Literature on Psoriatic Arthritis

Psoriatic arthritis: clinical spectrum and diagnostic procedures.

Clin Dermatol. 2007 Nov-Dec;25(6):519-23

Authors: Kleinert S, Feuchtenberger M, Kneitz C, Tony HP

Psoriatic arthritis presents with a broad clinical spectrum of symptoms. Symmetrical polyarthritis with joint pain and joint swelling is one pattern of clinical manifestations that often indicates erosive progressive disease. Unlike in rheumatoid arthritis, the distal interphalangeal joints are regularly involved. Sometimes, the disease focuses on the larger joints of the lower extremities; iliosacral and intervertebral joints and tendons can also be involved. Thus, inflammatory back pain as well as any other prolonged joint pain in a patient with psoriasis is suspicious of psoriatic arthritis. This article reviews the clinical spectrum and diagnostic procedures that can lead to the diagnosis of psoriatic arthritis.

PMID: 18021887 [PubMed - in process]

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TNF-mediated inflammatory disease.

J Pathol. 2007 Dec 27;214(2):149-160

Authors: Bradley J

TNF was originally described as a circulating factor that can cause necrosis of tumours, but has since been identified as a key regulator of the inflammatory response. This review describes the known signalling pathways and cell biological effects of TNF, and our understanding of the role of TNF in human disease. TNF interacts with two different receptors, designated TNFR1 and TNFR2, which are differentially expressed on cells and tissues and initiate both distinct and overlapping signal transduction pathways. These diverse signalling cascades lead to a range of cellular responses, which include cell death, survival, differentiation, proliferation and migration. Vascular endothelial cells respond to TNF by undergoing a number of pro-inflammatory changes, which increase leukocyte adhesion, transendothelial migration and vascular leak and promote thrombosis. The central role of TNF in inflammation has been demonstrated by the ability of agents that block the action of TNF to treat a range of inflammatory conditions, including rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease and psoriasis. The increased incidence of infection in patients receiving anti-TNF treatment has highlighted the physiological role of TNF in infectious diseases. Copyright (c) 2007 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

PMID: 18161752 [PubMed - as supplied by publisher]

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Incidence and risk factors for psoriasis in the general population.

Arch Dermatol. 2007 Dec;143(12):1559-65

Authors: Huerta C, Rivero E, Rodríguez LA

OBJECTIVES: To study the clinical spectrum of psoriasis and the incidence in the general population and to identify risk factors associated with the occurrence of psoriasis. DESIGN: Prospective cohort study with nested case-control analysis. SETTING: The data source was the United Kingdom General Practice Research Database containing computerized clinical information entered by general practitioners (GPs). PATIENTS: The study population comprised patients receiving a first-ever diagnosis of psoriasis between January 1, 1996, and December 31, 1997, and free of cancer. INTERVENTIONS: Diagnosis of psoriasis was validated in a random sample of 14% of all ascertained cases requesting confirmation by the GPs. Nested case-control analysis included 3994 cases of psoriasis and a random sample of 10 000 controls frequency matched to cases by age, sex, and calendar year. MAIN OUTCOME MEASURES: Incidence rate of psoriasis and estimates of the odds ratio (OR) and 95% confidence interval (CI) for psoriasis as associated with selected risk factors. RESULTS: The incidence rate of psoriasis was 14 per 10 000 person-years. Patients with antecedents of skin disorders and skin infection within the last year carried the highest risk of developing psoriasis (OR, 3.6 [95% CI, 3.2-4.1], and OR, 2.1 [95% CI, 1.8-2.4], respectively). Also, smoking was found to be an independent risk factors for psoriasis (OR, 1.4 [95% CI, 1.3-1.6]). We did not find an association between risk of psoriasis and antecedents of stress, diabetes, hypertension, hyperlipidemia, cardiovascular disease, or rheumatoid arthritis. CONCLUSIONS: The incidence rate in our study was higher than those published in other studies, probably owing to our case definition that considered cases recorded by the GPs independently of a specialist confirmation. Our results confirm the association between psoriasis, skin disorders, and smoking.

PMID: 18087008 [PubMed - in process]

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The risk of mortality in patients with psoriasis: results from a population-based study.

