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Hen O, Harrison SR, De Marco G, Marzo-Ortega H. Early psoriatic arthritis: when is the right time to start advanced therapy? Ther Adv Musculoskelet Dis 2024; 16:1759720X241266727. [PMID: 39071239 PMCID: PMC11283661 DOI: 10.1177/1759720x241266727] [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: 02/02/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024] Open
Abstract
Despite significant advances in the treatment of psoriatic arthritis (PsA) in the last two decades, remission remains elusive and there is no cure. Evidence from rheumatoid arthritis (RA) confirming enhanced response and outcome from earlier treatment intervention suggests the plausibility of the window of opportunity in the pathogenesis of RA. Yet, data are lacking in PsA. Although treatment response may be enhanced in shorter disease duration, it is unknown how this early intervention may impact long-term outcomes. Furthermore, it remains to be demonstrated whether there is a best treatment strategy and time of intervention. Crucially, the main hurdle when aiming for early treatment intervention is the ability to achieve a timely diagnosis that highlights the need to focus research efforts on characterizing the very early disease stages including the transition to PsA in the at-risk psoriasis population.
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Affiliation(s)
- Or Hen
- NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Medicine ‘C’, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Stephanie R. Harrison
- NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Stephanie R. Harrison is also affiliated to Leeds Institute of Data Analytics, University of Leeds, Leeds
| | - Gabriele De Marco
- NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Stephanie R. Harrison is also affiliated to Leeds Institute of Data Analytics, University of Leeds, Leeds
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Second Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
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Bellis E, Ruscitti P, Donzella D, Crepaldi G, Data V, Gammino M, Gatto M, Guardo V, Lomater C, Marucco E, Saracco M, Iagnocco A. Retention Rate of Ixekizumab in Psoriatic Arthritis: A Real-World Study. J Pers Med 2024; 14:716. [PMID: 39063970 PMCID: PMC11278385 DOI: 10.3390/jpm14070716] [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: 06/03/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
We aimed to examine the drug retention rate (DRR) of the interleukin-17 inhibitor ixekizumab in a real-world monocentric cohort of psoriatic arthritis (PsA) patients and to assess the predictors of drug discontinuation. Consecutive PsA patients who underwent treatment with ixekizumab from October 2019 to February 2023 were enrolled in this observational, retrospective, monocentric study. Clinical records were assessed at baseline and throughout the follow-up period. We collected sociodemographic data, smoking habits, body mass index, the presence of Human Leukocyte Antigen B27, comorbidities, disease involvement and duration, previous therapy, discontinuation of ixekizumab, reasons for discontinuation, and adverse events (AEs). DRR was evaluated as time to drug discontinuation and assessed through Kaplan-Meier curves. Baseline factors predicting drug discontinuation were investigated through logistic regression models. Eighty PsA patients were included in this study. Ixekizumab was administered at a dose of 160 mg by subcutaneous injection at baseline, followed by 80 mg every four weeks thereafter. Ixekizumab had a 38-month-cumulative DRR of 43.8%, accounting for both inefficacy and AEs. When considering only inefficacy, the DRR was 62.6%. Comorbidities (p = 0.665), obesity (p = 0.665), smoking (p = 0.884), disease duration ≤ 2 years (p = 0.071), axial (p = 0.131) and skin involvement (p = 0.460), and previous therapies, including conventional synthetic (p = 0.504) and biological (p = 0.474) Disease-Modifying Antirheumatic Drugs (bDMARDs), as well as the number of previous bDMARDs or targeted synthetic Disease-Modifying Antirheumatic Drugs (tsDMARDs), did not significantly affect the DRR (p = 0.349). Multivariate analysis found no independent predictors of drug discontinuation. The most frequent AEs leading to discontinuation were skin reactions; no severe infections were observed. In our real-world study, comorbidities, disease duration, and previous therapies did not affect the DRR of ixekizumab. Ixekizumab had a favorable safety profile, with no severe AEs observed.
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Affiliation(s)
- Elisa Bellis
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Denise Donzella
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Gloria Crepaldi
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Valeria Data
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Marinella Gammino
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Mariele Gatto
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Valeria Guardo
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Claudia Lomater
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Elena Marucco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Marta Saracco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, AO Mauriziano di Torino, 10128 Turin, Italy (G.C.)
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Ribeiro AL, Eder L. From Psoriasis to Psoriatic Arthritis: Ultrasound Insights Connecting Psoriasis with Subclinical Musculoskeletal Inflammation and the Path to Psoriatic Arthritis. Curr Rheumatol Rep 2024; 26:235-247. [PMID: 38512585 DOI: 10.1007/s11926-024-01146-9] [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] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW This review summarizes the literature about the transition from psoriasis to psoriatic arthritis (PsA), focusing on musculoskeletal ultrasound (MSUS) for detecting subclinical inflammation and its role in diagnosis and triage of high-risk patients. RECENT FINDINGS MSUS effectively detects subclinical musculoskeletal inflammation in patients with psoriasis; however, some of these lesions are non-specific and can be found in healthy individuals. Preliminary evidence suggest that subclinical sonographic findings may predict progression to PsA in psoriasis patients. MSUS can also improve referrals' accuracy and its integration in the PsA classification criteria may improve early PsA detection. MSUS is a valuable tool for detecting subclinical abnormalities in psoriasis patients, which indicate an increased likelihood of progressing to PsA. Its integration into referral protocols and clinical use could improve PsA diagnosis. We propose an MSUS-inclusive algorithm for PsA referrals and triage, which requires validation. The potential of early intervention in reducing PsA progression in psoriasis patients with subclinical inflammation remains to be established.
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Affiliation(s)
- A L Ribeiro
- Department of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto, 76 Grenville Street Room 6326, Toronto, Ontario, M5S 1B2, Canada
| | - L Eder
- Department of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto, 76 Grenville Street Room 6326, Toronto, Ontario, M5S 1B2, Canada.
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Corte G, Atzinger A, Temiz SA, Noversa de Sousa R, Mutlu MY, Schoenau V, Raimondo MG, Kleyer A, Kuwert T, Ramming A, Simon D, Sticherling M, Schmidkonz C, Schett G, Fagni F. Anatomical pattern of entheseal and synovial fibroblast activation in patients with psoriasis and its risk of developing psoriatic arthritis. RMD Open 2024; 10:e004294. [PMID: 38862244 PMCID: PMC11168197 DOI: 10.1136/rmdopen-2024-004294] [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: 03/01/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES To assess the presence and anatomical distribution of activated fibroblasts in the joints and entheses of patients with psoriasis with arthralgia and to test how fibroblast activation visualised by 68gallium-labelled fibroblast activation protein inhibitor-04 (68Ga-FAPI-04)-positron emission tomography (PET)/CT correlates with clinical tenderness, musculoskeletal ultrasound findings and progression to psoriatic arthritis (PsA). METHODS We conducted a prospective cohort study in patients with psoriasis and arthralgia who underwent clinical and ultrasound evaluation and whole-body PET/CT imaging with 68Ga-FAPI-04. 68Ga-FAPI-04 uptake at synovial and entheseal sites was assessed by maximal standardised uptake values (SUVmax) and PET/CT Joint Index (JI); logistic regression models were used to investigate its correlation with clinical and ultrasound findings. Survival analyses were performed on patients with at least 6 months of follow-up. RESULTS 36 patients with psoriasis were enrolled. 68Ga-FAPI-04 uptake was found in 318 (7.9%) joints and 369 (7.3%) entheses in 29 (80.6%) participants, with a mean SUVmax (SD) of 3.2 (1.8) for joints and 2.9 (1.6) for entheses. Large joints and the lower limbs were predominantly affected. A significant positive relationship was found between 68Ga-FAPI-04-PET/CT signal intensity and the 68 tender joint count (SUVmax: p<0.001; PET/CT-JI: p<0.001) and tender entheses count (SUVmax: p<0.001; PET/CT-JI: p=0.002). No correlations were found with ultrasound findings (SUVmax: p=0.969; PET/CT-JI: p=0.720). Patients with relevant synovio-entheseal 68Ga-FAPI-04 uptake showed a statistically significant higher risk of developing PsA (p=0.02), independent of ultrasound findings. CONCLUSIONS Patients with psoriasis presenting with arthralgia show localised signs of resident tissue activation in joints and entheses, which are associated with higher risk of developing PsA.
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Affiliation(s)
- Giulia Corte
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Selahattin Alp Temiz
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Rita Noversa de Sousa
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Serviço de Medicina Interna, Hospital Pedro Hispano, Hospital Pedro Hispano, Matosinhos, Porto, Portugal
| | - Melek Yalcin Mutlu
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Verena Schoenau
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Maria Gabriella Raimondo
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Torsten Kuwert
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Michael Sticherling
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Erlangen University Hospital, Erlangen, Germany
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Amberg, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Erlangen University Hospital, Erlangen, Germany
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Wortsman X. Role of Color Doppler Ultrasound in Cutaneous Inflammatory Conditions. Semin Ultrasound CT MR 2024; 45:264-286. [PMID: 38056784 DOI: 10.1053/j.sult.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Inflammatory cutaneous diseases can be challenging to diagnose and manage. Nowadays, the anatomical information provided by ultrasound is critical for detecting subclinical alterations and assessing the severity and activity of these conditions. Many of these entities can be clinically observed in dermatology and other specialties, such as rheumatology, plastic surgery, ophthalmology, and otolaryngology, among others. We review the ultrasonographic patterns of the most common inflammatory cutaneous conditions. In several cases, such as hidradenitis suppurativa, acne, and morphea, there are ultrasonographic staging systems of severity or activity that are pivotal in the management of these diseases. The early ultrasonographic diagnosis of these entities implies a proper management of the patients and, therefore, improve their quality of life. Thus, knowledge of the current use of ultrasound in this field seems essential.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Tortosa-Cabañas M, Tejero-Carmona ME, García-Montes N, Guillén-Astete CA. Ultrasound Changes in the Enthesis and Peri-enthesis Area of the Patellar and Achilles Tendons in Response to Physical Exercise: Comparison Between Healthy Subjects and Patients with Spondyloarthritis in Clinical Remission. Acad Radiol 2024:S1076-6332(24)00230-7. [PMID: 38796403 DOI: 10.1016/j.acra.2024.04.021] [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: 12/14/2023] [Revised: 04/09/2024] [Accepted: 04/13/2024] [Indexed: 05/28/2024]
Abstract
RATIONALE AND OBJECTIVES The goal of achieving clinical remission in patients with spondyloarthritis does not necessarily include the resolution of entheseal inflammation from a histological perspective. However, enthesis not clinically inflamed, under mechanical stress, may behave differently from healthy subjects considering the physiopathology of SpA. Our goal was to determine whether ultrasound changes in entheses differ between SpA patients in clinical remission and healthy subjects. METHODS SpA patients in clinical remission and matched healthy controls were recruited. At baseline, the following variables were measured on the dominant side by ultrasound: thickness of the distal patellar enthesis (hDP), the deep infrapatellar bursa (hDIB), the Achilles enthesis (hA), the preachilleal bursa (hPAB), effusion in the preachileal bursa (hePAB), and the presence of power Doppler signal in both enthesis. All measurements except hDP and hA were collected again after exercise (post-stress ultrasound). RESULTS 30 patients and 30 controls were enrolled. In all subjects, hDIB, hPAB, and the preachileal bursa occupancy index increased significantly after the exercise. The increase was significantly greater in patients for all variables. At baseline, in patients, hyperemia was detected in one patellar tendon (3.3%) and in two Achilles tendons (6.7%). After exercise, the number of tendons with hyperemia increased to 11/30 (36.7%) and 12/30 (40%), respectively. Among controls, there was no detectable basal hyperemia, but after exercise, it was detected in 1/30 patellar tendons (3.3%) and 2/30 Achilles tendons (6.7%). CONCLUSION Exercise triggers a greater effusive and hyperemic synovial response in patients in remission than in healthy controls. These findings suggest that the definition of remission should also include an assessment of the synovial response to mechanical stress. HIGHLIGHTS
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Affiliation(s)
| | | | - Nuria García-Montes
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Alcorcón, Madrid, Spain
| | - Carlos Antonio Guillén-Astete
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Alcorcón, Madrid, Spain; Universidad Europea de Madrid, Dept. of Medicine, Fac. of Biomedical and Health Sciences, Spain.
