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A clinical study of psoriatic arthropathy
Prasad PVS,Bikku Babu,Kaviarasan P,Senthilnathan A
Indian Journal of Dermatology, Venereology and Leprology , 2007,
Abstract: Background: The incidence of uncomplicated psoriasis is 1-3% in the general population. Arthritis is found in increased frequency in psoriatic patients and its incidence is estimated to be 5-7%. Aim: To assess the prevalence of arthritis in psoriatic patients. Methods: Four hundred and seventy-two psoriatic patients were enrolled in the study out of which 40 patients had (psoriatic) arthropathy (PsA). Severity of psoriasis was assessed by the psoriasis area and severity index (PASI). Routine blood investigations were carried out along with radiological investigations. Results: Forty percent of the 40 PsA patients were in the age group of 51-60 years. Seven patients out of the 40 (17.5%) psoriatic arthropathic (PsA) patients had a family history of psoriasis. Nail involvement was observed in 37 cases (92.5%). Rheumatoid factor was present in five out of the 40 (12.5%) PsA patients. Serum uric acid levels were above normal in eighteen out of the 40 (45%) PsA patients. Asymmetric oligoarthropathy was the most commonly observed feature in 42.5% of the 40 PsA patients. Narrowing of joint spaces and erosions were observed in 62.5% and 45% of the 40 PsA patients. Conclusion: There is an association between the duration of skin lesions and duration of arthropathy. Similarly the PASI score is also directly related with arthropathy.
Clinical profile of psoriatic arthropathy
Chaudhary SP,Singh Trilochan,Kaur Inderjeet,Suri Sudha
Indian Journal of Dermatology, Venereology and Leprology , 1990,
Abstract: Thirty patients of psoriatic arthritis were examined for, elucidation of Epidemiological aspects and clinical variation of this disease. Mill′s and Wright criteria for the diagnosis of was applied. Arthritis antedated psoriasis of skin in 13.3% and the onset was acute in .36.7%. The types of arthritis observed were polyarticular in 33.3% mixed in 2D%, oligoarthritis in 16.7%, DIP in 13.3%, sacroilitis ′in 10% and arthritis mutilans in 6.7%. The joints found to be most frequently involved were proximal ′interphalangeal (66.6%) and distal interphalangeal joints (65%) of I the hands. No distinct pattern of dermal psoriasis in psoriatic arthritis was observed., Nail changes were observed in 76.60/c of patients. No other eye changes except blepharitis was seen in two (7%) patients.HLA-A and HLA-B phenotyping was done in 16 patients, among them 12 patients had peripheral type of psoriatic arthritis HIA-A 1 B 17 and B 27 were present in 6 (20%),9 (30%) and 2 (7%) patients respectively.
Radiological changes in psoriatic arthropathy  [cached]
Mittal R,Gupta Seema,Kaur Ravinder
Indian Journal of Dermatology, Venereology and Leprology , 1997,
Abstract: Forty-one cases of psoriatic arthropathy (PA) were selected for the study. Biopsy, x rays of hands, feet, cervical and dorsolumbar spine, sacro-iliac joints and routine investigations were carried out. Clinical diagnosis of psoriasis was confirmed histopathologically. Radiological changes in order of frequency were most common in feet - 26/41, hands - 24/41, sacro-iliac joints -11/41, dorso-lumbar spine - 4/41 and cervical spine - 3/41. Distinctive radiological changes were seen in psoriatic arthritis.
Eye changes in psoriatic arthropathy
Chaudhari SP,Kaur Inderjeet,Ram Jagat,Kaur Surrinder
Indian Journal of Dermatology, Venereology and Leprology , 1990,
Abstract: Forty patients of psoriatic arthitis were examined for eye changes. Other than blepharitis seen in 2 patients and seitile cataract in 3 patients no eye changes could be elicited. Out of the, 18 patients HLA-B 27 was in 3 patients whereas Al and B 17 was in 6 and 9 patients respectively.
