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Lo Y, Chiu HY, Tsai TF. Clinical Features and Genetic Polymorphism in Chinese Patients with Erythrodermic Psoriasis in a Single Dermatologic Clinic. Mol Diagn Ther 2021; 24:85-93. [PMID: 31820331 DOI: 10.1007/s40291-019-00441-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Erythrodermic psoriasis (EP) is a rare variant of psoriasis that involves more complications and poorer biologic drug survival than plaque-type psoriasis vulgaris (PV). No prior study has explored human leukocyte antigen (HLA) or other genetic polymorphisms in patients with EP. OBJECTIVES Our objective was to describe the clinical features, comorbidities, and HLA polymorphisms among Chinese patients with EP. METHODS We enrolled consecutive patients with EP from our clinic, with EP defined as generalized confluent erythematous thin plaques covering at least 80% body surface area. Patients were categorized as having primary or secondary EP. Aggravating factors, comorbidities including psoriatic arthritis, family history of psoriasis, age of onset, and treatment history were also identified. Genetic studies were performed for HLA-C and HLA-DRB1, and the results were compared with those from a healthy population and patients with PV. RESULTS Of the 63 included patients, the male to female ratio was 2.71:1. Five (7.9%) patients had primary EP, and 58 (92.1%) had secondary EP. Genotyping of HLA-C and HLA-DRB1 was available in 61 and 58 subjects, respectively. HLA-C*0102 was the most frequent HLA-C allele (34.4%), followed by HLA-C*0702 (18.0%). The frequency of HLA-C*0602 allele (4.1%) was lower than in patients with plaque-type psoriasis (4.1 vs. 16.3%, corrected p value [Pc] = 0.02) and similar to that in the healthy population in Taiwan. The most frequent HLA-DRB1 allele was HLA-DRB1*0901 (20.7%), followed by HLA-DRB1*0803 (13.8%). An increased prevalence of psoriatic arthritis (61.9%) and higher male predominance were also noted in comparison with PV. CONCLUSIONS There are HLA differences in Chinese patients with EP compared with patients with PV. The incidence of psoriatic arthritis is also higher. The implications of the above findings await further investigation.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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152
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Meier K, Schloegl A, Poddubnyy D, Ghoreschi K. Skin manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20975915. [PMID: 33343725 PMCID: PMC7727049 DOI: 10.1177/1759720x20975915] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Spondyloarthritides (SpA) like psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis and inflammatory bowel disease (IBD)-associated SpA can present with characteristic skin manifestations. These SpA-associated skin disorders may precede joint involvement, reflect a loss of efficacy of a current systemic treatment or can even be treatment associated. Cutaneous manifestations in SpA not only add additional morbidity with physical impact but also impose a psychosocial burden on affected patients. Psoriasis (PsO) - the main skin disease in SpA - has a variety of clinical presentations, including plaque-type PsO, inverse PsO, guttate PsO, erythrodermic PsO, nail PsO and pustular types. SpA associated with IBD presents with neutrophilic and granulomatous skin disorders, including pyoderma gangrenosum, hidradenitis suppurativa and cutaneous Crohn's disease. Reactive arthritides has a favourable prognosis and may feature keratoderma blenorrhagicum or balanitis circinatum as typical skin manifestations. Immunologically, SpA-associated skin diseases share interleukin (IL)-17 and IL-23 dysregulation but show distinctive genetic and immunological profiles. Therefore, they vary in their treatment responses to targeted therapies with biologicals or small molecules. In this review, we highlight the clinical presentation of skin manifestations in SpA and discuss therapeutic approaches in this interdisciplinary field.
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Affiliation(s)
- Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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153
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Caputo V, Strafella C, Termine A, Dattola A, Mazzilli S, Lanna C, Cosio T, Campione E, Novelli G, Giardina E, Cascella R. Overview of the molecular determinants contributing to the expression of Psoriasis and Psoriatic Arthritis phenotypes. J Cell Mol Med 2020; 24:13554-13563. [PMID: 33128843 PMCID: PMC7754002 DOI: 10.1111/jcmm.15742] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/07/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
Psoriasis and psoriatic arthritis are multifactorial chronic disorders whose etiopathogenesis essentially derives from the alteration of several signalling pathways and the co-occurrence of genetic, epigenetic and non-genetic susceptibility factors that altogether affect the functional and structural property of the skin. Although shared and differential susceptibility genes and molecular pathways are known to contribute to the onset of pathological phenotypes, further research is needed to dissect the molecular causes of psoriatic disease and its progression towards Psoriatic Arthritis. This review will therefore be addressed to explore differences and similarities in the etiopathogenesis and progression of both disorders, with a particular focus on genes involved in the maintenance of the skin structure and integrity (keratins and collagens), modulation of patterns of recognition (through Toll-like receptors and dectin-1) and immuno-inflammatory response (by NLRP3-dependent inflammasome) to microbial pathogens. In addition, special emphasis will be given to the contribution of epigenetic elements (methylation pattern, non-coding RNAs, chromatin modifiers and 3D genome organization) to the etiopathogenesis and progression of psoriasis and psoriatic arthritis. The evidence discussed in this review highlights how the knowledge of patients' clinical and (epi)genomic make-up could be helpful for improving the available therapeutic strategies for psoriasis and psoriatic arthritis treatment.
