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Petzinna SM, Winter L, Skowasch D, Pizarro C, Weber M, Kütting D, Behning C, Bauer CJ, Schäfer VS. Assessing sleep-related breathing disorders among newly diagnosed rheumatoid and psoriatic arthritis patients: a cross-sectional study. Rheumatol Int 2024; 44:1025-1034. [PMID: 38713410 PMCID: PMC11108881 DOI: 10.1007/s00296-024-05610-8] [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: 03/05/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES This cross-sectional study aimed to determine the prevalence and risk factors for sleep-related breathing disorders (SRBD) in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to develop a screening algorithm for early detection. METHODS We evaluated newly diagnosed RA or PsA patients using the Epworth Sleepiness Scale (ESS) questionnaire, cardiorespiratory polygraphy (RPG), and clinical and laboratory assessments. Sleep apnea syndrome (SAS) was diagnosed based on pathological RPG findings excessive daytime sleepiness, defined as ESS score above 10. RESULTS The study included 39 patients (22 RA, 17 PsA) and 23 controls. In RPG, SRBD was identified in 38.5% of arthritis patients compared to 39.1% of controls (p = 1.00), with male gender (p = .004) and age (p < .001) identified as risk factors. Excessive daytime sleepiness was noted in 36.4% of RA patients, 17.6% of PsA patients, and 21.7% of controls. Of the 24 patients diagnosed with SRBD, 41.6% met the criteria for SAS. SAS prevalence was 31.8% among RA patients, 0% in PsA patients, and 13% in controls. A significant association was observed between excessive daytime sleepiness and SRBD (p = .036). CONCLUSION Our findings reveal a high prevalence of SRBD in newly diagnosed, untreated RA and PsA patients in ESS and RPG, with excessive daytime sleepiness being a reliable predictor of SRBD. Patients with RA exhibited a higher predisposition to SAS. We therefore suggest incorporating ESS and RPG as screening tools in RA or PsA for early detection and management of SRBD.
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Affiliation(s)
- Simon M Petzinna
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany.
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Lone Winter
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Dirk Skowasch
- Clinic of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Carmen Pizarro
- Clinic of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Clinic of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Daniel Kütting
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Claus-Jürgen Bauer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Valentin S Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
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2
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Weman L, Salo H, Kuusalo L, Huhtakangas J, Vähäsalo P, Backström M, Kärki J, Sokka-Isler T. Intense symptoms of pain are associated with poor sleep, fibromyalgia, depression and sleep apnea in patients with rheumatoid arthritis and psoriatic arthritis. A register-based study. Joint Bone Spine 2024; 91:105744. [PMID: 38795765 DOI: 10.1016/j.jbspin.2024.105744] [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: 12/03/2023] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To study whether poor sleep and comorbidities are associated with high symptom levels of patient-reported outcomes (PROs) pain, patient global assessment and fatigue in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in a nation-wide cross-sectional setting. METHODS Clinical data were extracted from The Finnish Rheumatology Quality Register between 1.2021 and 9.2022. Self-reported sleep was categorized as "good" (little/no difficulties) or "poor" (great difficulties/can't) sleep. Data concerning comorbidities were collected from national registers. Descriptive statistics were used. Regression analyses were applied to analyze independent associations of sleep status, comorbidities and disease activity with pain in RA and PsA, adjusting for age and sex. RESULTS Among 13,512 patients with RA, 6052 [mean (SD) age 62 (13), 71% female] had sleep status reported; in PsA 1861/3636 [age 55 (13), 48% female]. In RA, 5072 (84%) reported good and 980 (16%) poor sleep; the corresponding numbers in PsA were 1460 (78%) and 401 (22%). Median values for objective disease activity were low and similar in patients with poor sleep and good sleep in both diseases. Among patients with no swollen joints, the median values for PROs were approximately three times higher for patients with poor sleep vs. good sleep in both diagnoses (P<0.001). In regression analyses, "poor" sleep was independently associated with higher symptoms in pain [B (95%CI) 20 (18,22) in RA and 23 (19, 26) in PsA], followed by comorbid fibromyalgia, as well as depression in RA and sleep apnea in PsA. CONCLUSION "Poor" sleep quality and comorbidities are independently associated with pain. Patient's sleep status is important to know especially in patients with severe symptoms without objective disease activity.
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Affiliation(s)
- Lauri Weman
- University of Eastern Finland, Kuopio, Finland.
| | - Henri Salo
- Data and Analytics, Finnish institute for health and welfare (THL), Helsinki, Finland
| | - Laura Kuusalo
- Centre for Rheumatology and Clinical Immunology, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Paula Vähäsalo
- Research Unit of Clinical Medicine, University of Oulu, Department of Children and Adolescents, Oulu University Hospital, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maria Backström
- Department of Pediatrics, Wellbeing Services County of Ostrobothnia, Vaasa, Finland, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Johanna Kärki
- Department of Children and Adolescents, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Tuulikki Sokka-Isler
- University of Eastern Finland, Kuopio, Finland; University of Eastern Finland and Rheumatology, Hospital Nova of Central Finland, Jyväskylä, Finland
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3
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Guo M, Su J, Zheng S, Chen B. Sleep in psoriasis: A meta-analysis. J Psychosom Res 2024; 176:111543. [PMID: 37956475 DOI: 10.1016/j.jpsychores.2023.111543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Currently, there are discrepant results regarding the quantitative effect of psoriasis on sleep, which may, in part, be attributed to the use of non-standardised questionnaires. METHODS The PubMed/Medline, Embase, and Cochrane databases were searched for cross-sectional, case-control or cohort studies that recruited patients with psoriasis and healthy controls and reported data regarding Pittsburgh Sleep Quality Index (PSQI) and the prevalence of sleep disturbance (SD) based on the PSQI, published from inception up to January 2023. Secondary outcomes included scores for the Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and Epworth Sleepiness Scale (ESS), and risk for restless legs syndrome (RLS). Meta-analyses using random-effects models were used for statistical analyses. RESULTS Fifteen studies including 1274 patients with psoriasis and 775 controls were analysed. A higher PSQI (weighted mean difference [WMD] = 3.397, P < 0.001, I2 = 84.2%) and a higher risk for SD (odds ratio [OR] = 6.640, P < 0.001, I2 = 67.5%) were observed in patients with psoriasis compared with controls. Subgroup analyses revealed a greater difference in PSQI score and/or risk for SD between patients with psoriasis and controls in subgroups of psoriatic arthritis, moderate-to-severe psoriasis, shorter psoriasis duration, and younger age. Moreover, patients with psoriasis exhibited higher ISI (WMD = 2.709, P < 0.001) and BDI scores (WMD = 4.565, P = 0.001), and risk for RLS (OR = 4.689, P = 0.01). However, there was no significant difference in ESS scores (WMD = -0.229, P = 0.77) compared with controls. CONCLUSION Psoriasis was associated with poor sleep quality and higher risk for SD, especially among patients with psoriatic arthritis, severe psoriasis, shorter duration of psoriasis, and younger age. Patients with psoriasis were also more likely to experience insomnia, RLS, and depression.
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Affiliation(s)
- Miaolan Guo
- Department of Nursing, Shantou University Medical College, Shantou 515000, China
| | - Jing Su
- Department of Nursing, Shantou University Medical College, Shantou 515000, China
| | - Shaoyan Zheng
- Academic Affairs Office, Shantou University Medical College, Shantou 515000, China
| | - Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou University Medical College, Shantou 515000, China; Sleep Medicine Center, Shantou University Medical College, Shantou 515000, China; Shantou University Medical College-Faculty of Medicine of University of Manitoba Joint Laboratory of Biological Psychiatry, Shantou 515000, China.
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4
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Toledano E, Hidalgo C, Gómez-Lechón L, Ibáñez M, Chacón CC, Martín-Vallejo J, Pastor S, Montilla C. SLEEP quality in patients with psoriatic arthritis and its relationship with disease activity and comorbidities: a cross-sectional study. Sci Rep 2023; 13:22927. [PMID: 38129461 PMCID: PMC10739913 DOI: 10.1038/s41598-023-48723-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
The assessment of psoriatic arthritis is complex and multidimensional. It is increasingly common to include the patient perspective using patient-reported outcomes. Although some research has explored sleep quality in patients with psoriatic arthritis, most studies have had small sample sizes, failed to assess sleep quality considering the inflammatory process together with the psychological well-being of patients, and have not described any use of sleep medication. Further, research to date has not provided data on the relationship of sleep quality with axial forms. In this context, the objective of this study was to assess sleep quality in patients with psoriatic arthritis and its relationship with clinical characteristics, disease activity, functioning, disease impact, fatigue and psychological status. A cross-sectional study was conducted including 247 consecutive patients with PsA recruited during 2021. Sleep quality was measured using the Pittsburgh Sleep Quality Index. We assessed correlations of Pittsburgh Sleep Quality Index score with peripheral disease activity (Disease Activity Index for PSoriatic Arthritis), axial disease activity (Ankylosing Spondylitis Disease Activity Score-C-reactive protein and Bath Ankylosing Spondylitis Disease Activity Index), functioning (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire), impact (Psoriatic Arthritis Impact of Disease questionnaire), anxiety, depression (Hospital Anxiety and Depression Scale) and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) scores. A multiple linear regression model was constructed with PSQI as the dependent variable and as independent variables those that could influence sleep quality. Nearly two-thirds (63.15%) of patients had poor sleep quality. Poorer sleep quality was associated with being female, higher joint counts, greater peripheral and axial disease activity, fatigue, anxiety and depression, functioning and disease impact (p < 0.001). Multiple linear regression analysis found that pain (β: 0.3; p < 0.007) and fatigue β: - 0.1; p < 0.001 contributed 40% to the sleep quality model. Poor sleep quality was common among patients with psoriatic arthritis. Emotional factors (fatigue, anxiety) seemed more important than inflammatory factors in sleep quality.
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Affiliation(s)
- Esther Toledano
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Cristina Hidalgo
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Luis Gómez-Lechón
- Rheumatology Department, Hospital Francesc De Borja, Gandía, Valencia, Spain
| | - Marta Ibáñez
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Sonia Pastor
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Carlos Montilla
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
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Kaplan H, Cengiz G, Şaş S, Eldemir YÖ. Is the C-reactive protein-to-albumin ratio the most remarkable simple inflammatory marker showing active disease in patients with axial spondyloarthritis, psoriatic arthritis, and rheumatoid arthritis? Clin Rheumatol 2023; 42:2959-2969. [PMID: 37470884 DOI: 10.1007/s10067-023-06703-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To learn which of the simple inflammation markers obtained from routine laboratory tests showed active disease best. METHODS The study included 256 patients (102 patients with axial spondyloarthritis [axSpA], 54 with psoriatic arthritis [PsA], and 100 with rheumatoid arthritis [RA]). The results of the routine laboratory tests requested during the outpatient clinic visits of the patients were noted. Inflammation-related ratio/indices were then calculated from these laboratory tests. Active and inactive diseases were defined according to the disease activity scores for each disease. Logistic regression and receiver operating characteristic (ROC) analyses were performed to determine the best laboratory marker(s) showing active disease and its cutoff value for all three diseases. RESULTS C-reactive protein to albumin ratio (CAR) was significantly higher in patients with active axSpA, PsA, and RA diseases than those with inactive diseases (p < 0.001, p = 0.006, and p < 0.001, respectively). In the logistic regression analysis, the CAR was the most important predictor of active disease in patients with axSpA, PsA, and RA. CAR had also showed the active disease at an acceptable level in axSpA and PsA and very well in RA. The cutoff values for active disease in axSpA, PsA, and RA were 0.75, 0.92, and 0.89, respectively. CONCLUSION CAR may be a promising simple laboratory marker to distinguish active disease in patients with axSpA, PsA, and RA. Key Points • Acute phase reactants and circulating blood cells have become an important target because of the search for a disease activity marker that can be used cheaply and quickly in the daily outpatient routine. • One or more of these simple markers have been previously discussed in various studies with different hypotheses. • We aimed to determine which of the inflammation markers obtained from routine laboratory tests showed active disease and to determine a cutoff value for this/these marker(s). • CAR was the most important simple laboratory marker to distinguish active disease in patients with axSpA, PsA, and RA. In addition, CAR showed the active disease at an acceptable level in axSpA and PsA, and very well in RA.