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7
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Bonfiglioli KR, Lopes FODA, de Figueiredo LQ, Ferrari LFF, Guedes L. Ultrasonographic Insights into Peripheral Psoriatic Arthritis: Updates in Diagnosis and Monitoring. J Pers Med 2024; 14:550. [PMID: 38929771 PMCID: PMC11205202 DOI: 10.3390/jpm14060550] [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: 04/22/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians' understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Reumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, Brazil; (F.O.d.A.L.); (L.Q.d.F.); (L.F.F.F.); (L.G.)
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Coronel L, Gouze H, Gudu T, Ruel-Gagné S, Padovano I, Costantino F, Vidal F, Breban M, Mahé E, D'Agostino MA. Prevalence of ultrasound and clinical findings suggestive of inflammatory arthritis in children with skin psoriasis. Rheumatology (Oxford) 2024; 63:1391-1396. [PMID: 37540167 DOI: 10.1093/rheumatology/kead398] [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: 01/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To evaluate the prevalence of clinical and US (grey-scale and Doppler) abnormalities in joints, periarticular structures and nails of children affected by skin psoriasis (PsO). METHODS We conducted a cross-sectional study including consecutive children affected by PsO. A systematic clinical and US evaluation of joints, entheses, tendons and nails were performed by independent examiners blinded to each other's assessment. RESULTS A total of 57 children [26 girls (46%)] with a mean age of 9 years (s.d. 4) were divided into two groups, asymptomatic (Asy, 42 children) and symptomatic (Sy, 15 children), according to musculoskeletal pain. Differences were observed between the two groups in relation to age [9 years (s.d. 3) vs 11 years (s.d. 4), P < 0.05], PsO duration [2.4 years (s.d. 2.4) vs 5.4 years (s.d. 3.9), P < 0.001], systemic treatment [23 (54.8%) vs 2 [13.3%], P < 0.01], tender joint count [0 vs 12 children (80%), P < 0.001], swollen joint count [0 vs 3 children (20%), P < 0.01] and entheseal pain [0 vs 10 (66.7%), P < 0.001] in Asy and Sy children, respectively. US evaluation showed statistically significant differences between the Asy and Sy groups for the presence of US abnormalities [16/42 (38%) vs 12/15 (80%)], synovitis [1/42 (2%) vs 4/15 (25%)] and enthesitis [4/42 (9.5%) vs 5/15 (33%)]. Three children in the Sy group were classified with juvenile PsA (JPsA). CONCLUSIONS US abnormalities were higher in the Sy group, with synovitis and enthesitis as the most prevalent findings. Asy patients were more frequently under systemic treatment. US and a systematic clinical evaluation are useful tools for detecting subclinical JPsA in children with PsO and musculoskeletal symptoms.
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Affiliation(s)
- Luis Coronel
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Rheumatology Division, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Hélène Gouze
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Inserm U1018, Center for Research in Epidemiology and Population Health "Integrative Respiratory Epidemiology" Team, Paris-Saclay University, Villejuif, France
| | - Tania Gudu
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Sophie Ruel-Gagné
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Ilaria Padovano
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Félicie Costantino
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Infection and Inflammation, UMR 1173, Inserm, UVSQ/Paris-Saclay University, Laboratory of Excellence INFLAMEX, Montigny-le-Bretonneux, France
| | - François Vidal
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
| | - Maxime Breban
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Infection and Inflammation, UMR 1173, Inserm, UVSQ/Paris-Saclay University, Laboratory of Excellence INFLAMEX, Montigny-le-Bretonneux, France
| | - Emmanuel Mahé
- Dermatology Department, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Maria-Antonietta D'Agostino
- Rheumatology Division, Hôpital Ambroise-Paré, APHP-Université Paris-Saclay, France
- Infection and Inflammation, UMR 1173, Inserm, UVSQ/Paris-Saclay University, Laboratory of Excellence INFLAMEX, Montigny-le-Bretonneux, France
- Rheumatology Department, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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Bhoi AK, Grover C, Singal A, Tandon A. Enthesopathy in patients with nail psoriasis - a cross-sectional evaluation of clinical, onychoscopic and ultrasonographic features. Indian J Dermatol Venereol Leprol 2023; 89:854-861. [PMID: 37317728 DOI: 10.25259/ijdvl_894_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/04/2023] [Indexed: 06/16/2023]
Abstract
Background Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the relationship of nail psoriasis with enthesitis remains under-explored. Aims This study was conducted to evaluate the clinical, onychoscopic (nail dermatoscopic) and ultrasonographic features in patients with nail psoriasis. Materials and Methods All nails of twenty adult patients with nail psoriasis were examined clinically and onychoscopically. Patients were evaluated for psoriatic arthritis (Classification Criteria for Psoriatic Arthritis), the severity of cutaneous disease (Psoriasis Area Severity Index) and nail disease (Nail Psoriasis Severity Index). Ultrasonography of the clinically involved digits was performed for evidence of distal interphalangeal joint enthesitis. Results Out of 20 patients, 18 patients had cutaneous psoriasis and 2 had isolated nail involvement. Among the 18 patients with skin psoriasis, 4 had associated psoriatic arthritis. The most commonly observed clinical and onychoscopic features were pitting (31.2% and 42.2%), onycholysis (36% and 36.5%) and subungual hyperkeratosis (30.2% and 30.5%), respectively. Ultrasonographic evidence of distal interphalangeal joint enthesitis was seen in 57% (175/307) of the digits with clinical nail involvement. Enthesitis was more common in patients with psoriatic arthritis (77% vs 50.6%). Nail thickening, crumbling and onychorrhexis (all features of nail matrix involvement) were significantly associated with enthesitis (P < 0.005). Limitation The major limitation was the small sample size and lack of controls. Only the clinically involved digits were evaluated for enthesitis. Conclusion Enthesitis was frequently detected on ultrasonography in patients with nail psoriasis, even in clinically asymptomatic individuals. Nail features of thickening, crumbling and onychorrhexis may predict underlying enthesitis and the potential development of arthritis. A comprehensive evaluation could help identify patients with psoriasis at risk for arthritis, helping improve long-term outcomes.
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Affiliation(s)
- Anil Kumar Bhoi
- Department of Dermatology and STD, University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital, Delhi, India
| | - Anupama Tandon
- Department of Dermatology and STD, University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital, Delhi, India
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Soriano ER, Ogdie A. Can Early Aggressive Treatment of Psoriasis Prevent Psoriatic Arthritis? A Debate at the GRAPPA Annual Meeting. J Rheumatol 2023; 50:8-10. [PMID: 37527866 DOI: 10.3899/jrheum.2023-0506] [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] [Accepted: 05/26/2023] [Indexed: 08/03/2023]
Abstract
In recent years, a number of studies have examined risk factors for development of psoriatic arthritis (PsA) among patients with PsO. Most recently, 5 studies have examined the effect of biologic therapy on the development of PsA. However, the results have been mixed, with 3 studies suggesting a lower risk for PsA among those using a biologic therapy and 2 suggesting a higher risk for PsA. At the 2022 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) meeting, Drs. Enrique Soriano and Alexis Ogdie conducted a debate to discuss the arguments for and against the use of biologic therapies in PsO for the purpose of preventing PsA.
