Duration Of Psoriasis Research Articles

Role of endothelial cell specific molecule-1 (endocan) and cardiac imaging in early detection of cardiac involvement in psoriatic patients with or without arthritis

Aim of the workMeasuring serum endocan level to determine its potential role in detecting subclinical cardiovascular involvement in psoriatic patients with or without arthritis. Patients and methodsThis work included 14 psoriatic arthritis (PsA) patients, 14 psoriasis only (PsO) patients, and 14 age and sex matched controls. The psoriasis area severity index was evaluated. Serum endocan level was measured, subclinical atherosclerosis was assessed using brachial artery flow-mediated vasodilation (FMD), and echocardiography: standard and tissue Doppler imaging (TDI) was performed. ResultsThe mean age of PsA patients was 38.3 ± 9.9 years and for PsO was 37.9 ± 8 years. They were 3 males and 11 females in both groups with a comparable psoriasis duration (11 ± 4.9 vs 8 ± 6.3 years; p = 0.17). PsA patients had significantly increased endocan level (618 ± 227.8 ng/L) compared to those with PsO or controls (359 ± 185.7 and 130.6 ± 38.2 ng/L respectively; p < 0.001). 4 (28.6%) PsA patients, 1 (7.1%) PsO patient and none of the controls had FMD abnormality. TDI revealed early diastolic mitral annular motion velocity (E') abnormality in 5 (35.7%) PsA patients. In PsA patients, endocan level was significantly elevated in patients with FMD or E' abnormality compared to those without (p = 0.01 and p = 0.001, respectively). Serum endocan significantly negatively correlated with FMD and E' in psoriatic patients. Serum endocan significantly detected FMD and E' abnormalities in psoriatic patients (p = 0.002 and p = 0.001, respectively). ConclusionSubclinical cardiovascular involvement was evident among psoriatic patients, particularly those with arthritis. Serum endocan is a promising endothelial biomarker for detecting subclinical atherosclerosis and preclinical cardiac dysfunction in psoriatic patients.

Adherence to systemic therapy in patients with psoriasis during the COVID-19 pandemic: A multicenter study.

BackgroundAdherence to treatment is important in chronic dermatological diseases. There are limited data regarding the adherence to treatment in patients with psoriasis during the COVID‐19 pandemic.AimsWe aimed to determine the rates of adherence to systemic treatments in patients with psoriasis and to identify the causes of non‐adherence during the COVID‐19 pandemic.MethodsWe conducted a cross‐sectional multicenter study from May 2021 to August 2021. A questionnaire including items regarding sociodemographic characteristics of the patients, disease‐related characteristics, and treatment‐related characteristics were filled out by the physicians. The Psoriasis Area Severity Index (PASI), Hospital Anxiety, and Depression Scale, and the Dermatology Life Quality Index were calculated. The rate of adherence and non‐adherence to treatment and reasons for non‐adherence to treatment were examined.ResultsA total of 342 patients with psoriasis were included (182 male/160 female) in the study. The mean age of the patients was 45.9 ± 14.2 years. The average duration of psoriasis was 192 ± 134.7 months. While the rate of adherence to treatment was 57.6%, the rate of non‐adherence to treatment was 42.4%. There were no significant differences with respect to adherence to treatment in comparison with oral and injection‐therapy groups. The most frequent reasons for non‐adherence to treatment were inability to go to the hospital (19.2%), concern about the COVID‐19 infection (16.3%), discontinuation of the treatment by the doctor (13.7%), inability to reach the doctor (7.3%), and inability to have access to the medication (7.3%).ConclusionAdherence to oral and injection therapies was fairly high among our patients with psoriasis during the COVID‐19 pandemic. Psoriasis severity and duration of medication use had a negative impact on adherence to treatment.

