Literature on Psoriatic Arthritis

Patients with juvenile psoriatic arthritis comprise two distinct populations.

Arthritis Rheum. 2006 Oct 30;54(11):3564-3572

Authors: Stoll ML, Zurakowski D, Nigrovic LE, Nichols DP, Sundel RP, Nigrovic PA

OBJECTIVE: Psoriatic arthritis (PsA) in children is clinically heterogeneous. We examined a large population of children with juvenile PsA for evidence of phenotypic clustering that could suggest the presence of distinct clinical entities. METHODS: We reviewed the medical records of 139 patients meeting the Vancouver criteria for juvenile PsA. To identify segregation into phenotypic groups, we compared younger patients with their older counterparts and subjected the whole population to 2-step cluster analysis. RESULTS: Among patients with juvenile PsA, the age at onset is biphasic, with peaks occurring at approximately 2 years of age and again in late childhood. Compared with children ages 5 years and older, younger patients are more likely to be female, exhibit dactylitis and small joint involvement, and express antinuclear antibodies. Progression to polyarticular disease (>/=5 joints) is more common in younger children, although joint involvement remains oligoarticular in the majority of children. In contrast, older patents tend to manifest enthesitis, axial joint disease, and persistent oligoarthritis. Uveitis is equally represented in both age groups. Despite a higher utilization of methotrexate therapy, younger patients required, on average, more than twice as long to achieve clinical remission (23 months versus 9.2 months; P = 0.044). Cluster analysis identified largely overlapping subgroups but suggested that the presence of dactylitis, rather than age, has the greatest capacity to predict essential features of the clinical phenotype. CONCLUSION: Juvenile PsA comprises 2 distinct populations of patients. Although the pathophysiologic correlate of this finding remains undefined, future studies should avoid the assumption that PsA in childhood constitutes a single etiologic entity.

PMID: 17075862 [PubMed - as supplied by publisher]

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Animation as a useful tool for assessing functional status in psoriatic arthritis.

J Dermatol Sci. 2006 Oct 13;

Authors: Nomura T, Kodama K, Nishimura M, Abe M, Onozuka T, Shimizu H

PMID: 17049209 [PubMed - as supplied by publisher]

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Adalimumab improves joint- and skin-related functional impairment in patients with psoriatic arthritis: Patient- reported outcomes of the Adalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT).

Ann Rheum Dis. 2006 Oct 17;

Authors: Gladman DD, Mease PJ, Cifaldi MA, Perdok RJ, Sasso E, Medich J

OBJECTIVE: To evaluate the effects of adalimumab on patient-reported outcomes of joint- and skin-related functional impairment, health-related quality of life (HRQOL), fatigue, and pain in patients with psoriatic arthritis (PsA). METHODS: Patients with moderately to severely active PsA were treated with adalimumab 40 mg every other week or placebo in this 24-week, randomised, controlled trial. Patient-reported outcomes included the Health Assessment Questionnaire Disability Index (HAQ DI), Short Form 36 Health Survey (SF-36), the Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-Fatigue), and the Dermatology Life Quality Index (DLQI). RESULTS: Adalimumab (N=151) and placebo (N=162) groups were comparable with respect to baseline demographics and disease severity. Statistically significant changes from baseline in HAQ DI were reported for adalimumab vs. placebo (-0.4 vs. & -0.1, p

PMID: 17046964 [PubMed - as supplied by publisher]

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Related ArticlesPrevalence and Risk Factors of Atherosclerosis in Patients with Psoriatic Arthritis.

Semin Arthritis Rheum. 2006 Oct 24;

Authors: Kimhi O, Caspi D, Bornstein NM, Maharshak N, Gur A, Arbel Y, Comaneshter D, Paran D, Wigler I, Levartovsky D, Berliner S, Elkayam O

OBJECTIVES: To evaluate the extent of subclinical atherosclerosis by measuring the intima-media wall thickness (IMT) of the common carotid artery in patients with psoriatic arthritis (PsA) and to identify vascular risk factors associated with PsA. METHODS: Forty-seven patients with PsA were compared with 100 allegedly healthy subjects. Carotid duplex scanning was used to measure common carotid artery IMT. Traditional risk factors, such as gender, age, body mass index (BMI), hypertension, smoking, and lipids were checked. Assessment of PsA activity included clinical patterns of involvement, degree of severity, duration of morning stiffness, number of tender and swollen joints, degree of pain and fatigue, the Bath Ankylosing Spondylitis Disease Activity Index, the Psoriasis Area and Severity Index, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen. RESULTS: The average IMT (mean +/- standard deviation) for PsA patients was significantly higher compared with controls (0.76 +/- 0.11 versus 0.64 +/- 0.27, respectively, P

PMID: 17067658 [PubMed - as supplied by publisher]

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Infliximab in refractory psoriatic arthritis with severe psoriasis. A two-year experience.

