Literature on Psoriatic Arthritis

Isoniazid intervention for latent tuberculosis among 86 patients with rheumatologic disease administered with anti-TNFalpha.

Clin Rheumatol. 2007 Feb 27;

Authors: Hanta I, Ozbek S, Kuleci S, Sert M, Kocabas A

In this study, we investigated the safety and toxicity of isoniazid (INH) intervention therapy to the patients with latent tuberculosis who were given tumor necrosis factor alpha (TNFalpha) for the treatment of their rheumatologic diseases. In this prospective clinical study, we enrolled 86 patients receiving anti-TNFalpha therapy for their rheumatologic diseases between April 2005 and September 2006. Of all the subjects, 45 had rheumatoid arthritis, 36 had ankylosing spondylitis, and 5 had psoriatic arthritis. In addition to anti-TNFalpha therapy, 60 of the 86 patients were given INH intervention for revealed latent tuberculosis. INH at a dosage of 300 mg daily was given for 9 months. Hepatotoxicity due to the INH therapy was considered when the serum alanine aminotransferase (ALT) and/or aspartate aminotransaminase (AST) levels showed at least threefold increase with respect to their baseline serum levels. Serum ALT and AST levels were measured by enzymatic colorimetric method in fasting peripheral blood samples at 0 (baseline), 1, 2, 3, 6, and 9 months. Of 86 patients, 47 (54.7%) were women (mean age+/-SD, 44.1 +/- 10.9 years) and 39 (45.3%) were men (38.8 +/- 10.1 years). Except five patients (8.3%), liver toxicity due to the INH therapy was not encountered among the patients, and after temporarily discontinuing the INH therapy of these five subjects, serum transaminase levels returned to the normal ranges. No hepatotoxicity was observed in the non-INH group. However, there was no statistical significance between INH-treated and non-INH-treated group (p = 0.317). In addition, none of the 86 patients developed active tuberculosis infection during the treatment period. In conclusion, for those patients who were assigned to the TNFalpha treatment for their rheumatologic disorders and carrying risk for latent tuberculosis, INH intervention therapy was found to be safe and efficacious.

PMID: 17332973 [PubMed - as supplied by publisher]

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Related Articles[Non-infective inflammations of the vertebral spine]

Z Orthop Ihre Grenzgeb. 2007 Jan-Feb;145(1):R1-19; quiz R20-4

Authors: Peters KM

Non-infective inflammations of the vertebral spine can be caused by seronegative spondylarthropathies or rheumatoid arthritis, respectively. Seronegative spondylarthropathies include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel diseases and undifferentiated arthritis. This review discusses etiology and pathogenesis, epidemiology, clinical features, diagnosis and differential diagnoses of these chronic inflammatory diseases with a special focus on vertebral involvement.

PMID: 17345531 [PubMed - in process]

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Related ArticlesThe pathogenic role of tissue-resident immune cells in psoriasis.

Trends Immunol. 2007 Feb;28(2):51-7

Authors: Boyman O, Conrad C, Tonel G, Gilliet M, Nestle FO

Psoriasis is a common chronic inflammatory skin disease, the study of which might also be of considerable value to the understanding of other inflammatory and autoimmune-type diseases, such as rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis and diabetes mellitus. There is clear evidence that T cells and dendritic cells have a central role in psoriasis. Based on recent data from humans and animal models, we propose that a psoriasis lesion can be triggered and sustained by the local network of skin-resident immune cells. This concept focuses attention on local, rather than systemic, components of the immune system for rationalized therapeutic approaches of psoriasis and possibly also other chronic inflammatory diseases.

PMID: 17197238 [PubMed - in process]

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Caffeine consumption and methotrexate dosing requirement in psoriasis and psoriatic arthritis.

