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Aydin SZ, Deodhar A. Are all entheses the same? Rheumatology (Oxford) 2024; 63:1-2. [PMID: 37326834 DOI: 10.1093/rheumatology/kead288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Sibel Zehra Aydin
- Faculty of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
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Management of particular clinical situations in psoriatic arthritis: an expert's recommendation document based on systematic literature review and extended Delphi process. Rheumatol Int 2021; 41:1549-1565. [PMID: 33934175 PMCID: PMC8316175 DOI: 10.1007/s00296-021-04877-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
To establish practical recommendations for the management of patients with psoriatic arthritis (PsA) with particular clinical situations that might lead to doubts in the pharmacological decision-making. A group of six expert rheumatologists on PsA identified particular clinical situations in PsA. Then, a systematic literature review (SLR) was performed to analyse the efficacy and safety of csDMARDs, b/tsDMARDs in PsA. In a nominal group meeting, the results of the SLR were discussed and a set of recommendations were proposed for a Delphi process. A total of 65 rheumatologists were invited to participate in the Delphi. Agreement was defined if ≥ 70% of the participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grade of recommendation was established based on the Oxford Evidence-Based Medicine categorisation. Particular clinical situations included monoarthritis, axial disease, or non-musculoskeletal manifestations. The SLR finally comprised 131 articles. A total of 16 recommendations were generated, all but 1 reached consensus. According to them, it is crucial to carefully analyse the impact of individual manifestations on patients (disability, quality of life, etc.), but also to recognise the impact of each drug singularities on selected clinical phenotypes to adopt the most appropriate treatment strategy. Early diagnosis and treatment to target approach, along with a close risk management, is also necessary. These recommendations are intended to complement gaps in national and international guidelines by helping health professionals address and manage particular clinical situations in PsA.
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Lequang JA. Innovations in Psoriasis Management: Based on Selected Presentations from the Symposium for Cosmetic Advances & Laser Education (SCALE) Virtual Congress-July 24 to 26, 2020. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:S8-S23. [PMID: 33362902 PMCID: PMC7733677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Jo Ann Lequang
- Ms. Lequang is Owner of LeQ Medical in Angleton, Texas; Director of Scientific Communications at NEMA Research, Inc., in Naples, Florida; and Founding Director of No Baby Blisters in Colorado Springs, Colorado
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Grinnell-Merrick LL, Lydon EJ, Mixon AM, Saalfeld W. Evaluating Inflammatory Versus Mechanical Back Pain in Individuals with Psoriatic Arthritis: A Review of the Literature. Rheumatol Ther 2020; 7:667-684. [PMID: 32935330 PMCID: PMC7695767 DOI: 10.1007/s40744-020-00234-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 01/03/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic immune-mediated disease characterized by psoriatic skin and nail changes, peripheral joint inflammation, enthesitis, dactylitis, and/or axial involvement, either alone or in combination with each other. The presence of axial involvement has been shown to be a marker of PsA severity; however, there is no widely accepted definition of axial involvement in PsA (axPsA) or consensus on how or when to screen and treat patients with suspected axPsA. Chronic back pain is a prominent feature of axPsA and is thought to have a relevant role in early identification of disease. Chronic back pain can be caused by inflammatory back pain (IBP) or mechanical back pain (MBP). However, MBP can complicate recognition of IBP and delay diagnosis of axPsA. While MBP can also be associated with chronic back pain of ≥ 3 months in duration that is typical of IBP, IBP is characterized by inflammation of the sacroiliac joint and lower spine that is differentiated from MBP by key characteristic features, including insidious onset at age < 40 years, improvement with exercise but not with rest, and nighttime pain. This review discusses the differences in identification and management of IBP and MBP in patients with PsA with axPsA. The summary of available evidence highlights the importance of appropriate and timely screening, difficulties and limitations of differential diagnoses and treatment, and unmet needs in axPsA. Psoriatic arthritis (PsA) is a long-term disease that may lead to psoriatic changes in skin and nails; inflammation of some joints, including finger and toe joints (dactylitis); inflammation of sites where tendons and ligaments connect to bone (enthesitis); and/or problems in the spine (axial involvement). Approximately 25–70% of patients with PsA have axial involvement (axPsA); this number varies because there is no widely accepted definition for axPsA. Chronic (long-lasting) back pain is a major feature of axSpA and can help doctors recognize axPsA early. Chronic back pain can be caused by inflammatory back pain (IBP) or mechanical back pain (MBP). IBP is described by back pain lasting ≥ 3 months, gradual onset at age < 40 years, improvement with exercise, no improvement with rest, pain at night (with improvement upon getting up), and changes in some laboratory test results. On the other hand, MBP is caused by a physical injury to the lower back. Both IBP and MBP can occur in patients with PsA, but they are treated in different ways. Being able to tell the difference between IBP and MBP is important to make sure that patients receive the right treatment. This review looks at the differences between IBP and MBP, screening for IBP, the difficulties and limitations of diagnosing and treating axPsA, and the needs of patients with axPsA for better diagnosis and treatment.
