Early Diagnosis Of Psoriatic Arthritis Research Articles

In the search for an accurate and early diagnosis of psoriatic arthritis: is the key in ultrasound?

In the search for an accurate and early diagnosis of psoriatic arthritis: is the key in ultrasound?

Ultrasound-based detection of inflammatory changes for early diagnosis and risk model construction of psoriatic arthritis.

Psoriatic arthritis (PsA) is the most prevalent coexisting condition associated with psoriasis. Early-stage PsA patients always present unspecific and subtle clinical manifestations causing delayed diagnosis and leading to unfavorable health outcomes. The application of ultrasound enables precise identification of inflammatory changes in musculoskeletal structures. Hence, we constructed ultrasound models to aid early diagnosis of PsA. This is a cross-sectional study carried out in the Department of Dermatology at West China Hospital (October 2018-April 2021). All participants underwent thorough ultrasound examinations. Participants were classified into the under 45 group (18 ≤ age ≤ 45) and over 45 group (age > 45) and then randomly grouped into derivation and test cohort (7:3). Univariable logistic regression, least absolute shrinkage and selection operator, and multivariable logistic regression visualized by nomogram were conducted in order. Receiver operating characteristic (ROC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA) were performed for model verification. A total of 1256 participants were included, with 767 participants in the under 45 group and 489 in the over 45 group. Eleven and sixteen independent ultrasonic variables were finally selected to construct the under 45 and over 45 model with the area under the ROC of 0.83 (95%CI: 0.78-0.87) and 0.83 (95%CI: 0.78-0.88) in derivation cohort, respectively. The DCA and CICA analyses showed good clinical utility of the two models. The implementation of the ultrasound models could streamline the diagnostic process for PsA in psoriasis patients, leading to expedited evaluations while maintaining diagnostic accuracy.

Psoriasis and Psoriatic Arthritis Have a Major Impact on Quality of Life and Depressive Symptoms: A Cross-Sectional Study of 300 Patients.

Psoriasis (Pso) and psoriatic arthritis (PsA) can reduce the quality of life (QoL) and are known to be associated with depression. Within this study, we aimed to assess the burden of disease, functional capacity, quality of life, and depressive symptoms and identify factors predicting functional impairment and depression in patients with psoriatic disease. A cross-sectional survey was conducted in a cohort of 300 patients with psoriatic disease including 150 patients from a university hospital dermatology outpatient clinic and 150 patients from a university hospital rheumatology outpatient clinic. Questionnaire-based assessment of signs of arthritis (Psoriasis Epidemiology Screening Tool; PEST), functional status (Functional Questionnaire Hannover; FFbH), quality of life (World Health Organization Quality of Life Brief Version; WHOQOL-BREF), and depressive symptoms (Patient health questionnaire9; PHQ-9) and retrospective medical chart analysis were performed. Despite treatment, burden of disease was high. Joint pain was reported in multiple regions in patients with Pso (n = 111) and patients with PsA (n = 189), but with differences in frequency and distribution patterns of symptoms. Functional impairment in everyday life was independently associated with diagnosis of PsA (odds ratio [OR] 9.56, p = 0.005), depressive symptoms (OR 5.44, p < 0.001) and age (OR 1.04, p = 0.033). At least mild depressive symptoms were demonstrated in 54% and 69% of patients with Pso and PsA, respectively. In a logistic regression model, depressive symptoms were independently associated with functional impairment (OR 4.50, p = 0.003), axial complaints (OR 2.80, p = 0.030), diagnosis of psoriatic arthritis (OR 2.69, p = 0.046), and number of joint regions with complaints (OR 1.10, p = 0.032). Functional impairment, QoL, and depressive symptoms are mutually interdependent. Early diagnosis of PsA and initiation of anti-inflammatory therapy are essential to avoid long-term damage, disability, and mental health complications. However, despite therapy many patients with PsA, and especially female patients, report a substantial residual disease burden due to their psoriatic disease which will need to be addressed by a more patient-centered approach.

Developing Ultrasound Measures for the Early Diagnosis of Psoriatic Arthritis.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) ultrasound (US) steering committee provided an update at GRAPPA's 2022 annual meeting on activities to enable earlier diagnosis of psoriatic arthritis. An update of the Diagnostic Ultrasound Enthesitis Tool (DUET) study included preliminary reliability results for US enthesitis elementary lesions. Common scanning pitfalls were reviewed. New projects included widening the scope of US beyond large entheses and validating small point-of-care US probes to evaluate enthesitis.

