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Park H, Lee JH, Kwok SK, Ju JH, Kim WU, Park SH, Lee JJ. Characteristics of patients with psoriatic arthritis in Korea: focusing on axial involvement. Korean J Intern Med 2024; 39:184-193. [PMID: 38062722 PMCID: PMC10790035 DOI: 10.3904/kjim.2023.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/20/2023] [Accepted: 07/03/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND/AIMS We aimed to clarify the clinical characteristics of psoriatic arthritis (PsA) in Korean patients focusing on PsA with axial involvement. METHODS A retrospective medical chart review was performed to identify PsA patients at a single tertiary center. Cases of AS patients with psoriasis were recruited from a prospective AS registry of the same center. Demographics, laboratory findings, and radiologic characteristics were assessed. RESULTS A total of 69 PsA patients were identified. In PsA patients, spondylitis (46.4%) was the most common form. Compared to AS patients with psoriasis, PsA patients with radiographic axial involvement were older (50.9 vs. 32.4 years; p < 0.001) and showed greater peripheral disease activity (peripheral arthritis 78.1 vs. 12.5%, p < 0.001; enthesitis 50.0 vs. 6.3%, p = 0.003). AS patients with psoriasis presented a higher rate of HLA-B*27 positivity (81.3 vs. 17.2%; p < 0.001) and a more frequent history of inflammatory back pain (100.0 vs. 75.0%; p = 0.039) than PsA patients with radiographic axial involvement. Significant proportions of PsA patients with radiographic axial involvement had cervical spine involvement (10/18, 55.6%) and spondylitis without sacroiliitis (10/23, 43.5%). CONCLUSION We demonstrate that axial involvement is common in Korean PsA patients, and its characteristics can be distinct from those of AS.
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Affiliation(s)
- Hanna Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ji Hyun Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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Zahran E, Youssof A, Shehata W, Bahgat A, Elshebiny E. Predictive role of serum rheumatoid factor in different disease pattern of psoriasis and psoriatic arthritis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Psoriasis is a multisystem inflammatory disorder with variable morphology, clinical pattern and multiple comorbidities. Interplay between genetic and environmental factors leading to an aberrant immune response in the skin may contribute to disease development. The assessment for risk factors, signs, and symptoms of potential comorbid diseases is an important component of patient management. The aim of this study is to determine rheumatoid factors (RF) positivity and its levels in psoriasis patients, and describe its relationship with the demographic and clinical characteristics, comorbidities, and disease patterns of psoriasis.
Results
Rheumatoid factor was positive in psoriatic patients more than control,30% of patients had positive rheumatoid factor while only 10% of control had positive results. Rheumatoid factor level was 63.8 ± 186.7 IU/ml in psoriasis vs. 9.3 ± 12.3 in control. Thirty percent of psoriasis patients have positive rheumatoid factor vs. 10% of control. There was no significant statistical difference between psoriasis patients with or without arthritis as regard rheumatoid factor positivity and titer; rheumatoid factor was positive in 20% in psoriatic patients with arthritis vs. 26% in psoriatic patients without arthritis. In psoriatic patients, the status of rheumatoid factor did not relate to disease severity, onset, course, site of affection, presence of scalp, nail affection, and presence of dactylitis (p value>0.5).
Conclusion
Psoriasis was associated with higher seropositivity of RF compared to age-matched non-psoriatic healthy controls. Occurrence and level of rheumatoid factor were not associated with severity or clinical pattern of psoriasis.