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Affiliation(s)
- Valerio Caputo
- Medical Genetics LaboratoryDepartment of Biomedicine and PreventionTor Vergata UniversityRomeItaly
- Genomic Medicine Laboratory UILDMIRCCS Santa Lucia FoundationRomeItaly
| | - Claudia Strafella
- Medical Genetics LaboratoryDepartment of Biomedicine and PreventionTor Vergata UniversityRomeItaly
- Genomic Medicine Laboratory UILDMIRCCS Santa Lucia FoundationRomeItaly
| | - Andrea Termine
- Genomic Medicine Laboratory UILDMIRCCS Santa Lucia FoundationRomeItaly
| | - Annunziata Dattola
- Dermatologic ClinicDepartment of Systems MedicineTor Vergata UniversityRomeItaly
| | - Sara Mazzilli
- Dermatologic ClinicDepartment of Systems MedicineTor Vergata UniversityRomeItaly
| | - Caterina Lanna
- Dermatologic ClinicDepartment of Systems MedicineTor Vergata UniversityRomeItaly
| | - Terenzio Cosio
- Dermatologic ClinicDepartment of Systems MedicineTor Vergata UniversityRomeItaly
| | - Elena Campione
- Dermatologic ClinicDepartment of Systems MedicineTor Vergata UniversityRomeItaly
| | - Giuseppe Novelli
- Medical Genetics LaboratoryDepartment of Biomedicine and PreventionTor Vergata UniversityRomeItaly
- Neuromed Institute IRCCSPozzilliItaly
| | - Emiliano Giardina
- Genomic Medicine Laboratory UILDMIRCCS Santa Lucia FoundationRomeItaly
- Department of Biomedicine and PreventionUILDM Lazio Onlus FoundationTor Vergata UniversityRomeItaly
| | - Raffaella Cascella
- Medical Genetics LaboratoryDepartment of Biomedicine and PreventionTor Vergata UniversityRomeItaly
- Department of Biomedical SciencesCatholic University Our Lady of Good CounselTiranaAlbania
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154
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Kasiem FR, Luime JJ, Vis M, Kok MR, Wervers K, Gerards AH, Appels C, van der Graaff WL, Starmans-Kool M, Goekoop-Ruiterman Y, van Groenendael J, Korswagen LA, Veris-van Dieren JJ, Hazes J, Tchetverikov I. Lessons learned from clinical phenotypes in early psoriatic arthritis: the real-world Dutch south west Early Psoriatic ARthritis study. Scand J Rheumatol 2020; 50:124-131. [PMID: 33084451 DOI: 10.1080/03009742.2020.1803398] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: This paper describes the baseline demographics, clinical characteristics, and patient-reported outcomes (PROs) according to clinical phenotype of patients with early psoriatic arthritis (PsA) for the purpose of creating a decision support system for daily clinical practice.Method: Patients with newly diagnosed PsA were included in the Dutch south west Early Psoriatic ARthritis (DEPAR) study. No classification criteria were applied, to ensure collection of real-world data on demographics, medication, clinical characteristics, and PROs. An IT infrastructure facilitated data collection.Results: We described 527 patients, categorized according to the clinical phenotype stated by the rheumatologist at the time of diagnosis, namely monoarthritis (15%), oligoarthritis (40%), polyarthritis (23%), enthesitis (10%), axial disease (2%), and dactylitis (10%). Overall psoriasis severity was mild and 83 patients (16%) had no psoriasis. Short-term sick leave (> 1 day per 4 weeks) was 17% and long-term sick leave (> 4 weeks) was 4%. The group with phenotype enthesitis reported the longest duration of complaints, had the highest fatigue scores, and contained the highest percentage of patients with a Hospital Anxiety and Depression Scale (HADS) anxiety score ≥ 8 and depression score ≥ 8.Conclusion: PsA patients presenting at outpatient clinics in the Netherlands had a mild degree of psoriasis, with impairment of quality of life and work productivity. Most patients presented with phenotype oligoarthritis. Those presenting with phenotype enthesitis more often reported scores suggestive of an anxiety or depression disorder and fatigue. It is important for attending rheumatologists to be aware of these differences when assessing patients with PsA.
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Affiliation(s)
- F R Kasiem
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Luime
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Vis
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - K Wervers
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A H Gerards
- Department of Rheumatology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Cwy Appels
- Department of Rheumatology, Amphia Hospital, Breda, The Netherlands
| | | | - Mjf Starmans-Kool
- Department of Rheumatology, Zuyderland Hospital, Heerlen, The Netherlands
| | | | - Jhlm van Groenendael
- Department of Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | - L-A Korswagen
- Department of Rheumatology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - J J Veris-van Dieren
- Department of Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | - Jmw Hazes
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - I Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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155
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Savage L, Tinazzi I, Zabotti A, Laws PM, Wittmann M, McGonagle D. Defining Pre-Clinical Psoriatic Arthritis in an Integrated Dermato-Rheumatology Environment. J Clin Med 2020; 9:jcm9103262. [PMID: 33053820 PMCID: PMC7601411 DOI: 10.3390/jcm9103262] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023] Open
Abstract
In excess of three quarters of patients with psoriatic arthritis (PsA) have preceding psoriasis (PsO), which offers a clinical biomarker for the recognition of early PsA. Numerous surveys have shown a remarkably high frequency of clinically occult musculoskeletal symptoms in psoriasis patients. Imaging studies, particularly ultrasound, show a high prevalence of subclinical enthesitis and other inflammatory changes in psoriasis subjects. Since a serum biomarker, such as the case of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis, neither exists nor seems biologically plausible at this point, this article explores how integration of rheumatological and dermatological assessment can be facilitated for the early recognition of potential PsA. Given that scalp disease is a PsA predictor, but may be managed in the community, then a particular need to access this group is needed. An integrated approach between rheumatology and dermatology can involve joint clinics, parallel clinics with discussion of relevant cases or virtual contact between specialties. Early therapy evaluation and integrated strategies have considerable implications for minimizing suffering and joint damage in PsA.
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Affiliation(s)
- Laura Savage
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, 33100 Udine, Italy;
| | - Philip M. Laws
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Miriam Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
- Correspondence:
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156
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Applying precision medicine to unmet clinical needs in psoriatic disease. Nat Rev Rheumatol 2020; 16:609-627. [PMID: 33024296 DOI: 10.1038/s41584-020-00507-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Abstract
Psoriatic disease (PsD) is a heterogeneous condition that can affect peripheral and axial joints (arthritis), entheses, skin (psoriasis) and other structures. Over the past decade, considerable advances have been made both in our understanding of the pathogenesis of PsD and in the treatment of its diverse manifestations. However, several major areas of continued unmet need in the care of patients with PsD have been identified. One of these areas is the prediction of poor outcome, notably radiographic outcome in patients with psoriatic arthritis, so that stratified medicine approaches can be taken; another is predicting response to the numerous current and emerging therapies for PsD, so that precision medicine can be applied to rapidly improve clinical outcome and reduce the risk of toxicity. In order to address these needs, novel approaches, including imaging, tissue analysis and the application of proteogenomic technologies, are proposed as methodological solutions that will assist the dissection of the critical immune-metabolic pathways in this complex disease. Learning from advances made in other inflammatory diseases, it is time to address these unmet needs in a multi-centre partnership aimed at improving short-term and long-term outcomes for patients with PsD.
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157
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Aydin SZ, Mathew AJ, Koppikar S, Eder L, Østergaard M. Imaging in the diagnosis and management of peripheral psoriatic arthritis. Best Pract Res Clin Rheumatol 2020; 34:101594. [PMID: 33032929 DOI: 10.1016/j.berh.2020.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Psoriatic arthritis is a heterogenous disease affecting peripheral and axial joints, tendons, ligaments, and their insertions, in addition to the skin and the nails. The complexity of the involved structures has puzzled clinicians trying to understand the underlying pathology that leads to symptoms in order to choose the appropriate medications with different modes of actions. Imaging, mainly ultrasound and magnetic resonance imaging, allows of accurate detection of inflammatory changes in the musculoskeletal structures, which helps to avoid false positive and negative assessments. The linking of different anatomical structures' involvement using imaging also provides insights into the pathogenesis of psoriatic arthritis. In this review, ultrasound and magnetic resonance imaging will be discussed in depth with regard to their use in the field of peripheral psoriatic arthritis, with a focus on the literature from the last 4 years and recent advances.
