Literature on Psoriatic Arthritis

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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Are patients with psoriasis undertreated? Results of National Psoriasis Foundation survey.

J Am Acad Dermatol. 2007 Dec;57(6):957-62

Authors: Horn EJ, Fox KM, Patel V, Chiou CF, Dann F, Lebwohl M

OBJECTIVE: We sought to assess whether patients with psoriasis with moderate or severe disease are being treated with systemic therapy. METHODS: Participants were identified from a random sample of the National Psoriasis Foundation contact database who were 18 years and older, with severe psoriasis (>10% body surface area) and moderate psoriasis (3%-10% body surface area); respondents with psoriatic arthritis were excluded. RESULTS: In all, 1657 respondents with psoriasis completed the survey (28% severe, 41% moderate). A total of 39% of respondents with severe psoriasis and 37% with moderate psoriasis were not currently receiving any treatment. Among respondents currently receiving therapy, only 43% of respondents with severe psoriasis received either traditional systemic therapy, biologic therapy, or phototherapy. LIMITATIONS: Respondents were from the National Psoriasis Foundation contact database and reported their current severity, which may be affected by their treatment. Body surface area as a measure of patient-reported severity has not been validated but has been used in several published studies. CONCLUSIONS: Almost 40% of respondents with psoriasis were currently not receiving treatment. For respondents with severe psoriasis, 26% were treated with systemic therapy, phototherapy, or both; 39% were not in treatment; and 35% were treated with topical therapy alone.

PMID: 17706322 [PubMed - indexed for MEDLINE]

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Eligibility creep: a cause for placebo group improvement in controlled trials of psoriasis treatments.

J Am Acad Dermatol. 2007 Dec;57(6):972-6

Authors: Hick J, Feldman SR

BACKGROUND: Placebo effects are common and of great interest. They are regularly seen in well-designed psoriasis trials. Apparent improvement in placebo-treated patients could be a result of patients having higher than normal psoriasis severity scores at the time their eligibility for a study is assessed. OBJECTIVE: We sought to test whether study eligibility criteria contribute to the placebo effect observed in psoriasis trials. METHODS: Data were obtained from controlled clinical trials of etanercept, adalimumab, and infliximab. We compared the magnitude of psoriasis improvement between the placebo groups of psoriasis and psoriatic arthritis studies. RESULTS: Placebo response rates were 14.4%, 14%, and 20% in psoriasis studies of etanercept, adalimumab, and infliximab, respectively. Placebo response rates in etanercept, adalimumab, and infliximab psoriatic arthritis studies were 23%, 14%, and 10%, respectively, for psoriatic arthritis outcomes. However, the placebo response rates for psoriasis in the psoriatic arthritis studies were 8.7%, -25%, and -12%, respectively. LIMITATIONS: This was a retrospective analysis and not a prospective study to assess the cause of placebo effects. CONCLUSIONS: The commonly observed placebo effect in psoriasis clinical trials is largely explained by eligibility creep, the tendency for patients to have higher measured severity at initial assessment visits when eligibility is determined. Future studies that investigate the placebo effect should be designed to avoid using measures of outcomes that are also used as entry criteria measures.

PMID: 17884244 [PubMed - indexed for MEDLINE]

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Polymorphisms of vitamin D receptor gene in Turkish familial psoriasis patients.

Arch Dermatol Res. 2007 Dec;299(10):487-491

Authors: Dayangac-Erden D, Karaduman A, Erdem-Yurter H

Psoriasis is characterized by hyperproliferation and abnormal differentiation of keratinocytes, and inflammation. 1,25-Dihydroxyvitamin D3, which is used for the treatment of psoriasis, binds to vitamin D receptor (VDR) and modulates gene transcription. We analyzed VDR gene FokI, ApaI and TaqI polymorphisms in 51 Turkish familial psoriasis patients (psoriasis vulgaris and psoriatic arthritis) and 100 healthy subjects, and evaluated the correlation between VDR genotypes and calcipotriol response. We found that the TT genotype was significantly more frequent in the patients than in the controls (51 vs. 35%: P

PMID: 17763859 [PubMed - as supplied by publisher]

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Hypertriglyceridaemia during treatment with adalimumab in psoriatic arthritis.

Br J Dermatol. 2007 Dec;157(6):1273-4

Authors: Stinco G, Piccirillo F, Patrone P

PMID: 17916219 [PubMed - in process]

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Quality indicators in psoriatic arthritis.

Clin Exp Rheumatol. 2007 Nov-Dec;25(6 Suppl 47):98-101

Authors: Kavanaugh A, Ritchlin C, Boehncke WH

Psoriatic arthritis (PsA) is an autoimmune, chronic, systemic inflammatory disorder characterized by the association of arthritis with psoriasis. Patients with PsA may have a heterogeneous and variable clinical course. The condition is complex and multifaceted, with the possibility for prominent involvement in the peripheral and axial diarthrodial joints, the skin and nails, and periarticular structures such as the entheses. Recently, members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) completed a systematic literature review on psoriatic arthritis. In conjunction with expert opinion and appropriate input from stakeholders, the information from the literature review will serve as the basis for the development of recommendations for the optimal treatment of patients with PsA. As such, these guidelines will form the basis for identifying what constitutes quality medical care for patients with PsA.

