lai,3,4 Ching-Heng Lin1 1Department of Medical Research, Taichung Veterans General Hospital, 2Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, 3School of Medicine, National Yang-Ming University, Taipei, 4Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, 5School of Medicine, Chung-Shan Medical University, 6Department of Medical Education, Taichung Veterans General Hospital, Taichung, 7Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan Purpose: The aim of this study is to investigate the association between the use of disease-modifying antirheumatic drugs (DMARDs and diabetes mellitus (DM in patients with ankylosing spondylitis (AS, rheumatoid arthritis (RA, or psoriasis/psoriatic arthritis (PS/PSA.Patients and methods: This retrospective cohort study used a nationwide, population-based administrative database to enroll 84,989 cases with AS, RA, or PS/PSA who initiated treatment with anti-tumor necrosis factor (anti-TNF drugs or nonbiologic DMARDs. Multivariable analysis was used to estimate the effect of different therapies on the risk of DM.Results: The incidence rates of DM per 1,000 person-years were 8.3 for users of anti-TNF drugs, 13.3 for users of cyclosporine (CSA, 8.4 for users of hydroxychloroquine (HCQ, and 8.1 for users of other nonbiologic DMARDs. Compared with the users of nonbiologic DMARDs, the multivariate-adjusted hazard ratios (aHRs for DM were significantly lower for those who used anti-TNF drugs with HCQ (aHR: 0.49, 95% confidence interval [CI]: 0.36–0.66 and those who used HCQ alone (aHR: 0.70, 95% CI: 0.63–0.78, but not for those who used anti-TNFs without HCQ (aHR: 1.23, 95% CI: 0.94–1.60 or CSA (aHR: 1.14, 95% CI: 0.77–1

Characteristic and Outcome of Psoriatic Arthritis Patients with Hyperuricemia.

Science.gov (United States)

AlJohani, Roa'A; Polachek, Ari; Ye, Justine Yang; Chandran, Vinod; Gladman, Dafna D

2018-02-01

To determine the characteristics of patients with psoriatic arthritis (PsA) who have hyperuricemia (HUC) and their outcomes, especially cardiovascular (CVD) and kidney diseases. Patients have been followed prospectively at the PsA clinic according to a standard protocol at 6- to 12-month intervals. We defined HUC in men > 450 µ mol/l or women > 360 µ mol/l. We matched patients with HUC based on sex and age ± 5 years with normal uric acid patients. Demographics information and disease characteristics were reviewed. Outcomes of patients with HUC, especially CVD and kidney diseases, were recorded. Conditional logistic regression was performed to determine factors independently associated with HUC in patients with PsA. There were 325 (31.9%) out of 1019 patients with PsA who had HUC. Of these, 318 cases were matched to 318 controls. There were 11 (3.4%) out of 325 patients with HUC who had gout. Patients with HUC had longer disease duration and a higher Psoriasis Area and Severity Index. They had more concurrent comorbidities, including CVD and metabolic diseases, as well as higher prevalence of kidney stones and higher creatinine. Only 1 patient with HUC was treated with allopurinol at first evaluation visit and 7 patients during followup. Over the followup, 163 of the 318 patients had persistent HUC (pHUC) for more than 2 visits. Patients with pHUC developed more myocardial infarction, heart failure, and renal impairment. Multivariate analysis showed an association between pHUC, PsA disease duration, and obesity. HUC is common in patients with PsA, especially in those with longer disease duration and obesity. Proper control of HUC and metabolic diseases may play a preventive role in improving PsA outcomes.

Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study.

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Michelsen, Brigitte; Kristianslund, Eirik Klami; Sexton, Joseph; Hammer, Hilde Berner; Fagerli, Karen Minde; Lie, Elisabeth; Wierød, Ada; Kalstad, Synøve; Rødevand, Erik; Krøll, Frode; Haugeberg, Glenn; Kvien, Tore K

2017-11-01

To investigate the predictive value of baseline depression/anxiety on the likelihood of achieving joint remission in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) as well as the associations between baseline depression/anxiety and the components of the remission criteria at follow-up. We included 1326 patients with RA and 728 patients with PsA from the prospective observational NOR-DMARD study starting first-time tumour necrosis factor inhibitors or methotrexate. The predictive value of depression/anxiety on remission was explored in prespecified logistic regression models and the associations between baseline depression/anxiety and the components of the remission criteria in prespecified multiple linear regression models. Baseline depression/anxiety according to EuroQoL-5D-3L, Short Form-36 (SF-36) Mental Health subscale ≤56 and SF-36 Mental Component Summary ≤38 negatively predicted 28-joint Disease Activity Score anxiety was associated with increased patient's and evaluator's global assessment, tender joint count and joint pain in RA at follow-up, but not with swollen joint count and acute phase reactants. Depression and anxiety may reduce likelihood of joint remission based on composite scores in RA and PsA and should be taken into account in individual patients when making a shared decision on a treatment target. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Arthritis in the buff

International Nuclear Information System (INIS)

Rothschild, B.; Williams, E.M.; Poteat, G.B.; Woods, R.

1987-01-01

Understanding the significance of radiologic perturbations in articular diseases is facilitated by correlation with its representation in intact macerated skeletons (from the collections of the Cleveland Museum of Natural History). Classic skeletal involvement is illustrated grossly and radiographically for the following conditions: rheumatoid arthritis calcium pyrophosphate deposition disease, osteoarthritis, ankylosing spondylitis, reactive (Reiter syndrome, psoriatic arthritis) diffuse idiopathic skeletal hyperostosis, and infectious arthritis. Distribution and lesion character is reviewed. Visualization of the gross bone lesion ''in the buff'' provides clear explanation of its radiologic appearance and facilitates the transition from x-ray image to the pathophysiology proposed in the interpretation

Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany

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Waller J

2017-03-01

Full Text Available John Waller,1 Emma Sullivan,1 James Piercy,1 Christopher M Black,2 Sumesh Kachroo2 1Adelphi Real World, Manchester, UK; 2Center for Observational and Real-World Evidence (CORE, Merck & Co., Inc., Kenilworth, NJ, USA Objectives: We examined rheumatologists’ motivation for prescribing biosimilars, assessed their treatment preferences in relation to prescribing behavior and explored patient attitudes to biosimilars. Methods: Data were taken from the Adelphi Real World Biosimilars Programme, a real-world, cross-sectional study undertaken with German rheumatologists and patients with rheumatoid arthritis, ankylosing spondyloarthritis or psoriatic arthritis in 2015–2016. Rheumatologists provided data on their prescribing behavior and attitudes toward biosimilars and invited the next eight eligible consecutive consulting patients to complete a questionnaire. Rheumatologists were split into “investigative”, “conservative” and “other” groups. Results: Overall, 50 rheumatologists and 261 patients participated. Biosimilars accounted for <10% of all biologic therapy prescriptions, and >95% of rheumatologists would prescribe a biooriginator rather than biosimilar as the first- or second-line therapy if unrestricted. Patients showed some reluctance to accept biosimilars, and a small proportion of patients were unhappy when switched from a biooriginator to a biosimilar. Satisfaction with treatment was highest in patients who started treatment with a biooriginator prior to biosimilar availability. Patient concerns when starting treatment with a biooriginator or a biosimilar included not knowing enough about the drug (25%–41%, potential side effects (26%–32% and potential long-term problems (19%–30%. Conclusion: Study results demonstrate that there is some reluctance from patients to accept biosimilars and the need to educate patients who are unsure to allow them to be involved in decision making, highlighting the importance of patient and

Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis

DEFF Research Database (Denmark)

Kristensen, Lars Erik; Lie, Elisabeth; Jacobsson, Lennart T H

2016-01-01

OBJECTIVE: Because new modes of action for the treatment of psoriatic arthritis (PsA) are emerging, it is important to understand the use of switching to a second or third antitumor necrosis factor (anti-TNF) agent. This study investigated drug survival and treatment response rates of patients...... with PsA undergoing second- and third-line anti-TNF therapy. METHODS: Patients with PsA were monitored in a prospective, observational study. Patients who switched anti-TNF therapy once (first-time switchers, n = 217) or twice (second-time switchers, n = 57) between January 2003 and March 2012 were...... studied. American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) good response at 3 and 6 months, as well as drug survival, were reported and further analyzed using the Cox and logistic regression models. RESULTS: Median age for first-time switchers was 47 years and 42% were...

The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis

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Wu, J J; Penfold, R B; Primatesta, P

2017-01-01

BACKGROUND: Sparse information is available concerning mental health issues in psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients. OBJECTIVE: To estimate risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, PsA and AS, respectively......, compared with the general population. METHODS: This population-based cohort study analysed 36 214 psoriasis patients, 5138 PsA patients and 1878 AS patients who were frequency-matched with a general population cohort. Annual incidence rate of depression, suicidal ideation and suicide attempt was calculated...... separately for psoriasis, PsA and AS. RESULTS: There was an increased risk of depression in the three cohorts; adjusted IRR: psoriasis, 1.14 (95% CI, 1.11, 1.17); PsA, 1.22 (95% CI, 1.16, 1.29); AS, 1.34 (95% CI, 1.23, 1.47). There was no significantly increased risk for suicidal ideations or suicide attempt...

Juvenile Idiopathic Arthritis

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Kenan Barut

2017-04-01

Full Text Available Juvenile idiopathic arthritis is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. The disease is divided into several subgroups, according to demographic characteristics, clinical features, treatment modalities and disease prognosis. Systemic juvenile idiopathic arthritis, which is one of the most frequent disease subtypes, is characterized by recurrent fever and rash. Oligoarticular juvenile idiopathic arthritis, common among young female patients, is usually accompanied by anti-nuclear antibodie positivity and anterior uveitis. Seropositive polyarticular juvenile idiopathic arthritis, an analogue of adult rheumatoid arthritis, is seen in less than 10% of paediatric patients. Seronegative polyarticular juvenile idiopathic arthritis, an entity more specific for childhood, appears with widespread large- and small-joint involvement. Enthesitis-related arthritis is a separate disease subtype, characterized by enthesitis and asymmetric lower-extremity arthritis. This disease subtype represents the childhood form of adult spondyloarthropathies, with human leukocyte antigen-B27 positivity and uveitis but commonly without axial skeleton involvement. Juvenile psoriatic arthritis is characterized by a psoriatic rash, accompanied by arthritis, nail pitting and dactylitis. Disease complications can vary from growth retardation and osteoporosis secondary to treatment and disease activity, to life-threatening macrophage activation syndrome with multi-organ insufficiency. With the advent of new therapeutics over the past 15 years, there has been a marked improvement in juvenile idiopathic arthritis treatment and long-term outcome, without any sequelae. The treatment of juvenile idiopathic arthritis patients involves teamwork, including an experienced paediatric rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist and a physiotherapist. The primary goals

Psoriatic arthritis mutilans (PAM) in the Nordic countries: demographics and disease status. The Nordic PAM study.

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Gudbjornsson, B; Ejstrup, L; Gran, J T; Iversen, L; Lindqvist, U; Paimela, L; Ternowitz, T; Ståhle, M

2013-01-01

To determine the prevalence and clinical characteristics of psoriatic arthritis mutilans (PAM) in the Nordic countries. Patients with putative PAM aged ≥ 18 years were recruited. Fifty-nine patients were included after clinical examination. The prevalence of PAM in the adult Nordic population was estimated to be 3.69 per million inhabitants [95% confidence interval (CI) 2.75-4.63]. The female to male ratio was close to 1:1. The mean age of skin disease onset was 25 years and the mean age of onset of joint disease was 30 years. The onset of skin disease was 2 years earlier among female patients. At inclusion, the mean duration of arthritis was 27 ± 11 years for male patients and 33 ± 11 years for female patients. PAM was most frequently seen in the distal interphalangeal (DIP) joints of the toes, followed by the IP joint of the thumb and the DIP joint of the little finger on the left hand. Female and male patients had similar numbers of painful and swollen joints. Enthesitis was found in 19 patients (32%), while 38 patients (64%) had a history of dactylitis. Twenty-three of these 38 patients (61%) had a history of dactylitis in the same finger/toe as they had PAM. At the time of inclusion, 45% of the patients were found to have clear or almost clear skin. PAM in the Nordic countries has a low prevalence, with only three to five cases per million inhabitants. The majority of the patients present with mild skin disease.

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

LENUS (Irish Health Repository)

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.

High 3-year golimumab survival in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis: real world data from 328 patients.

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Thomas, Konstantinos; Flouri, Irini; Repa, Argiro; Fragiadaki, Kalliopi; Sfikakis, Petros P; Koutsianas, Christos; Kaltsonoudis, Evripidis; Voulgari, Paraskevi V; Drosos, Alexandros A; Petrikkou, Evangelia; Sidiropoulos, Prodromos; Vassilopoulos, Dimitrios

2018-01-01

Our primary objective was to study the long-term survival on drug (SOD) of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) treated with golimumab (GLM) in real life settings. This was a retrospective, observational study of all patients treated with GLM in 4 Academic Centres in Greece during a 4-year period (09/2010-06/2014). SOD was analysed using Kaplan-Meier survival analysis, while Cox regression analysis estimating hazard ratios (HRs) for different baseline variables associated with drug discontinuation was performed for each disease. 328 patients (RA: 166, PsA: 82, AS: 80) were included. The estimated SOD at 2 and 3 years was 68% and 62% overall and was better for AS (79% and 76%) compared to RA (69% and 60%, p=0.067) and PsA (58% and 53%, p=0.001) patients; no difference was noted between RA and PsA patients (p=0.204). There was no difference in SOD between biologic-naïve and experienced nor between non-biologic co-treated or GLM monotherapy treated patients. Seropositivity (rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies) was associated with a lower risk for GLM discontinuation by multivariate analysis (HR=0.5, 95% CI=0.0.25-1.1, p=0.05) in RA patients. During 606 patient-years of follow-up, 11 (3.3%) patients discontinued GLM due to adverse events (AE), accounting for 11% of treatment discontinuations. The rates of serious AEs and serious infections were 2.3 and 1.0/100-patient-years, respectively. In this real-life study, GLM showed a high 3-year SOD in patients with inflammatory arthritides with a low rate of discontinuation due to AEs.

Quantitative and qualitative changes in leukocytes of psoriatic patients

International Nuclear Information System (INIS)

Mahesar, S.M.; Khand, A.A.

2011-01-01

Background: Psoriasis is a disease concerned with inflammation and scaling of skin. In psoriasis, cells of the skin come on surface quickly before their complete maturation. In psoriatic patients, T-cells produce an abnormally large amount of toxic chemicals and cause inflammation. This study was undertaken to find out values of prognostic significance for worsening of the disease at early stage and to evaluate the changes (quantitative and qualitative) occurring in white blood cells of psoriatic patients. Methods: A total of 158 subjects, 79 psoriatic patients (44 males and 35 females) and same numbers of normal control volunteers were recruited. Total and Differential Leukocyte Counts (TLC and DLC) were determined. Morphological examination was also undertaken. All results of patients were compared with normal control volunteers. Results : In 47.7% male and 54.2% female patients TLC was higher than controls while variation in differential count was observed in 61.3% male and 62.8% female patients. Overall, neutrophils in 45% patients, basophils in 30.3%, eosinophils in 65.8%, and monocytes in 15% of patients were elevated. In 77.2% psoriatic patients, lymphocytes were decreased. In volunteers total and differential leukocyte counts were within normal range. Total leukocyte count in normal males was 5,136 +- 31, and in psoriatic male subjects it was 10,498 +- 43, and it was 5,023 +- 35 against 11,390 +- 31 in normal versus psoriatic females ( p<0.001). Conclusion: Total leukocyte count was elevated in psoriatics while on DLC neutrophils, eosinophils and neutrophils were significantly raised where as lymphocytes were significantly decreased in psoriatic patients. Morphological changes were also noted. (author)

Power Doppler Ultrasound Evaluation of Peripheral Joint, Entheses, Tendon, and Bursa Abnormalities in Psoriatic Patients: A Clinical Study.

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Tang, Yuanjiao; Yang, Yujia; Xiang, Xi; Wang, Liyun; Zhang, Lingyan; Qiu, Li

2018-04-15

To evaluate the prevalence rates of peripheral joint, enthesis, tendon, and bursa abnormalities by power Doppler (PD) ultrasonic examination in patients with psoriatic arthritis (PsA), psoriatic patients without clinical signs of arthritis (non-PsA psoriasis group), and healthy individuals, to detect subclinical PsA. A total of 253 healthy volunteers, 242 non-PsA psoriatic patients, and 86 patients with PsA were assessed by 2-dimensional and power Doppler (PD) ultrasound. Peripheral joint, enthesis, tendon, and bursa abnormalities were observed, characterizing abnormal PD. The affected patients and sites with abnormalities in various ages were compared among groups; PD signal grades for the abnormalities were also compared. In the PsA group, significantly higher percentages of sites showing joint effusion/synovitis, enthesitis, and tenosynovitis in all age groups, and markedly higher rates of sites with bursitis were found in young and middle age groups, compared with the non-PsA and control groups (all p the non-PsA group showed significantly higher rates of joint effusion/synovitis and enthesitis sites, and elevated PD signal grades of synovitis, enthesitis, and tenosynovitis in comparison with the control group, both in young and middle age groups (all p tenosynovitis.

Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound.

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Freeston, J E; Coates, L C; Helliwell, P S; Hensor, E M A; Wakefield, R J; Emery, P; Conaghan, P G

2012-10-01

Enthesitis is a recognized feature of spondylarthritides (SpA), including psoriatic arthritis (PsA). Previously, ultrasound imaging has highlighted the presence of subclinical enthesitis in established SpA, but there are little data on ultrasound findings in early PsA. The aim of our study was to compare ultrasound and clinical examination (CE) for the detection of entheseal abnormalities in an early PsA cohort. Forty-two patients with new-onset PsA and 10 control subjects underwent CE of entheses for tenderness and swelling, as well as gray-scale (GS) and power Doppler (PD) ultrasound of a standard set of entheses. Bilateral elbow lateral epicondyles, Achilles tendons, and plantar fascia were assessed by both CE and ultrasound, the latter scored using a semiquantitative (SQ) scale. Inferior patellar tendons were assessed by ultrasound alone. A GS SQ score of >1 and/or a PD score of >0 was used to describe significant ultrasound entheseal abnormality. A total of 24 (57.1%) of 42 patients in the PsA group and 0 (0%) of 10 controls had clinical evidence of at least 1 tender enthesis. In the PsA group, for sites assessed by both CE and ultrasound, 4% (7 of 177) of nontender entheses had a GS score >1 and/or a PD score >0 compared to 24% (9 of 37) of tender entheses. CE overestimated activity in 28 (13%) of 214 of entheses. All the nontender ultrasound-abnormal entheses were in the lower extremity. The prevalence of subclinical enthesitis in this early PsA cohort was low. CE may overestimate active enthesitis. The few subclinically inflamed entheses were in the lower extremity, where mechanical stress is likely to be more significant. Copyright © 2012 by the American College of Rheumatology.

Childhood trauma and resilience in psoriatic patients: A preliminary report.

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Crosta, Maria Luigia; De Simone, Clara; Di Pietro, Salvatore; Acanfora, Mariateresa; Caldarola, Giacomo; Moccia, Lorenzo; Callea, Antonino; Panaccione, Isabella; Peris, Ketty; Rinaldi, Lucio; Janiri, Luigi; Di Nicola, Marco

2018-03-01

Psoriasis is a chronic inflammatory skin disease with a complex etiology, involving the immune system, genetic factors, and external/internal triggers, with psychosomatic aspects. The aim of the study was to investigate childhood trauma and resilience in a psoriatic sample compared with healthy controls. Correlations between childhood trauma, resilience, quality of life, clinical data and psoriatic features were also evaluated. Seventy-seven psoriatic patients and seventy-six homogeneous healthy controls were enrolled. We used the Psoriasis Area and Severity Index (PASI) to assess the severity of psoriasis and the Skindex-29 to measure health-related quality of life. The psychometric battery included the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-Risc) to assess trauma exposure and resilience, respectively. Psoriatic patients showed a significant prevalence of childhood trauma and a lower resilience level compared to healthy controls. Associations between traumatic experiences, low resilience and reduced quality of life in psoriatic subjects were also observed. A multidisciplinary approach is helpful to investigate clinical aspects, trigger factors and psychophysiological stress response in psoriatic subjects. Improving resilience with an early psychological intervention focused on self-motivation and strengthening of self-efficacy could facilitate the management of psoriasis. Copyright © 2018 Elsevier Inc. All rights reserved.

Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resnance imaging

International Nuclear Information System (INIS)

Jevtic, V.; Watt, I.; Rozman, B.; Kos-Golja, M.; Demsar, F.; Jarh, O.

1995-01-01

A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter's syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflamatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter's syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular desease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration. (orig.)

The OMERACT MRI in Arthritis Working Group - Update on Status and Future Research Priorities

DEFF Research Database (Denmark)

Østergaard, Mikkel; Bird, Paul; Gandjbakhch, Frédérique

2015-01-01

OBJECTIVE: To provide an update on the status and future research priorities of the Outcome Measures in Rheumatology (OMERACT) magnetic resonance imaging (MRI) in arthritis working group. METHODS: A summary is provided of the activities of the group within rheumatoid arthritis (RA), psoriatic...

Epigenetics of psoriatic disease: A systematic review and critical appraisal.

Science.gov (United States)

Pollock, Remy A; Abji, Fatima; Gladman, Dafna D

2017-03-01

Psoriasis is an inflammatory disease of the skin that is sometimes accompanied by an auto-inflammatory arthritis called psoriatic arthritis (PsA). Psoriasis and PsA are multifactorial diseases that result from complex interactions of environmental and genetic risk factors. Epigenetic marks, which are labile chemical marks with diverse functions, form a layer of biological information that sits at the interface of genetics and the environment. Aberrant epigenetic regulation has been previously implicated in other rheumatological disorders. The purpose of this review is to summarize and critically evaluate the nascent literature on epigenetics in psoriasis and PsA. A systematic review yielded 52 primary articles after applying inclusion and exclusion criteria. Data were extracted using a standardized template and study quality assessed using a methodological quality checklist. Studies reflect a broad range of epigenetic sub-disciplines, the most common being DNA methylation, followed by the parent of origin effect or genomic imprinting, expression or activity of epigenetic modifying enzymes, and histone modifications. Epidemiological studies demonstrating excessive paternal transmission provided the earliest evidence of epigenetic deregulation in psoriatic disease, however few studies have examined its molecular mechanisms. Methylation studies evolved rapidly from low resolution global to targeted analyses of known psoriatic disease susceptibility loci such as HLA-C*0602. The recent explosion of epigenome-wide association studies has provided us with novel insights into psoriasis pathogenesis, and the mechanism of action of UVB, methotrexate, and anti-TNF therapies, as well as molecular signatures of psoriasis that may have clinical relevance. Finally, recent studies of pharmacological inhibitors of epigenetic modifier enzymes demonstrate their potential applicability as novel treatment modalities for psoriasis. Challenges of epigenetics research in psoriasis and Ps

Psoriatic arthritis in patients with psoriasis: evaluation of clinical and epidemiological features in 133 patients followed at the University Hospital of Brasília Artrite psoriásica em pacientes com psoríase: avaliação de características clínicas e epidemiológicas em 133 pacientes atendidos no Hospital Universitário de Brasília

Directory of Open Access Journals (Sweden)

Jamille Nascimento Carneiro

2012-08-01

Full Text Available BACKGROUND: Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. Its prevalence in patients with psoriasis varies from 7 to 42% but its exact prevalence is unknown. OBJECTIVES: Considering the lack of national data related to its diagnosis in patients with psoriasis, this study aims to describe the clinical, laboratorial and radiological manifestations of psoriatic arthritis in these patients. METHODS: We evaluated 133 patients with psoriasis, treated as outpatients. These patients were asked to fill in the forms with data about the disease and were submitted to a clinical evaluation by a dermatologist and a rheumatologist. Suspected cases of arthritis were referred for further investigation and were classified according to presence or absence of psoriatic arthritis according to CASPAR criteria. RESULTS: The number of patients with psoriatic arthritis was 47 (35%, 17 of them were new cases. There was no difference between the groups regarding the type of psoriasis, nail involvement, presence of scalp lesions and psoriatic arthritis. Patients with psoriatic arthritis had more enthesitis and dactylitis (46.7% than those without arthritis. CONCLUSIONS: Despite the high prevalence of arthritis found, we know that results from epidemiological studies are variable, which limits their use and interpretation. We conclude that more studies are needed to draw a profile of rheumatic manifestations in our population of psoriasis patients.FUNDAMENTOS: A artrite psoriásica é uma artrite inflamatória associada à psoríase. Sua prevalência nos pacientes com psoríase de 7 a 42% mas sua exata prevalência ainda é desconhecida. OBJETIVOS: Considerando a escassez de dados nacionais relacionados ao seu diagnóstico em pacientes com psoríase o presente estudo visa descrever o quadro clínico, laboratorial e radiológico da doença nesses pacientes. MÉTODOS: Foram avaliados 133 pacientes com diagnóstico de psoríase acompanhados no

THE RISK OF CORONARY ARTERY DISEASE DEVELOPMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS (BECHTEREW’S DISEASE AND PSORIATIC ARTHRITIS: A 10-YEAR PROSPECTIVE FOLLOW-UP STUDY

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I. Z. Gaidukova

2016-01-01

Full Text Available Objective: assessment of coronary artery disease (CAD incidence among patients with ankylosing spondylitis (AS and psoriatic arthritis (PsA without manifestation of cardiovascular diseases.Materials and methods. We analyzed the data of 10-year prospective follow-up of the patient with AS (n = 278, psoriatic arthritis (n = 85 and healthy controls (n = 150 without any cardiovascular diseases. All groups were comparable in regard to cardiovascular risk factors. During these 10 years all new cases of CAD (verified by cardiologist in the study population were tracked.Results. New cases of CAD were fixed in 64 out of 278 patietns with AS and in 16 out of 150 controls (p = 0.0017. Using log-rank MantelCox test and logrank test for trend we demonstrated statistically significant differences in CAD incidence between patients without spondyloarthritis (SpA and patients with AS and PsA (p < 0,0001. The risk of CAD development was higher in PsA group than in the control group; relative risk was 4.16 (95 % confidence interval (CI 2.36–7.33, RR 6.1 (95 % CI 3.05–12.44 (p < 0.05. Increased risk of myocardial infarction was observed both in patients with AS (RR 4.98; 95 % CI 1.54–6.12 and patients with PsA (RR 5.2; 95 % CI 2.4–7.8 comparing to healthy controls. There was no significant difference between the AS-group and the control group in terms of risk of stenocardia development (p > 0.05.Conclusion. The risk of exertional stenocardia in patients with AS was not higher than that in individuals without SpA. However, patients with AS have higher risk of myocardial infarction than those without SpA. PsA patients have increased risk of CAD development comparing to healthy controls and individuals with AS.

The beneficial effect of total glucosides of paeony on psoriatic arthritis links to circulating Tregs and Th1 cell function.

Science.gov (United States)

Wang, Yi Na; Zhang, Yu; Wang, Yan; Zhu, Ding Xian; Xu, Li Qin; Fang, Hong; Wu, Wei

2014-03-01

Total glycosides of peony (TGP) is a natural immuno-modulatory drug extracted from traditional Chinese herb peony. It has been approved by State Food and Drug Administration for the treatment of rheumatoid arthritis. However, data of TGP effect on psoriatic arthritis (PsA) is still scarce. In this study, 19 patients with PsA received 12-week treatment of TGP, and clinical efficacy in joint manifestations was evaluated by DAS28 at weeks 0, 4, 8 and 12. Peripheral percentages of Tregs, Th1, Th2 and NK cells were analyzed, and serum Th1-type cytokines (IL-12, IFN-γ and TNF-α), Th2-type cytokines (IL-4, IL-5 and IL-10) as well as pro-inflammatory factors (IL-2, IL-6 and IL-8) were concomitantly examined. Six patients (32%) exhibited ≥25% decrease of DAS28 (responders). Interestingly, all responders displayed a continuous decrease in Treg and Th1 numbers during TGP treatment, concomitant with significant decreases in Th1-type cytokine levels. Serum IL-6 also showed a significant decline in responders. Non-responders lacked these sequential alterations. Thus, TGP merits further consideration as a promising therapeutic option for PsA. The result indicated that recovery of Tregs and Th1 may serve as prognostic markers to assess responsiveness to TGP treatment in PsA. Copyright © 2013 John Wiley & Sons, Ltd.

Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resnance imaging

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Jevtic, V. [Inst. of Radiology, Univ. Medical Centre, Ljubljana (Slovenia); Watt, I. [Dept. of Clinical Radiology, Bristol Royal Infirmary (United Kingdom); Rozman, B. [Dept. of Rheumatology, Univ. Medical Centre, Ljubljana (Slovenia); Kos-Golja, M. [Dept. of Rheumatology, Univ. Medical Centre, Ljubljana (Slovenia); Demsar, F. [Inst. Jozef Stefan, Ljubljana (Slovenia); Jarh, O. [Inst. Jozef Stefan, Ljubljana (Slovenia)

1995-07-01

A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter`s syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflamatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter`s syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular desease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration. (orig.)

Initial Experience of Using Dual-Energy CT with an Iodine Overlay Image for Hand Psoriatic Arthritis: Comparison Study with Contrast-enhanced MR Imaging.

Science.gov (United States)

Fukuda, Takeshi; Umezawa, Yoshinori; Tojo, Shinjiro; Yonenaga, Takenori; Asahina, Akihiko; Nakagawa, Hidemi; Fukuda, Kunihiko

2017-07-01

Purpose To determine the feasibility of dual-energy (DE) computed tomography (CT) with an iodine overlay image (IOI) for evaluation of psoriatic arthritis in the hand. Materials and Methods Approval from the institutional ethics committee and written informed consent from all patients were obtained. This prospective study included 16 patients who had psoriasis with finger joint symptoms from January 2015 to January 2016. Contrast material-enhanced (CE) DE CT and 1.5-T CE magnetic resonance (MR) imaging were performed within 1 month of each other. DE CT was performed with a tube voltage of 80 kV and 140 kV with use of a 0.4-mm tin filter. Images acquired with both modalities were evaluated by two radiologists independently by using a semiquantitative scoring system. Interreader agreement was calculated for each modality: Weighted κ values were calculated for synovitis, flexor tenosynovitis, and extensor peritendonitis, and κ values were calculated for periarticular inflammation. With consensus scores and CE MR images as the reference, the sensitivity and specificity of IOI DE CT for inflammatory lesions were calculated. Statistical analysis of discordant readings was performed by using the McNemar test. Results Interreader agreement for inflammatory lesions was excellent or good (weighted κ = 0.83 and κ = 0.75 in IOI DE CT; weighted κ = 0.81 and κ = 0.87 in CE MR imaging). The sensitivity and specificity of IOI DE CT were 0.78 and 0.87, respectively. Total agreement was 86.3%; however, there were significantly more lesions detected with IOI DE CT than with CE MR imaging alone (134 vs 20 lesions in 1120 evaluated items; P the abnormalities detected with IOI DE CT alone were located in distal interphalangeal joints. Conclusion IOI DE CT is a new imaging modality that may be useful for evaluating psoriatic arthritis in the hand, particularly in the detection of inflammatory lesions in small joints, and may be more useful than CE MR imaging, within the limitation

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

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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.

Accumulation of Oxidized Low-Density Lipoprotein in Psoriatic Skin and Changes of Plasma Lipid Levels in Psoriatic Patients

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Nilgun Solak Tekin

2007-01-01

Full Text Available Background. Psoriasis is a chronic inflammatory skin disease characterized by an accelerated turnover of epidermal cells and an incomplete differentiation in epidermis with lesion. However, the exact etiology of psoriasis is unknown. Abnormalities in essential fatty acid metabolism, free radical generation, lipid peroxidation, and release of lymphokines have been proposed. Objective. Our purpose was to evaluate the plasma lipids and oxidized low-density lipoprotein accumulation in psoriatic skin lesion in order to ascertain the possible participation of oxidative stress and oxidative modification of lipids in pathogenesis of psoriasis. Methods. The study group included 84 patients with psoriasis, and 40 sex- and age-matched healthy volunteers. Blood lipid profile was determined. Psoriatic and nonlesional skin samples of psoriatic patients were evaluated for the presence of oxidized low-density lipoprotein by using an immune-fluorescent staining method. Results. The mean levels of lipids (total cholesterol, triglyceride, and LDL cholesterol in patients with psoriasis were found to be significantly higher than those of healthy subjects. Psoriatic skins were shown positive oxidized low-density lipoprotein staining. There was no staining in nonlesional skin samples of the same individuals. Conclusion. Lipid peroxidation mediated by free radicals is believed to be one of the important causes of cell membrane destruction and cell damage. This study shows for the first time the accumulation of oxidized low-density lipoprotein in psoriatic skin lesion. We believe that accumulation of ox-LDL in psoriatic skin may have an important role in the immune-inflammatory events that result in progressive skin damage.

Differentiation of involved and uninvolved psoriatic skin from healthy skin using noninvasive visual, colorimeter and evaporimeter methods.

Science.gov (United States)

Pershing, L K; Bakhtian, S; Wright, E D; Rallis, T M

1995-08-01

Uninvolved skin of psoriasis may not be entirely normal. The object was to characterize healthy, uninvolved psoriatic skin and lesional skin by biophysical methods. Involved and uninvolved psoriatic and age-gender matched healthy skin was measured objectively with a colorimeter and evaporimeter and subjectively with visual assessment in 14 subjects. Visual assessment of erythema (E), scaling (S) and induration (I) as well as the target lesion score at the involved psoriatic skin sites were significantly elevated (puninvolved psoriatic skin >healthy skin (pcolorimeter L* and a* scale values at uninvolved psoriatic skin sites were lower and higher (pcolorimeter description (L*× b*)/a* significantly differentiated healthy skin from both involved and uninvolved psoriatic skin. These collective data highlight that even visually appearing uninvolved psoriatic skin is compromised compared with healthy skin. These objective, noninvasive but differential capabilities of the colorimeter and evaporimeter will aid in the mechanistic quantification of new psoriatic drug therapies and in conjuction with biochemical studies, add to understanding of the multifactorial pathogenesis of psoriasis.

Magnetic resonance imaging and bone scintigraphy in the differential diagnosis of unclassified arthritis

DEFF Research Database (Denmark)

Duer, Anne; Østergaard, M; Hørslev-Petersen, K

2008-01-01

OBJECTIVES: To investigate the value in clinical practice of hand magnetic resonance imaging (MRI) and whole body bone scintigraphy in the differential diagnosis of patients with unclassified arthritis. METHODS: 41 patients with arthritis (> or = 2 swollen joints, > 6 months' duration) which...... to psoriatic arthritis (RF negative + psoriasis); one to non-specific self-limiting arthritis). No patients classified as non-RA at baseline had fulfilled the ACR criteria after 2 years. The presence of MRI synovitis, MRI erosion and bone scintigraphic pattern compatible with RA showed 100% specificity...

Characterization of changes in IgG associated oligosaccharide profiles in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis using fluorophore linked carbohydrate electrophoresis.

Science.gov (United States)

Martin, K; Talukder, R; Hay, F C; Axford, J S

2001-07-01

To investigate fluorophore linked carbohydrate electrophoresis (FCE) as a method of analyzing serum immunoglobulin G (IgG) oligosaccharides in healthy individuals and those with rheumatic disease and compare with lectin binding assays of carbohydrate composition. IgG was isolated from patients with rheumatoid arthritis (RA) (n = 21), ankylosing spondylitis (AS) (n = 20), psoriatic arthritis (PsA) (n = 20), and healthy adults (n = 36). IgG oligosaccharides were released enzymatically, fluorescently labelled using 8 aminonaphthalene-136 trisulfonic acid; and identification of the oligosaccharide bands was by stepwise enzymatic degradation. Comparison of FCE was made with lectin binding analysis in which the lectins Ricinus communis (RCA1) and Bandeiraea simplicifolia (BSII) were used to detect galactose (Gal) and N-acetylglucosamine (GlcNAc), respectively. Each disease could be differentiated from healthy adults on the basis of Band 1 asialodigalacto core fucosylated oligosaccharide (gf2) intensity (p = 0.001), but not from each other. Reduced levels of different sugars were associated with specific diseases: reduced gf2 with RA (p < 0.001), PsA (p < 0.001) and AS (p < 0.02), reduced Band 5 disialo-digalacto core fucosylated (a2f) oligosaccharide with AS (p < 0.001), reduced Band 6 disialo-digalacto (a2) oligosaccharide with AS (p < 0.001) and PsA (p = 0.021). All diseases were associated with a significant increase in Band 4 asialo-agalacto core fucosylated oligosaccharide (g0f) (p < 0.001). In RA, FCE band intensities correlated with sugar quantity when identified using lectin binding analysis (p < 0.003). In contrast, there was no correlation between the same bands in healthy individuals. FCE is an accurate method of analyzing IgG associated oligosaccharides and reveals unique band patterns or sugar prints associated with healthy adults and patients with RA, PsA, and AS, and comparison with lectin binding analysis suggests undetected RA glycoprotein structural

Significance of clinical evaluation of the metacarpophalangeal joint in relation to synovial/bone pathology in rheumatoid and psoriatic arthritis detected by magnetic resonance imaging.

Science.gov (United States)

Stone, Millicent A; White, Lawrence M; Gladman, Dafna D; Inman, Robert D; Chaya, Sam; Lax, Matthew; Salonen, David; Weber, Deborah A; Guthrie, Judy A; Pomeroy, Emma; Podbielski, Dominik; Keystone, Edward C

2009-12-01

Rheumatologists base many clinical decisions regarding the management of inflammatory joint diseases on joint counts performed at clinic. We investigated the reliability and accuracy of physically examining the metacarpophalangeal (MCP) joints to detect inflammatory synovitis using magnetic resonance imaging (MRI) as the gold standard. MCP joints 2 to 5 in both hands of 5 patients with rheumatoid arthritis (RA) and 5 with psoriatic arthritis (PsA) were assessed by 5 independent examiners for joint-line swelling (visually and by palpation); joint-line tenderness by palpation (tender joint count, TJC) and stress pain; and by MRI (1.5 Tesla superconducting magnet). Interrater reliability was assessed using kappa statistics, and agreement between examination and corresponding MRI assessment was assessed by Fisher's exact tests (p 0.8) and positive predictive value (= 0.8). For PsA, significant associations exist between TJC and MRI synovitis scores (p < 0.01) and stress pain and MRI edema scores (p < 0.04). Assessment of swelling by palpation was not significantly associated with synovitis or edema as determined by MRI in RA or PsA (p = 0.54-1.0). In inflammatory arthritis, disease activity in MCP joints can be reliably assessed at the bedside by examining for joint-line tenderness (TJC) and visual inspection for swelling. Clinical assessment may have to be complemented by other methods for evaluating disease activity in the joint, such as MRI, particularly in patients with PsA.

THE DIAGNOSTIC VALUE OF CLINICAL EXAMINATION AND ULTRASOUND STUDY OF ENTHESES FOR EARLY DETECTION OF PSORIATIC AND RHEUMATOID ARTHRITIS: REMARC STUDY

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Tatiana Viktorovna Korotaeva

2013-01-01

Full Text Available The diagnosis of enthesitis can help in differentiating early psoriatic arthritis (ePsA from early rheumatoid arthritis (eRA.Objective. To estimate the diagnostic value of detecting enthesitis during clinical examination and ultrasound in ePsA and eRA.Subjects and methods. The trial included 36 patients with ePsA and 33 with eRA. Entheses were evaluated using the Leeds Enthesitis Index (LEI: lateral humeral epicondyle and medial femoral condyle (MFC, Achilles tendon insertion site (ATAP, and plantar fascia (PF point on the right and on the left. Enthesitis (on ultrasound presented with thickening, reduced echo density, and vascularization at Doppler energy imaging. DAS, DAS28, SDAI, CDAI, M±SD, Me [25th, 75th percentile], t-test, Fisher's exact test, χ2test, U test, and Spearman correlation coefficients (R were calculated; the value p < 0.05 was considered statistically significant.Results. Clinical examination revealed enthesitis in 41.6% of the patients with ePsA and in 39.4% of those with eRA (p >0.05. No significant differences were found between ePsA and eRA according to LEI (0.5 [0; 2] and 1 [0; 2] and to LEI+PF (1 [0; 2] and 1 [0; 2], respectively. Enthesitis of MFC and PF was significantly more frequently detected in ePsA than in eRA – 12 (33.3%/2 (6.1% and 10 (27.8%/2 (6.1% patients, respectively. In eRA versus ePsA, enthesitis of MFC was more frequently found (16 (48.4% and 8 (22.2% patients, respectively. Ultrasound revealed no significant differences between the groups in enthesitis. In ePsA, there was a significant correlation between DAS, DAS28, SDAI, CDAI, LEI, and LEI+PF.Conclusion. Enthesis ultrasound cannot differentiate ePsA from eRA. Clinical examination more frequently detects enthesitis in the knee joints in eRA and in the calcaneal region in ePsA.

