Literature on Psoriatic Arthritis

Related ArticlesAssociation of angiotensin-converting enzyme (ACE) gene insertion-deletion polymorphism with spondylarthropathies.

J Biomed Sci. 2008 Jan;15(1):61-7

Authors: Shehab DK, Al-Jarallah KF, Al-Awadhi AM, Al-Herz A, Nahar I, Haider MZ

Low back pain (LBP) is a common medical problem. Interaction between genetic and environmental factors predisposes individuals to LBP even at an early age. Inflammatory back pain or spondylarthropathies include ankylosing spondylitis (AS), psoriatic arthritis (PSA), reactive arthritis enteropathic and undifferentiated arthropathies. Angiotensin-converting enzyme (ACE) plays an important role in circulatory homeostasis, physiology of vasculature and inflammation. The insertion-deletion (I/D) polymorphism of the ACE gene has been shown to determine the plasma and tissue levels of ACE especially in the synovial fluid. The aim of this study was to investigate an association between ACE gene I/D polymorphism and inflammatory back pain (spondylarthropathies) secondary to ankylosing spondylitis (AS), psoriatic arthritis, inflammatory bowel disease and undifferentiated spondylarthropathies. The prevalence of ACE gene I/D polymorphism genotypes was determined in 63 patients with inflammatory back pain by polymerase chain reaction (PCR) and compared with that in 111 healthy controls. Of the 63 patients studied, 45 (71.4%) were with AS, 13 (20.6%) were with PSA, 4 (6.3%) were with reactive arthropathy and 1 (1.6%) manifested undifferentiated arthropathy. There were 43 males and 20 females. Mean age of patients was 39.0 +/- 11.36 years, age at onset of spondylarthropathy was 27.7 +/- 7.49 years and disease duration was 10.3 +/- 7.74 months. The controls were selected to match with the patients group in terms of gender ratio, age and ethnicity. The ACE gene polymorphism showed an overall significant difference between patients and controls (p = 0.050). When the ID and II genotype frequency was combined and compared with that for DD genotype amongst patient and control groups, a considerably higher incidence was detected for ID and II genotypes than the DD genotype in spondylarthropathy patients compared to that in the controls (p = 0.036). This study showed a significant association of the I-allele of ACE gene I/D polymorphism with spondylarthropathy in Kuwaiti Arabs.

PMID: 17713861 [PubMed - in process]

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Related ArticlesPsoriatic arthritis and arthroplasty: a review of the literature.

Bull NYU Hosp Jt Dis. 2008;66(1):41-8

Authors: lofin I, Levine B, Badlani N, Klein GR, Jaffe WL

Psoriatic arthritis is an inflammatory arthropathy as- sociated with the characteristic dermatologic lesions of psoriasis. The diagnosis of psoriatic arthritis is quite difficult, due to the overlap of patients with osteoarthritis (OA) or rheumatoid arthritis (RA) with concomitant non-associated psoriasis. A nonspecific elevation in inflammatory markers (erythrocyte sedimentation rate, ESR; antinuclear antibodies, ANA; or rheumatoid factor, RF) and characteristic radiographic features are often present in these patients. The mainstay of treatment is medical management, using NSAIDs, various immunosuppressants, and anti-TNF agents, for both pain control and possibly as disease modifying agents. Only a minority of patients require surgical intervention, leading to the limited amount of literature concerning total joint arthroplasty and psoriatic arthritis. While past literature has yielded high infection rates post-arthroplasty, newer studies have found more promising results. Alternative surgical options for treating destructive arthritis include open or arthroscopic synovectomy. While early results are promising, recurrence rates and long-term outcomes are not yet available.

PMID: 18333827 [PubMed - indexed for MEDLINE]

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Related ArticlesAcneiform eruption following anti-TNF-alpha treatment: a report of three cases.

J Drugs Dermatol. 2008 Jan;7(1):69-71

Authors: Sun G, Wasko CA, Hsu S

Tumor necrosis factor-alpha (TNF-alpha) antagonists are used to treat many autoimmune disorders including Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and more recently, psoriasis. The adverse effects of the treatment regimen for psoriasis are not as well documented as those for Crohn’s disease and rheumatoid arthritis. We report the development of acne vulgaris in 3 patients with psoriasis after initiating anti-TNF-alpha therapy.

