Literature on Psoriatic Arthritis

Related ArticlesDisease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER) extended report.

Rheumatology (Oxford). 2007 Aug;46(8):1309-15

Authors: Collantes E, Zarco P, Muñoz E, Juanola X, Mulero J, Fernández-Sueiro JL, Torre-Alonso JC, Gratacós J, González C, Batlle E, Fernández P, Linares LF, Brito E, Carmona L

OBJECTIVE: The national registry of spondyloarthropathies (REGISPONSER) is launched to classify patients with this group of diseases treated in Spanish rheumatology clinics. This manuscript describes the methodological and organizational background as well as characteristics of patients finally included, and provides a comparative analysis between characteristics of both ankylosing spondylitis and undifferentiated spondyloarthropathy groups of patients. PATIENTS AND METHODS: Twelve members of the GRESSER group have participated in the registry, for a one-year recruitment period. All consecutively registered adult patients treated in their clinics met the classification criteria of the European Spondyloarthropathies Study Group (ESSG). Data collected reflect the socio-demographic characteristics, as well as disease activity and functional status, clinical form at onset, treatment used and quality of life; all measured by standard instruments. RESULTS: Throughout 1 yr, 1385 patients have been included in the registry: 939 males (68%) and 440 females (32%), with an average age of 47 +/- 13 years (mean +/- s.d.), and an average disease duration of 12 +/- 9 years. Diagnoses of the included patients were: AS (n = 842, 61%), PsA (n = 290, 21%), u-SpA (n = 205, 15%), reactive arthritis (n = 16, 1.2%), inflammatory bowel disease arthritis (n = 13, 0.9%) and JCA-spondyloathropathy (n = 13, 0.9%). Regarding clinical form, 54% had axial disease, 20% peripheral disease, 24% mixed disease and 0.6% isolated enthesitic form. Low-back pain was the first symptom reported in 53% of the patients, and most common extra-articular disease manifestations were psoriasis (25%), anterior uveitis (16%) and intestinal inflammatory disease (4%). Some kind of work disability was reported by 353 patients (25.5%). CONCLUSIONS: Such databases are very useful to obtain information about characteristics of SpA patients treated in a certain location or following a specific treatment practice, and provide a tool for assessing the impact of the disease. Data collected in this registry provide an appropriate clinical and demographic profile of patients suffering from SpA in Spain.

PMID: 17526930 [PubMed - indexed for MEDLINE]

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Related ArticlesAdalimumab for severe psoriasis and psoriatic arthritis: an open-label study in 30 patients previously treated with other biologics.

J Am Acad Dermatol. 2007 Aug;57(2):269-75

Authors: Papoutsaki M, Chimenti MS, Costanzo A, Talamonti M, Zangrilli A, Giunta A, Bianchi L, Chimenti S

BACKGROUND: Psoriasis is a chronic, genetically determined, immune-mediated, inflammatory skin disease affecting approximately 2% to 3% of the Caucasian population. Previously reported data demonstrated adalimumab to be an efficacious treatment of psoriatic arthritis and plaque-type psoriasis. Adalimumab is a fully human monoclonal antibody IgG1 against tumor necrosis factor alpha. OBJECTIVE: To evaluate the efficacy and safety of adalimumab, in the treatment of psoriasis patients whose disease is refractory to treatment with other biologic agents. PATIENTS AND METHODS: Thirty patients affected by plaque-type psoriasis with or without psoriatic arthritis, unresponsive to conventional and biologic systemic treatments were enrolled. Adalimumab was administered in monotherapy, at a dosage of 40 mg, subcutaneously, once a week. RESULTS: At week 12, 26 of 30 patients (87%) achieved Psoriasis Area and Severity Index (PASI) 75; at week 24, 25 of 30 patients (83%) achieved PASI 75. Concerning psoriatic arthritis, at week 24, the mean Health Assessment Questionnaire score improved from 0.99 to 0.2, Ritchie articular index from 10.15 to 2, and Pain Visual Assessment Score from 6.32 to 1.2. Furthermore, therapy with adalimumab considerably enhanced patients’ quality of life as assessed by two measures (Dermatology Life Quality Index, Psoriasis Disability Index). Adalimumab was generally safe and well tolerated. LIMITATIONS: This is not a randomized placebo-controlled study and is restricted to a small number of patients. CONCLUSIONS: In our experience, although preliminary, monotherapy with adalimumab 40 mg weekly proved to be an effective and safe treatment for the management of plaque-type psoriasis and psoriatic arthritis, with a rapid onset of action in patients whose disease had been refractory to both conventional and biologic agents.