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Affiliation(s)
| | | | - Amanda M Mixon
- Arthritis and Rheumatology Clinic of Northern Colorado, Fort Collins, CO, USA
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Gazel U, Solmaz D, Ayan G, Ivory C, Karsh J, Aydin SZ. Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography. J Clin Med 2020; 9:jcm9092929. [PMID: 32927920 PMCID: PMC7564699 DOI: 10.3390/jcm9092929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022] Open
Abstract
We aimed to explore the accuracy of physical examination (PE) to detect the synovial and extra-synovial pathologies in psoriatic arthritis (PsA) in comparison to ultrasonography (US). Twenty-nine PsA patients with hand pain were included in the study. A detailed PE of the hands was performed and US scans were performed for the joints, extensor and flexor tendons, and entheses of the second to fifth fingers of both hands. The agreement between PE and US findings was calculated. The strongest agreement for the joints was between "swollen joints" and power Doppler (PD) signals in the metacarpophalangeal (MCP) joints and grey scale synovitis in the proximal interphalangeal (PIP) joints. The agreement of tender entheses on PE and inflammation on US (hypoechogenicity, thickening, and/or PD signals) was poor for both extensor (Kappa = -0.027, Prevalence Adjusted and Bias Adjusted Kappa (PABAK) = 0.344) and flexor compartments (Kappa = 0.039, PABAK = 0.569). Similar to enthesitis, comparison of any PE and US findings showed a poor agreement at the extensor and flexor tendon regions (extensor: Kappa = 0.123, PABAK = 0.448, and flexor: Kappa = 0.171, PABAK = 0.431). Our study showed that there was a poor to fair agreement of PE and US findings of hands. US can add value when determining the source of pain in PsA in the small joints.
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Affiliation(s)
- Ummugulsum Gazel
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
- Correspondence:
| | - Dilek Solmaz
- Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University, Cigli, Izmir 35620, Turkey;
| | - Gizem Ayan
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
| | - Catherine Ivory
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
| | - Jacob Karsh
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
| | - Sibel Zehra Aydin
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
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Ayan G, Solmaz D, Bakirci S, Tinazzi I, Omma A, Kucuksahin O, Ozisler C, Yavuz S, Bayindir O, Kimyon G, Dogru A, Tarhan EF, Can M, Kilic L, Duruoz MT, Aksu K, Kalyoncu U, Aydin SZ. Large joint and lower extremity involvement have higher impact on disease outcomes in oligoarticular psoriatic arthritis. Int J Rheum Dis 2020; 23:1094-1099. [PMID: 32567814 DOI: 10.1111/1756-185x.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/11/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Joints with different sizes and anatomical locations can be affected in psoriatic arthritis (PsA). Our aim was to explore the effect of different joint patterns on patient-reported outcomes (PROs) in patients with mono-oligoarthritis. METHODS Within PsArt-ID (Psoriatic Arthritis- International Database), 387/1670 patients who had mono-oligoarthritis (1-4 tender and swollen joints) were enrolled in cross-sectional assessment. The joints were categorized according to their size (small/large) and location (upper/lower extremity) and PROs, physician global assessment and C-reactive protein (CRP) were compared. Analysis was made by categorizing according to joint counts (1-2 joints/ 3-4 joints). RESULTS The mean age (SD) was 46.9 (14.24) with a mean (SD) PsA duration of 3.93 (6.03) years. Within patients with 1-2 involved joints (n = 302), size of the joints only had an impact on CRP values with large joints having higher CRP (P = .005), similar to lower extremity involvement (P = .004). PROs were similar regardless of size or location if 1-2 joints were inflamed. Within patients with 3-4 involved joints (n = 85), patient global assessment (PGA), pain, fatigue and physician global assessment were higher in the group with large joints. Similarly, PGA, pain, and physician global assessment were higher in patients with lower extremity involvement as well as higher CRP values. CONCLUSION For PsA patients with 3-4 joints involved, lower extremity and large joints are associated with poorer outcomes with worse PROs, physician global assessment, and higher CRP. The size and anatomical location of the joints are less important for patients with 1-2 joints in terms of the PROs.