Evaluation of ocular psoriasis with meibography

BackgroundPrevious studies has shown that dry eye test abnormalities, meibomian gland dysfunction (MGD), may occur in psoriasis. ObjectivesThe authors aimed to evaluate the dry eye disease (DED), MGD, in psoriasis patients with meibography which is a current, objective, noninvasive method for patients with meibomian gland diseases, to investigate the relationship between disease severity and ocular involvement. MethodsThis study included 50 participants with psoriasis and 50 healthy individuals. All subjects were examined by the same dermatologist and referred for ophthalmological examination including meibomian gland obstruction, lid margin alterations assessment, ocular surface disease index assessment, tear film break-up time test, Schirmer test, corneal conjunctival fluorescein staining assessment. Additionally, upper and lower lids were evaluated for meibomian gland loss with meibography. ResultsMGD (28%), meibomian gland loss (MGL) (29.5%), upper meiboscore (0.61 ± 0.81), lower meiboscore (0.46 ± 0.61), DED (22%) were significantly higher in the psoriasis group compared with the control group (p = 0.008, p < 0.001, p = 0.027, p = 0.041, p = 0.044, respectively). There was a significant relationship between MGD and psoriasis area severity index (PASI) (p = 0.015, Odds Ratio = 1.211). There was a significant positive relationship between MGL with PASI (p < 0.001, r = 608) and psoriasis duration (p < 0.001, r = 0.547). Study limitationsSmaller study group and inability to detect quality changes of meibum with meibography were limitations of the study. ConclusionsPsoriasis may affect the meibomian gland morphology, may cause structural changes in meibomian glands, and as a result of these may cause MGD and DED. Therefore, ophthalmologists and dermatologists should be aware of this situation and co-evaluate the patients in this respect.

Clinicoprognostic and Histopathological Features of Guttate and Plaque Psoriasis Based on PD-1 Expression.

Several studies have determined the correlation between programmed cell death protein-1 (PD-1) and chronic plaque psoriasis (CPP). However, limited studies have assessed the association between PD-1 expression and the clinicoprognostic and distinct clinicopathological characteristics of CPP and guttate psoriasis (GP). Twenty-nine patients with skin biopsy-confirmed CPP were recruited at the Asan Medical Center between January 2018 and June 2020, and 33 patients with biopsy-confirmed GP were enrolled between January 2002 and June 2020. The clinicoprognostic and histopathological characteristics were analyzed according to immunohistochemical PD-1 expression in the epidermal or dermal inflammatory infiltrates. The CPP and GP lesions were divided into PD-1-low and PD-1-high groups. The CPP epidermal PD-1-high group had typical histopathological changes and significantly higher psoriasis area and severity index scores (p = 0.014) and disease duration (p = 0.009) than the epidermal PD-1-low group. In patients with GP, compared with the dermal PD-1-high group, the dermal PD-1-low group exhibited significantly higher disease duration (p = 0.002) and relapse rate of plaque psoriasis (p = 0.005) and significantly lower relapse-free survival (p = 0.016). Upregulated epidermal PD-1 expression was correlated with the chronicity and severity of CPP, while downregulated dermal PD-1 expression was correlated with poor prognosis of GP.

Risk factors associated with osteoporosis and fracture in psoriatic arthritis.

Background:Although there are few studies mentioned there may be some relationship between psoriatic arthritis (PsA) and osteoporosis, clinical data in real world still need to be clarified in China. The aim of this study was to assess the areal and volumetric bone mineral density (BMD), frequency of fracture, and risk factors in patients with PsA.Methods:A total of one hundred PsA patients who visited Peking University First Hospital and one hundred age- and sex-matched healthy controls with DXA data were enrolled in the study. Patients with clinical fractures confirmed by X-ray during follow-up were also recorded. Clinical characteristics of the patients were recorded and compared between the abnormal BMD group and the normal BMD group, as well as between the fracture and non-fracture groups. Risk factors for fracture and low BMD were analyzed.Results:Mean BMD at the total hip and femoral neck was significantly lower in PsA patients than that in healthy controls (0.809 ± 0.193 vs. 0.901 ± 0.152 g/cm2, P = 0.041; 0.780 ± 0.146 vs. 0.865 ± 0.166 g/cm2, P = 0.037, respectively). Moreover, lumbar spine BMD was negatively correlated with psoriasis duration, swollen joint count and DAS28-CRP (r = –0.503, –0.580, –0.438; P < 0.05). Total hip BMD and femoral neck BMD were negatively correlated with HAQ (r = –0.521, –0.335; P < 0.05). Fractures occurred in 29 patients during the follow-up period. Logistic regression analysis showed that older age (OR 1.132 [95%CI: 1.026–1.248), P < 0.05], higher HAQ score (OR 1.493, 95%CI: 1.214–1.836, P < 0.01), higher disease activity index for psoriatic arthritis (OR 1.033, 95% CI: 1.002–1.679, P < 0.05) and hip joint involvement (OR 6.401, 95% CI: 4.012–44.180, P < 0.05) were risk factors for fracture in the multivariate model.Conclusions:Increased risks of osteoporosis and fracture were found in PsA patients compared to healthy controls. Besides age, high disease activity and hip joint involvement were risk factors for decreased BMD and fracture.

