1
|
Caso F, Costa L, Megna M, Cascone M, Maione F, Giacomelli R, Scarpa R, Ruscitti P. Early psoriatic arthritis: clinical and therapeutic challenges. Expert Opin Investig Drugs 2024; 33:945-965. [PMID: 39041193 DOI: 10.1080/13543784.2024.2383421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease of the enthesis and adjacent synovium, skin, and nail, which early diagnosis may be crucial for starting a prompt therapeutic intervention. Theoretically, early treatment offers the advantage of acting on the reduction of the articular damage progression since initial phases of the disease. AREAS COVERED This review explores the challenges of clinical-diagnostic aspects and the underlying pathophysiology of early PsA phases, as well as the evidence evaluating the impact of early intervention on disease outcomes. EXPERT OPINION Main instruments for early PsA diagnosis include recognizing synovial-entheseal inflammatory signs at onset, improving screening PsA high-risk subjects, and increasing disease knowledge of physicians and patients with psoriasis or familial history. PsA continues to significantly impact on the Quality of Life of patients affected by the disease, making necessary to deeply study clinical manifestations, risk factors, and underlying immunoinflammatory mechanisms, as well as to identify biomarkers for early identification. Additionally, it remains a need to increase more evidence on understanding how early treatment of PsA and of psoriasis might influence the course of the disease.
Collapse
Affiliation(s)
- Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luisa Costa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mario Cascone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Maione
- ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto Giacomelli
- Research and Clinical Unit of immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Rheumatology, Immunology and Clinical Medicine Unit, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
2
|
Nielsen ML, Petersen TC, Maul LV, Thyssen JP, Thomsen SF, Wu JJ, Navarini AA, Kündig T, Yawalkar N, Schlapbach C, Boehncke WH, Conrad C, Cozzio A, Micheroli R, Erik Kristensen L, Egeberg A, Maul JT. Predicting Psoriatic Arthritis in Psoriasis Patients - A Swiss Registry Study. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2024; 9:41-50. [PMID: 39295895 PMCID: PMC11361495 DOI: 10.1177/24755303231217492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
Background Psoriatic arthritis (PsA) is a prevalent comorbidity among patients with psoriasis, heavily contributing to their burden of disease, usually diagnosed several years after the diagnosis of psoriasis. Objectives To investigate the predictability of psoriatic arthritis in patients with psoriasis and to identify important predictors. Methods Data from the Swiss Dermatology Network on Targeted Therapies (SDNTT) involving patients treated for psoriasis were utilized. A combination of gradient-boosted decision trees and mixed models was used to classify patients based on their diagnosis of PsA or its absence. The variables with the highest predictive power were identified. Time to PsA diagnosis was visualized with the Kaplan-Meier method and the relationship between severity of psoriasis and PsA was explored through quantile regression. Results A diagnosis of psoriatic arthritis was registered at baseline of 407 (29.5%) treatment series. 516 patients had no registration of PsA, 257 patients had PsA at inclusion, and 91 patients were diagnosed with PsA after inclusion. The model's AUROCs was up to 73.7%, and variables with the highest discriminatory power were age, PASI, physical well-being, and severity of nail psoriasis. Among patients who developed PsA after inclusion, significantly more first treatment series were classified in the PsA-group, compared to those with no PsA registration. PASI was significantly correlated with the median burden/severity of PsA (P = .01). Conclusions Distinguishing between patients with and without PsA based on clinical characteristics is feasible and even predicting future diagnoses of PsA is possible. Patients at higher risk can be identified using important predictors of PsA.