Ann Rheum Dis. 2006 Oct 26;

Authors: Voulgari PV, Venetsanopoulou AI, Epagelis EK, Alamanos Y, Takalou I, Drosos AA

Infliximab was shown to be effective and safe in controlled trials regarding psoriatic arthritis (PsA).[1-4] In an open label study we reported a significant clinical benefit accompanied by clearing and healing of psoriatic skin lesions.[5] Thus, we conducted this study to evaluate the efficacy and safety of infliximab in patients with active PsA, and recalcitrant psoriasis in whom treatment with disease modifying anti-rheumatic drugs has failed. Thirty-two patients who had negative purified protein derivative skin test and normal chest radiographs were included. All had active disease which was defined as inverted exclamation markY6 tender or swollen joints count, Psoriasis Area and Severity Index (PASI) score inverted exclamation markY10 [6] and erythrocyte sedimentation rate inverted exclamation markY28 mmHg/h or C-reactive protein inverted exclamation markY10 mg/l. The end points were the percentage of patients who achieved the Psoriatic Arthritis Response criteria (PsARC) [7] and the improvement of PASI. Patients were treated with infliximab (5 mg/kgr/weight) at weeks 0, 2, 6 and every 8 weeks thereafter for a period of 2 years. If the clinical response was insufficient, the interval between infusions was shortened to 6 or 4 weeks. The clinical response according to the American College of Rheumatology (ACR) criteria [8] and the disease activity for 28 joint indices score (DAS-28) were recorded.[9].

PMID: 17068063 [PubMed - as supplied by publisher]

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Clinical, radiological, and functional assessment in psoriatic arthritis: is it different from other inflammatory joint diseases?

Ann Rheum Dis. 2006 Nov;65 Suppl 3:iii22-iii24

Authors: Gladman DD

PMID: 17038466 [PubMed - in process]

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Cervical myelopathy caused by periodontoid synovial pannus in a patient with psoriatic arthritis: a case report.

Clin Rheumatol. 2006 Oct 10;

Authors: Quarta L, Corrado A, Melillo N, Trotta A, D’onofrio F, Maruotti N, Cantatore FP

The atlantoaxial subluxation and the formation of a synovial periodontoid pannus are associated with rheumatoid arthritis causing mechanical compression of the spinal cord and cervical myelopathy. Atlantoaxial subluxation is very rare in psoriatic arthritis (PsA). Even more rare is the formation of a periodontoid synovial pannus associated with PsA and signs of myelopathy. In this report, cervical myelopathy caused by periodontoid synovial pannus in PsA is described.

PMID: 17031484 [PubMed - as supplied by publisher]

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MRI in psoriatic arthritis with hand and foot involvement.

Rheumatol Int. 2006 Oct 7;

Authors: Ghanem N, Uhl M, Pache G, Bley T, Walker UA, Langer M

Evaluation of MRI-findings in patients with involvement of psoriatic arthritis (PsA) in small joints in hands and feet. Twenty-five patients with symptomatic joint involvement were studied by MRI. All patients were found to be positive for one or more imaging criteria. Soft tissue oedema was identified in 22/25 (88%) patients. Joint effusion was observed in 23/25 (92%) patients, whereas bone erosion was seen in 20/25 (80%) patients. Bone marrow oedema was evident in 21/25 (84%) cases. In 12/25 (48%) cases, bone proliferation was noted. Tendon sheath effusion was present in 17/25 (68%) patients. Contrast enhancement of the synovia was detected in all patients (n = 25) (100%), whereas adjacent periost was enhanced in 22/25 (88%) and epiphysial bone marrow in 18/25 (72%) patients. MRI allows the assessment of PsA-alterations of soft tissue, cartilage, bone, bone marrow, and adjacent tendon sheath in patients with hand and foot involvement.

PMID: 17028861 [PubMed - as supplied by publisher]

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Low frequency of anticyclic citrullinated peptide antibodies in psoriatic arthritis but not in cutaneous psoriasis.

J Clin Rheumatol. 2006 Oct;12(5):226-9

Authors: Candia L, Marquez J, Gonzalez C, Santos AM, Londoño J, Valle R, Zabaleta J, Yaqub Z, Espinoza LR

