Features Of Psoriatic Arthritis Research Articles

IKK2 controls the inflammatory potential of tissue-resident regulatory T cells in a murine gain of function model

Loss-of-function mutations have provided crucial insights into the immunoregulatory actions of Foxp3+ regulatory T cells (Tregs). By contrast, we know very little about the consequences of defects that amplify aspects of Treg function or differentiation. Here we show that mice heterozygous for an Ikbkb gain-of-function mutation develop psoriasis. Doubling the gene dose (IkbkbGoF/GoF) results in dactylitis, spondylitis, and characteristic nail changes, which are features of psoriatic arthritis. IkbkbGoF mice exhibit a selective expansion of Foxp3 + CD25+ Tregs of which a subset express IL-17. These modified Tregs are enriched in both inflamed tissues, blood and spleen, and their transfer is sufficient to induce disease without conventional T cells. Single-cell transcriptional and phenotyping analyses of isolated Tregs reveal expansion of non-lymphoid tissue (tissue-resident) Tregs expressing Th17-related genes, Helios, tissue-resident markers including CD103 and CD69, and a prominent NF-κB transcriptome. Thus, IKK2 regulates tissue-resident Treg differentiation, and overactivity drives dose-dependent skin and systemic inflammation.

Ankle retinacula abnormalities as features of psoriatic arthritis: An ultrasound study

ObjectiveTo compare the ultrasonography (US) assessment of the retinacula of ankles in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). MethodsThis cross-sectional study included RA or PsA patients with ankle pain and healthy controls. The following US features were recorded: presence of synovitis, tenosynovitis and abnormalities of two retinacula (the superior peroneal retinaculum [SPR] and the flexor retinaculum [FR] evaluated in mode B and power Doppler). ResultsAmong the 80 included patients, 37 (46%) and 23 (29%) had RA and PsA; 20 (25%) patients were healthy controls. The FR was thicker in PsA than RA ankles 0.96±0.39 vs. 0.64±0.15, P<0.001 with no difference between RA patients and HCs. Other FR abnormalities such as hypoechogenicity, PD positivity or periostosis were more frequent in PsA than RA patients, P<0.001. On receiver-operating-characteristic curve analysis, a cut-off of 1mm FR thickness provided a sensitivity of 49% and specificity of 97% for the diagnosis of PsA. Overall, 39 and 3% of PsA and RA ankles exhibited retinaculitis of FR (thickness≥1mm with hypervascularization or hypoechogenicity). The two disease groups did not differ in the evaluation of SPR. ConclusionsUS abnormalities of FR were more frequent in PsA than RA and appeared to be specific for PsA. US assessment of FR might be useful to distinguish RA and PsA.

Therapeutic Effects of Apremilast on Enthesitis and Dactylitis in Real Clinical Setting: An Italian Multicenter Study.

Enthesitis and dactylitis are difficult-to-treat features of psoriatic arthritis (PsA), leading to disability and affecting quality of life. The aim of this study is to evaluate enthesitis (using the Leed enthesitis index (LEI)) and dactylitis at 6 and 12 months in patients treated with apremilast. Patients affected by PsA from fifteen Italian rheumatological referral centers were screened. The inclusion criteria were: (a) enthesitis or dactylitisphenotype; (b) treatment with apremilast 30 mg bid. Clinical and treatment history, including PsA disease activity, were recorded. Mann-Whitney and chi-squared tests were used to assess the differences between independent groups, and Wilcoxon matched pairs signed-rank test assessed the differences between dependent samples. A p-value of <0.05 was considered statistically significant. The Eph cohort consisted of 118 patients (median LEI 3); the Dph cohort included 96 patients with a median dactylitis of 1 (IQR 1-2). According to an intention to treat analysis, 25% and 34% of patients with enthesitis achieved remission (i.e., LEI = 0) in T1 and T2. The remission of dactylitis was 47% in T1 and 44% in T2. The per protocol analysis (patients observed for at least 12 months) showed that both dactylitis and LEI significantly improved in T1 (median LEI 1 (IQR 1-3)) and T2 (median LEI 0 (IQR 1-2)). Eph and Dph PsA patients treated with apremilast experienced a significant improvement in enthesitis and dactylitis activity. After 1 year, enthesitis and dactylitis remission was achieved in more than one-third of patients.

Acrodermatitis Continua of Hallopeau: A Diagnostic Challenge.

Acrodermatitis Continua of Hallopeau: A Diagnostic Challenge.