EULAR points to consider for the definition of clinical and imaging features suspicious for progression from psoriasis to psoriatic arthritis

BackgroundThe transition from psoriasis (PsO) to psoriatic arthritis (PsA) and the early diagnosis of PsA is of considerable scientific and clinical interest for the prevention and interception of PsA.ObjectiveTo formulate...

The Combination of IL-6, PLR and Nail Psoriasis: Screen for the Early Diagnosis of Psoriatic Arthritis.

Early screening or timely prediction of psoriatic arthritis (PsA) are crucial. The study aimed to compare the clinical characteristics, cytokines and inflammation index between plaque psoriasis and PsA to explore their values in the early diagnosis of PsA. This was a case-control study in a single center from January 2021 to February 2023. The differences in clinical characteristics and laboratory examinations between PsA and plaque psoriasis were conducted. Patients with rheumatoid arthritis (RA) were used as a positive control. The correlation between variables were analyzed and multivariable logistic regression were performed by using the 10-fold cross-validation to find independently risk factors of plaque psoriasis that are developing PsA. A total of 109 patients with plaque psoriasis (without joint damage), 47 patients with PsA and 41 patients with RA were enrolled in this study. The study found that the proportion of patients with elevated serum IL-6 levels, as well as the value of platelet to lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), were significantly higher in patients with PsA and early PsA (PsA course ≤2 years) compared to those with plaque psoriasis (p<0.05). After adjusting for age, gender, severity of skin lesions, and comorbidities (diabetes, hypertension, hyperlipidemia, hyperuricemia, and overweight/obesity), the study identified nail psoriasis (OR=4.35, 95% CI 1.67-11.29, p<0.002), elevated serum IL-6 (OR=6.78, 95% CI 2.34-19.67, p<0.001), and PLR (OR=8.37, 95% CI 2.97-23.61, p<0.001) as independent risk factors for PsA. A multivariable logistic regression analysis employing 10-fold cross-validation assessing the predictive association between the diagnosis of early PsA and the combination of IL-6, PLR, and nail psoriasis demonstrated that the area under the curve (AUC) was 0.84 (95% CI 0.77-0.90) and the F1-score was 0.67 (95% CI 0.54-0.80). The combination of elevated serum IL-6, PLR, and nail psoriasis can help to predict and screen the early stage of PsA.

The joint ultrasound markers in the early diagnosis of psoriatic arthritis

Objectives. Early establishment of arthritis in PsA based on clinical data and ultrasound examination. Material and methods. The study was conducted between 2019-2023, in the rheumatology and arthrology departments of the Timofei Moşneaga Republican Clinical Hospital, or treated in outpatient. In order to meet the requirements of the study, 100 people were examined, including 70 patients with PsA. Results. In patients with PsA the most common changes were an increase in the amount of intra-articular fluid and the proliferation of the synovial membrane. In total, fluid was detected in 293 out of 3,232 joints (9.1%). Conclusions. Ultrasound is a highly informative method in detecting a wide range of morphological changes in the joints of patients with PsA. The highest index of sensitivity appeared when inflammatory fluid, cartilage changes, osteophytes and tenosynovitis were detected.

The role of the traumatic factor and isomorphic reaction in the early diagnosis of psoriatic arthritis