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Affiliation(s)
- Sibel Zehra Aydin
- University of Ottawa Faculty of Medicine, Rheumatology, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada.
| | - Sahil Koppikar
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Lihi Eder
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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158
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Saif DS, El Tabl MA, Afifi N, Abdallah MS, El Hefnawy SM, Hassanein SA. Interleukin-17A biomarker as a predictor for detection of early axial spondyloarthritis changes in patients with psoriasis. Int J Rheum Dis 2020; 23:1664-1669. [PMID: 33016599 DOI: 10.1111/1756-185x.13997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 01/29/2023]
Abstract
AIM Although the pathogenic mechanisms of psoriatic arthritis (PsA) are not completely clarified, evidence suggests that interleukin 17A (IL-17A)-mediated immune responses play a pivotal role in the disease. This is best underscored by the important clinical effectiveness of IL-17A inhibitors in psoriasis treatment. We aim to investigate the predictive value of IL-17A in detecting the early axial spondyloarthropic (SpA) changes in psoriatic patients. METHODS The study enrolled 100 patients with psoriasis, classified into group 1, included 62 patients with only psoriatic skin lesions (Ps), and group 2 included 38 patients with PsA, and 100 age and gender matched healthy volunteers. All participants were subjected to general and local clinical examination, laboratory assessment including IL-17A in the serum by means of enzyme-linked immunosorbent assay, and axial joint radiological assessment. RESULTS Our study included 60 males (60%) and 40 females (40%).The positive radiological findings of early axial SpA changes were found among 30.6% of the Ps group and among 84.2% of the PsA group. There were significant differences between patients with positive magnetic resonance imaging (MRI) findings of early axial SpA and patients with negative MRI findings in both groups regarding IL-17A levels. There was a significant association between IL-17A level and early axial SpA changes in psoriatic patients with a clear cutoff point (222.5). CONCLUSION Our study can imply that IL-17A is a valuable, useful and low-cost biomarker in detecting early axial SpA changes in asymptomatic and nonradiographic axial SpA (nr-axial SpA) psoriatic patients that helps early management and prevent progressive axial involvement and disabilities.
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Affiliation(s)
- Dalia S Saif
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed A El Tabl
- Department of Neurosurgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Naglaa Afifi
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud S Abdallah
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City (USC), Menoufia, Egypt
| | - Sally M El Hefnawy
- Department of Biochemistry, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Shimaa A Hassanein
- Department of Radiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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159
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Köhm M, Zerweck L, Ngyuen PH, Burkhardt H, Behrens F. Innovative Imaging Technique for Visualization of Vascularization and Established Methods for Detection of Musculoskeletal Inflammation in Psoriasis Patients. Front Med (Lausanne) 2020; 7:468. [PMID: 32984365 PMCID: PMC7492526 DOI: 10.3389/fmed.2020.00468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
Psoriasis (PsO) is one of the common chronic inflammatory skin diseases. Approximately 3% of the European Caucasian population is affected. Psoriatic arthritis (PsA) is a chronic immune-mediated disease associated with PsO characterized by distinct musculoskeletal inflammation. Due to its heterogeneous clinical manifestations (e.g., oligo- or polyarthritis, enthesitis, dactylitis, and axial inflammation), early diagnosis of PsA is often difficult and delayed. Approximately 30% of PsO patients will develop PsA. The responsible triggers for the transition from PsO only to PsA are currently unclear, and the impacts of different factors (e.g., genetic, environmental) on disease development are currently discussed. There is a high medical need, recently unmet, to specifically detect those patients with an increased risk for the development of clinically evident PsA early to initiate sufficient treatment to inhibit disease progression and avoid structural damage and loss of function or even intercept disease development. Increased neoangiogenesis and enthesial inflammation are hypothesized to be early pathological findings in PsO patients with PsA development. Different disease states describe the transition from PsO to PsA. Two of those phases are of value for early detection of PsA at-risk patients to prevent later development of PsA as changes in biomarker profiles are detectable: the subclinical phase (soluble and imaging biomarkers detectable, no clinical symptoms) and the prodromal phase (imaging biomarkers detectable, unspecific musculoskeletal symptoms such as arthralgia and fatigue). To target the unmet need for early detection of this at-risk population and to identify the subgroup of patients who will transition from PsO to PsA, imaging plays an important role in characterizing patients precisely. Imaging techniques such as ultrasound (US), magnetic resonance imaging (MRI), and computerized tomography (CT) are advanced techniques to detect sensitively inflammatory changes or changes in bone structure. With the use of these techniques, anatomic structures involved in inflammatory processes can be identified. These techniques are complemented by fluorescence optical imaging as a sensitive method for detection of changes in vascularization, especially in longitudinal measures. Moreover, high-resolution peripheral quantitative CT (HR-pQCT) and dynamic contrast-enhanced MRI (DCE-MRI) may give the advantage to identify PsA-related early characteristics in PsO patients reflecting transition phases of the disease.
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Affiliation(s)
- Michaela Köhm
- Division of Rheumatology, Goethe-University Frankfurt, Frankfurt, Germany.,Clinical Research, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine and Pharmacology TMP, Frankfurt, Germany.,Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany
| | - Lukas Zerweck
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | - Phuong-Ha Ngyuen
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | - Harald Burkhardt
- Division of Rheumatology, Goethe-University Frankfurt, Frankfurt, Germany.,Clinical Research, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine and Pharmacology TMP, Frankfurt, Germany.,Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Centre of Innovative Diagnostics and Therapeutics Rheumatology/Immunology CIRI, Frankfurt, Germany
| | - Frank Behrens
- Division of Rheumatology, Goethe-University Frankfurt, Frankfurt, Germany.,Clinical Research, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine and Pharmacology TMP, Frankfurt, Germany.,Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Centre of Innovative Diagnostics and Therapeutics Rheumatology/Immunology CIRI, Frankfurt, Germany
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160
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Aiming for Cure and Preventive Initiatives in Psoriatic Disease: Building Synergy at NPF, GRAPPA, and PPACMAN. Curr Rheumatol Rep 2020; 22:78. [PMID: 32959152 DOI: 10.1007/s11926-020-00958-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW To provide a general overview of the organizations dedicated to advance clinical and translational research in the field of psoriatic disease and to describe the current and future opportunities for team science approaches to overcome unmet needs in the field. Descriptions of initiatives from the NPF, PPACMAN, and GRAPPA are summarized. RECENT FINDINGS Program projects have recently identified areas of knowledge gaps in diagnosis, treatment, and prevention of psoriasis and psoriatic arthritis (PsA). NPF's Psoriasis Prevention Initiative aims to identify interventions that can prevent the onset and relapse of psoriatic disease or related comorbidities. The Psorcast Study is a joint venture between PPACMAN and Sage Bionetworks based on patient-generated smartphone measurements of psoriatic disease. Similarly, GRAPPA is involved in a number of projects related to axial PsA, enthesitis prevalence, and biomarker discoveries. As important initiatives bring new targets for diagnosis and therapeutics in psoriatic disease, supra-endeavors such as the NIH-Accelerating Medicines Partnership (AMP) and the European Innovative Medicines Initiative (IMI) are promising public-private partnerships that can significantly catapult the field forward.
