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Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis
Elli Kruithof, Dominique Baeten, Leen De Rycke, Bernard Vandooren, Dirk Foell, Johannes Roth, Juan D Ca?ete, Annemieke M Boots, Eric M Veys, Filip De Keyser
Arthritis Research & Therapy , 2005, DOI: 10.1186/ar1698
Abstract: Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune disease that is characterized by inflammatory arthritis and skin psoriasis. It is commonly classified as a subtype of the spondyloarthropathy (SpA) concept, together with ankylosing spondylitis (AS), reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated spondyloarthropathy (USpA) [1]. Indeed, PsA shares a number of phenotypic characteristics with the other SpA subtypes, such as asymmetrical synovitis, enthesitis and familial aggregation. Typical SpA features such as sacroiliitis, presence of HLA-B27, uveitis and chronic inflammatory gut lesions are also found in PsA, albeit at a lower frequency than in other SpA subtypes [2-4]. Interestingly, the peripheral joint involvement is mostly asymmetrical and oligoarticular, as in SpA, but can also mimic rheumatoid arthritis (RA) with eventually destructive involvement of multiple small hand and feet joints [5]. Finally, skin and nail involvement, total ankylosis of destructed peripheral joints, predominant distal interphalyngeal joint involvement and arthritis mutilans sets PsA apart from both SpA and RA. Therefore, there is at present no clear consensus regarding whether PsA belongs to the SpA concept, whether it is a separate disease entity, or whether it is a heterogeneous disease group with oligoarticular and axial forms belonging to the SpA concept on the one hand and destructive, polyarticular forms resembling RA on the other [6,7]. This question will probably only be answered once the pathogenesis of the disease is fully elucidated, leading to an aetiological rather than phenotypical disease classification.In previous histopathological synovial studies we considered PsA as part of the SpA concept and compared it as such with other inflammatory joint diseases. Although some early data are available on PsA synovial histology based on small studies of surgical or blind needle specimens, only few studies systematicall
G. De Rosa,C. Mignogna
Reumatismo , 2011, DOI: 10.4081/reumatismo.2007.1s.46
Abstract: Psoriasis is a common, chronic, relapsing, papulo-squamous dermatitis, with overlying silvery scales. The scalp, sacral region, and extensor surfaces of extremity are commonly involved, even if flexural and intertriginous areas may be affected in the so-called “inverse psoriasis”. Involvement of nails is frequent. Oral lesions (geographic stomatitis and/or glossitis) are commonly described. 5-8% of psoriatic patients develop arthritis. Interphalangeal joints are characteristically involved, but large joints are also affected. From a histological point of view, psoriasis is a dynamic dermatosis that changes during the evolution of an individual lesion; we can classify it in an early stage, advanced stage, and later lesions. Lesions are usually diagnostic only in early stages or near the margin of advancing plaques. Munro microabscesses and Kogoj micropustoles are diagnostic clues of psoriasis, but they aren’t always present. All other features can be found in numerous eczematous dermatitis. Key words: Psoriasis, histopathology, immunohistochemistry
S. Loffredo,F. Ayala,G.C. Marone,A. Genovese
Reumatismo , 2011, DOI: 10.4081/reumatismo.2007.1s.28
Abstract: Psoriasis and psoriatic arthritis are chronic inflammatory disorders resulting from a combination of genetic and environmental factors, though the precise causal agents have not yet been identified. The immune system has a major role in their development and the possibility exists that self antigens or antigens from microbial agents, or microbial superantigens initiate a vigorous immune response. Different subsets of T-lymphocytes and dendritic cells, mast cells and granulocytes participate in the pathogenesis and several cytokines and chemokines have been identified in tissue lesions. TNF-α is a key proinflammatory cytokine with important pathogenetic role in psoriasis and psoriatic arthritis. Evidence from clinical trials targeting the TNF-α–TNF-α-receptor supports a central role for this cytokine in the pathogenesis of psoriasis and psoriatic arthritis. Angiogenesis is a prominent early event in lesional psoriatic skin and in synovial membrane psoriatic arthritis. Future potential targets in the treatment of these disorders include biologic agents aimed at blockade of other cytokines, chemokines and angiogenic factors. Key words: Psoriasis, psoriatic arthritis, immunity
Psoriatic arthritis: imaging techniques  [cached]
A. Spadaro,E. Lubrano
Reumatismo , 2012, DOI: 10.4081/reumatismo.2012.99