Rationale: Evaluation of the role of the deep Koebner's phenomenon and traumatization seems to be a promising direction in the search of the solution for the delayed diagnosis of psoriatic arthritis (PsA) in patients with psoriasis. We have put forward the question if joint and ligament abnormalities induced by a trauma or persistent physical activity could be an analogue of the skin isomorphic reaction in psoriasis.&#x0D; Aim: To identify joint and ligament abnormalities in patients with psoriasis caused by mechanical stress and their association with the deep Koebner's phenomenon and PsA.&#x0D; Materials and methods: This was an open-label, non-randomized, comparative study in parallel groups in 80 in-patients with psoriasis (recruited in the Dermatovenereological clinic № 1, Ufa); the control group included 80 in-patients with PsA. All patients were assessed by a dermatovenereologist, including past history, severity of psoriasis, degree of PsA activity, special questionnaires and the presence of an isomorphic reaction in the skin and periarticular tissues. The joints with maximal physical activity were assessed by X-ray. PsA was diagnosed by a rheumatologist.&#x0D; Results: The patients from both groups were matched in terms of age, gender, and duration of psoriasis. Pain, joint stiffness and limitation of mobility were present not only in the PsA group, but also in the patients with psoriasis (35%, 27.5% and 26.2% of the patients, respectively). Despite most of the patients in the psoriasis group had no active complaints (65.0% vs. 0% in the control group, p 0.001), clinical signs of inflammation of the tendons and entheses and relevant history were found in 47.5% (68.7% in the control group, p = 0.007). Hand tendinitis was most prevalent symptom in both groups: 40.0% (32/80) in the psoriasis group and 63.7% (51/80) in the PsA group (p = 0.003). Achilles tendon lesions were found in 17.5% (14/80) and 52.5% (42/80) (p 0.001) and periarticular edema in 27.5% (22/80) and 63.7% (51/80), respectively (p 0.001). The combination of these signs with psoriatic plaques in this area was observed in 32.5% (26/80) and 92.5% (74/80) of the patients, respectively (p 0.001). The comparison of the clinical and X-ray data showed that 38 patients with psoriasis and newly diagnosed PsA had had an increased physical load on the affected joints, as well as signs of a deep isomorphic reaction (tendinitis, periarticular edema, or enthesitis near the involved joints). In both groups, the most common form of PsA was distal one (63.2% [24/38] of the patients with newly diagnosed PsA and 58.7% [47/80] of the patients with previously diagnosed PsA, p = 0.648).&#x0D; Conclusion: Involvement of the periarticular tissues, as well as early, including preclinical, X-ray abnormalities in the joints of patients with psoriasis can be associated with increased physical activity and the deep Koebner's phenomenon. Therefore, even if patients with psoriasis do not have any clinical manifestations of PsA and no complaints when seen by a dermatovenereologist, it is recommended to perform a detailed collection of past history data with clarification of the type of physical activity and past trauma, as well as to examine both by inspection and palpation the periarticular tissues (tendons and entheses), for the timely use of X-ray examination, consultation of a rheumatologist aimed at diagnosis of psoriatic arthritis.

Immune and mathematical procedures in early diagnosis of psoriatic and seronegative rheumatoid arthritis

Objectives. Improvement of early diagnosis of psoriatic arthritis based on clinical data, immunological and mathematical research methods. Material and methods. The study was carried out between 2019 and 2022 at the Rheumatology and Nephrology Discipline, in the arthrology and rheumatology departments of the Timofei Moşneaga Republican Clinical Hospital. To accomplish the tasks set out in the study, 110 patients were examined, including 55 patients with psoriatic arthritis (group I) and 55 patients with rheumatoid arthritis (group II). Results. The range with the highest probability of psoriatic arthritis for the instrumental index is between 0.54 and 1.86. Of the 55 patients with psoriatic arthritis in 95% of patients clinical, laboratory, immunological and instrumental indices were within the range of the highest probability of the disease, which indicates a fairly high reliability of the mathematical model. Conclusions. Immune disorders in the early stages of rheumatoid arthritis and psoriatic arthritis are nonspecific and are characterized by an increase in CD16+ (26.2±1.5) and CD29+ (24.8±2.1) in rheumatoid arthritis, which is significantly higher than in psoriatic arthritis CD16+ (22.0±1.3) and CD29+ (17.4±3.2) (p &lt;0.05). A mathematical model of rheumatoid arthritis and psoriatic arthritis has been developed, which serves as an additional way of diagnosing rheumatoid arthritis and early psoriatic arthritis. Keywords: rheumatoid, psoriatic arthritis, mathematical, immune diagnosis.

Omics and Multi-Omics Analysis for the Early Identification and Improved Outcome of Patients with Psoriatic Arthritis.