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161
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Kampylafka E, Tascilar K, Lerchen V, Linz C, Sokolova M, Zekovic A, Kleyer A, Simon D, Rech J, Sticherling M, Schett G, Hueber AJ. Secukinumab leads to shifts from stage-based towards response-based disease clusters-comparative data from very early and established psoriatic arthritis. Arthritis Res Ther 2020; 22:207. [PMID: 32907626 PMCID: PMC7488266 DOI: 10.1186/s13075-020-02268-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/09/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Limited information exists about the very early forms of psoriatic arthritis. In particular, differences and responsiveness of patient-reported outcomes (PROs) in very early as compared to established PsA have not been investigated to date. METHODS Cross-sectional and prospective longitudinal evaluation of PROs related to pain (VAS), physical function (HAQ-DI, SF-36 physical), mental function (SF-36 mental), impact of psoriatic skin (DLQI), joint (PsAID), and global disease (VAS) in two small prospective observational studies on secukinumab 300 mg over 6 months in very early disease patients (IVEPSA study, N = 20) and established PsA (PSARTROS study, N = 20). Cluster analysis was performed at baseline and 24-weeks of follow-up. RESULTS While responses in pain and physical activity-related PROs to secukinumab were more pronounced in established PsA than a very early disease, effects on PROs related to general health perception, as well as those related to emotional and mental well-being, were modified in a similar way in very early disease and established PsA. Cluster analysis based on global disease activity and PROs showed that baseline clusters reflected very early disease and established PsA, while after secukinumab treatment these clusters were abolished and new clusters based on differential responses to physically and mentally oriented PROs formed. CONCLUSIONS Inhibition of IL-17A by secukinumab leads to comprehensive improvement of general health perception and mental well-being in very early and established PsA, while overall responses in pain and physical activity are more pronounced in established disease. Most importantly, treatment restructures the original patients' clusters based on disease stage and leads to the formation of new clusters that reflect their response in physical and mental-orientated PROs. TRIAL REGISTRATION NCT02483234 , registered 26 June 2015, retrospectively registered.
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Affiliation(s)
- Eleni Kampylafka
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Veronika Lerchen
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Linz
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Maria Sokolova
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ana Zekovic
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Sticherling
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Department of Dermatology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. .,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. .,Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany. .,Rheumatology Section, Sozialstiftung Bamberg, Bamberg, Germany.
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162
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Abstract
Patients with psoriatic arthritis (PsA) have a higher burden of cardio-metabolic comorbidities like obesity, hypertension, diabetes, and cardiovascular disease compared to the general population. Adipose tissue is thought to promote a chronic low grade inflammatory state through inflammatory mediators like tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), leptin, and adiponectin. A higher body mass index (BMI) is a risk factor for development of PsA and affects disease activity and response to therapy including both disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNFi). Obesity has an impact on the morbidity in PsA, particularly cardiovascular and/or metabolic. Patients with PsA have a higher cardiovascular risk and obesity may have an additive impact on morbidity and mortality. This review explores the relationship between obesity and PsA.
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Affiliation(s)
- Anand Kumthekar
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
| | - Alexis Ogdie
- University of Pennsylvania, Philadelphia, PA, USA
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163
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López-Medina C, Ortega-Castro R, Castro-Villegas MC, Font-Ugalde P, Puche-Larrubia MÁ, Gómez-García I, Arias-de la Rosa I, Barbarroja N, Schiotis R, Collantes-Estévez E. Axial and peripheral spondyloarthritis: does psoriasis influence the clinical expression and disease burden? Data from REGISPONSER registry. Rheumatology (Oxford) 2020; 60:1125-1136. [DOI: 10.1093/rheumatology/keaa398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/06/2020] [Indexed: 02/04/2023] Open
Abstract
Abstract
Objective
To evaluate whether the presence of psoriasis influences the clinical expression, disease activity and disease burden in both axial and peripheral phenotypes of spondyloarthritis (SpA).
Methods
Patients from the Spanish REGISPONSER registry classified as having SpA according to the ESSG criteria were included. Patients were classified as psoriatic or non-psoriatic depending on the presence of cutaneous or nail psoriasis; thereafter, they were classified as having either axial [presence of radiographic sacroiliitis OR inflammatory back pain (IBP)] or peripheral phenotype (absence of radiographic sacroiliitis AND absence of IBP AND presence of peripheral involvement). Pair-wise univariate and multivariate analyses among the four groups (psoriatic/non-psoriatic axial phenotypes and psoriatic/non-psoriatic peripheral phenotypes) were performed with adjustment for treatment intake.
Results
A total of 2296 patients were included in the analysis. Among patients with axial phenotype, psoriasis was independently associated (P < 0.05) with HLA-B27+ [odds ratio (OR) 0.27], uveitis (OR 0.46), synovitis (ever) (OR 2.59), dactylitis (OR 2.78) and the use of conventional synthetic DMARDs (csDMARDs) (OR 1.47) in comparison with non-psoriatic patients. Among patients with peripheral phenotype and adjusting for csDMARD intake, psoriasis was independently associated with higher age at disease onset (OR 1.05), HLA-B27+ (OR 0.14) and heel enthesitis (OR 0.22). Higher scores for patient-reported outcomes and greater use of treatment at the time of the study visit were observed in psoriatic patients with either axial or peripheral phenotype.
Conclusion
These findings suggest that, among all patients with SpA, psoriasis is associated with differences in clinical expression of SpA, a greater disease burden and increased use of drugs.
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Affiliation(s)
- Clementina López-Medina
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
- Rheumatology Department, Cochin Hospital from Paris/INSERM U 1153, Clinical Epidemiology and Biostatistics, Paris, France
| | - Rafaela Ortega-Castro
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - M Carmen Castro-Villegas
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Pilar Font-Ugalde
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - M Ángeles Puche-Larrubia
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Ignacio Gómez-García
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Iván Arias-de la Rosa
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | | | - Ruxandra Schiotis
- Rheumatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, SCBI, Cluj-Napoca, Romania
| | - Eduardo Collantes-Estévez
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
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164
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Xie W, Huang H, Deng X, Gao D, Zhang Z. Modifiable lifestyle and environmental factors associated with onset of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational studies. J Am Acad Dermatol 2020; 84:701-711. [PMID: 32827608 DOI: 10.1016/j.jaad.2020.08.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/13/2020] [Accepted: 08/08/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a progressive joint disease associated with psoriasis. OBJECTIVES To investigate the association of modifiable lifestyle and environmental factors with PsA risk among people with psoriasis. METHODS We conducted a systematic search of PubMed, Embase, and Cochrane Library through May 2, 2020, for observational studies reporting lifestyle or environmental factors for PsA onset in patients with psoriasis. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were combined using a random-effects model. RESULTS We included 16 studies comprising 322,967 individuals. Obesity and being overweight were associated with an increased PsA risk in patients with psoriasis (OR, 1.75 [95% CI, 1.42-2.16] and OR, 1.50 [95% CI, 1.08-2.09], respectively), with an increase of approximately 6% for each kg/m2 rise in body mass index (OR, 1.06; 95% CI, 1.03-1.10). The presence of PsA was associated with a history of physical trauma (OR, 1.33; 95% CI, 1.16-1.54) or fracture (OR, 1.46; 95% CI, 1.22-1.74). No significant associations were observed regarding alcohol consumption (OR, 0.99; 95% CI, 0.88-1.13), smoking (OR, 0.89; 95% CI, 0.75-1.06), female hormonal exposure (OR, 1.45; 95% CI, 0.95-2.20), and psychologically traumatic events. LIMITATIONS Inherent limitations in the included observational studies. CONCLUSIONS Several lifestyle and environmental factors are associated with PsA onset among patients with psoriasis. These findings indicate that such risk may be modified with lifestyle changes or avoidance of physical trauma in people with psoriasis.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Dai Gao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, West District, Beijing, China.