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Affiliation(s)
- Gizem Ayan
- Faculty of Medicine, Rheumatology, University of Ottawa, Ottawa, ON, Canada
| | - Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Sibel Bakirci
- Faculty of Medicine, Rheumatology, University of Ottawa, Ottawa, ON, Canada
| | - Ilaria Tinazzi
- Unit of Rheumatology, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Ahmet Omma
- Division of Rheumatology, Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Orhan Kucuksahin
- Division of Rheumatology, Department of Internal Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Cem Ozisler
- Division of Rheumatology, Department of Internal Medicine, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Sule Yavuz
- Division of Rheumatology, Department of Internal Medicine, Marmara University, Istanbul, Turkey
| | - Ozun Bayindir
- Division of Rheumatology, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Gezmis Kimyon
- Division of Rheumatology, Department of Internal Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Atalay Dogru
- Division of Rheumatology, Department of Internal Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Emine Figen Tarhan
- Division of Rheumatology, Department of Internal Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Meryem Can
- Division of Rheumatology, Department of Internal Medicine, Medipol University, Istanbul, Turkey
| | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Hospital, Hacettepe University, Ankara, Turkey
| | - Mehmet Tuncay Duruoz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Kenan Aksu
- Division of Rheumatology, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Hospital, Hacettepe University, Ankara, Turkey
| | - Sibel Zehra Aydin
- Faculty of Medicine, Rheumatology, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Zabotti A, Tinazzi I, Aydin SZ, McGonagle D. From Psoriasis to Psoriatic Arthritis: Insights from Imaging on the Transition to Psoriatic Arthritis and Implications for Arthritis Prevention. Curr Rheumatol Rep 2020; 22:24. [PMID: 32418006 PMCID: PMC7230038 DOI: 10.1007/s11926-020-00891-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To describe the recent advances in the field towards the prevention and early recognition of Psoriatic Arthritis (PsA). RECENT FINDINGS Defining the preclinical phase of PsA remains challenging since up to 50% of subjects with psoriasis have subclinical imaging enthesopathy, but many of these do not progress to PsA. Nevertheless, there is evidence that subjects with subclinical imaging enthesopathy are at increased risk of developing PsA. In recent years, it has been shown that both PsA and anti-citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA) are characterized by a subclinical phase of non-specific or brief duration arthralgia with shared imaging features accounting for joint symptomatology. Sonographically determined tenosynovitis and enthesitis are the key imaging features present in non-specific PsO arthralgia that are at risk of future PsA development. Furthermore, the early phases of PsA are complicated by factors including body mass index (BMI), which is a risk factor for PsA, but BMI is also associated with imaging abnormalities on enthesopathy. Fully disentangling these clinical and imaging factors will be important for enrichment for imminent PsA so that disease prevention strategies can be investigated. Psoriasis patients with arthralgia have a higher prevalence of tenosynovitis and imaging enthesopathy is at higher risk of transitioning to overt PsA.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Sibel Zehra Aydin
- Faculty of Medicine, Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
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