Arch Dermatol. 2007 Dec;143(12):1493-9

Authors: Gelfand JM, Troxel AB, Lewis JD, Kurd SK, Shin DB, Wang X, Margolis DJ, Strom BL

OBJECTIVE: To determine the risk of mortality in patients with psoriasis. DESIGN: Cohort study. SETTING: General practitioners participating in the General Practice Research Database in the United Kingdom, 1987-2002. PATIENTS: Mild psoriasis, defined as any patient with a diagnostic code of psoriasis but no history of systemic therapy; severe psoriasis, any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis. The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code. Control patients were selected in a 5:1 ratio from the same practice and date in practice as the patients with psoriasis. MAIN OUTCOME MEASURE: Hazard ratio (HR) of time to death using Cox proportional hazards models adjusted for age and sex. RESULTS: There was no overall effect of mild psoriasis on mortality (HR, 1.0; 95% confidence interval [CI], 0.97-1.02), whereas patients with severe psoriasis demonstrated an increased overall mortality risk (HR, 1.5; 95% CI, 1.3-1.7). The association of severe psoriasis with mortality persisted after adjustment for risk factors for mortality (HR, 1.4; 95% CI, 1.3-1.6) and after exclusion of patients with inflammatory arthropathy (HR, 1.5; 95% CI, 1.3-1.8). Male and female patients with severe psoriasis died 3.5 (95% CI, 1.2-5.8) and 4.4 (95% CI, 2.2-6.6) years younger, respectively, than patients without psoriasis (P

PMID: 18086997 [PubMed - in process]

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Infliximab in recalcitrant generalized pustular arthropatic psoriasis.

Eur J Dermatol. 2007 Dec 18;18(1):71-73

Authors: Vieira Serrão V, Martins A, Lopes MJ

Generalized pustular psoriasis is an unstable inflammatory type of psoriasis, with widespread areas of erythema and sterile pustules, associated with fever and systemic symptoms. Infliximab is a monoclonal antibody with anti-TNFalpha activity, approved for use in psoriasis. We describe a male patient with a long history of stable arthropathic psoriasis, hospitalized with a generalized pustular psoriasis and acute exacerbation of articular complaints. The disease was resistant to multiple therapies (acitretin, methotrexate and corticosteroids), so the patient was started on infliximab, with a very rapid response of both cutaneous and articular symptoms. He had complete clearing of lesions at week 12, and marked improvement of the articular symptoms. No recurrence occurred at 8 months of follow-up with infliximab every 8 weeks. Infliximab had an extremely rapid therapeutic action response on a recalcitrant generalized pustular psoriasis. The articular response was also excellent, with significant improvement of quality of life.

PMID: 18086593 [PubMed - as supplied by publisher]

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Reappraisal of the Effectiveness of Methotrexate in Psoriatic Arthritis: Results from a Longitudinal Observational Cohort.

J Rheumatol. 2007 Dec 15;

Authors: Chandran V, Schentag CT, Gladman DD

OBJECTIVE: In a previous study in our clinic, methotrexate (MTX) conferred no advantage with respect to clinical response or progression of damage after 24 months in patients with psoriatic arthritis (PsA). Our aim was to determine if MTX is being used earlier in the course of PsA and in a higher dose and whether that has led to improved outcomes. METHODS: All patients treated with MTX for at least 24 months in our clinic, between 1994 and 2004, were included in the study. The outcome measures were the progression of radiographic peripheral joint damage score and a >/= 40% reduction in the number of actively inflamed joints. The data from our study were compared to those obtained from our previous study. RESULTS: Fifty-nine patients (36 men) treated with MTX for 24 months were identified. The mean age was 46 years, PsA duration 8 years, and active joint count 12.1 (4.6 swollen). The mean increase in radiographic damage score was 1.5. Sixty-eight percent of patients demonstrated improvement at 24 months. When compared to our previous study, there was a trend for MTX to be used earlier, at a higher dose, with greater clinical improvement and less progression of damage. CONCLUSION: Our study suggests that treatment with MTX has changed in the past decade to include patients with shorter disease duration and less damage, at increased dose, and that there may be better response with less progression of damage.

PMID: 18085735 [PubMed - as supplied by publisher]

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The use of anti-Tumor Necrosis Factor therapy in HIV positive individuals with rheumatic disease.