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Affiliation(s)
- Enrique R Soriano
- E.R. Soriano, MD, MSc, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Zabotti A, De Marco G, Gossec L, Baraliakos X, Aletaha D, Iagnocco A, Gisondi P, Balint PV, Bertheussen H, Boehncke WH, Damjanov NS, de Wit M, Errichetti E, Marzo-Ortega H, Protopopov M, Puig L, Queiro R, Ruscitti P, Savage L, Schett G, Siebert S, Stamm TA, Studenic P, Tinazzi I, Van den Bosch FE, van der Helm-van Mil A, Watad A, Smolen JS, McGonagle DG. EULAR points to consider for the definition of clinical and imaging features suspicious for progression from psoriasis to psoriatic arthritis. Ann Rheum Dis 2023; 82:1162-1170. [PMID: 37295926 DOI: 10.1136/ard-2023-224148] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The transition from psoriasis (PsO) to psoriatic arthritis (PsA) and the early diagnosis of PsA is of considerable scientific and clinical interest for the prevention and interception of PsA. OBJECTIVE To formulate EULAR points to consider (PtC) for the development of data-driven guidance and consensus for clinical trials and clinical practice in the field of prevention or interception of PsA and for clinical management of people with PsO at risk for PsA development. METHODS A multidisciplinary EULAR task force of 30 members from 13 European countries was established, and the EULAR standardised operating procedures for development for PtC were followed. Two systematic literature reviews were conducted to support the task force in formulating the PtC. Furthermore, the task force proposed nomenclature for the stages before PsA, through a nominal group process to be used in clinical trials. RESULTS Nomenclature for the stages preceding PsA onset, 5 overarching principles and 10 PtC were formulated. Nomenclature was proposed for three stages towards PsA development, namely people with PsO at higher risk of PsA, subclinical PsA and clinical PsA. The latter stage was defined as PsO and associated synovitis and it could be used as an outcome measure for clinical trials evaluating the transition from PsO to PsA. The overarching principles address the nature of PsA at its onset and underline the importance of collaboration of rheumatologists and dermatologists for strategies for prevention/interception of PsA. The 10 PtC highlight arthralgia and imaging abnormalities as key elements of subclinical PsA that can be used as potential short-term predictors of PsA development and useful items to design clinical trials for PsA interception. Traditional risk factors for PsA development (ie, PsO severity, obesity and nail involvement) may represent more long-term disease predictors and be less robust for short-term trials concerning the transition from PsO to PsA. CONCLUSION These PtC are helpful to define the clinical and imaging features of people with PsO suspicious to progress to PsA. This information will be helpful for identification of those who could benefit from a therapeutic intervention to attenuate, delay or prevent PsA development.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Sciences, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Gabriele De Marco
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute for Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Nemanja S Damjanov
- Rheumatology, University of Belgrade Faculty of Medicine, Beograd, Serbia
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Enzo Errichetti
- Department of Medical and Biological Sciences University Hospital "Santa Maria della Misericordia", Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Helena Marzo-Ortega
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Lluis Puig
- Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Queiro
- Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Piero Ruscitti
- University of L'Aquila Department of Clinical Sciences and Applied Biotechnology, L'Aquila, Italy
| | - Laura Savage
- Chapel Allerton Hospital Department of Dermatology, Leeds, UK
| | - Georg Schett
- Rheumatology, Erlangen University Hospital, Erlangen, Germany
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Paul Studenic
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Ilaria Tinazzi
- Unit of Rheumatology, Don Calabria Sacred Heart Hospital, Negrar, Italy
| | | | - Annette van der Helm-van Mil
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Abdulla Watad
- Internal Medicine, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Dennis G McGonagle
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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12
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ÇAPKIN E. Musculoskeletal ultrasonography in rheumatic diseases. Turk J Med Sci 2023; 53:1537-1551. [PMID: 38813491 PMCID: PMC10760546 DOI: 10.55730/1300-0144.5723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/12/2023] [Accepted: 07/20/2023] [Indexed: 05/31/2024] Open
Abstract
Ultrasonography is an imaging technique based on sound waves used for the evaluation of soft tissues. Sound waves have been used for a long time in nonmedical fields, including military defense systems, radar systems, and detection of icebergs. Technological advances resulted in new techniques becoming available for medical imaging, including ultrasonography, magnetic resonance imaging, and computed tomography. Nowadays, the use of imaging has become a gold standard protocol in the diagnosis of many diseases, and recently developed diagnosis and therapy options provide more efficient treatment of rheumatic diseases. Thus, it has become possible to prevent structural damage and disability in patients with rheumatic disease. Musculoskeletal ultrasonography is becoming a preferred imaging technique for rheumatic diseases, as it has many advantages. Among its advantages are being inexpensive, being radiation-free, having a dynamic image capacity, helping to detect disease activity, and helping with early detection and diagnosis of structural damage. This review summarizes the use of ultrasonography in rheumatic diseases.
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Affiliation(s)
- Erhan ÇAPKIN
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Karadeniz Technical University, Farabi Hospital, Trabzon,
Turkiye
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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14
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Canoso JJ, Saavedra MA, Naredo E. To Diagnose Enthesitis Clinically, Should the Entheses Be Put to Work? J Rheumatol 2022; 49:974-976. [PMID: 35365581 DOI: 10.3899/jrheum.211052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Juan J Canoso
- J.J. Canoso, MD, Department of Medicine, ABC Medical Center, Mexico City, Mexico, and Division of Rheumatology, Tufts University School of Medicine, Boston, Massachusetts, USA;
| | - Miguel A Saavedra
- M.A. Saavedra, MD, Department of Medicine, Specialties Hospital "Antonio Fraga Mouret," National Medical Center La Raza, and Postgraduate Division, National Autonomous University of Mexico, Mexico City, Mexico
| | - Esperanza Naredo
- E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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15
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Gisondi P, Bellinato F, Maurelli M, Geat D, Zabotti A, McGonagle D, Girolomoni G. Reducing the Risk of Developing Psoriatic Arthritis in Patients with Psoriasis. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:213-220. [PMID: 35975124 PMCID: PMC9375973 DOI: 10.2147/ptt.s323300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/04/2022] [Indexed: 01/22/2023]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory arthritis associated with psoriasis, which may manifest with different domains such as dactylitis, enthesitis, synovitis and spondylitis. The estimated prevalence of PsA in patients with psoriasis ranges widely between 6% and 42%. In most cases, PsA is preceded by skin involvement by an average time of 7-8 years. In the complex patho-mechanisms involved in the transition from psoriasis to PsA, the gut and skin have been proposed as the sites of immune activation triggering or contributing to the development of PsA. In such a transition, a subclinical phase has been identified, characterized by enthesopathy where soluble biomarkers and imaging findings but no clinical symptoms are detectable. Recent studies have provided some evidence that timely treated psoriasis may reduce the risk of developing PsA.
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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
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Geat
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital ‘Santa Maria della Misericordia’ c/o University of Udine, Udine, Italy
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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16
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De Lorenzis E, Natalello G, Simon D, Schett G, D'Agostino MA. Concepts of Entheseal Pain. Arthritis Rheumatol 2022; 75:493-498. [PMID: 35818681 DOI: 10.1002/art.42299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/12/2022] [Accepted: 07/07/2022] [Indexed: 01/17/2023]
Abstract
Pain is the main symptom in entheseal diseases (enthesopathies) despite a paucity of nerve endings in the enthesis itself. Eicosanoids, cytokines, and neuropeptides released during inflammation and repeated nonphysiologic mechanical challenge not only stimulate or sensitize primary afferent neurons present in structures adjacent to the enthesis, but also trigger a "neurovascular invasion" that allows the spreading of nerves and blood vessels into the enthesis. Nociceptive pseudounipolar neurons support this process by releasing neurotransmitters from peripheral endings that induce neovascularization and peripheral pain sensitization. This process may explain the frequently observed dissociation between subjective symptoms such as pain and the structural findings on imaging in entheseal disease.
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Affiliation(s)
- Enrico De Lorenzis
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gerlando Natalello
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nurnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nurnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Maria Antonietta D'Agostino
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Gudu T, Ng B, Jethwa H, Graham C, Kudva V, Rammanohar J, Zhang C, Sapsford M, Jadon DR. Improving Imaging Modalities in Early Psoriatic Arthritis: The Role of Ultrasound in Early Diagnosis of Psoriatic Arthritis. Front Med (Lausanne) 2022; 8:804695. [PMID: 35071281 PMCID: PMC8776996 DOI: 10.3389/fmed.2021.804695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Despite recent advances, early diagnosis of psoriatic arthritis (PsA) remains a challenge in clinical practice. Ultrasound (US) could be a useful tool for the diagnosis and management of PsA. The objective of this review was to determine the role of US in early diagnosis of PsA. Methods: We have performed a literature review aiming to evaluate studies on US findings in psoriasis and their predictive value of progression to PsA, as well as studies on US features specific for PsA in comparison with other conditions. Results: A total of 40 studies were included. Sixteen studies assessed US findings in psoriasis, of which only 3 prospectively evaluated the role of US in predicting progression to PsA. Patients with PsA had a greater frequency of US abnormalities, in particular enthesitis and Power Doppler(PD) signal compared to patients with psoriasis only. In the longitudinal studies, psoriatic patients with higher enthesopathy scores at baseline were more likely to progress to PsA. Twenty-four studies evaluated US abnormalities in PsA and compared them to other conditions. Most specific US features that distinguish PsA from psoriasis were PD signal and erosions in joints and entheses. Extra-synovial changes, including peri-tendinous dermal soft tissue oedema with associated PD signal and flexor tendon enthesopathy, as well as thickening of the pulleys in the flexor tendons were highly characteristic for PsA, as they were frequently found in PsA patients, but in none of the RA patients. US-detected entheseal abnormalities in particular erosions and PD signal were more frequent in patients with PsA compared to fibromyalgia. Conclusion: Despite the wide use of US in PsA, more research is needed to identify predictive factors of progression to PsA in patients with psoriasis, as well as to determine most specific US features that differentiate PsA from other conditions.
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Affiliation(s)
- Tania Gudu
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Beverly Ng
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hannah Jethwa
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Catherine Graham
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Veda Kudva
- Queen Mary University, London, United Kingdom
| | | | - Chen Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mark Sapsford
- Department of Rheumatology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Deepak R Jadon
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Marchesoni A, Macchioni P, Gasparini S, Perricone C, Perrotta FM, Grembiale RD, Silvagni E, Ramonda R, Costa L, Zabotti A, Curradi G, Gualberti G, Marando F, Salvarani C. Use of Ultrasonography to Discriminate Psoriatic Arthritis from Fibromyalgia: A Post-Hoc Analysis of the ULISSE Study. J Clin Med 2021; 11:jcm11010180. [PMID: 35011921 PMCID: PMC8745640 DOI: 10.3390/jcm11010180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/18/2021] [Accepted: 12/26/2021] [Indexed: 01/26/2023] Open
Abstract
In psoriatic arthritis (PsA) patients with concomitant chronic widespread pain, the differential diagnosis with fibromyalgia syndrome (FMS) can be challenging. We evaluated whether ultrasound (US) examination of entheseal sites can distinguish pain from (PsA) enthesitis versus FMS. PsA and FMS patients underwent clinical evaluation and gray-scale (GS; B-mode) and power Doppler (PD) US examination of the entheses. At least one enthesis with GS- and PD-mode changes was found in 90% and 59.3% of PsA patients (n = 140) and 62.7% and 35.3% of FMS patients (n = 51), respectively. GS and PD identified changes in 49.5% and 19.2% of the 840 PsA entheses and 22.5% and 7.9% of the 306 FMS entheses, respectively. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 and 0.66 for B- and PD-mode, respectively, 3.5 being the best cut-off GS-score to discriminate the two conditions. Multivariate regression showed that Achilles and proximal patellar tendon enthesitis (B-mode) were strongly associated with PsA (odds ratio, ~2). Principal component analysis (B-mode) confirmed that PsA patients have a higher number of involved entheses and patterns of entheseal involvement than FMS patients. US evaluation of the entheses may help differentiate chronic widespread pain from PsA versus FMS.
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Affiliation(s)
- Antonio Marchesoni
- Rheumatology, Humanitas San Pio X, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-025-829-6415
| | - Pierluigi Macchioni
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena and Reggio Emilia, 42123 Reggio Emilia, Italy; (P.M.); (C.S.)
| | - Stefania Gasparini
- Reumatologia, Dipartimento di Medicina Interna, Ospedale di Fabriano, ASUR Marche, 62012 Fabriano, Italy;
| | - Carlo Perricone
- Rheumatology, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy;
| | - Fabio Massimo Perrotta
- Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, 86100 Campobasso, Italy;
| | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, 44122 Ferrara, Italy;
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, 35131 Padova, Italy;
| | - Luisa Costa
- Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80125 Naples, Italy;
| | - Alen Zabotti
- Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, 33100 Udine, Italy;
| | | | | | | | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena and Reggio Emilia, 42123 Reggio Emilia, Italy; (P.M.); (C.S.)
