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Kennelly JP, Xiao X, Gao Y, Kim S, Hong SG, Villanueva M, Ferrari A, Vanharanta L, Nguyen A, Nagari RT, Burton NR, Tol MJ, Becker AP, Lee MJ, Ikonen E, Backus KM, Mack JJ, Tontonoz P. Cholesterol binding to VCAM-1 promotes vascular inflammation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.17.613543. [PMID: 39345495 PMCID: PMC11429921 DOI: 10.1101/2024.09.17.613543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Hypercholesterolemia has long been implicated in endothelial cell (EC) dysfunction, but the mechanisms by which excess cholesterol causes vascular pathology are incompletely understood. Here we used a cholesterol-mimetic probe to map cholesterol-protein interactions in primary human ECs and discovered that cholesterol binds to and stabilizes the adhesion molecule VCAM-1. We show that accessible plasma membrane (PM) cholesterol in ECs is acutely responsive to inflammatory stimuli and that the nonvesicular cholesterol transporter Aster-A regulates VCAM-1 stability in activated ECs by controlling the size of this pool. Deletion of Aster-A in ECs increases VCAM-1 protein, promotes immune cell recruitment to vessels, and impairs pulmonary immune homeostasis. Conversely, depleting cholesterol from the endothelium in vivo dampens VCAM-1 induction in response to inflammatory stimuli. These findings identify cholesterol binding to VCAM-1 as a key step during EC activation and provide a biochemical explanation for the ability of excess membrane cholesterol to promote immune cell recruitment to the endothelium.
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Zhao H, Zhou Y, Wang Z, Zhang X, Chen L, Hong Z. Plasma proteins and psoriatic arthritis: a proteome-wide Mendelian randomization study. Front Immunol 2024; 15:1417564. [PMID: 39026678 PMCID: PMC11254630 DOI: 10.3389/fimmu.2024.1417564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
Background Previous epidemiological studies have identified a correlation between serum protein levels and Psoriatic Arthritis (PsA). However, the precise nature of this relationship remains uncertain. Therefore, our objective was to assess whether circulating levels of 2,923 plasma proteins are associated with the risk of PsA, utilizing the Mendelian randomization (MR) approach. Methods Two-sample MR analysis was performed to assess the causal impact of proteins on PsA risk. Exposure data for plasma proteins were sourced from a genome-wide association study (GWAS) conducted within the UK Biobank Pharma Proteomics Project, which encompassed 2,923 unique plasma proteins. The outcome data for PsA were sourced from the FinnGen study, a large-scale genomics initiative, comprising 3,537 cases and 262,844 controls. Additionally, colocalization analysis, Phenome-wide MR analysis, and candidate drug prediction were employed to identify potential causal circulating proteins and novel drug targets. Results We thoroughly assessed the association between 1,837 plasma proteins and PsA risk, identifying seven proteins associated with PsA risk. An inverse association of Interleukin-10 (IL-10) with PsA risk was observed [odds ratio (OR)=0.45, 95% confidence interval (CI), 0.28 to 0.70, P FDR=0.072]. Additionally, Apolipoprotein F (APOF) has a positive effect on PsA risk (OR=2.08, 95% CI, 1.51 to 2.86, P FDR=0.005). Subsequently, we found strong evidence indicating that IL-10 and APOF were colocalized with PsA associations (PP.H4 = 0.834 for IL-10 and PP.H4 = 0.900 for APOF). Phenome-wide association analysis suggested that these two proteins may have dual effects on other clinical traits (P FDR<0.1). Conclusion This study identified 7 plasma proteins associated with PsA risk, particularly IL-10 and APOF, which offer new insights into its etiology. Further studies are needed to assess the utility and effectiveness of these candidate proteins.
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Affiliation(s)
- Heran Zhao
- Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Third Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Zhou
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ziyan Wang
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xuan Zhang
- College of Orthopedics and Traumatology, Guangxi University of Chinese Medicine, Nanning, China
| | - Leilei Chen
- Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Third Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhinan Hong
- Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Third Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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3
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Wang Z, Lin X, Chen X, Qin D, Zhang Q, Wang H. Genetic causality and metabolite pathway identifying the relationship of blood metabolites and psoriasis. Skin Res Technol 2024; 30:e13840. [PMID: 38965811 PMCID: PMC11224122 DOI: 10.1111/srt.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease that causes significant disability. However, little is known about the underlying metabolic mechanisms of psoriasis. Our study aims to investigate the causality of 975 blood metabolites with the risk of psoriasis. MATERIALS AND METHODS We mainly applied genetic analysis to explore the possible associations between 975 blood metabolites and psoriasis. The inverse variance weighted (IVW) method was used as the primary analysis to assess the possible association of blood metabolites with psoriasis. Moreover, generalized summary-data-based Mendelian randomization (GSMR) was used as a supplementary analysis. In addition, linkage disequilibrium score regression (LDSC) was used to investigate their genetic correction further. Metabolic pathway analysis of the most suggested metabolites was also performed using MetaboAnalyst 5.0. RESULTS In our primary analysis, 17 metabolites, including unsaturated fatty acids, phospholipids, and triglycerides traits, were selected as potential factors in psoriasis, with odd ratios (OR) ranging from 0.986 to 1.01. The GSMR method confirmed the above results (β = 0.001, p < 0.05). LDSC analysis mainly suggested the genetic correlation of psoriasis with genetic correlations (rg) from 0.088 to 0.155. Based on the selected metabolites, metabolic pathway analysis suggested seven metabolic pathways including ketone body that may be prominent pathways for metabolites in psoriasis. CONCLUSION Our study supports the causal role of unsaturated fatty acid properties and lipid traits with psoriasis. These properties may be regulated by the ketone body metabolic pathway.
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Affiliation(s)
- Zhonghai Wang
- Department of CardiologyAffiliated Hospital of Southwest Jiaotong UniversityThe Third People's Hospital of ChengduChengduSichuanChina
- Department of GeriatricsNorth Sichuan Medical CollegeNanchongSichuanChina
| | - Xiuyu Lin
- Department of Information TechnologyAffiliated Hospital of Southwest Jiaotong UniversityThe Third People's Hospital of ChengduChengduSichuanChina
| | - Xin Chen
- Department of Laboratory MedicineAffiliated Hospital of Southwest Jiaotong UniversityThe Third People's Hospital of ChengduChengduSichuanChina
| | - Di‐Mao Qin
- Department of CardiologyAffiliated Hospital of Southwest Jiaotong UniversityThe Third People's Hospital of ChengduChengduSichuanChina
| | - Quan‐Bo Zhang
- Department of GeriatricsNorth Sichuan Medical CollegeNanchongSichuanChina
| | - Han Wang
- Department of CardiologyAffiliated Hospital of Southwest Jiaotong UniversityThe Third People's Hospital of ChengduChengduSichuanChina
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Bellinato F, Maurelli M, Geat D, Girolomoni G, Gisondi P. Managing the Patient with Psoriasis and Metabolic Comorbidities. Am J Clin Dermatol 2024; 25:527-540. [PMID: 38748391 PMCID: PMC11193697 DOI: 10.1007/s40257-024-00857-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 06/23/2024]
Abstract
Epidemiological data demonstrate strong associations between psoriasis and metabolic comorbidities, including obesity, hypertension, diabetes mellitus, dyslipidemia, and non-alcoholic fatty liver disease. The presence of metabolic comorbidities significantly influences the selection and effectiveness of pharmacological treatments. Some drugs should be prescribed with caution in patients with metabolic comorbidities because of an increased risk of adverse events, while others could have a reduced effectiveness. The aim of this narrative review is to highlight the challenges that healthcare professionals may face regarding the management of psoriasis in patients with metabolic comorbidities. In the first part of the article, the epidemiological association between psoriasis and metabolic comorbidities and their pathogenetic mechanisms is summarized. The second part describes the efficacy and safety profile of conventional and biologic drugs in patients with selected metabolic comorbidities including obesity, non-alcoholic fatty liver disease/hepatic steatosis, and diabetes. Finally, the role of pharmacological and non-pharmacological interventions, such as diet, alcohol abstinence, physical activity, and smoking avoidance is discussed. In conclusion, the choice of the best approach to manage patients with psoriasis with metabolic comorbidities should encompass both tailored pharmacological and individualized non-pharmacological interventions.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Davide Geat
- Department of Dermatology, Spedali Civili, Brescia, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
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Ishchenko A, Pazmino S, Neerinckx B, Lories R, de Vlam K. Comorbidities in Early Psoriatic Arthritis: Data From the Metabolic Disturbances in Psoriatic Arthritis Cohort Study. Arthritis Care Res (Hoboken) 2024; 76:231-240. [PMID: 37667975 DOI: 10.1002/acr.25230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/11/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of comorbidities and cardiovascular (CV) risk factors (RFs) in treatment-naive patients with early psoriatic arthritis (ePsA) and to identify factors that contribute to metabolic burden in ePsA. METHODS This was an observational longitudinal multicenter cohort study. Clinical and demographic characteristics, CV RFs, and comorbidities were compared in patients newly diagnosed with psoriatic arthritis (PsA) and sex- and age-matched controls. In patients with PsA, comorbidities were reevaluated after one year's follow-up because the disease activity changed. RESULTS Sixty-seven patients with ePsA and 61 healthy volunteers were included. The rate of comorbidities was similar in patients with ePsA and in healthy controls; 82.1% of patients with ePsA had CV RFs at baseline as compared with 62.3% of healthy volunteers (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.14-2.0). Patients with ePsA had higher odds of having multiple (two or more) comorbidities (OR 1.9, 95% CI 1.2-3.0) and multiple CV RFs (OR 2.1, 95% CI 1.3-3.2) than the controls. Comorbidities or CV RFs in patients with ePsA were not influenced by duration of skin psoriasis. Dyslipidemia was the most prevalent comorbidity in the PsA cohort (64.2% vs 39.3% in controls; OR 1.7, 95% CI 1.2-2.5). Patients with ePsA had, on average, above normal body mass index (mean ± SD 28.82 ± 4.5) and a higher rate of obesity (40.3% vs 18.3% in controls; OR 1.9, 95% CI 1.1-3.2). After 1 year, although disease activity scores improved, the proportion of patients with comorbidities and CV RFs did not increase or drop. CONCLUSION Our data imply that patients with PsA already have higher comorbidities and CV burden at early stages of the disease, suggesting that these are not only a consequence of long-lasting disease and chronic systemic inflammation.