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Affiliation(s)
- Hüseyin Kaplan
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Gizem Cengiz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Senem Şaş
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Yasemin Özden Eldemir
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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McGagh D, McGowan N, Hinds C, Saunders KEA, Coates LC. Actigraphy-derived physical activity levels and circadian rhythm parameters in patients with psoriatic arthritis: relationship with disease activity, mood, age and BMI. Ther Adv Musculoskelet Dis 2023; 15:1759720X231174989. [PMID: 37435529 PMCID: PMC10331082 DOI: 10.1177/1759720x231174989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/24/2023] [Indexed: 07/13/2023] Open
Abstract
Background Psoriatic arthritis (PsA) is associated with sleep disturbance, depression and a lifetime risk of obesity and cardiovascular disease. To date, there have been no studies investigating the relationship between objectively-measured physical activity (PA) levels and circadian rhythm disturbance with disease activity, daily symptoms and mood in patients with PsA. Objective This pilot study aimed to investigate the relationship between disease activity, daily symptoms and mood on PA and circadian rhythm in PsA. Design A prospective cohort study recruiting adults with PsA from rheumatology clinics at a single centre in the UK. Methods Participants wore an actigraph and recorded their symptoms and mood on a daily basis via a smartphone app for 28 days. Time spent in sedentary, light and moderate-to-vigorous physical activity (MVPA) and parameters reflecting the circadian rhythm of the rest-activity pattern were derived. This included the onset time of the least active 5-h (L5) and most active 10-h (M10) daily consecutive periods and the relative amplitude (RA). The relationship factors between baseline clinical status, daily symptoms, PA and circadian measures were examined using linear mixed effect regression models. Results Nineteen participants (8/19 female) were included. Participants with active PsA spent 63.87 min (95% CI: 18.5-109.3, p = 0.008) more in inactivity and 30.78 min (95% CI: 0.4-61.1, p = 0.047) less in MVPA per day compared to those in minimal disease activity (MDA). Age, body mass index and disease duration were also associated with PA duration. Participants with worse functional impairment had an M10 onset time 1.94 h (95% CI: 0.05-3.39, p = 0.011) later than those with no reported functional impairment. No differences were detected for L5 onset time or RA. Higher scores for positive mood components such as feeling energetic, cheerful and elated were associated with less time in inactivity and greater time spent in MVPA overall. Conclusion Our study highlights differences in PA and circadian rest-activity pattern timing based on disease activity, disability and daily mood in PsA. Reduced PA levels in patients with active disease may contribute to the observed increased risk of cardiovascular and metabolic sequelae, with further studies exploring this need.
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Affiliation(s)
- Dylan McGagh
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, The Botnar
Research Centre, Old Road, Headington, Oxford, OX3 7LD, UK
| | - Niall McGowan
- Sleep and Circadian Neuroscience Institute,
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford,
Oxfordshire, UK
- Department of Psychiatry, University of Oxford,
Oxford, UK
| | - Chris Hinds
- Oxford Digital Phenotyping Laboratory, Big Data
Institute, University of Oxford, Oxford, UK
| | - Kate E. A. Saunders
- Department of Psychiatry, University of Oxford,
Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford
Hospital, Oxford, UK
| | - Laura C. Coates
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford,
UK
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Burek-Michalska A, Turno-Kręcicka A, Grant-Kels JM, Grzybowski A. Biologic therapies for psoriasis and eyes. Clin Dermatol 2023; 41:523-527. [PMID: 37586569 DOI: 10.1016/j.clindermatol.2023.08.003] [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: 08/18/2023]
Abstract
Psoriasis is a systemic inflammatory disorder, manifested mainly by skin lesions, but the inflammation also may affect the joints and eye. Many comorbidities have been described in association with psoriasis, including metabolic syndrome and coronary plaques. The pathomechanism of psoriasis is multifaceted. Both genetic and immunologic aspects play a role in stimulating inflammation. Genetic susceptibility is conditioned by presence of the human leukocyte antigen-C*06:02 risk allele and the inflammatory reaction secondary to cytokines, such as tumor necrosis factor α, interleukin 17 (IL-17), IL-20, IL-23, and interferon alfa. Besides the conventional therapy of topical steroids and immunosuppressants, biologic therapies are widely used in the treatment of psoriasis, psoriatic arthritis, and coexisting uveitis. In the majority of cases, biologic therapy has a beneficial effect on uveitis, but in some cases, some of these drugs can lead to serious side effects threatening vision.
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Affiliation(s)
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznań, Poland
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Winders S, Lyon DE, Stechmiller JK, Kelly DL. Biomarkers of sleep disturbance in adults with chronic illness: A scoping review. Chronic Illn 2023; 19:3-25. [PMID: 35179070 DOI: 10.1177/17423953211073697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The purpose of this scoping review was to identify which biomarkers for sleep disturbance were the most prevalent and significant in the literature across chronic illnesses. METHODS A scoping review was conducted, following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, to provide a map of the existing literature on the biomarkers of sleep disturbance in adults with chronic illness. Peer-reviewed articles published between 2010-2020 were included if they measured a biomarker and discussed sleep deprivation, disturbance, or dysfunction secondary to a chronic illness. RESULTS A total of 21 articles were included and synthesized using data charting. There were 24 different biomarkers identified, most commonly collected through serum. Biomarkers were grouped, then biomarkers and correlations with sleep were identified and mapped. DISCUSSION Overall, the most common biomarkers studied were interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), c-reactive protein (CRP), and interleukin-1 beta (IL-1β). Cytokines were the most commonly studied biomarkers, with a majority of studies focusing on pro-inflammatory cytokines. Based on the results of this review, CRP, IL-6, TNF-α, and erythrocyte sedimentation rate (ESR) showed themost significant correlations with sleep across all chronic illnesses. Future research is still needed to identify an ideal biomarker for sleep disturbance that can be used across chronic illnesses.
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Affiliation(s)
- Samantha Winders
- 3463University of Florida School of Nursing, Gainesville, FL, USA
| | - Debra E Lyon
- 3463University of Florida School of Nursing, Gainesville, FL, USA
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Fahmi DS, Makarm WK, Zaghlol RS. Burden of enthesitis on the quality of life and work productivity in psoriatic arthritis patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
Psoriatic arthritis (PsA) which affects 6–42% of psoriasis patients is the most common extra-cutaneous manifestation of the psoriasis disease. Enthesitis may be considered as a sign of increased disease burden due to its association with several clinical aspects. Therefore, the aim of the study was to investigate the effect of clinical enthesitis on quality of life and work productivity in PsA patients.
Results
Enthesitis was detected in 50% of patients. There was statistically significant difference between the studied groups as regard disease activity index for psoriatic arthritis (DAPSA) score, psoriatic arthritis impact of the disease 12 (PsAID-12), Health Assessment Questionnaire disability index (HAQ-DI), and Spondyloarthritis Research Consortium of Canada index (SPARCC) with higher mean score in patients with enthesitis. The majority of patients with enthesitis had a higher percentage of impairment in daily activities (95.5%) than those without enthesitis (38.6%), as well as a statistically significant positive correlation between SPARCC index and both work absenteeism and work productivity loss. Furthermore, enthesitis in both the upper and lower sites was related with worse quality of life (36.4%) and higher work impairment (45.5%) compared to patients with enthesitis in either the upper or lower sites alone.
Conclusion
Enthesitis was a frequent complaint among PsA patients. PsA patients with enthesitis had a significant disease burden regardless of enthesitis location, and patients with enthesitis in both the upper and lower sites have a worse quality of life and a higher work impairment.
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Controne I, Scoditti E, Buja A, Pacifico A, Kridin K, Fabbro MD, Garbarino S, Damiani G. Do Sleep Disorders and Western Diet Influence Psoriasis? A Scoping Review. Nutrients 2022; 14:nu14204324. [PMID: 36297008 PMCID: PMC9608488 DOI: 10.3390/nu14204324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Western diet may trigger sleep disorders and vice versa, but their single and mutual effects on systemic inflammatory diseases (i.e., psoriasis) are far from being fully elucidated. At the same time, psoriatic patients display a great burden of sleep disorders and dysmetabolisms related to an unhealthy lifestyle (i.e., diet). These patients are also affected by a chronic disorder deeply modulated by environmental factors (i.e., sleep and diet) capable to influence drug-response and disease progression. Thus, we aimed to summarize the evidence in the literature that may highlight a potential link among psoriasis–diet–sleep in order to further promote a multidisciplinary approach to psoriatic patients in the scientific community.
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Affiliation(s)
- Ilaria Controne
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Egeria Scoditti
- Institute of Clinical Physiology, National Research Council (CNR), 73100 Lecce, Italy
| | - Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, 35128 Padova, Italy
| | - Alessia Pacifico
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23562 Lübeck, Germany
| | - Massimo Del Fabbro
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- IRCCS Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-662141
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11
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Li Y, Guo J, Cao Z, Wu J. Causal Association Between Inflammatory Bowel Disease and Psoriasis: A Two-Sample Bidirectional Mendelian Randomization Study. Front Immunol 2022; 13:916645. [PMID: 35757704 PMCID: PMC9226443 DOI: 10.3389/fimmu.2022.916645] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/16/2022] [Indexed: 12/30/2022] Open
Abstract
Background Previous observational studies have found an association between inflammatory bowel disease (IBD) and psoriasis. Using the mendelian randomization (MR) approach, we aim to determine whether there was a causal association between IBD and psoriasis. Methods We performed a two-sample MR with the genetic instruments identified for IBD and its main subtypes, Crohn’s disease (CD) and ulcerative colitis (UC), from a genome-wide association study (GWAS) involving 25,042 cases with an IBD diagnosis and 34,915 controls. Summarized data for psoriasis were obtained from different GWAS studies which included 4510 cases and 212,242 controls without psoriasis. Causal estimates are presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results The overall outcome of MR analysis was to demonstrate that genetic predisposition to IBD was associated with an increased risk of psoriasis (OR: 1.1271; 95% CI: 1.0708 to 1.1864). Psoriatic arthritis (PsA) had a significant association with total IBD (OR: 1.1202; 95% CI: 1.0491 to 1.1961). Casual relationship was also identified for CD-psoriasis (OR: 1.1552; 95% CI: 1.0955 to 1.2182) and CD-PsA (OR: 1.1407; 95% CI: 1.0535 to 1.2350). The bidirectional analysis did not demonstrate that a genetic predisposition to psoriasis was associated with total IBD, although psoriasis showed association with CD (OR: 1.2224; 95% CI: 1.1710 to 1.2760) but not with UC. A genetic predisposition to PsA had a borderline association with IBD (OR: 1.0716; 95% CI: 1.0292 to 1.1157) and a suggestive association with CD (OR: 1.0667; 95% CI: 1.0194 to 1.1162). Conclusion There appears to be a causal relationship between IBD and psoriasis, especially for PsA, but for psoriasis and IBD, only total psoriasis and PsA were associated with CD. Understanding that specific types of psoriasis and IBD constitute mutual risk factors facilitates the clinical management of two diseases.