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Wang Y, Zhang L, Yang M, Cao Y, Zheng M, Gu Y, Hu H, Chen H, Zhang M, Li J, Qiu L, Li W. Development of a Predictive Model for Screening Patients with Psoriasis at Increased Risk of Psoriatic Arthritis. Dermatol Ther (Heidelb) 2021; 12:419-433. [PMID: 34927222 PMCID: PMC8850526 DOI: 10.1007/s13555-021-00663-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction This study aimed to develop a predictive model based on ultrasound variables which can be used to screen patients with psoriasis who are prone to progress to psoriatic arthritis (PsA) in clinical practice. Methods This is a cross-sectional study conducted in a single center from October 2018 to November 2020. All subjects (non-PsA group, PsA group, and control group) underwent an ultrasound examination and their ultrasound abnormalities were recorded. On the basis of statistical analysis and clinical experts’ advice, several variables were selected for modelling. We used logistic regression to establish the prediction model. To assess the discrimination and accuracy of this model, internal validation and external validation were performed. Results A total of 852 patients with psoriasis but without PsA, 261 patients with PsA, and 86 healthy volunteers were included. Ultimately, the predictive model consisted of six variables, namely hand joint power Doppler (PD) signals (grade 0: OR 2.94, 95% CI 1.94–4.47; grade ≥ 1: OR 109.30, 95% CI 14.35–832.27; P < 0.001), wrist joint synovial thickening (grade 1: OR 1.29, 95% CI 0.69–2.43; grade 2: OR 4.30, 95% CI 1.92–9.65; grade 3: OR 11.05, 95% CI 1.01–120.64; P = 0.001), knee joint PD signals (grade 0: OR 1.01, 95% CI 0.56–1.80; grade ≥ 1: OR 14.77, 95% CI 3.99–54.69; P < 0.001), toe joint PD signals (grade 0: OR 1.18, 95% CI 0.78–1.79; grade ≥ 1: OR 5.74, 95% CI 2.84–11.63; P < 0.001), quadriceps tendon and patellar tendon enthesitis (OR 1.95, 95% CI 1.36–2.78, P < 0.001), Achilles tendon and plantar aponeurosis enthesitis (OR 1.63, 95% CI 1.14–2.32, P = 0.007). C-index for the predictive model was 0.80 (95% CI 0.76–0.83). After bootstrapping validation (1000 times), it was confirmed to be 0.79. The external validation showed the accuracy of the predictive model is 0.87 (95% CI 0.69–0.95). Conclusion This study succeeded in developing a predictive model with a high degree of accuracy to predict the risk of PsA in patients with psoriasis. Psoriatic arthritis often occurs in the population of patients with psoriasis. It brings a huge burden and pain to patients. At present, the diagnosis for psoriatic arthritis is very challenging. Numerous research studies have begun to focus on identifying patients with psoriasis at increased risk of psoriatic arthritis. Among a lot of modalities, ultrasound has been considered as a sensitive and convenient tool for screening early psoriatic arthritis. Our study successfully established a predictive model based on ultrasound variables to screen patients with psoriasis at high risk of transiting to psoriatic arthritis. After internal and external validation, it showed great accuracy and generalizability. We recommend that clinicians perform ultrasound screening of patients with psoriasis in clinical routine and get their risk value of transiting to psoriatic arthritis by using this model. For those patients with a high risk of progression to psoriatic arthritis, clinicians should refer them to a rheumatology department as soon as possible so that they could have access to early and effective management which might bring them good clinical and imaging outcomes.
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Affiliation(s)
- Yiyi Wang
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lingyan Zhang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Min Yang
- Department of Rheumatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanze Cao
- Neusoft Corporation, Dalian, 116085, China
| | | | - Yuanxia Gu
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hongxiang Hu
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hui Chen
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Min Zhang
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jingyi Li
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Li Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Wei Li
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Yoshida M, Taniguchi Y, Yoshida T, Nishikawa H, Terada Y. Ultrasonography of auricular cartilage is a potential tool for diagnosing relapsing polychondritis and monitoring disease activity. Int J Rheum Dis 2021; 25:201-209. [PMID: 34866329 PMCID: PMC9299703 DOI: 10.1111/1756-185x.14256] [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: 09/23/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 12/01/2022]
Abstract
Aim To assess the clinical utility of ultrasonography in the diagnosis and monitoring of disease activity in relapsing polychondritis (RP). Methods Auricular and nasal chondritis of 6 patients with RP were assessed by ultrasonography before treatment initiation. Changes in the ultrasonographic and clinical findings and serum inflammatory markers were longitudinally assessed. Ultrasonography was also performed in 6 patients with repeat ear trauma, 6 patients with auricular cellulitis and 6 healthy controls for comparison among groups. Results In all cases of RP, ultrasonographic findings before treatment revealed low‐echoic swollen auricular and nasal cartilage and perichondral soft‐tissue with increased power Doppler signals (PDS) corresponding to biopsy findings. After 2‐month treatment with prednisolone (PSL) combined with methotrexate, clinical and serum inflammatory markers were completely resolved. Although swollen perichondral soft‐tissue, cartilage and PDS on auricular ultrasonography were also significantly improved, PDS remained in 2 of 6 cases, which showed flare early after tapering PSL. Finally, ultrasonographic findings of RP were substantially differentiated between patients with repeat trauma and cellulitis and healthy controls based on the thickness of soft tissue around the cartilage, PDS and subperichondral serous effusion. Conclusion Assessment of RP lesions by ultrasonography is useful for the evaluation of cartilaginous lesions and monitoring of disease activity, especially when considering the treatment response and the timing of drug tapering.
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Affiliation(s)
- Mitsuharu Yoshida
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Takeshi Yoshida
- Department of Rheumatology, Chikamori Hospital, Kochi, Japan
| | - Hirofumi Nishikawa
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
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21
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Sarbu MI, Sarbu N, Cristea Ene D, Corche D, Baz R, Negru D, Nechita A, Fotea S, Anghel L, Tatu AL. New Perspectives on Diagnosing Psoriatic Arthritis by Imaging Techniques. Open Access Rheumatol 2021; 13:343-352. [PMID: 35221735 PMCID: PMC8866993 DOI: 10.2147/oarrr.s331859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Psoriatic arthritis is a chronic inflammatory condition that can lead to severe functional impairment and irreversible damage. The diagnosis can be difficult in early cases where the clinical exam is often scarce. The lack of a serological biomarker can lead to a considerable delay in diagnosis. In this review, we discuss the existent imaging methods that have improved the diagnosis of psoriatic arthritis (PsA). The degree and type of musculoskeletal involvement cannot be assessed by only one imaging method. We think that a combination of methods is the best approach to evaluate both structural damage and inflammatory lesions and that ultrasound (US) could be the best tool to screen a patient when considering the diagnosis of PsA. US is an accessible, non-ionizing technique that offers information regarding active inflammation in joints, entheses, and soft tissues.
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Affiliation(s)
| | - Nicolae Sarbu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Al. I. Cuza No 35, Galati, Romania
- Correspondence: Nicolae Sarbu Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Al. I. Cuza No 35, Galati, RomaniaTel +40728301044 Email
| | | | - Daniela Corche
- Sf Apostol Andrei Clinical County Emergency Hospital, Galati, Romania
| | - Radu Baz
- Department of Radiology and Medical Imaging, Clinical County Emergency Hospital Constanta, “Ovidius” University, Constanta, Romania
| | - Dragos Negru
- Department of Radiology – Imaging, University Hospital “Sf. Spiridon”, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania
- Department of Pediatrics, “Sf. Ioan” Clinical Hospital for Children, Galati, Romania
| | - Silvia Fotea
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania
- Department of Pediatrics, “Sf. Ioan” Clinical Hospital for Children, Galati, Romania
| | - Lucretia Anghel
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania
- Sf Apostol Andrei Clinical County Emergency Hospital, Galati, Romania
| | - Alin Laurentiu Tatu
- Faculty of Medicine and Pharmacy, Clinical Department, Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform’, ReForm-UDJG, “Dunarea de Jos” University, Galati, Romania
- Clinical Hospital St Parascheva of Infectious Diseases, Dermatology Department, Galati, Romania
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22
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Felbo SK, Terslev L, Juul Sørensen I, Hendricks O, Kuettel D, Lederballe Pedersen R, Chrysidis S, Duer A, Zachariae C, Skov L, Østergaard M. Musculoskeletal pain in psoriasis - relation to inflammation and additional value of ultrasound in psoriatic arthritis classification. Rheumatology (Oxford) 2021; 61:2835-2847. [PMID: 34849603 DOI: 10.1093/rheumatology/keab865] [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: 06/25/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate and compare clinical features and ultrasound signs of inflammation in joints and entheses in patients with psoriasis (PsO) with and without musculoskeletal pain, and the additional value of ultrasound in classification of psoriatic arthritis (PsA). Furthermore, to explore the association between such findings and patient-reported outcomes (PROs) and the performance of screening-questionnaires for identifying patients with PsA. METHODS Patients with PsO (n = 126) recruited from a nationwide survey were evaluated at one of four rheumatology departments. The evaluation included clinical examination, laboratory tests, radiography, greyscale (GS) and colour Doppler (CD) ultrasound of 48 joints and 12 entheses, PROs, and four screening-questionnaires for PsA. Patients were classified with Classification for PsA (CASPAR), ultrasound-modified CASPAR, and ultrasound-only criteria. RESULTS When subgroups of self-reported pain (63%), no pain (29%) and diagnosed PsA (9%) were compared, patients with pain had higher tenderness-related clinical scores (tender joints, entheses and fibromyalgia points) and ultrasound GS sum-scores, compared with 'no pain' patients. PROs were negligibly-moderately correlated with pain-related clinical scores (Spearman's rho = 0.11-0.59, all patients), and negligibly-weakly with ultrasound sum-scores (rho = 0.01-0.34). More patients could be classified as PsA when ultrasound synovitis/enthesitis was included as entry criterion (ultrasound-modified CASPAR, 66% of all patients) compared with conventional CASPAR (35%) or ultrasound-only criteria (52%). Sensitivities of screening-questionnaires were low for fulfilment of CASPAR (0.23-0.66), ultrasound-modified CASPAR (0.17-0.57), and ultrasound-only (0.20-0.57) criteria. CONCLUSION Self-reported pain in PsO is related to ultrasound inflammation. Ultrasound-modified CASPAR criteria identified almost twice as many patients as conventional CASPAR criteria. Screening-questionnaires showed limited value.