Abstract: Imaging techniques to assess psoriatic arthritis (PsA) include radiography, ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT) and bone scintigraphy. The radiographic hallmark of PsA is the combination of destructive changes (joint erosions, tuft resorption, osteolysis) with bone proliferation (including periarticular and shaft periostitis, ankylosis, spur formation and non-marginal syndesmophytes). US has an increasing important role in the evaluation of PsA. In fact, power Doppler US is useful mainly for its ability to assess musculoskeletal (joints, tendons, entheses) and cutaneous (skin and nails) involvement, to monitor efficacy of therapy and to guide steroid injections at the level of inflamed joints, tendon sheaths and entheses. MRI allows direct visualization of inflammation in peripheral and axial joints, and peripheral and axial entheses, and has dramatically improved the possibilities for early diagnosis and objective monitoring of the disease process in PsA. MRI has allowed explaining the relationships among enthesitis, synovitis and osteitis in PsA, supporting a SpA pattern of inflammation where enthesitis is the primary target of inflammation. CT has little role in assessment of peripheral joints, but it may be useful in assessing elements of spine disease. CT accuracy is similar to MRI in assessment of erosions in sacroiliac joint involvement, but CT is not as effective in detecting synovial inflammation. Bone scintigraphy lacks specificity and is now supplanted with US and MRI techniques.
L. Punzi,M. Poswiadek,F. Oliviero,A. Lonigro
Reumatismo , 2011, DOI: 10.4081/reumatismo.2007.1s.52
Abstract: Psoriatic arthritis (PsA) has been classically defined as an inflammatory arthritis associated with psoriasis. However, in comparison with other relevant inflammatory arthropathies, in which a definite diagnosis is frequently possible only by means of laboratory investigations, in PsA true laboratory diagnostic markers are lacking. Some markers are utilised more to differentiate other diseases than to characterise PsA. For example in polyarticular PsA, which may be in some cases indistinguishable from RA, the rheumatoid factor (RF) or the more specific and recently introduced antibodies to cyclic citrullinated peptides (anti-CCP), may be useful to better identify RA. However, RF was found in 5% to 13% of patients with PsA, and anti-CCP may be observed in almost similar percentage. The determination of ESR and/or CRP is frequently disappointing in PsA, since they are both elevated in only half of the patients with PsA. However, ESR and/or CRP are included in the most utilised response criteria for RA, such as ACR and DAS, and, in addition are also considered reliable in the assessment of PsA. Furthermore, elevated levels of ESR have been proposed as one of the best predictors of damage progression and, in addition, a low ESR seems protective, while an ESR >15 mm/h is one of the factors associated with an increased mortality in PsA. The synovial fluid (SF) effusion is much higher in PsA, in comparison with other arthropathies. When available, SF analysis may offer additive information useful for the diagnosis, such as the increased number of leukocytes, which underlines the inflammatory nature of the effusion even in a patient with normal serum levels of acute phase response. We found that elevated IL-1 levels in SF of patients with early disease (<6 months), may be predictive of an evolution in polyarticular form at follow-up. This observation is in keeping with the crucial role that inflammatory cytokines play in PsA, probably related to a genetic predisposition. The recent introduction in PsA of anti-TNF-α agents and the demonstration of their efficacy in the management of many clinical disease expressions including peripheral arthropathy, axial involvement, enthesopathy and skin manifestations, have stimulated the research also in the field of the possible laboratory markers. Key words: Psoriatic arthritis, laboratory investigations arthritis
Angiogenic and Inflammatory Properties of Psoriatic Arthritis  [PDF]
Toshiyuki Yamamoto
ISRN Dermatology , 2013, DOI: 10.1155/2013/630620