Enthesitis in psoriatic arthritis

Enthesitis is a distinctive feature of psoriatic arthritis. New imaging techniques help to better understand the pathophysiology of entheses, being one of the essential factors of the subclinical and prodromal stages of psoriatic arthritis. This paper aims to review the main clinical scores, imaging scores, confounding factors that might influence the interpretation of results and the impact of medication on enthesitis in psoriatic arthritis.

Clinical Features of Psoriatic Arthritis in Children

Psoriasis is one of the most common childhood skin disorders, the second after atopic dermatitis. Psoriatic Arthritis (PsA) is a chronic inflammatory disorder of the joints, spine and enthesis, usually associated with psoriasis. In children, PsA belongs to the group of juvenile idiopathic arthritis (according to the classification of the International League of Associations for Rheumatology, ILAR). The paper reviews the current scientific literature data on PsA peculiarities in childhood, the highest incidence in children, distribution by gender, as well as the predominant forms of joint syndrome. Results: Juvenile PsA is characterized by the pronounced clinical heterogeneity. The disease is twice as common in the girls. Two peaks of incidence are distinguished among 6-7 years and 14-18 years. Skin events precede the development of arthritis in 30% of children. The predominant form of the disease in children is asymmetric oligoarthritis.

Cartilage Degradation in Psoriatic Arthritis Is Associated With Increased Synovial Perfusion as Detected by Magnetic Resonance Imaging.

Objective: Even though cartilage loss is a known feature of psoriatic arthritis (PsA), research is sparse on its role in the pathogenesis of PsA and its potential use for disease detection and monitoring. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and dynamic contrast-enhanced MRI (DCE MRI), research has shown that early cartilage loss is strongly associated with synovial inflammation in rheumatoid arthritis (RA). The aim of this study was to determine if acute inflammation is associated with early cartilage loss in small finger joints of patients with PsA.Methods: Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution 3 Tesla dGEMRIC and DCE MRI using a dedicated 16-channel hand coil. Semi-quantitative and quantitative perfusion parameters were calculated. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), total cartilage thickness (TCT), and joint space width (JSW).Results: We found significant negative correlations between perfusion parameters (except Kep) and dGEMRIC indices, with the highest value at the MCP joints (KTrans: τ = −0.54, p = 0.01; Kep: τ = −0.02, p = 0.90; IAUC: τ = −0.51, p = 0.015; Initial Slope: τ = −0.54, p = 0.01; Peak: τ = −0.67, p = 0.002). Heterogeneous correlations were detected between perfusion parameters and both, total PsAMRIS and PsAMRIS synovitis sub-scores. No significant correlation was seen between any perfusion parameter and JSW and/or TCT.Conclusion: As examined by DCE MRI and dGEMRIC, there is a potential association between early cartilage loss and acute synovial inflammation in small finger joints of PsA patients.

Ultrasound characteristics of osteophytes in psoriatic arthritis

Objective. To assess the relationship between ultrasound and clinical characteristics of psoriatic arthritis (PsA) and osteophytes detected by ultrasound (US).Methods. Data collection: demographical, clinical, antropometric (body mass index, BMI). US examination included 868 joints and 3348 entheses (bilateral shoulders, acromioclavicular joints, elbows, wrists, hips, knees, ankles; entheses at the projection of these joints (total number is 54). In the joints – synovitis count, Power Doppler (PD) + synovitis count (SC), the number of joints with osteophytes; in entheses – Grey Scale (GS) enthesitis count (EC), PD + EC, count of entheses with structural components (erosion, enthesophytes, calcification).Results. In all, 62 PsA patients were examined: 32 (51.6%) were women, mean age was 43.0 ± 10.4 years, the duration of PsA was 7 (3; 10) years. The number of joints with osteophytes was 314 of 868 (36.2%). US osteophytes were detected in 51 (82.3%) patients. The number of joints with osteophytes correlated with GS EC (r = 0.398; p &lt; 0.01), PD + EC (r = 0.302; p &lt; 0.05), SC (r = 0.425; p &lt; 0.01), and PD + SC (r = 0.322; p &lt; 0.05). Patients without osteophytes, with local and generalized osteophytes were comparable by sex and duration of the disease. In patients with generalized osteophytes, GS EC (p &lt; 0.05), PD + SC (p &lt; 0.05), SC (p &lt; 0.01), comorbid pathology (p &lt; 0.05), BMI (p &lt; 0.05) were significantly higher.Conclusion. The frequency of osteophytes in patients with PsA was high. The number of synovitis and enthesitis, both GC and PD+, was more common in patients with generalized osteophytes, which probably suggests an important role of entheseal and synovial inflammation in PsA in the development of osteophytes. BMI and the frequency of comorbidities in patients with generalized osteophytes were higher.