Collapse
Affiliation(s)
- Mia-Louise Nielsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Simon F Thomsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Thomas Kündig
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Curdin Conrad
- Department of Dermatology, CHUV University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Antonio Cozzio
- Department of Dermatology, Venereology and Allergy, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julia-Tatjana Maul
- Faculty of Medicine, University of Zürich, Zürich, Switzerland
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| |
Collapse
|
3
|
Packham J, Tarar B. An overview of psoriatic arthritis including clinical manifestations, assessment, diagnostic criteria, investigations, drug management and GRAPPA guidelines. Musculoskeletal Care 2022; 20 Suppl 1:S2-S11. [PMID: 36356108 DOI: 10.1002/msc.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic and often progressive inflammatory disease, occurring in up to 30% of patients with psoriasis. Assessment of patients with PsA requires consideration of all disease domains, including peripheral arthritis, axial disease, enthesitis, dactylitis, skin psoriasis, psoriatic nail disease, uveitis and inflammatory bowel disease. Co-morbidities and related conditions should all be considered including: obesity, metabolic syndrome, cardiovascular disease, anxiety/depression, liver disease, chronic infections, malignancy, osteoporosis, fibromyalgia and reproductive health.
Collapse
Affiliation(s)
- Jonathan Packham
- Haywood Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Bilal Tarar
- Haywood Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| |
Collapse
|
4
|
Towards a combined pediatric rheumatology-dermatology clinic: One-year experience. North Clin Istanb 2021; 8:37-41. [PMID: 33623871 PMCID: PMC7881422 DOI: 10.14744/nci.2020.32848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/04/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Dermatological findings may be the sole complaints of diseases in pediatric rheumatology practice. Evaluating patients with a multi-disciplinary approach may facilitate access to an accurate diagnosis. Herein, we reported our one-year experience in collaborative pediatric rheumatology-dermatology. METHODS: Patients were initially evaluated separately in pediatric rheumatology-dermatology outpatient clinics. Subsequently, once a week, the final diagnoses of patients with suspected skin rash were collaboratively discussed by two pediatric rheumatologists and a dermatologist. RESULTS: A hundred and one patients were included in this study. Of these 101 patients, 65 attended to dermatology outpatient clinic initially, while the remaining 36 applied to the pediatric rheumatology outpatient clinic. The most common mucocutaneous finding was squamous lesions in 30 patients, followed by erythematous lesions in 28 and mucosal ulcers in 14. Finally, 69 patients were diagnosed with a rheumatic disease while 32 had differential diagnoses apart from rheumatic diseases. CONCLUSION: Patients with rheumatologic diseases frequently present with only mucocutaneous findings. Thus, a detailed examination of the mucosa, skin and its attachments is of paramount importance in rheumatology practice. We suggest that a close interaction between pediatric rheumatology-dermatology and the formation of consensus clinics are going to assist clinicians in making easier and accurate diagnoses.
Collapse
|
5
|
Savage L, Tinazzi I, Zabotti A, Laws PM, Wittmann M, McGonagle D. Defining Pre-Clinical Psoriatic Arthritis in an Integrated Dermato-Rheumatology Environment. J Clin Med 2020; 9:jcm9103262. [PMID: 33053820 PMCID: PMC7601411 DOI: 10.3390/jcm9103262] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023] Open
Abstract
In excess of three quarters of patients with psoriatic arthritis (PsA) have preceding psoriasis (PsO), which offers a clinical biomarker for the recognition of early PsA. Numerous surveys have shown a remarkably high frequency of clinically occult musculoskeletal symptoms in psoriasis patients. Imaging studies, particularly ultrasound, show a high prevalence of subclinical enthesitis and other inflammatory changes in psoriasis subjects. Since a serum biomarker, such as the case of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis, neither exists nor seems biologically plausible at this point, this article explores how integration of rheumatological and dermatological assessment can be facilitated for the early recognition of potential PsA. Given that scalp disease is a PsA predictor, but may be managed in the community, then a particular need to access this group is needed. An integrated approach between rheumatology and dermatology can involve joint clinics, parallel clinics with discussion of relevant cases or virtual contact between specialties. Early therapy evaluation and integrated strategies have considerable implications for minimizing suffering and joint damage in PsA.