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Affiliation(s)
- Yajia Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jia Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqin Cao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jianhuang Wu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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12
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Alnaqbi KA, Hannawi S, Namas R, Alshehhi W, Badsha H, Al-Saleh J. Consensus statements for evaluation and nonpharmacological Management of Psoriatic Arthritis in UAE. Int J Rheum Dis 2022; 25:725-732. [PMID: 35678066 PMCID: PMC9544782 DOI: 10.1111/1756-185x.14357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 12/13/2022]
Abstract
Objective Psoriatic arthritis (PsA), a chronic inflammatory arthropathy, is often underdiagnosed in Middle Eastern countries, substantially impacting the treatment of affected individuals. This article aims to highlight current unmet clinical needs and provide consensus recommendations for region‐specific evaluation methods and nonpharmacological therapies in the United Arab Emirates (UAE). Method An extensive literature review was conducted, focusing especially on global and regional guidelines for the evaluation and treatment of PsA. These form the basis of the consensus statements formulated. Additionally, an expert panel of key opinion leaders from the UAE reviewed these guidelines and available literature at an advisory board meeting to identify unmet needs, bridge clinical gaps in the UAE, and develop consensus statements for the evaluation and treatment of PsA. Result The consensus statements were developed based on overarching principles for the management of PsA, evaluation of patients with PsA, and nonpharmacological approaches for the management of PsA. The overarching principles included adopting a targeted, multidisciplinary approach, along with collaboration between rheumatologists and dermatologists in cases of clinically significant skin involvement. The panel also highlighted the value of composite disease severity measures for characterizing clinical manifestations of PsA. In terms of nonpharmacological management approaches, lifestyle modification (comprising dietary change, exercise, and cessation of smoking) and psychotherapy were recommended. Conclusion The consensus statements will aid healthcare professionals in clinical decision‐making in the context of PsA.
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Affiliation(s)
- Khalid A Alnaqbi
- Department of Rheumatology, Tawam Hospital, Al Ain, UAE.,College of Medicine and Health Sciences, UAE University, Al Ain, UAE
| | - Suad Hannawi
- Emirates Health Services (EHS), Dubai, UAE.,Ministry of Health and Prevention, Dubai, UAE
| | - Rajaie Namas
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic, Abu Dhabi, UAE
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13
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Halioua B, Chelli C, Misery L, Taieb J, Taieb C. Sleep Disorders and Psoriasis: An Update. Acta Derm Venereol 2022; 102:adv00699. [PMID: 35191513 PMCID: PMC9574693 DOI: 10.2340/actadv.v102.1991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis alters patients’ quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;’ physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.
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14
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Skougaard M, Stisen ZR, Jørgensen TS, Egeberg A, Hansen RL, Perez-Chada LM, Mogensen M, Merola JF, Gerwien JG, Kristensen LE. Increased prevalence of sleep disturbance in psoriatic arthritis is associated with inflammatory and non-inflammatory measures. Scand J Rheumatol 2022; 52:259-267. [PMID: 35302402 DOI: 10.1080/03009742.2022.2044116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine the prevalence of sleep disturbances, quantified by the Pittsburgh Sleep Quality Index (PSQI), in patients with psoriatic arthritis (PsA), psoriasis (PsO) and healthy controls (HCs), explore associations between PSQI and clinical and patient-reported outcomes, and evaluate the effect of treatment on PSQI. METHOD Patients were included from the Parker Institute's PsA patient cohort to evaluate the prevalence of sleep disturbances. Univariate and multivariate regression analyses were used to explore associations between sleep disturbance and outcome measures. Treatment effect in PsA patients was assessed with a mixed-effect model for repeated measures. RESULTS In total, 109 PsA patients, 20 PsO patients, and 20 HCs were included. Sleep disturbances were reported by 66.1% of PsA patients, 45.0% of PsO patients, and 15.0% of HCs. Univariate regression analyses revealed statistically significant associations (p < 0.001) between PSQI and Disease Activity Score (DAS28CRP), tender points, visual analogue scale (VAS) patient global and pain, Psoriatic Arthritis Impact of Disease fatigue, Health Assessment Questionnaire (HAQ), and painDETECT score. Multivariate regression analysis demonstrated VAS patient global, VAS pain, and tender points as being independently associated with PSQI. The mixed-effect model revealed no effect of treatment. CONCLUSION More PsA patients than PsO patients and HCs reported sleep disturbances. Sleep disturbances were associated with inflammatory and non-inflammatory measures possibly explaining the limited effect of treatment. This demonstrates the need for interdisciplinary approaches to improve the management of sleep disturbance in PsA.Trial registration: ClinicalTrials.gov (NCT02572700).
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Affiliation(s)
- M Skougaard
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Z R Stisen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - T S Jørgensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - A Egeberg
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - R L Hansen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - L M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Mogensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - J F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - L E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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15
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Stenger S, Grasshoff H, Hundt JE, Lange T. Potential effects of shift work on skin autoimmune diseases. Front Immunol 2022; 13:1000951. [PMID: 36865523 PMCID: PMC9972893 DOI: 10.3389/fimmu.2022.1000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 02/16/2023] Open
Abstract
Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.
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Affiliation(s)
- Sarah Stenger
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
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16
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Factors Associated with Health-Related Quality of Life in Psoriatic Arthritis Patients: A Longitudinal Analysis. Rheumatol Ther 2021; 8:1341-1354. [PMID: 34287811 PMCID: PMC8380589 DOI: 10.1007/s40744-021-00349-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is considered a multifaceted disease, with patients reporting low health-related quality of life (HRQoL). Data on disease burden are substantial and there exists a need for properly designed studies to learn more about the evolution of HRQoL in this condition. This study aims to identify factors associated to HRQoL evolution in PsA patients followed-up in a real-world setting in Spain. METHODS We conducted a retrospective longitudinal observational study including incident patients from the rheumatology outpatient clinic of Hospital Clínico San Carlos (Madrid, Spain), diagnosed for the first time of PsA, defined as having received any ICD9/ICD10 diagnosis code of PsA, from 2007 to 2016, and followed-up until loss of follow-up, death, or November 2017. The influence of demographic and clinical variables in baseline HRQoL [assessed with the Rosser Classification Index (RCI)] was analyzed using bivariable and multivariable generalized linear models. The influence of those variables and of treatment-related factors in repeated measures of HRQoL was analyzed using bivariable and multivariable generalized estimating equations (GEE) models nested by patient. RESULTS Two hundred and thirty patients were included in the analysis, with 3384 registered visits. At baseline, older age, a previous diagnosis of obesity, and the presence of enthesitis were significantly associated with worse HRQoL. During follow-up, using an exchangeable working correlation structure, the presence of enthesitis was also associated with worse HRQoL, coefficient (95% CI) - 0.006 (- 0.01 to - 0.002), p = 1.00E-03; conversely, treatment with methotrexate or antimalarials was associated with better HRQoL with 0.007 (0.001-0.014), p = 0.020 and 0.003 (0.001-0.005), p = 3.00E-03, respectively. CONCLUSIONS Musculoskeletal manifestations and comorbidities exert a deleterious effect in HRQoL of PsA patients. Therefore, the optimal management of this condition needs to also address these manifestations in order to try to restore the QoL of these patients.
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17
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Vucemilovic AS, Puljak L. Outcome domains and measures for pain in psoriasis used in registered trials: analysis of studies on ClinicalTrials.gov. J Comp Eff Res 2021; 10:909-915. [PMID: 34111965 DOI: 10.2217/cer-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Psoriasis includes unpleasant symptoms such as pain. This study aimed to investigate whether clinical trials have domains related to pain in their study designs. Materials and methods: We analyzed all clinical trials about interventions for psoriasis treatment registered on ClinicalTrials.gov and the frequency of pain-related outcomes. Results: Our analysis included 1033 registered clinical trials. They had 1329 primary outcomes and 5457 secondary outcomes. The pain was used in six (0.6%) protocols as a primary outcome and 68 (6.5%) protocols as a secondary outcome. Conclusion: Pain as an outcome was used in few registered clinical trial protocols for the treatment of psoriatic conditions. Future studies should investigate why the trialists do not include pain among primary or secondary outcomes.
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Affiliation(s)
| | - Livia Puljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, Zagreb, Croatia
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18
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Haugeberg G, Michelsen B, Kavanaugh A. Impact of skin, musculoskeletal and psychosocial aspects on quality of life in psoriatic arthritis patients: A cross-sectional study of outpatient clinic patients in the biologic treatment era. RMD Open 2021; 6:rmdopen-2020-001223. [PMID: 32409518 PMCID: PMC7299507 DOI: 10.1136/rmdopen-2020-001223] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In psoriatic arthritis (PsA), both psoriasis and musculoskeletal manifestations may impair Health-Related Quality of Life (HRQoL). Our objective was to explore the impact of the various disease manifestations and disease consequences, including psychosocial factors, on HRQoL in PsA patients treated in the biologic treatment era. METHODS Data collection in the 131 outpatient clinic PsA patients assessed included demographics, disease activity measures for both skin and musculoskeletal involvement and patient-reported outcome (PRO) measures, treatment and psychosocial burden. The skin dimension of quality of life was assessed by the Dermatology Life Quality Index (DLQI) and the overall HRQoL by the 15-Dimensional (15D) Questionnaire. RESULTS The mean age was 51.9 years, PsA disease duration 8.6 years, 50.4% were men, 56.9% were employed/working and 47.7% had ≥1 comorbidities. Prevalence of monotherapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was 36.6% and with biologic DMARDs 12.2% and combination of both 22.9%. Mean DLQI was 3.3 and 15D 0.84. In adjusted analysis, not employed/working, higher scores for fatigue, sleep disturbances, anxiety and depression, Modified Health Assessment Questionnaire and presence of comorbidities were independently associated with impaired HRQoL (lower 15D scores), whereas Psoriasis Area Severity Index (PASI) and DLQI were not. Younger age and higher Psoriatic Arthritis Disease Activity Score and PASI scores were independently associated with impaired skin quality of life (higher DLQI score). CONCLUSION Our study highlights the negative impact the psychosocial burden, impaired physical function and comorbidities has on reduced HRQoL in PsA outpatients. Thus, to further improve HRQoL in PsA patients, not only physical concerns but also psychological concerns need to be addressed.