Ann Rheum Dis. 2007 Dec 13;

Authors: Cepeda EJ, Williams FM, Ishimori ML, Weisman MH, Reveille JD

OBJECTIVE: The purpose of this study was to examine the safety and efficacy of anti-TNF agents (etanercept, infliximab and adalimumab) in HIV-positive patients with rheumatic diseases refractory to standard therapy. METHODS: Patients were treated with anti-TNF blocker with rheumatic diseases refractory to disease modifying anti-rheumatic drugs who had a CD4 count of > 200 mm3 and an HIV viral load of

PMID: 18079191 [PubMed - as supplied by publisher]

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Psoriasis and the eye: Prevalence of eye disease in Singaporean Asian patients with psoriasis.

J Dermatol. 2007 Dec;34(12):805-10

Authors: Chandran NS, Greaves M, Gao F, Lim L, Cheng BC

There is little published data on the incidence of eye disease in Asian patients with psoriasis. We determined the frequency of ocular complications in Singaporean Asian patients with chronic plaque psoriasis and related these to extent and severity of psoriasis, family history, treatment and presence of arthritis. A cross-sectional prevalence investigation was carried out in 100 patients who received a comprehensive eye examination. Psoriasis extent and severity was graded by the Lattice System Physician’s Global Assessment (LS-PGA). Two patients (four eyes) had uveitis, one of whom had psoriatic arthritis (2% incidence). Presence or absence of uveitis correlated with mean LS-PGA scores. Sixty-three patients had cataract unrelated to previous steroid or phototherapy treatment; in younger (5) LS-PGA scores. Three eyes in two patients (2% prevalence) had glaucomatous optic neuropathy unrelated to previous treatment, and comparable with expected population frequency. These findings, although limited by lack of data from a comparable control population, suggest that eye complications are common in Asian patients with psoriasis and eye symptoms should be elicited during history taking. Besides signs and symptoms of eye disease, an LS-PGA score of more than 5 should prompt referral for ophthalmological examination.

PMID: 18078405 [PubMed - in process]

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Detection of subclinical joint involvement in psoriasis with bone scintigraphy and its response to oral methotrexate.

Clin Exp Dermatol. 2007 Dec 10;

Authors: Raza N, Hameed A, Ali MK

Subclinical joint involvement in psoriasis has been found with bone scintigraphy. In this study, 35 of 50 (70%) patients with psoriasis without clinical arthropathy had joint involvement on bone scintigraphy. Patients with positive bone scans were started on oral methotrexate, and 20 patients who completed treatment had repeat bone scintigraphy. Of the 20 patients, the post-treatment bone scans found that 12 (60%) had involvement of different sets of joints, 1 (5%) had no change and 7 (35%) patients had fewer joints involved. We suggest that subclinical joint involvement in psoriasis can be detected with bone scintigraphy, and that it is fleeting in nature. A certain degree of treatment-induced regression of joint involvement on bone scintigraphy may be possible.

PMID: 18076689 [PubMed - as supplied by publisher]

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The genetics and biology of Irf5-mediated signaling in lupus.

Autoimmunity. 2007 Dec;40(8):591-601

Authors: Kozyrev SV, Alarcon-Riquelme ME

Recently much attention was attracted to the importance of the type I interferon pathway in the initiation and development of the autoimmune disease systemic lupus erythematosus (SLE). Many SLE patients have increased serum levels of IFN-alpha and display an IFN gene expression “signature” characterized by strong overexpression of IFN-responsive genes in leukocytes and target tissues. Moreover, about 20% of cancer patients treated with IFN-alpha therapy manifest symptoms resembling SLE and some later develop the disease. One of the key genes of the IFN-alpha pathway, IRF5, was found to be strongly associated with SLE. Two functional SNPs lead to alternative splicing and altered steady-state level of IRF5 gene expression. Besides, the gene has a polymorphic inserion/deletion in exon 6, which contributes to the diversity in the isoform pattern of IRF5. Interestingly, recent studies have not found association of IRF5 with the other autoimmune diseases, such as rheumatoid arthritis or psoriasis, suggesting the unique role for IRF5 in the development of lupus. Here, we present the current knowledge on IRF5 genetics and its biological function and discuss the possible ways in which IRF5 contributes to susceptibility to SLE.

PMID: 18075793 [PubMed - in process]

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