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

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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.

Dual energy CT iodine map for delineating inflammation of inflammatory arthritis

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Fukuda, Takeshi; Fukuda, Kunihiko [The Jikei University School of Medicine, Department of Radiology, Tokyo (Japan); Umezawa, Yoshinori; Asahina, Akihiko; Nakagawa, Hidemi [The Jikei University School of Medicine, Department of Dermatology, Tokyo (Japan); Furuya, Kazuhiro [The Jikei University School of Medicine, Division of Rheumatology Department of Internal Medicine, Tokyo (Japan)

2017-12-15

Iodine mapping is an image-processing technique used with dual-energy computed tomography (DECT) to improve iodine contrast resolution. CT, because of its high spatial resolution and thin slice reconstruction, is well suited to the evaluation of the peripheral joints. Recent developments in the treatment of inflammatory arthritis that require early diagnosis and precise therapeutic assessment encourage radiological evaluation. To facilitate such assessment, we describe DECT iodine mapping as a novel modality for evaluating rheumatoid arthritis and psoriatic arthritis of the hands and feet. (orig.)

Major cost savings associated with biologic dose reduction in patients with inflammatory arthritis.

LENUS (Irish Health Repository)

Murphy, C L

2015-01-01

The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS)) would remain in remission following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28 < 2.6, BASDAI < 4) was offered a reduction in dosing frequency of two commonly used biologic therapies (etanercept 50 mg once per fortnight instead of weekly, adalimumab 40 mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6, 12, 18 and 24 months following reduction in dosing frequency. Cost saving was calculated. 79 patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n = 45), 13% psoriatic arthritis (n = 10) and 30% ankylosing spondylitis (n = 24). 57% (n = 45) were taking etanercept and 43% (n = 34) adalimumab. The percentage of patients in remission at 24 months was 56% (n = 44). This resulted in an actual saving to the state of approximately 600,000 euro over two years. This study demonstrates the reduction in biologic dosing frequency is feasible in Inflammatory Arthritis. There was a considerable cost saving at two years. The potential for major cost savings in biologic usage should be pursued further.

Comparison of screening questionnaires to identify psoriatic arthritis in a primary-care population: a cross-sectional study.

Science.gov (United States)

Coates, L C; Savage, L; Waxman, R; Moverley, A R; Worthington, S; Helliwell, P S

2016-09-01

Many questionnaires are available for assessment of psoriatic arthritis (PsA), but there is little evidence comparing them. To test the proposed CONTEST questionnaire, which was developed to identify patients with psoriasis who have undiagnosed PsA, and compare it with the validated Psoriasis Epidemiology Screening Tool (PEST) questionnaire in a primary-care setting. A random sample of adult patients with psoriasis and no diagnosis of arthritis was identified from five general practice surgeries in Yorkshire, U.K. Consenting patients completed both questionnaires and were assessed by a dermatologist and rheumatologist. Diagnosis of PsA was made by the assessing rheumatologist. Receiver operator characteristic (ROC) curve analysis examined the sensitivity and specificity of potential cut points. In total 932 packs were sent to recruit 191 (20·5%) participants. Of these, 169 (88·5%) were confirmed to have current or previous psoriasis. Using physician diagnosis 17 (10·1%) were found to have previously undiagnosed PsA, while 90 (53·3%) had another musculoskeletal complaint and 62 (36·7%) had no musculoskeletal problems. Using ROC curve analysis, all of the questionnaires showed a significant ability to identify PsA. The area under the curve (AUC) for the CONTEST questionnaires was slightly higher than that of PEST (0·69 and 0·70 vs. 0·65), but there was no significant difference identified. Examining the sensitivities and specificities for the different cut points suggested that a PEST score ≥ 2 would perform better in this dataset, and the optimal scores for CONTEST and CONTEST plus joint manikin were 3 and 4, respectively. The accuracy of the questionnaires to identify PsA appeared similar, with a slightly higher AUC for the CONTEST questionnaires. The optimal cut points in this study appeared lower than in previous studies. © 2016 British Association of Dermatologists.

Early rheumatoid arthritis and its differentiation from other joint abnormalities

International Nuclear Information System (INIS)

Boutry, Nathalie; Carmo, Clarissa Canella Moraes do; Flipo, Rene-Marc; Cotten, Anne

2009-01-01

The introduction of disease-modifying antirheumatic drugs has created new demands on imaging to early identify patients with rheumatoid arthritis and opened new prospects in therapeutic management of patients with aggressive disease. Therefore, new imaging modalities such as magnetic resonance imaging and ultrasound have developed during the past few years in this field. In some cases, both magnetic resonance imaging and ultrasound may be also useful in making the distinction between early rheumatoid arthritis and other joints abnormalities, including early psoriatic arthritis. This article will review key aspects of important advances in imaging in rheumatoid arthritis, particularly focusing on magnetic resonance imaging and ultrasound.

A nationwide non-medical switch from originator infliximab to biosimilar CT-P13 in 802 patients with inflammatory arthritis

DEFF Research Database (Denmark)

Glintborg, Bente; Sørensen, Inge Juul; Loft, Anne Gitte

2017-01-01

Objectives According to guidelines, a nationwide non-medical switch from originator (INX, Remicade) to biosimilar infliximab (Remsima, CT-P13) was conducted in Danish patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA). We investigated disease...

Power of crowdsourcing: novel methods of data collection in psoriasis and psoriatic arthritis.

Science.gov (United States)

Armstrong, April W; Harskamp, Caitlin T; Cheeney, Safia; Wu, Julie; Schupp, Clayton W

2012-12-01

Crowdsourcing is a novel method of collecting research data from diverse patient populations. The quality of research data obtained through crowdsourcing is unknown. The primary aim of this pilot study was to examine how data collected from an online crowdsourcing World Wide Web site compare with those from published literature in psoriasis and psoriatic arthritis (PsA). Crowdsourced data were collected from a health crowdsourcing site from August 23, 2008, to June 27, 2011. The crowdsourced data were compared with findings from systematic reviews, meta-analyses, and clinical trials. A total of 160 online patients with psoriasis or PsA were included in the analysis. Among them, 127 patients with psoriasis provided 313 complete responses on psoriasis symptoms and 276 complete responses to psoriasis treatments; 33 patients with PsA provided 91 complete responses on PsA symptoms and 79 responses to PsA treatments. We compared topical treatments, phototherapy, and systemic treatments for psoriasis and PsA from crowdsourced data with the published literature. For the treatment with the largest response rates, equivalency testing was performed comparing crowdsourced data and the published literature. Overall, crowdsourced data were not equivalent to those published in the medical literature. Crowdsourcing sites used different outcomes measures from those reported in clinical trials. Differences existed in assessment of treatment effectiveness between crowdsourced data and those published in the literature. With improvements in the collection of crowdsourced data, crowdsourcing can be a valuable tool for collecting patient data in real-world settings for psoriasis and PsA. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Calprotectin and TNF trough serum levels identify power Doppler ultrasound synovitis in rheumatoid arthritis and psoriatic arthritis patients in remission or with low disease activity.

Science.gov (United States)

Inciarte-Mundo, José; Ramirez, Julio; Hernández, Maria Victoria; Ruiz-Esquide, Virginia; Cuervo, Andrea; Cabrera-Villalba, Sonia Raquel; Pascal, Mariona; Yagüe, Jordi; Cañete, Juan D; Sanmarti, Raimon

2016-07-08

Serum levels of calprotectin, a major S100 leucocyte protein, are associated with disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients. Higher drug trough serum levels are associated with good response in patients treated with tumour necrosis factor inhibitors (TNFi). Power Doppler ultrasound (PDUS) synovitis is predictive of flare and progression of structural damage in patients in clinical remission. The purpose of this study was to analyse the accuracy of calprotectin and TNFi trough serum levels in detecting PDUS synovitis in RA and PsA patients in clinical remission or with low disease activity who were receiving TNFi. We conducted a cross-sectional study of 92 patients (42 with RA, 50 with PsA) receiving adalimumab (ADA), etanercept (ETN) or infliximab who were in remission or had low disease activity (28-joint Disease Activity Score based on erythrocyte sedimentation rate ultrasound scores (all r coefficients >0.50 in RA). Calprotectin correlated with the PDUS synovitis score in patients treated with ADA and ETN. Using PDUS synovitis (yes or no) as the reference variable, calprotectin had an AUC of 0.826. The best cut-off was ≥1.66 μg/ml, with a likelihood ratio of 2.77. C-reactive protein (AUC 0.673) and erythrocyte sedimentation rate (AUC 0.731) had a lower discriminatory capacity. TNFi trough serum levels were significantly associated with PDUS synovitis (OR 0.67, 95 % CI 0.52-0.85, p < 0.001) but their accuracy (AUC <0.5) was less than that of calprotectin. TNFi trough serum levels were inversely correlated with calprotectin and PDUS synovitis in RA and PsA patients receiving ADA and ETN. Calprotectin and TNFi trough serum levels may help identify PDUS synovitis in RA and PsA patients in clinical remission or with low disease activity.

Value of contrast-enhanced ultrasound in rheumatoid arthritis

International Nuclear Information System (INIS)

Zordo, Tobias de; Mlekusch, Sabine P.; Feuchtner, Gudrun M.; Mur, Erich; Schirmer, Michael; Klauser, Andrea S.

2007-01-01

The purpose of this review is to describe the spectrum of sonographic findings in rheumatic diseases with respect to the diagnostic potential using US contrast media which prove activity or inactivity in synovial tissue where new treatment regimes target. Synovial activity can be found in non-erosive and erosive forms of primary and secondary osteoarthritis, and in inflammatory forms of joint diseases like rheumatoid arthritis and peripheral manifestations of spondyloarthritis including, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis and enteropathic arthritis. It can also be present in metabolic and endocrine forms of arthritis, in connective tissue arthropathies like systemic lupus erythematosus or scleroderma and in infectious arthritis. Ultrasound should be used as first-line imaging modality in suspected early cases of RA and other forms of arthritis, whereas contrast-enhanced ultrasound (CEUS) can further enable for sensitive assessment of vascularity which correlates with disease activity

Value of contrast-enhanced ultrasound in rheumatoid arthritis

Energy Technology Data Exchange (ETDEWEB)

Zordo, Tobias de; Mlekusch, Sabine P.; Feuchtner, Gudrun M. [Department of Radiology II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck (Austria); Mur, Erich [Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck (Austria); Schirmer, Michael [Department of Internal Medicine, Hospital of the Elisabethines Klagenfurt, Voelkermarkter Strasse 15-19, 9020 Klagenfurt (Austria); Klauser, Andrea S. [Department of Radiology II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck (Austria)], E-mail: andrea.klauser@i-med.ac.at

2007-11-15

The purpose of this review is to describe the spectrum of sonographic findings in rheumatic diseases with respect to the diagnostic potential using US contrast media which prove activity or inactivity in synovial tissue where new treatment regimes target. Synovial activity can be found in non-erosive and erosive forms of primary and secondary osteoarthritis, and in inflammatory forms of joint diseases like rheumatoid arthritis and peripheral manifestations of spondyloarthritis including, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis and enteropathic arthritis. It can also be present in metabolic and endocrine forms of arthritis, in connective tissue arthropathies like systemic lupus erythematosus or scleroderma and in infectious arthritis. Ultrasound should be used as first-line imaging modality in suspected early cases of RA and other forms of arthritis, whereas contrast-enhanced ultrasound (CEUS) can further enable for sensitive assessment of vascularity which correlates with disease activity.

Impact of Disease Severity, Illness Beliefs, and Coping Strategies on Outcomes in Psoriatic Arthritis.

Science.gov (United States)

Howells, Laura; Chisholm, Anna; Cotterill, Sarah; Chinoy, Hector; Warren, Richard B; Bundy, Christine

2018-02-01

Little is known about how people with psoriatic arthritis (PsA) cope with and manage their condition, but data show that psychological problems are underrecognized and undertreated. The Common Sense Self-Regulatory Model (CS-SRM) suggests illness beliefs, mediated by coping, may influence health outcomes. The study aimed to investigate the roles of disease severity, illness beliefs, and coping strategies in predicting depression, anxiety, and quality of life (QoL) in people with PsA. Additionally, we aimed to assess the role of depression and anxiety in predicting QoL. We conducted a cross-sectional observational study, where adults with PsA (n = 179) completed validated measures of predictor (illness beliefs, coping strategies, disease severity) and outcome variables (depression, anxiety, QoL) using an online survey distributed via social media. The participants were a community sample of 179 adults with PsA, ages 20 to 72 years (77.1% female). After controlling for disease severity, hierarchical multiple regression models indicated that more negative beliefs about consequences and behavioral disengagement as a coping method predicted levels of depression, and self-blame predicted anxiety. Beliefs about consequences and the presence of depression predicted quality of life scores after controlling for disease severity. This study offers support for the use of the CS-SRM in explaining variation on psychological outcomes in individuals with PsA. The illness beliefs and coping strategies identified as predictors in this article are potential targets for interventions addressing PsA-related distress and QoL. © 2017, American College of Rheumatology.

Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients.

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Garrido-Cumbrera, Marco; Hillmann, Ottfrid; Mahapatra, Raj; Trigos, David; Zajc, Petra; Weiss, Luisa; Bostynets, Galya; Gossec, Laure; Coates, Laura C

2017-12-01

Psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) are both chronic, inflammatory conditions that result in a substantial burden of disease and reduced quality of life for patients. Patient involvement in developing optimal disease management strategies, including defining appropriate goals, therapies, and treatment options, as well as in setting policy priorities and agendas, is key. A working group of patient organization representatives and rheumatologists explored what patients consider to be unmet needs, important treatment gaps, and future priorities in PsA and AxSpA management. Reducing pain and fatigue, and improving physical and social functioning and work productivity were identified as important treatment goals for patients. Although the major treatment target for both PsA and AxSpA is remission, with low/minimal disease activity an alternative target for patients with established or long-standing disease, the meaning of remission from the patient's perspective needs to be explored further as it may differ considerably from the physician's perspective. Key recommendations from the working group to tackle unmet needs included reducing time to diagnosis, increasing patient and physician disease awareness, focusing on patients' priorities for treatment goals, and improving patient-physician communication. By addressing these key action points moving forward, the hope is that outcomes will continue to improve for patients with PsA and AxSpA.

Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain.

Science.gov (United States)

Gratacós, Jordi; Luelmo, Jesús; Rodríguez, Jesús; Notario, Jaume; Marco, Teresa Navío; de la Cueva, Pablo; Busquets, Manel Pujol; Font, Mercè García; Joven, Beatriz; Rivera, Raquel; Vega, Jose Luis Alvarez; Álvarez, Antonio Javier Chaves; Parera, Ricardo Sánchez; Carrascosa, Jose Carlos Ruiz; Martínez, Fernando José Rodríguez; Sánchez, José Pardo; Olmos, Carlos Feced; Pujol, Conrad; Galindez, Eva; Barrio, Silvia Pérez; Arana, Ana Urruticoechea; Hergueta, Mercedes; Coto, Pablo; Queiro, Rubén

2018-06-01

To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.

HLA-B27 frequency in a group of patients with psoriatic arthritis Freqüência de HLA-B27 em uma amostra de pacientes com artrite psoriática

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Danilo Garcia Ruiz

2012-12-01

Full Text Available 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 data were processed descriptively and comparatively by appropriate software. Parametric and non parametric tests were used with 5% statistical significance. RESULTS: HLA-B27 was negative in 32 of the 44 patients (72,7%. Most of them were male, Caucasian, living in Rio de Janeiro, with plaque type psoriasis and average age of 52,9 years. There was statistical significant correlation between positive HLA-B27 and male gender (p=0,004. Negative HLA-B27 had a tendency to correlate with hands and wrists arthritis (p=0,07. There was an inverse significant correlation between HLA values and Schöber's test (p=0,02. CONCLUSION: Although HLA-B27 is negative in most of patients, it is significantly associated to male gender and inversely correlated with Schöber's test.FUNDAMENTOS: O HLA-B27 está associado às espondiloartrites, grupo de doenças que engloba, entre outras, a artrite psoriásica. OBJETIVOS: Descrever a freqüência de HLA-B27 em uma amostra de pacientes brasileiros com artrite psoriásica e correlacionar sua presença ou ausência com as manifestações clínicas dos mesmos. MÉTODOS: Estudo transversal avaliando 44 pacientes com artrite psoriásica de um ambulatório de Reumatologia. A avaliação consistia em registro de informações demográficas e sociais, exame clínico da pele e das articulações e pesquisa de HLA-B27. Os dados gerados foram tratados por meio de estatística descritiva e comparativa em Software apropriado. Foram utilizados

Smoking paradox in the development of psoriatic arthritis among patients with psoriasis: a population-based study.

Science.gov (United States)

Nguyen, Uyen-Sa D T; Zhang, Yuqing; Lu, Na; Louie-Gao, Qiong; Niu, Jingbo; Ogdie, Alexis; Gelfand, Joel M; LaValley, Michael P; Dubreuil, Maureen; Sparks, Jeffrey A; Karlson, Elizabeth W; Choi, Hyon K

2018-01-01

Smoking is associated with an increased risk of psoriatic arthritis (PsA) in the general population, but not among patients with psoriasis. We sought to clarify the possible methodological mechanisms behind this paradox. Using 1995-2015 data from The Health Improvement Network, we performed survival analysis to examine the association between smoking and incident PsA in the general population and among patients with psoriasis. We clarified the paradox using mediation analysis and conducted bias sensitivity analyses to evaluate the potential impact of index event bias and quantify its magnitude from uncontrolled/unmeasured confounders. Of 6.65 million subjects without PsA at baseline, 225 213 participants had psoriasis and 7057 developed incident PsA. Smoking was associated with an increased risk of PsA in the general population (HR 1.27; 95% CI 1.19 to 1.36), but with a decreased risk among patients with psoriasis (HR 0.91; 95% CI 0.84 to 0.99). Mediation analysis showed that the effect of smoking on the risk of PsA was mediated almost entirely through its effect on psoriasis. Bias-sensitivity analyses indicated that even when the relation of uncontrolled confounders to either smoking or PsA was modest (both HRs=~1.5), it could reverse the biased effect of smoking among patients with psoriasis (HR=0.9). In this large cohort representative of the UK general population, smoking was positively associated with PsA risk in the general population, but negatively associated among patients with psoriasis. Conditioning on a causal intermediate variable (psoriasis) may even reverse the association between smoking and PsA, potentially explaining the smoking paradox for the risk of PsA among patients with psoriasis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of training on concordance among rheumatologists and dermatologists in the assessment of patients with psoriasis and psoriatic arthritis.

Science.gov (United States)

Salvarani, Carlo; Girolomoni, Giampiero; Di Lernia, Vito; Gisondi, Paolo; Tripepi, Giovanni; Egan, Colin Gerard; Marchesoni, Antonio

2016-12-01

To evaluate the impact of training on the reliability among dermatologists and rheumatologists in the assessment of psoriatic arthritis (PsA) patients. Overall, 9 hospital-based rheumatologists and 8 hospital-based dermatologists met in Reggio Emilia, Italy on October 2015 to assess 17 PsA patients. After 1 month, physicians underwent a 3-h training session by 4 recognized experts and then assessed 19 different PsA patients according to a modified Latin square design. Measures included tender (TJC) and swollen joint count (SJC), dactylitis, enthesitis, Schober test, psoriasis body surface area (BSA), Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), and static physician's global assessment of PsA disease activity (sPGA). Variance components analyses were performed to estimate the intraclass correlation coefficient (ICC). TJC and enthesitis-measured pre-training by dermatologists or rheumatologists revealed moderate-substantial agreement (ICC: 0.4-0.8). In contrast, SJC and Schober test showed fair (ICC: 0.2-0.4) and moderate agreement, respectively (ICC: 0.4-0.6), while poor agreement (ICC: 0-0.2) was represented by dactylitis. Moderate-substantial (ICC: 0.4-0.8) agreement was observed for most skin measures by dermatologists and rheumatologists, apart from BSA, where fair agreement (ICC: 0.2-0.4) was observed. Agreement levels were similar before and after training for arthritis measures. In contrast, levels of agreement after training for 3 of the 4 skin measures were increased for dermatologists and all 4 skin measures were increased for rheumatologists. Substantial to excellent agreement was observed for TJC, enthesitis, PASI, and sPGA. Rheumatologists benefited from training to a greater extent. Copyright © 2016 Elsevier Inc. All rights reserved.

The Danish nationwide clinical register for patients with rheumatoid arthritis: DANBIO

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Ibfelt EH

2016-10-01

Full Text Available Else Helene Ibfelt,1 Dorte Vendelbo Jensen,2,3 Merete Lund Hetland2,4 1Registry Support Centre (East, Epidemiology and Biostatistics, Research Centre for Prevention and Health, Rigshospitalet, Glostrup University Hospital, 2DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, 3Department of Rheumatology, Herlev and Gentofte University Hospital, Hellerup, 4Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Introduction: DANBIO is a research register and a data source for rheumatologic diseases (rheumatoid arthritis [RA], axial spondyloarthritis, and psoriatic arthritis for monitoring clinical quality at the national, regional, and hospital levels. Study population: The register includes patients with rheumatologic diseases who are treated at a hospital or a private rheumatologic clinic. Registration is mandatory for all patients with RA regardless of treatment and also for patients with other diagnoses if treated with biological disease-modifying antirheumatic drugs. Since 2006, the registration has been done electronically, including patient-reported outcome measures registered electronically by the patients with the use of touch screens. Main variables: Core variables such as diagnosis, year of diagnosis, age, and sex are registered at the beginning. Data entered at later visits included the following: patient-reported outcomes for disease activity, pain, fatigue, functional status, and physician-reported objective measures of disease activity, treatment, C-reactive protein, and, when indicated, imaging. For subgroups of patients, the variables such as quality of life, sociodemographic factors, lifestyle, and comorbidity are also registered. Descriptive data: The DANBIO cohort comprised ~26,000 patients with RA, 3,200 patients with axial spondyloarthritis, and 6

Current Status of Multidisciplinary Care in Psoriatic Arthritis in Spain: NEXUS 2.0 Project.

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Queiro, Rubén; Coto, Pablo; Joven, Beatriz; Rivera, Raquel; Navío Marco, Teresa; de la Cueva, Pablo; Alvarez Vega, Jose Luis; Narváez Moreno, Basilio; Rodriguez Martínez, Fernando José; Pardo Sánchez, José; Feced Olmos, Carlos; Pujol, Conrad; Rodríguez, Jesús; Notario, Jaume; Pujol Busquets, Manel; García Font, Mercè; Galindez, Eva; Pérez Barrio, Silvia; Urruticoechea-Arana, Ana; Hergueta, Merce; López Montilla, M Dolores; Vélez García-Nieto, Antonio; Maceiras, Francisco; Rodríguez Pazos, Laura; Rubio Romero, Esteban; Rodríguez Fernandez Freire, Lourdes; Luelmo, Jesús; Gratacós, Jordi

2018-02-26

1) To analyze the implementation of multidisciplinary care models in psoriatic arthritis (PsA) patients, 2) To define minimum and excellent standards of care. A survey was sent to clinicians who already performed multidisciplinary care or were in the process of undertaking it, asking: 1) Type of multidisciplinary care model implemented; 2) Degree, priority and feasibility of the implementation of quality standards in the structure, process and result for care. In 6 regional meetings the results of the survey were presented and discussed, and the ultimate priority of quality standards for care was defined. At a nominal meeting group, 11 experts (rheumatologists and dermatologists) analyzed the results of the survey and the regional meetings. With this information, they defined which standards of care are currently considered as minimum and which are excellent. The simultaneous and parallel models of multidisciplinary care are those most widely implemented, but the implementation of quality standards is highly variable. In terms of structure it ranges from 22% to 74%, in those related to process from 17% to 54% and in the results from 2% to 28%. Of the 25 original quality standards for care, 9 were considered only minimum, 4 were excellent and 12 defined criteria for minimum level and others for excellence. The definition of minimum and excellent quality standards for care will help achieve the goal of multidisciplinary care for patients with PAs, which is the best healthcare possible. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Perioperative Management of Patients with Psoriatic Arthritis: Case ...

African Journals Online (AJOL)

... glucocorticoids, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation. Case presentation: We report the case of a 32 year old lady on treatment for skin psoriasis and arthritis who presents with bilateral hip pain. Investigations reveal grade 2 avascular necrosis of femoral head

In etanercept-treated psoriatic arthritis patients clinical improvement correlated with an increase of serum cortisol relative to other adrenal hormones.

Science.gov (United States)

Atzeni, F; Sarzi-Puttini, P; DePortu, S; Cutolo, M; Carrabba, M; Straub, R H

2008-01-01

In patients with rheumatoid arthritis (RA), long-term therapy with anti-tumor necrosis factor (TNF) antibodies sensitizes the pituitary gland and improves adrenal androgen secretion in prednisolone-naïve patients. However, whether this is similar in psoriatic arthritis (PsA) is not known. The aim of this study was to assess the effect of 12 weeks of etanercept treatment upon the function of the HPA axis in patients with PsA. Eleven prednisolone-naïve patients (mean age 47.3+/-8.9 years) with PsA were included. We measured serum levels of adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone (17OHP), cortisol, and androstenedione (ASD), at baseline and at 4 and 12 weeks after initiation of anti-TNF therapy (etanercept, 50 mg every week as a single dose by sc. injection). Clinical improvement was assessed using the Disease Activity Score-28 (DAS-28). Mean levels of serum ACTH, serum cortisol, serum 17OHP and serum ASD did not markedly change during 12 weeks of etanercept treatment. Similarly, the ratio of serum cortisol divided by serum ACTH did not change during 12 weeks of anti-TNF treatment. However, an increase of serum cortisol relative to serum 17OHP or ASD was related to clinical improvement. This indicates that improvement was linked to higher serum cortisol levels relative to others adrenal hormones. This is the first study to demonstrate baseline serum levels and the course of HPA axis-related hormones in patients with PsA. An increase of serum cortisol relative to others adrenocortical hormones (i.e., androstenedione and ACTH) was accompanied by clinical improvement.

A probable case of rheumatoid arthritis from the middle Anglo-Saxon period.

Science.gov (United States)

Mckinnon, Katie; Van Twest, Melanie S; Hatton, Martin

2013-06-01

We present here a case of erosive polyarthropathy in an incomplete skeleton from a middle-Saxon period (c. AD 650-900) cemetery site in Sedgeford, Norfolk, England. After a differential diagnosis that includes erosive osteoarthritis and psoriatic arthritis, we believe rheumatoid arthritis (RA) to be the most probable cause. This example may therefore add to the evidence for an early date for the appearance of RA in Europe. Copyright © 2013 Elsevier Inc. All rights reserved.

Effect of radiosynovectomy in patients with inflammatory joint disorders not caused by rheumatoid arthritis

International Nuclear Information System (INIS)

Kroeger, S.; Klutmann, S.; Bohuslavizki, K.H.; Clausen, M.; Sawula, J.A.; Brenner, W.; Henze, E.

1999-01-01

Aim: Effect of radiosynovectomy (RS) should be evaluated both by subjective and objective parameters in patients with osteoarthritis and in patients with inflammatory joint disorders not caused by rheumatoid arthritis. Methods: A total of 98 joints in 61 patients were investigated. Patients were divided into two groups. The first group included 35 patients with therapy-resistant effusions caused by severe osteoarthritis (46 joints). The second group consisted of 26 patients (52 joints) with ankylosing spondylitis, reactive arthritis, undifferentiated spondylarthropathy, psoriatic arthritis, pigmented villo-nodular synovitis, and recurrent synovitis following surgery. Effect of RS was evaluated by a standardized questionnaire and quantified by T/B-ratios derived from blood pool images prior to and after RS. Results: Within the first patient group suffering from osteoarthritis, 40% showed a good or excellent improvement of clinical symptoms, 51% were unchanged, and in 9% symptoms worsened. Similar results were found in the second patient group. The majority of unchanged results were small finger joints. In contrast, wrist and knee joints showed a better improvement. Good correlation between results of bone scan and patients subjective impression was found in 38% and 67% in the first and the second patient group, respectively. Conclusion: Radiosynovectomy might be an effective treatment in osteoarthritis and inflammatory joint disorders not caused by rheumatoid arthritis. (orig.) [de

X-ray microanalysis of psoriatic skin

International Nuclear Information System (INIS)

Grundin, T.G.; Roomans, G.M.; Forslind, B.; Lindberg, M.; Werner, Y.

1985-01-01

Electron probe x-ray microanalysis was used to study elemental distribution in uninvolved and involved skin from patients with psoriasis, and in skin from healthy controls. Significant differences were found between the involved and uninvolved psoriatic skin. In the involved skin, the concentrations of Mg, P, and K were higher in the stratum germinativum, spinosum, and granulosum, compared to the corresponding strata in uninvolved skin. Neither involved nor uninvolved psoriatic stratum germinativum differed markedly from nonpsoriatic control stratum germinativum. In uninvolved psoriatic skin only a lower level of K was noted. In comparison to uninvolved psoriatic skin, the elemental composition of the various strata of involved psoriatic skin shows a pattern typical for highly proliferative, nonneoplastic cells

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

Science.gov (United States)

Salaffi, Fausto; Di Carlo, Marco; Carotti, Marina; Farah, Sonia; Gutierrez, Marwin

2016-01-01

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 indices (all at a P level touch-screen format of PsAID-12, assessed using the minimal disease activity – Outcome Measurements in Rheumatology Clinical Trials criteria, was very good, with an area under the receiver operating characteristic curve of 0.937 and a resulting cutoff value of 2.5. The touch-screen questionnaire was readily accepted and preferred. The mean time spent for completing the

Low starting dosage of infliximab with possible escalating dosage in psoriatic arthritis gives the same treatment results as standard dosage of adalimumab or etanercept: results from the nationwide Icelandic ICEBIO registry

Directory of Open Access Journals (Sweden)

Gudbjornsson B

2018-05-01

Full Text Available Bjorn Gudbjornsson,1,2 Arni Jon Geirsson,3,4 Niels Steen Krogh5 1Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; 2Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 3Department of Rheumatology, University Hospital, Reykjavik, Iceland; 4Laeknasetrid - Medical Clinic, University of Iceland, Reykjavik, Iceland; 5Zitelab Aps, Copenhagen, Denmark Objective: To explore differences in response to a low dosage regimen of infliximab with an escalating dosage in comparison to a standard dosage of etanercept and adalimumab in patients with psoriatic arthritis (PsA. Methods: Biologically naïve PsA patients who were beginning anti-TNF-α therapy were selected from the ICEBIO registry. Demographics and clinical differences were compared in four treatment groups: infliximab <4 mg/kg; infliximab >4 mg/kg; etanercept or adalimumab at baseline and on follow-up (6 and 12 months, last visit. The Kruskal–Wallis rank sum test was used for comparison of the groups and the Wilcoxon test to compare the two infliximab dosage regimens. Results: One hundred and eighty-five patients (61% female were identified; 84 patients received infliximab, 66 etanercept, and 35 adalimumab. A total of 19% of the patients treated with infliximab escalated their dosage ≥4 mg/kg. No significant differences were observed at baseline in respect to visual analog scale (VAS pain, VAS fatigue, Health Assessment Questionnaire, C-reactive protein (CRP, numbers of swollen or tender joints, or Disease Activity Score (DAS 28-CRP values. A similar treatment response was observed in all four treatment groups on follow-up. Conclusion: In respect to treatment effects, a low dosage of infliximab with possible escalating dosage is acceptable for the majority of PsA patients who are in need of biological treatment. Keywords: psoriatic arthritis, outcome, biological treatment, routine care, clinical nationwide registry

A Phase III, Randomized, Controlled Trial of Apremilast in Patients with Psoriatic Arthritis: Results of the PALACE 2 Trial.

Science.gov (United States)

Cutolo, Maurizio; Myerson, Gary E; Fleischmann, Roy M; Lioté, Frédéric; Díaz-González, Federico; Van den Bosch, Filip; Marzo-Ortega, Helena; Feist, Eugen; Shah, Kamal; Hu, ChiaChi; Stevens, Randall M; Poder, Airi

2016-09-01

Apremilast, an oral phosphodiesterase 4 inhibitor, downregulates intracellular inflammatory mediator synthesis by elevating cyclic adenosine monophosphate levels. The PALACE 2 trial evaluated apremilast efficacy and safety in patients with active psoriatic arthritis (PsA) despite prior conventional disease-modifying antirheumatic drugs and/or biologic therapy. Eligible patients were randomized (1:1:1) to placebo, apremilast 20 mg BID, or apremilast 30 mg BID. At Week 16, patients with swollen and tender joint count improvement 20% improvement in American College of Rheumatology response criteria (ACR20) at Week 16. In the intent-to-treat population (N = 484), ACR20 at Week 16 was achieved by more patients receiving apremilast 20 mg BID [37.4% (p = 0.0002)] and 30 mg BID [32.1% (p = 0.0060)] versus placebo (18.9%). Clinically meaningful improvements in signs and symptoms of PsA, physical function, and psoriasis were observed with apremilast through Week 52. The most common adverse events were diarrhea, nausea, headache, and upper respiratory tract infection. Diarrhea and nausea generally occurred early and usually resolved spontaneously with continued treatment. Laboratory abnormalities were infrequent and transient. Apremilast demonstrated clinical improvements in PsA for up to 52 weeks, including signs and symptoms, physical function, and psoriasis. No new safety signals were observed. ClinicalTrials.gov identifier: NCT01212757.

Use of aspirin, non-steroidal anti-inflammatory drugs, and acetaminophen (paracetamol), and risk of psoriasis and psoriatic arthritis: a cohort study.

Science.gov (United States)

Wu, Shaowei; Han, Jiali; Qureshi, Abrar A

2015-02-01

Non-steroidal anti-inflammatory drugs (NSAIDs) have been reported to induce or exacerbate psoriasis. We aimed to evaluate the association between several widely used analgesics, including aspirin, non-aspirin NSAIDs, and acetaminophen (paracetamol), and risk of psoriasis and psoriatic arthritis (PsA) in a large cohort of US women, the Nurses' Health Study II (1991-2005). Information on regular use of aspirin, NSAIDs, and acetaminophen was collected for 95,540 participants during the follow-up. During 1,321,280 person-years of follow-up, we documented 646 incident psoriasis cases and 165 concomitant PsA cases. Compared to women who reported no use, regular acetaminophen and NSAIDs users with more than 10 years of use had multivariate hazard ratios of 3.60 [95% confidence interval (CI): 2.02-6.41] and 2.10 (95% CI: 1.11-3.96) for PsA, respectively. There was no clear association between aspirin and risk of psoriasis or PsA. In conclusion, long-term acetaminophen and NSAIDs use may be associated with an increased risk of PsA. Special attention on psoriasis and PsA screening may be needed for those who are prescribed for acetaminophen and NSAIDs for long-term periods.

Radiographic manifestations of arthritis in AIDS patients

International Nuclear Information System (INIS)

Rosenberg, Z.S.; Norman, A.; Solomon, G.

1988-01-01

The purpose of this study is to familiarize the radiologist with a newly discovered association between arthritis and acquired immunodeficiency syndrome (AIDS). The authors retrospectively reviewed the clinical and radiographic findings in 31 patients with human immunodeficiency virus (HIV) infection referred to their rheumatology clinic with musculoskeletal complaints. The patients carried a wide range of clinical diagnosis including Reiter syndrome, psoriatic arthritis, undifferentiated seronegative arthritis, isolated enthesopathies, rheumatoid arthritis and osteonecrosis. Radiographs were available in 24 of the 31 patients, and in 20 they showed radiographic features of arthritis, which included soft-tissue swelling periarticular osteoporosis, synovial effusions, sacroiliitis, periosteal reaction, joint space narrowing, marginal erosions, and osteonecrosis. Although the radiographic abnormalities were frequently mild, they were significant, given the short duration of disease in many of their patients (weeks to months) at the time radiographs were obtained. The range of radiographic findings in their series was varied and paralleled the wide range of clinical diagnoses. No findings were pathognomonic for HIV-associated arthritis. Nevertheless, HIV infection needs to be considered in any patient belonging to a recognized risk group who presents with musculoskeletal disease. This is particularly important since immunosupressive drugs used for the treatment of arthritis can be detrimental to patients with HIV infection

Blood cell gene expression profiling in subjects with aggressive periodontitis and chronic arthritis

DEFF Research Database (Denmark)

Sørensen, Lars K; Poulsen, Anne Havemose; Sønder, Søren U

2008-01-01

with untreated localized aggressive periodontitis (LAgP) or generalized aggressive periodontitis (GAgP). Differentially expressed genes were validated in groups of subjects with LAgP, GAgP, juvenile idiopathic arthritis (JIA), or rheumatoid arthritis (RA) and controls. METHODS: Candidate genes were identified...

Exploring the existence of a stayer population with mover-stayer counting process models: application to joint damage in psoriatic arthritis.

Science.gov (United States)

Yiu, Sean; Farewell, Vernon T; Tom, Brian D M

2017-08-01

Many psoriatic arthritis patients do not progress to permanent joint damage in any of the 28 hand joints, even under prolonged follow-up. This has led several researchers to fit models that estimate the proportion of stayers (those who do not have the propensity to experience the event of interest) and to characterize the rate of developing damaged joints in the movers (those who have the propensity to experience the event of interest). However, when fitted to the same data, the paper demonstrates that the choice of model for the movers can lead to widely varying conclusions on a stayer population, thus implying that, if interest lies in a stayer population, a single analysis should not generally be adopted. The aim of the paper is to provide greater understanding regarding estimation of a stayer population by comparing the inferences, performance and features of multiple fitted models to real and simulated data sets. The models for the movers are based on Poisson processes with patient level random effects and/or dynamic covariates, which are used to induce within-patient correlation, and observation level random effects are used to account for time varying unobserved heterogeneity. The gamma, inverse Gaussian and compound Poisson distributions are considered for the random effects.

Persistence with golimumab in immune-mediated rheumatic diseases: a systematic review of real-world evidence in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis

Directory of Open Access Journals (Sweden)

Svedbom A

2017-04-01

estimates of OLE trials.Conclusion: The data reviewed in this study indicate that golimumab may have higher persistence than other TNFis, a notion that is supported by indirect comparisons of persistence data from OLEs of randomized controlled trials (RCTs. Furthermore, the study suggests that persistence may be lower in biologic-experienced compared with biologic-naive patients and higher in axial spondyloarthritis compared with rheumatoid arthritis and psoriatic arthritis. Keywords: golimumab, Simponi, Treatment persistence, drug survival, retention rates, real-world evidence (RWE

Experience and Satisfaction With a Multidisciplinary Care Unit for Patients With Psoriasis and Psoriatic Arthritis.