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3
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Gazel U, Ayan G, Solmaz D, Bakirci S, Karsh J, Sampaio M, Jibri Z, Aydin SZ. Limited added value of whole spine MRI in spondyloarthritis for disease activity assessment. Clin Rheumatol 2021; 40:4909-4913. [PMID: 34189673 DOI: 10.1007/s10067-021-05837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the added value of whole spine magnetic resonance imaging (MRI) for disease activity assessment in ankylosing spondylitis (AS) and psoriatic arthritis (PsA). METHOD Spine and sacroiliac joint (SIJ) MRI scans requested by rheumatologists between 2012 and 2018 were screened retrospectively, and patients who had known diagnosis of AS or PsA were included, if the MRI was done for disease activity assessment. All MRI scans were reviewed by two experienced musculoskeletal radiologists independently, blinded to patients' diagnosis and to the other MRI. Comparisons were done for the presence of active and structural lesions. In addition, radiologists were asked to rate for "confidence level for active inflammation related to SpA." Analysis was done using the consensus scores. RESULTS Ninety patients with known diagnosis of AS (n = 55) or PsA (n = 35) were included. The frequency of active and structural lesions was not significantly different both in AS vs PsA, neither in the cervical/thoracic/lumbar spine or the SIJ. The percentage of people only with any inflammatory changes on the spine MRI without any inflammation in the SIJ MRI was 24% in AS and 23% in PsA. However, considering the confidence level of the radiologists on active inflammation, only one patient's spine MRI was scored as active, while SIJ MRI being negative for inflammation. CONCLUSIONS The spinal MRI had limited added value to the SIJ MRI in SpA, when performed to assess disease activity, limiting its value in routine practice unless clinically indicated. Key Points • Spine MRI adds limited value to SIJs in SpA, when performed for disease activity assessment. • SpA disease activity assessment may be restricted to sacroiliac joint MRI, unless clinically indicated.
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Affiliation(s)
- Ummugulsum Gazel
- Faculty of Medicine, Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada.
| | - Gizem Ayan
- Faculty of Medicine, Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada
| | - Dilek Solmaz
- Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University, Izmir, Turkey
| | - Sibel Bakirci
- Antalya Education and Research Hospital, Antalya, Turkey
| | - Jacob Karsh
- Faculty of Medicine, Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada
| | - Marcos Sampaio
- Faculty of Medicine, Radiology, University of Ottawa, 501 Smyth Rd, ON, K1H 8L6, Ottawa, Canada
| | - Zaid Jibri
- Faculty of Medicine, Radiology, University of Ottawa, 501 Smyth Rd, ON, K1H 8L6, Ottawa, Canada
| | - Sibel Zehra Aydin
- Faculty of Medicine, Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada
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Kim TJ. Biologic therapies for the treatment of psoriatic arthritis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory rheumatic disease commonly associated with plaque psoriasis that, manifests with peripheral arthritis, dactylitis, enthesitis, and axial involvement. PsA can be progressive and harmful, resulting in joint deformities, functional impairments, low quality of life, and increased mortality. It was found that both non-pharmacologic and pharmacologic treatment could improve conditions of PsA. Recently launched biological products have become the main therapeutic agents used for treating PsA unresponsive to conventional disease modifying anti-rheumatic drugs. This paper aims at introducing available biologics for PsA management in Korea. The tumor necrosis factor-α inhibitor was the first approved biological product to show outstanding efficacy for treating PsA. Ustekinumab, designed for blocking interleukin-12/23, has been approved and widely used. Interleukin-17 inhibitors such as secukinumab and ixekizumab have also been introduced to improve the symptoms of PsA. It was found that many patients with PsA experienced a dramatic improvement in their condition after using these biological products. Additionally, new immunological modulators such as phosphodiesterase inhibitors and Janus kinase inhibitors were approved for the treatment of PsA.
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Elsawy NA, Helal AMH, Abd ElHamid HA, Abdel-Fattah YH. Fibromyalgia in patients with psoriatic arthritis: Impact on disease activity indices, fatigue and health-related quality of life. Int J Rheum Dis 2020; 24:189-196. [PMID: 33073935 DOI: 10.1111/1756-185x.13987] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the frequency of fibromyalgia (FM) in patients with psoriatic arthritis (PsA) and its impact on disease activity indices, fatigue and health-related quality of life (QOL). METHODS This cross-sectional study randomly recruited patients with PsA attending an outpatient clinic between June 2017 and December 2018. Disease activity, functional ability, fatigue, and QOL were assessed for all patients. The recruited PsA patients were screened for concomitant FM, then classified into group Ι, patients with PsA only, and group ΙI, patients with FM-PsA. The severity and impact of FM were assessed for group II patients. RESULTS A total of 60 patients with PsA were assessed with a mean age of 49.30 ± 11.69 years, of which 43.3% were female. A total of 23 PsA patients had concomitant FM (38.3%). Patients with FM-PsA showed a statistically higher disease activity in all aspects of PsA except for C-reactive protein, swollen joint count (SJC) and dactylitis count. Patients in both groups had similar functional levels, while fatigue and QOL were statistically worse in patients with FM-PsA than in patients with PsA only. CONCLUSION These results might highlight the importance of considering FM as a contextual factor in disease activity assessment in patients with PsA, especially in those with discrepancies in tender joint count/patient-reported outcomes vs SJC/inflammatory markers and those with persistently high disease activity indices.