The definitive diagnosis and early treatment of many immune-mediated inflammatory diseases (IMIDs) is hindered by variable and overlapping clinical manifestations. Psoriatic arthritis (PsA), which develops in ~30% of people with psoriasis, is a key example. This mixed-pattern IMID is apparent in entheseal and synovial musculoskeletal structures, but a definitive diagnosis often can only be made by clinical experts or when an extensive progressive disease state is apparent. As with other IMIDs, the detection of multimodal molecular biomarkers offers some hope for the early diagnosis of PsA and the initiation of effective management and treatment strategies. However, specific biomarkers are not yet available for PsA. The assessment of new markers by genomic and epigenomic profiling, or the analysis of blood and synovial fluid/tissue samples using proteomics, metabolomics and lipidomics, provides hope that complex molecular biomarker profiles could be developed to diagnose PsA. Importantly, the integration of these markers with high-throughput histology, imaging and standardized clinical assessment data provides an important opportunity to develop molecular profiles that could improve the diagnosis of PsA, predict its occurrence in cohorts of individuals with psoriasis, differentiate PsA from other IMIDs, and improve therapeutic responses. In this review, we consider the technologies that are currently deployed in the EU IMI2 project HIPPOCRATES to define biomarker profiles specific for PsA and discuss the advantages of combining multi-omics data to improve the outcome of PsA patients.

The role of trauma and isomorphic reaction in the pathogenesis of psoriatic arthritis

The role of biomechanical stress and trauma in the initiation of inflammation of the joints and periarticular structures in psoriatic arthritis (PA) is currently not fully understood. Soft tissues and joints are the target for constant biomechanical stress and microtrauma, leading to inflammation. There is an opinion that this inflammation in PA is due to an analogue of the skin isomorphic reaction that develops in the skin of psoriatic patients in response to trauma. Some authors have called this reaction the deep Koebner phenomenon. It is assumed that the early, preclinical phase of psoriatic arthritis may be based on inflammation of the enthesis as a response to microtrauma, and explained by the proximity of the entheses and the articular membranes. Detection of early changes in entheses in psoriatic patients, including those who do not have complaints from the musculoskeletal system, is of great importance for the early diagnosis of psoriatic arthritis. In the literature review, the sources for the period 20102021 were studied, devoted to the role of the isomorphic reaction and microtraumatization in the pathogenesis of PA, as well as the role of various imaging methods for the early diagnosis of enthesitis in psoriatic patients.

Expressions and difficulty of clinical manifestations in the early diagnosis of psoriatic arthritis

Objectives. Study of clinical manifestations in psoriatic arthritis: enthesitis, dactylitis, peripheral arthritis, axial arthritis, skin manifestations, for early diagnosis, which would allow the establishment of an adjusted treatment and the elaboration of measures to prevent complications. Materials and methods. The performed clinical study has an analytical-observational retrospective and included the patients who were hospitalized in the Rheumatology and Arthrology departments of the “Timofei Moşneaga” Republican Clinical Hospital during 2015-2021. The study included 103 patients with psoriasis (47 men and 56 women) with various clinical forms of psoriasis and different ages. Results. The clinical examination of primary or referred patients with cutaneous manifestations, revealed peripheral arthritis in 15 patients (24.6%), dactylitis – in 37 (60.7%), heel pain was detected in 32 (52.5%), axial arthritis – in 30 (49.2%), enthesitis, distal interphalangeal arthritis and tendonitis were not detected. Those who primary or referred with joint manifestations, in 35 (57.4%) of patients was present peripheral arthritis, dactylitis in 40 (65.6%), enthesis of the elbow joints in 11 (18%), knee joints - in 8 (13.1%), the calcaneal region - to 25 (41%), arthritis of the distal interphalangeal joints was detected in 21 (34.4%), tendinitis - to 13 (21.3%). Discussions. The obtained results allow us to state that one of the directions in improving the diagnosis of PsA consists in the use of ultrasound examination and MRI imaging of the joints of the hands and feet. This makes it possible to effectively identify the characteristic of enthesopathy, edema of tissues, as well as destructive changes in the joints of the hands and feet. Conclusions. In the study group of patients with psoriasis, in 25 (24.2%) no joint damage was detected. The frequency of detection of psoriatic arthritis and other rheumatic diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis etc.) was 59.2% and 16.6%, respectively, 32 (52.5%) out of 61 (59.2%) patients with PsA were primarily diagnosed. The sensitivity and specificity of the mPEST (Psoriasis Epidemiology Screening Tool) questionnaire in relation to the CASPAR criteria were 77% and 69% respectively. The highest indicators of sensitivity, specificity and accuracy in the diagnosis of PsA has ultrasound and MRI: 88%, 92%, 89% and respectively, 89%, 94%, 91%.