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Affiliation(s)
- Alla Ishchenko
- Ziekenhuis Netwerk Atwerpen, Antwerp, and University Hospitals Leuven, Leuven, Belgium
| | - Sofia Pazmino
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Barbara Neerinckx
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Rik Lories
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Kurt de Vlam
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
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Bai R, Ren L, Guo J, Xian N, Luo R, Chang Y, Dai Y, Lei H, Zheng Y. The causal relationship between pure hypercholesterolemia and psoriasis: A bidirectional, two-sample Mendelian randomization study. Skin Res Technol 2023; 29:e13533. [PMID: 38011000 PMCID: PMC10681133 DOI: 10.1111/srt.13533] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Several studies have reported the association between pure hypercholesterolemia (PH) and psoriasis, but the causal effect remains unclear. METHODS We explored the causal effect between PH and psoriasis using two-sample bidirectional Mendelian randomization (MR) analysis using data from genome-wide association studies. Single nucleotide polymorphisms related with exposures at the genome-wide significance level (p < 5×10-8 ) and less than the linkage disequilibrium level (r2 < 0.001) were chosen as instrumental variables. Subsequently, we used inverse variance weighting (IVW), MR-Egger and weighted median (WM) methods for causal inference. p < 0.05 was considered statistically significant. Heterogeneity was tested using Cochran's Q-test, and horizontal pleiotropy was examined using the MR-Egger intercept. Leave-one-out analyses were performed to assess the robustness and reliability of the results. RESULTS MR results showed a positive causal effect of PH on psoriasis [IVW: odds ratios (OR): 1.139, p = 0.032; MR-Egger: OR: 1.434, p = 0.035; WM: OR: 1.170, p = 0.045] and psoriatic arthritis (PsA) (IVW: OR: 1.210, p = 0.049; MR-Egger regression: OR: 1.796, p = 0.033; WM: OR: 1.317, p = 0.028). However, there is no causal relationship between PH and psoriasis vulgaris as well as other unspecified psoriasis. Inverse MR results suggested a negative causal relationship between PsA and PH (IVW: OR: 0.950, p = 0.037). No heterogeneity and horizontal pleiotropy exist, and these results were confirmed to be robust. CONCLUSION PH has a positive casual effect on psoriasis and PsA, and PsA may reduce the risk of having PH.
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Affiliation(s)
- Ruimin Bai
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Landong Ren
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Jiaqi Guo
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Ningyi Xian
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Ruiting Luo
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yaxin Chang
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yilin Dai
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Hao Lei
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yan Zheng
- Department of Dermatologythe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiChina
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Madenidou AV, Mavrogeni S, Nikiphorou E. Cardiovascular Disease and Cardiac Imaging in Inflammatory Arthritis. Life (Basel) 2023; 13:life13040909. [PMID: 37109438 PMCID: PMC10143346 DOI: 10.3390/life13040909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Cardiovascular morbidity and mortality are more prevalent in inflammatory arthritis (IA) compared to the general population. Recognizing the importance of addressing this issue, the European League Against Rheumatism (EULAR) published guidelines on cardiovascular disease (CVD) risk management in IA in 2016, with plans to update going forward based on the latest emerging evidence. Herein we review the latest evidence on cardiovascular disease in IA, taking a focus on rheumatoid arthritis, psoriatic arthritis, and axial spondylarthritis, reflecting on the scale of the problem and imaging modalities to identify disease. Evidence demonstrates that both traditional CVD factors and inflammation contribute to the higher CVD burden. Whereas CVD has decreased with the newer anti-rheumatic treatments currently available, CVD continues to remain an important comorbidity in IA patients calling for prompt screening and management of CVD and related risk factors. Non-invasive cardiovascular imaging has been attracting much attention in view of the possibility of detecting cardiovascular lesions in IA accurately and promptly, even at the pre-clinical stage. We reflect on imaging modalities to screen for CVD in IA and on the important role of rheumatologists and cardiologists working closely together.
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8
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Xiao Y, Jing D, Tang Z, Peng C, Yin M, Liu H, Chen X, Shen M. Serum Lipids and Risk of Incident Psoriasis: A Prospective Cohort Study from the UK Biobank Study and Mendelian Randomization Analysis. J Invest Dermatol 2022; 142:3192-3199.e12. [PMID: 35850211 DOI: 10.1016/j.jid.2022.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/27/2022] [Accepted: 06/10/2022] [Indexed: 01/05/2023]
Abstract
The association between dyslipidemia and psoriasis has been studied widely. However, which individual indicators of serum lipids determine an increasing risk of incident psoriasis is still underappreciated in prospective cohorts. On the basis of UK Biobank, we investigate the causal relationship between four serum lipids and incident psoriasis by Cox proportional hazard model and Mendelian randomization analysis. After adjusting for covariates, high-density lipoprotein deficiency (<1.0 mmol/l for men, <1.3 mmol/l for women) and high triglyceride level (≥1.7 mmol/l) at baseline were associated with 16.6% and 10.6% increased risk of incident psoriasis, respectively. The effects were more pronounced in women, with 16.9 and 19.7% additional risk of psoriasis, respectively. The effects in the younger group (aged <60 years) and obese group in women were also more pronounced. No similar effect was observed in low-density lipoprotein and total cholesterol. Our subsequent Mendelian randomization analysis reinforced the main finding that high-density lipoprotein deficiency and high triglyceride cause incident psoriasis genetically. In conclusion, serum high-density lipoprotein/triglyceride levels predict psoriasis, particularly in women, indicating a distinct role of lipids engaging in the pathogenesis of psoriasis modified by sex. More metabolic-targeted, sex-specific management of psoriasis is suggested in the future.
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Affiliation(s)
- Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Danrong Jing
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenwei Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Cong Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Mingzhu Yin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
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9
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Abstract
Spondyloarthropathies, also known as spondyloarthritis, encompasses a spectrum of diseases classified by it's axial and peripheral musculoskeletal manifestations. Extra-articular features are common in SpA making these systemic rheumatologic diseases involve the skin, eye, gut, and other organ systems.Research has identified risk factors for the development of spondyloarthritis, particularly regarding genetic susceptibility and the strong association with HLA-B27. Multiple studies have elucidated clinical risk factors associated with SpA disease activity and severity. In this review, we aim to explore the environmental risk factors for spondyloarthritis.
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Affiliation(s)
- Yvette Farran
- Division of Rheumatology, Department of Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at The University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX 77030, USA
| | - John Reveille
- Division of Rheumatology, Department of Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at The University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX 77030, USA
| | - Mark Hwang
- Division of Rheumatology, Department of Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at The University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX 77030, USA.
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10
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Yao L, D'Agostino GD, Park J, Hang S, Adhikari AA, Zhang Y, Li W, Avila-Pacheco J, Bae S, Clish CB, Franzosa EA, Huttenhower C, Huh JR, Devlin AS. A biosynthetic pathway for the selective sulfonation of steroidal metabolites by human gut bacteria. Nat Microbiol 2022; 7:1404-1418. [PMID: 35982310 DOI: 10.1038/s41564-022-01176-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 06/20/2022] [Indexed: 12/13/2022]
Abstract
Members of the human gut microbiome enzymatically process many bioactive molecules in the gastrointestinal tract. Most gut bacterial modifications characterized so far are hydrolytic or reductive in nature. Here we report that abundant human gut bacteria from the phylum Bacteroidetes perform conjugative modifications by selectively sulfonating steroidal metabolites. While sulfonation is a ubiquitous biochemical modification, this activity has not yet been characterized in gut microbes. Using genetic and biochemical approaches, we identify a widespread biosynthetic gene cluster that encodes both a sulfotransferase (BtSULT, BT0416) and enzymes that synthesize the sulfonate donor adenosine 3'-phosphate-5'-phosphosulfate (PAPS), including an APS kinase (CysC, BT0413) and an ATP sulfurylase (CysD and CysN, BT0414-BT0415). BtSULT selectively sulfonates steroidal metabolites with a flat A/B ring fusion, including cholesterol. Germ-free mice monocolonized with Bacteroides thetaiotaomicron ΔBT0416 exhibited reduced gastrointestinal levels of cholesterol sulfate (Ch-S) compared with wild-type B. thetaiotaomicron-colonized mice. The presence of BtSULT and BtSULT homologues in bacteria inhibited leucocyte migration in vitro and in vivo, and abundances of cluster genes were significantly reduced in patients with inflammatory bowel disease. Together, these data provide a mechanism by which gut bacteria sulfonate steroidal metabolites and suggest that these compounds can modulate immune cell trafficking in the host.
