Abstract
(1) Background: In literature it is reported that 20–30% of psoriatic patients evolve to psoriatic arthritis over time. Currently, no specific biochemical markers can either predict progression to psoriatic arthritis or response to therapies. This study aimed to identify osteoimmunological markers applicable to clinical practice, giving a quantitative tool for evaluating pathological status and, eventually, to provide prognostic support in diagnosis. (2) Methods: Soluble (serum) bone and cartilage markers were quantified in 50 patients with only psoriasis, 50 psoriatic patients with psoriatic arthritis, and 20 healthy controls by means of multiplex and enzyme-linked immunoassays. (3) Results: Differences in the concentrations of matrix metalloproteases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), receptor activator of nuclear factor kappa-B- ligand (RANK-L), procollagen type I N propeptide (PINP), C-terminal telopeptide of type I collagen (CTx-I), dickkopf-related protein 1 (DKK1), and sclerostin (SOST) distinguished healthy controls from psoriasis and psoriatic arthritis patients. We found that MMP2, MMP12, MMP13, TIMP2, and TIMP4 distinguished psoriasis from psoriatic arthritis patients undergoing a systemic treatment, with a good diagnostic accuracy (Area under the ROC Curve (AUC) > 0.7). Then, chitinase-3-like protein 1 (CHI3L1) and MMP10 distinguished psoriasis from psoriatic arthritis not undergoing systemic therapy and, in the presence of onychopathy, MMP8 levels were higher in psoriasis than in psoriatic arthritis. However, in these latter cases, the diagnostic accuracy of the identified biomarkers was low (0.5 < AUC < 0.7). (4) Conclusions. By highlighting never exploited differences, the wide osteoimmunological biomarkers panel provides a novel clue to the development of diagnostic paths in psoriasis and psoriasis-associated arthropathic disease.
Highlights
Adult psoriatic disease depicts a continuum encompassing disease progression from psoriasis (Ps) to psoriatic arthritis (PsA) [1]
We found that MMP2, MMP12, MMP13, TIMP2, and TIMP4 distinguished psoriasis from psoriatic arthritis patients undergoing a systemic treatment, with a good diagnostic accuracy (Area under the Relative Operating Characteristic (ROC) Curve (AUC) > 0.7)
Chitinase-3-like protein 1 (CHI3L1) and MMP10 distinguished psoriasis from psoriatic arthritis not undergoing systemic therapy and, in the presence of onychopathy, MMP8 levels were higher in psoriasis than in psoriatic arthritis
Summary
Adult psoriatic disease depicts a continuum encompassing disease progression from psoriasis (Ps) to psoriatic arthritis (PsA) [1]. 20–30% of Ps patients develop PsA but the non-clinically oriented instrumental screening of psoriatic patients is neither routinely adopted nor recommended due to the connected costs [1] Both clinical signs, such as psoriatic onychopathy and non-specific inflammatory parameters, are considered to identify Ps patients with a putative higher risk of developing PsA [3]. This is accompanied by other proposed tools, such as the psoriasis epidemiology screening tool (PEST) questionnaire, evaluating the risk of developing PsA [4]. Epidemiological studies based on clinical health records comparing Ps and PsA cohorts displayed contrasting results about the possible risk factors implicated in the evolution from Ps to PsA [5]
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