Science.gov (United States)

Urruticoechea-Arana, Ana; Serra Torres, Marta; Hergueta Diaz, Mercedes; González Guerrero, María Eugenia; Fariñas Padron, Leslie; Navarro Martín, Sara; Vargas Osorio, Kelly; Palacios Abufón, Andrés; García de Yébenes, María Jesús; Loza, Estíbaliz

2017-08-24

To describe patient's characteristics, the activity and patient's satisfaction with a multidisciplinary care unit in patients with psoriasis and psoriatic arthritis (PsA). A retrospective medical records review of patients with psoriasis or PsA attended in a multidisciplinary care unit was performed. Included patients were contacted to fulfill a satisfaction questionnaire. A specific electronic database was set up. Data regarding to patients and their baseline characteristics and the activity of the unit were collected. Descriptive analysis were performed. A total of 112 patients with 154 visits were included in almost 3 years, 54% women, with a mean age of 51 years, 43.7% presented hyperlipidemia and 30.4% arterial hypertension. Half of patients were referred due to diagnostic doubts and the other half for therapeutic problems. After the evaluation of the patients, 66 patients (58.9%) met diagnostic criteria for PsA, and 13 (11.6%) of an inflammatory disease other than PsA, and 95% came back to their usual physician. The most ordered test were laboratory tests (75.6% of patients), followed by X-rays in 57 patients (51.3%). In general the number of patients with different treatments increased, and 55.4% and 42% of patients changed their topic and systemic treatments respectively. The level of satisfaction was very high and all of patients considered that their disease was better controlled in this multidisciplinary care unit. This multidisciplinary care unit has improved the care and satisfaction of patients with psoriasis or PsA, and increased collaboration between rheumatology and dermatology departments. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Clustered multistate models with observation level random effects, mover-stayer effects and dynamic covariates: modelling transition intensities and sojourn times in a study of psoriatic arthritis.

Science.gov (United States)

Yiu, Sean; Farewell, Vernon T; Tom, Brian D M

2018-02-01

In psoriatic arthritis, it is important to understand the joint activity (represented by swelling and pain) and damage processes because both are related to severe physical disability. The paper aims to provide a comprehensive investigation into both processes occurring over time, in particular their relationship, by specifying a joint multistate model at the individual hand joint level, which also accounts for many of their important features. As there are multiple hand joints, such an analysis will be based on the use of clustered multistate models. Here we consider an observation level random-effects structure with dynamic covariates and allow for the possibility that a subpopulation of patients is at minimal risk of damage. Such an analysis is found to provide further understanding of the activity-damage relationship beyond that provided by previous analyses. Consideration is also given to the modelling of mean sojourn times and jump probabilities. In particular, a novel model parameterization which allows easily interpretable covariate effects to act on these quantities is proposed.

Psychopathological Variables and Sleep Quality in Psoriatic Patients

Directory of Open Access Journals (Sweden)

Maria Luca

2016-07-01

Full Text Available Psoriasis is an inflammatory disease frequently associated with psychiatric disturbances and sleep disorders. The aim of the study was to assess the prevalence of depression, interaction anxiety, audience anxiety, and sleep quality in psoriatic patients. One hundred and two psoriatic patients were enrolled and underwent the following questionnaires: Zung Self-Rating Depression Scale (SDS, Interaction Anxiousness Scale (IAS, Audience Anxiousness Scale (AAS, Pittsburgh Sleep Quality Index (PSQI. The severity of skin lesions was assessed by Psoriasis Area Severity Index (PASI. The presence of a link between clinical variables and with demographic data has been investigated. Psoriasis was linked to depression, interaction and audience anxiety, as well as to poor sleep quality; 37.5% of patients were depressed, 46.1% scored above 37 at the IAS, 47.1% scored above 33 at the AAS. Thirty-nine subjects (38.2% presented a PSQI ≥ 5. An association between interaction anxiety and lower limbs psoriasis-related erythema as well as between PSQI and head psoriasis-related erythema was found, particularly among male patients. Hence, psoriatic patients should be assessed from a holistic point of view, in order to identify associated disorders that could benefit from targeted treatments.

Development and testing of new candidate psoriatic arthritis screening questionnaires combining optimal questions from existing tools.

Science.gov (United States)

Coates, Laura C; Walsh, Jessica; Haroon, Muhammad; FitzGerald, Oliver; Aslam, Tariq; Al Balushi, Farida; Burden, A D; Burden-Teh, Esther; Caperon, Anna R; Cerio, Rino; Chattopadhyay, Chandrabhusan; Chinoy, Hector; Goodfield, Mark J D; Kay, Lesley; Kelly, Stephen; Kirkham, Bruce W; Lovell, Christopher R; Marzo-Ortega, Helena; McHugh, Neil; Murphy, Ruth; Reynolds, Nick J; Smith, Catherine H; Stewart, Elizabeth J C; Warren, Richard B; Waxman, Robin; Wilson, Hilary E; Helliwell, Philip S

2014-09-01

Several questionnaires have been developed to screen for psoriatic arthritis (PsA), but head-to-head studies have found limitations. This study aimed to develop new questionnaires encompassing the most discriminative questions from existing instruments. Data from the CONTEST study, a head-to-head comparison of 3 existing questionnaires, were used to identify items with a Youden index score of ≥0.1. These were combined using 4 approaches: CONTEST (simple additions of questions), CONTESTw (weighting using logistic regression), CONTESTjt (addition of a joint manikin), and CONTESTtree (additional questions identified by classification and regression tree [CART] analysis). These candidate questionnaires were tested in independent data sets. Twelve individual questions with a Youden index score of ≥0.1 were identified, but 4 of these were excluded due to duplication and redundancy. Weighting for 2 of these questions was included in CONTESTw. Receiver operating characteristic (ROC) curve analysis showed that involvement in 6 joint areas on the manikin was predictive of PsA for inclusion in CONTESTjt. CART analysis identified a further 5 questions for inclusion in CONTESTtree. CONTESTtree was not significant on ROC curve analysis and discarded. The other 3 questionnaires were significant in all data sets, although CONTESTw was slightly inferior to the others in the validation data sets. Potential cut points for referral were also discussed. Of 4 candidate questionnaires combining existing discriminatory items to identify PsA in people with psoriasis, 3 were found to be significant on ROC curve analysis. Testing in independent data sets identified 2 questionnaires (CONTEST and CONTESTjt) that should be pursued for further prospective testing. Copyright © 2014 by the American College of Rheumatology.

Update on research and future directions of the OMERACT MRI inflammatory arthritis group

DEFF Research Database (Denmark)

Conaghan, Philip G; McQueen, Fiona M; Bird, Paul

2011-01-01

of this score will require more PsA imaging datasets. As well, due to improved image resolution since the development of the original rheumatoid arthritis MRI scoring system (RAMRIS), the Task Force has worked on semiquantitative assessment of joint space narrowing, and developed a reliable method......The OMERACT Magnetic Resonance Imaging (MRI) Task Force has developed and evolved the psoriatic arthritis MRI score (PsAMRIS) over the last few years, and at OMERACT 10, presented longitudinal evaluation by multiple readers, using PsA datasets obtained from extremity MRI magnets. Further evaluation...

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

Science.gov (United States)

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

2012-04-01

To compare the efficacy and safety of treatment with infliximab plus methotrexate with methotrexate alone in methotrexate-naive patients with active psoriatic arthritis (PsA). 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/week) alone. The primary assessment was American College of Rheumatology (ACR) 20 response at week 16. Secondary outcome measures included psoriasis area and severity index (PASI), disease activity score in 28 joints (DAS28) and dactylitis and enthesitis assessments. At week 16, 86.3% of patients receiving infliximab plus methotrexate and 66.7% of those receiving methotrexate alone achieved an ACR20 response (palone experienced a 75% or greater improvement in PASI (palone group. Treatment with infliximab plus methotrexate in methotrexate-naive patients with active PsA demonstrated significantly greater ACR20 response rates and PASI75 improvement compared with methotrexate alone and was generally well tolerated. This trial is registered in the US National Institutes of Health clinicaltrials.gov database, identifier NCT00367237.

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.

LENUS (Irish Health Repository)

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.

Immunogenicity induced by biologicals in the treatment of psoriasis and psoriatic arthritis: View of the problem

Directory of Open Access Journals (Sweden)

T. V. Korotaeva

2015-01-01

Full Text Available The present-day views of the immunogenicity of biological agents (BAs used to in the treatment of psoriasis and psoriatic arthritis are analyzed. The immunogenicity of these medicaments is noted to depend on their molecular structure, individual patient characteristics, and used treatment regimens. As this takes place, the primary structure of the drug and its posttranslation modifications during manufacture are key factors. It is pointed out that a number of antigenic structures may give rise to the body's BA antibodies – murine epitopes, idiotopes, and allotropes, neoantigens forming in the coupling area of hybrid proteins, nonlinear epitopes present in the aggregated preparations. BAs that tend to form large immune complexes with these antibodies are most immunogenic. The antibodies to most BAs, except drugs based on soluble tumor necrosis factor-α receptors (etanercept, are neutralizing, i.e. they affect the efficiency of therapy, particularly when used over a long period of time.The results of trials evaluating the impact of antibodies to BAs on their clinical value are considered. It is believed that immunogenicity is itself of great importance in respect to the occurrence of the escape phenomenon of a response to BA therapy and to its safety. Attention is drawn to immunogenicity diagnostic problems; at the same it is noted that none of the used laboratory diagnostic techniques can reveal individual BA antibody forms and isotypes. It is concluded that there is a need for further investigations to standardize optimal methods for diagnosing neutralizing antibodies, to elaborate criteria for predicting a response to therapy in terms of an immunogenicity factor, and to reveal pathogenetic mechanisms responsible for the production of antibodies to BAs. The design of novel medicaments with minimal immunogenicity will depend on whether these mechanisms are common to all drugs or specific.

Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain.

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Torre-Alonso, Juan Carlos; Carmona, Loreto; Moreno, Mireia; Galíndez, Eva; Babío, Jesús; Zarco, Pedro; Linares, Luis; Collantes-Estevez, Eduardo; Barrial, Manuel Fernández; Hermosa, Juan Carlos; Coto, Pablo; Suárez, Carmen; Almodóvar, Raquel; Luelmo, Jesús; Castañeda, Santos; Gratacós, Jordi

2017-08-01

The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.

Review of the treatment of psoriatic arthritis with biological agents: choice of drug for initial therapy and switch therapy for non-responders.

Science.gov (United States)

D'Angelo, Salvatore; Tramontano, Giuseppina; Gilio, Michele; Leccese, Pietro; Olivieri, Ignazio

2017-01-01

Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory disease with a broad clinical spectrum and variable course. It can involve musculoskeletal structures as well as skin, nails, eyes, and gut. The management of PsA has changed tremendously in the last decade, thanks to an earlier diagnosis, an advancement in pharmacological therapies, and a wider application of a multidisciplinary approach. The commercialization of tumor necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab) as well as interleukin (IL)-12/23 (ustekinumab) and IL-17 (secukinumab) inhibitors is representative of a revolution in the treatment of PsA. No evidence-based strategies are currently available for guiding the rheumatologist to prescribe biological drugs. Several international and national recommendation sets are currently available with the aim to help rheumatologists in everyday clinical practice management of PsA patients treated with biological therapy. Since no specific biological agent has been demonstrated to be more effective than others, the drug choice should be made according to the available safety data, the presence of extra-articular manifestations, the patient's preferences (e.g., administration route), and the drug price. However, future studies directly comparing different biological drugs and assessing the efficacy of treatment strategies specific for PsA are urgently needed.

MRI pattern of arthritis in systemic lupus erythematosus: a comparative study with rheumatoid arthritis and healthy subjects

Energy Technology Data Exchange (ETDEWEB)

Tani, Chiara; Possemato, Niccolo; Delle Sedie, Andrea; Bombardieri, Stefano; Mosca, Marta [University of Pisa, Rheumatology Unit, Department of Clinical and Experimental Medicine, Pisa (Italy); D' aniello, Dario; Caramella, Davide [Radiology Unit, University of Pisa, Pisa (Italy)

2014-10-24

In this study we aimed to describe the magnetic resonance imaging (MRI) pattern of the distribution of bone marrow edema (BME) and joint erosion in hands and wrists of patients with systemic lupus erythematosus (SLE) with arthritis in comparison with rheumatoid arthritis (RA) and healthy subjects (H). SLE patients with arthritis (n = 50), patients with RA (n = 22), and H (n = 48) were enrolled. Every patient underwent a non-dominant hand (2nd-5th metacarpophalangeal joints) and wrist MRI without contrast injection with a low-field extremity dedicated 0.2-Tesla instrument. BME was observed in two SLE patients in the hand (4 %) and in 15 in the wrist (13 %) versus three (30 %), and 14 (63 %) RA patients. No BME was found in H. Erosions were observed in the hand in 24 SLE patients (48 %), 15 RA patients (68 %), and 9 H (18 %); in the wrist, in 41 (82 %) SLE, all RA and 47 (97 %) H. The cumulative erosive burden in SLE was significantly higher than in H (c = 0.002) but similar to RA patients. Joint involvement of the wrist in SLE is similar to RA and is not as rare as expected, as shown by the comparison with healthy subjects. On the contrary, the involvement of the hand in SLE is significantly lower compared to RA. (orig.)

MRI pattern of arthritis in systemic lupus erythematosus: a comparative study with rheumatoid arthritis and healthy subjects

International Nuclear Information System (INIS)

Tani, Chiara; Possemato, Niccolo; Delle Sedie, Andrea; Bombardieri, Stefano; Mosca, Marta; D'aniello, Dario; Caramella, Davide

2015-01-01

In this study we aimed to describe the magnetic resonance imaging (MRI) pattern of the distribution of bone marrow edema (BME) and joint erosion in hands and wrists of patients with systemic lupus erythematosus (SLE) with arthritis in comparison with rheumatoid arthritis (RA) and healthy subjects (H). SLE patients with arthritis (n = 50), patients with RA (n = 22), and H (n = 48) were enrolled. Every patient underwent a non-dominant hand (2nd-5th metacarpophalangeal joints) and wrist MRI without contrast injection with a low-field extremity dedicated 0.2-Tesla instrument. BME was observed in two SLE patients in the hand (4 %) and in 15 in the wrist (13 %) versus three (30 %), and 14 (63 %) RA patients. No BME was found in H. Erosions were observed in the hand in 24 SLE patients (48 %), 15 RA patients (68 %), and 9 H (18 %); in the wrist, in 41 (82 %) SLE, all RA and 47 (97 %) H. The cumulative erosive burden in SLE was significantly higher than in H (c = 0.002) but similar to RA patients. Joint involvement of the wrist in SLE is similar to RA and is not as rare as expected, as shown by the comparison with healthy subjects. On the contrary, the involvement of the hand in SLE is significantly lower compared to RA. (orig.)

Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective.

Science.gov (United States)

Goeree, Ron; Chiva-Razavi, Sima; Gunda, Praveen; Graham, Christopher N; Miles, LaStella; Nikoglou, Efthalia; Jugl, Steffen M; Gladman, Dafna D

2018-02-01

The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective. A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150 mg and 300 mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses. Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses

Differential effects of treatment with UV-light (365 nm) and 8-methoxypsoralen on chromosomes of healthy persons and psoriatic patients

International Nuclear Information System (INIS)

Loeber, G.; Kittler, L.

1986-01-01

The effect of 8-methoxypsoralen (8-MOP, 5 x 10 -5 M), near UV-light of 365 nm wavelength (UVA, 1.5 J/cm 2 ) and the combination of both (PUVA treatment) were studied on lymphocytes in vitro taken from healthy persons and patients with psoriasis vulgaris and psoriasis arthritis (psoriasis arthropathica). Chromosomes isolated from cell nuclei were visualized by means of Giemsa staining technique and analyzed for induction of chromosomal defects, i.e. premature centromere division (PCD), major coiling (MC), and formation of gaps and fragile sites. Exposure of nonpsoriatic lymphocytes to 8-MOP, UVA or PUVA increased the rate of PCD or MC generation. In experiments with psoriatic lymphocytes a much weaker effect was found, with a moderate increase of PCD and MC after UVA or PUVA treatment in the case of psoriasis vulgaris, and of MC after UVA treatment of psoriasis arthritis. On the average the number of chromosomes per metaphase plate displaying PCD did not exceed 10. No indication was obtained for the preference of certain chromosome groups or the appearance of 'fragile sites'. Under all experimental conditions the number of chromosome gaps ranged in the order of their spontaneous induction. The findings suggest PCD and MC investigations as possible sensitive tools for diagnosing latent psoriasis and for refined analysis of psoriatic cells or chromosomes. (author)

Clinical and Patient-reported Outcomes in Patients with Psoriatic Arthritis (PsA) by Body Surface Area Affected by Psoriasis: Results from the Corrona PsA/Spondyloarthritis Registry.

Science.gov (United States)

Mease, Philip J; Karki, Chitra; Palmer, Jacqueline B; Etzel, Carol J; Kavanaugh, Arthur; Ritchlin, Christopher T; Malley, Wendi; Herrera, Vivian; Tran, Melody; Greenberg, Jeffrey D

2017-08-01

Psoriatic arthritis (PsA) is commonly comorbid with psoriasis; the extent of skin lesions is a major contributor to psoriatic disease severity/burden. We evaluated whether extent of skin involvement with psoriasis [body surface area (BSA) > 3% vs ≤ 3%] affects overall clinical and patient-reported outcomes (PRO) in patients with PsA. Using the Corrona PsA/Spondyloarthritis Registry, patient characteristics, disease activity, and PRO at registry enrollment were assessed for patients with PsA aged ≥ 18 years with BSA > 3% versus ≤ 3%. Regression models were used to evaluate associations of BSA level with outcome [modified minimal disease activity (MDA), Health Assessment Questionnaire (HAQ) score, patient-reported pain and fatigue, and the Work Productivity and Activity Impairment questionnaire score]. Adjustments were made for age, sex, race, body mass index, disease duration, and history of biologics, disease-modifying antirheumatic drug, and prednisone use. This analysis included 1240 patients with PsA with known BSA level (n = 451, BSA > 3%; n = 789, BSA ≤ 3%). After adjusting for potential confounding variables, patients with BSA > 3% versus ≤ 3% had greater patient-reported pain and fatigue and higher HAQ scores (p = 2.33 × 10 -8 , p = 0.002, and p = 1.21 × 10 -7 , respectively), were 1.7× more likely not to be in modified MDA (95% CI 1.21-2.41, p = 0.002), and were 2.1× more likely to have overall work impairment (1.37-3.21, p = 0.0001). These Corrona Registry data show that substantial skin involvement (BSA > 3%) is associated with greater PsA disease burden, underscoring the importance of assessing and effectively managing psoriasis in patients with PsA because this may be a contributing factor in PsA severity.

Identifying Psoriasis and Psoriatic Arthritis Patients in Retrospective Databases When Diagnosis Codes Are Not Available: A Validation Study Comparing Medication/Prescriber Visit-Based Algorithms with Diagnosis Codes.

Science.gov (United States)

Dobson-Belaire, Wendy; Goodfield, Jason; Borrelli, Richard; Liu, Fei Fei; Khan, Zeba M

2018-01-01

Using diagnosis code-based algorithms is the primary method of identifying patient cohorts for retrospective studies; nevertheless, many databases lack reliable diagnosis code information. To develop precise algorithms based on medication claims/prescriber visits (MCs/PVs) to identify psoriasis (PsO) patients and psoriatic patients with arthritic conditions (PsO-AC), a proxy for psoriatic arthritis, in Canadian databases lacking diagnosis codes. Algorithms were developed using medications with narrow indication profiles in combination with prescriber specialty to define PsO and PsO-AC. For a 3-year study period from July 1, 2009, algorithms were validated using the PharMetrics Plus database, which contains both adjudicated medication claims and diagnosis codes. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of the developed algorithms were assessed using diagnosis code as the reference standard. Chosen algorithms were then applied to Canadian drug databases to profile the algorithm-identified PsO and PsO-AC cohorts. In the selected database, 183,328 patients were identified for validation. The highest PPVs for PsO (85%) and PsO-AC (65%) occurred when a predictive algorithm of two or more MCs/PVs was compared with the reference standard of one or more diagnosis codes. NPV and specificity were high (99%-100%), whereas sensitivity was low (≤30%). Reducing the number of MCs/PVs or increasing diagnosis claims decreased the algorithms' PPVs. We have developed an MC/PV-based algorithm to identify PsO patients with a high degree of accuracy, but accuracy for PsO-AC requires further investigation. Such methods allow researchers to conduct retrospective studies in databases in which diagnosis codes are absent. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

One year survey of hospitalized psoriatic patients and their treatment in Razi Hospital

Directory of Open Access Journals (Sweden)

Farnaghi F

1998-05-01

Full Text Available During one year survey, 77 psoriatic patients were hospitalized in the dermatology department of Razi Hospital. This comprised 19% of admitted patients in this period. 29% (n=22 of psoriatic patients had previous history of hospitalization. On admission, the mean age of patients was 32.8 years, the mean and peak age of disease onset were 26.46 and between 11-20 years, respectively. 14% (n=10 of the patients had a family history of psoriasis and 70% (n=7 of those with a positive family history had their age of onset under 20 years. Involvement of different regions was as follows: Scalp: 88% (n=68, nails: 53% (n=41 and joints (arthritis: 10% (n=8. Psoriasis was associated with scrotal tongue in 19% (n=13 and with geographic tongue in 10% (n=8 of patients. Regarding the medical treatment, the drugs which were used most frequently were tigason in 34% (n=41 and ditranol in 22% (n=26 of the cases. The mean duration of hospitalization was 39.29 days and most patients were discharged from the hospital in a good condition without any serious complication. During this period 9% of patients had a relapse of their disease.

The Danish nationwide clinical register for patients with rheumatoid arthritis: DANBIO.

Science.gov (United States)

Ibfelt, Else Helene; Jensen, Dorte Vendelbo; Hetland, Merete Lund

2016-01-01

DANBIO is a research register and a data source for rheumatologic diseases (rheumatoid arthritis [RA], axial spondyloarthritis, and psoriatic arthritis) for monitoring clinical quality at the national, regional, and hospital levels. The register includes patients with rheumatologic diseases who are treated at a hospital or a private rheumatologic clinic. Registration is mandatory for all patients with RA regardless of treatment and also for patients with other diagnoses if treated with biological disease-modifying antirheumatic drugs. Since 2006, the registration has been done electronically, including patient-reported outcome measures registered electronically by the patients with the use of touch screens. Core variables such as diagnosis, year of diagnosis, age, and sex are registered at the beginning. Data entered at later visits included the following: patient-reported outcomes for disease activity, pain, fatigue, functional status, and physician-reported objective measures of disease activity, treatment, C-reactive protein, and, when indicated, imaging. For subgroups of patients, the variables such as quality of life, sociodemographic factors, lifestyle, and comorbidity are also registered. The DANBIO cohort comprised ∼26,000 patients with RA, 3,200 patients with axial spondyloarthritis, and 6,200 patients with psoriatic arthritis in 2015. DANBIO has high nationwide coverage and completeness on key data variables. More than 60 original papers as well as annual reports of clinical quality (since 2005) have been published. DANBIO is a powerful register for research in rheumatologic diseases and furthermore serves as a Clinical Quality Register with the aim of monitoring treatment quality in patients with RA in Denmark.

A systematic review of measurement properties of patient reported outcome measures in psoriatic arthritis: A GRAPPA-OMERACT initiative.

Science.gov (United States)

Højgaard, Pil; Klokker, Louise; Orbai, Ana-Maria; Holmsted, Kim; Bartels, Else M; Leung, Ying Ying; Goel, Niti; de Wit, Maarten; Gladman, Dafna D; Mease, Philip; Dreyer, Lene; Kristensen, Lars E; FitzGerald, Oliver; Tillett, William; Gossec, Laure; Helliwell, Philip; Strand, Vibeke; Ogdie, Alexis; Terwee, Caroline B; Christensen, Robin

2018-04-01

An updated psoriatic arthritis (PsA) core outcome set (COS) for randomized controlled trials (RCTs) was endorsed at the Outcome Measures in Rheumatology (OMERACT) meeting in 2016. To synthesize the evidence on measurement properties of patient reported outcome measures (PROMs) for PsA and thereby contribute to development of a PsA core outcome measurement set (COMS) as described by the OMERACT Filter 2.0. A systematic literature search was performed in EMBASE, MEDLINE and PsycINFO on Jan 1, 2017 to identify full-text articles with an aim of assessing the measurement properties of PROMs in PsA. Two independent reviewers rated the quality of studies using the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, and performed a qualitative evidence synthesis. Fifty-five studies were included in the systematic review. Forty-four instruments and a total of 89 scales were analyzed. PROMs measuring COS domains with at least fair quality evidence for good validity and reliability (and no evidence for poor properties) included the Stockerau Activity Score for PsA (German), Psoriasis Symptom Inventory, visual analogue scale for Patient Global, 36 Item Short Form Health Survey Physical Function subscale, Health Assessment Questionnaire Disability Index, Bath Ankylosing Spondylitis Functional Index, PsA Impact of Disease questionnaire, PsA Quality of Life questionnaire, VITACORA-19, Functional Assessment of Chronic Illness Therapy Fatigue scale and Social Role Participation Questionnaire. At least one PROM with some evidence for aspects of validity and reliability was available for six of the eight mandatory domains of the PsA COS. Copyright © 2018 Elsevier Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

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

Two-year survival rates of anti-TNF-α therapy in psoriatic arthritis (PsA) patients with either polyarticular or oligoarticular PsA.

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Iannone, F; Lopriore, S; Bucci, R; Scioscia, C; Anelli, M G; Notarnicola, A; Lapadula, G

2015-05-01

To evaluate the 2-year drug survival rates of the tumour necrosis factor (TNF)-α blockers adalimumab, etanercept, and infliximab in psoriatic arthritis (PsA) patients with either oligoarticular (oligo-PsA) or polyarticular PsA (poly-PsA). We studied a prospective cohort of 328 PsA patients with peripheral arthritis (213 with poly-PsA and 115 with oligo-PsA), beginning their first ever anti-TNF-α treatment with adalimumab, etanercept, or infliximab. The aim of the study was to evaluate the drug survival rates and possible baseline predictors at 2 years. After 24 months, persistence in therapy with the first anti-TNF-α blocker was not statistically different in the oligo-PsA (70.4%) and poly-PsA (65.7%) subsets. Predictors of drug discontinuation were female sex [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.00-2.68, p = 0.04] and starting the therapy in years 2003-8 (HR 0.51, 95% CI 0.33-0.80, p = 0.003). In poly-PsA, the persistence of etanercept (68.3%) was significantly higher than that of adalimumab (51.9%, p = 0.01), whereas in oligo-PsA no significant difference was detected. In poly-PsA, the period 2003-8 was a negative predictor (HR 0.36, 95% CI 0.21-0.62, p = 0.0001) whereas in oligo-PsA female gender was a positive predictor of drug discontinuation (HR 2.08, 95% CI 1.02-4.24, p = 0.04). With regard to clinical outcomes, the best responses in terms of European League Against Rheumatism (EULAR) 'good' response or Disease Activity Score (DAS28) remission, crude or adjusted according to the LUND Efficacy indeX (LUNDEX), were seen in patients on etanercept or infliximab. Our study provides some evidence that anti-TNF-α drugs may perform differently in PsA, and that the analysis of clinical disease subsets may improve our knowledge and promote better management of PsA.

The French version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR).

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Quartier, Pierre; Hofer, Michael; Wouters, Carine; Truong, Thi Thanh Thao; Duong, Ngoc-Phoi; Agbo-Kpati, Kokou-Placide; Uettwiller, Florence; Melki, Isabelle; Mouy, Richard; Bader-Meunier, Brigitte; Consolaro, Alessandro; Bovis, Francesca; Ruperto, Nicolino

2018-04-01

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the French language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations and construct validity (convergent and discriminant validity). A total of 100 JIA patients (23% systemic, 45% oligoarticular, 20% RF negative polyarthritis, 12% other categories) and 122 healthy children, were enrolled at the paediatric rheumatology centre of the Necker Children's Hospital in Paris. Notably, none of the enrolled JIA patients is affected with psoriatic arthritis. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the French version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.

A comparison of region-based and pixel-based CEUS kinetics parameters in the assessment of arthritis

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Grisan, E.; Raffeiner, B.; Coran, A.; Rizzo, G.; Ciprian, L.; Stramare, R.

2014-03-01

Inflammatory rheumatic diseases are leading causes of disability and constitute a frequent medical disorder, leading to inability to work, high comorbidity and increased mortality. The gold-standard for diagnosing and differentiating arthritis is based on patient conditions and radiographic findings, as joint erosions or decalcification. However, early signs of arthritis are joint effusion, hypervascularization and synovial hypertrophy. In particular, vascularization has been shown to correlate with arthritis' destructive behavior, more than clinical assessment. Contrast Enhanced Ultrasound (CEUS) examination of the small joints is emerging as a sensitive tool for assessing vascularization and disease activity. The evaluation of perfusion pattern rely on subjective semi-quantitative scales, that are able to capture the macroscopic degree of vascularization, but are unable to detect the subtler differences in kinetics perfusion parameters that might lead to a deeper understanding of disease progression and a better management of patients. Quantitative assessment is mostly performed by means of the Qontrast software package, that requires the user to define a region of interest, whose mean intensity curve is fitted with an exponential function. We show that using a more physiologically motivated perfusion curve, and by estimating the kinetics parameters separately pixel per pixel, the quantitative information gathered is able to differentiate more effectively different perfusion patterns. In particular, we will show that a pixel-based analysis is able to provide significant markers differentiating rheumatoid arthritis from simil-rheumatoid psoriatic arthritis, that have non-significant differences in clinical evaluation (DAS28), serological markers, or region-based parameters.

Updating the Psoriatic Arthritis (PsA) Core Domain Set: A Report from the PsA Workshop at OMERACT 2016.

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Orbai, Ana-Maria; de Wit, Maarten; Mease, Philip J; Callis Duffin, Kristina; Elmamoun, Musaab; Tillett, William; Campbell, Willemina; FitzGerald, Oliver; Gladman, Dafna D; Goel, Niti; Gossec, Laure; Hoejgaard, Pil; Leung, Ying Ying; Lindsay, Chris; Strand, Vibeke; van der Heijde, Désirée M; Shea, Bev; Christensen, Robin; Coates, Laura; Eder, Lihi; McHugh, Neil; Kalyoncu, Umut; Steinkoenig, Ingrid; Ogdie, Alexis

2017-10-01

To include the patient perspective in accordance with the Outcome Measures in Rheumatology (OMERACT) Filter 2.0 in the updated Psoriatic Arthritis (PsA) Core Domain Set for randomized controlled trials (RCT) and longitudinal observational studies (LOS). At OMERACT 2016, research conducted to update the PsA Core Domain Set was presented and discussed in breakout groups. The updated PsA Core Domain Set was voted on and endorsed by OMERACT participants. We conducted a systematic literature review of domains measured in PsA RCT and LOS, and identified 24 domains. We conducted 24 focus groups with 130 patients from 7 countries representing 5 continents to identify patient domains. We achieved consensus through 2 rounds of separate surveys with 50 patients and 75 physicians, and a nominal group technique meeting with 12 patients and 12 physicians. We conducted a workshop and breakout groups at OMERACT 2016 in which findings were presented and discussed. The updated PsA Core Domain Set endorsed with 90% agreement by OMERACT 2016 participants included musculoskeletal disease activity, skin disease activity, fatigue, pain, patient's global assessment, physical function, health-related quality of life, and systemic inflammation, which were recommended for all RCT and LOS. These were important, but not required in all RCT and LOS: economic cost, emotional well-being, participation, and structural damage. Independence, sleep, stiffness, and treatment burden were on the research agenda. The updated PsA Core Domain Set was endorsed at OMERACT 2016. Next steps for the PsA working group include evaluation of PsA outcome measures and development of a PsA Core Outcome Measurement Set.

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

International Nuclear Information System (INIS)

Tehranzadeh, Jamshid; Ashikyan, Oganes; Anavim, Arash; Shin, John

2008-01-01

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 PsA of

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

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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

Evaluation of Magnetic Resonance Imaging Responsiveness in Active Psoriatic Arthritis at Multiple Timepoints during the First 12 Weeks of Antitumor Necrosis Factor Therapy.

Science.gov (United States)

Feletar, Marie; Hall, Stephen; Bird, Paul

2016-01-01

To assess the responsiveness of high- and low-field extremity magnetic resonance imaging (MRI) variables at multiple timepoints in the first 12 weeks post-antitumor necrosis factor (anti-TNF) therapy initiation in patients with psoriatic arthritis (PsA) and active dactylitis. Twelve patients with active PsA and clinical evidence of dactylitis involving at least 1 digit were recruited. Patients underwent sequential high-field conventional (1.5 Tesla) and extremity low-field MRI (0.2 Tesla) of the affected hand or foot, pre- and postgadolinium at baseline (pre-TNF), 2 weeks (post-TNF), 6 weeks, and 12 weeks. A blinded observer scored all images on 2 occasions using the PsA MRI scoring system. Eleven patients completed the study, but only 6 patients completed all high-field and low-field MRI assessments. MRI scores demonstrated rapid response to TNF inhibition with score reduction in tenosynovitis, synovitis, and osteitis at 2 weeks. Intraobserver reliability was good to excellent for all variables. High-field MRI demonstrated greater sensitivity to tenosynovitis, synovitis, and osteitis and greater responsiveness to change posttreatment. Treatment responses were maintained to 12 weeks. This study demonstrates the use of MRI in detecting early response to biologic therapy. MRI variables of tenosynovitis, synovitis, and osteitis demonstrated responsiveness posttherapy with high-field scores more responsive to change than low-field scores.

The 'psoriatic march': a concept of how severe psoriasis may drive cardiovascular comorbidity.

LENUS (Irish Health Repository)

Boehncke, Wolf-Henning

2011-04-01

There is increasing awareness that psoriasis is more than \\'skin deep\\'. Several recent reviews focussed on biomarkers indicating the systemic dimension of psoriasis and the aspect of comorbidity psoriasis shares with other chronic inflammatory diseases, such as Crohn\\'s disease and rheumatoid arthritis. Of emerging significance is the relationship to cardiovascular disease, as this contributes substantially to the patients\\' increased mortality. In this viewpoint, we examine currently available evidence favouring the concept of a causal link between psoriasis and cardiovascular disease: systemic inflammation may cause insulin resistance, which in turn triggers endothelial cell dysfunction, leading to atherosclerosis and finally myocardial infarction or stroke. While this \\'psoriatic march\\' is not yet formally proven, it raises clinically and academically relevant questions, and gains support by recent observations of numerous investigators.

Bone mineral density status and frequency of osteoporosis and clinical fractures in 155 patients with psoriatic arthritis followed in a university hospital.

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Busquets, Noemi; Vaquero, Carmen Gómez; Moreno, Jesús Rodríguez; Vilaseca, Daniel Roig; Narváez, Javier; Carmona, Loreto; Nolla, Joan M

2014-01-01

To assess the bone mineral density (BMD) and the frequency of osteoporosis and clinical fractures in a large group of Spanish patients with psoriatic arthritis (PsA). BMD was determined by DXA in all the patients who were willing to participate and had peripheral PsA regularly evaluated in a tertiary university hospital. All patients underwent a physical examination and general laboratory analysis. We gathered demographic and clinical variables related with BMD and risk of fractures. We also recorded the history of clinical low impact fractures. The population of reference to calculate T-score and Z-score came from a Spanish database. One hundred and fifty-five patients were included (64 postmenopausal women, 26 premenopausal women and 65 men). The clinical forms of PsA were: 46% oligoarticular and 54% polyarticular. Mean disease duration was 13.7±9.4 years and mean ESR was 21.8±13.9mm/h; 66% of patients had received glucocorticoid treatment. We found no differences in BMD status between the patients and the Spanish general population, neither in the whole series nor in each defined subgroup. Frequency of osteoporosis was 16%; it was higher in postmenopausal women (28%) than in men (9%) or premenopausal women (4%). Frequency of clinical fractures was 13%; it accounted specially in postmenopausal women. The magnitude of the problem of osteoporosis in PsA seems to be mild. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Salivary TNFα levels in groups of subjects with rheumatoid arthritis and chronic periodontitis.

Science.gov (United States)

Gamel, Ehsan B; Hashim, Nada T; Satti, Asim; Gismalla, Bakri G

2017-01-07

Rheumatoid arthritis (RA) and chronic periodontitis are the most common chronic inflammatory diseases with significant pathological and clinical similarities. Numerous studies have indicated a relationship between rheumatoid arthritis and periodontal disease. The aim of this study was to compare the TNF-α levels in saliva among patients with Rheumatoid arthritis (RA) and chronic periodontitis as well as healthy subjects. One hundred and seventy-one patients were enrolled in this cross-sectional study. Fifty-seven patients diagnosed of RA, 57 patients with chronic periodontitis and 57 healthy subjects. These patients have been examined with regard to TNF-α level from salivary samples. Their teeth were examined with regard to Plaque Index , Gingival Index, probing depth and clinical attachment level.All patients were non-smokers. The results revealed a significant difference in all periodontal parameters among the three groups. The chronic periodontitis group showed a significantly higher value in all clinical periodontal parameters in comparison to both the RA and healthy groups. No significant difference was found between salivary TNF-α level among the three study groups. Patients with chronic periodontitis had the highest periodontal indices. However there was no significant difference regarding the level of salivary TNF-α. Hence, suppression of proinflammatory cytokines might prove beneficial in suppressing periodontal diseases among RA patients.

Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission?

Science.gov (United States)

Alivernini, Stefano; Tolusso, Barbara; Petricca, Luca; Bui, Laura; Di Sante, Gabriele; Peluso, Giusy; Benvenuto, Roberta; Fedele, Anna Laura; Federico, Franco; Ferraccioli, Gianfranco; Gremese, Elisa

2017-07-01

To define the synovial characteristics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in clinical and ultrasound remission achieved by combination therapy with methotrexate (MTX) and tumour necrosis factor (TNF) blockers. Patients with RA in remission (n=25) (disease activity score (DAS)<1.6 for at least 6 months), patients with RA in low disease activity (LDA) (n=10) (1.6

Identification and quantification of amino acids from psoriatic and normal epidermis by high performance liquid chromatography

International Nuclear Information System (INIS)

Mahesar, S.M.; Khuhawar, M.Y.

2010-01-01

In this study, a modified fluorescence technique high performance liquid chromatography (HPLC) was adapted to separate the amino acids from the hydrolyzed keratin samples. These samples obtained from the epidermal layer of the normal and psoriatic human subjects. The keratin extracts are quantified in gram percentage of the dried skin and the amino acids concentrations are measured in mu g/g, mean retention time (tR), slope value and the coefficient of determination (r2) of each eluted amino acid is calculated. The coefficients of variation for amino acid standards ranged from 0.12% to 0.28%, mean, standard deviation of peak area and coefficients of variation of peak area were calculated. From the normal hydrolysated keratin protein fraction, 12 amino acids were determined and identified as aspartic acid, glutamic acid, asparagines, serine, glutamine, glycine, histidine, citrulline, arganine, fi-alanine, tyrosine, and valine. These amino acids were also determined in psoriatic samples while standard deviations (SD), standard error mean (SEM) and coefficient variation (CV%) of normal and psoriatic samples were also calculated. The higher concentration of amino acids in normal samples against psoriatic samples determined as glutamic acid 92.76+- 16. 83/50. 87+-9.88, glutamine 198.05+-18.74/19.74+-3.74 while higher concentrations of amino acids determined in psoriatic samples against normal samples as asparagines 81. 06+-10+-10.62/29. 98+-3.641; arganine 164.42+-35. 11/46. 14+-46, tyrosine 214.38+-29. 61/59. 64+-8. 82, and valine 169.7+-19.35/128.06+-15.14.1 is concluded that the absolute concentration of amino acids in psoriatic skin indicated a number of variations as compared to normal skin samples. (author)

Income disparities in healthcare use remain after controlling for healthcare need: evidence from Swedish register data on psoriasis and psoriatic arthritis.

