Literature on Psoriatic Arthritis

Related ArticlesOn the heritability of psoriatic arthritis. Disease concordance among monozygotic and dizygotic twins.

Ann Rheum Dis. 2008 Oct;67(10):1417-21

Authors: Pedersen OB, Svendsen AJ, Ejstrup L, Skytthe A, Junker P

OBJECTIVE: A nationwide unselected twin population to estimate the relative importance of genetic and environmental effectors in the aetiopathogenesis of psoriatic arthritis (PsA). METHODS: The study comprised three Danish nationwide twin cohorts. In 1994 and 2002 a total of 37 388 and 46 418 Danish twin individuals respectively were asked by questionnaire if they had PsA. Twins reporting PsA were invited to participate in a clinical examination. Patients were classified according to the Moll and Wright and the CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria. Heritability was estimated by probandwise concordance rates and variance component analysis. RESULTS: 228 twin individuals reported PsA. Following diagnostic validation in 164 (70%), 50 probands were diagnosed with PsA according to the Moll and Wright criteria. Five of their co-twins were either dead, had emigrated, or did not participate in the twin study and nine did not respond, resulting in 36 complete pairs. A total of one of 10 monozygotic pairs and one of 26 dizygotic pairs were concordant for PsA, yielding a 6.2% difference in proportions (95% CI: -11%, 37%). Five of 10 monozygotic pairs and four of 26 dizygotic pairs were concordant for psoriatic skin disease implying a 35% difference (95% CI: 2%, 60%, p

PMID: 18218666 [PubMed - indexed for MEDLINE]

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Related ArticlesThe occurrence of psoriatic arthritis in Denmark.

Ann Rheum Dis. 2008 Oct;67(10):1422-6

Authors: Pedersen OB, Svendsen AJ, Ejstrup L, Skytthe A, Junker P

OBJECTIVE: To apply and compare different classification criteria on a representative nationwide sample of psoriatic arthritis (PsA) twins and to estimate the prevalence and incidence of PsA. METHODS: The study comprised three Danish nationwide twin cohorts. In 1994 37 388 Danish twin individuals and in 2002 46 418 twin individuals received a questionnaire, including questions on rheumatic diseases. Twins reporting PsA and their co-twins were classified according to the Moll and Wright and CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria based on interview, clinical examination and scrutiny of medical records. RESULTS: 228 twin individuals reported PsA and 164 (72%) participated in clinical validation. By using the Moll and Wright and CASPAR criteria, 54 and 50 cases were diagnosed with PsA respectively. The positive predictive value of self-reported PsA was 31%. According to the Moll and Wright and CASPAR criteria the prevalence was 0.15% (95% CI: 0.13%, 0.22%) and 0.14% (95% CI: 0.11%, 0.19%) respectively. The annual incidence rate based on new self-reported cases in 2002 was 6/100 000 person-years (95% CI: 3/100 000 person-years, 11/100 000 person-years). CONCLUSIONS: The positive predictive value of self-reported PsA was 31%. The prevalence and incidence figures of PsA were equivalent to the previously reported occurrence in population- and hospital-based studies.

PMID: 18208866 [PubMed - indexed for MEDLINE]

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Related ArticlesPsoriasiform lesions induced by tumour necrosis factor antagonists: a skin-deep medical conundrum.

Ann Rheum Dis. 2008 Aug;67(8):1181-3

Authors: Carter JD, Gerard HC, Hudson AP

Rarely, tumour necrosis factor (TNF)alpha antagonist therapy has been associated with de novo psoriasiform eruptions. This is unusual in that these same drugs are used to treat psoriasis. Most of these cases involve the palms and soles, yet palmoplantar pustular psoriasis represents only 1.7% of all cases of psoriasis. Keratoderma blenorrhagicum is a psoriasiform rash that occurs primarily on the palms and soles of some patients with reactive arthritis. It is grossly and histologically indistinguishable from pustular psoriasis. Chlamydia trachomatis is a common aetiological agent for reactive arthritis, and in vitro studies have shown that chlamydial replication is inversely proportional to TNFalpha levels. Three patients taking TNFalpha antagonists are presented who developed such lesions and who were found to be positive for C trachomatis DNA in the affected skin. It is proposed that these psoriasiform lesions may not be psoriasis, but rather keratoderma blenorrhagicum.

PMID: 18299302 [PubMed - indexed for MEDLINE]

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Related ArticlesLower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case-control study.

Ann Rheum Dis. 2008 Jan;67(1):26-30

Authors: Gisondi P, Tinazzi I, El-Dalati G, Gallo M, Biasi D, Barbara LM, Girolomoni G

BACKGROUND: Psoriasis is associated with a form of spondyloarthropathy in 10-30% of cases. A major feature of psoriatic arthritis is enthesitis. In some patients with psoriasis the presence of enthesitis could be underdiagnosed. OBJECTIVE: To investigate the presence of lower limbs entheseal abnormalities in patients with chronic plaque psoriasis without signs and symptoms of psoriatic arthritis. METHODS: Thirty patients with psoriasis and 30 controls underwent ultrasonographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). RESULTS: Mean GUESS score was significantly higher in patients with psoriasis as compared with controls: 7.9 (0.6) vs 2.9 (0.3); p

PMID: 17720726 [PubMed - in process]

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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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Related ArticlesSwitching tumour necrosis factor alpha antagonists in patients with ankylosing spondylitis and psoriatic arthritis: an observational study over a 5-year period.