Collapse
Affiliation(s)
- Laura Savage
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, 33100 Udine, Italy;
| | - Philip M. Laws
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Miriam Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (L.S.); (P.M.L.); (M.W.)
- Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
- Correspondence:
| |
Collapse
|
6
|
Rech J, Sticherling M, Stoessel D, Biermann MHC, Häberle BM, Reinhardt M. Psoriatic arthritis epidemiology, comorbid disease profiles and risk factors: results from a claims database analysis. Rheumatol Adv Pract 2020; 4:rkaa033. [PMID: 33134811 PMCID: PMC7585407 DOI: 10.1093/rap/rkaa033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/17/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Psoriasis is a systemic inflammatory disease often accompanied by comorbidities, including metabolic syndrome, cardiovascular diseases and depression. Up to 41% of psoriasis patients develop psoriatic arthritis (PsA), making it one of the most relevant manifestations. A large health claims data set was analysed to determine the rate of PsA development in psoriasis patients. Furthermore, comorbid disease profiles of psoriasis patients with or without PsA were compared, and potential risk factors for the development of PsA were identified. METHODS This was a non-interventional, retrospective analysis of anonymized insurance health claims data using a subset of the Institute of Applied Health Research Berlin (InGef) database. The primary outcome was the prevalence and incidence of diagnosed PsA among psoriasis patients in Germany. Risk factors for the development of PsA in psoriasis patients were determined by conditional logistic regression analysis. RESULTS The cumulative percentage of patients with existing psoriasis developing concomitant PsA over 4 years was 3.44%, with a mean time to diagnosis of PsA of 1.5 years. Psoriasis patients diagnosed with acute rheumatism (odds ratio: 2.93, 95% CI = 1.76, 4.86; P < 0.001) or pain in unspecific joints (odds ratio: 1.74, 95% CI = 1.01, 2.99; P = 0.047) showed an increased risk for development of PsA later on. Interestingly, fewer than half of the patients with concomitant PsA consulted a rheumatologist. CONCLUSIONS Unspecific arthritic symptoms are likely to precede PsA diagnoses and can develop soon after onset of psoriasis, with accumulating risk over time. There is a high unmet need for early rheumatological assessment of psoriasis patients.
Collapse
Affiliation(s)
- Jürgen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | | | | | | |
Collapse
|
7
|
Mease PJ, Etzel CJ, Huster WJ, Armstrong AW, Muram TM, Lisse J, Rebello S, Dodge R, Murage MJ, Greenberg JD, Malatestinic WN. Evaluation of Changes in Skin and Joint Outcomes and Associated Treatment Changes in Psoriatic Arthritis (PsA): Experience From the Corrona PsA/SpA Registry. J Rheumatol 2020; 48:376-384. [PMID: 32358158 DOI: 10.3899/jrheum.190422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize skin severity and joint activity outcomes and associated treatment changes in patients with psoriatic arthritis (PsA) through 12 months of follow-up after enrollment in the Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry. METHODS Patients ≥ 18 years of age with a diagnosis of PsA and a history of psoriasis between March 21, 2013, and September 30, 2016, were enrolled (n = 647). Demographics, clinical features, and treatment characteristics were collected and stratified by skin severity and joint activity. Change in joint and skin from enrollment to the 12-month visit was classified by change in category of Clinical Disease Activity Index (CDAI) or body surface area (BSA). Tests of association evaluated the relationship between changes in therapy and changes in skin severity and joint activity. RESULTS Patients with improvement in both joint activity and skin severity saw the largest median reduction in both CDAI and BSA, while those who worsened in both had the greatest median increase in both CDAI and BSA. The majority of PsA patients (> 50%) had no change in skin severity regardless if they had reduced therapy (50%), no therapy changes (54%), or increased therapy (56%; P = 0.5875). However, there was a significant association between changes in therapy and changes in joint activity (P < 0.001). Patients who increased therapy were more likely to have improvement in joint activity (32%) compared to patients who reduced therapy (22%) or had no therapy changes (11%). CONCLUSION The clinical implication for our findings suggests the assessment and incorporation of both skin and joint components may be advisable.
