Literature on Psoriatic Arthritis

Related ArticlesDetailed analysis of the cell infiltrate and the expression of mediators of synovial inflammation and joint destruction in the synovium of patients with psoriatic arthritis: implications for therapy.

Ann Rheum Dis. 2006 May 25;

Authors: van Kuijk AW, Reinders-Blankert P, Smeets TJ, Dijkmans BA, Tak PP

OBJECTIVE: The synovial tissue is a primary target of many inflammatory arthropathies, including psoriatic arthritis (PsA). Identification of pro- inflammatory molecules in the synovium may help to identify potentially therapeutic targets. Therefore, we performed a study investigating extensively the features of cell infiltration and expression of mediators of inflammation and joint destruction in the synovium of PsA patients compared with rheumatoid arthritis (RA) patients matched for disease duration and use of medication. METHODS: Multiple synovial tissue biopsies were obtained by arthroscopy from an inflamed joint in 19 patients with PsA (8 oligoarthritis, 11 polyarthritis) and 24 patients with RA. Biopsy specimens were analyzed by immunohistochemistry to detect T cells, plasma cells, fibroblast-like synoviocytes, macrophages, pro- inflammatory cytokines, matrix metalloproteinases and tissue inhibitor metalloproteinase-1, adhesion molecules and vascular markers. Stained sections were evaluated by digital image analysis. RESULTS: The synovial infiltrate of PsA and RA patients was comparable with regard to numbers of fibroblast-like synoviocytes and macrophages. T cell numbers were significantly lower in the synovium of PsA patients. The number of plasma cells also tended to be lower in PsA. The expression of TNF-alpha, IL-1beta, IL- 6 and IL-18 was in PsA as high as in RA. The expression of MMPs, adhesion molecules, and vascular markers was comparable for PsA and RA. CONCLUSION: These data demonstrate increased pro- inflammatory cytokine expression in PsA synovium, comparable with results obtained in RA, and support the notion that in addition to TNF-alpha blockade, there may be a rationale for therapies directed at IL-1beta, IL-6 and IL-18.

PMID: 16728461 [PubMed - as supplied by publisher]

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Related ArticlesSystematic Review of Treatments for Psoriatic Arthritis: An Evidence Based Approach and Basis for Treatment Guidelines.

J Rheumatol. 2006 May 15;

Authors: Kavanaugh AF, Ritchlin CT

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disorder characterized by the association of arthritis and psoriasis. In addition to a heterogeneous and variable clinical course, PsA is complex and multifaceted and may include prominent involvement in the peripheral and axial diarthrodial joints, the skin and nails, and in periarticular structures such as entheses. A central mission of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is to develop guidelines, based upon the best scientific evidence, for the optimal treatment of patients with PsA. We outline the specific methods and procedures used in this evidence-based, systematic review of treatments for PsA, which we hope will provide a basis for future treatment guidelines.

PMID: 16724373 [PubMed - as supplied by publisher]

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Related ArticlesTherapies for Peripheral Joint Disease in Psoriatic Arthritis. A Systematic Review.

J Rheumatol. 2006 May 15;

Authors: Soriano ER, McHugh NJ

OBJECTIVE: Traditional drug treatments for psoriatic arthritis (PsA) include nonsteroidal antiinflammatory agents (NSAID) and disease modifying antirheumatic drugs (DMARD), although the evidence base for their effectiveness is not well established. This review was compiled from a comprehensive literature search of electronic bibliographic databases for all English publications that were systematic reviews, metaanalyses, randomized controlled trials, controlled trials, and observational studies. The evidence supports NSAID for symptom relief, although data are lacking for COX-2-specific agents. No evidence exists to support systemic corticosteroids or corticosteroids by intraarticular injection, although the latter are commonly used in clinical practice. Among traditional DMARD, grade 1B evidence supports sulfasalazine, cyclosporine, and leflunomide for symptom relief, with lower-grade evidence for methotrexate. None of them slows radiographic progression. Grade 1B evidence supports improvement in symptoms, physical function, quality of life, and radiographic progression with anti-TNF antagonists (etanercept, infliximab, and adalimumab). The relative lack of evidence poses challenges in developing algorithms for treatment of peripheral arthritis in PsA.

PMID: 16724372 [PubMed - as supplied by publisher]

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Related ArticlesTherapies for Axial Disease in Psoriatic Arthritis. A Systematic Review.

J Rheumatol. 2006 May 15;

Authors: Nash P

Prevalence rates for axial involvement in psoriatic arthritis (PsA) vary from 40% to 74% depending upon criteria for diagnosis. In the absence of trial evidence to assess axial involvement in PsA, the GRAPPA group, by consensus, has suggested that outcome measures and therapies for axial disease in ankylosing spondylitis (AS) be used. This systematic review addresses the management of axial disease in PsA, and provides treatment recommendations based on the AS literature.

PMID: 16724371 [PubMed - as supplied by publisher]

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Related ArticlesTherapies for Dactylitis in Psoriatic Arthritis. A Systematic Review.