New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?

Psoriasis and psoriatic arthritis (PsA) development is sustained by tumor necrosis factor (TNF)α, interleukin (IL)17, and IL23; hence, biologics targeting those cytokines represent useful therapeutic weapons for both conditions. Nevertheless, biologics strongly reduce PsA risk; several studies reported the possibility of new-onset PsA during biologic therapy for psoriasis. The aim of this 1-year prospective study is to evaluate the prevalence of paradoxical PsA in psoriasis patients under biologic therapy and review the existing literature. For each patient, age, sex, psoriasis duration, psoriasis severity, comorbidities, and previous and current psoriasis treatments were collected, and each subject was screened for PsA using the Early ARthritis for Psoriatic patient (EARP) questionnaire every 3 months for 1 year. New-onset PsA was diagnosed in 10 (8.5%) out of 118 patients (three male, 30.0%; mean age 44.5 years) involving every different biologic class (anti-TNF, anti-IL12/23, anti-IL17, and anti-IL23). No significant risk factor for new-onset PsA was identified; no significant difference was found comparing patients who developed PsA and subjects who did not develop PsA regarding psoriasis severity, past/current therapies, and comorbidities. Clinicians must keep in mind the possibility of PsA onset also in patients undergoing biologics so that PsA screening should be strongly recommended at each follow-up.

Dyslipidemia in Psoriasis: A Case - Controlled Study

INTRODUCTION: Psoriasis is a chronic inflammatory condition of skin which can be associated with other ailments including dyslipidemia which is an abnormal serum lipid profile. OBJECTIVE: The aim of present study was to determine correlation between dyslipidemia and Psoriasis of patients visiting the Out-patient Department of Patan Hospital METHODS: Ninety patients were selected for study. Among them 30 patients with psoriasis were taken as cases and 60 patients that matched for age and sex with Psoriasis patients were taken as controls. The lipid profile that comprised four parameters: serum High-density Lipoprotein, Low-density Lipoprotein, Total Cholesterol and Triglyceride were determined and compared for both case and control groups. RESULTS: More than 95% of the psoriatic patients had dyslipidemia. The odds of dyslipidemia among Psoriatic patients were 1.709 times higher compared to control group (p &lt;0.001). Among the parameters, results showed High-density lipoprotein was significantly lower while Triglyceride was significantly higher among the cases compared to controls with p value of 0.012 and 0.001 respectively. The risk factors like smoking and alcohol were present in higher proportions among the patients with dyslipidemia but it failed to reach statistical significance. With increase in duration of Psoriasis and PASI scores, lipid parameters i.e., Total cholesterol, triglyceride and Low-density lipoprotein increased while High density lipoprotein decreased but this correlation was insignificant. CONCLUSION: This study showed Dyslipidemia is significantly higher among patients with Psoriasis especially lipid profile parameters Triglyceride and total cholesterol. Thus, timely screening and management of dyslipidemia among Psoriatic patients might be helpful in prevention of future cardiovascular events.

Study of The Relationship Between Psoriasis of Different Clinical Varieties and Osteoporosis