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Affiliation(s)
- Lina Yao
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Gabriel D D'Agostino
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Jinseok Park
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Saiyu Hang
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Arijit A Adhikari
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Yancong Zhang
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Wei Li
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | | | - Sena Bae
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Eric A Franzosa
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Curtis Huttenhower
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jun R Huh
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - A Sloan Devlin
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
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11
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Piaserico S, Orlando G, Messina F. Psoriasis and Cardiometabolic Diseases: Shared Genetic and Molecular Pathways. Int J Mol Sci 2022; 23:9063. [PMID: 36012327 PMCID: PMC9409274 DOI: 10.3390/ijms23169063] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
A convincing deal of evidence supports the fact that severe psoriasis is associated with cardiovascular diseases. However, the precise underlying mechanisms linking psoriasis and cardiovascular diseases are not well defined. Psoriasis shares common pathophysiologic mechanisms with atherosclerosis and cardiovascular (CV) risk factors. In particular, polymorphism in the IL-23R and IL-23 genes, as well as other genes involved in lipid and fatty-acid metabolism, renin-angiotensin system and endothelial function, have been described in patients with psoriasis and with cardiovascular risk factors. Moreover, systemic inflammation in patients with psoriasis, including elevated serum proinflammatory cytokines (e.g., TNF-α, IL-17, and IL-23) may contribute to an increased risk of atherosclerosis, hypertension, alteration of serum lipid composition, and insulin resistance. The nonlinear and intricate interplay among various factors, impacting the molecular pathways in different cell types, probably contributes to the development of psoriasis and cardiovascular disease (CVD). Future research should, therefore, aim to fully unravel shared and differential molecular pathways underpinning the association between psoriasis and CVD.
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Affiliation(s)
- Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padua, Via V. Gallucci 4, 35128 Padua, Italy
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12
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Orlando G, Molon B, Viola A, Alaibac M, Angioni R, Piaserico S. Psoriasis and Cardiovascular Diseases: An Immune-Mediated Cross Talk? Front Immunol 2022; 13:868277. [PMID: 35686132 PMCID: PMC9170986 DOI: 10.3389/fimmu.2022.868277] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Psoriasis is a chronic immune-mediated inflammatory skin disease, characterized by well-demarcated scaly, erythematous, infiltrated plaques. The cutaneous-to-systemic expansion of the inflammation in psoriasis leads to the concept of “psoriatic march” or “inflammatory skin march”. Accordingly, psoriasis is thought to be a systemic inflammatory disease associated with numerous comorbidities. Indeed, it’s currently considered an independent risk factor for cardiovascular diseases. Here, we discuss the current knowledge on TNF-α and IL-23/IL-17 mediated pathways linking the psoriatic plaque to the cardiovascular compartment. We further argue the possible involvement of the endothelial compartment in the psoriatic plaque- cardiovascular system crosstalk.
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Affiliation(s)
- Gloria Orlando
- Unit of Dermatology, Department of Medicine - DIMED, University of Padova, Padova, Italy.,Department of Biomedical Sciences - DSB, University of Padova, Padova, Italy
| | - Barbara Molon
- Department of Biomedical Sciences - DSB, University of Padova, Padova, Italy.,Istituto di Ricerca Pediatrica, Città della Speranza - IRP, Padova, Italy
| | - Antonella Viola
- Department of Biomedical Sciences - DSB, University of Padova, Padova, Italy.,Istituto di Ricerca Pediatrica, Città della Speranza - IRP, Padova, Italy
| | - Mauro Alaibac
- Unit of Dermatology, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Roberta Angioni
- Department of Biomedical Sciences - DSB, University of Padova, Padova, Italy.,Istituto di Ricerca Pediatrica, Città della Speranza - IRP, Padova, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine - DIMED, University of Padova, Padova, Italy
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13
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Cherni I, Nouir R, Ghalila H, Somaï M, Daoued F, Aydi Z, Hamzaoui S, Boussema F, Jaïdane N. Non-invasive and rapid diagnosis of type 2 diabetes mellitus based on the analysis of hair by front-face fluorescence spectroscopy. APPLIED OPTICS 2022; 61:4022-4029. [PMID: 36256075 DOI: 10.1364/ao.454245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/02/2022] [Indexed: 06/16/2023]
Abstract
Rapid and early detection of pathologies for screening purposes is not always easy with traditional methods. New low-cost optical techniques that are suitable for preventive detection and, more specifically, for developing countries must be developed. The objective of this work is to propose UV-VIS fluorescence of hair as a promising technique for a simple and rapid preliminary diagnosis of type II diabetes. In this work, we analyzed 130 hair samples taken from volunteers of different ages at the Habib Thameur Hospital in Tunis, Tunisia. These samples were analyzed clinically beforehand, and 50 were classified as healthy acting as a control, 24 were classified as low-level diabetics with a glycated hemoglobin A1C (HbA1c) <7%, and the other 56 were classified as high-level diabetics having an HbA1c >7%. The fluorescence of the patients' hair led to several interesting results. Indeed, a clear discrimination was obtained not only between the healthy and patients with a disease, but also a discrimination between diabetics with low levels and high levels or diabetics with and without complication. Also, a strong correlation between fluorescence spectra and glycated HbA1c for the diabetic population was clearly established. A linear discriminant analysis shows that it is possible to predict the status of test patients after having trained a fraction of the population. All these results show the ability of the front-face fluorescence (FFF) technique to detect disease and predict advanced states simply by capturing the fluorescence of the hair illuminated by a single LED. This work shows for the first time, to our knowledge, the capability of the FFF technique on hair samples for the diagnosis of diabetes.
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14
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Ogdie A, Shin DB, Love TJ, Gelfand JM. Body surface area affected by psoriasis and the risk for psoriatic arthritis: a prospective population-based cohort study. Rheumatology (Oxford) 2022; 61:1877-1884. [PMID: 34508558 PMCID: PMC9071556 DOI: 10.1093/rheumatology/keab622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Increasing psoriasis severity has been associated with comorbidities including cardiovascular disease. The objective of this study was to examine the association of psoriasis severity with the development of PsA. METHODS A prospective population-based cohort study was performed within The Health Improvement Network, a UK medical record database. Patients aged 25-60 years with a code for psoriasis were randomly selected between 2008 and 2011. Questionnaires were sent to their general practitioners to confirm the diagnosis of psoriasis and provide the patient's approximate body surface area (BSA). Incidence of PsA was calculated by BSA, and Cox proportional hazard ratios were used to examine the risk of developing PsA by BSA category after adjusting for other covariates. RESULTS Among 10 474 questionnaires sent, 9987 (95%) were returned, 9069 (91%) had confirmed psoriasis, and BSA was provided for 8881 patients: 52% had mild psoriasis, 36% moderate psoriasis and 12% severe psoriasis. The mean age was 46, and 49% were female. Mean follow-up time was 4.2 years (s.d. 2.1); the incidence of PsA was 5.4 cases per 1000 person-years. After adjusting for age and sex, BSA >10% [hazard ratio (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3-10% (HR 1.44, 95% CI: 1.02, 2.03), obesity (HR 1.64, 95% CI: 1.19, 2.26) and depression (HR 1.68, 95% CI: 1.21, 2.33) were associated with incident PsA. CONCLUSIONS In this large prospective cohort study, BSA assessed by general practitioners was a strong predictor of developing PsA, and obesity and depression were additive risk factors.
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Affiliation(s)
- Alexis Ogdie
- Departments of Medicine/Rheumatology
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thorvardur Jon Love
- Department of Medicine, University of Iceland and Landspitali, Reykjavik, Iceland
| | - Joel M Gelfand
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Obesity and Dyslipidemia Synergistically Exacerbate Psoriatic Skin Inflammation. Int J Mol Sci 2022; 23:ijms23084312. [PMID: 35457132 PMCID: PMC9032572 DOI: 10.3390/ijms23084312] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 01/27/2023] Open
Abstract
Patients with psoriasis are frequently complicated with metabolic syndrome; however, it is not fully understood how obesity and dyslipidemia contribute to the pathogenesis of psoriasis. To investigate the mechanisms by which obesity and dyslipidemia exacerbate psoriasis using murine models and neonatal human epidermal keratinocytes (NHEKs), we used wild-type and Apoe-deficient dyslipidemic mice, and administered a high-fat diet for 10 weeks to induce obesity. Imiquimod was applied to the ear for 5 days to induce psoriatic dermatitis. To examine the innate immune responses of NHEKs, we cultured and stimulated NHEKs using IL-17A, TNF-α, palmitic acid, and leptin. We found that obesity and dyslipidemia synergistically aggravated psoriatic dermatitis associated with increased gene expression of pro-inflammatory cytokines and chemokines. Treatment of NHEKs with palmitic acid and leptin amplified pro-inflammatory responses in combination with TNF-α and IL-17A. Additionally, pretreatment with palmitic acid and leptin enhanced IL-17A-mediated c-Jun N-terminal kinase phosphorylation. These results revealed that obesity and dyslipidemia synergistically exacerbate psoriatic skin inflammation, and that metabolic-disorder-associated inflammatory factors, palmitic acid, and leptin augment the activation of epidermal keratinocytes. Our results emphasize that management of concomitant metabolic disorders is essential for preventing disease exacerbation in patients with psoriasis.
