Literature on Psoriatic Arthritis

Related ArticlesTargeting effector memory T-cells with Kv1.3 blockers.

Curr Opin Drug Discov Devel. 2007 Jul;10(4):438-45

Authors: Wulff H, Pennington M

After initially being pursued for general immunosuppression, the voltage-gated potassium channel Kv1.3 has more recently emerged as an attractive pharmacological target for the selective suppression of CCR7- effector memory T-cells in T-cell mediated autoimmune diseases such as multiple sclerosis, type 1 diabetes, rheumatoid arthritis and psoriasis. This article gives a brief summary of the role of Kv1.3 in autoimmune diseases, reviews the progress made in both developing peptidic and small-molecule inhibitors for this challenging target, and in validating Kv1.3 as a target for the treatment of autoimmune diseases.

PMID: 17659485 [PubMed - indexed for MEDLINE]

]]>

Related ArticlesPathogenesis and clinical features of psoriasis.

Lancet. 2007 Jul 21;370(9583):263-71

Authors: Griffiths CE, Barker JN

Psoriasis, a papulosquamous skin disease, was originally thought of as a disorder primarily of epidermal keratinocytes, but is now recognised as one of the commonest immune-mediated disorders. Tumour necrosis factor alpha, dendritic cells, and T-cells all contribute substantially to its pathogenesis. In early-onset psoriasis (beginning before age 40 years), carriage of HLA-Cw6 and environmental triggers, such as beta-haemolytic streptococcal infections, are major determinants of disease expression. Moreover, at least nine chromosomal psoriasis susceptibility loci have been identified. Several clinical phenotypes of psoriasis are recognised, with chronic plaque (psoriasis vulgaris) accounting for 90% of cases. Comorbidities of psoriasis are attracting interest, and include impairment of quality of life and associated depressive illness, cardiovascular disease, and a seronegative arthritis known as psoriatic arthritis. A more complete understanding of underlying pathomechanisms is leading to new treatments, which will be discussed in the second part of this Series.

PMID: 17658397 [PubMed - indexed for MEDLINE]

]]>

Related ArticlesEfficacy and tolerability of anti-TNF therapy in psoriatic arthritis patients: Results from the South Swedish Arthritis Treatment Group Register.

Ann Rheum Dis. 2007 Jul 20;

Authors: Kristensen LE, Gülfe A, Saxne T, Geborek P

BACKGROUND: The use of TNF blocking agents in psoriatic arthritis (PsA) is increasing, and the SSATG register has followed patients with PsA for more than 5 years. OBJECTIVE: To present efficacy and tolerability data of TNF-blocking agents on PsA in clinical practice. Also to study potential predictors for drug survival. Material and METHODS: Patients (n=261) with active PsA, starting anti-TNF therapy for the first time in southern Sweden, were included. Basal characteristics, disease activity measures, and termination reason for TNF-blockers were prospectively collected during the period April 1999 to September 2006. Cox proportional hazard models were used to investigate predictors for treatment termination. RESULTS: Overall, response rates at 3-12 months for VASglobal50 and VASpain50 were about 50%, whereas response rates for EULAR overall and EULAR good were around 75% and 55%, respectively. Concomitant MTX (HR=0.64 (95% CI 0.39-0.95), p=0.03), etanercept (HR=0.49 (0.28-0.86), p=0.01), and high CRP-levels (HR=0.77 (0.61-0.97), p=0.03) at treatment initiation were associated with better overall drug survival. The improved drug survival of concomitant MTX appeared to be related to significantly fewer drop outs because of adverse events (HR= 0.24 (0.11-0.52), p

PMID: 17644547 [PubMed - as supplied by publisher]

]]>

Related ArticlesDo all anti-citrullinated protein/peptide antibody (ACPA) tests measure the same? Evaluation of discrepancy between ACPA tests in RA and non-RA patients.