PMID: 17574299 [PubMed - indexed for MEDLINE]

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Related ArticlesIs there a role for topically delivered eicosapentaenoic acid in the treatment of psoriasis?

Eur J Dermatol. 2007 Jul-Aug;17(4):284-91

Authors: Zulfakar MH, Edwards M, Heard CM

The n-3 fatty acids have demonstrable biological activities and have been associated with many health improvements from child brain development to arthritis. In this review we sought to pull together the works that have examined the potential use of n-3 fatty acids in psoriasis. The rationale of using EPA and/or its metabolites is supported by findings which suggest that it has anti-inflammatory properties and plays an important role in the resolution phase of inflammation. EPA use in psoriasis has also been demonstrated in trials using oral, intravenous, and topical preparations, with generally positive outcomes. Depth profile analysis revealed that EPA and its metabolite, 15-HEPE are deposited in the epidermis, particularly in the metabolically active basal layer. This is considered advantageous in psoriasis therapy. Currently there are many unknowns about psoriasis aetiology and the effects of blocking different cytokines have on the disease progression. Furthermore not enough is known about EPA effects on cellular immunity other than via prostaglandin and leukotriene synthesis to fully understand the mode of action of EPA. However, evidence so far suggests EPA does have a potential role in the treatment of psoriasis, in particular for topical treatments either as an active anti-inflammatory agent by itself, or as a dual action permeation enhancer for other anti-psoriatic treatments. The challenges include optimising the delivery of EPA to the skin and determining the derivatives of EPA which would give maximal effects, and overcoming pharmacokinetic and formulation problems to optimally deliver EPA to its intended target cells.

PMID: 17540633 [PubMed - indexed for MEDLINE]

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Related ArticlesCytokine inhibitors in rheumatoid arthritis and other autoimmune diseases.

Curr Opin Pharmacol. 2007 Aug;7(4):412-7

Authors: Williams RO, Paleolog E, Feldmann M

The clinical success of TNFalpha blocking biologics in a growing number of immune-mediated pathologies, including rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis and psoriasis, confirms the importance of TNFalpha in driving chronic inflammation and represents an important step forward in the treatment of these conditions. TNFalpha blockade, however, is a treatment, rather than a cure, and is not effective in all patients or in all autoimmune diseases and further research is needed to get closer to a cure. Recently, the identification of a novel, IL-17 producing, T helper cell subset, that plays a dominant pathogenic role in animal models of autoimmunity, is a major advance on existing knowledge, although the role of these cells in human disease remains to be established. Cytokines driving angiogenesis are also important in disease chronicity and thus might be valid therapeutic targets.

PMID: 17627887 [PubMed - indexed for MEDLINE]

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Related ArticlesInternational spondyloarthritis interobserver reliability exercise–the INSPIRE study: I. Assessment of spinal measures.