Int J Dermatol. 2007 Feb;46(2):157-9

Authors: Swanson DL, Barnes SA, Mengden Koon SJ, El-Azhary RA

Background Recent animal and human studies have suggested that the therapeutic benefit of methotrexate in the treatment of rheumatoid arthritis may be substantially reduced in patients who are concomitantly consuming caffeine. Here, we aimed to investigate the effect of caffeine consumption on the methotrexate dosing requirements in patients with psoriasis and psoriatic arthritis. Methods One hundred and fifty patients with diagnoses of psoriasis or psoriatic arthritis were surveyed for their current weekly methotrexate dosage and their usual daily consumption of caffeine. Results Seventy-five of the patients given the survey responded; of these, 11 were eliminated because they did not report their methotrexate dosage or were no longer taking methotrexate. Of the remaining 64 patients, no correlation was found between the methotrexate dosage needed for disease maintenance and the amount of caffeine consumed. Conclusions Our findings suggest that caffeine does not affect methotrexate dosage requirements in patients with psoriasis and psoriatic arthritis. These results do not rule out an effect of caffeine in other inflammatory diseases treated with methotrexate.

PMID: 17269967 [PubMed - in process]

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Magnetic resonance imaging and bone scintigraphy in the differential diagnosis of unclassified arthritis.

Ann Rheum Dis. 2007 Feb 8;

Authors: Duer A, Ostergaard M, Vallø J, Hørslev Petersen K

OBJECTIVES: To investigate the value in clinical practice of hand magnetic resonance imaging (MRI) and whole-body bone scintigraphy in the differential diagnosis of patients with unclassified arthritis. METHODS: 41 patients with arthritis (>/=2 swollen joints; >6 months’ duration), which remained unclassified despite conventional clinical, biochemical and radiographical (hands and feet) examinations, were included. Patients who fulfilled the ACR criteria for RA, or had radiographic bone erosions, were excluded. Contrast-enhanced MRI of the wrist and metacarpophalangeal joints of the most symptomatic hand and whole-body bone scintigraphy were performed. Subsequently, two rheumatologists agreed on the most likely diagnosis and patients were treated accordingly. A final diagnosis was made by another specialist review 2 years later. RESULTS: Tentative diagnoses after MRI and bone scintigraphy were: RA: 13, osteoarthritis: 8, other inflammatory diseases: 11, arthralgias without inflammatory or degenerative origin: 9. Two years later, 11 of 13 patients with an original tentative RA diagnosis had fulfilled the ACR criteria, while 2 were reclassified (one to psoriatic arthritis (RF-negative; +psoriasis), one to unspecific selflimiting arthritis). No patients classified as non-RA at baseline had fulfilled the ACR criteria after 2 years. Presence of MRI synovitis, MRI erosion and bone scintigraphic pattern compatible with RA showed 100% specificity for an RA diagnosis at 2 years’ follow-up. CONCLUSIONS: In arthritis patients, unclassified despite conventional clinical, biochemical and radiographic examinations, MRI and scintigraphy allowed correct classification as RA or non-RA in 39 of 41 patients, when fulfilment of ACR criteria 2 years later was considered the standard reference.

PMID: 17289759 [PubMed - as supplied by publisher]

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Investigation of association of the DLG5 gene with psoriatic arthritis.

Ann Rheum Dis. 2007 Feb;66(2):273-4

Authors: Ho P, Worthington J, Bruce IN, Barton A

PMID: 17242020 [PubMed - in process]

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A follow-up study in 28 patients treated with infliximab for severe recalcitrant psoriasis: evidence for efficacy and high incidence of biological autoimmunity.

Br J Dermatol. 2007 Feb;156(2):329-36

Authors: Poulalhon N, Begon E, Lebbé C, Lioté F, Lahfa M, Bengoufa D, Morel P, Dubertret L, Bachelez H