Abstract Background Psoriasis is considered as a systemic disease since it is an inflammatory skin disorder associated with increased level of many inflammatory cytokines, which can result in many comorbidities. It was hypothesized that there is an association between psoriasis and osteoporosis and many studies investigated this association, but the majority of them focused on the association between psoriatic arthritis and osteoporosis, while this study excluded psoriatic arthritis and investigated the association between psoriasis of different clinical varieties and osteoporosis. Objective to assess the associated relationship between psoriasis and osteoporosis in psoriatic patients of different clinical varieties, by measuring the prevalence of osteoporosis in a sample of these patients. Subjects and methods Our cross-sectional study included 42 psoriatic male and female patients with non specific ages, 48% of them were males (20 patients) and 52% of them were females (22 patients), and it excluded any patients with endocrinal disorders, chronic renal failure, liver cell failure, other chronic inflammatory disoredres, malabsorption, history of alcohol misuse, history of intake of steroids for longer than 6 months, pregnant women and psoriatic arthritis. All patients were subjected to a questionnaire for detailed history taking, complete general and dermatological examinations, evaluation of psoriasis severity by Psoriasis Area and Severity Index (PASI) score and bone mineral density (BMD) measurement using the DEXA method of the lumbar spine (L1L4) and femoral neck. Results The prevalence of osteoporosis among psoriatic patients was (9.5%), (10%) in males and (9%) in females, which was lower than the prevalence of osteoporosis in the population. While the prevalence of osteopenia was 50%, (45%) in males and (54.5%) in females, which was higher than the prevalence of osteopenia in the population. Additionally this study showed a statistically significant negative correlation between the age of the patients and BMD, and a highly significant positive correlation between the BMI of the patients and BMD, while there were non significant negative correlations between both (duration of psoriasis and PASI score) and BMD, and no significant correlations between clinical variants of psoriasis and BMD. Conclusion Psoriasis is associated with a decrease in the bone mineral density more in males, with higher incidence of osteopenia rather than osteoporosis. The decrease in BMD increases with increasing age, duration of psoriasis and PASI score, decreases with increasing BMI, while the clinical variants of psoriasis didn’t seem to affect the BMD of psoriatic patients.

IL-23 blockade with guselkumab potentially modifies psoriasis pathogenesis: rationale and study protocol of a phase 3b, randomised, double-blind, multicentre study in participants with moderate-to-severe plaque-type psoriasis (GUIDE)

BackgroundGuselkumab is an interleukin (IL)-23 pathway blocker with proven efficacy in patients with moderate-to-severe plaque psoriasis. Early intervention with guselkumab may result in changes to the clinical disease course versus...

Mediterranean diet in axial spondyloarthritis: an observational study in an Italian monocentric cohort

BackgroundLittle evidence is available about the impact of diet on disease activity of axial spondyloarthritis (axSpA). This study evaluated the impact of a 6-month nutritional advice based on the Mediterranean diet on the disease activity of axSpA.MethodsWe prospectively collected the information of a group of axSpA patients who were offered nutritional advice for a 6-month period, who were compared to axSpA patients followed at the same center who were not on a specific diet. A nutritionist gave suggestions for dietary modification at baseline and thereafter every 2 months until month 6. Adherence to the Mediterranean diet was evaluated with the PREDIMED questionnaire ranging from 0 (no adherence) to 10 (optimal adherence); disease activity was evaluated with ASDAS-CRP. A multivariable regression analysis was conducted to identify independent predictors of PREDIMED and of ASDAS-CRP improvement (improvement ≥ 20% of each score).ResultsA total of 161 patients were included: 81 receiving nutritional advice and 80 controls; 47 in the nutritional group and 63 controls had complete information until month 6. Overall, 40 (36.4%) were females, the mean age was 51.7 ± 1.3 years, and 58 (52.7%) were affected with psoriasis. No relevant change of anthropometric or laboratory measures was observed in either group. Adherence to the Mediterranean diet was moderate (PREDIMED score 6.7 ± 1.8 at baseline; 7.6 ± 2.1 at month 6) and improved more in the nutritional group compared to controls (p = 0.020). Predictors of a PREDIMED improvement ≥ 20% were receiving nutritional advice (OR 4.53, 1.36–15.1, p = 0.014), age (per 10-year increase OR 1.05, 1.02–1.68, p = 0.007), and BMI (OR 0.77, 0.63–0.9, p = 0.006). An ASDAS-CRP improvement ≥ 20% was more frequent in the nutritional group compared to controls (p = 0.020). A PREDIMED improvement ≥ 20% was associated with a ASDAS-CRP improvement ≥ 20% (OR 6.75,1.8–25.3, p = 0.005). Psoriasis and disease duration were negatively but not significantly associated to the ASDAS-CRP improvement.ConclusionsImproving adherence to the Mediterranean diet may have a beneficial impact on the activity of axSpA. Patients with a lower BMI and older patients are more prone to modify their diet towards the Mediterranean diet following nutritional advice. Patients with psoriasis may have a limited benefit from dietary improvement.Study registrationProtocol No. 52723, Padova Hospital Medical Ethical Committee (October 11, 2010).

Treatment of psoriasis with biologics in the early COVID-19 pandemic: A study examining patient attitudes toward the treatment and disease course.