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Affiliation(s)
- Noha A Elsawy
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abdel-Moneim H Helal
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hala A Abd ElHamid
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yousra Hisham Abdel-Fattah
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Kiltz U, Sfikakis PP, Gaffney K, Sator PG, von Kiedrowski R, Bounas A, Gullick N, Conrad C, Rigopoulos D, Lespessailles E, Romanelli M, Ghislain PD, Brandt-Jürgens J, Rashkov R, Aassi M, Orsenigo R, Perella C, Pournara E, Gathmann S, Jagiello P, Veit J, Augustin M. Secukinumab Use in Patients with Moderate to Severe Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis in Real-World Setting in Europe: Baseline Data from SERENA Study. Adv Ther 2020; 37:2865-2883. [PMID: 32378070 PMCID: PMC7467439 DOI: 10.1007/s12325-020-01352-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Secukinumab, a fully human monoclonal antibody that directly inhibits interleukin-17A, has demonstrated robust efficacy in the treatment of moderate to severe psoriasis (PsO), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), with a rapid onset of action, sustained long-term clinical responses and a consistently favourable safety profile across phase 3 trials. Here, we report the clinical data at enrolment from SERENA, designed to investigate the real-world use of secukinumab across all three indications. METHODS SERENA is an ongoing, longitudinal, observational study conducted at 438 sites across Europe in patients with moderate to severe plaque PsO, active PsA or active AS. Patients should have received at least 16 weeks of secukinumab treatment before enrolment in the study. RESULTS Overall 2800 patients were included in the safety set; patients with PsA (N = 541) were older than patients with PsO (N = 1799) and patients with AS (N = 460); patients with PsO had a higher mean body weight than patients with PsA and patients with AS; and patients with PsO and patients with AS were predominantly male. Time since diagnosis was longer in patients with PsO compared with patients with PsA and patients with AS, and about 40% of patients were either current or former smokers. The proportion of obese patients (body mass index ≥ 30 kg/m2) was similar across indications. Patients were treated with secukinumab for a mean duration of 1 year prior to enrolment (range 0.89-1.04). The percentages of patients with prior biologics exposure were 31.5% PsO, 59.7% PsA and 55% AS. The percentages of patients prescribed secukinumab monotherapy were 75% (n = 1349) in PsO, 48.2% (n = 261) in PsA and 48.9% (n = 225) in AS groups. CONCLUSION Baseline demographics of the study population are consistent with existing literature. This large observational study across all secukinumab indications will provide valuable information on the long-term effectiveness and safety of secukinumab in the real-world setting.
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Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany.
- Ruhr-University Bochum, Bochum, Germany.
| | - Petros P Sfikakis
- Joint Rheumatology Programme, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Karl Gaffney
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, UK
| | | | | | | | - Nicola Gullick
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Curdin Conrad
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Dimitris Rigopoulos
- Dermatology and Venerology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marco Romanelli
- Dermatology Department, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126, Pisa, PI, Italy
| | | | | | - Rasho Rashkov
- Department of Internal Medicine, Medical University, Sofia, Bulgaria
| | | | | | | | | | | | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Hamburg, Germany
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Feld J, Chandran V, Haroon N, Inman R, Gladman D. Axial disease in psoriatic arthritis and ankylosing spondylitis: a critical comparison. Nat Rev Rheumatol 2019; 14:363-371. [PMID: 29752461 DOI: 10.1038/s41584-018-0006-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Ankylosing spondylitis (AS) was first identified in the late 17th century. 250 years later, inflammatory spine disease was recognized to be one of the patterns of psoriatic arthritis (PsA). Isolated spondylitis is rare among patients with PsA, occurring in less than 5% of patients; however, many patients with PsA have axial disease that is concurrent with peripheral arthritis. At the other end of the spondyloarthritis spectrum, psoriasis is observed in 10% of patients with AS. Although axial involvement in PsA can be indistinguishable from axial disease in AS, it can also differ in several respects, raising the question of whether axial PsA and AS (with or without psoriasis) are different clinical presentations of the same disease, or whether they are separate diseases that have overlapping features. In this Review, the clinical presentation, metrology, radiographic characteristics, genetic factors, treatment options and axial prognosis of the two diseases are addressed. The aim of this Review is to capture all available comparisons made to date, to highlight the similarities and differences between AS and axial PsA and to propose a research agenda.