Collapse
Affiliation(s)
- Philip J Mease
- P.J. Mease, MD, MACR, Swedish-Providence-St. John Health Systems, and University of Washington, Seattle, Washington;
| | - Carol J Etzel
- C.J. Etzel, PhD, S. Rebello, MPH, R. Dodge, MS, Corrona, LLC, Waltham, Massachusetts
| | - William J Huster
- W. Huster, PhD, T. Muram, MD, J. Lisse, MD, M.J. Murage, PhD, MPH, W. Malatestinic, PharmD, MBA, Eli Lilly and Company, Indianapolis, Indiana
| | - April W Armstrong
- A. Armstrong, MD, MPH, University of Southern California, Los Angeles, California
| | - Talia M Muram
- W. Huster, PhD, T. Muram, MD, J. Lisse, MD, M.J. Murage, PhD, MPH, W. Malatestinic, PharmD, MBA, Eli Lilly and Company, Indianapolis, Indiana
| | - Jeffrey Lisse
- W. Huster, PhD, T. Muram, MD, J. Lisse, MD, M.J. Murage, PhD, MPH, W. Malatestinic, PharmD, MBA, Eli Lilly and Company, Indianapolis, Indiana
| | - Sabrina Rebello
- C.J. Etzel, PhD, S. Rebello, MPH, R. Dodge, MS, Corrona, LLC, Waltham, Massachusetts
| | - Rhiannon Dodge
- C.J. Etzel, PhD, S. Rebello, MPH, R. Dodge, MS, Corrona, LLC, Waltham, Massachusetts
| | - Mwangi J Murage
- W. Huster, PhD, T. Muram, MD, J. Lisse, MD, M.J. Murage, PhD, MPH, W. Malatestinic, PharmD, MBA, Eli Lilly and Company, Indianapolis, Indiana
| | - Jeffrey D Greenberg
- J.D. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York, USA
| | - William N Malatestinic
- W. Huster, PhD, T. Muram, MD, J. Lisse, MD, M.J. Murage, PhD, MPH, W. Malatestinic, PharmD, MBA, Eli Lilly and Company, Indianapolis, Indiana
| |
Collapse
|
8
|
Hile G, Kahlenberg JM, Gudjonsson JE. Recent genetic advances in innate immunity of psoriatic arthritis. Clin Immunol 2020; 214:108405. [PMID: 32247832 DOI: 10.1016/j.clim.2020.108405] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/28/2020] [Accepted: 03/28/2020] [Indexed: 12/19/2022]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous disease that affects multiple organ systems including the peripheral and axial joints, entheses and nails. PsA is associated with significant comorbidities including cardiovascular, metabolic, and psychiatric diseases. The pathogenesis of PsA is complex and involves genetic, immunologic and environmental factors. Recent evidence suggests the heritability for PsA to be stronger and distinct from that of PsC. Prominent genes identified via GWAS for PsA include HLA-B/C, HLAB, IL12B, IL23R, TNP1, TRAF3IP3, and REL. We review the genetics of psoriatic arthritis and discuss the role of the innate immune system as important in the pathogenesis of PsA by focusing on key signaling pathways and cellular makeup. Understanding the candidate genes identified in PsA highlights pathways of critical importance to the pathogenesis of psoriatic disease including the key role of the innate immune response, mediated through IL-23/IL-17 axis, RANK and NFκB signaling pathways.
Collapse
Affiliation(s)
- Grace Hile
- Department of Dermatology, University of Michigan, Ann Arbor 48109, MI, USA.