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165
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Ogdie A, Eder L. The need for strategies to address obesity and psoriatic arthritis prevention in psoriasis. Br J Dermatol 2020; 182:523-524. [PMID: 32107778 DOI: 10.1111/bjd.18595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - L Eder
- Women's College Hospital, University of Toronto, Toronto, ON, Canada
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166
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Rigopoulos D, Stathopoulou A, Gregoriou S. Small Molecules and Biologics in the Treatment of Nail Psoriasis. Skin Appendage Disord 2020; 6:134-141. [PMID: 32656230 DOI: 10.1159/000507298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
Nail psoriasis (PsO) is a disorder with profound impact on patients' quality of life. Several challenges and unmet needs remain in the treatment of nail PsO. Introduction of biologics and small molecules in the treatment of nail PsO has allowed for rapid control of the disease and high efficacy. The aim of this review was to present the published studies on nail PsO therapy with biologics and small molecules and illuminate the results in the studies where the design and outcome evaluation had nail PsO in the forefront.
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Affiliation(s)
- Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Stathopoulou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Gregoriou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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167
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De Marco G, Berekméri A, Coates LC, Dubash S, Emmel J, Gladman DD, Lubrano E, McGonagle DG, Mahmood F, Marchesoni A, Mason L, Ogdie A, Wittmann M, Helliwell PS, Marzo-Ortega H. Systematic literature review of non-topical treatments for early, untreated (systemic therapy naïve) psoriatic disease: a GRAPPA initiative. Rheumatol Adv Pract 2020; 4:rkaa032. [PMID: 33542971 PMCID: PMC7850142 DOI: 10.1093/rap/rkaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Psoriatic disease (PsD) is a complex systemic disorder with cutaneous and musculoskeletal manifestations. Current evidence on pharmacological interventions, effective across the spectrum of clinical manifestations of early, systemic treatment-naïve PsD, is limited. This review aims to appraise such evidence. METHODS This systematic review examined seven patient-intervention-comparator-outcome research questions to address the efficacy of the interventions on the following: across the spectrum of clinical manifestations PsD activity; peripheral arthritis; dactylitis; spondylitis; enthesitis; skin; and nails. Early PsD was defined as a disease duration of ≤2 years, except for studies investigating outcomes restricted to the skin. Eligible references were clinical trials or well-designed prospective studies/series reporting on adult humans, untreated, with cutaneous and/or musculoskeletal features of PsD. RESULTS Nine references (out of 160 319, publication range 1946-2019) fulfilled the eligibility criteria. No study adopted comprehensive (that is, simultaneous assessment of different PsD manifestations) composite indices as primary outcome measures. Individual studies reported that apremilast and biologics successfully improved outcomes (disease activity index for PsA, minimal disease activity, PsA DAS, psoriasis area and severity index, PsA response criteria) when efficacy analyses were restricted to single manifestations of untreated PsD. Only qualitative synthesis of evidence was possible, owing to the following factors: data heterogeneity (disease classification criteria, outcome measures); unavailable data subsets (focused on early, untreated PsD) at the single study level; and insufficient data on the exposure of participants to previous treatment. CONCLUSION Effective interventions, albeit limited in scope, were found for early, treatment-naïve PsD. No study provided evidence about the management of co-occurring cutaneous and musculoskeletal manifestations in early, treatment-naïve PsD. This review highlights an unmet need in research on early PsD.
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Affiliation(s)
- Gabriele De Marco
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Anna Berekméri
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
| | - Sayam Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Jenny Emmel
- Library & Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dafna D Gladman
- University of Toronto, Toronto Western Hospital and Krembil Research Institute, Toronto, Ontario, Canada
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, Italy
| | - Dennis G McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Farrouq Mahmood
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Laura Mason
- Library & Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Miriam Wittmann
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Philip S Helliwell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
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168
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Mathew AJ, Østergaard M. Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis-Status and Recent Advances. Front Med (Lausanne) 2020; 7:296. [PMID: 32695789 PMCID: PMC7338655 DOI: 10.3389/fmed.2020.00296] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Enthesitis, inflammation at the attachment sites of tendons, ligaments, fascia, and joint capsules to bones plays a critical role in the pathogenesis of spondyloarthritis (SpA), including psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) has aided in a better understanding of pathophysiology, early diagnosis, prognostication, therapeutic outcomes, and follow up of enthesitis. The concept of enthesitis as a focal insertional pathology has transformed over the past decade, with the help of MRI, to a more widespread entity involving both bone and surrounding soft tissues. The utility of MRI in the differential diagnosis of suspected enthesitis has recently been explored. With the emergence of the treat-to-target concept, and a domain-based approach in the management of SpA, objective and sensitive monitoring of response to targeted therapy becomes prudent. Properties like high sensitivity, ability to image intra-osseous pathology along with surrounding structures exemplify the utility of MRI technology. Considering the lack of a comprehensive, validated MRI score the Outcome Measures in Rheumatology (OMERACT) MRI in Arthritis Working Group, informed by a systematic literature review, developed the first international, consensus-based MRI-scoring system, combined with MRI definitions of pathologies for enthesitis in patients with spondyloarthritis (SpA) and PsA. An atlas with representative images of each grade of the scoring system was subsequently developed by the group to aid readers interested in using the heel enthesitis MRI scoring system (HEMRIS). The HEMRIS can find utility in clinical trials targeting enthesitis as the primary outcome. MRI also finds value for global assessment of the total burden of enthesitis. The concept of whole-body MRI (WBMRI), enabling visualization of entheses throughout the body using a single image is relatively new. The MRI whole-body score for inflammation in peripheral joints and entheses (MRI-WIPE) is a promising scoring system, which is undergoing further testing in clinical trials and longitudinal cohorts evaluating global measures of inflammation at entheses. This review discusses the role of MRI in diagnosis and monitoring of enthesitis in SpA and PsA, along with recent advances in the field, based on published literature.
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Affiliation(s)
- Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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169
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Meneghetti TC, Padilha TMH, Azevedo VF, Cat MNL, Sarolli BMS, de Carvalho VO. The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis. Adv Rheumatol 2020; 60:33. [PMID: 32552795 DOI: 10.1186/s42358-020-00136-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). OBJECTIVES To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. METHODS Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. RESULTS Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. CONCLUSION MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.
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Affiliation(s)
- Thaís Cugler Meneghetti
- Pediatric Rheumatology, Unit of Pediatrics at Clinics Hospital, Federal University of Paraná, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil.
| | | | - Valderílio Feijó Azevedo
- Rheumatology Division of the Department of Internal Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Mônica Nunes Lima Cat
- Statistics Unit of the Department of Pediatrics, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | - Vânia Oliveira de Carvalho
- Pediatric Dermatology Division of the Department of Pediatrics, Federal University of Paraná, Curitiba, Paraná, Brazil
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170
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Castillo R, Scher JU. Not your average joint: Towards precision medicine in psoriatic arthritis. Clin Immunol 2020; 217:108470. [PMID: 32473975 DOI: 10.1016/j.clim.2020.108470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/31/2022]
Abstract
Precision medicine, propelled by advances in multi-omics methods and analytics, aims to revolutionize patient care by using clinically-actionable molecular markers to guide diagnostic and therapeutic decisions. We describe the applications of precision medicine in risk stratification, drug selection, and treatment response prediction in psoriatic arthritis, for which targeted, personalized approaches are steadily emerging.