BackgroundSince March 2020, the coronavirus disease 2019 (COVID‐19) pandemic has been ongoing all around the world with a wide range of clinical course including asymptomatic cases to severe and fatal respiratory tract disease. Patients on immunosuppressive treatments were predicted to be more susceptible to COVID‐19.AimsIt was aimed to assess treatment continuity, the course of psoriasis and the course and clinical features of COVID‐19 in patients treated with biological agents for psoriasis at the early initial period of COVID‐19 pandemic.Patients/MethodsPatients treated with biological agents for psoriasis at our institute were contacted by phone between 1 and 10 July 2020 and fulfilled a questionnaire about their continuity to psoriasis treatments, clinical course of psoriasis, and any suspicion/diagnosis of COVID‐19.ResultsA total of 106 patients, 41 females and 65 males, were enrolled. Mean age of the patients was 46.1 ± 12.1 years (range: 19–77). Median duration of psoriasis was 18 years (min–max: 1 month–51 years). Twenty‐four patients (22.6%) were using tumor necrosis alpha inhibitors (ETA:1, IFX:19, ADA:4), whereas 82 patients (77.4%) were using interleukin (IL) 12/23 or IL‐17 inhibitors (UST:48, SECU:30, IXE:4). Seventy‐six patients (71.7%) continued the treatment, whereas 30 patients (28.3%) interrupted the treatment voluntarily. Twenty out of 30 patients (66.6%) who interrupted the treatment had an exacerbation of psoriasis. None of the patients were diagnosed with COVID‐19 in the study period.ConclusionPatients with psoriasis who received biological therapy continued their treatment at a high rate during the early period of the COVID‐19 pandemic. No COVID‐19 diagnosis was made among patients whether they continued or discontinued treatment. Recurrence and exacerbation of psoriasis in a significant proportion of patients who interrupted treatment and absence of COVID‐19 diagnosis in each group support the importance and safety of continuity of biological treatments for psoriasis in COVID‐19 era.

Long-Term Proactive Treatment of Plaque Psoriasis with Calcipotriene/Betamethasone Dipropionate Foam Prolongs Remission and Reduces Relapses Irrespective of Patient Baseline Characteristics.

IntroductionThe phase 3 PSO LONG study (NCT02899962) demonstrated superior efficacy of proactive (PM) versus reactive management (RM) using calcipotriene 0.005%/betamethasone dipropionate 0.064% (Cal/BD) foam in adults with psoriasis. Here, we evaluated whether certain baseline parameters had an effect on time to first relapse (TTFR), number of relapses, and assessed interactions between treatment effect.MethodsPSO LONG included an initial 4-week open-label phase (once-daily Cal/BD foam) and a 52-week maintenance phase where patients were randomized to twice-weekly Cal/BD (PM) or vehicle foam (RM), with a 4-week once-daily Cal/BD foam rescue treatment for relapse. Baseline parameters analyzed using a stepwise variable selection procedure included body surface area, modified Psoriasis Area Severity Index (mPASI), Physician Global Assessment (PGA), body mass index, age, sex, Dermatology Life Quality Index, and duration of psoriasis. Continuous variables were divided into groups based on standard criteria.ResultsOverall, the effect of treatment on TTFR did not vary across any baseline parameters. Variables with a statistically significant effect on TTFR were: treatment group (PM vs. RM hazard ratio [HR]: 0.56; p < 0.001); PGA (moderate vs. mild HR: 1.42; severe vs. mild HR: 2.32; overall p = 0.009); mPASI (moderate vs. mild HR: 1.19; severe vs. mild HR: 1.77; overall p = 0.009); and sex (women vs. men HR: 1.26; p = 0.030). Variables with a significant effect on the number of relapses were: treatment group (PM vs. RM, rate ratio [RR] 0.52; p < 0.001); PGA at baseline (moderate vs. mild, RR 1.38; severe vs. mild, RR 2.22; overall p < 0.001); and mPASI (moderate vs. mild, RR 1.25; severe vs. mild, HR 1.70; overall p = 0.002).ConclusionAll patients benefitted from long-term PM versus RM with Cal/BD foam regardless of baseline characteristics, and the benefit of treatment increased with greater disease severity.Trial RegistrationClinicalTrials.gov identifier, NCT02899962.

Illness Acceptance as the Measure of the Quality of Life in Moderate Psoriasis.