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Affiliation(s)
- Glenn Haugeberg
- Division of Rheumatology, Dept. of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
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19
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McGonagle D, McInnes IB, Deodhar A, Schett G, Shawi M, Kafka S, Karyekar CS, Kollmeier AP, Hsia EC, Xu XL, Sheng S, Agarwal P, Zhou B, Ritchlin CT, Rahman P, Mease PJ. Resolution of Enthesitis by Guselkumab and Relationships to Disease Burden: 1-Year Results of Two Phase-3 Psoriatic Arthritis Studies. Rheumatology (Oxford) 2021; 60:5337-5350. [PMID: 33822898 PMCID: PMC8566200 DOI: 10.1093/rheumatology/keab285] [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: 02/20/2021] [Revised: 03/17/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To further characterize the effect of guselkumab, a selective IL-23p19-subunit inhibitor approved for PsA, on enthesitis and assess relationships between enthesitis resolution and patient status/outcomes. Methods Adults with active PsA despite standard therapies in the phase 3 DISCOVER-1 and DISCOVER-2 studies were randomized 1:1:1 to guselkumab 100 mg every 4 weeks (Q4W); guselkumab 100 mg at week 0, week 4, Q8W; or placebo through week 20 followed by guselkumab 100 mg Q4W. Independent assessors evaluated enthesitis using the Leeds Enthesitis Index (LEI; total score 0–6). Enthesitis findings through week 24 were pre-specified to be pooled across studies; post hoc and week 52 analyses also employed pooled data. Results Among 1118 randomized, treated patients in DISCOVER-1 and 2 who had ≥1 LEI site evaluated, 65% had enthesitis at baseline. These patients exhibited numerically more swollen and tender joints, systemic inflammation and impaired physical function than patients without enthesitis. Guselkumab Q4W and Q8W were superior to placebo in resolving pre-existing enthesitis at week 24 (45 and 50% vs 29%; both adjusted P = 0.0301). Enthesitis resolution rates continued to rise; 58% of guselkumab-randomized patients achieved resolution at week 52, including patients with mild (LEI = 1; 70–75%), moderate (LEI = 2; 69–73%) or severe (LEI = 3–6; 42–44%) enthesitis at baseline. Among guselkumab-randomized patients with resolved enthesitis at week 24, 42% achieved minimal disease activity at week 52, vs 17% of patients with unresolved enthesitis. Conclusion Guselkumab resulted in higher proportions of PsA patients with resolved enthesitis by week 24, with maintenance of resolution rates through 1 year. As enthesitis confers greater disease burden, sustained resolution could portend better patient outcomes. Clinical trial registration DISCOVER 1 (NCT03162796) and DISCOVER 2 (NCT03158285)
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Affiliation(s)
- Dennis McGonagle
- Rheumatology, Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | | | - Atul Deodhar
- Rheumatology, Oregon Health & Science University, Portland, OR, USA
| | - Georg Schett
- Internal Medicine 3, FAU Erlangen-Nuremburg and Universitatsklinikum, Erlangen, Germany
| | - May Shawi
- Immunology, Janssen Global Services, LLC, Horsham, PA, USA
| | - Shelly Kafka
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | | | - Elizabeth C Hsia
- Immunology, Janssen Research & Development, LLC, San Diego, CA, USA.,Rheumatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Xie L Xu
- Immunology, Janssen Research & Development, LLC, San Diego, CA, USA
| | - Shihong Sheng
- Clinical Biostatistics, Janssen Research & Development, Spring House, PA, USA
| | - Prasheen Agarwal
- Clinical Biostatistics, Janssen Research & Development, Spring House, PA, USA
| | - Bei Zhou
- Clinical Biostatistics, Janssen Research & Development, Spring House, PA, USA
| | - Christopher T Ritchlin
- Allergy/Immunology and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Proton Rahman
- Rheumatology, Memorial University of Newfoundland, St. Johns, NL, Canada
| | - Philip J Mease
- Rheumatology, Swedish Medical Center/Providence St Joseph Health and University of Washington, Seattle, WA, USA
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20
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Sapsford M, Evans J, Clunie G, Jadon D. A comparison of clinical examination and ultrasound enthesitis indices in patients with psoriatic arthritis, adjusted for concomitant fibromyalgia. Ther Adv Musculoskelet Dis 2021; 13:1759720X211003812. [PMID: 33854573 PMCID: PMC8010809 DOI: 10.1177/1759720x211003812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives: To: (a) determine the extent of ultrasound (US)-detected peripheral enthesitis in a cohort of patients with psoriatic arthritis (PsA); (b) compare this with three clinical examination (CE) enthesitis indices; and (c) determine the effect of concurrent fibromyalgia on the evaluation of enthesitis. Methods: A prospective single-centre cross-sectional study of consecutive outpatients with established PsA undergoing clinical examination for enthesitis and US examination for inflammatory and structural lesions of enthesitis. Multivariable analyses tested for association between US scores, CE enthesitis indices and influence of concurrent fibromyalgia. Results: A total of 106 patients were assessed. Of these, 91/106 (85.8%) had CE enthesitis and 105/106 (99.1%) had ⩾1 US feature of enthesitis. There was a moderate correlation between US entheseal inflammation and both the Leeds Enthesitis Index (LEI) (Spearman rank, r = 0.36) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) (r = 0.44). US entheseal damage did not correlate with CE enthesitis indices. Twenty-eight (26.4%) patients were classified as having concurrent fibromyalgia, in whom multivariable regression analyses demonstrated no correlation between US scores and CE enthesitis indices. PsA patients without fibromyalgia demonstrated a statistically significant association between both LEI (r = 0.48, p < 0.0001) and SPARCC (r = 0.62, p < 0.0001) and US entheseal inflammation. Conclusion: There is a moderate association between US entheseal inflammation, but not damage, and CE enthesitis indices in patients with PsA. The presence of concurrent fibromyalgia is linked with higher CE enthesitis scores, without an increase in US inflammation, suggesting that CE enthesitis indices should be used/interpreted with caution in these patients. Imaging, including US, should be the preferred modality to detect enthesitis in PsA patients with concurrent fibromyalgia.
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Affiliation(s)
- Mark Sapsford
- Department of Rheumatology, Cambridge University Hospitals NHSFT, Cambridge, UK
| | - Jobie Evans
- Department of Rheumatology, Cambridge University Hospitals NHSFT, Cambridge, UK
| | - Gavin Clunie
- Department of Rheumatology, Cambridge University Hospitals NHSFT, Cambridge, UK
| | - Deepak Jadon
- Rheumatology Research Unit, Addenbrooke's Hospital, Cambridge University Hospital Trust, Hills Road, Cambridge CB2 0QQ, UK
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21
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Mohammadpourhodki R, Sadeghnezhad H, Ebrahimi H, Basirinezhad MH, Maleki M, Bossola M. The Effect of Aromatherapy Massage With Lavender and Citrus Aurantium Essential Oil on Quality of Life of Patients on Chronic Hemodialysis: A Parallel Randomized Clinical Trial Study. J Pain Symptom Manage 2021; 61:456-463.e1. [PMID: 32889038 DOI: 10.1016/j.jpainsymman.2020.08.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/15/2023]
Abstract
CONTEXT Poor quality of life is a major problem in hemodialysis patients. OBJECTIVES This study was conducted to assess the effect of aromatherapy massage on hemodialysis patients' quality of life. METHODS In this parallel randomized clinical trial study, 105 hemodialysis patients who meet the inclusion criteria were assessed and assigned into intervention and control groups using block randomization. Participants in the intervention groups received aromatherapy massage with Lavender essential oil or Citrus Aurantium essential oil for four weeks (three times per week). For the control group, only foot massage was performed. The level of quality of life was measured by the 36-Item Short-Form Health Survey questionnaire (SF-36) before and after the intervention. Data analysis was performed using descriptive and inferential statistics (analysis of variance, chi-square, and Fisher's exact tests). RESULTS There was a significant difference between the mean score of quality of life in the Lavender essential oil group and Citrus Aurantium essential oil group with the control group after intervention. However, there was no significant difference between the mean score of quality of life in the Lavender essential oil group and Citrus Aurantium essential oil group after the intervention. CONCLUSIONS In this study, both aromatherapy massages have positive effects on the quality of life of hemodialysis patients. Therefore, nurses are advised to use these aromatherapy massages to improve the quality of life of hemodialysis patients.
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Affiliation(s)
- Reza Mohammadpourhodki
- Kashmar Center of Higher Health Education, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Sadeghnezhad
- Kashmar Center of Higher Health Education, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ebrahimi
- Randomized Controlled Trial Research Center, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Mohammad Hasan Basirinezhad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Maleki
- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Maurizio Bossola
- Università Cattolica del Sacro Cuore, Roma, Italy; Haemodialysis Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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22
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Martin A, Chopra R, Nicassio PM. Nonpharmacologic Pain Management in Inflammatory Arthritis. Rheum Dis Clin North Am 2021; 47:277-295. [PMID: 33781495 DOI: 10.1016/j.rdc.2020.12.009] [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: 01/18/2023]
Abstract
This article provides an overview of nonpharmacologic options for the treatment of pain in patients with inflammatory arthritis, such as peripheral spondyloarthritis, psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis. The experience of pain in chronic disease is a complex process influenced by multiple domains of health. The discussion focuses on the establishment of a framework for pain control that engages with factors that influence the experience of pain and explores the evidence base that supports specific modalities of nonpharmacologic pain control, such as mindfulness, cognitive behavioral therapy, exercise, massage, splinting, and heat therapy. Rheumatoid and spondyloarthritides are considered separately.
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Affiliation(s)
- Alexander Martin
- Division of Rheumatology, UMass Medical School, 119 Belmont Street, Worcester, MA 01605, USA
| | - Ratnesh Chopra
- Division of Rheumatology, UMass Medical School, 119 Belmont Street, Worcester, MA 01605, USA.
| | - Perry M Nicassio
- Department of Psychiatry, UCLA, 760 Westwood Plaza, C9-402, Los Angeles, CA 90095, USA
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Halioua B, Misery L, Seite S, Delvigne V, Chelli C, Taieb J, Taieb C. Influence of Skin Subjective Symptoms on Sleep Quality in Patients with Cutaneous Disorders: A Study of 2871 Subjects. Clin Cosmet Investig Dermatol 2021; 14:143-152. [PMID: 33603431 PMCID: PMC7886096 DOI: 10.2147/ccid.s288557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/31/2020] [Indexed: 01/16/2023]
Abstract
Introduction Previous studies showed more sleep disturbance (SD) in patients with cutaneous disorders (CD). During CD, unpleasant subjective symptoms [USS], such as itch, pain and others (tingling, burning, or tightness) have a negative influence on sleep quality. This study aims to evaluate the prevalence of SD in CD patients and to identify the influence of itch, pain and other unpleasant sensations on SD. Materials and Methods An international, anonymized real-life survey was conducted with individuals [18−75 years], with physician-confirmed CD, or without CD. The 25 items covered sociodemographic characteristics, feeling of overall sleep quality and skin unpleasant sensations. Severity of SD and unpleasant sensations were assessed using a 10-cm Visual Analogue Scale (VAS). Results From 3834 analyzed questionnaires, 2871 (67.3%) were in the CD group and 863 (32.7%) in the control group. Patients with CD had significantly more SD (71.2% vs 32.7% in the control group, p<0.0001). CD patients without any reported unpleasant sensation were at higher risk for SD than control subjects (OR 1,362 [95% CI 1.975–2.405] p=0.0013). SS were highly associated with SD (OR 1.641 [95% CI 1.393–1.933] p<0.0001). Pruritus, pain and intermediate sensations were significant predictors of SD, with odds ratios of 1.670, 1.625 and 1.326, respectively. VAS sleep scores were strongly associated with pruritus (r: 0.25, p<0.0001) and pain (r: 0.25 p<0.0001) severity ratings. Discussion SD is a common problem for patients with CD. Patients with subjective symptoms suffer more from SD, suggesting that they are aggravating factors, but are likely not the only reason for SD in CD patients. We found that during CD, intermediate sensations also contribute to SD. Despite some limitations and the potential bias due to the study design, our results confirm for the first time on an international level the influence of subjective symptoms on sleep quality in patients with CD.
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Affiliation(s)
| | - Laurent Misery
- Univ Brest, LIEN, F-29200, Brest, France.,Department of Dermatologie, University Hospital of Brest, Brest, France
| | - Sophie Seite
- La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, France
| | | | - Clara Chelli
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Jonathan Taieb
- APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Charles Taieb
- European Market Maintenance, Assessment, Patients Priority Department, Fontenay-sous-Bois, France.,Hôpital Necker Enfants Malades, Paris, France
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Mease P. Enthesitis in psoriatic arthritis (Part 3): clinical assessment and management. Rheumatology (Oxford) 2021; 59:i21-i28. [PMID: 32159795 PMCID: PMC7065458 DOI: 10.1093/rheumatology/keaa042] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/05/2019] [Indexed: 01/07/2023] Open
Abstract
Enthesitis is a common clinical feature of PsA, which is characterized by inflammation at the site of insertion of tendons, ligaments and joint capsule fibres into bone. Enthesitis is relatively unique to the spondyloarthritides, setting this group of diseases apart from other rheumatological conditions. The pathophysiological underpinnings of this clinical domain, and the imaging assessment of it, are described in accompanying articles in this supplement. The focus of this article is on the assessment of enthesitis by physical examination, the impact of enthesitis on function and quality of life, the impact of concomitant FM on clinical assessment, and the evidence for therapy of enthesitis garnered in trials of biologic and targeted synthetic DMARDs. Several physical examination measures of enthesitis have been developed and have proved reliable in assessment of enthesitis. Enthesitis has a significant deleterious impact on function and quality of life. The presence of concomitant FM in ≤20% of patients may result in artefactual worsening of assessment of disease severity and hinder achievement of the goal of low disease activity or remission. Several targeted therapies, which, for example, target the TNF, IL-17, IL-23, phosphodiesterase 4 or Janus kinase pathways, have shown significant efficacy in the treatment of enthesitis, resulting in improvement of function and quality of life for patients with PsA.