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Affiliation(s)
- Joy Feld
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vinod Chandran
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nigil Haroon
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Robert Inman
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada
| | - Dafna Gladman
- Centre for Prognosis Studies in Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. .,Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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8
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Use of systemic glucocorticoids in patients with psoriatic arthritis by Argentinian and other Latin-American rheumatologists. Rheumatol Int 2019; 39:723-727. [PMID: 30830285 DOI: 10.1007/s00296-019-04266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
To analyse the administration of systemic glucocorticoids (SGC) to patients with Psoriatic arthritis (PsA). Online, anonymous, multiple-choice, closed-ended survey on SGC use in PsA, dose, duration of therapy, and the reason for administration. One hundred and twenty rheumatologists from Argentina (ARG) and 75 from other countries in Latin-America (LAT) completed the survey. Only 6% of the respondents indicated that they did not prescribe SGC, and 65% claimed that they administered them to less than 10% of their patients. Among those physicians who used SGC, 71% prescribed between 5 and 10 mg/day of prednisone, and only 5% over 10 mg/day. Seventy-three percent of the respondents administered SGC for less than 3 months, and 93% associated them with DMARDs, Biological Therapy (BT), or DMARDs plus BT. Clinical indications for SGC were (more than one option was possible): peripheral arthritis (79%), dactylitis (23%), enthesitis (20%), cutaneous involvement (11%), and axial involvement (8%). Thirty-four percent of ARG physicians versus 21% of LAT used SGC in over 10% of their patients (p 0.07) while 76.5% of ARG versus 59% of LAT administered doses higher than 5 mg/day of prednisone (p 0.01). SGC were indicated by most of the rheumatologists surveyed, but only to a reduced number of patients with PsA, at low doses, for short periods of time, associated with DMARDs/BT, and with the aim of treating peripheral joint manifestations. Argentinian physicians tended to prescribe SGC to more patients and at slightly higher doses.
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Soare A, Weber S, Maul L, Rauber S, Gheorghiu AM, Luber M, Houssni I, Kleyer A, von Pickardt G, Gado M, Simon D, Rech J, Schett G, Distler JHW, Ramming A. Cutting Edge: Homeostasis of Innate Lymphoid Cells Is Imbalanced in Psoriatic Arthritis. THE JOURNAL OF IMMUNOLOGY 2018; 200:1249-1254. [DOI: 10.4049/jimmunol.1700596] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 12/07/2017] [Indexed: 11/19/2022]
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10
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Pfeifer EC, Saxon DR, Janson RW. Etanercept-Induced Hypoglycemia in a Patient With Psoriatic Arthritis and Diabetes. J Investig Med High Impact Case Rep 2017; 5:2324709617727760. [PMID: 29721512 PMCID: PMC5917447 DOI: 10.1177/2324709617727760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 12/12/2022] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis and inflammation involving the axial skeleton and/or peripheral joints. It is more likely to be associated with metabolic syndrome and diabetes when compared with other inflammatory arthritides. Tumor necrosis factor-α (TNF-α) is one of several cytokines often elevated in rheumatologic disorders including PsA and has also been found to be elevated in patients with obesity, metabolic syndrome, diabetes, and/or atherosclerotic disease. We describe the case of a patient with PsA as well as poorly controlled type 2 diabetes mellitus who experienced not only improvement in his psoriasis and arthritis with the anti-TNF-α agent etanercept but also recurrent hypoglycemia and significant improvement in hemoglobin A1c despite discontinuation of all conventional therapy for diabetes.