Abstract: Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis and included in seronegative spondyloarthropathy. PsA has several unique characteristics different from rheumatoid arthritis (RA), such as enthesopathy, dactylitis, and abnormal bone remodeling. As compared with synovitis of RA (pannus), proliferation of PsA synovium is mild and characterized by hypervascularity and increased infiltration of polymorphonuclear leukocytes in the synovial tissues. Angiogenesis plays a crucial role in cutaneous psoriasis, and several angiogenic factors such as vascular endothelial growth factor, interleukin-8, angiopoietin, tumor necrosis factor-α and transforming growth factor-β, are suggested to play an important role also in the pathophysiology of PsA. Further, IL-17 has various functions such as upregulation of proinflammatory cytokines, attraction of neutrophils, stimulation of keratinocytes, endothelial cell migration, and osteoclast formation via RANKL from activated synovial fibroblasts. Thus, IL-17 may be important in angiogenesis, fibrogenesis, and osteoclastogenesis in PsA. In this paper, roles of angiogenesis in the psoriatic synovium are discussed, which may strengthen the understanding of the pathogenesis of PsA. 1. Introduction Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy in association with psoriasis. PsA is classified as one of the seronegative spondyloarthropathy characterized by joint destruction with extra-articular involvement (i.e., eye, gut, and bowel). The involved joints present swelling, redness, and deformity to the end, which are usually periphery (main involvements are distal interphalangeal joints), but sacroiliac joints are less frequently affected. In nearly 70% of patients, cutaneous lesions precede the onset of joint pain, in 20% arthropathy starts before skin manifestations, and in 10% both are contemporary. Results of laboratory examination show elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) which reflect acute-phase inflammation. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies are usually negative. HLA-B27 is found chiefly in patients with spondylitis type PsA. Radiographic features of joint space narrowing, erosions, osteolysis, new bone formation, enthesitis, spur formation, pencil-in-cup appearance, and bamboo spine. Although, in general, patients with severe cutaneous psoriasis often complain of arthralgia, skin severity and joint lesions are not always parallel. A number of studies have suggested genetic,
Psoriatic arthritis: A retrospective study of 162 patients  [PDF]
Pavlica Ljiljana,Peri?-Hajzler Zorica,Joveli? Aleksandra,?ekler Boris
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0509613p
Abstract: Aim. The aim of our study was to determine the prevalence of psoriatic arthritis in the patients with psoriasis and to analyze retrospectively the results of a 34-year multidisciplinary management of the patients with psoriatic arthritis. Methods. The study included 162 out of 183 treated patients with psoriatic arthritis, aged 48 ± 15 years. All the patients satisfied the current diagnostic criteria for psoriasis and psoriatic arthritis according to the American College of Rheumatology. Results. Psoriatic arthritis developed in 183 (9.3%) out of 1976 patients with psoriasis. Time interval for establishing the diagnosis was 4 years. A positive family history of the disease had 15.0% of the studied patients. Its onset was most often at 42 years of age in 70.4% of the cases, and 2 months to 59 years after the appearance of psoriasis. Psoriatic arthritis without psoriasis appeared in 1.8% of the patients. A severe form of arthritis had 64.2% of the patients, mainly the patients with scalp psoriasis (χ2=3.2; p<0.05). Nail changes had 35% of the patients. Distal interphalangeal joints were involved in 63.6%, axial skeleton in 36.4%, oligoarthritis in 45.0%, polyarthritis in 55.0%, and mutilating form in 6.8% of the patients. Elevated Erythrocyte Sedimentation Rate was reveald in 61.7% of the patients. Immunoglobulin M (IgM) rheumatoid factor was altered in 4.3% of the patients. The human leukocyte antigen (HLA) typing in the 28 patients were: A2 32.0%, A3 18.0%, Al and A9 14.0%, A28 and A29 3.5%, B8 and B16 14.0%, B5 and B12 11.0%, B13,B15, B18, B27 and B35 7.0%. Radiologic changes were most often in hand and foot joints, less frequently in the knees and quite infrequently in hips and shoulders joints. Sacroiliitis was found in 46.4% of the patients. Psoriasis was treated with topical corticosteroids and salicylic ointments in all the patients, ultraviolet (PUVA therapy) in 5.6% and retinoids in 4.3% of them. Artrithis was treated with nonsteroidal anti-inflammatory drugs, with systemic corticosteroids 41.3% and with disease modified antirheumatic drugs, most frequently methotrexate, 59.9% of the patients. Radionuclide synovectomy was performed in 6.8%, surgery in 6.2% and physical therapy in all the patients. Conclusion. Psoriatic arthritis developed in 9.3% of the psoriatic patients. Time interval for establishing the diagnosis was long, and there were no specific laboratory findings. All the synovial joints could be involved in the psoriatic process. Scintigraphy should be used only in case of early suspected sacroiliitis. The treatment of psoriatic arthr
Capillaroscopic assessment of vascular changes in psoriasis vulgaris and psoriatic arthritis. Kapilaroskopowa ocena zmian naczyniowych w uszczycy zwyczajnej i stawowej.