Ann Rheum Dis. 2007 Jul 20;

Authors: Vander Cruyssen B, Nogueira L, Van Praet J, Deforce D, Elewaut D, Serre G, de Keyser F

BACKGROUND: Different methods exist to demonstrate anti-citrullinated protein/peptide antibodies (ACPA). Aims: To evaluate discrepancy between 4 ACPA tests. Patients and METHODS: Population 1 consisted of patients with a new diagnostic problem including 86 RA and 450 non-RA patients. Population 2 consisted of 155 RA patients with longstanding disease. Population 3 consisted of 188 psoriatic arthritis (PsA) patients and population 4 consisted of 192 lupus (SLE) patients. Populations 1 and 2 were tested with the anti-human fibrinogen antibodies (AhfibA) test, anti-CCP2 from Eurodiagnostica (CCP2-euro), anti-CCP2 from Pharmacia (CCP2-phar) and anti-CCP3 test by Inova (CCP3). Samples were annotated as discrepant if positive in one and negative in at least one other test. Each discrepant sample was re-analyzed in a different run. Populations 3 and 4 were analyzed in the CCP2-euro and AhFibA test. RESULTS: In population 1, ACPA positivity was found in 17 of 450 (3.8%) non-RA patients. 14 (82%) of those 17 samples were discrepant. In contrast, 61 (70.9%) of 86 RA patients were ACPA positive of whom 18 (29.5%) out of 61 were discrepant (70.9% vs. 29.5%, p

PMID: 17644546 [PubMed - as supplied by publisher]

]]>

Related ArticlesAutoimmune diseases induced by TNF-targeted therapies: analysis of 233 cases.

Medicine (Baltimore). 2007 Jul;86(4):242-51

Authors: Ramos-Casals M, Brito-Zerón P, Muñoz S, Soria N, Galiana D, Bertolaccini L, Cuadrado MJ, Khamashta MA

Tumor necrosis factor (TNF)-targeted therapies are increasingly used for a rapidly expanding number of rheumatic and autoimmune diseases. With this use and longer follow-up periods of treatment, there are a growing number of reports of the development of autoimmune processes related to anti-TNF agents. We have analyzed the clinical characteristics, outcomes, and patterns of association with the different anti-TNF agents used in all reports of autoimmune diseases developing after TNF-targeted therapy found through a MEDLINE search of articles published between January 1990 and December 2006. We identified 233 cases of autoimmune diseases (vasculitis in 113, lupus in 92, interstitial lung diseases in 24, and other diseases in 4) secondary to TNF-targeted therapies in 226 patients. The anti-TNF agents were administered for rheumatoid arthritis (RA) in 187 (83%) patients, Crohn disease in 17, ankylosing spondylitis in 7, psoriatic arthritis in 6, juvenile RA in 5, and other diseases in 3. The anti-TNF agents administered were infliximab in 105 patients, etanercept in 96, adalimumab in 21, and other anti-TNF agents in 3. We found 92 reported cases of lupus following anti-TNF therapy (infliximab in 40 cases, etanercept in 37, and adalimumab in 15). Nearly half the cases fulfilled 4 or more classification criteria for systemic lupus erythematosus (SLE), which fell to one-third after discarding preexisting lupus-like features. One hundred thirteen patients developed vasculitis after receiving anti-TNF agents (etanercept in 59 cases, infliximab in 47, adalimumab in 5, and other agents in 2). Leukocytoclastic vasculitis was the most frequent type of vasculitis, and purpura was the most frequent cutaneous lesion. A significant finding was that one-quarter of patients with vasculitis related to anti-TNF agents had extracutaneous involvement. Twenty-four cases of interstitial lung disease associated with the use of anti-TNF agents were reported. In these patients, 2 specific characteristics should be highlighted: the poor prognosis in spite of cessation of anti-TNF therapy, and the possible adjuvant role of concomitant methotrexate. In conclusion, the use of anti-TNF agents has been associated with an increasing number of cases of autoimmune diseases, principally cutaneous vasculitis, lupus-like syndrome, SLE, and interstitial lung disease.

PMID: 17632266 [PubMed - indexed for MEDLINE]

]]>

Related ArticlesRegression analysis of multivariate panel count data.