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor 48109, MI, USA.
| |
Collapse
|
9
|
Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic. Clin Rheumatol 2018; 37:2741-2749. [PMID: 30056525 DOI: 10.1007/s10067-018-4238-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 01/05/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune arthritis, occurring in patients with psoriasis (Pso), that may affect the whole musculoskeletal system but also nails, eye, and gastrointestinal tract. Dermatologists and rheumatologists usually manage Pso and PsA separately, but early diagnosis and integrated management could achieve better outcomes of both skin and musculoskeletal manifestations, thus improving the health-related quality of life (HRQoL) of patients. In this work, we have described a model of integrated dermo-rheumatologic approach for the early diagnosis of PsA and to present the outcomes of the multidisciplinary management of PsA patients after 48 weeks of follow-up. Pso patients complaining musculoskeletal symptoms were enrolled in a DErmo-Rheumatologic Clinic (DERC) in order to screen, classify, and treat patients with PsA, employing an operative working procedure and a specific flowchart. The integrated dermatologic and rheumatologic management of PsA patients allowed a prompt establishment of the diagnosis and the best therapeutic approach in these patients, with a significant improvement of skin and articular diseases and, eventually, a consistent amelioration of HRQoL. Dermatologists and rheumatologists usually manage the "psoriatic disease" in separated outpatient clinics. In our study, we have demonstrated that a combined DERC, by means of a tight cooperation between the dermatologist and the rheumatologist, which use a specific working procedure and treatment flowchart, may achieve the optimal clinical management of these patients, with a consistent clinical remission of the disease and a significant amelioration of the HRQoL.
Collapse
|
10
|
Abstract
Psoriatic arthritis is a major comorbidity of psoriasis that significantly impairs quality of life and physical function. Because skin lesions classically precede joint symptoms, dermatologists are in a unique position to identify patients at risk for psoriatic arthritis before irreversible joint damage occurs. Here we review the literature to identify the clinical and genetic factors most highly associated with development of psoriatic arthritis, with the goal of assisting dermatologists in risk-stratifying their psoriasis patients.
Collapse
Affiliation(s)
- Kristine Busse
- Department of Dermatology and Psoriasis Treatment Center, University of California—San Francisco, San Francisco, California
| | - Wilson Liao
- Department of Dermatology and Psoriasis Treatment Center, University of California—San Francisco, San Francisco, California
| |
Collapse
|
11
|
Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs 2015; 74:423-41. [PMID: 24566842 PMCID: PMC3958815 DOI: 10.1007/s40265-014-0191-y] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. Up to 40 % of patients with psoriasis will go on to develop PsA, usually within 5-10 years of cutaneous disease onset. Both conditions share common pathogenic mechanisms involving genetic and environmental factors. Because psoriasis is typically present for years before PsA-related joint symptoms emerge, dermatologists are in a unique position to detect PsA earlier in the disease process through regular, routine screening of psoriasis patients. Distinguishing clinical features of PsA include co-occurrence of psoriatic skin lesions and nail dystrophy, as well as dactylitis and enthesitis. Patients with PsA are usually seronegative for rheumatoid factor, and radiographs may reveal unique features such as juxta-articular new bone formation and pencil-in-cup deformity. Early treatment of PsA with disease-modifying anti-rheumatic drugs has the potential to slow disease progression and maintain patient quality of life. Optimally, a single therapeutic agent will control both the skin and joint psoriatic symptoms. A number of traditional treatments used to manage psoriasis, such as methotrexate and cyclosporine, are also effective for PsA, but these agents are often inadequately effective, temporary in benefit and associated with significant safety concerns. Biologic anti-tumour necrosis factor agents, such as etanercept, infliximab and adalimumab, are effective for treating patients who have both psoriasis and PsA. However, a substantial number of patients may lose efficacy, have adverse effects or find intravenous or subcutaneous administration inconvenient. Emerging oral treatments, including phosphodiesterase 4 inhibitors, such as apremilast, and new biologics targeting interleukin-17, such as secukinumab, brodalumab and ixekizumab, have shown encouraging clinical results in the treatment of psoriasis and/or PsA. Active and regular collaboration of dermatologists with rheumatologists in managing patients who have psoriasis and PsA is likely to yield more optimal control of psoriatic dermal and joint symptoms, and improve long-term patient outcomes.