Science.gov (United States)

Löfvendahl, Sofia; Jöud, Anna; Petersson, Ingemar F; Theander, Elke; Svensson, Åke; Carlsson, Katarina Steen

2018-04-01

We used a southern Swedish cohort of psoriasis (PSO) and psoriatic arthritis (PsA) patients and population-based referents (N = 57,800) to investigate the influence of socioeconomic and demographic factors on the probability of healthcare use and on healthcare costs when controlling for need as measured by PSO/PsA and common additional morbidities such as diabetes, depression and myocardial infarction. People with PSO/PsA were identified by ICD-10 codes in the Skåne Healthcare Register 1998-2007. Resource use and costs for years 2008-2011 were retrieved from the Skåne Healthcare Register and the Swedish Prescribed Drug Register, and socioeconomic data were retrieved from Statistics Sweden. After controlling for PSO/PsA and common additional morbidities, income, and to some extent education, had significant effects on the probability of five types of healthcare use. Overall, income showed a bell-shaped relationship to healthcare costs, with patients in income quintiles 2 and 3 having the highest mean annualized cost irrespective of model specification. Education did not have a significant effect in most specifications. Analyses including interaction effects indicated similarly higher costs across income quintiles in the PSO and PsA subgroups, though these cost differences were lower in magnitude for patients with PSO in quintile 5 and with PsA in quintile 1. In conclusion, our results show persistent socioeconomic disparities in healthcare use among a cohort of chronically ill patients and referents, even after controlling for the presence of PSO/PsA and common additional morbidities. These disparities persist even in a country with general healthcare coverage and low out-of-pocket payments.

DEVELOPMENT OF ALOPECIA DURING TREATMENT WITH A TUMOR NECROSIS FACTOR-ALPHA INHIBITOR IN A FEMALE PATIENT WITH PSORIATIC ARTHRITS: A CLINICAL CASE

Directory of Open Access Journals (Sweden)

R. G. Mukhina

2016-01-01

Full Text Available Objective: to describe a case of the total development of alopecia in a female patient with psoriatic arthritis during treatment with a tumor necrosis factor-αlpha (TNF-α inhibitor. Materials and methods. Patient I., aged 36 years has been followed up at the Kazan’ Center of Rheumatic Diseases and Osteoporosis since 1998. At approximately the same time, the patient noted the appearance of skin eruptions behind the ears, on the skin of the scalp. She was examined by a dermatologist who diagnosed psoriasis. In 2005, she was admitted to Kazan’ Rheumatology Center, City Clinical Hospital Seven, for the development of obvious synovitis of the knee joint and for the inefficiency of therapy with nonsteroidal anti-inflammatory drugs and diagnosed with psoriatic arthritis. During the prescribed therapy with methotrexate 10 mg/week, evident menstrual irregularities were observed in the patient who stopped using the drug herself. The second pregnancy occurred in 2008. Articular syndrome progression and eruptive psoriasis were recorded in the lactation period. After lactation cessation in 2009, she was hospitalized again. Her examination revealed high laboratory activity (erythrocyte sedimentation rate, as high as 40 mm/hr; magnetic resonance imaging of the knee joints showed the signs of bilateral synovitis; lumbar spine radiography exhibited grade II sacroiliitis. Leflunomide 20 mg/day was recommended as a basic drug. In 2012, the patient used leflunomide, her condition worsened; joint pain progressed; new joints were involved into the process, and cutaneous manifestations were aggravated. To verify a diagnosis and to choose therapy, the patient was referred to a consultation at the Moscow Research Institute of Rheumatology. Results. In connection with the high activity of the disease and with no response to the performed therapy, it was recommended to initiate therapy with biologics, such as infliximab, the drug of choice. Seven infliximab

Psychometric properties of the painDETECT questionnaire in rhuematoid arthritis, psoriatic arthritis and spondyloarthritis

DEFF Research Database (Denmark)

Rifbjerg-Madsen, Signe; Wæhrens, Eva Elisabet Ejlersen; Danneskiold-Samsøe, Bente

2017-01-01

that can identify underlying pain mechanisms are needed. The painDETECT questionnaire (PDQ) was originally designed to differentiate between pain phenotypes. The objectives were to evaluate the psychometric properties of the PDQ in patients with inflammatory arthritis by applying Rasch analysis...... and to explore the reliability of pain classification by test-retest. METHODS: For the Rasch analysis 900 questionnaires from patients with RA, PsA and SpA (300 per diagnosis) were extracted from 'the DANBIO painDETECT study'. The analysis was directed at the seven items assessing somatosensory symptoms...... and included: 1) the performance of the six-category Likert scale; 2) whether a unidimensional construct was defined; 3) the reliability and precision of estimates. Another group of 30 patients diagnosed with RA, PsA or SpA participated in a test-retest study. Intraclass Correlation Coefficients (ICC...

The Prevalence of Metabolic Syndrome in Psoriathic Arthritis Patients, a Cross-sectional Study on Iranian Population

Directory of Open Access Journals (Sweden)

Fatemeh Shirani

2016-11-01

Full Text Available Introduction: Psoriasis is a T-cell mediated chronic inflammatory disorder with multiple skin, nails and joints involvement. The reported prevalence of psoriatic arthritis (PsA varies from 5 to 42 cases per 100 psoriasis patients. Insulin resistance is believed to be central to the pathogenesis of metabolic syndrome (metS, a constellation of major risk factors for cardiovascular diseases, including atherogenic dyslipidemia, truncal adiposity, hypertension and hyperglycemia. The association of psoriasis with metS and is increasingly being reported.  Although the literature relating PsA to metS is accumulating, there is still a paucity of evidence, especially from Asia. Here, we examined the prevalence of metS and its components in patients with PsA.  Methods: The study was performed among outpatients attending the specialty clinics and Rheumatology ward of an institutional tertiary referral center. A consecutive sample of 80 patients diagnosed as having psoriatic arthritis in our clinics was studied. Age, gender, body mass index, blood pressure and waist circumference, and history of smoking of patients were measured and asked at the enrolment visit. Venous samples were taken after 8 h of overnight fasting for the estimation of serum lipid profile, glucose and uric acid levels. Also an ultrasonographic examination was done for detection of NAFLD. Results: 46 patients (57.5% were male and 34 patients (42.5% were female. Mean age of the participants was 43 years (SD: 11.3. The prevalence of abnormal components of metabolic syndrome was 53.8% for BMI, 48.8% for TG level, 50% for HDL, 46.3 for LDL, 45% for Cholesterol, 23.8% for FBS, 47.5% for waist circumflex and 42.5 for uric acid. 40% of the patients had abnormal SBP and 41.2% had abnormal DBP. 30% of the participants were current smokers and 43.8 had NAFLD on ultrasonographic examination. 51.3% of patients had metabolic syndrome according to the Adult Treatment Panel III criteria for adult

Building Bridges between Researchers and Patient Research Partners: A Report from the GRAPPA 2014 Annual Meeting

NARCIS (Netherlands)

de Wit, M.P.T.; Campbell, W.; Orbai, A.M.; Tillett, W.; Fitzgerald, O.; Gladman, D.D.; Lindsay, C.A.; McHugh, N.J.; Mease, P.J.; O'Sullivan, D.; Steinkoenig, I.; Windisch, G.; Goel, N.

2015-01-01

for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recently engaged patients as collaborative partners in psoriatic arthritis (PsA) research. We summarize Building Bridges, a session held at the GRAPPA 2014 annual meeting, where interactive dialogue was encouraged between all

Validation of the OMERACT Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) for the Hand and Foot in a Randomized Placebo-controlled Trial.

Science.gov (United States)

Glinatsi, Daniel; Bird, Paul; Gandjbakhch, Frederique; Mease, Philip J; Bøyesen, Pernille; Peterfy, Charles G; Conaghan, Philip G; Østergaard, Mikkel

2015-12-01

To assess changes following treatment and the reliability and responsiveness to change of the Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) in a randomized controlled trial. Forty patients with PsA randomized to either placebo or abatacept (ABA) had MRI of either 1 hand (n = 20) or 1 foot (n = 20) at baseline and after 6 months. Images were scored blindly twice by 3 independent readers according to the PsAMRIS (for synovitis, tenosynovitis, periarticular inflammation, bone edema, bone erosion, and bone proliferation). Inflammatory features improved numerically but statistically nonsignificantly in the ABA group but not the placebo group. Baseline intrareader intraclass correlation coefficients (ICC) were good (≥ 0.50) to very good (≥ 0.80) for all features in both hand and foot. Baseline interreader ICC were good (ICC 0.72-0.96) for all features, except periarticular inflammation and bone proliferation in the hand and tenosynovitis in the foot (ICC 0.25-0.44). Intrareader and interreader ICC for change scores varied. Guyatt's responsiveness index (GRI) was high for inflammatory features in the hand and metatarsophalangeal joints (GRI -0.67 to -3.13; bone edema not calculable). Minimal change and low prevalence resulted in low ICC and GRI for bone damage. PsAMRIS showed overall good intrareader agreement in the hand and foot, and inflammatory feature scores were responsive to change, suggesting that PsAMRIS may be a valid tool for MRI assessment of hands and feet in PsA clinical trials.

Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011.

Science.gov (United States)

Armstrong, April W; Schupp, Clayton; Wu, Julie; Bebo, Bruce

2012-01-01

To ascertain impairment in quality of life and work productivity among patients with psoriasis and psoriatic arthritis. From 2003 through 2011, the National Psoriasis Foundation collected survey data from patients with psoriasis and psoriatic arthritis via email and telephone correspondences. Survey data were collected from psoriasis and psoriatic arthritis patients in the general community in the U.S. Quality of life focusing on emotional impact (anger, frustration, helplessness, etc.) and physical impact (pain, pruritus, physical irritation, etc.); employment status. The surveys were performed through random sampling of participants from a database of over 75,000 patients. From 2003 to 2011, 5,604 patients completed the surveys. Psoriasis and psoriatic arthritis affected overall emotional wellbeing in 88% of patients, and they interfered with enjoyment of life in 82%. Most patients reported experiencing anger (89%), frustration (89%), helplessness (87%), embarrassment (87%), and self-consciousness (89%). Many patients also actively concealed physical manifestations of their diseases (83%), and experienced pain (83%) and pruritus (93%) regularly. Of note, 12% of patients were unemployed, and 11% worked part-time. Among unemployed patients, 92% cited psoriasis and/or psoriatic arthritis as the sole reasons for not working. Among working patients, 49% missed work days regularly due to psoriasis. Compared to patients with mild psoriasis, patients with severe psoriasis have 1.8 times greater odds to be unemployed after adjusting for age and gender (Adjusted OR = 1.7, 95% CI 1.4-2.3). Patients with psoriasis and psoriatic arthritis continue to experience significant impairment of quality of life and work productivity.

Plasma YKL-40

DEFF Research Database (Denmark)

Jensen, Peter; Wiell, C; Milting, K

2013-01-01

Background  Plasma YKL-40 is an inflammatory biomarker. No useful biomarker exists in patients with psoriasis or psoriatic arthritis. Objective  To measure YKL-40 and high-sensitivity C-reactive protein (hs-CRP) in patients with psoriasis or psoriatic arthritis before and during treatment. Methods......-CRP at inclusion and during 48 weeks of adalimumab treatment. The patients with psoriatic arthritis were divided into responders and non-responders. Results  In patients with psoriasis, the baseline median PASI score was 10.8 and baseline YKL-40 was 45 μg/L. Seventeen per cent had elevated plasma YKL-40 compared...

Deficient SOCS3 and SHP-1 Expression in Psoriatic T Cells

DEFF Research Database (Denmark)

Eriksen, Karsten W; Woetmann, Anders; Skov, Lone

2010-01-01

IFN-alpha and skin-infiltrating activated T lymphocytes have important roles in the pathogenesis of psoriasis. T cells from psoriatic patients display an increased sensitivity to IFN-alpha, but the pathological mechanisms behind the hyperresponsiveness to IFN-alpha remained unknown. In this study......-alpha signaling in psoriatic T cells. In conclusion, our data suggest that loss of regulatory control is involved in the aberrant hypersensitivity of psoriatic T cells to IFN-alpha.Journal of Investigative Dermatology advance online publication, 4 February 2010; doi:10.1038/jid.2010.6....

Bone pathology inpsoriatic arthritis

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V. V. Badokin

2007-01-01

Full Text Available Objective. To study different variants of osteolysis in pts with psoriatic arthritis (PA and to reveal their relationship with other clinico-radiological features of joint damage. Material and methods. 370 pts with definite PA having different variants of joint damage were included. Radiological examination of bones and joints (in some cases large picture frame was performed. Morphological evaluation of synovial biopsies was done in 34 pts with PA and 10 pts with rheumatoid arthritis (RA. Results. Different types of osteolysis were revealed in 80 (21,6% pts. Osteolytic variant of joint damage was present in 29 pts. 33 pts had acral, 48 — intra-articular osteolysis and 16 - true bone atrophy. Frequency and intensity of bone resorption were associated with severity of PA. Acral osteolysis correlated with arthritis of distal interphalangeal joints and onychodystrophy. Intra-articular osteolysis was most often present in distal interphalangeal joints of hands and metacarpophalangeal joints (39,6% and 41,7% respectively. Characteristic feature of PA was combination of prominent resorption with formation of bone ankylosis and periosteal reaction. Ankylosis was present in 33,3% of pts with intra-articular osteolysis and in 60% of pts with combination of different osteolysis variants. Systemic reaction of microcirculation in synovial biopsies was most prominent in osteolytic variant: marked thickening of capillary and venule basal membrane with high level of acid phosphatase, increased capillary and precapillary blood flow with stasis features, vascular lymphocyte and macrophage infiltration, productive vasculitis with annular wall thickening, thrombovasculitis and villi deep layer sclerosis. Conclusion. Different variants of osteolysis show bone involvement in PA. Acral and intra- articular osteolysis association with bone ankylosis and periostitis proves their common pathogenetic entity.

Blood flow in the forearm in patients with Rheumatoid arthritis and healthy subjects under local thermotherapy

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C. Mucha

2002-02-01

Full Text Available Objectives: Muscle blood flow in the forearm of patients with rheuma-toid arthritis and healthy volunteers following treatment with temperature increasingarm baths, mudpacks and short- or decimeter-wave diathermy was studied in thisinvestigation. The aim of the study was to find out the difference of reactive hyperemia between the different temperature methods as well as the influence on theconsensual reaction. Subjects: Eighty patients with rheumatoid arthritis, stage 3 according toSteinbrocker, as well as 80 healthy human subjects had been assigned numerically in the four therapy- and controlgroups. Patients with diseases influencing the peripheral blood flow were excluded. Design: Blood flow was measured by venous occlusion plethysmography in both forearms with the subjects lyingsupine. The application of the local heat therapies had been excluded on the left forearm. The forearm blood flow wasmonitored before heat therapy, directly after as well as in two further 10 minutes intervals. An analysis of variancewas used to determine the influence on blood flow of the response to the heat therapies in patients with rheumatoidarthritis and healthy subjects.Results: Under homogeneous starting conditions and a statistically uniformed high blood flow in rest the reactive values of blood flow on the left-hand side of application and the right consensual side showed high significant differencesbetween all methods of therapy. Differences between the patients and the healthy subjects only showed tendencies withpartially lower reactions, concerning the patients with rheumatoid arthritis. All methods of heat therapy caused a statistically provable consensual reaction that turned out smaller after diathermic methods. Here the post therapeuticreaction of the blood flow on the side of application was also lower or rather shorter. Conclusion: Greater differences of the blood flow in rest between the patients with rheumatoid arthritis and healthysubjects

Quality of Life and Work Productivity Impairment among Psoriasis Patients: Findings from the National Psoriasis Foundation Survey Data 2003–2011

Science.gov (United States)

Armstrong, April W.; Schupp, Clayton; Wu, Julie; Bebo, Bruce

2012-01-01

Objective To ascertain impairment in quality of life and work productivity among patients with psoriasis and psoriatic arthritis. Design From 2003 through 2011, the National Psoriasis Foundation collected survey data from patients with psoriasis and psoriatic arthritis via email and telephone correspondences. Setting Survey data were collected from psoriasis and psoriatic arthritis patients in the general community in the U.S. Main Outcome Measures Quality of life focusing on emotional impact (anger, frustration, helplessness, etc.) and physical impact (pain, pruritus, physical irritation, etc.); employment status. Patients The surveys were performed through random sampling of participants from a database of over 75,000 patients. Results From 2003 to 2011, 5,604 patients completed the surveys. Psoriasis and psoriatic arthritis affected overall emotional wellbeing in 88% of patients, and they interfered with enjoyment of life in 82%. Most patients reported experiencing anger (89%), frustration (89%), helplessness (87%), embarrassment (87%), and self-consciousness (89%). Many patients also actively concealed physical manifestations of their diseases (83%), and experienced pain (83%) and pruritus (93%) regularly. Of note, 12% of patients were unemployed, and 11% worked part-time. Among unemployed patients, 92% cited psoriasis and/or psoriatic arthritis as the sole reasons for not working. Among working patients, 49% missed work days regularly due to psoriasis. Compared to patients with mild psoriasis, patients with severe psoriasis have 1.8 times greater odds to be unemployed after adjusting for age and gender (Adjusted OR = 1.7, 95% CI 1.4–2.3). Conclusion Patients with psoriasis and psoriatic arthritis continue to experience significant impairment of quality of life and work productivity. PMID:23285231

The use of high-frequency ultrasound in the study of skin and psoriatic nail

International Nuclear Information System (INIS)

Gutierrez, Marwin; Restrepo, Juan Pablo; Filippucci, Emilio; Grassi, Walter

2009-01-01

Over the last few years, continuous advances have been made in the field of ultrasonography, developing equipment providing high-quality grey scale imaging with an axial resolution power less than 0.1 mm and very sensitive power Doppler technique. This fact has opened the way to detailed imaging of the superficial tissues, including the skin. This pictorial essay shows the main sonographic findings obtainable with last generation high-frequency transducers and power Doppler technique in patients with psoriatic disease. Sonographic images shown were selected from an image database collected in 20 patients with definite diagnosis of psoriasis and in 10 healthy subjects. The present report provides pictorial evidence that high resolution grey scale ultrasound and power Doppler technique allow for a detailed morpho structural assessment and a sensitive blood flow evaluation at both skin and nail level in patients with psoriatic disease.

Safety and clinical efficacy of golimumab in the treatment of arthritides

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Ismail Simsek

2010-09-01

Full Text Available Ismail Simsek, Yusuf YaziciNew York University School of Medicine, NYU Hospital for Joint Diseases, New York, USAAbstract: Golimumab is a human anti-tumor necrosis factor (TNF-alpha monoclonal antibody that was recently approved for the treatment of patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. This review covers the published clinical trial data on the use of golimumab for the approved indications mentioned above with respect to efficacy and safety. The various ongoing trials for golimumab have yielded promising results in terms of efficacy and safety in methotrexate-naive and -resistant patients with rheumatoid arthritis, as well as in patients who were previously treated with other anti-TNF agents. In addition, the efficacy of golimumab in psoriatic arthritis and ankylosing spondylitis has also been demonstrated. The real safety information will be available only once the drug has been used in many more patients, who frequently have comorbid conditions.Keywords: arthritis, rheumatoid, psoriatic arthritis, ankylosing spondylitis

Safety of etanercept in elderly subjects with rheumatoid arthritis

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Alfredomaria Lurati

2009-12-01

Full Text Available Alfredomaria Lurati, Mariagrazia Marrazza, Katia Angela, Magda ScarpelliniFornaroli Hospital, Rheumatology Unit, Magenta, ItalyObjective: To report side effects seen in a clinical cohort of patients aged >65 years with rheumatoid arthritis (RA treated with the tumor necrosis factor-α TNF-α blocker etanercept and to compare the side effects rate with patients aged ≤65 years.Methods: All patients with RA that started etanercept and who were referred to our rheumatology unit from November 2005 to March 2009 were included in this study and prospectively followed to collect side effects related to therapy.Results: One hundred three patients were enrolled: 41 (37 females, 4 males aged >65 years and 62 (40 females, 22 males aged <65 years. In the patients aged >65 years, the safety profile (defined as rate of side effects of etanercept was similar to that in patients aged ≤65 years (P > 0.05 and the survival curves between the groups were similar (P > 0.05.Conclusions: In our three-year experience, the anti-TNFα agent etanercept has been well tolerated and safe in elderly patients. The risk of side effects in these patients was no greater than in subjects aged ≤65 years. However, such inhibitors are associated with various and numerous side effects and elderly patients with RA should be carefully monitored to limit the risk of side effects during anti-TNFα therapy as much as possible.Keywords: anti-TNF therapy, rheumatoid arthritis, elderly

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH PSORIATIC ARTHRITIS: ITS ASSOCIATION WITH INFLAMMATION AND SUBCLINICAL ATHEROSCLEROSIS

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E. I. Markelova

2016-01-01

Full Text Available Metabolic syndrome (MS is a cluster of metabolic disorders giving rise to atherosclerotic  cardiovascular diseases (CVD. The combination  of inflammatory activity and a high spread of traditional  risk factors (RF for CVD in patients with psoriatic arthritis (PsA permits them to be referred to as a higher cardiovascular risk group as compared to the general population.Objective: to estimate the spread of MS and its association with inflammation and subclinical atherosclerosis in patients with PsA.Subjects and methods. This investigation enrolled 128 patients with PsA (61.7% women and 38.3% men; their median age was 43 [34; 49.5] years; the duration of PsA and psoriasis – 7 [3; 13] and 15 [6; 26] years, respectively. There was a preponderance of patients with moderate (3.7 ≥ DAS > 2.4 and high (DAS > 3.7 disease activity: 33 (25.8% and 74 (57.8%, respectively. MS was diagnosed on the basis of the 2011 National  Guidelines of the Russian Cardiology Society for Cardiovascular Prevention.  All the patients underwent carotid Doppler ultrasound (CDU for the diagnosis of subclinical atherosclerosis. Results and discussion. MS was diagnosed in 49 (38.3% patients with PsA. The most common  MS criteria were abdominal  obesity in 72 (56.3% and dyslipidemia [an elevation of low-density lipoproteins (LDL  level in 101 (78.9%, and a decrease in high-density lipoproteins (HDL  level in 65 (50.8]. Hypertension was diagnosed in 32 (25%. 65 (50.8% patients were found to have subclinical atherosclerosis,  as evidenced by CDU.The patients with MS were older than those without this condition  (46 [43; 52] and 39 [31; 46] years, respectively; p < 0.0001. These groups did not differ in PsA duration (15 [7; 29] and 15 [5.5; 25] years respectively; p = 0.47. The patients with MS had higher DAS values (4.4 [3.2; 5.6] and 3.6 [2.5; 4.7], respectively; p = 0.02; mean intima media thickness (IMT  (0.78 [0.72; 0.86] and 0.73 [0.66; 0.77] mm; p < 0.0001 and

Psoriatic Arthritis

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... OII) Timed Up & Go (TUG) Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) Young Investigators Resources for Doctoral Students/Post-Doctoral Fellows Evidence-Based Practice for Academic Researchers Responsible Data Management in Research Career Planning Treatments Patient ...

Psoriatic Arthritis

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... this research; and the dissemination of information on research progress in these diseases. Contact Us NIAMS Archive Viewers and Players Social Media Moderation Policy FOIA Privacy Statement Accessibility Disclaimer Digital Strategy ...

Methotrexate: the emerging drug of choice for serious rheumatoid arthritis.

Science.gov (United States)

Salach, R H; Cash, J M

1994-01-01

The recently recognized high morbidity and unexpected mortality associated with rheumatoid arthritis (RA) has spurred new interest in more aggressive, early treatment of this disease. Methotrexate (MTX) has rapidly become the rheumatologist's drug of choice for serious RA because of its favorable efficacy to toxicity ratio and rapid onset of action compared with other second-line agents. The initial concerns about hepatic fibrosis and cirrhosis in psoriatic patients has subsided somewhat as long-term liver toxicity data are accumulating in patients with RA. Routine liver biopsy with incremental doses of MTX is no longer recommended. Potential for severe lung, hematologic, and infectious complications exists, mandating careful monitoring of RA patients taking MTX.

Structural Biology of the TNFα Antagonists Used in the Treatment of Rheumatoid Arthritis

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Heejin Lim

2018-03-01

Full Text Available The binding of the tumor necrosis factor α (TNFα to its cognate receptor initiates many immune and inflammatory processes. The drugs, etanercept (Enbrel®, infliximab (Remicade®, adalimumab (Humira®, certolizumab-pegol (Cimzia®, and golimumab (Simponi®, are anti-TNFα agents. These drugs block TNFα from interacting with its receptors and have enabled the development of breakthrough therapies for the treatment of several autoimmune inflammatory diseases, including rheumatoid arthritis, Crohn’s disease, and psoriatic arthritis. In this review, we describe the latest works on the structural characterization of TNFα–TNFα antagonist interactions related to their therapeutic efficacy at the atomic level. A comprehensive comparison of the interactions of the TNFα blockers would provide a better understanding of the molecular mechanisms by which they neutralize TNFα. In addition, an enhanced understanding of the higher order complex structures and quinary structures of the TNFα antagonists can support the development of better biologics with the improved pharmacokinetic properties. Accumulation of these structural studies can provide a basis for the improvement of therapeutic agents against TNFα for the treatment of rheumatoid arthritis and other autoimmune inflammatory diseases in which TNFα plays an important role in pathogenesis.

Incorporation of 14C-linoleic acid in lipids of normal and psoriatic human skin

International Nuclear Information System (INIS)

Ruestow, B.; Metz, D.; Kunze, D.; Meffert, H.

1980-01-01

The 14 C-linoleic acid incorporation in lipids of surviving epidermis and corium of normal and psoriatic human skin was investigated. Changes of lipid metabolism were found in both epidermis and corium. Particularly the turnover of phospholipids was increased in the uninvolved psoriatic epidermis in relation to the involved psoriatic epidermis or to healthy controls. Possible reasons of these phenomena and the significance of structural lipids in psoriasis are discussed. (author)

Long-term treatment of rheumatoid arthritis with adalimumab

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Murdaca G

2013-05-01

Full Text Available Giuseppe Murdaca, Francesca Spanò, Francesco PuppoDepartment of Internal Medicine, Clinical Immunology Unit, University of Genoa, Genoa, ItalyAbstract: Rheumatoid arthritis (RA is a chronic inflammatory disease that is associated with joint damage and progressive disability, an increased risk of morbidity related to comorbid conditions and substantial socioeconomic costs. Tumor necrosis factor-alpha (TNF-α is a proinflammatory cytokine known to have a central role in the initial host response to infection and in the pathogenesis of various immune-mediated diseases, such as RA, ankylosing spondylitis, psoriasis and/or psoriatic arthritis, Crohn’s disease, and systemic lupus erythematosus. Five TNF-α inhibitors are available for the clinical use: infliximab; adalimumab; etanercept; golimumab; and certolizumab pegol. Infliximab is a chimeric human/murine IgG1 monoclonal antibody (mAb; adalimumab, and golimumab are human mAbs; certolizumab pegol is composed of the fragment antigen-binding anti-binding domain of a humanized anti-TNF-α mAb, combined with polyethylene glycol to increase its half-life in the body; etanercept is a fusion protein that acts as a “decoy receptor” for TNF-α. In this paper, we will briefly review the current data on efficacy and safety of adalimumab in patients with RA, its potential beneficial effects upon comorbid conditions, such as endothelial dysfunction and accelerated atherosclerosis in RA, and the immunogenicity.Keywords: adalimumab, efficacy, safety, rheumatoid arthritis, VEGF, immunogenicity, infections

Radiologic comparison of erosive polyarthritis with prominent interphalangeal involvement

International Nuclear Information System (INIS)

Gold, R.H.; Bassett, L.W.; Theros, E.G.

1982-01-01

Psoriatic arthritis, Reiter's disease, and multicentric reticulohistiocytosis may manifest prominent interphalangeal joint and cutaneous involvement. All three disorders may also affect the sacroiliac joints and spine. Despite these similarities, there are basic radiologic differences enabling distinction between the three disorders. Erosive osteoarthritis must also be considered in the differential diagnosis of interphalangeal erosive arthritis. Psoriatic erosions are characteristically ill defined, often bilaterally asymmetrical, usually unaccompanied by significant osteoporosis, and frequently associated with florid proliferation of subperiosteal new bone. An unilateral polyarticular pattern, which often occurs in a single ray, is the most prevalent of several patterns of involvement. Reiter's disease exhibits many clinical and radiologic similarities to psoriatic arthritis, but in the former there tends to be selective involvement of the joints of the lower limbs and particularly the feet, with relative sparing of the hands and wrists, while in the latter the joints of the upper and lower limbs tend to be involved to an equal extent. Multicentric reticulohistiocytosis (MR). Lesions predominate in skin and synovium and result in sharply circumscribed, rapidly progressive, strikingly bilaterally symmetrical erosions spreading from joint margins to articular surfaces. Most or all of the diarthrodial joints may be affected, but interphalangeal joint predominance and early and severe atlanto-axial involvement are characteristic. Erosive osteoarthritis is characterized by interphalangeal subchondral erosions, accompanying periosteal new bone that is more subtle than that of psoriatic arthritis, and interphalangeal bony ankylosis that occurs with the same frequency as that of psoriatic arthritis. (orig.)

Comorbidity and economic burden among moderate-to-severe psoriasis and/or psoriatic arthritis patients in the US Department of Defense population.

Science.gov (United States)

Lee, Seina; Xie, Lin; Wang, Yuexi; Vaidya, Neel; Baser, Onur

2018-06-01

To examine the comorbidity and economic burden among moderate-to-severe psoriasis (PsO) and/or psoriatic arthritis (PsA) patients in the US Department of Defense (DoD) population. This retrospective cohort claims analysis was conducted using DoD data from November 2010 to October 2015. Adult patients with ≥2 diagnoses of PsO and/or PsA (cases) were identified, and the first diagnosis date from November 2011 to October 2014 was defined as the index date. Patients were considered moderate-to-severe if they had ≥1 non-topical systemic therapy or phototherapy during the 12 months pre- or 1 month post-index date. Patients without a PsO/PsA diagnosis during the study period (controls) were matched to cases on a 10:1 ratio based on age, sex, region, and index year; the index date was randomly selected. One-to-one propensity score matching (PSM) was conducted to compare study outcomes in the first year post-index date, including healthcare resource utilization (HRU), costs, and comorbidity incidence. A total of 7,249 cases and 72,490 controls were identified. The mean age was 48.1 years. After PSM, comorbidity incidence was higher among cases, namely dyslipidemia (18.3% vs 13.5%, p < .001), hypertension (13.8% vs 8.7%, p < .001), and obesity (8.8% vs 6.1%, p < .001). Case patients had significantly higher HRU and costs, including inpatient ($2,196 vs $1,642; p < .0016), ambulatory ($8,804 vs 4,642; p < .001), emergency room ($432 vs $350; p < .001), pharmacy ($6,878 vs $1,160; p < .001), and total healthcare costs ($18,311 vs $7,795; p < .001). Claims data are collected for payment purposes; therefore, such data may have limitations for clinical research. During follow-up, DoD patients with moderate-to-severe PsO and/or PsA experienced significantly higher HRU, cost, and comorbidity burden.

Quality of life of healthy subjects and patients with arthritis and ...

African Journals Online (AJOL)

with arthritis and diabetes mellitus were enrolled into the study. Data were ... Most chronic illnesses such as rheumatoid arthritis which ..... Contribution of Authors. The authors .... and demographic factors on quality of life in renal transplant ...

Effect of Xerostomia on the Functional Capacity of Subjects with Rheumatoid Arthritis.

Science.gov (United States)

Lins E Silva, Marília; Carvalho, Camila Nunes; Carvalho, Alessandra de Albuquerque Tavares; Leão, Jair Carneiro; Duarte, Angela Luzia Pinto; Gueiros, Luiz Alcino

2016-10-01

To evaluate the intensity of xerostomia and hyposalivation in subjects with rheumatoid arthritis (RA) as well as the effects of these conditions on functional incapacity and disease activity. The study sample comprised 236 individuals of both sexes who had RA. All the individuals were submitted to clinical evaluation and unstimulated sialometry. Functional capacity was determined by using the Health Assessment Questionnaire (HAQ), xerostomia was assessed using the Xerostomia Inventory, and disease activity was evaluated with the 28-joint Disease Activity Score (DAS28). The effect of Sjögren syndrome (SS) was analyzed, and the sample was divided into 2 groups: RA (191 subjects) and RA/SS (45 subjects). The Xerostomia Inventory showed positive and significant correlation with fatigue (r = 0.243; p xerostomia (OR 3.89, 95% CI 1.84-8.23, p Xerostomia demonstrated an adverse effect on quality of life of subjects with RA, being associated with a reduction in functional capacity. In this clinical setting, xerostomia can be monitored as a marker of worse clinical evolution.

An indirect comparison and cost per responder analysis of adalimumab, methotrexate and apremilast in the treatment of methotrexate-naïve patients with psoriatic arthritis.

Science.gov (United States)

Betts, Keith A; Griffith, Jenny; Friedman, Alan; Zhou, Zheng-Yi; Signorovitch, James E; Ganguli, Arijit

2016-01-01

Apremilast was recently approved for the treatment of active psoriatic arthritis (PsA). However, no studies compare apremilast with methotrexate or biologic therapies, so its relative comparative efficacy remains unknown. This study compared the response rates and incremental costs per responder associated with methotrexate, apremilast, and biologics for the treatment of active PsA. A systematic literature review was performed to identify phase 3 randomized controlled clinical trials of approved biologics, methotrexate, and apremilast in the methotrexate-naïve PsA population. Using Bayesian methods, a network meta-analysis was conducted to indirectly compare rates of achieving a ≥20% improvement in American College of Rheumatology component scores (ACR20). The number needed to treat (NNT) and the incremental costs per ACR20 responder (2014 US$) relative to placebo were estimated for each of the therapies. Three trials (MIPA for methotrexate, PALACE-4 for apremilast, and ADEPT for adalimumab) met all inclusion criteria. The NNTs relative to placebo were 2.63 for adalimumab, 6.69 for apremilast, and 8.31 for methotrexate. Among methotrexate-naïve PsA patients, the 16 week incremental costs per ACR20 responder were $3622 for methotrexate, $26,316 for adalimumab, and $45,808 for apremilast. The incremental costs per ACR20 responder were $222,488 for apremilast vs. methotrexate. Among methotrexate-naive PsA patients, adalimumab was found to have the lowest NNT for one additional ACR20 response and methotrexate was found to have the lowest incremental costs per ACR20 responder. There was no statistical evidence of greater efficacy for apremilast vs. methotrexate. A head-to-head trial between apremilast and methotrexate is recommended to confirm this finding.

A hot spot for systemic lupus erythematosus, but not for psoriatic arthritis, identified by spatial analysis suggests an interaction between ethnicity and place of residence.

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Al-Maini, Mustafa; Jeyalingam, Thurarshen; Brown, Patrick; Lee, Jennifer J Y; Li, Lennon; Su, Jiandong; Gladman, Dafna D; Fortin, Paul R

2013-06-01

To describe the spatial distribution of incident cases of systemic lupus erythematosus (SLE) using geographic information systems (GIS). Spatial analyses were carried out on 890 SLE patients and 541 psoriatic arthritis (PsA) patients (controls). Age- and sex-adjusted rates for SLE/PsA for each census tract were calculated using denominator population values from the Canadian census. Spatial variations in relative risk were estimated by modeling risk as the product of a time effect, an age effect, and a spatially autocorrelated risk surface to identify hot spots. Patients within the detected hot spot were compared to those outside the hot spot to identify explanatory factors. SLE patients were predominantly female (87.75%) and the incidence rate was highest among those 15-19 years of age (2.4 cases/100,000 person-years). In an SLE hot spot containing 59 patients, 100% of the patients were female and 49.1% (n = 29) were Caucasian, while outside of the hot spot, 86.9% (n = 722) of the patients were female and 68.4% (n = 568) were Caucasian. The proportion of cases of Chinese ethnicity was significantly greater within the hot spot. An interaction was found between Chinese ethnicity and residence within the hot spot, with the risk of SLE to the Chinese population found to be twice the risk to the non-Chinese population. GIS was used to map SLE cases and a hot spot was identified after adjustment for age and sex. Ethnicity by itself did not confer an increased risk of SLE, but the interaction of ethnicity with location of residence significantly increased the risk of SLE. Copyright © 2013 by the American College of Rheumatology.

An old woman with chronic palmar dermatosis, rheumatism, and nail changes

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Vitorino Modesto dos Santos

2017-02-01

Full Text Available Psoriasis is a chronic inflammatory condition with variable changes on the skin and nails, sometimes associated with osteoarticular manifestations characterizing the psoriatic arthritis. This arthritis may precede, follow, or be concomitant with the skin lesions of psoriasis. Unsuspected psoriatic arthritis may be misdiagnosed by other seronegative spondyloarthritis, mainly in primary care attention, and ominous outcomes are related to late and inadequate management. Therefore, diagnostic exercises with base on significant clinical and radiological images might contribute to enhance the suspicion index about these challenging conditions.

Psoriasis and associated variables in classification and outcome of juvenile idiopathic arthritis - an eight-year follow-up study

DEFF Research Database (Denmark)

Ekelund, Maria; Aalto, Kristiina; Fasth, Anders

2017-01-01

BACKGROUND: To study the impact of psoriasis and features associated with psoriasis on classification and outcome in a population-based follow-up cohort of children with juvenile idiopathic arthritis (JIA). METHODS: In all, 440 children with JIA were followed for a median of 8 years...... in a prospective Nordic population-based cohort study. Data for remission was available for 427 of these children. The presence of psoriasis, psoriasis-like rash, dactylitis, nail pitting, enthesitis, tenosynovitis and heredity was assessed in relation to ILAR classification and remission. RESULTS: Clinical...... findings associated with psoriasis developed consecutively during the 8-year period. Six of 14 children with psoriasis were not classified as juvenile psoriatic arthritis according to the ILAR criteria at 8 year follow-up. Dactylitis was more common in children with early onset of JIA. After 8 years we...

Quality of life of healthy subjects and patients with arthritis and ...

African Journals Online (AJOL)

Tropical Journal of Pharmaceutical Research July 2017; 16 (7): 1729-1735 ... Conclusions: Arthritis and diabetes mellitus severely impaired patient QOL. Arthritis has ... pronounced effects on QOL either alone or as co-morbid chronic illness. ... health care providers [1-3]. ... administered to hospital patients following ethical.

Spondyloarthritis

NARCIS (Netherlands)

Dougados, Maxime; Baeten, Dominique

2011-01-01

Spondyloarthritis is a group of several related but phenotypically distinct disorders: psoriatic arthritis, arthritis related to inflammatory bowel disease, reactive arthritis, a subgroup of juvenile idiopathic arthritis, and ankylosing spondylitis (the prototypic and best studied subtype). The past

Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review.

Science.gov (United States)

Zabotti, Alen; Bandinelli, Francesca; Batticciotto, Alberto; Scirè, Carlo Alberto; Iagnocco, Annamaria; Sakellariou, Garifallia

2017-09-01

To systematically review the role of musculoskeletal US in patients suffering from PsA or psoriasis (Pso) in terms of prevalence, diagnosis, prognosis, monitoring and treatment. A systematic literature review was conducted through medical databases (MEDLINE via PubMed, Embase) and the grey literature up to September 2015 to inform a new study of the Musculoskeletal Ultrasound Study Group of the Italian Society for Rheumatology. All articles reporting data on musculoskeletal US in PsA or Pso were included and extracted according to the underlying clinical question. A total of 86 publications were included. The prevalence of US abnormalities showed a wide range for each examined feature (e.g. 37-95% for entheses thickness of the lower limbs). The performance of US for diagnosis of disease or elementary lesions was variable across studies, but no study evaluated the overall performance of US in addition to clinical findings for diagnosing PsA. Considering US in defining PsA and Pso prognosis, several works focused on US of entheses of lower limbs in Pso, while for the monitoring of PsA activity five different scoring systems were identified. Last, the results of the role of US in guiding intra-articular interventions were controversial for the clinical outcomes, but in favour of US for accuracy. despite the recognized importance of US in the management of PsA and Pso, this review clearly demonstrated the need of pivotal research in order to optimize the use of US in the diagnosis and monitoring of psoriatic disease. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis.

