Literature on Psoriatic Arthritis

Related ArticlesAssessing the impact of psoriatic arthritis on patient function and quality of life: lessons learned from other rheumatologic conditions.

Semin Arthritis Rheum. 2009 Feb;38(4):320-35

Authors: Mease PJ

OBJECTIVES: To identify and describe measures that can be used to assess the impact of psoriatic arthritis (PsA) on patient functioning and health-related quality of life (HRQOL). METHODS: A literature search of the PubMed database to identify papers describing assessment tools for quality of life and function in rheumatic diseases. RESULTS: Many tools have been developed that can be used to assess the impact of rheumatic disease on patient functioning and HRQOL. Although several disease-specific tools have been developed for rheumatoid arthritis, ankylosing spondylitis, and psoriasis, few have been developed specifically for PsA, a condition that affects both skin and joints. However, several have been adopted from their use in other conditions and used in clinical trials, such as the Health Assessment Questionnaire and Short Form 36 and have shown good performance characteristics. The Psoriatic Arthritis Quality of Life questionnaire, a recently developed disease-specific instrument, has good internal consistency, validity, and reliability. Initiatives are underway by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis to evaluate Psoriatic Arthritis Quality of Life responsiveness to treatment in clinical trials, in addition to other projects intended to improve the assessment of quality of life and function in PsA. These efforts are influenced by “lessons learned” from assessment tools in rheumatoid arthritis, ankylosing spondylitis, and psoriasis. CONCLUSIONS: Assessing the impact of PsA and its treatment on patient function and quality of life is critical to improving patient outcomes, and therefore, valid and reliable tools that can be easily used in both clinical trials and clinical practice are being developed and refined.

PMID: 18304610 [PubMed - in process]

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Related ArticlesUsefulness of magnetic resonance imaging of the hand versus anticyclic citrullinated peptide antibody testing to confirm the diagnosis of clinically suspected early rheumatoid arthritis in the absence of rheumatoid factor and radiographic erosions.

Semin Arthritis Rheum. 2008 Oct;38(2):101-9

Authors: Narváez J, Sirvent E, Narváez JA, Bas J, Gómez-Vaquero C, Reina D, Nolla JM, Valverde J

OBJECTIVE: The diagnosis of rheumatoid arthritis (RA) is sometimes difficult to establish early in the disease process, particularly in the absence of its classic hallmarks. Our aim was to compare the practical usefulness of magnetic resonance imaging (MRI) of the hand versus anticyclic citrullinated peptide (anti-CCP) antibody testing to confirm the diagnosis of clinically suspected RA in the absence of rheumatoid factor (RF) and radiographic erosions. METHODS: We prospectively included patients with early inflammatory arthritis and strong clinical suspicion of RA, in whom initial complementary tests (RF and radiographs of hands, wrists, and feet) did not provide unequivocal confirmation of the diagnosis. In all patients, anti-CCP antibodies were assessed and contrast-enhanced MRI of the most affected hand was performed according to a specifically designed protocol. The MRI criterion for the diagnosis of RA was either the presence of synovitis with bone erosions or bone marrow edema, which is currently considered to be a forerunner of erosions. RESULTS: In the 40 patients (28 women), the mean age at diagnosis was 54 +/- 6 years and the median duration of symptoms was 4 +/- 2.6 months (range 1.5 to 12). Final diagnoses at 1-year follow-up were RA in 31 patients, undifferentiated arthritis in 7 (5 self-limiting), and psoriatic arthropathy (PsA) and antisynthetase syndrome in 1 patient each. Anti-CCP antibodies were positive only in 7 patients, all of whom were finally diagnosed with RA. The prevalence of anti-CCP positivity in our series of seronegative RA patients was thus 23% (7/31); in these patients the anti-CCP antibodies had a specificity of 100% (95% CI: 71.7 to 100) and sensitivity of 23% (95% CI: 9.6 to 41.1). Use of the MRI criterion led to the correct diagnosis in 100% of patients with RA and to false-positive results (1 with PsA and 1 with antisynthetase syndrome). The MRI criterion had a specificity of 78% (95% CI: 40.0 to 97.2) and sensitivity of 100% (95% CI: 90.8 to 100) for identification of seronegative RA. CONCLUSION: Although the tests are not mutually exclusive, in our experience MRI is more helpful than anti-CCP antibody determination in confirming the diagnosis of clinically suspected early RA in patients in whom the diagnosis cannot be confirmed using conventional methods.