PMID: 18021513 [PubMed - in process]

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Quantitative measurement of patient status in the regular care of patients with rheumatic diseases over 25 years as a continuous quality improvement activity, rather than traditional research.

Clin Exp Rheumatol. 2007 Nov-Dec;25(6 Suppl 47):69-81

Authors: Pincus T, Maclean R, Yazici Y, Harrington JT

Patient assessment in rheumatology is characterized by an important paradox: many extensively-characterized quantitative measures and indices have been developed for rheumatoid arthritis (RA), psoriatic arthritis, systemic lupus erythematosus (SLE), ankylosing spondylitis, vasculitis, osteoarthritis, fibromyalgia, and other rheumatic diseases. However, most regular rheumatology care is guided largely by qualitative clinical impressions, without such measures or indices or any quantitative data other than laboratory tests to assess patient status and/or quality of care. This paradox may be explained in part by regarding the development of measures primarily as clinical research activities, while viewing the application of measurements in regular clinical care as continuous quality improvement (CQI) activities. The development of measures has emphasized validity and reliability, but generally ignored feasibility and acceptability to patients and health professionals, both of which are needed for application in regular clinical care. A summary of the application of clinical measurement in patients with RA over 25 years between 1982 and 2007 at a weekly academic rheumatology clinic conducted by the senior author is presented as 20 often contemporaneous CQI cycles. These cycles include development of a user-friendly modified health assessment questionnaire (MHAQ); assessment of psychological status; monitoring of mortality outcomes; comparisons of joint counts, radiographic scores, and laboratory tests to the MHAQ; a 28-joint count; prospective study of the MHAQ to predict mortality when joint counts, radiographic scores, and laboratory tests are available; development of a multidimensional HAQ (MDHAQ) with complex activities; a fatigue scale; a self-report joint count; scoring templates; a computerized data management system; flow sheets to monitor MDHAQ status; visual analog scales as 21 circles rather than 10 cm lines; composite RAPID3 (rheumatology assessment patient index data) scores for 3 patient measures; and defining RAPID categories for high, moderate and low severity, and near remission. The latter cycles remain under study as ongoing CQI activities.

PMID: 18021510 [PubMed - in process]

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Quality of life in patients with psoriasis and psoriasis arthritis with a special focus on stigmatization experience.

Clin Dermatol. 2007 Nov-Dec;25(6):547-54

Authors: Schmid-Ott G, Schallmayer S, Calliess IT

Negative impact of psoriasis and psoriasis arthritis on quality of life is a central consequence of these diseases. Feelings of stigmatization might, for example, already emerge with only small patches of skin being affected. Empirical data indicate that treating dermatologists should address possible negative effects elicited by problematic encounters with the public and in sexual relationships even if the severity of the disease is low, because lesions on invisible parts of the body can already cause serious adverse impairment. Such psychosocial consequences can be reduced by attending a self-help organization and by taking part in an interdisciplinary patient education program led by dermatologists.

PMID: 18021891 [PubMed - in process]

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Psoriasis: epidemiology.

Clin Dermatol. 2007 Nov-Dec;25(6):535-46

Authors: Gudjonsson JE, Elder JT

Psoriasis is a chronic, inflammatory and hyperproliferative skin disease with a genetic basis. While epidermal hyperplasia and altered keratinocyte differentiation are prominent features, considerable evidence indicates that psoriasis is immunologically mediated. Recently, the identification of HLA-Cw6 as the disease allele conferring susceptibility to psoriasis has provided a focus for elucidation of these events. In this article, we will focus on the epidemiology of psoriasis and its associated arthritis.

PMID: 18021890 [PubMed - in process]

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Comorbidities in psoriasis.

Clin Dermatol. 2007 Nov-Dec;25(6):529-34

Authors: Christophers E

Epidemiological studies have shown that, in psoriasis patients, associated disorders may occur more frequently than expected. Such comorbidities include psoriatic arthritis, psoriatic pustular diseases, Crohn disease, and signs of metabolic syndrome, which leads to atherosclerosis with coronary heart disease. Although the disorders represent separate entities, they appear to follow overlapping pathogenic pathways. Comorbidities often become clinically manifest years after onset of psoriasis and are frequently seen in severe disease. Persistent low-grade inflammation with secretion of proinflammatory cytokines (eg, tumor necrosis factor alpha) favors the development of insulin resistance and metabolic syndrome. In addition, biochemical and immunologic observations point toward an inflammatory immune mechanism that uses tools of the innate defense armamentarium.

PMID: 18021889 [PubMed - in process]

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