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16
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Harris HR, Korkes KMN, Li T, Kvaskoff M, Cho E, Carvalho LF, Qureshi AA, Abrao M, Missmer SA. Endometriosis, Psoriasis, and Psoriatic Arthritis: A Prospective Cohort Study. Am J Epidemiol 2022; 191:1050-1060. [PMID: 35029650 PMCID: PMC9393059 DOI: 10.1093/aje/kwac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/16/2023] Open
Abstract
Endometriosis, psoriasis, and psoriatic arthritis (PsA) are chronic inflammatory disorders whose etiologies remain poorly understood but may be correlated, as endometriosis has been associated with other inflammatory disorders. We investigated the bidirectional associations between laparoscopically confirmed endometriosis and physician-diagnosed psoriasis and PsA in the Nurses' Health Study II cohort (n = 116,429, United States, 1991-2013). We confirmed 4,112 incident cases of laparoscopically confirmed endometriosis (mean age at diagnosis = 40.3 years) and 697 validated physician-diagnosed cases of psoriasis (mean age at diagnosis = 43.6 years), 110 of which presented with concomitant PsA. A history of psoriasis with concomitant PsA was associated with a 2-fold higher risk of endometriosis (hazard ratio (HR) = 2.01, 95% CI: 1.23, 3.30); however, no association was observed between psoriasis without PsA and endometriosis risk (HR = 0.93, 95% CI: 0.68, 1.26). When endometriosis was the exposure, it was not associated with a risk of subsequent psoriasis (HR = 1.28, 95% CI: 0.95, 1.72). The risk of psoriasis with PsA was notably higher; however, the sample size was small and the confidence intervals wide (HR = 1.77, 95% CI: 0.89, 3.52). Our findings suggest that psoriasis with concomitant PsA is associated with greater risk of laparoscopically confirmed endometriosis. In addition, there was a suggestive association between endometriosis diagnosis and subsequent risk of psoriasis with PsA.
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Affiliation(s)
- Holly R Harris
- Correspondence to Dr. Holly Harris, Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., M4-B859, Seattle, WA 98109-1024 (e-mail: )
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Psoriasis and Atherosclerosis-Skin, Joints, and Cardiovascular Story of Two Plaques in Relation to the Treatment with Biologics. Int J Mol Sci 2021; 22:ijms221910402. [PMID: 34638740 PMCID: PMC8508744 DOI: 10.3390/ijms221910402] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023] Open
Abstract
It is known that both psoriasis (PSO) limited to the skin and psoriatic arthritis (PSA) increase the risk of cardiovascular complications and atherosclerosis progression by inducing systemic inflammatory response. In recent decades, the introduction of biological medications directed initially against TNF-α and, later, different targets in the inflammatory cascade brought a significant breakthrough in the efficacy of PSO/PSA treatment. In this review, we present and discuss the most recent findings related to the interplay between the genetics and immunology mechanisms involved in PSO and PSA, atherosclerosis and the development of cardiac dysfunction, as well as the current PSO/PSA treatment in view of cardiovascular safety and prognosis.
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18
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Karmacharya P, Chakradhar R, Ogdie A. The epidemiology of psoriatic arthritis: A literature review. Best Pract Res Clin Rheumatol 2021; 35:101692. [DOI: 10.1016/j.berh.2021.101692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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19
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Rai S, Bhatia V, Bhatnagar S. Drug repurposing for hyperlipidemia associated disorders: An integrative network biology and machine learning approach. Comput Biol Chem 2021; 92:107505. [PMID: 34030115 DOI: 10.1016/j.compbiolchem.2021.107505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 12/31/2022]
Abstract
Hyperlipidemia causes diseases like cardiovascular disease, cancer, Type II Diabetes and Alzheimer's disease. Drugs that specifically target HL associated diseases are required for treatment. 34 KEGG pathways targeted by lipid lowering drugs were used to construct a directed protein-protein interaction network and driver nodes were determined using CytoCtrlAnalyser plugin of Cytoscape 3.6. The involvement of driver nodes of HL in other diseases was verified using GWAS. The central nodes of the network and 34 overrepresented pathways had a critical role in Hyperlipidemia. The PI3K-AKT signalling pathway, non-essentiality, non-centrality and approved drug target status were the predominant features of the driver nodes. Next, a Random Forest classifier was trained on 1445 molecular descriptors calculated using PaDEL for 50 approved lipid lowering and 84 lipid raising drugs as the positive and negative training set respectively. The classifier showed average accuracy of 76.8 % during 5-fold cross validation with AUC of 0.79 ± 0.06 for the ROC curve. The classifier was applied to select molecules with favourable properties for lipid lowering from the 130 approved drugs interacting with the identified driver nodes. We have integrated diverse network data and machine learning to predict repurposing of nine drugs for treatment of HL associated diseases.
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Affiliation(s)
- Sneha Rai
- Computational and Structural Biology Laboratory, Division of Biotechnology, Netaji Subhas Institute of Technology, Dwarka, New Delhi, 110078, India; Department of Biotechnology, Noida Institute of Engineering and Technology, Greater Noida, India
| | - Venugopal Bhatia
- Computational and Structural Biology Laboratory, Division of Biotechnology, Netaji Subhas Institute of Technology, Dwarka, New Delhi, 110078, India
| | - Sonika Bhatnagar
- Computational and Structural Biology Laboratory, Division of Biotechnology, Netaji Subhas Institute of Technology, Dwarka, New Delhi, 110078, India; Computational and Structural Biology Laboratory, Department of Biological Sciences and Engineering, Netaji Subhas University of Technology Dwarka, New Delhi 110078, India.
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Karamani C, Antoniadou IT, Dimou A, Andreou E, Kostakis G, Sideri A, Vitsos A, Gkavanozi A, Sfiniadakis I, Skaltsa H, Papaioannou GT, Rallis MC, Maibach H. Optimization of psoriasis mouse models. J Pharmacol Toxicol Methods 2021; 108:107054. [PMID: 33775808 DOI: 10.1016/j.vascn.2021.107054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Psoriasis, is a common, chronic, autoimmune, inflammatory, relapsing disease, which would benefit from reliable and human-relevant animal models to test drugs pre-clinically and to understand their mechanism of action. Because of its ease of use, convenience and low cost, the imiquimod (IMQ)-induced psoriasis-like model is widely utilized; however, it is not known whether all mouse strains are equivalent and if the hairless mouse is appropriate, so that the imiquimod model can be further optimized. METHODS Under similar experimental conditions, common mouse strains (BALB/c, C57BL/6J, and ApoE) and a new hairless strain (ApoE/SKH-hr2) as well as several inducers (IMQ, IMQ + acetic acid (AcOH) topical and IMQ + AcOH systemic) were compared by clinical, histopathological, biophysical and locomotor activity assessments. RESULTS AND DISCUSSION The BALB/c mice yielded an optimal psoriasis-like phenotype with IMQ + AcOH topical treatment, and the corresponding phenotypes for the other mouse strains were C57BL/6J moderate and ApoE mild. In contrast, the ApoE/SKH-hr2 mice, as a result of the absence of a Munro abscess in the histopathology analysis, left doubt about the psoriasis-like acquisition. Locomotor activity of BALB/c mice treated with IMQ, IMQ + AcOH topically and IMQ + AcOH systemically showed decreased distance and rearing coverage and increased immobility with all treatments. Hence, the BALB/c mouse strain appears to be an optimal psoriasis-like model when utilizing IMQ + AcOH topical application.
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Affiliation(s)
- Christina Karamani
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Ivi Theodosia Antoniadou
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Aikaterini Dimou
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Evgenia Andreou
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Georgios Kostakis
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Asimina Sideri
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Andreas Vitsos
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Athena Gkavanozi
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | | | - Helen Skaltsa
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmacognosy and Chemistry of Natural Products, Panepistimiopolis, 15784 Athens, Greece
| | - Georgios Theodoros Papaioannou
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece
| | - Michail Christou Rallis
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Pharmacy, Section of Pharmaceutical Technology, Panepistimiopolis, 15784 Athens, Greece.
| | - Howard Maibach
- Department of Dermatology, University of California, San Francisco, 2340 Sutter Street, San Francisco, CA 94115, USA
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21
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Chronic Systemic Inflammatory Skin Disease as a Risk Factor for Cardiovascular Disease. Curr Probl Cardiol 2021; 46:100799. [PMID: 33607473 DOI: 10.1016/j.cpcardiol.2021.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 11/24/2022]
Abstract
Chronic systemic skin disease and cardiovascular disease are multisystem disorders which have been associated with each other for centuries. Recent research has strengthened this association, particularly in systemic inflammatory disease. Here we explore the current literature on psoriasis, hidradenitis suppurativa, lupus erythematosus, acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. Psoriasis is a chronic inflammatory disorder that has been labeled as a risk-modifier for hyperlipidemia and coronary artery disease by the American College of Cardiology ACC lipid guidelines. Cardiovascular disease is also found at a significantly higher rate in patients with hidradenitis suppurativa and lupus erythematosus. Some associations have even been noted between cardiovascular disease and acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. While many of these associations have been attributed to a shared underlying disease process such as chronic systemic inflammation and shared underlying risk factors, these dermatologic manifestations can help to identify patients at higher risk for cardiovascular disease.