Joanna Bartosińska,Gra?yna Chodorowska,Maria Juszkiewicz-Borowiec,Bart?omiej Wawrzynki
Clinical Dermatology , 2010,
Abstract: Background: In the process of psoriatic plaque formation numerous morphological and functional abnormalities, including microvascular changes, are observed. Similar vascular abnormalities occur within the synovial membrane of patients with psoriatic arthritis. Capillaroscopy is a diagnostic procedure which allows for visualization of quantitative and qualitative changes within the capillaries. Objectives: The aim of the study was assessment of vascular changes in psoriasis vulgaris as well as psoriatic arthritis with emphasis to capillaroscopic differences in these two types of diseases. Material and methods: The study included 111 adult psoriatic patients. 53 patients suffered from psoriatic arthritis while 58 patients had psoriasis vulgaris. Nailfold capillaroscopies of II to V fingers of both hands were performed. Results: 16.98% of patients with psoriatic arthritis presented pale a capillaroscopic background, which was not observed in patients with psoriasis vulgaris. Sub- -papillary venular plexus was visible significantly more frequently in patients with psoriatic arthritis (p=0.032). In 30.19% of patients with psoriatic arthritis a decreased number of nailfold capillaries was found. 43.40% of patients with psoriatic arthritis and 24.14% of patients with psoriasis vulgaris had thin nailfold capillaries. Frail nailfold capillaries were found only in patients with psoriatic arthritis (16.93%). No statistically significant differences were detected between the group of patients with psoriatic arthritis and those with psoriasis vulgaris with regard to the frequency of changes in the shape and contour of the vascular loop (p>0.05). Conclusions: Patients suffering from both types of diseases i.e. psoriatic arthritis and psoriasis vulgaris, presented specific microcirculatory abnormalities. However more severe capillaroscopic changes were found in psoriatic arthritis patients in comparison with patients with psoriasis vulgaris.
R. Scarpa,R. Peluso,M. Atteno
Reumatismo , 2011, DOI: 10.4081/reumatismo.2007.1s.49
Abstract: Psoriatic arthritis is a spondyloarthropathy, which occurs in patients with skin and/or nail psoriasis. Basing its characterization on morphological purposes, several types of arthritis have been described. Alternatively, we propose a simplified classification into three subsets, focusing on the levels of expression of cutaneous and articular elements which devise this syndrome. The first is established psoriatic arthritis which occurs in patients with evident or remittent skin and/or nail psoriasis. Its clinical spectrum consists of the five subsets classically described by Moll and Wright in 1973. The second is psoriatic arthritis “sine psoriasis” which occurs in subjects without psoriasis but with a family history of the disease in first or second-degree relatives. The third is early psoriatic arthritis which consists of an articular involvement of recent onset, occurring in subjects belonging to established or sine psoriasis subsets. Key words: Psoriatic arthritis, classification, clinical subsets
A. Mathieu,A. Cauli,A. Vacca,A. Mameli
Reumatismo , 2011, DOI: 10.4081/reumatismo.2007.1s.25
Abstract: Psoriasis and psoriatic arthritis are linked diseases characterised by (distinct ?) immune-mediated pathogenetic mechanisms and by a genetic background interacting with environmental factors. Some candidate susceptibility genes have been studied extensively; they include HLA genes, genes within the HLA region and genes outside the HLA region; among them corneodesmosin and other genes of PSORS1 region, MICA and TNF-a polymorphisms. The main findings in the literature are discussed. Key words: Genetics, psosriasis, psoriatic arthritis
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