IntroductionPsoriasis is a chronic disease with intermittent flares and remissions. Each individual perceives the disease, its somatic effects, resultant dysfunction and related problems differently. This attitude is primarily determined by one’s characterological traits and type of illness. A primary response to the diagnosis can be denial, underestimation, acceptance or overestimation of the disease. The aim of the study was to analyze the level of illness acceptance and its effect on the quality of life in moderate psoriasis depending on sociodemographic and clinical characteristics of the patients.Materials and MethodsThe study included 186 patients with plaque psoriasis with Psoriasis Area Severity Index (PASI) scores ≤10. The inclusion criteria of the study were duration of psoriasis >2 years, age ≥18 years, and lack of other somatic or mental disorders during three months preceding the study. The study participants completed the Acceptance of Illness Scale (AIS), Dermatology Life Quality Index (DLQI) as well as an original survey containing questions about their sociodemographic characteristics and information about their disease.ResultsMean AIS score for the study group was 24.3 pts. Patients older than 40 years presented with lower levels of illness acceptance than younger persons (p = 0.0311). Also, patients’ sex and duration of psoriasis significantly affected the acceptance of the illness, with lower AIS scores found in women (p = 0.0092) and persons with a longer history of the disease (p = 0.0362). Mean DLQI score for the study group was 13.3 pts. A lower level of illness acceptance turned out to exert an unfavorable effect on the quality of life (QOL) in psoriasis (p = 0.0015; R = −0.33).ConclusionIn this study, patients with psoriasis presented with a moderate level of the illness acceptance, and a significant correlation was found between this parameter and QOL.

Frequency of Different Types of Arthritis in patients of Psoriasis

Background: Psoriatic arthritis (PsA) is type of inflammatory arthritis associated with psoriasis. There are multiple patterns of joint involvement in patients with psoriasis Aim: To determine the frequency of arthritis and its different types in patients of psoriasis presenting at a tertiary care hospital in Lahore Methods: This cross Sectional study was conducted in Dermatology Department of Services Hospital, Lahore from 11th April, 2017 to 10th October, 2017. Two hundred and sixty patients having psoriasis were enrolled in the study, Patients’ detailed history about psoriasis, duration of psoriasis and joint pain or stiffness was taken. After written and informed consent Physical examination was done to determine the type of psoriasis and nail involvement. All the joints were examined for tenderness and deformities to assess the evidence of arthritis and its different types according to the site of involved joints. Results: Total numbers of patients included in the study was 260; in which 176 (67.7%) patients were males and 84 (32.3%) were females with the total mean age of 38 ±13.22 years. Out of 260 patients, 62(23.8%) patients had psoriatic arthritis (PsA), Out of these 62 patients having PsA, 23(37.1%) patients had Oligoarthritis, followed by Symmetric arthritis 19(30.6%) patients, Distal interphalangeal arthritis (DIP) in 15 (24.2 %). Conclusion: Our study concluded that almost one fourth of psoriasis patients had arthritis, asymmetrical oligoarthritis/monoarthritis came out to be the most common type in our study followed by symmetric polyarthritis, distal interphalangeal arthritis (DIP), Arthritis mutilans and axial arthritis Keywords: Psoriasis, types of psoriasis, arthritis, psoriatic arthropathy

Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis

ObjectiveTo estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis who had received a continuous treatment with biological disease-modifying antirheumatic drugs (bDMARDs) compared with phototherapy.MethodsA retrospective non-randomised study...

English

BACKGROUND We wanted to determine the prevalence of ocular manifestations assess the frequency and distribution of potential sight threatening complications in patients with psoriasis. METHODS This is a non interventional, observational hospital based study conducted at a tertiary health care centre which included 105 patients with psoriasis. A background history was taken regarding the duration of psoriasis and treatment taken. The prevalence of ocular manifestations were assessed by detailed ocular examination which involved the best corrected visual acuity using Snellen’s chart, examination of the anterior chamber using slit lamp, examination of the fundus, intraocular pressure measurement, dry eye evaluation including Schirmer’s test, tear film break up time test, and Rose Bengal stain test. RESULTS In total 105 patients with psoriasis were enrolled in this study. Among the 105 patients whose 210 eyes were examined, 77 % had psoriasis vulgaris, 14 % had scalp psoriasis, and 9 % had palmoplantar psoriasis. Among the 105 patients, 38 patients had symptomatic ocular manifestations. Out of the 38 % patients with symptomatic ocular manifestations, we found that 28 %, 25 %, 17 %, 2 % of the patients manifested with evaporative dry eye, blepharoconjunctivitis, redness and episcleritis respectively. CONCLUSIONS In our study, ocular manifestations were even seen among the asymptomatic patients. Hence a multi-disciplinary approach including effective screening and early detection of ocular manifestations followed by prompt treatment is essential to reduce the morbidity in patients with psoriasis. KEY WORDS Psoriasis, Dry Eye, Uveitis