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Affiliation(s)
- Rochelle Castillo
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, United States of America
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY, United States of America; Psoriatic Arthritis Center, New York University School of Medicine, New York, NY, United States of America.
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171
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Zabotti A, Tinazzi I, Aydin SZ, McGonagle D. From Psoriasis to Psoriatic Arthritis: Insights from Imaging on the Transition to Psoriatic Arthritis and Implications for Arthritis Prevention. Curr Rheumatol Rep 2020; 22:24. [PMID: 32418006 PMCID: PMC7230038 DOI: 10.1007/s11926-020-00891-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To describe the recent advances in the field towards the prevention and early recognition of Psoriatic Arthritis (PsA). RECENT FINDINGS Defining the preclinical phase of PsA remains challenging since up to 50% of subjects with psoriasis have subclinical imaging enthesopathy, but many of these do not progress to PsA. Nevertheless, there is evidence that subjects with subclinical imaging enthesopathy are at increased risk of developing PsA. In recent years, it has been shown that both PsA and anti-citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA) are characterized by a subclinical phase of non-specific or brief duration arthralgia with shared imaging features accounting for joint symptomatology. Sonographically determined tenosynovitis and enthesitis are the key imaging features present in non-specific PsO arthralgia that are at risk of future PsA development. Furthermore, the early phases of PsA are complicated by factors including body mass index (BMI), which is a risk factor for PsA, but BMI is also associated with imaging abnormalities on enthesopathy. Fully disentangling these clinical and imaging factors will be important for enrichment for imminent PsA so that disease prevention strategies can be investigated. Psoriasis patients with arthralgia have a higher prevalence of tenosynovitis and imaging enthesopathy is at higher risk of transitioning to overt PsA.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Sibel Zehra Aydin
- Faculty of Medicine, Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
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Affiliation(s)
- B Kirby
- St Vincent's University Hospital and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - O Fitzgerald
- Conway Institute for Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland
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173
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Abstract
This review summarizes existing research on the gut microbiome composition and function in psoriasis and psoriatic arthritis, exploring potential roles in disease pathogenesis, progression, and management. A strong relationship between skin, joint, and gastrointestinal inflammation exists, as demonstrated by an increased prevalence of psoriasis, psoriatic arthritis, and inflammatory bowel disease co-occurring together; however, the link between them has not been fully elucidated. Studies analyzing the gut microbiome in psoriasis and psoriatic arthritis reveal a unique pattern of dysbiosis. With regard to the gut microbiome's role in psoriasis and psoriatic arthritis pathogenesis, we discuss several theories including intestinal permeability, altered immune homeostasis, and imbalance of short- and medium-chain fatty acid-producing bacteria. We also discuss how the gut microbiome affects patient risk of psoriatic arthritis and other serious comorbidities, and how fecal microbes could be used clinically as therapeutic targets or markers of disease.
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174
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Abstract
In 1973, IL-6 was identified as a soluble factor that is secreted by T cells and is important for antibody production by B cells. Since its discovery more than 40 years ago, the IL-6 pathway has emerged as a pivotal pathway involved in immune regulation in health and dysregulation in many diseases. Targeting of the IL-6 pathway has led to innovative therapeutic approaches for various rheumatic diseases, such as rheumatoid arthritis, juvenile idiopathic arthritis, adult-onset Still’s disease, giant cell arteritis and Takayasu arteritis, as well as other conditions such as Castleman disease and cytokine release syndrome. Targeting this pathway has also identified avenues for potential expansion into several other indications, such as uveitis, neuromyelitis optica and, most recently, COVID-19 pneumonia. To mark the tenth anniversary of anti-IL-6 receptor therapy worldwide, we discuss the history of research into IL-6 biology and the development of therapies that target IL-6 signalling, including the successes and challenges and with an emphasis on rheumatic diseases. In this Perspective article, the authors recount the earliest stages of translational research into IL-6 biology and the subsequent development of therapeutic IL-6 pathway inhibitors for the treatment of autoimmune rheumatic diseases and potentially numerous other indications.
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175
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Affiliation(s)
- Vinod Chandran
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Krembil Research Institute, University Health Network, Toronto, Canada
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Landini Enríquez VV, Jurado Santa-Cruz F, Peralta-Pedrero ML, Morales-Sánchez MA. Content validity of psoriatic arthritis screening questionnaires: systematic review. Int J Dermatol 2020; 59:902-914. [PMID: 32153017 DOI: 10.1111/ijd.14821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is the main entity associated with psoriasis (PsO). Consequently, several PsA screening instruments have been developed, most of them are self-administered questionnaires, known as patient-reported outcome measures (PROMs). OBJECTIVE To identify, summarize, and systematically evaluate the evidence of the content validity of PsA screening PROMs, in patients with PsO, by the dermatologist, based on COSMIN methodology. METHODS A structured literature search was performed, until June 2019, that included development and/or validation studies of a questionnaire for the screening of PsA in patients with PsO. The evaluation was based on the PROMs' development, relevance, comprehensiveness, and comprehensibility. RESULTS Eleven PROMs were included in the systematic review with four additional validation studies of the included instruments. Only ToPAS2 (Toronto Psoriatic Arthritis Screen) questionnaire had an adequate content validity. CONTEST (Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis), CEPPA (Center of Excellence for Psoriasis sand Psoriatic Arthritis), and SiPAS (Simple Psoriatic Arthritis Screening questionnaire) qualified as inadequate. CONCLUSIONS Despite the existence of eleven validated PsA screening PROMs, none were supported by very high-quality evidence of their content validity, which brings the opportunity for the creation of a new proposal PROM for the screening of PsA.