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Affiliation(s)
- Emily C Pfeifer
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - David R Saxon
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Robert W Janson
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Denver Veterans Affairs Medical Center, Denver, CO, USA
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Gunes A, Gundogdu I, Mutlu M, Ozturk EA, Cakci A, Akin I. Functions of the inner ear in psoriatic arthritis. Auris Nasus Larynx 2016; 43:626-31. [PMID: 26915283 DOI: 10.1016/j.anl.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/27/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to investigate whether there is a negative impact as a result of psoriatic arthritis disease of the inner ear function. METHODS Twenty-four successive patients and 38 healthy volunteers, younger than 60 years of age, who were followed up for at least for one year in the outpatient clinics of physical therapy and rehabilitation with the diagnosis of PsA according to CASPAR criteria (17) and who did not complain of any hearing impairment were included in the study. Distortion-product otoacoustic emission (DPOAE) values between 1kHz and 4kHz, tympanometric examination results, stapes reflex values, speech reception threshold (SRT) and speech discrimination (SD) values, pure-tone values between 250 and 8000Hz and high-frequency values between 10,000, 12,500 and 16,000Hz were analyzed. Statistical comparisons between both groups were performed using chi-square test and Mann-Whitney U test. p<0.05 was accepted as the level of statistical significance. RESULTS Our study population consisted of 24 [9 male (37.5%) and 15 female (62.5%)] patients with a mean age of 47.21±11.28 (range, 28-59) years and 38 [16 male (42.1%) and 22 female (57.9%)] healthy volunteers with a mean age of 44.39±8.12 (range, 29-59) years as the control group. Mean duration of arthritis was 7.62±4.88 years. In the evaluation of hearing frequencies of the patients between 4000 and 6000Hz, a statistically significant difference was found relative to the control group (p<005). DPOAE values of the patients were analyzed within the 1000-4000Hz interval. When compared with the control group, a statistically significant difference was found at 3000 and 4000Hz (p<005). CONCLUSION Our study provides strong evidence suggesting the necessity of monitorization of these patients regarding sensorineural hearing loss so as to take measures against the development of hearing loss during early stage, which may be another disability in patients with PsA, which is itself a potential cause of severe disability.
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Affiliation(s)
- Akif Gunes
- Department of Otorhinolaryngology, Golbasi Hasvak State Hospital, Ankara, Turkey.
| | - Ibrahim Gundogdu
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Murad Mutlu
- Department of Otorhinolaryngology, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Erhan Arif Ozturk
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Aytul Cakci
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Istemihan Akin
- Department of Otorhinolaryngology, Kafkas University Medical School, Kars, Turkey
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12
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Schoels MM, Aletaha D, Alasti F, Smolen JS. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis 2015; 75:811-8. [DOI: 10.1136/annrheumdis-2015-207507] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/20/2015] [Indexed: 12/30/2022]
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13
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Cohen JM, Husni ME, Qureshi AA, Merola JF. Psoriatic arthritis: it's as easy as "PSA". J Am Acad Dermatol 2015; 72:905-6. [PMID: 25890458 DOI: 10.1016/j.jaad.2014.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/05/2014] [Accepted: 12/07/2014] [Indexed: 01/11/2023]
Affiliation(s)
| | - M Elaine Husni
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic and Cleveland Clinic Learner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Abrar A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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14
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Tezel N, Yilmaz Tasdelen O, Bodur H, Gul U, Kulcu Cakmak S, Oguz ID, Karabulut E. Is the health-related quality of life and functional status of patients with psoriatic arthritis worse than that of patients with psoriasis alone? Int J Rheum Dis 2014; 18:63-9. [PMID: 24460852 DOI: 10.1111/1756-185x.12283] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM The aim of this study was to compare the health-related quality of life and functional status of patients with psoriasis (Ps), psoriatic arthritis (PsA) and control subjects. METHOD Eighty patients with PsA, 40 patients with Ps and 40 healthy subjects were included. Physical functions were evaluated with the Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) while life satisfaction was evaluated with the Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire. The Disease Activity Score 28 (DAS28), Disease Activity Index for the Assessment of Reactive Arthritis (DAREA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Maastrich Ankylosing Spondylitis Enthesitis Score (MASES) and visual analog scale-pain were calculated. RESULTS The HAQ-S data revealed that physical functional status in the PsA group was worse than the Ps and control groups (mean scores: 0.5 ± 0.5, 0.2 ± 0.5 and 0.1 ± 0.3, respectively). The PsAQoL data revealed a worse quality of life in the PsA and Ps groups than in the control group but the same quality of life in the PsA and Ps groups (mean scores: 6.9 ± 5.4, 7 ± 5.9 and 3.3 ± 4.2, respectively). Both the HAQ-S and PsAQoL data were found to be moderately to weakly correlated with disease activity measures (DAS28, DAREA, BASDAI, ASDAS-CRP), pain and enthesitis. CONCLUSION Patients with Ps and PsA had worse quality of life and patients with PsA had worse functional status than healthy individuals. Although Ps patients with arthritis had a worse functional status than the ones without arthritis, quality of life according to PSAQoL was found to be similar between them.