Development and Validation of a Sonographic Enthesitis Instrument in Psoriatic Arthritis: The GRAPPA Diagnostic Ultrasound Enthesitis Tool (DUET) Project.

Enthesitis is a key feature in psoriatic arthritis (PsA) and may be the initial site of musculoskeletal inflammation in patients with PsA. Ultrasound (US) optimizes the detection of enthesitis, but the lack of a validated sonographic enthesitis scoring system for PsA limits the ability to conduct US-based studies of approaches to improve the early diagnosis of PsA. Creating a sonographic enthesitis scoring system that reliably identifies PsA at early stages is an important step in optimizing early diagnosis and encouraging timely interventions that will ultimately improve longterm outcomes for patients with PsA. The Group for Research and Assessment of Psoriasis and PsA (GRAPPA) US working group has set a goal of improving the evaluation of enthesitis in patients with PsA by using US through the development of a Diagnostic Ultrasound Enthesitis Tool (DUET). This article summarizes the proposed DUET study design and methodology as discussed during the 2019 GRAPPA annual meeting in Paris, France.

Proteoglycan loss in the articular cartilage is associated with severity of joint inflammation in psoriatic arthritis\u2014a compositional magnetic resonance imaging study

BackgroundEven though cartilage loss is a known feature of psoriatic arthritis (PsA), little is known about its role in the pathogenesis of PsA. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) as a non-invasive marker of the tissue’s proteoglycan content, such early (i.e., pre-morphological) changes have been associated with inflammation in rheumatoid arthritis (RA). Yet, this association has not been studied before in PsA.MethodsThe metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution clinical standard morphological and dGEMRIC sequences using a 3T MRI scanner (Magnetom Skyra, Siemens) and a dedicated 16-channel hand coil. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), and total cartilage thickness (TCT). Kendall tau correlation coefficients (τ) were calculated.ResultsWe found significant negative correlations between dGEMRIC indices and total PsAMRIS (τ = − 0.5, p = 0.012), synovitis (τ = − 0.56, p = 0.006), flexor tenosynovitis (τ = − 0.4, p = 0.049), and periarticular inflammation (τ = − 0.72, p < 0.001). Significant positive correlations were found between TCT and dGEMRIC indices at all joint levels (τ = 0.43, p < 0.001). No significant correlations were determined between dGEMRIC indices and bone erosion, bone edema, or bone proliferation.ConclusionIn PsA, proteoglycan loss as assessed by dGEMRIC is associated with periarticular inflammation, synovitis, and flexor tenosynovitis, but not with bone erosion or proliferation. Thereby, these findings contribute to in vivo concepts of the disease’s pathophysiology. Beyond morphology, advanced MRI techniques may be used to assess cartilage composition in PsA and to identify early changes in the cartilage as an imaging biomarker with potential application in detection, monitoring, and prediction of outcomes of PsA.Trial registration2014123117, December 2014.

The GRAPPA Sonographic Enthesitis Workshop.

Enthesitis is a key feature in psoriatic arthritis (PsA) and may be the initial site of musculoskeletal inflammation in patients with PsA. Ultrasound (US) could improve the accuracy of clinical enthesitis assessment, but at present no consensus exists on a global sonographic enthesitis scoring method that can evaluate the extent of enthesitis at the patient level. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) US Working Group has set up a goal to optimize the evaluation of enthesitis in patients with PsA using US through the development and validation of new instruments using a combined data-driven and expert opinion-driven approach. This article summarizes the GRAPPA US Working Group's recent activities and focuses on a 2-day workshop that the group held following the annual 2018 GRAPPA meeting in Toronto, Ontario, Canada.

033 Ultrasound (US) features of psoriatic arthritis (PsA): observations from an early inflammatory arthritis (EIA) diagnostic service

033 Ultrasound (US) features of psoriatic arthritis (PsA): observations from an early inflammatory arthritis (EIA) diagnostic service

REVISITING THE DIAGNOSIS OF PSORIATIC ARTHRITIS IN PATIENTS WITH PSORIASIS

Aim: To study clinical and x-ray characteristics of psoriatic arthritis in patients with psoriasis during hospital treatment in the Dermatovenereology and Dermato-Oncology Department of the Moscow Regional Research and Clinical Institute (MONIKI). Materials and methods: We examined 70 patients with generalized psoriasis vulgaris and clinically suspected or definitely diagnosed psoriatic arthritis. Functional insufficiency, characteristics, activity and radiological stage of joint disease were estimated. Results: Usually, patients with psoriasis had oligoor polyarthritis which was rarely associated with psoriatic ankylosing spondylitis and more commonly associated with peripheral arthritis. Only 6% of the patients had isolated arthralgia. Conclusion: In patients with psoriasis, psoriatic arthritis may manifest as arthralgia or low-activity arthritis without radiological signs. Thus, early detection of the disease is of importance.