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22
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Aksentijevich M, Lateef SS, Anzenberg P, Dey AK, Mehta NN. Chronic inflammation, cardiometabolic diseases and effects of treatment: Psoriasis as a human model. Trends Cardiovasc Med 2020; 30:472-478. [PMID: 31837960 PMCID: PMC7428846 DOI: 10.1016/j.tcm.2019.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/22/2019] [Accepted: 11/02/2019] [Indexed: 01/25/2023]
Abstract
Chronic inflammation in humans is associated with accelerated development of cardiometabolic diseases such as myocardial infarction, stroke, and diabetes. Strong evidence from animal models and human interventional trials including CANTOS (The Canakinumab Anti-inflammatory Thrombosis Outcome Study) suggests that targeting residual systemic inflammation in humans may impart a benefit in reducing cardiometabolic diseases. Diseases associated with heightened immune-activation and systemic inflammation including psoriasis, rheumatoid arthritis, systemic lupus erythematosus, and human immunodeficiency virus infection are associated with upwards of two to seven-fold risk of future adverse cardiac events even when adjusted for traditional risk factors. Over the past decade, psoriasis has been utilized as a human model to study inflammatory-induced cardiometabolic dysfunction and to better understand residual risk due to inflammation. The high prevalence and early onset of cardiovascular disease in psoriasis enhances the likelihood of discovering novel pathways in vascular disease progression when followed over time. Furthermore, the United States Food and Drug Administration approved treatments for psoriasis include cytokine inhibitors (anti-tumor necrosis factor, anti-interleukin 17, anti-interleukin 12/23) which while treating the skin disease provide a unique opportunity to characterize how treating the inflammatory pathways may impact atherosclerosis. Herein, we provide a review of chronic inflammation, cardiometabolic disease associations, and treatment effects with a focus on psoriasis as a human model of study.
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Affiliation(s)
- Milena Aksentijevich
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Sundus S Lateef
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Paula Anzenberg
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Amit K Dey
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Nehal N Mehta
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA.
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Dai YX, Shen YJ, Chou YJ, Chang YT, Chen TJ, Li CP, Wu CY. Obesity, but Not Metabolic Diseases, Is Associated with Risk of Psoriasis: A Population-Based Cohort Study in Taiwan. Dermatology 2020; 236:521-528. [DOI: 10.1159/000508303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/29/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Obesity and metabolic diseases including diabetes, hyperlipidemia, and hypertension are reportedly associated with an increased risk of psoriasis. However, few prospective studies have investigated the association of obesity and metabolic diseases with the risk of psoriasis. <b><i>Objective:</i></b> To examine whether obesity or metabolic diseases increase the risk of psoriasis. <b><i>Methods:</i></b> Participants were collected from 4 rounds (2001, 2005, 2009, and 2013) of the Taiwan National Health Interview Survey. Incident cases of psoriasis were identified from the National Health Insurance database. Participants were followed from the time of the National Health Interview Survey interview until December 31, 2017, or until a diagnosis of psoriasis was made or the participant died. The Cox regression model was used for the analyses. <b><i>Results:</i></b> Of 60,136 participants, 406 developed psoriasis during 649,506 person-years of follow-up. Compared to participants with a BMI of 18.5–22.9, the adjusted hazard ratios (aHR) of psoriasis were 1.34 (95% CI 1.05–1.71) for a BMI of 25.0–29.9 and 2.70 (95% CI 1.95–3.72) for a BMI ≥30. Neither individual nor multiple metabolic diseases were associated with incident psoriasis. Participants with a BMI ≥30 were at significantly higher risk of both psoriasis without arthritis (aHR 2.60; 95% CI 1.85–3.67) and psoriatic arthritis (aHR 3.96; 95% CI 1.45–10.82). <b><i>Conclusion:</i></b> Obesity, but not metabolic diseases, significantly increased the risk of psoriasis.
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24
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Szentpetery A, Haroon M, FitzGerald O. Cardiovascular Comorbidities in Psoriatic Disease. Rheumatol Ther 2020; 7:5-17. [PMID: 31813119 PMCID: PMC7021890 DOI: 10.1007/s40744-019-00185-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
Psoriatic disease (PsD) is a multisystem inflammatory disorder with a high prevalence of cardiovascular (CV) risk factors contributing to accelerated atherosclerosis and its sequelae. Imaging studies, notably with ultrasound, computed tomography, and positron emission tomography (PET) scanning have confirmed significant atherosclerotic change with plaque formation and vessel stenosis. Atherosclerosis is likely driven by a combination of traditional risk factors which occur more frequently in PsD and by systemic inflammation with associated pro-inflammatory cytokine production. While the mechanisms driving atherosclerosis in PsD are incompletely understood, it is now best practice to try to minimize the impact of CV risk factors by regular assessment, prevention, and treatment and also by ensuring that inflammatory musculoskeletal and cutaneous disease is adequately suppressed. Future studies need to focus on improving our understanding of the mechanisms driving atherosclerosis and, as a consequence, developing more rationale approaches to prevention and treatment.
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Affiliation(s)
- Agnes Szentpetery
- Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
| | - Muhammad Haroon
- Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland.
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25
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Gisondi P, Bellinato F, Girolomoni G, Albanesi C. Pathogenesis of Chronic Plaque Psoriasis and Its Intersection With Cardio-Metabolic Comorbidities. Front Pharmacol 2020; 11:117. [PMID: 32161545 PMCID: PMC7052356 DOI: 10.3389/fphar.2020.00117] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Psoriasis is a chronic, systemic immune-mediated disease characterized by development of erythematous, indurated, scaly, pruritic plaques on the skin. Psoriasis is frequently associated to comorbidities, including psoriatic arthritis, cardiovascular diseases, diabetes mellitus, obesity, non-alcoholic fatty liver disease, and inflammatory bowel diseases. In this review, we discuss the pathophysiological relationship between psoriasis and cardio-metabolic comorbidities and the importance of therapeutic strategies to reduce systemic inflammation in patients with moderate-to-severe psoriasis. Pathogenesis of psoriasis and its comorbidities share both genetic predisposition and inflammatory pathways, which include the TNFα and the IL-23/IL-17 pathways. These pathways are selectively addressed by biological treatments, which have substantially changed the outcomes of psoriasis therapy and affect positively comorbidities including reducing cardiovascular risk, allowing a more comprehensive approach to the patient.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Cristina Albanesi
- Laboratory of Experimental Immunology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
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Misitzis A, Cunha PR, Kroumpouzos G. Skin disease related to metabolic syndrome in women. Int J Womens Dermatol 2019; 5:205-212. [PMID: 31700973 PMCID: PMC6831757 DOI: 10.1016/j.ijwd.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
Sex hormones are involved in pathways of metabolic syndrome (MetS), an observation supported by animal studies. The relationships of sex hormones with components of MetS, such as insulin resistance and dyslipidemia, have been studied in pre- and postmenopausal women. High testosterone, low sex hormone-binding globulin, and low estrogen levels increase the risks of MetS and type 2 diabetes in women. Cutaneous diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance and increased risk for MetS. Furthermore, inflammatory skin conditions, such as hidradenitis suppurativa and psoriasis, increase the risk for MetS. Patients with such skin conditions should be followed for metabolic complications, and early lifestyle interventions toward these populations may be warranted.
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Affiliation(s)
- Angelica Misitzis
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paulo R Cunha
- Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts
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27
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Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol 2019; 15:153-166. [DOI: 10.1038/s41584-019-0175-0] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Solmaz D, Eder L, Aydin SZ. Update on the epidemiology, risk factors, and disease outcomes of psoriatic arthritis. Best Pract Res Clin Rheumatol 2018; 32:295-311. [PMID: 30527433 DOI: 10.1016/j.berh.2018.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/21/2018] [Accepted: 09/09/2018] [Indexed: 02/08/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects different structures of the musculoskeletal system in addition to the skin and the nail. The complexity of the disease had been a barrier to understand the pathogenesis and define valid outcome tools; however, our understanding about the disease has considerably increased with time mainly because of the advances in imaging, new discoveries in genetics and underlying inflammatory pathways, and better understanding of the epidemiology of the disease and environmental risk factors. The purpose of this review is to summarize developments and changes in epidemiology, risk factors for developing PsA, and outcome measures with a focus on data obtained in the last 10 years.
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Affiliation(s)
- Dilek Solmaz
- Division of Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada; Izmir Katip Celebi University, Izmir, Turkey.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, The Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sibel Zehra Aydin
- Division of Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada; The Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada.
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Brandon TG, Manos CK, Xiao R, Ogdie A, Weiss PF. Pediatric psoriatic arthritis: a population-based cohort study of risk factors for onset and subsequent risk of inflammatory comorbidities. ACTA ACUST UNITED AC 2018; 3:131-136. [PMID: 31355354 DOI: 10.1177/2475530318799072] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Relatively little is known about the epidemiology of juvenile psoriatic arthritis (PsA), including clinical features associated with the development of arthritis among children with psoriasis and subsequent risk of inflammatory comorbidities. Objective To identify the overall risk of arthritis among children with psoriasis and subsequent risk of inflammatory comorbidities. Methods Using Clinformatics™ DataMart (OptumInsight, Eden Prairie, MN) de-identified US administrative claims data from 2000-2013, we identified children 0-16 years with an incident diagnosis of psoriasis or PsA using ICD-9-CM diagnostic, procedure and pharmacy billing codes. Cox proportional hazard regression was performed to assess clinical features associated with development of arthritis in children with psoriasis. Incidence rate ratios were used to compare the relative frequency of co-morbid diagnoses. Results We identified 212 children with PsA, 4,312 with psoriasis-only, and 45,240 controls. Approximately 33% of children with PsA received a diagnostic code for psoriasis before arthritis. Median time to index code for arthritis after index code for psoriasis was 17.6 months (IQR 4.1-38.1). Older age and uveitis were associated with a significantly increased risk of developing arthritis in children with psoriasis. Children with PsA had a significantly increased risk of uveitis, diabetes, and depressive disorder when compared to patients with psoriasis and inflammatory bowel disease, uveitis, diabetes, and depressive disorder when compared to controls. Conclusion Most children with PsA developed arthritis first. Older age and uveitis were risk factors for arthritis among children with psoriasis. PsA was associated with increased risk of several clinically relevant inflammatory comorbidities.