Collapse
MESH Headings
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/genetics
- Arthritis, Psoriatic/immunology
- Clinical Trials as Topic
- Drug Therapy, Combination
- Early Diagnosis
- Glucocorticoids/administration & dosage
- Glucocorticoids/adverse effects
- Glucocorticoids/therapeutic use
- Humans
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Practice Guidelines as Topic
- Psoriasis/diagnosis
- Psoriasis/drug therapy
- Psoriasis/genetics
- Psoriasis/immunology
Collapse
Affiliation(s)
- Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, WA, USA,
| | | |
Collapse
|
12
|
Leeb BF, Haindl PM, Brezinschek HP, Mai HTH, Deutsch C, Rintelen B. Patient-centered psoriatic arthritis (PsA) activity assessment by Stockerau Activity Score for Psoriatic Arthritis (SASPA). BMC Musculoskelet Disord 2015; 16:73. [PMID: 25887796 PMCID: PMC4393861 DOI: 10.1186/s12891-015-0512-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 02/27/2015] [Indexed: 11/30/2022] Open
Abstract
Background To investigate whether a modified Rheumatoid Arthritis Disease Activity Index-5 could be applied as a routine assessment tool for psoriatic arthritis (PsA) patients. Methods Ninety-seven PsA outpatients (mean age 49.78 years; age range 23–80 years; 49 male, 48 female), completed a prototype questionnaire. Tender and swollen joint counts, including enthesiopathy, physician’s assessment of disease activity on a visual analog scale (MDglob), erythrocyte sedimentation rate, and patient satisfaction with disease status (PatSat: 1 = excellent to 5 = unsatisfactory) were recorded. Factorial analysis was performed and alpha, as a measure of reliability, and tau were calculated. The ultimate five-item questionnaire, calculated by (Q1 + Q2 + Q3 + Q4 + Q5)/5, was then handed over to 152 PsA outpatients (mean age 54.02 years; age range 26–80 years; 82 male, 70 female), and analyzed accordingly. Results Analyzing the internal consistency of the prototype questionnaire revealed the highest alpha value of 0.849, on deleting the question targeting disease course. Alpha for the final Stockerau Activity Score for Psoriatic Arthritis (SASPA) was 0.875, with all items contributing to the final result (item loading from 0.573 to 0.910). Kendall’s tau for the relationship between SASPA scores and swollen joint count, tender joint count, and MDglob was 0.34, 0.416, and 0.392, respectively. The sensitivity of the questionnaire to change was demonstrated in patients starting treatment with a tumor necrosis factor blocker (standardized mean difference: 2.1). Conclusion The SASPA questionnaire constitutes a fully patient-administered tool to monitor PsA activity. Its reliability, convergent validity, and sensitivity to change were demonstrated.
Collapse
Affiliation(s)
- Burkhard F Leeb
- 2nd Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau, Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, A-2000, Stockerau, Austria. .,Private Rheumatology Office, Babogasse 20, A-2020, Hollabrunn, Austria. .,Department for Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 2, A-8036, Graz, Austria.
| | - Pia M Haindl
- 2nd Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau, Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, A-2000, Stockerau, Austria.
| | - Hans-Peter Brezinschek
- Department for Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 2, A-8036, Graz, Austria.
| | - Harsono T H Mai
- 2nd Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau, Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, A-2000, Stockerau, Austria.
| | - Christoph Deutsch
- 2nd Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau, Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, A-2000, Stockerau, Austria.
