Psoriatic arthritis

Carpal tunnel syndrome related to rheumatic disease (Review)

Carpal tunnel syndrome (CTS) is the most commonly occurring type of entrapment neuropathy in the world. Several conditions may contribute to the development of CTS, such as obesity, repetitive wrist movements, pregnancy, genetic predisposition and rheumatoid arthritis (RA) inflammation. CTS is characterized by a wide range of pathophysiological factors, including increased pressure, mechanical trauma and ischemic damage to the median nerve that runs through the wrist tunnel. In the present narrative literature review, the way rheumatic diseases (RDs) contribute to CTS occurrence is investigated. The epidemiological, clinical, paraclinical and pathogenesis aspects of the relationship are examined. CTS is the most common neurological finding in RA, and incidences of RA, psoriatic arthritis and CTS are closely related. The association of CTS with systemic lupus erythematosus, Sjögren's syndrome, Behcet's disease and systemic sclerosis is weaker. In these cases, the prevalence of CTS is similar to that in the general population. As the occurrence of CTS is increasing, understanding the common mechanism and making an early diagnosis are required to limit pain and costs. When patients with RD present with symptoms such as wrist pain, tingling sensations or numbness in their fingers, CTS should be suspected. This suspicion should not be interpreted in terms of RD. To accurately evaluate patients with RD, a detailed electrophysiological examination should be included in the evaluation process. A diagnostic algorithm should include neuromuscular ultrasound or magnetic resonance imaging for patients with RD.

Challenges in Diagnosing Psoriatic Arthritis in Primary Care: A Meta-Ethnographic Study

Psoriatic arthritis (PsA) is a complex and debilitating chronic inflammatory joint disorder that is often associated with psoriasis and presents significant challenges in its early diagnosis and management. Therefore, this study aimed to investigate the diagnostic intricacies of PsA in primary care settings to shed light on the prevalence, barriers, and implications of delayed diagnosis. To achieve our research objectives, we conducted a qualitative synthesis using the meta-ethnographic method, which is a robust approach for synthesizing qualitative data. We systematically searched the PubMed, Web of Science, and Embase databases for relevant articles using predefined search terms such as "psoriatic arthritis," "diagnosis," and "primary care." The inclusion criteria were narrative articles in English that provided insights into the diagnostic challenges of PsA in primary care. Conference presentations, original articles, and duplicate articles were excluded. Our analysis revealed four key themes that elucidated the multifaceted nature of PsA diagnosis in primary care: (1) a variety of initial and non-specific symptoms, highlighting the diverse clinical presentations that can mimic other conditions; (2) the lack of experience with PsA among primary care professionals, underscoring the importance of education and training; (3) the lack of skin lesions, which can complicate diagnosis when not present; and (4) a delay in diagnosis, with potentially severe consequences for patients' health and quality of life. This study highlights the challenges inherent in the diagnosis of PsA in primary care settings. The multifaceted nature of the disease, coupled with limited experience among primary care providers, often results in delayed diagnosis and subsequent treatment initiation. Early recognition and intervention are pivotal for optimizing patient outcomes. Addressing these challenges necessitates a comprehensive approach involving heightened clinical suspicion, continuous medical education, interdisciplinary collaboration, and utilization of standardized diagnostic criteria. Collaboration between primary care physicians and specialists is crucial for enhancing the accuracy and timeliness of PsA diagnosis and ultimately improving patient well-being and quality of life.

Could serum HMGB1 levels be a predictor associated with psoriatic arthritis?

Background/aim: Psoriasis is a chronic autoimmune disease that predominantly affects the skin and musculoskeletal system. We hypothesized that HMGB1, an inflammatory nuclear protein, may play a role in the musculoskeletal involvement of psoriasis. Methods: Forty patients with psoriasis and 45 with psoriatic arthritis were involved in the study; the results were compared with 22 healthy controls. Serum HMGB1 levels were evaluated from peripheral blood samples. Results: Serum HMGB1 levels were found to be significantly higher in patients with psoriasis regardless of joint involvement (p < 0.001). Also, HMGB1 levels were correlated with the extent of psoriasis. Conclusion: Serum HMGB1 levels may contribute to the progression of psoriasis to psoriatic arthritis and correlate with the severity of skin involvement.

