Literature on Psoriatic Arthritis

Related ArticlesInvestigating the role of the HLA-Cw*06 and HLA-DRB1 genes in susceptibility to psoriatic arthritis: comparison with psoriasis and undifferentiated inflammatory arthritis.

Ann Rheum Dis. 2007 Aug 29;

Authors: Ho PY, Barton A, Worthington J, Plant D, Griffiths CE, Young HS, Bradburn P, Thomson W, Silman AJ, Bruce IN

OBJECTIVE: Psoriasis of early onset (Type I; age of onset 40 years). HLA-DRB1*07, in linkage disequilibrium with HLA-Cw*06, was also associated with PsA patients having type I psoriasis (OR 2.7, 95% CI 2.1, 3.7, p

PMID: 17728335 [PubMed - as supplied by publisher]

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Related ArticlesMethotrexate combined with isoniazid therapy for latent tuberculosis is well tolerated in rheumatoid arthritis patients: experience from an urban arthritis clinic.

Ann Rheum Dis. 2007 Aug 29;

Authors: Mor A, Bingham CO, Kishimoto M, Izmirly PM, Greenberg J, Reddy S, Rosenthal PB

OBJECTIVES: Reactivation of Mycobacterium tuberculosis (TB) is a significant problem with all available tumor necrosis factor (TNF) antagonists when used to treat rheumatoid arthritis (RA), psoriatic arthritis, psoriasis and other inflammatory diseases. Concerns have been raised regarding the appropriate management of patients with latent TB (LTB) exposure (or active TB infection) before initiating TNF antagonists since the safety data of combined therapy with two potentially hepatotoxic medications, methotrexate (MTX) and isoniazid (INH), is lacking. The goal of this study was to investigate the toxicity of MTX and INH therapy in RA patients before initiating TNF antagonists. METHODS: To investigate the toxicity of MTX and INH therapy in RA patients we performed a retrospective chart review of patients seen at the Bellevue Hospital Arthritis Clinic in New York City between 2002-2006. Forty-four patients who were concomitantly treated with both drugs were included. The primary outcome investigated was increase in liver function tests (LFT). RESULTS: Transient increases in LFT were seen in 11% of patients, but in no case was this more than twice the upper limit of normal values. All abnormal LFT resolved spontaneously without intervention. In addition, no patient has developed signs or symptoms of TB reactivation. CONCLUSION: The use of INH for LTB was well tolerated in RA patients on a background regimen of MTX. While the risks and benefits of all therapy must always be considered, in our experience the additive risk of INH to MTX in terms of hepatotoxicity was low. Nonetheless it is prudent to follow LFT closely on patients taking this combination.

PMID: 17711866 [PubMed - as supplied by publisher]

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Related ArticlesEfficacy and tolerability of anti-TNF therapy in psoriatic arthritis patients: Results from the South Swedish Arthritis Treatment Group Register.

Ann Rheum Dis. 2007 Jul 20;

Authors: Kristensen LE, Gülfe A, Saxne T, Geborek P

BACKGROUND: The use of TNF blocking agents in psoriatic arthritis (PsA) is increasing, and the SSATG register has followed patients with PsA for more than 5 years. OBJECTIVE: To present efficacy and tolerability data of TNF-blocking agents on PsA in clinical practice. Also to study potential predictors for drug survival. Material and METHODS: Patients (n=261) with active PsA, starting anti-TNF therapy for the first time in southern Sweden, were included. Basal characteristics, disease activity measures, and termination reason for TNF-blockers were prospectively collected during the period April 1999 to September 2006. Cox proportional hazard models were used to investigate predictors for treatment termination. RESULTS: Overall, response rates at 3-12 months for VASglobal50 and VASpain50 were about 50%, whereas response rates for EULAR overall and EULAR good were around 75% and 55%, respectively. Concomitant MTX (HR=0.64 (95% CI 0.39-0.95), p=0.03), etanercept (HR=0.49 (0.28-0.86), p=0.01), and high CRP-levels (HR=0.77 (0.61-0.97), p=0.03) at treatment initiation were associated with better overall drug survival. The improved drug survival of concomitant MTX appeared to be related to significantly fewer drop outs because of adverse events (HR= 0.24 (0.11-0.52), p

PMID: 17644547 [PubMed - as supplied by publisher]

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Related ArticlesDo all anti-citrullinated protein/peptide antibody (ACPA) tests measure the same? Evaluation of discrepancy between ACPA tests in RA and non-RA patients.