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Affiliation(s)
- Sara Kamp Felbo
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Inge Juul Sørensen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dorota Kuettel
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, South West Jutland Hospital, Esbjerg, Denmark
| | - Anne Duer
- Department of Diagnostic Radiology, Rigshospitalet, Glostrup, Denmark
| | - Claus Zachariae
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Lone Skov
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Al Rayes H, Alazmi M, Attar S, Alderaan K, Alghamdi M, Alghanim N, Alhazmi A, Alkhadhrawi N, Almohideb M, Alzahrani Z, Bedaiwi M, Halabi H. Consensus-based recommendations on the diagnosis, referral and clinical management of patients with psoriatic arthritis. Rheumatol Int 2021; 42:391-401. [PMID: 34716785 DOI: 10.1007/s00296-021-05029-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Psoriatic arthritis (PsA) is a highly heterogeneous disease with complex manifestations. Limited understanding of the disease and non-availability of local guidelines pose challenges in the management of PsA in Saudi Arabia. Therefore, this expert consensus is aimed to provide recommendations on the management of patients with PsA, including referral pathway, definition of remission and treat-to-target (T2T) approach. A Delphi technique of consensus development was used involving an expert panel comprised of 10 rheumatologists, one dermatologist and one family physician. Based on the review of available published evidence and the opinions of clinical experts, key recommendations were developed. A consensus was achieved in defining the following: management guideline adaptable for Saudi Arabia, most useful screening tool, laboratory investigations, imaging tests and criteria for referring suspected PsA patients to a rheumatologist. In addition, an agreement was achieved in defining the T2T strategy and remission for the clinical management of PsA. Overall, these recommendations provide an evidence-based framework for the management of PsA patients in Saudi Arabia.
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Affiliation(s)
- Hanan Al Rayes
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, 21577, Saudi Arabia.
| | - Mansour Alazmi
- Department of Rheumatology, Prince Mohammed Medical City, Al Jouf, Saudi Arabia
| | - Suzan Attar
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khaled Alderaan
- Department of Rheumatology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mushabab Alghamdi
- Department of Rheumatology, University of Bisha, Bisha, Saudi Arabia
| | - Nayef Alghanim
- Department of Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alhazmi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nadeer Alkhadhrawi
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammad Almohideb
- Department of Dermatology, King Saud Bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Zeyad Alzahrani
- Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohamed Bedaiwi
- Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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24
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Saalfeld W, Mixon AM, Zelie J, Lydon EJ. Differentiating Psoriatic Arthritis from Osteoarthritis and Rheumatoid Arthritis: A Narrative Review and Guide for Advanced Practice Providers. Rheumatol Ther 2021; 8:1493-1517. [PMID: 34519965 PMCID: PMC8572231 DOI: 10.1007/s40744-021-00365-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple organ systems and is characterized by skin and joint manifestations. PsA is frequently undiagnosed and/or misdiagnosed, especially because of the similarities in clinical presentation shared with other arthritic diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). An accurate and timely diagnosis of PsA is crucial to prevent delays in optimal treatment, which can lead to irreversible joint damage and increased functional disability. Patients are usually seen by a number of different healthcare providers on their path to a diagnosis of PsA, including advanced practice providers (APPs). This review provides a comprehensive overview of the characteristic features that can be used to facilitate the differentiation of PsA from RA and OA. Detailed information on clinical manifestations, biomarkers, radiologic features, and therapeutic recommendations for PsA included here can be applied in routine clinical settings to provide APPs with the confidence and knowledge to recognize and refer patients more accurately to rheumatologists for management of patients with PsA.
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Affiliation(s)
- William Saalfeld
- Arthritis Center of Nebraska, 3901 Pine Lake Road, Suite 120, Lincoln, NE, 68516, USA.
| | - Amanda M Mixon
- Arthritis and Rheumatology Clinic of Northern Colorado, Fort Collins, CO, USA
| | - Jonna Zelie
- URMC Division of Rheumatology, Rochester, NY, USA
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25
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Ji C, Wang H, Bao C, Zhang L, Ruan S, Zhang J, Gong T, Cheng B. Challenge of Nail Psoriasis: An Update Review. Clin Rev Allergy Immunol 2021; 61:377-402. [PMID: 34478047 DOI: 10.1007/s12016-021-08896-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/11/2022]
Abstract
Nail psoriasis is a refractory disease that affects 50-79% skin psoriasis patients and up to 80% of patients with psoriatic arthritis (PsA). The pathogenesis of nail psoriasis is still not fully illuminated, although some peculiar inflammatory cytokines and chemokines seems to be the same as described in psoriatic skin lesions. Psoriatic nail involving matrix can cause pitting, leukonychia, red spots in lunula, and nail plate crumbling, while nail bed involvement can result in onycholysis, oil-drop discoloration, nail bed hyperkeratosis, and splinter hemorrhages. The common assessment methods of evaluating nail psoriasis includes Nail Psoriasis Severity Index (NAPSI), Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), Nail Psoriasis Quality of life 10 (NPQ10), and so on. Treatment of nail psoriasis should be individualized according to the number of involving nail, the affected site of nail and presence of skin and/or joint involvement. Generally, topical therapies are used for mild nail psoriasis, while biologic agents such as etanercept are considered for severe nail disease and refractory nail psoriasis. Even though the current literature has shown some support for the pathogenesis, clinical presentation, or therapies of nail psoriasis, systemic review of this multifaceted disease is still rare to date. We elaborate recent developments in nail psoriasis epidemiology, pathogenesis, anatomy, clinical manifestation, diagnosis, differential diagnosis, and therapies to raise better awareness of the complexity of nail psoriasis and the need for early diagnosis or intervention.
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Affiliation(s)
- Chao Ji
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Haiqing Wang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Chengbei Bao
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Liangliang Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Shifan Ruan
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Jing Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
| | - Bo Cheng
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
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26
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Smerilli G, Di Matteo A, Cipolletta E, Grassi W, Filippucci E. Enthesitis in Psoriatic Arthritis, the Sonographic Perspective. Curr Rheumatol Rep 2021; 23:75. [PMID: 34427783 PMCID: PMC8384799 DOI: 10.1007/s11926-021-01039-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To provide an overview of the ultrasound (US) studies focusing on enthesitis in psoriatic arthritis (PsA). Recent Findings Last-generation US equipment has demonstrated the ability to detect subtle morphostructural and vascular abnormalities at entheseal level. US is able to identify pathologic changes in both “classical” (i.e., the site of attachment of tendons, ligaments, and joint capsules into the bone) and “functional” entheses (i.e., anatomical regions where tendons or ligaments wrap around bony pulleys). Summary US has the potential to be the first-line method in the assessment of enthesitis. In the present review we critically discussed the current definitions of US enthesitis, the scoring systems, and the main fields of application (i.e., the detection of enthesitis in PsA and psoriasis, the identification of different disease subsets, and the assessment of response to treatment).
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
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27
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Coras R, Kavanaugh A, Kluzniak A, Holt D, Weilgosz A, Aaron A, Quehenberger O, Ritchlin C, Guma M. Differences in oxylipin profile in psoriasis versus psoriatic arthritis. Arthritis Res Ther 2021; 23:200. [PMID: 34303373 PMCID: PMC8310583 DOI: 10.1186/s13075-021-02575-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background Oxylipins are biological lipids that have been implicated in inflammation. We previously found that certain oxylipins correlated with clinical manifestations in psoriatic arthritis (PsA) patients. Here, we compare oxylipin profiles in PsA patients and those with psoriasis (PsO) without inflammatory arthritis to identify oxylipins that associate with specific disease manifestations to better understand disease pathogenesis and identify new biomarkers. Methods Consecutive patients with PsA (who met the CASPAR classification criteria for PsA) and PsO were recruited from the Rheumatology Outpatient Clinic. A thorough clinical examination was performed, including entheseal (Leeds enthesitis index (LEI)) and joint involvement (SJC/TJC 66/68). Patients were evaluated for pain and global disease activity on a visual analog scale (VAS) ranging from 0 to 100. This was followed by disease activity scores calculation: cDAPSA (Disease Activity Index for Psoriatic Arthritis) and Psoriasis Area and Severity Index (PASI). Serum oxylipins were determined by mass spectrometry and their association with clinical characteristics (PASI/LEI and cDAPSA) was analyzed using Metaboanalyst 4.0 and R version 3.6.1. Results Twenty PsO (average age 52 [10.8], 55% males) and 19 PsA patients (average age 60.5 [11.4], 63.1% males) were included. PsO patients had an average body mass index (BMI) of 33.7 (6.84) and an average PASI of 3.8 (4.2). PsA patients had an average BMI of 31.9 (5.6), TJC of 9.3 (10.41), SJC of 3.7 (4.23), with an average cDAPSA of 23.3 (11.4). 63.1% of PsA patients had enthesitis (average LEI 2.2 [3]) and the same percentage had psoriasis (average PASI 3(5]). Sera were analyzed for oxylipin levels. PsO and PsA patients with higher PASI score (> 2.5) had significantly lower serum concentrations of pro-inflammatory oxylipins, most of them arachidonic acid derived (AA). Oxylipin profiling did not associate with cDAPSA. Interestingly, several AA-derived oxylipins (5,15 di-HETE (5S,15S-dihydroxy-6E,8Z,10Z,13E-eicosatetraenoic acid), 5-oxoETE (5-Oxo-eicosatetraenoic acid), PGE2 (prostaglandin E2), 11bPGE2 (11 beta prostaglandin D2), and LTB4 (leukotriene B4)) were significantly increased in PsA patients with enthesitis compared to those without. Conclusions The AA-derived proinflammatory oxylipins were lower in both PsO and PsA patients with higher skin scores. Joint disease activity was not associated with the concentrations of oxylipins. Yet, enthesitis was associated with an increase of AA-derived pro-inflammatory oxylipins in PsA patients. Further studies are needed to determine whether oxylipin profiling can be a good biomarker of enthesitis in PsA patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02575-y.
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Affiliation(s)
- Roxana Coras
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. .,Autonomous University of Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Arthur Kavanaugh
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Angela Kluzniak
- Department of Medicine, University of Rochester, Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Dustina Holt
- Department of Medicine, University of Rochester, Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Amy Weilgosz
- Department of Medicine, University of Rochester, Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Armando Aaron
- Department of Pharmacology, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Oswald Quehenberger
- Department of Pharmacology, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Christopher Ritchlin
- Department of Medicine, University of Rochester, Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Monica Guma
- Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Autonomous University of Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
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28
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Chisălău BA, Bărbulescu AL, Pârvănescu CD, Firulescu SC, Dinescu ȘC, Dumitrașcu RM, Turcu-Stiolica A, Ionescu RA, Popoviciu HV, Covei SB, Boldeanu MV, Vilcea AM, Ciurea PL, Vreju FA. Entheseal involvement in a group of psoriatic arthritis patients: An ultrasonographic study. Exp Ther Med 2021; 22:1044. [PMID: 34373730 PMCID: PMC8343913 DOI: 10.3892/etm.2021.10476] [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: 04/28/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory potentially destructive disease that requires early diagnosis and therapeutic approach. Its main pathogenic event and the condition's hallmark is considered to be enthesitis. Clinical examination of the enthesis can be a challenge in the clinical practice; thus, ultrasonography (US) has emerged as an indispensable imaging tool for evaluating both structural and inflammatory changes of this structure. In the present study, we aimed to analyze the type and frequency of entheseal involvement in PsA patients by US examination, performing a retrospective study on 41 patients diagnosed with PsA. Ultrasonographically confirmed enthesitis, identified according to Outcome Measures in Rheumatology group (OMERACT, initially Outcome Measures in Rheumatoid Arthritis Clinical Trials) definitions, was present in 26 of the included patients, Achilles enthesis being the most common site involved. The prevalence of tendon structure abnormalities and the presence of entesophytes underlines the importance of chronic inflammation on entheseal sites. US examination has proven to be a reliable imaging method, with significant and continuous improvement, which is clearly a requisite part for current understanding and diagnosis of enthesitis and more than this, for the patient follow-up algorithm.