Discovery of CLEC2B as a diagnostic biomarker and screening of celastrol as a candidate drug for psoriatic arthritis through bioinformatics analysis

BACKGROUND

Psoriatic arthritis (PSA) is a chronic, immune-mediated inflammatory joint disease that is liked to mortality due to cardiovascular disease. Diagnostic markers and effective therapeutic options for PSA remain limited due to the lack of understanding of the pathogenesis. We aimed to identify potential diagnostic markers and screen the therapeutic compounds for PSA based on bioinformatics analysis.

METHODS

Differentially expressed genes (DEGs) of PSA were identified from the GSE61281 dataset. WGCNA was used to identify PSA-related modules and prognostic biomarkers. Clinical samples were collected to validate the expression of the diagnostic gene. These DEGs were subjected to the CMap database for the identification of therapeutic candidates for PSA. Potential pathways and targets for drug candidates to treat PSA were predicted using Network Pharmacology. Molecular docking techniques were used to validate key targets.

RESULTS

CLEC2B was identified as a diagnostic marker for PSA patients (AUC > 0.8) and was significantly upregulated in blood samples. In addition, celastrol was identified as a candidate drug for PSA. Subsequently, the network pharmacology approach identified four core targets (IL6, TNF, GAPDH, and AKT1) of celastrol and revealed that celastrol could treat PSA by modulating inflammatory-related pathways. Finally, molecular docking demonstrated stable binding of celastrol to four core targets in the treatment of PSA. Animal experiments indicated celastrol alleviated inflammatory response in the mannan-induced PSA.

CONCLUSION

CLEC2B was a diagnostic marker for PSA patients. Celastrol was identified as a potential therapeutic drug for PSA via regulating immunity and inflammation.

Psoriatic arthritis of the temporomandibular joint: A systematic review

OBJECTIVES

Psoriasis is an inflammatory condition brought on by the immune system. This study aimed to perform a systematic review related to psoriatic arthritis (PsA) of the temporomandibular joint (TMJ).

METHODS

The search strategy was developed by a radiologist expert with more than 20 years of experience. The search was performed without time restrictions in five electronic databases: PubMed, Web of Science, Embase, Scopus and Ovid. The search strategy was based on MeSH and Emtree terms. The methodological quality of the studies was rated using the quality assessment tools from the National Heart Lung and Blood Institute (NHLBI).

RESULTS

Twenty-three publications were included, 10 being case reports. One hundred-fifty-one patients with TMJ PsA were reported. Psoriasis evolution ranged from 1.5 years to 24 years. Clinical symptoms of TMJ involvement included: TMJ pain and sounds, limited range of jaw movements, preauricular swelling, malocclusion, headache, tinnitus, neck stiffness and altered dietary function. TMJ was evaluated by magnetic resonance imaging (six studies), computed tomography (eight articles) and by ultrasonography findings (two articles). For TMJ treatment, topical and systemic medication was reported in 11 studies. Five studies included patients needing surgical procedures for TMJ ankylosis.

CONCLUSIONS

A relationship between TMD and psoriasis has been revealed. TMJ PsA has been investigated and debated, although the radiographic findings or clinical symptoms of PsA are not noticeably different from other forms of TMJ arthritis. Conservative therapy can lead to significant improvement of TMJ function.

Exploring comorbidity and pharmacological treatment patterns in psoriasis - a retrospective population-based cross-sectional study

Background

Individuals with psoriasis face an increased risk of suffering from various comorbid conditions. However, there haven´t been any studies conducted in Sweden to examine the frequency of comorbidities and the corresponding treatment for these conditions among psoriasis patients.

Methods

The Cosmic electronic medical record represents a comprehensive repository of medical information including all residents of Region Jönköping. To conduct a population-based retrospective cross-sectional study, all individuals diagnosed with psoriasis between April 9, 2008 and July 1, 2016, were identified via the electronic medical records using ICD-10 codes. Data on comorbidity and dispensation of prescribed drugs against these comorbid conditions were analyzed.

