[Psoriasis arthritis. An interdisciplinary challenge]

Multispectral optoacoustic tomography might be a helpful tool for noninvasive early diagnosis of psoriatic arthritis

Currently used imaging methods for diagnosis of psoriatic arthritis (PsA) frequently come along with exposure to radiation and can often only show long-term effects of the disease. The aim of the study was to check the feasibility of a new optoacoustic imaging method to identify PsA. 22 psoriasis patients and 19 healthy volunteers underwent examination using multispectral optoacoustic tomography (MSOT). The presence of arthritis was assessed via quantification of optoacoustic signal intensity of the endogenous chromophores oxy- and deoxyhemoglobin. We conducted high-resolution real-time ultrasound images of the finger joints. The semi quantitative analysis of the optoacoustic signals for both hemoglobin species showed a significant higher blood content and oxygenation in PsA patients compared to healthy controls. Our results indicate that MSOT might allow detection of inflammation in an early stage. If the data is further confirmed, this technique might be a suitable tool to avoid delay of diagnosis of PsA.

Analysis of pharmaceutical care in patients with psoriatic arthritis using statutory health insurance data

BACKGROUND

Psoriatic arthritis (PsA) is an inflammatory joint disease. Despite numerous health care research studies, there is hardly any data regarding the current state of pharmaceutical care of PsA patients in Germany.

STUDY POPULATION AND METHODS

Based on a systematic literature search and routine administrative data from the Rhineland/Hamburg (statutory) health insurance fund ("Allgemeine Ortskrankenkasse", AOK), the present study provides an up-to-date overview of pharmaceutical care of German PsA patients. Selected were those in- and outpatients who - in the first or second quarter of 2014 - had been coded as having the diagnosis of psoriatic arthritis (L40.5+) according to the International Classification of Diseases (ICD-10-GM version 2015). On the basis of this "predefined cohort", drug prescription data was subsequently analyzed for a five-year period (January 1, 2010 to December 31, 2014).

RESULTS

Overall, 3,205 AOK-insured individuals (45 % male, 55 % female) were diagnosed with PsA. Mean age was 58.9 years; 53.7 % of PsA patients received systemic treatment. Nonsteroidal antiinflammatory drugs (NSAIDs) were the most frequently prescribed agents, followed by corticosteroids. Among patients on systemic treatment, 72.1 % were treated with disease-modifying antirheumatic drugs (DMARDs); 20.9 % with a combination of DMARDs and biologics.

CONCLUSION

Not only does pharmacological treatment of PsA have to ensure adequate patient care aimed at preventing disease progression, it also has to be approached with economic responsibility.

Introduction of a metabolic joint asymmetry score derived from conventional bone scintigraphy. A new tool to differentiate psoriatic from rheumatoid arthritis

AIM

Clinical differentiation of psoriatic arthritis (PsA) and rheumatoid arthritis (rA) based on the pattern of joint involvement can be difficult; the frequent form of PsA with polyarthritis of the peripheral joints may sometime resemble rA. We investigated a metabolic joint asymmetry score (MJAS), reflecting the overall asymmetric joint involvement on conventional bone scintigraphy, for differentiating PsA from rA in patients presenting with peripheral polyarthritis.

PATIENTS, METHODS

106 patients (n = 61, PsA; n = 45, rA) with peripheral polyarthritis (≥ 5 joints) as well as 26 control subjects with no history of chronic joint disorders were analyzed. The intensity of articular 99mTc-MDP uptake in 40 peripheral joint pairs was scored regarding the bilateral difference of each joint based on a scale of 0-2 (no significant, moderate, and marked asymmetry, respectively). The patient's MJAS was defined as the sum of uptake difference scores of all joint pairs. The association of MJAS with the underlying condition (Psoriasis criteria, Revised Criteria of the ACR) was examined.

RESULTS

5280 peripheral joint pairs were investigated. There was no significant difference in the total number of involved joints in PsA 15.0 ± 8.2 versus rA 17.5 ± 8.8 patients (p = 0.132), but significantly less involvement in the control group (6.7 ± 5.0, p < 0.001). MJAS was markedly higher in PsA (17.0 ± 9.6) than in rA (4.8 ± 3.9, p < 0.001), and correlated with the total number of involved joints in PsA (r = 0.516, p < 0.001), but not in rA (r = 0.078, p = 0.380). The MJAS disparity between PsA and rA persisted after exclusion of the DIP joints (14.4 ± 7.7 vs. 4.4 ± 3.3; p<0.001).

CONCLUSIONS

The new reproducible semi-quantification method for the asymmetry of metabolic joint involvement permits differentiation of psoriatic from rheumatoid peripheral arthritis with MJAS being markedly higher in patients with PsA as compared to rA patients. The score may offer an effective complementary tool for characterizing patients with peripheral polyarthritis.

Quality of life in psoriasis patients

Patient-reported outcomes are major components of decision making in clinical research, reimbursement, health policy and health care for psoriasis. The most important construct in patient-reported outcomes is health-related quality of life (HRQoL) which encompasses the individual's well-being with respect to health. HRQoL cannot directly be measured but is assessed in single dimensions, especially physical, emotional, social and functional aspects. For this, disease- and condition-specific instruments are used. Psoriasis is a chronic inflammatory disease affecting the skin as well as other tissues and organ systems. Patients suffer from a large scale of impairments, for example, physical symptoms, stigmatization and embarrassment, psychological strain and disabilities in profession. Improvement of HRQoL is a major objective of disease management. Current knowledge on determinants of HRQoL and the treatments available increase QoL in clinical care.