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Affiliation(s)
- Nihal Tezel
- Department of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Queiro R, Alperi M, Alonso S, Riestra JL, Ballina J. Determinants of psoriatic arthritis in patients with psoriasis. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.09.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Cantini F, Niccoli L, Nannini C, Kaloudi O, Bertoni M, Cassarà E. Psoriatic arthritis: a systematic review. Int J Rheum Dis 2011; 13:300-17. [PMID: 21199465 DOI: 10.1111/j.1756-185x.2010.01540.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psoriatic arthritis is an inflammatory rheumatic disorder of unknown etiology occurring in patients with psoriasis. The Classification Criteria for Psoriatic Arthritis study group has recently developed a validated set of classification criteria for psoriatic arthritis with a sensitivity of 91.4% and a specificity of 98.7%. Three main clinical patterns have been identified: oligoarticular (≤ 4 involved joints) or polyarticular (≥ 5 involved joints) peripheral disease and axial disease with or without associated peripheral arthritis. In this context distal interphalangeal arthritis and arthritis mutilans may occur. According to other reports, also in our centre, asymmetric oligoarthritis is the most frequent pattern at onset. Axial disease has been estimated between 5% and 36% of patients. It is characterized by an irregular involvement of the axial skeleton with a predilection for the cervical spine. Recurrent episodes of enthesitis and dactylitis represent a hallmark of psoriatic arthritis. In around 20% of cases distal extremity swelling with pitting edema of the hands or feet is observed. Unilateral acute iridocyclitis, usually recurrent in alternate fashion, is the most frequent extra-articular manifestation, and accelerated atherosclerosis is the prominent comorbidity. The clinical course of peripheral and axial psoriatic arthritis is usually less severe than rheumatoid arthritis and ankylosing spondylitis, respectively. Local corticosteroid injections and non-steroidal anti-inflammatory drugs are recommended in milder forms. Sulphasalazine and methotrexate are effective in peripheral psoriatic arthritis. Recent studies have provided evidence on the efficacy of anti-tumor necrosis factor-α drugs to control symptoms and to slow or arrest radiological disease progression.
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Affiliation(s)
- Fabrizio Cantini
- 2nd Department of Internal Medicine, Rheumatology Unit, Hospital Misericordia e Dolce, Prato, Italy.
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Collamer AN, Battafarano DF. Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: clinical features and possible immunopathogenesis. Semin Arthritis Rheum 2010; 40:233-40. [PMID: 20580412 DOI: 10.1016/j.semarthrit.2010.04.003] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 04/17/2010] [Accepted: 04/26/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The induction or exacerbation of psoriasis in patients treated with tumor necrosis factor (TNF) antagonists is a well-established phenomenon. The goals of this comprehensive literature analysis were to update currently available data regarding this adverse event, to identify any clinical patterns in the cohort of reported patients, and to review the possible immunopathogenesis. METHODS A systematic literature review was performed utilizing PubMed and Medline databases (1996 to August 2009) searching the index terms "tumor necrosis factor alpha inhibitor," "TNF," "infliximab," "etanercept," "adalimumab," combined with the terms "psoriasis," "pustular," "skin," "rash," "palmoplantar," and "paradoxical." All relevant articles were reviewed. Patients who did not appear to meet accepted classification criteria for their treated disease, who had a more probable explanation or other likely diagnosis for their skin findings or known possible triggering factor for the skin eruption, including infection, were excluded from this analysis. RESULTS Two hundred seven cases met inclusion criteria for review. Of these, 43% were diagnosed with rheumatoid arthritis, 26% with seronegative spondyloarthropathy, and 20% with inflammatory bowel disease. Mean patient age was 45 years and 65% were female. Fifty-nine percent were being treated with infliximab, 22% with adalimumab, and 19% with etanercept. Lesion morphology included pustular psoriasis in 56%, plaque psoriasis in 50%, and guttate lesions in 12%; 15% experienced lesions of more than 1 type. No statistically significant predisposing factors for the development of new-onset psoriasis were found. Sixty-six percent of patients were able to continue TNF antagonist therapy with psoriasis treatments. The pathogenesis appears to involve disruption of the cytokine milieu with production of unopposed interferon-α production by plasmacytoid dendritic cells in genetically predisposed individuals. Genetic polymorphisms may play a role in this paradoxical reaction to TNF blockade. CONCLUSIONS TNF antagonist induced psoriasis is a well-described adverse event without any known predisposing risk factors. Most patients can be managed conservatively without drug withdrawal. Registry data reporting is necessary to define the true incidence and prevalence of this condition. Genomic studies of affected patients may assist with identification of predisposed patients and elucidation of the molecular trigger of this perplexing response.