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Affiliation(s)
| | - Andreea Lili Bărbulescu
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | | | - Ștefan Cristian Dinescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Răzvan Adrian Ionescu
- Third Internal Medicine Department, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Horațiu Valeriu Popoviciu
- Department of Rheumatology, BFK and Medical Rehabilitation, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Mures, Romania
| | - Simona Bănicioiu Covei
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihail Virgil Boldeanu
- Department of Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Alina Maria Vilcea
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Paulina Lucia Ciurea
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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29
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Kaeley GS, Kaler JK. Peripheral Enthesitis in Spondyloarthritis: Lessons from Targeted Treatments. Drugs 2021; 80:1419-1441. [PMID: 32720292 DOI: 10.1007/s40265-020-01352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A significant proportion of patients with spondyloarthritis (SpA) have peripheral enthesitis. Data suggest that psoriatic arthritis (PsA) patients with enthesitis have a higher disease burden than those without enthesitis. Over the past decade, there has been a proliferation of treatment options for spondyloarthropathy. These medications target multiple signaling pathways, including tumor necrosis factor (TNF), interleukin (IL)-17A, IL-12/23, IL-23, thymus (T)-cell co-stimulation, intracellular Janus kinases, and phosphodiesterase enzymes. As a key domain in SpA, enthesitis outcomes are included in pivotal trials of these agents and are reported as secondary outcome measures. One significant limitation is that the clinical evaluation of enthesitis relies on eliciting tenderness on palpation and is insensitive when compared with imaging. Furthermore, direct comparisons between studies are not available due to the use of different outcome measures, lack of consistent and comprehensive reporting outcomes, and subgroup analyses with a lower number of patients with enthesitis. This systematic review describes the epidemiology, pathophysiology, and available targeted therapies against enthesitis, as well as a detailed report of their efficacy. One major trend identified during this review is incomplete reporting of outcome measures, as many studies reported proportions of enthesitis prevalence. Factors that affected responsiveness in clinical trials included the entheseal instrument used, the number of subjects available for comparison, as well as the therapeutic agent. In general, anti-TNF and anti-IL-17 agents, as well as Janus kinase inhibitors, show moderate responsiveness for enthesitis. The data for IL-23 targeting is contradictory.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine Jacksonville, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA.
| | - Jaspreet K Kaler
- Division of Rheumatology, University of Florida College of Medicine Jacksonville, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA
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Gottlieb AB, Merola JF. A clinical perspective on risk factors and signs of subclinical and early psoriatic arthritis among patients with psoriasis. J DERMATOL TREAT 2021; 33:1907-1915. [PMID: 34176399 DOI: 10.1080/09546634.2021.1942423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Psoriasis is a chronic, immune-mediated disease that includes a broad spectrum of systemic manifestations, complications, and comorbidities. Approximately 20%-30% of patients with psoriasis eventually develop psoriatic arthritis, and up to half of those without psoriatic arthritis experience subclinical musculoskeletal abnormalities. Recognition of early musculoskeletal inflammatory signs in patients with psoriasis is important to understand the extent and severity of this systemic disease, assess the risk of structural joint damage, and ensure timely and effective treatment of the complete spectrum of psoriatic disease. Delayed or ineffective treatment can lead to decreased quality of life, irreversible musculoskeletal damage, and loss of function. In this review, we highlight features of subclinical or early psoriatic arthritis among patients with psoriasis of which dermatologists should be aware. Recent knowledge of features of preclinical psoriatic arthritis in patients with psoriasis is presented. We briefly discuss important risk factors, clinical features, and other characteristics of patients likely to progress from psoriasis to psoriatic arthritis that should be known by dermatologists. Screening tools commonly used in the dermatology clinic to detect psoriatic arthritis are also critically reviewed. Finally, we provide expert commentary for dermatologists concerning the treatment of patients with psoriasis and subclinical signs of early psoriatic arthritis.
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Affiliation(s)
- Alice B Gottlieb
- Mount Sinai-Beth Israel Hospital, Icahn School of Medicine at Mount Sina, New York, NY, USA
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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31
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Gottlieb AB, Bakewell C, Merola JF. Musculoskeletal Imaging for Dermatologists: Techniques in the Diagnosis and Management of Psoriatic Arthritis. Dermatol Ther (Heidelb) 2021; 11:1199-1216. [PMID: 34145558 PMCID: PMC8322349 DOI: 10.1007/s13555-021-00565-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Indexed: 01/18/2023] Open
Abstract
Psoriatic arthritis is an inflammatory condition affecting up to 30% of patients with psoriasis. Patients may experience irreversible joint damage if not treated early, and diagnostic delays of even 6 months are associated with radiographic progression and impaired function. Therefore, early detection and intervention are of critical importance in patients with psoriatic arthritis. Given that psoriasis often precedes symptoms of psoriatic arthritis, dermatologists are uniquely positioned to identify patients with psoriatic arthritis early in their disease course, before permanent damage has occurred. Several screening tools have been developed to help dermatologists identify patients who may have psoriatic arthritis, but these tools may not capture patients with subclinical disease or quantify the type and severity of the underlying tissue insult, which is often the presenting sign of psoriatic arthritis. In these cases, a combination of clinical assessment and musculoskeletal imaging (e.g., ultrasound) is required. This review summarizes three common musculoskeletal imaging techniques used in the diagnosis and management of patients with psoriatic arthritis: conventional radiography, ultrasound, and magnetic resonance imaging. Further understanding of musculoskeletal imaging will assist dermatologists in making treatment decisions and allow them to have a more active role in the detection of psoriatic arthritis.
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Affiliation(s)
| | | | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gisondi P, Bellinato F, Targher G, Idolazzi L, Girolomoni G. Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis. Ann Rheum Dis 2021; 81:68-73. [PMID: 34144965 DOI: 10.1136/annrheumdis-2021-219961] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/03/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis who had received a continuous treatment with biological disease-modifying antirheumatic drugs (bDMARDs) compared with phototherapy. METHODS A retrospective non-randomised study involving patients with moderate-to-severe plaque psoriasis, who were prescribed at least 5 years of bDMARDs or at least three narrow-band ultraviolet light B (nb-UVB) phototherapy courses, and did not have a diagnosis of PsA at enrolment. Development of PsA in each patient was assessed by a rheumatologist according to the Classification for Psoriatic Arthritis criteria. The annual and cumulative incidence rate of PsA was estimated by using an event per person-years analysis. Cox proportional hazards models were undertaken to assess the hazard risk (HR) of PsA after adjustment for confounders. RESULTS A total of 464 psoriatic patients (bDMARDs, n=234 and nb-UVB, n=230) were followed between January 2012 and September 2020 (corresponding to 1584 and 1478 person year of follow-up for the two groups, respectively). The annual incidence rate of PsA was 1.20 cases (95% CI 0.77 to 1.89) versus 2.17 cases (95% CI 1.53 to 3.06) per 100 patients/year in the bDMARDs versus phototherapy group, respectively (HR 0.29, 0.12-0.70; p=0.006). The variables independently associated with higher risk of PsA were older age (adjusted HR 1.04, 1.02-1.07), nail psoriasis (adjusted HR 3.15, 1.63-6.06) and psoriasis duration >10 years (adjusted HR 2.02, 1.09-3.76); notably, bDMARDs treatment was associated with a lower risk of incident PsA (adjusted HR 0.27, 0.11-0.66). CONCLUSIONS bDMARDs treatment may delay or reduce the risk of incident PsA in patients with moderate-to-severe chronic plaque psoriasis.
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Affiliation(s)
- Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
| | - Francesco Bellinato
- Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Università degli Studi di Verona, Verona, Italy
| | - Luca Idolazzi
- Section of Rheumatology, Università degli Studi di Verona, Verona, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
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Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with a highly variable clinical presentation that does not have a validated molecular or imaging test, making accurate diagnosis a challenge. Consequences of diagnostic delay include irreversible joint damage and significant morbidity. Over the past few decades, there have been major advances in the understanding and treatment of PsA, leading to more targeted therapies. However, there is no current method to predict optimal treatment strategy to achieve minimal disease activity and prevent medication-related adverse events in the management of early disease. PsA is also associated with other comorbidities that include metabolic syndrome and psychosocial burden; two areas that are often unaddressed in the clinical setting and have associated sequelae. This chapter focuses on key domains of unmet needs, which include diagnostic challenges, delay in diagnosis, prognostication systems and stratified medicine approaches and precision medicine strategies for established and emerging therapies.
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Affiliation(s)
- Beverly Cheok Kuan Ng
- Clinical Research Fellow, Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK.
| | - Deepak Rohit Jadon
- Consultant Rheumatologist, Department of Medicine, University of Cambridge, Cambridge, UK.
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Ultrasound-Verified Peripheral Arthritis in Patients with HLA-B*35 Positive Spondyloarthritis. Life (Basel) 2021; 11:life11060524. [PMID: 34199710 PMCID: PMC8228545 DOI: 10.3390/life11060524] [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: 05/14/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background: We aimed to investigate possible association between the HLA-B*35 allele and peripheral arthritis, tenosynovitis and enthesitis. Methods: Ultrasound of peripheral joints and tendons was performed in 72 HLA-B*35 positive patients with preliminary diagnosis of undifferentiated axial form of spondyloarthitis and joint and tendon pain. Patients with other known types of axial and peripheral spondyloarthritis were excluded as well as patients with other known types of arthritis. Results: Pathological changes were found in the joints of 33 (46%) patients and on the tendons in 13 (18%) patients. The most common ultrasound findings were joint effusion and synovial proliferation with positive power Doppler signal grade 1. The most common ultrasound finding in patients with painful tendons was tenosynovitis. A higher disease activity and an increased incidence of elevated CRP (≥5 mg/L) were more often observed in the group with positive ultrasound findings. Conclusion: In this study, we showed that the HLA-B*35 allele could be a potential risk factor for developing peripheral arthritis, but not for tenosynovits and enthesitis in patients with the undifferentiated axial form of spondyloarthritis. This result may influence the follow up of these patients, especially since it gives us an opportunity to consider the use of different types of DMARDs in the treatment of these patients.