Background Infliximab, an antitumour necrosis factor-alpha chimeric monoclonal antibody, is effective for the treatment of severe psoriasis. While the induction of antinuclear antibodies (ANA) and antidouble-stranded-DNA antibodies (anti-dsDNA-ab) is frequently observed in patients with rheumatoid arthritis and Crohn disease receiving infliximab, the incidence of induced biological and clinical autoimmunity remains unknown in the context of psoriasis. Objectives To investigate biological and clinical signs of autoimmunity in 28 patients receiving infliximab for severe, recalcitrant forms of psoriasis, and the clinical response to treatment. Methods Twenty-eight patients, 15 men and 13 women (median age 39.4 years) with psoriasis refractory to three or more systemic treatments were included. Twenty presented with plaque-type psoriasis [median Psoriasis Area and Severity Index (PASI) score 25.9; range 7.2-48], five with psoriatic erythroderma (median PASI score 54; range 48-72) and three with generalized pustular psoriasis (GPP). Psoriatic arthritis was present in 13 patients (46.4%). Infliximab 5 mg kg(-1) was given at week (W) 0, W2, W6 and every 8 weeks thereafter. Clinical data were assessed at baseline and before each infusion. Detection of ANA and of IgM and IgG anti-dsDNA-ab were performed at baseline and at W22 by immunofluorescence and enzyme-linked immunosorbent assay, respectively. Results The mean number of infliximab infusions was 5.5 (range 2-15). Among patients with plaque-type and erythrodermic psoriasis, 17 of 25 (68%) and three of five reached a PASI improvement of 75% or more, respectively, while rapid improvement of clinical and biological signs was observed in all three patients with GPP. The prevalence of positive detection of ANA raised from 12% at baseline to 72% at W22 (P = 0.0001), an increase which was also observed for IgM anti-dsDNA-ab (68% vs. 0%, P

PMID: 17223874 [PubMed - in process]

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Related ArticlesVEGF, FGF1, FGF2 and EGF gene polymorphisms and psoriatic arthritis.

BMC Musculoskelet Disord. 2007;8:1

Authors: Butt C, Lim S, Greenwood C, Rahman P

BACKGROUND: Angiogenesis appears to be a first-order event in psoriatic arthritis (PsA). Among angiogenic factors, the cytokines vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and fibroblast growth factors 1 and 2 (FGF1 and FGF2) play a central role in the initiation of angiogenesis. Most of these cytokines have been shown to be upregulated in or associated with psoriasis, rheumatoid arthritis (RA) or ankylosing spondylitis (AS). As these diseases share common susceptibility associations with PsA, investigation of these angiogenic factors is warranted. METHODS: Two hundred and fifty-eight patients with PsA and 154 ethnically matched controls were genotyped using a Sequenom chip-based MALDI-TOF mass spectrometry platform. Four SNPs in the VEGF gene, three SNPs in the EGF gene and one SNP each in FGF1 and FGF2 genes were evaluated. Statistical analysis was performed using Fisher’s exact test, and the Cochrane-Armitage trend test. Associations with haplotypes were estimated by using weighted logistic models, where the individual haplotype estimates were obtained using Phase v2.1. RESULTS: We have observed an increased frequency in the T allele of VEGF +936 (rs3025039) in control subjects when compared to our PsA patients [Fisher’s exact p-value = 0.042; OR 0.653 (95% CI: 0.434, 0.982)]. Haplotyping of markers revealed no significant associations. CONCLUSION: The T allele of VEGF in +936 may act as a protective allele in the development of PsA. Further studies regarding the role of pro-angiogenic markers in PsA are warranted.

PMID: 17204151 [PubMed - in process]

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Pyoderma vegetans associated with severe psoriatic arthritis: good response to etanercept.

Dermatology. 2007;214(1):77-81

Authors: Carrera C, Mascaró JM, Moreno-Romero JA, Iranzo P, Palou J, Zamora E, Herrero C

Pyoderma vegetans (PV) is an inflammatory dermatosis, characterized clinically by large exudative vegetating plaques, and histopathologically by epidermal pseudoepitheliomatous hyperplasia and dense inflammatory infiltrates. Although PV is a very rare condition, it is a chronic disorder that may accompany any systemic process that compromises immunity. Treatment is very difficult, and correction of predisposing causes may be useful. We present a 49-year-old woman affected by severe psoriatic arthritis since she was 19, with giant verrucous plaques on her lower limbs that had worsened progressively during the last 15 years. After ruling out other vegetating cutaneous disorders, PV was diagnosed in association with psoriasis. Despite numerous previous systemic and topical therapeutic attempts no response was observed. Etanercept was introduced, which resulted in a marked improvement within 3 weeks. Herein, we report a diagnostic and therapeutic challenge of the first case of PV associated with psoriasis that presented a good response to etanercept.

PMID: 17191052 [PubMed - in process]

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