PMID: 18221987 [PubMed - indexed for MEDLINE]

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Related ArticlesInsights into the pathology and treatment of spondyloarthritis: from the bench to the clinic.

Semin Arthritis Rheum. 2008 Oct;38(2):83-100

Authors: Davis JC, Mease PJ

OBJECTIVE: The spondyloarthritides are a set of chronic inflammatory diseases that consists of 5 interrelated subsets (ankylosing spondylitis [AS], psoriatic arthritis [PsA], reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated spondyloarthropathy). The aim of this review was to evaluate the classification, genetic susceptibility, pathology, and response to treatment of spondyloarthritis (SpA). METHODS: Searches were conducted of the PubMed database for articles focusing on the classification, pathology, and treatment of SpA. RESULTS: The 5 subsets of SpA share many clinical, immunohistochemical, and genetic features, including the common presence of human leukocyte antigen-B27 and the absence of rheumatoid factor. Evidence suggests that the pathology of SpA is mediated by immune cells. In particular, tumor necrosis factor-alpha appears to be an important driver of inflammation and damage in SpA. A number of different SpA classification criteria have been developed, including the Modified New York Criteria for AS, the European Spondyloarthropathy Study Group criteria, the Amor criteria, as well as criteria for PsA, notably the Moll and Wright criteria and the Classification of Psoriatic Arthritis criteria. Suboptimal efficacy and adverse effects often limit the use of conventional pharmacologic treatments for SpA, including nonsteroidal antiinflammatory drugs and disease-modifying antirheumatic drugs, such as methotrexate and sulfasalazine. Recent evidence has demonstrated that targeted biologic response modifiers, such as TNF-alpha antagonists, are well tolerated and efficacious treatments for SpA. CONCLUSIONS: Significant advances have occurred in our understanding of the pathophysiology, diagnosis, and classification of the spondyloarthritides and effective treatments are available.

PMID: 18166219 [PubMed - indexed for MEDLINE]

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A Comparison of the Efficacy and Safety of Celecoxib 200 mg and Celecoxib 400 mg Once Daily in Treating the Signs and Symptoms of Psoriatic Arthritis.

Semin Arthritis Rheum. 2007 Dec;37(3):164-73

Authors: Kivitz AJ, Espinoza LR, Sherrer YR, Liu-Dumaw M, West CR

OBJECTIVE: To evaluate the efficacy of the cyclooxygenase-2 selective inhibitor celecoxib in treating patients with psoriatic arthritis (PsA) in flare. METHODS: This 12-week, multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group study compared the efficacy and safety of celecoxib 400 mg (n = 201) or celecoxib 200 mg (n = 213) once daily (qd) with placebo (n = 194) in treating the signs and symptoms of PsA in flare. The primary efficacy measure was the number of patients responding to treatment according to the American College of Rheumatology Responders Index 20% (ACR-20) at week 12. Efficacy and safety were assessed for all randomized patients who received at least 1 dose of study medication. RESULTS: At the week-12 primary endpoint, approximately 50% of patients in each treatment group were responders according to the ACR-20 criteria, and no statistically significant treatment differences between treatment groups were observed. However, at week 2, the ACR-20 response rates for the celecoxib 400 mg (49%) and 200 mg (39%) groups were significantly higher than for the placebo group (28%) (P

PMID: 17570469 [PubMed - in process]

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Related ArticlesSustained Clinical Response and High Infliximab Survival in Psoriatic Arthritis Patients: A 3-year Long-Term Study.

Semin Arthritis Rheum. 2007 Sep 19;

Authors: Voulgari PV, Venetsanopoulou AI, Exarchou SA, Alamanos Y, Tsifetaki N, Drosos AA