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Affiliation(s)
- Timothy G Brandon
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness (CPCE), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Pharmacoepidemiology Research and Training (CPeRT), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia K Manos
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexis Ogdie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pamela F Weiss
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness (CPCE), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Pharmacoepidemiology Research and Training (CPeRT), University of Pennsylvania, Philadelphia, Pennsylvania
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Snekvik I, Nilsen T, Romundstad P, Saunes M. Metabolic syndrome and risk of incident psoriasis: prospective data from the HUNT Study, Norway. Br J Dermatol 2018; 180:94-99. [DOI: 10.1111/bjd.16885] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 02/06/2023]
Affiliation(s)
- I. Snekvik
- Department of Public Health and Nursing Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
- Department of Dermatology St Olav's Hospital Trondheim University Hospital Trondheim Norway
| | - T.I.L. Nilsen
- Department of Public Health and Nursing Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
- Clinic of Anaesthesia and Intensive Care St Olav's Hospital Trondheim University Hospital Trondheim Norway
| | - P.R. Romundstad
- Department of Public Health and Nursing Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
| | - M. Saunes
- Department of Dermatology St Olav's Hospital Trondheim University Hospital Trondheim Norway
- Department of Cancer Research and Molecular Medicine Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
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Dolcino M, Pelosi A, Fiore PF, Patuzzo G, Tinazzi E, Lunardi C, Puccetti A. Long Non-Coding RNAs Play a Role in the Pathogenesis of Psoriatic Arthritis by Regulating MicroRNAs and Genes Involved in Inflammation and Metabolic Syndrome. Front Immunol 2018; 9:1533. [PMID: 30061880 PMCID: PMC6054935 DOI: 10.3389/fimmu.2018.01533] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/21/2018] [Indexed: 01/03/2023] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory arthritis, characterized by inflammation of entheses and synovium, leading to joint erosions and new bone formation. It affects 10-30% of patients with psoriasis, and has an estimated prevalence of approximately 1%. PsA is considered to be primarily an autoimmune disease, driven by autoreactive T cells directed against autoantigens present in the skin and in the joints. However, an autoinflammatory origin has recently been proposed. Long noncoding RNAs (lncRNAs) are RNAs more than 200 nucleotides in length that do not encode proteins. LncRNAs play important roles in several biological processes, including chromatin remodeling, transcription control, and post-transcriptional processing. Several studies have shown that lncRNAs are expressed in a stage-specific or lineage-specific manner in immune cells that have a role in the development, activation, and effector functions of immune cells. LncRNAs are thought to play a role in several diseases, including autoimmune disorders. Indeed, a few lncRNAs have been identified in systemic lupus erythematosus, rheumatoid arthritis, and psoriasis. Although several high-throughput studies have been performed to identify lncRNAs, their biological and pathological relevance are still unknown, and most transcriptome studies in autoimmune diseases have only assessed protein-coding transcripts. No data are currently available on lncRNAs in PsA. Therefore, by microarray analysis, we have investigated the expression profiles of more than 50,000 human lncRNAs in blood samples from PsA patients and healthy controls using Human Clariom D Affymetrix chips, suitable to detect rare and low-expressing transcripts otherwise unnoticed by common sequencing methodologies. Network analysis identified lncRNAs targeting highly connected genes in the PsA transcriptome. Such genes are involved in molecular pathways crucial for PsA pathogenesis, including immune response, glycolipid metabolism, bone remodeling, type 1 interferon, wingless related integration site, and tumor necrosis factor signaling. Selected lncRNAs were validated by RT-PCR in an expanded cohort of patients. Moreover, modulated genes belonging to meaningful pathways were validated by RT-PCR in PsA PBMCs and/or by ELISA in PsA sera. The findings indicate that lncRNAs are involved in PsA pathogenesis by regulating both microRNAs and genes and open new avenues for the identification of new biomarkers and therapeutical targets.
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Affiliation(s)
- Marzia Dolcino
- Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Pelosi
- Immunology Area, Pediatric Hospital Bambino Gesù, Rome, Italy
| | | | | | - Elisa Tinazzi
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Antonio Puccetti
- Department of Experimental Medicine - Section of Histology, University of Genova, Genova, Italy
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Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 2018; 80:251-265.e19. [PMID: 29928910 DOI: 10.1016/j.jaad.2018.06.027] [Citation(s) in RCA: 336] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/30/2018] [Accepted: 06/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Wide-ranging prevalence estimates of psoriatic arthritis (PsA) in patients with psoriasis have been reported. OBJECTIVES To assess the prevalence and incidence of PsA in patients with psoriasis. METHODS Two authors independently searched 3 databases for studies reporting on the prevalence or incidence of PsA in patients with psoriasis. A proportion meta-analysis was performed to calculate the pooled proportion estimates of PsA in patients with psoriasis. RESULTS A total of 266 studies examining 976,408 patients with psoriasis were included. Overall, the pooled proportion (95% confidence interval [CI]) of PsA among patients with psoriasis was 19.7% (95% CI, 18.5%-20.9%). In children and adolescents (<18 years of age), the pooled prevalence was 3.3% (95% CI, 2.1%-4.9%). The PsA prevalence was 22.7% (95% CI, 20.6%-25.0%) in European patients with psoriasis, 21.5% (95% CI, 15.4%-28.2%) in South American patients with psoriasis, 19.5% (95% CI, 17.1%-22.1%) in North American patients with psoriasis, 15.5% (95% CI, 0.009%-51.5%) in African patients with psoriasis, and 14.0% (95% CI, 95% CI, 11.7%-16.3%) in Asian patients with psoriasis. The prevalence of PsA was 23.8% (95% CI, 20.1%-27.6%) in studies in which the Classification Criteria for Psoriatic Arthritis were applied. The incidence of PsA among patients with psoriasis ranged from 0.27 to 2.7 per 100 person-years. LIMITATIONS Between-study heterogeneity may have affected the estimates. CONCLUSIONS We found that 1 in 4 patients with psoriasis have PsA. With the growing recognition of the Classification Criteria for Psoriatic Arthritis, more homogenous and comparable prevalence estimates are expected to be reported.
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Snekvik I, Nilsen T, Romundstad P, Saunes M. Psoriasis and cardiovascular disease risk factors: the HUNT Study, Norway. J Eur Acad Dermatol Venereol 2018; 32:776-782. [DOI: 10.1111/jdv.14835] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 02/06/2023]
Affiliation(s)
- I. Snekvik
- Department of Public Health and Nursing; Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology; Trondheim Norway
- Department of Dermatology; St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - T.I.L. Nilsen
- Department of Public Health and Nursing; Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology; Trondheim Norway
| | - P.R. Romundstad
- Department of Public Health and Nursing; Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology; Trondheim Norway
| | - M. Saunes
- Department of Dermatology; St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
- Department of Cancer Research and Molecular Medicine; Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology; Trondheim Norway
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Garcia Ferrer HR, Azan A, Iraheta I, Von Feldt J, Espinoza LR, Manasson J, Scher JU, Garcia Kutzbach A, Ogdie A. Potential risk factors for reactive arthritis and persistence of symptoms at 2 years: a case-control study with longitudinal follow-up. Clin Rheumatol 2017; 37:415-422. [PMID: 29139030 DOI: 10.1007/s10067-017-3911-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/13/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022]
Abstract
The objective of the study is to determine the risk factors for the development of reactive arthritis (ReA) and examine the factors associated with the persistence of symptoms. Patients with a new diagnosis of ReA and controls with a gastrointestinal (GI), urogenital, or sexually transmitted infection in the 3-6 months prior to study entry were prospectively enrolled in Guatemala City. ReA patients fulfilled the Assessment in Spondyloarthritis International Society criteria for peripheral spondyloarthropathy (SpA). Patients underwent history, examination, Achilles tendon ultrasound, and blood draw. Human leukocyte antigen (HLA) type and serum biomarkers were measured. t tests and nonparametric equivalents were used to examine the association of clinical, laboratory, and imaging factors with ReA. Patients were contacted 2 years later to assess for persistence of symptoms. Study subjects included patients with ReA (N = 32) and controls (N = 32). ReA patients were most frequently infected in April whereas controls were most frequently infected in August. Two ReA patients and two controls were HLA-B27-positive. Serum cathepsin K and C-reactive protein were higher in ReA patients compared to controls (p = 0.03 for both), while total cholesterol and low-density lipoprotein were lower (p = 0.008 and 0.045, respectively). Among those with ReA, 15 (47%) patients had continued symptoms at 2 years. These patients had a lower matrix metalloproteinase-3 level at diagnosis than patients for whom ReA resolved (p = 0.004). HLA-B27 was not associated with development of ReA in Guatemala; however, the month of infection was associated with ReA. The most striking finding was the persistence of arthritis at 2 years in nearly half of the patients.
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Affiliation(s)
- Helga Raquel Garcia Ferrer
- Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | - Alexander Azan
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isa Iraheta
- Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala
| | - Joan Von Feldt
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Julia Manasson
- New York University School of Medicine, New York, NY, USA
| | - Jose U Scher
- New York University School of Medicine, New York, NY, USA
| | - Abraham Garcia Kutzbach
- Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | - Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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35
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Hu SCS, Lan CCE. Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment. Int J Mol Sci 2017; 18:ijms18102211. [PMID: 29065479 PMCID: PMC5666891 DOI: 10.3390/ijms18102211] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a common and chronic inflammatory disease of the skin. It may impair the physical and psychosocial function of patients and lead to decreased quality of life. Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. More recently, studies have shown that psoriasis is a systemic inflammatory disorder which can be associated with various comorbidities. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction and stroke. In addition, the prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, mortality rates have been found to be increased and life expectancy decreased in patients with psoriasis, as compared to the general population. Various studies have also shown that systemic treatments for psoriasis, including methotrexate and tumor necrosis factor-α inhibitors, may significantly decrease cardiovascular risk. Mechanistically, the presence of common inflammatory pathways, secretion of adipokines, insulin resistance, angiogenesis, oxidative stress, microparticles, and hypercoagulability may explain the association between psoriasis and cardiometabolic disorders. In this article, we review the evidence regarding the association between psoriasis and cardiovascular comorbidities, focusing on severe vascular events, cardiovascular risk factors and implications for treatment.