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Affiliation(s)
- Philip Mease
- Rheumatology Division, Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
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25
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Tang H, Liu Y, Liu Y, Zhao H. Comparison of Role of Hand and Wrist Ultrasound in Diagnosis of Subclinical Synovitis in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Retrospective, Single-Center Study. Med Sci Monit 2020; 26:e926436. [PMID: 33311430 PMCID: PMC7739713 DOI: 10.12659/msm.926436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background This retrospective study aimed to compare the roles of hand and wrist ultrasound in diagnosing subclinical synovitis in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) at a single center in Sichuan, China. Material/Methods Forty-one patients with SLE and 20 patients with RA were included. SLE was diagnosed using the American rheumatology Society (ACR) classification standard. Severity of SLE was evaluated using the SLE disease activity index (SLEDAI). General and clinical manifestations and laboratory indicators were measured. Spearman correlation analysis was used for analyzing correlations between musculoskeletal ultrasound results and indexes. Results Among 41 patients with SLE, 26 (63.4%) had joint pain, and 39 (95.1%) had at least 1 joint abnormality. Thirteen patients with SLE (31.7%) had wrist joint involvement, 7 (17.1%) had metacarpal phalangeal-1 (MCP1) involvement, 8 (19.5%) had MCP2 involvement, 17 (41.5%) had MCP3 involvement, 14 (34.1%) had MCP4 involvement, and 5 (12.2%) had MCP5 involvement. Meanwhile, 2 (4.8%) had proximal interphalangeal-1 (PIP1) involvement, 10 (24.4%) had PIP2 involvement, 17 (41.5%) had PIP3 involvement, 12 (29.3%) had PIP4 involvement, and 3 (7.3%) had PIP4 involvement. Twelve patients demonstrated knee joint involvement. MCP joints had the highest involvement frequency (P=0.003). The most frequently detected disease was synovitis, followed by tenosynovitis, joint effusion, and bone erosion. ESR (P=0.002), CRP (P=0.020), and SLEDAI (P=0.011) of patients with SLE with arthralgia were significantly higher compared to patients without arthralgia. In patients with RA, musculoskeletal ultrasound scores were correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease activity score-28 (DAS28), and interleukin-6 (IL-6). In patients with SLE, musculoskeletal ultrasound scores were correlated with double-stranded DNA (dsDNA), ribonucleoprotein (RNP), DAS28, and IL-6. Conclusions Musculoskeletal ultrasound is highly sensitive in evaluating subclinical synovitis in patients with SLE, and its score is positively correlated with dsDNA, RNP IL-6, and DAS28 in patients with SLE.
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Affiliation(s)
- Honghu Tang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Hua Zhao
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
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26
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Haugeberg G, Lund Nilsen TI, Kavanaugh A, Thomsen RS, Gulati AM, Hoff M. Physical and Psychosocial Burden of Psoriatic Arthritis: Longitudinal Data From a Population-Based Study in Norway. Arthritis Care Res (Hoboken) 2020; 73:138-145. [PMID: 33242358 DOI: 10.1002/acr.24412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) can have a significant impact on health-related quality of life (HRQoL). Data on the timing of changes in the HRQoL of patients with PsA are limited. The present study was undertaken to explore associations between sleep disturbance, fatigue, pain, anxiety, depression, general health status, and satisfaction with life before and after a diagnosis of PsA compared to the general population. METHODS Patients diagnosed with PsA between the Nord-Trøndelag Health Study (HUNT2 [1995-1997] and HUNT3 [2006-2008]) surveys were compared to the general population. The adjusted odds ratio (ORadj ) with 95% confidence interval (95% CI) was estimated at both time points. RESULTS Among 36,507 individuals participating in both the HUNT2 and HUNT3 surveys, 160 were diagnosed with PsA between the surveys. The prevalence of sleep disturbances and fatigue was higher in PsA patients after diagnosis compared to the general population (ORadj 2.24 [95% CI 1.55-3.25] and ORadj 1.94 [95% CI 1.27-2.98], respectively). The prevalence of pain and poor health status were higher in patients with PsA compared with the general population even before PsA was diagnosed (ORadj 2.81 [95% CI 1.96-4.02] and ORadj 3.08 [95% CI 2.19-4.35], respectively) and increased after diagnosis of PsA (ORadj 12.87 [95% CI 6.27-26.40] and ORadj 5.63 [95% CI 3.99-7.95], respectively). For anxiety, depression, and life satisfaction, patients who developed PsA were comparable to the general population both before and after the diagnosis of PsA. CONCLUSION Compared to the general population, PsA patients reported a higher prevalence of pain and poorer health status before diagnosis. Increased prevalence of sleep disturbances and fatigue in PsA patients was only found after the PsA diagnosis, and no differences between patients with PsA and the control group were found for anxiety and depression.
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Affiliation(s)
- Glenn Haugeberg
- Sorlandet Hospital, Kristiansand, and Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | | | | | - Mari Hoff
- Norwegian University of Science and Technology and St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Orbai AM, Birt JA, Holdsworth EA, Booth N, Malatestinic WN, Sprabery AT, Reginato AM. Impact of Enthesitis on Psoriatic Arthritis Patient-Reported Outcomes and Physician Satisfaction with Treatment: Data from a Multinational Patient and Physician Survey. Rheumatol Ther 2020; 7:937-948. [PMID: 33052584 PMCID: PMC7695789 DOI: 10.1007/s40744-020-00242-3] [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: 07/22/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Enthesitis is a core outcome domain assessed in psoriatic arthritis (PsA) clinical trials. Limited evidence describes the impact of enthesitis on patient-reported outcomes (PROs) and physician satisfaction with current treatment options. The objective of this analysis is to characterize the impact of enthesitis on PROs and physician satisfaction with currently available treatment in clinical practice settings. Methods Cross-sectional survey of rheumatologists, dermatologists, and their consulting patients with PsA in Australia, Canada, European Union (EU5), and the USA conducted in 2018. Physicians assessed current presence and severity of enthesitis, overall disease severity, other symptoms experienced, and their satisfaction with the current treatment. PsA participant self-reported data included current pain level, EQ5D, Psoriatic Arthritis Impact of Disease (PsAID12), Health Assessment Questionnaire Disability Index (HAQ-DI), and Work Productivity and Activity Impairment Index (WPAI-SHP). Bivariate descriptive analyses were conducted to describe features and outcomes in participants with and without enthesitis. Results Rheumatologists (454) and dermatologists (238) provided information for 3157 participants with PsA. Mean participant age was 49.2 years, and 45.9% were female. Enthesitis was present currently in 6.5% (205) of participants with PsA. Those with enthesitis had worse overall disease severity compared to those without enthesitis (12.2% vs 2.2% severe) and had more extraarticular manifestations, including nail psoriasis, dactylitis, and sacroiliitis. Enthesitis was associated with more pain, worse quality of life (QoL), increased disability, and a negative impact on work. Participants with enthesitis had higher NSAIDs and opioid pain medication use but similar biologic use. Physicians were significantly less satisfied with current PsA treatment in participants with enthesitis versus without enthesitis. Conclusions Participants with psoriatic arthritis with enthesitis experienced significantly higher disease burden than those without enthesitis but were not more likely to receive advanced therapies. Physicians were significantly more dissatisfied with treatment in patients with enthesitis than in those without it. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00242-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie A Birt
- Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA.
| | | | | | | | | | - Anthony M Reginato
- Division of Rheumatology and Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Chu P, Ju YES, Hinze AM, Kim AH. Measures of Sleep in Rheumatologic Diseases: Sleep Quality Patient-Reported Outcomes in Rheumatologic Diseases. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:410-430. [PMID: 33091275 PMCID: PMC7586459 DOI: 10.1002/acr.24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Philip Chu
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yo-El S. Ju
- Sleep Medicine Center, Department of Neurology, Washington University School of Medicine, Saint Louis, MO
| | - Alicia M. Hinze
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alfred H.J. Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
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Palominos PE, Coates L, Kohem CL, Orbai AM, Smolen J, de Wit M, Kiltz U, Leung YY, Cañete JD, Scrivo R, Balanescu A, Dernis E, Meisalu S, Soubrier M, Aydin SZ, Gaydukova I, Kalyoncu U, Gossec L. Determinants of sleep impairment in psoriatic arthritis: An observational study with 396 patients from 14 countries. Joint Bone Spine 2020; 87:449-454. [DOI: 10.1016/j.jbspin.2020.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/31/2020] [Indexed: 01/07/2023]
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Tektonidou MG, Katsifis G, Georgountzos A, Theodoridou A, Koukli EM, Kandili A, Giokic-Kakavouli G, Karatsourakis TD. Real-world evidence of the impact of adalimumab on work productivity and sleep measures in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20949088. [PMID: 33062067 PMCID: PMC7534071 DOI: 10.1177/1759720x20949088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/08/2020] [Indexed: 01/21/2023] Open
Abstract
Objective: Our aim was to evaluate the effect of adalimumab on work productivity measures, overall activity impairment, and sleep quality in patients with active moderate to severe rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) treated in routine care settings in Greece and determine factors associated with work impairment and sleep disturbance. Methods: Patients with active moderate to severe RA (n = 184), PsA (n = 166), and AS (n = 150) were enrolled in this 24-month, prospective, observational study at 80 hospital outpatient clinics and private practices throughout Greece. Patients received adalimumab alone or in combination with standard antirheumatic therapies according to routine care. Work productivity and sleep were assessed through two patient-reported outcome measures: the Work Productivity and Activity Impairment–General Health questionnaire and the Medical Outcomes Study Sleep Scale (MOS-SS). Pearson correlation coefficients were estimated to assess the association of work impairment and sleep disturbances with disease activity scores. Results: In the overall population, adalimumab significantly lowered absenteeism [mean (95% confidence interval) reduction, 18.9% (13.3–24.5%); n = 100]; presenteeism [40.0% (33.8–46.3%); n = 98], overall work productivity impairment [46.8% (40.4–53.2%); n = 94], activity impairment [47.0% (44.3–49.6); n = 421], and the MOS-SS sleep problems index [31.6 (29.5–34.1); n = 421] after 24-month treatment (p < 0.001). Significant improvements were also noted across the RA, PsA, and AS subpopulations (p < 0.05). Improvements in overall work impairment and sleep disturbance positively correlated with improvements in disease activity measures. Conclusion: Adalimumab improves work productivity and sleep problems while lowering disease activity in patients with moderate to severe RA, PsA, and AS managed in real-world settings.