Ann Rheum Dis. 2007 Jul 20;

Authors: Vander Cruyssen B, Nogueira L, Van Praet J, Deforce D, Elewaut D, Serre G, de Keyser F

BACKGROUND: Different methods exist to demonstrate anti-citrullinated protein/peptide antibodies (ACPA). Aims: To evaluate discrepancy between 4 ACPA tests. Patients and METHODS: Population 1 consisted of patients with a new diagnostic problem including 86 RA and 450 non-RA patients. Population 2 consisted of 155 RA patients with longstanding disease. Population 3 consisted of 188 psoriatic arthritis (PsA) patients and population 4 consisted of 192 lupus (SLE) patients. Populations 1 and 2 were tested with the anti-human fibrinogen antibodies (AhfibA) test, anti-CCP2 from Eurodiagnostica (CCP2-euro), anti-CCP2 from Pharmacia (CCP2-phar) and anti-CCP3 test by Inova (CCP3). Samples were annotated as discrepant if positive in one and negative in at least one other test. Each discrepant sample was re-analyzed in a different run. Populations 3 and 4 were analyzed in the CCP2-euro and AhFibA test. RESULTS: In population 1, ACPA positivity was found in 17 of 450 (3.8%) non-RA patients. 14 (82%) of those 17 samples were discrepant. In contrast, 61 (70.9%) of 86 RA patients were ACPA positive of whom 18 (29.5%) out of 61 were discrepant (70.9% vs. 29.5%, p

PMID: 17644546 [PubMed - as supplied by publisher]

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Anti-TNF{alpha} therapy in patients with impaired renal function.

Ann Rheum Dis. 2007 Mar 2;

Authors: Hueber AJ, Tunc A, Schett G, Manger B

Renal insufficiency is a frequent comorbidity in patients with inflammatory rheumatic diseases such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Decreased renal function is a limiting factor for the use of non-steroidal and anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). Therefore, therapeutic alternatives would be an improvement of our treatment options for these patients. For tumour necrosis factor alpha (TNFalpha) inhibitors no data about their use in patients with impaired renal function are available, because it has been an exclusion criterion in all major clinical trials.

PMID: 17337474 [PubMed - as supplied by publisher]

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Magnetic resonance imaging and bone scintigraphy in the differential diagnosis of unclassified arthritis.

Ann Rheum Dis. 2007 Feb 8;

Authors: Duer A, Ostergaard M, Vallø J, Hørslev Petersen K

OBJECTIVES: To investigate the value in clinical practice of hand magnetic resonance imaging (MRI) and whole-body bone scintigraphy in the differential diagnosis of patients with unclassified arthritis. METHODS: 41 patients with arthritis (>/=2 swollen joints; >6 months’ duration), which remained unclassified despite conventional clinical, biochemical and radiographical (hands and feet) examinations, were included. Patients who fulfilled the ACR criteria for RA, or had radiographic bone erosions, were excluded. Contrast-enhanced MRI of the wrist and metacarpophalangeal joints of the most symptomatic hand and whole-body bone scintigraphy were performed. Subsequently, two rheumatologists agreed on the most likely diagnosis and patients were treated accordingly. A final diagnosis was made by another specialist review 2 years later. RESULTS: Tentative diagnoses after MRI and bone scintigraphy were: RA: 13, osteoarthritis: 8, other inflammatory diseases: 11, arthralgias without inflammatory or degenerative origin: 9. Two years later, 11 of 13 patients with an original tentative RA diagnosis had fulfilled the ACR criteria, while 2 were reclassified (one to psoriatic arthritis (RF-negative; +psoriasis), one to unspecific selflimiting arthritis). No patients classified as non-RA at baseline had fulfilled the ACR criteria after 2 years. Presence of MRI synovitis, MRI erosion and bone scintigraphic pattern compatible with RA showed 100% specificity for an RA diagnosis at 2 years’ follow-up. CONCLUSIONS: In arthritis patients, unclassified despite conventional clinical, biochemical and radiographic examinations, MRI and scintigraphy allowed correct classification as RA or non-RA in 39 of 41 patients, when fulfilment of ACR criteria 2 years later was considered the standard reference.

PMID: 17289759 [PubMed - as supplied by publisher]

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Investigation of association of the DLG5 gene with psoriatic arthritis.

Ann Rheum Dis. 2007 Feb;66(2):273-4

Authors: Ho P, Worthington J, Bruce IN, Barton A

PMID: 17242020 [PubMed - in process]

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Related ArticlesPrediction of major clinical response (ACR50) to infliximab in psoriatic arthritis refractory to methotrexate.