Long-Term Effectiveness and Drug Survival of Apremilast in Treating Psoriasis: A Real-World Experience

Background: Apremilast is an oral phosphodiesterase 4 (PDE4) inhibitor used for the treatment of moderate to severe psoriasis. Long-term data on the effectiveness and drug survival of patients treated with apremilast are limited. Objective: The aim of this study was to analyze the characteristics, effectiveness, and drug survival of patients treated with apremilast in a real-world setting. Methods: We conducted a retrospective cohort study of patients with psoriasis who received at least 1 dose of apremilast between 2015 and 2018. We documented sex; age; type, duration, and severity (using Psoriasis Area Severity Index [PASI] and Dermatology Life Quality Index [DLQI]) of psoriasis; comorbidities; previous treatment modalities; adverse events; and reasons for therapy discontinuation. For drug survival, estimates and efficacy analysis with Kaplan-Meier statistics were used. Results: The drug survival rate of the 93 reviewed patients was 69.5% at 6 months, 34.7% at 12 months, and 25.8% at 24 months after initiating therapy. The median survival duration was 8.0 months. Therapy was discontinued in 66.6 and 27.8% due to loss of efficacy and adverse events, respectively. At 24 months, 35.9% had achieved PASI75 response and 23.7% had achieved PASI90 response. Most observed adverse events were gastrointestinal issues, weight loss, and headache. Conclusions: Apremilast is an effective and well-tolerated therapy for patients with moderate to severe psoriasis, especially for patients with difficult-to-treat locations and/or contraindications to other biologics. Furthermore, apremilast was used for patients with a history of nonresponse to biologics and was favored for patients with relatively low PASI (<10) and a high DLQI.

Quality of life in children with psoriasis: results from a monocentric study.

BACKGROUND Psoriasis is a chronic inflammatory disease that can impair quality of life and psychological status not only in adult patients, but also in children. Few data about quality of life in children with psoriasis are available in literature. The aim of this study was to investigate the impact on the quality of life in children with psoriasis and the relationship with severity, localization, age at onset, duration and family history of psoriasis. METHODS Health-related quality of life was assessed in 110 children and adolescents with psoriasis using a validated Italian version of the Children's Dermatology Life Quality Index. Clinical and anamnestic data were collected in all patients. RESULTS The mean value of Children's Dermatology Life Quality Index was 4.20±3.73. Multivariate analysis showed a statistically significant correlation of the Children's Dermatology Life Quality Index with the severity of psoriasis (P<0.001) and with the presence of psoriasis in visible areas (P<0.001) independently from the severity. CONCLUSIONS Psoriasis has a remarkable social and psychological impact on life, also in children. Quality of life should be assessed in children with psoriasis also when psoriasis is mild but localized in visible areas.

Prevalence of Metabolic Syndrome and Its Parameters and Their Correlations With Psoriasis Duration, Severity, and Sleep Quality In Psoriasis Patients: A Cross-Sectional Study.