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Affiliation(s)
- Maria G Tektonidou
- 1st Department of Propaedeutic and Internal Medicine, Joint Rheumatology Program, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Athens, 11 527, Greece
| | - Gkikas Katsifis
- Rheumatology Clinic Naval Hospital of Athens, Athens, Greece
| | | | - Athina Theodoridou
- Academic Research Fellow Hippokration Hospital Thessaloniki, Thessaloniki, Greece
| | | | - Anna Kandili
- Rheumatologist, Metropolitan general Hospital Athens, Cholargos, Athens, Greece
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Ulutatar F, Unal-Ulutatar C, Tuncay Duruoz M. Fibromyalgia in patients with psoriatic arthritis: Relationship with enthesopathy, sleep, fatigue and quality of life. Int J Rheum Dis 2020; 24:183-188. [PMID: 32951342 DOI: 10.1111/1756-185x.13963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/19/2020] [Accepted: 08/16/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the relationship of fibromyalgia with enthesopathy, sleep, fatigue and quality of life in patients with psoriatic arthritis. METHODS The psoriatic arthritis patients according to CASPAR criteria were included in the study. The diagnosis of fibromyalgia was based on 2016 ACR criteria. Demographic and clinical parameters were noted. Disease activity and enthesopathy were evaluated with Disease Activity Score-28 (DAS-28) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), respectively. Functional assessment scales in this study were Psoriatic Arthritis Quality of Life (PsAQoL), Pittsburgh Sleep Quality Index (PSQI), Multidimensional Assessment of Fatigue (MAF). Fibromyalgia Impact Questionnaire (FIQ) was used to assess the functional status of fibromyalgia. The Mann-Whitney U test and Spearman correlation coefficient (ρ) were used. Hierarchical multiple regression analysis used to examine the differential contributions to FIQ score. P < .05 was accepted as significant. RESULTS We enrolled 50 PsA patients (31 female, 19 male) with a mean age of 49.5 years (SD: 10.2) and mean disease duration 7.5 years (SD: 7.5). Thirty-two patients (64% of PsA patients) fulfilled ACR criteria for fibromyalgia. The mean scores of MASES, PSQI, MAF and PsAQoL were significantly higher in patients with fibromyalgia (P < .05). The correlations between FIQ and other functional parameters were as follows; MASES (ρ = 0.71, P < .0005), PSQI (ρ = 0.62, P < .0005), MAF (ρ = 0.60, P < .0005), PsAQoL (ρ = 0.61, P < .0005). A moderate correlation was existing between FIQ and DAS-28 (ρ = 0.42, P = .03). CONCLUSIONS Coexistence of fibromyalgia in PsA patients is associated with the presence of enthesopathy, poor quality of life, sleep disturbance and fatigue.
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Affiliation(s)
- Firat Ulutatar
- School of Medicine, PMR Department, Pain Medicine Division, Cukurova University, Adana, Turkey
| | - Cagri Unal-Ulutatar
- PMR Department, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Tuncay Duruoz
- School of Medicine, PMR Department, Rheumatology Division, Marmara University, Istanbul, Turkey
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Haugeberg G, Hoff M, Kavanaugh A, Michelsen B. Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates. Arthritis Res Ther 2020; 22:198. [PMID: 32847612 PMCID: PMC7448431 DOI: 10.1186/s13075-020-02294-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) may be influenced by skin and musculoskeletal manifestations. All of these in turn affect the psychosocial impact of disease. The objective was to explore the occurrence of sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) patients, and their correlates. Methods A broad data collection was performed in 137 Norwegian PsA outpatient clinic patients including demographics, disease activity measures for both skin and musculoskeletal involvement, and patient-reported outcome measures. Sleep disturbances and fatigue were defined present if the numeric rating scale (0–10) score was ≥ 5. Anxiety/depression was assessed using a questionnaire (1–3; 1 defined as no anxiety/depression). Descriptive statistics was applied, and associations were explored using univariate and adjusted linear regression analysis. Results The mean age was 52.3 years, PsA disease duration 8.8 years; 49.6% were men and 54.8% were currently employed/working. The prevalence of sleep disturbances was 38.0%, fatigue 44.5%, and anxiety/depression 38.0%. In adjusted analysis, pain, fatigue, and higher mHAQ were associated with sleep disturbances. Sleep disturbances, pain, and anxiety/depression were associated with fatigue, whereas only fatigue was associated with anxiety/depression. Conclusions The prevalence of sleep disturbances, fatigue, and anxiety/depression was frequently reported by PsA patients. No measures reflecting skin involvement or objective measures of musculoskeletal involvement were independently associated with sleep disturbances, fatigue, or anxiety/depression. Our data suggest that patients’ perceptions of musculoskeletal involvement (pain or mHAQ) play an important role causing sleep disturbances and fatigue, whereas fatigue in PsA patients is strongly associated with anxiety/depression.
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Affiliation(s)
- Glenn Haugeberg
- Division of Rheumatology, Department of Medicine, Sorlandet Hospital, P.O.Box 416, N-4604, Kristiansand S, Norway. .,Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Mari Hoff
- Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Brigitte Michelsen
- Division of Rheumatology, Department of Medicine, Sorlandet Hospital, P.O.Box 416, N-4604, Kristiansand S, Norway
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Mease PJ, Liu M, Rebello S, Hua W, McLean RR, Hur P, Ogdie A. Disease Characteristics, Quality of Life, and Work Productivity by Enthesitis Site: Real-world Data From the US Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol 2020; 48:367-375. [PMID: 32482647 DOI: 10.3899/jrheum.191117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effect of clinical enthesitis by body site in patients with psoriatic arthritis (PsA). METHODS Adults with PsA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013-March 2018) were included. Enthesitis at enrollment was assessed by the Spondyloarthritis Research Consortium of Canada Enthesitis Index and classified by affected sites (upper, lower, or both). Disease activity (e.g., Clinical Disease Activity Index, Clinical Disease Activity Index for PsA), patient-reported outcomes (PRO; e.g., patient-reported pain and fatigue), and work productivity were compared between those with and without enthesitis using t- or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables. The association of enthesitis with disease activity and PRO measures versus no enthesitis was modeled using multivariable-adjusted linear or logistic regression. RESULTS Of 2003 patients with PsA, 391 (19.5%) had enthesitis: 80 (20.5%) in upper sites only; 137 (35.0%) in lower sites only; and 174 (44.5%) in both. Regardless of location, disease activity and PRO were worse in patients with versus without enthesitis. In adjusted models, the presence of enthesitis at any site was significantly associated with worse disease activity versus no enthesitis. Enthesitis in lower or both upper and lower sites was associated with higher pain and fatigue scores and greater work impairment versus no enthesitis. CONCLUSION Patients with clinical enthesitis had worse disease activity regardless of enthesitis location versus those without enthesitis, and patients with enthesitis in lower or both upper and lower sites had worse pain, fatigue, and work impairment.
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Affiliation(s)
- Philip J Mease
- P.J. Mease, MD, MACR, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington;
| | - Mei Liu
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Sabrina Rebello
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Winnie Hua
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Robert R McLean
- M. Liu, PhD, S. Rebello, MPH, W. Hua, MS, R.R. McLean, DSc, MPH, Corrona, LLC, Waltham, Massachusetts
| | - Peter Hur
- P. Hur, PharmD, MBA, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Alexis Ogdie
- A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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McGagh D, Coates LC. Assessment of the many faces of PsA: single and composite measures in PsA clinical trials. Rheumatology (Oxford) 2020; 59:i29-i36. [PMID: 32159792 PMCID: PMC7065465 DOI: 10.1093/rheumatology/kez305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/24/2019] [Indexed: 11/14/2022] Open
Abstract
PsA is a complex, heterogeneous disease that can place a large burden on patients' psychological and physical well-being. The multifaceted nature of PsA poses a significant assessment challenge, both in randomized control trials and in clinical practice. In recent years, there has been much progress in the development of unidimensional and composite measures of disease activity, as well as of questionnaires that capture the patient's perspective of the condition. Despite these advances, there remains uncertainty around which tools to implement within a research setting. This review aims to summarize the currently available clinical and patient-derived assessment tools, providing a practical and informative resource for the assessment of PsA. This review will also explore recent advancements in digital approaches to the assessment of rheumatological conditions. This will highlight the potential for digitalization in the assessment and monitoring of PsA, outlining innovative means of capturing disease activity and treatment response.
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Affiliation(s)
- Dylan McGagh
- Medical School, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists? Dermatol Ther 2020; 33:e13283. [PMID: 32092214 DOI: 10.1111/dth.13283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
Psoriasis (Pso) and psoriatic arthritis (PsA) are chronic and debilitating diseases which often develop in the same patient and are linked to a wide range of comorbid conditions. Dermatologists and rheumatologists need to cooperate in combined clinics, especially when they deal with severe, recalcitrant disease, and multiple comorbidities. The clinical and research benefits of this collaboration have been previously described to contribute to a better and more sustainable health care system. To apply a more holistic approach of patients with Pso and PsA, we established the first dual care clinic in Greece, for Pso and PsA patients, based at Attikon General University Hospital. Hereby, we describe the infrastructure and operation of a combined Pso and PsA clinic (PPAC), in the national health care system of Greece, and its impact on the management of Pso and PsA. The PPAC is a single-day joint clinic, held once a week, which consists of three dermatologists and three rheumatologists. We present the results of 185 newly diagnosed patients between December 2018 and January 2019. Mean age of onset of Pso was 34 ± 16 years old and 47 ± 12 years old for PsA. Most patients suffered from severe plaque Pso (144/185, 78%) and asymmetric oligoarticular arthritis (59/185, 32%), for which they were receiving treatment with biologic agents (105/185, 57%). Many required monitoring for hypertension (74/185, 40%), dyslipidemia (69/185, 37%), diabetes (17/185, 9%), and depression (20/185, 11%). Patients reported high levels of care satisfaction (visual analogue scale: 86 ± 11.5), using the PPAC facility, compared to different referrals between specialties. This is the first joint dermatology-rheumatology clinic in Greece, providing comprehensive care in patients with Pso and PsA. Our results support the concept of combined clinics delivering better integrated care for such patients.
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Affiliation(s)
- Elina Theodorakopoulou
- 2nd Dermatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dalamaga
- 2nd Dermatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pelagia Katsimbri
- 4th Department of Internal Medicine, Rheumatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, Rheumatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Papadavid
- 2nd Dermatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Pruritus and sleep disturbances in patients with psoriasis. Arch Dermatol Res 2019; 312:103-111. [DOI: 10.1007/s00403-019-01998-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
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Zhao SS, Miller N, Harrison N, Duffield SJ, Dey M, Goodson NJ. Systematic review of mental health comorbidities in psoriatic arthritis. Clin Rheumatol 2019; 39:217-225. [PMID: 31486931 DOI: 10.1007/s10067-019-04734-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/05/2019] [Accepted: 08/01/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis of psoriatic arthritis (PsA) studies, we pooled data from existing literature to (1) estimate the prevalence of mental health disorders in PsA patients and (2) compare disease activity in PsA patients with and without these comorbidities. METHOD We searched PubMED, Web of Science, Scopus, PsycINFO and the Cochrane Library using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Where possible, meta-analysis was performed using random effects model. Prevalence estimates were pooled according to the severity of mental health disorders. RESULTS A total of 24 studies, amounting to 31,227 PsA patients, were included for review. Anxiety and depression were the only consistently reported mental health disorders, defined using a range of screening criteria/thresholds. Anxiety prevalence ranged from 4 to 61% with a pooled estimate of 33% (95%CI 17 to 53%) having at least mild anxiety and 21% (95%CI 14 to 29%) at least moderate. Depression prevalence ranged from 5 to 51%, with 20% (95%CI 8 to 35%) having at least mild and 14% (95%CI 8 to 21%) at least moderate. Only two studies compared disease activity according to the presence of mental health comorbidities; both reported higher disease activity and pain among those with comorbid anxiety and depression. CONCLUSIONS Anxiety and depression are highly prevalent among PsA patients. Studies of other mental health disorders were scarce. More studies are needed on the impact of these comorbidities on disease activity and long-term outcomes.Key Points• One in three patients with psoriatic arthritis has at least mild anxiety, while 1 in 5 reported at least mild depression.• PsA patients with anxiety and/or depression reported greater disease activity.• More research is needed on other mental health comorbidities, particularly sleep, suicide/self-harm and substance misuse.