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Affiliation(s)
- Angelique N Collamer
- Rheumatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA.
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Serrato VA, Azevedo VF, Sabatoski V, Gonçalves BP, Machado DM. Influenza H1N1 infection in a patient with psoriatic arthritis in treatment with Adalimumab: a case report. Clin Rheumatol 2010; 32 Suppl 1:S21-3. [PMID: 20204666 PMCID: PMC7103179 DOI: 10.1007/s10067-010-1415-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 12/23/2009] [Accepted: 02/17/2010] [Indexed: 01/13/2023]
Abstract
In March 2009 was the beginning of an epidemic flue caused by avian influenza A virus H1N1. The disease varies from mild to serious and fatal cases. There are many hypotheses explaining why this virus infection would be fatal. One of these is the impaired immune response of the infected patient. The use of tumor necrosis factor-alpha inhibitors may cause decreased immune response and greater susceptibility to infections. We presented a case of a patient using adalimumab that have developed H1N1 without complications. This is the first case of H1N1 in a patient using adalimumab reported in Brazil. We discuss the possibility that anti-TNF may not predisposes to a serious form of the disease or fatal complications.
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Affiliation(s)
- Varlei A Serrato
- Ambulatory Pain, Federal University of Paraná, Curitiba, Paraná, Brazil
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Abstract
Psoriasis and Psoriatic Arthritis (PsA) are chronic inflammatory diseases that have a major impact on health. The prevalence and incidence estimates of these two closely related diseases show ethnic and geographic variations, being generally more common in the colder north than in the tropics. In Europe the prevalence of psoriasis varies anywhere from 0.6 to 6.5%. In the USA, the estimated prevalence of diagnosed psoriasis is 3.15%. The prevalence in Africa varies depending on geographic location, being lowest in West Africa. Psoriasis is less prevalent in China and Japan than in Europe, and is entirely absent in natives of the Andean region of South America. There are fewer reports on the incidence of psoriasis, but a recent study from Rochester, USA showed an increasing trend over the last 2 decades. The prevalence of PsA also shows similar variation, being highest in people of European descent and lowest in the Japanese. Although, study methodology and case definition may explain some of the variations, genetic and environmental factors are important. Genetic epidemiologic studies have shown that both diseases have a strong genetic component. The strongest association is with HLA-Cw*06. Associations with a number of genes including IL12B and IL23R have recently been confirmed. Environmental risk factors including streptococcal pharyngitis, stressful life events, low humidity, drugs, HIV infection, trauma, smoking and obesity have been associated with psoriasis and PsA. Here we have reviewed the current literature on the epidemiology and genetics of psoriasis and PsA.
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Soriano ER, Rosa J. Update on the treatment of peripheral arthritis in psoriatic arthritis. Curr Rheumatol Rep 2009; 11:270-7. [DOI: 10.1007/s11926-009-0038-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Golicki D, Macioch T, Niewada M, Jakubczyk M, Tlustochowicz M, Owczarek W, Tlustochowicz W. TNF-alpha inhibitors for psoriatic arthritis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Dominik Golicki
- Department of Pharmacoeconomics; Medical University of Warsaw; Warsaw Poland
| | - Tomasz Macioch
- Department of Pharmacoeconomics; Medical University of Warsaw; Warsaw Poland
| | - Maciej Niewada
- Department of Clinical Pharmacology; Medical University of Warsaw; Warsaw Poland
| | - Michal Jakubczyk
- Department of Pharmacoeconomics; Medical University of Warsaw; Warsaw Poland
| | - Malgorzata Tlustochowicz
- Department of Internal Diseases and Rheumatology; Military Institute of the Health Services; Warsaw Poland
| | - Witold Owczarek
- Department of Dermatology; Military Institute of the Health Services; Warsaw Poland
| | - Witold Tlustochowicz
- Department of Internal Diseases and Rheumatology; Military Institute of the Health Services; Warsaw Poland
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Abatacept as an option therapy in difficult to treat psoriatic arthritis. Rheumatol Int 2009; 30:849-50. [DOI: 10.1007/s00296-009-1041-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 06/21/2009] [Indexed: 12/30/2022]