| | - Bernhard Rintelen
- 2nd Department of Medicine, Center for Rheumatology, Lower Austria, State Hospital Stockerau, Karl Landsteiner Institute for Clinical Rheumatology, Landstrasse 18, A-2000, Stockerau, Austria.
| |
Collapse
|
13
|
Luelmo J, Gratacos J, Moreno Martínez-Losa M, Ribera M, Romaní J, Calvet J, Leal L, Larrosa M. Multidisciplinary Psoriasis and Psoriactic Arthritis Unit: Report of 4 years’ Experience. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
14
|
Luelmo J, Gratacós J, Moreno Martínez-Losa M, Ribera M, Romaní J, Calvet J, Leal L, Larrosa M. Experiencia de 4 años de funcionamiento de una unidad multidisciplinar de psoriasis y artritis psoriásica. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:371-7. [DOI: 10.1016/j.ad.2013.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 10/11/2013] [Accepted: 10/19/2013] [Indexed: 11/28/2022] Open
|
15
|
Experiencia de 4 años de funcionamiento de una unidad multidisciplinar de psoriasis y artritis psoriásica. ACTA ACUST UNITED AC 2014; 10:141-6. [DOI: 10.1016/j.reuma.2014.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/23/2014] [Indexed: 11/19/2022]
|
16
|
Husni ME, Qureshi AA, Koenig AS, Pedersen R, Robertson D. Utility of the PASE questionnaire, psoriatic arthritis (PsA) prevalence and PsA improvement with anti-TNF therapy: results from the PRISTINE trial. J DERMATOL TREAT 2013; 25:90-5. [DOI: 10.3109/09546634.2013.800185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
17
|
Chang CA, Gottlieb AB, Lizzul PF. Management of psoriatic arthritis from the view of the dermatologist. Nat Rev Rheumatol 2011; 7:588-98. [PMID: 21912431 DOI: 10.1038/nrrheum.2011.125] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. Although the main assessment measures for PsA are borrowed from the standard criteria used to assess rheumatoid arthritis, a number of new criteria such as the PsAJAI and CPDAI are being developed specifically for PsA. Long-term consequences of untreated PsA include persistent inflammation, progressive joint damage and, in many cases, substantial functional limitations, pain and disability. Moreover, patients with PsA have an increased mortality risk and an increased risk of developing cardiovascular disease and metabolic syndrome. Both GRAPPA and the AAD have developed treatment guidelines, which are discussed here. Psoriasis commonly precedes arthritic symptoms; thus, dermatologists are ideally placed to make the initial diagnosis of PsA and treat it appropriately, affording the opportunity to slow disease progression, improve physical function and enhance quality of life. This Review explores the management of patients with PsA, with a particular emphasis on assessment tools, long-term consequences and treatment issues from the viewpoint of the dermatologist.
Collapse
Affiliation(s)
- Caroline A Chang
- Department of Dermatology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | | | | |
Collapse
|
18
|
Qualität einer interdisziplinären Sprechstunde in der Rheumaorthopädie. Z Rheumatol 2010; 69:749-54. [DOI: 10.1007/s00393-010-0666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Reich K, Krüger K, Mössner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol 2009; 160:1040-7. [PMID: 19210498 DOI: 10.1111/j.1365-2133.2008.09023.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Because psoriatic arthritis (PsA) usually develops years after the first manifestation of skin symptoms, in many cases the initial diagnosis of PsA depends on the dermatologist. OBJECTIVES To investigate the prevalence and clinical pattern of PsA in a daily practice population of patients with psoriasis. METHODS Patients were enrolled in an observational prospective cross-sectional cohort study at 48 community and academic centres. Demographic and medical parameters were recorded, including severity of skin symptoms (Psoriasis Area and Severity Index, PASI), previous and current treatments, concomitant diseases, and the impact of psoriasis on productivity and health-related quality of life (Dermatology Life Quality Index, DLQI). Patients with joint symptoms were referred to a rheumatologist for diagnosis and to record the activity and pattern of arthritis. RESULTS Among 1511 patients 20.6% had PsA; in 85% of the cases PsA was newly diagnosed. Of these patients more than 95% had active arthritis and 53.0% had five or more joints affected. Polyarthritis (58.7%) was the most common manifestation pattern, followed by oligoarthritis (31.6%) and arthritis mutilans (4.9%). Distal interphalangeal involvement was present in 41.0% and dactylitis in 23.7% of the patients. Compared with patients without arthritis, patients with PsA had more severe skin symptoms (mean PASI 14.3 vs. 11.5), a lower quality of life (mean DLQI 11.6 vs. 7.7) and greater impairment of productivity parameters. CONCLUSIONS The findings are consistent with a high prevalence of undiagnosed cases of active PsA among patients with psoriasis seen by dermatologists. As many of these patients also have significant skin symptoms, treatment strategies are required that are equally effective in the control of skin and joint symptoms of psoriasis.