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Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Natasha Miller
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Nicholas Harrison
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Stephen J Duffield
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mrinalini Dey
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Nicola J Goodson
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK.
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Bedaiwi M, Al-Homood IA, El-Garf A, Uthman I, Sunna N, Nassier R, Mohamed H, Al Saleh J. Disease burden and treatment challenges of psoriatic arthritis in Africa and the Middle East. Rheumatol Int 2019; 39:1321-1329. [PMID: 31134289 DOI: 10.1007/s00296-019-04319-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 01/17/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic, inflammatory arthropathy occurring in up to 30% of patients with psoriasis, and is characterized by multiple manifestations including peripheral arthritis, enthesitis, dactylitis, spondylitis, and psoriatic skin and nail disease. This complex and heterogeneous disease is poorly understood and its diagnosis and treatment are suboptimal, particularly in Africa and the Middle East, where very few studies into the impact of PsA have been carried out. This article aims to highlight the disease burden of PsA in the region as well as to identify unmet clinical needs. A non-systematic review was carried out in the PubMed database and the most relevant publications were selected. Expert rheumatologists practicing in Africa and the Middle East provide an insight into the challenges of treating PsA in daily practice, along with recommendations for improvements.
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Affiliation(s)
- Mohamed Bedaiwi
- Division of Rheumatology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Ibrahim A Al-Homood
- Department of Medical Specialties, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman El-Garf
- Rheumatology Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Imad Uthman
- Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | - Jamal Al Saleh
- Rheumatology Unit, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Sleep quality among adult patients with chronic dermatoses. Postepy Dermatol Alergol 2019; 36:659-666. [PMID: 31997991 PMCID: PMC6986286 DOI: 10.5114/ada.2019.84007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
Chronic dermatoses, including atopic dermatitis, psoriasis, prurigo nodularis, chronic spontaneous urticaria and hidradenitis suppurativa, as well as accompanying subjective symptoms (itch and pain), have a great impact on patients’ well-being. Skin plays an important role in the physiological sleep process. This review attempts to analyze the association between chronic dermatoses in adults and sleep quality in recent studies. Polysomnography and actigraphy are performed for the objective assessment of sleep quality. Questionnaire-based subjective evaluations of sleep quality, including the Pittsburgh Sleep Quality Index and Medical Outcomes Study Sleep Scale, are useful in clinical studies and clinical practice. Subjective symptoms such as itch and pain have an essential influence on sleep quality and general quality of life in patients with chronic skin diseases.
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Kibari A, Cohen AD, Gazitt T, Bitterman H, Lavi I, Feldhamer I, Shalom G, Greenberg-Dotan S, Zisman D. Cardiac and cardiovascular morbidities in patients with psoriatic arthritis: a population-based case control study. Clin Rheumatol 2019; 38:2069-2075. [PMID: 30937638 DOI: 10.1007/s10067-019-04528-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the prevalence of risk factors associated with cardiovascular disease (CVD) and CVD-related morbidity in a large Middle-Eastern psoriatic arthritis (PsA) cohort. METHOD A retrospective case control study was conducted using Israel's largest health care provider's patient database from 2000 to 2013. For each patient with PsA, 10 patients with no history of psoriasis or arthritis were matched for age and sex. Analysis of CVD-related risk factors and morbidity included hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus type 2 (DM-2), obesity, smoking, ischemic heart disease (IHD), congestive heart failure (CHF), cerebrovascular accident (CVA), carotid artery disease, peripheral vascular disease (PVD), aortic aneurism, valvular heart disease (VHD), and cardiomyopathy. Statistical analysis was conducted using t test and chi-square tests as appropriate. Univariate and multivariable logistic regression models assessed the association between PsA and CVD-related risk factors and morbidity. RESULTS Three thousand one hundred sixty-one PsA patients were included, with average age 58 ± 15.0 years, of whom 53.4% were women. Increased prevalence of DM-2, HLD, HTN, and obesity (OR 1.7, 1.5, 1.5, 1.5 respectively) was noted in the PsA group. Increased prevalence of IHD (p < 0.0001), PVD (p < 0.0001), CHF (p = 0.002), VHD (p < 0.0001), and cardiomyopathy (p = 0.006) was found in the PsA group compared to the control group even after adjusting for CVD risk factors. CONCLUSIONS A high prevalence of CVD-related risk factors and morbidity was found in this Middle Eastern PsA population, in accordance with data from other geographic regions. These results emphasize the importance of clinician awareness of the increased risk for CVD-related complications in PsA patients.
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Affiliation(s)
- Adi Kibari
- Rheumatology Unit, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Haim Bitterman
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Ilan Feldhamer
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Guy Shalom
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Sari Greenberg-Dotan
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Sandikci SC, Colak S, Aydoğan Baykara R, Öktem A, Cüre E, Omma A, Kucuk A. Evaluation of restless legs syndrome and sleep disorders in patients with psoriatic arthritis. Z Rheumatol 2018; 78:987-995. [DOI: 10.1007/s00393-018-0562-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sleep disorders in patients with psoriatic arthritis and psoriasis. Reumatologia 2018; 56:301-306. [PMID: 30505012 PMCID: PMC6263298 DOI: 10.5114/reum.2018.79501] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023] Open
Abstract
Objectives To assess and measure occurrence of sleep disorders in patients with psoriatic arthritis (PsA) and psoriasis (Ps). Material and methods The study included 62 patients with psoriatic arthritis and 52 patients with psoriasis. The measurement of sleep quality was conducted using the Pittsburgh Sleep Quality Index (PSQI), the evaluation of fatigue by the fatigue subscale of the FACIT-F questionnaire and the patient's quality of life by the Health Assessment Questionnaire (HAQ). The psoriasis severity was determined using the Psoriasis Area Severity Index (PASI) and the activity of arthritis by the disease activity score of 28 joints (DAS 28). The Visual Analogue Scale (VAS) was used to assess the severity of pain. Results Poor sleep quality was found in 67.7% of PsA patients, 57.7% in Ps patients and 14.6% within the control group. Sleeping disorders in patients with PsA and Ps were related to worse quality of life and intense fatigue. Methotrexate treatment was not related to sleeping disorders, but an improvement in sleep quality was observed in both PsA and Ps patients who were treated with anti TNF-α antibodies (p < 0.001 and p = 0.032 respectively). Following the use of the linear regression model, the following factors worsen the sleep quality in PsA: pain (R2 = 0.462, p < 0.001), tender joint count (R2 = 0.434, p < 0.001), C-reactive protein (CRP) concentration (R2 = 0.391, p < 0.001), patient's age (R2 = 0.284, p = 0.003) and duration of psoriasis (R2 = 0.166, p = 0.006). In Ps patients the factors were: severity of skin lesions (R2 = 0.329, p < 0.001), duration of psoriasis (R2 = 0.290, p = 0.004) and patient's age (R2 = 0.282, p = 0.019). Conclusions Poor sleep quality in patients with PsA or Ps is a common symptom. Sleep disorders are more frequent in patients with PsA than in those with psoriasis.
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Abstract
OBJECTIVE The aim of this study was to investigate possible relationships among hematologic factors, psychological dimensions, the presence of self-reported sleep problems, and clinical characteristics in patients with burning mouth syndrome (BMS). METHODS Twenty-five postmenopausal female patients with primary BMS (aged 55.2 ± 9.6 years) were included. All participants underwent clinical and psychological evaluations and blood sampling. The patients were subdivided according to the absence or presence of the self-reported sleep problems. RESULTS Pain intensity of BMS patients with sleep problems was significantly higher than those without sleep problems, and the severity of oral complaints was correlated with the presence of depression, anxiety, hostility, phobia, and psychosis. Estradiol levels were significantly lower, and FSH and LH levels were higher in BMS patients with sleep problems than those without sleep problems. DISCUSSION BMS patients with sleep problems may suffer inharmonious psychoneuroendocrinological interactions that might worsen oral BMS symptoms.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital , Seoul, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Kyung Hee University Hospital , Seoul, Korea
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Kaeley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C. Enthesitis: A hallmark of psoriatic arthritis. Semin Arthritis Rheum 2018; 48:35-43. [PMID: 29429762 DOI: 10.1016/j.semarthrit.2017.12.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe the growing importance of enthesitis in patients with psoriatic arthritis (PsA) and discuss the advantages and disadvantages of clinical and imaging methods currently used to assess enthesitis. METHODS PubMed literature searches were conducted using the terms psoriatic arthritis, entheses, enthesitis, pathology, imaging, ultrasound, magnetic resonance imaging, clinical, and indices. Articles were deemed relevant if they provided insight into the pathology, monitoring, and/or diagnosis of enthesitis in PsA, or if they discussed clinical or imaging indices used to assess enthesitis. RESULTS Enthesitis is an early manifestation of PsA that is associated with increased disease activity and reduced quality of life. A variety of clinical indices exist to assess enthesitis in PsA; however, the Leeds Enthesitis Index and Maastricht Ankylosing Spondylitis Enthesitis Score index have been the most frequently used indices in recent clinical trials. Limitations of these indices include an inability to discern structural involvement, risk of missing subclinical enthesitis, and lack of sensitivity in detecting enthesitis, especially in patients with central sensitization and/or pain amplification. Such limitations have led to the emergent importance of imaging techniques in the assessment of enthesitis. Although there have been recent advances in magnetic resonance imaging, ultrasound (US) appears to be the preferred method for detecting enthesitis because it allows for accurate assessment of the soft-tissue components of entheses and also for new bone formation. Hypoechogenicity, increased thickness of tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity have been identified as important US characteristics of enthesitis. CONCLUSION Enthesitis is thought to be integrally involved in the pathogenesis of PsA and is associated with worse prognostic outcomes in patients with PsA. A validated US index with entheses that are less confounded by mechanical factors and obesity would be the most effective measure of enthesitis in PsA. As imaging techniques continue to advance, our understanding of enthesitis and its involvement in PsA will also improve.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, 653-1 West 8th St., LRC 2nd Floor L-14, Jacksonville, FL, 32209.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Sibel Z Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico
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Duruöz MT, Erdem D, Gencer K, Ulutatar F, Baklacıoğlu HŞ. Validity and reliability of the Turkish version of the Jenkins Sleep Scale in psoriatic arthritis. Rheumatol Int 2017; 38:261-265. [PMID: 29250729 DOI: 10.1007/s00296-017-3911-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/11/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the validity and reliability of the Turkish version of Jenkins Sleep Scale (JSS) in psoriatic arthritis (PsA). METHODS Patients with PsA according to Classification Criteria for Psoriatic Arthritis (CASPAR) were included in the study. Data about age, sex, body mass index (BMI), disease duration (month) and joint symptom duration (month) were noted. Psoriatic Arthritis Quality of Life (PsAQoL) Scale was used to assess the quality of life, Multidimensional Assessment of Fatigue (MAF) Scale was used to evaluate fatigue, and Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. The reliability of JSS scale was determined by internal consistency (Cronbach's alpha coefficient). Face validity and construct validity (convergent and divergent validities) were evaluated. The correlation of the JSS with the PSQI, MAF scale, and PsAQoL scale was assessed for convergent validity. The correlation of the JSS with age, body mass index (BMI), duration of joint symptoms and disease duration were assessed for divergent validity. RESULTS The mean age of 56 patients was 42.71 ± 11.79. The Cronbach's alpha of the JSS was 0.862. The JSS had significant correlations with PSQI (rho = 0.653, P < 0.001), MAF (rho = 0.457, P < 0.001), PsAQoL (rho = 0.496, P < 0.001). There were no significant correlations between JSS and age (rho = - 0.052, P = 0.716), BMI (rho = - 0.085, P = 0.550), disease duration (rho = 0.161, P = 0.276) and duration of joint symptoms (rho = 0.107, P = 0.474). CONCLUSION The Turkish version of JSS is a valid and reliable instrument in PsA.