POS1102 THE PREVALENCE OF INFLAMMATORY BACK PAIN IN PATIENTS WITH SKIN PSORIASIS WITHOUT PSORIATIC ARTHRITIS. DATA FROM DERMATOLOGICAL REAL-WORLD SETTING.

BackgroundPsoriasis (PsO) is an inflammatory disease associated with psoriatic arthritis (PsA). PsA affects peripheral and axial joints1,2. Psoriasis can precede the onset of PsA by approximately 3 to 8 years, axial involvement often undiagnosed3. There are limited data about the prevalence of inflammatory back pain (IBP) in PsO patients (pts) without clinical symptoms of PsA4.ObjectivesTo study the prevalence of IBP in PsO pts without PsA symptomsMethods108 PsO pts without PsA over a 10-month period (March 2021 to December 2021) were incluided. Participants filled out a questionnaire on IBP. Additionaly the prevalence of stiffness in the back and neck was estimated. IBP was defined as an affirmative answer to the question ‘Did you suffer from low back pain for ≥3 months?’ and IBP criteria was based on criteria ASAS (the ASsessment in Ankylosing Spondylitis) and was confirmed if at least 3 out of the following 4 criteria were present: (a) onset before age 40, (b) insidious onset, (c) improvement with exercise, (d) associated with morning stiffnessResultsIt was found that more than 40% of patients complained of pain or stiffness in the back. Stiffness and pain in the neck were observed in every fourth patient on average. Of those patients who complained of pain in the back or neck, 37% noted that they had pain at rest (when they get up in the morning or lie down for a long time), and 21.3% had inflammatory pain at night (when patients are forced to woke up, they needed to do exercises) (Table 1). It was found that the risks of developing spondylitis with neck pain, neck stiffness, back pain, back stiffness were higher in 4,549 times (95% CI [1,720; 12,031]), in 19,444 times (95% CI [6,480; 58,343]) 15 times (95% CI [4.646; 48.427]) and 34.857 times (95% CI [7.583; 160.230]), respectively.ConclusionIBP was found in more than 40% PsO patients. Every fourth PsO patients complained of stiffness and pain in the neck. The presence of these symptoms significantly increased the risk of developing PsA with spondylitis. The presence of IBP should be taken into account for early diagnosis of PsA in the dermatological practice.

Clinical heterogeneity in the early diagnosis of psoriatic arthritis

Introduction PsA are included in the group of HLA-B27-associated joint diseases, united in the group of seronegative spondylitis (SSA). At the same time, this disease differs from ankylosing spondylitis and other spondylitis with a particularly diverse clinical picture and the existence of only the syndromes inherent in it, for example, intermittent synovitis, palindromic rheumatism or mutilating arthritis. Purpose of the study Research of clinical heterogeneity of early psoriatic arthritis and the possibility of early diagnosis. Materials and methods The current study included 104 patients with PsA who were admitted to the rheumatology and arthrology departments of the Republican Clinical Hospital „Timofei Moşneaga” from 2003 to October 2021. Results The frequency of expression of individual clinico-anatomical variants of joint syndrome was different in patients with PsA-e and PsA-t (in PsA-e compared to PsA-t, the oligoarticular variant was significantly more likely to be observed (43.1% and 19%, respectively, p=0.01) and less often the variant of spondyloarthritis (7.8% and 19%, p=0.1), while the variant of polyarthritis (33.3% and 38%, p = 0,6) and distal interphalangeal (15,7% and 15%, p=0,9) were detected with the same frequency, as regards the mutilating variant, this was observed only in PsA-t. Conclusions The early stage of psoriatic arthritis is characterized by pronounced heterogeneity of manifestations of joint syndrome and damage to the tendon-ligament apparatus. In PsA-e oligoarthritis and polyarticular variants are the most common, less often - distal interphalangeal and spondyloarthritic. In the first 3 months after the onset of clinical manifestations of PsA, oligoarthritis was observed in 75.4% of patients and polyarthritis in 14% (p=0.0001), and after 6 months - 63% and 26.6% respectively (p=0.001). With a progression of the duration of the disease, the number of patients with arthritis increased, and by the end of the 2nd year was determined in 47.6% of patients, and oligoarthritis - in 28.6%.

Diagnosis and Intervention in Early Psoriatic Arthritis.