Ann Rheum Dis. 2007 Oct;66(10):1393-7

Authors: Conti F, Ceccarelli F, Marocchi E, Magrini L, Spinelli FR, Spadaro A, Scrivo R, Valesini G

OBJECTIVE: To evaluate the clinical response after switching from one tumour necrosis factor (TNF)alpha antagonist to another in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA). METHODS: In this ongoing, longitudinal, observational study, data were prospectively collected on efficacy and safety since 2000 for patients starting biological treatments. The present analysis was restricted to patients with a diagnosis of spondyloarthropathy (SpA) who switched from one TNFalpha antagonist to another because of inadequate efficacy or adverse events. RESULTS: In total, 589 anti-TNFalpha-naive patients were registered, of whom 165 had a diagnosis of SpA; 7 patients with AS and 15 with PsA received >1 TNFalpha antagonist. Two patients with PsA were treated with all the drugs. In all, 16 subjects switched from infliximab to etanercept, 7 from etanercept to adalimumab and 1 from etanercept to infliximab. Overall, a clinical response was seen in 75% of patients who changed from infliximab to etanercept, and in 57.1% who switched from etanercept to adalimumab. CONCLUSIONS: The findings of this study on a selected population of patients with SpA indicate that the failure of an initial TNFalpha antagonist does not preclude the response to another one. Further trials are needed to confirm this preliminary observation.

PMID: 17613555 [PubMed - indexed for MEDLINE]

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Related ArticlesThe effect of etanercept on osteoclast precursor frequency and enhancing bone marrow edema in patients with psoriatic arthritis.

Ann Rheum Dis. 2007 Oct 29;

Authors: Anandarajah AP, Schwarz EM, Totterman S, Monu J, Feng C, Shao T, Haas-Smith SA, Ritchlin CT

OBJECTIVE: The frequency of osteoclast precursors (OCPF) and the presence of bone marrow edema (BME) are potential response biomarkers in psoriatic arthritis (PsA). Previous studies suggest a central role for TNF in the formation of osteoclast precursors. To better understand this association, the effect of etanercept on OCPF and BME was analyzed in PsA patients with erosive arthritis. METHODS: Twenty PsA patients with active erosive PsA were enrolled. Etanercept was administered twice weekly for 24 weeks. OCPF was measured and clinical assessments were performed at baseline, 2, 12 and 24 weeks. Gadolinium enhanced MR images were obtained at baseline and 24 weeks. RESULTS: Significant improvement in joint score (p

PMID: 17967829 [PubMed - as supplied by publisher]

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Related ArticlesPrevalence and characteristics of uveitis in spondylarthropathies: a systematic literature review.

Ann Rheum Dis. 2007 Oct 25;

Authors: Zeboulon N, Dougados M, Gossec L

OBJECTIVES: Uveitis is reported as the most frequent extra articular manifestation in spondylarthritis (SPA) however its prevalence and characteristics are not well established. The objective was to perform a systematic literature review in order to address these issues. METHODS: DATA SOURCES: A systematic literature analysis was conducted in the Medline database up to October 2006 and in the abstracts of rheumatology scientific meetings for the years 2004, 2005 and 2006. A hand search of references was also performed. Review methods: Articles were analysed if they reported the prevalence or the characteristics of uveitis in SPA. Data abstraction was standardized. Statistical analysis was mainly descriptive. RESULTS: Among the 957 articles selected by the search, 126 articles (29,877 patients) allowed a calculation of the prevalence of uveitis in SPA; 36 articles (1,989 patients) described its characteristics. Prevalence of uveitis was 32.7+/-0.5%; it varied with the type of SPA, e.g. 33.2+/-0.8% for ankylosing spondylitis versus 25.1+/-2.3% for psoriatic arthritis. This prevalence increased with mean disease duration and was higher in HLA B27 positive patients with an odds ratio of 4.2. Uveitis was acute in 88.7+/-2.5%, anterior in 90.5+/-2.0%, unilateral in 87.3+/-2.8%. Recurrence concerned 50.6+/-2.6% and a reduction of visual acuity was observed in 8.3+/-3.8%. CONCLUSION: Prevalence of uveitis varies with disease duration and according to the type of SPA. Reduction of visual acuity is not exceptional. Because of recent promising data concerning the effects of anti tumor necrosis factor therapy on uveitis flares in SPA, it was important to determine this baseline prevalence.

PMID: 17962239 [PubMed - as supplied by publisher]

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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 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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