The Prevalence and Characteristics of Psoriatic Arthritis in Patients With Psoriasis in a Tertiary Hospital

Objectives: This study aims to investigate psoriatic arthritis (PsA) prevalence in patients with psoriasis (Ps), and compare clinical and laboratory characteristics of patients with or without PsA. Patients and methods: A total of 126 patients (59 males, 67 females; mean age 45.6±13.8 years; range 18 to 82 years) with Ps who applied to Dermatology Outpatient Clinic between October 2009 and September 2010 were included in this study. The patients were screened for PsA using Classification of Psoriatic Arthritis criteria. The patients classified as PsA were grouped according to Moll and Wright criteria. Enthesopathy was evaluated according to Maastricht Ankylosing Spondylitis Enthesis score. Psoriasis Area and Severity Index scores were calculated by the same dermatologist. Results: The prevalence of PsA was 25.4%. Ps duration was significantly longer in the group with PsA. The most common type was asymmetrical oligoarticular type (53.1%). Compared to previous studies, the rate of isolated spondyloarthropahty was higher in our study (21.9%). Nail involvement, Psoriasis Area and Severity Index score, mean erythrocyte sedimentation rate, and C-reactive protein values were significantly higher in the group with PsA. Conclusion: High rate of isolated spondyloarthropahty in patients with PsA indicates that PsA must be kept in mind in the differential diagnosis of seronegative spondyloarthropathies. The fact that nail involvement is seen more frequently in patients with arthritis may assist in screening of PsA in patients with Ps. In addition, our results showing a higher probability of PsA development in patients with more severe skin lesions and a higher probability of arthritis development in patients with long lasting Ps may guide clinicians in terms of the probability of arthritis development in patients with Ps.

Exploratory study to identify mechanical factors that may contribute to toe dactylitis in patients with psoriatic arthritis

Background Dactylitis (sausage digit) is one of the most commonly reported features of psoriatic arthritis (PsA), the second most common inflammatory arthritis after rheumatoid arthritis (RA). It has been hypothesised that dactylitis is a functional enthesitis at the proximal interphalangeal joints (hands and feet), causing multiple pathologies to varying levels of severity. Dactylitis results in synovitis, tenosynovitis, bone and soft tissue oedema to the digit, described as tender and non-tender dactylitis. Trauma and physical insult to the digit have been suggested as a possible cause. The aim of this study was to explore the mechanical factors that may contribute to toe dactylitis in patients with PsA.

Aortitis in a patient with psoriatic arthritis

Aortitis, inflammation of the aortic tissue, is most commonly caused by vasculitic rheumatic conditions, and less frequently infectious organisms. Involvement of the aorta is well defined in HLA-B27-associated spondyloarthropathies such as long-standing ankylosing spondylitis and Reiter's syndrome. However, unlike other spondyloarthropathies, aortic involvement or true aortitis is not a feature of psoriatic arthritis and has been reported in only a few cases. Herein, we report the case of a 22 year-old woman with psoriatic arthritis who developed descending aortitis while using tumor necrosis factor inhibitors.

Time Trends in Epidemiology and Characteristics of Psoriatic Arthritis Over 3 Decades: A Population-based Study

Time Trends in Epidemiology and Characteristics of Psoriatic Arthritis Over 3 Decades: A Population-based Study