Psoriatic arthritis (PsA) is a chronic inflammatory disorder that affects approximately 20–30% of patients with psoriasis. PsA causes deformities and joint damage, impairing quality of life and causing long-term functional disability. Several recent studies demonstrated that early diagnosis and intervention for PsA prevents permanent invalidity. However, the clinical features of PsA vary and are shared with other differential diseases, such as reactive arthritis, osteoarthritis, and ankylosing spondylitis. The common and overlapping features among these diseases complicate the accurate early diagnosis and intervention of PsA. Therefore, this review focuses on the current knowledge of the diagnosis of early PsA and discusses the meaning of early intervention for early PsA.

Assessment of four screening tools and retrieval of key questions to detect undiagnosed psoriatic arthritis in Chinese patients with psoriasis: A multicenter study.

Several screening tools have been developed to facilitate early diagnosis of psoriatic arthritis (PsA); however, their performance varied greatly across different studies. In this study, we validated and compared the performance of four screening tools in detecting undiagnosed PsA Chinese patients with psoriasis, and determined the key questions and their weights. The four screening tools were the Early Arthritis for Psoriatic Patients (EARP) questionnaire, Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire, Psoriasis and Arthritis Screening Questionnaire (PASQ), and Psoriasis Epidemiology Screening Tool (PEST). The receiver-operator curve (ROC) with area under curve (AUC) was used to determine sensitivity, specificity, and accuracy. Least absolute shrinkage and selection operator and logistic regression were utilized to retrieve key questions, and a nomogram was utilized to visualize their weights. Of 482 psoriasis patients from dermatology clinics, 77 were newly diagnosed with PsA. Another 68 patients with newly diagnosed PsA from rheumatology clinics were incorporated in the analysis. ROC analysis indicated that the optimal cut-off values for EARP, PASE, PASQ, and PEST were 3, 40, 7, and 3, with corresponding sensitivities of 91.4%, 88.6%, 86.2%, and 88.5%, and specificities of 88.6%, 75.2%, 80.2%, and 83.6%, respectively. The AUC of EARP (0.925) was higher than those of PASE (0.885), PASQ (0.905), and PEST (0.827). However, none of them were sufficiently sensitive to identify pure axial PsA (sensitivities of EARP, PASQ, and PASE were 25.0%, 36.8%, and 42.1%, respectively). Twelve key questions were retrieved from these four tools to establish a nomogram with a high discrimination (C-index=0.993) and a good calibration (mean absolute error=0.014). In conclusion, to screen undiagnosed PsA, EARP has slightly better balanced sensitivity and specificity, and higher accuracy. The retrieval of key questions and nomogram signify the necessity of attributing different scores to differently weighted questions when developing a new screening tool to make it function more efficiently.

Combined Single Cell Transcriptome and Surface Epitope Profiling Identifies Potential Biomarkers of Psoriatic Arthritis and Facilitates Diagnosis via Machine Learning.

Early diagnosis of psoriatic arthritis (PSA) is important for successful therapeutic intervention but currently remains challenging due, in part, to the scarcity of non-invasive biomarkers. In this study, we performed single cell profiling of transcriptome and cell surface protein expression to compare the peripheral blood immunocyte populations of individuals with PSA, individuals with cutaneous psoriasis (PSO) alone, and healthy individuals. We identified genes and proteins differentially expressed between PSA, PSO, and healthy subjects across 30 immune cell types and observed that some cell types, as well as specific phenotypic subsets of cells, differed in abundance between these cohorts. Cell type-specific gene and protein expression differences between PSA, PSO, and healthy groups, along with 200 previously published genetic risk factors for PSA, were further used to perform machine learning classification, with the best models achieving AUROC ≥ 0.87 when either classifying subjects among the three groups or specifically distinguishing PSA from PSO. Our findings thus expand the repertoire of gene, protein, and cellular biomarkers relevant to PSA and demonstrate the utility of machine learning-based diagnostics for this disease.

Systematic review and meta-analysis: risk factors for psoriatic arthritis. Part 1.