Psoriasis is an inflammatory skin disease that may lead to comorbidities, including metabolic syndrome (MS). We determined the prevalence of MS and its correlation with psoriasis duration, severity, and sleep quality in psoriasis patients. A total of 112 subjects with chronic plaque psoriasis were studied. Demographics, MS parameters, disease duration, severity, and sleep quality were examined. The Psoriasis Area and Severity Index (PASI) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess psoriasis severity and sleep quality, respectively. Presence of MS and its correlations with psoriasis duration, severity and sleep quality were investigated. Of 112 patients, 76 (67.8%) were diagnosed with MS. Of all patients, 74.1% had a high PASI, and 84.8% had a high PSQI. The mean values of psoriasis duration, body mass index, waist circumference, fasting glucose, HOMA-IR, triglyceride levels, blood pressure, PSQI, sleep latency, and daytime sleep dysfunction were significantly higher in the MS group than non-MS group, whereas the mean HDL level was lower. The prevalences of MS, high fasting glucose, and low HDL were significantly higher among female, but not male, patients with severe psoriasis (PASI >10) than those without severe psoriasis. Disease duration, high body mass index, waist circumference, blood pressure, fasting glucose, HOMA-IR, triglyceride levels, low HDL, and poor sleep quality were significantly correlated with the presence of MS. However, only waist circumference, fasting glucose, blood pressure, and low HDL were predictive of the development of MS. MS is common among psoriasis patients, and especially in females with advanced psoriasis, high fasting glucose, and low HDL levels. Besides diagnostic criteria of MS, a long duration of psoriasis, poor sleep quality and high-HOMA-IR correlate with the development of MS. High fasting glucose and low HDL levels may facilitate MS development in association with psoriasis severity in females.

OP0224 CONTINUOUS COMPOSITE MEASURES FOR ROUTINE CARE IN PSORIATIC ARTHRITIS: THRESHOLDS OF MEANING AND CLINICALLY IMPORTANT DIFFERENCE ESTIMATES FOR THE 3 AND 4 VAS SCALES FROM A UK MULTICENTRE STUDY

Background:There is a recognised need for a continuous composite measure of disease activity for the assessment of Psoriatic Arthritis (PsA) in routine clinical settings to allow objective assessment of response and implementation of treat to target.1 Longer multidimensional measures are considered less feasible in routine care and a number of shorter measures have been proposed including, the Disease Activity Score for Psoriatic Arthritis (DAPSA), Disease Activity Score 28 (DAS28), the 3 Visual Analogue Scale (VAS) (comprising physician global VAS, patient global VAS and patient skin VAS) or 4 VAS (comprising physician global VAS, patient pain VAS, joint VAS and patient skin VAS). Testing of these measures in clinical trial datasets has been suggested but thresholds of meaning have not been established.2Objectives:To estimate clinically relevant thresholds of disease activity and improvement for composite measures for routine clinical practice in PsA.Methods:Clinical and patient reported outcome measures were assessed in patients fulfilling CASPAR criteria for PsA at three consecutive follow up visits in a UK multicentre observational study. Participants underwent clinical assessment and completed patient reported measures including health anchor questions. Estimates for Minimal Detectible Change (MDC) were derived using 1.96*2*Standard Error of the Mean (SEM). Minimal Clinically Important Difference (MCID) for improvement were derived using the health anchor method and two distribution methods (Table 1). Thresholds for low, moderate and high disease activity were triangulated from established cut-off values for the patient global VAS, PASDAS and DAPSA.Table 1.Minimal Clinically Important Difference (MCID) and Minimal detectable change (MDC)ANCHOR (MEDIAN)DISTRIBUTION#1DISTRIBUTION #2MDCCPDAI0.51.491.54.16GRACE0.260.60.772.18PASDAS1.220.640.761.58DAS280.20.850.621.463VAS1.131.160.913.124VAS1.110.960.942.45DAPSA7.259.0910.4035.63Disease Activity Score for Psoriatic Arthritis (DAPSA); Psoriatic Arthritis Disease Activity Score (PASDAS); Composite Psoriatic Arthritis Disease Activity Index (CPDAI); Disease Activity Score 28 (DAS28).Distribution #1: Baseline standard deviation (sd) * √ 1 – Cronbach’s alphaDistribution #2: 0.5 * baseline sdMinimal detectable change (MDC): 1.96*2*SEM where SEM = baseline sd √1 - ICCResults:139 subjects were recruited (59 male, 80 female, mean (range) age (years) 52.7 (19 – 83), mean (range) duration of psoriasis (years) 21.9 (2 – 71), mean (range) duration of psoriatic arthritis (years) 6.1 (0 – 41). Cut-off values for low, moderate and high disease activity were 1.3, 2.4, and 4.8 for the 3 Vas and 1.6, 2.8 and 5.0 for the 4 VAS (Figure 1). Estimates for the MCID and MDC for the continuous composite measures and are reported in Table 1.Conclusion:We report estimates of clinically relevant improvements for continuous composite measures in PsA and estimates of low, moderate and high disease activity for the 3 and 4 VAS scales. The thresholds of meaning can now be tested in independent observational and clinical trial datasets.