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Mathew AJ, Østergaard M, Eder L. Imaging in psoriatic arthritis: Status and recent advances. Best Pract Res Clin Rheumatol 2021; 35:101690. [PMID: 34016527 DOI: 10.1016/j.berh.2021.101690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The heterogeneous nature of psoriatic arthritis (PsA), encompassing several domains, with varied presentations brings about considerable challenges in disease evaluation. Prompt diagnosis and targeted therapy have resulted in disease remission being accepted as an attainable goal in PsA. Imaging has played a pivotal role in early diagnosis, better understanding of pathogenesis, monitoring of disease, and as an outcome measurement tool in clinical trials in PsA. Conventional radiography has been the cornerstone of assessing structural damage. With the advent of ultrasound and magnetic resonance imaging, better delineation of the various structures involved in the disease process is possible, thus enabling sensitive assessment of inflammatory and structural pathologies together. In this review, imaging modalities used in routine assessment and clinical trials in PsA will be discussed in detail, focusing on advances over the past 5 years.
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Affiliation(s)
- Ashish J Mathew
- Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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36
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Ultrasound Evaluation of the Effectiveness of the Use of Acitretin in the Treatment of Nail Psoriasis. J Clin Med 2021; 10:jcm10102122. [PMID: 34068890 PMCID: PMC8157176 DOI: 10.3390/jcm10102122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022] Open
Abstract
The study aimed to evaluate the effect of retinoid treatment on the morphological changes in the nail apparatus in patients with nail psoriasis. Material and methods: 41 patients aged 32 to 64 with nail psoriasis, without clinical signs of psoriatic arthritis, started on acitretin 0.6 to 0.8 mg kg b.w./d, for six months and 28 people in the control group were included in the study. Both groups had ultrasound examination of fingernails and digital extensor tendon in the distal interphalangeal joints. In psoriatic patients, US examination was conducted before starting the treatment and after six months. A total of 685 nails were examined. Results: After six months of treatment, there was a reduction in the thickness of the nail bed and nail matrix (p = 0.046 and p = 0.031, respectively). The thickness of the nail plates decreased, although it was statistically insignificant (p = 0.059) and it was higher than in the control group (p = 0.034). The reduced severity of clinical nail changes after six months of retinoid treatment did not correlate with the reduction in extensor tendon thickness in any group of patients. Conclusions: In patients with nail psoriasis, acitretin treatment resulted in a rapid decrease in the thickness of the nail bed and matrix, but it did not affect the thickness of the nail plate after six months. There was no effect of acitretin on the digital extensor tendon thickness or the increased blood supply to the tendon area. The results of the study may indicate the usefulness of ultrasound nail examinations in patients with nail psoriasis not only to assess the advancement of morphological changes and response to treatment, but also to choose the potential treatment.
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37
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Villani AP, Boutroy S, Coutisson C, Carlier MC, Barets L, Marotte H, Richert B, Chapurlat RD, Jullien D, Confavreux CB. Distal phalangeal bone erosions observed by HR-pQCT in patients with psoriatic onycholysis. Rheumatology (Oxford) 2021; 60:1176-1184. [PMID: 32885241 DOI: 10.1093/rheumatology/keaa415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES PsA prevalence among skin psoriasis is ∼30%. Nail psoriasis, especially onycholysis, is present in >70% of PsA and the risk of developing PsA is more than doubled in patients with nail involvement. We hypothesized that onycholysis may be associated with early bone erosions of the DIP joint without harbouring PsA symptoms. METHODS We compared tendon thickness, assessed by US, and bone erosions, assessed by high-resolution peripheral quantitative CT, of the DIP joint in patients with psoriatic onycholysis without PsA (ONY) with those in patients with cutaneous psoriasis only (PSO). We used patients with PsA as reference (PsA group), and healthy age-matched controls (CTRL). Differences between groups were assessed by analysis of variance tests followed by post hoc analysis using the Scheffe method. RESULTS Mean (s.e.m.) age of the 87 participants (61% males) was 45.2 (1.3) years. The mean extensor tendon thickness was significantly larger in ONY than in PSO patients. In the PsA group, 68% of patients exhibited erosions of three different shapes: V-, Omega- and U-shape. Association with erosions was greater in the ONY group than in the PSO group (frequency: 57 vs 14%; P < 0.001; mean number of erosions: 1.10 (0.35) vs 0.03 (0.03); P < 0.001). CONCLUSION Onycholysis was associated with significant enthesopathy and bone erosions in our cohort. These data support the pathogenic role of enthesopathy in PsA. Onycholysis may be considered as a surrogate marker of severity in psoriasis. TRIAL REGISTRATION ClinicalTrails.gov, https://clinicaltrials.gov, NCT02813720.
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Affiliation(s)
- Axel P Villani
- Hospices Civils de Lyon, Service de Dermatologie - Hôpital Edouard Herriot, Lyon, France.,Université Claude Bernard Lyon I, Lyon, France.,Groupe Ongle de la Société Française de Dermatologie, Paris, France
| | | | | | | | - Loïs Barets
- Hospices Civils de Lyon, Service de Rhumatologie - Hôpital Edouard Herriot, Lyon, France
| | - Hubert Marotte
- SAINBIOSE INSERM 1059, Université de Lyon, Saint Etienne, France.,Service de Rhumatologie, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Bertrand Richert
- Groupe Ongle de la Société Française de Dermatologie, Paris, France.,Département de Dermatologie - CHU Brugmann - St Pierre et Reine Fabiola, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Roland D Chapurlat
- Université Claude Bernard Lyon I, Lyon, France.,INSERM UMR 1033-LYOS, Lyon, France.,Hospices Civils de Lyon, Service de Rhumatologie - Hôpital Edouard Herriot, Lyon, France
| | - Denis Jullien
- Hospices Civils de Lyon, Service de Dermatologie - Hôpital Edouard Herriot, Lyon, France.,Université Claude Bernard Lyon I, Lyon, France
| | - Cyrille B Confavreux
- Université Claude Bernard Lyon I, Lyon, France.,INSERM UMR 1033-LYOS, Lyon, France.,Hospices Civils de Lyon, Service de Rhumatologie - Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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38
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Quality of life and its relation to periarticular bone changes in psoriatic patients with or without joint involvement. Clin Rheumatol 2021; 40:3175-3183. [PMID: 33634329 DOI: 10.1007/s10067-021-05641-7] [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: 07/27/2020] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess periarticular bone changes in psoriasis patients with or without joint involvement and its effect on patients' quality of life (QoL). METHODS This cross-sectional study enrolled 50 patients with psoriasis (25 only with skin psoriasis (PsO) and 25 with psoriatic arthritis (PsA)), as well as 25 healthy controls. All participants were analyzed by high-resolution computed tomography (HR-CT) scans of the dominant hand (second and third metacarpophalangeal joints) for detection of new bone formation (enthesophytes) and erosions. Demographic, laboratory, clinical, and disease-specific data, including physical function and QoL, were collected. RESULTS Physical function and QoL scores were significantly worse in the PsA patients than in the PsO patients. All 25 PsA patients (100%), 18 PsO patients (72%), and 5 healthy individuals (20%) had periarticular bone changes. Statistically significant higher erosion number and volume as well as higher enthesophyte number and height were found in PsA patients compared to both PsO patients and controls, and in PsO patients compared to controls. In PsO patients, the number of erosions and enthesophytes had a negative correlation with some Short Form (SF)-36 sub-scores. In the PsA patients, the number of erosions had a positive correlation with psoriasis disability index, while the number of enthesophytes had a negative correlation with the general health SF-36 sub-score. CONCLUSION In PsO patients, there may be subclinical periarticular inflammation (erosions and enthesophytes) that raise the suspicion of occult PsA or the possibility of PsO transition to PsA and these periarticular bone changes may worsen QoL in PsO patients. Key Points • Skin psoriasis patients may have subclinical PsA. • Periarticular bone changes in PsO patients may be the early sign for uploading PsA disease. • Quality of life is highly affected in PsA than in PsO patients.
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Qi F, Yao A, He Y. Medical imaging examination in psoriasis and early psoriatic arthritis patients: an updated systematic review and meta-analysis. Int J Dermatol 2021; 60:1354-1362. [PMID: 33611815 DOI: 10.1111/ijd.15384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Abstract
Psoriatic arthritis appears in one in four skin psoriasis patients. Early detection of the presence of joint involvement and early interception of its developments may minimize long-term functional disability, and the radiological methods may be a perfect choice. To summarize and compare different imaging methods for diagnosing early-stage psoriatic arthritis and determine the necessity of joint examination in all psoriasis patients, several electronic databases, including MEDLINE and EMBASE, were searched for English language studies. A specific selection criterion followed the retrieval of studies. Thirteen studies were finally enrolled in the meta-analysis, eight of which compared the bone changes presentat on medical imaging examination between psoriasis patients without psoriatic arthritis and healthy people; three studies focused on differences between psoriatic arthritis patients and free joint involvement psoriasis patients shown on medical imaging tests. Medical imaging examination, including ultrasound (US), high-resolution peripheral quantitative CT scans (HR-pQCT), and magnetic resonance imaging (MRI), can be good choices for detecting the start of asymptomatic joint inflammation in psoriasis patients, which is essential to early detection and interception of joint damage to lower joint deformities and improve the future quality of life for patients. Additionally, the examination for psoriasis patients with arthralgia is also highly recommended.
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Affiliation(s)
- Fei Qi
- Capital Medical University, Beijing, China.,Department of Dermatology, Beijing Chao-yang Hospital, Beijing, China
| | - Amin Yao
- Capital Medical University, Beijing, China.,Department of Dermatology, Beijing Chao-yang Hospital, Beijing, China
| | - Yanling He
- Department of Dermatology, Beijing Chao-yang Hospital, Beijing, China
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40
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Lubrano E, Scriffignano S, Perrotta FM. Psoriatic Arthritis, Psoriatic Disease, or Psoriatic Syndrome? J Rheumatol 2020; 46:1428-1430. [PMID: 31676545 DOI: 10.3899/jrheum.190054] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ennio Lubrano
- Head of Academic Rheumatology Unit and MoRhe Project;
| | - Silvia Scriffignano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso, Italy
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41
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Dermatologists’ Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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42
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Belinchón I, Salgado-Boquete L, López-Ferrer A, Ferran M, Coto-Segura P, Rivera R, Vidal D, Rodríguez L, de la Cueva P, Queiro R. Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:835-846. [PMID: 32659259 PMCID: PMC7351070 DOI: 10.1016/j.ad.2020.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022] Open
Abstract
Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.
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Affiliation(s)
- I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, España
| | - L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Ferran
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Álvarez-Buylla, Mieres, Asturias, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - D Vidal
- Servicio de Dermatología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - L Rodríguez
- Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España.
| | - R Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
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43
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Rodríguez-Caminero S, Queiro R. Ultrasound subclinical musculoskeletal findings in inflammatory bowel disease: diagnostic value of positive Doppler signal. Rheumatology (Oxford) 2020; 59:3571-3572. [PMID: 32699882 DOI: 10.1093/rheumatology/keaa320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023] Open
Affiliation(s)
| | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
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44
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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.