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Reich K, Krüger K, Mössner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol 2009; 160:1040-7. [PMID: 19210498 DOI: 10.1111/j.1365-2133.2008.09023.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Because psoriatic arthritis (PsA) usually develops years after the first manifestation of skin symptoms, in many cases the initial diagnosis of PsA depends on the dermatologist. OBJECTIVES To investigate the prevalence and clinical pattern of PsA in a daily practice population of patients with psoriasis. METHODS Patients were enrolled in an observational prospective cross-sectional cohort study at 48 community and academic centres. Demographic and medical parameters were recorded, including severity of skin symptoms (Psoriasis Area and Severity Index, PASI), previous and current treatments, concomitant diseases, and the impact of psoriasis on productivity and health-related quality of life (Dermatology Life Quality Index, DLQI). Patients with joint symptoms were referred to a rheumatologist for diagnosis and to record the activity and pattern of arthritis. RESULTS Among 1511 patients 20.6% had PsA; in 85% of the cases PsA was newly diagnosed. Of these patients more than 95% had active arthritis and 53.0% had five or more joints affected. Polyarthritis (58.7%) was the most common manifestation pattern, followed by oligoarthritis (31.6%) and arthritis mutilans (4.9%). Distal interphalangeal involvement was present in 41.0% and dactylitis in 23.7% of the patients. Compared with patients without arthritis, patients with PsA had more severe skin symptoms (mean PASI 14.3 vs. 11.5), a lower quality of life (mean DLQI 11.6 vs. 7.7) and greater impairment of productivity parameters. CONCLUSIONS The findings are consistent with a high prevalence of undiagnosed cases of active PsA among patients with psoriasis seen by dermatologists. As many of these patients also have significant skin symptoms, treatment strategies are required that are equally effective in the control of skin and joint symptoms of psoriasis.
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Affiliation(s)
- K Reich
- Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany.
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Davis JC, Mease PJ. Insights Into the Pathology and Treatment of Spondyloarthritis: From the Bench to the Clinic. Semin Arthritis Rheum 2008; 38:83-100. [DOI: 10.1016/j.semarthrit.2007.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 10/11/2007] [Accepted: 10/29/2007] [Indexed: 12/18/2022]
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Immunopathogenesis of psoriatic arthritis: Recent advances. Open Med (Wars) 2008. [DOI: 10.2478/s11536-008-0029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractPsoriatic Arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis. The pathophysiology of PsA includes genetic, environmental and immunologic factors. Recent studies revealed the dynamic role of the immune system in the pathogenesis of the disease. Adhesion molecules, proinflammatory cytokines, angiogenic factors and metalloproteinases appear to orchestrate the inflammatory response in PsA. This article summarizes the current immunologic findings and suggests future therapeutic and researching approaches in the field of PsA.
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Abstract
PURPOSE OF REVIEW Psoriatic arthritis pathogenesis is incompletely understood and the pathophysiologic role of the synovium is only beginning to be elucidated. Currently, approaches similar to those applied to rheumatoid arthritis are being applied to psoriatic arthritis synovia. RECENT FINDINGS Synovitis is being re-examined along with efforts to better characterize the clinical phenotype and improve patient stratification. The dermatological perspective brings an alternative view of autoimmunity and the role of innate immunity. A pathogenetic basis for the differing roles of skin and synovium is suggested by a landmark animal study that demonstrated a psoriasis-like skin disease coupled with a T cell and B cell dependent arthritis. The histopathology of the synovio-entheseal complex has been described. Systematic methods for evaluating synovitis have been developed and cross-sectional evaluations of psoriatic arthritis synovia in the context of other arthritides have been performed. Fresh looks at psoriatic arthritis synovia suggest similarity to rheumatoid arthritis synovia. SUMMARY Research into the pathophysiology of psoriatic arthritis is at an early, yet promising stage. Instruments are being developed to characterize and stratify psoriatic arthritis. The role of synovia remains unclear, but we now have a better understanding of the pathology of innate and adaptive immunity and are reminded that psoriatic arthritis is a systemic disease.
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Coexistence of familial Mediterranean fever and psoriasis in a patient with seronegative spondyloarthropathy. Rheumatol Int 2008; 29:107-10. [DOI: 10.1007/s00296-008-0616-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 05/13/2008] [Indexed: 12/28/2022]
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