According to epidemiological and clinical studies, every fourth patient with psoriasis develops psoriatic arthritis (PsA), and in many cases there is a destructive form of arthritis that leads to disability. Late diagnosis of PsA is associated with a significant reduction in the effectiveness of therapy. Therefore, early diagnosis of this disease is so important.Objective: to determine the methods for early detection of PsA, in particular the identification of risk factors (RFs) for its development, which will prevent the progression of the disease and the disability of patients.Materials and methods. The literature review and meta-analysis is presented in two parts. Part 1 of the systematic review included articles on exogenous RFs for the development of PsA published over the past 10 years.PubMed (MEDLINE), EMBASE, and Google Scholar databases were searched for articles published before March 1, 2021. We searched for currently registered trials in the registers of clinical trials of US (ClinicalTrials.gov), of China (Chinese Clinical Trial Registry) and the WHO InternationalClinical Trial Registry Platform. The statistical analysis was prepared in accordance with the international guidelines for systematic reviews and meta-analysis (PRISMA) using the Statistic SPSS 26.0 program (USA).Results and discussion. 957 articles published up to March 1, 2021 were identified. After further analysis, irrelevant articles were excluded. A total of 73 articles were included in the review and analysis, 32 of which were included in Part 1. The most common exogenous RFs are: mechanical injuries, medications, and psychotraumatic situations.Conclusion. PsA is a multifactorial disease. Currently, a large number of exogenous RFs for the development of this disease have been established. Knowledge of RFs and the ability to recognize them will help dermatovenereologists and rheumatologists to effectively assess and predict the patient's condition. Correction of modifiable RFs, early prescription of appropriate therapy will help to reduce the number of PsA cases, the development of functional disorders and prevent the growth of disability. However, studies on the comprehensive assessment of RFs in PsA are still insufficient. Further study of methods for the early diagnosis of PsA is needed in order to optimize its treatment.

Improving Imaging Modalities in Early Psoriatic Arthritis: The Role of Ultrasound in Early Diagnosis of Psoriatic Arthritis.

Objective: Despite recent advances, early diagnosis of psoriatic arthritis (PsA) remains a challenge in clinical practice. Ultrasound (US) could be a useful tool for the diagnosis and management of PsA. The objective of this review was to determine the role of US in early diagnosis of PsA.Methods: We have performed a literature review aiming to evaluate studies on US findings in psoriasis and their predictive value of progression to PsA, as well as studies on US features specific for PsA in comparison with other conditions.Results: A total of 40 studies were included. Sixteen studies assessed US findings in psoriasis, of which only 3 prospectively evaluated the role of US in predicting progression to PsA. Patients with PsA had a greater frequency of US abnormalities, in particular enthesitis and Power Doppler(PD) signal compared to patients with psoriasis only. In the longitudinal studies, psoriatic patients with higher enthesopathy scores at baseline were more likely to progress to PsA. Twenty-four studies evaluated US abnormalities in PsA and compared them to other conditions. Most specific US features that distinguish PsA from psoriasis were PD signal and erosions in joints and entheses. Extra-synovial changes, including peri-tendinous dermal soft tissue oedema with associated PD signal and flexor tendon enthesopathy, as well as thickening of the pulleys in the flexor tendons were highly characteristic for PsA, as they were frequently found in PsA patients, but in none of the RA patients. US-detected entheseal abnormalities in particular erosions and PD signal were more frequent in patients with PsA compared to fibromyalgia.Conclusion: Despite the wide use of US in PsA, more research is needed to identify predictive factors of progression to PsA in patients with psoriasis, as well as to determine most specific US features that differentiate PsA from other conditions.

Ambulatório conjunto de dermatologia e reumatologia para tratamento de psoríase e artrite psoriásica: experiência de um hospital terciário no sul do Brasil

Introduction: several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA relates to better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: retrospective cohort of patients with previous or suspect diagnosis of PSO and/or PSA who were cared for in the combined dermatology and rheumatology clinic from January 2013 to January 2017. Results: among the 55 patients previously diagnosed with PSO, 30.9% (n=17) were diagnosed with PSA. Changes in medical therapy were made for 58.5% (n = 48) of patients, mainly due to poor cutaneous or articular disease control. Imunobiologicals were the most commonly initiated class of medicine, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most initiated medicine (18.7%; n = 9), or with changes in its dosage or route of administration (20.8%; n = 10), totaling 39.5% (n = 19) of changes in medical therapy. There was an increase in the proportions of patients undergoing systemic therapies (79.2%; n = 65). Conclusions: this study reenforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a combined approach between dermatology and rheumatology is feasible in Brazil, with similar outcomes to those reported in international literature.