BACKGROUND: Anticyclic citrullinated peptide (anti-CCP) antibodies are highly specific for the diagnosis of rheumatoid arthritis (RA). The clinical distinction between RA and psoriatic arthritis (PsA) is often difficult to establish; therefore, the presence of rheumatoid factor (RF) and anti-CCP antibodies could be useful. Seven percent to 40% of patients with longstanding psoriasis will develop PsA at some point. Therefore, it is important to study the positivity of these antibodies in these two interrelated populations. OBJECTIVE: The aim of this study was to determine the seropositivity of anti-CCP antibodies in patients with psoriasis and PsA and to compare it with that seen in patients with other inflammatory, noninflammatory (osteoarthritis) arthritides and healthy controls. PATIENTS AND METHODS: Serum anti-CCP antibodies were measured in 106 patients with cutaneous psoriasis, 72 patients with PsA, 41 healthy controls (HC), 41 patients with undifferentiated or early inflammatory arthritis (UA), and 41 patients with RA and 41 with osteoarthritis using a commercial second-generation enzyme-linked immunosorbent assay. We considered a positive result to be >20 UI/mL, as recommended by the manufacturer. RESULTS: Of 106 patients with PsA, 55 were women and 51 men. The mean age was 42.87 +/- 17.71 years and the mean disease duration was 5.3 +/- 2.10 years. Anti-CCP antibodies were not present in patients with psoriasis without arthritis. In contrast, 7 of 72 (9.72%) patients with PsA were positive for anti-CCP antibodies with a median titer of 7.16 units. Only one patient with PsA was positive for RF. Most of these patients were female with polyarticular joint involvement. Distal interphalangeal involvement was present in 4 and 2 had dactylitis. We found clear differences when we compared patients with PsA with patients with psoriasis (P = 0.001). Of the 43 patients with UA studies, 4 initially exhibited a low titer positive anti-CCP antibody, and at follow up, another patient developed anti-CCP antibodies and later developed RA. None of the patients with UA developed PsA at 5-year follow up. Thirty-two of the 41 patients had a positive anti-CCP antibody and the mean +/- standard deviation of the anti-CCP units was 80.61 +/- 55.5.2. Six of the 41 (14.6%) patients with osteoarthritis studied had positive anti-CCP with a mean titer of 7.388. None of the healthy controls exhibited positively for anti-CCP antibodies. CONCLUSION: Anti-CCP antibodies may be found in patients with PsA and not in our patients with only cutaneous psoriasis. These antibodies may also be found in some patients with osteoarthritis and rarely in patients with UA; such patients will be of interest to follow prospectively.

PMID: 17023808 [PubMed - in process]

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Decreased levels of metalloproteinase-9 and angiogenic factors in skin lesions of patients with psoriatic arthritis after therapy with anti-TNF-alpha.

J Autoimmune Dis. 2006;3:5

Authors: Cordiali-Fei P, Trento E, D’Agosto G, Bordignon V, Mussi A, Ardigò M, Mastroianni A, Vento A, Solivetti F, Berardesca E, Ensoli F

ABSTRACT: BACKGROUND: Inflammation represents an early and key event in the development of both the cutaneous psoriasis and psoriatic arthritis. Compelling evidences indicate that the production of TNF-alpha plays a central role in psoriasis by sustaining the inflammatory process in the skin as well as in the joints. Among the multiple effects produced by TNF-alpha on keratinocytes, the induction of matrix metalloproteinase-9 (MMP-9), a collagenase implicated in joint inflammatory arthritis which acts as an angiogenesis promoting factor, might represent a key mechanism in the pathogenesis of the disease. Aims of the present study were to investigate a) the role of MMP-9 in the development of psoriasis by assessing the presence of MMP-9 in lesional skin and in sera of psoriatic patients; b) the association of MMP-9 with the activity of the disease; c) the relationship between MMP-9 and TNF-alpha production. METHODS: Eleven psoriatic patients, clinically presenting joint symptoms associated to the cutaneous disease, were included in a therapeutic protocol based on the administration of anti-TNF-alpha monoclonal antibody (Infliximab). Sera and skin biopsies were collected before treatment and after 6 weeks of therapy. Tissues were kept in short term cultures and production soluble mediators such as TNF-alpha, MMP-9, MMP-2, VEGF and E-Selectin, which include angiogenic molecules associated to the development of plaque psoriasis, were measured in the culture supernatants by immunoenzymatic assays (ng/ml or pg/ml per mg of tissue). MMP-9 concentrations were also measured in the sera. The cutaneous activity of disease was evaluated by the Psoriasis Area and Severity Index (PASI). RESULTS: Clinical and laboratory assessment indicated that all but one patients had a significant improvement of the PASI score after three months of therapy. The clinical amelioration was associated to a significant decrease of MMP-9 (P = 0.017), TNF-alpha (P = 0.005) and E-selectin (P = 0.018) levels, spontaneously released by lesional biopsies before and after therapy. In addition, significant correlations were found between the PASI measurements and TNF-alpha (r2 = 0.33, P = 0.005), MMP-9 (r2 = 0.25, P = 0.017), E-selectin (r2 = 0.24, P = 0.018) production. MMP-9 levels were significantly correlated with those of TNF-alpha (r2 = 0.30, P = 0.008). A significant decrease of MMP-9 in the sera, associated to the clinical improvement was also found. CONCLUSION: Our findings show the existence of a direct relationship between MMP-9 and TNF-alpha production strongly suggesting that MMP-9 may play a key role in the skin inflammatory process in psoriasis.

PMID: 17022813 [PubMed - in process]

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