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Affiliation(s)
- Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
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Abstract
PURPOSE OF REVIEW Patients with psoriasis and psoriatic arthritis, collectively termed psoriatic disease (PsD), are at an increased risk of developing cardiovascular diseases (CVD). The purpose if this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of CVD in psoriatic patients and approaches to improve the management of these comorbidities. RECENT FINDINGS Studies have shown that CVD risk is independent of traditional cardiovascular risk factors and is related to the systemic inflammatory nature of PsD. The use of surrogate markers, such as imaging of subclinical atherosclerosis, allows detection of patients at high cardiovascular risk before the occurrence of clinical events. These modalities could be clinically useful as clinical cardiovascular risk algorithms, such as the Framingham Risk Score, and have been shown to underestimate the actual cardiovascular risk in patients with PsD. Additional challenges related to the management of CVD in psoriatic patients include the underdiagnosis and undertreatment of traditional cardiovascular risk factors in rheumatology, dermatology and primary care setting. Effective measures used to control PsD, such as tumour necrosis factor inhibitors and methotrexate, has been associated with reduced cardiovascular risk in psoriatic patients. These findings highlight the importance of controlling disease activity as potential target that could lead to reduced cardiovascular risk. Together this highlights the importance of optimization of cardiovascular risk stratification and management of cardiovascular risk factors in patients with PsD.
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Affiliation(s)
- Curtis Sobchak
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Imiquimod induced ApoE-deficient mice might be a composite animal model for the study of psoriasis and dyslipideamia comorbidity. J Dermatol Sci 2017; 88:20-28. [PMID: 28579438 DOI: 10.1016/j.jdermsci.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/28/2017] [Accepted: 05/10/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psoriasis patients are at increased risk of developing lipid metabolism disturbances. Both psoriasis and dyslipideamia not only closely interact in disease development, but occur as mutual side effects in some medicine treatment. The interactive mechanism of the two diseases is complicated and still unclear. OBJECTIVE Here, we proposed applying imiquimod on the dorsal skin of ApoE-/- mice to establish a composite animal model which formed psoriasiform skin lesions under hyperlipidemic condition. METHOD By comparison with corresponding wild-type(C57BL/6) mice, the composite mice model was evaluated by skin pathological features, lipid levels, immune inflammatory factors in order to clarify the diseases interplay mechanism. In addition, IL-17 mAb treatment was applied to observe the effect of IL-17 antibody on the composite animal model. RESULTS The results verified that imiquimod-induced ApoE-/- mice model presented keratinocyte hyperplasia, parakeratosis, inflammatory cells infiltration and elevated serum lipid levels, and also reflected the complex interaction between inflammation and lipid metabolism. IL-17 mAb could inhibit psoriasis skin lesions with lipid accumulation via STAT3 pathway, but no influence on elevated serum cholesterol. CONCLUSIONS Imiquimod-induced ApoE-/- mice model presented the pathological features of psoriasis and dyslipideamia, which could be an ideal composite animal model for the study of pathogenesis and pharmacotherapeutics of psoriasis and dyslipideamia comorbidity.
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Kim ES, Han K, Kim MK, Park YM, Baek KH, Moon SD, Han JH, Song KH, Kwon HS. Impact of metabolic status on the incidence of psoriasis: a Korean nationwide cohort study. Sci Rep 2017; 7:1989. [PMID: 28512338 PMCID: PMC5434014 DOI: 10.1038/s41598-017-01983-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 04/05/2017] [Indexed: 12/14/2022] Open
Abstract
Growing evidence suggests that obesity is a risk factor for incident psoriasis. This study was aimed to evaluate the association of obesity and metabolic status with the incidence of psoriasis. A total of 418,057 adults were followed-up using a nationwide prospective cohort study in Korea. Participants were stratified based on the body mass index categories and metabolic condition. During the follow-up visit, 11054 (2.6%) cases were found to have psoriasis. Diabetes, hypertension, hyperlipidemia, and obesity were all found to be risk factors for incident psoriasis. The metabolically unhealthy non-obese (MUNO) subjects (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.22-1.37) and metabolically unhealthy obese subjects (MUO; HR, 1.33; 95% CI, 1. 26-1.41) had a significantly higher risk of psoriasis incidence as compared to metabolically healthy non-obese subjects. The risk of psoriasis development was found to be high among the MUNO and MUO subjects in both sexes and all age groups. In conclusion, the metabolic health status was significantly associated with an increased risk of psoriasis in both obese and non-obese individuals. However, further studies are needed to evaluate whether the control of metabolic parameters can lower the incidence of psoriasis.
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Affiliation(s)
- Eun Sook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's hospital, Incheon, 21431, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea
| | - Mee Kyoung Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA
| | - Ki-Hyun Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea
| | - Sung Dae Moon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's hospital, Incheon, 21431, Korea
| | - Je-Ho Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's hospital, Incheon, 21431, Korea
| | - Ki-Ho Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea. .,Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's hospital, Seoul, 07345, Korea.
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Ogdie A. The preclinical phase of PsA: a challenge for the epidemiologist. Ann Rheum Dis 2017; 76:1481-1483. [PMID: 28274910 DOI: 10.1136/annrheumdis-2017-211109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/19/2017] [Indexed: 12/31/2022]
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Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees AS, Gelfand JM. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol 2017; 76:377-390. [PMID: 28212759 PMCID: PMC5731650 DOI: 10.1016/j.jaad.2016.07.064] [Citation(s) in RCA: 640] [Impact Index Per Article: 91.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/17/2016] [Accepted: 07/01/2016] [Indexed: 02/08/2023]
Abstract
Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Sungat Grewal
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sinéad M Langan
- London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, United Kingdom
| | - Nehal N Mehta
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Alexis Ogdie
- Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Choi JW, Kim BR, Seo E, Youn SW. Could Psoriatic Arthritis Be Easily Diagnosed from Current Suspicious Physical Findings in the Dermatology Clinic? Ann Dermatol 2017; 29:48-54. [PMID: 28223746 PMCID: PMC5318526 DOI: 10.5021/ad.2017.29.1.48] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/09/2016] [Accepted: 05/23/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The prevalence and clinical characteristics of psoriatic arthritis (PsA) in patients with psoriasis are not well described in Asian populations, including Koreans. OBJECTIVE The purpose of this study was to investigate the prevalence of PsA by using the classification of psoriatic arthritis (CASPAR) criteria on the basis of physical examination only, as well as its correlation with psoriasis severity and other medical conditions including nail psoriasis. METHODS A single-center, cross-sectional observational cohort study was conducted, and the included patients were evaluated for PsA according to the CASPAR criteria. The psoriasis area severity index (PASI) and the nail psoriasis severity index (NAPSI) were calculated. RESULTS The prevalence of PsA in patients with psoriasis in Korea was 13.5%. When performing logistic regression, hyperlipidemia and localized pustular psoriasis were found to be significant predictors of PsA. The PASI score was significantly higher in PsA patients than in those with psoriasis alone (p=0.014). Psoriatic nail involvement was found in 85.5% of the study population, and all PsA patients had nail psoriasis. The mean NAPSI score was higher in patients with PsA; however, the difference was not statistically significant. CONCLUSION There was a close relation between psoriasis severity and PsA, although nail psoriasis severity was not related to PsA status. Dermatologists can diagnose PsA from current physical findings by using the CASPAR criteria. To validate the CASPAR criteria for PsA diagnosis, the definition of nail psoriasis clinical types and severity in the CASPAR criteria should be reviewed again.
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Affiliation(s)
- Jee Woong Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunmi Seo
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Presence of selected metabolic syndrome components in patients with psoriasis vulgaris. Postepy Dermatol Alergol 2016; 33:114-9. [PMID: 27279820 PMCID: PMC4884779 DOI: 10.5114/ada.2016.59153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/01/2015] [Indexed: 02/08/2023] Open
Abstract
Introduction Recent studies have suggested a strong association between psoriasis and obesity, dyslipidemia, hypertension, resistance to insulin and metabolic syndrome. Aim To assess the prevalence of selected metabolic syndrome components in patients with psoriasis and the effect of the abnormalities on the disease activity. Material and methods Two hundred and forty-six patients diagnosed with psoriasis and 75 healthy individuals as controls were included in the study. Psoriasis activity was evaluated by the Psoriasis Area and Severity Index (PASI). Results There was a statistically significant difference in triglyceride concentration between psoriasis patients and controls (p = 0.00001), which was not found for high-density lipoprotein (HDL) concentration. Mean values of serum glucose level in patients with psoriasis were significantly higher than in controls (p = 0.046). Further statistical analysis of the obtained results showed significantly higher systolic blood pressure in the psoriasis patients than in the controls (p = 0.0001), but there was no statistically significant difference in diastolic blood pressure between the investigated groups (p > 0.05). Conclusions Higher prevalence of metabolic syndrome components was observed in patients with psoriasis than in the general population.