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Affiliation(s)
- Venecia V Landini Enríquez
- Universidad Nacional Autónoma de México, Mexico City, Mexico.,Research and Education Department Dermatological Center "Dr. Ladislao de la Pascua", Mexico City, Mexico
| | - Fermín Jurado Santa-Cruz
- Universidad Nacional Autónoma de México, Mexico City, Mexico.,Research and Education Department Dermatological Center "Dr. Ladislao de la Pascua", Mexico City, Mexico
| | - María L Peralta-Pedrero
- Universidad Nacional Autónoma de México, Mexico City, Mexico.,Research and Education Department Dermatological Center "Dr. Ladislao de la Pascua", Mexico City, Mexico
| | - Martha-Alejandra Morales-Sánchez
- Universidad Nacional Autónoma de México, Mexico City, Mexico.,Research and Education Department Dermatological Center "Dr. Ladislao de la Pascua", Mexico City, Mexico
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Simon D, Tascilar K, Kleyer A, Bayat S, Kampylafka E, Sokolova M, Zekovic A, Hueber AJ, Rech J, Schuster L, Engel K, Sticherling M, Schett G. Structural entheseal lesions in patients with psoriasis are associated with an increased risk of progression to psoriatic arthritis. Arthritis Rheumatol 2020; 74:253-262. [DOI: 10.1002/art.41239] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/30/2019] [Accepted: 02/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- David Simon
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Koray Tascilar
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Sara Bayat
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Eleni Kampylafka
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Maria Sokolova
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Ana Zekovic
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Institute of Rheumatology University of Belgrade 11000Belgrade Serbia
| | - Axel J Hueber
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Section Rheumatology Sozialstiftung Bamberg96049Bamberg Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Louis Schuster
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
| | - Klaus Engel
- Siemens Healthcare GmbH Digital Technology & Camp; Innovation SHS DS DTI 91052Erlangen Germany
| | - Michael Sticherling
- Department of Dermatology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
| | - Georg Schett
- Department of Internal Medicine 3 ‐ Rheumatology and Immunology Friedrich‐Alexander University (FAU) Erlangen‐Nürnberg and Universitätsklinikum Erlangen 91054Erlangen Germany
- Deutsches Zentrum fur Immuntherapie 91054Erlangen Germany
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178
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Coto P, Riestra S, Rozas P, Señaris A, Queiro R. Improving the standard of care for patients with spondyloarthritis-related immune inflammatory conditions: results of a Delphi study and proposal for early detection. Ther Adv Chronic Dis 2020; 11:2040622320904295. [PMID: 32110287 PMCID: PMC7016300 DOI: 10.1177/2040622320904295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Our objective was to provide consensus recommendations on the optimal management of the immune-mediated inflammatory diseases (IMIDs) seen in patients with spondyloarthritis (SpA) using a multidisciplinary approach, and to develop a simple tool to help earlier recognition and referral of coexisting IMIDs in patients who already have one type of IMID. Methods A total of 28 experts in the multidisciplinary management of the SpA-associated IMIDs assessed two questionnaires: one with statements focused on the multidisciplinary management of IMIDs, and a second questionnaire focused on questions useful for early recognition and referral. Panelists assessed the statements with a 9-point ordinal scale (1 = strongly disagree, 9 = strongly agree) using a modified Delphi methodology. Results Consensus was reached on 72 out of the 82 statements (87.8%). Panelists agreed that the multidisciplinary approach to IMIDs is not sufficiently developed. The creation of multidisciplinary IMID units might be necessary. These units might focus primarily on patients with two or more coexisting IMIDs, or on IMIDs that are especially complex from a diagnostic or therapeutic point of view. Specialists who attend to patients with IMIDs should perform a screening for other coexisting IMIDs. A simple tool to help earlier recognition and referral of coexisting IMIDs is proposed. Conclusions There is a need to improve care for patients with SpA-associated IMIDs. We provide expert recommendations to guide the adoption of a multidisciplinary approach for these cases, and a simple tool that may be useful for earlier recognition of coexisting IMIDs.
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Affiliation(s)
- Pablo Coto
- Dermatology Division, Hospital Vital Alvarez Buylla, Mieres-Asturias, Spain
| | - Sabino Riestra
- Gastroenterology Service, IBD Unit, Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | - Paloma Rozas
- Ophthalmology Service, Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | - Ana Señaris
- Ophthalmology Service, Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | - Rubén Queiro
- Rheumatology Division, Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), Av. Roma, s/n, Oviedo-Asturias, 33011, Spain
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Kubanov AA, Bakulev AL, Gluzmin MI, Kokhan MM, Kruglova LS, Rudneva NS, Olisova OY, Sokolovsky EV, Khobeish MM. Certolizumab pegol: new opportunities for treatment of moderate to severe plaque psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-5-50-57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Tumor necrosis factor alpha (TNF-α) is one of the key inflammatory cytokines in the pathogenesis of psoriasis and psoriatic arthritis, and its inhibition with genetically engineered biological drugs ensures control of the main symptoms of these diseases. Certolizumab pegol is a PEGylated (linked to polyethylene glycol) Fab’ fragment of a monoclonal antibody that inhibits human TNF-α. It is approved for treatment of moderate to severe plaque psoriasis and psoriatic arthritis. This review summarizes the results of randomized clinical trials of efficacy and safety of certolizumab pegol in plaque psoriasis (CIMPASI 1, CIMPASI 2, and CIMPACT) and psoriatic arthritis (Rapid-PsA). The represented data demonstrate high efficacy of certolizumab pegol is bio-naïve patients and in patients previously exposed to other TNF inhibitors or IL17 inhibitors. The absence of the Fc-fragment in certolizumab pegol ensures minimal to no placental transfer of the drug and enables its usage during the entire pregnancy.Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.
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Affiliation(s)
- A. A. Kubanov
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - A. L. Bakulev
- Saratov State Medical University named after V. I. Razumovsky, Ministry of Health of the Russian Federation
| | - M. I. Gluzmin
- Kuban State Medical University, Ministry of Health of the Russian Federation
| | - M. M. Kokhan
- Ural Research Institute for Dermatovenerology and Immunopatology
| | - L. S. Kruglova
- Central State Medical Academy, Administrative Department of the President of the Russian Federation
| | | | - O. Yu. Olisova
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - E. V. Sokolovsky
- Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation
| | - M. M. Khobeish
- Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation
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Abstract
PURPOSE OF REVIEW The therapeutic response to biologic agents in psoriasis is significantly higher than observed in psoriatic arthritis (PsA). In this review, specific actions to improve treatment outcomes in PsA are discussed. RECENT FINDINGS Increased understanding of disease pathogenesis derived from improved preclinical models and advances in cell-based and molecular technologies provide new tools to identify therapeutic targets. In addition to the important contributions of metabolic comorbidities, chronic pain and the lack of a diagnostic biomarker signal the need for new strategies to improve outcomes. Potential strategies include the following: (1) discover a novel pathway or cellular subset, (2) apply stratification biomarkers to individualize therapy, (3) preclinical intervention, (4) combination therapy, (5) lifestyle modification, (6) address chronic pain and fatigue, and (7) multidisciplinary care. The future holds great promise for enhanced treatment responses in PsA based on improved understanding of individual variation in disease pathophysiology coupled with comprehensive and integrated treatment programs.
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Affiliation(s)
- Christopher Ritchlin
- Allergy, Immunology and Rheumatology Division, Center for Musculoskeletal Research, University of Rochester Medical Center, Box 695, Rochester, NY, 14642, USA.
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology and Psoriatic Arthritis Center, New York University School of Medicine, New York, NY, USA
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181
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Frischknecht L, Vecellio M, Selmi C. The role of epigenetics and immunological imbalance in the etiopathogenesis of psoriasis and psoriatic arthritis. Ther Adv Musculoskelet Dis 2019; 11:1759720X19886505. [PMID: 31723358 PMCID: PMC6836300 DOI: 10.1177/1759720x19886505] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Psoriasis (Ps) and psoriatic arthritis (PsA) represent a clinical and immunopathogenic continuum, called psoriatic disease, cumulatively affecting approximately 3% of the general population. Psoriatic disease is a chronic inflammatory disorder affecting the skin and musculoskeletal system. The immuno-pathogenesis is characterized by an activation of the TNF/IL-23/IL-17 cytokine axis, leading to an immunologic imbalance of T-cells resident in all affected tissues, mainly entheses. In the majority of cases, skin Ps predates rheumatological manifestations. Secondary to the higher incidence and the availability of mouse models, there is stronger data available on skin Ps, and data are, in most cases, relevant also to PsA. In a widely accepted model, environmental trigger factors like infections or trauma are capable of initiating an inflammatory cascade, ultimately creating a sustained state of chronic inflammation in genetically susceptible individuals. Besides well-known genetic susceptibility loci, epigenetic DNA modifications, which are associated with Ps development have been characterized recently and will be discussed in this article. The current evidence is promising in the possibility to provide new therapeutic avenues and fill the unmet need of patients, for whom current treatments either do not allow the disease to be controlled or must be continued for life.