Polymorphism of the prolactin extrapituitary promoter in psoriatic arthritis

Psoriatic arthritis is characterized as seronegative arthritisthat aVects patients suVering from psoriasis [1]. Aetiologyof this condition is still not clear and therapeuticapproaches are not always successful. However, goodresponse to bromocriptine therapy decreasing prolactin lev-els in patients with psoriatic arthritis has been demonstratedin some reports [ 2, 3]. Prolactin acts as a cytokine and playsa role in pathogenesis of systemic autoimmune diseasessuch as rheumatoid arthritis and systemic lupus erythemat-osus [4, 5]. Moreover, high serum prolactin levels wereobserved in group of patients with psoriasis and linkbetween keratinocytes hyperproliferation and prolactin hasbeen proposed [6]. The peptide hormone prolactin is pro-duced from pituitary lactotrophs and extrapituitary tissuessuch as lymphocytes as well. Extrapituitary PRL produc-tion is regulated by an alternative promoter located 5.8 kbupstream from the pituitary one [7, 8]. A functional singlenucleotide polymorphism (SNP) G/T at the position i1149of this extrapituitary promoter has been observed and inlymphocytes higher PRL mRNA expression found to beconnected with G allele [9]. In our work we studiedi1149G/T SNP PRL in group of 83 Czech patients withpsoriatic arthritis (PsA).We genotyped i1149G/T SNP in 83 PsA patients and123 healthy individuals (control group). PsA patients: 43(51.8%) females, 40 (48.2%) males, average age 54.1 years.Control group: 40 (32.5%) females and 83 (67.5%) males,average age 38.7 years. This study was approved by theEthical Committee of the Third Faculty of Medicine,Charles University, Prague.PCR-RFLP methodology was used for i1149G/T SNPdetection. PCR: The 137 bp region of the PRL extrapitu-itary promoter was ampli Wed by employing following prim-ers: Forward primer 5 GCAGGTCAAGATAACCTGGAand reverse primer 5 CATCTCAGAGTTGAATTTATTTCCTT. The PCR reaction was run under these conditions:initial temperature 94°C for 2 min, then 32 cycles with94°C for 17 s, 55°C for 17 s, 72°C for 17 s, and Wnal tem-perature 72°C for 1 min. RFLP: ApoI restriction endonu-clease was used. The three genotypes were identiWed asindicated: the homozygote TT was characterized by120 + 17 bp, the homozygote GG by 85 + 35 + 17 bp, andthe heterozygote GT genotype by 120 + 85 + 35 + 17 bpDNA fragments. Results were evaluated by Chi square testwith Bonferroni correction.The genotypes and alleles frequency of i1149G/T SNPPRL extrapituitary promoter were similar in group of PsApatients and control group (Table1). We did not Wnd anydiVerences in genotype and allele distribution betweenhealthy female and male and between female and malepatients with psoriatic arthritis, respectively (data notshown). Moreover, we correlated genotype and allele distri-bution of i1149G/T SNP with clinical feature of psoriaticarthritis, such as age of onset psoriasis and radiologicaltype of psoriatic arthritis. In Table2 there are results of thiscorrelation, where no signiWcant association was detected.In conclusion, i1149G/T SNP of the extrapituitary pro-lactin promoter is not associated with psoriatic arthritis (seeTable 1) and its characteristic such as the onset of skinlesion and radiological type of arthritis (see Table2). OurWndings could indicate that i1149G/T SNP prolactin

Psoriasis Arthritis

This article presents an overview of psoriatic arthritis, including the origin, genetic influence and immunologic factors involved in its evolution. The clinical features of psoriatic arthritis are also reviewed in this article, and a discussion of the diagnosis and treatment is included. We have highlighted the current psoriasis treatments, new biological therapies, and their use in practice. This paper reviews the efficacy of these agents, and the importance of their early appliance. The available published data on the efficacy of antimalarials, sulfasalazine, methotrexate, azathioprine and ciclosporin are described, as well as new data on leflunomide and other novel agents.

Bildgebende Verfahren in der Rheumatologie: Bildgebung bei der Psoriasisarthritis (PsA)

Conventional radiography is still the standard method of imaging in PsA since it displays many joints at the same time, thereby allowing different types of joint involvement to be recognized. Moreover, thanks to the high resolution of radiography, bony changes in a single joint are depicted in a brilliant way. Several features of psoriatic arthritis allow the distinction from rheumatoid arthritis, including the frequent involvement of the distal interphalangeal joints, asymmetry of joint involvement, axial involvement of finger joints, oligoarticular involvement; however, symmetric polyarthritis is also possible. At the level of the single joint, there are signs of severe destructive changes potentially leading to mutilation and at the same time signs of periostal bone proliferation and ankylosis may be present. Bony proliferation and/or osteolysis are not restricted to the joint region but can affect also the total phalanx with bone apposition or concentric osteolysis which may lead to a complete disappearance of phalanxes. For purposes of quantification of radiographic changes scoring methods are used that were originally developed for rheumatoid arthritis. So far, there is only one validated scoring method that was specifically designed for PsA and that takes into account both features of PsA, damage as well as proliferation of bone. In contrast to conventional radiography, MRI and sonography are able to visualize inflammatory processes within the soft tissue (joint capsules, tendon sheaths, tendon insertions, etc.), allowing an estimation of disease activity. Scintigraphy is nonspecific and can only be used to detect clinically silent inflammatory spots. The relatively frequent spinal (axial) involvement is similar to that seen in ankylosing spondylitis. However, unilateral sacroiliitis, asymmetry of syndesmophytes and development of parsyndesmophytes may distinguish PsA from ankylosing spondylitis. While conventional radiography demonstrates the bony consequences of inflammation in the spine, MRI also shows the active inflammatory changes in sacroiliacal joints and vertebrae.