J Rheumatol. 2007 Aug;34(8):1733-9

Authors: Gladman DD, Inman RD, Cook RJ, van der Heijde D, Landewé RB, Braun J, Davis JC, Mease P, Brandt J, Vargas RB, Chandran V, Helliwell P, Kavanaugh A, O’Shea FD, Khan MA, Pipitone N, Rahman P, Reveille JD, Stone MA, Taylor W, Veale DJ, Maksymowych WP

OBJECTIVE: To determine whether the axial measures used in primary ankylosing spondylitis (AS) were reproducible for both AS and psoriatic arthritis (PsA) with axial disease. METHODS: A group of 20 rheumatologists from 11 countries with expertise in spondyloarthritis (SpA) met for a combined physical examination exercise to assess 10 patients with PsA with axial involvement (9 men, 1 woman, mean age 52 yrs, mean disease duration 17 yrs) and 9 AS patients (7 men, 2 women, mean age 38 yrs, mean disease duration 16 yrs). A modified Latin-square design was used. Measures included were occiput to wall, tragus to wall, cervical rotation, chest expansion, lateral spinal bending, modified Schober, and hip mobility. Data were analyzed using intraclass correlation coefficients (ICC) adjusted for order of measurements. RESULTS: The majority of the variance was contributed by the patients. There was no order effect. Observer effect was noted especially for chest expansion for both AS and PsA patients, and for the modified Schober in PsA. The ICC demonstrated very good to excellent agreement for most measures for both AS and PsA. Chest expansion provided only moderate agreement for AS and PsA. CONCLUSION: Overall, measures of spinal mobility used in primary AS perform well with respect to interobserver reliability, and are equally reproducible when applied to PsA patients with axial involvement. Thus, these measures should now be evaluated in therapeutic trials of patients with PsA to determine sensitivity to change and concordance with other measures of structural damage.

PMID: 17611985 [PubMed - indexed for MEDLINE]

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Related ArticlesInvestigating the role of the HLA-Cw*06 and HLA-DRB1 genes in susceptibility to psoriatic arthritis: comparison with psoriasis and undifferentiated inflammatory arthritis.

Ann Rheum Dis. 2007 Aug 29;

Authors: Ho PY, Barton A, Worthington J, Plant D, Griffiths CE, Young HS, Bradburn P, Thomson W, Silman AJ, Bruce IN

OBJECTIVE: Psoriasis of early onset (Type I; age of onset 40 years). HLA-DRB1*07, in linkage disequilibrium with HLA-Cw*06, was also associated with PsA patients having type I psoriasis (OR 2.7, 95% CI 2.1, 3.7, p

PMID: 17728335 [PubMed - as supplied by publisher]

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Related ArticlesMethotrexate combined with isoniazid therapy for latent tuberculosis is well tolerated in rheumatoid arthritis patients: experience from an urban arthritis clinic.

Ann Rheum Dis. 2007 Aug 29;

Authors: Mor A, Bingham CO, Kishimoto M, Izmirly PM, Greenberg J, Reddy S, Rosenthal PB

OBJECTIVES: Reactivation of Mycobacterium tuberculosis (TB) is a significant problem with all available tumor necrosis factor (TNF) antagonists when used to treat rheumatoid arthritis (RA), psoriatic arthritis, psoriasis and other inflammatory diseases. Concerns have been raised regarding the appropriate management of patients with latent TB (LTB) exposure (or active TB infection) before initiating TNF antagonists since the safety data of combined therapy with two potentially hepatotoxic medications, methotrexate (MTX) and isoniazid (INH), is lacking. The goal of this study was to investigate the toxicity of MTX and INH therapy in RA patients before initiating TNF antagonists. METHODS: To investigate the toxicity of MTX and INH therapy in RA patients we performed a retrospective chart review of patients seen at the Bellevue Hospital Arthritis Clinic in New York City between 2002-2006. Forty-four patients who were concomitantly treated with both drugs were included. The primary outcome investigated was increase in liver function tests (LFT). RESULTS: Transient increases in LFT were seen in 11% of patients, but in no case was this more than twice the upper limit of normal values. All abnormal LFT resolved spontaneously without intervention. In addition, no patient has developed signs or symptoms of TB reactivation. CONCLUSION: The use of INH for LTB was well tolerated in RA patients on a background regimen of MTX. While the risks and benefits of all therapy must always be considered, in our experience the additive risk of INH to MTX in terms of hepatotoxicity was low. Nonetheless it is prudent to follow LFT closely on patients taking this combination.