PMID: 18246701 [PubMed - indexed for MEDLINE]

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Related ArticlesThe challenge of early diagnosis of psoriatic arthritis.

J Rheumatol. 2008 Jan;35(1):3-5

Authors: Olivieri I, D’Angelo S, Padula A, Palazzi C

PMID: 18176985 [PubMed - indexed for MEDLINE]

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Related ArticlesPrevalence of malignancy in psoriatic arthritis.

Arthritis Rheum. 2008 Jan;58(1):82-7

Authors: Rohekar S, Tom BD, Hassa A, Schentag CT, Farewell VT, Gladman DD

OBJECTIVE: To determine the prevalence and types of malignancy in a large cohort of patients with psoriatic arthritis (PsA), and to compare this rate with that in the general population. METHODS: A cohort analysis of patients who were followed up prospectively from 1978 to 2004 at the University of Toronto Psoriatic Arthritis Clinic was performed. Patients were followed up at 6-12-month intervals according to a standard protocol, which included recording of malignancy, and tracked on a computer database. The cohort was linked with a provincial database to find malignancies that may have been missed by the protocol or developed after patients were lost to followup. Data were presented and analyzed using descriptive statistics and the Cox regression model with robust estimate of variance. Rates of first malignancy in the cohort were compared with rates in the population to derive standardized incidence ratios (SIRs). RESULTS: Of the 665 patients included, 68 (10.2%) developed a malignancy at an average age of 62.4 years. The most frequently seen malignancies were breast (20.6%), lung (13.2%), and prostate (8.8%) cancer. The SIR for all cancers was 0.98 (95% confidence interval 0.77-1.24). Overall cancer type-specific SIRs were 0.69 (95% CI 0.26-1.83) for hematologic and 0.88 (95% CI 0.46-1.69) for lung cancer. In females, the SIR for breast cancer was 1.55 (95% CI 0.92-2.62), and in males, the SIR for prostate cancer was 0.65 (95% CI 0.29-1.44). CONCLUSION: Overall, 10.2% of patients in the Toronto PsA cohort developed cancer. The most frequent cancers were breast, lung, and prostate cancer. The incidence of malignancy in the large PsA cohort did not differ from that in the general population.

PMID: 18163513 [PubMed - indexed for MEDLINE]

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Related ArticlesComparison of Vancouver and International League of Associations for rheumatology classification criteria for juvenile psoriatic arthritis.

Arthritis Rheum. 2008 Jan 15;59(1):51-8

Authors: Stoll ML, Lio P, Sundel RP, Nigrovic PA

OBJECTIVE: The International League of Associations for Rheumatology (ILAR) criteria constitute the current international diagnostic standard for juvenile psoriatic arthritis (PsA), replacing the less-restrictive Vancouver criteria. The impact of this change on the population diagnosed with juvenile PsA is unknown. METHODS: We reviewed the records of patients seen in a pediatric rheumatology clinic with International Classification of Diseases, Ninth Revision diagnosis codes for psoriasis, PsA, or spondylarthritis. Characteristics of children who met the Vancouver and ILAR criteria were compared. RESULTS: Of 139 children meeting the Vancouver criteria for juvenile PsA, ILAR criteria excluded 80 (58%). Grounds for exclusion were insufficiently definitive rash (44%), a competing diagnosis of enthesitis-related arthritis (23%), family history of psoriasis limited to second-degree relatives (16%), fulfillment of criteria for >1 subtype of juvenile idiopathic arthritis (JIA) (5%), and HLA-B27 in a male with arthritis onset after age 6 (2%). Remaining patients were not homogeneous but could be divided into younger and older subpopulations differing in clinical features as described previously among patients identified under the Vancouver standard. Of excluded patients, 76% were reclassified as having other forms of JIA yet were phenotypically comparable with those retained. CONCLUSION: Despite apparently modest changes from previous criteria, ILAR definitions strikingly restrict the diagnosis of PsA in childhood. Similarity between excluded and included patients suggests that these restrictions may not reflect substantive clinical differences. To the extent that excluded patients become reclassified within JIA, current criteria risk compromising other ILAR categories while reducing the number of patients available for the study of juvenile PsA.