J Rheumatol. 2006 May 15;

Authors: Helliwell PS

Dactylitis is a hallmark clinical feature of psoriatic arthritis (PsA). Acute dactylitis appears to be a severity marker for PsA and psoriasis. Traditionally, clinicians have used nonsteroidal antiinflammatory rheumatic drugs and local corticosteroid injections to treat dactylitis, although conventional disease modifying antirheumatic drugs also are recommended. In this systematic review, the limited data on treatments for dactylitis in PsA highlight the need for a valid, reliable, and responsive clinical outcome measure. Infliximab is the only drug to demonstrate significant improvement of dactylitis during a clinical study.

PMID: 16724369 [PubMed - as supplied by publisher]

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Related ArticlesTherapies for Psoriatic Enthesopathy. A Systematic Review.

J Rheumatol. 2006 May 15;

Authors: Ritchlin CT

Enthesitis is defined as inflammation at sites of tendon, ligament, joint capsule, or fascia insertion sites to bone, and is a hallmark feature of psoriatic arthritis. Several outcome measures have been developed to assess enthesitis, but none have been validated in psoriatic arthritis. In this evidence-based review, we assess the limited data on treatments for enthesitis and make recommendations for further studies in psoriatic enthesitis.

PMID: 16724370 [PubMed - as supplied by publisher]

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Related ArticlesPharmacoeconomic considerations in the treatment of psoriatic arthritis.

Rheumatology (Oxford). 2006 May 16;

Authors: Kavanaugh A

PMID: 16705044 [PubMed - as supplied by publisher]

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Related Articles[Psoriasis and psoriatic arthritis]

Rev Med Liege. 2006 May-Jun;61(5-6):334-40

Authors: Henno A, Rausin A, Malaise M, de la Brassinne M

Psoriasis is a frequent multifactorial chronic skin disease that can lead to a decreased quality of life. Some patients also present arthritis. Those two complex inflammatory diseases share some of their characteristics, but several clinical manifestations can be distinguished in each of them. In addition to classical medications (constituted of topical treatments, methotrexate, ciclosporin and retinoids for cutaneous psoriasis and non steroidal anti-inflammatory drugs or methotrexate for psoriatic arthritis), they are the target of a new generation of therapies: the biologics.

PMID: 16910258 [PubMed - in process]

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Related ArticlesJuvenile psoriatic arthritis and acquired sensorineural hearing loss in a teenager: is there an association?

Clin Exp Rheumatol. 2006 May-Jun;24(3):344-6

Authors: Giani T, Simonini G, Lunardi C, Puccetti A, De Martino M, Falcini F

Autoimmune inner ear disease is a cause of sensorineural hearing loss, first described in 1979 by McCabe. The occurrence during rheumatic diseases is already documented in adults, but to our knowledge, this evidence is still lacking in children. A 13-yr-old girl affected by juvenile psoriatic arthritis, treated with etanercept, developed a bilateral and asymmetric sensorineural deafness. The patient significantly improved after steroid administration. Once ruled out the principal causes of sensorineural hearing loss, we also considered the hypothesis of an anti-TNF side effect. However, the clinical presentation, the efficacy on steroid treatment and the presence of inner ear auto-antibodies prompt us to consider autoimmune-SNHL as the most plausible diagnosis. The young age of our patient seems to suggest a genetic susceptibility to autoimmunity and supports the concept of associated autoimmune diseases.

PMID: 16870107 [PubMed - in process]

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Related ArticlesPatients with psoriatic arthritis have an increased number of lymphocytes in the duodenal mucosa in comparison with patients with psoriasis vulgaris.

J Rheumatol. 2006 May;33(5):924-7

Authors: Lindqvist U, Kristjánsson G, Pihl-Lundin I, Hagforsen E, Michaëlsson G

OBJECTIVE: To determine if there is evidence of inflammation in the duodenal mucosa in patients with psoriatic arthritis (PsA) and to compare the results with those in patients with psoriasis vulgaris (PsV). METHODS: Nineteen consecutive patients with PsA underwent gastroduodenoscopy, and biopsy specimens were taken from the duodenal and gastric mucosa. In addition to routine processing, the duodenal mucosal specimens were stained for CD3+, CD8+ and CD4+ T lymphocytes, tryptase-positive mast cells, and EG2-positive eosinophil granulocytes. The results were compared with those in duodenal mucosal specimens from patients with PsV and patients with irritable bowel syndrome. RESULTS: Compared with PsV patients (without antibodies against gliadin), patients with PsA had a highly significant increase in intraepithelial CD3+ and CD8+ lymphocytes and also in CD4+ lymphocytes in the lamina propria in the villi. The lymphocyte increase was not related to presence of IgA antibodies against gliadin, endomysium, or transglutaminase, or to concomitant gastritis. Patients with PsA and PsV showed a pronounced increase in mast cells and eosinophil granulocytes. CONCLUSION: The increased lymphocyte infiltration in the duodenal mucosa in PsA, but not in PsV, might indicate different pathogenetic mechanisms in these psoriasis variants.

PMID: 16541478 [PubMed - indexed for MEDLINE]

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