CLINICAL ASSESSMENT IN PSORIATIC ARTHRITIS  [cached]
C. Salvarani,N. Pipitone,M.G. Catanoso
Reumatismo , 2011, DOI: 10.4081/reumatismo.2007.1s.68
Abstract: Due to the heterogenous clinical picture, with a possible combination in any individual patient of axial disease, peripheral arthritis, enthesitis and dactylitis, psoriatic arthritis (PsA) is difficult to assess. Validated assessment tools for PsA are lacking. Recently, international study groups have a special interest in developing and validating standardized tools to assess PsA. We will review the existing assessment modalities of PsA focusing on axial diasese, peripheral arthritis, enthesitis and dactylitis. Measures of function and disability recommended for PsA will be also reviewed. Key words: Psoriatic arthritis, assessment tools, clinical trials
Sustained maintenance of clinical remission after adalimumab dose reduction in patients with early psoriatic arthritis: a long-term follow-up study
Cantini F, Niccoli L, Cassarà E, Kaloudi O, Nannini C
Biologics: Targets and Therapy , 2012, DOI: http://dx.doi.org/10.2147/BTT.S31145
Abstract: stained maintenance of clinical remission after adalimumab dose reduction in patients with early psoriatic arthritis: a long-term follow-up study Original Research (2335) Total Article Views Authors: Cantini F, Niccoli L, Cassarà E, Kaloudi O, Nannini C Published Date July 2012 Volume 2012:6 Pages 201 - 206 DOI: http://dx.doi.org/10.2147/BTT.S31145 Received: 23 February 2012 Accepted: 30 March 2012 Published: 12 July 2012 Fabrizio Cantini, Laura Niccoli, Emanuele Cassarà, Olga Kaloudi, Carlotta Nannini Division of Rheumatology, Misericordia e Dolce Hospital of Prato, Prato, Italy Purpose: The primary purpose of this study was to evaluate the proportion of psoriatic arthritis (PsA) patients maintaining clinical remission after adalimumab (ADA) dose reduction compared with patients with rheumatoid arthritis. Secondary purposes include evaluating the proportion of PsA patients who achieve remission, the duration of remission after ADA dose reduction, time to relapse, psoriasis course, and the frequency of adverse events at the end of follow-up. Methods: This was a single-center, prospective, follow-up, case-control study of 76 consecutive patients (35 females, 41 males; mean age 46 ± 10.2 years) who met the classification criteria for psoriatic arthritis and required anti-tumor necrosis factor therapy according to Group for Research and Assessment of Psoriasis and Psoriatic Arthritis recommendations. The 76 patients were compared with 55 patients (40 females, 15 males; mean age 50 ± 11.6 years) who satisfied the American College of Rheumatology criteria for rheumatoid arthritis and received the same treatment. Case patients and controls were recruited from January 2008 to December 2010. At baseline, PsA patients and controls received 40 mg of ADA every other week, usually with methotrexate (10 to 20 mg/weekly). In the presence of clinical remission, ADA dose was reduced to 40 mg every 4 weeks in both groups. Results: Fifty-three of the 76 (69.7%) PsA patients and 17 of the 55 (30.9%) rheumatoid arthritis (P < 0.019) controls achieved remission after a mean time of 5.1 ± 1.2 and 6.3 ± 1.6 months, respectively (P = nonsignificant). After halving the dose of ADA, 47 of the 53 (88.6%) PsA patients and three of the 17 (17.6%) controls maintained remission (P = 0.016) over a mean follow-up period of 28.9 ± 8.4 and 24.2 ± 6.4 months, respectively. No significant changes in Psoriatic Arthritis Severity Index scores were observed. The mean time to relapse was 8.3 ± 3.4 months in six case patients and 7.2 ± 4.2 in 14 controls (P = not significant). No serious adverse events occurred in either group. Conclusion: Clinical remission is possible in a high percentage of patients with early PsA receiving ADA. Such remission is maintained in a high proportion of subjects after ADA dose halving, with relevant advantages in terms of patient compliance, drug-exposure risk, and economic burden.
Sustained maintenance of clinical remission after adalimumab dose reduction in patients with early psoriatic arthritis: a long-term follow-up study  [cached]
Cantini F,Niccoli L,Cassarà E,Kaloudi O
Biologics: Targets and Therapy , 2012,
Abstract: Fabrizio Cantini, Laura Niccoli, Emanuele Cassarà, Olga Kaloudi, Carlotta NanniniDivision of Rheumatology, Misericordia e Dolce Hospital of Prato, Prato, ItalyPurpose: The primary purpose of this study was to evaluate the proportion of psoriatic arthritis (PsA) patients maintaining clinical remission after adalimumab (ADA) dose reduction compared with patients with rheumatoid arthritis. Secondary purposes include evaluating the proportion of PsA patients who achieve remission, the duration of remission after ADA dose reduction, time to relapse, psoriasis course, and the frequency of adverse events at the end of follow-up.Methods: This was a single-center, prospective, follow-up, case-control study of 76 consecutive patients (35 females, 41 males; mean age 46 ± 10.2 years) who met the classification criteria for psoriatic arthritis and required anti-tumor necrosis factor therapy according to Group for Research and Assessment of Psoriasis and Psoriatic Arthritis recommendations. The 76 patients were compared with 55 patients (40 females, 15 males; mean age 50 ± 11.6 years) who satisfied the American College of Rheumatology criteria for rheumatoid arthritis