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McDougall, John; Bruce, Bonnie; Spiller, Gene; Westerdahl, John; McDougall, Mary

2002-02-01

To demonstrate the effects of a very low-fat, vegan diet on patients with rheumatoid arthritis (RA). Single-blind dietary intervention study. SUBJECTS AND STUDY INTERVENTIONS: This study evaluated the influence of a 4-week, very low-fat (approximately 10%), vegan diet on 24 free-living subjects with RA, average age, 56 +/- 11 years old. Prestudy and poststudy assessment of RA symptomatology was performed by a rheumatologist blind to the study design. Biochemical measures and 4-day diet data were also collected. Subjects met weekly for diet instruction, compliance monitoring, and progress assessments. There were significant (p 0.05). Weight also decreased significantly (p 0.05), RA factor decreased 10% (ns, p > 0.05), while erythrocyte sedimentation rate was unchanged (p > 0.05). This study showed that patients with moderate-to-severe RA, who switch to a very low-fat, vegan diet can experience significant reductions in RA symptoms.

[Hepatobiliary System Diseases as the Predictors of Psoriasis Progression].

Science.gov (United States)

Smirnova, S V; Barilo, A A; Smolnikova, M V

2016-01-01

To assess the state of the hepatobiliary system in psoriasis andpsoriatic arthritis in order to establish a causal relationship and to identify clinical and functional predictors of psoriatic disease progression. The study includedpatients with extensive psoriasis vulgaris (n = 175) aged 18 to 66 years old and healthy donors (n = 30), matched by sex and age: Group 1--patients with psoriasis (PS, n = 77), group 2--patients with psoriatic arthritis (PsA, n = 98), group 3--control. The evaluation of functional state of the hepatobiliary system was performed by the analysis of the clinical and anamnestic data and by the laboratory-instrumental methods. We identified predictors of psoriasis: triggers (stress and nutritionalfactor), increased total bilirubin, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, eosinophilia, giardiasis, carriers of hepatitis C virus, ductal changes andfocal leisons in the liver, thickening of the walls of the gallbladder detected by ultrasound. Predictors ofpsoriatic arthritis: age over 50 years, dyspeptic complaints, the presence of hepatobiliary system diseases, the positive right hypochondrium syndrome, the clinical symptoms of chronic cholecystitis, excess body weight, high levels of bilirubin, cholesterol and low density lipoprotein, hepatomegaly, non-alcoholic fatty liver disease. High activity of hepatocytes cytolysis, cholestasis, inflammation, metabolic disorders let us considerpsoriatic arthritis as a severe clinical stage psoriatic disease when the hepatobiliary system, in turn, is one of the main target organs in systemic psoriatic process. Non-alcoholic fatty liver disease and chronic cholecystitis are predictors of psoriatic disease progression.

Chronic Inflammatory Disease, Lifestyle and Treatment Response

Science.gov (United States)

2018-01-25

Autoimmune Diseases; Inflammatory Bowel Diseases; Crohn Disease (CD); Colitis, Ulcerative (UC); Arthritis, Rheumatoid (RA); Spondylarthropathies; Arthritis, Psoriatic (PsA); Psoriasis; Hidradenitis Suppurativa (HS); Uveitis

Insight into the Endocrine System and the Immune System: A Review of the Inflammatory Role of Prolactin in Rheumatoid Arthritis and Psoriatic Arthritis

NARCIS (Netherlands)

Tang, Man W.; Garcia, Samuel; Gerlag, Danielle M.; Tak, Paul P.; Reedquist, Kris A.

2017-01-01

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects females three times more frequently than males. A potential role for hormones, such as prolactin (PRL), may in part explain this phenomenon. The risk of developing RA is increased in women who are lactating after the first

Improvements in productivity at paid work and within the household, and increased participation in daily activities after 24 weeks of certolizumab pegol treatment of patients with psoriatic arthritis: results of a phase 3 double-blind randomised placebo-controlled study

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Kavanaugh, A; Gladman, D; van der Heijde, D; Purcaru, O; Mease, P

2015-01-01

Objectives To evaluate the effect of certolizumab pegol (CZP) on productivity outside and within the home, and on participation in family, social and leisure activities in adult patients with psoriatic arthritis (PsA). Methods RAPID-PsA (NCT01087788) is a phase 3, double-blind, placebo-controlled trial. 409 patients with active PsA were randomised 1:1:1 to placebo, CZP 200 mg every 2 weeks (Q2W) or CZP 400 mg every 4 weeks (Q4W). The arthritis-specific Work Productivity Survey (WPS) assessed the impact of PsA on paid work and household productivity, and participation in social activities during the preceding month. WPS responses were compared between treatment arms using a non-parametric bootstrap-t method. Results At baseline, 56.6%, 60.1% and 61.5% of placebo, CZP 200 mg Q2W and CZP 400 mg Q4W patients were employed. By week 24, employed CZP patients reported an average of 1.0–1.8 and 3.0–3.9 fewer days of absenteeism and presenteeism, respectively, per month compared with 1.0 and 0.3 fewer days for placebo patients (pproductivity or days lost for participation in family, social and leisure activities. Improvements with CZP were seen as early as week 4 and continued to week 24. Conclusions CZP treatment significantly improved productivity at paid work and within the home, and resulted in greater participation in social activities for PsA patients. Trial registration number NCT01087788. PMID:24942382

Generalised pustular psoriasis induced by cyclosporin a withdrawal responding to the tumour necrosis factor alpha inhibitor etanercept.

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Kamarashev, J; Lor, P; Forster, A; Heinzerling, L; Burg, G; Nestle, F O

2002-01-01

We report a 50-year-old male patient with a 15-year history of psoriasis including mutilating psoriatic arthritis, in whom the withdrawal of cyclosporin A induced a generalised pustular exacerbation and a aggravation of the joint condition. Two weekly injections of 25 mg of the tumour necrosis factor alpha inhibitor etanercept led to a rapid improvement of his psoriatic arthritis, as well as regression of the pustular eruption, while residual erythema was still present. The clinical response was reflected by an increase in circulating interleukin (IL) 10 and a decrease in IL-6 and IL-8 serum levels during treatment. We conclude that etanercept may be a safe and effective therapy not only in severe psoriatic arthritis, but also in cases of pustular rebound after withdrawal of immunosuppressive agents. Copyright 2002 S. Karger AG, Basel

Point of care testing of phospholipase A2 group IIA for serological diagnosis of rheumatoid arthritis

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Liu, Nathan J.; Chapman, Robert; Lin, Yiyang; Mmesi, Jonas; Bentham, Andrew; Tyreman, Matthew; Abraham, Sonya; Stevens, Molly M.

2016-02-01

Secretory phospholipase A2 group IIA (sPLA2-IIA) was examined as a point of care marker for determining disease activity in rheumatoid (RA) and psoriatic (PsA) arthritis. Serum concentration and activity of sPLA2-IIA were measured using in-house antibodies and a novel point of care lateral flow device assay in patients diagnosed with varying severities of RA (n = 30) and PsA (n = 25) and found to correlate strongly with C-reactive protein (CRP). Levels of all markers were elevated in patients with active RA over those with inactive RA as well as both active and inactive PsA, indicating that sPLA2-IIA can be used as an analogue to CRP for RA diagnosis at point of care.Secretory phospholipase A2 group IIA (sPLA2-IIA) was examined as a point of care marker for determining disease activity in rheumatoid (RA) and psoriatic (PsA) arthritis. Serum concentration and activity of sPLA2-IIA were measured using in-house antibodies and a novel point of care lateral flow device assay in patients diagnosed with varying severities of RA (n = 30) and PsA (n = 25) and found to correlate strongly with C-reactive protein (CRP). Levels of all markers were elevated in patients with active RA over those with inactive RA as well as both active and inactive PsA, indicating that sPLA2-IIA can be used as an analogue to CRP for RA diagnosis at point of care. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr08423g

Early and sustained efficacy with apremilast monotherapy in biological-naïve patients with psoriatic arthritis: a phase IIIB, randomised controlled trial (ACTIVE).

Science.gov (United States)

Nash, Peter; Ohson, Kamal; Walsh, Jessica; Delev, Nikolay; Nguyen, Dianne; Teng, Lichen; Gómez-Reino, Juan J; Aelion, Jacob A

2018-05-01

Evaluate apremilast efficacy across various psoriatic arthritis (PsA) manifestations beginning at week 2 in biological-naïve patients with PsA. Patients were randomised (1:1) to apremilast 30 mg twice daily or placebo. At week 16, patients whose swollen and tender joint counts had not improved by ≥10% were eligible for early escape. At week 24, all patients received apremilast through week 52. Among 219 randomised patients (apremilast: n=110; placebo: n=109), a significantly greater American College of Rheumatology 20 response at week 16 (primary outcome) was observed with apremilast versus placebo (38.2% (42/110) vs 20.2% (22/109); P=0.004); response rates at week 2 (first assessment) were 16.4% (18/110) versus 6.4% (7/109) (P=0.025). Improvements in other efficacy outcomes, including 28-joint count Disease Activity Score (DAS-28) using C reactive protein (CRP), swollen joint count, Health Assessment Questionnaire-Disability Index (HAQ-DI), enthesitis and morning stiffness severity, were observed with apremilast at week 2. At week 16, apremilast significantly reduced PsA disease activity versus placebo, with changes in DAS-28 (CRP) (P<0.0001), HAQ-DI (P=0.023) and Gladman Enthesitis Index (P=0.001). Improvements were maintained with continued treatment through week 52. Over 52 weeks, apremilast's safety profile was consistent with prior phase 3 studies in psoriasis and PsA. During weeks 0-24, the incidence of protocol-defined diarrhoea was 11.0% (apremilast) and 8.3% (placebo); serious adverse event rates were 2.8% (apremilast) and 4.6% (placebo). In biological-naïve patients with PsA, onset of effect with apremilast was observed at week 2 and continued through week 52. The safety profile was consistent with previous reports. NCT01925768; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

DEFF Research Database (Denmark)

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 psoriati...... arthritis (PsA). In this pilot study, we looked at possible differences between joint synovitis and tenosynovitis in PsA as compared with rheumatoid arthritis (RA)....

Work Productivity and Costs Related to Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis.

Science.gov (United States)

Kruntorádová, Klára; Klimeš, Jiří; Šedová, Liliana; Štolfa, Jiří; Doležal, Tomáš; Petříková, Alena

2014-09-01

To determine and compare the impact of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriasis on work productivity, to calculate the productivity costs (PC), and to map out factors that influence (functional status and disease activity) work productivity. The Work Productivity and Activity Impairment questionnaire was used to evaluate productivity losses of patients with RA (n = 77), AS (n = 230), and psoriasis (n = 93). Demographic data, patient-reported outcomes (PROs) (Health Assessment Questionnaire [HAQ] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and clinical parameters (Disease Activity Score in 28 joints [DAS28], body surface area [BSA], and Psoriasis Area and Severity Index [PASI]) were collected. The correlations among PROs, clinical parameters, and overall productivity loss were examined, and multiple regression models were used to examine relationships among parameters and productivity loss. PC were calculated using the friction cost approach. Mean patient age and disease duration were 47.1 and 15.7 years, respectively. The mean HAQ and DAS28 in patients with RA were 1.22 and 5.6, respectively. The mean BASDAI score in patients with AS was 4.43. The mean BSA and PASI score in patients with psoriasis were 21.1% and 12.9, respectively. The percentage of patients with psoriatic arthritis (in those with psoriasis) was 24.7%. We did not find significant differences in Work Productivity and Activity Impairment domains among various diagnoses. Patients with AS, RA, and psoriasis reported overall work productivity losses of 40.9%, 42.9%, and 42.8%, respectively. Daily activity impairments were approximately 50.0%. Overall work productivity loss strongly correlated with PROs, whereas correlations with clinical parameters were weak. The HAQ and BASDAI were identified as major predictors of productivity impairment. The greatest loss in productivity was in those with psoriatic arthritis; however, it was not significant. In

Radiosynovectomy in the treatment of arthritis

International Nuclear Information System (INIS)

Liepe, Knut

2005-01-01

Full text: Radiosynovectomy is a useful therapeutic option that involves radiopharmaceutical injections into joints, especially to treat rheumatoid arthritis. The indications included different kinds of arthritis, such as rheumatoid arthritis, psoriatic arthritis, Bechterew's disease, hemophiliac arthritis, osteoarthritis, but also patients with joint prosthesis and synovial effusion. There are three commercial available radiopharmaceuticals for the treatment: yttrium-90 for the knee (185 to 250 MBq), rhenium-186 for larger joints (shoulder and hip with 111 MBq; elbow, wrist, ankle joint with can also rederbium-169 for smaller joints (acromioclavicular joint with 37 MBq, thumb base and MTP I with 30 MBq, MCP and MTP II-V with 22 MBq, PIP with 18.5 MBq, and DIP with 15 MBq, respectively). Decisive for the treatment is a positive sign for arthritis in the two-phase bone scan with 99mTc-HMDP (high uptake in the blood pool phase). Only for radiosynovecotmy in the knee an ultrasound with an evidence of effusion is sufficient. Side effects by the treatment are rare, such as temporary radiation or crystal synovitis, tissue necrosis (extra articular fraction or intra-articular), joint infection (1 of 35,000 joints) or effects due to the immobilisation (thrombosis, pulmonary embolism (immobilization of the knee), lymphoedema or loss of motion. In the treatment of the knee a prophylaxis with heparin is necessary to protect the patients for a pulmonary embolism. The clinical outcome is depending from the primary disease and the stage of arthrosis. Kresnik at al reported in 2190 treated joints an overall response rate of 73 ± 17%. A higher response rate was observed in patients with early stage of arthrosis (73 ± 12%) to patients with advance stage (52 ± 24%). The best results had patients with hemophiliac arthritis (91 ± 4%). In our hospital were treated up to 10.000 joints with a mean response rate of 70-80%. There was a higher response rate in larger joints with 81 ± 5

Radiosynovectomy in the treatment of arthritis

International Nuclear Information System (INIS)

Liepe, K.

2007-01-01

Full text: Radiosynovectomy is a useful therapeutic option that involves radiopharmaceutical injections into joints, especially to treat rheumatoid arthritis. The indications included different kinds of arthritis, such as rheumatoid arthritis, psoriatic arthritis, Bechterew's disease, hemophiliac arthritis, osteoarthritis, but also patients with joint prosthesis and synovial effusion. There are three commercial available radiopharmaceuticals for the treatment: yttrium-90 for the knee (185 to 250 MBq), rhenium-186 for larger joints (shoulder and hip with 111 MBq; elbow, wrist, ankle joint with 74 MBq) and erbium- 169 for smaller joints (acromioclavicular joint with 37 MBq, thumb base and MTP I with 30 MBq, MCP and MTP II-V with 22 MBq, PIP with 18.5 MBq, and DIP with 15 MBq, respectively). Decisive for the treatment is a positive sign for arthritis in the two-phase bone scan with 99mTc- HMDP (high uptake in the blood pool phase). Only for radiosynovectomy in the knee an ultrasound with an evidence of effusion is sufficient. Side effects by the treatment are rare, such as temporary radiation or crystal synovitis, tissue necrosis (extra-articular fraction or intraarticular), joint infection (1 of 35,000 joints) or effects due to the immobilization (thrombosis, pulmonary embolism (immobilization of the knee), lymph edema or loss of motion. In the treatment of the knee, a prophylaxis with heparin is necessary to protect the patients for pulmonary embolism. The radiation absorbed dose to the patients are low because a low leakage rate from the treated joint (lymphogenic uptake of 1.8%ID (0.45 to 4.78). These leads to a radiation exposure to the testis of 0.1mSv (0.05 to 0.18) and to the ovary of 0.2 mSv (0.1 to 0.38). Significantly is the radiation exposure of the physician, here especially at the finger pulp. A high beta dose of 22.1 μSv/MBq for the forefinger was observed using only a syringe protection in treatments of knees ( 90 Y), this resulted in a annual

Gold Finger: Metal Jewellery as a Disease Modifying Antirheumatic Therapy!

Directory of Open Access Journals (Sweden)

T. Hlaing

2009-01-01

Full Text Available Polyarticular psoriatic arthritis is a chronic, progressive and disabling auto-immune disease often affecting the small joints of the hands in a symmetrical fashion. The disease can progress rapidly causing joint swelling and damaging cartilage and bone around the joints resulting in severe deformities. We report a very unusual case of a 49-year-old woman who presented with polyarticular psoriatic arthritis affecting all proximal interphalangeal (PIP joints of both hands except the left ring finger PIP joint. On clinical examination there was no evidence of arthritis in the left ring finger PIP joint. We confirmed the paucity of joint damage in the PIP joint of the left ring finger using more modern imaging modalities such as musculoskeletal ultrasound and MRI scan of the small joints of the hands. All other PIP joints in both hands demonstrated advanced degrees of joint damage secondary to chronic psoriatic inflammatory arthritis. We postulated that wearing a gold wedding ring has helped protecting the PIP joint of the left ring finger from the damaging effect of inflammatory arthritis. The possible mechanisms by which metal jewellery (gold ring confer protection to adjacent joints was discussed.

Heterogeneous nuclear ribonucleoproteins C1/C2 identified as autoantigens by biochemical and mass spectrometric methods

DEFF Research Database (Denmark)

Heegaard, N H; Larsen, Martin Røssel; Muncrief, T

2000-01-01

ribonucleoproteins. The clinical spectrum of patients with these autoantibodies includes arthritis, psoriasis, myositis, and scleroderma. None of 59 patients with rheumatoid arthritis, 19 with polymyositis, 33 with scleroderma, and 10 with psoriatic arthritis had similar antibodies. High-resolution protein...

Psoriatic Alopecia in a Patient with Systemic Lupus Erythematosus

Directory of Open Access Journals (Sweden)

Wimolsiri Iamsumang

2017-03-01

Full Text Available Psoriasis is a chronic, recurrent, and relatively common inflammatory dermatologic condition, which demonstrates various clinical manifestations including hair loss. It was once believed that alopecia was not a presentation of scalp psoriasis, but it is now widely accepted that psoriatic alopecia exists. Although the majority of patients get hair regrowth, it can potentially lead to permanent hair loss. Herein, we report a case of 26-year-old female patient with systemic lupus erythematosus who presented with scalp hair loss and nonpruritic scaly plaques on the scalp. Her clinical presentation, dermoscopic, and histopathologic findings were consistent with psoriatic alopecia. Additionally, we also described a novel scalp dermoscopic pattern of “patchy dotted vessels” which we detected in the lesion of scalp psoriasis.

Lymphatic albumin clearance from psoriatic skin

International Nuclear Information System (INIS)

Staberg, B.; Klemp, P.; Aasted, M.; Worm, A.M.; Lund, P.

1983-01-01

In nine patients with untreated psoriasis vulgaris, human serum albumin labelled with 125 I or 131 I was injected intradermally in symmetrically located involved and uninvolved skin. The activity of the depots was followed by external detection, and the arrival of labelled albumin in plasma was monitored. In involved psoriatic skin the local mean half-time (T1/2) for tracer disappearance was 20.8 +/- 8.2 (S.D.) hr and in clinically normal skin, 29.1 +/- 9.6 (S.D.) hr. The difference was significant (p less than 0.002). Accordingly, the tracer from involved skin reached higher plasma levels than the tracer from uninvolved skin. However, under slight lymphatic stasis the appearance rate of radiolabelled albumin in plasma from both tissues was minimal during 1 to 2 hours after the injection, indicating that a local direct transvascular drainage of plasma albumin from the interstitium of diseased and normal skin was negligible. We conclude that the previously demonstrated increased extravasation of plasma proteins in involved psoriatic skin is compensated by an increased lymphatic drainage of plasma proteins, and not by an increased local transvascular return

Contribution of the STAT4 rs7574865 gene polymorphism to the susceptibility to autoimmune thyroiditis in healthy Turk population and psoriatic subgroups.

Science.gov (United States)

Hiz, Meliha M; Kılıç, Sevilay; Işık, Selda; Ogretmen, Zerrin; Silan, Fatma

2015-01-01

STAT4 is an important transcription factor that activates gene transcription as a response to cytokines. Recently, the influence of STAT4 gene on autoimmune disease has been widely studied in many different immune-related diseases. Autoimmune, metabolic and cardiovascular disorders are more common in psoriatic patients. STAT4 may be a unique gene that switches on in autoimmune-related thyroid disease in psoriatic patients. To explore the association of a STAT4 rs7574865 polymorphism to autoimmune thyroid diseases in the general Turkish population and psoriatic subgroups. A total of 132 psoriatic patients and 118 non-psoriatic volunteers were genotyped for STAT4 rs7574865 using real time PCR. Twenty-four of the psoriatic patients and 15 of the non-psoriatic volunteers have autoimmune-related thyroid diseases. The prevalence of the T allele [OR = 4.37; 95% CI: 1.05-19; p = 0.03] of the STAT4 rs7574865 was higher in individuals with autoimmune-related thyroid diseases among the all non-psoriatic volunteers. The volunteers with autoimmune-related thyroid diseases has an increased allele positivity and carriers having at least one of the risk allele was significantly higher than in counterparts with a GG wild genotype [ORGT/TT vs. GG: 1.73; 95% CI: 0.09-32; p = 0.03]. Yet, there was no evidence of an association between rs7574865 and autoimmune-related thyroid disease in psoriatic patients. The STAT4 rs7574865 polymorphism increases autoimmune-related thyroid disease susceptibility among the general population but not in psoriatic patients.

Effect of radiosynovectomy in patients with inflammatory joint disorders not caused by rheumatoid arthritis; Wirksamkeit der Radiosynoviorthese bei degenerativ-entzuendlichen und chronisch-entzuendlichen Gelenkerkrankungen

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Kroeger, S.; Klutmann, S.; Bohuslavizki, K.H.; Clausen, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin; Sawula, J.A.; Brenner, W.; Henze, E. [Kiel Univ. (Germany). Klinik fuer Nuklearmedizin

1999-07-01

Aim: Effect of radiosynovectomy (RS) should be evaluated both by subjective and objective parameters in patients with osteoarthritis and in patients with inflammatory joint disorders not caused by rheumatoid arthritis. Methods: A total of 98 joints in 61 patients were investigated. Patients were divided into two groups. The first group included 35 patients with therapy-resistant effusions caused by severe osteoarthritis (46 joints). The second group consisted of 26 patients (52 joints) with ankylosing spondylitis, reactive arthritis, undifferentiated spondylarthropathy, psoriatic arthritis, pigmented villo-nodular synovitis, and recurrent synovitis following surgery. Effect of RS was evaluated by a standardized questionnaire and quantified by T/B-ratios derived from blood pool images prior to and after RS. Results: Within the first patient group suffering from osteoarthritis, 40% showed a good or excellent improvement of clinical symptoms, 51% were unchanged, and in 9% symptoms worsened. Similar results were found in the second patient group. The majority of unchanged results were small finger joints. In contrast, wrist and knee joints showed a better improvement. Good correlation between results of bone scan and patients subjective impression was found in 38% and 67% in the first and the second patient group, respectively. Conclusion: Radiosynovectomy might be an effective treatment in osteoarthritis and inflammatory joint disorders not caused by rheumatoid arthritis. (orig.) [German] Ziel: Der Therapieerfolg der Radiosynoviorthese (RSO) sollte bei aktivierter Arthrose und anderen chronisch-entzuendlichen Gelenkerkrankungen anhand der subjektiven Befindlichkeit und objektiver Parameter evaluiert werden. Methoden: Es wurden insgesamt 98 Gelenke bei 61 Patienten behandelt. Entsprechend der Grunderkrankung umfasste die erste Gruppe 35 Patienten mit einer therapieresistenten, aktivierten Arthrose (46 Gelenke). Die zweite Patientengruppe beinhaltete 26 Patienten (52

Skin rash and arthritis a simplified appraisal of less common associations.

Science.gov (United States)

Cozzi, A; Doria, A; Gisondi, P; Girolomoni, G

2014-06-01

Skin and joint manifestations are part of the clinical spectrum of many disorders. Well-known associations include psoriatic arthritis and arthritis associated with autoimmune connective tissue diseases. This review focuses on less common associations where skin lesions can provide easily accessible and valuable diagnostic clues, and directly lead to the specific diagnosis or limit the list of possibilities. This may also affect health care resources as diagnostic tests are often low-specific, highly expensive and poorly available. This group of diseases can be divided into two subsets, based on the presence/absence of fever, and then further classified according to elementary skin lesions (macular, urticarial, maculo-papular, vesico-bullous, pustular, petechial and nodular). In most instances joint involvement occurs as peripheral migrating polyarthritis. Erythematosus macular or urticarial rashes occur in most febrile disorders such as monogenic autoinflammatory syndromes, Schnitzler's syndrome, Still's disease and rheumatic fever and afebrile diseases as urticarial vasculitis. Pustular rash may be observed in chronic recurrent multifocal osteomyelitis (CRMO) and pyogenic arthritis with pyoderma gangrenosum and acne (PAPA) syndrome (both febrile) as well as in Behcet's disease and Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome (both non-febrile). Papular lesions are typical of secondary syphilis, sarcoidosis, interstitial granulomatous dermatitis, papular petechial of cutaneous small-vessel vasculitis and nodular lesions of polyarteritis nodosa and multicentric reticulohistiocytosis all of which are afebrile. Differential diagnosis includes infections and drug reactions which may mimic several of these conditions. To biopsy the right skin lesion at the right time it is essential to obtain relevant histological information. © 2013 European Academy of Dermatology and Venereology.

A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases

DEFF Research Database (Denmark)

Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek

2017-01-01

Chronic inflammatory diseases (CIDs), including Crohn's disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro...

Laser capture microdissection followed by next-generation sequencing identifies disease-related microRNAs in psoriatic skin that reflect systemic microRNA changes in psoriasis

DEFF Research Database (Denmark)

Løvendorf, Marianne B; Mitsui, Hiroshi; Zibert, John R

2015-01-01

Psoriasis is a systemic disease with cutaneous manifestations. MicroRNAs (miRNAs) are small non-coding RNA molecules that are differentially expressed in psoriatic skin; however, only few cell- and region-specific miRNAs have been identified in psoriatic lesions. We used laser capture...... microdissection (LCM) and next-generation sequencing (NGS) to study the specific miRNA expression profiles in the epidermis (Epi) and dermal inflammatory infiltrates (RD) of psoriatic skin (N = 6). We identified 24 deregulated miRNAs in the Epi and 37 deregulated miRNAs in the RD of psoriatic plaque compared...... with normal psoriatic skin (FCH > 2, FDR

A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases

DEFF Research Database (Denmark)

Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek

2017-01-01

Chronic inflammatory diseases (CIDs), including Crohn’s disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro...

Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis

Energy Technology Data Exchange (ETDEWEB)

Tehranzadeh, J.; Ashilyan, O.; Anavim, A.; Tramma, S. [Univ. of California, Orange (United States). Dept. of Radiological Sciences

2006-11-15

The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis. We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0-3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis. Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7 respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb.

Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis

International Nuclear Information System (INIS)

Tehranzadeh, J.; Ashilyan, O.; Anavim, A.; Tramma, S.

2006-01-01

The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis. We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0-3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis. Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7 respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb

The Prevalance of Diabetes in Psoriatic Patients Versus the Prevalance of Psoriasis in Diabetic Patients

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Nahide Onsun

2010-03-01

Full Text Available Background and Design: Previous studies reported that there are some relations between psoriasis and the diabetes mellitus. However, incidence rates of diabetes mellitus in psoriasis and also incidence rates of psoriasis in diabetes mellitus are lacking.Our aim was to assess and compare incidence rates of diabetes mellitus in patients with psoriasis and incidence rates of psorasis in diabetes mellitus and also evaluate the role of psoriasis as a risk factor for diabetes mellitus. Material and Method: Four hundred eighteen patients with psoriasis and one hundred fifty four patients with diabetes were included. Blood glucose, oral glucose tolerance test (OGTT, glycolised hemoglobine (HbA1C were performed in psoriatic patients and these results were consulted with diabetes clinic. Psoriasis screening by clinical history, dermatologic examination, skin biopsy; if it is necessary were held for patients with diabetes. Results: Prevalance of diabetes was 9.3% in psoriatic patients; prevalance of psoriasis was 1.3% in diabetic patients. The proportion of diabetes was significantly higher in psoriatic patients compared to the proportion of psoriasis in diabetic patients (odds ratio (OR: 7.82, confidence interval (CI: 1.86-32.79, p=0.001. The age and sex-adjusted proportion of diabetes was significantly higher in psoriatic patients as compared the proportion of psoriasis in diabetic patients (OR: 18.35, p<0.001. Differences of mean duration of disease and mean PASİ (psorasis area severity index were not significant between the psoriatic patients without diabetes mellitus and with diabetes mellitus.Conclusion: Risk rate of diabetes is increased in psoriatic patients. Chronic inflammation may lead insulin resistance and diabetes. We think that development of diabetes in patients with psoriasis depends on chronic inflammation. Unfortunately we could not assess the role of therapeutical agents especially effect of potent corticosteroids in development of

Long-term use of adalimumab in the treatment of rheumatic diseases

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Charalampos Papagoras

2009-05-01

Full Text Available Charalampos Papagoras, Paraskevi V Voulgari, Alexandros A DrososRheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, GreeceAbstract: Adalimumab, a fully humanized monoclonal antibody against tumor necrosis factor-alpha (TNFα, has been evaluated in various randomized placebo-controlled trials in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. In the short time frame of these trials adalimumab has been shown to be effective in reducing disease activity, slowing radiographic disease progression and improving patients’ quality of life, while at the same time demonstrating an acceptable safety profile. Furthermore, release of adalimumab on the market, prospective observational studies, as well as open-label extensions of the original double-blind trials have provided experience and data about the long-term efficacy and safety of the drug. Initial effectiveness, in terms of reducing disease activity, is sustained, while in most cases patients treated with adalimumab experienced a slower radiographic progression and consequently less disability and improved health-related quality-of-life outcomes. Moreover, long-standing treatment of thousands of patients with adalimumab outside the controlled context of clinical trials was not related to new safety signals, with the most common adverse events being respiratory infections. The most common serious adverse events seem to be tuberculosis reactivation, while a putative association with malignant lymphoma development is not yet proven. Besides, both of these adverse reactions pertain to the whole TNFα blocker group. In conclusion, adalimumab is a safe and effective option for the treatment of patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. Keywords: adalimumab, tumor necrosis factor-alpha, rheumatoid arthritis, ankylosing spondylitis

Confocal laser-scanning microscopy of capillaries in normal and psoriatic skin

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Archid, Rami; Patzelt, Alexa; Lange-Asschenfeldt, Bernhard; Ahmad, Sufian S.; Ulrich, Martina; Stockfleth, Eggert; Philipp, Sandra; Sterry, Wolfram; Lademann, Juergen

2012-10-01

An important and most likely active role in the pathogenesis of psoriasis has been attributed to changes in cutaneous blood vessels. The purpose of this study was to use confocal laser-scanning microscopy (CLSM) to investigate dermal capillaries in psoriatic and normal skin. The structures of the capillary loops in 5 healthy participants were compared with those in affected skin of 13 psoriasis patients. The diameters of the capillaries and papillae were measured for each group with CLSM. All investigated psoriasis patients showed elongated, widened, and tortuous microvessels in the papillary dermis, whereas all healthy controls showed a single capillary loop in each dermal papilla. The capillaries of the papillary loop and the dermal papilla were significantly enlarged in the psoriatic skin lesions (diameters 24.39±2.34 and 146.46±28.52 μm, respectively) in comparison to healthy skin (diameters 9.53±1.8 and 69.48±17.16 μm, respectively) (P<0.001). CLSM appears to represent a promising noninvasive technique for evaluating dermal capillaries in patients with psoriasis. The diameter of the vessels could be seen as a well-quantifiable indicator for the state of psoriatic skin. CLSM could be useful for therapeutic monitoring to delay possible recurrences.

No association of psoriasis with autoimmune thyroiditis.

Science.gov (United States)

Vassilatou, E; Papadavid, E; Papastamatakis, P; Alexakos, D; Koumaki, D; Katsimbri, P; Hadjidakis, D; Dimitriadis, G; Rigopoulos, D

2017-01-01

Common autoimmune diseases tend to coexist in the same patients. Few studies have examined the possible association between autoimmune thyroiditis and psoriasis or psoriatic arthritis (PsA), with inconsistent results. To investigate the prevalence of autoimmune thyroiditis in psoriatic patients with or without PsA, living in an iodine-sufficient area. We studied prospectively, 114 psoriatic patients with disease duration of 5-38 years, 30 of them with PsA, and 286 age- and body mass index (BMI)-matched subjects without psoriasis or known thyroid disease or autoimmune disease. A detailed medical history was obtained from all participants and clinical examination and laboratory evaluation was performed. Psoriasis severity was assessed with Psoriasis Area and Severity Index (PASI). Autoimmune thyroiditis was defined by the presence of positive autoantibodies to thyroid peroxidase and/or thyroglobulin. There was no difference in the prevalence of autoimmune thyroiditis between psoriatic patients and controls (20.2% vs. 19.6%). The prevalence of autoimmune thyroiditis in male and female psoriatic patients was similar (9.6% and 10.5% respectively), in contrast to the increased, as expected, prevalence in female vs. male controls (14.7% vs. 4.9%, P thyroiditis were similar in psoriatic patients and controls (7.9% and 7.0% respectively). Autoimmune thyroiditis in psoriatic patients was not related with age of psoriasis onset, psoriasis duration, PASI score, PsA and obesity. These data support that psoriatic patients with or without PsA do not have an increased risk for autoimmune thyroiditis. © 2016 European Academy of Dermatology and Venereology.

Biomarkers: project update from the GRAPPA 2012 annual meeting.

Science.gov (United States)

FitzGerald, Oliver; Mease, Philip J

2013-08-01

For members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), an important goal has been the identification of soluble biomarkers in psoriatic arthritis that might predict the development of radiographic progression. Work over the past year has resulted in approval of a draft protocol, and an announcement is forthcoming of the outcome of an assessment process for centers that applied to manage the project. GRAPPA is now ready to commence formal negotiations with potential funding partners and intends to initiate this project in the near future.

Clinical evaluation of joint scintigraphy in rheumatoid arthritis

International Nuclear Information System (INIS)

Shimabukuro, Kunisada; Sakata, Hiromichi; Shirono, Kazuo; Nakajo, Masataka; Shinohara, Shinji

1983-01-01

Pertechnetate (sup(99m)TcO 4 - ) joint scintigraphy was performed on 45 patients with rheumatoid arthritis, 3 with nonspecific arthritis and 6 normal subjects. 1) The sites of radioisotopic accumulation were generally in agreement with those of clinical involvement in rheumatoid arthritis. 2) By analysis of build-up curves in the wrist joint, tracer was found to be concentrated more rapidly in rheumatoid arthritis (T 1/2 = 0.67 min.) than in nonspecific arthritis (T 1/2 = 2.66 min.) 3) The degree of radioisotopic accumulation correlated well with the value of CRP and erythrocyte sedimentation rate. It could be cosidered that pertechnetate joint scintigraphy is useful for clinical evaluation of rheumatoid arthritis. (author)

Hand 'stress' arthritis in young subjects: effects of Flexiqule (pharma-standard Boswellia extract). A preliminary case report.

Science.gov (United States)

Belcaro, G; Feragalli, B; Cornelli, U; Dugall, M

2015-10-22

This case report (supplement registry study) evaluated subjects with painful 'stress' arthritis of the hand mainly localized at the joints. The patients received a suggestion to follow a rehabilitation plan (standard management; SM). A second group also used the same SM in association with the oral, pharma-standard supplement FlexiQule (Alchem) a new standardized, phytosomal preparation manufactured from the Boswellia plant, which can be used for self-management in inflammatory conditions (150 mg / 3 times daily). The two resulting registry groups included 12 subjects using SM+Flexiqule and and 11 controls (SM only). The groups were comparable. Serology showed no significant alterations: only ESR was slightly elevated (minimal elevation). After 2 weeks, the ESR was normal in the supplement group and mildly elevated in controls (p<0.05%). The decrease in hypertermic areas was greater/faster (p<0.05) in the supplement group. The identification of a working stress and the localization to the dominant hand was comparable in both groups. At 2 weeks, the decrease in pain was significantly faster and more important with the supplement (p<0.05). The hand became more usable in time and the score was better with the supplement (p<0.05). No supplemented patient had to use other drugs, while in the control group 3 subjects eventually used NSAIDs to control pain and stiffness and one used corticosteroids. In conclusion, the natural extract Flexiqule was effective in controlling work-related stress arthritis (without inflammaìtory signs) over a 2 weeks period, better than only Standard Management. More prolonged and larger studies are needed.

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

International Nuclear Information System (INIS)

Namey, T.C.; 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

Expression and Localization of Peroxisome Proliferator-Activated Receptors and Nuclear Factor κB in Normal and Lesional Psoriatic Skin

DEFF Research Database (Denmark)

Westergaard, Majken; Henningsen, Jeanette; Johansen, Claus

2003-01-01

Abnormal epidermal proliferation and differentiation characterize the inflammatory skin disease psoriasis. Here we demonstrate that expression of PPARdelta mRNA and protein is markedly upregulated in psoriatic lesions and that lipoxygenase products accumulating in psoriatic lesions are potent...... activators of PPARdelta. The expression levels of NF-kappaB p50 and p65 were not significantly altered in lesional compared with nonlesional psoriatic skin. In the basal layer of normal epidermis both p50 and p65 were sequestered in the cytoplasm, whereas p50, but not p65, localized to nuclei...... in the suprabasal layers, and this distribution was maintained in lesional psoriatic skin. In normal human keratinocytes PPAR agonists neither impaired IL-1beta-induced translocation of p65 nor IL-1beta-induced NF-kappaB DNA binding. We show that PPARdelta physically interacts with the N-terminal Rel homology...

Cardiogoniometry in psoriatic patients and its comparison with a control group

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Hoorak Poorzand

2017-01-01

Conclusion: Abnormalities in resting ECG and CGM and their correlation with disease severity raises concerns about the need for cardiovascular follow-ups of psoriatic patients, especially those with severe disease.

Advances in rheumatology: new targeted therapeutics

NARCIS (Netherlands)

Tak, Paul P.; Kalden, Joachim R.

2011-01-01

Treatment of inflammatory arthritides - including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis - has seen much progress in recent years, partially due to increased understanding of the pathogenesis of these diseases at the cellular and molecular levels. These conditions

A STUDY ON CLINICAL PROFILE OF SERONEGATIVE SPONDYLOARTHROPATHY IN NORTH KERALA

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Vijith Kumar Kuttat

2016-08-01

Full Text Available INTRODUCTION Seronegative spondyloarthropathy is a group of chronic autoimmune disorders that share common clinical, radiological and genetic features that are clearly distinct from other inflammatory rheumatic diseases and characterised by absence of rheumatoid factor. It includes ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease, acute anterior uveitis, undifferentiated spondyloarthropathies and juvenile spondyloarthropathies. OBJECTIVES To study the clinical profile of adult patients with seronegative spondyloarthropathy and to classify the patients into specific subtypes based on standard clinical criteria. METHODOLOGY A cross-sectional study was conducted among 100 patients with seronegative spondyloarthropathy attending Internal Medicine Department of Calicut Medical College, Kerala using semi-structured questionnaire and standard clinical tests. RESULTS Males were found to be more affected with a male female ratio of 2.7:1. Undifferentiated spondyloarthropathy was the most common subtype followed by Psoriatic arthritis and reactive arthritis. Enthesopathy was noted in 88% of patients. Skin and mucosal involvement was seen in 33%. Morning stiffness and peripheral joint involvement was present in most of the cases. Symmetric polyarthritis was the most common presentation of psoriatic arthritis, seen in the study group. CONCLUSION Prevalence of Seronegative spondyloarthropathies is on the rise among people of North Kerala. Early diagnosis and appropriate treatment is necessary to prevent complications and improve the quality of life of affected persons.

Lipid management among individuals with inflammatory arthritis in the national REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort.