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Clinical Risk Factors for the Development of Psoriatic Arthritis Among Patients with Psoriasis: A Review of Available Evidence. Curr Rheumatol Rep 2016; 17:64. [PMID: 26290111 DOI: 10.1007/s11926-015-0540-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Psoriatic arthritis (PsA), a chronic inflammatory arthritis, affects about 10% of patients with psoriasis with higher prevalence seen in patients with more extensive skin disease. Early identification of PsA may result in improved outcomes. While it remains unclear which patients with psoriasis will develop PsA, several studies have identified potential risk factors for PsA among patients with psoriasis. This review examines the basic epidemiologic principles of identifying risk factors and reviews the evidence to date about risk factors for PsA among patients with psoriasis.
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Haroon M, FitzGerald O. Psoriatic arthritis: complexities, comorbidities and implications for the clinic. Expert Rev Clin Immunol 2016; 12:405-16. [DOI: 10.1586/1744666x.2016.1139453] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Transcriptome profiling unveils the role of cholesterol in IL-17A signaling in psoriasis. Sci Rep 2016; 6:19295. [PMID: 26781963 PMCID: PMC4726068 DOI: 10.1038/srep19295] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/08/2015] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease characterized by altered proliferation and differentiation of keratinocytes as well as infiltration of immune cells. Increased expression of Th17 cells and cytokines secreted by them provides evidence for its central role in the pathogenesis of psoriasis. IL-17A, signature cytokine of Th17 cells was found to be highly differentially expressed in psoriatic lesional skin. However, cellular and molecular mechanism by which IL-17A exerts its function on keratinocyte is incompletely understood. To understand IL-17A mediated signal transduction pathways, gene expression profiling was done and differentially expressed genes were analysed by IPA software. Here, we demonstrate that during IL-17A signaling total cholesterol levels were elevated, which in turn resulted in the suppression of genes of cholesterol and fatty acid biosynthesis. We found that accumulation of cholesterol was essential for IL-17A signaling as reduced total cholesterol levels by methyl β cyclodextrin (MBCD), significantly decreased IL-17A induced secretion of CCL20, IL-8 and S100A7 from the keratinocytes. To our knowledge this study for the first time unveils that high level of intracellular cholesterol plays a crucial role in IL-17A signaling in keratinocytes and may explain the strong association between psoriasis and dyslipidemia.
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Dommasch ED, Li T, Okereke OI, Li Y, Qureshi AA, Cho E. Risk of depression in women with psoriasis: a cohort study. Br J Dermatol 2015; 173:975-80. [PMID: 26186277 DOI: 10.1111/bjd.14032] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psoriasis is a common, chronic and inflammatory disease of the skin, which has been associated with depression in cross-sectional studies with limited adjustment for confounders. OBJECTIVES In this prospective cohort study, we investigated the risk of incident depression among individuals with psoriasis and psoriatic arthritis (PsA). METHODS We included 50 750 US female nurses from the Nurses' Health Study who were free of depression at baseline in 2000. Those participants who had ever self-reported clinician-diagnosed depression or regular use of antidepressants, or had a Mental Health Inventory score of ≤ 52 were excluded. In 2008, we retrospectively asked participants if they had ever received a physician's diagnosis of psoriasis or PsA. We defined depression as self-report of clinician-diagnosed depression or regular use of antidepressant medication. Time-dependent Cox proportional hazard models were used to estimate age and multivariate-adjusted relative risks (RRs) of clinical depression. RESULTS After adjusting for covariates including body mass index, physical activity, smoking and the presence of major chronic conditions, the multivariate-adjusted RRs of clinical depression were 1·29 [95% confidence interval (CI) 1·10-1·52] for women with psoriasis and 1·52 (95% CI 1·06-2·19) for women with psoriasis and concomitant PsA, compared with women without psoriasis. CONCLUSIONS We found an increased risk of depression in US women with psoriasis compared with those without psoriasis. This risk was higher in those who reported concomitant PsA. Future studies are needed to confirm these findings in other populations and to identify pathophysiological mechanisms linking psoriasis to depression.
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Affiliation(s)
- E D Dommasch
- Department of Dermatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, U.S.A
| | - T Li
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - O I Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A.,Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A
| | - Y Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A
| | - A A Qureshi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Epidemiology, Brown School of Public Health, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
| | - E Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.,Department of Epidemiology, Brown School of Public Health, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
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Abstract
Psoriatic arthritis (PsA) is a chronic systemic inflammatory disorder characterized by joint and entheseal inflammation with a prevalence of 0.05% to 0.25% of the population and 6% to 41% of patients with psoriasis. PsA is a highly heterogeneous inflammatory arthritis. In this review, current knowledge is discussed regarding the epidemiology of PsA, including disease manifestations, classification criteria for adult and juvenile PsA, methods for recognizing early PsA, including use of screening tools and knowledge of risk factors for PsA, and medical comorbidities associated with PsA.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, White Building, Room 5024, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Pamela Weiss
- Division of Rheumatology, Children's Hospital of Philadelphia, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 3535 Market Street, Room 1526, Philadelphia, PA 19104, USA
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Abstract
There is evidence that patients with moderate to severe psoriasis have an increased risk of conditions such as cardiovascular disease, obesity, diabetes mellitus, and metabolic syndrome. The precise mechanisms underlying the observed increase in cardiovascular disease in psoriasis remain to be defined but inflammatory pathways mutual to both conditions are probably involved. Suppression of systemic inflammation in psoriasis could help reduce cardiovascular inflammation but robust evidence is still lacking evidence is lacking. This article summarizes the current literature on cardiovascular and metabolic comorbidities in psoriasis, identifies research gaps, and suggests management strategies to reduce cardiovascular risk in patients with moderate to severe psoriasis.
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Daïen CI, Sellam J. Obesity and inflammatory arthritis: impact on occurrence, disease characteristics and therapeutic response. RMD Open 2015; 1:e000012. [PMID: 26509048 PMCID: PMC4613154 DOI: 10.1136/rmdopen-2014-000012] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/19/2015] [Accepted: 06/14/2015] [Indexed: 12/15/2022] Open
Abstract
Overweight and obesity are increasing worldwide and now reach about one-third of the world's population. Obesity also involves patients with inflammatory arthritis. Knowing the impact of obesity on rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis) is thus an important issue. This article first reviews the epidemiological and clinical data available on obesity in inflammatory rheumatic diseases, that is, its impact on incident disease, disease characteristics and the therapeutic response. The second part of this review gives an overview of the factors potentially involved in the specifics of inflammatory arthritis in patients with obesity, such as limitations in the clinical assessment, diet, microbiota and adipokines.
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Affiliation(s)
- Claire I Daïen
- Rheumatology Department, Teaching Hospital of Montpellier and UMR5535, CNRS, Institut de Génétique Moléculaire, Montpellier, France
| | - Jérémie Sellam
- Rheumatology Department, Saint-Antoine Teaching Hospital, DHU i2B, Univ Paris 06, Paris and Inserm UMRS_938, Paris, France
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Ohara Y, Kishimoto M, Takizawa N, Yoshida K, Okada M, Eto H, Deshpande GA, Ritchlin CT, Tanaka A, Higashiyama M, Matsui K, Tsuji S. Prevalence and Clinical Characteristics of Psoriatic Arthritis in Japan. J Rheumatol 2015; 42:1439-42. [PMID: 26077408 DOI: 10.3899/jrheum.141598] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the prevalence of psoriatic arthritis (PsA) in Japanese patients with psoriasis. METHODS A multicenter, noninterventional, retrospective cross-sectional study was conducted at 3 tertiary care centers in Japan. PsA was diagnosed by rheumatologists based on clinical findings. Prevalence of PsA, clinical characteristics, comorbidities, and treatment patterns were examined. RESULTS PsA was identified in 431 of 3021 patients with psoriasis, with a mean prevalence of 14.3% (range, 8.8-20.4%). No large differences between these results and previous reports from Western countries were observed in arthritis distribution, skin disease type, or treatment selection. CONCLUSION The prevalence of PsA in patients with psoriasis in Japan approaches 20% in some areas, similar to that observed in Western countries, and is higher than previously reported in Asia. Clinical features including age, sex, age at onset, and manifestation patterns were also similar to those reported in the West.
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Affiliation(s)
- Yuri Ohara
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Mitsumasa Kishimoto
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center.
| | - Naoho Takizawa
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Kazuki Yoshida
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Masato Okada
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Hikaru Eto
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Gautam A Deshpande
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Christopher T Ritchlin
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Atsushi Tanaka
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Mari Higashiyama
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Kazuo Matsui
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
| | - Shigeyoshi Tsuji
- From the Immuno-Rheumatology Center, and the Department of Dermatology, St. Luke's International Hospital, Tokyo; Department of Rheumatology, and the Department of Dermatology, Kameda Medical Center, Chiba, Japan; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Department of Dermatology, Nissay Hospital; Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.Y. Ohara, MD*, M. Kishimoto, MD*, Immuno-Rheumatology Center, St. Luke's International Hospital; N. Takizawa, MD, Department of Rheumatology, Kameda Medical Center; K. Yoshida, MD, MPH, Department of Epidemiology, Harvard School of Public Health; M. Okada, MD, Immuno-Rheumatology Center, St. Luke's International Hospital; H. Eto, MD, Department of Dermatology, St. Luke's International Hospital; G.A. Deshpande, MD, MA, Immuno-Rheumatology Center, St. Luke's International Hospital; C.T. Ritchlin, MD, Allergy, Immunology, and Rheumatology Division, University of Rochester Medical Center; A. Tanaka, MD, Department of Dermatology, Kameda Medical Center; M. Higashiyama, MD, Department of Dermatology, Nissay Hospital; K. Matsui, MD, Department of Rheumatology, Kameda Medical Center; S. Tsuji, MD, Department of Orthopedics, National Hospital Organization, Osaka Minami Medical Center
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