Results

During the study period, 1.7% of the population (4,587 individuals) were diagnosed with psoriasis, with 74.3% of cases classified as mild to moderate psoriasis and 25.7% as severe. The remaining 268,949 individuals did not receive a psoriasis diagnosis. The study showed that psoriasis patients had higher odds of experiencing the majority of the comorbid conditions examined. Arthritis other than psoriasis arthritis was found to be the most prevalent comorbid diagnosis among psoriasis patients (adjusted OR 7.2, CI 95% 6.4-8.2, p < 0.001), followed by obesity (OR 2.4, CI 95% 1.9-3.1, p < 0,001). There was no significant difference in drug prescription for comorbid diseases between patients with psoriasis and patients without psoriasis except for arthritis and smoking cessation treatment.

Conclusions

Individuals with psoriasis are more susceptible to experiencing multiple comorbid conditions compared to the general population, particularly those with severe psoriasis. There is no evidence of undertreatment of comorbidity except for arthritis among psoriasis patients.

Serum salusin-α and salusin-β levels in patients with psoriatic arthritis

INTRODUCTION

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by skin lesions and joint involvement. Salusin-α and salusin-β are two new bioactive molecules. It is reported that salusins may have role in regulation of the immune system and inflammation. The aim of our study was to evaluate the serum salusin-α and salusin-β levels in PsA patients and to establish the possible relationship with the disease features.

MATERIAL AND METHODS

Our study included 40 PsA patients who fulfilled the CASPAR criteria and 40 healthy volunteers. Demographic, clinical, laboratory and radiological data and disease activity indices (PASI, BASDAI, BASFI, HAQ) were recorded in all patients. The enzyme-linked immunosorbent assay (ELISA) method was used to measure serum salusin-α and salusin-β levels.

RESULTS

The demographic data were as follows: 13 patients (32.5%) were males and 27 (67.5%) were female, mean age was 48.5 years and mean disease duration was 2.4 years. Patients' history was taken and clinical assessment was performed; 20 (50%) patients had a family history, 18 (45%) patients were smoker, 19 (47.5%) patients had HLA-B27 positivity, 33 (82.5%) had sacroiliitis, 36 (90%) had enthesitis, 23 (57.5%) had distal interphalangeal (DIP) joint and nail involvement, 26 (65%) had wrist involvement, and 11 (27.5%) had ankle involvement. Laboratory data of the patients were recorded; 20 (50%) patients had elevated CRP level and 25 (62.5%) patients had an elevated ESR level. The study results showed that PsA patients had an elevated serum salusin-α level when compared with the control group (p = 0.004). The association between serum salusin-α level and ankle arthritis was found (p = 0.04). Serum levels of salusin-β were similar in PsA patients and controls both (p = 0.285).

CONCLUSIONS

We found elevated serum salusin-α in PsA patients while the serum salusin-β levels were normal. Salusin-α may have a possible role in disease pathogenesis and it may be use as a reliable biomarker in PsA patients. Multicenter prospective studies are needed in this regard.

Single-Cell RNA Sequencing Reveals the Immune Cell Profiling in IMQ Induced Psoriasis-Like Model

PURPOSE

Psoriasis is a chronic systemic inflammatory skin disease with a high recurrence rate. The immune response plays an important role in psoriasis. However, the subsets of immune cells involved in inflammation in psoriatic mice have not been fully studied. This study showed the immune environment characteristics of psoriasis in mice.

METHODS

We used single-cell RNA sequencing (10× Genomics) as an unbiased analytical strategy to investigate the heterogeneity of skin immune cells in imiquimod-induced psoriasis mice systematically.

RESULTS

We identified 10 major clusters and their marker genes among 14,439 cells. The proportions of macrophages, NK/T cells, conventional dendritic cells (cDCs) and plasmacytoid dendritic cells (pDCs) were increased in psoriatic mice. Macrophages were the largest group and were further divided into 7 subgroups, and all macrophage clusters were increased in psoriatic mice. Differentially expressed genes in control versus psoriatic mice skin lesions showed that Fcgr4, Saa3 and Acp5 in macrophages, Acp5, Fcgr4 and Ms4a6d in NK/T cells, Saa3 in cDCs, and Ifitm1 in pDCs were upregulated in psoriasis mice. Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis emphasized the role of oxidative phosphorylation signals and antigen processing and presentation signals in murine psoriasis-like models.

CONCLUSION

Our study reveals the immune environment characteristics of the commonly used IMQ induced psoriasis-like models and provides a systematic insight into the immune response of mice with psoriasis, which is conducive to comparing the similarities and differences between the mouse model and human psoriasis.