Literature on Psoriatic Arthritis

Related ArticlesA systematic review and meta-analysis of efficacy and toxicity of disease modifying anti-rheumatic drugs and biologic agents for psoriatic arthritis.

Ann Rheum Dis. 2007 Sep 7;

Authors: Ravindran V, Scott DL, Choy EH

OBJECTIVE: Treatments for psoriatic arthritis (PsA) range from high-cost agents like tumour necrosis factor (TNF) inhibitors evaluated in large randomised control trials (RCTs) and low-cost disease modifying anti-rheumatic drugs (DMARDs) studied in less detail. We compared their efficacy and toxicity in a systematic review. METHODS: We searched Medline, PubMed and EmBase (1966-2006) for RCTs in PsA. We included RCTs that were randomised, placebo-controlled, in English, involved current treatments and only enrolled PsA patients. Efficacy was assessed by the numbers of patients withdrawn for lack of effect; toxicity by withdrawals for adverse events. RCTs were compared using risk ratios (RR) with 95% confidence intervals (CI). RESULTS: We identified 32 potentially relevant RCTs; 14 were excluded because they involved unused agents, were unblinded, were not placebo-controlled and enrolled patients with other diseases. 18 studies were included in the meta-analysis assessing DMARD monotherapy (11), DMARD combinations (1), TNF inhibitors (5) and alefacept (1). Treatment was more effective than placebo (RR = 0.35; 95% CI 0.25, 0.49) but caused more toxicity (RR = 2.33; 95% CI 1.61, 3.37). There was evidence that gold, sulfasalazine, leflunomide and TNF inhibitors were effective; gold and TNF inhibitors showed the largest effect sizes; TNF inhibitors had the best efficacy/toxicity ratio (number needed to harm/number needed to treat=0.25); tolerability was least with gold and leflunomide. CONCLUSION: Efficacy/toxicity ratios were highest with TNF inhibitors followed by leflunomide, gold and sulfasalazine. Gold, though effective, has excessive toxicity and sulfasalazine, though of low toxicity, was also relatively ineffective.

PMID: 17827183 [PubMed - as supplied by publisher]

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Related Articles[An unusual case of pneumocystis pneumonia–case report and review]

Laeknabladid. 2007 Sep;93(9):607-13

Authors: Dereksson K, Kristjansson M, Baldursson O

A 63 year old woman seeks medical attention for symptoms of fever, headache and increasing dyspnoea. She has a history of psoriatic-arthritis and uses 10 mg/week of methotrexate as arthritic treatment. There is also a history of severe alcohol abuse. She is in respiratory failure, with basal pulmonary crackles and increased serum inflammatory markers, a normal white-cell count but with a lowered lymphocyte count. A CT-scan reveals ground-glass lung changes. Bronchial biopsy reveals the fungus P. jiroveci which infects immunodeficient hosts. After extensive testing it was concluded that the patient’s immunodeficiency was attributed to the combination of methotrexate, ethanol and psoriatic-arthritis. In this article, a case of pneumocystis pneumonia is reviewed as well as the infective mechanism of P. jiroveci and host-defence against the fungus. Additionally, symptoms and signs of the infection, diagnostic approach and treatment are reviewed. Because the combination of methotrexate and ethanol played a significant role in the immunodeficiency of the patient, their effect on the immune system is addressed.

PMID: 17823501 [PubMed - indexed for MEDLINE]

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Related ArticlesEnvironmental risk factors for the development of psoriatic arthritis: results from a case control study.

Ann Rheum Dis. 2007 Sep 6;

Authors: Pattison EJ, Harrison BJ, Griffiths CE, Silman AJ, Bruce IN

OBJECTIVE: To identify potential risk factors for the onset of inflammatory arthritis (IA) in a large cohort of patients with psoriatic arthritis (PsA) of recent onset. METHODS: We recruited cases with psoriasis and an onset of IA within the past 5 years. Controls were patients who had psoriasis but no arthritis. We assessed potential factors associated with the development of IA using a detailed postal questionnaire. An unmatched analysis adjusted for age and gender was performed. Exposure was censored in the controls at a “dummy-date” assigned randomly in proportion to the percentage of cases developing IA in any given year. RESULTS: We studied 98 cases and 163 controls. Exposures showing a positive association prior to the onset of IA in patients with psoriasis were: rubella vaccination (OR [95% C.I.] = 12.4 [1.2-122]), injury sufficient to require a medical consultation (2.53 [1.1-6.0]), recurrent oral ulcers (4.2 [2.0-9.0]) and moving house (2.3 [1.2-4.4]). Cases were also more likely to have experienced a fractured bone requiring hospital admission (50% vs. 9%, p=0.040). CONCLUSIONS: We found a number of environmental exposures associated with the onset of IA in subjects with psoriasis. The strongest associations were with trauma thereby adding to the hypothesis of a ‘deep Koebner phenomenon’ in PsA. Our data also suggest that exposure of the immune system to certain infection related triggers may also be of relevance. Further studies are needed to verify these observations and to examine potential immunological mechanisms that underlie them.

PMID: 17823200 [PubMed - as supplied by publisher]

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