Science.gov (United States)

Navarro-Millán, Iris; Gamboa, Christopher M; Curtis, Jeffrey R; Safford, Monika M

2018-01-01

Objective Hyperlipidemia guidelines do not currently identify inflammatory arthritis (IA) as a cardiovascular disease (CVD) risk factor. We compared hyperlipidemia treatment of individuals with and without IA (rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis) in a large national cohort. Methods Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were classified as having IA (without diabetes or hypertension); diabetes (but no IA); hypertension (but no diabetes or IA); or no IA, diabetes, or hypertension. Multivariable logistic regression models examined the odds of medical treatment among those with hyperlipidemia. Results Thirty-nine participants had IA, 5423 had diabetes, 7534 had hypertension, and 5288 had no diabetes, hypertension, or IA. The fully adjusted odds of treatment were similar between participants with IA and those without IA, hypertension, or diabetes. Participants with diabetes and no IA and participants with hypertension and no IA were twice as likely to be treated for hyperlipidemia as those without IA, diabetes, or hypertension. Conclusion Despite their higher CVD risk, patients with IA were as likely to be treated for hyperlipidemia as those without diabetes, hypertension, or IA. Lipid guidelines should identify IA as a CVD risk factor to improve CVD risk optimization in IA.

The tumor necrosis factor-α inhibitor golimumab in the treatment of rheumatoid arthritis

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Natalia Vladimirovna Chichasova

2014-01-01

Full Text Available The tumor necrosis factor-α (TNF-α golimumab (GLM, that is a fully human monoclonal anti-body, was registered in Russia in 2012 to treat rheumatic diseases, such as rheumatoid arthritis (RA, ankylosing spondylitis, and psoriatic arthritis. Its distinguishing characteristics are a high affinity for TNF-α and easiness-to-use: the drug as a 0.5-ml solution is injected subcutaneously once monthly. The registration of the medication was followed by the implementation of a massive program of clinical trials. The randomized placebo-controlled GO-FORWARD, GO-BEFORE, and GO-AFTER studies have indicated that GLM is effective in patients with RA from different subgroups and has a favorable safety profile as compared to that of the entire class of biological agents. According to the data of these studies, GLM had a positive effect on the functional status and quality of life in patients with RA: there was a significantly greater decrease in HAQ scores in both the early and long open treatment phases (to 5 years and in fatigability than in the control group (p=0.032, physical and mental health improvements, as shown by the SF-36 questionnaire, and a significant reduction in disability.

The impact of a revised EQ-5D population scoring on preference-based utility scores in an inflammatory arthritis cohort.

LENUS (Irish Health Repository)

Adams, Roisin

2012-02-01

BACKGROUND AND OBJECTIVE: It is well established that there are problems with the EQ-5D. This is due to the original scoring methods used and how negative time trade-off (TTO) values were treated. A revised scoring method has been published. This article applies this to an inflammatory arthritis cohort. The objective is to examine the impact of a revised scoring system for the EQ-5D (UK) TTO on the utility estimates and in the case of rheumatoid arthritis, to explore the impact of using different utility metrics on the incremental cost-effectiveness ratio (ICER) results of an economic model. METHODS: A total of 504 patients with inflammatory arthritis were rescored using revised EQ-5D scoring, which uses an episodic random utility model to deal with negative TTO values. Differences in utility scores were compared and the new mapping coefficients were obtained. These were then used in an economic model to examine the impact on the ICER. RESULTS: In rheumatoid arthritis, the overall change is less for the revised EQ-5D scoring than with the original EQ-5D (TTO) but greater than the SF-6D: EQ-5D UK -0.22 (95% confidence interval [CI] -0.30 to -0.15), revised EQ-5D UK -0.16 (95% CI -0.21 to -0.10) and SF-6D -0.08 (95% CI -0.11 to -0.05). A similar trend is seen in the psoriatic arthritis group. The economic model produced different ICERs, when different utility measures were used; EQ-5D (TTO) euro42,402, SF-6D euro111,788, and revised EQ-5D (TTO) euro57,747. CONCLUSION: In the context of inflammatory arthritis, this article demonstrates that a revised scoring for EQ-5D may have a significant impact on utility estimates and on the output of the economic model.

Tumor necrosis factor antagonist mechanisms of action: a comprehensive review

NARCIS (Netherlands)

Tracey, Daniel; Klareskog, Lars; Sasso, Eric H.; Salfeld, Jochen G.; Tak, Paul P.

2008-01-01

During the past 30 years, elucidation of the pathogenesis of rheumatoid arthritis, Crohn's disease, psoriasis, psoriatic arthritis and ankylosing spondylitis at the cellular and molecular levels has revealed that these diseases share common mechanisms and are more closely related than was previously

Noninvasive acceleration measurements to characterize knee arthritis and chondromalacia.

Science.gov (United States)

Reddy, N P; Rothschild, B M; Mandal, M; Gupta, V; Suryanarayanan, S

1995-01-01

Devising techniques and instrumentation for early detection of knee arthritis and chondromalacia presents a challenge in the domain of biomedical engineering. The purpose of the present investigation was to characterize normal knees and knees affected by osteoarthritis, rheumatoid arthritis, and chondromalacia using a set of noninvasive acceleration measurements. Ultraminiature accelerometers were placed on the skin over the patella in four groups of subjects, and acceleration measurements were obtained during leg rotation. Acceleration measurements were significantly different in the four groups of subjects in the time and frequency domains. Power spectral analysis revealed that the average power was significantly different for these groups over a 100-500 Hz range. Noninvasive acceleration measurements can characterize the normal, arthritis, and chondromalacia knees. However, a study on a larger group of subjects is indicated.

The OMERACT MRI in Arthritis Working Group - Update on Status and Future Research Priorities.

Science.gov (United States)

Østergaard, Mikkel; Bird, Paul; Gandjbakhch, Frédérique; Eshed, Iris; Haugen, Ida K; Haavardsholm, Espen A; Lillegraven, Siri; Foltz, Violaine; Glinatsi, Daniel; Peterfy, Charles; Ejbjerg, Bo; Bøyesen, Pernille; Mease, Philip J; Hermann, Kay-Geert; Emery, Paul; Genant, Harry K; Conaghan, Philip G

2015-12-01

To provide an update on the status and future research priorities of the Outcome Measures in Rheumatology (OMERACT) magnetic resonance imaging (MRI) in arthritis working group. A summary is provided of the activities of the group within rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis (OA), and its research priorities. The OMERACT RA MRI score (RAMRIS) evaluating bone erosion, bone edema (osteitis), and synovitis is now the standard method of quantifying articular pathology in RA trials. Cartilage loss is another important part of joint damage, and at the OMERACT 12 conference, we provided longitudinal data demonstrating reliability and sensitivity to change of the RAMRIS JSN component score, supporting its use in future clinical trials. The MRI group has previously developed a PsA MRI score (PsAMRIS). At OMERACT 12, PsAMRIS was evaluated in a randomized placebo-controlled trial of patients with PsA, demonstrating the responsiveness and discriminatory ability of applying the PsAMRIS to hands and feet. A hand OA MRI score (HOAMRIS) was introduced at OMERACT 11, and has subsequently been further validated. At OMERACT 12, good cross-sectional interreader reliability, but variable reliability of change scores, were reported. Potential future research areas were identified at the MRI session at OMERACT 12 including assessment of tenosynovitis in RA and enthesitis in PsA and focusing on alternative MRI techniques. MRI has been further developed and validated as an outcome measure in RA, PsA, and OA. The group will continue its efforts to optimize the value of MRI as a robust biomarker in rheumatology clinical trials.

Incorporation of n-3 PUFA and γ-linolenic acid in blood lipids and red blood cell lipids together with their influence on disease activity in patients with chronic inflammatory arthritis - a randomized controlled human intervention trial

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Springer Monika

2011-08-01

Full Text Available Abstract Background and aim Marine n-3 fatty acids and γ-linolenic acid both have anti-inflammatory effects and may be useful to help treat inflammatory diseases. The effects of these alone or combined were examined in patients with arthritis in a randomized controlled trial. Design Patients with rheumatoid arthritis or psoriatic arthritis were randomized into four groups in a double-blind, placebo-controlled parallel designed study. Patients received the respective capsules (1: 3.0 g n-3 LC-PUFA/d; 2: 3.2 g γ-linolenic acid/d; 3: 1.6 g n-3 LC-PUFA + 1.8 g γ-linolenic acid/d; 4: 3.0 g olive oil for a twelve week period. Clinical status was evaluated and blood samples were taken at the beginning and at the end of the period. Differences before and after intervention were tested with paired t-test or with Wilcoxon test for non-normal data distribution. Results 60 patients (54 rheumatoid arthritis, 6 psoriatic arthritis were randomised, 47 finished per protocol. In group 1, the ratio of arachidonic acid (AA/eicosapentaenoic acid (EPA decreased from 6.5 ± 3.7 to 2.7 ± 2.1 in plasma lipids and from 25.1 ± 10.1 to 7.2 ± 4.7 in erythrocyte membranes (p ≤ 0.001. There was no significant influence on AA/EPA ratio due to interventions in group 2-4. In group 2, the intake of γ-linolenic acid resulted in a strong rise of γ-linolenic acid and dihomo-γ-linolenic acid concentrations in plasma lipids, cholesteryl esters, and erythrocyte membranes. The combination of n-3 LC-PUFA and γ-linolenic acid (group 3 led to an increase of γ-linolenic acid and dihomo-γ-linolenic acid concentrations in plasma lipids, cholesteryl esters, and erythrocyte mem-branes. This increase was only half of that in group 2. Conclusions Incorporation of eicosanoid precursor FAs was influenced by an intake of n-3 LC-PUFA and γ-linolenic acid suggesting a possible benefit for therapy of chronic inflammatory diseases. Trial Registration ClinicalTrials NCT01179971

Physical activity maintenance in patients with rheumatoid arthritis

DEFF Research Database (Denmark)

Loeppenthin, K; Esbensen, Bente Appel; Østergaard, Mikkel

2014-01-01

OBJECTIVE: To describe the experience of physical activity maintenance in patients with rheumatoid arthritis. DESIGN: A qualitative salutogenic-oriented interview study. SETTING: A rheumatology outpatient clinic. SUBJECTS: A purposive sample of 16 physically active patients (mean age 50, range 37...... with non-arthritis populations. CONCLUSION: This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life.......-67) diagnosed with rheumatoid arthritis on average 21 years previously (range 4-46 years). METHODS: In-depth interviews were conducted using a semi-structured interview guide to illuminate how the phenomenon 'physical activity maintenance' was experienced by patients with rheumatoid arthritis. The interviews...

Psoriatic Pseudobalanitis Circinata as a Post-Viral Koebner Phenomenon

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Anna Zampetti

2010-11-01

Full Text Available In the absence of any other lesions on the body, the diagnosis of localized genital psoriasis can be difficult, requiring further examinations including a biopsy. We report a case of psoriatic pseudobalanitis circinata triggered by a herpes virus infection, and we discuss the Koebner phenomenon and the therapeutic management of psoriasis of the genital area.

New Ross Community Hospital, Hospital Road, New Ross, Wexford.

LENUS (Irish Health Repository)

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.

Rheumatic diseases and pregnancy | Gcelu | South African Medical ...

African Journals Online (AJOL)

The aim of this article is to discuss the optimal management of pregnant women with SLE and other rheumatic diseases, including antiphospholipid antibody syndrome, Sjögren's syndrome, systemic sclerosis, rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. The effects of pregnancy on underlying diseases ...

Health-related quality of life for patients with rheumatoid arthritis foot involvement.

Science.gov (United States)

Wickman, Amy M; Pinzur, Michael S; Kadanoff, Ruth; Juknelis, Dainius

2004-01-01

Rheumatoid arthritis is a common disabling form of arthritis that frequently affects the hands and feet. With time, the majority of affected individuals will become disabled. Sixty-nine consecutively selected mild to moderately affected individuals with rheumatoid arthritis provided demographic data and agreed to complete the Short Musculoskeletal Function Assessment (SFMA) instrument. Focus group subjects selectively used minimally adaptive nonprescription footwear. Control subjects had similar disease expression, but did not alter their choice of footwear due to their disease. Adult patients with rheumatoid arthritis demonstrate a significant negative impact on their quality of life with mild or moderate disease expression, as evidenced by poor scores in all six domains of the SFMA. Subjects who used even mildly adaptive nonprescription footwear demonstrated a statistically significant negative impact in mobility (p expression. Focus subjects also demonstrated a trend to less favorable scores in the arm and hand domain. Mean scores of the daily activity, emotional status, and bother index domains fared worse than population norms, but there was no statistical difference between subjects using, or not using, adaptive footwear. Individuals affected with mild to moderate rheumatoid arthritis are disabled as compared with the general population. There is a severe negative impact on mobility and functional capacity when the disease process begins to affect their feet.

Paradoxical arthritis occurring during anti-TNF in patients with inflammatory bowel disease: histological and immunological features of a complex synovitis.

Science.gov (United States)

Alivernini, Stefano; Pugliese, Daniela; Tolusso, Barbara; Bui, Laura; Petricca, Luca; Guidi, Luisa; Mirone, Luisa; Rapaccini, Gian Ludovico; Federico, Francesco; Ferraccioli, Gianfranco; Armuzzi, Alessandro; Gremese, Elisa

2018-01-01

Paradoxical arthritis under tumour necrosis factor inhibitor (TNF-i) for inflammatory bowel disease (IBD) has been described. This study aims to evaluate the histological features of paired synovial tissue (ST) and colonic mucosa (CM) tissue in patients with IBD developing paradoxical arthritis under TNF-i. Patients with IBD without history of coexisting joint involvement who developed arthritis under TNF-i were enrolled. Each patient underwent ST biopsy and ileocolonoscopy with CM biopsies. ST and CM paired samples were stained through immunohistochemistry (IHC) for CD68, CD21, CD20, CD3 and CD117. Clinical and immunological parameters (anticitrullinated peptides antibodies (ACPA)-immunoglobulin (Ig)M/IgA rheumatoid factor (RF)) were collected. Psoriatic arthritis (PsA) and ACPA/IgM-RF/IgA-RF negative rheumatoid arthritis (RA) were enrolled as comparison. 10 patients with IBD (age 46.0±9.7 years, 13.2±9.9 years of disease duration, 2.5±1.6 years of TNF-i exposure, six with Crohn's disease and four with ulcerative colitis, respectively) were studied. At ST level, IHC revealed that patients with IBD with paradoxical arthritis showed more similar histological findings in terms of synovial CD68 + , CD21 + , CD20 + , CD3 + and CD117 + cells compared with PsA than ACPA/IgM-RF/IgA-RF negative RA. Analysing the CM specimens, patients with IBD showed the presence of CD68 + , CD3 + , CD117 + and CD20 + cells in 100%, 70%, 60% and 50% of cases, respectively, despite endoscopic remission. Finally, addition of conventional disease-modifying antirheumatic drugs and switch to ustekinumab were more effective than swapping into different TNF-i in patients with IBD with paradoxical arthritis. Patients with IBD may develop histologically proven synovitis during TNF-i, comparable to PsA. The inhibition of inflammatory pathways alternative to TNF (IL12/1L23) may be an effective therapeutic option for severe paradoxical articular manifestations.

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

International Nuclear Information System (INIS)

Mansouri, A.; Hamidatou Alghem, L.; Beladel, B.; Mokhtari, O.E.K.; Bendaas, A.; Benamar, M.E.A.

2013-01-01

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.

A comparative study of renal dysfunction in patients with inflammatory arthropathies: strong association with cardiovascular diseases and not with anti-rheumatic therapies, inflammatory markers or duration of arthritis.

LENUS (Irish Health Repository)

Haroon, Muhammad

2012-02-01

AIMS: The aim of this study was to investigate the prevalence of chronic kidney disease (CKD) among comparable patients with rheumatoid arthritis (RA) and seronegative inflammatory arthritis, and to explore any predictive factors for renal impairment. METHODS: Consecutive patients with peripheral joint disease (oligo and polyarthritis) were recruited from our inflammatory arthritis clinics. We divided patients in two groups: RA group and seronegative inflammatory arthritis group. The cohort consisted of 183 patients (RA = 107, seronegative arthritis = 76 [psoriatic arthritis = 69, undifferentiated oligoarthritis = 7]). Estimated glomerular filtration rate (eGFR) was calculated using the established Modification of Diet in Renal Disease equation. Demographic details, disease-specific characteristics, anti-rheumatic drugs and the presence of cardiovascular diseases were recorded. RESULTS: In total, 17.48% (n = 32) of the cohort had CKD. There was no statistically significant variation between the two groups as regards baseline demographics, disease characteristics, use of anti-rheumatic drugs and the presence of individual cardiovascular diseases. We found that eGFR and the presence of CKD were similar among these groups. Among patients with CKD, 72% had undiagnosed CKD. No association of statistical significance was noted between CKD and the use of corticosteroids, disease-modifying antirheumatic drugs and anti-tumor necrosis factor agents. The association of cardiovascular diseases with CKD remained significant after adjusting for confounders (age, gender, duration of arthritis, high C-reactive protein, use of anti-rheumatic drugs). CONCLUSIONS: Patients with inflammatory arthritis are more prone to have CKD. This could have serious implications, as the majority of rheumatology patients use non-steroidal anti-inflammatory drugs and different immunosuppressives, such as methotrexate. No association of kidney dysfunction was noted with inflammatory disease

Skin therapies: dermatologic perspective on the rheumatology-dermatology interface.

Science.gov (United States)

Sasaki, Jodie L; Koo, John Y

2015-01-01

Psoriasis is a common, chronic, inflammatory skin condition in which up to 42% of patients may develop psoriatic arthritis. Consequently, dermatologists and rheumatologists frequently manage the same patient for psoriasis and psoriatic arthritis, respectively. Hence, it is important for the two specialties to understand one another and work together to optimise care of patients with psoriatic disease. This article discusses several areas of clinical concern in which coordination of care is especially critical. First, when selecting a therapeutic modality, it is best to use treatments that improve both the joints and the skin, and exercise caution while using options that can rarely worsen the skin, such as systemic steroids. Second, a close working relationship between the two specialties is critical in making prompt and early diagnosis of psoriatic arthritis. Dermatologists often are on the frontlines for detecting early signs of joint involvement, and the prevalence of undiagnosed PsA among patients with psoriasis is estimated to be 15.5%. Third, in the rare instance of anti-TNF induced paradoxical worsening of the skin disease, it is highly recommended that these patients be referred to dermatologists as soon as possible for optimal management of the skin manifestations. Lastly, dermatologists in the US have a long history of undertreating generalised psoriasis, especially with regards to the use of systemic agents. Therefore, the consideration of systemic agents by the rheumatologist may greatly benefit the patient by treating both the joint and skin manifestations. In summary, this article highlights the importance of interdisciplinary coordination between rheumatologists and dermatologists for which both specialties offer unique and complementary expertise to the care of patients with psoriatic disease.

Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis.

Science.gov (United States)

Foeldvari, Ivan; Wierk, Angela

2005-02-01

To assess the effectiveness of methotrexate (MTX) in the treatment of juvenile idiopathic arthritis (JIA) associated uveitis, which is still one of the most common causes of visual impairment. A retrospective chart review of patients with the diagnosis of uveitis associated with JIA between July 1, 2002, and December 31, 2002. Four hundred sixty-seven patients with JIA were followed. Thirty-eight had uveitis: 31 associated with oligoarticular JIA and 7 with psoriatic JIA. Twenty-five of the 38 patients received MTX; in 23 patients uveitis was the indication for MTX therapy. In the MTX treated group 46/50 eyes had uveitis, the mean (range) age at onset of uveitis was 7.82 years (1.8-15.8), and the mean age at onset of arthritis was 7.25 years (1.25-15.7). MTX treatment was started an average of 11.4 months (0-72) after the onset of uveitis. The mean MTX dose was 15.6 mg/m2. Remission occurred after 4.25 months (1-12). Mean duration of remission was 10.3 months (3-27). The total duration of MTX therapy was 661 months and patients were in remission for 417/661 months. In 6 patients MTX was discontinued after 12 months of remission. Four patients were still in remission after 7.5 months (1-14). MTX seems to be an effective therapy for JIA associated uveitis.

Arthritis - resources

Science.gov (United States)

Resources - arthritis ... The following organizations provide more information on arthritis : American Academy of Orthopaedic Surgeons -- orthoinfo.aaos.org/menus/arthritis.cfm Arthritis Foundation -- www.arthritis.org Centers for Disease Control and Prevention -- www. ...

A role for b-cell-depleting agents in treating psoriatic skin lesions induced by tumor necrosis factor-alpha antagonists: A case report and literature review

Directory of Open Access Journals (Sweden)

Ancuta Codrina Mihaela

2014-01-01

Full Text Available Despite recent advances in understanding the pathological pathways, clinical pattern and management opportunities for new-onset psoriasis as a paradoxical adverse event in patients receiving TNF inhibitors for their immune-mediated disorder, there is a subset of patients who are either partial responders or non-responders, whatever the therapeutic scenario. We present the case of new-onset psoriasis and severe alopecia development in a case study of long-standing rheumatoid arthritis (RA treated with adalimumab (ADA and leflunomide. Since skin lesions and alopecia are resistant to the classic protocol (topical treatment, ADA discontinuation and RA becomes highly active, rituximab (RTX was started. Dramatic improvement in joint disease, total remission of alopecia and partial remission of pustular psoriasis were described after the first RTX cycle. Although B-cell-depleting agents result in controversial effects on psoriatic skin lesions, this is the first case of ADA-induced psoriasis and alopecia that improved under RTX, suggesting a possible role in treating such a patient population.

Intestinal Dysbiosis and Rheumatoid Arthritis: A Link between Gut Microbiota and the Pathogenesis of Rheumatoid Arthritis

Directory of Open Access Journals (Sweden)

Gabriel Horta-Baas

2017-01-01

Full Text Available Characterization and understanding of gut microbiota has recently increased representing a wide research field, especially in autoimmune diseases. Gut microbiota is the major source of microbes which might exert beneficial as well as pathogenic effects on human health. Intestinal microbiome’s role as mediator of inflammation has only recently emerged. Microbiota has been observed to differ in subjects with early rheumatoid arthritis compared to controls, and this finding has commanded this study as a possible autoimmune process. Studies with intestinal microbiota have shown that rheumatoid arthritis is characterized by an expansion and/or decrease of bacterial groups as compared to controls. In this review, we present evidence linking intestinal dysbiosis with the autoimmune mechanisms involved in the development of rheumatoid arthritis.

[Preference for etanercept pen versus syringe in patients with chronic arthritis. Nurse education workshop].

Science.gov (United States)

Garcia-Diaz, Silvia; Girabent-Farrés, Montserrat; Roig-Vilaseca, Daniel; Reina, Delia; Cerdà, Dacia; González, Marina; Torrente-Segarra, Vicenç; Fíguls, Ramon; Corominas, Hèctor

2013-01-01

The aims of this study are to evaluate the level of fear of post-injection pain prior to the administration, the difficulty in handling the device, and the level of satisfaction of patients using a pre-filled syringe versus an etanercept pen, as well as to evaluate the usefulness of the training given by nursing staff prior to starting with the pen, and the preferences of patients after using both devices. A prospective study was designed to follow-up a cohort of patients during a 6 months period. The data was collected using questionnaires and analyzed with SPSS 18.00. Rank and McNemar tests were performed. Statistical significance was pre-set at an α level of 0.05. A total of 29 patients were included, of whom 69% female, and with a mean age 52.5±10.9 years. Of these, 48% had rheumatoid arthritis, 28% psoriatic arthritis, 21% ankylosing spondylitis, and 3% undifferentiated spondyloarthropathy. There were no statistically significant differences either with the fear or pain or handling of the device between the syringe and the pen (P=.469; P=.812; P=.169 respectively). At 6 months, 59% of patients referred to being satisfied or very satisfied with the pen. Almost all (93%) found useful or very useful the training given by nursing staff prior to using the pen, and 55% preferred the pen over the pre-filled syringe. The etanercept pen is another subcutaneous device option for patients with chronic arthritis. According to the present study, nursing educational workshops before starting this therapy are recommended. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Simultaneous Response in Several Domains in Patients with Psoriatic Disease Treated with Etanercept as Monotherapy or in Combination with Conventional Synthetic Disease-modifying Antirheumatic Drugs.

Science.gov (United States)

Behrens, Frank; Meier, Lothar; Prinz, Jörg C; Jobst, Jürgen; Lippe, Ralph; Löschmann, Peter-Andreas; Lorenz, Hanns-Martin

2018-04-01

To evaluate patients with psoriatic arthritis (PsA) receiving etanercept (ETN) monotherapy or ETN plus conventional synthetic disease-modifying antirheumatic drugs (csDMARD) to determine the proportion achieving a clinically meaningful response in arthritis, psoriasis, and quality of life simultaneously. A prospective, multicenter, 52-week observational study in patients with active PsA evaluated treatment with ETN in clinical practice (ClinicalTrials.gov: NCT00293722). This analysis assessed simultaneous achievement of 3 treatment targets: low disease activity (LDA) based on 28-joint count Disease Activity Score (DAS28); body surface area (BSA) involvement ≤ 3%; and a score > 45 on the Medical Outcomes Study Short Form-12 (SF-12) physical component summary. Of 579 patients, 380 received ETN monotherapy and 199 received combination ETN plus csDMARD. At 52 weeks, data for all 3 disease domains were available for 251 patients receiving monotherapy and 151 receiving combination therapy. In the monotherapy and combination therapy groups, 61 (24.3%) and 37 (24.5%) patients, respectively, achieved all 3 treatment targets simultaneously. A significantly greater proportion of patients receiving monotherapy versus combination therapy achieved SF-12 > 45 (43.0% vs 31.8%; p < 0.05) and DAS28 LDA (72.5% vs 62.3%; p < 0.05). Conversely, BSA ≤ 3% was reached by a significantly greater proportion receiving combination therapy (75.5% vs 56.6%; p < 0.001). However, baseline BSA involvement was higher for the monotherapy group. While nearly half the patients achieved arthritis and psoriasis treatment targets simultaneously and one-fourth reached all 3 treatment targets, combining ETN and csDMARD did not substantially improve clinical response compared with ETN monotherapy in this real-world PsA patient population.

The Effects of Pterostilbene on Neutrophil Activity in Experimental Model of Arthritis

Czech Academy of Sciences Publication Activity Database

Perečko, Tomáš; Drábiková, K.; Lojek, Antonín; Číž, Milan; Poništ, S.; Bauerová, K.; Nosál, R.; Harmatha, Juraj; Jančinová, V.

-, č. 106041 (2013), 106041/1-106041/7 ISSN 2314-6133 Institutional support: RVO:68081707 ; RVO:61388963 Keywords : protein kinase C * adjuvant arthritis * rheumatoid arthritis * resveratrol Subject RIV: EI - Biotechnology ; Bionics

Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre.

Science.gov (United States)

Goirand, Maxime; Breton, Sylvain; Chevallier, Frédéric; Duong, Ngoc-Phoi; Uettwiller, Florence; Melki, Isabelle; Mouy, Richard; Wouters, Carine; Bader-Meunier, Brigitte; Job-Deslandre, Chantal; Quartier, Pierre

2018-04-02

Childhood-onset spondyloarthropathies usually start with enthesitis and peripheral arthritis. However, axial disease may develop afterward. Patients are most often classified, following revised (Edmonton 2011) ILAR criteria, as enthesitis-related arthritis, psoriatic arthritis, or unclassified juvenile idiopathic arthritis, particularly in cases of psoriasis in the patient or a first-degree relative. In adults, peripheral spondyloarthritis is classified by ASAS criteria. We retrospectively studied patients with childhood-onset spondyloarthropathies followed for more than one year in our referral centre. We did not exclude patients with a personal or familial history of psoriasis. We included 114 patients followed between January 2008 and December 2015 for a median of 2.5 years (IQR = 2.3). Sixty-nine per-cent of patients fulfilled the revised ILAR classification criteria for enthesitis-related arthritis, and 92% the ASAS criteria for peripheral spondyolarthritis (p <  0.001). Axial disease and sacroiliitis were rare at disease onset. However, they appeared during follow-up in 63% and 47% of cases respectively, after a median disease duration of 2.6 (IC 95% [2.2-4.4]) and 5.3 years (IC 95% [4.1-7.7]), respectively. Multivariable analysis showed that familial history of spondyloarthritis was associated with the presence of sacroiliitis and active disease at the latest follow-up (OR = 3.61 [1.5-8.7], p <  0.01 and 2.98 [1.2-7.3], p = 0.02, respectively). Axial involvement developed in most patients within five years. Revised Edmonton criteria were less sensitive than ASAS criteria to classify patients as having childhood-onset spondyloarthropathies. The main risk factor for both sacroiliitis and persistent active disease was a familial history of spondyloarthritis.

Job retention vocational rehabilitation for employed people with inflammatory arthritis (WORK-IA): a feasibility randomized controlled trial.

Science.gov (United States)

Hammond, Alison; O'Brien, Rachel; Woodbridge, Sarah; Bradshaw, Lucy; Prior, Yeliz; Radford, Kate; Culley, June; Whitham, Diane; Ruth Pulikottil-Jacob

2017-07-21

Inflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working. The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written advice about managing work problems. To help plan a randomized controlled trial, we tested screening, recruitment, intervention delivery, response rates, applicability of the control intervention and identified the relevant primary outcome. A feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support services, assistive technology, work modifications, psychological and disclosure support, workplace visits and employer liaison. Fifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = -12.4 (SD 13.2); control = -2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status

Juvenile idiopathic arthritis in adulthood: fulfilment of classification criteria for adult rheumatic diseases, long-term outcomes and predictors of inactive disease, functional status and damage.

Science.gov (United States)

Oliveira-Ramos, Filipa; Eusébio, Mónica; M Martins, Fernando; Mourão, Ana Filipa; Furtado, Carolina; Campanilho-Marques, Raquel; Cordeiro, Inês; Ferreira, Joana; Cerqueira, Marcos; Figueira, Ricardo; Brito, Iva; Canhão, Helena; Santos, Maria José; Melo-Gomes, José A; Fonseca, João Eurico

2016-01-01

To determine how adult juvenile idiopathic arthritis (JIA) patients fulfil classification criteria for adult rheumatic diseases, evaluate their outcomes and determine clinical predictors of inactive disease, functional status and damage. Patients with JIA registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) older than 18 years and with more than 5 years of disease duration were included. Data regarding sociodemographic features, fulfilment of adult classification criteria, Health Assessment Questionnaire, Juvenile Arthritis Damage Index-articular (JADI-A) and Juvenile Arthritis Damage Index-extra-articular (JADI-E) damage index and disease activity were analysed. 426 patients were included. Most of patients with systemic JIA fulfilled criteria for Adult Still's disease. 95.6% of the patients with rheumatoid factor (RF)-positive polyarthritis and 57.1% of the patients with RF-negative polyarthritis matched criteria for rheumatoid arthritis (RA). 38.9% of the patients with extended oligoarthritis were classified as RA while 34.8% of the patients with persistent oligoarthritis were classified as spondyloarthritis. Patients with enthesitis-related arthritis fulfilled criteria for spondyloarthritis in 94.7%. Patients with psoriatic arthritis maintained this classification. Patients with inactive disease had lower disease duration, lower diagnosis delay and corticosteroids exposure. Longer disease duration was associated with higher HAQ, JADI-A and JADI-E. Higher JADI-A was also associated with biological treatment and retirement due to JIA disability and higher JADI-E with corticosteroids exposure. Younger age at disease onset was predictive of higher HAQ, JADI-A and JADI-E and decreased the chance of inactive disease. Most of the included patients fulfilled classification criteria for adult rheumatic diseases, maintain active disease and have functional impairment. Younger age at disease onset was predictive of higher disability and decreased the

EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders

DEFF Research Database (Denmark)

Agca, R; Heslinga, S C; Rollefstad, S

2017-01-01

and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing...... was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist...... is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which...

Trace element analysis in rheumatoid arthritis under chrysotherapy

International Nuclear Information System (INIS)

Lecomte, R.; Paradis, P.; Monaro, S.; Barrette, M.; Lamoureux, G.; Menard, H.A.

1981-01-01

Proton induced X-ray emission (PIXE) analysis is used to measure trace element concentrations in blood serum from patients with rheumatoid arthritis. Initially trace element contaminations in blood-collecting and storing devices are determined. Then mean values and nyctemeral cycles are measured both in normal subjects and patients with rheumatoid arthritis and other similar pathologies. Abnormal concentrations of Cu and Zn and anomalies in the nyctemeral cycle are found in the patients. In the second phase of the project, the special case of chrysotherapeutically treated (gold salt treatment) rheumatoid arthritis patients is studied for extended periods of time (up to 53 weeks). (orig.)

Psoralen-UVA-treated psoriatic lesions

International Nuclear Information System (INIS)

Hashimoto, K.; Kohda, H.; Kumakiri, M.; Blender, S.L.; Willis, I.

1978-01-01

Psoralen-ultraviolet light (PUVA)-treated psoriatic lesions were studied for ultrastructural changes. In early stages of treatment, sunburn cells in the epidermis and bizarre giant cells in the dermis were more frequently observed. When clinical improvement was apparent, these changes had subsided. Dermal abnormality in long-term therapy consisted of a thick perivascular cost of amorphous substance. No abnormality was found in the epidermal keratinocytes in long-term therapy, except a clustering and giant cell formation of melanocytes, a heavy melanization of keratinocytes, and hyperkeratosis. Low-dose initiation and slow increment of both 8-methoxypsoralen and UVA is probably a reasonable regimen for benign dermatoses such as psoriasis because it will allow enough time for the skin to become more protected, while the therapeutic results are as satisfactory as in a high-dose schedule

Social media for arthritis-related comparative effectiveness and safety research and the impact of direct-to-consumer advertising.

Science.gov (United States)

Curtis, Jeffrey R; Chen, Lang; Higginbotham, Phillip; Nowell, W Benjamin; Gal-Levy, Ronit; Willig, James; Safford, Monika; Coe, Joseph; O'Hara, Kaitlin; Sa'adon, Roee

2017-03-07

Social media may complement traditional data sources to answer comparative effectiveness/safety questions after medication licensure. The Treato platform was used to analyze all publicly available social media data including Facebook, blogs, and discussion boards for posts mentioning inflammatory arthritis (e.g. rheumatoid, psoriatic). Safety events were self-reported by patients and mapped to medical ontologies, resolving synonyms. Disease and symptom-related treatment indications were manually redacted. The units of analysis were unique terms in posts. Pre-specified conditions (e.g. herpes zoster (HZ)) were selected based upon safety signals from clinical trials and reported as pairwise odds ratios (ORs); drugs were compared with Fisher's exact test. Empirically identified events were analyzed using disproportionality analysis and reported as relative reporting ratios (RRRs). The accuracy of a natural language processing (NLP) classifier to identify cases of shingles associated with arthritis medications was assessed. As of October 2015, there were 785,656 arthritis-related posts. Posts were predominantly US posts (75%) from patient authors (87%) under 40 years of age (61%). For HZ posts (n = 1815), ORs were significantly increased with tofacitinib versus other rheumatoid arthritis therapies. ORs for mentions of perforated bowel (n = 13) were higher with tocilizumab versus other therapies. RRRs associated with tofacitinib were highest in conditions related to baldness and hair regrowth, infections and cancer. The NLP classifier had a positive predictive value of 91% to identify HZ. There was a threefold increase in posts following television direct-to-consumer advertisement (p = 0.04); posts expressing medication safety concerns were significantly more frequent than favorable posts. Social media is a challenging yet promising data source that may complement traditional approaches for comparative effectiveness research for new medications.

Juvenile Arthritis

Science.gov (United States)

Juvenile arthritis (JA) is arthritis that happens in children. It causes joint swelling, pain, stiffness, and loss of motion. It can affect any joint, but ... of JA that children get is juvenile idiopathic arthritis. There are several other forms of arthritis affecting ...

Frequency of inflammatory-like MR imaging findings in asymptomatic fingers of healthy volunteers

International Nuclear Information System (INIS)

Agten, Christoph A.; Rosskopf, Andrea B.; Jonczy, Maciej; Pfirrmann, Christian W.A.; Buck, Florian M.; Brunner, Florian

2018-01-01

To describe the frequency of inflammatory-like findings on MR imaging in asymptomatic volunteers and compare them with patients with known rheumatoid arthritis and psoriatic arthritis. MR images of fingers in 42 asymptomatic volunteers and 33 patients with rheumatoid/psoriatic arthritis were analyzed. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid/Psoriatic Arthritis MRI Scoring System (RAMRIS/PsAMRIS) and tenosynovitis scoring system were used to assess: bone marrow edema (BME), erosions, tendon sheath fluid/tenosynovitis, joint effusion, and soft-tissue edema. Findings and scores were compared between volunteers and patients. Inter-reader agreement was calculated (intraclass correlation coefficients, ICC). In volunteers, tendon sheath fluid was very common in at least one location (42/42 volunteers for reader 1, 34/42 volunteers for reader 2). BME, erosions, joint effusion, and soft-tissue edema were absent (except one BME in the 3rd proximal phalanx for reader 1). Tendon sheath fluid scores in volunteers and tenosynovitis scores in patients were high (reader 1, 7.17 and 5.39; reader 2, 2.31 and 5.45). Overall, inter-reader agreement was substantial (ICC = 0.696-0.844), except for tendon sheath fluid (ICC = 0.258). Fluid in the finger flexor tendon sheaths may be a normal finding and without gadolinium administration should not be interpreted as tenosynovitis. Bone marrow edema, erosions, joint effusion, and soft-tissue edema in the fingers most likely reflect pathology if present. (orig.)

Frequency of inflammatory-like MR imaging findings in asymptomatic fingers of healthy volunteers

Energy Technology Data Exchange (ETDEWEB)

Agten, Christoph A.; Rosskopf, Andrea B.; Jonczy, Maciej; Pfirrmann, Christian W.A.; Buck, Florian M. [University Hospital Balgrist, Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Brunner, Florian [University of Zurich, Faculty of Medicine, Zurich (Switzerland); University Hospital Balgrist, Department of Physical Medicine and Rheumatology, Zurich (Switzerland)

2018-02-15

To describe the frequency of inflammatory-like findings on MR imaging in asymptomatic volunteers and compare them with patients with known rheumatoid arthritis and psoriatic arthritis. MR images of fingers in 42 asymptomatic volunteers and 33 patients with rheumatoid/psoriatic arthritis were analyzed. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid/Psoriatic Arthritis MRI Scoring System (RAMRIS/PsAMRIS) and tenosynovitis scoring system were used to assess: bone marrow edema (BME), erosions, tendon sheath fluid/tenosynovitis, joint effusion, and soft-tissue edema. Findings and scores were compared between volunteers and patients. Inter-reader agreement was calculated (intraclass correlation coefficients, ICC). In volunteers, tendon sheath fluid was very common in at least one location (42/42 volunteers for reader 1, 34/42 volunteers for reader 2). BME, erosions, joint effusion, and soft-tissue edema were absent (except one BME in the 3rd proximal phalanx for reader 1). Tendon sheath fluid scores in volunteers and tenosynovitis scores in patients were high (reader 1, 7.17 and 5.39; reader 2, 2.31 and 5.45). Overall, inter-reader agreement was substantial (ICC = 0.696-0.844), except for tendon sheath fluid (ICC = 0.258). Fluid in the finger flexor tendon sheaths may be a normal finding and without gadolinium administration should not be interpreted as tenosynovitis. Bone marrow edema, erosions, joint effusion, and soft-tissue edema in the fingers most likely reflect pathology if present. (orig.)

Impact of inflammation on iron stores in involved and non-involved psoriatic skin

International Nuclear Information System (INIS)

Pinheiro, T.; Ynsa, M.D.; Alves, L.C.; Teixeira, P.; Ferreira, J.; Filipe, P.