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Affiliation(s)
- Lukas Frischknecht
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Matteo Vecellio
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Carlo Selmi
- Rheumatology and Clinical Immunology Unit, Humanitas Clinical and Research Center-IRCCS, via A. Manzoni 56, 20089 Rozzano, Milan, Italy
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182
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Zabotti A, McGonagle DG, Giovannini I, Errichetti E, Zuliani F, Zanetti A, Tinazzi I, De Lucia O, Batticciotto A, Idolazzi L, Sakellariou G, Zandonella Callegher S, Sacco S, Quartuccio L, Iagnocco A, De Vita S. Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia. RMD Open 2019; 5:e001067. [PMID: 31749987 PMCID: PMC6827749 DOI: 10.1136/rmdopen-2019-001067] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 01/21/2023] Open
Abstract
Objective Non-specific musculoskeletal pain is common in subjects destined to develop psoriatic arthritis (PsA). We evaluated psoriatic patients with arthralgia (PsOAr) compared with psoriasis alone (PsO) and healthy controls (HCs) using ultrasonography (US) to investigate the anatomical basis for joint symptoms in PsOAr and the link between these imaging findings and subsequent PsA transition. Methods A cross-sectional prevalence analysis of clinical and US abnormalities (including inflammatory and structural lesions) in PsOAr (n=61), PsO (n=57) and HCs (n=57) was performed, with subsequent prospective follow-up for PsA development. Results Tenosynovitis was the only significant sonographic feature that differed between PsOAr and PsO (29.5% vs 5.3%, p<0.001), although synovitis and enthesitis were numerically more frequent in PsOAr. Five patients in PsOAr and one in PsO group developed PsA, with an incidence rate of 109.2/1000 person-years in PsOAr vs 13.4/1000 person-years in PsO (p=0.03). Visual Analogue Scale pain, Health Assessment Questionnaire, joint tenderness and US active enthesitis were baseline variables associated with PsA development. Conclusion Tenosynovitis was associated with arthralgia in subjects with psoriasis. Baseline US evidence of enthesitis was associated with clinical PsA development in the longitudinal analysis. These findings are relevant for enriching for subjects at risk of imminent PsA development.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Dennis G McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Enzo Errichetti
- Institute of Dermatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Francesca Zuliani
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Orazio De Lucia
- Rheumatology and Orthopedic Department, ASST-Gaetano Pini/CTO Orthopedic and Traumatology Specialist Center, Milan, Italy
| | - Alberto Batticciotto
- Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi. "Ospedale di Circolo - Fondazione Macchi", Varese, Italy
| | - Luca Idolazzi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Garifallia Sakellariou
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Stefania Sacco
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
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Ly K, Beck KM, Smith MP, Orbai AM, Liao W. Tofacitinib in the management of active psoriatic arthritis: patient selection and perspectives. PSORIASIS (AUCKLAND, N.Z.) 2019; 9:97-107. [PMID: 31696051 PMCID: PMC6717840 DOI: 10.2147/ptt.s161453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/23/2019] [Indexed: 12/30/2022]
Abstract
Tofacitinib is an oral Janus kinase inhibitor approved for the treatment of psoriatic arthritis (PsA). It provides an alternative option for patients who have had an inadequate response and tolerance to other disease modifying antirheumatic drugs (DMARDs). It has demonstrated comparable efficacy to biologics, is effective in the management of treatment resistant disease, and is reported to improve enthesitis, dactylitis, and radiographic progression. Tofacitinib is also associated with an increased risk of serious infections, malignancy, and laboratory abnormalities. There is currently a large armamentarium of therapies for psoriatic arthritis, and choosing among treatments can be challenging. Due to this wide selection, a thorough assessment of psoriatic disease phenotype, patient preference, disease presentation, and comorbidities is critical. This review addresses key considerations in patient selection for the treatment of PsA with tofacitinib.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mary P Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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184
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Kampylafka E, Simon D, d'Oliveira I, Linz C, Lerchen V, Englbrecht M, Rech J, Kleyer A, Sticherling M, Schett G, Hueber AJ. Disease interception with interleukin-17 inhibition in high-risk psoriasis patients with subclinical joint inflammation-data from the prospective IVEPSA study. Arthritis Res Ther 2019; 21:178. [PMID: 31349876 PMCID: PMC6659205 DOI: 10.1186/s13075-019-1957-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A specific subset of psoriasis patients is characterized by subclinical inflammatory changes. These patients frequently present with arthralgia and have a higher risk to develop psoriatic arthritis (PsA). We hypothesized that IL-17A inhibition in this subset of patients can intercept the link between skin and joint disease and resolves pain and inflammatory changes. METHODS Psoriasis, but no PsA, patients were included in the open prospective exploratory Interception in very early PsA (IVEPSA) study. Patients had to have nail or scalp involvement or a high psoriasis area severity index (PASI) (> 6) as well as inflammatory or erosive changes in MRI or CT. Patients received treatment with the anti-interleukin (IL)-17A antibody secukinumab over 24 weeks. Clinical assessments of skin and joint disease were done at baseline and after 12 and 24 weeks, MRI and CT at baseline and after 24 weeks. RESULTS Twenty patients were included, 85% of them reporting arthralgia and 40% had tender joints at the examination. Eighty-three percent had at least one inflammatory lesion in the MRI, most of them synovitis/enthesitis. Skin disease (PASI: p < 0.002; BSA: p < 0.003) and arthralgia (VAS pain: p < 0.003) significantly improved after 24 weeks. Total PsAMRIS (p = 0.005) and synovitis subscore (p = 0.008) also significantly improved. Erosions and enthesiophytes did not progress, while bone mass in the distal radius significantly (p = 0.020) increased after 24 weeks. CONCLUSIONS These data suggest that very early disease interception in PsA is possible leading to a comprehensive decline in skin symptoms, pain, and subclinical inflammation. IVEPSA therefore provides rationale for future early interventions with the concept to prevent the onset of PsA in high-risk individuals. TRIAL REGISTRATION Trial registry name PSARTROS; trial registry number: NCT02483234; June 26, 2015.
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Affiliation(s)
- Eleni Kampylafka
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Isabelle d'Oliveira
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christina Linz
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Veronika Lerchen
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, Friedrich-Alexander University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) and Universitaetsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Sektion Rheumatologie, Sozialstiftung Bamberg, Bamberg, Germany
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Zhang Y, Li Z, Ma Y, Mu Z. Association of total oxidant status, total antioxidant status, and malondialdehyde and catalase levels with psoriasis: a systematic review and meta-analysis. Clin Rheumatol 2019; 38:2659-2671. [DOI: 10.1007/s10067-019-04676-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
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