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Affiliation(s)
- Mehmet Tuncay Duruöz
- Rheumatology Division, Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Didem Erdem
- Rheumatology Division, Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey.
| | - Kardelen Gencer
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fırat Ulutatar
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Hatice Şule Baklacıoğlu
- Rheumatology Division, Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
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Wong ITY, Chandran V, Li S, Gladman DD. Sleep Disturbance in Psoriatic Disease: Prevalence and Associated Factors. J Rheumatol 2017; 44:1369-1374. [PMID: 28620064 DOI: 10.3899/jrheum.161330] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to determine the prevalence and quality of sleep in patients with psoriatic arthritis (PsA) and those with psoriasis without PsA (PsC) followed in the same center, to identify factors associated with sleep disturbance, and to compare findings to those of healthy controls (HC). METHODS The study included 113 PsA [ClASsification for Psoriatic ARthritis (CASPAR) criteria] and 62 PsC (PsA excluded by a rheumatologist) patients and 52 HC. Clinical variables were collected using a standard protocol. The sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Other patient-reported outcomes collected included the Health Assessment Questionnaire (HAQ), Dermatology Life Quality Index, EQ-5D, Medical Outcomes Study Short Form-36 survey, patient's global assessment, and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue) scale. Statistical analyses included descriptive statistics, Wilcoxon rank-sum test, and linear regression. RESULTS The prevalence of poor sleep quality was 84%, 69%, and 50% in PsA, PsC, and HC, respectively. Total PSQI score was higher in both patients with PsA and patients with PsC compared with HC (p < 0.01) and higher in patients with PsA compared to patients with PsC (p < 0.0001). EQ-5D anxiety component, EQ-5D final, and FACIT-fatigue were independently associated with worse PSQI in patients with PsC and those with PsA (p < 0.05). Actively inflamed (tender or swollen) joints are independently associated with worse PSQI in patients with PsA (p < 0.01). CONCLUSION Patients with psoriatic disease have poor sleep quality. Poor sleep is associated with fatigue, anxiety, and lower EQ-5D. In patients with PsA, poor sleep is associated with active joint inflammation.
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Affiliation(s)
- Ian T Y Wong
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network
| | - Vinod Chandran
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network
| | - Suzanne Li
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network
| | - Dafna D Gladman
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. .,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network.
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47
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Bergman M, Lundholm A. Mitigation of disease- and treatment-related risks in patients with psoriatic arthritis. Arthritis Res Ther 2017; 19:63. [PMID: 28320454 PMCID: PMC5359960 DOI: 10.1186/s13075-017-1265-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psoriatic arthritis is a part of the family of diseases referred to as spondyloarthropathies, a diverse group of chronic inflammatory disorders with common clinical, radiographic, and genetic features. Peripheral arthritis is the most common symptom of psoriatic arthritis and patients also frequently experience involvement of the entheses, spine, skin, and nails. Due to the diverse clinical spectrum of disease severity, tissues affected, and associated comorbidities, the treatment of psoriatic arthritis can be challenging and it is necessary to mitigate risks associated with both the disease and its treatment. These risks include disease-specific, treatment-related, and psychological risks. Disease-specific risks include those associated with disease progression that can limit functional status and be mitigated through early diagnosis and initiation of treatment. Risks also arise from comorbidities that are associated with psoriatic arthritis such as cardiovascular disease, obesity, diabetes mellitus, and gastrointestinal inflammation. Patient outcomes can be affected by the treatment strategy employed and the pharmacologic agents administered. Additionally, it is important for physicians to be aware of risks specific to each therapeutic option. The impact of psoriatic arthritis is not limited to the skin and joints and it is common for patients to experience quality-of-life impairment. Patients are also more likely to have depression, anxiety, and alcoholism. This article reviews the many risks associated with psoriatic arthritis and provides guidance on mitigating these risks.
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Affiliation(s)
- Martin Bergman
- Taylor Hospital, 8 Morton Avenue, Suite 304, Ridley Park, PA, 19078, USA.
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Gimenéz-Arnau AM, Spector S, Antonova E, Trzaskoma B, Rosén K, Omachi TA, Stull D, Balp MM, Murphy T. Improvement of sleep in patients with chronic idiopathic/spontaneous urticaria treated with omalizumab: results of three randomized, double-blind, placebo-controlled studies. Clin Transl Allergy 2016; 6:32. [PMID: 27540466 PMCID: PMC4989527 DOI: 10.1186/s13601-016-0120-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/08/2016] [Indexed: 02/02/2023] Open
Abstract
Background
Patients with chronic idiopathic/spontaneous urticaria (CIU/CSU) report difficulty with sleep. Methods We examined the effect of omalizumab on sleep-related outcomes during 3–6 months omalizumab or placebo treatment and a 16-week follow-up period within three Phase III double-blind randomized placebo-controlled pivotal trials in CIU/CSU: ASTERIA I, ASTERIA II, and GLACIAL. Sleep quality was assessed in all three studies using sleep-related questions included in an electronic diary, the Chronic Urticaria Quality of Life Questionnaire, and the Medical Outcomes Study Sleep Scale. Score changes from baseline in the treatment arms were compared with that in the placebo arm and adjusted for baseline score and weight. We also examined correlations of sleep scores at baseline, week 12, and week 24 and the slopes of change between sleep and itch and hive. Results Patients treated with omalizumab reported a larger reduction in sleep problems than those in the placebo arm; omalizumab 300 mg demonstrated the greatest improvement on all sleep components among all treatment arms. The largest reduction in sleep problems was reported within the first 4 weeks of therapy. After treatment discontinuation, sleep quality worsened. Sleep scores demonstrated moderate-to-strong correlation between them, and the change in sleep scores was associated with changes in itch and hives. Conclusions Improvement in sleep was reported after the first dose of omalizumab. Sleep continued to improve throughout the active treatment period. Patients receiving omalizumab 300 mg achieved greater improvement in sleep than those in other treatment arms. Trial registration ClinicalTrials.gov, NCT01287117 (ASTERIA I), NCT01292473 (ASTERIA II), and NCT01264939 (GLACIAL) Electronic supplementary material The online version of this article (doi:10.1186/s13601-016-0120-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana M Gimenéz-Arnau
- Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Sheldon Spector
- California Allergy and Asthma Medical Group, Inc., 11645 Wilshire Blvd, #1155, Los Angeles, CA 90025 USA
| | - Evgeniya Antonova
- Medical Affairs, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080-4990 USA
| | - Benjamin Trzaskoma
- Medical Affairs, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080-4990 USA
| | - Karin Rosén
- Medical Affairs, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080-4990 USA
| | - Theodore A Omachi
- Medical Affairs, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080-4990 USA
| | - Donald Stull
- Data Analytics and Design Strategy, RTI Health Solutions, Manchester, UK
| | | | - Thomas Murphy
- National Allergy, Asthma, and Urticaria Centers of Charleston, 7555 Northside Drive, Charleston, SC 29420 USA
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49
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Egeberg A, Hansen PR, Gislason GH, Skov L, Mallbris L. Risk of self-harm and nonfatal suicide attempts, and completed suicide in patients with psoriasis: a population-based cohort study. Br J Dermatol 2016; 175:493-500. [PMID: 27038335 DOI: 10.1111/bjd.14633] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psoriasis is a common inflammatory skin disease, and inflammation may affect suicidal behaviour. Current data on the incidence and risk of suicidal behaviour in patients with psoriasis are scarce. OBJECTIVES We investigated the association between psoriasis and the risk of self-harm and suicide attempts and suicides. METHODS All Danish patients aged ≥ 18 years with mild or severe psoriasis (cases) from 1 January 1997 to 31 December 2011 were matched on age, sex and calendar time 1 : 5 with healthy controls. The outcome was a diagnosis of self-harm or a nonfatal suicide attempt, or completed suicide. Incidence rates per 10 000 person-years were calculated, and incidence rate ratios (IRRs) and confidence intervals (CIs) were estimated by Poisson regression models. RESULTS The study cohort comprised 408 663 individuals, including 57 502 and 11 009 patients with mild and severe psoriasis, respectively. In total 280 cases of self-harm or suicide attempts, and 574 suicides occurred during follow-up. There was no increased risk of self-harm or suicide attempts in patients with mild psoriasis (IRR 1·01, 95% CI 0·17-2·01), but this risk was significantly increased in severe psoriasis (IRR 1·69, 95% CI 1·00-2·84). There was no increased risk of suicides in mild (IRR 1·05, 95% CI 0·84-1·32) or severe psoriasis (IRR 0·78, 95% CI 0·45-1·36). Similar results were found when suicides were confirmed by official forensic investigations, and when psoriasis was compared with atopic dermatitis. CONCLUSIONS We found limited evidence to suggest an increased risk of self-harm and nonfatal suicide attempts in patients with psoriasis. Importantly, after adjustment for psoriatic arthritis this risk was no longer significantly increased. The risk of completed suicide was also not increased, regardless of psoriasis severity.
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Affiliation(s)
- A Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark. .,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark.
| | - P R Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark
| | - G H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark.,The Danish Heart Foundation, DK-1127, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, DK-1353, Copenhagen, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, DK-2900, Hellerup, Denmark
| | - L Mallbris
- Unit of Dermatology and Venereology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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50
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Henry AL, Kyle SD, Bhandari S, Chisholm A, Griffiths CEM, Bundy C. Measurement, Classification and Evaluation of Sleep Disturbance in Psoriasis: A Systematic Review. PLoS One 2016; 11:e0157843. [PMID: 27327082 PMCID: PMC4915697 DOI: 10.1371/journal.pone.0157843] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/06/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psoriasis is a long-term immune-mediated inflammatory disorder mainly, but not only, affecting skin, and is associated with significant medical and psychological morbidity. Evidence suggests that sleep is disrupted in psoriasis, however high quality empirical evidence is lacking. Given the importance of sleep for health, characterisation of sleep disruption in psoriasis is an important goal. We therefore conducted a systematic review of the sleep-psoriasis literature. METHODS Searches were conducted in Pubmed, SCOPUS and Web of Science from inception to May 2016. Studies were compared against inclusion/exclusion criteria and underwent a quality evaluation. Given the heterogeneity of studies, we conducted a narrative synthesis of the findings. RESULTS Searches revealed 32 studies which met our predetermined inclusion/exclusion criteria. Whilst 93.7% of studies reported sleep disruption in this population, ranging from 0.05% to 85.4%, many had important methodological shortcomings. Over half of all quantitative studies (54.8%; 17/31) relied on non-validated measures, contributing to heterogeneity in study findings. In those that employed valid measures, assessing sleep was often not the primary objective. We frequently found the absence of adequate sample size calculations and poor statistical reporting. CONCLUSION This review showed that in psoriasis, reported sleep rates of sleep disturbance varied substantially. Most studies lacked a hypothesis driven research question and/or failed to use validated measures of sleep. We were unable to draw firm conclusions about the precise prevalence and nature of sleep disturbance within the psoriasis population. We offer suggestions to help advance understanding of sleep disturbance in psoriasis.
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Affiliation(s)
- Alasdair L. Henry
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Simon D. Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sahil Bhandari
- Manchester Medical School, University of Manchester, Manchester, United Kingdom
| | - Anna Chisholm
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Christopher E. M. Griffiths
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Christine Bundy
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
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