PMID: 18163407 [PubMed - indexed for MEDLINE]

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Related ArticlesCytokines in arthritis–the ‘big numbers’ move centre stage.

Rheumatology (Oxford). 2008 Jan;47(1):8-12

Authors: Gaston JS

More than 20 yrs ago, T-helper lymphocytes were divided into Th1 and Th2 subsets on the basis of their cytokine production. The pro-inflammatory Th1 subset was considered predominant in inflammatory arthritis, but evidence for this notion was incomplete, and some called into question the role of helper T cells. The identification of a novel T cell subset, Th17 cells, which appears to be critical for several forms of autoimmune inflammation, including arthritis, requires a reconsideration of arthritis pathogenesis and the role of T cells. This review deals with several of the newly described (’big number’) cytokines which are involved in the differentiation and action of Th17 cells, and pays particular attention to the pathogenesis of spondyloarthritis because of the implication of the same cytokine networks in psoriasis and inflammatory bowel disease. The role of dendritic cells as coordinators of T cell differentiation in response to pathogen-derived signals in also emphasized.

PMID: 17715172 [PubMed - in process]

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Related ArticlesFrom the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis.

J Am Acad Dermatol. 2008 Jan;58(1):94-105

Authors: Lebwohl M, Bagel J, Gelfand JM, Gladman D, Gordon KB, Hsu S, Kalb RE, Kimball AB, Korman NJ, Krueger GG, Mease P, Morison WL, Paller A, Pariser DM, Ritchlin C, Strober B, Van Voorhees A, Weinstein GD, Young M, Horn L

BACKGROUND: Biologics are widely used in the treatment of psoriasis and psoriatic arthritis. OBJECTIVE: Our aim was to arrive at a consensus on the kind of monitoring and the vaccinations that should be performed before and during biologic therapy. METHODS: Medical literature and data presented at meetings were reviewed and a consensus conference was held by members of the Medical Board of the National Psoriasis Foundation. RESULTS: Consensus was established on monitoring and vaccination practices that included discussion and recognition of variations in those practices. History, physical examination, chemistry screen with liver function tests, complete blood cell count, and platelet count and tuberculosis testing are widely obtained at baseline and with variable frequencies thereafter. Patients treated with efalizumab have platelet counts checked more often; liver function tests are repeated more frequently in patients treated with infliximab; patients taking tumor necrosis factor blockers undergo tuberculosis testing more often; and patients treated with alefacept have CD4 counts checked approximately every 2 weeks. Avoidance of live vaccines during biologic therapy and administration of essential vaccines before biologic therapy were discussed, although vaccination is performed only to a variable degree. There was no consistency in the measurement of antinuclear antibodies among the experts. LIMITATIONS: There are few evidence-based studies on monitoring practices for patients with psoriasis taking biologic therapies. CONCLUSIONS: In patients taking biologic therapies for psoriasis, monitoring of blood chemistries, blood counts, CD4 counts, antinuclear antibodies, tuberculin skin tests, history, and physical examination may be warranted depending on the particular therapy and the particular patient. Vaccination practices are also addressed.

PMID: 17980456 [PubMed - in process]

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Related ArticlesLower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case-control study.

Ann Rheum Dis. 2008 Jan;67(1):26-30

Authors: Gisondi P, Tinazzi I, El-Dalati G, Gallo M, Biasi D, Barbara LM, Girolomoni G

BACKGROUND: Psoriasis is associated with a form of spondyloarthropathy in 10-30% of cases. A major feature of psoriatic arthritis is enthesitis. In some patients with psoriasis the presence of enthesitis could be underdiagnosed. OBJECTIVE: To investigate the presence of lower limbs entheseal abnormalities in patients with chronic plaque psoriasis without signs and symptoms of psoriatic arthritis. METHODS: Thirty patients with psoriasis and 30 controls underwent ultrasonographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). RESULTS: Mean GUESS score was significantly higher in patients with psoriasis as compared with controls: 7.9 (0.6) vs 2.9 (0.3); p

PMID: 17720726 [PubMed - in process]

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