2015-01-01

Accumulating evidence supports a role for cellular Fe in cell proliferation, inflammation, and disease tolerance. Psoriasis is a severe inflammatory and hyper proliferative condition of human skin whose aetiology remains poorly understood. Herein, we performed nuclear microscopy techniques to quantify with cellular resolution and high sensitivity the concentration of Fe in lesional (psoriatic plaques) and non-lesional adjacent skin of psoriatic patients. Fe contents were measured across skin depth and along epidermal strata either by quantitatively imaging Fe distribution in regions of interest, or by determining Fe profiles through analysis of sequential points along selected transepts. Both procedures require deconvolution of spectra to project quantitative elemental data through the application of different software codes. Using these approaches a detailed quantitative distribution of Fe was resolved. We show that in both lesional and non-lesional skin, the epidermal profiles of Fe contents showed a peak at the basal layer and that Fe concentration along the basal layer was not uniformly distributed. Typically, Fe levels were significantly higher in epidermal ridges relative to regions above dermal papillae. Lesional skin displayed excess Fe over extended regions above basal layer. In conclusion, we found significantly increased Fe deposits in the epidermis of psoriatic patients, particularly in areas of epidermal hyper proliferation. These findings suggest an important role for Fe in the pathogenesis of psoriasis. They also raise the possibility that manipulation of Fe levels in the skin may become relevant for the clinical management of psoriasis

Impact of inflammation on iron stores in involved and non-involved psoriatic skin

Energy Technology Data Exchange (ETDEWEB)

Pinheiro, T., E-mail: murmur@ctn.ist.utl.pt [Instituto de Bioengenharia e Biociências, Instituto Superior Técnico, Universidade de Lisboa (Portugal); Ynsa, M.D. [Centro de Micro-Análisis de Materiales, Universidad Autonoma de Madrid (Spain); Alves, L.C. [Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa (Portugal); Teixeira, P.; Ferreira, J.; Filipe, P. [Unidade de Investigação em Dermatologia, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa (Portugal)

2015-04-01

Accumulating evidence supports a role for cellular Fe in cell proliferation, inflammation, and disease tolerance. Psoriasis is a severe inflammatory and hyper proliferative condition of human skin whose aetiology remains poorly understood. Herein, we performed nuclear microscopy techniques to quantify with cellular resolution and high sensitivity the concentration of Fe in lesional (psoriatic plaques) and non-lesional adjacent skin of psoriatic patients. Fe contents were measured across skin depth and along epidermal strata either by quantitatively imaging Fe distribution in regions of interest, or by determining Fe profiles through analysis of sequential points along selected transepts. Both procedures require deconvolution of spectra to project quantitative elemental data through the application of different software codes. Using these approaches a detailed quantitative distribution of Fe was resolved. We show that in both lesional and non-lesional skin, the epidermal profiles of Fe contents showed a peak at the basal layer and that Fe concentration along the basal layer was not uniformly distributed. Typically, Fe levels were significantly higher in epidermal ridges relative to regions above dermal papillae. Lesional skin displayed excess Fe over extended regions above basal layer. In conclusion, we found significantly increased Fe deposits in the epidermis of psoriatic patients, particularly in areas of epidermal hyper proliferation. These findings suggest an important role for Fe in the pathogenesis of psoriasis. They also raise the possibility that manipulation of Fe levels in the skin may become relevant for the clinical management of psoriasis.

Arthritis in Children

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... Issues Listen Español Text Size Email Print Share Arthritis Page Content Article Body Arthritis is an inflammation ... with antibiotics, even if arthritis develops. Juvenile Idiopathic Arthritis (JIA) Juvenile idiopathic arthritis (JIA) has previously been ...

Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis

DEFF Research Database (Denmark)

Wiell, Charlotte; Szkudlarek, Marcin; Hasselquist, Maria

2007-01-01

The aim of the present study was to assess ultrasonography (US) for the detection of inflammatory and destructive changes in finger and toe joints, tendons, and entheses in patients with psoriasis-associated arthritis (PsA) by comparison with magnetic resonance imaging (MRI), projection radiography...... (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd-5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP...... tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer...

The Corrona US registry of rheumatic and autoimmune diseases.

Science.gov (United States)

Kremer, Joel M

2016-01-01

The Corrona US national registry collects data concerning patient status from both the rheumatologist and patient at routine clinical encounters. Corrona has functioning disease registries in rheumatoid arthritis, psoriatic arthritis, spondyloarthropathies, psoriasis and inflammatory bowel disease. Corrona merges data concerning long-term effectiveness and safety, as well as comparative and cost effectiveness of agents to treat these autoimmune diseases.

Head-to-toe whole-body MRI in psoriatic arthritis, axial spondyloarthritis and healthy subjects

DEFF Research Database (Denmark)

Poggenborg, René Panduro; Pedersen, Susanne Juhl; Eshed, Iris

2015-01-01

with conventional MRI (convMRI). METHODS: WBMRI (3.0-T) of patients with peripheral PsA (n = 18) or axial SpA (n = 18) and of HS (n = 12) was examined for proportion of evaluable features (readability) and the presence and pattern of lesions in axial and peripheral joints. Furthermore, global WBMRI scores...... of inflammation and structural damage were constructed, and WBMRI findings were compared with clinical measures and convMRI (SpA/HS: spine and SI joints; PsA/HS: hand). RESULTS: The readability (92-100%) and reproducibility (intrareader intraclass correlation coefficient: 0.62-1.0) were high in spine/SI joint...

Gonococcal arthritis

Science.gov (United States)

Disseminated gonococcal infection (DGI); Disseminated gonococcemia; Septic arthritis - gonococcal arthritis ... Gonococcal arthritis is an infection of a joint. It occurs in people who have gonorrhea , which is caused by ...

National Psoriasis Foundation

Science.gov (United States)

... 723-9166 | Submit a Question | Learn More National Psoriasis Foundation provides you with the help you need to best manage your psoriasis or psoriatic arthritis, while promoting research to find ...

Aggressive Periodontitis and Chronic Arthritis: Blood Mononuclear Cell Gene Expression and Plasma Protein Levels of Cytokines and Cytokine Inhibitors

DEFF Research Database (Denmark)

Sørensen, Lars Korsbæk Connor; Poulsen, Anne Havemose; Bendtzen, Klaus

2009-01-01

-inflammatory cytokines and cytokine receptors in patients with periodontitis and patients with arthritis representing two examples of chronic inflammatory diseases, such as periodontitis and arthritis. To identify possible disease-specific characteristics of subjects with periodontitis relative to subjects with chronic......TNF-RI plasma levels in patients with LAgP and RA. CONCLUSIONS: The study demonstrated only a few changes in the PBMC expression of various cytokine and cytokine inhibitor genes in aggressive periodontitis and chronic arthritis compared to controls. There were a few similarities among disease groups...... inflammation in general, patients with arthritis (juvenile idiopathic arthritis [JIA] and rheumatoid arthritis [RA]) were included. METHODS: The study population consisted of white adults periodontitis (LAgP; n = 18), generalized aggressive periodontitis...

Genetics Home Reference: psoriatic arthritis

Science.gov (United States)

... disease to fight microbial invaders and facilitate tissue repair. When this has been accomplished, the body ordinarily stops the inflammatory response to prevent damage to its own cells and tissues. Mechanical stress on the joints, such as occurs ...

Sexual dysfunctions in psoriatic patients

Directory of Open Access Journals (Sweden)

Maria Isabela Sarbu

2015-04-01

Full Text Available Psoriasis is a chronic, immune-mediated disorder with a worldwide occurrence characterized by well-defined infiltrated erythematous papules and plaques, covered by silvery white or yellowish scales. It is a physically, socially and emotionally invalidating disorder that affects 1-2% of the population. Sexual health is an important part of general health and sexual dysfunctions can negatively affect self-esteem, confidence, interpersonal relationships and the quality of life. Dermatology Life Quality Index (DLQI, Psoriasis Disability Index (PDI and the Impact of Psoriasis on Quality of Life (IPSO questionnaire are all questionnaires used to assess the quality of life of patients with psoriasis and each has one question regarding sexual dysfunction. Several scales were also designed to particularly assess sexual satisfaction in men and women. The aim of this paper is to perform an overview of the existing studies on sexual dysfunction in psoriatic patients.

Rheumatoid Arthritis - Neuropsychology, Depression and Anxiety. A case - control study -120 Portuguese Female subjects.

Directory of Open Access Journals (Sweden)

Luis Maia

2012-07-01

Full Text Available Objectives: Impact of Rheumatoid Arthritis in cognitive functions has not been well acknowledged in Portugal. With this original article we intended to elucidate this problem in this specific country. Methods: We measured the results of 60 Rheumatoid Arthritis female patients (study group, comparing every patient in a case control paired plan (years in school and age, with control subjects (n = 60, in a total of 120 subjects. All participants were evaluated with Paced Auditory Selective Attention Test, Word List Generation Test, Luria Nebraska Neuropsychological Battery, a Portuguese depressive screening test (IACLIDE, STAI (anxiety trace and trait test and the Mini Mental state examination.Results: The outcomes demonstrate, for the first conclusive time in Portuguese patients, the occurrence of main deficits in terms of cognitive functioning (measured by a variety ofneuropsychological tests, and depressive and anxietysymptomatology. Conclusion: This article asset the need to pay attention in psychoeducational, psychotherapeutic and cognitive stimulation, and reinforcement of neuropsychological intervention in these types of patients.Objectivos: O impacto da artrite reumatóide nas funçõescognitivas não tem sido bem reconhecido em Portugal. Com este artigo original pretendemos elucidar este problema neste país específico.Métodos: Avaliámos os resultados de 60 pacientes femininos com artrite reumatóide (grupo de estudo, comparando cada paciente num estudo de caso-controle, emparelhando ossujeitos com Artrite Reumatóide (60 sujeitos com 60 pacientes Artrite Reumatóide, nas variáveis anos de escolaridade eidade (a variável género era uma constante = feminino.Todos os participantes foram avaliados com o Teste de Atenção Auditiva Selectiva (PASAT, teste de geração de lista de palavras, Bateria Neuropsicológica de Luria Nebraska, um teste português de despistagem de sintomatologia depressiva (IACLIDE, um teste de rastreamento de tra

MR imaging of the knee in patients with rheumatic diseases

International Nuclear Information System (INIS)

Weissman, B.N.; Winalski, C.S.; Aliabadi, P.; Kikinis, R.; Shortkroff, S.; Sledge, C.B.

1990-01-01

This paper evaluates the MR appearances of the knees in patients with rheumatic diseases, including the grading of changes, quantification of changes, and the role of intravenous gadolinium. MR imaging of the knee was performed in 19 patients with arthritis, including rheumatoid arthritis (n = 11), juvenile rheumatoid arthritis (n = 2), Reiter syndrome (n = 2), Crohn arthritis (n = 1), and psoriatic arthritis (n = 3). Spin-echo images (T1, T2, and proton density weighted) were obtained in sagittal, coronal, and axial planes. T1-weighted axial images were obtained before and after intravenous injection of Gd-DTPA

Circulating levels of interleukin-6, vascular endothelial growth factor, YKL-40, matrix metalloproteinase-3, and total aggrecan in spondyloarthritis patients during 3 years of treatment with TNFα inhibitors

DEFF Research Database (Denmark)

Pedersen, Susanne Juhl; Hetland, Merete Lund; Sørensen, Inge Juul

2010-01-01

The objectives of the study were to investigate short and long-term changes and relations to treatment response of plasma interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), YKL-40, matrix metalloproteinase-3 (MMP-3), and total aggrecan in patients with spondyloarthritis (SpA) treated...... with tumor necrosis factor-alpha (TNFα) inhibitors and to compare with levels in healthy subjects. Biomarkers were measured in an observational cohort of 49 SpA patients (ankylosing spondylitis, n=32, and psoriatic arthritis, n=17) initiating TNFα inhibitor therapy (infliximab, n=38; etanercept, n=8...

Ultrasound and magnetic resonance imaging in the evaluation of psoriatic dactylitis: status and perspectives.

Science.gov (United States)

Bakewell, Catherine J; Olivieri, Ignazio; Aydin, Sibel Z; Dejaco, Christian; Ikeda, Kei; Gutierrez, Marwin; Terslev, Lene; Thiele, Ralf; D'Agostino, Maria Antionetta; Kaeley, Gurjit S

2013-12-01

Dactylitis, a characteristic feature of the spondyloarthropathies, occurs in up to 48% of patients with psoriatic arthritis (PsA). No clear consensus on the underlying components and pathogenesis of dactylitis exists in the literature. We undertook a systematic review of ultrasound (US) and magnetic resonance imaging (MRI) literature to better define imaging elements that contribute to the dactylitic digit seen in PsA. Our objectives were to determine first the level of homogeneity of each imaging modality's definition of the components of dactylitis, and second, to evaluate the metric properties of each imaging modality according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) filter. Searches were performed in PUBMED and EMBASE for articles pertaining to MRI, US, and dactylitis. Data regarding the reported features of dactylitis were collected and categorized, and the metrological qualities of the studies were assessed. The most commonly described features of dactylitis were flexor tendon tenosynovitis and joint synovitis (90%). Extratendinous soft tissue thickening and extensor tendonitis were described nearly equally as being present and absent. Discrepancy exists as to whether entheses proper contribute to the etiology of dactylitis. An increasing number of studies categorize abnormalities in several tissue compartments including the soft tissue, tendon sheaths, and joints, as well as ligaments. The understanding of which tissues contribute to dactylitic inflammation has evolved. However, there is a lack of literature regarding the natural history of these abnormalities. This systematic review provides guidance in defining elementary lesions that may discriminate dactylitic digits from normal digits, leading to development of a composite measure of activity and severity of dactylitis.

Anti-TNF agents for the treatment of active non-radiographic axial spondyloarthritis

Directory of Open Access Journals (Sweden)

I. Olivieri

2013-03-01

Full Text Available The spondyloarthritis (SpA complex includes ankylosing spondylitis (AS, reactive arthritis, psoriatic arthritis, arthritis related to inflammatory bowel disease and forms that do not meet established criteria for these definite categories which are designated as undifferentiated SpA. In the early 1990s, two sets of classification criteria were suggested with the purpose to cover the whole clinical spectrum of SpA: the Amor criteria and the European Spondylarthropathy Study Group (ESSG criteria...

Sedentary behaviour in patients with rheumatoid arthritis

DEFF Research Database (Denmark)

Thomsen, Tanja; Beyer, Nina; Aadahl, Mette

2015-01-01

BACKGROUND: Despite increasing interest in investigating sedentary behaviour (SB) in the general population and in patients with rheumatoid arthritis (RA), there is little documentation of the subjective experiences of SB in patients with RA. This study aimed to examine how patients with RA...... modification of physical activity level causing increase in SB, especially during periods of disease flare. Prioritizing and planning of SB also functioned as part of self-management strategies. 3) It has nothing to do with my arthritis; for some patients, SB was not related to RA, but simply reflected a way...

Reactive Arthritis

Directory of Open Access Journals (Sweden)

Eren Erken

2013-06-01

Full Text Available Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropaty which has occured as a result of an infectious processes, mostly after gastrointestinal and genitourinary tract infections. Reiter syndrome is a frequent type of reactive arthritis. Both reactive arthritis and Reiter syndrome belong to the group of seronegative spondyloarthropathies, associated with HLA-B27 positivity and characterized by ongoing inflammation after an infectious episode. The classical triad of Reiter syndrome is defined as arthritis, conjuctivitis and urethritis and is seen only in one third of patients with Reiter syndrome. Recently, seronegative asymmetric arthritis and typical extraarticular involvement are thought to be adequate for the diagnosis. However, there is no established criteria for the diagnosis of reactive arthritis and the number of randomized and controlled studies about the therapy is not enough. [Archives Medical Review Journal 2013; 22(3.000: 283-299

Targeting of human interleukin-12B by small hairpin RNAs in xenografted psoriatic skin

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Jakobsen Maria

2011-02-01

Full Text Available Abstract Background Psoriasis is a chronic inflammatory skin disorder that shows as erythematous and scaly lesions. The pathogenesis of psoriasis is driven by a dysregulation of the immune system which leads to an altered cytokine production. Proinflammatory cytokines that are up-regulated in psoriasis include tumor necrosis factor alpha (TNFα, interleukin-12 (IL-12, and IL-23 for which monoclonal antibodies have already been approved for clinical use. We have previously documented the therapeutic applicability of targeting TNFα mRNA for RNA interference-mediated down-regulation by anti-TNFα small hairpin RNAs (shRNAs delivered by lentiviral vectors to xenografted psoriatic skin. The present report aims at targeting mRNA encoding the shared p40 subunit (IL-12B of IL-12 and IL-23 by cellular transduction with lentiviral vectors encoding anti-IL12B shRNAs. Methods Effective anti-IL12B shRNAs are identified among a panel of shRNAs by potency measurements in cultured cells. The efficiency and persistency of lentiviral gene delivery to xenografted human skin are investigated by bioluminescence analysis of skin treated with lentiviral vectors encoding the luciferase gene. shRNA-expressing lentiviral vectors are intradermally injected in xenografted psoriatic skin and the effects of the treatment evaluated by clinical psoriasis scoring, by measurements of epidermal thickness, and IL-12B mRNA levels. Results Potent and persistent transgene expression following a single intradermal injection of lentiviral vectors in xenografted human skin is reported. Stable IL-12B mRNA knockdown and reduced epidermal thickness are achieved three weeks after treatment of xenografted psoriatic skin with lentivirus-encoded anti-IL12B shRNAs. These findings mimick the results obtained with anti-TNFα shRNAs but, in contrast to anti-TNFα treatment, anti-IL12B shRNAs do not ameliorate the psoriatic phenotype as evaluated by semi-quantitative clinical scoring and by

Arthritis Foundation

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... Vision Leadership News Partners & Sponsors Careers Code of Ethics Financials Annual Report Contact Us Privacy Policy Terms & Conditions Donate Press Store Blog Community Local Offices Kids Get Arthritis Too Español Arthritis Today Social Media Newsletters Sign Up for E-Newsletters Arthritis Foundation ...

Healthcare costs in psoriasis and psoriasis sub-groups over time following psoriasis diagnosis.

Science.gov (United States)

Al Sawah, Sarah; Foster, Shonda A; Goldblum, Orin M; Malatestinic, William N; Zhu, Baojin; Shi, Nianwen; Song, Xue; Feldman, Steven R

2017-09-01

To quantify healthcare costs in patients with psoriasis overall and in psoriasis patient sub-groups, by level of disease severity, presence or absence of psoriatic arthritis, or use of biologics. Administrative data from Truven Health Analytics MarketScan Research Database were used to select adult patients with psoriasis from January 2009 to January 2014. The first psoriasis diagnosis was set as the index date. Patients were required to have ≥6 months of continuous enrollment with medical and pharmacy benefits pre-index and ≥12 months post-index. Patients were followed from index until the earliest of loss to follow-up or study end. All-cause healthcare costs and outpatient pharmacy costs were calculated for the overall psoriasis cohort and for the six different psoriasis patient sub-groups: (a) patients with moderate-to-severe disease and mild disease, (b) patients with psoriatic arthritis and those without, and (c) patients on biologics and those who are not. Costs are presented per-patient-per-year (PPPY) and by years 1, 2, 3, 4, and 5 of follow-up, expressed in 2014 US dollars. A total of 108,790 psoriasis patients were selected, with a mean age of 46.0 years (52.7% females). Average follow-up was 962 days. All-cause healthcare costs were $12,523 PPPY. Outpatient pharmacy costs accounted for 38.6% of total costs. All-cause healthcare costs were highest for patients on biologics ($29,832), then for patients with psoriatic arthritis ($23,427) and those with moderate-to-severe disease ($21,481). Overall, all-cause healthcare costs and outpatient pharmacy costs presented an upward trend over a 5-year period. Psoriasis is associated with significant economic burden, which increases over time as the disease progresses. Patients with moderate-to-severe psoriasis, those with psoriatic arthritis, or use of biologics contributes to higher healthcare costs. Psoriasis-related pharmacy expenditure is the largest driver of healthcare costs in patients with psoriasis.

A designated centre for people with disabilities operated by Peter Bradley Foundation Limited, Limerick

LENUS (Irish Health Repository)

Mc Ardle, Angela

2015-01-01

Joint destruction, as evidenced by radiographic findings, is a significant problem for patients suffering from rheumatoid arthritis and psoriatic arthritis. Inherently irreversible and frequently progressive, the process of joint damage begins at and even before the clinical onset of disease. However, rheumatoid and psoriatic arthropathies are heterogeneous in nature and not all patients progress to joint damage. It is therefore important to identify patients susceptible to joint destruction in order to initiate more aggressive treatment as soon as possible and thereby potentially prevent irreversible joint damage. At the same time, the high cost and potential side effects associated with aggressive treatment mean it is also important not to over treat patients and especially those who, even if left untreated, would not progress to joint destruction. It is therefore clear that a protein biomarker signature that could predict joint damage at an early stage would support more informed clinical decisions on the most appropriate treatment regimens for individual patients. Although many candidate biomarkers for rheumatoid and psoriatic arthritis have been reported in the literature, relatively few have reached clinical use and as a consequence the number of prognostic biomarkers used in rheumatology has remained relatively static for several years. It has become evident that a significant challenge in the transition of biomarker candidates to clinical diagnostic assays lies in the development of suitably robust biomarker assays, especially multiplexed assays, and their clinical validation in appropriate patient sample cohorts. Recent developments in mass spectrometry-based targeted quantitative protein measurements have transformed our ability to rapidly develop multiplexed protein biomarker assays. These advances are likely to have a significant impact on the validation of biomarkers in the future. In this review, we have comprehensively compiled a list of candidate

A designated centre for people with disabilities operated by Brothers of Charity Services Clare, Clare

LENUS (Irish Health Repository)

Mc Ardle, Angela

2015-01-01

Joint destruction, as evidenced by radiographic findings, is a significant problem for patients suffering from rheumatoid arthritis and psoriatic arthritis. Inherently irreversible and frequently progressive, the process of joint damage begins at and even before the clinical onset of disease. However, rheumatoid and psoriatic arthropathies are heterogeneous in nature and not all patients progress to joint damage. It is therefore important to identify patients susceptible to joint destruction in order to initiate more aggressive treatment as soon as possible and thereby potentially prevent irreversible joint damage. At the same time, the high cost and potential side effects associated with aggressive treatment mean it is also important not to over treat patients and especially those who, even if left untreated, would not progress to joint destruction. It is therefore clear that a protein biomarker signature that could predict joint damage at an early stage would support more informed clinical decisions on the most appropriate treatment regimens for individual patients. Although many candidate biomarkers for rheumatoid and psoriatic arthritis have been reported in the literature, relatively few have reached clinical use and as a consequence the number of prognostic biomarkers used in rheumatology has remained relatively static for several years. It has become evident that a significant challenge in the transition of biomarker candidates to clinical diagnostic assays lies in the development of suitably robust biomarker assays, especially multiplexed assays, and their clinical validation in appropriate patient sample cohorts. Recent developments in mass spectrometry-based targeted quantitative protein measurements have transformed our ability to rapidly develop multiplexed protein biomarker assays. These advances are likely to have a significant impact on the validation of biomarkers in the future. In this review, we have comprehensively compiled a list of candidate

Inter- relationship between rheumatoid arthritis and periodontitis.

Science.gov (United States)

Rajkarnikar, J; Thomas, B S; Rao, S K

2013-01-01

Periodontal medicine defines a rapidly emerging branch of Periodontology focusing on establishing a strong relationship between periodontal health and systemic health. It is speculated that the major common dysregulation which links Periodontitis with Rheumatoid arthritis (RA) is being played by the mediators of immune inflammatory response. To determine whether there is any relationship between periodontal disease and Rheumatoid arthritis. A total of 100 patients were included for the present study which was divided into two groups: one group (cases) included 50 patients attending the Department of Orthopedics, Kasturba Medical College, Manipal who were diagnosed of Rheumatoid arthritis. Another subject population included 50 patients as controls attending the Department of Oral Medicine, Manipal College of Dental Sciences, Manipal with age and gender matched with those of rheumatoid arthritis group. Specific measures for periodontitis included plaque index, gingival index, number of missing teeth, and radiographic alveolar bone loss scores. Measures of rheumatoid arthritis included health assessment questionaires, levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Various periodontal parameters were compared between the cases and controls. The average alveolar bone loss was statistically more severe in Rheumatoid arthritis (RA) group than in the controls although there were similar plaque index in both the groups. The gingival index was statistically higher in the RA group. The Erythrocyte Sedimentation Rate (ESR) and C- Reactive Protein (CRP) levels of RA patients were also significantly associated with the severity of periodontal disease. There was a significant association between Rheumatoid arthritis and Periodontitis which may be due to a common underlying deregulation of the inflammatory response in these individuals.

Quantitative imaging by pixel-based contrast-enhanced ultrasound reveals a linear relationship between synovial vascular perfusion and the recruitment of pathogenic IL-17A-F+IL-23+ CD161+ CD4+ T helper cells in psoriatic arthritis joints.

Science.gov (United States)

Fiocco, Ugo; Stramare, Roberto; Martini, Veronica; Coran, Alessandro; Caso, Francesco; Costa, Luisa; Felicetti, Mara; Rizzo, Gaia; Tonietto, Matteo; Scanu, Anna; Oliviero, Francesca; Raffeiner, Bernd; Vezzù, Maristella; Lunardi, Francesca; Scarpa, Raffaele; Sacerdoti, David; Rubaltelli, Leopoldo; Punzi, Leonardo; Doria, Andrea; Grisan, Enrico

2017-02-01

To develop quantitative imaging biomarkers of synovial tissue perfusion by pixel-based contrast-enhanced ultrasound (CEUS), we studied the relationship between CEUS synovial vascular perfusion and the frequencies of pathogenic T helper (Th)-17 cells in psoriatic arthritis (PsA) joints. Eight consecutive patients with PsA were enrolled in this study. Gray scale CEUS evaluation was performed on the same joint immediately after joint aspiration, by automatic assessment perfusion data, using a new quantification approach of pixel-based analysis and the gamma-variate model. The set of perfusional parameters considered by the time intensity curve includes the maximum value (peak) of the signal intensity curve, the blood volume index or area under the curve, (BVI, AUC) and the contrast mean transit time (MTT). The direct ex vivo analysis of the frequencies of SF IL17A-F + CD161 + IL23 + CD4 + T cells subsets were quantified by fluorescence-activated cell sorter (FACS). In cross-sectional analyses, when tested for multiple comparison setting, a false discovery rate at 10%, a common pattern of correlations between CEUS Peak, AUC (BVI) and MTT parameters with the IL17A-F + IL23 + - IL17A-F + CD161 + - and IL17A-F + CD161 + IL23 + CD4 + T cells subsets, as well as lack of correlation between both peak and AUC values and both CD4 + T and CD4 + IL23 + T cells, was observed. The pixel-based CEUS assessment is a truly measure synovial inflammation, as a useful tool to develop quantitative imaging biomarker for monitoring target therapeutics in PsA.

Jojoba Oil Soft Colloidal Nanocarrier of a Synthetic Retinoid: Preparation, Characterization and Clinical Efficacy in Psoriatic Patients.

Science.gov (United States)

Nasr, Maha; Abdel-Hamid, Sameh; Moftah, Noha H; Fadel, Maha; Alyoussef, Abdullah A

2017-01-01

Nanotechnology has provided substantial benefits in drug delivery, especially in the treatment of dermatological diseases. Psoriasis is a chronic inflammatory skin disease in which topical delivery of antipsoriatic agents is considered the first line treatment. To investigate whether the encapsulation of the synthetic retinoid tazarotene in a nanocarrier based on jojoba oil would decrease its irritation potential and clinically improve its therapeutic outcome in psoriatic patients. A microemulsion system based on jojoba wax and labrasol/plurol isostearique was prepared and characterized. The selected formula displayed spherical morphology, particle size of 15.49±2.41 nm, polydispersity index of 0.20 ±0.08, negative charge and low viscosity. The microemulsion provided two folds increase in skin deposition of tazarotene, correlating with higher reduction in psoriatic patients PASI scores after treatment (68% reduction in PASI scores versus 8.96% reduction with the marketed gel). No irritation was encountered in patients using microemulsion, with redness and inflammation reported with the marketed gel-treated patients. Jojoba oil microemulsion proved to be advantageous in reducing the irritancy of tazarotene, enhancing its skin deposition and achieving better therapeutic outcome in psoriatic patients. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Rheumatoid arthritis as psychic problem

Directory of Open Access Journals (Sweden)

Jiří Kaas

2014-01-01

Full Text Available The article deals with the issue of psychic problems of rheumatoid arthritis patients. Rheumatoid arthritis is a chronic, inflammatory motor system disease with comprehensive impact on the patient's life. The disease is often considered an exclusively physical disease. But such approach is insufficient because the disease is accompanied by motor limitations of different intensities, by pain and by fatigue that cause considerable exhaustion to the patient. The patients often must give up their hobbies and in some cases even their jobs. In most serious cases, even common daily activities including self–servicing actions become an obstacle to the patient. It is therefore logical that the psyche of a patient with such disease is considerably strained. One of the partial goals of the study consisted in mapping the subjectively perceived quality of life of rheumatoid arthritis patients in facet 8, "negative feelings", and in ascertaining whether there is statistically significant relation to facets 1, "pain and discomfort", and 2, "energy and fatigue". Another goal consisted in comparing the subjectively perceived quality of life between men and women with rheumatoid arthritis, as well as between population of rheumatoid arthritis patients and control healthy population. The study was implemented within the research project of the Grant Agency of the University of South Bohemia in České Budějovice number 120/2012/S, „Reflection of quality of life in nursing", under use of two standardized questionnaires, WHOQOL–100 and HAQ. This article presents exclusively the data acquired based on the WHOQOL–100 questionnaire. The research set consisted of patients suffering from rheumatoid arthritis from all over the Czech Republic. The size of the set was determined by a statistician at 200 individuals suffering from the disease, in a ratio of 150 women and 50 men. The selection set was derived from the basic set of rheumatoid arthritis patients and

Rheumatoid arthritis as psychic problem

Directory of Open Access Journals (Sweden)

Jiří Kaas

2014-12-01

Full Text Available The article deals with the issue of psychic problems of rheumatoid arthritis patients. Rheumatoid arthritis is a chronic, inflammatory motor system disease with comprehensive impact on the patient's life. The disease is often considered an exclusively physical disease. But such approach is insufficient because the disease is accompanied by motor limitations of different intensities, by pain and by fatigue that cause considerable exhaustion to the patient. The patients often must give up their hobbies and in some cases even their jobs. In most serious cases, even common daily activities including self-servicing actions become an obstacle to the patient. It is therefore logical that the psyche of a patient with such disease is considerably strained. One of the partial goals of the study consisted in mapping the subjectively perceived quality of life of rheumatoid arthritis patients in facet 8, "negative feelings", and in ascertaining whether there is statistically significant relation to facets 1, "pain and discomfort", and 2, "energy and fatigue". Another goal consisted in comparing the subjectively perceived quality of life between men and women with rheumatoid arthritis, as well as between population of rheumatoid arthritis patients and control healthy population. The study was implemented within the research project of the Grant Agency of the University of South Bohemia in České Budějovice number 120/2012/S, "Reflection of quality of life in nursing", under use of two standardized questionnaires, WHOQOL-100 and HAQ. This article presents exclusively the data acquired based on the WHOQOL-100 questionnaire. The research set consisted of patients suffering from rheumatoid arthritis from all over the Czech Republic. The size of the set was determined by a statistician at 200 individuals suffering from the disease, in a ratio of 150 women and 50 men. The selection set was derived from the basic set of rheumatoid arthritis patients and can

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African Journals Online (AJOL)

psoriatic arthritis (PsA), and inflammatory bowel disease (IBD), as ... The biologic disease-modifying anti-rheumatic drugs (DMARDs) are classified according to .... (an integrin receptor antagonist) may also be effective in Crohn's disease and ...

Magnetic resonance imaging in spondyloarthritis--how to quantify findings and measure response

DEFF Research Database (Denmark)

Østergaard, Mikkel; Poggenborg, René Panduro; Axelsen, Mette Bjørndal

2010-01-01

Sensitive and reliable tools for monitoring disease activity and damage, and for prognostication, are essential in the management of patients with spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis. Magnetic resonance imaging (MRI) allows direct visualisation...

Concerning the etiology of bony bridges along the sides of the terminal phalanx of the great toe

Energy Technology Data Exchange (ETDEWEB)

Fischer, E.

1987-06-01

Besides in acromegaly bony bridges at the terminal phalanx of the great toe occur in one third of cases with peripheral signs of diffuse idiopathic skeletal hyperostosis, systemic diseases as rheumatoid arthritis or psoriatic arthritis with chronic inflammation of the interphalangeal joint of the great toe respectively extraarticular osseous changes in the terminal phalanx of the great toe do not influence the development of such bridges.

Study Of Topical Anti-Inflammatory Potency And Clinical Efficacy Of Formulations Of Mometasone And Betamethasone By Cutaneous Blood Flow Measurements In Psoriatic Patients Using Laser Doppler Velocimetry

Directory of Open Access Journals (Sweden)

Mulekar S. V

1997-01-01

Full Text Available Laser Doppier Velocimetry (LDV was used to measure cutaneous blood flow (CBF in psoriatic skin lesions to assess the effect of once daily application of Mometasone furoate (MF in a base claimed to possess a “reservoir” effect, as against Betamethasone-17-valarate (BV in a conventional cream base, applied twice daily, for 4 weeks. Bilaterally symmetrical active lesions were studied in 10 psoriatics, at baseline and at the end of 2 and 4 weeks’ treatment. The formulations were also evaluated for topical anti-inflammatory potency in terms of their ability to inhibit the Post-Ischaemic-Reactive-Hyperaemic-Response (PIRHR induced on normal uninvolved skin treated under occlusion. The lesions were also assessed subjectively for clinical Psoriatic Hyperaemia Index (PHI = CBF on lesions/CBF on uninvolved skin: 8.42 + 1.74 & 10.13 + 1.70 correlating with high CPI (9 + 0.50 & 9.1 + 0.51. During treatment with MF or BV, the lesions resolved rapidly, with a concomitant decrease in PHI and CPI (Week 2 : PHI = 3.40 + 0.46 & 5.19 + 1.65, CPI = 4.15 + 0.86& 5.20 + 0.87 and Week 4 : PHI = 1.99 + 0.23 & 2.81 + 0.74 CPI = 2.00 + 0.50 & 2.88 + 0.72 respectively. The two formulations Inhibited PIRHR to same extent (auc/min: Control = 1871 + 399.22, MF = 536.11 + 153.34 & BV = 567.5 + 110.76, indicating equal potency. The results show that pharmaceutical factor such as vehicle can significantly influence the clinical efficacy of corticoids.

Undifferentiated seronegative spondyloarthritis with inflammatory bowel disease and a family history of psoriasis. Sicca syndrome

Directory of Open Access Journals (Sweden)

Norma Marigliano

2013-04-01

Full Text Available Background: Seronegative spondyloarthritis is characterized by the presence of subcutaneous nodules, asymmetrical peripheral arthritis, sacroileitis with or without spondylitis, and rheumatoid-factor negativity. Other common clinical manifestations include oral ulcers, conjunctivitis, and cutaneous lesions such as psoriasis. Familial aggregation has also been described. According to the 1986 classification, corresponding clinical entities include ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, arthritis associated with inflammatory bowel disease (IBD, and undifferentiated spondyloarthritis. The disease is also frequently associated with the HLA B27 antigen. From the clinical point of view, there are often incomplete forms of spondyloarthritis, such as reactive arthritis triggered by asymptomatic infections, psoriatic arthritis without psoriasis itself, initial phases of specific forms of spondyloarthritis or the phase of ankylosing spondylitis characterized by sacroiliac lesions, and all forms that remain undifferentiated for long periods of time. Moreover, there are close relations between arthropathy and IBDs, such as Crohn’s disease, ulcerative colitis, and Whipple’s syndrome. Recently, microscopic inflammatory bowel lesions and psoriatic arthritis have been described. Case report: A 30-year-old man (HLA B27-negative who had been vaccinated against TBC and HBV presented with a 6-year history of recurrent episodes of predominantly left-sided sciatica. The pain was worse at night and during rest. He was suffering from bilateral sacroileitis without spondylitis. Three to five times a day, usually after eating, he passed watery feces containing mucous and small amounts of bright red blood. Colonoscopy revealed pancolitis with histological evidence of chronic inflammation interspersed with areas of acute inflammation, edema, hyperemia, and glandular distortion. One year later, the clinical manifestations and histological

Contribution of the STAT4 rs7574865 gene polymorphism to the susceptibility to autoimmune thyroiditis in healthy Turk population and psoriatic subgroups

OpenAIRE

Hiz, Meliha M.; K?l??, Sevilay; I??k, Selda; Ogretmen, Zerrin; Silan, Fatma

2016-01-01

Introduction STAT4 is an important transcription factor that activates gene transcription as a response to cytokines. Recently, the influence of STAT4 gene on autoimmune disease has been widely studied in many different immune-related diseases. Autoimmune, metabolic and cardiovascular disorders are more common in psoriatic patients. STAT4 may be a unique gene that switches on in autoimmune-related thyroid disease in psoriatic patients. The aim of the study: To explore the association of a STA...

Comparative anti-psoriatic efficacy studies of clobetasol loaded chitin nanogel and marketed cream.

Science.gov (United States)

Panonnummal, Rajitha; Jayakumar, R; Sabitha, M

2017-01-01

In the present study chitin nanogel loaded with anti-psoriatic drug clobetasol was developed (CLCNG) for its topical delivery in psoriasis. CLCNG had the particle size of 132±14nm, with gel like consistency, stability in refrigerator, having higher drug release properties at acidic pH. CLCNG exhibited significant toxicity towards HaCaT and THP-1cell lines by MTT assay. The uptake of nanogel by HaCaT cell lines was confirmed by fluorescent microscopy. CLCNG at 0.35mg/ml exhibited significant anti-inflammatory activity with an average of 65% and 70% inhibition in COX and LOX activities expressed in THP-1 cells. In vitro skin permeation studies revealed the increased transdermal flux with fragmented stratum corneum and loosened epidermal layers in CLCNG treated samples, compared with control drug solution. The in vivo anti-psoriatic studies done on imiquimod model confirmed the potential benefits of the nanogel for the topical delivery of clobetasol in psoriasis. Copyright © 2016 Elsevier B.V. All rights reserved.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Arthritis Managing Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health- ... on this website. Copyright Johns Hopkins Arthritis Center © 2018 Patient Privacy Johns Hopkins Rheumatology

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Managing Your Arthritis Managing Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult ...

Rheumatoid Arthritis Educational Video Series

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... Corner / Patient Webcasts / Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos ... Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life ...

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... is Happening to the Joints? Rheumatoid Arthritis: Gaining Control – Working with your Rheumatologist Rheumatoid Arthritis: Additional Conditions ... Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients ...

The Role of IL-17 in the Angiogenesis of Rheumatoid Arthritis

Science.gov (United States)

2015-06-01

Sonder, K. Bendtzen, and P. Holmstrup. 2008. Blood cell gene expression profiling in subjects with ag- gressive periodontitis and chronic arthritis. J...event that fosters chronic inflammation and bone erosion in RA by facilitating unbalanced leukocyte migration and pannus formation. Hence inhibition of...cell polarization and joint vascularization in vivo in chronic and acute arthritis models and in vitro in RA peripheral blood mononuclear cells (PBMC)s

Arthritis in America

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... Digital Press Kit Read the MMWR Science Clips Arthritis in America Time to Take Action! Language: English ( ... by about 40% by being physically active. Problem Arthritis is common and a growing health threat. Arthritis ...

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Corner / Patient Webcasts / Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos ... Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life ...

Effects of Oral Administration of Type II Collagen on Rheumatoid Arthritis

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Trentham, David E.; Dynesius-Trentham, Roselynn A.; Orav, E. John; Combitchi, Daniel; Lorenzo, Carlos; Sewell, Kathryn Lea; Hafler, David A.; Weiner, Howard L.

1993-09-01

Rheumatoid arthritis is an inflammatory synovial disease thought to involve T cells reacting to an antigen within the joint. Type II collagen is the major protein in articular cartilage and is a potential autoantigen in this disease. Oral tolerization to autoantigens suppresses animal models of T cell-mediated autoimmune disease, including two models of rheumatoid arthritis. In this randomized, double-blind trial involving 60 patients with severe, active rheumatoid arthritis, a decrease in the number of swollen joints and tender joints occurred in subjects fed chicken type II collagen for 3 months but not in those that received a placebo. Four patients in the collagen group had complete remission of the disease. No side effects were evident. These data demonstrate clinical efficacy of an oral tolerization approach for rheumatoid arthritis.

Arthritis and Rheumatic Diseases

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... Health Topics Arthritis and Rheumatic Diseases Arthritis and Rheumatic Diseases Arthritis is often used to refer to any ... primary immunodeficiency syndrome March 11, 2013 Arthritis and Rheumatic Disease News Research Brief | January 9, 2017 Tofacitinib Shows ...