Ann Rheum Dis. 2007 Jan 25;

Authors: Gratacòs J, Casado E, Real J, Torre-Alonso JC

OBJECTIVES: To determine the predictive factors of clinical response to infliximab in patients with refractory psoriatic polyarthritis. METHODS: Multicenter open study which included 69 patients with psoriatic polyarthritis refractory to methotrexate (15 mg/week at least for 8 weeks). Patients were treated with infliximab 5mg/Kg every 8 weeks in addiction to their stable doses of methotrexate. A major clinical response was defined by the ACR 50 at week 38. Logistic regression analysis was performed to analyze which of the following parameters at the start of treatment were associated with an ACR50 response: demographic and clinical characteristics, duration of disease, tender and swollen joint counts, involvement of large joints (knee and/or hip), ESR, CRP, HAQ disability index, axial involvement and presence of erosions at baseline. RESULTS: In an intention-to-treat analysis 44% of patients achieved an ACR50 response. In the univariate analysis both the presence of large joints involvement and severe disability were associated with a poor clinical response. In a multivariate logistic regression analysis high CRP values was independently associated to a good therapeutical response (OR=18.7; 95% CI = 1.8- 181.6, p=0.011). In contrast, large joint involvement and severe disability were associated with a poor response, although only for large joint involvement reached statistical significance (OR=29.3; 95% CI= 3.2- 266.3, p=0.003). CONCLUSION: A lower disability and mainly the lack of large join involvement and higher CRP serum levels at the start of the infliximab treatment seem to be factors that influence the probability to achieve a good therapeutical response in psoriatic arthritis patients.

PMID: 17179176 [PubMed - as supplied by publisher]

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Related ArticlesHLA-Cw6 and HLA-DRB1*07 together are associated with less severe joint disease in psoriatic arthritis.

Ann Rheum Dis. 2007 Jan 12;

Authors: Ho PY, Barton A, Worthington J, Thomson W, Silman AJ, Bruce IN

OBJECTIVE: HLA genes predict disease severity in psoriasis (HLA-Cw6) and rheumatoid arthritis (shared epitope (SE)), but the situation is unclear for psoriatic arthritis (PsA). The aim of this study was to determine the association of the HLA-Cw6 and HLA-DRB1 gene with disease severity in a large UK PsA cohort. METHODS: Genotyping of the HLA-Cw and HLA-DRB1 loci was undertaken in DNA samples from PsA patients (n=480). Stratification and regression analysis were used within the PsA cases to determine whether HLA-Cw6, HLA-DRB1 or the presence of the SE alleles predicted disease severity as measured by the health assessment questionnaire (HAQ) score, the total number of damaged or involved joints adjusted for disease duration and disease modifying antirheumatic treatments. RESULTS: HLA-Cw6 was found to be in linkage disequilibrium with HLA-DRB1*07 (r2 = 0.46). PsA patients who carried both HLA-Cw6 and HLA-DRB1*07 had fewer damaged or involved joints [41% fewer damaged (95% CI 23 to 55%, p=0.02) and 31% fewer involved joints (95% CI 16 to 44%, p

PMID: 17223660 [PubMed - as supplied by publisher]

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Related ArticlesEctopic lymphoid neogenesis in psoriatic arthritis.

Ann Rheum Dis. 2007 Jan 12;

Authors: Cañete JD, Santiago B, Cantaert T, Sanmartí R, Palacín A, Celis R, Graell E, Gil-Torregrosa B, Baeten D, Pablos JL

OBJECTIVE: Ectopic lymphoid neogenesis (LN) occurs in rheumatoid synovium where it is postulated to drive local antigen-dependent B cell development and autoantibody production. This process involves the expression of specific homing chemokines and the development of high endothelial venules (HEV). We aimed to investigate whether these phenomena occur in psoriatic arthritis (PsA) synovium, where autoantibodies have not been described and the organization and function of B cells is not clear, and to analyze their clinical correlates. METHODS: Arthroscopic synovial biopsies from PsA patients before and after TNF-[alpha] blockade were characterized by immunohistochemistry for T/B cell segregation, peripheral lymph node addressin (PNAd)- positive HEV, and CXCL13, CCL21 and CXCL12 chemokines expression in relationship to the size of lymphoid aggregates. RESULTS: Lymphoid aggregates of variable size were observed in 25 of 27 PsA synovial tissues. T/B cell segregation was often observed and correlated with the size of lymphoid aggregates. A close relationship between the presence of large and highly organized aggregates, the development of PNAd+ HEV, and the expression of CXCL13 and CCL21 was found. Large organized aggregates with all LN features were found in 13 of 27 tissues. LN in PsA synovitis was not related to the duration, pattern, or severity of the disease. The synovial LN pattern remained stable over time in persistent synovitis, but a complete response to therapy was associated with a regression of the LN features. CONCLUSIONS: LN occurs frequently in inflamed PsA synovial tissues. Highly organized follicles display the characteristic features of PNAd+ HEV and CXCL13 and CCL21 expression, demonstrating that the microanatomical bases for germinal center formation are present in PsA. The regression of LN upon effective treatment indicates that the pathogenic and clinical relevance of these structures in PsA merits further investigation.

PMID: 17223654 [PubMed - as supplied by publisher]

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