Biostatistics. 2007 Jul 11;

Authors: He X, Tong X, Sun J, Cook RJ

We consider panel count data which are frequently obtained in prospective studies involving recurrent events that are only detected and recorded at periodic assessment times. The data take the form of counts of the cumulative number of events detected at each inspection time, along with explanatory covariates. Examples arise in diverse areas such as epidemiological studies, medical follow-up studies, reliability studies, and tumorigenicity experiments. This article is concerned with regression analysis of multivariate panel count data which arise if more than one type of recurrent event is of interest and individuals are only observed intermittently. We present a class of marginal mean models which leave the dependence structures for related types of recurrent events completely unspecified. Estimating equations are developed for regression parameters, and the resulting estimates are shown to be consistent and asymptotically normal. Simulation studies show that the proposed estimation procedures work well for practical situations. The methodology is applied to a motivating study of patients with psoriatic arthritis in which the events of interest are the onset of joint damage according to 2 different criteria.

PMID: 17626224 [PubMed - as supplied by publisher]

]]>

Related Articles[Psoriasis und Psoriasis arthritis in childhood and adolescence. Overview and consensus statement of the 9th Wörlitz Expert Round Table Discussion 2006 for the Society for Child and Adolescent Rheumatology]

Z Rheumatol. 2007 Jul;66(4):349-54

Authors: Sticherling M, Minden K, Küster RM, Krause A, Borte M

There are about 1.2-1.6 million psoriasis sufferers in Germany. In about a third of these, the disease manifests before the age of 20. A classic complication of psoriasis is psoriasis arthritis (PsA), which, from the latest figures, effects about 20% of all psoriasis patients. PsA also starts in childhood and is included under the term juvenile idiopathic arthritis (JIA). The expert round table discussion which took place in 2006 in Wörlitz elaborated the recommendations for the classification, comprehensive diagnostics and therapy of effected children and adolescents. As controlled studies are lacking, the treatment of PsA has been empirically based and carried out in analogy with the treatment of other forms of JIA. The use of methotrexate (MTX) shows a good success rate. In 2004, about a third of the patients found in the core documentation, including over 80% of children and adolescents undergoing a primary therapy, were treated with MTX, a quarter in combination with other medication. A total of 7% of all and 16% of those undergoing primary therapy were treated with etanercept, most (>80%) in combination with basis medication, usually MTX. Consensus opinion indicated that an early, and intensive local skin therapy should be applied in order to reduce inflammatory activity. If PsA is present, the early use of non-steroid anti-inflammatories as well as local therapy of the joints with the intra-articular application of glucocorticosteroids is recommended. The primary medication should preferentially be MTX, if necessary combined with other therapies. In cases of a severe, episodic progression as well as high inflammatory activity, systemic glucocorticosteroids should be considered. Further studies addressing both the clinical course of jPsA compared to the adult manifestation as well as optimal therapeutic procedures should be initiated in the near future.

PMID: 17623119 [PubMed - indexed for MEDLINE]

]]>

Related ArticlesTreatment goals in psoriasis.

J Dtsch Dermatol Ges. 2007 Jul;5(7):566-74

Authors: Reich K, Mrowietz U

The introduction of biologics has not only broadened the therapeutic armamentarium for psoriasis but also stimulated discussion about the treatment of this common skin condition. The recently presented German S3 psoriasis guideline contains detailed information on the efficacy of the different products and describes important safety and practical aspects of psoriasis treatments. Patient surveys and recent studies in Germany indicate a relatively high mean severity of skin symptoms and low quality of life among affected patients. One possible explanation is that the conventional traditional and new treatment options are not being used consistently. In this paper, minimum treatment goals for psoriasis that should be achieved by an individually selected treatment regimen are presented. If, after a defined period of time, an at least 50 % reduction of the baseline Psoriasis Area and Severity Index (PASI) and a Dermatology Life Quality Index of ( not less-than 5 is not reached, patients should be switched to another therapy, after a balanced discussion. Whenever necessary, a continuous maintenance therapy should be instituted with special attention to these goals. Patients should carefully be monitored for the presence of psoriatic arthritis and comorbidities because these may need to be integrated in the planning of treatment goals on an interdisciplinary basis.

PMID: 17610606 [PubMed - indexed for MEDLINE]

]]>