OBJECTIVE: To investigate the efficacy, toxicity, and survival of infliximab in patients with psoriatic arthritis (PsA). METHODS: Thirty-two patients with PsA, refractory to at least 2 disease-modifying antirheumatic drugs, were included in this prospective, open-label, uncontrolled study. All had active disease, defined as having a tender or swollen joint count >/=6, Psoriasis Area and Severity Index (PASI) scores >/=10, and erythrocyte sedimentation rate >/=28 mm Hg/h, or C-reactive protein >/=10 mg/L. The primary endpoints were the percentage of patients who achieved the Psoriatic Arthritis Response criteria (PsARC) and the improvement of PASI. Patients were treated with infliximab (5 mg/kg) at weeks 0, 2, 6, and every 8 weeks thereafter for a period of 3 years. Data concerning infliximab efficacy, tolerability, concomitant therapy, adverse events, and drug discontinuation were recorded. The clinical response according to the American College of Rheumatology (ACR) criteria as well as the disease activity for 28 joint indices score (DAS-28) were also recorded. RESULTS: After the third year of treatment, PsARC was achieved by 23/32 of patients, PASI 70 by 24/32, and PASI 90 by 23/32. A significant improvement of ACR and DAS-28 was noted. Clinical improvement was associated with a reduction of acute phase reactants. Eight patients withdrew from the study primarily for acute allergic reactions. After the first year, infliximab survival was 84%, while after the second year, it was 75%, which was maintained throughout the third year of treatment. CONCLUSION: Infliximab was effective, safe, and well tolerated in patients with PsA. The clinical response was maintained for a period of 3 years with high infliximab survival.

PMID: 17888499 [PubMed - as supplied by publisher]

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Lack of echocardiographic and Doppler abnormalities in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors.

Semin Arthritis Rheum. 2006 Apr;35(5):333-9

Authors: Gonzalez-Juanatey C, Amigo-Diaz E, Miranda-Filloy JA, Testa A, Revuelta J, Garcia-Porrua C, Martin J, Llorca J, Gonzalez-Gay MA

OBJECTIVE: To assess the prevalence of echocardiographic and Doppler abnormalities in psoriatic arthritis (PsA) patients without clinically evident cardiovascular manifestations or classic atherosclerosis risk factors. METHODS: Fifty PsA patients were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients seen during the period of recruitment that had classic cardiovascular risk factors or had suffered cardiovascular or cerebrovascular events were excluded. Fifty healthy matched controls were also studied. Echocardiographic and Doppler studies were performed in all cases and controls. RESULTS: In PsA patients the frequency of aortic and tricuspid (10%) and mitral regurgitation (16%) was not different from that seen in matched controls (10, 4, and 12%). Also, the pulmonary artery systolic pressure was normal in the group of PsA patients (23.4+/-3.9 mm Hg). The prevalence of diastolic dysfunction, in all cases due to impaired relaxation, was similar in PsA patients (28%) and controls (24%) (P=0.65). In addition, no significant echocardiographic and Doppler differences were observed when PsA patients with polyarticular pattern were compared with the remaining PsA patients. CONCLUSIONS: The present study shows that actively treated PsA patients without cardiovascular risk factors or clinically evident cardiovascular disease do not exhibit silent subclinical echocardiographic abnormalities.

PMID: 16616156 [PubMed - indexed for MEDLINE]

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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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Related ArticlesCardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis.

Semin Arthritis Rheum. 2004 Dec;34(3):585-92

Authors: Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT

OBJECTIVE: To evaluate the cardiovascular risk profile of spondylarthropathy patients, particularly ankylosing spondylitis and psoriatic arthritis. METHODS: A Pubmed literature search was performed to collect English-language articles for this clinically orientated review. Studies were selected if they included (cardiovascular) mortality and morbidity and/or data about cardiovascular risk factors in spondylarthropathies. RESULTS: Ankylosing spondylitis as well as psoriatic arthritis appear to be associated with an increased cardiovascular mortality and morbidity. Several factors, ie, smoking, altered lipid profile, hypertension, increased fibrinogen level, enhanced number of platelets, and hypercoagulability might explain the enhanced cardiovascular risk. Moreover, a decline in physical activity, the presence of HLA-B27, and inflammation may play a role. Finally, undertreatment of cardiovascular morbidity also may contribute to the higher cardiovascular risk. CONCLUSIONS: The available data indicate an increased cardiovascular risk in spondylarthropathy patients, particularly those with ankylosing spondylitis and psoriatic arthritis. RELEVANCE: Rheumatologists should be aware of the enhanced cardiovascular risk in patients with ankylosing spondylitis and psoriatic arthritis. If modifiable cardiovascular risk factors are identified, treatment could ultimately result in a lower cardiovascular morbidity and mortality.

PMID: 15609262 [PubMed - indexed for MEDLINE]

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