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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:
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Molina Collada J, Macía-Villa C, Plasencia C, Álvaro-Gracia JM, de Miguel E. Doppler enthesitis: a potential useful outcome in the assessment of axial spondyloarthritis and psoriatic arthritis. Clin Rheumatol 2020; 40:2013-2020. [PMID: 33034818 DOI: 10.1007/s10067-020-05450-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyse the frequency of power Doppler (PD) enthesitis in active axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients and its potential usefulness in clinical practice. METHODS A prospective multicentre cross-sectional study in patients with axSpA and PsA with active disease was undertaken. Patients underwent bilateral ultrasound (US) examination of the peripheral entheses according to the Madrid Sonographic Enthesis Index (MASEI). The MASEI and Outcome Measures in Rheumatology (OMERACT) PD enthesitis definitions were checked. An inter-reader analysis of recorded videos was performed to determine reliability. RESULTS Sixty-four consecutive patients were included. The mean DAS28 (3.9 ± 1.3) for peripheral involvement, mean BASDAI (5.6 ± 2.2) for axial involvement, and CRP values (10 ± 10.9) reflected moderate-high disease activity at baseline. The mean global MASEI score was 29.4 (± 11.4), and 55 patients (86%) scored ≥ 18 (proposed cut-off point to diagnose SpA). At the patient level, abnormal US findings consistent with at least one enthesis showing a PD signal were observed in 52 (81.3%) patients using the MASEI PD definition and 48 (75%) using the OMERACT PD definition, without significant variation between axSpA and PsA. The inter-reader reliability was excellent (kappa = 0.92 for MASEI PD and 0.86 for OMERACT PD). CONCLUSIONS PD enthesitis was found in the majority of patients with active axSpA and PsA, independent of axial or peripheral affectation. Both MASEI and OMERACT PD definitions were useful in detecting active enthesitis. These findings support the usefulness of a PD US evaluation of entheses in the assessment of axSpA and PsA. Key Points • PD enthesitis is a very common finding in patients with active axSpA and PsA • Both MASEI and OMERACT PD definitions are useful to detect active enthesitis • US enthesitis may reveal information in axSpA and PsA.
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Affiliation(s)
- Juan Molina Collada
- Department of Rheumatology, Gregorio Marañón University Hospital, Madrid, Spain.
| | | | | | | | - Eugenio de Miguel
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain
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Cutaneous immunohistochemical expression of interleukin-23 receptor (IL-23R) in psoriasis and psoriatic arthritis patients: Relation to musculoskeletal ultrasound findings. THE EGYPTIAN RHEUMATOLOGIST 2020. [DOI: 10.1016/j.ejr.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Köhm M, Zerweck L, Ngyuen PH, Burkhardt H, Behrens F. Innovative Imaging Technique for Visualization of Vascularization and Established Methods for Detection of Musculoskeletal Inflammation in Psoriasis Patients. Front Med (Lausanne) 2020; 7:468. [PMID: 32984365 PMCID: PMC7492526 DOI: 10.3389/fmed.2020.00468] [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: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
Psoriasis (PsO) is one of the common chronic inflammatory skin diseases. Approximately 3% of the European Caucasian population is affected. Psoriatic arthritis (PsA) is a chronic immune-mediated disease associated with PsO characterized by distinct musculoskeletal inflammation. Due to its heterogeneous clinical manifestations (e.g., oligo- or polyarthritis, enthesitis, dactylitis, and axial inflammation), early diagnosis of PsA is often difficult and delayed. Approximately 30% of PsO patients will develop PsA. The responsible triggers for the transition from PsO only to PsA are currently unclear, and the impacts of different factors (e.g., genetic, environmental) on disease development are currently discussed. There is a high medical need, recently unmet, to specifically detect those patients with an increased risk for the development of clinically evident PsA early to initiate sufficient treatment to inhibit disease progression and avoid structural damage and loss of function or even intercept disease development. Increased neoangiogenesis and enthesial inflammation are hypothesized to be early pathological findings in PsO patients with PsA development. Different disease states describe the transition from PsO to PsA. Two of those phases are of value for early detection of PsA at-risk patients to prevent later development of PsA as changes in biomarker profiles are detectable: the subclinical phase (soluble and imaging biomarkers detectable, no clinical symptoms) and the prodromal phase (imaging biomarkers detectable, unspecific musculoskeletal symptoms such as arthralgia and fatigue). To target the unmet need for early detection of this at-risk population and to identify the subgroup of patients who will transition from PsO to PsA, imaging plays an important role in characterizing patients precisely. Imaging techniques such as ultrasound (US), magnetic resonance imaging (MRI), and computerized tomography (CT) are advanced techniques to detect sensitively inflammatory changes or changes in bone structure. With the use of these techniques, anatomic structures involved in inflammatory processes can be identified. These techniques are complemented by fluorescence optical imaging as a sensitive method for detection of changes in vascularization, especially in longitudinal measures. Moreover, high-resolution peripheral quantitative CT (HR-pQCT) and dynamic contrast-enhanced MRI (DCE-MRI) may give the advantage to identify PsA-related early characteristics in PsO patients reflecting transition phases of the disease.
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Affiliation(s)
- Michaela Köhm
- Division of Rheumatology, Goethe-University Frankfurt, Frankfurt, Germany.,Clinical Research, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine and Pharmacology TMP, Frankfurt, Germany.,Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany
| | - Lukas Zerweck
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | - Phuong-Ha Ngyuen
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | - Harald Burkhardt
- Division of Rheumatology, Goethe-University Frankfurt, Frankfurt, Germany.,Clinical Research, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine and Pharmacology TMP, Frankfurt, Germany.,Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Centre of Innovative Diagnostics and Therapeutics Rheumatology/Immunology CIRI, Frankfurt, Germany
| | - Frank Behrens
- Division of Rheumatology, Goethe-University Frankfurt, Frankfurt, Germany.,Clinical Research, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine and Pharmacology TMP, Frankfurt, Germany.,Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt, Germany.,Centre of Innovative Diagnostics and Therapeutics Rheumatology/Immunology CIRI, Frankfurt, Germany
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Vyas K, Jain SK, Mittal A, Kumar R, Saxena S, Malviya S. Sonographic Evaluation of Subclinical Enthesopathy in Patients of Chronic Plaque Psoriasis. Indian Dermatol Online J 2020; 11:580-585. [PMID: 32832446 PMCID: PMC7413449 DOI: 10.4103/idoj.idoj_446_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/19/2020] [Accepted: 04/20/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Psoriasis is associated with spondyloarthropathy in 10%-30% of cases. Enthesitis is major feature of psoriatic arthritis. Ultrasonography can detect subclinical entheseal abnormalities in psoriasis patients. OBJECTIVES To determine the prevalence of subclinical enthesopathy in psoriasis vulgaris using ultrasonography and evaluating its correlation with severity and duration of psoriasis. MATERIALS AND METHODS This study included 50 patients of psoriasis vulgaris and 50 healthy controls. Sonographic evaluation of six sites bilaterally (proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligaments, distal quadriceps, and brachial triceps tendons) were done in each subject. All Ultrasonographic findings were identified according to MASEI (Madrid sonography enthesitis index). Enthesopathy scores of patients and controls were compared and receiver operating characteristic curve was used to determine cut off value of MASEI, above which ultrasound enthesitis of clinical significance could be diagnosed. RESULTS 31 (62%) psoriasis patients had subclinical enthesopathy of clinical significance as compared to only 5 (10%) of controls. Mean MASEI score between psoriasis cases and control was statistically different, 12.72 ± 7.55 (Mean ± SD) and (5.14 ± 4.69), respectively (P value 0.000001).The receiver operating characteristic curve established an ultrasound score of >11 as the best cut-off to differentiate between subject with enthesopathy of clinical significance from those with enthesopathy of unknown significance. No statistically significant correlation was found between the degree of enthesopathy (MASEI score) and duration and severity of the psoriasis. CONCLUSION Ultrasonography can effectively screen subclinical entheseal abnormalities in psoriasis patients.
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Affiliation(s)
- Kapil Vyas
- Department of Dermatology, Venereology and Leprology, Geetanjali Medical College and Hospital, Udaipur, India
| | - Suresh K Jain
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, India
| | - Asit Mittal
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, India
| | - Ramesh Kumar
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, India
| | - Sangeeta Saxena
- Department of Radiology, Government Medical College, Kota, Rajasthan, India
| | - Sourabh Malviya
- Consultant Rheumatologist, Medanta Hospital, Indore, Madhya Pradesh, India
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Sarabia S, Farrer C, Yeung J, Jerome D, Lee KA, Cook R, Eder L. The Pattern of Musculoskeletal Complaints in Patients With Suspected Psoriatic Arthritis and Their Correlation With Physical Examination and Ultrasound. J Rheumatol 2020; 48:214-221. [PMID: 32414953 DOI: 10.3899/jrheum.190857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the pattern of musculoskeletal (MSK) symptoms and their correlation with clinical and sonographic findings among psoriasis patients with suspected psoriatic arthritis (PsA). METHODS Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their MSK complaints. The study included the following steps: (1) assessment by an advanced practice physiotherapist, (2) targeted MSK ultrasound, and (3) assessment by a rheumatologist. In addition, patients were asked to complete questionnaires about the nature and duration of their MSK symptoms and to mark the location of their painful joints on a homunculus. Each patient was classified by a rheumatologist as "Not PsA," "Possible PsA," or "PsA". MSK symptoms and patient-reported outcomes (PRO) were compared between patients with PsA and Possible/Not PsA. Agreement between modalities was assessed using κ statistics. RESULTS Two hundred three patients with psoriasis and MK symptoms were enrolled (8.8% PsA, 23.6% Possible PsA). Patients classified as PsA had worse scores on the PsA Impact of Disease (P = 0.004) and Functional Assessment of Chronic Illness Therapy-Fatigue scale (P = 0.02). There was no difference between the 2 groups in the presence, distribution, and duration of MSK symptoms. Analysis of agreement in physical examination between modalities revealed the strongest agreement between the rheumatologist and physiotherapist (κ = 0.28). The lowest levels of agreement were found between ultrasound and patient (κ = 0.08) and physiotherapist and ultrasound (κ = 0.08). CONCLUSION The results of this study suggest that the intensity, rather than the type, duration, or distribution of MSK symptoms, is associated with PsA among patients with psoriasis.
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Affiliation(s)
| | - Chandra Farrer
- C. Farrer, BScPT, Division of Rheumatology, Women's College Hospital, and Department of Physical Therapy, University of Toronto, Toronto
| | - Jensen Yeung
- J. Yeung, MD, Division of Dermatology, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto
| | - Dana Jerome
- D. Jerome, MD, L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto
| | - Ker-Ai Lee
- K.A. Lee, MMath, R. Cook, PhD, Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard Cook
- K.A. Lee, MMath, R. Cook, PhD, Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lihi Eder
- D. Jerome, MD, L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto;
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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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