Collapse
Affiliation(s)
- K Reich
- Dermatologikum Hamburg, Stephansplatz 5, 20354 Hamburg, Germany.
| | | | | | | |
Collapse
|
20
|
Husni ME, Meyer KH, Cohen DS, Mody E, Qureshi AA. The PASE questionnaire: Pilot-testing a Psoriatic Arthritis Screening and Evaluation tool. J Am Acad Dermatol 2007; 57:581-7. [PMID: 17610990 DOI: 10.1016/j.jaad.2007.04.001] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 03/19/2007] [Accepted: 04/10/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complications associated with psoriatic arthritis (PsA) may be prevented with early diagnosis and initiation of therapy. Up to one third of psoriasis patients may have PsA. There is a need to screen psoriasis patients early for symptoms of PsA. OBJECTIVE To develop and validate a patient self-administered tool to screen psoriasis patients for signs and symptoms of inflammatory arthritis. METHODS The questionnaire (PASE; Psoriatic Arthritis Screening and Evaluation) was developed using standardized methodology for the development of both functional and health-related instruments geared toward musculoskeletal diseases. A multidisciplinary team of dermatologists, rheumatologists, and patient focus groups were involved in the design of the questionnaire. RESULTS A total of 69 participants with known psoriasis and PsA before the initiation of systemic therapy were screened with PASE after institutional review board approval. The average age was 51 years, and 51% of the participants were female. A total of 25% (17/69) were diagnosed with PsA in this study, and 37% (24/69) were diagnosed with osteoarthritis. Patients with concomitant PsA and osteoarthritis were excluded. PASE total scores ranged from 23 to 68 (possible range, 15-75). In patients with PsA, the median total score was 53 (25th and 75th percentiles, 49 and 63, respectively) and 39 (25th and 75th percentiles, 28 and 47) in non-PsA patients (P < .001). Median PASE total score for osteoarthritis patients was 43 (25th and 75th percentiles, 37 and 51) and significantly different to PsA patient total median scores (P = .002). Using receiver operator curves, we determined that PASE total score > or =47 was able to distinguish PsA from non-PsA patients with 82% sensitivity and 73% specificity. LIMITATIONS PASE is a screening tool for PsA and does not replace a comprehensive musculoskeletal evaluation by a rheumatologist. CONCLUSION The PASE questionnaire is a self-administered tool that can be used to screen for PsA among patients with psoriasis. PASE can distinguish between symptoms of PsA and osteoarthritis. A larger study is needed to validate PASE in dermatology clinics in the community.
Collapse
Affiliation(s)
- M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | |
Collapse
|
21
|
Mody E, Husni ME, Schur P, Qureshi AA. Multidisciplinary evaluation of patients with psoriasis presenting with musculoskeletal pain: a dermatology: rheumatology clinic experience. Br J Dermatol 2007; 157:1050-1. [PMID: 17725678 DOI: 10.1111/j.1365-2133.2007.08139.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|