Pharmacogenetics and pharmacogenomics in psoriasis treatment: current challenges and future prospects.

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Sutherland, Alison; Power, Rebecca J; Rahman, Proton; O'Rielly, Darren D

2016-08-01

Topical, systemic, oral disease modifying, and biologic agents are part of the armamentarium to manage psoriatic disease. The choice of therapy depends upon disease severity, relevant co-morbidities and patient preference. There is great variability in patient response with these agents, and there is still no clear method of selecting the preferred therapeutic agent for efficacy or lack of adverse events. This article will review the pharmacogenetic and pharmacogenomic targets that are currently known with respect to psoriasis vulgaris, and the most frequent co-morbidity of psoriasis, psoriatic arthritis. Presently, no clinically actionable biomarker exists for any therapeutic agent used to treat psoriasis or psoriatic arthritis. The lack of validated outcome measures and conflicting results of open-label studies conducted may be attributed to a multitude of issues that confound discovery. Consequently, studies have been underpowered to identify genes or genetic variants worth translating to clinical practice. In order to achieve a pharmacogenetic/pharmacogenomic signature, improvements in study design of future investigations are required, including carefully designed prospective studies. It is imperative to combine known clinical, serological, and molecular markers with consistent outcomes and an adequate health economic evaluation before they can be adopted widely in clinical practice.

A Rare Side Effect due to TNF-Alpha Blocking Agent: Acute Pleuropericarditis with Adalimumab

Directory of Open Access Journals (Sweden)

Hakan Ozkan

2013-01-01

Full Text Available Tumor necrosis factor-alpha antagonism is an important treatment strategy in patients with rheumatoid arthritis, psoriatic arthritis, vasculitis, and ankylosing spondylitis. Adalimumab is one of the well-known tumor necrosis factor-alpha blocking agents. There are several side effects reported in patients with adalimumab therapy. Cardiac side effects of adalimumab are rare. Only a few cardiac side effects were reported. A 61-year-old man treated with adalimumab for the last 6 months due to psoriatic arthritis presented with typically acute pleuropericarditis. Chest X-ray and echocardiography demonstrated marked pericardial effusion. Patient was successfully evaluated for the etiology of acute pleuro-pericarditis. Every etiology was excluded except the usage of adalimumab. Adalimumab was discontinued, and patient was treated with 1200 mg of ibuprofen daily. Control chest X-ray and echocardiography after three weeks demonstrated complete resolution of both pleural and pericardial effusions. This case clearly demonstrated the acute onset of pericarditis with adalimumab usage. Acute pericarditis and pericardial effusion should be kept in mind in patients with adalimumab treatment.

Early Subchondral Bone Loss at Arthritis Onset Predicted Late Arthritis Severity in a Rat Arthritis Model.

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Courbon, Guillaume; Cleret, Damien; Linossier, Marie-Thérèse; Vico, Laurence; Marotte, Hubert

2017-06-01

Synovitis is usually observed before loss of articular function in rheumatoid arthritis (RA). In addition to the synovium and according to the "Inside-Outside" theory, bone compartment is also involved in RA pathogenesis. Then, we investigated time dependent articular bone loss and prediction of early bone loss to late arthritis severity on the rat adjuvant-induced arthritis (AIA) model. Lewis female rats were longitudinally monitored from arthritis induction (day 0), with early (day 10) and late (day 17) steps. Trabecular and cortical microarchitecture parameters of four ankle bones were assessed by microcomputed tomography. Gene expression was determined at sacrifice. Arthritis occurred at day 10 in AIA rats. At this time, bone erosions were detected on four ankle bones, with cortical porosity increase (+67%) and trabecular alterations including bone volume fraction (BV/TV: -13%), and trabecular thickness decrease. Navicular bone assessment was the most reproducible and sensitive. Furthermore, strong correlations were observed between bone alterations at day 10 and arthritis severity or bone loss at day 17, including predictability of day 10 BV/TV to day 17 articular index (R 2  = 0.76). Finally, gene expression at day 17 confirmed massive osteoclast activation and interestingly provided insights on strong activation of bone formation inhibitor markers at the joint level. In rat AIA, bone loss was already observed at synovitis onset and was predicted late arthritis severity. Our results reinforced the key role of subchondral bone in arthritis pathogenesis, in favour to the "Inside-Outside" theory. Mechanisms of bone loss in rat AIA involved resorption activation and formation inhibition changes. J. Cell. Physiol. 232: 1318-1325, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... She is a critical member of our patient care team. Managing Your Arthritis Managing Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health- ...

Increased risk of migraine in patients with psoriasis

DEFF Research Database (Denmark)

Egeberg, A.; Mallbris, L.; Gislason, G. H.

2015-01-01

Background: Psoriasis and migraine are common conditions with potential overlap of pathophysiological mechanisms. Both these diseases have been associated with increased cardiovascular risk but little is known about their interplay. Objective: We sought to investigate the link between psoriasis...... and adjusted incidence rate ratios were estimated by Poisson regression models. Results: The study comprised a total of 5,379,859 individuals, including 53,006 and 6831 patients with mild and severe psoriasis, respectively, and 6243 patients with psoriatic arthritis. Fully adjusted incidence rate ratios...... for migraine were 1.37 (95% confidence interval 1.30-1.45), 1.55 (95% confidence interval 1.29-1.86), and 1.92 (95% confidence interval 1.65-2.22) for mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. Stratification for sex revealed increased risk of migraine in both male and female...

Imaging of Posttraumatic Arthritis, Avascular Necrosis, Septic Arthritis, Complex Regional Pain Syndrome, and Cancer Mimicking Arthritis.

Science.gov (United States)

Rupasov, Andrey; Cain, Usa; Montoya, Simone; Blickman, Johan G

2017-09-01

This article focuses on the imaging of 5 discrete entities with a common end result of disability: posttraumatic arthritis, a common form of secondary osteoarthritis that results from a prior insult to the joint; avascular necrosis, a disease of impaired osseous blood flow, leading to cellular death and subsequent osseous collapse; septic arthritis, an infectious process leading to destructive changes within the joint; complex regional pain syndrome, a chronic limb-confined painful condition arising after injury; and cases of cancer mimicking arthritis, in which the initial findings seem to represent arthritis, despite a more insidious cause. Copyright © 2017 Elsevier Inc. All rights reserved.

Collagen-Induced Arthritis: A model for Murine Autoimmune Arthritis.

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Pietrosimone, K M; Jin, M; Poston, B; Liu, P

2015-10-20

Collagen-induced arthritis (CIA) is a common autoimmune animal model used to study rheumatoid arthritis (RA). The development of CIA involves infiltration of macrophages and neutrophils into the joint, as well as T and B cell responses to type II collagen. In murine CIA, genetically susceptible mice (DBA/1J) are immunized with a type II bovine collagen emulsion in complete Freund's adjuvant (CFA), and receive a boost of type II bovine collagen in incomplete Freund's adjuvant (IFA) 21 days after the first injection. These mice typically develop disease 26 to 35 days after the initial injection. C57BL/6J mice are resistant to arthritis induced by type II bovine collagen, but can develop arthritis when immunized with type II chicken collagen in CFA, and receive a boost of type II chicken collagen in IFA 21 days after the first injection. The concentration of heat-killed Mycobacterium tuberculosis H37RA (MT) in CFA also differs for each strain. DBA/1J mice develop arthritis with 1 mg/ml MT, while C57BL/6J mice require and 3-4 mg/ml MT in order to develop arthritis. CIA develops slowly in C57BL/6J mice and cases of arthritis are mild when compared to DBA/1J mice. This protocol describes immunization of DBA/1J mice with type II bovine collagen and the immunization of C57BL/6J mice with type II chicken collagen.

Rheumatoid Arthritis Educational Video Series

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Primary sialoangiectasia - a diagnostic pitfall in Sjogren's syndrome - Case report

NARCIS (Netherlands)

Kalk, WWI; Vissink, A; Spijkervet, FKL; Bootsma, H

A case of primary sialoangiectasia, which in this case was initially misdiagnosed as Sjogren's syndrome, is described. Other diseases, including HIV infection, psoriatic arthritis, and acute parotitis, may cause glandular changes similar to the changes found in the syndrome. Therefore, sialography

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult ...

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult ...

Infectious Arthritis

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Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Infectious arthritis is an infection in the joint. The infection ...

TNF-alpha inhibitors: Current indications

OpenAIRE

Sharma Rashmi; Sharma Chaman

2007-01-01

Advances in the DNA hybrid technology led to the development of various biologicals that specifically target TNF-α. There are currently three anti- TNF- α drugs available- etanercept, infliximab and adalimumab. Etanercept is approved by FDA for rheumatoid arthritis (RA) in 2000 followed by its approval for ankylosing spondylitis, psoriasis and psoriatic arthritis. Infliximab and adalimumab are approved by FDA in 2002 for RA. Infliximab is also approved for ankylosing spondylitis, ps...

Using Big Data to Evaluate the Association between Periodontal Disease and Rheumatoid Arthritis.

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Grasso, Michael A; Comer, Angela C; DiRenzo, Dana D; Yesha, Yelena; Rishe, Naphtali D

2015-01-01

An association between periodontal disease and rheumatoid arthritis is believed to exist. Most investigations into a possible relationship have been case-control studies with relatively low sample sizes. The advent of very large clinical repositories has created new opportunities for data-driven research. We conducted a retrospective cohort study to measure the association between periodontal disease and rheumatoid arthritis in a population of 25 million patients. We demonstrated that subjects with periodontal disease were roughly 1.4 times more likely to have rheumatoid arthritis. These results compare favorably with those of previous studies on smaller cohorts. Additional work is needed to identify the mechanisms behind this association and to determine if aggressive treatment of periodontal disease can alter the course of rheumatoid arthritis.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Play Rheumatoid Arthritis: Symptoms and Diagnosis Rheumatoid Arthritis: What is Happening to the Joints? Rheumatoid Arthritis: Gaining Control – Working with your Rheumatologist Rheumatoid Arthritis: Additional Conditions ...

Temporomandibular Joint Involvement in Psoriatic Arthritis

African Journals Online (AJOL)

Maxillofacial Radiology,. Faculty of Dentistry,. Kirikkale University, Turkey. This is an open access article distributed under the terms of the Creative Commons ... Figure 2: Panoramic radiograph revealed bilaterally decreased joint spaces, erosion and the loss of cortical edge on condylar heads. [Downloaded free from ...

Secukinumab for rheumatology: development and its potential place in therapy

Directory of Open Access Journals (Sweden)

Koenders MI

2016-06-01

Full Text Available Marije I Koenders, Wim B van den Berg Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: Rheumatic disease is not a single disorder, but a group of more than 100 diseases that affect joints, connective tissues, and/or internal organs. Although rheumatic diseases like rheumatoid arthritis (RA, psoriatic arthritis, and ankylosing spondylitis (AS differ in their pathogenesis and clinical presentation, the treatment of these inflammatory disorders overlaps. Non-steroid anti-inflammatory drugs are used to reduce pain and inflammation. Additional disease-modifying anti-rheumatic drugs are prescribed to slowdown disease progression, and is in RA more frequently and effectively applied than in AS. Biologicals are a relatively new class of treatments that specifically target cytokines or cells of the immune system, like tumor necrosis factor alpha inhibitors or B-cell blockers. A new kid on the block is the interleukin-17 (IL-17 inhibitor secukinumab, which has been recently approved by the US Food and Drug Administration for moderate-to-severe plaque psoriasis, psoriatic arthritis, and AS. IL-17 is a proinflammatory cytokine that has an important role in host defense, but its proinflammatory and destructive effects have also been linked to pathogenic processes in autoimmune diseases like RA and psoriasis. Animal models have greatly contributed to further insights in the potential of IL-17 blockade in autoimmune and autoinflammatory diseases, and have resulted in the development of various potential drugs targeting the IL-17 pathway. Secukinumab (AIN457 is a fully human monoclonal antibody that selectively binds to IL-17A and recently entered the market under the brand name Cosentyx®. By binding to IL-17A, secukinumab prevents it from binding to its receptor and inhibits its ability to trigger inflammatory responses that play a role in the development of various autoimmune diseases. With secukinumab being

Psoriasis-like skin disease and arthritis caused by inducible epidermal deletion of Jun proteins.

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Zenz, Rainer; Eferl, Robert; Kenner, Lukas; Florin, Lore; Hummerich, Lars; Mehic, Denis; Scheuch, Harald; Angel, Peter; Tschachler, Erwin; Wagner, Erwin F

2005-09-15

Psoriasis is a frequent, inflammatory disease of skin and joints with considerable morbidity. Here we report that in psoriatic lesions, epidermal keratinocytes have decreased expression of JunB, a gene localized in the psoriasis susceptibility region PSORS6. Likewise, inducible epidermal deletion of JunB and its functional companion c-Jun in adult mice leads (within two weeks) to a phenotype resembling the histological and molecular hallmarks of psoriasis, including arthritic lesions. In contrast to the skin phenotype, the development of arthritic lesions requires T and B cells and signalling through tumour necrosis factor receptor 1 (TNFR1). Prior to the disease onset, two chemotactic proteins (S100A8 and S100A9) previously mapped to the psoriasis susceptibility region PSORS4, are strongly induced in mutant keratinocytes in vivo and in vitro. We propose that the abrogation of JunB/activator protein 1 (AP-1) in keratinocytes triggers chemokine/cytokine expression, which recruits neutrophils and macrophages to the epidermis thereby contributing to the phenotypic changes observed in psoriasis. Thus, these data support the hypothesis that epidermal alterations are sufficient to initiate both skin lesions and arthritis in psoriasis.

Biologisk behandling af psoriasis og psoriasisartritis

DEFF Research Database (Denmark)

Kragballe, Knud; Deleuran, Bent

2008-01-01

Psoriasis is an immune-mediated inflammatory skin disease which may be associated with psoriatic arthritis. Biological therapy is indicated in patients who do not respond to, or are intolerant to, or have contraindication against traditional therapy. TNFalpha antagonists are used for both skin...

Medicines, injections, and supplements for arthritis

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Arthritis - medications; Arthritis - steroid injections; Arthritis - supplements; Arthritis - hyaluronic acid ... the-counter pain relievers can help with your arthritis symptoms. "Over-the-counter" means you can buy ...

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Patient Webcasts / Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos ... member of our patient care team. Managing Your Arthritis Managing Your Arthritis Managing Chronic Pain and Depression ...

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... is Happening to the Joints? Rheumatoid Arthritis: Gaining Control – Working with your Rheumatologist Rheumatoid Arthritis: Additional Conditions ... for Patients Arthritis Drug Information Sheets Benefits and Risks of Opioids in Arthritis Management How to Give ...

Evaluation of Fitness and the Balance Levels of Children with a Diagnosis of Juvenile Idiopathic Arthritis: A Pilot Study.

Science.gov (United States)

Patti, Antonino; Maggio, Maria Cristina; Corsello, Giovanni; Messina, Giuseppe; Iovane, Angelo; Palma, Antonio

2017-07-19

Background: Juvenile idiopathic arthritis is a main cause of physical disability and has high economic costs for society. The purpose of this study was to assess the fitness levels and the postural and balance deficits with a specific test battery. Methods: Fifty-six subjects were enrolled in this study. Thirty-nine healthy subjects were included in the control group and seventeen in the juvenile idiopathic arthritis group. All subjects were evaluated using a posturography system. The fitness level was evaluated with a battery of tests (Abalakov test, sit-up test, hand grip test, backsaver sit and reach, the toe touch test). An unpaired t -test was used to determine differences. Pearson's correlation coefficient was used to evaluate the correlation between the tests. Results: The battery of tests demonstrated that subjects in the juvenile idiopathic arthritis group have lower fitness levels compared to the control group. The juvenile idiopathic arthritis group showed low postural control with respect to the control group. Pearson analysis of the juvenile idiopathic arthritis group data showed significant correlations between variables. Pearson's results from the control group data showed a similar trend. Conclusions: The results suggest that the battery of tests used could be an appropriate tool. However, we highlight that these conclusions need to be supported by other studies with a larger population scale.

What Is Juvenile Arthritis?

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... Initiative Breadcrumb Home Health Topics English Español Juvenile Arthritis Basics In-Depth Download Download EPUB Download PDF What is it? Points To Remember About Juvenile Arthritis Juvenile arthritis is the term used to describe ...

Classification and clinical assessment

Directory of Open Access Journals (Sweden)

F. Cantini

2012-06-01

Full Text Available There are at least nine classification criteria for psoriatic arthritis (PsA that have been proposed and used in clinical studies. With the exception of the ESSG and Bennett rules, all of the other criteria sets have a good performance in identifying PsA patients. As the CASPAR criteria are based on a robust study methodology, they are considered the current reference standard. However, if there seems to be no doubt that they are very good to classify PsA patients (very high specificity, they might be not sensitive enough to diagnose patients with unknown early PsA. The vast clinical heterogeneity of PsA makes its assessment very challenging. Peripheral joint involvement is measured by 78/76 joint counts, spine involvement by the instruments used for ankylosing spondylitis (AS, dactylitis by involved digit count or by the Leeds dactylitis index, enthesitis by the number of affected entheses (several indices available and psoriasis by the Psoriasis Area and Severity Index (PASI. Peripheral joint damage can be assessed by a modified van der Heijde-Sharp scoring system and axial damage by the methods used for AS or by the Psoriatic Arthritis Spondylitis Radiology Index (PASRI. As in other arthritides, global evaluation of disease activity and severity by patient and physician and assessment of disability and quality of life are widely used. Finally, composite indices that capture several clinical manifestations of PsA have been proposed and a new instrument, the Psoriatic ARthritis Disease Activity Score (PASDAS, is currently being developed.

Tailor systemic therapy to the patient with severe psoriasis.

Science.gov (United States)

Van de Velde, Vanessa; Tidman, Michael J

2016-02-01

There is no standard definition regarding the severity of psoriasis, and a number of factors should be considered, including the extent and stability of skin disease, involvement of joints, response to treatment, and impact on quality of life. Erythrodermic psoriasis and pustular psoriasis are severe conditions and the patient may be systemically unwell and febrile. NICE recommends that four key areas should be evaluated and recorded when assessing patients: severity, using the static Physician's Global Assessment (sPGA); disease impact on physical, psychological and social wellbeing using the Dermatology Life Quality Index (DLQI); the presence of psoriatic arthritis; and comorbidities. Ideally, patients should be assessed annually for psoriatic arthritis: the Psoriasis Epidemiology Screening Tool is a validated tool to screen for psoriatic arthritis in primary and secondary care. Patients with severe psoriasis should undergo cardiovascular risk assessment at presentation and every five years, or more frequently if indicated. Referral to secondary care should be made for patients with any type of psoriasis with poor response to topical therapy (after 2 or 3 months according to SIGN) and for extensive psoriasis. Cases where the psoriasis is having a significant physical or psychological impact on an individual's quality of life warrant early referral, as do those where the diagnosis is uncertain. Patients with generalised pustular psoriasis or erythroderma should be referred urgently for same-day specialist input. Patients with acute guttate psoriasis who may require phototherapy should also be referred. Children and adolescents with any type of psoriasis should be referred to a specialist at initial presentation.

Autoradiographical in-vitro examination of the cell proliferation of persisting psoriatic plaques in preferred areas under therapy with ultraviolet light: Photochemotherapy (PUVA) and selective ultraviolet phototherapy (SUP)

International Nuclear Information System (INIS)

Middendorf, M.

1982-01-01

The application of ultraviolet rays (PUVA, SUP) brought significant progress in the treatment of psoriasis. The goal of UV-irradiation is to normalise the epidermal growth conditions. The cell cycle of persisting psoriatic plaque in preferred areas was examined under therapy with PUVA and SUP using an autoradiographic in-vitro method, double labelling with 14 C- and 3 H-thymididin. The results were compared to the known cell-kinetic parameters of psoriasis. The values thus obtained confirm the characteristic changes in the cell cycle of psoriasis. Furthermore, there is a block within the DNA-synthesis phase in the plaques persisting under UV-therapy. The resistence of persisting psoriatic plaques in preferred regions against UV-therapy is regarded as an indication of an extreme disturbance in the proliferation behaviour of the psoriatic skin. (orig./MG) [de

Effect of intermittent aerobic exercise on sleep quality and sleep disturbances in patients with rheumatoid arthritis

DEFF Research Database (Denmark)

Løppenthin, Katrine; Esbensen, Bente Appel; Jennum, Poul

2014-01-01

of an intermittent aerobic exercise intervention on sleep, assessed both objectively and subjectively in patients with rheumatoid arthritis. METHODS/DESIGN: A randomized controlled trial including 44 patients with rheumatoid arthritis randomly assigned to an exercise training intervention or to a control group....... The intervention consists of 18 session intermittent aerobic exercise training on a bicycle ergometer three times a week. Patients are evaluated according to objective changes in sleep as measured by polysomnography (primary outcome). Secondary outcomes include changes in subjective sleep quality and sleep...... disturbances, fatigue, pain, depressive symptoms, physical function, health-related quality of life and cardiorespiratory fitness. DISCUSSION: This trial will provide evidence of the effect of intermittent aerobic exercise on the improvement of sleep in patients with rheumatoid arthritis, which is considered...

Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort.

Science.gov (United States)

Tillett, William; Charlton, Rachel; Nightingale, Alison; Snowball, Julia; Green, Amelia; Smith, Catherine; Shaddick, Gavin; McHugh, Neil

2017-12-01

To describe the time interval between the onset of psoriasis and PsA in the UK primary care setting and compare with a large, well-classified secondary care cohort. Patients with PsA and/or psoriasis were identified in the UK Clinical Practice Research Datalink (CPRD). The secondary care cohort comprised patients from the Bath PsA longitudinal observational cohort study. For incident PsA patients in the CPRD who also had a record of psoriasis, the time interval between PsA diagnosis and first psoriasis record was calculated. Comparisons were made with the time interval between diagnoses in the Bath cohort. There were 5272 eligible PsA patients in the CPRD and 815 in the Bath cohort. In both cohorts, the majority of patients (82.3 and 61.3%, respectively) had psoriasis before their PsA diagnosis or within the same calendar year (10.5 and 23.8%), with only a minority receiving their PsA diagnosis first (7.1 and 14.8%). Excluding those who presented with arthritis before psoriasis, the median time between diagnoses was 8 years [interquartile range (IQR) 2-15] in the CPRD and 7 years (IQR 0-20) in the Bath cohort. In the CPRD, 60.1 and 75.1% received their PsA diagnosis within 10 and 15 years of their psoriasis diagnosis, respectively; this was comparable with 57.2 and 67.7% in the Bath cohort. A similar distribution for the time interval between psoriasis and arthritis was observed in the CPRD and secondary care cohort. These data can inform screening strategies and support the validity of data from each cohort. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Interleukin-17-positive mast cells contribute to synovial inflammation in spondylarthritis

NARCIS (Netherlands)

Noordenbos, Troy; Yeremenko, Nataliya; Gofita, Ioana; van de Sande, Marleen; Tak, Paul P.; Caňete, Juan D.; Baeten, Dominique

2012-01-01

Objective Studies comparing spondylarthritis (SpA) to rheumatoid arthritis (RA) synovitis suggest that innate immune cells may play a predominant role in the pathogenesis of SpA. Recent observations have indicated a marked synovial mast cell infiltration in psoriatic SpA. We therefore undertook the

Sulfasalazine efficacy and tolerability in rheumatic diseases

Directory of Open Access Journals (Sweden)

V. V. Badokin

2005-01-01

Full Text Available Sulfasalazine is one of the main disease modifying drugs for the treatment of chronic inflammatory joint and spine diseases. The article describes mechanism of action of sulfasalazine and its main metabolites. Detailed information about anti-inflammatory and immunosuppressive action of the drug is presented. Results of many studies of sulfasalazine efficacy in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and reactive arthritis are discussed from the evidence based medicine point of view. Data on sulfasalazine tolerability and safety are presented with separate discussion of hypersensitivity and dose-dependent adverse reactions so as their treatment and prophylaxis.

Rheumatoid Arthritis: Can It Affect the Lungs?

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Rheumatoid arthritis: Can it affect the lungs? Can rheumatoid arthritis affect your lungs? Answers from April Chang-Miller, ... know. Arthritis Foundation. http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/articles/lung-disease-rheumatoid-arthritis.php. Accessed ...

Significance of radionucleid examination of joints in diagnosis of subclinical arthritis background

International Nuclear Information System (INIS)

Andersone, D.; Bulina, I.

2005-01-01

Background. A large group of inflammation arthritis is represented by seronegative spondyloarthropathies (SpA), including several nosologies: psoriatic arthritis Bechterev's disease, Reiter's disease, etc. One of the most common SpA forms is Reactive arthritis (ReA). Inflammation process in joints is the most characteristic symptom, which determines severeness, course and prognosis of the disease. One of the most sensitive methods of examination of joints is radionucleid (RN) examination. Increased RNV accumulation in the joints is not a specific feature .for a concrete disease, and growth of its accumulation corresponds to the exudative component of inflammation process which reveals the early stage of joint inflammation (subclinical arthritis). Objectives: To find out how often subclinical inflammation processes (subclinical sinovitis) are observed in patients with minimal systemic activity of ReA. To detect in which joints subclinical sinovitis localizes most commonly. To evaluate significance of radionucleid examinations in diagnosis of subclinical arthritis. Material and methods. RN examination of joints was performed in 41 patient with ReA in I stage of activity and in 35 patients with ReA in II stage of activity, when the causative agent of infection - Chlamydia trachomatis - is localized in the urogenital tract. ReA was diagnosed according to diagnostic criteria of French Rheumatologists Association. For clinical description of joints index was used, characterized by pain intensity during joint palpation, and expressed by gradation degree from 0-3. In 76 patients with ReA I activity degree (ReA I) and ReA II activity degree (ReA II) radionucleid examination was done with marked 99 Tc and analysis of the obtained joint scintigrams for SI area. In the control group, 90 joint scintigrams were analyzed for patients with degenerative joint diseases without palpation pain in the examined joints, determining Tc index (Tc ind) in separate joints and summary Tc ind

Arthritis self-efficacy scale scores in knee osteoarthritis: a systematic review and meta-analysis comparing arthritis self-management education with or without exercise.

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Brand, Emily; Nyland, John; Henzman, Cameron; McGinnis, Mark

2013-12-01

Systematic literature review and meta-analysis. To evaluate studies that used arthritis self-management education alone or with exercise to improve Arthritis Self-Efficacy Scale scores of patients with knee osteoarthritis. Increasing self-efficacy may improve patient knee osteoarthritis symptom management and function. MEDLINE (1946-March 2013), CINAHL (1981-March 2013), and PsycINFO (1967-March 2013) databases were searched. Twenty-four studies, including 3163 subjects (women, n = 2547 [80.5%]; mean ± SD age, 65.3 ± 6.5 years), met the inclusion criteria. A meta-analysis was performed to compare the standardized mean difference effect sizes (Cohen d) of randomized controlled studies that used the Arthritis Self-Efficacy Scale pain (13 studies, n = 1906), other symptoms (13 studies, n = 1957), and function (5 studies, n = 399) subscales. Cohen d effect sizes were also calculated for cohort studies that used the Arthritis Self-Efficacy Scale pain (10 studies, n = 1035), other symptoms (9 studies, n = 913), and function (3 studies, n = 141) subscales. Both randomized controlled studies and cohort studies were grouped by intervention type (intervention 1, arthritis self-management education alone; intervention 2, arthritis self-management education with exercise), and effect sizes were compared (Mann-Whitney U tests, Pmanagement education with exercise displayed higher methodological quality scale scores (76.8 ± 13.1 versus 61.6 ± 19.6, P = .03). Statistically significant standardized effect-size differences between intervention 1 and intervention 2 were not observed. Small to moderate effect sizes were observed regardless of whether the intervention included exercise. Exercise interventions used in conjunction with arthritis self-management education programs need to be developed to better enhance the self-efficacy of patients with knee osteoarthritis. Therapy, level 2b-.

How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis

NARCIS (Netherlands)

Visser, Henk; le Cessie, Saskia; Vos, Koen; Breedveld, Ferdinand C.; Hazes, Johanna M. W.

2002-01-01

To develop a clinical model for the prediction, at the first visit, of 3 forms of arthritis outcome: self-limiting, persistent nonerosive, and persistent erosive arthritis. A standardized diagnostic evaluation was performed on 524 consecutive, newly referred patients with early arthritis.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult Patients with Arthritis Complementary ...

Detection of rheumatoid arthritis using infrared imaging

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Frize, Monique; Adéa, Cynthia; Payeur, Pierre; Di Primio, Gina; Karsh, Jacob; Ogungbemile, Abiola

2011-03-01

Rheumatoid arthritis (RA) is an inflammatory disease causing pain, swelling, stiffness, and loss of function in joints; it is difficult to diagnose in early stages. An early diagnosis and treatment can delay the onset of severe disability. Infrared (IR) imaging offers a potential approach to detect changes in degree of inflammation. In 18 normal subjects and 13 patients diagnosed with Rheumatoid Arthritis (RA), thermal images were collected from joints of hands, wrists, palms, and knees. Regions of interest (ROIs) were manually selected from all subjects and all parts imaged. For each subject, values were calculated from the temperature measurements: Mode/Max, Median/Max, Min/Max, Variance, Max-Min, (Mode-Mean), and Mean/Min. The data sets did not have a normal distribution, therefore non parametric tests (Kruskal-Wallis and Ranksum) were applied to assess if the data from the control group and the patient group were significantly different. Results indicate that: (i) thermal images can be detected on patients with the disease; (ii) the best joints to image are the metacarpophalangeal joints of the 2nd and 3rd fingers and the knees; the difference between the two groups was significant at the 0.05 level; (iii) the best calculations to differentiate between normal subjects and patients with RA are the Mode/Max, Variance, and Max-Min. We concluded that it is possible to reliably detect RA in patients using IR imaging. Future work will include a prospective study of normal subjects and patients that will compare IR results with Magnetic Resonance (MR) analysis.

Weather and rheumatoid arthritis : the role of the microclimate near the skin

NARCIS (Netherlands)

Patberg, Wiebe Reinier

2005-01-01

Although there is a widespread opinion that weather affects arthritis, scientific proof is lacking. The number of studies on this subject is small, which might be explained by the difficulty of monitoring disease activity in RA. Subjective variables like pain can be judged every day, but the daily

Clinical characteristics, treatment and outcome of children with Lyme arthritis in Nova Scotia.

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Glaude, Pier Diane; Huber, Adam M; Mailman, Timothy; Ramsey, Suzanne; Lang, Bianca; Stringer, Elizabeth

2015-10-01

Lyme disease is an emerging problem in Nova Scotia. Lyme arthritis is a late manifestation of Lyme disease. To describe the demographic characteristics, referral patterns and clinical course of children diagnosed with Lyme arthritis in a tertiary care pediatric rheumatology clinic in Nova Scotia. In the present retrospective chart review, subjects diagnosed with Lyme arthritis between 2006 and 2013 were identified through the clinic database. Demographic variables, referral patterns, clinical presentation and information regarding treatment course and outcome were collected. Seventeen patients were identified; 76% presented in 2012 and 2013. In 37.5% of cases, the referring physician suspected Lyme disease. Most patients presented with one or more painful and/or swollen joints; 94% had knee involvement. Only three of 17 patients had a history of erythema migrans and four of 17 recalled a tick bite. Five patients had a history of neurological manifestations consistent with Lyme disease, although, none had a diagnosis made at the time. Arthritis usually resolved after treatment with standard antibiotics; however, at last follow-up, two patients had antibiotic refractory Lyme arthritis, with one having joint damage despite aggressive arthritis treatment. A significant increase in cases of Lyme arthritis has recently been recognized in a pediatric rheumatology clinic in Nova Scotia. A history of a tick bite or erythema migrans were not sensitive markers of Lyme arthritis, and this diagnosis was often not considered by the referring physician. Educational initiatives should be undertaken to increase local awareness of this treatable cause of arthritis in children.

Nail psoriasis in an adult successfully treated with a series of herbal skin care products family – a case report.

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Tirant, M; Hercogovấ, J; Fioranelli, M; Gianfaldoni, S; Chokoeva, A A; Tchernev, G; Wollina, U; Novotny, F; Roccia, M G; Maximov, G K; França, K; Lotti, T

2016-01-01

Psoriasis is a common chronic inflammatory dermatosis that causes significant distress and morbidity. Approximately 50% of patients with cutaneous psoriasis and 90% of patients with psoriatic arthritis demonstrate nail involvement of their psoriasis. Left untreated, nail psoriasis may progress to debilitating nail disease that leads to not only impairment of function but also on quality of life. We report the case of a 50-year-old male patient with recalcitrant nail dystrophies on the fingers since the age of 40, who responded successfully to Dr. Michaels® product family. The patient had a 35-year history of plaque psoriasis localised on the scalp, ears, groin, limbs, and trunk and with psoriatic arthritis. The nail symptoms consisted of onycholysis, onychomycosis, leukonychia, transverse grooves, nail plate crumbling and paronychia of the periungal skin. This case represents the efficacy and safety of the Dr. Michaels® (Soratinex® and Nailinex®) product family with successful resolution of nail dystrophies and surrounding paronychia with no reported adverse events.

Rheumatoid Arthritis Educational Video Series

Medline Plus

Full Text Available ... Happening to the Joints? Rheumatoid Arthritis: Gaining Control – Working with your Rheumatologist Rheumatoid Arthritis: Additional Conditions Rheumatoid Arthritis: The Immune System Don’t have ...

Development of the Digital Arthritis Index, a Novel Metric to Measure Disease Parameters in a Rat Model of Rheumatoid Arthritis

Directory of Open Access Journals (Sweden)

Maria A. Lim

2017-11-01

Full Text Available Despite a broad spectrum of anti-arthritic drugs currently on the market, there is a constant demand to develop improved therapeutic agents. Efficient compound screening and rapid evaluation of treatment efficacy in animal models of rheumatoid arthritis (RA can accelerate the development of clinical candidates. Compound screening by evaluation of disease phenotypes in animal models facilitates preclinical research by enhancing understanding of human pathophysiology; however, there is still a continuous need to improve methods for evaluating disease. Current clinical assessment methods are challenged by the subjective nature of scoring-based methods, time-consuming longitudinal experiments, and the requirement for better functional readouts with relevance to human disease. To address these needs, we developed a low-touch, digital platform for phenotyping preclinical rodent models of disease. As a proof-of-concept, we utilized the rat collagen-induced arthritis (CIA model of RA and developed the Digital Arthritis Index (DAI, an objective and automated behavioral metric that does not require human-animal interaction during the measurement and calculation of disease parameters. The DAI detected the development of arthritis similar to standard in vivo methods, including ankle joint measurements and arthritis scores, as well as demonstrated a positive correlation to ankle joint histopathology. The DAI also determined responses to multiple standard-of-care (SOC treatments and nine repurposed compounds predicted by the SMarTRTM Engine to have varying degrees of impact on RA. The disease profiles generated by the DAI complemented those generated by standard methods. The DAI is a highly reproducible and automated approach that can be used in-conjunction with standard methods for detecting RA disease progression and conducting phenotypic drug screens.

Altered expression of prohibitin in psoriatic lesions and its cellular implication

International Nuclear Information System (INIS)

Kim, Soon Young; Kim, Younghwa; Hwang, Ha Young; Kim, Tae-Yoon

2007-01-01

Psoriasis is characterized by excessive proliferation of keratinocytes accompanying acanthosis and incomplete differentiation. Prohibitin was investigated by examining its function of HaCaT as well as psoriasis. Psoriatic involved skin revealed high level of prohibitin in the basal layer. Prohibitin was analyzed by applying RNAi (PHBi) with HaCaT, which demonstrated increased S-phase. PHBi showed enhanced sensitivity to anthralin-mediated cell death due to enhanced loss of mitochondrial membrane potential, suggesting a protective role of prohibitin against apoptosis. Collectively, prohibitin plays a role both in cell cycle regulation and in maintaining mitochondrial integrity, implying its association with pathogenesis of psoriasis

Analysis of the Juvenile Idiopathic Arthritis Immunization Schedule

Directory of Open Access Journals (Sweden)

L. S. Namazova-Baranova

2016-01-01

Full Text Available Background: The connection between vaccination and autoimmune diseases (and rheumatic pathology in particular is still a subject of discussions. When discussing the possibility of vaccinating rheumatic patients we should take into account the ultra high dangers that infectious diseases pose for such patients, including those that can be prevented by vaccination. We should also take into account the experience of using various vaccine types in rheumatic patients, which illustrates of their high safety profile.Objective: Our aim was to study the immunization schedule in children with juvenile idiopathic arthritis.Methods: The evaluation of vaccine history and other anamnestic data in juvenile idiopathic arthritis patients was based on individual medical records (individual child’s card/preventive vaccination certificate, as well as questionnaires filled by mothers.Results: It has been determined that a significant proportion of children with vaccination schedule deviations are juvenile idiopathic arthritis patients. Almost one in four children with a confirmed rheumatic diagnosis has not been immunized against the major vaccine-preventable diseases. In one non-vaccinated group, there was a case of juvenile arthritis onset after recovering from measles. A small number of patient mothers connects the manifestation of rheumatic diseases with vaccination.Conclusion: Violations of vaccination status in JIA patients require corrections according to the results of clinical studies and the recommendations of international experts.

Problems experienced by people with arthritis when using a computer.

Science.gov (United States)

Baker, Nancy A; Rogers, Joan C; Rubinstein, Elaine N; Allaire, Saralynn H; Wasko, Mary Chester

2009-05-15

To describe the prevalence of computer use problems experienced by a sample of people with arthritis, and to determine differences in the magnitude of these problems among people with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). Subjects were recruited from the Arthritis Network Disease Registry and asked to complete a survey, the Computer Problems Survey, which was developed for this study. Descriptive statistics were calculated for the total sample and the 3 diagnostic subgroups. Ordinal regressions were used to determine differences between the diagnostic subgroups with respect to each equipment item while controlling for confounding demographic variables. A total of 359 respondents completed a survey. Of the 315 respondents who reported using a computer, 84% reported a problem with computer use attributed to their underlying disorder, and approximately 77% reported some discomfort related to computer use. Equipment items most likely to account for problems and discomfort were the chair, keyboard, mouse, and monitor. Of the 3 subgroups, significantly more respondents with FM reported more severe discomfort, more problems, and greater limitations related to computer use than those with RA or OA for all 4 equipment items. Computer use is significantly affected by arthritis. This could limit the ability of a person with arthritis to participate in work and home activities. Further study is warranted to delineate disease-related limitations and develop interventions to reduce them.

Calcipotriol inhibits the proliferation of hyperproliferative CD29 positive keratinocytes in psoriatic epidermis in the absence of an effect on the function and number of antigen-presenting cells

DEFF Research Database (Denmark)

Jensen, A.M.; Llado, Minna Fyhn Lykke; Skov, L.

1998-01-01

The aim of this study was to elucidate some of the possible mechanisms of action of the vitamin D analogue calcipotriol in vivo. Calcipotriol is finding increasing use in the treatment of psoriasis, but the primary target cell in vivo has not yet been identified. We treated psoriatic patients...... psoriatic and normal skin, calcipotriol treatment did not alter the capacity of epidermal antigen-presenting cells to stimulate the proliferation of autologous T cells, either in the absence or in the presence of exogenous antigen. Epidermal cell suspensions were analysed further by staining...... for infiltrating leucocytes (CD45+) and Langerhans cells (CD1a+). Flow cytometric analysis showed that calcipotriol did not alter the number of CD45+ cells or Langerhans cells in psoriatic skin. These results indicate that calcipotriol does not alter either the number of the function of epidermal antigen...

Forms of Arthritis

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... this page please turn Javascript on. Forms of Arthritis Past Issues / Fall 2006 Table of Contents Today, ... of Linda Saisselin Osteoarthritis (OA) — the form of arthritis typically occurring during middle or old age, this ...

Rheumatoid arthritis (image)

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Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks itself. The pattern of joints ... other joints and is worse in the morning. Rheumatoid arthritis is also a systemic disease, involving other body ...

Juvenile rheumatoid arthritis

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