and received the same treatment. Case patients and controls were recruited from January 2008 to December 2010. At baseline, PsA patients and controls received 40 mg of ADA every other week, usually with methotrexate (10 to 20 mg/weekly). In the presence of clinical remission, ADA dose was reduced to 40 mg every 4 weeks in both groups.Results: Fifty-three of the 76 (69.7%) PsA patients and 17 of the 55 (30.9%) rheumatoid arthritis (P < 0.019) controls achieved remission after a mean time of 5.1 ± 1.2 and 6.3 ± 1.6 months, respectively (P = nonsignificant). After halving the dose of ADA, 47 of the 53 (88.6%) PsA patients and three of the 17 (17.6%) controls maintained remission (P = 0.016) over a mean follow-up period of 28.9 ± 8.4 and 24.2 ± 6.4 months, respectively. No significant changes in Psoriatic Arthritis Severity Index scores were observed. The mean time to relapse was 8.3 ± 3.4 months in six case patients and 7.2 ± 4.2 in 14 controls (P = not significant). No serious adverse events occurred in either group.Conclusion: Clinical remission is possible in a high percentage of patients with early PsA receiving ADA. Such remission is maintained in a high proportion of subjects after ADA dose halving, with relevant advantages in terms of patient compliance, drug-exposure risk, and economic burden.Keywords: psoriatic arthritis, anti-TNF, adalimumab, remission, dose reduction
CLINICAL PRESENTATION OF PSORIATIC ARTHRITIS  [cached]
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
The Th17/IL-23 Axis and Natural Immunity in Psoriatic Arthritis  [PDF]
Shinji Maeda,Yoshihito Hayami,Taio Naniwa,Ryuzo Ueda
International Journal of Rheumatology , 2012, DOI: 10.1155/2012/539683
Abstract: Psoriatic arthritis (PsA) is a chronic inflammatory skin disease that causes enthesitis and destructive arthritis and significantly lowers patient quality of life. Recognition of the two target organs (the skin and joints) involved in the immunopathophysiology of PsA helped in elucidating the pathology of various systemic autoimmune diseases targeting multiple organs. Recent advances in immunology and genetics have made it clear that acquired immunity, especially that mediated by the Th17/IL-23 axis, plays an important role in the inflammatory pathology observed in psoriasis and PsA. Additionally, involvement of natural immunity has also been suggested. Microbial infection has been known to trigger psoriasis and PsA. Recent clinical studies using biopharmaceuticals, such as tumor-necrosis-factor- (TNF-) α inhibitors and IL-12/23 p40 antibodies, indicate that studies need not be based only on the immunological phenomena observed in PsA pathology since disease pathology can now be verified using human-based science. Considering this aspect, this paper discusses the immunopathology of PsA compared to psoriasis (cutaneous) and rheumatoid arthritis in humans and immunopathology of PsA with respect to the Th17/IL-23 axis and microbial infection. 1. Introduction Psoriasis is a typical inflammatory keratosis, characterized by inflammation, telangiectasia, hyperproliferation, and abnormal differentiation of epidermal cells, and it is sometimes complicated by arthritis. There is considerable variation in reports concerning the transition from psoriasis to psoriatic arthritis (PsA), with figures ranging from 6% to 42%. The onset of cutaneous psoriatic eruptions usually precedes that of PsA; a study involving 1000 patients with PsA showed that cutaneous eruptions preceded the onset of PsA in 86% of cases by more than 12 years [1, 2]. PsA often causes destructive arthritis and arthropathy, which considerably decrease patient quality of life. Thus, clinicians must anticipate when patients with psoriasis vulgaris will progress to arthropathic psoriasis and intervene decisively in the early stages of onset of arthropathy, therapeutically targeting psoriatic skin and joint inflammation. Psoriasis can affect two target organs—the skin and synovial membrane—and its main pathogenesis is considered to be chronic inflammation. The cause of this disease is probably based on the common foundations of autoimmune or autoinflammatory pathology. The mechanism by which this occurs begins with antigen-presenting cells, which are presumed to activate cutaneous and synovial membrane T
Type I autoimmune hepatitis, inverted psoriasis with psoriatic arthropathy and type 2 diabetes mellitus as complications of a chronic B virus hepatitis treated with interferon - Case report
George S?raci,Ofelia Pascarenco,?tefan C. Vesa,Oliviu Pascu
Human & Veterinary Medicine , 2012,
Abstract: We present the case of a 31 year old male patient, admitted in the 3rd Medical Clinic Cluj-Napoca for asthenia, fatigue, effort hepatalgia,pain located in the legs and small joints of the hands. Patient has been diagnosed a year ago with chronic B viral hepatitis and receivedPeginterferon alpha 2a treatment. After performing clinical and paraclinical exams we established that patient suffers from type I autoimmunehepatitis, inverted psoriasis with psoriatic arthropathy, recent onset of type II diabetes mellitus. These conditions are likely to appear consecutivelyto Interferon therapy. The markers for B virus hepatitis (Ag-HBs, IgM-HBc, AgHBe, ADN-HBV) were negative. The evolution was favorableafter therapy with immunosuppressants, corticoids, oral antidiabetics and antisecretors.
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