PMID: 17711866 [PubMed - as supplied by publisher]

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Related ArticlesCombination immunosuppressive therapies: the promise and the peril.

Arch Dermatol. 2007 Aug;143(8):1053-7

Authors: Robinson MR, Korman BD, Korman NJ

BACKGROUND: Targeted immunotherapeutic agents (TIs), also known as biological agents, are efficacious treatments for many immunologically mediated disorders, including psoriasis. In several of these diseases, including rheumatoid arthritis, Crohn’s disease, and multiple sclerosis, certain TIs have been studied in combination with nonspecific immunosuppressive agents and with other TIs. OBSERVATIONS: Recently, the rheumatology, neurology, and gastroenterology literature has reported several examples of possible associated toxic effects when certain TIs are used in combination with other immunosuppressive agents. These toxic effects have included an increased risk of infection and malignancy. CONCLUSIONS: Combination therapies are often used by dermatologists. Several TIs have been approved for psoriasis; however, clinical trials using these drugs in combination with other immunosuppressive agents have not yet been performed. The implications for dermatologists of the toxic effects associated with TI combination therapy are unclear. However, combination therapy with certain TIs should be used with caution until more data are available.

PMID: 17709665 [PubMed - indexed for MEDLINE]

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Related Articles[Juvenile psoriatic arthritis]

Zhongguo Dang Dai Er Ke Za Zhi. 2007 Aug;9(4):339-42

Authors: Lu S, Zhou W, Zhang Q, Yu XY, Liu DM, Liu XY

A case of juvenile psoriatic arthritis in a 12 year-old boy was reported. The patient had a history of one and half a year of bilateral heel pain, followed by pain in the right knee and ankle and right hip joint. He developed psoriatic lesions affecting his nails and skin. He had increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) contents. Human leukocyte antigen (HLA) B27 was detected but serum rheumatoid factor was not in the patient. A skin biopsy revealed psoriasis and ultrasonography demonstrated synovitis in right knee and ankle. Juvenile psoriatic arthritis was diagnosed based on his physical, laboratory and skin biopsy findings. A treatment with nonsteroidal anti-inflammatory drugs and sulfasalazine produced no effect. Leflunomide in conjunction with anti-TNF biologic agents (Etanercept) was administered, followed by symptomatic improvement 2 weeks later.

PMID: 17706035 [PubMed - indexed for MEDLINE]

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Related Articles[Use of infliximab in ulcerative colitis]

Z Gastroenterol. 2007 Aug;45(8):907-11

Authors: Tilg H, Feichtenschlager T, Knoflach P, Petritsch W, Schöfl R, Vogelsang H, Reinisch W

Infliximab, a chimeric monoclonal anti-tumour necrosis factor alpha (TNF) antibody has dramatically changed the management of various chronic inflammatory disorders such as Crohn’s disease (CD), rheumatoid arthritis, ankylosing spondylitis or psoriasis. This drug is well established for the treatment of CD in case of steroid-refractoriness, failure to respond to an immunosuppressant agent or fistulizing disease. The immunological concept that ulcerative colitis (UC) reflects primarily a T-helper cell type-2 mediated disease prevented the earlier use of anti-TNF agents in this disease. Promising initial pilot studies in steroid-refractory UC patients led to two large placebo-controlled trials in patients with moderate to severe UC. These studies clearly showed a benefit for infliximab treatment in UC with mucosal healing and improved life quality. Infliximab therefore can be used in patients not responding adequately to steroids and/or immunosuppressants. Furthermore, one study showed evidence that infliximab might also be effective in severe, intravenous steroid-refractory UC. Therefore, infliximab might be used alternatively to cyclosporine A or tacrolimus in this patient group. Infliximab has now been established as an additional treatment option in patients with chronic-active UC not responding to an immunosuppressive agent and/or in case of severe acute UC. Experienced gastroenterologists should be involved in the decision making for such a therapy to balance thoroughly the benefit/risk ratio for our patients.

PMID: 17701864 [PubMed - indexed for MEDLINE]

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